Original Article
Health Disparities of Coronavirus Disease 2019 in Texas, March–July 2020
Abstract
Objectives: Although disparities in coronavirus disease 2019 (COVID-19) prevalence are known, knowledge of the recent surge of COVID-19 in Texas and factors affecting fatality rates is limited. Understanding the health disparities associated with COVID-19 can help healthcare professionals determine the populations that are most in need of COVID-19 preventive care and treatment. The aim of this study was to assess COVID-19-related case and mortality rates.Methods: Our cross-sectional analysis used Texas Department of State Health Services COVID-19 case surveillance counts. Case, hospitalization, and mortality counts were obtained from March to July 2020.
Results: From March to July 2020, there were 420,397 COVID-19-related cases and 6954 deaths in Texas. There were 3277 new cases and 104 deaths in March, and 261,876 new cases and 3660 deaths in July. The number of new COVID-19 cases was the highest from March to April (relative risk 1.77, 95% confidence interval [CI] 1.76–1.78). Although the death rate in June was a 30% increase over the rate in May, death rates nearly tripled by the end of July, for a total of 3660 deaths. Of the 3958 deaths, demographic data were available for 753 deaths. Of these, 440 were male, 16 Asian, 95 Black, 221 Hispanic, 325 White, and 96 were “Other” or “Unknown.” Males were associated with a slightly higher chance of acquiring COVID-19 than females (odds ratio [OR] 1.11, 95% CI 1.09–1.14) and nearly a 29% higher chance of dying of COVID-19 compared with females (OR 1.29, 95% CI 1.11–1.49). Bivariate analysis revealed that the probability of acquiring COVID-19 was 12% higher in older adults compared with individuals younger than 65 years old (OR 1.12, 95% CI 1.08–1.16), and older adults had an 18.8 times higher risk of death when compared with the rate of younger individuals (OR 18.79, 95% CI 15.93–22.15). Hispanics and Blacks were 70% and 48%, respectively, more likely to contract COVID-19 than Whites. All races had lower significant chance of death when compared with Whites. At the end of July, there was a total of 430,485 Texas COVID-19 cases and 6387 fatalities (8.8% of all cases and 4% of all deaths in the United States.). Case fatality ratios were the highest in older adults. As we continued to observe data, in contrast to previous study time points, we found that Asians and Hispanics had no significant difference in COVID mortality rates and were comparable in terms of mortality odds and death case ratios when compared with Whites.
Conclusions: This time period represents the highest COVID-19 surge time in Texas. Although our data consist of a short time period of population-level data in an ongoing pandemic and are limited by information reported to the Texas Department of State Health Services, older age, male sex, Hispanics, and Blacks are currently associated with higher infection rates, whereas older age, male sex, and Whites are associated with higher mortality rates. Clinicians and decision makers should be aware of the COVID-19 health disparities and risk factors for mortality to better promote targeted interventions and allocate resources accordingly.
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References
1. Zhai P, Ding Y, Wu X, et al. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 2020;55:105955.
2. Tang D, Comish P, Kang R. The hallmarks of COVID-19 disease. PLoS Pathog 2020;16:e1008536.
3. Frederiksen LSF, Zhang Y, Foged C, et al. The long road toward COVID-19 herd immunity: vaccine platform technologies and mass immunization strategies. Front Immunol 2020;11:1817.
4. Callaway E. COVID vaccine excitement builds as Moderna reports third positive result. Nature 2020;587:337–338.
5. Callaway E. What Pfizer's landmark COVID vaccine results mean for the pandemic. Nature 2020. doi:10.1038/d41586-020-03166-8.
6. Disparities in outcomes among COVID-19 patients in a large health care system in California. Health Aff 2020;39:1253–1262.
7. Sy KTL, Martinez ME, Rader B, et al. Socioeconomic disparities in subway use and COVID-19 outcomes in New York City. Am J Epidemiol 2021;190: 1234–1242.
8. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and racial/ ethnic disparities. JAMA 2020;323:2466–2467.
9. Mandelbaum J. Acknowledging and addressing COVID-19 health disparities in the American South. South Med J 2020;113:325–325.
10. Millett GA, Jones AT, Benkeser D, et al. Assessing differential impacts of COVID-19 on black communities. Ann Epidemiol 2020;47:37–44. .
11. Price-Haywood EG, Burton J, Fort D, et al. Hospitalization and mortality among Black patients and White patients with Covid-19. N Engl J Med 2020;382:2534–2543.
12. Shi D, Wu W, Wang Q, et al. Clinical characteristics and factors associated With long-term viral excretion in patients with severe acute respiratory syndrome coronavirus 2 infection: a single-center 28-day study. J Infect Dis 2020;222:910–918.
13. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430–436.
14. Singh AK, Gupta R, Ghosh A, et al. Diabetes in COVID-19: prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr 2020;14:303–310.
.
15. Centers for Disease Control and Prevention. National Diabetes Statistics Report 2020: estimates of diabetes and its burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published 2020. Accessed August 20, 2020.
16. Du RH, Liang LR, Yang CQ, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J 2020;55:2000524.
17. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, et al. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ 2020;11:29.
18. Li L-Q, Huang T, Wang Y-Q, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol 2020;92:577–583.
19. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020;146:110–118.
20. Hu SS, Homa DM, Wang T, et al. State-specific patterns of cigarette smoking, smokeless tobacco use, and E-cigarette use among adults - United States, 2016. Prev Chronic Dis 2019;16:E17.
21. Lassale C, Gaye B, Hamer M, et al. Ethnic disparities in hospitalisation for COVID-19 in England: the role of socioeconomic factors, mental health, and inflammatory and pro-inflammatory factors in a community-based cohort study. Brain Behav Immun 2020;88:44–49.
22. Rentsch CT, Kidwai-Khan F, Tate JP, et al. Covid-19 by race and ethnicity: a national cohort study of 6 million United States veterans. medRxiv 2020. doi: 10.1101/2020.05.12.20099135.
23. Lieberman-Cribbin W, Tuminello S, Flores RM, et al. Disparities in COVID-19 testing and positivity in New York City. Am J Prev Med 2020;59:326–332.
24. Mody A, Pfeifauf K, Bradley C, et al. Understanding drivers of COVID-19 racial disparities: a population-level analysis of COVID-19 testing among Black and White populations. Clin Infect Dis 2020;ciaa1848. .
25. Rentsch CT, Kidwai-Khan F, Tate JP, et al. Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: a nationwide cohort study. PLoS Med 2020;17:e1003379.
26. Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19:767–783.
27. Koralnik IJ, Tyler KL. COVID-19: a global threat to the nervous system. Ann Neurol 2020;88:1–11.
28. Oxley TJ, Mocco J, Majidi S, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 2020;382:e60.
29. Trejo-Gabriel-Galán JM. Stroke as a complication and prognostic factor of COVID-19. Neurologia 2020;35:318–322.