Original Article

Health Disparities of Coronavirus Disease 2019 in Texas, March–July 2020

Authors: Christy Xavier, MS, PharmD, Rafia S. Rasu, MPharm, PhD


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.
Posted in: Infectious Disease55

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Table 1. Monthly Texas COVID-19 case, death, and case fatality ratios, March–July 2020

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Fig. 1. Monthly Texas coronavirus disease 2019 incidence, hospitalizations, and deaths from March to July 2020. This graph depicts the incidence, average hospitalization days, and mortality rates for Texas from March to July 2020. Monthly cases, mortality, and average hospitalization days increased from month to month, with the highest increases seen from June to July. Although the risk of being infected with coronavirus disease 2019 increased from May to July, the mortality rate significantly decreased in May and June and was insignificant in April and July. Case fatality ratios showed a similar trend, with the highest death case ratio in April and a subsequent decrease from May to July. *Statistical significance of relative risk.

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Table 2. Demographic case, fatality, and case fatality ratios on July 19 and August 1, 2020

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Fig. 2. Total cases, daily hospitalizations, fatalities, and case fatality ratios at study time points. The total number of positive cases was 325,030 and deaths was 3958 on July 19, which increased to 430,485 cases and 6387 deaths on August 1. Cases increased over time, whereas daily hospitalizations decreased, possibly because of increased recoveries or discharges home and fatalities. Fatalities increased at the end of July, corresponding to an increase in death case ratio over time. The chance of acquiring COVID-19 from each study point to the next increased significantly, whereas the chances of being hospitalized with COVID-19 decreased steadily throughout time. The probability of dying from COVID-19 was only significant from July 22 to July 27. *Statistical significance of odds ratio. COVID-19, coronavirus disease 2019.

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Fig. 3. Impact of sex, age, and race/ethnicity on COVID-19 case fatality ratios at study time points. (A) Case fatality ratios between males and females. Males had higher case fatality ratios at all study points compared with females. Males had a case fatality ratio of 3.02 on July 19, 2020, which increased to 19.38 on August 1, 2020. (B) Case fatality ratios between individuals younger and older than 65 years. Older adults had the highest case fatality ratio compared with individuals younger than 65 years old and among other demographics. (C) Case fatality ratios among the different races and ethnicities. Of the known races, Whites, Asians, and Hispanics had the highest case fatality ratios. Although most of the races had an increase in case fatality ratios over time, Whites and Blacks experienced a decrease in death case ratio by the end of July 2020. COVID-19, coronavirus disease 2019.

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