Racial and Ethnic Disparities in SARS-CoV-2 Testing and COVID-19 Outcomes in a Medicaid Managed Care Cohort

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Introduction | Socioeconomic differences may confound racial and ethnic differences in testing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and coronavirus disease 2019 (COVID-19) outcomes.

Methods | A retrospective cohort study was conducted of racial/ethnic differences in SARS-CoV-2 testing and positive tests and COVID-19 hospitalizations, and deaths among adults impaneled at a Northern California regional medical center and enrolled in the county Medicaid managed care plan (N=84,346) as of March 1, 2020. Logistic regressions adjusted for demographics, comorbidities, and neighborhood characteristics.

Results | Nearly 30% of enrollees were ever tested for SARS-CoV-2, and 4% tested positive. A total of 19.7 per 10,000 were hospitalized for and 9.4 per 10,000 died from COVID-19. Those identified as Asian, Black, or of other/unknown race had lower testing rates whereas those identified as Latino had higher testing rates than Whites. Enrollees of Asian or other/unknown race had slightly higher and Latinos much higher odds of a positive test (OR=3.77, 95% CI=3.41, 4.17) than Whites. Odds of hospitalization (OR=2.85, 95% CI=1.85, 4.40) and death (OR=4.75, 95% CI=2.23, 10.12) were higher for Latino relative to White patients, even after adjusting for demographics, comorbidities, and neighborhood characteristics.

Conclusions | In a Medicaid managed care population, where socioeconomic differences may be reduced, the odds of a positive SARS-CoV-2 test, COVID-19 hospitalization, and death were higher for Latino but not Black patients relative to White patients. Racial/ethnic disparities depend on local context. The substantially higher risk facing Latinos should be a key consideration in California’s strategies to mitigate disease transmission and harm.

A press release about the study is available here. The full study is available in AJPM.