Study underscores role of race, poverty in COVID-19

A new analysis by researchers at Massachusetts General Hospital (MGH) offers new perspective on the disproportionate impact that the novel coronavirus (COVID-19) has had on people of color, low-income populations, and other structurally disadvantaged groups. Their findings, published in a research letter to the Journal of General Internal Medicine, emphasize the urgency of addressing inequities that have been exposed by the coronavirus pandemic.

For the study, researchers analyzed the socioeconomic and demographic characteristics of patients tested for COVID-19 at 14 sites within the Mass General Brigham system from the earliest days of the pandemic until mid-December 2020. Those sites include not only hospitals also but community health centers and urgent care clinics. Combining the results of both inpatient and outpatient testing for COVID-19 distinguished this analysis from most earlier inquiries, which primarily focused on inpatient testing. 

Another factor that distinguishes this analysis is its sheer size: It is based on test results from 394,536 patients. Electronic health records were used to compile data regarding each patient's gender, race, and insurance status, as well as where they lived. Publicly available data for information such as median household income and employment status was then compiled for each ZIP code.

The analysis found that 29,977 patients or 7.6 percent of those tested had positive results for COVID-19. Males (8.2 percent) were slightly more likely than females (7.2 percent) to test positive.

Stark contrasts emerged when the researchers broke down positive cases by race and socioeconomic factors. For example the study found that 5.6 percent of white patients tested positive, compared to 17.2 percent of Hispanic patients and 11.9 percent of Black patients.

Using ZIP codes, the researchers found that patients from communities where the median annual household income was $70,000 or less were nearly three times more likely to test positive for COVID-19 than patients from communities where median households were greater than $100,000 per year—13.3 percent compared to 4.7 percent. Medicaid patients had more positive tests (14.2 percent) than those with commercial insurance (6.8 percent). People who lived in areas where unemployment was higher than 5 percent were nearly twice as likely to have COVID-19 than those from communities with unemployment of 3.5 percent or less.

On the other hand, in ZIP codes populated by a significant portion of people with jobs in the service sector, who couldn't stay home and work remotely during the pandemic, were more than three times as likely to contract COVID-19 than others from communities with relatively fewer service-sector employees—13.4 percent compared to 4.2 percent, the researchers said.

"Although our study is innovative in using patient-level data to assess the association between positive COVID tests and socioeconomic and demographic characteristics of individual patients,” said Marcela del Carmen, MD, senior author of the paper and interim president of the MGPO, in a statement, “the results confirm that structural constructs in our society persevere and contribute to health outcomes inequities.”

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