Racial Disparities in COVID-19 Severity Are Partially Mediated by Chronic Stress-Evidence from a Large Integrated Healthcare System.
J Racial Ethn Health Disparities
; 2024 Jan 31.
Article
em En
| MEDLINE
| ID: mdl-38294635
ABSTRACT
BACKGROUND:
Racial and ethnic minorities have experienced a disproportionate burden of severe COVID-19. Whether chronic stress, also disproportionately experienced by racial and ethnic minorities, explains this excess risk is unknown.METHODS:
We identified 9577 adults (≥ 18 years) diagnosed with COVID-19 from January 1, 2020, through September 30, 2021, enrolled in Kaiser Permanente Georgia (KPGA) with complete biomarker data. Self-reported race (Black or White) was defined from electronic medical records. Chronic stress, defined as allostatic load (AL), a composite score (scale 0-7) based on seven cardio-metabolic biomarkers, was categorized as below (low AL) or above (high AL) the median. Severe COVID-19 was defined as hospitalization or mortality within 30 days of COVID-19 diagnosis. The association between race, AL, and severe COVID-19 was assessed using multivariable Poisson regression. The mediating effect of AL was assessed using the Valeri and VanderWeele method. All results were expressed as risk ratios (RRs) with 95% confidence intervals.RESULTS:
Overall, Black (vs. White) KPGA members had an 18% excess risk of AL (RR 1.18, 95%CI 1.14-1.23) and a 24% excess risk of severe COVID-19 (RR 1.24, 95%CI 1.12, 1.37). AL explained 23% of the Black-White disparities in severe COVID-19.CONCLUSIONS:
In our study, chronic stress, characterized by AL, partially mediated Black-White disparities in severe COVID-19 outcomes.
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Temas:
ECOS
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Equidade_desigualdade
Bases de dados:
MEDLINE
Tipo de estudo:
Prognostic_studies
Aspecto:
Equity_inequality
Idioma:
En
Revista:
J Racial Ethn Health Disparities
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos