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
in 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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Prognostic_studies
Aspects:
Equity_inequality
Language:
En
Journal:
J Racial Ethn Health Disparities
/
J. racial ethnic health disparities (Internet)
/
Journal of racial and ethnic health disparities (Internet)
Year:
2024
Document type:
Article
Affiliation country:
Estados Unidos
Country of publication:
Suiza