Disproportionate Burden of COVID-19 Infection Among Hispanic Patients During the First COVID-19 Surge in South Texas

Meredith G Hosek; Aditi Sharma; Mary Nunn; Sydney T Tran; Madeleine O Bousquet; Zachary T Allen; Farah A L Allawi; Robert Geller; Andrew McCracken; Carmen G Sanchez; Anna G Taranova; Roberto Villarreal; Martin Goros; Jonathan Gelfond; Barbara S Taylor

doi:10.1089/heq.2021.0185

Disproportionate Burden of COVID-19 Infection Among Hispanic Patients During the First COVID-19 Surge in South Texas

Health Equity. 2022 Jul 22;6(1):546-553. doi: 10.1089/heq.2021.0185. eCollection 2022.

Authors

Affiliations

¹ Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA.
² Department of Internal Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas, USA.
³ Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas, USA.
⁴ Department of Research & Information Management, University Health, San Antonio, Texas, USA.
⁵ Department of Clinical & Business Analytics, University Health, San Antonio, Texas, USA.
⁶ Department of Public Health, Innovation, and Equity, University Health, San Antonio, Texas, USA.
⁷ Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, Texas, USA.
⁸ Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA.

Abstract

Introduction: The morbidity and mortality of the COVID-19 pandemic have disproportionately burdened Hispanic populations in the United States. While health equity research is typically conducted in populations where Hispanics are the minority, this project analyzes COVID-19 racioethnic transmission trends over the first 6 months of the pandemic within a large majority-minority city in South Texas.

Methods: Patients diagnosed with COVID-19 across inpatient, emergency department, and outpatient settings of a large county health system were included in a clinical registry. For 4644 COVID-19-positive patients between March 16 and August 31, 2020, demographic and clinical data were abstracted from the registry. Race/ethnicity trends over time were compared for patients with and without COVID-19 diagnoses. Logistic regressions identified predictors of inpatient diagnosis by age, race/ethnicity, and testing delay.

Results: The proportion of patients with COVID-19 identifying as Hispanic increased rapidly during the pandemic's first months: from 55.6% in March to 85.7% in June. A significantly greater proportion of patients identified as Hispanic within the COVID-19 cohort compared to other diagnoses cohort. Testing delay was 11.6% longer for Hispanic patients, with each day of testing delay associated with 7% increased odds of inpatient COVID-19 diagnosis.

Conclusion: These findings highlight the disproportionate impact of COVID-19 on Hispanic populations even within a majority-minority community. In the United States, Hispanic persons are more likely to work frontline jobs, live in multigenerational homes in poverty, and be uninsured. The burden of COVID-19 cases within Bexar County's largest hospital system reflects this systemic inequity. Identifying racioethnic health disparities supports efforts toward mitigating structural factors that predispose minority groups to illness and death.

Keywords: COVID-19; COVID-19 transmission; Hispanic health; South Texas; ethnic disparity; health disparity.