Disparities in COVID-19 related outcomes in the United States by race and ethnicity pre-vaccination era: an umbrella review of meta-analyses

• Published in: Frontiers in public health Vol. 11; p. 1206988
• Main Authors: Duong, Khanh N C, Le, Lan M, Veettil, Sajesh K, Saidoung, Pantakarn, Wannaadisai, Warintorn, Nelson, Richard E, Friedrichs, Mike, Jones, Barbara E, Pavia, Andrew T, Jones, Makoto M, Samore, Matthew H, Chaiyakunapruk, Nathorn
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 07.09.2023
• Subjects: Black or African American - statistics & numerical data; COVID-19; COVID-19 - epidemiology; COVID-19 - ethnology; COVID-19 - therapy; Ethnicity - statistics & numerical data; health equity; Health Inequities; Hispanic or Latino - statistics & numerical data; Hospitalization - statistics & numerical data; Humans; Outcome Assessment, Health Care - statistics & numerical data; Public Health; Race Factors; race/ethnicity; Social Determinants of Health - ethnology; Social Determinants of Health - statistics & numerical data; the US; umbrella review; United States - epidemiology; Vaccination; White - statistics & numerical data; United States; COVID-19; health equity; umbrella review; the US; race/ethnicity
• ISSN: 2296-2565; 2296-2565
• DOI: 10.3389/fpubh.2023.1206988

Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US. In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805. Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant (  ≤ 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60-2.71), which was supported by highly suggestive evidence; with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60-2.70) with highly suggestive evidence which remained after sensitivity analyses. Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization compared to their White counterparts. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.