Explaining Racial and Ethnic Inequities in SARS-CoV-2-Related Outcomes: Results from a Serosurvey in Chicago

Overview

Journal J Racial Ethn Health Disparities

Specialties Public Health
Social Sciences

Date 2025 Mar 10

PMID 40063297

Authors

Christopher A Eyo

Joshua M Schrock

Christina Hayford

Daniel T Ryan

Rana Saber

Nanette Benbow

Michael E Newcomb

Alexis R Demonbreun

Elizabeth M McNally

Richard T DAquila

Thomas W McDade

Brian Mustanski

Affiliations

Soon will be listed here.

Abstract

Background: Several studies have documented racial and ethnic disparities related to SARS-CoV-2/COVID-19 prevalence and associated health outcomes, but the proximal determinants underpinning these disparities remain unclear. Here, we test whether demographics, household composition, occupation type, chronic conditions, health insurance coverage, and neighborhood disadvantage account for racial and ethnic inequities in COVID-19 outcomes.

Methods: We conducted a serosurvey of adults in Chicago, IL (n = 5991) before emergency use authorization for COVID-19 vaccines in December 2020. Participants completed an online survey and provided a dried blood spot (DBS) sample for quantification of SARS-CoV-2 antibodies.

Results: Hispanic/Latino and Black participants had greater odds of being seropositive and being diagnosed with COVID-19 compared to White participants. Among seropositive participants, Hispanic/Latino and Black participants had higher antibody concentrations compared to White participants, and Hispanic/Latino participants had higher levels of symptom severity compared to White participants. Adding all variables to the model yielded a statistically significant reduction in the magnitude of Hispanic/Latino vs. White disparities in symptom severity among seropositive participants (Δ = - 59.4%, P = 0.015). We detected spatial clustering of high symptom severity in predominantly Hispanic/Latino neighborhoods and low symptom severity in predominantly White neighborhoods. Multiple inequities remained apparent after adjustment for all covariates.

Conclusions: Household composition, demographics, occupation type, chronic conditions, and neighborhood disadvantage collectively explain a substantial proportion of Hispanic/Latino vs. White inequities in symptom severity, but these factors are not sufficient to explain racial and ethnic inequities in SARS-CoV-2 seropositivity and COVID-19 case rates.

References

Bassett M, Chen J, Krieger N . Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: A cross-sectional study. PLoS Med. 2020; 17(10):e1003402. PMC: 7575091. DOI: 10.1371/journal.pmed.1003402. View

Mackey K, Ayers C, Kondo K, Saha S, Advani S, Young S . Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths : A Systematic Review. Ann Intern Med. 2020; 174(3):362-373. PMC: 7772883. DOI: 10.7326/M20-6306. View

Romano S, Blackstock A, Taylor E, El Burai Felix S, Adjei S, Singleton C . Trends in Racial and Ethnic Disparities in COVID-19 Hospitalizations, by Region - United States, March-December 2020. MMWR Morb Mortal Wkly Rep. 2021; 70(15):560-565. PMC: 8344991. DOI: 10.15585/mmwr.mm7015e2. View

Khan M, Shirmeen A . Proximate determinants of fertility and reproductive health. Ulster Med J. 2007; 76(1):6-7. PMC: 1940282. View

Linde S, Walker R, Campbell J, Egede L . Historic Residential Redlining and Present-day Diabetes Mortality and Years of Life Lost: The Persistence of Structural Racism. Diabetes Care. 2022; 45(8):1772-1778. PMC: 9346977. DOI: 10.2337/dc21-2563. View

Baltes P, Staudinger U, Lindenberger U . Lifespan psychology: theory and application to intellectual functioning. Annu Rev Psychol. 2004; 50:471-507. DOI: 10.1146/annurev.psych.50.1.471. View

Lynch E, Malcoe L, Laurent S, Richardson J, Mitchell B, Meier H . The legacy of structural racism: Associations between historic redlining, current mortgage lending, and health. SSM Popul Health. 2021; 14:100793. PMC: 8099638. DOI: 10.1016/j.ssmph.2021.100793. View

Nardone A, Casey J, Morello-Frosch R, Mujahid M, Balmes J, Thakur N . Associations between historical residential redlining and current age-adjusted rates of emergency department visits due to asthma across eight cities in California: an ecological study. Lancet Planet Health. 2020; 4(1):e24-e31. PMC: 10018700. DOI: 10.1016/S2542-5196(19)30241-4. View

Krieger N, Van Wye G, Huynh M, Waterman P, Maduro G, Li W . Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013-2017. Am J Public Health. 2020; 110(7):1046-1053. PMC: 7287548. DOI: 10.2105/AJPH.2020.305656. View

10.

Alcendor D . Racial Disparities-Associated COVID-19 Mortality among Minority Populations in the US. J Clin Med. 2020; 9(8). PMC: 7466083. DOI: 10.3390/jcm9082442. View

11.

Louis-Jean J, Cenat K, Njoku C, Angelo J, Sanon D . Coronavirus (COVID-19) and Racial Disparities: a Perspective Analysis. J Racial Ethn Health Disparities. 2020; 7(6):1039-1045. PMC: 7537778. DOI: 10.1007/s40615-020-00879-4. View

12.

Price-Haywood E, Burton J, Fort D, Seoane L . Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med. 2020; 382(26):2534-2543. PMC: 7269015. DOI: 10.1056/NEJMsa2011686. View

13.

Gu T, Mack J, Salvatore M, Prabhu Sankar S, Valley T, Singh K . Characteristics Associated With Racial/Ethnic Disparities in COVID-19 Outcomes in an Academic Health Care System. JAMA Netw Open. 2020; 3(10):e2025197. PMC: 7578774. DOI: 10.1001/jamanetworkopen.2020.25197. View

14.

Adkins-Jackson P, Chantarat T, Bailey Z, Ponce N . Measuring Structural Racism: A Guide for Epidemiologists and Other Health Researchers. Am J Epidemiol. 2021; 191(4):539-547. PMC: 9077112. DOI: 10.1093/aje/kwab239. View

15.

Guallar M, Meirino R, Donat-Vargas C, Corral O, Jouve N, Soriano V . Inoculum at the time of SARS-CoV-2 exposure and risk of disease severity. Int J Infect Dis. 2020; 97:290-292. PMC: 7293836. DOI: 10.1016/j.ijid.2020.06.035. View

16.

Bi Q, Lessler J, Eckerle I, Lauer S, Kaiser L, Vuilleumier N . Insights into household transmission of SARS-CoV-2 from a population-based serological survey. Nat Commun. 2021; 12(1):3643. PMC: 8206123. DOI: 10.1038/s41467-021-23733-5. View

17.

Semenzato L, Botton J, Drouin J, Cuenot F, Dray-Spira R, Weill A . Chronic diseases, health conditions and risk of COVID-19-related hospitalization and in-hospital mortality during the first wave of the epidemic in France: a cohort study of 66 million people. Lancet Reg Health Eur. 2021; 8:100158. PMC: 8282330. DOI: 10.1016/j.lanepe.2021.100158. View

18.

Petersen R, Pan L, Blanck H . Racial and Ethnic Disparities in Adult Obesity in the United States: CDC's Tracking to Inform State and Local Action. Prev Chronic Dis. 2019; 16:E46. PMC: 6464044. DOI: 10.5888/pcd16.180579. View

19.

Kho A, Daumit G, Truesdale K, Brown A, Kilbourne A, Ladapo J . The National Heart Lung and Blood Institute Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Alliance. Health Serv Res. 2022; 57 Suppl 1:20-31. PMC: 9108215. DOI: 10.1111/1475-6773.13983. View

20.

Erener S . Diabetes, infection risk and COVID-19. Mol Metab. 2020; 39:101044. PMC: 7308743. DOI: 10.1016/j.molmet.2020.101044. View