Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study.
Identifieur interne : 000138 ( Main/Corpus ); précédent : 000137; suivant : 000139Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study.
Auteurs : Christopher T. Rentsch ; Farah Kidwai-Khan ; Janet P. Tate ; Lesley S. Park ; Joseph T. King ; Melissa Skanderson ; Ronald G. Hauser ; Anna Schultze ; Christopher I. Jarvis ; Mark Holodniy ; Vincent Lo Re ; Kathleen M. Akgün ; Kristina Crothers ; Tamar H. Taddei ; Matthew S. Freiberg ; Amy C. JusticeSource :
- PLoS medicine [ 1549-1676 ] ; 2020.
English descriptors
- KwdEn :
- Adult (MeSH), African Americans (statistics & numerical data), Aged (MeSH), Aged, 80 and over (MeSH), Betacoronavirus (MeSH), Clinical Laboratory Techniques (statistics & numerical data), Cohort Studies (MeSH), Coronavirus Infections (diagnosis), Coronavirus Infections (ethnology), Coronavirus Infections (mortality), Ethnic Groups (statistics & numerical data), European Continental Ancestry Group (statistics & numerical data), Female (MeSH), Hispanic Americans (statistics & numerical data), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (diagnosis), Pneumonia, Viral (ethnology), Pneumonia, Viral (mortality), Retrospective Studies (MeSH), United States (epidemiology), Veterans (statistics & numerical data), Young Adult (MeSH).
- MESH :
- geographic , epidemiology : United States.
- diagnosis : Coronavirus Infections, Pneumonia, Viral.
- ethnology : Coronavirus Infections, Pneumonia, Viral.
- mortality : Coronavirus Infections, Pneumonia, Viral.
- statistics & numerical data : African Americans, Clinical Laboratory Techniques, Ethnic Groups, European Continental Ancestry Group, Hispanic Americans, Veterans.
- Adult, Aged, Aged, 80 and over, Betacoronavirus, Cohort Studies, Female, Humans, Male, Middle Aged, Pandemics, Retrospective Studies, Young Adult.
Abstract
BACKGROUND
There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States.
METHODS AND FINDINGS
This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6-60.5) than Hispanic (52.7, 95% CI 52.1-53.4) and White individuals (38.6, 95% CI 38.4-38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85-2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74-1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80-1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73-1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41-2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11-1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health.
CONCLUSIONS
In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.
DOI: 10.1371/journal.pmed.1003379
PubMed: 32960880
PubMed Central: PMC7508372
Links to Exploration step
pubmed:32960880Le document en format XML
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Rentsch</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Kidwai Khan, Farah" sort="Kidwai Khan, Farah" uniqKey="Kidwai Khan F" first="Farah" last="Kidwai-Khan">Farah Kidwai-Khan</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Tate, Janet P" sort="Tate, Janet P" uniqKey="Tate J" first="Janet P" last="Tate">Janet P. 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Akgün</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Crothers, Kristina" sort="Crothers, Kristina" uniqKey="Crothers K" first="Kristina" last="Crothers">Kristina Crothers</name><affiliation><nlm:affiliation>VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Taddei, Tamar H" sort="Taddei, Tamar H" uniqKey="Taddei T" first="Tamar H" last="Taddei">Tamar H. Taddei</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Freiberg, Matthew S" sort="Freiberg, Matthew S" uniqKey="Freiberg M" first="Matthew S" last="Freiberg">Matthew S. Freiberg</name><affiliation><nlm:affiliation>Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, Tennessee, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Justice, Amy C" sort="Justice, Amy C" uniqKey="Justice A" first="Amy C" last="Justice">Amy C. Justice</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32960880</idno><idno type="pmid">32960880</idno><idno type="doi">10.1371/journal.pmed.1003379</idno><idno type="pmc">PMC7508372</idno><idno type="wicri:Area/Main/Corpus">000138</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000138</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study.</title><author><name sortKey="Rentsch, Christopher T" sort="Rentsch, Christopher T" uniqKey="Rentsch C" first="Christopher T" last="Rentsch">Christopher T. Rentsch</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Kidwai Khan, Farah" sort="Kidwai Khan, Farah" uniqKey="Kidwai Khan F" first="Farah" last="Kidwai-Khan">Farah Kidwai-Khan</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Tate, Janet P" sort="Tate, Janet P" uniqKey="Tate J" first="Janet P" last="Tate">Janet P. Tate</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Park, Lesley S" sort="Park, Lesley S" uniqKey="Park L" first="Lesley S" last="Park">Lesley S. Park</name><affiliation><nlm:affiliation>Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="King, Joseph T" sort="King, Joseph T" uniqKey="King J" first="Joseph T" last="King">Joseph T. King</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Skanderson, Melissa" sort="Skanderson, Melissa" uniqKey="Skanderson M" first="Melissa" last="Skanderson">Melissa Skanderson</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Hauser, Ronald G" sort="Hauser, Ronald G" uniqKey="Hauser R" first="Ronald G" last="Hauser">Ronald G. Hauser</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Schultze, Anna" sort="Schultze, Anna" uniqKey="Schultze A" first="Anna" last="Schultze">Anna Schultze</name><affiliation><nlm:affiliation>Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Jarvis, Christopher I" sort="Jarvis, Christopher I" uniqKey="Jarvis C" first="Christopher I" last="Jarvis">Christopher I. Jarvis</name><affiliation><nlm:affiliation>Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Holodniy, Mark" sort="Holodniy, Mark" uniqKey="Holodniy M" first="Mark" last="Holodniy">Mark Holodniy</name><affiliation><nlm:affiliation>VA Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, California, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Lo Re, Vincent" sort="Lo Re, Vincent" uniqKey="Lo Re V" first="Vincent" last="Lo Re">Vincent Lo Re</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Akgun, Kathleen M" sort="Akgun, Kathleen M" uniqKey="Akgun K" first="Kathleen M" last="Akgün">Kathleen M. Akgün</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Crothers, Kristina" sort="Crothers, Kristina" uniqKey="Crothers K" first="Kristina" last="Crothers">Kristina Crothers</name><affiliation><nlm:affiliation>VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Taddei, Tamar H" sort="Taddei, Tamar H" uniqKey="Taddei T" first="Tamar H" last="Taddei">Tamar H. Taddei</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Freiberg, Matthew S" sort="Freiberg, Matthew S" uniqKey="Freiberg M" first="Matthew S" last="Freiberg">Matthew S. Freiberg</name><affiliation><nlm:affiliation>Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, Tennessee, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Justice, Amy C" sort="Justice, Amy C" uniqKey="Justice A" first="Amy C" last="Justice">Amy C. Justice</name><affiliation><nlm:affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, United States of America.</nlm:affiliation></affiliation></author></analytic><series><title level="j">PLoS medicine</title><idno type="eISSN">1549-1676</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>African Americans (statistics & numerical data)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Betacoronavirus (MeSH)</term><term>Clinical Laboratory Techniques (statistics & numerical data)</term><term>Cohort Studies (MeSH)</term><term>Coronavirus Infections (diagnosis)</term><term>Coronavirus Infections (ethnology)</term><term>Coronavirus Infections (mortality)</term><term>Ethnic Groups (statistics & numerical data)</term><term>European Continental Ancestry Group (statistics & numerical data)</term><term>Female (MeSH)</term><term>Hispanic Americans (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (diagnosis)</term><term>Pneumonia, Viral (ethnology)</term><term>Pneumonia, Viral (mortality)</term><term>Retrospective Studies (MeSH)</term><term>United States (epidemiology)</term><term>Veterans (statistics & numerical data)</term><term>Young Adult (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="ethnology" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>African Americans</term><term>Clinical Laboratory Techniques</term><term>Ethnic Groups</term><term>European Continental Ancestry Group</term><term>Hispanic Americans</term><term>Veterans</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Betacoronavirus</term><term>Cohort Studies</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Retrospective Studies</term><term>Young Adult</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS AND FINDINGS</b></p><p>This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6-60.5) than Hispanic (52.7, 95% CI 52.1-53.4) and White individuals (38.6, 95% CI 38.4-38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85-2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74-1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80-1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73-1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41-2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11-1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32960880</PMID><DateCompleted><Year>2020</Year><Month>10</Month><Day>01</Day></DateCompleted><DateRevised><Year>2020</Year><Month>10</Month><Day>01</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">1549-1676</ISSN><JournalIssue CitedMedium="Internet"><Volume>17</Volume><Issue>9</Issue><PubDate><Year>2020</Year><Month>09</Month></PubDate></JournalIssue><Title>PLoS medicine</Title><ISOAbbreviation>PLoS Med</ISOAbbreviation></Journal><ArticleTitle>Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study.</ArticleTitle><Pagination><MedlinePgn>e1003379</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1371/journal.pmed.1003379</ELocationID><Abstract><AbstractText Label="BACKGROUND">There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States.</AbstractText><AbstractText Label="METHODS AND FINDINGS">This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6-60.5) than Hispanic (52.7, 95% CI 52.1-53.4) and White individuals (38.6, 95% CI 38.4-38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85-2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74-1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80-1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73-1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41-2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11-1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health.</AbstractText><AbstractText Label="CONCLUSIONS">In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Rentsch</LastName><ForeName>Christopher T</ForeName><Initials>CT</Initials><Identifier Source="ORCID">0000-0002-1408-7907</Identifier><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kidwai-Khan</LastName><ForeName>Farah</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tate</LastName><ForeName>Janet P</ForeName><Initials>JP</Initials><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Park</LastName><ForeName>Lesley S</ForeName><Initials>LS</Initials><Identifier Source="ORCID">0000-0002-3848-7753</Identifier><AffiliationInfo><Affiliation>Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>King</LastName><ForeName>Joseph T</ForeName><Initials>JT</Initials><Suffix>Jr</Suffix><Identifier Source="ORCID">0000-0003-2823-9649</Identifier><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Skanderson</LastName><ForeName>Melissa</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hauser</LastName><ForeName>Ronald G</ForeName><Initials>RG</Initials><Identifier Source="ORCID">0000-0002-7361-7162</Identifier><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schultze</LastName><ForeName>Anna</ForeName><Initials>A</Initials><Identifier Source="ORCID">0000-0002-1637-837X</Identifier><AffiliationInfo><Affiliation>Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jarvis</LastName><ForeName>Christopher I</ForeName><Initials>CI</Initials><AffiliationInfo><Affiliation>Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Holodniy</LastName><ForeName>Mark</ForeName><Initials>M</Initials><Identifier Source="ORCID">0000-0002-6655-7982</Identifier><AffiliationInfo><Affiliation>VA Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, California, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lo Re</LastName><ForeName>Vincent</ForeName><Initials>V</Initials><Suffix>3rd</Suffix><Identifier Source="ORCID">0000-0001-7955-0600</Identifier><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Akgün</LastName><ForeName>Kathleen M</ForeName><Initials>KM</Initials><Identifier Source="ORCID">0000-0003-2623-7463</Identifier><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Crothers</LastName><ForeName>Kristina</ForeName><Initials>K</Initials><Identifier Source="ORCID">0000-0001-9702-0371</Identifier><AffiliationInfo><Affiliation>VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Taddei</LastName><ForeName>Tamar H</ForeName><Initials>TH</Initials><Identifier Source="ORCID">0000-0002-6500-1739</Identifier><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Freiberg</LastName><ForeName>Matthew S</ForeName><Initials>MS</Initials><AffiliationInfo><Affiliation>Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, Tennessee, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Justice</LastName><ForeName>Amy C</ForeName><Initials>AC</Initials><Identifier Source="ORCID">0000-0003-0139-5502</Identifier><AffiliationInfo><Affiliation>VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, United States of America.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>U01 AA026224</GrantID><Acronym>AA</Acronym><Agency>NIAAA NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>U24 AA020794</GrantID><Acronym>AA</Acronym><Agency>NIAAA NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>U01 AA020790</GrantID><Acronym>AA</Acronym><Agency>NIAAA NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>U10 AA013566</GrantID><Acronym>AA</Acronym><Agency>NIAAA NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>PLoS Med</MedlineTA><NlmUniqueID>101231360</NlmUniqueID><ISSNLinking>1549-1277</ISSNLinking></MedlineJournalInfo><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Protocol" UI="C000657964">COVID-19 diagnostic testing</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001741" MajorTopicYN="N">African Americans</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019411" MajorTopicYN="N">Clinical Laboratory Techniques</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000208" MajorTopicYN="N">ethnology</QualifierName><QualifierName UI="Q000401" MajorTopicYN="Y">mortality</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005006" MajorTopicYN="N">Ethnic Groups</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D044465" MajorTopicYN="N">European Continental Ancestry Group</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006630" MajorTopicYN="N">Hispanic Americans</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000208" MajorTopicYN="N">ethnology</QualifierName><QualifierName UI="Q000401" MajorTopicYN="Y">mortality</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014728" MajorTopicYN="N">Veterans</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList><CoiStatement>The authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>06</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>08</Month><Day>31</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>22</Day><Hour>17</Hour><Minute>12</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>2</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32960880</ArticleId><ArticleId IdType="doi">10.1371/journal.pmed.1003379</ArticleId><ArticleId IdType="pii">PMEDICINE-D-20-02701</ArticleId><ArticleId 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