Patients on hemodialysis experienced racial, social disparities linked with COVID-19 risk
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According to this study, patients categorized as “non-Hispanic Black” and Hispanic who were on hemodialysis faced significantly greater risk for contracting COVID-19 during the first surge of cases in New York City.
However, socioeconomic status, racial minority status, language and housing crowding were significantly associated with COVID-19 among “non-Hispanic white” patients. The findings suggest unequal exposure to COVID-19 that requires “targeted risk-mitigation strategies,” according to Sri Lekha Tummalapalli, MD, MBA, MAS, of the Rogosin Institute in New York City, and colleagues.
“In our study, racial/ethnic disparities in COVID-19 incidence in the hemodialysis population mirrored trends seen in the general population of New York City, but they were only partially explained by neighborhood COVID-19 cumulative incidence and were not explained by census indicators of social vulnerability, suggesting that additional unmeasured social variables contribute to excess risk,” Tummalapalli and colleagues wrote. “Our findings that race/ethnicity modifies the association between neighborhood social vulnerability and COVID-19 suggest that neighborhood-level factors contributed to COVID-19 incidence among non-Hispanic white patients, whereas other residual factors, such as unmeasured household exposures, accounted for excess COVID-19 cases in the Black and Hispanic patients in our study sample.”
Methods
The researchers conducted a retrospective cohort study of 1,378 patients on in-center hemodialysis at eight dialysis units withing New York City. Patients received hemodialysis between March 1 and Aug. 3, 2020, during the initial surge of COVID-19 cases. Tummalapalli and colleagues examined the association of race/ethnicity and social vulnerability to COVID-19 infection. They used the social vulnerability index (SVI) to quantify the impact of social factors on COVID-19 risk in relation to race. Patients’ demographic information was extracted from electronic health records and neighborhood factors were taken from census data involved in a previous community survey. During routine clinical exams, patients received regular COVID-19 checks. However, New York City limited testing mainly to hospitalized patients during the time period of the study. Due to this limitation, cases of COVID-19 among study patients were presumed based off of signs and symptoms.
Social, racial associations with COVID-19 infections
Among the study cohort, 21.3% of patients were non-Hispanic white, 41.9% were non-Hispanic Black, 15% were Hispanic, 12.6% were Asian or Pacific Islander and 9% had an unknown or missing race identification. They ranged in age from 18 to older than 80 years, with most patients between 45 and 79 years old.
Overall, patients on hemodialysis faced higher social vulnerability compared with the general city population. Patients living in high SVI areas were younger, more likely to be women (46% vs. 39%), more likely to be non-Hispanic Black (51% vs. 33%) and Hispanic (17% vs. 13%), less likely to be married and more likely to have kidney failure caused by diabetes (44% vs. 38%), according to the researchers. In total, 17.9% of patients were infected with symptomatic COVID-19. Those infected had a higher likelihood of being single, were more likely to travel to dialysis via a van service and were more likely to have kidney failure caused by diabetes.
Compared with non-Hispanic white patients, non-Hispanic Black and Hispanic patients had a higher likelihood of contracting COVID-19. In unadjusted analyses, socioeconomic status, racial minority status, language and housing crowding were significantly associated with COVID-19 among non-Hispanic white patients. Moreover, the significance of these factors ceased in adjusted analyses, while housing crowding remained significant for white patients. Overall, the SVI factors did not correlate with racial/ethnic-related COVID-19 associations.
“A greater understanding of patients’ household composition and other community exposures may be useful for risk-stratifying patients and providing individualized education about risk mitigation,” Tummalapalli and colleagues wrote. They added, “As the COVID-19 pandemic continues, qualitative and survey-based research on the perceptions and practices of patients on dialysis and their household contacts surrounding social distancing, mask wearing, and vaccination will be highly informative.”
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