Higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and coronavirus-2019 (COVID-19)–related mortality among Black and Hispanic populations in the United States are likely due to decreased health care accessibility and increased exposure compared with White populations, according to findings from a systematic review by the Department of Veterans Affairs published in the Annals of Internal Medicine.

Investigators searched publication databases for observational studies on COVID-19 conducted in the United States and current infection statistics from the Centers for Disease Control and Prevention. Of the 54 studies included, 39 were individual-level and 15 were population-level studies.

Of the cross-sectional or cohort studies, a total of 25 were assessed as having fair and 8 as having poor methodological quality due to missing data or failing to adjust for potential confounders.

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On the basis of these cohort studies, 10 of which included more than 1000 patients, 13 studies reported ethnic biases for COVID-19 infection. The studies observed that Black populations were at 1.5 to 3.5 times higher risk for COVID-19 infection and Hispanic populations at 1.3 to 7.7 times higher risk compared with White populations.

Similarly, Black individuals were 1.5 to 3 times and Hispanic individuals were 1.5 times more likely to be hospitalized with SARS-CoV-2 compared with White individuals. The COVID-19–related mortality risk was 3.2 times higher for both minority groups compared with White patients.

These findings were largely verified by ecological studies, which on the whole tended to have higher methodological quality compared with the cross-sectional or cohort studies.

In total, 10 ecological studies and 10 individual-level studies controlled for variables that may have contributed to disparities of infection, hospitalization, and mortality rates due to COVID-19. These factors included exposure, susceptibility, and access to health care. A large study of more than 20,000 patients found disparity increased risk among Black patients (odds ratio [OR], 1.03; 95% CI, 1.01-1.05) and among Hispanic patients, population density (OR, 1.02; 95% CI, 1.01-1.02) and income (OR, 1.04; 95% CI, 1.02-1.06) were significant contributors.

These results may have been limited by the overall poor quality of the cohort studies and the fact that 23% of included studies were preprints and had not gone through the review process.

The study authors concluded Black and Hispanic populations were disproportionately affected by SARS-CoV-2 in the United States, likely due to disparities more than to susceptibility. Further research is needed to confirm these observations and to identify possible interventions that may mitigate the disparities.


Mackey K, Ayers CK, Kondo KK, et al. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: a systematic review. Ann Intern Med. Published online December 1, 2020. doi:10.7326/M20-6306

This article originally appeared on Infectious Disease Advisor