Racial Disparities in COVID-19 Severity Are Partially Mediated by Chronic Stress-Evidence from a Large Integrated Healthcare System.

IF 3.2 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Racial and Ethnic Health Disparities Pub Date : 2025-04-01 Epub Date: 2024-01-31 DOI:10.1007/s40615-024-01920-6

Miranda M Montoya, Jennifer C Gander, Shakira F Suglia, Bennett McDonald, Shivani A Patel, Teaniese Davis, Rachel E Patzer, Ram Jagannathan, Larissa Teunis, Jessica L Harding

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引用次数: 0

Abstract

Background: Racial and ethnic minorities have experienced a disproportionate burden of severe COVID-19. Whether chronic stress, also disproportionately experienced by racial and ethnic minorities, explains this excess risk is unknown.

Methods: We identified 9577 adults (≥ 18 years) diagnosed with COVID-19 from January 1, 2020, through September 30, 2021, enrolled in Kaiser Permanente Georgia (KPGA) with complete biomarker data. Self-reported race (Black or White) was defined from electronic medical records. Chronic stress, defined as allostatic load (AL), a composite score (scale 0-7) based on seven cardio-metabolic biomarkers, was categorized as below (low AL) or above (high AL) the median. Severe COVID-19 was defined as hospitalization or mortality within 30 days of COVID-19 diagnosis. The association between race, AL, and severe COVID-19 was assessed using multivariable Poisson regression. The mediating effect of AL was assessed using the Valeri and VanderWeele method. All results were expressed as risk ratios (RRs) with 95% confidence intervals.

Results: Overall, Black (vs. White) KPGA members had an 18% excess risk of AL (RR: 1.18, 95%CI: 1.14-1.23) and a 24% excess risk of severe COVID-19 (RR: 1.24, 95%CI: 1.12, 1.37). AL explained 23% of the Black-White disparities in severe COVID-19.

Conclusions: In our study, chronic stress, characterized by AL, partially mediated Black-White disparities in severe COVID-19 outcomes.

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COVID-19 严重程度的种族差异部分受慢性压力的影响--来自一个大型综合医疗保健系统的证据。

背景：少数种族和少数族裔患严重 COVID-19 的比例过高。少数种族和少数族裔所承受的慢性压力也不成比例，是否能解释这种超额风险，目前尚不清楚：我们确定了从 2020 年 1 月 1 日到 2021 年 9 月 30 日期间在 Kaiser Permanente Georgia (KPGA) 登记并拥有完整生物标记物数据的 9577 名确诊 COVID-19 的成人（≥ 18 岁）。自我报告的种族（黑人或白人）根据电子病历确定。慢性压力的定义是异位负荷（AL），即基于七种心血管代谢生物标记物的综合评分（0-7分），分为低于（低AL）或高于（高AL）中位数。严重的 COVID-19 被定义为在确诊 COVID-19 后 30 天内住院或死亡。使用多变量泊松回归评估了种族、AL 和严重 COVID-19 之间的关系。AL 的中介效应采用 Valeri 和 VanderWeele 方法进行评估。所有结果均以风险比（RRs）和 95% 置信区间表示：总体而言，黑人（与白人相比）KPGA 会员的 AL 风险高出 18%（RR：1.18，95%CI：1.14-1.23），严重 COVID-19 风险高出 24%（RR：1.24，95%CI：1.12，1.37）。AL解释了黑人与白人在严重COVID-19方面23%的差异：在我们的研究中，以AL为特征的慢性压力在一定程度上介导了黑人与白人在严重COVID-19结果上的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Racial and Ethnic Health Disparities PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.30

自引率

5.10%

发文量

263

期刊介绍： Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.