In a recent study published in Frontiers in Public Health, researchers from the USA of America (US) investigated the racial and ethnic variation in symptoms, activity level, health status, and missed work.
They assessed this via follow-ups post-initial infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the symptoms were equally prevalent among the many groups, they found that three and 6 months post-infection, Hispanic participants reported poorer health and reduced activity in comparison with non-Hispanic participants.
Further, racial minority participants reported more negative impacts on health status, activity, and absence from work as in comparison with the White population.
The coronavirus disease 2019 (COVID-19) pandemic highlighted disparities, wherein ethnic and racial minoritized populations were observed to face greater infection risks on account of the essential nature of their work, limited distant work options, and challenges in practicing social distancing.
The infected individuals faced barriers to care, including underinsurance and lack of primary care, with economic consequences. Disparities persevered in health outcomes, for instance, higher hospitalization and mortality rates amongst Black and Hispanic populations.
Despite these challenges, recovery-related differences after SARS-CoV-2 infection remained understudied, with existing studies having limitations like varied follow-up durations, inconsistent findings, and insufficient consideration of social health determinants.
Researchers in the current study aimed to handle this gap. The study assessed symptoms and health-related effects following SARS-CoV-2 infection across ethnicities and races, aiming to guide equitable health interventions effectively.
Concerning the study
In the current study, a secondary evaluation was performed using data from a US-based, prospective, multicenter, longitudinal cohort study named Progressive Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE). The first cohort involved adults positive for SARS-CoV-2 infection enrolled from December 2020 to July 2022, together with a SARS-CoV-2-negative group for considering non-SARS-CoV-2-related effects.
A complete of three,161 participants accomplished enrollment and reported symptoms and other outcomes every three months via surveys. Out of those participants, 2,402 were SARS-CoV-2-positive and 759 SARS-CoV-2-negative.
Among the many SARS-CoV-2-positive participants, 14.0% were Hispanic, 11.0% were Asian, 7.9% were Black, 9.9% were categorized as Other/Multiple races, and 71.1% were White. Among the many SARS-CoV-2-negative participants, 16.5% were Hispanic, 14.8% were Asian, 13.1% were Black, 8.1% were categorized as Other/Multiple races, and 64% were White.
The researchers evaluated 21 COVID-19-like symptoms and “other symptoms” at enrollment and three and 6 months post-infection using the Centers for Disease Control and Prevention’s symptom list.
Through the follow-ups, health status (rated on a 5-point scale from excellent to poor), activity level in comparison with pre-SARS-CoV-2 symptoms (same, somewhat less, much less), and missed work prior to now three months (categorized into workdays) were assessed.
Data were collected on ethnicity and race. Interactions between ethnicity or race and SARS-CoV-2 infection status were considered.
Generalized estimating equations (GEE) logistic regression was used to estimate marginal odds ratios (ORs) for various outcomes, adjusting for SARS-CoV-2 infection status, demographic aspects, substance use, social determinants of health, pre-existing health conditions, COVID-19 vaccination status, and survey time point.
Results and discussion
Post SARS-CoV-2 infection, symptoms were found to be mostly similar across ethnic and racial groups over time. At three months, Hispanic individuals had higher odds of reporting fair/poor health (OR = 1.94) and reduced activity in comparison with their non-Hispanic counterparts. No significant differences by ethnicity were observed at six months.
At three months, participants of Other/Multiple races had higher odds of reporting fair/poor health (OR = 1.9) and reduced activity in comparison with White participants. At six months, Asian participants had a greater probability of reporting fair/poor health (OR = 1.88), Black individuals reported more missed work (OR = 2.83), and Other/Multiple race participants reported more health issues (OR = 1.83), reduced activity, and missed work (OR = 2.25).
The findings help to enhance our understanding of the ethnic and racial disparities in outcomes after SARS-CoV-2 infection and may very well be used to tell clinical and public health initiatives and policy.
Nevertheless, the study is proscribed by small sample sizes in ethnic and racial subgroups, lack of adjustment for insurance and frontline employee status, potential participant representativeness issues, variations in response rates, lack of exploration of neurological and mental health sequelae, recruitment at different pandemic stages, and the absence of adjustments for multiple comparisons.
In conclusion, the findings suggest that while the symptom prevalence was similar among the many groups, the ethnic and racial minority groups suffered opposed effects on health status, activity level, and absence from work as in comparison with non-Hispanic and White populations, respectively.
Examining the underlying aspects contributing to those differences could aid the efforts to advertise health equity and improve our preparedness for future pandemics.
- O’Laughlin KN, Klabbers RE, Mannan IE, et al. (2024). Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection. Frontiers in Public Health. doi: 10.3389/fpubh.2023.1324636. https://www.frontiersin.org/articles/10.3389/fpubh.2023.1324636/full