In an analysis of patients on hemodialysis in New York City, there were substantial racial/ethnic disparities in COVID-19 rates that were not explained by neighborhood social vulnerability. The findings appear in an upcoming issue of JASN.
The COVID-19 pandemic has disproportionately affected socially disadvantaged groups, including Black and Hispanic individuals, those with limited English proficiency, and persons of low socioeconomic status. To examine potential racial/ethnic and socioeconomic disparities in COVID-19 in individuals with kidney failure who are undergoing hemodialysis (which puts them at risk of acquiring COVID-19 because they travel several times each week to receive treatment in a congregate setting), Sri Lekha Tummalapalli, MD, MBA, MAS (Weill Cornell Medicine and The Rogosin Institute) and her colleagues analyzed information on 1,378 patients receiving in-center hemodialysis in New York City between March 1, 2020 and August 3, 2020.
A total of 247 patients (17.9%) developed symptomatic COVID-19. Compared with non- Hispanic White patients, non-Hispanic Black patients and Hispanic patients were 1.76-times and 2.66-times more likely to develop symptomatic COVID-19, respectively, after adjustments. “Racial/ethnic disparities in COVID-19 incidence among patients on hemodialysis largely mirrored community transmission patterns, and likely reflect neighborhood spread to this vulnerable population,” said Dr. Tummalapali.
The investigators found that neighborhood-level social vulnerability factors—such as income, education level, languages spoken, and housing crowding—were associated with COVID-19 incidence among non-Hispanic White patients, but these factors did not explain racial/ethnic disparities. Black and Hispanic patients on hemodialysis faced an excess risk of acquiring COVID-19, regardless of the neighborhood they lived in.
“These results suggest that other unmeasured household and community exposures contribute to racial/ethnic disparities in acquiring COVID-19,” said Dr. Tummalapalli. “Understanding factors that drive disparities could inform policies and interventions designed to mitigate disparities.”
American Society of Nephrology