Throughout the pandemic, racial and ethnic minority groups in America have experienced worse outcomes from COVID-19. These groups also often have a higher burden of risk factors for severe COVID-19, such as higher prevalence of hypertension, diabetes, and obesity. Newly published results from a PCORnet®-leveraged study identify a factor that also may be at play: Inequitable receipt of COVID-19 treatments across racial and ethnic groups.
The study, which was published in the U.S. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, used PCORnet resources to explore patient receipt of three different medications used for treatment of COVID-19 during the pandemic. It found that therapeutic use of monoclonal antibodies (mAb), which are highly effective at preventing the progression of COVID-19, were used unequally in Black, Asian, and Hispanic COVID-19 patients, adding important evidence about the complex topic of health equity in the time of COVID-19.
“This research adds to the growing body of evidence that while we are all experiencing the pandemic, we are not experiencing it equally,” said Thomas Carton, co-author and PCORnet investigator for the study. “Using the PCORnet infrastructure, we were able to rapidly illuminate the disparities in mAb COVID-19 treatment use. This marks an important step toward addressing racial and ethnic health equity gaps that aren’t new but were highlighted by the pandemic.”
Specifically, the study found that Hispanic patients testing positive for SARS-CoV-2, the virus that causes COVID-19, received monoclonal antibodies 58% less often than non-Hispanic patients. Black, Asian and patients of other races received monoclonal antibodies 22%, 48%, and 47% less often than White patients, respectively. In inpatient settings, differences in treatment with dexamethasone and remdesivir were observed, but at a smaller scale. Black patients actually received remdesivir more often than White patients.
The disparities in monoclonal antibody use might reflect systemic factors such as limited access to testing and care, especially within the window needed to qualify for monoclonal treatment, inadequate insurance coverage, and transportation challenges; lack of a primary care provider to recommend treatment; variations in treatment supply and distribution; potential biases in prescribing practices; and limited penetration of messaging in some communities about monoclonal antibodies availability and effectiveness to prevent disease progression. Additional reasons might include hesitancy about receiving treatment.
The path forward
According to Carton, insights from this research underscore the need for better awareness and solutions to ensure equitable receipt of therapies in the treatment of COVID-19.
“Expanded research, resources, community partnerships, and efforts are needed at multiple levels to make meaningful progress to address inequities, especially those related to health, which have been made worse by the pandemic,” said lead author Jennifer Wiltz, Deputy Medical Director of the CDC National Center for Chronic Disease Prevention and Health Promotion. “I hope this latest research inspires action across communities, clinical groups, and sectors to address the gaps we’ve illuminated and bring us closer to equitable health care for all.”
The authors would like to see drivers understood and barriers addressed. As an example of program underway, CDC’s COVID Response and Resilient Communities initiative, puts community health workers in communities of greatest burden, allowing them to reach communities, facilitate access to services, and improve service delivery for people who otherwise face barriers to care.