Epidemiologic Risk Modeling of Disproportionate Burden of SARS-CoV-2 Case Positivity and COVID-19 Mortality among Blacks/African Americans in Washington DC, USA

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Holmes L Jr. Deepika K Williams J Chinaka C John V Ogundele B Okundaye O Philipcien G Poleon M Thompson J Enwere M Ward D Picolli T Comeaux C R Shikha Jain Naresh Dasari Ram Sanjiv Alur Ramesh Adhikari Gbadebo O Ogungbade


Background: Historically, populations with deprived optimal care, preventive health services, value-based care, and low socio-economic status with marginalized social hierarchy had been observed with poor health outcomes and excess mortality during pandemics. The current COVID-19 global pandemic mirrors the flu pandemic of 1918, where the social gradient predicted the disproportionate burden of mortality among blacks in the United States (US). The current study aimed to assess the racial differentials in SARS-Cov-2 case positivity, case fatality and mortality in Washington DC, US as well as the potential explanatory model therein.

Materials and Methods: A cross-sectional ecologic design was used to examine the COVID-19 data from the Washington DC Department of Health (https://coronavirus.dc.gov/data ) by race/ethnicity, sex, ward (geographic locale), and age. This predictive model examined the pre- (November, 2020) and post-thanksgiving (December, 2020) data for trends. While the variables examined were in aggregate data format, chi square statistic and binomial regression models were used for variable characterization by race and mortality risk race prediction respectively.

Results: During late November, the SARS-Cov-2 case positivity in Washington DC was higher among Blacks/AA (n=9,441(46.7%)) relative to Whites, 4603 (22.8%). With respect to Hispanics, the SARS-Cov-2 case positivity was 4,853 (24.1%) and 13,477 (66.9%) among non-Hispanics. With respect to COVID-19 mortality, this was lowest among non-Hispanic Whites (NHW), 1.50%, intermediate among Hispanics (1.81%), and highest among non-Hispanic Blacks (NHB), 5.30%. There was sex differential in mortality cumulative incidence (CmI), with males (57.0%) compared to females (43.0%) illustrating higher mortality. The mortality CmI by age was lowest among cases, 20-29 years (6.4%), intermediate among cases, 50-69 years (36.3%) and highest among individuals, 70 years and older, 58.7%. With respect to the geographic locale (DC-Ward), the mortality CmI was higher in DC- Wards 4-6 (39.3%) and wards DC-7-8 (35.4%) but lower in DC-Wards 1-3 (22.1%). The mortality risk from COVID-19 illustrated racial/ethnic differentials. Relative to NHW in Washington DC, NHB were almost 4 times as likely to die from COVID-19 in November 2020 prior to Thanksgiving, prevalence odds ratio, (pOR)=3.62, 95%CI, 2.78-4.73, Attributable fraction of exposed (AFE),72%, while Hispanics were 25% more likely to die, Hispanics, pOR=1.25, 95%CI, 1.0-1.74, AFE(18%).

During the first week in December, post –thanksgiving period, the SARS-Cov-2 case positivity was lower among Whites (n, 5719, (23.0%)) compared to Blacks/AA, 11,218 (47%). The CmI mortality was highest among NHB, n=521 (74%), intermediate among Hispanics, n=93 (13.2%) and lowest among NHW, n=72, (10.2%). Similarly, there was racial differential in mortality risk,with increased risk observed among Blacks/AA, relative to their White counterparts in DC. Compared to Whites, Blacks/AA were 4 times as likely to die from COVID-19, pOR=4.00, 95%CI, 2.87-4.80, AFE (73%).

Conclusions: There were racial/ethnic disparities in SARS-Cov-2 case positivity, COVID-19 mortality and mortality risk, which was higher among Blacks/AA relative to their White counterparts in Washington DC. Additionally, mortality was higher in male compared to female as well as DC-ward variation by mortality.


Keywords: SARS-Cov-2 case positivity, COVID-19 Mortality, Washington DC, Racial/ethnic disparities, Social inequity

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How to Cite
L JR., Holmes et al. Epidemiologic Risk Modeling of Disproportionate Burden of SARS-CoV-2 Case Positivity and COVID-19 Mortality among Blacks/African Americans in Washington DC, USA. Medical Research Archives, [S.l.], v. 10, n. 6, june 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2788>. Date accessed: 20 apr. 2024. doi: https://doi.org/10.18103/mra.v10i6.2788.
Research Articles


1. Anderson, R. M., Heesterbeek, H., Klinkenberg, D., Hollingsworth, T. D. (2020). How will country-based mitigation measures influence the course of the COVID-19 epidemic? The Lancet, 395(10228), 931 – 934. DOI: https://doi.org/10.1016/S0140-6736(20)30567-5
2. Giwa, A, and Desai, A. (2020). Novel coronavirus COVID-19: an overview for emergency clinicians. Emerg Med Pract, 22(2 Suppl 2), 1 – 21
3. Estreicher, M., Hranjec, T., Pepe, P. E. et al. (2020). Spotting the Clotting: Hypercoagulopathy in COVID-19. Available at: https://www.emsworld.com/1224381/spotting-clotting-hypercoagulopathy-covid-19 Accessed November 20, 2020
4. Bikdeli, B., Madhavan, M. V., Jimenez, D, Chuich, T., Dreyfus, I., Driggin, E., et al. (2020). COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up. J Am Coll Cardiol,75(23) [epub ahead of print]. DOI: 10.1016/j.jacc.2020.04.031
5. Omran A. R. (2005). The epidemiologic transition: a theory of the epidemiology of population change. 1971. The Milbank quarterly, 83(4), 731–757. https://doi.org/10.1111/j.1468-0009.2005.00398.
6. McKeown R. E. (2009). The Epidemiologic Transition: Changing Patterns of Mortality and Population Dynamics. American journal of lifestyle medicine, 3(1Suppl), 19S–26S. https://doi.org/10.1177/1559827609335350
7. Holmes Jr, L., Enwere, E, Williams, J., Ogundele, B., Chavan, P., Piccoli, T., Chinaka, C.; Comeaux, C.; Pelaez, L.; Okundaye, O.; Stalnaker, L.; Kalle, F.; Deepika, K.; Philipcien, G.; Poleon, M.; Ogungbade, G.; Elmi, H.; John, V.; Dabney, K.W. (2020). Black–White Risk Differentials in COVID-19 (SARS-COV-2) Transmission, Mortality and Case Fatality in the United States: Translational Epidemiologic Perspective and Challenges. Int. J. Environ. Res. Public Health, 17(2), 4322 doi:10.3390/ijerph17124322
8. Rothe C, Schunk M, Sothmann P, et al. (2020). Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med, 382(10), 970-971. doi:10.1056/NEJMc2001468
9. Singhal T. (2020). A Review of Coronavirus Disease-2019 (COVID-19). Indian journal of pediatrics, 87(4), 281–286. https://doi.org/10.1007/s12098-020-03263-6
10. Holmes Jr, L.(2018). Applied epidemiologic principles and concept: Clinician’s Guidelines to study Conduct and Interpretation, CRC. Available at: https://www.routledge.com/Applied-Epidemiologic-Principles-and-Concepts-Clinicians-Guide-to-Study/Jr/p/book/9780367560089 Accessed November, 18, 2020.
11. Mohanty, S. K., Satapathy, A., Naidu, M. M., Mukhopadhyay, S., Sharma, S., Barton, L. M., Stroberg, E., Duval, E. J., Pradhan, D., Tzankov, A., &Parwani, A. V. (2020). Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19) - anatomic pathology perspective on current knowledge. Diagnostic pathology, 15(1), 103. https://doi.org/10.1186/s13000-020-01017-8
12. DHSS, Delaware Health and Social Services. My Healthy Community: Delaware Environmental Public Health Tracking Network. Available at: https://myhealthycommunity.dhss.delaware.gov/locations/state Accessed November 21, 2020
13. Gee, G. C., & Ford, C. L. (2011). STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions. Du Bois review: social science research on race, 8(1), 115–132. https://doi.org/10.1017/S1742058X11000130
14. Krogstad, J. M,, Gonzalez-Barrera, A., & Lopez, M. H. (2020). Hispanics more likely than Americans overall to see coronavirus as a major threat to health and finances. Pew Research Center; Available at: https://www.pewresearch.org/fact-tank/2020/03/24/hispanics-more-likely-than-americans-overall-to-see-coronavirus-as-a-major-threat-to-health-and-finances/ . Accessed November 20, 2020.
15. Despres, C. (2020). Coronavirus case rates and death rates for Latinos in the United States. Salud America! Available at: https://salud-america.org/coronavirus-case-rates-and-death-rates-for-latinos-in-the-united-states/. Accessed November 20, 2020.
16. CDC, Centers for Disease Control and Prevention (2020). National Center for Health Statistics. Weekly updates by select demographic and geographic characteristics. Provisional death counts for coronavirus disease (COVID-19). Available at: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/. Accessed November 22, 2020.
17. Lincoln, K. D., Abdou, C. M., & Lloyd, D. (2014). Race and socioeconomic differences in obesity and depression among Black and non-Hispanic White Americans. Journal of health care for the poor and underserved, 25(1), 257–275. https://doi.org/10.1353/hpu.2014.0038
18. Singh, G. K., Daus, G. P., Allender, M., Ramey, C. T., Martin, E. K., Perry, C., Reyes, A., &Vedamuthu, I. P. (2017). Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016. International Journal of MCH and AIDS, 6(2), 139–164. https://doi.org/10.21106/ijma.236
19. Walker, R. J., Strom Williams, J., &Egede, L. E. (2016). Influence of Race, Ethnicity and Social Determinants of Health on Diabetes Outcomes. The American journal of the medical sciences, 351(4), 366–373. https://doi.org/10.1016/j.amjms.2016.01.008
20. Noonan, A.S., Velasco-Mondragon, H.E. & Wagner, F.A. (2016). Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev 37, 12 https://doi.org/10.1186/s40985-016-0025-4
21. Holmes, L., Jr, Shutman, E., Chinaka, C., Deepika, K., Pelaez, L., & Dabney, K. W. (2019). Aberrant Epigenomic Modulation of Glucocorticoid Receptor Gene (NR3C1) in Early Life Stress and Major Depressive Disorder Correlation: Systematic Review and Quantitative Evidence Synthesis. International journal of environmental research and public health, 16(21), 4280. https://doi.org/10.3390/ijerph16214280
22. Sanders, J. M., Monogue, M. L., Jodlowski, T. Z., Cutrell, J. B. et al. (2020). Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA, 323(18), 1824-1836. doi:10.1001/jama.2020.6019
23. Holmes, L., Chan, W., Jiang, Z. et al. (2007). Effectiveness of androgen deprivation therapy in prolonging survival of older men treated for locoregional prostate cancer. Prostate Cancer Prostatic Dis 10, 388–395. https://doi.org/10.1038/sj.pcan.4500973

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