Acute Respiratory Illness across Race and Ethnicity in Disparate Healthcare Settings

The disproportionate effect of COVID-19 on racial and ethnic minority populations prompted the CDC to investigate disparities within acute respiratory illness (ARI) across healthcare settings.

The Centers for Disease Control and Prevention used the IBM Explorys Electronic Health Record database to detail 33,992,254 unique nonpharmacy healthcare encounters (ambulatory care or telehealth, emergency department, and hospitalizations) from January 1, 2020-May 1, 2021.

Healthcare encounters were classified as ARI based on ICD-10 and SNOMED codes, before being sorted by months and US Census region. Investigators estimated the population denominator as the total number of people by bridged racial/ethnic group. They also estimated the rate of ARI visits per 100,000 people across healthcare settings, as well as the ration of ARI visits to non-ARI visits.

Investigators used Poisson generalized estimating equations within designated geographic regions to compare the rate of visits by race/ethnicity, using white persons as the referent.

There was a total of 244,137 (6.5%) ARI hospitalizations, 237873 (18%) ARI emergency visits, and 1,636,383 (5.7%) ARI ambulatory visits. Investigators saw similar rates of ARI visits across race/ethnicity in all settings combined, but higher rates of ARI hospitalization among Hispanic persons (2.5 [1.7-3.7]) and higher rates of emergency department visits among Black persons (2.5 [1.9-3.2]).

The study authors added, “we also observed differences in the relative proportion of care received for ARI vs. other visits types by setting, for example with Black persons utilizing higher rates of hospital visits for ARI vs non-ARI care (2.2 [1.7-2.7]) but lower rates of ambulatory care for ARI (0.9 [0.7-0.96]).”

The investigators found that rates of ARI visits and proportions of ARI to non-ARI visits differed between racial/ethnic groups by setting. They recommended further study into the nuanced care required by each unique healthcare setting to ensure health equity.

The study, “Healthcare Utilization for Acute Respiratory Illness by Race/Ethnicity across Ambulatory, Emergency, and Hospital Settings,” was presented virtually by Alexandra M. Mellis, PhD at IDWeek 2021, held September 29-October 3, 2021.