PLoS Medicine (Oct 2021)

Changes in the associations of race and rurality with SARS-CoV-2 infection, mortality, and case fatality in the United States from February 2020 to March 2021: A population-based cohort study.

  • George N Ioannou,
  • Jacqueline M Ferguson,
  • Ann M O'Hare,
  • Amy S B Bohnert,
  • Lisa I Backus,
  • Edward J Boyko,
  • Thomas F Osborne,
  • Matthew L Maciejewski,
  • C Barrett Bowling,
  • Denise M Hynes,
  • Theodore J Iwashyna,
  • Melody Saysana,
  • Pamela Green,
  • Kristin Berry

DOI
https://doi.org/10.1371/journal.pmed.1003807
Journal volume & issue
Vol. 18, no. 10
p. e1003807

Abstract

Read online

BackgroundWe examined whether key sociodemographic and clinical risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and mortality changed over time in a population-based cohort study.Methods and findingsIn a cohort of 9,127,673 persons enrolled in the United States Veterans Affairs (VA) healthcare system, we evaluated the independent associations of sociodemographic and clinical characteristics with SARS-CoV-2 infection (n = 216,046), SARS-CoV-2-related mortality (n = 10,230), and case fatality at monthly intervals between February 1, 2020 and March 31, 2021. VA enrollees had a mean age of 61 years (SD 17.7) and were predominantly male (90.9%) and White (64.5%), with 14.6% of Black race and 6.3% of Hispanic ethnicity. Black (versus White) race was strongly associated with SARS-CoV-2 infection (adjusted odds ratio [AOR] 5.10, [95% CI 4.65 to 5.59], p-value ConclusionsIn this study, we found that strongly positive associations of Black and AI/AN (versus White) race and urban (versus rural) residence with SARS-CoV-2 infection, mortality, and case fatality observed early in the pandemic were ameliorated or reversed by March 2021.