JMIR Publications

ABSTRACT

Background:

In the United States, the COVID-19 pandemic has magnified the disproportionate and long-standing health disparities experienced by Black communities. Though it is acknowledged that social determinants of health (SDOH), rather than biological factors likely contribute to this disparity, few studies, using rigorous analytic approaches in large, information-rich community-based datasets, are dedicated to understanding the underlying drivers of these racial disparities.

Objective:

The overall aim of our study is to elucidate the mechanisms with which racial disparities in severe COVID-19 outcomes arise using both quantitative and qualitative methods.

Methods:

In this protocol, we outline a convergent parallel mixed-methods approach to identifying, quantifying, and contextualizing factors that contribute to the dramatic disparity in COVID-19 severity (i.e., hospitalization, mortality) in Black vs. white COVID-19 patients within Kaiser Permanente Georgia’s (KPGA) integrated healthcare system. To do this, we will generate two quantitative cohorts of KPGA members with a confirmed COVID-19 diagnosis between Jan 1, 2020 and Jun 1, 2021: an electronic medical record (EMR) cohort including routinely captured data on diagnoses, medications, and laboratory values and including a subset hospitalized at Emory Healthcare to capture additional in-hospital data; and a survey cohort where participants will answer a range of questions related to demographics (e.g., race, education), usual health behaviors (e.g., physical activity, smoking), impact of COVID-19 (e.g., job loss, caregiving responsibilities) and medical mistrust. Key outcomes of interest for these two cohorts include hospitalization, mortality, intensive care unit admission, hospital readmission, and long COVID-19. Finally, we will conduct qualitative semi-structured interviews to capture perceptions of and experiences of being hospitalized with COVID-19 as well as related interactions with KPGA healthcare providers. We will analyze and interpret quantitative and qualitative data separately, and then integrate the qualitative and quantitative findings using a triangulation design approach.

Results:

This study has been funded by a Woodruff Health Sciences grant from Dec 2020 to Dec 2022. As of April 2022, 31,420 KPGA members diagnosed with COVID-19 have been included in the EMR cohort, including 2,387 who were hospitalized at Emory Healthcare, and 482 KPGA members completed the survey. In addition, 20 KPGA members (10 Black and 10 white) have been interviewed about their experiences navigating care with COVID-19. Data analysis will begin in May 2022 with results anticipated to be published in December 2022.

Conclusions:

Results from this mixed-methods pilot study in a diverse integrated care setting in the Southeastern U.S. will provide insights into the mechanisms underpinning racial disparities in COVID-19 complications. The quantitative and qualitative data will provide important context to generate hypotheses around the mechanisms for racial disparities in COVID-19, and may help to inform the development of multi-level strategies to reduce the burden of racial disparities in COVID-19 and its ongoing sequalae. Incorporating contextual information, elucidated from qualitative interviews, will increase the efficacy, adoption, and sustainability of such strategies. Clinical Trial: n/a