Health inequities in SARS-CoV-2 infection, seroprevalence, and COVID-19 vaccination: Results from the East Bay COVID-19 study

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Abstract

Comprehensive data on transmission mitigation behaviors and both SARS-CoV-2 infection and serostatus are needed from large, community-based cohorts to identify COVID-19 risk factors and the impact of public health measures. We conducted a longitudinal, population-based study in the East Bay Area of Northern California. From July 2020-March 2021, approximately 5,500 adults were recruited and followed over three data collection rounds to investigate the association between geographic and demographic characteristics and transmission mitigation behavior with SARS-CoV-2 prevalence. We estimated the populated-adjusted prevalence of antibodies from SARS-CoV-2 infection and COVID-19 vaccination, and self-reported COVID-19 test positivity. Population-adjusted SARS-CoV-2 seroprevalence was low, increasing from 1.03% (95% CI: 0.50–1.96) in Round 1 (July-September 2020), to 1.37% (95% CI: 0.75–2.39) in Round 2 (October-December 2020), to 2.18% (95% CI: 1.48–3.17) in Round 3 (February-March 2021). Population-adjusted seroprevalence of COVID-19 vaccination was 21.64% (95% CI: 19.20–24.34) in Round 3, with White individuals having 4.35% (95% CI: 0.35–8.32) higher COVID-19 vaccine seroprevalence than individuals identifying as African American or Black, American Indian or Alaskan Native, Asian, Hispanic, two or more races, or other. No evidence for an association between transmission mitigation behavior and seroprevalence was observed. Despite >99% of participants reporting wearing masks individuals identifying as African American or Black, American Indian or Alaskan Native, Asian, Hispanic, two or more races, or other, as well as those in lower-income households, and lower-educated individuals had the highest SARS-CoV-2 seroprevalence and lowest vaccination seroprevalence. Results demonstrate that more effective policies are needed to address these disparities and inequities.

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  1. SciScore for 10.1101/2021.12.02.21266871: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: In the screening phase, all residential addresses within the East Bay cities and communities of Albany, Berkeley, El Cerrito, El Sobrante, Emeryville, Hercules, Kensington, Oakland, Piedmont, Pinole, Richmond, and San Pablo (∼307,000 residential households) were mailed an invitation to complete a consent form and screening questionnaire.
    Sex as a biological variablenot detected.
    RandomizationOrder of inclusion for Whites was randomly sampled.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Three tests were used to assess anti-SARS-CoV-2 antibodies in DBS: Ortho VITROS® Anti-SARS-CoV-2 Total IgG and spike IgG ELISA targeted antibodies against the SARS-CoV-2 spike protein (indicating prior natural infection or vaccination), and Roche-NC Total IgG targeted antibodies against the nucleocapsid (NC) protein (indicating prior natural infection only).(13) Before COVID-19 vaccines were available in the study region during rounds 1 and 2, detection of antibodies against the SARS-CoV-2 spike protein was considered evidence of SARS-CoV-2 infection.
    anti-SARS-CoV-2
    suggested: None
    Anti-SARS-CoV-2 Total IgG
    suggested: None
    Roche-NC Total IgG
    suggested: None
    DBS samples that tested both negative for anti-NC antibodies and positive for anti-spike antibodies in Round 3 were considered to have antibodies from COVID-19 vaccination alone.
    anti-NC
    suggested: None
    anti-spike
    suggested: (GeneTex Cat# GTX632604, RRID:AB_2864418)

    Results from OddPub: Thank you for sharing your code.


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation of this study was the under-representation of certain demographics in our sample. Supplementary mailings of recruitment postcards in Spanish were sent to residences in ZIP codes with high proportions of Spanish speaking households. We also placed recruitment flyers in local grocery stores and conducted outreach to community organizations, local government officials, and school districts in the study region. Despite these efforts, non-Whites, males, lower income households, and individuals with lower education and from lower socioeconomic ZIP codes were underrepresented in our sample. Unhoused individuals were also not captured in our sample. This was important given evidence that individuals who identify as Hispanic or Black, and other underrepresented groups, are at the highest risk for COVID-19.(23) These discrepancies may have led to underestimation of overall SARS-CoV-2 seroprevalence and self-reported infection, although the MRP models may have somewhat minimized this effect by pooling information across similar observed characteristics in the sample data. Our seroprevalence estimates were consistent with weekly case prevalence reported by public health agencies in ZIP codes with high response rates (Figure S-5).(29) Additionally, there may be unmeasured confounding from variables not included in the analyses and self-selection bias from some participants in COVID-19 research who may be more fervent adherers to COVID-19 public health measures. Finally, som...

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.


    About SciScore

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