Epidemiology of COVID-19 vs. influenza: Differential failure of COVID-19 mitigation among Hispanics, Cook County Health, Illinois

  1. William E. Trick
  2. Sheila Badri
  3. Kruti Doshi
  4. Huiyuan Zhang
  5. Katayoun Rezai
  6. Michael J. Hoffman
  7. Robert A. Weinstein

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Abstract

During the early phases of the COVID-19 pandemic in the U.S., African-American or Hispanic communities were disproportionately impacted. To better understand the epidemiology and relative effects of COVID-19 among hospitalized Hispanic patients, we compared individual and census-tract level characteristics of patients diagnosed with COVID-19 to those diagnosed with influenza, another viral infection with respiratory transmission. We evaluated temporal changes in epidemiology related to a shelter-in-place mandate.

Methods

We evaluated patients hospitalized at Cook County Health, the safety-net health system for the Chicago metropolitan area. Among self-identified hospitalized Hispanic patients, we compared those with influenza (2019–2020 season) to COVID-19 infection during March 16, 2020-May 11, 2020. We used multivariable analysis to identify differences in individual and census-tract level characteristics between the two groups.

Results

Relative to non-Hispanic blacks and whites, COVID-19 rapidly increased among Hispanics during promotion of social-distancing policies. Whereas non-Hispanic blacks were more likely to be hospitalized for influenza, Hispanic patients predominated among COVID-19 infections (40% relative increase compared to influenza). In the comparative analysis of influenza and COVID-19, Hispanic patients with COVID-19 were more likely to reside in census tracts with higher proportions of residents with the following characteristics: Hispanic; no high school diploma; non-US citizen; limited English speaking ability; employed in manufacturing or construction; and overcrowding. By multivariable analysis, Hispanic patients hospitalized with COVID-19 compared to those with influenza were more likely to be male (adjusted OR = 1.8; 95% CI 1.1 to 2.9), obese (aOR = 2.5; 95% CI 1.5 to 4.2), or reside in a census tract with ≥40% of residents without a high-school diploma (aOR = 2.5; 95% CI 1.3 to 4.8).

Conclusions

The rapid and disproportionate increase in COVID-19 hospitalizations among Hispanics after the shelter-in-place mandate indicates that public health strategies were inadequate in protecting this population—in particular, for those residing in neighborhoods with lower levels of educational attainment.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.21.20199018: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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.

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  2. Version published to 10.1371/journal.pone.0240202
  3. Version published to 10.1101/2020.09.21.20199018v1 on medRxiv
  4. Version published to 10.1101/2020.09.21.20199018v2 on medRxiv