Racial/ethnic and neighbourhood social vulnerability disparities in COVID-19 testing positivity, hospitalization, and in-hospital mortality in a large hospital system in Pennsylvania: A prospective study of electronic health records

Background Disparities in COVID-19 mortality by race/ethnicity or neighborhood have been documented using surveillance data. We aimed to describe disparities by race/ethnicity and neighbourhood social vulnerability in COVID-19 positivity, hospitalization, and mortality. Methods We obtained data from the electronic health records of all individuals who tested positive for COVID-19 in the University of Pennsylvania Health System (UPHS) or were hospitalized with confirmed COVID-19 infection in five UPHS hospitals from March 1, 2020, to March 31, 2021. The main predictors were race/ethnicity and neighbourhood-level social vulnerability. The main outcomes were COVID-19 test positivity, hospitalization with COVID-19, and 30-day in-hospital mortality following hospitalization with COVID-19. Findings A total of 225,129 unique individuals received COVID-19 testing and 18,995 had a positive test result. A total of 5,794 unique patients were hospitalized with COVID-19 and 511 died in-hospital within 30 days. Racial/ethnic minority groups and residents of higher social vulnerability neighbourhoods had higher test positivity and risk of hospitalization. We did not see in-hospital mortality disparities during the first wave but observed 75% and 68% higher odds of death among Hispanic and Asians compared to Whites during subsequent waves. Interpretation We observed significant racial/ethnic and neighbourhood disparities in COVID-19 outcomes, especially test positivity and odds of hospitalization, highlighting the importance of equitably improving access to preventive measures to reduce SARS-CoV-2 infection, including reducing exposure to the virus and ensuring equity in vaccination. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)