TY - JOUR
AU - M. M. Montoya
AU - J. C. Gander
AU - S. F. Suglia
AU - B. McDonald
AU - S. A. Patel
AU - T. Davis
AU - R. E. Patzer
AU - R. Jagannathan
AU - L. Teunis
AU - J. L. Harding
A1 - 
AB - BACKGROUND: Racial and ethnic minorities have experienced a disproportionate burden of severe COVID-19. Whether chronic stress, also disproportionately experienced by racial and ethnic minorities, explains this excess risk is unknown. METHODS: We identified 9577 adults (≥ 18 years) diagnosed with COVID-19 from January 1, 2020, through September 30, 2021, enrolled in Kaiser Permanente Georgia (KPGA) with complete biomarker data. Self-reported race (Black or White) was defined from electronic medical records. Chronic stress, defined as allostatic load (AL), a composite score (scale 0-7) based on seven cardio-metabolic biomarkers, was categorized as below (low AL) or above (high AL) the median. Severe COVID-19 was defined as hospitalization or mortality within 30 days of COVID-19 diagnosis. The association between race, AL, and severe COVID-19 was assessed using multivariable Poisson regression. The mediating effect of AL was assessed using the Valeri and VanderWeele method. All results were expressed as risk ratios (RRs) with 95% confidence intervals. RESULTS: Overall, Black (vs. White) KPGA members had an 18% excess risk of AL (RR: 1.18, 95%CI: 1.14-1.23) and a 24% excess risk of severe COVID-19 (RR: 1.24, 95%CI: 1.12, 1.37). AL explained 23% of the Black-White disparities in severe COVID-19. CONCLUSIONS: In our study, chronic stress, characterized by AL, partially mediated Black-White disparities in severe COVID-19 outcomes.
AD - Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.; Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA.; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.; Regenstrief Institute, Indianapolis, IN, USA.; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. jessica.harding@emory.edu.; Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. jessica.harding@emory.edu.
AN - 38294635
BT - J Racial Ethn Health Disparities
C5 - Healthcare Disparities
CP - 2
DA - Apr
DO - 10.1007/s40615-024-01920-6
DP - NLM
ET - 20240131
IS - 2
JF - J Racial Ethn Health Disparities
LA - eng
N2 - BACKGROUND: Racial and ethnic minorities have experienced a disproportionate burden of severe COVID-19. Whether chronic stress, also disproportionately experienced by racial and ethnic minorities, explains this excess risk is unknown. METHODS: We identified 9577 adults (≥ 18 years) diagnosed with COVID-19 from January 1, 2020, through September 30, 2021, enrolled in Kaiser Permanente Georgia (KPGA) with complete biomarker data. Self-reported race (Black or White) was defined from electronic medical records. Chronic stress, defined as allostatic load (AL), a composite score (scale 0-7) based on seven cardio-metabolic biomarkers, was categorized as below (low AL) or above (high AL) the median. Severe COVID-19 was defined as hospitalization or mortality within 30 days of COVID-19 diagnosis. The association between race, AL, and severe COVID-19 was assessed using multivariable Poisson regression. The mediating effect of AL was assessed using the Valeri and VanderWeele method. All results were expressed as risk ratios (RRs) with 95% confidence intervals. RESULTS: Overall, Black (vs. White) KPGA members had an 18% excess risk of AL (RR: 1.18, 95%CI: 1.14-1.23) and a 24% excess risk of severe COVID-19 (RR: 1.24, 95%CI: 1.12, 1.37). AL explained 23% of the Black-White disparities in severe COVID-19. CONCLUSIONS: In our study, chronic stress, characterized by AL, partially mediated Black-White disparities in severe COVID-19 outcomes.
PY - 2025
SN - 2196-8837
SP - 810
EP - 818+
ST - Racial Disparities in COVID-19 Severity Are Partially Mediated by Chronic Stress-Evidence from a Large Integrated Healthcare System
T1 - Racial Disparities in COVID-19 Severity Are Partially Mediated by Chronic Stress-Evidence from a Large Integrated Healthcare System
T2 - J Racial Ethn Health Disparities
TI - Racial Disparities in COVID-19 Severity Are Partially Mediated by Chronic Stress-Evidence from a Large Integrated Healthcare System
U1 - Healthcare Disparities
U3 - 10.1007/s40615-024-01920-6
VL - 12
VO - 2196-8837
Y1 - 2025
ER -