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Review 2: "Health Disparities and COVID-19: A Retrospective Study Examining Individual and Community Factors Causing Disproportionate COVID-19 Outcomes in Cook County, Illinois, March 16-May 31, 2020"

This study provides further empirical evidence about the racial differences in COVID-19 morbidity and mortality. The preprint is potentially informative and somewhat reliable, but there are unmeasured confounders and it lacks some clarity around some data points.

Published onSep 10, 2020
Review 2: "Health Disparities and COVID-19: A Retrospective Study Examining Individual and Community Factors Causing Disproportionate COVID-19 Outcomes in Cook County, Illinois, March 16-May 31, 2020"
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key-enterThis Pub is a Review of
Health Disparities and COVID-19: A Retrospective Study Examining Individual and Community Factors Causing Disproportionate COVID-19 Outcomes in Cook County, Illinois, March 16-May 31, 2020
Description

Background: Early data from the COVID-19 pandemic suggests that the disease has had a disproportionate impact on communities of color causing higher infection and mortality rates within those communities. Methods: This study used demographic data from the 2018 US census estimates, mortality data from the Cook County Medical Examiners office, and testing results from the Illinois Department of Public Health to perform both bivariate and multivariate regression analyses to explore the role race plays in COVID-19 outcomes at the individual and community levels. Results: Principal findings show that: 1) while Black Americans make up 22% of Cook County population, they account for 36% of the county COVID-19 related deaths; 2) the average age of death from COVID-19 is seven years younger for minorities compared to Non-Hispanic White (White) decedents; 3) minorities were more likely than Whites to have seven of the top 10 co-morbidities at death; 4) residents of predominantly minority areas were twice as likely to test positive for COVID-19 (p = 0.0001, IRR 1.94, 95% CI 1.50, 2.50) than residents of predominantly White areas; and 5) residents of predominantly minority areas were 1.43 times more likely to die of COVID-19 than those in predominantly White areas (p = 0.03). Conclusions: There are notable differences in COVID-19 related outcomes between racial and ethnic groups at individual and community levels. We hope that this study will scientifically illustrate the health disparities experienced by communities of color and help to address the underlying systemic inequalities still prevalent within our country.

RR:C19 Evidence Scale rating by reviewer:

  • Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review:

From the methods section, it is not clear from the methods if individual level data was available. It would seem that all the data is aggregated at the Zip Code level. From a study design perspective, it would seem like an ecological study with its limitations which need to be mentioned in the limitation section. The results in Table 3 and Table 4 need to be presented clearly. For example, from Table 3 it is not clear if it is a univariate analysis using negative binomial regression. From table 4 it is not clear whether the dependent variable is death. It seems that the analysis has been stratified by race. If this is the case this needs to be clarified. Also, hypertension and obesity are combined as one category and then added in the model. It is not clear if the authors wanted to show an interaction between hypertension and obesity. If yes, this needs to be indicated. If this is an interaction then the main effects should not be in the outputs. Similarly, hypertension and cardiovascular disease has been combined as one category. This needs to be clarified. As this study focuses on a sensitive issue of ethnic minorities, there needs to a mention of ethical review for the study which is currently missing. Overall, the study shows results which indicate disproportionate mortality among racial and ethnic groups. Although the title indicates COVID-19 related outcomes, the main focus of the manuscript is mortality which needs to be highlighted.

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