TY - JOUR
T1 - Disparities in COVID-19 Monoclonal Antibody Delivery
T2 - a Retrospective Cohort Study
AU - Wu, En Ling
AU - Kumar, Rebecca N.
AU - Moore, W. Justin
AU - Hall, Gavin T.
AU - Vysniauskaite, Indre
AU - Kim, Kwang Youn A.
AU - Angarone, Michael P.
AU - Stosor, Valentina
AU - Ison, Michael G
AU - Bba, Adam Frink
AU - Achenbach, Chad J.
AU - Gates, Khalilah L.
N1 - Funding Information:
Research reported in this publication was supported, in part, by the Northwestern University Feinberg School of Medicine Division of Infectious Diseases Emerging Infectious Diseases grant. EW is currently and RNK was previously (2019–2021) supported by the National Institute of Health (grant number T32 AI095207). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
We thank David H. Cooke, MD (Northwestern Memorial HealthCare); Cynthia Barnard, PhD MBA MSJS (Northwestern Memorial HealthCare); Amy Leonard, RN (Northwestern Medicine); Julia Bongiorno, PMP (Northwestern Medicine); Michael J. Postelnick, RPh BCPS (Northwestern Medicine); John Bailitz, MD (Department of Medicine, Northwestern University Feinberg School of Medicine); and Michael G. Ison, MD MS for their leadership in developing and implementing the monoclonal antibody infusion program across the Northwestern Medicine healthcare system.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Society of General Internal Medicine.
PY - 2022/8
Y1 - 2022/8
N2 - Background: Disparities in access to anti-SARS-CoV-2 monoclonal antibodies have not been well characterized. Objective: We sought to explore the impact of race/ethnicity as a social construct on monoclonal antibody delivery. Design/Patients: Following implementation of a centralized infusion program at a large academic healthcare system, we reviewed a random sample of high-risk ambulatory adult patients with COVID-19 referred for monoclonal antibody therapy. Main Measures: We examined the relationship between treatment delivery, race/ethnicity, and other demographics using descriptive statistics, binary logistic regression, and spatial analysis. Key Results: There was no significant difference in racial composition between patients who did (n = 25) and patients who did not (n = 378) decline treatment (p = 0.638). Of patients who did not decline treatment, 64.8% identified as White, 14.8% as Hispanic/Latinx, and 11.1% as Black. Only 44.6% of Hispanic/Latinx and 31.0% of Black patients received treatment compared to 64.1% of White patients (OR 0.45, 95% CI 0.25–0.81, p = 0.008, and OR 0.25, 95% CI 0.12–0.50, p < 0.001, respectively). In multivariable analysis including age, race, insurance status, non-English primary language, county Social Vulnerability Index, illness severity, and total number of comorbidities, associations between receiving treatment and Hispanic/Latinx or Black race were no longer statistically significant (AOR 1.32, 95% CI 0.69–2.53, p = 0.400, and AOR 1.34, 95% CI 0.64–2.80, p = 0.439, respectively). However, patients who were uninsured or whose primary language was not English were less likely to receive treatment (AOR 0.16, 95% CI 0.03–0.88, p = 0.035, and AOR 0.37, 95% CI 0.15–0.90, p = 0.028, respectively). Spatial analysis suggested decreased monoclonal antibody delivery to Cook County patients residing in socially vulnerable communities. Conclusions: High-risk ambulatory patients with COVID-19 who identified as Hispanic/Latinx or Black were less likely to receive monoclonal antibody therapy in univariate analysis, a finding not explained by patient refusal. Multivariable and spatial analyses suggested insurance status, language, and social vulnerability contributed to racial disparities.
AB - Background: Disparities in access to anti-SARS-CoV-2 monoclonal antibodies have not been well characterized. Objective: We sought to explore the impact of race/ethnicity as a social construct on monoclonal antibody delivery. Design/Patients: Following implementation of a centralized infusion program at a large academic healthcare system, we reviewed a random sample of high-risk ambulatory adult patients with COVID-19 referred for monoclonal antibody therapy. Main Measures: We examined the relationship between treatment delivery, race/ethnicity, and other demographics using descriptive statistics, binary logistic regression, and spatial analysis. Key Results: There was no significant difference in racial composition between patients who did (n = 25) and patients who did not (n = 378) decline treatment (p = 0.638). Of patients who did not decline treatment, 64.8% identified as White, 14.8% as Hispanic/Latinx, and 11.1% as Black. Only 44.6% of Hispanic/Latinx and 31.0% of Black patients received treatment compared to 64.1% of White patients (OR 0.45, 95% CI 0.25–0.81, p = 0.008, and OR 0.25, 95% CI 0.12–0.50, p < 0.001, respectively). In multivariable analysis including age, race, insurance status, non-English primary language, county Social Vulnerability Index, illness severity, and total number of comorbidities, associations between receiving treatment and Hispanic/Latinx or Black race were no longer statistically significant (AOR 1.32, 95% CI 0.69–2.53, p = 0.400, and AOR 1.34, 95% CI 0.64–2.80, p = 0.439, respectively). However, patients who were uninsured or whose primary language was not English were less likely to receive treatment (AOR 0.16, 95% CI 0.03–0.88, p = 0.035, and AOR 0.37, 95% CI 0.15–0.90, p = 0.028, respectively). Spatial analysis suggested decreased monoclonal antibody delivery to Cook County patients residing in socially vulnerable communities. Conclusions: High-risk ambulatory patients with COVID-19 who identified as Hispanic/Latinx or Black were less likely to receive monoclonal antibody therapy in univariate analysis, a finding not explained by patient refusal. Multivariable and spatial analyses suggested insurance status, language, and social vulnerability contributed to racial disparities.
KW - COVID-19
KW - SARS-CoV-2
KW - Social Vulnerability Index
KW - monoclonal antibody
KW - racial/ethnic disparities
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U2 - 10.1007/s11606-022-07603-4
DO - 10.1007/s11606-022-07603-4
M3 - Article
C2 - 35469360
AN - SCOPUS:85128844949
SN - 0884-8734
VL - 37
SP - 2505
EP - 2513
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 10
ER -