Disparities in COVID-19 Monoclonal Antibody Delivery: a Retrospective Cohort Study

• Published in: Journal of general internal medicine : JGIM 2022-08, Vol.37 (10), p.2505-2513
• Main Authors: Wu, En-Ling, Kumar, Rebecca N., Moore, W. Justin, Hall, Gavin T., Vysniauskaite, Indre, Kim, Kwang-Youn A., Angarone, Michael P., Stosor, Valentina, Ison, Michael G., BBA, Adam Frink, Achenbach, Chad J., Gates, Khalilah L.
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal; Black or African American; Cohort analysis; Comorbidity; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - ethnology; COVID-19 - therapy; Demographics; Ethnicity; Healthcare Disparities; Hispanic or Latino; Hispanic people; Humans; Immunotherapy; Insurance; Internal Medicine; Language; Medicine; Medicine & Public Health; Minority & ethnic groups; Monoclonal antibodies; Original Research; Patients; Race; Race factors; Retrospective Studies; Severe acute respiratory syndrome coronavirus 2; Spatial analysis; Statistical analysis; White
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-022-07603-4

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.