Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 — United States, March 2020–August 2021

Abstract

The COVID-19 pandemic has magnified longstanding health care and social inequities, resulting in disproportionately high COVID-19-associated illness and death among members of racial and ethnic minority groups (1). Equitable use of effective medications (2) could reduce disparities in these severe outcomes (3). Monoclonal antibody (mAb) therapies against SARS-CoV-2, the virus that causes COVID-19, initially received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) in November 2020. mAbs are typically administered in an outpatient setting via intravenous infusion or subcutaneous injection and can prevent progression of COVID-19 if given after a positive SARS-CoV-2 test result or for postexposure prophylaxis in patients at high risk for severe illness. Dexamethasone, a commonly used steroid, and remdesivir, an antiviral drug that received EUA from FDA in May 2020, are used in inpatient settings and help prevent COVID-19 progression (2). No large-scale studies have yet examined the use of mAb by race and ethnicity. Using COVID-19 patient electronic health record data from 41 U.S. health care systems that participated in the PCORnet, the National Patient-Centered Clinical Research Network, this study assessed receipt of medications for COVID-19 treatment by race (White, Black, Asian, and Other races [including American Indian or Alaska Native, Native Hawaiian or Other * These authors contributed equally to this report. Fact sheets for healthcare providers for FDA emergency use authorization are available from https://www.fda.gov/media/145611/download for REGEN-COV (casirivimab and imdevimab) and https://www.fda.gov/ media/145802/download for bamlanivimab and etesevimab. The SARS-CoV-2 B.1.1.529 (Omicron) variant is not neutralized by bamlanivimab and etesevimab or casirivimab and imdevimab, the mAb-based COVID-19 treatments that were most frequently prescribed before the emergence of Omicron. https://www.covid19treatmentguidelines.nih.gov/management/ clinical-management/ PCORnet is a national network-of-networks developed to conduct patientcentered outcomes research. The PCORnet infrastructure supports large-scale studies using its distributed data network. https://doi.org/10.1016/j. jclinepi.2020.09.036 Pacific Islander, and multiple or Other races]) and ethnicity (Hispanic or non-Hispanic). Relative disparities in mAb** treatment among all patients (805,276) with a positive SARS-CoV-2 test result and in dexamethasone and remdesivir treatment among inpatients (120,204) with a positive SARS-CoV-2 test result were calculated. Among all patients with positive SARS-CoV-2 test results, the overall use of mAb was infrequent, with mean monthly use at 4% or less for all racial and ethnic groups. Hispanic patients received mAb 58% less often than did non-Hispanic patients, and Black, Asian, or Other race patients received mAb 22%, 48%, and 47% less often, respectively, than did White patients during November 2020-August 2021. Among inpatients, disparities were different and of lesser magnitude: Hispanic inpatients received dexamethasone 6% less often than did non-Hispanic inpatients, and Black inpatients received remdesivir 9% more often than did White inpatients. Vaccines and preventive measures are the best defense against infection; use of COVID-19 medications postexposure or postinfection can reduce morbidity and mortality and relieve strain on hospitals but are not a substitute for COVID-19 vaccination. Public health policies and programs centered around the specific needs of communities can promote health equity (4). Equitable receipt of outpatient treatments, such as mAb and antiviral medications, and implementation of prevention practices are essential to reducing existing racial and ethnic inequities in severe COVID-19-associated illness and death. ** mAbs included in this study include bamlanivimab, bamlanivimab and etesevimab, casirivimab, and imdevimab, and unspecified monoclonal antibodies. Medications are prescribed or administered in the 14 days before or after the index event. All patients include 78.8% outpatient, 10.9% inpatient, and 10.3% with no associated care setting for mAbs. Care setting was designated with the test. Care setting was classified as the highest care setting within 16 days of a positive test result but does not necessarily reflect the care setting in which medications were provided. Patients initially tested in the outpatient setting would be assigned to the inpatient setting if they were admitted within 16 days of receipt of a positive test result.

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