Racial and Ethnic Disparities in Receipt of Medications for

Morbidity and Mortality Weekly Report

96 MMWR / January 21, 2022 / Vol. 71 / No. 3 US Department of Health and Human Services/Centers for Disease Control and Prevention

Racial and Ethnic Disparities in Receipt of Medications for Treatment

of COVID-19 — United States, March 2020–August 2021

Jennifer L. Wiltz, MD

*; Amy K. Feehan, PhD

*; NoelleAngelique M. Molinari, PhD

; Chandresh N. Ladva, PhD

; Benedict I. Truman, MD

;

Jeffrey Hall, PhD

; Jason P. Block, MD

; Sonja A. Rasmussen, MD

; Joshua L. Denson, MD

; William E. Trick, MD

; Mark G. Weiner, MD

;

Emily Koumans, MD

; Adi Gundlapalli, MD, PhD

; Thomas W. Carton, PhD

; Tegan K. Boehmer, PhD

On January 14, 2022, this report was posted as an MMWR Early

Release on the MMWR website (https://www.cdc.gov/mmwr).

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 effec-

tive 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 progres-

sion 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 treat-

ment 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 patient-

centered 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 remdesi-

vir 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 preven-

tive 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.

Please note: This report has been corrected. An erratum has been published.

Morbidity and Mortality Weekly Report

MMWR / January 21, 2022 / Vol. 71 / No. 3 97

US Department of Health and Human Services/Centers for Disease Control and Prevention

The PCORnet-distributed data infrastructure was queried,

¶¶

and 41 sites*** returned data on monthly receipt of medications

for COVID-19 treatment during March 2020–August 2021.

The monthly percentage of patients with a positive SARS-CoV-2

test result who received mAb (November 2020–August 2021)

and of inpatients with a SARS-CoV-2 positive test result who

received dexamethasone or remdesivir (March 2020–August

2021) was calculated separately by race and by ethnicity

(as aggregated in PCORnet) for adults aged ≥20 years.

Differences in treatment by race and ethnicity were assessed

in two ways. First, pairwise Wilcoxon signed rank tests, with

p-values indicated as p

, were used to assess whether treatment

receipt differed systematically over time (systematic temporal

differences) by race or ethnicity. Second, relative monthly

treatment disparities were calculated as the difference in

percentage of patients treated between racial or ethnic minority

(Black, Asian, Other for race; Hispanic ethnicity) and majority

(White; non-Hispanic) groups divided by the percentage

treated in the majority groups for each month.

†††

The grand

means (means of relative monthly treatment disparities) were

calculated, and t-tests for statistical difference from zero,

with p-values indicated as p

, were used to assess presence of

overall relative treatment disparities. Results were considered

statistically significant for p-values <0.05. GraphPad Prism

software (version 9.3.0; GraphPad Software, Inc) was used

for analyses and visualization. This activity was reviewed by

CDC and conducted consistent with applicable federal law

and CDC policy.

§§§

¶¶

A query is a single statistical SAS package that runs at sites to generate the data

required. This study used a modular program that generated aggregate data

at the site level and combined all results returned to the coordinating center,

resulting in a single aggregate report on data across all responding sites.

*** Forty-one sites include Duke University, Medical University of South

Carolina, University of North Carolina, Vanderbilt University Medical

Center, Wake Forest Baptist Health, Allina Health, Intermountain

Healthcare, Medical College of Wisconsin, University of Iowa Healthcare,

University of Kansas, University of Nebraska, University of Texas SW Medical

Center, University of Utah, University Medical Center New Orleans,

Children’s Hospital Colorado, Children’s Hospital of Philadelphia,

Cincinnati Children’s Hospital, Nationwide Children’s Hospital, Nemours

Children’s Hospital, Seattle Children’s Hospital, St. Louis Children’s

Hospital, Columbia, Montefiore, Mount Sinai Health System, New York

University Langone Medical Center, Weill Cornell Medicine, Lurie Children’s

Hospital, Northwestern University, Fenway Health, Health Choice Network,

OCHIN, Inc, Johns Hopkins University, Ohio State University, Penn State

College of Medicine and Penn State Health Milton S. Hershey Medical

Center, Temple University, University of Michigan, University of Pittsburgh

Medical Center, AdventHealth, Orlando Health System, University of

Florida Health, and University of Miami. These sites represent academic

and community hospitals; are located across all 50 states, Washington, D.C.,

Puerto Rico, U.S. Virgin Islands, U.S. Armed forces, and Guam; serve

patients who are self-pay, public or privately insured; and total 3.0% of

COVID-19 cases (as compared with CDC case surveillance.)

†††

https://pubmed.ncbi.nlm.nih.gov/16032956/

§§§

45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5

U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

During March 2020–August 2021, a total of

5,918,199 patients in PCORnet health care systems were

tested

¶¶¶

for SARS-CoV-2, and 805,276 (13.6%) test results

were positive (Table 1), representing approximately 3.0% of

all positive results reported to CDC (Supplementary Table,

https://stacks.cdc.gov/view/cdc/113252). These patients are

similar demographically to those included in CDC case data by

age, sex, race, and ethnicity. Geographically, patients in the Census

Pacific division are underrepresented whereas those in the Mountain

division are overrepresented. Among patients with a positive test

result, 2.9% were Asian, 15.7% Black, 61.2% White, and 10.9%

Other race; 18.6% were Hispanic and 71.7% were non-Hispanic

ethnicity (Table 1). Compared with all persons with a positive

SARS-CoV-2 test result, a higher proportion of patients with

high-risk comorbidities**** were treated with mAb. Critical

care

††††

was required by 3.4% of all persons with positive test

results compared with 1.8% of those treated with mAb.

Mean monthly mAb use among all patients with positive

SARS-CoV-2 test results who were White, Black, Asian, or

Other race was 4.0%, 2.8%, 2.2%, and 2.2%, respectively;

among patients of Hispanic or non-Hispanic ethnicity, mAb

use was 1.8% and 4.0%, respectively. Patients who were Black,

Asian, or Other race received mAb 22.4%, 48.3%, and 46.5%,

respectively, less often than did White patients (Table 2);

systematic temporal differences in mAb receipt were observed

by race (all p

<0.01) (Figure). SARS-CoV-2 positive patients of

Hispanic ethnicity received mAb 57.7% less often (p

<0.001)

than did non-Hispanic patients; systematic temporal differ-

ences in mAb receipt were observed by ethnicity (p

=0.002).

Mean monthly dexamethasone use among inpatients who

were White, Black, Asian, or Other race was 35.8%, 33.8%,

31.4%, and 34.2%, respectively; among patients of Hispanic

or non-Hispanic ethnicity, dexamethasone use was 32.5%

and 35.4%, respectively. Relative disparities in dexamethasone

receipt by race were not statistically significant (Table 2); how-

ever, small but systematic temporal differences in dexametha-

sone receipt were observed among White inpatients and Black

and Asian inpatients (both p

<0.05) (Supplementary Figure,

https://stacks.cdc.gov/view/cdc/113252). Hispanic inpatients

were treated with dexamethasone 6.2% less often than were

non-Hispanic inpatients and systematic temporal treatment

differences were also observed (p

=0.005).

¶¶¶

Testing was by polymerase chain reaction or antigen test; a positive, detected,

or presumptive positive result was considered to be a positive test.

**** High-risk criteria defined by the FDA include age ≥65 years, obesity,

pregnancy, chronic kidney disease, diabetes, immunosuppression,

cardiovascular disease, and lung disease, along with other underlying

conditions that are not explicitly listed in the EUAs for these treatments.

††††

Critical care services are identified by International Classification of Diseases,

Tenth Revision critical care codes (99291 and 99292) for the evaluation and

management of the critically ill or critically injured patient.

Morbidity and Mortality Weekly Report

98 MMWR / January 21, 2022 / Vol. 71 / No. 3 US Department of Health and Human Services/Centers for Disease Control and Prevention

TABLE 1. Demographic and medical risk characteristics of patients with positive SARS-CoV-2 test results, by clinical setting and medications

received — 41 health care systems in the National Patient-Centered Clinical Research Network, United States, March 2020–August 2021

Characteristic

No. (%)*

All patients with positive

SARS-CoV-2 test result

Patients receiving

monoclonal antibodies

Inpatients with positive

SARS-CoV-2 test result

Patients receiving

dexamethasone

Patients receiving

remdesivir

No. of unique patients 805,276 12,539 120,204 40,685 35,315

Demographics

Age group, yrs

20–39 312,680 (38.8) 1,639 (13.1) 20,966 (17.4) 4,966 (12.2) 3,354 (9.5)

40–54 209,202 (26.0) 2,933 (23.4) 23,296 (19.4) 8,285 (20.4) 6,885 (19.5)

55–64 128,550 (16.0) 3,045 (24.3) 24,025 (20.0) 8,874 (21.8) 7,779 (22.0)

65–74 86,848 (10.8) 3,075 (24.5) 24,267 (20.2) 9,124 (22.4) 8,257 (23.4)

75–84 47,047 (5.8) 1,425 (11.4) 18,016 (15.0) 6,420 (15.8) 6,056 (17.1)

≥85 20,949 (2.6) 422 (3.4) 9,634 (8.0) 3,016 (7.4) 2,967 (8.4)

Sex

Female 437,651 (54.3) 6,709 (53.5) 59,583 (49.6) 19,262 (47.3) 16,607 (47.0)

Male 367,359 (45.6) 5,828 (46.5) 60,603 (50.4) 21,416 (52.6) 18,704 (53.0)

Other

†

/Missing

264 (0.0) 3 (0.0) 17 (0.0) 8 (0.0) 3 (0.0)

Race

Asian 22,968 (2.9) 206 (1.6) 4,396 (3.7) 1,219 (3.0) 1,003 (2.8)

Black or African American 126,166 (15.7) 1,904 (15.2) 28,403 (23.6) 8,879 (21.8) 8,172 (23.1)

White 493,181 (61.2) 9,366 (74.7) 59,212 (49.3) 22,910 (56.3) 19,318 (54.7)

Other

88,026 (10.9) 773 (6.2) 20,729 (17.2) 6,151 (15.1) 5,366 (15.2)

Missing

74,935 (9.3) 280 (2.2) 7,449 (6.2) 1,511 (3.7) 1,443 (4.1)

Ethnicity

Hispanic 149,565 (18.6) 1,006 (8.0) 25,953 (21.6) 7,557 (18.6) 6,895 (19.5)

Non-Hispanic 577,394 (71.7) 11,189 (89.2) 88,007 (73.2) 31,627 (77.7) 27,147 (76.9)

Other** 5,553 (0.7) 20 (0.2) 273 (0.2) 84 (0.2) 104 (0.3)

Missing

72,764 (9.0) 318 (2.5) 5,955 (5.0) 1,410 (3.5) 1,161 (3.3)

Medical conditions associated with high risk

††

Anemia 72,830 (9.0) 2,187 (17.4) 28,645 (23.8) 9,762 (24.0) 8,553 (24.2)

Arrythmia 73,318 (9.1) 2,527 (20.2) 33,443 (27.8) 12,235 (30.1) 10,828 (30.7)

Asthma 60,080 (7.5) 1,890 (15.1) 14,542 (12.1) 5,301 (13.0) 4,944 (14.0)

COPD 26,636 (3.3) 879 (7.0) 13,447 (11.2) 5,551 (13.6) 5,513 (15.6)

Cancer 37,027 (4.6) 1,641 (13.1) 11,642 (9.7) 4,716 (11.6) 3,605 (10.2)

Chronic kidney disease 50,580 (6.3) 1,795 (14.3) 26,221 (21.8) 9,269 (22.8) 8,418 (23.8)

Chronic pulmonary disorders 100,625 (12.5) 3,219 (25.7) 28,994 (24.1) 11,282 (27.7) 10,582 (30.0)

Coagulopathy 33,374 (4.1) 985 (7.9) 18,908 (15.7) 7,442 (18.3) 6,469 (18.3)

Congestive heart failure 40,179 (5.0) 1,344 (10.7) 21,246 (17.7) 7,868 (19.3) 7,329 (20.8)

Coronary artery disease 54,051 (6.7) 2,074 (16.5) 25,308 (21.1) 9,305 (22.9) 8,607 (24.4)

Diabetes type 2 107,527 (13.4) 3,890 (31.0) 41,888 (34.8) 15,462 (38.0) 14,706 (41.6)

Hypertension 209,848 (26.1) 7,265 (57.9) 69,671 (58.0) 25,653 (63.1) 23,633 (66.9)

Mental health disorders 97,046 (12.1) 2,728 (21.8) 23,857 (19.8) 8,015 (19.7) 7,044 (19.9)

Peripheral vascular disorders 31,930 (4.0) 1,250 (10.0) 14,484 (12.0) 5,373 (13.2) 4,596 (13.0)

Severe obesity (BMI ≥40 kg/m

) 60,052 (7.5) 2,430 (19.4) 17,716 (14.7) 7,781 (19.1) 6,891 (19.5)

Outcome

§§

Critical care 27,585 (3.4) 225 (1.8) 21,412 (17.8) 10,675 (26.2) 8,244 (23.3)

Abbreviations: BMI=body mass index; CDM = common data model; COPD = chronic obstructive pulmonary disease; PCORnet = National Patient-Centered Clinical

Research Network.

* Percentages are simple summary numbers (column percentages) out of the total in each category. Strata are not expected to sum to the total because the small

cell masking by the data partners before submission of data.

†

For sex stratifications, Other includes all remaining PCORnet CDM values that are not male or female.

For sex, race, and ethnicity stratifications, Missing includes PCORnet CDM values of Refuse to answer, No Information, Unknown, and missing values.

For race stratifications, Other includes PCORnet CDM values of Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, Multiple races, and Other.

** For ethnicity stratifications, Other includes PCORnet CDM values of Other.

††

Recorded history of the diagnoses in electronic health record (outpatient or inpatient) within 3 years before a positive test. Patients can have more than one condition.

§§

Fourteen days before to 30 days after a positive test result.

Mean monthly remdesivir use among inpatients who were

White, Black, Asian, or Other race was 29.0%, 31.2%, 26.2%,

and 30.6%, respectively; among patients of Hispanic or non-

Hispanic ethnicity, remdesivir use was 30.4% and 29.3%,

respectively. Black inpatients received remdesivir 9.3% more

often (p

=0.03) than did White inpatients; systematic temporal

differences were also observed (p

=0.03). Asian, Other race,

and Hispanic inpatients did not experience significant relative

disparities or systematic temporal differences in remdesivir

treatment compared with White and non-Hispanic inpatients.

Morbidity and Mortality Weekly Report

MMWR / January 21, 2022 / Vol. 71 / No. 3 99

US Department of Health and Human Services/Centers for Disease Control and Prevention

TABLE 2. Average monthly frequency and relative disparity in receipt of medications for treatment of COVID-19, by race and ethnicity —

41 health care systems in the National Patient-Centered Clinical Research Network, United States, March 2020–August 2021

Treatment/Race

and ethnicity

Total no. eligible

for treatment*

Total no. (%)

treated

Mean of monthly

percentage treated

†

Mean of monthly

relative disparity,

% (95% CI) p

Monoclonal antibodies

(November 2020–August 2021)

Race

White 334,472 9,366 (2.8) 4.0 — Ref. —

Black 73,853 1,904 (2.6) 2.8 0.004 −22.4 (−38.7 to −6.1) 0.0125

Asian 14,744 206 (1.4) 2.2 0.002 −48.3 (−63.1 to −33.6) <0.0001

Other 45,521 773 (1.7) 2.2 0.002 −46.5 (−51.1 to −41.9) <0.0001

Ethnicity

Non-Hispanic 387,403 11,189 (2.9) 4.0 — Ref. —

Hispanic 80,176 1,006 (1.3) 1.8 0.002 −57.7 (−66.6 to −48.9) <0.0001

Dexamethasone

(March 2020–August 2021)

Race

White 59,212 22,910 (38.7) 35.8 — Ref. —

Black 28,403 8,879 (31.3) 33.8 0.024 −1.9 (−7.8 to 3.9) 0.498

Asian 4,396 1,219 (27.7) 31.4 0.020 −2.0 (−17.3 to 13.2) 0.782

Other 20,729 6,151 (29.7) 34.2 0.106 −1.3 (−9.1 to 6.6) 0.735

Ethnicity

Non-Hispanic 88,007 31,627 (35.9) 35.4 — Ref. —

Hispanic 25,953 7,557 (29.1) 32.5 0.005 −6.2 (−11.7 to −0.6) 0.032

Remdesivir

(March 2020–August 2021)

Race

White 59,212 19,318 (32.6) 29.0 — Ref. —

Black 28,403 8,172 (28.8) 31.2 0.028 9.3 (0.9 to 17.7) 0.032

Asian 4,396 1,003 (22.8) 26.2 0.200 −15.1 (−30.3 to 0.1) 0.052

Other 20,729 5,366 (25.9) 30.6 0.323 1.7 (−9.4 to 12.8) 0.748

Ethnicity

Non-Hispanic 88,007 27,147 (30.8) 29.3 — Ref. —

Hispanic 25,953 6,895 (26.6) 30.4 0.423 8.8 (−0.4 to 18.0) 0.060

Abbreviation: Ref. = referent group.

* For monoclonal antibody therapy, all patients with a positive SARS-CoV-2 test result were considered eligible for treatment. For dexamethasone and remdesivir,

inpatients with a positive SARS-CoV-2 test result were considered eligible for treatment.

†

Mean of monthly treated time series tested for differences using pairwise Wilcoxon signed rank tests with p value given as p

. Mean of monthly percent treated =

[(n treated / n eligible)

March 2020

+ (n treated / n eligible)

April 2020

+ . . . (n treated / n eligible)

August 2021

] / n total no. months.

The difference in percentage of patients treated among racial (Black, Asian, or Other races) or ethnic minority (Hispanic) and majority (White or non-Hispanic) groups

divided by the percentage treated in the majority groups for each month. Assessed as nonzero using t tests with p-value given as p

. Total number of months for

dexamethasone and remdesivir=18 and for monoclonal antibodies=10. Mean of monthly relative disparity, % = [(Minority − majority / Majority)

March2020

(minority − majority / Majority)

April 2020

. . . + (Minority − majority / Majority)

August 2021

] / Total no. of months.

Discussion

This large-scale study from 41 U.S. health care systems

found disparate mAb treatment of COVID-19 in Hispanic,

Black, Asian, and Other race patients relative to non-Hispanic

and White patients. Large relative differences were noted for

mAb treatment, yet absolute differences were small. Relative

differences in treatment with dexamethasone and remdesivir

were less apparent in hospital settings, which might be attrib-

uted to ease of medication access. mAb treatment must be

administered by intravenous infusion or subcutaneous injec-

tion by a health care provider, typically in outpatient settings,

soon after receipt of a positive test result and within 10 days

of symptom onset. The finding of mAb treatment disparities

is consistent with previous studies. A single-center study of

kidney transplant patients found that Black and Hispanic

patients infected with SARS-CoV-2 were less likely to receive

mAb and more likely to be hospitalized (5). The current study

did not identify the underlying causes for the observed dispari-

ties. mAb treatment disparities might reflect systemic factors

such as limited access to testing and care because of availability

constraints, inadequate insurance coverage, and transportation

challenges; lack of a primary care provider to recommend

treatment; variations in treatment supply and distribution;

potential biases in prescribing practices; and limited penetra-

tion of messaging in some communities about mAb availability

and effectiveness to prevent disease progression. Additional

Morbidity and Mortality Weekly Report

100 MMWR / January 21, 2022 / Vol. 71 / No. 3 US Department of Health and Human Services/Centers for Disease Control and Prevention

FIGURE. Monthly* percentage of COVID-19 patients (n = 805,276) receiving monoclonal antibody treatment,

†

by race

and ethnicity

—

41 health care systems in the National Patient-Centered Clinical Research Network — United States, November 2020–August 2021

Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Percentage of patients

Date

20212020

Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Date

20212020

Race

100100

Percentage of patients

Ethnicity

Non-Hispanic

Hispanic

White

Black

Other

Asian

* Systematic temporal differences in medication receipt by race and ethnicity were assessed by pairwise Wilcoxon signed rank test.

†

mAbs require administration by intravenous infusion or subcutaneous injection.

White race is the referent group; p-values for Black, Asian, and Other races are 0.004, 0.002, and 0.002, respectively.

Non-Hispanic ethnicity is the referent group; p = 0.002 for Hispanic ethnicity.

reasons might include hesitancy about receiving treatment; a

previous study found patients who were non-Hispanic White

and English-speaking accepted mAb treatment more often than

did those who were non-White and Hispanic (6).

In inpatient settings, Black inpatients received remdesivir

more often, and Black, Asian, and Hispanic inpatients received

dexamethasone less often than did comparison groups. This

could indicate racial and ethnic differences in clinical indica-

tions for medication use (e.g., age distribution and prevalence

of comorbidities) or could be reflective of varying prescribing

practices, protocols, and drug access by institutions that serve

populations of different racial and ethnic distributions (7).

mAbs are authorized for use in persons at high-risk for severe

COVID-19 with positive SARS-CoV-2 test results and as

postexposure prophylaxis. In this study, a larger percentage of

patients who received mAb had high-risk medical conditions,

in accordance with current treatment guidelines. However, this

study also found mAb treatments have been used relatively less

commonly in racial and ethnic minority groups, amplifying

the increased risk for severe COVID-19–associated outcomes,

including death among these groups, as a consequence of their

higher prevalence of preexisting conditions.

§§§§

Reducing racial and ethnic disparities in COVID-19 treat-

ment requires patient and clinician awareness of the problem

and its solutions; resources; and action from government,

private entities, and community- and faith-based organizations

to implement effective interventions. Bringing health care

to populations facing barriers in access to mAb via a mobile

infusion unit or via telehealth providers has been shown to

increase mAb use, decrease severe outcomes, and reduce costs

(8,9). These examples of meeting persons in community venues

can be helpful in delivering outpatient treatments, address-

ing pandemic disparities, and managing underlying chronic

conditions affected by social determinants of health.

¶¶¶¶

Moreover, disparities in COVID-19 treatment are the latest

example of longstanding unequal treatment of many medical

§§§§

CDC data on SARS-CoV-2 hospitalization and death by race/ethnicity are

available from COVID-NET, a population-based surveillance system

collecting data through a network of 250 acute-care hospitals across 14 states

(https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-

discovery/hospitalization-death-by-race-ethnicity.html). CDC’s National

Center for Chronic Disease Prevention and Health Promotion data on 124

chronic disease indicators by race and ethnicity in the U.S. population are

available online. https://www.cdc.gov/cdi/index.html

¶¶¶¶

https://www.cdc.gov/chronicdisease/programs-impact/sdoh.htm

Morbidity and Mortality Weekly Report

MMWR / January 21, 2022 / Vol. 71 / No. 3 101

US Department of Health and Human Services/Centers for Disease Control and Prevention

conditions.***** Multicomponent, multisystem programs and

policies can support health equity.

†††††

One such program is

the COVID Response and Resilient Communities initiative,

which places community health workers in communities to

reduce long-standing disparities and deliver interventions

to manage COVID-19.

§§§§§

Future studies of COVID-19

treatment disparities should account for persons with high-

risk conditions and include newer medications, such as the

oral antiviral agents Paxlovid and molnupiravir, as well as

sotrovimab,

¶¶¶¶¶

which is the only mAb treatment currently

available for early treatment of patients infected with the

SARS-CoV-2 B.1.1.529 (Omicron) variant.******

***** https://www.nap.edu/catalog/10260/unequal-treatment-confronting-racial-and-

ethnic-disparities-in-health-care

†††††

Public health policies and programs centered around the specific needs of

communities can promote health equity, including health equity

considerations for racial and ethnic minority groups. https://www.cdc.gov/

coronavirus/2019-ncov/community/health-equity/race-ethnicity.html

§§§§§

COVID Response and Resilient Communities initiative provides financial

support and technical assistance to 69 states, localities, territories, tribes,

tribal organizations, urban Indian health organizations, and health service

providers to tribes. Intended populations include those at high risk because

of their race or ethnicity. https://www.cdc.gov/covid-community-health-

workers/pdfs/CCR-fact-sheet-H.pdf

¶¶¶¶¶

Sotrovimab is a mAb authorized for use under an EUA from FDA in May

2021 for the treatment of mild to moderate COVID-19. It was not included

in this analysis as it was less commonly used during the study period. The

fact sheet for health care providers is available online. https://www.fda.gov/

media/149534/download

****** https://www.covid19treatmentguidelines.nih.gov/therapies/

statement-on-therapies-for-high-risk-nonhospitalized-patients/

The findings in this report are subject to at least five limi-

tations. First, the aggregate data structure did not allow for

adjustment of demographic or clinical factors that might be

correlated with race and ethnicity. Second, all patients with a

positive test result were used as the denominator for calcula-

tions of mAb treatment proportions because persons at risk

for progression to severe illness could not be identified in

aggregate data. Percentage use might be higher and relative

disparities might be different if the denominator were spe-

cific to mAb prescribing guidelines. Third, missing race and

ethnicity was more common among all patients with positive

test results than among those treated; more work is needed

to fully understand the implications of missing or inaccurate

data (10). Fourth, mAb use was captured solely from electronic

health records; disparities noted here might be restricted to

patients who received mAb within a health care system because

treatment received in non–health care settings (e.g., govern-

ment-run infusion sites) is not likely to be recorded. Finally,

PCORnet data are derived from a convenience sample of health

care facilities, limiting generalizability to the U.S. population.

The COVID-19 pandemic has magnified and amplified

inequities that must be addressed to achieve equitable health

outcomes. The United States has surpassed 800,000 deaths

from COVID-19 and is experiencing another case surge caused

by Omicron.

††††††

Vaccines and preventive measures are the

best defense against infection; postinfection, COVID-19 medi-

cations reduce morbidity and mortality and relieve strain on

hospitals. A lower proportion of persons of racial and ethnic

minority groups received mAb outpatient treatment for pre-

venting severe COVID-19. This finding highlights disparities

as a priority for intervention and can guide strategies aimed

at more equitable COVID-19 outcomes. Policies, resources,

and programs addressing the specific needs of served popula-

tions, institutions, and places can accelerate progress towards

health equity (4). Strategizing the equitable receipt of current

and emerging outpatient treatments

§§§§§§

by reducing barri-

ers to accessing treatment might prevent disparities in severe

COVID-19 outcomes. Efforts to reduce racial and ethnic

disparities with equitable outpatient COVID-19 treatment

access, practices, and supportive systems are urgently needed.

††††††

https://covid.cdc.gov/covid-data-tracker

§§§§§§

https://emergency.cdc.gov/han/2021/han00461.asp

Summary

What is already known about this topic?

Racial and ethnic disparities in SARS-CoV-2 infection risk and

death from COVID-19 have been well documented.

What is added by this report?

Analysis of data from 41 health care systems participating in the

PCORnet, the National Patient-Centered Clinical Research

Network, found lower use of monoclonal antibody treatment

among Black, Asian, and Other race and Hispanic patients with

positive SARS-CoV-2 test results, relative to White and non-

Hispanic patients. Racial and ethnic differences were smaller for

inpatient administration of remdesivir and dexamethasone.

What are the implications for public health practice?

Equitable receipt of COVID-19 treatments by race and ethnicity

along with vaccines and other prevention practices are essential

to reduce inequities in severe COVID-19–associated illness

and death.

Morbidity and Mortality Weekly Report

102 MMWR / January 21, 2022 / Vol. 71 / No. 3 US Department of Health and Human Services/Centers for Disease Control and Prevention

Acknowledgments

PCORnet, the National Patient-Centered Clinical Research

Network; Patient-Centered Outcomes Research Institute.

Corresponding author: Jennifer L. Wiltz, [email protected].

CDC COVID-19 Response Team;

Department of Infectious Diseases,

Ochsner Clinic Foundation, Jefferson, Louisiana;

Department of Population

Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School,

Boston, Massachusetts;

Louisiana Public Health Institute, New Orleans,

Louisiana;

College of Medicine and College of Public Health and Health

Professions, University of Florida, Gainesville, Florida;

Center for Health

Equity and Innovation, Cook County Health, Chicago, Illinois;

Section of

Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane

University School of Medicine, New Orleans, Louisiana;

Department of

Population Health Sciences, Weill Cornell Medicine, New York, New York.

All authors have completed and submitted the International

Committee of Medical Journal Editors form for disclosure of

potential conflicts of interest. Amy K. Feehan receives research

support from the Louisiana Public Health Institute. Joshua L. Denson

reports grants from the American Diabetes Association, research

funding from the Gordon and Betty Moore Foundation, the Society

of Critical Care Medicine, and the National Institutes of Health

(NIH); and personal fees from Astrazeneca, GlaxoSmithKline, and

Guidepoint Global, outside the current work. Jason P. Block reports

a grant from the National Institute of Diabetes and Digestive and

Kidney Diseases, NIH and receipt of honoraria for participating in

a panel discussion for the Kenner Foundation on “Early Detection

of Pancreatic Cancer.” No other potential conflicts of interest

were disclosed.

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