Race implications of COVID-19 in Utah: a population-based cohort study.

Background The COVID-19 pandemic disproportionately affected marginalized populations in the United States. We characterize statewide COVID-19 health outcomes by race and ethnicity. Methods We conducted a retrospective analysis of individuals alive on January 1, 2020 with known sex, race, and ethnicity data utilizing the Utah Population Database. COVID-19 health outcomes were identified by diagnostic codes. Ethnically diverse individuals were matched to non-Hispanic White (NHW) individuals by age and sex. Demographic characteristics were compared using Chi-square test. Conditional logistic regression models were used to estimate odds ratios (OR) for COVID-19 related outcomes with adjustment for potential confounders. Results Among 1, 230, 862 individuals, 50% were NHW, 37% Hispanic/Latino, 2.6% Asian, 1.9% Black/ African American, 1.1% Native Hawaiian/ Pacific Islander (NHPI), 0.85% America Indian/ Alaskan Native (AIAN), and 6.6% multiracial. NHPI were the youngest, median age of 26. NHPIs had over a 4-fold increase in hospitalization and 11.28-fold higher odds of COVID-19-specific death compared to NHW. AIAN had more than 2-fold higher odds of hospitalization, ICU admission, death due to COVID-19 compared to NHW. Conclusions Significant racioethnic disparities in COVID-19 health outcomes were observed in NHPI and AIAN populations and underscore the need for targeted public health strategies to mitigate disparities.