COVID-19 Infection in the Veterans Health Administration: Gender Specific Racial and Ethnic Differences

Upchurch, Dawn M.; Wong, Michelle S.; Yuan, Anita; Haderlein, Taona P.; McClendon, Juliette; Christy, Alicia; Washington, Donna L.

Purpose Racial/ethnic minoritized groups, women, and economically disadvantaged groups are disproportionately affected by the COVID-19 pandemic. We investigated racial/ethnic differences by gender in correlates of COVID-19 infection among veterans seeking health care services at the Veterans Health Administration (VHA). Little is known about gender-specific factors associated with infection among veterans. This study seeks to fill this gap. Methods The sample was veterans with results from a COVID-19 test (polymerase chain reaction) conducted at VHA facilities between March 1, 2020 and August 5, 2020 and linked to CDC Social Vulnerability Index data (39,223 women, 316,380 men). Bivariate, multivariate logistic, and predicted probability analyses were conducted. All analyses were stratified by gender. Results Similar percentages of women and men tested positive for COVID-19 (9.6% vs. 10.0%). In multivariate analysis, compared to non-Hispanic White women, American Indian/Alaskan Native, Black, and Hispanic women all had significantly higher odds of infection. Similar racial/ethnic differences were found for men. Both older men and women (>40) had lower odds of infection, but the age cut points differed (40 for women, 55 for men). Men 80+ had higher odds than those aged <40. For men, but not for women, being employed (vs. unemployed) was associated with increased odds of infection, and having comorbidities was associated with decreased odds. There were significant differences within and across gender-by-race/ethnicity in infection, after adjusting for covariates. Conclusions American Indian/Alaska Native, Hispanic, and Black women and men veterans are disproportionately impacted by COVID-19 infection. Widespread testing and tracking, education, and outreach regarding COVID-19 mitigation and vaccination efforts are recommended.