# Racial and ethnic differences in COVID-19 infection and vaccine uptake across multiple waves of the pandemic in Southeast Michigan: a retrospective cohort study

## TL;DR

This study found that Middle Eastern or Arab and Hispanic or Latino patients had higher rates of COVID-19 infection compared to Black and White patients in Southeast Michigan during the pandemic.

## Contribution

The study specifically highlights disparities in infection rates among the Middle Eastern or Arab ethnic group, which is underrepresented in prior research.

## Key findings

- MEA and Hispanic or Latino patients had higher infection rates (19.1% and 20.9%) compared to Black and White patients.
- MEA patients had consistently higher odds of infection across all pandemic waves despite similar vaccination rates to White patients.
- Black and Hispanic or Latino individuals showed lower vaccine uptake and higher infection risks compared to White patients.

## Abstract

The COVID-19 pandemic revealed significant racial and ethnic disparities in the United States, yet limited data exist for Middle Eastern or Arab (MEA) ethnic group. We aimed to assess COVID-19 infection and vaccine rates among MEA and other racial and ethnic groups across multiple waves of the pandemic.

We conducted a retrospective cohort study of adult patients who visited eight emergency departments (EDs) within a large Southeast Michigan healthcare system during the first 2 years of the pandemic. Five pandemic waves were defined: Initial (pre-October 2020), Holiday (October 2020–March 2021), Alpha (March 2021–June 2021), Delta (June 2021–December 2021), and Omicron (December 2021–June 2022). Chi-squared tests assessed infection differences, while logistic regression evaluated infection odds and Kaplan–Meier analysis for vaccine uptake.

Among 168,288 ED patients, 20,253 (12%) tested positive for SARS-CoV-2. MEA and Hispanic or Latino (HL) patients exhibited higher infection rates (19.1 and 20.9%, respectively) compared to Black and White patients (13.5 and 9.8%, respectively). MEA patients consistently had higher odds of infection across all waves, despite similar vaccination rates to White patients. Black and HL patients showed varying but higher likelihoods of infection across waves and lower vaccine uptake compared to White patients.

MEA patients experienced disproportionately high infection rates in the ED despite comparable vaccination uptake to White patients. Black and HL individuals had both lower vaccine uptake and elevated infection risks. These disparities underscore the need for culturally tailored interventions to address health inequities in future pandemics.