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Black, Hispanic Patients See Lower Paxlovid, COVID-19 Treatment Access

Paxlovid and COVID-19 treatment access was lower for racial minorities but was especially egregious for older adults or immunocompromised folks at higher risk of serious illness.

Racial health disparities in COVID-19 treatment access continue to become apparent, with the latest data from the CDC showing that Paxlovid access for Black and Hispanic people was about a third lower than it was for White people.

That trend was particularly egregious for older Black people, the Morbidity and Mortality Weekly Report showed. Compared to their White counterparts, Black people ages 65 to 79 years old—a group more vulnerable to severe COVID-19 due to age—were 44 percent less likely to get a Paxlovid prescription.

These findings come as the nation continues to grapple with the racial health disparities laid bare at the start of the pandemic. In 2020, researchers focused on the disproportionate burden Black and Hispanic people faced in terms of COVID-19 infection.

Since then, disparities in vaccination rates have emerged, while more recent data has documented differences in COVID-19 treatment access.

In this latest assessment, the CDC looked at EHR data from 30 healthcare facilities participating in PCORnet. The agency documented how many of the nearly 700,000 COVID-19 patients ages 20 and older included in the study received access to certain treatments, including Paxlovid, Lagevrio, Veklury, or mAbs, between January and July of 2022.

Overall, around 12 percent of patients got a Paxlovid prescription, with far fewer patients receiving any other kind of treatment.

mAb treatment was the next most common COVID-19 treatment, with 2.7 percent of study participants receiving it. CDC said it was more common than Paxlovid for patients with a previous organ transplant.

Some groups were more likely to get a Paxlovid prescription than others, the CDC found. Particularly, those at higher medical risk were more likely to get Paxlovid, with folks over 50, those undergoing active cancer treatment, those using corticosteroids, those using immunosuppressive medications, and those with an underlying medical condition all having higher than average Paxlovid prescription rates.

Moreover, there were considerable racial health disparities at play.

Black and Hispanic people were markedly less likely to get Paxlovid prescriptions than their White counterparts, with prescription rates being around 36 percent lower for Black patients and 30 percent lower for Hispanic patients.

Those identifying as multiple or other race saw around 15 percent lower Paxlovid prescription rates, while prescriptions were 23 percent lower for American Indian or Alaska Native and Northern Hawaiian or other Pacific Islander (AIAN/NHOPI) people and 19 percent lower for Asian patients.

What’s more, treatment differences were apparent even when looking at groups more vulnerable to severe COVID-19 infection. Paxlovid access was around 44 percent less for Black patients ages 65 to 79 than for White patients the same age. This comes even as older adults are at higher risk for COVID-19 complications.

Additionally, racial health disparities emerged when looking at immunocompromised people, who are also at higher risk for COVID-19 complications. Immunocompromised Black, multiple or other race, and Hispanic patients were treated with Paxlovid and mAbs less often than immunocompromised White and non-Hispanic patients.

The CDC researchers said many of the typical patient care access barriers could be at play here. For one thing, neighborhood and neighborhood segregation could be playing a role, with racial minorities being less likely to live near a facility that can dispense certain COVID-19 treatments.

“Persons living in counties that are both high-poverty areas and majority Black, Hispanic, or American Indian or Alaska Native are less likely to have access to COVID-19 treatment facilities,” the researchers wrote. “Limited access to treatment is particularly detrimental when patients need timely services, as is required for COVID-19 medications that must be initiated soon after symptom onset (5 days for oral antivirals, 7 days for mAbs and Veklury, as authorized by EUAs).”

The researchers also posited that limited patient trust, fueled by decades of mistreatment of Black and Brown bodies and institutional racism, might be creating some disparities. While some patients of color may decline treatment due to limited trust in the medical institution, CDC also pointed out that explicit and implicit biases of medical providers could influence prescribing practices.

“Race and ethnicity also could be proxies for other barriers, such as limited knowledge of treatment options, lack of internet access for telemedicine services, limited transportation, and language barriers,” CDC added.

The agency said community health will be critical for closing the COVID-19 treatment gap. Leaning on trusted community messengers to spread information about COVID-19 treatments and gain patient trust will be critical, CDC said, as will empowering providers who practice in disproportionately affected communities. Federal programs, like the Test-to-Treat program, will also help ameliorate the care access barriers that often limit treatment.

“Racial and ethnic disparities persist in outpatient COVID-19 treatment, even among older adults and patients with immunocompromise,” CDC concluded. “Expansion of programs focused on equitable outpatient COVID-19 treatment, including raising patient awareness using trusted sources, educating clinicians and other prescribers, and expanding patient access to prescribers, can facilitate equitable health outcomes.”

Separate studies have revealed racial health disparities in in-patient COVID-19 treatments, with a recent JAMA Network Open paper showing that Black patients were less likely than their White counterparts to get treatments like remdesivir and immunomodulatory drugs.

Black patients were 12 percent less likely to receive dexamethasone, the study authors found. Black patients were also 11 percent less likely to receive remdesivir and 23 percent less likely to receive an immunomodulatory drug, like tocilizumab.

Both of those drugs are recommended for COVID-19 patients, with remdesivir being recommended for most adults and tocilizumab being recommended for moderately to severely ill hospitalized COVID-19 patients.

Despite treatment differences, the researchers found limited difference in in-hospital and 30-day mortality between Black and White patients. Still, the racial health disparities in COVID-19 treatment access are a problem, according to Florian Mayr, MD, MPH, the study’s co-author.

“We should not be seeing racial disparities in treatment, even if those disparities may not be resulting in more deaths,” Mayr, an assistant professor of critical care medicine at Pitt’s School of Medicine and an interventionist at the VA Pittsburgh Healthcare System, said in a statement.

“When entire hospitals are underperforming in providing evidence-based treatments, we can target hospital-wide interventions to address the problem. But correcting racial disparities in provision of treatment within hospitals requires a multilayer approach.”

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