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?:abstract
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BACKGROUND Black, Hispanic, and Indigenous persons in the United States have an increased risk of SARS-CoV-2 infection and death from COVID-19, due to persistent social inequities. However, the magnitude of the disparity is unclear because race-ethnicity information is often missing in surveillance data. METHODS We quantified the burden of SARS-CoV-2 notification, hospitalization, and case fatality rates in an urban county by racial-ethnic group using combined race-ethnicity imputation and quantitative bias analysis for misclassification. RESULTS The ratio of the absolute racial-ethnic disparity in notification rates after bias adjustment, compared with the complete case analysis, increased 1.3-fold for persons classified Black and 1.6-fold for those classified Hispanic, in reference to classified White persons. CONCLUSIONS These results highlight that complete case analyses may underestimate absolute disparities in notification rates. Complete reporting of race-ethnicity information is necessary for health equity. When data are missing, quantitative bias analysis methods may improve estimates of racial-ethnic disparities in the COVID-19 burden.
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