Health Inequity in Viral Infections in a Medicaid Population: Lessons from Influenza and COVID-19

OBJECTIVES: Inequities in healthcare access and management across racial groups in the United States have come into the forefront during the COVID-19 pandemic. This analysis used the MarketScan Multi-state Medicaid Database to investigate viral diagnoses and associated healthcare resource utilization by race over the 2018-2020 viral seasons.

METHODS: Individuals continuously eligible for each independent viral season (July-June) were identified for the 2018-2020 seasons in the MarketScan Multi-state Medicaid Database. Within each season the number of influenza visits, COVID-19 visits, and total visits were assessed on a monthly basis. Among patients with a viral diagnosis, utilization of inpatient or emergency services during the month were also examined. Diagnosis and healthcare resource utilization outcomes were compared across racial groups (White, Black, Hispanic, or Other) to assess potential race-based health inequities.

RESULTS: Eligible populations ranged from approximately 6-8.5 million per viral season, with roughly 49%, 35%, 10%, and 6% of patients classified as White, Black, Hispanic, and Other, respectively. Influenza infection peaks were observed in the 2018 and 2019 seasons, while COVID-19 spanned the 2019-2020 seasons. Hispanic patients had the highest ratio of viral:total visits for both viruses. Racial groups also demonstrated different patterns in overall service use with White patients most likely and Black patients least likely to utilize healthcare services on a monthly basis. There were significant differences in viral-associated healthcare service use across groups with Black patients tending to have the highest proportion of patients with COVID-19 or influenza diagnoses in the ER and COVID-19 diagnoses in the IP setting.

CONCLUSIONS: Despite all patients having Medicaid health insurance, there were differences in rates of viral infections and associated healthcare resource utilization across race based groups. Although some trends were amplified when looking at COVID-19, analyses of influenza infection and overall service utilization indicate underlying, non-COVID related inequities healthcare utilization.