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Front Public Health
. 2026 Jan 12:13:1646801.
doi: 10.3389/fpubh.2025.1646801. eCollection 2025.
Racial and ethnic differences in COVID-19 infection and vaccine uptake across multiple waves of the pandemic in Southeast Michigan: a retrospective cohort study
Elkhansa Sidahmed 1 2 , Ramin Homayouni 1 3 , Karen Childers 4 5 , Chen Shen 2 , Elie Mulhem 1
Affiliations
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Keywords: COVID-19 infection rates; COVID-19 vaccine uptake; Hispanic or Latino; Middle Eastern or Arab; pandemic waves; racial and ethnic disparities.
. 2026 Jan 12:13:1646801.
doi: 10.3389/fpubh.2025.1646801. eCollection 2025.
Racial and ethnic differences in COVID-19 infection and vaccine uptake across multiple waves of the pandemic in Southeast Michigan: a retrospective cohort study
Elkhansa Sidahmed 1 2 , Ramin Homayouni 1 3 , Karen Childers 4 5 , Chen Shen 2 , Elie Mulhem 1
Affiliations
- PMID: 41602013
- PMCID: PMC12832436
- DOI: 10.3389/fpubh.2025.1646801
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Keywords: COVID-19 infection rates; COVID-19 vaccine uptake; Hispanic or Latino; Middle Eastern or Arab; pandemic waves; racial and ethnic disparities.