ORIGINAL RESEARCH article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
This article is part of the Research TopicLong-Term Clinical and Epidemiological Perspectives on Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)View all 10 articles
Racial and Ethnic Differences in COVID-19 Infection and Vaccine Uptake Across Multiple Waves of the Pandemic in Southeast Michigan: A Retrospective Cohort Study
Provisionally accepted
- 1Corewell Health Beaumont Research Institute, Royal Oak, United States
- 2Oakland University William Beaumont School of Medicine, Rochester, United States
- 3Henry Ford Health System, Detroit, United States
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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 two 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 (HL), MiddleEastern or Arab (MEA), pandemic waves, racial and ethnic disparities
Received: 13 Jun 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Sidahmed, Homayouni, Childeres, Shen and Mulhem. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Elkhansa Sidahmed
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