Socioeconomic and racial review of COVID-19 antiviral prescriptions: a large health system cohort

BACKGROUND: Racial and socioeconomic disparities in COVID-19 have been well documented early in the pandemic, but less is known about the structural and socioeconomic barriers in COVID-19 antiviral prescribing in the later period when therapies became widely available. OBJECTIVE: Evaluate the socioeconomic factors associated with COVID-19 antiviral treatment outpatient prescription. DESIGN: Retrospective single healthcare system cohort study. SETTING: Three hospital system in Massachusetts USA. PARTICIPANTS: adults diagnosed with COVID-19 or prescribed antiviral therapy in outpatient encounters or emergency departments (ED) between Oct/2022 and Jul/2024. RESULTS: Among 9,984 patients with COVID-19, 19.5% received antiviral treatment. In adjusted analyses, increasing age (OR 1.03 per year, 95% CI 1.02-1.03), non-White race (OR 1.35, 95% CI 1.14-1.60), and ED encounters (OR 1.15, 95% CI 1.02-1.30) were independently associated with higher odds of treatment. Social vulnerability demonstrated a non-linear relationship: patients with moderate vulnerability had higher odds of treatment, while the most vulnerable group did not. CONCLUSIONS: In this late-pandemic cohort, antiviral prescribing remained low and demonstrated persistent but complex disparities. Social vulnerability showed a non-linear association with treatment, suggesting that patients with the highest vulnerability may face barriers to access despite greater need.