Ioannou GN, Ferguson JM, O’Hare AM, et al. - Findings revealed that Black and American Indian/Alaska Native (AI/AN vs White) race and urban (vs rural) residence were strongly positively associated with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection, mortality, and case fatality early in the pandemic; these links were ameliorated or reversed by March 2021.

• Changes in the links of key sociodemographic and clinical factors with Coronavirus Disease 2019 (COVID-19) infection, mortality, or case fatality were studied between February 2020 and March 2021 in a cohort of about 9.1 million individuals enrolled in the national US Veterans Affairs healthcare system, including 216,046 who tested positive and 10,230 who died of COVID-19 during the study period.

• During this time frame, there was a strong association of Black (vs White) race with a 5-fold higher risk of SARS-CoV-2 infection, a 4-fold higher risk of mortality, and a 2.5-fold higher risk of case fatality.

• However, attenuation of these links was evident over time and such associations remained no longer statistically significant by November 2020 for infection and mortality and were reversed for case fatality.

• There was an association of AI/AN (vs White) race with SARS-CoV-2 infection early in the pandemic, however, decline in this link was evident over time and this association reversed by March 2021.

• A 2.5-fold higher risk of death, and 2.2-fold higher risk of case fatality in February to April 2020 was observed in relation to urban (vs rural) residence, but these links attenuated over time and reversed by September 2020.

• Factors consistently linked with infection were high comorbidity burden, younger age, Hispanic ethnicity, and obesity, while those consistently related to mortality included high comorbidity burden, older age, Hispanic ethnicity, and male gender.