Higher SARS-CoV-2 infection burden among racialized individuals: evidence from Canadian serology data

INTRODUCTION: COVID-19 infection risk has not been evenly distributed across racial groups, with exposure being shaped by social and structural factors. The emergence of highly transmissible variants (i.e., Omicron) dramatically increased infection rates. However, it remains unclear whether racial disparities in infection risk disappeared or persisted over the course of the pandemic. OBJECTIVE: To understand how SARS-CoV-2 infection risk differed between racial groups in Canada and whether those disparities changed with the Omicron variant. METHODS: We analyzed cross-sectional SARS-CoV-2 seroprevalence data from the Canadian Blood Services serosurveillance program (June 2020 to April 2023) using a previously described dynamic susceptible-infection model, while accounting for seroreversion. Race-specific force of infection was estimated for the pre-Omicron and Omicron periods (with the emergence of Omicron defined as beginning December 26, 2021). RESULTS: Prior to Omicron, racialized individuals had a 121% higher force of infection (IRR = 2.205; 95% CI: 2.115-2.299). During the Omicron period, infection rates rose significantly within each racial group relative to the pre-Omicron period, with a 55.52-fold increase among White individuals and a 31.27-fold increase among racialized individuals. Despite this, racialized individuals remained disproportionately affected following the emergence of Omicron, with 24% higher infection rates than those of their White counterparts (IRR = 1.242; 95% CI: 1.231-1.253). CONCLUSION: Widespread infection during Omicron did not result in epidemiologic equity, as racialized populations continued to experience higher infection risk despite crude seroprevalence depicting convergence.