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Racial/Ethnic Disparities in Hospitalization and Mortality in COVID-19
Quick Takes
- Black and Hispanic patients were more likely than White patients to test positive for COVID-19, but no more likely to be hospitalized than White patients.
- Black patients had, however, lower odds of critical illness and death compared to Whites.
- Reports on the racial differences in the incidence of hospitalization and mortality related to COVID-19 have varied, and are likely related to confounding socioeconomic issues.
Study Questions:
How do comorbidities and neighborhood characteristics impact race-related coronavirus disease 2019 (COVID-19) outcomes?
Methods:
In this retrospective cohort study, all patients who underwent testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the New York University Langone Health System (NYULH) between March 1 and April 8, 2020 were identified through the system’s integrated health records. Patients were classified as hospitalized if they were admitted to NYULH after testing positive for COVID-19. Critical illness was defined as a composite of care in the intensive care unit, use of mechanical ventilation, discharge to hospice, or death. The analysis examined the impact of clinical characteristics and socioeconomic status (SES) based on the Agency for Healthcare Research and Quality SES Index; a composite of neighborhood indicators which includes density, median income, education, number of people per room in a household, and value of owner-occupied buildings.
Results:
Of 9,722 patients who met inclusion criteria, 4,843 (49.8%) patients tested positive (1,887 [39.0%] White, 759 [15.7%] Black, 1,255 [25.9%] Hispanic, 341 [7.0%] Asian, and 358 [7.4%] multiracial/other). A total of 2,623 patients (54.2%) were admitted to an NYULH hospital, of whom 1,858 (70.8%) were discharged alive; 36.3% experienced critical illness, and 24.7% died or were discharged to hospice. The risk of testing positive was higher in Blacks (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.6) and Hispanics (OR, 1.5; 95% CI, 1.3-1.7) compared to White patients after adjusting for clinical and neighborhood characteristics. Asian patients on the other hand were more likely to be hospitalized (OR, 1.6; 95% CI, 1.1-2.3) than White patients in adjusted analysis. Blacks were less likely to have critical illness (OR, 0.6; 95% CI, 0.4-0.8) or die of COVID-19 (hazard ratio, 0.7; 95% CI, 0.6-0.9) compared to White patients.
Conclusions:
Black and Hispanic patients were more likely than White patients to test positive for COVID-19, but no more likely to be hospitalized than White patients. Black patients also had lower odds of critical illness and death compared to Whites.
Perspective:
This important study provides further clarity on the impact of race on COVID-19–related outcomes. The findings confirm previous reports of the increased prevalence of COVID-19 in Blacks and Hispanics, and support the notion of at least partial contribution of SES to that observation. Reports on the incidence of hospitalization and mortality related to COVID-19 in Blacks has varied, however, with some studies reporting significantly higher rates and others showing no difference, which may relate to factors unaccounted for in this study such as access to care and insurance status that could differ between the Black population in New York and that in Louisiana and California. Overall, it appears that an inherent racial susceptibility to COVID-19 is unlikely, and attention should be focused on underlying socioeconomic factors that affect access to testing and care.
Clinical Topics: COVID-19 Hub, Prevention
Keywords: Coronavirus, COVID-19, ACC COVID-19 Podcast, Critical Illness, African Americans, Healthcare Disparities, Hispanic Americans, Hospices, Patient Discharge, Primary Prevention, Respiration, Artificial, severe acute respiratory syndrome coronavirus 2, Socioeconomic Factors, Ventilation
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