COVID-19 Inpatient Mortality Disparities Among American Indian Adults in Mississippi’s Safety Net Hospital

Abstract

Background Long-standing health disparities experienced by American Indians (AIs) are associated with increased all-cause mortality rates and shortened life expectancies when compared to other races and ethnicities. Nationally, these disparities have persisted with the COVID-19 pandemic as AIs are more likely than all other races to be infected, hospitalized, or die from SARS-CoV-2. The Mississippi Band of Choctaw Indians, the only federally recognized American Indian tribe in the state, has been one of the hardest hit in the nation. Methods Using de-identified data from the University of Mississippi Medical Center’s COVID-19 Research Registry, a retrospective cohort study was conducted to assess COVID-19 inpatient mortality outcomes among adults (≥ age 18) admitted at the state’s safety net hospital in 2020. Results Exactly 41% ( n = 25) of American Indian adults admitted with a deemed diagnosis of COVID-19 died while in hospital, in comparison to 19% ( n = 153) of blacks and 23% ( n = 65) of whites. Racial disparities persisted even when controlling for those risk factors the CDC reported put adults at greatest risk of severe outcomes from the disease. The adjusted probability of inpatient mortality among American Indians was 46% ( p < 0.00) in comparison to 19% among blacks and 20% among whites. Conclusion Although comorbidities were commonly observed among COVID-19 + American Indian inpatients, only one was associated with inpatient mortality. This challenges commonly cited theories attributing disparate COVID-19 mortality experiences among indigenous populations to disparate comorbidity experiences. Expanded studies are needed to further investigate these associations.

In-Hospital Mortality Disparities Among American Indian and Alaska Native, Black, and White Patients With COVID-19

“…A recent study in a single Mississippi hospital 21 found that even when controlling for the risk factors that the Centers for Disease Control and Prevention believed at the time put individuals at greatest risk of death from the novel coronavirus, American Indian and Alaska Native adults with COVID-19 had an in-hospital odds of death more than twice that of Black adults (odds ratio [OR], 0.23; P < .001) or White adults (OR, 0.24; P < .001). The authors therefore hypothesized that COVID-19 mortality rates would be significantly greater among American Indian and Alaska Native adults than those of any other race admitted to hospitals across the state and that higher COVID-19 in-hospital mortality rates among Indigenous patients would not be associated with greater comorbidity risk among American Indian and Alaska Native patients.…”

“…16,17 Application to COVID-19 interrogations have also proven effective. [18][19][20] A recent study in a single Mississippi hospital 21 found that even when controlling for the risk factors that the Centers for Disease Control and Prevention believed at the time put individuals at greatest risk of death from the novel coronavirus, American Indian and Alaska Native adults with…”

The Impact of Comorbidities among Ethnic Minorities on COVID-19 Severity and Mortality in Canada and the USA: A Scoping Review

“…Eight studies were conducted in Michigan [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], six in New York [ 45 , 46 , 47 , 48 , 49 , 50 ], four in Atlanta [ 51 , 52 , 53 , 54 ], and four in California [ 55 , 56 , 57 , 58 ]. The remaining studies were divided as follows: one in three states (California, Oregon, and Washington) [ 59 ], one in Massachusetts [ 60 ], one in Tennessee [ 61 ], two in Wisconsin [ 62 , 63 ], one in Mississippi [ 64 ], one in Cleveland [ 65 ], one in Pennsylvania [ 66 ], two in Louisiana [ 67 , 68 ], one in the Midwest [ 69 ], one near the Mexico border [ 70 ], one in New Orleans [ 71 ], one in Georgia [ 72 ], one in Northeast Ohio and South Florida [ 73 ], one in Milwaukee and Southeast Wisconsin [ 74 ], one in Florida [ 75 ], one in Missouri [ 76 ], and one in Illinois [ 77 ] ( Table 1 ).…”

“…With respect to the study design, the selected 59 studies can be categorized into studies that were retrospective in nature, cross-sectional in nature, association studies, case-control studies, and cohort studies. There were 45 studies that were retrospective in nature, including observational studies [ 19 , 20 , 22 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 43 , 44 , 46 , 47 , 49 , 51 , 52 , 53 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 68 , 70 , 71 , 72 , 76 ]. Additionally, there was one association study [ 37 ], seven cohort studies [ 21 , 24 , 25 , 28 , 45 , 54 , 73 ], five cross-sectional studies [ 23 , 55 , 63 , 74 , 77 ], and one case-control study [ 48 ] ( Table 1 ).…”

“…Overall, the following races/ethnicities were examined in our included studies: Black/African American, Asian, Hispanic, White/Caucasian, and Indigenous people. Firstly, 58 studies included Black/African American patients [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , ...…”