Disaggregating Asian Race Reveals COVID-19 Disparities among Asian Americans at New York City’s Public Hospital System

Abstract

There is growing recognition of the burden of COVID-19 among Asian Americans, but data on outcomes among Asian ethnic subgroups remain extremely limited. We conducted a retrospective analysis of 85,328 patients tested for COVID-19 at New York City’s public hospital system between March 1 and May 31, 2020, to describe characteristics and COVID-19 outcomes of Asian ethnic subgroups compared to Asians overall and other racial/ethnic groups. South Asians had the highest rates of positivity and hospitalization among Asians, second only to Hispanics for positivity and Blacks for hospitalization. Chinese patients had the highest mortality rate of all groups and were nearly 1.5 times more likely to die than Whites. The high burden of COVID-19 among South Asian and Chinese Americans underscores the urgent needs for improved data collection and reporting as well as public health program and policy efforts to mitigate the disparate impact of COVID-19 among these communities.

Death Toll of COVID-19 on Asian Americans: Disparities Revealed

“…Under the logic that patients with severe COVID-19 are more likely to be admitted to the hospita, l hospitalization rates could serve as a proxy for disease severity, and the vast majority of studies show Asian Americans have higher rates of hospitalization. 14,15,[29][30][31][32][33][34] Three studies in major health systems found 1.5 times higher odds of hospitalization compared to non-Hispanic Whites, similar to the 1.6 times higher risk found in the KFF study, which was the highest of any group. 15 Furthermore, a retrospective cohort study from 12 hospitals and 60 clinics in Minnesota (N=5577 with 12.2% Asians) found that Asian Americans had 2.4 times higher odds of hospitalization compared to non-Hispanic Whites; among Asian patients, those with limited-English proficiency had 1.6 times higher odds of hospitalization.…”

“…9 While early studies were limited to specific states and counties and unadjusted, numerous subsequent studies confirmed a higher COVID-19 CFR for Asian Americans. [10][11][12][13][14][15][16] One of the largest studies to date is a Kaiser Family Foundation (KFF) analysis that used EPIC electronic health record (EHR) data of 332,956 COVID-19 patients from 399 hospitals across 21 states. 15 Compared to the U.S. population, the KFF sample had higher shares of Black and White patients and lower shares of Hispanic and Asian patients, although Asian patients still comprised 3% of the active patient population and about 11,000 COVID-positive cases.…”

“…14,15,17,[22][23][24][25][26][27][28] They were twice as likely as non-Hispanic White Americans to test positive in the KFF study and second most likely to test positive after Hispanic Americans in the New York City (NYC) Health and Hospitals system. 14,15 In the University of Washington Medicine system, Vietnamese, Korean, and Mandarin/Cantonese speakers had 4.4, 2.8, and 1.5 times higher positivity rates, respectively, than English speakers. 17 Together, these studies provide compelling evidence that Asian Americans with COVID-19 have disproportionately gone undiagnosed.…”

“…38,39 Analyzing testing positivity rates by primary language demonstrated a wide range of positivity, 17 as did disaggregation by national origin for rates of positivity, hospitalization, and mortality. 14 With disaggregated data from the NYC public hospital system, Chinese patients had the highest mortality rate of any racial or ethnic group, while South Asians had the highest rates of positivity and hospitalization among Asian subgroups. 14 Filipino Americans have also experienced disproportionate mortality in California.…”

Understanding differences within ethnic group designation: comparing risk factors and health indicators between Iranian and Arab Americans in Northern California

“…Within ethnic categories, differences in risk factors and health indicators have been observed for Latinx, Asian, and Black Americans. While some differences within ethnic categories have been attributed to country of origin [4][5][6], others are related to differences in lived experiences in the US which result from differential experiences with discrimination and stigma [7][8][9]. Research into health differences within ethnic categories has also led to observations about immigration related health patterns, like the healthy immigrant paradox, which does not seem to hold for all ethnic groups [10][11][12][13][14].…”