Hospitalization and Mortality among Black Patients and White Patients with Covid-19

Abstract

BACKGROUNDMany reports on coronavirus disease 2019 have highlighted age-and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19. METHODSIn this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chainreaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death. RESULTSA total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19-positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19-positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17). CONCLUSIONSIn a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.

Obstetric Hemorrhage Risk Associated with Novel COVID-19 Diagnosis from a Single-Institution Cohort in the United States

“…This is aligned with many studies both in pregnant and nonpregnant populations that have demonstrated significant racial disparities in incidence and outcomes. 13,20,21 A multitude of factors, including health care access, social determinants of health, and underlying comorbidities may underlie these disparities in COVID-19 spread, incidence, and outcomes in non-White populations. The etiology of these demographic findings should be interrogated seriously with both qualitative and quantitative approaches.…”

Screening and testing for COVID‐19 before surgery

“…18,28,31,39,[41][42][43]46,47,50,52,53,57,61,63,64,[69][70][71][72][73] The immunopathogenesis of SARS-CoV-2 infection is typified by an aggressive inflammatory response, 74 and accordingly, elevated inflammatory markers are common. 18,28,[41][42][43]46,47,50,52,61,63,64,[69][70][71][72] Lymphopaenia and an increased neutrophil to lymphocyte ratio can occur in many patients with SARS-CoV-2 infection. 37,52,74 Close monitoring of inflammatory markers and serum cytokine and chemokine levels is crucial to the optimal management of COVID-19 patients, 37,75 as severe SARS-CoV-2 infection can result in the manifestation of a cytokine storm syndrome.…”

Soziale Ungleichheit und COVID-19: Sozialepidemiologische Perspektiven auf die Pandemie

“…International mehren sich aktuell die Hinweise, die auf eine sozial ungleiche Verteilung des Risikos für eine Infektion mit SARS-CoV-2 und für schwere Verläufe von COVID-19 in einigen Ländern hindeuten [4]. Aus den USA liegen erste Berichte vor, dass Afroamerikanerinnen und Afroamerikaner sowohl bei den bestätigten Fällen als auch bei Hospitalisierungen und Todesfällen aufgrund von COVID-19 überrepräsentiert sind [5][6][7]. Aus New York City, einem der Epizentren des Ausbruchs in den USA, berichten die lokalen Gesundheitsbehörden eine doppelt so hohe altersadjustierte Sterberate für Afroamerikanerinnen und Afroamerikaner sowie eine um 50 % erhöhte Sterberate in der Bevölkerung mit hispanobzw.…”

“…Auch aus Großbritannien gibt es Berichte, dass People of Color (POC) häufiger schwere klinische Verläufe zeigen [9]. Ein Teil dieser ethnischen Ungleichheiten im COVID-19-Sterberisiko dürfte auf Unterschiede im sozioökonomischen Status zurückgehen [7,10,11], auch wenn die komplexen Muster gesundheitlicher Ungleichheit nach Ethnizität nicht allein auf diese reduzierbar sind [11]. Zu den Mustern sozioökonomischer Ungleichheit im COVID-19-Geschehen liegen bisher jedoch nur wenige und meist ökologische Analysen vor.…”