Patient and Hospital Factors Associated With Differences in Mortality Rates Among Black and White US Medicare Beneficiaries Hospitalized With COVID-19 Infection

Asch, David A.; Islam, Nazmul; Sheils, Natalie E.; Chen, Yong; Doshi, Jalpa A.; Buresh, John; Werner, Rachel M.

doi:10.1001/jamanetworkopen.2021.12842

Cited by 83 publications

(87 citation statements)

References 18 publications

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“…differences in individual characteristics (income, comorbid conditions) and hospital characteristics contribute to racial disparities in COVID-19 outcomes in the US [36]. The racial disparities in SOFA scores we found among patients with COVID might be due to the systemic overestimation of mortality among Black persons or underestimation of mortality among White persons.…”

Section: Plos Onementioning

confidence: 78%

Racial disparities in the SOFA score among patients hospitalized with COVID-19

et al. 2021

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Background Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. Research question Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? Study design and methods Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. Results Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11–1.99). Interpretation Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.

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Section: Plos Onementioning

confidence: 78%

Racial disparities in the SOFA score among patients hospitalized with COVID-19

et al. 2021

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“…Recently, Asch et al showed that Black patients hospitalized with COVID-19 had 11% higher odds of death, as compared to White patients even following adjustment for sociodemographic characteristics between groups. Importantly, this group found that the higher mortality among Black patients can be explained in large part by having received treatment at hospitals that care for a disproportionate number of Black patients, suggesting that hospital segregation and inequitable distribution of resources are contributing to outcome disparities [ 15 ]. On the other hand, Yehia et al reported that hospital mortality was not higher in Black patients as compared to White patients diagnosed with COVID-19, citing mortality rates of 23.1% in hospitalized White patients and 19.2% in hospitalized Black patients within a cohort of 11,210 individuals [ 16 ], an encouraging finding dissimilar to previous literature reports but concurrent with that of this current study.…”

Section: Discussionmentioning

confidence: 99%

Critical Care Among Disadvantaged Minority Groups Made Equitable: Trends Throughout the COVID-19 Pandemic

Lopez

Whelan

Kojima

et al. 2022

J. Racial and Ethnic Health Disparities

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Background US racial and ethnic minorities have well-established elevated rates of comorbidities, which, compounded with healthcare access inequity, often lead to worse health outcomes. In the current COVID-19 pandemic, it is important to understand existing disparities in minority groups’ critical care outcomes and mechanisms behind these—topics that have yet to be well-explored. Objective Assess for disparities in racial and ethnic minority groups’ COVID-19 critical care outcomes. Design Retrospective cohort study. Participants A total of 2125 adult patients who tested positive for COVID-19 via RT-PCR between March and December 2020 and required ICU admission at the Cleveland Clinic Hospital Systems were included. Main Measures Primary outcomes were mortality and hospital length of stay. Cohort-wide analysis and subgroup analyses by pandemic wave were performed. Multivariable logistic regression models were built to study the associations between mortality and covariates. Key Results While crude mortality was increased in White as compared to Black patients (37.5% vs. 30.5%, respectively; p = 0.002), no significant differences were appraised after adjustment or across pandemic waves. Although median hospital length of stay was comparable between these groups, ICU stay was significantly different (4.4 vs. 3.4, p = 0.003). Mortality and median hospital and ICU length of stay did not differ significantly between Hispanic and non-Hispanic patients. Neither race nor ethnicity was associated with mortality due to COVID-19, although APACHE score, CKD, malignant neoplasms, antibiotic use, vasopressor requirement, and age were. Conclusions We found no significant differences in mortality or hospital length of stay between different races and ethnicities. In a pandemic-influenced critical care setting that operated outside conditions of ICU strain and implemented standardized protocol enabling equitable resource distribution, disparities in outcomes often seen among racial and ethnic minority groups were successfully mitigated. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01254-1.

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“…It was observed that black patients with COVID-19 usually had higher mortality rates that white patients, which was also noted among pediatric patients. However, the racial disparities are more like to be multifactorial while black race alone was not associated with the high mortality rates (109)(110)(111). Black patients had higher prevalence of chronic diseases, such as diabetes, hypertension, chronic renal diseases and so forth.…”

Section: Skeletal Complicationmentioning

confidence: 99%

Complication and Sequelae of COVID-19: What Should We Pay Attention to in the Post-Epidemic Era

et al. 2021

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COVID-19 is widespread worldwide and seriously affects the daily life and health of humans. Countries around the world are taking necessary measures to curb the spread. However, COVID-19 patients often have at least one organ complication and sequelae in addition to respiratory symptoms. Controlling the epidemic is only a phased victory, and the complication and sequelae of COVID-19 will need more attention in the post-epidemic era. We collected general information from over 1000 articles published in 2020 after the COVID-19 outbreak and systematically analyzed the complication and sequelae associated with eight major systems in COVID-19 patients caused by ACE2 intervention in the RAS regulatory axis. The autoimmune response induced by 2019-nCoV attacks and damages the normal tissues and organs of the body. Our research will help medical workers worldwide address COVID-19 complication and sequelae.

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Patient and Hospital Factors Associated With Differences in Mortality Rates Among Black and White US Medicare Beneficiaries Hospitalized With COVID-19 Infection

Cited by 83 publications

References 18 publications

Racial disparities in the SOFA score among patients hospitalized with COVID-19

Racial disparities in the SOFA score among patients hospitalized with COVID-19

Critical Care Among Disadvantaged Minority Groups Made Equitable: Trends Throughout the COVID-19 Pandemic

Complication and Sequelae of COVID-19: What Should We Pay Attention to in the Post-Epidemic Era

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