Racial disparities in COVID-19 hospitalizations do not lead to disparities in outcomes

Krishnamoorthy, Geetha; Arsene, Camelia; Jena, Nihar; Mogulla, Swathi; Coakley, R.; Khine, Justin; Khosrodad, Nadia; Klein, Anke; Sule, Anupam A

doi:10.1016/j.puhe.2020.11.021

Cited by 20 publications

(27 citation statements)

References 25 publications

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“…This is consistent with findings from both national and international studies (8,38). The likely causes of racial-/ethnic-health disparities in COVID-19 outcomes were discussed extensively in prior studies (9,11,14,16,37,(39)(40)(41)(42)(43)(44). Some literature argued that minority communities may be more susceptible to severe complications of COVID-19 because of existing disparities in underlying conditions known to be associated with COVID-19 mortality, including hypertension, cardiovascular disease, kidney disease, and diabetes.…”

Section: Discussionsupporting

confidence: 82%

Demographic disparities in clinical outcomes of COVID-19: data from a statewide cohort in South Carolina

Yang

Zhang

Chen

et al. 2021

Preprint

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Background: Current literature examining the clinical characteristics of COVID-19 patients underrepresent COVID-19 cases who were either asymptomatic or had a mild illness. Objective: To generate a state level description and examine the demographic disparities of clinical outcomes of COVID-19. Design: Statewide population-based cohort study Setting: COVID-19 surveillance facilities in South Carolina Patients: Adults COVID-19 cases reported to the SC DHEC by Case Report Form from March 04 to December 31, 2020 Measurements: The primary predictors were socio-demographic characteristics. The outcomes were COVID-19 disease severity, hospitalization, and mortality, which collected from the standardized CRF. Results: Among a total of 280,177 COVID-19 cases, 5.2% (14,451) were hospitalized and 1.9% (5,308) died. Individuals who were older, male gender, Blacks, Hispanic or Latino, and residing in small towns had higher odds for hospitalization and death from COVID-19 (Ps<0.0001). Regarding disease severity, 144,157 (51.5%) were asymptomatic, while 34.4% and 14.2% had mild and moderate/severe symptoms, respectively. Older individuals (OR: 1.14, 95%CI: 1.11, 1.18), Hispanic or Latino (OR: 2.07; 95%CI: 1.96, 2.18), and people residing in small towns (OR: 1.15; 95%CI: 1.08, 1.23) had higher odds of experiencing moderate/severe symptoms, while male and Asian (vs Whites) patients had lower odds of experiencing moderate/severe symptoms. Limitations: Potential misclassification of outcomes due to missing data; other variables were not evaluated, such as comorbidities. Conclusion: As the first statewide population-based study using data from multiple healthcare systems with a long follow up period in the US, we provide a more generalizable picture of COVID-19 symptoms and clinical outcomes. The findings from this study reinforce the fact that rural residence, racial and ethnic social determinants of health, unfortunately, remain predictors of poor health outcomes for COVID-19 patients.

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Section: Discussionsupporting

confidence: 82%

Demographic disparities in clinical outcomes of COVID-19: data from a statewide cohort in South Carolina

Yang

Zhang

Chen

et al. 2021

Preprint

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“…Our study found that several social determinants of health put patients at risk for hospitalization during COVID-19 infection, including lower socioeconomic status, indexed by zip code and employment status, race, ethnicity, English as a second language, and public insurance. Prior studies have associated similar disparities – such as ethnic and racial minority groups, 7–11 poverty, 5 lower education levels, 4 public insurance coverage 5 , 6 , 11 – with higher hospitalization rates in those infected with COVID-19, yet the topic remains understudied, 7–11 and only few have focused on the risk of inpatient admission as a primary outcome 4 , 6 , 9–11 or addressed the breadths of social determinants, as our study has.…”

Section: Discussionmentioning

confidence: 90%

“…1 Clinical predisposing factors for hospitalization including: older age, male gender, obesity, COVID-19 Risk of Complications Score have been reported in southeast Michigan, a region significantly impacted by the pandemic. 2,3 Ethnic and racial minorities, poverty, and low education levels, 4 poverty and black race, [5][6][7][8][9] non-Hispanic black race, [7][8][9][10] public insurance use (ie, Medicare or Medicaid) 5,6,11 have been reported as health-care disparities having high hospitalization rates.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Disparities in Social Determinants of Health on Hospitalization Rates for Patients with COVID-19 in Michigan (USA)

McCrohan¹,

Nierenberg²,

Karabon³

et al. 2021

IJGM

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“…Our results suggest that the mechanism driving convergence is primarily affecting mortality within the county level, and is potentially linked to changes in cumulative COVID-19 prevalence rather than time. Given prior evidence that conditional on hospitalization, mortality among Black and White COVID-19 patients is similar, we discuss potential mechanisms upstream of hospitalization (Goyal et al, 2020; Krishnamoorthy et al, 2021; Moore, 2020; Renelus et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

Lawton

Zheng

et al. 2021

Preprint

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Background: Non Hispanic Black populations have suffered greater per capita COVID19 mortality at more than 1.5 times that of White populations. Previous work has established that, over time, rates of Black and White mortality have converged; however, some studies suggest that regional shifts in COVID19 prevalence may play a role in the relative change between racial groups. The study objective was to investigate changes in Black and White COVID19 mortality over time and uncover potential mechanisms driving these changes. Methods and Findings: Using county level COVID-19 mortality data stratified by race, we investigate the trajectory of non Hispanic Black mortality, White mortality, and the Black/White per capita mortality ratio from June 2020 to January 2021. Over this period, in the counties studied, cumulative mortality rose by 56.7% and 82.8% for Black and White populations respectively, resulting in a decrease in mortality ratio of 0.369 (23.8%). These trends persisted even when a county-level fixed-effects model was used to estimate changes over time within counties (controlling for all time invariant county level characteristics and removing the effects of changes in regional distribution of COVID19). Next, we leverage county level variation over time in COVID19 prevalence to show that the declines in the Black/White mortality ratio can be explained by changes in COVID19 prevalence. Finally, we study heterogeneity in the time trend, finding that convergence occurs most significantly in younger populations, areas with less dense populations, and outside of the Northeast. Limitations include suppressed data in counties with fewer than 10 deaths in a racial category, and the use of provisional COVID19 death data that may be incomplete. Conclusions: The results of this study suggest that convergence in Black/White mortality is not driven by county level characteristics or changes in the regional dispersion of COVID19, but instead by changes within counties. Further, declines in the Black/White mortality ratio appear strongly linked to changes in COVID19 prevalence, rather than a time specific effect. Further studies on changes in exposure by race over time, or on the vulnerability of individuals who died at different points in the pandemic, may provide crucial insight on mechanisms and strategies to further reduce COVID19 mortality disparities.

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Racial disparities in COVID-19 hospitalizations do not lead to disparities in outcomes

Cited by 20 publications

References 25 publications

Demographic disparities in clinical outcomes of COVID-19: data from a statewide cohort in South Carolina

Demographic disparities in clinical outcomes of COVID-19: data from a statewide cohort in South Carolina

The Impact of Disparities in Social Determinants of Health on Hospitalization Rates for Patients with COVID-19 in Michigan (USA)

Understanding Convergence Between Non-Hispanic Black and White COVID-19 Mortality: A County-Level Approach

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