Temporal variations in the severity of COVID-19 illness by race and ethnicity

Abstract

IntroductionEarly reports highlighted racial/ethnic disparities in the severity of COVID-19 seen across the USA; the extent to which these disparities have persisted over time remains unclear. Our research objective was to understand temporal trends in racial/ethnic variation in severity of COVID-19 illness presenting over time.MethodsWe conducted a retrospective cohort analysis using longitudinal data from Cedars-Sinai Medical Center, a high-volume health system in Southern California. We studied patients admitted to the hospital with COVID-19 illness from 4 March 2020 through 5 December 2020. Our primary outcome was COVID-19 severity of illness among hospitalised patients, assessed by racial/ethnic group status. We defined overall illness severity as an ordinal outcome: hospitalisation but no intensive care unit (ICU) admission; admission to the ICU but no intubation; and intubation or death.ResultsA total of 1584 patients with COVID-19 with available demographic and clinical data were included. Hispanic/Latinx compared with non-Hispanic white patients had higher odds of experiencing more severe illness among hospitalised patients (OR 2.28, 95% CI 1.62 to 3.22) and this disparity persisted over time. During the initial 2 months of the pandemic, non-Hispanic blacks were more likely to suffer severe illness than non-Hispanic whites (OR 2.02, 95% CI 1.07 to 3.78); this disparity improved by May, only to return later in the pandemic.ConclusionIn our patient sample, the severity of observed COVID-19 illness declined steadily over time, but these clinical improvements were not seen evenly across racial/ethnic groups; greater illness severity continues to be experienced among Hispanic/Latinx patients.

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“…Many elderly patients were excluded because of acute or chronic cognitive impairment, which resulted in a relatively limited study population. For practical reasons, only Swedish and English-speaking patients were included, which might have ruled out patients known to have an increased risk of developing severe COVID-19 ( 67 , 68 ).…”

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“…Men usually have better blood lead degrees than women [43]. Study finished via way of means of Ebinger JE et al [44] confirmed that extra COVID-19 severity remains skilled amongst Hispanic/Latinx patients.…”

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“…Of these 59 studies, 18 (30.5%) were conducted across the USA [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. 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 [ ...…”

“…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 , ...…”