Assessment of Racial/Ethnic Disparities in Hospitalization and Mortality in Patients With COVID-19 in New York City

Abstract

IMPORTANCE Black and Hispanic populations have higher rates of coronavirus disease 2019 hospitalization and mortality than White populations but lower in-hospital case-fatality rates. The extent to which neighborhood characteristics and comorbidity explain these disparities is unclear. Outcomes in Asian American populations have not been explored. OBJECTIVETo compare COVID-19 outcomes based on race and ethnicity and assess the association of any disparities with comorbidity and neighborhood characteristics. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted within the New York University Langone Health system, which includes over 260 outpatient practices and 4 acute care hospitals. All patients within the system's integrated health record who were tested for severe acute respiratory syndrome coronavirus 2 between March 1, 2020, and April 8, 2020, were identified and followed up through May 13, 2020. Data were analyzed in June 2020. Among 11 547 patients tested, outcomes were compared by race and ethnicity and examined against differences by age, sex, body mass index, comorbidity, insurance type, and neighborhood socioeconomic status.EXPOSURES Race and ethnicity categorized using self-reported electronic health record data (ie, non-Hispanic White, non-Hispanic Black, Hispanic, Asian, and multiracial/other patients). MAIN OUTCOMES AND MEASURESThe likelihood of receiving a positive test, hospitalization, and critical illness (defined as a composite of care in the intensive care unit, use of mechanical ventilation, discharge to hospice, or death). RESULTSAmong 9722 patients (mean [SD] age, 50.7 [17.5] years; 58.8% women), 4843 (49.8%) were positive for COVID-19; 2623 (54.2%) of those were admitted for hospitalization (1047 [39.9%] White, 375 [14.3%] Black, 715 [27.3%] Hispanic, 180 [6.9%] Asian, 207 [7.9%] multiracial/other). In fully adjusted models, Black patients (odds ratio [OR], 1.3; 95% CI, 1.2-1.6) and Hispanic patients (OR, 1.5; 95% CI, 1.3-1.7) were more likely than White patients to test positive. Among those who tested positive, odds of hospitalization were similar among White, Hispanic, and Black patients, but higher among Asian (OR, 1.6, 95% CI, 1.1-2.3) and multiracial patients (OR, 1.4; 95% CI, 1.0-1.9) compared with White patients. Among those hospitalized, Black patients were less likely than White patients to have severe illness (OR, 0.6; 95% CI, 0.4-0.8) and to die or be discharged to hospice (hazard ratio, 0.7; 95% CI, 0.6-0.9). CONCLUSIONS AND RELEVANCEIn this cohort study of patients in a large health system in New York City, Black and Hispanic patients were more likely, and Asian patients less likely, than White patients to test positive; once hospitalized, Black patients were less likely than White patients to have (continued) Key Points Question Do outcomes among patients with coronavirus disease 2019 (COVID-19) differ by race/ethnicity, and are observed disparities associated with comorbidity and neighborhood characteristics? Findings This cohort study including ...

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

“…Unmeasured or otherwise undetected subclinical risk factors may also be driving the persistent disparities 34 35 Notably, at least one prior study of racial/ethnic disparities in COVID-19 severity, involving over 2600 patients hospitalised in New York City during the first few months of the pandemic, paradoxically found that NHBs and Hispanic/Latinx patients had less illness severity than NHW patients. 36 In accordance with other studies reporting more affluent and travelled individuals more affected earlier in the pandemic, 37 followed by less affluent and more essential worker individuals increasingly affected later in the pandemic, 33 severity of COVID-19 illness may be determined by relative dose, type, timing and chronicity of SARS-CoV-2 exposure on top of factors specific to race/ ethnicity and SES. Several limitations to our study merit consideration.…”

Hypertension, a Moving Target in COVID-19

“…A large cohort study of patients within a large health system in New York City found among patients hospitalized for COVID-19, that Black patients were even less likely than White patients to have severe illness and to die or be discharged to hospice. 94 In agreement with another study focusing on black non-Hispanic and white non-Hispanic patients 12 a study in an health care system in the United States including almost 3.5 Million members, revealed that race among White, Black, Hispanic, and Asian participants was the most important predictor of SARS-CoV-2 infection and hospitalization due to COVID-19 but not for mortality. 96 Thus, it appears that specific race/ethnic groups of patients are not inherently more susceptible to having poorer COVID-19 outcomes than other ethnic groups.…”

“… 18 This indicates that differences in hypertension together with differential patterns of other comorbidities including obesity, diabetes, and CKD could impact on outcome in COVID-19 in specific race/ethnic groups. 94 In the large cohort of 7868 hospitalized patients from the American Heart Association COVID-19 Cardiovascular Disease Registry, Hispanic and non-Hispanic Black patients accounted for 58.5% of all patients hospitalized and bore a greater burden of mortality and morbidity. 95 However, race/ethnicity was not independently associated with worse in-hospital mortality or major cardiovascular events after adjustment.…”

“…Rather, existing structural determinants pervasive for example in Black and Hispanic communities may explain the observed disproportionately higher out-of-hospital deaths and hospitalizations due to COVID-19 in these populations. 94 Nevertheless, whether or not the higher prevalence of hypertension, poorer BP control and susceptibility for HMOD in specific populations might contribute to COVID-19 related outcomes in addition to racial/ethnic disparities should be explored in future research.…”

Accuracy of Computable Phenotyping Approaches for SARS-CoV-2 Infection and COVID-19 Hospitalizations from the Electronic Health Record

“…Mortality was defined based on the discharge disposition of the first COVID-19 hospitalization. Consistent with other studies, [24][25][26] we used a composite endpoint of in-hospital mortality, transfer to inpatient hospice or discharge to facility or home-based hospice to define our outcome of early mortality.…”