Characteristics and Factors Associated With Coronavirus Disease 2019 Infection, Hospitalization, and Mortality Across Race and Ethnicity

Abstract

Background Data on the characteristics of COVID-19 patients disaggregated by race/ethnicity remain limited. We evaluated the sociodemographic and clinical characteristics of patients across racial/ethnic groups and assessed their associations with COVID-19 outcomes. Methods This retrospective cohort study examined 629,953 patients tested for SARS-CoV-2 in a large health system spanning California, Oregon, and Washington between March 1 and December 31, 2020. Sociodemographic and clinical characteristics were obtained from electronic health records. Odds of SARS-CoV-2 infection, COVID-19 hospitalization, and in-hospital death were assessed with multivariate logistic regression. Results 570,298 patients with known race/ethnicity were tested for SARS-CoV-2, of whom 27.8% were non-White minorities. 54,645 individuals tested positive, with minorities representing 50.1%. Hispanics represented 34.3% of infections but only 13.4% of tests. While generally younger than White patients, Hispanics had higher rates of diabetes but fewer other comorbidities. 8,536 patients were hospitalized and 1,246 died, of whom 56.1% and 54.4% were non-White, respectively. Racial/ethnic distributions of outcomes across the health system tracked with state-level statistics. Increased odds of testing positive and hospitalization were associated with all minority races/ethnicities. Hispanic patients also exhibited increased morbidity, and Hispanic race/ethnicity was associated with in-hospital mortality (OR: 1.39 [95% CI: 1.14-1.70]). Conclusion Major healthcare disparities were evident, especially among Hispanics who tested positive at a higher rate, required excess hospitalization and mechanical ventilation, and had higher odds of in-hospital mortality despite younger age. Targeted, culturally-responsive interventions and equitable vaccine development and distribution are needed to address the increased risk of poorer COVID-19 outcomes among minority populations.

Clinical Trends Among U.S. Adults Hospitalized With COVID-19, March to December 2020

“…Inequities in social determinants of health with downstream effects on overall health of racial/ethnic minority groups ( 34 ) likely also contributed to these disparities. Other studies have similarly found increased morbidity and mortality associated with COVID-19 among non-Hispanic Black ( 33 ) and Hispanic ( 35 , 36 ) persons compared with non-Hispanic White persons.…”

Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19

“…Racial disparities have been noted in outcomes of COVID-19. 23 Hence, we included race as a covariate in our analysis. Testosterone, estradiol, and IGF-1 were measured at the time of presentation (ie, baseline or day 0) and at days 3, 7, 14, and 28 after admission (if the patient remained hospitalized).…”

Ambient air pollution and low temperature associated with case fatality of COVID-19: A nationwide retrospective cohort study in China

“…It is therefore critical to identify key modifiable risk factors that affect the case fatality of COVID-19. [4][5][6][7] Environmental factors, especially air pollution and temperature, have been widely identified to be associated with increasing risk of adverse health outcomes, such as for ischemic heart disease, stroke, diabetes, chronic obstructive pulmonary disease, and respiratory infection. [8][9][10][11] Emerging evidence indicates potential links between exposure to polluted air and COVID-19 mortality and fatality.…”