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

Abstract

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.

The Impact of Comorbidities among Ethnic Minorities on COVID-19 Severity and Mortality in Canada and the USA: A Scoping Review

“…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 [ 71 ], one in Georgia [ 72 ], one in Northeast Ohio and South Florida [ 73 ], one in Milwaukee and Southeast Wisconsin [ 74 ], one in Florida [ 75 ], one in Missouri [ 76 ], and one in Illinois [ 77 ] ( 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 , ...…”

“…According to 34 studies included, Black patients had a higher prevalence of several comorbidities, such as diabetes, hypertension, obesity, and chronic kidney disease, than White patients [ 65 , 68 ]. A retrospective observational study by Krishnamoorthy et al found that Black patients under the age of 65 years old had a lower prevalence of diabetes than those aged 65 years and older (34.9% vs. 46.9%).…”

“…Out of the 59 articles, 52 of the articles mentioned mortality [ 20 , 21 , 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 , 54 , 55 , 56 , 57 , 59 , 61 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ], 32 mentioned ICU admissions [ 19 , 21 , 23 , 24 , 25 …”

“…With regards to racial differences and COVID-19 mortality, 76.9% of the articles (40 out of 52) found a significant association of different races and COVID-19 mortality, whereas 21.2% of the articles (11 out of 52) did not [ 41 , 45 , 47 , 51 , 54 , 55 , 56 , 57 , 65 , 68 , 69 ]. The races compared were between Black and all other race categories (White, Asian, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and multiple races) [ 51 , 54 ], Black and White [ 65 ], non-Hispanic White, non-Hispanic Black, Hispanic and Asian patients [ 45 , 57 , 77 ], non-Hispanic Black and non-Hispanic White [ 41 , 68 , 69 ], Hispanic and non-Hispanic patients [ 55 , 56 ], Black and Asian [ 47 ], Non-Hispanic Black, Non-Hispanic White, and Hispanic [ 74 ]. Previous studies reported higher COVID-19-related mortality rates in ethnic minorities including, but not limited to, Black, Hispanic, and Asian races when compared to White patients [ 20 , 24 , 27 , 28 , 30 , 32 , 34 , 35 , 37 , 44 , 49 , 59 , 61 , 63 , 64 , 67 ] ( Table 3 ).…”