Higher comorbidities and early death in hospitalized African-American patients with Covid-19

Abstract

Background African-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and assess efficacy of treatment interventions. Methods We performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a 52-day period at the height of the pandemic in the United States. This study was performed at an urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population. Results Of the 1103 consecutive patients who tested positive for COVID-19, 529 required hospitalization and were included in the study. 88% of patients were Black; and a majority (52%) were 61–80 years old with a mean body mass index in the “obese” range. 98% had one or more comorbidities. Hypertension was the most common (79%) pre-existing condition followed by diabetes mellitus (56%) and chronic kidney disease (17%). Patients with chronic kidney disease who received hemodialysis were found to have lower mortality, than those who did not receive it, suggesting benefit from hemodialysis Age > 60 years and coronary artery disease were independent predictors of mortality in multivariate analysis. Cox proportional hazards modeling for time to death demonstrated a significantly high ratio for COPD/Asthma, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP (180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil:lymphocyte ratio (8.3:10.0) were predictive of mortality on admission and at 48–96 h. Of the 529 inpatients 48% died, and one third of them died within the first 3 days of admission. 159/529patients received invasive mechanical ventilation, of which 86% died and of the remaining 370 patients, 30% died. Conclusions COVID-19 patients in our predominantly Black neighborhood had higher in-hospital mortality, likely due to higher prevalence of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in African-American patients.

Asthma and COVID-19 risk: a systematic review and meta-analysis

“…Scores on the NOS ranged between 6 [ 16 , 29 ] to 9 (maximum 9), with a higher score indicating a high quality. All studies scored 7 or above and were of high quality.…”

Impact of asthma on COVID-19 mortality in the United States: Evidence based on a meta-analysis

“…After evaluating and assessing as much as 257 potential studies, 201 studies were removed due to outcome of interest being not available. In the end, what underlay this meta-analysis were eligible fifty-six articles with 426,261 COVID-19 patients [5] , [6] , [7] , [8] , [9] , [16] , [17] , [18] , [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] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] . The detail of selection process is shown by a chart flow in Figure 1 .…”

“…Taken together, those urged us to investigate the association between asthma and COVID-19 mortality in a specific country or region. To date, a number of individual studies have explored the association between asthma and COVID-19 mortality in the United States with conflicting results [5] , [6] , [7] , [8] , [9] , but no quantitative meta-analysis on this topic was conducted to address this issue. Therefore, we performed a quantitative meta-analysis to investigate the impact of asthma on the risk for COVID-19 mortality in the United States.…”

The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort

“…A retrospective, longitudinal review of the electronic health record (EHR) of Nephrology AA patients from a large academic medical center located in Central Brooklyn was performed. Our center serves a predominantly AA community that has been subject to widespread disparate health outcomes [16]. e race/ethnicity makeup is as follows: White-3%, Black-86%, Hispanic-8%, and Asian-2% [17].…”