Hispanics and Blacks with COVID-19 More Likely to Suffer Severe Illness than Whites
Presenter: Anirudh Rao, MD, Department of Medicine, MedStar Washington Hospital Center, Washington, DC.
A summary of the oral abstract, Outcomes for Black and Hispanic patients with COVID-19: a large healthcare system experience, October 17, 2021, Chest 2021.
Hispanic patients are more likely to suffer severe illness from COVID-19 than Black or White patients, according to this retrospective cohort study of data from a large healthcare system. “COVID-19 has had a disproportionate impact on patients from racial and ethnic minority groups,” said Anirudh Rao, lead author of the study abstract published in Chest. “Black and Hispanic people suffer disproportionately higher rates of infection with SARS-CoV-2, hospitalization, need for mechanical ventilation, and mortality compared with non-Hispanic Whites. However, case fatality rates are similar across racial and ethnic groups.”
For this study, investigators abstracted data from electronic health records of a large health system—MedStar Health, encompassing 9 acute care hospitals in the Baltimore-Washington DC region. “We analyzed outcomes for patients with COVID-19 hospitalized between March 1, 2020, and July 1, 2020,” Rao said. “Patients were stratified based on their race and ethnicity. The primary outcome was survival to hospital discharge, and secondary outcomes included need for mechanical ventilation. The statistical analyses included descriptive statistics and multivariate logistic regressions.”
A total of 2,969 patients were included in this analysis: 466 (15.7%) patients were White, 1,811 (61%) patients were Black, and 654 (22%) patients were Hispanic. The average age of the White, Black and Hispanic patients was 69 years, 64 years, and 50 years, respectively. Compared with White patients, Black and Hispanic patients were at significantly increased risk of having severe illness, as defined by the need for mechanical ventilation: Odds ratios (OR) were 1.35 for Blacks (confidence interval [CI] 1.04–1.75) and 1.43 for Hispanics (CI 1.06–1.93), even with adjustments for demographic variables.
“When compared to White and Black patients, Hispanic patients were at decreased odds of death (OR 0.45),” Rao said. “However, when adjusting for variables including age, gender, insurance, and comorbidities, there were no statistically significant differences in the odds of death between each group.”
“A Kaplan Meier curve shows time on mechanical ventilation was significantly longer for Hispanic patients compared to Black and White patients,” Rao continued. “A second curve of time from hospital presentation to death or discharge demonstrated that Black and Hispanic patients have an increased time ratio compared to White patients.”
In conclusion, Rao said, “In this large cohort of patients from the Baltimore-Washington DC region hospitalized for SARS-CoV-2 infection, we demonstrate that patients of Hispanic ethnicity have higher odds of severe illness, as defined by need for mechanical ventilation, but lower hospital mortality than non-Hispanic White patients. The lower hospital mortality rate is likely mediated by the younger age of the Hispanic group. Policy makers should consider interventions to target the social determinants, such as differences in access to healthcare and risk of exposure to COVID-19 that may account for the higher odds of severe infection and delayed presentation among Hispanic patients.”
Disclosures
Anirudh Rao, MD: No relevant relationships.
Reference
Rao A, Alnababteh M, Flores J, et al. Outcomes for Black and Hispanic patients with COVID-19: a large healthcare system experience. Chest 2021; 160 (4) (suppl):A581. doi: 10.1016/j.chest.2021.07.559