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- Title
Characteristics Associated With Racial/Ethnic Disparities in COVID-19 Outcomes in an Academic Health Care System.
- Authors
Gu, Tian; Mack, Jasmine A.; Salvatore, Maxwell; Prabhu Sankar, Swaraaj; Valley, Thomas S.; Singh, Karandeep; Nallamothu, Brahmajee K.; Kheterpal, Sachin; Lisabeth, Lynda; Fritsche, Lars G.; Mukherjee, Bhramar
- Abstract
Key Points: Question: What sociodemographic and underlying health conditions are associated with COVID-19 outcomes and do they differ by race/ethnicity? Findings: In this cohort study of 5698 patients tested for or diagnosed with COVID-19, high population density, type 2 diabetes, and kidney disease were associated with hospitalization, in addition to older age, male sex, and obesity. Adjusting for covariates, non-Hispanic Black patients were 1.72-fold more likely to be hospitalized than non-Hispanic White patients, while no significant race differences were observed in intensive care unit admission and mortality. Meaning: These findings suggest that racial disparities existed in COVID-19 outcomes that cannot be explained after controlling for age, sex, socioeconomic status, and comorbidity score; therefore, targeted interventions to support high-risk populations are needed. This cohort study examines sociodemographic characteristics associated with coronavirus disease 2019 outcomes among Black and White patients in Michigan. Importance: Black patients are overrepresented in the number of COVID-19 infections, hospitalizations, and deaths in the US. Reasons for this disparity may be due to underlying comorbidities or sociodemographic factors that require further exploration. Objective: To systematically determine patient characteristics associated with racial/ethnic disparities in COVID-19 outcomes. Design, Setting, and Participants: This retrospective cohort study used comparative groups of patients tested or treated for COVID-19 at the University of Michigan from March 10, 2020, to April 22, 2020, with an outcome update through July 28, 2020. A group of randomly selected untested individuals were included for comparison. Examined factors included race/ethnicity, age, smoking, alcohol consumption, comorbidities, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and residential-level socioeconomic characteristics. Exposure: In-house polymerase chain reaction (PCR) tests, commercial antibody tests, nasopharynx or oropharynx PCR deployed by the Michigan Department of Health and Human Services and reverse transcription–PCR tests performed in external labs. Main Outcomes and Measures: The main outcomes were being tested for COVID-19, having test results positive for COVID-19 or being diagnosed with COVID-19, being hospitalized for COVID-19, requiring intensive care unit (ICU) admission for COVID-19, and COVID-19–related mortality (including inpatient and outpatient). Medical comorbidities were defined from the International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, codes and were aggregated into a comorbidity score. Associations with COVID-19 outcomes were examined using odds ratios (ORs). Results: Of 5698 patients tested for COVID-19 (mean [SD] age, 47.4 [20.9] years; 2167 [38.0%] men; mean [SD] BMI, 30.0 [8.0]), most were non-Hispanic White (3740 patients [65.6%]) or non-Hispanic Black (1058 patients [18.6%]). The comparison group included 7168 individuals who were not tested (mean [SD] age, 43.1 [24.1] years; 3257 [45.4%] men; mean [SD] BMI, 28.5 [7.1]). Among 1139 patients diagnosed with COVID-19, 492 (43.2%) were White and 442 (38.8%) were Black; 523 (45.9%) were hospitalized, 283 (24.7%) were admitted to the ICU, and 88 (7.7%) died. Adjusting for age, sex, socioeconomic status, and comorbidity score, Black patients were more likely to be hospitalized compared with White patients (OR, 1.72 [95% CI, 1.15-2.58]; P =.009). In addition to older age, male sex, and obesity, living in densely populated areas was associated with increased risk of hospitalization (OR, 1.10 [95% CI, 1.01-1.19]; P =.02). In the overall population, higher risk of hospitalization was also observed in patients with preexisting type 2 diabetes (OR, 1.82 [95% CI, 1.25-2.64]; P =.02) and kidney disease (OR, 2.87 [95% CI, 1.87-4.42]; P <.001). Compared with White patients, obesity was associated with higher risk of having test results positive for COVID-19 among Black patients (White: OR, 1.37 [95% CI, 1.01-1.84]; P =.04. Black: OR, 3.11 [95% CI, 1.64-5.90]; P <.001; P for interaction =.02). Having any cancer was associated with higher risk of positive COVID-19 test results for Black patients (OR, 1.82 [95% CI, 1.19-2.78]; P =.005) but not White patients (OR, 1.08 [95% CI, 0.84-1.40]; P =.53; P for interaction =.04). Overall comorbidity burden was associated with higher risk of hospitalization in White patients (OR, 1.30 [95% CI, 1.11-1.53]; P =.001) but not in Black patients (OR, 0.99 [95% CI, 0.83-1.17]; P =.88; P for interaction =.02), as was type 2 diabetes (White: OR, 2.59 [95% CI, 1.49-4.48]; P <.001; Black: OR, 1.17 [95% CI, 0.66-2.06]; P =.59; P for interaction =.046). No statistically significant racial differences were found in ICU admission and mortality based on adjusted analysis. Conclusions and Relevance: These findings suggest that preexisting type 2 diabetes or kidney diseases and living in high–population density areas were associated with higher risk for COVID-19 hospitalization. Associations of risk factors with COVID-19 outcomes differed by race.
- Subjects
ACADEMIC medical centers; BLACK people; COMPARATIVE studies; CONFIDENCE intervals; ETHNIC groups; HEALTH services accessibility; HEALTH status indicators; HOSPITAL care; LONGITUDINAL method; COVID-19 testing; EVALUATION of medical care; NASOPHARYNX; POLYMERASE chain reaction; RACE; RESEARCH funding; STATISTICAL sampling; COMORBIDITY; LOGISTIC regression analysis; SOCIOECONOMIC factors; BODY mass index; RETROSPECTIVE studies; REVERSE transcriptase polymerase chain reaction; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; COVID-19
- Publication
JAMA Network Open, 2020, Vol 3, Issue 10, pe2025197
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2020.25197