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Hospitalization and Mortality among Black Patients and White Patients with COVID-19

Our take —

Existing research on racial and ethnic differences in COVID-19 outcomes is lacking. Though black patients make up only 31% of established patients at Ochsner Health, they comprised 70.4% of COVID-19 diagnoses, and 76.9% of all hospital admissions. However, black patients did not have an increased risk of mortality. The study highlights notable racial differences in clinical presentation, conceivably due to systematic differences in the lived experiences of African-Americans, leading to delays in care and higher prevalence of chronic conditions, but more research in this area is needed.

Study design

Retrospective Cohort

Study population and setting

This retrospective medical-record based cohort study includes 3481 patients (1030 white non-Hispanic; 2450 black non-Hispanic) who tested positive for SARS-CoV-2 on polymerase chain reaction assay at an Ochsner Health facility in New Orleans, LA between March 1 and April 11, 2020 (follow-up through May 7, 2020). Patients self-reported race and ethnic group. Those who were Hispanic, Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Highlander, or who did not have a recorded race or ethnic group were excluded (n=145). The study characterized clinical presentation, hospital course, and disease outcomes among black non-Hispanic and white non-Hispanic patients with laboratory confirmed COVID-19.

Summary of Main Findings

Most of the patients included (n=2450, 70.4%) were black non-Hispanic, whereas, among 522,679 patients who received care at Ochsner Health and in the previous 12 months, only 31% identified as black non-Hispanic. Black patients were more likely than white patients to have Medicaid insurance, live in a low-income area, and more often presented with a higher prevalence of chronic comorbidities, fever, cough, or dyspnea. Compared to white patients, black patients presented with higher levels of creatinine, aspartate aminotransferase, and inflammatory markers, but had lower white cell, lymphocyte, and platelet counts. In unadjusted and adjusted analyses, black patients were more likely to be hospitalized than white patients (35.7% vs. 29.5%), but black race was not associated with mortality (unadjusted case-fatality rates 21.6% and 30.1% for black patients and white patients, respectively).

Study Strengths

This was a decently sized study at a large and integrated medical system in New Orleans, LA. Data on numerous clinical and laboratory characteristics were extracted from the medical record. Multiple imputation was used to impute missing data for BMI (n=683), venous lactate (n=268), C-reactive protein (n=287), procalcitonin (n=305), and lymphocyte (n=32). Unadjusted and adjusted analyses are consistent across several adjustment sets, indicating the robustness of results.

Limitations

The analysis was limited to one integrated-delivery health system in Louisiana and based on data available in the medical record, which is subject to data entry errors and missing data. Results may not generalize beyond the healthcare system.

Value added

This study presents a comprehensive comparison of clinical presentation and disease course between black non-Hispanic patients and white non-Hispanic patients in a major U.S. city.