Findings argue against biologic cause for racial disparities

Black race was not found to be a contributing factor in mortality among patients hospitalized for Covid-19 after controlling for sociodemographic factors in a newly reported retrospective, cohort analysis.

Researchers tracked deaths among more than 11,000 patients hospitalized for Covid-19 at 92 hospitals in 12 states, finding no statistically significant difference in mortality risk between Black and White patients after adjusting for age, sex, insurance, comorbidities, neighborhood deprivation and site of care (hazard ratio, 0.93; 95% CI, 0.80-1.09).

Black patients did have a higher prevalence of comorbid conditions and they were more likely to have Medicaid insurance and live in economically disadvantaged neighborhoods, and they had a higher risk for death in the unadjusted analysis.

As other studies have shown, older age and male sex were significantly associated with a greater risk for death among the patients hospitalized for Covid-19, wrote researcher Baligh Yehia, MD, of Ascension Health, St. Louis, Missouri, and colleagues, in the August 18 issue of JAMA Network Open.

All-cause, in-hospital mortality was 20.3% among the patients in the study, and 38.1% among those who received mechanical ventilation.

The researchers noted that several previous studies – including one from a Louisiana health system and one from Georgia (metropolitan Atlanta and southern Georgia) – have also shown no difference in mortality by race among patients hospitalized with Covid-19.

“Taken together, these findings suggest that while Black U.S. residents may be at higher risk of contracting Covid-19 and represent a disproportionate share of Covid-19 death, mortality for those able to access hospital care does not differ from white patients,” they wrote.

Of the 11,210 patients with confirmed Covid-19 presenting to hospitals, 4,180 (37.3%) were Black and 5,583 (49.8%) were men. The median age was 61 years (range, 46 to 74).

Compared to white patients, Black patients were younger (median [interquartile range] age, 66 [50 to 80] years versus 61 [46 to 72] years), were more likely to be women (2,259 [49.0%] versus 2,293 [54.9%]), were more likely to have Medicaid insurance (611 [13.3%] versus 1,031 [24.7%]), and had higher median (interquartile range) scores on the Neighborhood Deprivation Index (−0.11 [−0.70 to 0.56] versus 0.82 [0.08 to 1.76]) and the Elixhauser Comorbidity Index (21 [0 to 44] versus 22 [0 to 46]).

Among the main study findings:

  • All-cause in-hospital mortality among hospitalized white and Black patients was 23.1% (724 of 3,218) and 19.2% (540 of 2,812), respectively.
  • Among patients with an ICU stay, 36.4% of white patients (477 of 1,312) and 35.2% of Black patients (388 of 1,102) died.
  • Among patients receiving mechanical ventilation, 39.0% of patients (415 of 1064) and 38.2% of Black patients (335 of 877) died.
  • In the final adjusted modelling, older age was associated with greater mortality; ≥85 years, aged 65 to 84 years, and aged 50 to 64 years had 3.96 (95% CI, 2.82-5.55), 2.38 (95%CI, 1.73-3.26), and 1.36 (95%CI, 1.11-1.67), respectively, greater risk for death compared with those aged 18 to 49 years.

Male patients had 1.23 (95% CI 1.11-1.36) times the risk of death compared with female patients, and patients with Medicare insurance (HR, 1.47; 95% CI, 1.08-2.00) and patients whose insurance coverage was unknown (HR, 2.17; 95% CI, 1.32-3.57) had higher risk of mortality than those with commercial insurance.

Having chronic kidney disease or coronary artery disease was also linked to a greater risk for death.

In an editorial published with the study, Duke University professor of medicine and researcher L. Ebony Boulware, MD, wrote that Covid-19 “is another unwelcome addition to the long list of health conditions that disproportionately affect Black and Brown lives in the United States.”

Much of Boulware’s research has focused on racial disparities in healthcare, with an emphasis on organ donation.

She wrote that if the study findings are not due to residual confounding, which is a possibility with any observational study, they suggest that sociodemographic and not biologic differences between the Black and white patients hospitalized for Covid-19 accounted for the worse pre-adjustment outcomes among Blacks.

The absence of a racial difference in mortality among patients treated in hospitals “provides an argument against potentially misguided calls for new studies to identify and target as-yet unrecognized race-based biological differences as explanations for Covid-19 disparities,” she wrote.

“Rather, it strongly supports an argument for eliminating disparities through policies designed to improve the social and environmental conditions leading to poor health and to ensure that Black U.S. residents and others have equitable access to health care.”

She noted that the argument is increasingly relevant “as reports emerge that millions of individuals at risk of Covid-19 have recently lost their health insurance because of pandemic-related unemployment, with the risk of potentially worsening Covid-19 and other health disparities through a lack of access to health care.”

  1. Black race was not found to be a contributing factor in mortality among patients hospitalized for Covid-19 after controlling for sociodemographic factors.
  2. The retrospective cohort study involving more than 11,000 patients hospitalized with Covid-19 showed no statistically significant difference in mortality risk between Black and white patients after adjusting for age, sex, insurance, comorbidities, neighborhood deprivation and site of care.

Salynn Boyles, Contributing Writer, BreakingMED™

The researchers reported no funding source and no conflicts of interest related to this study.

Editorial author L. Ebony Boulware had no relevant disclosures.

 

Cat ID: 190

Topic ID: 79,190,254,930,585,728,791,932,730,933,190,926,192,927,151,928,925,934