Racial Disparities in Incidence and Outcomes Among Patients With COVID-19. JAMA Netw Open 2020 Sep 01;3(9):e2021892
Date
09/26/2020Pubmed ID
32975575Pubmed Central ID
PMC7519420DOI
10.1001/jamanetworkopen.2020.21892Scopus ID
2-s2.0-85091807867 (requires institutional sign-in at Scopus site) 259 CitationsAbstract
IMPORTANCE: Initial public health data show that Black race may be a risk factor for worse outcomes of coronavirus disease 2019 (COVID-19).
OBJECTIVE: To characterize the association of race with incidence and outcomes of COVID-19, while controlling for age, sex, socioeconomic status, and comorbidities.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 2595 consecutive adults tested for COVID-19 from March 12 to March 31, 2020, at Froedtert Health and Medical College of Wisconsin (Milwaukee), the largest academic system in Wisconsin, with 879 inpatient beds (of which 128 are intensive care unit beds).
EXPOSURES: Race (Black vs White, Native Hawaiian or Pacific Islander, Native American or Alaska Native, Asian, or unknown).
MAIN OUTCOMES AND MEASURES: Main outcomes included COVID-19 positivity, hospitalization, intensive care unit admission, mechanical ventilation, and death. Additional independent variables measured and tested included socioeconomic status, sex, and comorbidities. Reverse transcription polymerase chain reaction assay was used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
RESULTS: A total of 2595 patients were included. The mean (SD) age was 53.8 (17.5) years, 978 (37.7%) were men, and 785 (30.2%) were African American patients. Of the 369 patients (14.2%) who tested positive for COVID-19, 170 (46.1%) were men, 148 (40.1%) were aged 60 years or older, and 218 (59.1%) were African American individuals. Positive tests were associated with Black race (odds ratio [OR], 5.37; 95% CI, 3.94-7.29; P = .001), male sex (OR, 1.55; 95% CI, 1.21-2.00; P = .001), and age 60 years or older (OR, 2.04; 95% CI, 1.53-2.73; P = .001). Zip code of residence explained 79% of the overall variance in COVID-19 positivity in the cohort (ρ = 0.79; 95% CI, 0.58-0.91). Adjusting for zip code of residence, Black race (OR, 1.85; 95% CI, 1.00-3.65; P = .04) and poverty (OR, 3.84; 95% CI, 1.20-12.30; P = .02) were associated with hospitalization. Poverty (OR, 3.58; 95% CI, 1.08-11.80; P = .04) but not Black race (OR, 1.52; 95% CI, 0.75-3.07; P = .24) was associated with intensive care unit admission. Overall, 20 (17.2%) deaths associated with COVID-19 were reported. Shortness of breath at presentation (OR, 10.67; 95% CI, 1.52-25.54; P = .02), higher body mass index (OR per unit of body mass index, 1.19; 95% CI, 1.05-1.35; P = .006), and age 60 years or older (OR, 22.79; 95% CI, 3.38-53.81; P = .001) were associated with an increased likelihood of death.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study of adults tested for COVID-19 in a large midwestern academic health system, COVID-19 positivity was associated with Black race. Among patients with COVID-19, both race and poverty were associated with higher risk of hospitalization, but only poverty was associated with higher risk of intensive care unit admission. These findings can be helpful in targeting mitigation strategies for racial disparities in the incidence and outcomes of COVID-19.
Author List
Muñoz-Price LS, Nattinger AB, Rivera F, Hanson R, Gmehlin CG, Perez A, Singh S, Buchan BW, Ledeboer NA, Pezzin LEAuthors
Blake W. Buchan PhD Professor in the Pathology department at Medical College of WisconsinNathan A. Ledeboer PhD Vice Chair, Professor in the Pathology department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Betacoronavirus
Body Mass Index
Cohort Studies
Comorbidity
Coronavirus Infections
Cross-Sectional Studies
Dyspnea
Female
Health Status Disparities
Hospitalization
Humans
Incidence
Intensive Care Units
Male
Middle Aged
Minority Groups
Odds Ratio
Pandemics
Pneumonia, Viral
Poverty
Respiration, Artificial
Wisconsin
