How Do Presenting Symptoms and Outcomes Differ by Race/Ethnicity among Hospitalized Patients with Coronavirus Disease 2019 Infection? Experience in Massachusetts

Thomas R. McCarty, Kelly E. Hathorn, Walker D. Redd, Nicolette J. Rodriguez, Joyce C. Zhou, Ahmad Najdat Bazarbashi, Cheikh Njie, Danny Wong, Quoc Dien Trinh, Lin Shen, Valerie E. Stone, Walter W. Chan

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: Population-based literature suggests severe acute respiratory syndrome coronavirus 2 infection may disproportionately affect racial/ethnic minorities; however, patient-level observations of hospitalization outcomes by race/ethnicity are limited. Our aim in this study was to characterize coronavirus disease 2019 (COVID-19)-Associated morbidity and in-hospital mortality by race/ethnicity. Methods: This was a retrospective analysis of 9 Massachusetts hospitals including all consecutive adult patients hospitalized with laboratory-confirmed COVID-19. Measured outcomes were assessed and compared by patient-reported race/ethnicity, classified as white, black, Latinx, Asian, or other. Student t test, Fischer exact test, and multivariable regression analyses were performed. Results: A total of 379 patients (aged 62.9 ± 16.5 years; 55.7% men) with confirmed COVID-19 were included (49.9% white, 13.7% black, 29.8% Latinx, 3.7% Asian), of which 376 (99.2%) were insured (34.3% private, 41.2% public, 23.8% public with supplement). Latinx patients were younger, had fewer cardiopulmonary disorders, were more likely to be obese, more frequently reported fever and myalgia, and had lower D-dimer levels compared with white patients (P <. 05). On multivariable analysis controlling for age, gender, obesity, cardiopulmonary comorbidities, hypertension, and diabetes, no significant differences in in-hospital mortality, intensive care unit admission, or mechanical ventilation by race/ethnicity were found. Diabetes was a significant predictor for mechanical ventilation (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.11-3.23), while older age was a predictor of in-hospital mortality (OR, 4.18; 95% CI, 1.94-9.04). Conclusions: In this multicenter cohort of hospitalized COVID-19 patients in the largest health system in Massachusetts, there was no association between race/ethnicity and clinically relevant hospitalization outcomes, including in-hospital mortality, after controlling for key demographic/clinical characteristics. These findings serve to refute suggestions that certain races/ethnicities may be biologically predisposed to poorer COVID-19 outcomes.

Original languageEnglish
Pages (from-to)E4131-E4138
JournalClinical Infectious Diseases
Volume73
Issue number11
DOIs
StatePublished - Dec 1 2021

Keywords

  • coronavirus disease 2019 (COVID-19)
  • healthcare disparities
  • race/ethnicity
  • severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

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