Racial and Ethnic Differences and Clinical Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) Presenting to the Emergency Department

Zanthia Wiley; Katie Ross-Driscoll; Zhensheng Wang; Laken Smothers; Aneesh K Mehta; Rachel E Patzer

doi:10.1093/cid/ciab290

Racial and Ethnic Differences and Clinical Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) Presenting to the Emergency Department

Clin Infect Dis. 2022 Feb 11;74(3):387-394. doi: 10.1093/cid/ciab290.

Authors

Zanthia Wiley¹, Katie Ross-Driscoll^{2

3}, Zhensheng Wang^{2

3}, Laken Smothers^{2

3}, Aneesh K Mehta¹, Rachel E Patzer^{2

3}

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
² Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, USA.
³ Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA.

Abstract

Background: Since the introduction of remdesivir and dexamethasone for severe COVID-19 treatment, few large multi-hospital-system US studies have described clinical characteristics and outcomes of minority COVID-19 patients who present to the emergency department (ED).

Methods: This cohort study from the Cerner Real World Database (87 US health systems) from 1 December 2019 to 30 September 2020 included PCR-confirmed COVID-19 patients who self-identified as non-Hispanic Black (Black), Hispanic White (Hispanic), or non-Hispanic White (White). The main outcome was hospitalization among ED patients. Secondary outcomes included mechanical ventilation, intensive care unit care, and in-hospital mortality. Descriptive statistics and Poisson regression compared sociodemographics, comorbidities, receipt of remdesivir or dexamethasone, and outcomes by racial/ethnic groups and geographic region.

Results: 94 683 COVID-19 patients presented to the ED. Blacks comprised 26.7% and Hispanics 33.6%. Nearly half (45.1%) of ED patients presented to hospitals in the South. 31.4% (n = 29 687) were hospitalized. Lower proportions of Blacks were prescribed dexamethasone (29.4%; n = 7426) compared with Hispanics (40.9%; n = 13 021) and Whites (37.5%; n = 14 088). Hospitalization risks, compared with Whites, were similar in Blacks (RR: .94; 95% CI: .82-1.08; P = .4) and Hispanics (.99; .81-1.21; P = .91), but risk of in-hospital mortality was higher in Blacks (1.18; 1.06-1.31; P = .002) and Hispanics (1.28; 1.13-1.44; P < .001).

Conclusions: Minority patients were overrepresented among COVID-19 ED patients, and while their risks of hospitalization were similar to Whites, in-hospital mortality risk was higher. Interventions targeting upstream social determinants of health are needed to reduce racial/ethnic disparities in COVID-19.

Keywords: COVID-19; disparities; emergency department; ethnicity; race.

MeSH terms

COVID-19 Drug Treatment*
Cohort Studies
Emergency Service, Hospital
Humans
SARS-CoV-2

Abstract

MeSH terms

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