How Do Presenting Symptoms and Outcomes Differ by Race/Ethnicity Among Hospitalized Patients with COVID-19 Infection? Experience in Massachusetts

Clin Infect Dis. 2020 Aug 22;ciaa1245. doi: 10.1093/cid/ciaa1245. Online ahead of print.

Abstract

Background: Population-based literature suggest SARS-CoV-2 infection may disproportionately affect racial/ethnic minorities; however, patient-level observations of hospitalization outcomes by race/ethnicity are limited. The aim of this study was to characterize COVID-19-associated morbidity and in-hospital mortality by race/ethnicity.

Methods: This was a retrospective analysis of nine 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. Students t-test, Fischer exact test, and multivariable regression analyses were performed.

Results: 379 patients (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 have obesity, more frequently reported fever and myalgia, and had lower D-dimer levels compared to White patients (p&0.05). On multivariable analysis controlling for age, gender, obesity, cardiopulmonary comorbidities, hypertension, and diabetes, no significant differences in in-hospital mortality, ICU admission, or mechanical ventilation by race/ethnicity were found. Diabetes was a significant predictor for mechanical ventilation (OR 1.89; 95% 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 multi-center 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.

Keywords: Coronavirus disease 2019 (COVID-19); Healthcare Disparities; Race/Ethnicity; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).