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Multicenter Study
. 2021 Dec 6;73(11):e4131-e4138.
doi: 10.1093/cid/ciaa1245.

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

Thomas R McCarty  1   2   3 , Kelly E Hathorn  1   2   3 , Walker D Redd  2   3 , Nicolette J Rodriguez  1   2   3 , Joyce C Zhou  3 , Ahmad Najdat Bazarbashi  1   2   3 , Cheikh Njie  2   3 , Danny Wong  2   3 , Quoc-Dien Trinh  3   4 , Lin Shen  1   2   3 , Valerie E Stone  2   3   5   6 , Walter W Chan  1   2   3
Affiliations
Multicenter Study

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

Thomas R McCarty et al. Clin Infect Dis. .

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.

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

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Figures

Figure 1.
Figure 1.
Hospitalization outcomes of patients with COVID-19 infection by race/ethnicity. A, ICU admission rate and need for mechanical ventilation. B, All-cause, in-hospital mortality rate. Abbreviations: COVID-19, coronavirus disease 2019; ICU, intensive care unit.
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References

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