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Comparative Study
. 2021 Apr 22;11(1):8738.
doi: 10.1038/s41598-021-88308-2.

Racial disparities in COVID-19 outcomes exist despite comparable Elixhauser comorbidity indices between Blacks, Hispanics, Native Americans, and Whites

Fares Qeadan  1 , Elizabeth VanSant-Webb  2 , Benjamin Tingey  3 , Tiana N Rogers  2 , Ellen Brooks  3 , Nana A Mensah  3 , Karen M Winkfield  4   5 , Ali I Saeed  6 , Kevin English  7 , Charles R Rogers  3
Affiliations
Comparative Study

Racial disparities in COVID-19 outcomes exist despite comparable Elixhauser comorbidity indices between Blacks, Hispanics, Native Americans, and Whites

Fares Qeadan et al. Sci Rep. .

Abstract

Factors contributing to racial inequities in outcomes from coronavirus disease 2019 (COVID-19) remain poorly understood. We compared by race the risk of 4 COVID-19 health outcomes--maximum length of hospital stay (LOS), invasive ventilation, hospitalization exceeding 24 h, and death--stratified by Elixhauser comorbidity index (ECI) ranking. Outcomes and ECI scores were constructed from retrospective data obtained from the Cerner COVID-19 De-Identified Data cohort. We hypothesized that racial disparities in COVID-19 outcomes would exist despite comparable ECI scores among non-Hispanic (NH) Blacks, Hispanics, American Indians/Alaska Natives (AI/ANs), and NH Whites. Compared with NH Whites, NH Blacks had longer hospital LOS, higher rates of ventilator dependence, and a higher mortality rate; AI/ANs, higher odds of hospitalization for ECI = 0 but lower for ECI ≥ 5, longer LOS for ECI = 0, a higher risk of death across all ECI categories except ECI ≥ 5, and higher odds of ventilator dependence; Hispanics, a lower risk of death across all ECI categories except ECI = 0, lower odds of hospitalization, shorter LOS for ECI ≥ 5, and higher odds of ventilator dependence for ECI = 0 but lower for ECI = 1-4. Our findings contest arguments that higher comorbidity levels explain elevated COVID-19 death rates among NH Blacks and AI/ANs compared with Hispanics and NH Whites.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Data flow chart for the study. The final cohort size of 52,411 COVID-19 patients is stratified by ECI group.
Figure 2
Figure 2
Predicted mortality versus Elixhauser AHRQ weighted score, among COVID-19 infected patients (by race).
Figure 3
Figure 3
Predicted ventilator dependence versus Elixhauser AHRQ weighted score, among COVID-19 infected patients (by race).
See this image and copyright information in PMC

References

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