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. 2021 Jul 21;16(7):e0254809.
doi: 10.1371/journal.pone.0254809. eCollection 2021.

The impact of race and ethnicity on outcomes in 19,584 adults hospitalized with COVID-19

Ann M Navar  1 , Stacey N Purinton  2 , Qingjiang Hou  2 , Robert J Taylor  2 , Eric D Peterson  1
Affiliations

The impact of race and ethnicity on outcomes in 19,584 adults hospitalized with COVID-19

Ann M Navar et al. PLoS One. .

Abstract

Introduction: At the population level, Black and Hispanic adults in the United States have increased risk of dying from COVID-19, yet whether race and ethnicity impact on risk of mortality among those hospitalized for COVID-19 is unclear.

Methods: Retrospective cohort study using data on adults hospitalized with COVID-19 from the electronic health record from 52 health systems across the United States contributing data to Cerner Real World DataTM. In-hospital mortality was evaluated by race first in unadjusted analysis then sequentially adjusting for demographics and clinical characteristics using logistic regression.

Results: Through August 2020, 19,584 patients with median age 52 years were hospitalized with COVID-19, including n = 4,215 (21.5%) Black and n = 5,761 (29.4%) Hispanic patients. Relative to white patients, crude mortality was slightly higher in Black adults [22.7% vs 20.8%, unadjusted OR 1.12 (95% CI 1.02-1.22)]. Mortality remained higher among Black adults after adjusting for demographic factors including age, sex, date, region, and insurance status (OR 1.13, 95% CI 1.01-1.27), but not after including comorbidities and body mass index (OR 1.07, 95% CI 0.93-1.23). Compared with non-Hispanic patients, Hispanic patients had lower mortality both in unadjusted and adjusted models [mortality 12.7 vs 25.0%, unadjusted OR 0.44(95% CI 0.40-0.48), fully adjusted OR 0.71 (95% CI 0.59-0.86)].

Discussion: In this large, multicenter, EHR-based analysis, Black adults hospitalized with COVID-19 had higher observed mortality than white patients due to a higher burden of comorbidities in Black adults. In contrast, Hispanic ethnicity was associated with lower mortality, even in fully adjusted models.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: Ann Marie Navar and Eric Peterson receive support for consulting to Cerner Corporation for activities outside of this work. Rob Taylor, Qingjiang Hou, and Stacey Purinton are employees of Cerner Corporation. Cerner Corporation-employed co-authors (QH, RT, SP) received salary from Cerner corporation during the time they participated on this research project. Cerner Corp. provided in-kind support for the study through their effort and through providing access to data. Cerner Corp. co-authors were a part of the study team and had roles in creating the dataset and data acquisition (RT, SP), data analysis (QH), the concept and design of the study, data interpretation, and critical revision of the manuscript (QH, RT, SP). EP and AMN receive fees for research consulting to Cerner Corporation outside of the present work. EP and AMN were not compensated for their work on this manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Association between Black race and Hispanic ethnicity and inpatient mortality.
The figure shows odds ratios and 95% confidence intervals (CI) for race (Black vs white) and ethnicity (Hispanic vs non-Hispanic) in unadjusted models (Model 0, black diamond), adjusting for demographic characteristics (Model 1, white circle), and comorbidities and body mass index (model 2, grey square).
See this image and copyright information in PMC

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