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. 2021 Sep:39:101075.
doi: 10.1016/j.eclinm.2021.101075. Epub 2021 Sep 3.

Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database

Ami R Buikema  1 , Paul Buzinec  1 , Misti L Paudel  1 , Katherine Andrade  1 , Jonathan C Johnson  1 , Yvette M Edmonds  1 , Sumit K Jhamb  2 , Benjamin Chastek  1 , Harish Raja  3 , Feng Cao  1 , Erin M Hulbert  1 , Stephanie Korrer  1 , Dibyajyoti Mazumder  2 , Jerry Seare  1 , Brian K Solow  4 , U Michael Currie  5
Affiliations

Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database

Ami R Buikema et al. EClinicalMedicine. 2021 Sep.

Abstract

Background: Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19.

Methods: This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression.

Findings: Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620-1·763; Black: 1·810, 1·743-1·880; Asian: 1·503, 1·381-1·636) and during follow-up (Hispanic: 1·700, 1·638-1·764; Black: 1·578, 1·526-1·633; Asian: 1·391, 1·288-1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809-0·959) but higher for Asian patients (1·205, 1·000-1·452).

Interpretation: Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19-related care, further analyses of disaggregated population-level COVID-19 data are needed.

Keywords: COVID-19; Electronic Health Records; Ethnic Groups; Minority Groups; Retrospective Studies; SARS-CoV-2; United States.

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Conflict of interest statement

Ami Buikema, Paul Buzinec, Katherine Andrade, Jonathan Johnson, Yvette Edmonds, Sumit Jhamb, Benjamin Chastek, Harish Raja, Feng Cao, Erin Hulbert, Stephanie Korrer, Dibyajyoti Mazumder, Jerry Seare, and Brian Solow report that they are employees of Optum, which provided access to the data used in this research. Misti Paudel reports that she was an employee of Optum at the time this study was conducted. U. Michael Currie reports that he is an employee of UnitedHealth Group.

Figures

Fig 1
Fig. 1
Evidence of racial and ethnic disparities among patients with confirmed COVID-19. In each panel, p < 0.001 for difference across racial/ethnic groups. ED, emergency department. A, Distribution of index encounter site. Percentages may not sum to 100.0% because of rounding. B, Follow-up all-cause hospitalization. Error bars represent 95% CIs. C, Follow-up all-cause mortality. Error bars represent 95% CIs.
See this image and copyright information in PMC

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