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Multicenter Study
. 2021 Oct 1;4(10):e2130479.
doi: 10.1001/jamanetworkopen.2021.30479.

Racial and Ethnic Disparities in Rates of COVID-19-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death in the United States From March 2020 to February 2021

Anna M Acosta  1 , Shikha Garg  1   2 , Huong Pham  1 , Michael Whitaker  1 , Onika Anglin  1   3 , Alissa O'Halloran  1 , Jennifer Milucky  1 , Kadam Patel  1   3 , Christopher Taylor  1 , Jonathan Wortham  1   2 , Shua J Chai  4   5 , Pam Daily Kirley  4 , Nisha B Alden  6 , Breanna Kawasaki  6 , James Meek  7 , Kimberly Yousey-Hindes  7 , Evan J Anderson  8   9   10   11 , Kyle P Openo  9   10   11 , Andrew Weigel  12 , Maya L Monroe  13 , Patricia Ryan  13 , Libby Reeg  14 , Alexander Kohrman  14 , Ruth Lynfield  15 , Erica Bye  15 , Salina Torres  16 , Yadira Salazar-Sanchez  16 , Alison Muse  17 , Grant Barney  17 , Nancy M Bennett  18 , Sophrena Bushey  18 , Laurie Billing  19 , Eli Shiltz  19 , Melissa Sutton  20 , Nasreen Abdullah  20 , H Keipp Talbot  21 , William Schaffner  21 , Jake Ortega  22 , Andrea Price  22 , Alicia M Fry  1   2 , Aron Hall  1 , Lindsay Kim  1   2 , Fiona P Havers  1   2
Affiliations
Multicenter Study

Racial and Ethnic Disparities in Rates of COVID-19-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death in the United States From March 2020 to February 2021

Anna M Acosta et al. JAMA Netw Open. .

Abstract

Importance: Racial and ethnic minority groups are disproportionately affected by COVID-19.

Objectives: To evaluate whether rates of severe COVID-19, defined as hospitalization, intensive care unit (ICU) admission, or in-hospital death, are higher among racial and ethnic minority groups compared with non-Hispanic White persons.

Design, setting, and participants: This cross-sectional study included 99 counties within 14 US states participating in the COVID-19-Associated Hospitalization Surveillance Network. Participants were persons of all ages hospitalized with COVID-19 from March 1, 2020, to February 28, 2021.

Exposures: Laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test within 14 days prior to or during hospitalization.

Main outcomes and measures: Cumulative age-adjusted rates (per 100 000 population) of hospitalization, ICU admission, and death by race and ethnicity. Rate ratios (RR) were calculated for each racial and ethnic group compared with White persons.

Results: Among 153 692 patients with COVID-19-associated hospitalizations, 143 342 (93.3%) with information on race and ethnicity were included in the analysis. Of these, 105 421 (73.5%) were 50 years or older, 72 159 (50.3%) were male, 28 762 (20.1%) were Hispanic or Latino, 2056 (1.4%) were non-Hispanic American Indian or Alaska Native, 7737 (5.4%) were non-Hispanic Asian or Pacific Islander, 40 806 (28.5%) were non-Hispanic Black, and 63 981 (44.6%) were White. Compared with White persons, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely to have higher cumulative age-adjusted rates of hospitalization, ICU admission, and death as follows: American Indian or Alaska Native (hospitalization: RR, 3.70; 95% CI, 3.54-3.87; ICU admission: RR, 6.49; 95% CI, 6.01-7.01; death: RR, 7.19; 95% CI, 6.47-7.99); Latino (hospitalization: RR, 3.06; 95% CI, 3.01-3.10; ICU admission: RR, 4.20; 95% CI, 4.08-4.33; death: RR, 3.85; 95% CI, 3.68-4.01); Black (hospitalization: RR, 2.85; 95% CI, 2.81-2.89; ICU admission: RR, 3.17; 95% CI, 3.09-3.26; death: RR, 2.58; 95% CI, 2.48-2.69); and Asian or Pacific Islander (hospitalization: RR, 1.03; 95% CI, 1.01-1.06; ICU admission: RR, 1.91; 95% CI, 1.83-1.98; death: RR, 1.64; 95% CI, 1.55-1.74).

Conclusions and relevance: In this cross-sectional analysis, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely than White persons to have a COVID-19-associated hospitalization, ICU admission, or in-hospital death during the first year of the US COVID-19 pandemic. Equitable access to COVID-19 preventive measures, including vaccination, is needed to minimize the gap in racial and ethnic disparities of severe COVID-19.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Alden reported receiving grants from CDC Emerging Infections Program outside the submitted work. Dr Anderson reported receiving personal fees from Medscape and Kentucky Bioprocessing; grants from MedImmune, Regeneron, PaxVax, GlaxoSmithKline, Merck, and Micron; and grants and personal fees from Pfizer, Sanofi Pasteur, and Janssen Pharmaceuticals outside the submitted work. Mr Weigel reported receiving grants from CDC outside the submitted work. Dr Lynfield reported serving as associate editor for the AAP Red Book outside the submitted work, with the fee donated to the Minnesota Department of Health. Ms Billing reported receiving grants from CDC outside the submitted work. Mr Shiltz reported receiving grants from CDC outside the submitted work. Dr Schaffner reported serving as a consultant to VBI Vaccines outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cumulative COVID-19–Associated Hospitalization Rates, by Age Group and Race and Ethnicity, United States, March 1, 2020, to February 28, 2021
A, Cumulative hospitalization rates were age adjusted. Data are from the COVID-19-Associated Hospitalization Surveillance Network.
Figure 2.
Figure 2.. Monthly Age-Adjusted COVID-19–Associated Hospitalization Rates and Rate Ratios, by Race and Ethnicity, United States, March 1, 2020, to February 28, 2021
All rate ratios statistically significant with P < .01 except for rate ratios among non-Hispanic Asian or Pacific Islander persons in January 2021 and February 2021. Data are from the COVID-19-Associated Hospitalization Surveillance Network.
Figure 3.
Figure 3.. Cumulative Age-Adjusted Hospitalization, Intensive Care Unit (ICU) Admission, and In-Hospital Death Rates by Race and Ethnicity, United States, March 1, 2020 to February 28, 2021
Cumulative hospitalization rates per 100 000 population were calculated using all hospitalized persons in the COVID-19–Associated Hospitalization Surveillance Network with known race and ethnicity for the numerator and National Center for Health Statistics vintage 2019 bridged-race population estimates for the denominator. ICU admission and in-hospital death status were only available for sampled hospitalized patients with known race and ethnicity, complete medical record review, and a discharge disposition; therefore, cumulative rates of ICU admission and in-hospital death per 100 000 population were calculated using weighted frequencies as the numerator and National Center for Health Statistics vintage 2019 bridged-race population estimates for the denominator.
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