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. 2022 Mar 1;5(3):e224304.
doi: 10.1001/jamanetworkopen.2022.4304.

Racial Disparities in COVID-19 Outcomes Among Black and White Patients With Cancer

Julie Fu  1 , Sonya A Reid  2   3 , Benjamin French  4 , Cassandra Hennessy  4 , Clara Hwang  5 , Na Tosha Gatson  6   7 , Narjust Duma  8 , Sanjay Mishra  3 , Ryan Nguyen  9 , Jessica E Hawley  10   11 , Sunny R K Singh  5 , David D Chism  12 , Neeta K Venepalli  13 , Jeremy L Warner  2   3   14 , Toni K Choueiri  8 , Andrew L Schmidt  8 , Leslie A Fecher  15 , Jennifer E Girard  15 , Mehmet A Bilen  16 , Deepak Ravindranathan  16 , Sharad Goyal  17 , Trisha M Wise-Draper  18 , Cathleen Park  19 , Corrie A Painter  20 , Sheila M McGlown  21 , Gilberto de Lima Lopes Jr  22 , Oscar K Serrano  23 , Dimpy P Shah  24 ; COVID-19 and Cancer Consortium (CCC19)
Collaborators, Affiliations

Racial Disparities in COVID-19 Outcomes Among Black and White Patients With Cancer

Julie Fu et al. JAMA Netw Open. .

Erratum in

  • Error in Supplement 2.
    [No authors listed] [No authors listed] JAMA Netw Open. 2022 Jun 1;5(6):e2217952. doi: 10.1001/jamanetworkopen.2022.17952. JAMA Netw Open. 2022. PMID: 35648408 Free PMC article. No abstract available.

Abstract

Importance: Non-Hispanic Black individuals experience a higher burden of COVID-19 than the general population; hence, there is an urgent need to characterize the unique clinical course and outcomes of COVID-19 in Black patients with cancer.

Objective: To investigate racial disparities in severity of COVID-19 presentation, clinical complications, and outcomes between Black patients and non-Hispanic White patients with cancer and COVID-19.

Design, setting, and participants: This retrospective cohort study used data from the COVID-19 and Cancer Consortium registry from March 17, 2020, to November 18, 2020, to examine the clinical characteristics and outcomes of COVID-19 in Black patients with cancer. Data analysis was performed from December 2020 to February 2021.

Exposures: Black and White race recorded in patient's electronic health record.

Main outcomes and measures: An a priori 5-level ordinal scale including hospitalization intensive care unit admission, mechanical ventilation, and all-cause death.

Results: Among 3506 included patients (1768 women [50%]; median [IQR] age, 67 [58-77] years), 1068 (30%) were Black and 2438 (70%) were White. Black patients had higher rates of preexisting comorbidities compared with White patients, including obesity (480 Black patients [45%] vs 925 White patients [38%]), diabetes (411 Black patients [38%] vs 574 White patients [24%]), and kidney disease (248 Black patients [23%] vs 392 White patients [16%]). Despite the similar distribution of cancer type, cancer status, and anticancer therapy at the time of COVID-19 diagnosis, Black patients presented with worse illness and had significantly worse COVID-19 severity (unweighted odds ratio, 1.34 [95% CI, 1.15-1.58]; weighted odds ratio, 1.21 [95% CI, 1.11-1.33]).

Conclusions and relevance: These findings suggest that Black patients with cancer experience worse COVID-19 outcomes compared with White patients. Understanding and addressing racial inequities within the causal framework of structural racism is essential to reduce the disproportionate burden of diseases, such as COVID-19 and cancer, in Black patients.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Reid reported receiving personal fees from Novartis outside the submitted work. Dr Hwang reported receiving personal fees from EMD Sorono, Genentech, Dendreon, and Bristol-Myers-Squibb; grants from Merck, AstraZeneca, and Bayer outside the submitted work; and stock holdings in Johnson and Johnson. Dr Gatson reported serving as advisory board consultant for Novocure outside the submitted work. Dr Duma reported receiving personal fees from Pfizer, AstraZeneca, Merck, Janssen, Neogenomics, Bristol-Myers-Squibb, and Genentech outside the submitted work. Dr Mishra reported receiving grants to his institution from National Cancer Institute, American Association for Cancer Research, and Lung Ambition Alliance during the conduct of the study and personal fees from National Geographic for writing articles outside the submitted work. Dr Nguyen reported receiving personal fees from Promega outside the submitted work. Dr Hawley reported receiving grants from the National Institutes of Health and the Prostate Cancer Foundation, personal fees from Seagen, nonfinancial support (biospecimen sharing) from Dendreon Reagents, and clinical trial support from Regeneron outside the submitted work. Dr Warner reported receiving grants from the National Institutes of Health, National Cancer Institute, and American Association for Cancer Research during the conduct of the study; receiving personal fees from Westat, Roche, Melax Tech, and Flatiron Health; and being an owner of HemOnc.org, LLC, outside the submitted work. Dr Choueiri reported being a member of CCC19 and European Society for Medical Oncology (ESMO)–CoCare during the conduct of the study; receiving personal fees from Pfizer, Exelixis, Merck, Roche, EMD Serono, Eisai, and Bristol-Myers-Squibb; receiving royalties from UpToDate outside the submitted work; and serving on the Genitourinary Steering Committees of the National Cancer Institute, National Comprehensive Cancer Network, ESMO, and American Society for Clinical Oncology. Dr Fecher reported receiving grants from Bristol-Myers-Squibb, Kartos, Array, ECOG-ACRIN, Pfizer, and EMD Serono and personal fees from Elsevier outside the submitted work. Dr Bilen reported personal fees from Exelixis, Bayer, Bristol-Myers-Squibb, Eisai, Pfizer, AstraZeneca, Janssen, Calithera Biosciences, Genomic Health, Nektar, EMD Serono, SeaGen, and Sanofi; and grants from Merck, Xencor, Bayer, Bristol-Myers-Squibb, Genentech/Roche, SeaGen, Incyte, Nektar, AstraZeneca, Tricon Pharmaceuticals, Genome & Company, Advanced Accelerator Applications, Peloton Therapeutics, and Pfizer outside the submitted work. Dr Wise-Draper reported receiving grants from Merck, Bristol-Myers-Squibb, Janssen, Tesaro/GlaxoSmithKline, AstraZeneca, and Isoray; and personal fees from Shattuck Labs, Rakuten, Merck, and Exicure outside the submitted work. Dr Painter reported receiving personal fees from Nuscan and One Health outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Adjusted Associations of Key Risk Factors With COVID-19 Severity and 30-Day All-Cause Mortality Stratified by Race and Ethnicity
Data are shown for 3506 patients. Odds ratios (ORs) greater than 1 indicate higher COVID-19 severity or higher odds of 30-day all-cause mortality. ORs were adjusted for age (linear and quadratic terms), sex, region of patient residence, smoking status, obesity, cardiovascular and pulmonary comorbidities, kidney disease, diabetes, type of malignant neoplasm, Eastern Cooperative Oncology Group performance status, cancer status, timing and modality of anticancer therapy, and month of COVID-19 diagnosis. The contrast for cancer status is active and progressing cancer status vs remission or no evidence of disease; there was no evidence of effect modification for other categories (ie, active and responding, active and stable, unknown).
See this image and copyright information in PMC

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