Disparities in outcomes of COVID-19 hospitalizations in native American individuals

Abstract

Objectives: This study aimed to investigate COVID-19-related disparities in clinical presentation and patient outcomes in hospitalized Native American individuals.

Methods: The study was performed within 30 hospitals of the Banner Health system in the Southwest United States and included 8,083 adult patients who tested positive for SARS-CoV-2 infection and were hospitalized between 1 March 2020 and 4 September 2020. Bivariate and multivariate analyses were used to assess racial and ethnic differences in clinical presentation and patient outcomes.

Results: COVID-19-related hospitalizations in Native American individuals were over-represented compared with non-Hispanic white individuals. Native American individuals had fewer symptoms at admission; greater prevalence of chronic lung disease in the older adult; two times greater risk for ICU admission despite being younger; and 20 times more rapid clinical deterioration warranting ICU admission. Compared with non-Hispanic white individuals, Native American individuals had a greater prevalence of sepsis, were more likely to require invasive mechanical ventilation, had a longer length of stay, and had higher in-hospital mortality.

Conclusion: Native American individuals manifested greater case-fatality rates following hospitalization than other races/ethnicities. Atypical symptom presentation of COVID-19 included a greater prevalence of chronic lung disease and a more rapid clinical deterioration, which may be responsible for the observed higher hospital mortality, thereby underscoring the role of pulmonologists in addressing such disparities.

Keywords: ARDS; COVID-19; Native American; mortality; racial disparities.

Figure 1

Distributions of clinical outcomes of COVID-19 by age and race in hospitalized population. LOS was examined in live inpatients; A, Native American; B, Black and African American; H, Hispanic; O, Others; W, White. (A) Mortality by Age and Race. (B) ICU admission by Age and Race. (C) Ventilation by Age and Race. (D) Sepis by Age and Race. (E) Admission through ED by Age and Race. (F) LOS by Age and Race.