Risk Factors for In-hospital Mortality from COVID-19 Infection among Black Patients – An Urban Center Experience

Abstract

Background

Racial disparities are central in the national conversation about Covid-19. Black/African Americans are contracting and dying from COVID-19 disproportionately. We assessed risk factors for death from COVID-19 among black inpatients at an urban center in Detroit, MI.

Methods

This was a retrospective, single-center cohort study. We reviewed the electronic medical records of patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes COVID-19) on qualitative polymerase-chain-reaction assay, who were admitted between 3/8-5/6/2020. The primary outcome was in-hospital mortality.

Results

The case fatality rate was 29.1% (122/419). The mean duration of symptoms prior to hospitalization was 5.3 (3.9) days. Patients who died were older (mean [SD] age, 68.7 [14.8] years vs 60.3 [16.0] years; p <0.0001), had dementia (35 [28.7%] vs 34 [11.4%]; p <0.0001), hemiplegia (14 [11.5%] vs 12 [4.0%]; p=0.004), malignancy (11 [9.0%] vs 12 [4.0%]; p=0.04), and moderate-severe liver disease (4 [3.3%] vs 1 [0.3%]; p=0.01). The incidence of AMS on presentation was higher among patients who died than those who survived, 43% vs. 20.0%, respectively (p<0.0001). From multivariable analysis, the odds of death increased with age (≥60 yrs.), admission from a nursing facility, Charlson score, altered mental status, higher C-reactive protein on admission, need for mechanical ventilation, presence of shock, and acute respiratory distress syndrome.

Conclusions

These demographic, clinical and laboratory factors should help healthcare providers identify black patients at highest risk for severe COVID-19-associated outcomes. Early and aggressive interventions among this at-risk population can help mitigate adverse outcomes.