COVID-19: RACIAL DISPARITY AND CARDIOVASCULAR COMORBIDITIES THAT PREDICT MORTALITY

Background

There have been reports of significant racial disparities in COVID-19 infection outcomes. Despite this claim, there is a relative paucity of literature regarding racial and ethnic variations. We aimed to evaluate the relative significance of race/ethnicity, socioeconomic status, and other comorbidities on COVID-19 outcomes.

Methods

This is a retrospective study of 812 confirmed COVID-19+ patients admitted to a safety-net hospital between 3/1/20 and 6/31/20. Patients were stratified by self-reported racial/ethnic groups. Median household income (MHI) was estimated from the US census bureau website based on zip codes of residence. Demographics and prevalence of comorbidities were compared using independent t-test and χ². Multivariate regression analysis was used to determine predictors of mortality.

Results

501 patients (62%) were included in the analysis. The racial breakdown was: Non-Hispanic Whites 98 (19.6%), vs. Non-Whites 403 (80.4%; Non-Hispanic Black 126 [25.1%], Hispanic 250 [49.9%], East Asian 9 [1.8%], South Asian 13 [2.6%], American Indian 1 [0.2%], and Other 4 [0.8%]). White patients were older (71.1 vs. 57.6, p <0.001), more likely to have high MHI (39.8% vs. 7.2%, p < 0.001). Non-Hispanic Whites had more comorbidities: CHF (p = 0.008), CAD (p = 0.004), A-fib (p = 0.003), and higher Charlson comorbidity index (CI; p <0.001). The two groups had similar gender, ICU admission, ventilation requirement, hypertension, diabetes, hyperlipidemia, chronic kidney disease, and CVA (all p=NS). Non-Hispanic Whites had higher death rate (36.7% vs. 26.3%, p = 0.04). After controlling for age, gender, CI, and other risk factors, there was no statistically significant difference in mortality in the two groups. Age, male gender, CI, and ventilation requirement were independent predictors of mortality irrespective of race.

Conclusion

In our sample, race/ethnicity was not an independent predictor of mortality in patients with COVID-19, after controlling for other variables including socioeconomic status. Our study further underscores the important role that safety net hospitals play in providing quality care to communities in need.