Mortality and risk factors among US Black, Hispanic, and White patients with COVID-19
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Abstract
Background
Little is known about risk factors for COVID-19 outcomes, particularly across diverse racial and ethnic populations in the United States.
Methods
In this prospective cohort study, we followed 3,086 COVID-19 patients hospitalized on or before April 13, 2020 within an academic health system in New York (The Mount Sinai Health System) until June 2, 2020. Multivariable logistic regression was used to evaluate demographic, clinical, and laboratory factors as independent predictors of in-hospital mortality. The analysis was stratified by self-reported race and ethnicity.
Findings
A total of 3,086 COVID-19 patients were hospitalized, of whom 680 were excluded (78 due to missing race or ethnicity data, 144 were Asian, and 458 were of other unspecified race/ethnicity). Of the 2,406 patients included, 892 (37.1%) were Hispanic, 825 (34.3%) were black, and 689 (28.6%) were white. Black and Hispanic patients were younger than White patients (median age 67 and 63 vs. 73, p<0.001 for both), and they had different comorbidity profiles. Older age and baseline hypoxia were associated with increased mortality across all races. There were suggestive but non-significant interactions between Black race and diabetes (p=0.09), and obesity (p=0.10). Among inflammatory markers associated with COVID-19 mortality, there was a significant interaction between Black race and interleukin-1-beta (p=0.04), and a suggestive interactions between Hispanic ethnicity and procalcitonin (p=0.07) and interleukin-8 (p=0.09).
Interpretation
In this large, racially and ethnically diverse cohort of COVID-19 patients in New York City, we identified similarities and important differences across racial and ethnic groups in risk factors for in-hospital mortality.
Funding
Icahn School of Medicine at Mount Sinai, New York, NY.
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SciScore for 10.1101/2020.09.08.20190686: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Experimental Models: Organisms/Strains Sentences Resources Self-reported race and ethnicity were classified into 3 mutually exclusive categories: Non-Hispanic White (White), Non-Hispanic Black (Black), and Hispanic (Supplemental Table 1). Non-Hispanic Whitesuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing …SciScore for 10.1101/2020.09.08.20190686: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Experimental Models: Organisms/Strains Sentences Resources Self-reported race and ethnicity were classified into 3 mutually exclusive categories: Non-Hispanic White (White), Non-Hispanic Black (Black), and Hispanic (Supplemental Table 1). Non-Hispanic Whitesuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has limitations that warrant specific mention. The dataset was derived from the electronic health record database without manual review, which may limit the completeness of comorbidity labels. Race and ethnicity were self-reported and were missing or unspecified in 17.4% of the initial cohort. The strengths of our database include its size and the inclusion of 37.1% Hispanic patients, a vulnerable population in this pandemic which, to our knowledge, has not been specifically examined in the literature to date. Additionally, our near-complete follow-up of the cohort’s hospital outcomes (99.3%) strengthens the validity of our findings. In conclusion, our analysis of a diverse cohort drawn from the New York metropolitan area highlights both similarities and important differences across racial and ethnic groups in risk factors for death among hospitalized COVID-19 patients.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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