Disparities in COVID-19 hospitalizations and mortality among black and Hispanic patients: cross-sectional analysis from the greater Houston metropolitan area

  1. Alan P. Pan
  2. Osman Khan
  3. Jennifer R. Meeks
  4. Marc L. Boom
  5. Faisal N. Masud
  6. Julia D. Andrieni
  7. Robert A. Phillips
  8. Yordanos M. Tiruneh
  9. Bita A. Kash
  10. Farhaan S. Vahidy

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Abstract

Background

Disparate racial/ethnic burdens of the Coronavirus Disease 2019 (COVID-19) pandemic may be attributable to higher susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or to factors such as differences in hospitalization and care provision.

Methods

In our cross-sectional analysis of lab-confirmed COVID-19 cases from a tertiary, eight-hospital healthcare system across greater Houston, multivariable logistic regression models were fitted to evaluate hospitalization and mortality odds for non-Hispanic Blacks (NHBs) vs. non-Hispanic Whites (NHWs) and Hispanics vs. non-Hispanics.

Results

Between March 3rd and July 18th, 2020, 70,496 individuals were tested for SARS-CoV-2; 12,084 (17.1%) tested positive, of whom 3536 (29.3%) were hospitalized. Among positive cases, NHBs and Hispanics were significantly younger than NHWs and Hispanics, respectively (mean age NHBs vs. NHWs: 46.0 vs. 51.7 years; p  < 0.001 and Hispanic vs. non-Hispanic: 44.0 vs. 48.7 years; p  < 0.001). Despite younger age, NHBs (vs. NHWs) had a higher prevalence of diabetes (25.2% vs. 17.6%; p  < 0.001), hypertension (47.7% vs. 43.1%; p  < 0.001), and chronic kidney disease (5.0% vs. 3.3%; p  = 0.001). Both minority groups resided in lower median income (median income [USD]; NHBs vs. NHWs: 63,489 vs. 75,793; p  < 0.001, Hispanic vs. non-Hispanic: 59,104 vs. 68,318; p  < 0.001) and higher population density areas (median population density [per square mile]; NHBs vs. NHWs: 3257 vs. 2742; p  < 0.001, Hispanic vs. non-Hispanic: 3381 vs. 2884; p  < 0.001). In fully adjusted models, NHBs (vs. NHWs) and Hispanics (vs. non-Hispanic) had higher likelihoods of hospitalization, aOR (95% CI): 1.42 (1.24–1.63) and 1.61 (1.46–1.78), respectively. No differences were observed in intensive care unit (ICU) utilization or treatment parameters. Models adjusted for demographics, vital signs, laboratory parameters, hospital complications, and ICU admission vital signs demonstrated non-significantly lower likelihoods of in-hospital mortality among NHBs and Hispanic patients, aOR (95% CI): 0.65 (0.40–1.03) and 0.89 (0.59–1.31), respectively.

Conclusions

Our data did not demonstrate racial and ethnic differences in care provision and hospital outcomes. Higher susceptibility of racial and ethnic minorities to SARS-CoV-2 and subsequent hospitalization may be driven primarily by social determinants.

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  1. Version published to 10.1186/s12889-021-11431-2
  2. ScreenIT

    SciScore for 10.1101/2020.08.19.20177956: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results 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:
    Limitations of our study include use of data from a single healthcare system across the greater Houston area. Although HM serves patient populations in communities located beyond the metropolitan area, hospital data may not be representative of a generalized population. The findings from our data need to be replicated across large and diverse healthcare systems and evaluated in light of specific demographic contexts in the region. Additionally, given the observational nature of our study, all estimates are associative and do not imply causation. In particular, we did not perform adjusted analyses for factors associated with hospitalization or mortality, as that was not the focus of this study. Any association observed in our bivariable analysis of factors related to morality or hospitalization would warrant separate validation analyses to be of interpretational value. Median household income and population density were included as approximations of socioeconomic and social distancing challenges; however, the true effects are undoubtedly more complex and multifactorial in nature.18,19 Future analyses should employ additional population measures to account for social determinants of health.

    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.

    About SciScore

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  3. Version published to 10.1101/2020.08.19.20177956v1 on medRxiv