Massachusetts general hospital Covid-19 registry reveals two distinct populations of hospitalized patients by race and ethnicity

  1. Ingrid V. Bassett
  2. Virginia A. Triant
  3. Bridget A. Bunda
  4. Caitlin A. Selvaggi
  5. Daniel J. Shinnick
  6. Wei He
  7. Frances Lu
  8. Bianca C. Porneala
  9. Tingyi Cao
  10. Steven A. Lubitz
  11. James B. Meigs
  12. John Hsu
  13. Andrea S. Foulkes

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Abstract

To evaluate differences by race/ethnicity in clinical characteristics and outcomes among hospitalized patients with Covid-19 at Massachusetts General Hospital (MGH).

Methods

The MGH Covid-19 Registry includes confirmed SARS-CoV-2-infected patients hospitalized at MGH and is based on manual chart reviews and data extraction from electronic health records (EHRs). We evaluated differences between White/Non-Hispanic and Hispanic patients in demographics, complications and 14-day outcomes among the N = 866 patients hospitalized with Covid-19 from March 11, 2020—May 4, 2020.

Results

Overall, 43% of patients hospitalized with Covid-19 were women, median age was 60.4 [IQR = (48.2, 75)], 11.3% were Black/non-Hispanic and 35.2% were Hispanic. Hispanic patients, representing 35.2% of patients, were younger than White/non-Hispanic patients [median age 51y; IQR = (40.6, 61.6) versus 72y; (58.0, 81.7) (p<0.001)]. Hispanic patients were symptomatic longer before presenting to care (median 5 vs 3d, p = 0.039) but were more likely to be sent home with self-quarantine than be admitted to hospital (29% vs 16%, p<0.001). Hispanic patients had fewer comorbidities yet comparable rates of ICU or death (34% vs 36%). Nonetheless, a greater proportion of Hispanic patients recovered by 14 days after presentation (62% vs 45%, p<0.001; OR = 1.99, p = 0.011 in multivariable adjusted model) and fewer died (2% versus 18%, p<0.001).

Conclusions

Hospitalized Hispanic patients were younger and had fewer comorbidities compared to White/non-Hispanic patients; despite comparable rates of ICU care or death, a greater proportion recovered. These results have implications for public health policy and the design and conduct of clinical trials.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.08.20190421: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The MGH Covid registry was approved by the Partners HealthCare Institutional Review Board (Protocol #2020P000829).
    Consent: Because this work was limited to chart review, individual consent was not obtained.
    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:
    A limitation of this study is that due to sample size, we were unable to meaningfully assess differences among other racial and ethnic groups. Hispanics are disproportionately impacted by Covid-19 and have a severe disease despite younger age and fewer documented comorbidities. This underscores the urgent need to report disaggregated outcomes to better understand Covid-19 among racial/ethnic groups. The design and practice of clinical trials for treatments and vaccines can benefit from a deeper understanding of the profound heterogeneity of the populations Covid-19 impacts. As measures are taken to fortify public health infrastructure in the United States, consideration of potential racial/ethnic differences in presentation and access to care as well as in clinical outcomes is essential to the reduction of health disparities.

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1371/journal.pone.0244270
  3. Version published to 10.1101/2020.09.08.20190421v1 on medRxiv