Addressing COVID-19 Disparities Between Hispanic and Non-Hispanic White Populations of Arizona

Abstract

Introduction: The coronavirus disease (COVID-19) pandemic1,2 contributed to over 1.03 million deaths in the United States (U.S.) and 30,768 deaths in Arizona3. Nationwide, Hispanics are at increased risk for infection, hospitalization, and death, when compared to non-Hispanic White (NHW)4. Although Hispanic COVID-19 disparities are clear in the U.S., study of Hispanic COVID-19 disparities in Arizona are less clear. Objective: To compare COVID-19 interventions and clinical outcomes between Hispanic and NHW populations in rural and urban healthcare settings of Arizona. Methods: A retrospective cohort of COVID-19 patients from January 1, 2020 through June 17, 2022 admitted to hospitals affiliated with the Midwestern University Graduate Medical Education consortium were assessed. Data was abstracted to counterbalance NHW and minority patients by date of admission. Data collected included patient demographics, presenting symptoms, vital signs, laboratory values at the time of emergency department presentation, treatment modalities, and clinical outcomes. Results: A total of 627 patients were analyzed with 31.7% (199/627) identifying as Hispanic, 41.8% (262/627) female, and 61.9% (388/627) allocated to the rural hospital group. No difference in mortality was seen in the rural or urban setting and there was no difference in administered COVID-19 therapeutics. Kaplan-Meier curves were parallel between Hispanic and NHW patients who survived COVID-19 with no difference in the length of stay (LOS) days. Kaplan-Meier curves differed between Hispanics and NHW patients who expired from COVID-19 with Hispanics at a greater LOS prior to mortality. Differences between Hispanic and NHW mortality patients included Hispanics presenting at a younger age, increased CRP elevations, and a greater delay between symptom onset and COVID-19 testing. Hispanics who expired were more likely to present with shortness of breath, hypoxia, and a documented bacterial infection during hospitalization as compared to Hispanics who survived. Conclusion: Following admission, patients regardless of Hispanic or NHW identification, received equitable care in our Arizona subset which resulted in comparable rates of mortality. Hispanics initially presented at increased disease severity, which is suggestive of factors outside of the hospital, prior to admission, responsible for the disparities seen at the national level with variation between states.