Differences in the Risk of Health Outcomes in COVID-19 Continuum for African Americans in Healthcare Settings: A Systematic Review and Meta-Analysis

Abstract

Background: African Americans/Blacks represent the major health disparities population in the US. Thus, we performed a systematic review of published work to quantitatively assess outcome-dependent differences across the COVID-19 continuum among African Americans compared to Whites and other races.Methods: We searched the MEDLINE, Scopus, and Cochrane Library up to March 31, 2021, to identify studies that treated African Americans as an independent racial group and assessed the risk of SARS-CoV-2 infection and/or the subsequent COVID-19 outcomes in US healthcare settings. We used random-effects meta-analysis to generate unadjusted and adjusted pooled estimates of odds ratio (OR) or hazard ratio (HR)/risk ratio (RR) of the racial differences in the risk of each COVID-19 outcome. Graphs were constructed to visualize the trends in racial disparities along the COVID-19 continuum. This study is registered with PROSPERO, CRD42021239596.Findings: Of the 9863 articles identified, 78 were eligible for qualitative synthesis and 67 for meta-analysis. Compared to Whites, the higher risks of COVID-19 outcomes for Blacks continued to decrease along the continuum, from substantial disparities in SARS-CoV-2 infection (adjusted OR [95% CI], 1·96 [1·65–2·34]) and hospitalization (adjusted OR [95% CI], 1·49 [1·26–1·75]) to becoming minimal in infection fatality (adjusted OR, 1·00; adjusted HR/RR, 0·99) or reversed in in-hospital mortality (adjusted OR [95% CI], 0.83 [0·71–0·96]; adjusted HR/RR [95% CI], 0·86 [0·78–0·95]). Compared to other racial minorities, Blacks had higher risk of hospitalization or infection fatality but similar risk of infection or in-hospital mortality. Although Black COVID-19 patients had higher prevalence of most comorbidities than non-Black non-White patients, certain comorbidities or risk factors were more prevalent among White patients compared to other races.Interpretation: The magnitude and direction of COVID-19 racial disparities varied by outcomes. Once the COVID-19 patients received hospital care, there were no differences in outcomes among different races, despite pre-existing disparities.Funding: This work is supported by the US National Institute on Minority Health and Health Disparities of the National Institute of Health, award number U54 MD013376 to YCC.Declaration of Interest: None to declare.