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

Alan P Pan,Bita A Kash,Jennifer R Meeks,Osman Khan,Julia D Andrieni,Yordanos M Tiruneh,Robert A Phillips,Faisal N Masud,Marc L Boom,Farhaan S Vahidy

doi:10.1186/s12889-021-11431-2

Abstract

BackgroundDisparate 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.MethodsIn 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.ResultsBetween 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.ConclusionsOur 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.

Highlights

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
We evaluate racial and ethnic differences in hospitalization and in-hospital mortality among the population testing positive for SARS-CoV-2
We present three explanatory logistic regression models each for the outcome of hospitalization and mortality, separately fitted for nonHispanic Black (NHB) race and Hispanic ethnicity

Summary

Methods

Study setting and design Houston Methodist (HM) comprises a flagship tertiary care hospital and seven community and continuing care hospitals across the greater Houston area. We present three explanatory logistic regression models each for the outcome of hospitalization and mortality, separately fitted for NHB (vs NHW) race and Hispanic ethnicity (vs nonHispanic) This approach allowed us to adjust three distinct covariate sub-sets representing varying levels of available exposure information for each outcome. For hospitalization: 1) Baseline models adjusted for age, sex, and insurance type, 2) Full socio-demographic models which included model-1 variables and added median household income and population density, and 3) Sociodemographic and comorbidity models which adds CCI, obesity, hypertension, and smoking to model-2. For inhospital mortality: 1) Baseline socio-demographic and comorbidity models including age, sex, median household income, CCI, obesity, hypertension, and smoking, 2) Hospital admission models including model-1 and vital sign and laboratory measures, and 3) Comprehensive clinical models incorporating all variables of model in addition to in-hospital complications, treatment course, and critical care utilization parameters. All data preparation and analyses were performed using R statistical software (version 3.6.1; The R Foundation)

Results

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Discussion

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