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Hospitalization and Mortality among Black Patients and White Patients with Covid-19.
N Engl J Med. 2020 06 25; 382(26):2534-2543.NEJM

Abstract

BACKGROUND

Many reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19.

METHODS

In this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death.

RESULTS

A total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19-positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19-positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17).

CONCLUSIONS

In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.

Authors+Show Affiliations

From the Ochsner Health Center for Outcomes and Health Services Research (E.G.P.-H., J.B., D.F.) and the University of Queensland Ochsner Clinical School (E.G.P.-H., L.S.) - both in New Orleans.From the Ochsner Health Center for Outcomes and Health Services Research (E.G.P.-H., J.B., D.F.) and the University of Queensland Ochsner Clinical School (E.G.P.-H., L.S.) - both in New Orleans.From the Ochsner Health Center for Outcomes and Health Services Research (E.G.P.-H., J.B., D.F.) and the University of Queensland Ochsner Clinical School (E.G.P.-H., L.S.) - both in New Orleans.From the Ochsner Health Center for Outcomes and Health Services Research (E.G.P.-H., J.B., D.F.) and the University of Queensland Ochsner Clinical School (E.G.P.-H., L.S.) - both in New Orleans.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32459916

Citation

Price-Haywood, Eboni G., et al. "Hospitalization and Mortality Among Black Patients and White Patients With Covid-19." The New England Journal of Medicine, vol. 382, no. 26, 2020, pp. 2534-2543.
Price-Haywood EG, Burton J, Fort D, et al. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med. 2020;382(26):2534-2543.
Price-Haywood, E. G., Burton, J., Fort, D., & Seoane, L. (2020). Hospitalization and Mortality among Black Patients and White Patients with Covid-19. The New England Journal of Medicine, 382(26), 2534-2543. https://doi.org/10.1056/NEJMsa2011686
Price-Haywood EG, et al. Hospitalization and Mortality Among Black Patients and White Patients With Covid-19. N Engl J Med. 2020 06 25;382(26):2534-2543. PubMed PMID: 32459916.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospitalization and Mortality among Black Patients and White Patients with Covid-19. AU - Price-Haywood,Eboni G, AU - Burton,Jeffrey, AU - Fort,Daniel, AU - Seoane,Leonardo, Y1 - 2020/05/27/ PY - 2020/5/28/pubmed PY - 2020/7/1/medline PY - 2020/5/28/entrez SP - 2534 EP - 2543 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 382 IS - 26 N2 - BACKGROUND: Many reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19. METHODS: In this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death. RESULTS: A total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19-positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19-positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17). CONCLUSIONS: In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/32459916/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMsa2011686?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -