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Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry.
Circulation. 2021 06 15; 143(24):2332-2342.Circ

Abstract

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has exposed longstanding racial and ethnic inequities in health risks and outcomes in the United States. We aimed to identify racial and ethnic differences in presentation and outcomes for patients hospitalized with COVID-19.

METHODS

The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7868 patients by race/ethnicity treated at 88 hospitals across the United States between January 17, 2020, and July 22, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events (death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization alone. Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital.

RESULTS

Among 7868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios for mortality were 0.93 (95% CI, 0.76-1.14) for Black patients, 0.90 (95% CI, 0.73-1.11) for Hispanic patients, and 1.31 (95% CI, 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median odds ratio across hospitals was 1.99 (95% CI, 1.74-2.48). Results were similar for major adverse cardiovascular events. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted odds ratio, 1.48 [95% CI, 1.16-1.90]).

CONCLUSIONS

Although in-hospital mortality and major adverse cardiovascular events did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity because of their disproportionate representation among COVID-19 hospitalizations.

Authors+Show Affiliations

Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, CA (F.R.).Duke Clinical Research Institute, Duke University, Durham, NC (N.S., D.H., R.A.M., T.Y.W.).Department of Internal Medicine, Cardiology Division, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S R.D.).Department of Internal Medicine, Cardiology Division, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S R.D.).TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (D.A.M.).Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (S.M.S.).Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY.American Heart Association, Dallas, TX (J.H.W.).Duke Clinical Research Institute, Duke University, Durham, NC (N.S., D.H., R.A.M., T.Y.W.).Duke Clinical Research Institute, Duke University, Durham, NC (N.S., D.H., R.A.M., T.Y.W.).Division of Cardiology, Emory University School of Medicine, Atlanta, GA (D.G.).Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Portland, OR (T.J.G.).Division of Cardiology, Department of Medicine, Irving Medical Center (M.A.), Columbia University, New York, NY.Division of Cardiology, University of California San Francisco (M.A.A.).Division of Cardiology, University of California San Francisco (M.A.A.).Duke Clinical Research Institute, Duke University, Durham, NC (N.S., D.H., R.A.M., T.Y.W.). Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, IL (C.W.Y.).

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33200953

Citation

Rodriguez, Fatima, et al. "Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry." Circulation, vol. 143, no. 24, 2021, pp. 2332-2342.
Rodriguez F, Solomon N, de Lemos JA, et al. Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry. Circulation. 2021;143(24):2332-2342.
Rodriguez, F., Solomon, N., de Lemos, J. A., Das, S. R., Morrow, D. A., Bradley, S. M., Elkind, M. S. V., Williams, J. H., Holmes, D., Matsouaka, R. A., Gupta, D., Gluckman, T. J., Abdalla, M., Albert, M. A., Yancy, C. W., & Wang, T. Y. (2021). Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry. Circulation, 143(24), 2332-2342. https://doi.org/10.1161/CIRCULATIONAHA.120.052278
Rodriguez F, et al. Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry. Circulation. 2021 06 15;143(24):2332-2342. PubMed PMID: 33200953.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry. AU - Rodriguez,Fatima, AU - Solomon,Nicole, AU - de Lemos,James A, AU - Das,Sandeep R, AU - Morrow,David A, AU - Bradley,Steven M, AU - Elkind,Mitchell S V, AU - Williams,Joseph H, AU - Holmes,DaJuanicia, AU - Matsouaka,Roland A, AU - Gupta,Divya, AU - Gluckman,Ty J, AU - Abdalla,Marwah, AU - Albert,Michelle A, AU - Yancy,Clyde W, AU - Wang,Tracy Y, Y1 - 2020/11/17/ PY - 2020/11/18/pubmed PY - 2021/6/30/medline PY - 2020/11/17/entrez KW - COVID-19 KW - cardiovascular diseases KW - health status disparities KW - race factors SP - 2332 EP - 2342 JF - Circulation JO - Circulation VL - 143 IS - 24 N2 - BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has exposed longstanding racial and ethnic inequities in health risks and outcomes in the United States. We aimed to identify racial and ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. METHODS: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7868 patients by race/ethnicity treated at 88 hospitals across the United States between January 17, 2020, and July 22, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events (death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization alone. Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. RESULTS: Among 7868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios for mortality were 0.93 (95% CI, 0.76-1.14) for Black patients, 0.90 (95% CI, 0.73-1.11) for Hispanic patients, and 1.31 (95% CI, 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median odds ratio across hospitals was 1.99 (95% CI, 1.74-2.48). Results were similar for major adverse cardiovascular events. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted odds ratio, 1.48 [95% CI, 1.16-1.90]). CONCLUSIONS: Although in-hospital mortality and major adverse cardiovascular events did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity because of their disproportionate representation among COVID-19 hospitalizations. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/33200953/Racial_and_Ethnic_Differences_in_Presentation_and_Outcomes_for_Patients_Hospitalized_With_COVID_19:_Findings_From_the_American_Heart_Association's_COVID_19_Cardiovascular_Disease_Registry_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.052278?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -