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Association of Race and Ethnicity With Comorbidities and Survival Among Patients With COVID-19 at an Urban Medical Center in New York

Educational Objective
To understand the association of race and ethnicity with comorbidities and survival rates among patients with COVID-19
1 Credit CME
Key Points

Question  Does the presentation of comorbidities in patients with coronavirus disease 2019 (COVID-19) differ by race/ethnicity, and is there a difference in case fatality rates among ethnic and racial groups when controlling for key risk factors?

Findings  In a cohort study of 5902 patients with positive COVID-19 diagnosis treated at a single academic medical center in New York, non-Hispanic Black and Hispanic patients had a higher proportion of more than 2 medical comorbidities and were more likely to test positive for COVID-19 compared with their non-Hispanic White counterparts. However, their survival outcomes were at least as good as those of their non-Hispanic White counterparts when controlling for age, sex, and comorbidities.

Meaning  In this study, non-Hispanic Black and Hispanic patients experienced similar outcomes as their non-Hispanic White counterparts after COVID-19 infection; this is critical to further understanding the observed population differences in mortality by race/ethnicity reported elsewhere.

Abstract

Importance  As of May 11, 2020, there have been more than 290 000 deaths worldwide from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). Risk-adjusted differences in outcomes among patients of differing ethnicity and race categories are not well characterized.

Objectives  To investigate whether presenting comorbidities in patients with COVID-19 in New York City differed by race/ethnicity and whether case fatality rates varied among different ethnic and racial groups, controlling for presenting comorbidities and other risk factors.

Design, Setting, and Participants  This cohort study included 5902 patients who presented for care to the Montefiore Medical Center, a large urban academic medical center in the Bronx, New York, between March 14 and April 15, 2020, and tested positive for SARS-CoV-2 on reverse transcription quantitative polymerase chain reaction assay. Final data collection was April 27, 2020.

Exposures  Patient characteristics, including self-identified ethnicity/race, age, sex, socioeconomic status, and medical comorbidities, were tabulated.

Main Outcomes and Measures  Overall survival. Associations between patient demographic characteristics, comorbidities, and race/ethnicity were examined using χ2 tests, and the association with survival was assessed using univariable and multivariable Cox proportional hazards regression, based on time from positive COVID-19 test.

Results  Of 9268 patients who were tested, 5902 ethnically diverse patients (63.7%) had SARS-CoV-2. Of these, 3129 patients (53.0%) were women, and the median (interquartile range) age was 58 (44-71) years. A total of 918 patients (15.5%) died within the study time frame. Overall, 1905 patients (32.3%) identified as Hispanic; 1935 (32.8%), non-Hispanic Black; 509 (8.6%), non-Hispanic White; and 171 (2.9%), Asian; the death rates were 16.2% (309), 17.2% (333), 20.0% (102), and 17.0% (29), respectively (P = .25). Hispanic and non-Hispanic Black patients had a higher proportion of more than 2 medical comorbidities with 654 (34.3%) and 764 (39.5%), respectively, compared with 147 (28.9%) among non-Hispanic White patients (P < .001). Hispanic and non-Hispanic Black patients were also more likely to test positive for COVID-19 than White patients, with 1905 of 2919 Hispanic patients (65.3%), 1935 of 2823 non-Hispanic Black patients (68.5%), and 509 of 960 non-Hispanic White patients (53.0%) having positive test results for SARS-CoV-2 (P < .001). While controlling for age, sex, socioeconomic status and comorbidities, patients identifying as Hispanic (hazard ratio, 0.77; 95% CI, 0.61-0.98; P = .03) or non-Hispanic Black (hazard ratio, 0.69; 95% CI, 0.55-0.87; P = .002) had slightly improved survival compared with non-Hispanic White patients.

Conclusions and Relevance  In this cohort study of patients with COVID-19 who presented for care at the same urban medical center, non-Hispanic Black and Hispanic patients did not experience worse risk-adjusted outcomes compared with their White counterparts. This finding is important for understanding the observed population differences in mortality by race/ethnicity reported elsewhere.

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Article Information

Accepted for Publication: July 26, 2020.

Published: September 25, 2020. doi:10.1001/jamanetworkopen.2020.19795

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Kabarriti R et al. JAMA Network Open.

Corresponding Authors: Madhur K. Garg, MD, Department of Radiation Oncology (mgarg@montefiore.org), and Andrew D. Racine, MD, PhD, Department of Pediatrics (aracine@montefiore.org), Montefiore Medical Center and Albert Einstein College of Medicine, 111 210th St, Bronx, NY 10467.

Author Contributions: Drs Kabarriti and Brodin had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Kabarriti and Brodin contributed equally to this article.

Concept and design: Kabarriti, Brodin, Guha, Garg.

Acquisition, analysis, or interpretation of data: Kabarriti, Brodin, Maron, Kalnicki, Garg, Racine.

Drafting of the manuscript: Kabarriti, Brodin, Kalnicki, Garg.

Critical revision of the manuscript for important intellectual content: Brodin, Maron, Guha, Garg, Racine.

Statistical analysis: Kabarriti, Brodin.

Administrative, technical, or material support: Kabarriti, Maron, Guha, Kalnicki, Garg.

Supervision: Kabarriti, Kalnicki, Garg, Racine.

Conflict of Interest Disclosures: None reported.

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