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Assessment of Racial/Ethnic Disparities in Hospitalization and Mortality in Patients With COVID-19 in New York City

Educational Objective
To identify the key insights or developments described in this article
Key Points

Question  Do outcomes among patients with coronavirus disease 2019 (COVID-19) differ by race/ethnicity, and are observed disparities associated with comorbidity and neighborhood characteristics?

Findings  This cohort study including 9722 patients found that Black and Hispanic patients were more likely than White patients to test positive for COVID-19. Among patients hospitalized with COVID-19 infection, Black patients were less likely than White patients to have severe illness and to die or be discharged to hospice.

Meaning  Although Black patients were more likely than White patients to test positive for COVID-19, after hospitalization they had lower mortality, suggesting that neighborhood characteristics may explain the disproportionately higher out-of-hospital COVID-19 mortality among Black individuals.

Abstract

Importance  Black and Hispanic populations have higher rates of coronavirus disease 2019 (COVID-19) hospitalization and mortality than White populations but lower in-hospital case-fatality rates. The extent to which neighborhood characteristics and comorbidity explain these disparities is unclear. Outcomes in Asian American populations have not been explored.

Objective  To compare COVID-19 outcomes based on race and ethnicity and assess the association of any disparities with comorbidity and neighborhood characteristics.

Design, Setting, and Participants  This retrospective cohort study was conducted within the New York University Langone Health system, which includes over 260 outpatient practices and 4 acute care hospitals. All patients within the system’s integrated health record who were tested for severe acute respiratory syndrome coronavirus 2 between March 1, 2020, and April 8, 2020, were identified and followed up through May 13, 2020. Data were analyzed in June 2020. Among 11 547 patients tested, outcomes were compared by race and ethnicity and examined against differences by age, sex, body mass index, comorbidity, insurance type, and neighborhood socioeconomic status.

Exposures  Race and ethnicity categorized using self-reported electronic health record data (ie, non-Hispanic White, non-Hispanic Black, Hispanic, Asian, and multiracial/other patients).

Main Outcomes and Measures  The likelihood of receiving a positive test, hospitalization, and critical illness (defined as a composite of care in the intensive care unit, use of mechanical ventilation, discharge to hospice, or death).

Results  Among 9722 patients (mean [SD] age, 50.7 [17.5] years; 58.8% women), 4843 (49.8%) were positive for COVID-19; 2623 (54.2%) of those were admitted for hospitalization (1047 [39.9%] White, 375 [14.3%] Black, 715 [27.3%] Hispanic, 180 [6.9%] Asian, 207 [7.9%] multiracial/other). In fully adjusted models, Black patients (odds ratio [OR], 1.3; 95% CI, 1.2-1.6) and Hispanic patients (OR, 1.5; 95% CI, 1.3-1.7) were more likely than White patients to test positive. Among those who tested positive, odds of hospitalization were similar among White, Hispanic, and Black patients, but higher among Asian (OR, 1.6, 95% CI, 1.1-2.3) and multiracial patients (OR, 1.4; 95% CI, 1.0-1.9) compared with White patients. Among those hospitalized, Black patients were less likely than White patients to have severe illness (OR, 0.6; 95% CI, 0.4-0.8) and to die or be discharged to hospice (hazard ratio, 0.7; 95% CI, 0.6-0.9).

Conclusions and Relevance  In this cohort study of patients in a large health system in New York City, Black and Hispanic patients were more likely, and Asian patients less likely, than White patients to test positive; once hospitalized, Black patients were less likely than White patients to have critical illness or die after adjustment for comorbidity and neighborhood characteristics. This supports the assertion that existing structural determinants pervasive in Black and Hispanic communities may explain the disproportionately higher out-of-hospital deaths due to COVID-19 infections in these populations.

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Article Information

Accepted for Publication: September 20, 2020.

Published: December 4, 2020. doi:10.1001/jamanetworkopen.2020.26881

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

Corresponding Author: Gbenga Ogedegbe, MD, MPH, Department of Population Health, NYU Grossman School of Medicine, New York, NY (Olugbenga.ogedegbe@nyulangone.org).

Author Contributions: Drs Ogedegbe and Horwitz 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.

Concept and design: Ogedegbe, Francois, Jones, Reynolds, Horwitz.

Acquisition, analysis, or interpretation of data: Ogedegbe, Ravenell, Adhikari, Butler, Cook, Iturrate, Jean-Louis, Jones, Onakomaiya, Petrilli, Pulgarin, Regan, Reynolds, Seixas, Volpicelli, Horwitz.

Drafting of the manuscript: Ogedegbe, Ravenell, Adhikari, Butler, Cook, Francois, Jones, Onakomaiya, Regan, Volpicelli, Horwitz.

Critical revision of the manuscript for important intellectual content: Ravenell, Cook, Francois, Iturrate, Jean-Louis, Jones, Petrilli, Pulgarin, Reynolds, Seixas.

Statistical analysis: Ogedegbe, Adhikari, Butler, Francois, Jean-Louis, Jones, Pulgarin, Regan, Horwitz.

Administrative, technical, or material support: Ogedegbe, Ravenell, Francois, Iturrate, Onakomaiya, Petrilli, Horwitz.

Supervision: Ogedegbe, Francois, Volpicelli, Horwitz.

Conflict of Interest Disclosures: None reported.

Disclaimer: Dr Ogedegbe, the first author and corresponding author of this manuscript, is also an associate editor at JAMA Network Open. He was not involved in the editorial review or decision to accept this article.

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