In the first 6 months of 2020, 53% of deaths from COVID-19 in 88 hospitals across the United States were Black or Hispanic patients, according to a new analysis.
Researchers wanted to understand if this higher death rate was because there were more hospital admittances of Black and Hispanic people with COVID-19, they were more likely to die once admitted, or both of these factors.
After adjusting for clinical and socioeconomic factors, researchers at Stanford University School of Medicine, CA, and Duke University in Durham, NC, found no significant racial differences in mortality rates among hospitalized patients.
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The overall mortality rate among the patients was 18.4% of those who remained in the hospital. This figure is likely to be a minimum fatality rate since it excludes patients transferred to hospices or other hospitals, or where the outcome was unknown.
Cardiovascular complications are a significant cause of death for patients with COVID-19. SARS-CoV-2, the virus that causes the disease, directly affects the heart muscle and causes the blood to become stickier. This leads to a greater likelihood of stroke, heart attacks, or blood clots in the lung.
However, scientists do not know how race affects the risk of these poor COVID-19 outcomes.
In this study, after adjustments, there were no differences by race in terms of major adverse cardiovascular events, namely death from cardiovascular causes and occurrence of events such as myocardial infarction, stroke, and heart failure.
Rather, the researchers conclude that the disproportionately high numbers of Black and Hispanic people hospitalized with COVID-19 drove the high death toll among these populations.
“The COVID-19 pandemic has shone a spotlight on racial and ethnic disparities in healthcare that have been happening for years,” says Dr. Fatima Rodriguez, assistant professor of cardiovascular medicine at Stanford, who led the study.
“Our study shows an overrepresentation of Black and Hispanic patients in terms of morbidity and mortality that needs to be addressed upstream before hospitalization,” she adds.
Hardest hit groups
Out of 7,868 patients treated at 88 hospitals across the U.S. between January 17 and July 22, 2020, 35.2% were white, 33% were Hispanic, 25.5% were Black, and 6.3% were Asian.
For comparison, the U.S. Census Bureau estimates that white people account for 60% of the population as a whole, Hispanic people 18.5%, Black people 13.4%, and Asian people 5.9%.
The study reveals that Black and Hispanic patients treated for COVID-19 at the hospitals were significantly younger, with an average age of 57 and 60, respectively, compared with 69 for white patients and 64 for Asian patients.
Despite being younger, they had more underlying health conditions that might put them at higher risk of acquiring a severe infection compared with patients from other racial groups. For example, Black patients had the highest prevalence of obesity, hypertension, and diabetes of any racial group.
“My work focuses on preventing chronic disease before hospitalizing patients,” says Rodriguez, an expert in health disparities in cardiovascular medicine. “We need to invest in communities to increase opportunities for healthy lifestyles and good healthcare. Structural racism, we know, is a major roadblock for preventing good health.”
The analysis appears in the journal Circulation.
Severe infection risks
For their analysis, the researchers used data from the American Heart Association COVID-19 Cardiovascular Disease Registry. The registry gathers structured and standardized information from various hospitals across the U.S. regarding patients admitted with COVID-19.
The data include extensive information about demographic factors, biomarkers, and clinical data. Because of its focus on cardiovascular disease, it also provides detailed information about cardiovascular complications and outcomes. This will give the researchers a better understanding of the relationship between cardiovascular disease and COVID-19.
They found that Hispanic and Black patients were more likely to lack health insurance and have lower socioeconomic status. They also faced longer delays between symptom onset and a COVID-19 diagnosis.
The authors propose several other factors that may increase the risk of transmission among Black and Hispanic individuals, such as performing essential work during lockdowns, living in multi-generational households, and limited access to COVID-19 testing.
In addition, they note that marginalized populations are likely to have a higher prevalence of health conditions that increase the severity of the infection.
The authors acknowledge several limitations of their analysis. For example, they only had data on hospitalized patients.
They write: “Patients may have died or experienced non-fatal events without seeking hospital-based medical care, and racial or ethnic disparities in care-seeking behavior have been described previously.”
In addition, they note that their sample included an overrepresentation of urban and large academic teaching hospitals, and hospitals in the north-east and south of the country. Patients treated at these settings may have received different care and had different outcomes compared with those treated at other hospitals.
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