Characteristics and Factors Associated with COVID-19 Infection, Hospitalization, and Mortality Across Race and Ethnicity.

Publication Title

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Authors

Chengzhen L Dai, Institute for Systems Biology, Seattle, WAFollow
Sergey A Kornilov, Institute for Systems Biology, Seattle, WAFollow
Ryan Roper, Institute for Systems BiologyFollow
Hannah Cohen-Cline, Center for Outcomes Research and Education, Providence Health and Services, United StatesFollow
Kathleen Jade, Institute for Systems Biology, Seattle, WA, USA.Follow
Brett Smith, Institute for Systems BiologyFollow
James R Heath, Institute for Systems Biology, Seattle, WA, USA.
George Diaz, Providence Regional Medical CenterFollow
Jason D Goldman, Division of Infectious Diseases Swedish Medical Center Seattle WA.Follow
Andrew T Magis, Institute for Systems Biology, Seattle, Washington.Follow
Jennifer J Hadlock, Institute for Systems Biology, Seattle, WA, USA.Follow

Document Type

Article

Publication Date

2-20-2021

Keywords

2019-nCoV; diversity/inclusion; seattle; washington; isb; psjh_core; prmc; everett; swedish

Abstract

BACKGROUND: Data on the characteristics of COVID-19 patients disaggregated by race/ethnicity remain limited. We evaluated the sociodemographic and clinical characteristics of patients across racial/ethnic groups and assessed their associations with COVID-19 outcomes.

METHODS: This retrospective cohort study examined 629,953 patients tested for SARS-CoV-2 in a large health system spanning California, Oregon, and Washington between March 1 and December 31, 2020. Sociodemographic and clinical characteristics were obtained from electronic health records. Odds of SARS-CoV-2 infection, COVID-19 hospitalization, and in-hospital death were assessed with multivariate logistic regression.

RESULTS: 570,298 patients with known race/ethnicity were tested for SARS-CoV-2, of whom 27.8% were non-White minorities. 54,645 individuals tested positive, with minorities representing 50.1%. Hispanics represented 34.3% of infections but only 13.4% of tests. While generally younger than White patients, Hispanics had higher rates of diabetes but fewer other comorbidities. 8,536 patients were hospitalized and 1,246 died, of whom 56.1% and 54.4% were non-White, respectively. Racial/ethnic distributions of outcomes across the health system tracked with state-level statistics. Increased odds of testing positive and hospitalization were associated with all minority races/ethnicities. Hispanic patients also exhibited increased morbidity, and Hispanic race/ethnicity was associated with in-hospital mortality (OR: 1.39 [95% CI: 1.14-1.70]).

CONCLUSION: Major healthcare disparities were evident, especially among Hispanics who tested positive at a higher rate, required excess hospitalization and mechanical ventilation, and had higher odds of in-hospital mortality despite younger age. Targeted, culturally-responsive interventions and equitable vaccine development and distribution are needed to address the increased risk of poorer COVID-19 outcomes among minority populations.

Specialty/Research Institute

Infectious Diseases

Specialty/Research Institute

Population Health