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Showing content from https://pubmed.ncbi.nlm.nih.gov/33084902/ below:

Characteristics Associated With Racial/Ethnic Disparities in COVID-19 Outcomes in an Academic Health Care System

Affiliations

• ¹ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor.
• ² Rogel Cancer Center, University of Michigan Medicine, Ann Arbor.
• ³ Data Office for Clinical and Translational Research, University of Michigan, Ann Arbor.
• ⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
• ⁵ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
• ⁶ Department of Learning Health Sciences, University of Michigan, Ann Arbor.
• ⁷ Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
• ⁸ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.
• ⁹ Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
• ¹⁰ Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor.

• PMID: 33084902
• PMCID: PMC7578774
• DOI: 10.1001/jamanetworkopen.2020.25197

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Tian Gu et al. JAMA Netw Open. 2020.

• ¹ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor.
• ² Rogel Cancer Center, University of Michigan Medicine, Ann Arbor.
• ³ Data Office for Clinical and Translational Research, University of Michigan, Ann Arbor.
• ⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
• ⁵ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
• ⁶ Department of Learning Health Sciences, University of Michigan, Ann Arbor.
• ⁷ Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
• ⁸ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.
• ⁹ Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
• ¹⁰ Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor.

• PMID: 33084902
• PMCID: PMC7578774
• DOI: 10.1001/jamanetworkopen.2020.25197

Item in Clipboard

• Errors in Table, Figure Legend, and the Supplement.

  [No authors listed] [No authors listed] JAMA Netw Open. 2021 Aug 2;4(8):e2126218. doi: 10.1001/jamanetworkopen.2021.26218. JAMA Netw Open. 2021. PMID: 34398209 Free PMC article. No abstract available.

Importance: Black patients are overrepresented in the number of COVID-19 infections, hospitalizations, and deaths in the US. Reasons for this disparity may be due to underlying comorbidities or sociodemographic factors that require further exploration.

Objective: To systematically determine patient characteristics associated with racial/ethnic disparities in COVID-19 outcomes.

Design, setting, and participants: This retrospective cohort study used comparative groups of patients tested or treated for COVID-19 at the University of Michigan from March 10, 2020, to April 22, 2020, with an outcome update through July 28, 2020. A group of randomly selected untested individuals were included for comparison. Examined factors included race/ethnicity, age, smoking, alcohol consumption, comorbidities, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and residential-level socioeconomic characteristics.

Exposure: In-house polymerase chain reaction (PCR) tests, commercial antibody tests, nasopharynx or oropharynx PCR deployed by the Michigan Department of Health and Human Services and reverse transcription-PCR tests performed in external labs.

Main outcomes and measures: The main outcomes were being tested for COVID-19, having test results positive for COVID-19 or being diagnosed with COVID-19, being hospitalized for COVID-19, requiring intensive care unit (ICU) admission for COVID-19, and COVID-19-related mortality (including inpatient and outpatient). Medical comorbidities were defined from the International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, codes and were aggregated into a comorbidity score. Associations with COVID-19 outcomes were examined using odds ratios (ORs).

Results: Of 5698 patients tested for COVID-19 (mean [SD] age, 47.4 [20.9] years; 2167 [38.0%] men; mean [SD] BMI, 30.0 [8.0]), most were non-Hispanic White (3740 patients [65.6%]) or non-Hispanic Black (1058 patients [18.6%]). The comparison group included 7168 individuals who were not tested (mean [SD] age, 43.1 [24.1] years; 3257 [45.4%] men; mean [SD] BMI, 28.5 [7.1]). Among 1139 patients diagnosed with COVID-19, 492 (43.2%) were White and 442 (38.8%) were Black; 523 (45.9%) were hospitalized, 283 (24.7%) were admitted to the ICU, and 88 (7.7%) died. Adjusting for age, sex, socioeconomic status, and comorbidity score, Black patients were more likely to be hospitalized compared with White patients (OR, 1.72 [95% CI, 1.15-2.58]; P = .009). In addition to older age, male sex, and obesity, living in densely populated areas was associated with increased risk of hospitalization (OR, 1.10 [95% CI, 1.01-1.19]; P = .02). In the overall population, higher risk of hospitalization was also observed in patients with preexisting type 2 diabetes (OR, 1.82 [95% CI, 1.25-2.64]; P = .02) and kidney disease (OR, 2.87 [95% CI, 1.87-4.42]; P < .001). Compared with White patients, obesity was associated with higher risk of having test results positive for COVID-19 among Black patients (White: OR, 1.37 [95% CI, 1.01-1.84]; P = .04. Black: OR, 3.11 [95% CI, 1.64-5.90]; P < .001; P for interaction = .02). Having any cancer was associated with higher risk of positive COVID-19 test results for Black patients (OR, 1.82 [95% CI, 1.19-2.78]; P = .005) but not White patients (OR, 1.08 [95% CI, 0.84-1.40]; P = .53; P for interaction = .04). Overall comorbidity burden was associated with higher risk of hospitalization in White patients (OR, 1.30 [95% CI, 1.11-1.53]; P = .001) but not in Black patients (OR, 0.99 [95% CI, 0.83-1.17]; P = .88; P for interaction = .02), as was type 2 diabetes (White: OR, 2.59 [95% CI, 1.49-4.48]; P < .001; Black: OR, 1.17 [95% CI, 0.66-2.06]; P = .59; P for interaction = .046). No statistically significant racial differences were found in ICU admission and mortality based on adjusted analysis.

Conclusions and relevance: These findings suggest that preexisting type 2 diabetes or kidney diseases and living in high-population density areas were associated with higher risk for COVID-19 hospitalization. Associations of risk factors with COVID-19 outcomes differed by race.

PubMed Disclaimer

Conflict of Interest Disclosures: Dr Singh reported receiving salary support from Blue Cross Blue Shield of Michigan outside the submitted work. Dr Nallamothu reported serving as a principal investigator or coinvestigator on research grants from the National Institutes of Health (NIH), US Department of Veterans Affairs Health Services Research and Development, and the American Heart Association; receiving personal fees as Editor-in-Chief of Circulation: Cardiovascular Quality & Outcomes ; being a co-inventor on a US Utility Patent Number US15/356,012 (US20170148158A1), held by the University of Michigan and licensed to AngioInsight; and holding ownership shares in and receiving consultancy fees from AngioInsight. Dr Lisabeth reported receiving personal fees from University of Michigan during the conduct of the study and grants from the NIH outside the submitted work. No other disclosures were reported.

Abbreviations: ICU, intensive care unit; OR, odds…

Abbreviations: ICU, intensive care unit; OR, odds ratio. ^aχ² test P < .001, comparing the proportion between White and Black patients. ^bLogistic regression with Firth correction. ^cMultivariable logistic regression with adjustment 1 (ie, age, sex, race/ethnicity; having test results positive for coronavirus disease 2019 also adjusted for population density). ^dMultivariable logistic regression with adjustment 2 (adjustment 1 + Neighborhood Disadvantage Index). ^eMultivariable logistic regression with adjustment 3 (adjustment 2 + comorbidity score).

The results were from model…

The results were from model logit P(Y_COVID = 1|X, Covariate) = β₀ + β_XX + β_RaceRace + β_intX × Race + β_covCovariate, in which Covariate = age + sex + NDI (+ comorbidity score in demographic and socioeconomic status models). ^aReference: age 18 to younger than 35 years. ^bReference: women. ^cReference: body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) 18.5 to less than 25. ^dReference: never smoker. ^eReference: no alcohol consumption. ^fPer 1000 persons per square mile. ^gFrom 2010 census data.

The results were from…

The results were from model logit P(Y_COVID = 1|X, Covariate) = β₀ + β_XX + β_RaceRace + β_intX × Race + β_covCovariate, in which Y_COVID = Y_{hospitalization} (A) or Y_COVID = Y_ICU (B) and Covariate = age + sex + NDI (+ comorbidity score in demographic and socioeconomic status models). ^aReference: age 18 to younger than 35 years. ^bReference: women. ^cReference: BMI 18.5 to less than 25. ^dReference: never smoker. ^eReference: no alcohol consumption. ^fPer 1000 persons per square mile. ^gFrom 2010 census data.

• COVID-19 outcomes, risk factors and associations by race: a comprehensive analysis using electronic health records data in Michigan Medicine. Gu T, Mack JA, Salvatore M, Sankar SP, Valley TS, Singh K, Nallamothu BK, Kheterpal S, Lisabeth L, Fritsche LG, Mukherjee B. Gu T, et al. medRxiv [Preprint]. 2020 Jun 18:2020.06.16.20133140. doi: 10.1101/2020.06.16.20133140. medRxiv. 2020. PMID: 32793920 Free PMC article. Updated. Preprint.

• Racial Disparities in Incidence and Outcomes Among Patients With COVID-19.

  Muñoz-Price LS, Nattinger AB, Rivera F, Hanson R, Gmehlin CG, Perez A, Singh S, Buchan BW, Ledeboer NA, Pezzin LE. Muñoz-Price LS, et al. JAMA Netw Open. 2020 Sep 1;3(9):e2021892. doi: 10.1001/jamanetworkopen.2020.21892. JAMA Netw Open. 2020. PMID: 32975575 Free PMC article.

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

  Kabarriti R, Brodin NP, Maron MI, Guha C, Kalnicki S, Garg MK, Racine AD. Kabarriti R, et al. JAMA Netw Open. 2020 Sep 1;3(9):e2019795. doi: 10.1001/jamanetworkopen.2020.19795. JAMA Netw Open. 2020. PMID: 32975574 Free PMC article.

• Hospitalization and Mortality among Black Patients and White Patients with Covid-19.

  Price-Haywood EG, Burton J, Fort D, Seoane L. Price-Haywood EG, et al. N Engl J Med. 2020 Jun 25;382(26):2534-2543. doi: 10.1056/NEJMsa2011686. Epub 2020 May 27. N Engl J Med. 2020. PMID: 32459916 Free PMC article.

• Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit.

  Suleyman G, Fadel RA, Malette KM, Hammond C, Abdulla H, Entz A, Demertzis Z, Hanna Z, Failla A, Dagher C, Chaudhry Z, Vahia A, Abreu Lanfranco O, Ramesh M, Zervos MJ, Alangaden G, Miller J, Brar I. Suleyman G, et al. JAMA Netw Open. 2020 Jun 1;3(6):e2012270. doi: 10.1001/jamanetworkopen.2020.12270. JAMA Netw Open. 2020. PMID: 32543702 Free PMC article. Review.

• Prognostic factors in patients with diabetes hospitalized for COVID-19: Findings from the CORONADO study and other recent reports.

  Scheen AJ, Marre M, Thivolet C. Scheen AJ, et al. Diabetes Metab. 2020 Sep;46(4):265-271. doi: 10.1016/j.diabet.2020.05.008. Epub 2020 May 21. Diabetes Metab. 2020. PMID: 32447101 Free PMC article. Review.

• Current Challenges With the Use of Test-Negative Designs for Modeling COVID-19 Vaccination and Outcomes.

  Shi X, Li KQ, Mukherjee B. Shi X, et al. Am J Epidemiol. 2023 Feb 24;192(3):328-333. doi: 10.1093/aje/kwac203. Am J Epidemiol. 2023. PMID: 36446573 Free PMC article.

• Neurological manifestations of patients with mild-to-moderate COVID-19 attending a public hospital in Lima, Peru.

  Carcamo Garcia MH, Garcia Choza DD, Salazar Linares BJ, Diaz MM. Carcamo Garcia MH, et al. eNeurologicalSci. 2021 Jun;23:100338. doi: 10.1016/j.ensci.2021.100338. Epub 2021 Apr 14. eNeurologicalSci. 2021. PMID: 33875971 Free PMC article.

• Body Mass Index and Clinical Outcomes in Adult COVID-19 Patients of Diverse Ethnicities.

  Hafez W, Abdelshakor M, Kishk S, Gebril A, Gador M, Osman S, Abuelsaoud HM, Abdelrahman A. Hafez W, et al. Healthcare (Basel). 2022 Dec 19;10(12):2575. doi: 10.3390/healthcare10122575. Healthcare (Basel). 2022. PMID: 36554099 Free PMC article.

• COVID-19 Vaccine Rollouts and the Reproduction of Urban Spatial Inequality: Disparities Within Large US Cities in March and April 2021 by Racial/Ethnic and Socioeconomic Composition.

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• Time trends, factors associated with, and reasons for COVID-19 vaccine hesitancy: A massive online survey of US adults from January-May 2021.

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