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From Brief19: Black patients hospitalized at disproportionately higher rates. What does this mean?

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May 28, 2020

A new article published in The New England Journal of Medicine compares hospitalization and mortality rates among Black and non-Hispanic White patients in Louisiana. Previous data has shown that Black individuals account for a disproportionately high number of cases and deaths in places like the Bronx in New York, Georgia, and others. This study assessed the characteristics of 3,626 patients at the time of hospital admission and followed their courses between March 1st and April 11th. Black persons comprise 31 percent of the patient population served by Ochsner Health, the integrated-delivery health system where the study occurred. However, 77 percent of hospitalized patients and 71 percent of the patients who died were Black. Once hospitalized, Black race was not independently associated with an increased risk of death, suggesting that other factors were responsible for the high percentages in comparison to their representation in the population. For example, Black patients were more likely to present to the hospital having already developed signs of severe illness, including new evidence of kidney and/or liver dysfunction, and elevated markers of inflammation. While a metric of existing medical problems found that the fraction of patients with pre-existing medical conditions among Black and non-Black patients was similar, in reality that metric may not have been adequate; the "Charlson Comorbidity Index" is designed to predict 1-year mortality based on 17 conditions. Even amongst patients with many chronic medical problems, 1-year survival is usually quite high and so only extreme differences would show a "statistically significant" effect. Indeed, out of 12 chronic medical illnesses listed, 10 were more common in Black patients, including high blood pressure, diabetes, and obesity. All of these have been reported to increase risk of severe illness and death from covid-19. Also in this study, Black patients were more likely to require intensive care (36 percent versus 30 percent), mechanical ventilation (28 percent versus 21 percent). Of interest, in this cohort of patients, female sex was associated with higher rates of admission. This comes in contrast to many prior studies that have shown disproportionately high rates of male patients experiencing more severe SARS-CoV-2 infections.

Shared with permission from Brief19, a daily review of #covid-19 research and policy.

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