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Black and Hispanic communities have been disproportionately hit by COVID-19 this year, but the Black patients who do get hospital care are less likely to die or be discharged to hospice care, according to a new study published Friday in the journal JAMA Network Open.
Although Black patients overall were more likely than White patients to test positive for COVID-19, Black patients who were hospitalized had lower mortality than Whites after hospitalization, the authors wrote. The results suggest that overall mortality rates of Black patients with COVID-19 are related to structural factors.
"We know that Black and Hispanic populations account for a disproportionate share of COVID-19-related deaths relative to their population size in New York and major cities across the country," Gbenga Ogedegbe, MD, the lead author and a population health professor at NYU Langone Health, said in a statement.
"We were, however, surprised to find that Black and Hispanic patients were no more likely to be hospitalized across NYU Langone than White patients, which means we need to look at other structural factors at play," he said, including poor housing conditions, unequal access to health care, differences in employment opportunities and poverty.
Ogedegbe and colleagues analyzed data from NYU Langone Health's electronic health records to follow 9,722 people who received a COVID-19 test at doctor's offices and hospitals in Manhattan, Brooklyn and Long Island. The patients were tested between March 1 and April 8 and tracked through May 13.
Overall, 4,843 people tested positive, including 39% who were White patients and 15.7% who were Black patients. Among those, 2,623 were hospitalized, including 39.9% who were White patients and 14.3% who were Black patients. The hospitalized patients tended to be older and have more underlying conditions. About 71% were discharged, 25% died or were discharged to hospice care, and 4.5% were still hospitalized in mid-May.
The research team found that Black and Hispanic patients had a lower risk of critical illness and were less likely to die or be discharged to hospice compared to White patients. Even after adjusting for age, sex, insurance status and comorbidities, Black patients had a lower risk of death than White patients, and Hispanic and Asian patients had similar rates to White patients.
"Our findings provide more evidence that the social determinants of health play a critical role in determining patient outcomes, particularly for Black patients, before they ever get to the hospital," Joseph Ravenell, MD, one of the study authors and associate dean for diversity affairs and inclusion at NYU Langone, said in the statement.
Black patients are more likely to be uninsured or underinsured than White patients and more likely to die at home due to a lack of access to care, Ravenell and Ogedegbe said. Future studies should look at the structural aspects of racial and ethnic disparities among COVID-19 hospitalizations and deaths, they added.
Sources
JAMA Network Open, "Assessment of Racial/Ethnic Disparities in Hospitalization and Mortality in Patients With COVID-19 in New York City."
NYU Langone Health, "Once Hospitalized, Black Patients with COVID-19 Have Lower Risk of Death Than White Patients."
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Cite this: Black COVID-19 Patients Who Are Hospitalized Face Lower Death Risks - Medscape - Dec 08, 2020.
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