Black Patients Hospitalized With COVID-19 Show High Incidence of Comorbidities, Mortality

Black patients hospitalized with coronavirus disease 2019 (COVID-19) from an urban academic medical center in New York City exhibited high rates of present comorbidities and in-hospital mortality, with chronic obstructive pulmonary disease (COPD) and asthma significantly linked with early death, according to a study published this week in BMC Infectious Diseases.

As researchers highlight, African-American/Black patients have represented a higher risk of morbidity and mortality due to COVID-19 than any other racial group. “Such burden of disease is of particular concern since it disproportionately affects communities with considerable health disparities in New York City, where African-Americans and Latinos constitute as much as 53% of the population,” noted researchers.

Examining patients with COVID-19 hospitalized at the State University of New York, Downstate Medical Center, Brooklyn, New York, researchers sought to assess potential causes of disparities in COVID-19 outcomes, as well as delineate prognostic indicators and assess effectiveness of treatment interventions in patient care. The facility is a designated COVID-only facility serving a majority Black population.

The researchers performed a retrospective cohort study of clinical features and laboratory data of patients with COVID-19 (N = 529) admitted over a 52-day period at the height of the pandemic in the United States (March 2–April 23).

Among the patient cohort, 88% were Black, of whom more than half (52%) were aged 61 to 80 years with a mean body mass index of 30 kg/m2, indicating obesity. Virtually all (98%) presented with 1 or more preexisting condition. The most common comorbidities included hypertension (79%) and diabetes (56%); 17 % had chronic kidney disease (CKD).

For patients with CKD, those who received hemodialysis were found to have lower mortality than patients who did not receive it. The presence of coronary artery disease was also found to be an independent predictor of mortality among patients with CKD in the multivariate analysis.

Notably, time to death modeling conducted via Cox proportional hazards represented a significantly higher hazard ratio (HR) for death in patients with the paired comorbidites of COPD and asthma (HR = 1.79; CI, 1.20–2.68; P = .005). This analysis additionally showed that patients who had pre-admission ACE inhibitors (P = .013) and ARBs (P = .013) had a beneficial effect.

Nearly half of the assessed inpatients (n = 255; 48%) died, with more than one-third of those patients dying within 3 days of admission (Black, n = 78; others, n = 13). Of the 159 patients who received invasive mechanical ventilation, 86% died.

“Patients with COVID-19 in our predominantly Black neighborhood had higher in-hospital mortality, likely due to higher prevalence of comorbidities,” concluded researchers. “Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in Black patients.”

Reference

Gupta R, Agrawal R, Bukhari Z, et al. Higher comorbidities and early death in hospitalized African-American patients with COVID-19. BMC Infect Dis. Published online January 18, 2020. doi:10.1186/s12879-021-05782-9