Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database
Background: Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537021003552 |
| _version_ | 1818642757618499584 |
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| author | Ami R. Buikema Paul Buzinec Misti L. Paudel Katherine Andrade Jonathan C. Johnson Yvette M. Edmonds Sumit K. Jhamb Benjamin Chastek Harish Raja Feng Cao Erin M. Hulbert Stephanie Korrer Dibyajyoti Mazumder Jerry Seare Brian K. Solow U. Michael Currie |
| author_facet | Ami R. Buikema Paul Buzinec Misti L. Paudel Katherine Andrade Jonathan C. Johnson Yvette M. Edmonds Sumit K. Jhamb Benjamin Chastek Harish Raja Feng Cao Erin M. Hulbert Stephanie Korrer Dibyajyoti Mazumder Jerry Seare Brian K. Solow U. Michael Currie |
| author_sort | Ami R. Buikema |
| collection | DOAJ |
| description | Background: Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. Methods: This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. Findings: Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620–1·763; Black: 1·810, 1·743–1·880; Asian: 1·503, 1·381–1·636) and during follow-up (Hispanic: 1·700, 1·638–1·764; Black: 1·578, 1·526–1·633; Asian: 1·391, 1·288–1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809–0·959) but higher for Asian patients (1·205, 1·000–1·452). Interpretation: Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19–related care, further analyses of disaggregated population-level COVID-19 data are needed. Funding: None. |
| first_indexed | 2024-12-16T23:48:08Z |
| format | Article |
| id | doaj.art-fae286f449d94744b788c1c1b64c0b41 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-16T23:48:08Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-fae286f449d94744b788c1c1b64c0b412022-12-21T22:11:26ZengElsevierEClinicalMedicine2589-53702021-09-0139101075Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record databaseAmi R. Buikema0Paul Buzinec1Misti L. Paudel2Katherine Andrade3Jonathan C. Johnson4Yvette M. Edmonds5Sumit K. Jhamb6Benjamin Chastek7Harish Raja8Feng Cao9Erin M. Hulbert10Stephanie Korrer11Dibyajyoti Mazumder12Jerry Seare13Brian K. Solow14U. Michael Currie15Optum, Eden Prairie, MN, USA; Corresponding author at: 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA.Optum, Eden Prairie, MN, USAOptum, Eden Prairie, MN, USAOptum, Eden Prairie, MN, USAOptum, Eden Prairie, MN, USAOptum, Eden Prairie, MN, USAOptum, Noida, IndiaOptum, Eden Prairie, MN, USAOptum, Boston, MA, USAOptum, Eden Prairie, MN, USAOptum, Eden Prairie, MN, USAOptum, Eden Prairie, MN, USAOptum, Noida, IndiaOptum, Eden Prairie, MN, USAOptum, Irvine, CA, USAUnitedHealth Group, Minnetonka, MN, USABackground: Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. Methods: This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. Findings: Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620–1·763; Black: 1·810, 1·743–1·880; Asian: 1·503, 1·381–1·636) and during follow-up (Hispanic: 1·700, 1·638–1·764; Black: 1·578, 1·526–1·633; Asian: 1·391, 1·288–1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809–0·959) but higher for Asian patients (1·205, 1·000–1·452). Interpretation: Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19–related care, further analyses of disaggregated population-level COVID-19 data are needed. Funding: None.http://www.sciencedirect.com/science/article/pii/S2589537021003552COVID-19SARS-CoV-2Retrospective StudiesElectronic Health RecordsEthnic GroupsMinority Groups |
| spellingShingle | Ami R. Buikema Paul Buzinec Misti L. Paudel Katherine Andrade Jonathan C. Johnson Yvette M. Edmonds Sumit K. Jhamb Benjamin Chastek Harish Raja Feng Cao Erin M. Hulbert Stephanie Korrer Dibyajyoti Mazumder Jerry Seare Brian K. Solow U. Michael Currie Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database EClinicalMedicine COVID-19 SARS-CoV-2 Retrospective Studies Electronic Health Records Ethnic Groups Minority Groups |
| title | Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database |
| title_full | Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database |
| title_fullStr | Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database |
| title_full_unstemmed | Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database |
| title_short | Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database |
| title_sort | racial and ethnic disparity in clinical outcomes among patients with confirmed covid 19 infection in a large us electronic health record database |
| topic | COVID-19 SARS-CoV-2 Retrospective Studies Electronic Health Records Ethnic Groups Minority Groups |
| url | http://www.sciencedirect.com/science/article/pii/S2589537021003552 |
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