Disparities in COVID-19 Hospitalizations and Mortality among Black and Hispanic Patients: Cross-Sectional Analysis from the Greater Houston Metropolitan Area

  1. Alan P. Pan
  2. Osman Khan
  3. Jennifer R. Meeks
  4. Marc L. Boom
  5. Faisal N. Masud
  6. Julia D. Andrieni
  7. Robert A. Phillips
  8. Yordanos M. Tiruneh
  9. Bita A. Kash
  10. Farhaan S. Vahidy
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Abstract

Background

Disparate racial and ethnic burdens of the Coronavirus Disease 2019 (COVID-19) pandemic may be attributable to higher susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or to factors such as differences in hospitalization and care provision.

Methods

In our cross-sectional analysis of lab-confirmed COVID-19 cases from a tertiary, eight-hospital healthcare system (Houston Methodist) across greater Houston, multivariable logistic regression models were fitted to evaluate the odds of hospitalization and mortality for non-Hispanic Blacks (NHBs) vs. non-Hispanic Whites (NHWs) and Hispanics vs. non-Hispanics.

Findings

Between March 3 rd and July 18 th , 2020, 70,496 individuals were tested for SARS-CoV-2; 12,084 (17·1%) tested positive, of whom 3,536 (29·3%) were hospitalized. Among positive cases, NHBs and Hispanics were significantly younger than NHWs and Hispanics, respectively (mean age NHBs vs. NHWs: 46.0 vs. 51.7 year and Hispanic vs. non-Hispanic: 44.0 vs. 48.7 years). Despite younger age, NHBs (vs. NHWs) had a higher prevalence of diabetes (25.2%), hypertension (47.7%), and chronic kidney disease (5.0%). Both minority groups resided in lower median income and higher population density areas. In fully adjusted models, NHBs and Hispanics had higher likelihoods of hospitalization, aOR (CI): 1·42 (1·24–1·63) and 1·61 (1·46–1·78), respectively. No differences were observed in intensive care unit (ICU) utilization or treatment parameters. Models adjusted for demographics, vital signs, laboratory parameters, hospital complications, and ICU admission demonstrated non-significantly lower likelihoods of in-hospital mortality among NHBs and Hispanics, aOR (CI): 0·65 (0·40–1·03) and 0·89 (0·59–1·31), respectively.

Interpretation

Our data did not demonstrate racial and ethnic differences in care provision and hospital outcomes. Higher susceptibility of racial and ethnic minorities to SARS-CoV-2 and subsequent hospitalization may be driven primarily by social determinants.

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