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Risk Factors for In-hospital Mortality from Coronavirus Disease 2019 Infection Among Black Patients-An Urban Center
Ashish Bhargava1, Mamta Sharma1, Kathleen Riederer1
1Department of Internal Medicine, Thomas Mackey Center for Infectious Diseases Research, Ascension St. John Hospital, Detroit, Michigan, USA.
Insights
Black patients with COVID-19 faced high mortality. Risk factors for death included older age, nursing facility admission, and severe symptoms like altered mental status, shock, and acute respiratory distress syndrome.
Area of Science:
- Medical Research
- Public Health
- Epidemiology
Background:
- Racial disparities in coronavirus disease 2019 (COVID-19) outcomes are a significant concern, with Black/African Americans disproportionately affected.
- This study focuses on identifying risk factors for mortality among Black inpatients diagnosed with COVID-19 at an urban hospital.
Purpose of the Study:
- To assess demographic, clinical, and laboratory risk factors associated with in-hospital mortality in Black patients with COVID-19.
- To inform early identification and intervention strategies for high-risk individuals within this population.
Main Methods:
- Retrospective, single-center cohort study.
- Analysis of electronic medical records for patients positive for severe acute respiratory syndrome coronavirus 2 (COVID-19) admitted between March 8, 2020, and May 6, 2020.
- Primary outcome measured was in-hospital mortality.
Main Results:
- The case fatality rate was 29.1% (122/419).
- Patients who died were more likely to present with altered mental status (43% vs. 20.0%, P < .0001).
- Multivariable analysis identified increased odds of death with age (≥60 years), nursing facility admission, higher Charlson score, altered mental status, elevated C-reactive protein, mechanical ventilation, shock, and acute respiratory distress syndrome.
Conclusions:
- Identified demographic, clinical, and laboratory factors can aid healthcare providers in pinpointing Black patients at highest risk for severe COVID-19 outcomes.
- Prompt and intensive interventions for this at-risk population may help reduce adverse outcomes.
Background:
Racial disparities are central in the national conversation about coronavirus disease 2019 (COVID-19) , with Black/African Americans being disproportionately affected. We assessed risk factors for death from COVID-19 among Black inpatients at an urban hospital in Detroit, Michigan.
Methods:
This was a retrospective, single-center cohort study. We reviewed the electronic medical records of patients positive for severe acute respiratory syndrome coronavirus 2 (the COVID-19 virus) on qualitative polymerase chain reaction assay who were admitted between 8 March 2020 and 6 May 2020. The primary outcome was in-hospital mortality.
Results:
The case fatality rate was 29.1% (122/419). The mean duration of symptoms prior to hospitalization was 5.3 (3.9) days. The incidence of altered mental status on presentation was higher among patients who died than those who survived, 43% vs 20.0%, respectively (P < .0001). From multivariable analysis, the odds of death increased with age (≥60 years), admission from a nursing facility, Charlson score, altered mental status, higher C-reactive protein on admission, need for mechanical ventilation, presence of shock, and acute respiratory distress syndrome.
Conclusions:
These demographic, clinical, and laboratory factors may help healthcare providers identify Black patients at highest risk for severe COVID-19-associated outcomes. Early and aggressive interventions among this at-risk population may help mitigate adverse outcomes.
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