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Age, Comorbid Conditions, and Racial Disparities in COVID-19 Outcomes
Zanthia Wiley1, Julianne N Kubes2, Jason Cobb3
1Division of Infectious Diseases - Emory University Hospital Midtown, Emory University School of Medicine, 550 Peachtree Street, 7th floor of Medical Office Tower, Atlanta, GA, 30308, USA. zwiley@emory.edu.
Insights
Black and non-Black patients with COVID-19 had similar hospitalization and mortality risks. However, Black patients faced higher acute kidney injury risks, particularly younger individuals. Further research into age and comorbidities is needed.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- COVID-19 disproportionately impacts Black populations.
- Understanding disparities in COVID-19 outcomes is crucial for targeted interventions.
- Previous studies highlight racial disparities in COVID-19 severity and mortality.
Purpose of the Study:
- To compare hospitalization risks between Black and non-Black COVID-19 patients.
- To assess differences in mortality and acute kidney injury (AKI) among hospitalized patients.
- To investigate how age and comorbidities influence these disparities.
Main Methods:
- Retrospective cohort study of 831 adult COVID-19 patients from four academic hospitals.
- Data collected from March 1, 2020, to May 31, 2020.
- Primary outcome: hospitalization risk; secondary outcomes: mortality and AKI.
Main Results:
- Crude hospitalization odds were similar, but adjusted for age, Black patients had 55% higher odds.
- Mortality differences were most pronounced when adjusted for age alone.
- Acute kidney injury was more frequent in hospitalized Black patients, irrespective of adjustments.
- Disparities in hospitalization and AKI were most significant in younger patients.
Conclusions:
- Adjusted analyses show similar hospitalization and mortality risks for Black and non-Black patients with COVID-19.
- Black patients experienced a higher risk of acute kidney injury.
- Examining disparities without considering age and comorbidities can obscure important patterns.
- Further subgroup analyses by age and comorbidities are essential for effective intervention strategies.
Background:
Black patients are disproportionately affected by COVID-19. The purpose of this study was to compare risks of hospitalization of Black and non-Black COVID-19 patients presenting to the emergency department and, of those hospitalized, to compare mortality and acute kidney injury.
Methods:
A retrospective cohort of 831 adult COVID-19 patients (68.5% Black) who presented to the emergency departments of four academic hospitals, March 1, 2020-May 31, 2020. The primary outcome was risk of hospitalization among Blacks vs. non-Blacks. Secondary outcomes were mortality and acute kidney injury, among hospitalized patients.
Results:
The crude odds of hospitalization were not different in Black vs. non-Black patients; however, with adjustment for age, Blacks had 55% higher odds of hospitalization. Mortality differed most in the model adjusted for age alone. Acute kidney injury was more common in the Black hospitalized patients, regardless of adjustment. Stratified analyses suggested that disparities in the risk of hospitalization and of in-hospital acute kidney injury were highest in the youngest patients.
Conclusions:
Our report shows that Black and non-Black patients presenting to the emergency department with COVID-19 had similar risks of hospitalization and, of those who were hospitalized, similar mortality when adjusted for multiple factors. Blacks had higher risk of acute kidney injury. Our results suggest that examination of disparities without exploration of the individual effects of age and comorbidities may mask important patterns. While stratified analyses suggest that disparities in outcomes may differ substantially by age and comorbid conditions, further exploration among these important subgroups is needed to better target interventions to reduce disparities in COVID-19 clinical outcomes.
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