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Racial disparities in COVID-19 outcomes exist despite comparable Elixhauser comorbidity indices between Blacks,

Fares Qeadan1, Elizabeth VanSant-Webb2, Benjamin Tingey3

  • 1Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA. fares.qeadan@utah.edu.

Scientific Reports
|April 23, 2021
PubMed

Insights

Racial disparities in COVID-19 outcomes persist even with similar comorbidity scores. Non-Hispanic Blacks and American Indians/Alaska Natives faced worse outcomes than Hispanics and Whites, challenging comorbidity as the sole explanation.

Area of Science:

  • Public Health
  • Epidemiology
  • Health Disparities

Background:

  • Racial inequities in COVID-19 outcomes are not fully understood.
  • Existing research often overlooks the role of comorbidities in these disparities.

Purpose of the Study:

  • To compare COVID-19 health outcomes by race, stratified by comorbidity index.
  • To investigate if comorbidity levels explain racial disparities in COVID-19 outcomes.

Main Methods:

  • Retrospective analysis of the Cerner COVID-19 De-Identified Data cohort.
  • Comparison of four COVID-19 outcomes: maximum length of hospital stay (LOS), invasive ventilation, hospitalization duration, and death.
  • Stratification by Elixhauser Comorbidity Index (ECI) ranking across racial groups: non-Hispanic Blacks, Hispanics, American Indians/Alaska Natives (AI/ANs), and non-Hispanic Whites.

Main Results:

  • Non-Hispanic Blacks experienced longer hospital LOS, higher ventilator use, and increased mortality compared to non-Hispanic Whites.
  • AI/ANs showed varied hospitalization risks based on ECI, longer LOS for ECI=0, higher death risk across most ECI categories, and increased ventilator dependence.
  • Hispanics had lower death risk except for ECI=0, lower hospitalization odds, shorter LOS for ECI≥5, and mixed ventilator dependence based on ECI.

Conclusions:

  • Comorbidity levels do not fully explain the elevated COVID-19 death rates observed in non-Hispanic Blacks and AI/ANs compared to Hispanics and non-Hispanic Whites.
  • Racial disparities in COVID-19 outcomes are influenced by factors beyond comorbidities.
  • Further research is needed to identify and address the root causes of these persistent health inequities.

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