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Published on: September 6, 2024
Racial disparities in COVID-19 associated pulmonary embolism: A multicenter cohort study
Brandon Metra1, Ross Summer2, Sandra Elaine Brooks3
1Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, United States of America.
Insights
Black individuals face higher risks of pulmonary embolism and mortality following COVID-19 infection. This study highlights significant racial disparities in COVID-19 outcomes, particularly concerning pulmonary embolism (PE) and death.
Area of Science:
- Medical research
- Public health
- Epidemiology
Background:
- Thromboembolism is a known complication of severe COVID-19.
- Limited research exists on racial disparities in COVID-19-related pulmonary embolism (PE).
Purpose of the Study:
- To investigate racial disparities in the incidence of pulmonary embolism (PE) and mortality among patients with COVID-19.
- To analyze the association between race and adverse outcomes following COVID-19 diagnosis.
Main Methods:
- Retrospective cohort study using a large, multicenter electronic health record dataset (TriNetX).
- Inclusion of adults diagnosed with COVID-19 between January and September 2020.
- Propensity matching used to balance sociodemographic and clinical variables between racial groups.
Main Results:
- Black race was significantly associated with a higher risk of developing PE (RR 1.537) and mortality (RR 1.890) post-COVID-19 diagnosis.
- Black patients with COVID-19 and PE exhibited a higher mortality rate compared to white patients (RR 1.397).
- Both racial groups experienced increased mortality with COVID-associated PE compared to COVID-19 or PE alone.
Conclusions:
- Black race is linked to increased risks of pulmonary embolism and mortality after COVID-19.
- Racial disparities in COVID-19 outcomes, specifically PE and mortality, are evident, with Black patients facing worse prognoses.
Background:
Thromboembolism is a recognized component of severe coronavirus disease 2019 (COVID-19) disease. However, research into racial disparities in COVID-19-related pulmonary embolism is limited.
Materials And Methods:
In this retrospective cohort study, we examined adults diagnosed with COVID-19 between January 20 and September 30, 2020, using a multicenter electronic health record dataset of over 73 million patients (TriNetX), mostly in the USA. The main study outcomes were development of pulmonary embolism or mortality within 30 days of COVID-19 diagnosis. Secondary outcome analysis included hospitalization, mechanical ventilation, and ICU admission within 30 days of diagnosis, as well as lab values within 0-1 days of diagnosis. Sociodemographic and clinical variables were used to create balanced cohorts via propensity matching.
Results:
346,953 patients were identified, with 56.0% non-Hispanic white and 14.7% non-Hispanic black; the mean age was 47.6 years. 3879 patients developed PE, with 2036 (1.30% of 157,049) white and 1088 (2.16% of 50,376) black patients. After propensity matching, black race was associated with higher mortality (risk ratio 1.890 [95% CI 1.727-2.067]) and PE (RR 1.537 [1.380-1.711]; p < 0.0001). Both races had higher mortality with COVID-associated PE than COVID or PE alone (RR 1.575-1.627 and 3.000-5.389 respectively; p < 0.0001). Black patients with COVID-19 and PE had a higher rate of mortality compared to white patients (RR 1.397 [1.059-1.844]; p = 0.0174).
Interpretation:
Black race was associated with higher risk of pulmonary embolism and mortality after COVID-19. Additionally, black patients with COVID-19 and PE had a higher mortality compared to white patients.
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