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Racial Disparities in Coronavirus Disease 2019 Mortality Are Present in Heart Transplant Recipients
Stanley B Wolfe1, Tiffany Calero2, Asishana A Osho1
1Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
Insights
Black and Hispanic heart transplant recipients face a significantly higher risk of death from COVID-19. These disparities highlight persistent racial/ethnic inequalities in post-transplant outcomes.
Area of Science:
- Cardiology
- Immunology
- Public Health
Background:
- Heart transplant recipients are a vulnerable population due to immunosuppression and comorbidities.
- Coronavirus disease 2019 (COVID-19) has disproportionately affected vulnerable groups.
- Understanding COVID-19 mortality in heart transplant recipients is crucial.
Purpose of the Study:
- To investigate the association between race/ethnicity and COVID-19 mortality in adult heart transplant recipients in the U.S.
- To determine if existing racial/ethnic disparities in COVID-19 outcomes extend to this specific patient group.
Main Methods:
- Utilized the Organ Procurement and Transplantation Network database to identify adult heart transplant recipients.
- Stratified recipients into four race/ethnicity cohorts.
- Analyzed COVID-19 as the primary cause of death, with multivariable adjustment.
Main Results:
- Out of 22,157 recipients, 153 died from COVID-19.
- COVID-19 mortality rates differed significantly across race/ethnicity groups (P = .007).
- Black and Hispanic recipients had a higher risk of COVID-19 death compared to White recipients (HR 2.78 and 3.92, respectively).
Conclusions:
- Black and Hispanic heart transplant recipients experienced higher COVID-19 mortality rates.
- Racial/ethnic disparities in COVID-19 mortality observed in the general population are present in heart transplant recipients.
- These findings underscore the need for targeted interventions and equitable care in post-transplant populations.
Background:
Studies have demonstrated the devastating effects of coronavirus disease 2019 (COVID-19) on vulnerable populations. Although they receive close follow-up, heart transplant recipients represent a particularly vulnerable population, given long-term immunosuppression and comorbid conditions. We sought to investigate the association between race/ethnicity and the probability of death due to COVID-19 in adult heart transplant recipients in the United States.
Methods:
Adult isolated heart transplant recipients were identified using the Organ Procurement and Transplantation Network database. Recipients who were described as deceased or lost to follow-up before January 2020 were excluded. Recipients were stratified into 4 cohorts by race/ethnicity. The primary outcome of interest was death due to COVID-19.
Results:
A total of 22 157 adult recipients were identified. During the course of follow-up, 153 recipients had COVID-19 reported as the primary cause of death. COVID-19 mortality was significantly different between race/ethnicity cohorts (Black, n = 34 [0.79%]; Hispanic, n = 23 [1.33%]; White, n = 92 [0.60%]; other, n = 4 [0.44%]; P = .007). COVID-19 was listed as a contributing cause of mortality in 0.12% of Black, 0.23% of Hispanic, 0.04% of White, and 0.33% of other recipients (P = .002). No significant difference in non-COVID mortality or all-cause mortality was observed. After multivariable adjustment, Black (hazard ratio, 2.78 [1.40-5.52]; P = .003) and Hispanic (hazard ratio, 3.92 [1.88-8.16]; P < .001) recipients were at higher risk of death due to COVID-19 compared with White recipients.
Conclusions:
Compared with White recipients, Black and Hispanic recipients experienced higher rates of COVID-19 mortality after transplantation. These findings suggest that racial/ethnic disparities of COVID-19 mortality in the general population persist in adult heart transplant recipients.
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