Black and Hispanic people made up nearly 60% of COVID-19 hospitalizations in a new study, a disproportionate number that researchers attribute to societal structures reinforcing health disparities among racial and ethnic groups.
The study looked at data from 7,868 people hospitalized for COVID-19 between Jan. 17 and July 22 at 88 U.S. hospitals taking part in the American Heart Association COVID-19 Cardiovascular Disease Registry. Hispanic and Black patients had a disproportionate risk of landing in the hospital: 33% were Hispanic, 25.5% were Black, 6.3% were Asian and 35.2% were white.
Yet data from the U.S. Census Bureau for ZIP codes where participating hospitals are located show Hispanic people make up just 9% of the local population and Black people make up 10.6%. Asian people, meanwhile, account for 4.7% of the local population and non-Hispanic white people account for 59.3%.
Black and Hispanic patients, once admitted, did not appear to be dying at a higher rate. Researchers also did not find any racial or ethnic differences in the rate of heart attacks, strokes or cases of heart failure among hospitalized COVID-19 patients. Black and Hispanic patients accounted for more than half – 53% – of all COVID-19 deaths.
A very small number of patients were American Indian or Alaska Native, and thus were not included in the findings.
"Our findings suggest that in order to address disparities in the burden of COVID-19 among vulnerable patient groups, we must focus on structural reasons for the higher rates of viral transmission and hospitalizations for Black and Hispanic patients," said Dr. Fatima Rodriguez, lead author of the study, which was funded by the AHA.
The findings were presented Tuesday at the AHA's virtual Scientific Sessions conference and simultaneously published in its journal Circulation.
The study also found Hispanic and Black COVID-19 patients were substantially younger – with a median age of 57 and 60, respectively, compared to 69 for white patients and 64 for Asian patients. They also were more often uninsured. Black patients had the highest prevalence of obesity, high blood pressure and diabetes, as well as the highest rates of mechanical ventilation and kidney dialysis while hospitalized.
"COVID-19 disproportionately affects Hispanic and Black patients, but where a patient was treated may explain more of the differences in outcomes than race/ethnicity in hospitalized patients," said Rodriguez, a cardiologist and health disparities researcher at Stanford Medicine in California. The odds of death for a patient was 99% higher at one hospital compared with a similar patient treated at another hospital, the study found.
Death rates overall appear to be declining in more recent months of the pandemic. The new study found 18.4% of COVID-19 patients died in the hospital between January and July. Another study published in the Journal of Hospital Medicine found COVID-19 death rates in New York City hospitals were 25.6% in March compared to 7.6% in August.
Rodriguez said the results were limited by data from hospitals that "overrepresent urban and large academic teaching hospitals, and findings may not be generalizable to other parts of the U.S."
She called for future studies to explore why so many Black and Hispanic people are hospitalized for COVID-19 and how specific hospitals can impact patient outcomes. She also wants to see future research on how COVID-19 patients fare after they leave the hospital.
Dr. Olajide Williams, who was not involved in the research, called it "an important study that confirmed the striking COVID-19 disparities in hospitalization."
"The truth is that I was not surprised by any of the study findings," said Williams, chief of staff of neurology at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City.
"What this does is retell the story through a lens that resonates more with people due to the proximity of COVID to all our lives," he said. "While our battle is downstream in the trenches of medical care, the war can only be won upstream against social determinants of health. This requires greater advocacy, greater community participation, and re-imagining health care through a more holistic lens."
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