Racial and Ethnic Differences and Clinical Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) Presenting to the Emergency Department

• Type of Material: Article
• Authors: Zanthia Wiley, Emory University; Katie Ross-Driscoll, Emory University; Zhensheng Wang, Emory University; Laken Smothers, Emory University; Aneesh Mehta, Emory University; Rachel Patzer, Emory University
• Language: English
• Date: 2022-01-05
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [e-mail].
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciab290
• Title of Journal or Parent Work: CLINICAL INFECTIOUS DISEASES
• Volume: 74
• Issue: 3
• Start Page: 387
• End Page: 394
• Grant/Funding Information: This work was not supported by grant funding. The Emory Health Services Research Center in the Emory University School of Medicine Department of Medicine and Department of Surgery for resources to support analyst time and effort to complete the study.
• Keywords: disparities; race; Microbiology; COVID-19; BIAS; DISPARITIES; RACE/ETHNICITY; Science & Technology; emergency department; Infectious Diseases; ethnicity; Life Sciences & Biomedicine; BLACK; Immunology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background: Since the introduction of remdesivir and dexamethasone for severe COVID-19 treatment, few large multi-hospital-system US studies have described clinical characteristics and outcomes of minority COVID-19 patients who present to the emergency department (ED). Methods: This cohort study from the Cerner Real World Database (87 US health systems) from 1 December 2019 to 30 September 2020 included PCR-confirmed COVID-19 patients who self-identified as non-Hispanic Black (Black), Hispanic White (Hispanic), or non-Hispanic White (White). The main outcome was hospitalization among ED patients. Secondary outcomes included mechanical ventilation, intensive care unit care, and in-hospital mortality. Descriptive statistics and Poisson regression compared sociodemographics, comorbidities, receipt of remdesivir or dexamethasone, and outcomes by racial/ethnic groups and geographic region. Results: 94 683 COVID-19 patients presented to the ED. Blacks comprised 26.7% and Hispanics 33.6%. Nearly half (45.1%) of ED patients presented to hospitals in the South. 31.4% (n = 29 687) were hospitalized. Lower proportions of Blacks were prescribed dexamethasone (29.4%; n = 7426) compared with Hispanics (40.9%; n = 13 021) and Whites (37.5%; n = 14 088). Hospitalization risks, compared with Whites, were similar in Blacks (RR:. 94; 95% CI:. 82-1.08; P = .4) and Hispanics (.99;. 81-1.21; P = .91), but risk of in-hospital mortality was higher in Blacks (1.18; 1.06-1.31; P = .002) and Hispanics (1.28; 1.13-1.44; P <. 001). Conclusions: Minority patients were overrepresented among COVID-19 ED patients, and while their risks of hospitalization were similar to Whites, in-hospital mortality risk was higher. Interventions targeting upstream social determinants of health are needed to reduce racial/ethnic disparities in COVID-19.