More than half of all in-hospital deaths due to COVID-19 during the first six months of 2020 were among Black and Hispanic patients, according to a new study led by researchers at the Stanford University School of Medicine and Duke University.
The researchers did not find any racial or ethnic differences in mortality rates among people hospitalized with the disease. Yet a disproportionate number of Black and Hispanic people became sick enough to require hospitalization, and they made up 53% of inpatient deaths.
Fatima Rodriguez, MD, assistant professor of cardiovascular medicine at Stanford, is the lead author of the study, which was published Nov. 17 in Circulation. Tracy Wang, MD, professor of medicine at Duke University, is the senior author.
"The COVID-19 pandemic has shown a spotlight on racial and ethnic disparities in health care that have been happening for years," said Rodriguez, an expert in health disparities in cardiovascular medicine. "Our study shows an over-representation of Black and Hispanic patients in terms of morbidity and mortality that needs to be addressed upstream before hospitalization."
Researchers examined a sample of 7,868 patients hospitalized with the coronavirus at 88 hospitals across the country between Jan. 17 and July 22. The data was collected from the American Heart Association's COVID-19 Cardiovascular Disease Registry. The average mortality rate for all patients was 18.4%.
The researchers found that white patients accounted for 35.2% of the sample, Hispanic patients for 33%, Black patients for 25.5% and Asian patients for 6.3%.
The U.S. Census Bureau estimates that white people make up 60% of the nation's population, Hispanic people 18.5%, Black people 13.4% and Asian people 5.9%.
Hospitals, not race and ethnicity, tied to mortality rate
"Interestingly, more of the variations in mortality were explained by the site of the care than by race or ethnicity," Rodriguez said. "We need to understand more about differences between hospitals. Is it different treatment protocols that are rapidly evolving during the pandemic? Or perhaps minority-serving hospitals have different resources? This is an active area of research within the registry used for this study as we enroll more sites across the country."
The study also found that Black and Hispanic patients were significantly younger than others, with an average age of 57 and 60, respectively, compared with 69 for white patients and 64 for Asian patients. In addition, Black and Hispanic patients had more underlying health conditions. Black patients had the highest prevalence of obesity, hypertension and diabetes. They also had the highest rates of mechanical ventilation and renal replacement therapy and the lowest rates of remdesivir use at 6.1%. The antiviral medication was the first treatment approved for COVID-19.
Somewhat surprisingly, heart problems occurred infrequently among all patients, Rodriguez said.
"Asian patients showed higher rates of cardiorespiratory disease severity when they arrived at the hospital," she said. "That was an interesting finding. They tended to be older and to come to the hospital later in the disease progression."
The study had some limitations, Rodriguez said, including an overrepresentation of urban and large academic teaching hospitals in the data sample, but the findings remain startling.
"My work focuses on preventing chronic disease before patients are hospitalized," Rodriguez said. "We need to invest in communities to increase opportunity for healthy lifestyles and good health care. Structural racism, we know, is a major roadblock for preventing good health."
Researchers at the University of Texas Southwestern; Brigham and Women's Hospital; the Minneapolis Heart Institute; Columbia University; the American Heart Association; Emory University; Providence Heart Institute in Portland, Oregon; UC San Francisco; and Northwestern University contributed to this study.
This study was funded by the American Heart Association, the Gordon and Betty Moore Foundation, and the National Institutes of Health (grants K01 HL 144607, K23 HL141682-01A1 and R01HL146636-01A1).
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