This study reports on hospitalization and mortality among black and white patients with COVID-19. Using retrospective cohort data from Louisiana, the authors found an excess risk of hospitalization for COVID-19 among black patients versus white patients, which was not explained by comorbidities or obesity. In terms of mortality, 70.6% of patients who died were black (versus 31% of the cohort), but black race was not associated with higher in-hospital mortality than white race after accounting for differences in sociodemographic and clinical characteristics on admission.
The authors examined 3481 patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for SARS-CoV-2 on qualitative polymerase-chain-reaction assay.
Of the 3481 Covid-19–positive patients:
- 60.0% were female
- 70.4% were black non-Hispanic
- 29.6% were white non-Hispanic
- Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients
- 39.7% of Covid-19–positive patients (1382 patients) were hospitalized, 76.9% of whom were black
- Among the 326 patients who died from Covid-19, 70.6% were black.
In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission.
In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17).