A US study of 3,506 cancer patients infected with SARS-CoV-2 in 2020 shows that Black patients were significantly more likely than their White peers to have severe illness, regardless of demographic and clinical risk factors and cancer type, status, and therapy at COVID-19 diagnosis.
A Tufts University researcher led the study, which was published yesterday in JAMA Network Open, using electronic health records and data from the COVID-19 and Cancer Consortium registry from Mar 17 to Nov 18, 2020. Underlying illnesses such as cancer put COVID-19 patients at higher risk for severe illness and death.
Among all patients, 30% were Black, 50% were women, and median age at COVID-19 diagnosis was 65 years for Black patients and 68 for White patients. Black patients had higher rates of underlying illnesses than White patients, including obesity (45% vs 38%), diabetes (38% vs 24%), and kidney disease (23% vs 16%). Most patients had solid tumors, 20% of which were breast cancer.
Higher rates of ICU admission, ventilation, death
Black patients were more likely than their White peers to have moderate (41% vs 34%) or severe (15% vs 11%) COVID-19 at diagnosis (unweighted odds ratio [OR], 1.34; weighted OR, 1.21). Lung conditions were the most common COVID-19 complication (37% overall), with higher rates among Black, relative to White, patients (42% vs 35%).
Likewise, Black patients had higher rates of acute kidney injury (27% vs 15%) and cardiovascular complications (26% vs 22%) than their White peers. Black patients were less likely than White patients to receive the antiviral drug remdesivir (6% vs 10%) and more likely to receive the antimalarial drug hydroxychloroquine (24% vs 15%), which has been disproven as a treatment for COVID-19.
Compared with White patients, Black patients had higher rates of hospitalization (65% vs 55%), intensive care unit admission (23% vs 16%), mechanical ventilation (17% vs 10%), and death from any cause (19% vs 17%). Among the 618 patients who died during follow-up, 82% died within 30 days of COVID-19 diagnosis, with a 30-day mortality rate of 17% among Black patients and 13% among their White counterparts.
'Perfect storm' of cancer, COVID, disparities
The study authors noted that racial minorities, especially those who are Black, have had higher rates of COVID-19 infection, hospitalization, and death than their White counterparts. While Black Americans make up 13% of the US population, they make up 20% of COVID-19 cases and 23% of related deaths. Even before the pandemic, Black cancer patients had the highest death rates of all racial groups, the researchers said.
"These findings suggest that, within the framework of structural racism in the US, having cancer and COVID-19 is associated with worse outcomes among Black patients compared with White patients," they wrote.
"Unfortunately, if these same racial inequities in access to medical care hold for cancer screening, in the near future, we are likely to see worsening disparities in rates of advanced stage cancers at diagnosis."
The team defined structural racism as the ways in which societies reinforce discriminatory distribution of resources and attitudes among systems of healthcare, law enforcement, education, employment, benefits, media, and housing.
Racial health disparities are largely a social construct caused by discrimination, senior author Dimpy Shah, MD, PhD, said in a University of Texas at San Antonio news release. "Some of the societal root causes of health disparities, including lack of access to health care, social determinants of health, preexisting comorbidities and access to clinical research, are common to both cancer and COVID-19, and together these two diseases create a perfect storm," she said.
The researchers urged more work addressing the cumulative and synergistic association of racial inequities on clinical outcomes. "This is a call for action to eradicate root causes of racial inequities, within the causal framework of structural racism, to reduce the disproportionate burden of diseases, such as COVID-19 and cancer, among Black patients and, possibly, other minority racial and ethnic groups," they concluded.
