Hospitalized US indigenous patients had higher COVID-19 death rates

Hospitalized American Indian and Alaska Native COVID-19 patients died at a significantly higher rate than their Black and White peers early in the pandemic, despite being younger and having lower rates of underlying illnesses, shows a study published yesterday in JAMA Network Open.

University of Mississippi at Jackson researchers studied 18,731 adult COVID-19 patients with race data hospitalized in 103 state hospitals from Mar 1 to Dec 31, 2020. Median patient age was 66 years, 54.0% were women, 49.1% were Black, 48.7% were White, and 1.2% were American Indian or Alaska Native. Indigenous patients were significantly younger than their Black and White peers (average age, 52.4, 60.2, 68.3 years, respectively).

Pooled data showed that, across underlying illness groups, the odds of in-hospital death were 75% lower among Black patients than among their American Indian and Alaska Native counterparts (odds ratio [OR], 0.25) and 77% lower among White patients (OR, 0.23).

Within underlying illness groups, indigenous patients at the lowest risk per an Elixhauser Comorbidity Index Score of 0 or less had an adjusted odds of in-hospital death of 0.10, compared with 0.03 for Black patients (OR, 0.29) and 0.04 for White patients (OR, 0.37).

At index scores of 16 or higher, the odds of in-hospital death were 0.69 for indigenous patients, compared with 0.28 for Black patients (OR, 0.16) and 0.25 for their White peers (OR, 0.14).

"Discrimination, marginalization, inability to see preferred clinicians, and systemic underfunding of the Indian Health Service (IHS) have been widely cited as barriers to American Indian and Alaska Native individuals accessing care," the researchers wrote.

In a related commentary, Loretta Christensen, MD, and Shawnell Damon, MPH, both of the IHS, said that poverty, lack of running water and basic utilities, and insufficient access to healthy food and to broadband for virtual heath visits could also contribute.

"To improve health outcomes in the American Indian and Alaska Native population, there must be a multifactorial and comprehensive approach to address the impact of health inequity, the social determinants of health, and research to define the clinical and physiologic responses to disease in this population," they wrote.
Mar 30 JAMA Netw Open study and commentary

Unhealthy lifestyles linked to poor COVID-19 outcomes

Unhealthy lifestyles are associated with more severe COVID-19 outcomes, according to a large UK study yesterday in BMC Infectious Diseases.

The study was based on UK-Biobank, a prospective cohort of 502,536 participants aged 37 to 73 years recruited from 2006 to 2010 and followed up in the ensuing years. The cohort tracks nine unhealthy lifestyle traits, including smoking, excessive alcohol consumption, poor diet, physical inactivity, sleep duration, and television viewing time.

Of 343,850 participants with complete data, 707 (0.21%) died from COVID-19 and 2,506 (0.76%) had severe COVID-19. All deaths and hospitalizations from Mar 1, 2020 to Feb 28, 2021, were included in the study.

"There was evidence of a nonlinear association between lifestyle score and COVID-19 mortality but limited evidence for nonlinearity between lifestyle score and severe COVID-19," the authors said.

The association was strongest in participants with socioeconomically disadvantaged backgrounds. Unhealthy lifestyles and low socioeconomic status (SES) have an additive effect for COVID-19 outcomes, the authors said. This is the first study to examine unhealthy habits, COVID-19 outcomes, and SES, they noted.

"Benefit from lifestyle focussed COVID-19 policy and interventions is likely to be greatest when support for healthy living is optimised in the most disadvantaged groups," the authors concluded.
Mar 30 BMC Infect Dis study