Racial minorities at higher risk for COVID-19 hospitalization, ICU care

Female hospital patient wearing mask
Female hospital patient wearing mask

Hispanolistic / iStock

Racial minority COVID-19 patients are at much higher risk for needing hospitalization and intensive care than their White counterparts, a new Kaiser Permanente Southern California (KPSC) study finds.

The retrospective study, published yesterday in the Annals of Internal Medicine, involved comparing the electronic health records of 47,974 adult Hispanic, Black, Asian, Pacific Islander, and White COVID-19 patients from Mar 1 to Jul 31, 2020. KPSC serves 10 Southern California counties, with a membership that roughly represents the racial makeup of its service area.

Of the 47,947 COVID-19 patients, 9.42% were hospitalized, and 3.12% were admitted to the intensive care unit (ICU). Those who needed hospitalization or ICU admission were, on average, older and obese, with a higher Elixhauser Comorbidity Index score than those who didn't need those levels of care.

The researchers saw disparities by race for all outcomes, even after adjustment for age, sex, underlying medical conditions, and body mass index (BMI). Racial minorities had a slightly higher chance than White patients of being tested for or diagnosed as having COVID-19 but were also at substantially higher risk for hospitalization and ICU care.

Hispanic patients were more likely than other minorities and White patients to be tested for and diagnosed as having COVID-19, while Asian, Black, and Pacific Islander patients had higher rates of severe COVID-19 outcomes than their White peers. Disparities in death rates weren't analyzed, because some racial groups had fewer than 10 deaths.

Targeted response, vaccination strategies

The authors noted that previous research has often been limited by small, nondiverse patient samples or a lack of reliable clinical data, which has prevented presenting a detailed depiction of coronavirus-related racial disparities.

"Our results confirm findings from earlier in the pandemic that suggest that COVID-19 affects Hispanic, Black or African American, and Asian persons disproportionately," the authors wrote. "Comprehensive health equity assessments of COVID-19 testing and outcomes are needed to support an equitable pandemic response and vaccination efforts."

The researchers said the findings suggest that racial differences in underlying illness and obesity burdens aren't the only factors behind the stark disparities in COVID-19 outcomes. They also underscore the need for culturally appropriate pandemic response and vaccination strategies that consider racial minority distrust in healthcare, resource limitations, English language proficiency, and health literacy.

"Inequities in COVID-19 outcomes are a call to action for a culturally appropriate pandemic response and vaccination strategies that go beyond addressing comorbidities and account for factors like distrust in the medical system, resource constraints, language proficiency, and health literacy," the authors wrote.

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