In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort Collaborative

Background: Studies examining racial and ethnic disparities in-hospital mortality for patients hospitalized with COVID-19 had mixed results. Findings from patients within academic medical centers (AMCs) are lacking, but important given the role of AMCs in improving health equity. Objective: The purp...

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Main Authors: Antonije Lazic, J. Mick Tilford, Bradley C. Martin, Mandana Rezaeiahari, Anthony Goudie, Ahmad Baghal, Melody Greer
Format: Article
Language:English
Published: Elsevier 2024-12-01
Series:American Journal of Medicine Open
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Online Access:http://www.sciencedirect.com/science/article/pii/S2667036424000074
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author Antonije Lazic
J. Mick Tilford
Bradley C. Martin
Mandana Rezaeiahari
Anthony Goudie
Ahmad Baghal
Melody Greer
author_facet Antonije Lazic
J. Mick Tilford
Bradley C. Martin
Mandana Rezaeiahari
Anthony Goudie
Ahmad Baghal
Melody Greer
author_sort Antonije Lazic
collection DOAJ
description Background: Studies examining racial and ethnic disparities in-hospital mortality for patients hospitalized with COVID-19 had mixed results. Findings from patients within academic medical centers (AMCs) are lacking, but important given the role of AMCs in improving health equity. Objective: The purpose of this study is to assess whether minority patients hospitalized with COVID-19 in National COVID Cohort Collaborative (N3C) institutions, which consist predominantly of AMCs, have higher mortality rates relative to White patients. Design: A retrospective analysis of patients hospitalized with COVID-19 was performed. Logistic regression analysis was used to test the primary hypothesis. A separate analysis tested whether there were differences by race and ethnicity during the delta variant phase of the pandemic. Patients: All hospitalized patients with COVID-19 who were above 17 years old were categorized by race and ethnicity as Black, Hispanic, Asian, White, Other, and Unknown. Main Measures: In-hospital mortality for patients with a known hospital outcome formed the primary outcome measure. Race and ethnicity were the primary independent variables. Key Results: There were 103,702 in-hospital Covid-19 admissions with 14,207 (13.7%) hospital deaths. Unadjusted in-hospital mortality for White patients was approximately 26% higher than for Black patients. After multivariable adjustment, none of the racial and ethnic groups had significantly different odds of in-hospital mortality compared to White patients. Only Hispanic patients had an odds ratio greater than one that was insignificant (OR = 1.06; 95% CI = 0.92-1.20). Findings for the delta variant phase were similar with the exception of the unknown category (OR = 1.90; 95% CI = 1.05-3.46). Conclusions: Disparities in-hospital mortality outcomes by race or ethnicity were not found in COVID-19 patients hospitalized in AMCs. AMCs are expected to lead health delivery systems in eliminating disparities associated with structural racism. The null findings are consistent with the hypothesis of no difference in hospital outcomes by race or ethnicity in academic medical centers.
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spelling doaj-art-f0ecf02ee6a342e8b5b64b9f740d6c752024-12-12T05:23:57ZengElsevierAmerican Journal of Medicine Open2667-03642024-12-0112100070In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort CollaborativeAntonije Lazic0J. Mick Tilford1Bradley C. Martin2Mandana Rezaeiahari3Anthony Goudie4Ahmad Baghal5Melody Greer6Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, ARDepartment of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR; Requests for reprints should be addressed to J. Mick Tilford, Department of Health Policy and Management, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 820, Little Rock, AR 72205.Division of Pharmaceutical Policy and Evaluation, University of Arkansas for Medical Sciences, Little Rock, ARDepartment of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, ARDepartment of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, ARDepartment of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, ARDepartment of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, ARBackground: Studies examining racial and ethnic disparities in-hospital mortality for patients hospitalized with COVID-19 had mixed results. Findings from patients within academic medical centers (AMCs) are lacking, but important given the role of AMCs in improving health equity. Objective: The purpose of this study is to assess whether minority patients hospitalized with COVID-19 in National COVID Cohort Collaborative (N3C) institutions, which consist predominantly of AMCs, have higher mortality rates relative to White patients. Design: A retrospective analysis of patients hospitalized with COVID-19 was performed. Logistic regression analysis was used to test the primary hypothesis. A separate analysis tested whether there were differences by race and ethnicity during the delta variant phase of the pandemic. Patients: All hospitalized patients with COVID-19 who were above 17 years old were categorized by race and ethnicity as Black, Hispanic, Asian, White, Other, and Unknown. Main Measures: In-hospital mortality for patients with a known hospital outcome formed the primary outcome measure. Race and ethnicity were the primary independent variables. Key Results: There were 103,702 in-hospital Covid-19 admissions with 14,207 (13.7%) hospital deaths. Unadjusted in-hospital mortality for White patients was approximately 26% higher than for Black patients. After multivariable adjustment, none of the racial and ethnic groups had significantly different odds of in-hospital mortality compared to White patients. Only Hispanic patients had an odds ratio greater than one that was insignificant (OR = 1.06; 95% CI = 0.92-1.20). Findings for the delta variant phase were similar with the exception of the unknown category (OR = 1.90; 95% CI = 1.05-3.46). Conclusions: Disparities in-hospital mortality outcomes by race or ethnicity were not found in COVID-19 patients hospitalized in AMCs. AMCs are expected to lead health delivery systems in eliminating disparities associated with structural racism. The null findings are consistent with the hypothesis of no difference in hospital outcomes by race or ethnicity in academic medical centers.http://www.sciencedirect.com/science/article/pii/S2667036424000074Academic Medical CentersCOVID-19DisparitiesHospital outcomes
spellingShingle Antonije Lazic
J. Mick Tilford
Bradley C. Martin
Mandana Rezaeiahari
Anthony Goudie
Ahmad Baghal
Melody Greer
In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort Collaborative
American Journal of Medicine Open
Academic Medical Centers
COVID-19
Disparities
Hospital outcomes
title In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort Collaborative
title_full In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort Collaborative
title_fullStr In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort Collaborative
title_full_unstemmed In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort Collaborative
title_short In-Hospital Mortality by Race and Ethnicity Among Hospitalized COVID-19 Patients Using Data From the US National COVID Cohort Collaborative
title_sort in hospital mortality by race and ethnicity among hospitalized covid 19 patients using data from the us national covid cohort collaborative
topic Academic Medical Centers
COVID-19
Disparities
Hospital outcomes
url http://www.sciencedirect.com/science/article/pii/S2667036424000074
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