Racial and Ethnic Differences and Clinical Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) Presenting to the Emergency Department. (2nd April 2021)

• Record Type: Journal Article
• Authors: Wiley, Zanthia; Ross-Driscoll, Katie; Wang, Zhensheng; Smothers, Laken; Mehta, Aneesh K; Patzer, Rachel E
• Is Part Of: Clinical infectious diseases. Volume 74:Number 3(2022)
• Page Start: 387
• Page End: 394
• Publication Date: 2021-04-02
• Subjects: COVID-19 -- race -- ethnicity -- disparities -- emergency department; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab290
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Since the introduction of remdesivir and dexamethasone for severe COVID-19 treatment, few large multi-hospital-system US studies have described clinical characteristics and outcomes of minority COVID-19 patients who present to the emergency department (ED). Methods: This cohort study from the Cerner Real World Database (87 US health systems) from 1 December 2019 to 30 September 2020 included PCR-confirmed COVID-19 patients who self-identified as non-Hispanic Black (Black), Hispanic White (Hispanic), or non-Hispanic White (White). The main outcome was hospitalization among ED patients. Secondary outcomes included mechanical ventilation, intensive care unit care, and in-hospital mortality. Descriptive statistics and Poisson regression compared sociodemographics, comorbidities, receipt of remdesivir or dexamethasone, and outcomes by racial/ethnic groups and geographic region. Results: 94 683 COVID-19 patients presented to the ED. Blacks comprised 26.7% and Hispanics 33.6%. Nearly half (45.1%) of ED patients presented to hospitals in the South. 31.4% (n = 29 687) were hospitalized. Lower proportions of Blacks were prescribed dexamethasone (29.4%; n = 7426) compared with Hispanics (40.9%; n = 13 021) and Whites (37.5%; n = 14 088). Hospitalization risks, compared with Whites, were similar in Blacks (RR: .94; 95% CI: .82–1.08; P = .4) and Hispanics (.99; .81–1.21; P = .91), but risk of in-hospital mortality was higher in Blacks (1.18; 1.06–1.31; P = .002) and Hispanics (1.28; 1.13–1.44; P < .001). Conclusions: Minority patients were overrepresented among COVID-19 ED patients, and while their risks of hospitalization were similar to Whites, in-hospital mortality risk was higher. Interventions targeting upstream social determinants of health are needed to reduce racial/ethnic disparities in COVID-19. Abstract : Blacks and Hispanics comprised 60.3% of emergency department patients with COVID-19. Compared with Whites, hospitalization risks were similar between racial/ethnic groups. In-hospital mortality risk was higher in Blacks and Hispanics compared with Whites.