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Variations in Presentation and Management of COVID-19 Inpatients by Race and Ethnicity in a Large Texas Metroplex

Published online by Cambridge University Press:  12 July 2021

Alison Liu Open the ORCID record for Alison Liu [Opens in a new window] ,
Akshat Patel ,
Ava Pierce  and
Ray Fowler
Alison Liu*
Affiliation:
University of Texas Southwestern Medical Center, Dallas, Texas, USA
Akshat Patel
Affiliation:
University of Texas Southwestern Medical Center, Dallas, Texas, USA
Ava Pierce
Affiliation:
University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Emergency Medicine, Parkland Health and Hospital Systems, Dallas, Texas, USA
Ray Fowler
Affiliation:
University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Emergency Medicine, Parkland Health and Hospital Systems, Dallas, Texas, USA
*
Corresponding author: Alison Liu, Email: alison.liu@utsouthwestern.edu
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Abstract

Objective:

The aim of this study was to assess variations in presentation and outcomes of coronavirus disease 2019 (COVID-19) across race/ethnicity at a large Texas metroplex hospital.

Methods:

A retrospective cohort study was performed.

Results:

Although COVID-19 patients demonstrated significant socioeconomic disparities, race/ethnicity was not a significant predictor of intensive care unit (ICU) admission (P = 0.067) or case fatality (P = 0.078). Hospital admission varied by month, with incidence among Black/African-American and Hispanic/Latino patients peaking earlier in the pandemic timeline (P < 0.001). Patients reporting Spanish as their primary language were significantly more likely to be admitted to the ICU (odds ratio, 1.75; P = 0.007).

Conclusions:

COVID-19 patients do not demonstrate significant racial/ethnic disparities in case fatality, suggesting that state-wide disparities in mortality rate are rooted in infection risk rather than hospital course. Variations in admission rates by race/ethnicity across the timeline and increased ICU admission among Spanish-speaking patients demonstrate the need to pursue tailored interventions on both a community and structural level to mitigate further health disparities throughout the pandemic and after.

Keywords

COVID-19 pandemichealthcare disparitiesminority healthsocioeconomic factors
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 17 , 2023 , e21
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

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References

Centers for Disease Control and Prevention (CDC). CDC COVID data tracker. https://covid.cdc.gov/covid-data-tracker/#cases_deathsinlast7days. Updated March 25, 2021. Accessed March 25, 2021.Google Scholar
APM Research Lab. The Color of Coronavirus: COVID-19 deaths by race and ethnicity in the U.S. American Public Media. https://www.apmresearchlab.org/covid/deaths-by-race. Updated March 5, 2021. Accessed January 9, 2021, and March 21, 2021.Google Scholar
Aleligne, YK, Appiah, D, Ebong, IA. Racial disparities in coronavirus disease 2019 (COVID-19) outcomes. Curr Opin Cardiol. 2021;36(3):360-366.CrossRefGoogle ScholarPubMed
Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. In: Smedley, BD, Stith, AY, Nelson, AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.Google Scholar
Williams, DR. The health of U.S. racial and ethnic populations. J Gerontol B Psychol Sci Soc Sci. 2005;60 Spec No 2:53-62.CrossRefGoogle ScholarPubMed
Dressler, WW, Oths, KS, Gravlee, CC. Race and ethnicity in public health research: models to explain health disparities. Annu Rev Anthropol. 2005;34(1):231-252.CrossRefGoogle Scholar
Cordner, A, Wilkie, AA, Wade, TJ, et al. Gender and racial/ethnic disparities: cumulative screening of health risk indicators in 20-50 year olds in the United States. J Health Dispar Res Pract. 2017;10(8):1.Google ScholarPubMed
Chidambaram, V, Tun, NL, Haque, WZ, et al. Factors associated with disease severity and mortality among patients with COVID-19: a systematic review and meta-analysis. PLoS One. 2020;15(11):e0241541.CrossRefGoogle ScholarPubMed
Mackey, K, Ayers, CK, Kondo, KK, et al. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: a systematic review. Ann Intern Med. 2021;174(3):362-373.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (CDC). Table of summary health statistics. National Health Interview Survey. https://www.cdc.gov/nchs/nhis/SHS/tables.htm,https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202009-508.pdf. Accessed March 20, 2021.Google Scholar
Quiñones, AR, Botoseneanu, A, Markwardt, S, et al. Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PLoS One. 2019;14(6):e0218462. doi: 10.1371/journal.pone.0218462 CrossRefGoogle ScholarPubMed
Kabarriti, R, Brodin, NP, Maron, MI, et al. Association of race and ethnicity with comorbidities and survival among patients with COVID-19 at an urban medical center in New York. JAMA Netw Open. 2020;3(9):e2019795.CrossRefGoogle ScholarPubMed
Shavers, VL. Measurement of socioeconomic status in health disparities research. J Natl Med Assoc. 2007;99(9):1013-1023.Google ScholarPubMed
Dorn, S. The COVID-19 pandemic and resulting economic crash have caused the greatest health insurance losses in American history. https://www.familiesusa.org/resources/the-covid-19-pandemic-and-resulting-economic-crash-have-caused-the-greatest-health-insurance-losses-in-american-history/. Published July 13, 2020. Accessed February 25, 2021.Google Scholar
Adepoju, OE, Ojinnaka, CO. County-level determinants of COVID-19 testing and cases: are there racial/ethnic disparities in Texas? Popul Health Manag. 2021. doi: 10.1089/pop.2020.0300 CrossRefGoogle ScholarPubMed
Ojinnaka, CO, Adepoju, OE, Burgess, AV, et al. Factors associated with COVID-related mortality: the case of Texas. J Racial Ethn Health Disparities. 2020:1-6. doi: 10.1007/s40615-020-00913-5 Google ScholarPubMed
Krieger, N, Chen, JT, Waterman, PD. Using the methods of the Public Health Disparities Geocoding Project to monitor COVID-19 inequities and guide action for health justice. https://www.hsph.harvard.edu/thegeocodingproject/covid-19-resources. Published May 15, 2020. Accessed February 25, 2021.Google Scholar
Chen, JT, Krieger, N. Revealing the unequal burden of COVID-19 by income, race/ethnicity, and household crowding: US county versus zip code analyses. J Public Health Manag Pract. 2021;27(Suppl 1):COVID-19 and Public Health: Looking Back, Moving Forward:S43-S56.CrossRefGoogle Scholar
Krieger, N, Kim, R, Feldman, J, et al. Using the index of concentration at the extremes at multiple geographical levels to monitor health inequities in an era of growing spatial social polarization: Massachusetts, USA (2010-14). Int J Epidemiol. 2018;47(3):788-819.CrossRefGoogle Scholar
Centers for Disease Control and Prevention (CDC). Hospitalization and death by race/ethnicity. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html#footnote02. Updated March 12, 2021. Accessed March 21, 2021.Google Scholar
United Health Foundation. Annual report. America’s health rankings. https://www.americashealthrankings.org/explore/annual/measure/Smoking/state/TX. Published 2020. Accessed March 21, 2021.Google Scholar
Kim, HN, Lan, KF, Nkyekyer, E, et al. Assessment of disparities in COVID-19 testing and infection across language groups in Seattle, Washington. JAMA Netw Open. 2020;3(9):e2021213.CrossRefGoogle ScholarPubMed
Rozenfeld, Y, Beam, J, Maier, H, et al. A model of disparities: risk factors associated with COVID-19 infection. Int J Equity Health. 2020;19(1):126.CrossRefGoogle Scholar
Karmakar, M, Lantz, PM, Tipirneni, R. Association of social and demographic factors with COVID-19 incidence and death rates in the US. JAMA Netw Open. 2021;4(1):e2036462.CrossRefGoogle ScholarPubMed
United States Census Bureau. QuickFacts Texas. https://www.census.gov/quickfacts/fact/table/TX/POP010210. Accessed March 21, 2020.Google Scholar
Abbott, G. Executive Order GA-08: relating to COVID-19 preparedness and mitigation. https://lrl.texas.gov/scanned/govdocs/Greg%20Abbott/2020/GA-08.pdf. Published March 19, 2020. Accessed March 20, 2021.Google Scholar
Abbott, G. Executive Order GA-14: relating to the statewide continuity of essential services and activities during the COVID-19 disaster. https://lrl.texas.gov/scanned/govdocs/Greg%20Abbott/2020/GA-14.pdf. Published March 31, 2020. Accessed March 20, 2021.Google Scholar
Abbott, G. Executive Order GA-16: relating to the safe, strategic reopening of select services as the first step to Open Texas in response to the COVID-19 disaster. https://lrl.texas.gov/scanned/govdocs/Greg%20Abbott/2020/GA-16.pdf. Published April 17, 2020. Accessed March 20, 2021.Google Scholar
Abbott, G. Executive Order GA-34: relating to the opening of Texas in response to the COVID-19 disaster. https://open.texas.gov/uploads/files/organization/opentexas/EO-GA-34-opening-Texas-response-to-COVID-disaster-IMAGE-03-02-2021.pdf. Published March 2, 2021. Accessed March 20, 2021.Google Scholar
Platoff, E. Texas Attorney General Ken Paxton warns Austin, San Antonio, Dallas to loosen coronavirus restrictions. https://www.texastribune.org/2020/05/12/texas-attorney-general-warn-cities-coronavirus/. Published May 12, 2020. Accessed March 20, 2021.Google Scholar
Karagiannidis, C, Windisch, W, McAuley, DF, et al. Major differences in ICU admissions during the first and second COVID-19 wave in Germany. Lancet Respir Med. 2021;9(5):e47-e48.CrossRefGoogle ScholarPubMed
Wolf, MS, Serper, M, Opsasnick, L, et al. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: a cross-sectional survey. Ann Intern Med. 2020;173(2):100-109.CrossRefGoogle ScholarPubMed
Clements, JM. Knowledge and behaviors toward COVID-19 among US residents during the early days of the pandemic: cross-sectional online questionnaire. JMIR Public Health Surveill. 2020;6(2):e19161.CrossRefGoogle ScholarPubMed
Li, Y, Zhang, R, Zhao, J, et al. Understanding transmission and intervention for the COVID-19 pandemic in the United States. Sci Total Environ. 2020;748:141560.CrossRefGoogle ScholarPubMed
Selden, TM, Berdahl, TA. COVID-19 and racial/ethnic disparities in health risk, employment, and household composition. Health Aff (Millwood). 2020;39(9):1624-1632.CrossRefGoogle ScholarPubMed
Pathak, I, Choi, Y, Jiao, D, et al. Racial-ethnic disparities in case fatality ratio narrowed after age standardization: a call for race-ethnicity-specific age distributions in State COVID-19 data. medRxiv. 2020. doi: 10.1101/2020.10.01.20205377 Google Scholar
Zelner, J, Trangucci, R, Naraharisetti, R, et al. Racial disparities in coronavirus disease 2019 (COVID-19) mortality are driven by unequal infection risks. Clin Infect Dis. 2021;72(5):e88-e95.CrossRefGoogle ScholarPubMed
Hutchins, SS, Fiscella, K, Levine, RS, et al. Protection of racial/ethnic minority populations during an influenza pandemic. Am J Public Health. 2009;99(Suppl 2):S261-S270.CrossRefGoogle ScholarPubMed
Schoenfeld-Walker, A, Singhvi, A, Holder, J, et al. Pandemic’s racial disparities persist in vaccine rollout. New York Times. https://www.nytimes.com/interactive/2021/03/05/us/vaccine-racial-disparities.html. Published March 5, 2021. Accessed March 20, 2021.Google Scholar
Nesbitt, LS. Disparities in COVID-19 outcomes: understanding the root causes is key to achieving equity. J Public Health Manag Pract. 2021;27(Suppl 1):COVID-19 and Public Health: Looking Back, Moving Forward:S63-S65.CrossRefGoogle ScholarPubMed
Ortega, P, Martinez, G, Diamond, L. Language and health equity during COVID-19: lessons and opportunities. J Health Care Poor Underserved. 2020;31(4):1530-1535.CrossRefGoogle ScholarPubMed