Temporal variations in the severity of COVID-19 illness by race and ethnicity

• Published in: BMJ nutrition, prevention & health prevention & health, 2021-06, Vol.4 (1), p.166-173
• Main Authors: Ebinger, Joseph E, Driver, Matthew, Ji, Hongwei, Claggett, Brian, Wu, Min, Luong, Eric, Sun, Nancy, Botting, Patrick, Kim, Elizabeth H, Hoang, Amy, Nguyen, Trevor Trung, Diaz, Jacqueline, Park, Eunice, Davis, Tod, Hussain, Shehnaz, Cheng, Susan, Figueiredo, Jane C
• Format: Article
• Language: English
• Subjects: Comorbidity; COVID-19; Cultural differences; Diabetes; Ethnicity; Family income; Health care; Heart attacks; Heart failure; Hispanic Americans; Hospitals; Hypertension; Hypothesis testing; Illnesses; Intubation; Laboratories; Minority & ethnic groups; Original Research; Pandemics; Patients; Population; Public health; Race; Socioeconomic factors; Trends; Variables
• ISSN: 2516-5542; 2516-5542
• DOI: 10.1136/bmjnph-2021-000253

IntroductionEarly reports highlighted racial/ethnic disparities in the severity of COVID-19 seen across the USA; the extent to which these disparities have persisted over time remains unclear. Our research objective was to understand temporal trends in racial/ethnic variation in severity of COVID-19 illness presenting over time.MethodsWe conducted a retrospective cohort analysis using longitudinal data from Cedars-Sinai Medical Center, a high-volume health system in Southern California. We studied patients admitted to the hospital with COVID-19 illness from 4 March 2020 through 5 December 2020. Our primary outcome was COVID-19 severity of illness among hospitalised patients, assessed by racial/ethnic group status. We defined overall illness severity as an ordinal outcome: hospitalisation but no intensive care unit (ICU) admission; admission to the ICU but no intubation; and intubation or death.ResultsA total of 1584 patients with COVID-19 with available demographic and clinical data were included. Hispanic/Latinx compared with non-Hispanic white patients had higher odds of experiencing more severe illness among hospitalised patients (OR 2.28, 95% CI 1.62 to 3.22) and this disparity persisted over time. During the initial 2 months of the pandemic, non-Hispanic blacks were more likely to suffer severe illness than non-Hispanic whites (OR 2.02, 95% CI 1.07 to 3.78); this disparity improved by May, only to return later in the pandemic.ConclusionIn our patient sample, the severity of observed COVID-19 illness declined steadily over time, but these clinical improvements were not seen evenly across racial/ethnic groups; greater illness severity continues to be experienced among Hispanic/Latinx patients.