Racial and ethnic variation in COVID-19 care, treatment, and outcomes: A retrospective cohort study from the MiCOVID-19 registry

• Published in: PloS one 2022-11, Vol.17 (11), p.e0276806-e0276806
• Main Authors: Sutton, Nadia R, Robinson-Lane, Sheria G, Yeow, Raymond Y, Chubb, Heather A, Kim, Tae, Chopra, Vineet
• Format: Article
• Language: English
• Subjects: Adult; Biology and Life Sciences; Body mass index; C-reactive protein; Cardiovascular disease; Child; Chronic obstructive pulmonary disease; Clinical outcomes; Cohort analysis; Cohort Studies; Collaboration; Comorbidity; Consortia; Coronaviruses; COVID-19; COVID-19 diagnostic tests; Creatine; Creatine kinase; Cultural differences; Death; Demographics; Dexamethasone; Enzymes; Erythrocyte sedimentation rate; Erythrocytes; Ethnicity; Evaluation; Evidence-based medicine; Ferritin; Health care access; Health care disparities; Hispanic Americans; Hospitalization; Hospitals; Humans; L-Lactate dehydrogenase; Laboratories; Lactate dehydrogenase; Lactic acid; Mechanical ventilation; Medical care; Medical records; Medicine and Health Sciences; Minority & ethnic groups; Mortality; Pandemics; Patients; People and Places; Quality control; Quality management; Race; Registries; Retrospective Studies; Severe acute respiratory syndrome coronavirus 2; Social factors; Steroids; Variance analysis; Ventilation; Ventilators; White People
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0276806

Racial and ethnic disparities in COVID-19 outcomes exist, but whether in-hospital care explains this difference is not known. We sought to determine racial and ethnic differences in demographics, comorbidities, in-hospital treatments, and in-hospital outcomes of patients hospitalized with COVID-19. This was a cohort study using MiCOVID-19, a multi-center, retrospective, collaborative quality improvement registry, which included data on patients hospitalized with COVID-19 across 38 hospitals in the State of Michigan. 2,639 adult patients with COVID-19 hospitalized at a site participating in the MiCOVID-19 Registry were randomly selected. Outcomes included in-hospital mortality, age at death, intensive care unit admission, and need for invasive mechanical ventilation by race and ethnicity. Baseline comorbidities differed by race and ethnicity. In addition, Black patients had higher lactate dehydrogenase, erythrocyte sedimentation rate, C-reactive protein, creatine phosphokinase, and ferritin levels. Black patients were less likely to receive dexamethasone and remdesivir compared with White patients (4.2% vs 14.3% and 2.2% vs. 11.8%, p < 0.001 for each). Black (18.7%) and White (19.6%) patients experienced greater mortality compared with Asian (13.0%) and Latino (5.9%) patients (p < 0.01). The mean age at death was significantly lower by 8 years for Black patients (69.4 ± 13.3 years) compared with White (77.9 ± 12.6), Asian (77.6 ± 6.6), and Latino patients (77.4 ± 15.5) (p < 0.001). COVID-19 mortality appears to be driven by both pre-hospitalization clinical and social factors and potentially in-hospital care. Policies aimed at population health and equitable application of evidence-based medical therapy are needed to alleviate the burden of COVID-19.