Blacks and Native Americans with health problems prior to contracting COVID-19 are more likely to have longer hospital stays, require treatment with a ventilator, and have a higher risk of death than Whites who have similar preexisting conditions, according to a new nationwide study led by University of Utah Health scientists.
The researchers say these results refute the notion that Black, Indigenous, and People of Color are at greater risk of COVID-19 complications because they have one or more previous illnesses or diseases.
"Our findings contest arguments that Blacks and other racial and ethnic minorities are dying from COVID-19 at higher rates than their White counterparts because they have more comorbidities," says Fares Qeadan, Ph.D., an assistant professor of Biostatistics in the Division of Public Health and lead author of the study. "In fact, when we compared Blacks, Native Americans, and Whites who had the same number of prior conditions, Blacks and Native Americans were still at higher risk of dying or being put on a ventilator."
The study appears in Scientific Reports.
Preexisting conditions such as cancer, heart disease, and obesity could be driving factors in higher risks for hospitalization, need for ventilation, and death due to COVID-19, according to the Centers for Disease Control and Prevention. Blacks, Latinos, and Native Americans all tend to also have more preexisting conditions than Whites. As a result, some researchers have suggested this could account for the higher rate—up to 3.7 times greater—of hospitalization and other COVID-19 complications among these racial and ethnic minority groups compared to Whites.
However, few studies have scrutinized whether populations with health disparities that have similar types of preexisting conditions as Whites have the same risk of COVID-19 complications. To address this concern, Qeadan and colleagues examined more than 52,000 medical records of patients who were diagnosed or who had tested positive for COVID-19.
Using a computerized analytical tool called the Elixhauser comorbidity index (ECI), they identified 31 common preexisting conditions that could contribute to COVID-19 complications. Each patient received a comorbidity score based on disease history and was then compared to patients with similar scores. This apples-to-apples approach, as well as multi-level regression models, allowed the researchers to more precisely identify differences in COVID comorbidities among racial and ethnic groups.
Specifically, compared with Whites, Blacks who had similar comorbidity scores had:
- Longer hospital stays (1.22 days vs. 1.07 days)
- Were more likely to be ventilator dependent (85% more when the comorbidity score is low and 23% more when the score is high), and
- Were more likely to die (47% more when the comorbidity score is low and 13% more when the score is high)
Compared with Whites, Native Americans with similar comorbidity scores had:
- Longer hospital stays (1.42 days vs. 1.07 days)
- Higher odds of ventilator dependence across all comorbidity scores, and
- Higher odds of death (234% higher when the comorbidity score is low and 169% higher when the score is elevated)
The researchers note that that their study only included patients who sought treatment for COVID-19. As a result, medically underserved and minority populations without health insurance may be underrepresented in this research. Differences in medical record coding within and between health care facilities also could have influenced these results.
"We hope the results of this study will help us better understand what's going on in medical care that creates these disproportionalities," says Elizabeth VanSant-Webb, a study co-author and project manager at the Sorenson Impact Center at University of Utah. "Hopefully, this will lead to better interventions to close the health care gap in this country."
Moving forward, the researchers plan to potentially to conduct a qualitative study to explore patients' experiences, provider behavior, and hospital practices that may have contributed to these disparities.
"Our study did not explicitly examine the influence of social determinants of health such as structural racism, which could have contributed to the inequities we found," says Charles R. Rogers, Ph.D., an assistant professor of Public Health and senior author of the study. "Decades before the pandemic, the value based on an individual simply because of the color of their skin has likely contributed to poor health outcomes and health care access at alarmingly high rates for communities of color and warrants further investigation."
In addition to Dr. Qeadan, Mrs. VanSant-Webb, and Dr. Rogers, University of Utah Health contributors included Benjamin Tingey, Ellen Brooks, Nana A. Mensah, and Tiana N. Rogers, Ph.D. Karen Winkfield, M.D., Ph.D, of Meharry-Vanderbilt Alliance in Nashville; Ali Saee, M.D., of the Norton Thoracic in Phoenix; and Kevin English, D. P.H., of the Albaquerque Southwest Tribal Epidemiology Center also co-authored the study
The study, "Racial Disparities in COVID-19 Outcomes Exist Despite Comparable Elixhauser Comorbidity Indices between Blacks, Hispanics, Native Americans, and Whites," appears in Scientific Reports. The V Foundation for Cancer Research, 5 for the Fight, Huntsman Cancer Institute, and the National Cancer Institute partly supported the study financially. The content does not necessarily represent the official views of any of these entities and is solely the responsibility of the research team.