tetano
Editor, Senior Moderator
Am J Med
. 2021 Nov 15;S0002-9343(21)00736-1.
doi: 10.1016/j.amjmed.2021.10.026. Online ahead of print.
Differences in Inflammation, Treatment and Outcomes between Black and non-Black Patients Hospitalized for COVID-19: A Prospective Cohort Study
Tariq U Azam[SUP] 1 [/SUP], Hanna Berlin[SUP] 2 [/SUP], Elizabeth Anderson[SUP] 1 [/SUP], Michael Pan[SUP] 3 [/SUP], Husam R Shadid[SUP] 3 [/SUP], Kishan Padalia[SUP] 3 [/SUP], Patrick O'Hayer[SUP] 3 [/SUP], Chelsea Meloche[SUP] 3 [/SUP], Rafey Feroze[SUP] 3 [/SUP], Erinleigh Michaud[SUP] 3 [/SUP], Christopher Launius[SUP] 1 [/SUP], Penelope Blakely[SUP] 1 [/SUP], Abbas Bitar[SUP] 1 [/SUP], Cristen Willer[SUP] 1 [/SUP], Rodica Pop-Busui[SUP] 4 [/SUP], John M Carethers[SUP] 5 [/SUP], Salim S Hayek[SUP] 6 [/SUP]
Affiliations
Abstract
Purpose: Racial disparities in COVID-19 outcomes have been described. We sought to determine whether differences in inflammatory markers, use of COVID-19 therapies, enrollment in clinical trials, and in-hospital outcomes contribute to racial disparities between Black and non-Black patients hospitalized for COVID-19.
Methods: We leveraged a prospective cohort study which enrolled 1325 consecutive patients hospitalized for COVID-19, of whom 341 (25.7%) were Black. We measured biomarkers of inflammation and collected data on the use COVID-19-directed therapies, enrollment in COVID-19 clinical trials, mortality, need for renal replacement therapy, and need for mechanical ventilation.
Results: Compared to non-Black patients, Black patients had a higher prevalence of COVID-19 risk factors including obesity, hypertension, and diabetes mellitus, and were more likely to require renal replacement therapy (15.8% vs. 7.1%, P<0.001) and mechanical ventilation (37.2% vs. 26.6%, P<0.001) during their hospitalization. Mortality was similar between both groups (15.5% for Blacks vs. 14.0% for non-Blacks, P=0.49). Black patients were less likely to receive corticosteroids (44.9% vs 63.8%, P<0.001) or remdesivir (23.8% vs. 57.8%, P<0.001), and were less likely to be enrolled in COVID-19 clinical trials (15.3% vs. 28.2%, P<0.001). In adjusted analyses, Black race was associated lower levels of C-reactive protein and soluble urokinase receptor, and higher odds of death, mechanical ventilation and renal replacement therapy. Differences in outcomes were not significant after adjusting for use of remdesivir and corticosteroids.
Conclusions: Racial differences in outcomes of patients with COVID-19 may be related to differences in inflammatory response and differential use of therapies.
Keywords: African Americans; Convalescent serum; M2C2; SARS-COV-2, Coronavirus, disparities; corticosteroids; remdesivir.
. 2021 Nov 15;S0002-9343(21)00736-1.
doi: 10.1016/j.amjmed.2021.10.026. Online ahead of print.
Differences in Inflammation, Treatment and Outcomes between Black and non-Black Patients Hospitalized for COVID-19: A Prospective Cohort Study
Tariq U Azam[SUP] 1 [/SUP], Hanna Berlin[SUP] 2 [/SUP], Elizabeth Anderson[SUP] 1 [/SUP], Michael Pan[SUP] 3 [/SUP], Husam R Shadid[SUP] 3 [/SUP], Kishan Padalia[SUP] 3 [/SUP], Patrick O'Hayer[SUP] 3 [/SUP], Chelsea Meloche[SUP] 3 [/SUP], Rafey Feroze[SUP] 3 [/SUP], Erinleigh Michaud[SUP] 3 [/SUP], Christopher Launius[SUP] 1 [/SUP], Penelope Blakely[SUP] 1 [/SUP], Abbas Bitar[SUP] 1 [/SUP], Cristen Willer[SUP] 1 [/SUP], Rodica Pop-Busui[SUP] 4 [/SUP], John M Carethers[SUP] 5 [/SUP], Salim S Hayek[SUP] 6 [/SUP]
Affiliations
- PMID: 34793753
- DOI: 10.1016/j.amjmed.2021.10.026
Abstract
Purpose: Racial disparities in COVID-19 outcomes have been described. We sought to determine whether differences in inflammatory markers, use of COVID-19 therapies, enrollment in clinical trials, and in-hospital outcomes contribute to racial disparities between Black and non-Black patients hospitalized for COVID-19.
Methods: We leveraged a prospective cohort study which enrolled 1325 consecutive patients hospitalized for COVID-19, of whom 341 (25.7%) were Black. We measured biomarkers of inflammation and collected data on the use COVID-19-directed therapies, enrollment in COVID-19 clinical trials, mortality, need for renal replacement therapy, and need for mechanical ventilation.
Results: Compared to non-Black patients, Black patients had a higher prevalence of COVID-19 risk factors including obesity, hypertension, and diabetes mellitus, and were more likely to require renal replacement therapy (15.8% vs. 7.1%, P<0.001) and mechanical ventilation (37.2% vs. 26.6%, P<0.001) during their hospitalization. Mortality was similar between both groups (15.5% for Blacks vs. 14.0% for non-Blacks, P=0.49). Black patients were less likely to receive corticosteroids (44.9% vs 63.8%, P<0.001) or remdesivir (23.8% vs. 57.8%, P<0.001), and were less likely to be enrolled in COVID-19 clinical trials (15.3% vs. 28.2%, P<0.001). In adjusted analyses, Black race was associated lower levels of C-reactive protein and soluble urokinase receptor, and higher odds of death, mechanical ventilation and renal replacement therapy. Differences in outcomes were not significant after adjusting for use of remdesivir and corticosteroids.
Conclusions: Racial differences in outcomes of patients with COVID-19 may be related to differences in inflammatory response and differential use of therapies.
Keywords: African Americans; Convalescent serum; M2C2; SARS-COV-2, Coronavirus, disparities; corticosteroids; remdesivir.