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Our new paper in @JAMANetworkOpen shows no disparity in adjusted outcomes between Black/Hispanic/White #COVID19 patients @nyulangone once hospitalized; if anything, Blacks seem to do a little better. Is this an anomaly? @gbengaogedegbe https://ja.ma/3n1NKhC /Thread
Actually, several other papers have now found the same. This study of 11,210 hospitalized patients at 92 @ascensionorg hospitals found no sig difference in mortality between Blacks & Whites @BYehia https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769387
This @cdcgov study of 2,491 hospitalized patients at 154 hospitals across the US confirms the findings https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1012/5872581
Not to mention this study of 1,382 hospitalized patients @OchsnerHealth and several other single site studies @Dr_E_PH https://www.nejm.org/doi/full/10.1056/NEJMsa2011686
Yet, it is indisputable that Black, Hispanic and Indigenous communities have 2-4 times greater age-adjusted #COVID19 mortality rates than Whites @apmresearch
https://www.apmresearchlab.org/covid/deaths-by-race
https://www.apmresearchlab.org/covid/deaths-by-race
So, why is that? Recall disparities can arise at any point in causal pathway. In this case, several other steps in the pathway are the likely culprits:
Higher risk of getting infected (more front-line jobs/less ability to work from home, more crowded living conditions); e.g. high risk Blacks & Hispanics more likely to live with someone in a high risk job https://pubmed.ncbi.nlm.nih.gov/32663045/
Living in worse environmental conditions, potentially increasing mortality risk @DrTMersha https://pubmed.ncbi.nlm.nih.gov/32389591/
More difficulty accessing (timely) care. Testing, e.g., less available in minority communities. Plus Blacks are 1.5 times more likely to be uninsured than Whites; Hispanics >2.5x. https://www.kff.org/racial-equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/
Possibly, more likely to be cared for in lower quality/less well-resourced hospitals. I haven’t seen data on #COVID19 mortality differences by hospital in US, but in other conditions, minority-serving hospitals often do worse on quality measures, e.g. https://pubmed.ncbi.nlm.nih.gov/31400737/
So, what our study and those of others show is that the degree of within-hospital bias seems to be relatively minimal; not enough to affect outcomes. That’s some good news, but more importantly, should help prioritize the many other areas we need to focus on to improve outcomes.
