October 7, 2020
New Orleans Cohort Shows High Rate of COVID-19 Hospitalization in Black Patients But Not More Deaths
Reviewed by Erica Kaufman West, M.D.
University Medical Center in New Orleans, Louisiana, found itself in the epicenter of the COVID-19 pandemic in March 2020. The authors of a recently published article in Open Forum Infectious Diseases performed a retrospective review of hospitalized patients at the center who were SARS-CoV-2 positive during that month.
The facility had 249 patients who tested positive and were hospitalized. Men made up 44.2% of the group; 87.1% of patients identified as Black, 6.4% identified as White. Typically, the hospital census is 55% Black patients, so there was a much higher percentage of Black patients with COVID-19 than would have been expected. Eighty-six percent of all patients had at least one comorbidity: age ≥ 65, hypertension, diabetes mellitus, cardiovascular disease, asthma, chronic lung disease, body mass index ≥ 40, end-stage renal disease, cancer, or liver disease. The most common comorbidities were hypertension (79%), hyperlipidemia (52%), and diabetes mellitus (52%). Black patients were more likely to have asthma and less likely to have dementia, and there was no difference by race in the other comorbidities. Presentation and hypoxia were similar in the two racial groups, and except for initial lactate dehydrogenase levels (which were higher in Black patients), labs were not different.
When the authors examined in-hospital outcomes, Black patients had a higher rate of acute kidney injury and need for dialysis and intubation. Surprisingly, the outcomes of Black patients were like those of other racial groups. Ultimately, Black patients were more likely to be exposed to SARS-CoV-2 and be hospitalized but did not have worse outcomes. Poorer outcomes at day 14 were only associated with patient age ≥ 65 and initial supplemental oxygen requirement – not race.
The authors suggest that one of the main ways to mitigate inequities would be to improve the ability of Black patients to avoid exposure to SARS-CoV-2 in the first place. This will require local and statewide efforts along with a redistribution of financial priorities in Louisiana and most other states.
(Silver et al. Open Forum Infect Dis. 2020;7(9):ofaa339.)
