From the Ochsner Health Center for Outcomes and Health Services Research (E.G.P.-H., J.B., D.F.) and the University of Queensland Ochsner Clinical School (E.G.P.-H., L.S.) - both in New Orleans.
N Engl J Med. 2020 Jun 25;382(26):2534-2543. doi: 10.1056/NEJMsa2011686. Epub 2020 May 27.
Many reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19.
In this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death.
A total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19-positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19-positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17).
In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.
许多关于 2019 年冠状病毒病（COVID-19）的报告强调了年龄和性别与健康结果之间的关系。需要更多关于 COVID-19 种族和族裔差异的信息。
在这项回顾性队列研究中，我们分析了 2020 年 3 月 1 日至 4 月 11 日期间在路易斯安那州接受综合医疗系统（Ochsner Health）治疗的患者的数据，这些患者的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2，引起 COVID-19 的病毒）在定性聚合酶链反应检测中呈阳性。Ochsner Health 人群中有 31%是非西班牙裔黑人，65%是非西班牙裔白人。主要结局是住院和院内死亡。
共有 3626 名患者检测呈阳性，其中 145 名被排除（84 名患者的种族或族裔群体数据缺失，9 名患者为西班牙裔，52 名患者为亚洲裔或其他种族或族裔群体）。在我们的分析中，3481 名 COVID-19 阳性患者中，60.0%为女性，70.4%为非西班牙裔黑人，29.6%为非西班牙裔白人。黑人患者的肥胖、糖尿病、高血压和慢性肾脏病患病率高于白人患者。共有 39.7%（1382 名）COVID-19 阳性患者住院，其中 76.9%为黑人。在多变量分析中，黑人种族、年龄增长、Charlson 合并症指数评分较高（表明疾病负担较大）、公共保险（医疗保险或医疗补助）、居住在低收入地区以及肥胖与住院的可能性增加有关。在 326 名死于 COVID-19 的患者中，70.6%为黑人。在调整后的生存时间分析中，与院内死亡率较高相关的变量包括年龄增长和呼吸频率升高；静脉乳酸、肌酐或降钙素水平升高；血小板或淋巴细胞计数降低。然而，黑人种族与更高的死亡率无关（与白人种族相比，死亡的风险比为 0.89；95%置信区间为 0.68 至 1.17）。
在路易斯安那州的一个大型队列中，COVID-19 住院患者中 76.9%为黑人，死亡患者中 70.6%为黑人，而黑人仅占 Ochsner Health 人群的 31%。在调整入院时的社会人口统计学和临床特征差异后，黑人种族与院内死亡率较高无关。
