Ascension Health, St Louis, Missouri.
Ascension Data Science Institute, St Louis, Missouri.
JAMA Netw Open. 2020 Aug 3;3(8):e2018039. doi: 10.1001/jamanetworkopen.2020.18039.
While current reports suggest that a disproportionate share of US coronavirus disease 2019 (COVID-19) cases and deaths are among Black residents, little information is available regarding how race is associated with in-hospital mortality.
To evaluate the association of race, adjusting for sociodemographic and clinical factors, on all-cause, in-hospital mortality for patients with COVID-19.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 11 210 adult patients (age ≥18 years) hospitalized with confirmed severe acute respiratory coronavirus 2 (SARS-CoV-2) between February 19, 2020, and May 31, 2020, in 92 hospitals in 12 states: Alabama (6 hospitals), Maryland (1 hospital), Florida (5 hospitals), Illinois (8 hospitals), Indiana (14 hospitals), Kansas (4 hospitals), Michigan (13 hospitals), New York (2 hospitals), Oklahoma (6 hospitals), Tennessee (4 hospitals), Texas (11 hospitals), and Wisconsin (18 hospitals).
Confirmed SARS-CoV-2 infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample.
Death during hospitalization was examined overall and by race. Race was self-reported and categorized as Black, White, and other or missing. Cox proportional hazards regression with mixed effects was used to evaluate associations between all-cause in-hospital mortality and patient characteristics while accounting for the random effects of hospital on the outcome.
Of 11 210 patients with confirmed COVID-19 presenting to hospitals, 4180 (37.3%) were Black patients and 5583 (49.8%) were men. The median (interquartile range) age was 61 (46 to 74) years. Compared with White patients, Black patients were younger (median [interquartile range] age, 66 [50 to 80] years vs 61 [46 to 72] years), were more likely to be women (2259 [49.0%] vs 2293 [54.9%]), were more likely to have Medicaid insurance (611 [13.3%] vs 1031 [24.7%]), and had higher median (interquartile range) scores on the Neighborhood Deprivation Index (-0.11 [-0.70 to 0.56] vs 0.82 [0.08 to 1.76]) and the Elixhauser Comorbidity Index (21 [0 to 44] vs 22 [0 to 46]). All-cause in-hospital mortality among hospitalized White and Black patients was 23.1% (724 of 3218) and 19.2% (540 of 2812), respectively. After adjustment for age, sex, insurance, comorbidities, neighborhood deprivation, and site of care, there was no statistically significant difference in risk of mortality between Black and White patients (hazard ratio, 0.93; 95% CI, 0.80 to 1.09).
Although current reports suggest that Black patients represent a disproportionate share of COVID-19 infections and death in the United States, in this study, mortality for those able to access hospital care did not differ between Black and White patients after adjusting for sociodemographic factors and comorbidities.
尽管目前的报告表明，美国新冠肺炎（COVID-19）病例和死亡病例中，黑人居民所占比例过高，但有关种族与住院死亡率之间关系的信息却很少。
评估种族与 COVID-19 住院患者全因死亡率之间的关系，同时调整社会人口统计学和临床因素。
设计、地点和参与者：这项队列研究纳入了 11210 名成年患者（年龄≥18 岁），他们于 2020 年 2 月 19 日至 2020 年 5 月 31 日期间在 92 家医院（美国 12 个州的 6 家医院、马里兰州 1 家医院、佛罗里达州 5 家医院、伊利诺伊州 8 家医院、印第安纳州 14 家医院、堪萨斯州 4 家医院、密歇根州 13 家医院、纽约州 2 家医院、俄克拉荷马州 6 家医院、田纳西州 4 家医院、得克萨斯州 11 家医院和威斯康星州 18 家医院）因确诊的严重急性呼吸冠状病毒 2（SARS-CoV-2）住院。
通过鼻咽样本聚合酶链反应检测呈阳性结果确诊 SARS-CoV-2 感染。
总体上和按种族检查住院期间的死亡情况。种族由自我报告并分为黑人、白人以及其他或缺失。使用混合效应 Cox 比例风险回归评估全因住院死亡率与患者特征之间的关联，同时考虑医院对结果的随机效应。
在 11210 名确诊患有 COVID-19 并住院的患者中，4180 名（37.3%）为黑人患者，5583 名（49.8%）为男性。中位（四分位间距）年龄为 61（46 至 74）岁。与白人患者相比，黑人患者更年轻（中位数[四分位间距]年龄，66 [50 至 80] 岁比 61 [46 至 72] 岁）、女性比例更高（2259 [49.0%] 比 2293 [54.9%]）、更可能拥有医疗补助保险（611 [13.3%] 比 1031 [24.7%]），并且中位数（四分位间距）的邻里剥夺指数（-0.11[-0.70 至 0.56]比 0.82[0.08 至 1.76]）和 Elixhauser 合并症指数（21[0 至 44] 比 22[0 至 46]）得分更高。白人患者和黑人患者的住院全因死亡率分别为 23.1%（724 例[3218 例]）和 19.2%（540 例[2812 例]）。在调整年龄、性别、保险、合并症、邻里剥夺和护理场所后，黑人患者与白人患者的死亡率风险无统计学差异（风险比，0.93；95%CI，0.80 至 1.09）。
尽管目前的报告表明，在美国，黑人患者在 COVID-19 感染和死亡中所占比例过高，但在这项研究中，在调整社会人口统计学因素和合并症后，能够获得医院治疗的黑人患者和白人患者的死亡率并无差异。
