Navar Ann M, Purinton Stacey N, Hou Qingjiang, Taylor Robert J, Peterson Eric D
University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
Cerner Corporation, Kansas City, MO, United States of America.
PLoS One. 2021 Jul 21;16(7):e0254809. doi: 10.1371/journal.pone.0254809. eCollection 2021.
At the population level, Black and Hispanic adults in the United States have increased risk of dying from COVID-19, yet whether race and ethnicity impact on risk of mortality among those hospitalized for COVID-19 is unclear.
Retrospective cohort study using data on adults hospitalized with COVID-19 from the electronic health record from 52 health systems across the United States contributing data to Cerner Real World DataTM. In-hospital mortality was evaluated by race first in unadjusted analysis then sequentially adjusting for demographics and clinical characteristics using logistic regression.
Through August 2020, 19,584 patients with median age 52 years were hospitalized with COVID-19, including n = 4,215 (21.5%) Black and n = 5,761 (29.4%) Hispanic patients. Relative to white patients, crude mortality was slightly higher in Black adults [22.7% vs 20.8%, unadjusted OR 1.12 (95% CI 1.02-1.22)]. Mortality remained higher among Black adults after adjusting for demographic factors including age, sex, date, region, and insurance status (OR 1.13, 95% CI 1.01-1.27), but not after including comorbidities and body mass index (OR 1.07, 95% CI 0.93-1.23). Compared with non-Hispanic patients, Hispanic patients had lower mortality both in unadjusted and adjusted models [mortality 12.7 vs 25.0%, unadjusted OR 0.44(95% CI 0.40-0.48), fully adjusted OR 0.71 (95% CI 0.59-0.86)].
In this large, multicenter, EHR-based analysis, Black adults hospitalized with COVID-19 had higher observed mortality than white patients due to a higher burden of comorbidities in Black adults. In contrast, Hispanic ethnicity was associated with lower mortality, even in fully adjusted models.
在人群层面，美国的黑人和西班牙裔成年人死于新冠病毒病（COVID-19）的风险增加，但种族和族裔是否会影响COVID-19住院患者的死亡风险尚不清楚。
采用回顾性队列研究，使用来自美国52个医疗系统电子健康记录中COVID-19住院成人的数据，这些数据被纳入Cerner真实世界数据TM。首先在未调整分析中按种族评估住院死亡率，然后使用逻辑回归依次对人口统计学和临床特征进行调整。
截至2020年8月，19584例中位年龄52岁的患者因COVID-19住院，其中包括4215例（21.5%）黑人患者和5761例（29.4%）西班牙裔患者。与白人患者相比，黑人成年人的粗死亡率略高[22.7%对20.8%，未调整比值比1.12（95%置信区间1.02-1.22）]。在调整了包括年龄、性别、日期、地区和保险状况等人口统计学因素后，黑人成年人的死亡率仍然较高（比值比1.13，95%置信区间1.01-1.27），但在纳入合并症和体重指数后则不然（比值比1.07，95%置信区间0.93-1.23）。与非西班牙裔患者相比，西班牙裔患者在未调整和调整模型中的死亡率均较低[死亡率12.7%对25.0%，未调整比值比0.44（95%置信区间0.40-0.48），完全调整比值比0.71（95%置信区间0.59-0.86）]。
在这项基于电子健康记录的大型多中心分析中，因COVID-19住院的黑人成年人由于合并症负担较高，观察到的死亡率高于白人患者。相比之下，西班牙裔种族与较低的死亡率相关，即使在完全调整模型中也是如此。
