Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor.
University of Michigan Medical School, Ann Arbor.
Am J Med. 2022 Mar;135(3):360-368. doi: 10.1016/j.amjmed.2021.10.026. Epub 2021 Nov 16.
Racial disparities in coronavirus disease 2019 (COVID-19) outcomes have been described. We sought to determine whether differences in inflammatory markers, use of COVID-19 therapies, enrollment in clinical trials, and in-hospital outcomes contribute to racial disparities between Black and non-Black patients hospitalized for COVID-19.
We leveraged a prospective cohort study that enrolled 1325 consecutive patients hospitalized for COVID-19, of whom 341 (25.7%) were Black. We measured biomarkers of inflammation and collected data on the use COVID-19-directed therapies, enrollment in COVID-19 clinical trials, mortality, need for renal replacement therapy, and need for mechanical ventilation.
Compared to non-Black patients, Black patients had a higher prevalence of COVID-19 risk factors including obesity, hypertension, and diabetes mellitus and were more likely to require renal replacement therapy (15.8% vs 7.1%, P < .001) and mechanical ventilation (37.2% vs 26.6%, P < .001) during their hospitalization. Mortality was similar between both groups (15.5% for Blacks vs 14.0% for non-Blacks, P = .49). Black patients were less likely to receive corticosteroids (44.9% vs 63.8%, P< .001) or remdesivir (23.8% vs 57.8%, P < .001) and were less likely to be enrolled in COVID-19 clinical trials (15.3% vs 28.2%, P < .001). In adjusted analyses, Black race was associated with lower levels of C-reactive protein and soluble urokinase receptor and higher odds of death, mechanical ventilation, and renal replacement therapy. Differences in outcomes were not significant after adjusting for use of remdesivir and corticosteroids.
Racial differences in outcomes of patients with COVID-19 may be related to differences in inflammatory response and differential use of therapies.
已经描述了 2019 年冠状病毒病（COVID-19）结果中的种族差异。我们旨在确定炎症标志物、COVID-19 治疗方法的使用、临床试验的参与以及住院结果的差异是否导致因 COVID-19 住院的黑人和非黑人患者之间存在种族差异。
我们利用了一项前瞻性队列研究，该研究纳入了 1325 名连续因 COVID-19 住院的患者，其中 341 名（25.7%）为黑人。我们测量了炎症生物标志物，并收集了 COVID-19 靶向治疗方法的使用、COVID-19 临床试验的参与、死亡率、需要肾脏替代治疗以及需要机械通气的数据。
与非黑人患者相比，黑人患者更常见 COVID-19 的危险因素，包括肥胖、高血压和糖尿病，并且更有可能需要肾脏替代治疗（15.8%比 7.1%，P<0.001）和机械通气（37.2%比 26.6%，P<0.001）。两组死亡率相似（黑人 15.5%，非黑人 14.0%，P=0.49）。黑人患者接受皮质类固醇（44.9%比 63.8%，P<0.001）或瑞德西韦（23.8%比 57.8%，P<0.001）的可能性较小，并且参与 COVID-19 临床试验的可能性也较小（15.3%比 28.2%，P<0.001）。在调整分析中，黑人种族与较低的 C 反应蛋白和可溶性尿激酶受体水平以及更高的死亡、机械通气和肾脏替代治疗几率相关。在调整瑞德西韦和皮质类固醇的使用后，结局差异并不显著。
COVID-19 患者结局的种族差异可能与炎症反应和治疗方法的差异有关。
