Study links higher COVID-19 mortality among Black patients to hospital quality
Black patients hospitalized with COVID-19 had higher rates of hospital mortality and discharge to hospice compared with white patients, according to a study in JAMA Network Open.
Researchers found that the differences could be attributed to differences in the hospitals to which the patients were admitted.
“The pandemic co-occurred with a national reawakening to the systematic disadvantage faced by Black members of our communities. In fact, the illness itself placed a heavier burden on Black people, who often had jobs that put them at greater risk of disease directly or through transportation to them,” David A. Asch, MD, MBA, executive director of Penn Medicine’s Center for Health Care Innovation, told Healio.
“There were reports that people of color with the disease fared worse than white people with the disease” Asch said. “In previous research, we had already demonstrated that hospitals vary substantially in the survival outcomes for their patients admitted with COVID-19. We thought to tie these concepts together: Perhaps Black patients did worse in part because they were more likely to be admitted to the hospitals where outcomes were worse for all? That kind of association has been found in other clinical settings.”
To examine differences in COVID-19 hospital mortality rates between Black and white patients and to assess whether the mortality rates reflect differences in patient characteristics by race or by the hospitals to which Black and white patients are admitted, Asch and colleagues performed a cohort study assessing Medicare beneficiaries admitted with a diagnosis of COVID-19 to any of 1,188 U.S. hospitals between Jan. 1, and Sept. 21, 2020.
Of the 44,217 Medicare beneficiaries included in the study, 33,459 (76%) were white and 10,758 (24%) were Black. Overall, 2,634 (8%) white patients and 1,100 (10%) Black patients died as inpatients, and 1,670 (5%) white patients and 350 (3%) Black patients were discharged to hospice within 30 days of hospitalization, for a total mortality-equivalent rate of 12.86% for white patients and 13.48% for Black patients, Asch and colleagues reported.
The study demonstrated that Black patients had similar odds of dying or being discharged to hospice (OR = 1.06; 95% CI, 0.99-1.12) in an unadjusted comparison with white patients. However, after adjustment for clinical and sociodemographic patient characteristics, Black patients were more likely to die or be discharged to hospice (OR = 1.11; 95% CI, 1.03-1.19), the researchers said.
They found that this difference became “indistinguishable” when adjustment was made for the hospitals where care was delivered (OR = 1.02; 95% CI, 0.94-1.1). In simulations, if Black patients in this sample were instead admitted to the same hospitals as white patients in the same distribution, their rate of mortality or discharge to hospice would decline from the observed rate of 13.48% to the simulated rate of 12.23% (95% CI for difference, 1.20%-1.30%), they reported.
“Society has created a set of circumstances that relentlessly disadvantage Black Americans. When we see the consequences of that disadvantage, the question that will define us is whether we blame the circumstances or blame ourselves for perpetuating them,” Asch said. “It’s hard to provide equitable care when social policies structurally oppose that goal. If we as clinicians are going to care for our patients, then our efforts can’t stop in our examining rooms or our hospitals. Clinicians need to pursue their cause through clinical care, through advances in the basic sciences, and through social change.”