Temporal variations in the severity of COVID-19 illness by race and ethnicity

Joseph E Ebinger; Matthew Driver; Hongwei Ji; Brian Claggett; Min Wu; Eric Luong; Nancy Sun; Patrick Botting; Elizabeth H Kim; Amy Hoang; Trevor Trung Nguyen; Jacqueline Diaz; Eunice Park; Tod Davis; Shehnaz Hussain; Susan Cheng; Jane C Figueiredo

doi:10.1136/bmjnph-2021-000253

Temporal variations in the severity of COVID-19 illness by race and ethnicity

BMJ Nutr Prev Health. 2021 Mar 22;4(1):166-173. doi: 10.1136/bmjnph-2021-000253. eCollection 2021.

Authors

Joseph E Ebinger^{1

2}, Matthew Driver^{1

2}, Hongwei Ji^{3

4}, Brian Claggett⁵, Min Wu^{1

2}, Eric Luong^{1

2}, Nancy Sun^{1

2}, Patrick Botting^{1

2}, Elizabeth H Kim^{1

2}, Amy Hoang^{1

2}, Trevor Trung Nguyen^{1

2}, Jacqueline Diaz^{1

2}, Eunice Park⁶, Tod Davis⁶, Shehnaz Hussain⁷, Susan Cheng^#^{1

2}, Jane C Figueiredo^#^{1

8

9}

Affiliations

¹ Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
² Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
³ Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁴ Department of Cardiology, Shanghai Tenth People's Hospital, Shanghai, China.
⁵ Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁶ Advanced Data Analytics, Enterprise Information Systems, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁷ Department of Public Health Sciences and Comprehensive Cancer Center, University of California, Davis, Davis, California, USA.
⁸ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁹ Cedars-Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, California, USA.

^# Contributed equally.

Abstract

Introduction: Early reports highlighted racial/ethnic disparities in the severity of COVID-19 seen across the USA; the extent to which these disparities have persisted over time remains unclear. Our research objective was to understand temporal trends in racial/ethnic variation in severity of COVID-19 illness presenting over time.

Methods: We conducted a retrospective cohort analysis using longitudinal data from Cedars-Sinai Medical Center, a high-volume health system in Southern California. We studied patients admitted to the hospital with COVID-19 illness from 4 March 2020 through 5 December 2020. Our primary outcome was COVID-19 severity of illness among hospitalised patients, assessed by racial/ethnic group status. We defined overall illness severity as an ordinal outcome: hospitalisation but no intensive care unit (ICU) admission; admission to the ICU but no intubation; and intubation or death.

Results: A total of 1584 patients with COVID-19 with available demographic and clinical data were included. Hispanic/Latinx compared with non-Hispanic white patients had higher odds of experiencing more severe illness among hospitalised patients (OR 2.28, 95% CI 1.62 to 3.22) and this disparity persisted over time. During the initial 2 months of the pandemic, non-Hispanic blacks were more likely to suffer severe illness than non-Hispanic whites (OR 2.02, 95% CI 1.07 to 3.78); this disparity improved by May, only to return later in the pandemic.

Conclusion: In our patient sample, the severity of observed COVID-19 illness declined steadily over time, but these clinical improvements were not seen evenly across racial/ethnic groups; greater illness severity continues to be experienced among Hispanic/Latinx patients.

Keywords: COVID-19.