Differences in Inflammation, Treatment, and Outcomes Between Black and Non-Black Patients Hospitalized for COVID-19: A Prospective Cohort Study

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: Racial differences in outcomes of patients with COVID-19 may be related to differences in inflammatory response and differential use of therapies.

Keywords: African Americans; Convalescent serum; Coronavirus; Corticosteroids; Disparities; M2C2; Remdesivir; SARS-COV-2.

Copyright © 2021 Elsevier Inc. All rights reserved.

Figures

Figure 1

Use of COVID-19-related therapies according to race. Horizontal bar graph demonstrating the proportion of Black and non-Black patients receiving each therapy with associated P value from univariable analysis. COVID-19 = coronavirus disease 2019.

Figure 2

COVID-19-directed interventions in black patients prior to and after EUA approval of remdesivir. Clustered bar graph showing proportions of Black patients pre- and post-EAU of remdesivir (periods 1 and 2, respectively), in additional to the proportion of non-Black patients in period 2 receiving COVID-19 therapies. P value is derived from the comparison between Black patients and non-Black patients in their receipt of COVID-19 therapies in period 2. COVID-19 = coronavirus disease 2019; EAU = emergency use authorization.

Figure 3

Odds ratios for Black race as a risk factor for COVID-19-related outcomes. Bar graphs showing the odds ratios for Black race for mortality, need for mechanical ventilation, and need for renal replacement therapy during hospitalization for COVID-19. Model 0 includes Black versus non-Black race only; model 1 includes race, sex, age, BMI, diabetes mellitus, hypertension, coronary artery disease, heart failure, chronic kidney disease, and eGFR on admission; model 2 adds CRP to model 1; and lastly, model 3 includes the use of remdesivir and corticosteroids. Error bars denote 95% confidence intervals. Dashed line denotes odds ratio of 1, with non-Black race being the reference. BMI = body mass index; COVID-19 = coronavirus disease 2019; CRP = C-reactive protein; eGFR = estimated glomerular filtration rate.