- This registry study compared clinical and demographic characteristics, complications and 14-day outcomes by race and ethnicity among patients hospitalized for COVID-19 at Massachusetts General Hospital
- Latinx patients were younger and had fewer of the comorbidities that have been associated with severe COVID-19 disease, yet their rate of a combination endpoint, ICU admission or death, was comparable to that of white/non-Latinx patients
- Despite similarly severe clinical courses, a greater proportion of Latinx than white/non-Latinx patients recovered within 14 days
- There is an urgent need to report COVID-19 clinical data by race/ethnicity
Within the Massachusetts General Hospital catchment area, certain towns have had COVID-19 rates two to three times higher than the state average. The disproportionate burden of COVID-19 in some communities has been attributed to higher proportions of essential workers in public-facing jobs, greater household size and poverty that limits access to care.
However, Ingrid V. Bassett, MD, MPH, of the Infectious Diseases Division, Andrea S. Foulkes, ScD, chief of the Biostatistics Center at Mass General, and colleagues have documented that Latinx people seem to be distinctly different from white, non-Latinx people in their response to COVID-19. As they report in PLOS One, the Latinx cohort became as ill, in general, as the white, non-Latinx cohort despite being younger and having fewer comorbidities.
Using the Mass General COVID-19 Data Registry, the researchers reviewed clinical and demographic characteristics, complications and 14-day outcomes for 866 patients with laboratory-confirmed COVID-19 who were hospitalized at Mass General between March 11 and May 4, 2020.
40% of the patients were white/non-Latinx, 35% were Latinx and 11% were Black/non-Latinx. For context, the Boston area is 20% Latinx, and Latinx people comprised only 8% of hospitalizations at Mass General in 2017.
Risk Factors and Presentation to Care
Compared with white/non-Latinx patients, Latinx patients were:
- Younger (median age 51 vs. 72; P<0.001)
- Less likely to be smokers (23% vs. 53%; P<0.001)
- More likely to have no known exposure to COVID-19 (49% vs. 35%; P<0.001)
- Less likely to have any of the comorbidities studied (cardiac/metabolic disease, hypertension, dyslipidemia, pulmonary disease and type 2 diabetes; P = 0.529)
- Symptomatic longer before seeking care (median 5 vs. 3 days; P=0.04)
- More likely to have been sent home with self-quarantine from presentation to care (29% vs. 16%; P<0.001)
Severity of Disease During 14-Day Follow-up
The Latinx cohort was more likely than the white/non-Latinx cohort to develop liver dysfunction (19% vs. 13%, P = 0.041) or acute renal injury/failure. However, Latinx patients were similarly at risk of a combination endpoint or being admitted to the ICU (34% vs. 36%) but had less death, and equally likely to develop acute respiratory distress syndrome (24% vs. 20%).
The team defined a favorable outcome as a hospital discharge or not requiring supplemental oxygen within 14 days of presenting for care. They conducted a multivariable analysis adjusted for age, sex, body mass index and smoking status.
Among patients not admitted to the ICU (or dead) within 14 days of seeking care, Latinx patients were more likely than white/non-Latinx patients to have a favorable outcome (OR, 1.99; P=0.01). This might reflect the lower risk of comorbidities and acute kidney injury among Latinx patients.
Continued Scrutiny Needed
Trials of treatments and vaccines need to reflect the profound heterogeneity of the populations COVID-19 affects. Thus, there is an urgent need to report COVID-19 clinical data by race/ethnicity. There may be differences not just in risk factors and access to care but also disease course and outcomes.
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