Black and Latino COVID-19 patients' worse outcomes stem largely from not being able to access care quickly enough, rather than any underlying health conditions, according to a new study.
A new study of more than 2,600 patients hospitalized for COVID-19 published Friday in JAMA Network Open found Black and Latino patients had a lower risk of mortality or critical illness and were less likely of being discharged to hospice compared to white patients.
While pre-existing health conditions certainly contribute to patients having an increased risk of complications from COVID-19, study lead author Dr. Gbenga Ogedegbe, professor of medicine and population health at NYU Langone Health, said Black patients had a lower risk of death compared to white patients after adjusting for age, sex, insurance status and comorbidity, while Latino and Asian patients had similar death rates to white patients.
He said the findings suggest Black and Latino patients had similar or even better outcomes than other racial groups once they were hospitalized, and that the higher rates of severe illness and mortality within those populations are occurring because too many are not making it to a hospital in order to get the care they need.
"You have to make it to the hospital first," Ogedegbe said. "If you make it in, then great, if you don't make it in then that's a problem — so a lot of the cases of mortality that we are talking about is just the fact that a lot of folks don't make it in to the hospital."
The study marks one of the first to examine the impact of neighborhood socioeconomic status on COVID-19 outcomes and adds to mounting evidence that the racial disparity in COVID-19 outcomes is more a product of larger structural factors that are negatively affecting outcomes in Black and Brown communities. Social factors that include poverty, poorer housing conditions, unequal access to health care, and having jobs that don't allow individuals to work from home have all played a role in creating the higher risks in minority communities.
Black and Latino hospitalization and mortality rates from the virus has put racial health inequities in the spotlight during the pandemic. Centers for Disease Control and Prevention figures showed that Blacks were 1.4 times more likely than whites of contracting COVID-19, and they were 3.7 times more likely to be hospitalized and nearly three times more likely to die from the disease. Similarly, Latinos were 1.7 times more likely than whites to contract COVID-19 and more than four times as likely to be hospitalized. Latinos and Blacks see similar mortality rates to the virus.
Previous studies cited Black and Latinos' higher rates of pre-existing health conditions like heart disease, diabetes and hypertension as the main cause for the higher COVID-19 mortality rates.
NYU Langone's study reviewed data from more than 9,700 of their patients' health records. The patients were tested for COVID-19 between March 1 and April 8 and had follow-ups through May 13. The health system collected demographic information, including race and ethnicity, body mass index, age, sex, and neighborhood socioeconomic status for every patient who tested positive for COVID-19 during the study period.
Of the more than 4,800 patients who tested positive for COVID-19, 39% were white, 16% were Black, 26% were Latino, and 7% were Asian. Among those who were hospitalized, more than 70% were eventually discharged, 36% became critically ill, and 25% died or were transferred to hospice care.
Ogedegbe said healthcare must do more long-term to address underlying social factors that have led Black and Latino patients to be more likely to die at home from COVID-19,or delay going to a hospital until they have become critically ill.
In the short term, Ogedegbe suggested the government and employers could take certain preventative steps to mitigate COVID'S impact on minority communities. They could provide essential workers with personal protective equipment and local governments could pass laws that allow those workers to take paid sick leave time in order to quarantine.
"We often blame the patients," Ogedegbe said. "But there's something about the lived environment and the exposure rate that is driving this — it's not about the person."
