Black Americans are more likely than white patients to be hospitalized or die from COVID-19, even when controlling for socio-economic status or health comorbidities, according to new research.
Researchers analyzed electronic health records of more than 1,000 confirmed COVID-19 cases at Sacramento, Calif.-based Sutter Health between Jan.1 and April 8. They found Black patients were 2.7 times more likely to be hospitalized for COVID-19 after adjusting for income, age, sex and underlying health conditions.
The findings, published Tuesday in Health Affairs, suggest Blacks may have more advanced illness by the time they visit the hospital. Researchers believe societal factors may be creating barriers that are preventing Black patients from accessing care at earlier stages of their illness.
The study found Black patients were more likely to be tested for COVID-19 at a hospital rather than outpatient clinic or other testing center, indicating that they are seeking care only after their illness is at an advanced stage.
"It leads us to really conclude that race definitely plays a pivotal role in determining how and when care is accessed and also in outcomes," said study co-author Kristen Azar, a research scientist at the Sutter Health's Center for Health Systems Research.
Earlier studies have highlighted the disproportionate impact COVID-19 has had on African Americans in both incidence and death rates. Black individuals were more than five times as likely to be hospitalized for COVID-19 compared with white individuals, according to the Centers for Disease Control and Prevention.
Black Americans are about 2.3 times more likely to die from coronavirus compared with whites and Asians, according to figures from American Public Media Research Lab. Experts have explained the disparity in outcomes has to do with racial minorities having higher rates of underlying chronic health conditions such as diabetes, hypertension and heart disease, all of which can lead to more severe illness if they contract COVID-19.
Recently released CDC data indicates the racial disparity among COVID-19 cases is even greater and more widespread than previously estimated. Blacks and Latinos nationwide were three times as likely to become infected and twice as likely to die from COVID-19 as white individuals, according to data the CDC provided the New York Times after the agency was sued for release of the information.
Both the higher incidence rates among Black and Latino individuals highlighted by the new CDC data as well as the findings of the Health Affairs study indicate other factors are limiting timely access to care for many African Americans. Among those who were tested, only 30% of Black patients were tested in an outpatient setting compared with 56% of whites, 60% of Asians, and 54% of Latinos, according to the study. By contrast, Black patients were tested more often in the emergency department or as a hospital inpatient, which together accounted for 70% of all testing among that group compared with 40% among Asians and 44% among whites.
The findings suggest certain communities don't have availability to care for patients outside of the emergency department, which researches say could have a significant impact on COVID-19 outcomes.
Azar said previous research has found possible barriers may exist for minority patients to access primary-care services even when they are in close proximity to a clinic. She said issues like comfort level with a physician or difficulties in scheduling an appointment could be factors that are causing individuals in those communities to delay seeking care until it becomes an emergency.
"It's a really complex situation in terms of how people access primary care," Azar said.
Such disparities reflect the larger problem of racial inequities in society, which have sparked protests across the country. Many healthcare organizations have put out statements that call for providers to step up their efforts toward narrowing the racial gaps in healthcare access and outcomes as a means of addressing institutional racism and discrimination.
The study concluded that policies supporting community-based outreach efforts to testing as well as a greater focus on providing more culturally competent care might lead to earlier diagnosis and better outcomes from COVID-19 among Black patients.
"I think it's important and necessary to address racism in order to really understand the true barriers that are preventing people from getting the care that they need," Azar said.