As coronavirus cases mount, racial minorities appear to be disproportionately affected by the pandemic. Across a sample population of 23 million patients across 16 states, 12% were black and 65% were white, but among the 108,000 of those patients who are documented COVID-19 positive, 22% were black and 46% were white.
The root causes of this disparity are not yet fully understood, but recent electronic health record data suggest that comorbidities could play a role. This analysis begins to examine how outcomes compare for patients of different races who share other health characteristics, such as common comorbidities.
In general, black patients were overrepresented among COVID-19 hospitalizations (27%) and deaths (22%) when compared to the broader sample population (12%). When examining only patients with no comorbidities, the gap narrowed. Among patients with no comorbidities, 17% of COVID-19 hospitalizations, 15% of COVID-19 deaths, and 12% of sampled patients were black.
Across all racial groups, patients who were hospitalized or who died had higher rates of comorbidities than the overall sample population. Specifically, the combination of diabetes and hypertension is much more prevalent among hospitalized COVID-19 patients (23%) and among those who died (28%) than in the sample population (5%), regardless of racial group. This pattern of comorbidity prevalence is consistent with past observations.
The data also indicate that black patients experience comorbidities at higher rates in general. For example, 6.7% of black patients ages 19-64 had diabetes and hypertension, compared to 3.6% of white patients. It isn’t yet clear whether the comorbidities themselves lead to worse COVID-19 outcomes for these patients, or whether there are other variables related to both the comorbidities and poor outcomes from COVID-19.
There are 42,388 (39%) COVID-19 patients who do not yet have a known outcome (either survived or died) as of May 4, 2020. Some of these patients may go on to be hospitalized or die, and this should be taken into consideration when examining these data.
The patients in the sample population have all had an interaction with the health system in the past 2 years. Thus, the sample population concentrates on patients with a certain baseline of access to healthcare and a relatively up-to-date, accurate list of diagnoses in their charts. There may be additional health impacts for patients who have limited access to healthcare, and these factors are not accounted for in this analysis.
Further, the analysis does not control for the various factors that might lead to increased comorbidities in specific racial groups. Future studies should explore the effects of variables like geographical location, population density, and socioeconomic status.
The data in this analysis were pooled from 27 health systems representing 240 hospitals that span 16 different states and cover 107 million patients as of May 4, 2020.