Infectious Disease

Study links higher COVID-19 mortality in black patients with hospital quality

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According to a study in JAMA Network Open, black patients hospitalized with COVID-19 had higher hospital mortality and hospice discharge rates compared to white patients.

The researchers found that the differences were due to differences in the hospitals the patients were admitted to.

Quote by David Asch

“The pandemic came along with a national reawakening, with the systematic disadvantage of black members of our communities. In fact, the disease itself put a greater burden on black people, who often had jobs that put them at greater risk of disease, either directly or through transportation. ” David A. Asch, MD, MBA, General Manager of Penn Medicine’s Center for Health Care Innovation, said Healio.

“There have been reports that people of color with the disease were worse off than white people with the disease,” said Asch. “In previous research, we had already shown that hospitals vary significantly in the survival outcomes of their patients admitted with COVID-19. We thought to combine these concepts: Perhaps some black patients did worse because they were more likely to be admitted to hospitals where the outcomes were worse for everyone? This type of association has been found in other clinical situations. “

To examine differences in COVID-19 hospital death rates between black and white patients and to assess whether the death rates reflect differences in patient characteristics by race or by the hospitals that admit black and white patients, Asch and colleagues conducted a cohort study through Medicare benefit recipients were admitted to one of 1,188 U.S. hospitals with a diagnosis of COVID-19 between January 1 and September 21, 2020.

Of the 44,217 Medicare beneficiaries enrolled in the study, 33,459 (76%) were white and 10,758 (24%) were black. A total of 2,634 (8%) white patients and 1,100 (10%) black patients inpatients died and 1,670 (5%) white patients and 350 (3%) black patients were discharged to hospice within 30 days of hospitalization, mortality equivalent rate of 12 , 86% for white patients and 13.48% for black patients, reported Asch and colleagues.

The study showed that in the unadjusted comparison with white patients, black patients had similar chances of dying or of being discharged into the hospice (OR = 1.06; 95% CI, 0.99-1.12). However, after adjusting for patient clinical and socio-demographic characteristics, black patients were more likely to die or be discharged to a hospice (OR = 1.11; 95% CI, 1.03-1.19), the researchers said.

They found that this difference became “indistinguishable” when an adjustment was made for the hospitals where care was provided (OR = 1.02; 95% CI, 0.94-1.1). In simulations, if black patients in this sample were instead admitted to the same hospitals as white patients in the same distribution, their mortality rate or their discharge to a hospice would change from the observed rate of 13.48% to the simulated rate of 12.23%. sink (95). % CI for difference, 1.20% -1.30%) they reported.

“Society has created a number of circumstances that relentlessly disadvantage black Americans. When we see the consequences of this disadvantage, the question will determine whether we blame the circumstances or blame ourselves for maintaining them, ”said Asch. “It is difficult to guarantee fair provision when social policy is structurally opposed to this goal. As clinicians, when we care for our patients, our efforts cannot end in our exam rooms or hospitals. Clinicians must pursue their cause through clinical care, advances in basic science, and through social change. “

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