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Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry.

Identifieur interne : 000346 ( Main/Exploration ); précédent : 000345; suivant : 000347

Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry.

Auteurs : Fatima Rodriguez [États-Unis] ; Nicole Solomon ; James A. De Lemos ; Sandeep R. Das ; David A. Morrow [États-Unis] ; Steven M. Bradley ; Mitchell S V. Elkind [États-Unis] ; Joseph H. Williams Iv [États-Unis] ; Dajuanicia Holmes ; Roland A. Matsouaka ; Divya Gupta [États-Unis] ; Ty J. Gluckman [États-Unis] ; Marwah Abdalla [États-Unis] ; Michelle A. Albert [États-Unis] ; Clyde W. Yancy [États-Unis] ; Tracy Y. Wang

Source :

RBID : pubmed:33200953

Abstract

Background: The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. Methods: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. Results: Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90). Conclusions: Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.

DOI: 10.1161/CIRCULATIONAHA.120.052278
PubMed: 33200953


Affiliations:


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Le document en format XML

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<name sortKey="Gupta, Divya" sort="Gupta, Divya" uniqKey="Gupta D" first="Divya" last="Gupta">Divya Gupta</name>
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<name sortKey="Albert, Michelle A" sort="Albert, Michelle A" uniqKey="Albert M" first="Michelle A" last="Albert">Michelle A. Albert</name>
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<name sortKey="Yancy, Clyde W" sort="Yancy, Clyde W" uniqKey="Yancy C" first="Clyde W" last="Yancy">Clyde W. Yancy</name>
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<name sortKey="Wang, Tracy Y" sort="Wang, Tracy Y" uniqKey="Wang T" first="Tracy Y" last="Wang">Tracy Y. Wang</name>
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<name sortKey="Das, Sandeep R" sort="Das, Sandeep R" uniqKey="Das S" first="Sandeep R" last="Das">Sandeep R. Das</name>
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<nlm:affiliation>Department of Internal Medicine, Cardiology Division, University of Texas Southwestern Medical Center.</nlm:affiliation>
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<region type="state">Massachusetts</region>
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<name sortKey="Bradley, Steven M" sort="Bradley, Steven M" uniqKey="Bradley S" first="Steven M" last="Bradley">Steven M. Bradley</name>
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<wicri:noCountry code="no comma">Minneapolis Heart Institute and Minneapolis Heart Institute Foundation.</wicri:noCountry>
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<name sortKey="Elkind, Mitchell S V" sort="Elkind, Mitchell S V" uniqKey="Elkind M" first="Mitchell S V" last="Elkind">Mitchell S V. Elkind</name>
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<country xml:lang="fr">États-Unis</country>
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<name sortKey="Williams Iv, Joseph H" sort="Williams Iv, Joseph H" uniqKey="Williams Iv J" first="Joseph H" last="Williams Iv">Joseph H. Williams Iv</name>
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<nlm:affiliation>American Heart Association, United States.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>American Heart Association</wicri:regionArea>
</affiliation>
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<name sortKey="Holmes, Dajuanicia" sort="Holmes, Dajuanicia" uniqKey="Holmes D" first="Dajuanicia" last="Holmes">Dajuanicia Holmes</name>
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<nlm:affiliation>Duke Clinical Research Institute, Duke University, Durham NC.</nlm:affiliation>
<wicri:noCountry code="subField">Durham NC</wicri:noCountry>
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<name sortKey="Matsouaka, Roland A" sort="Matsouaka, Roland A" uniqKey="Matsouaka R" first="Roland A" last="Matsouaka">Roland A. Matsouaka</name>
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<nlm:affiliation>Duke Clinical Research Institute, Duke University, Durham NC.</nlm:affiliation>
<wicri:noCountry code="subField">Durham NC</wicri:noCountry>
</affiliation>
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<author>
<name sortKey="Gupta, Divya" sort="Gupta, Divya" uniqKey="Gupta D" first="Divya" last="Gupta">Divya Gupta</name>
<affiliation wicri:level="2">
<nlm:affiliation>Division of Cardiology, Emory University School of Medicine, Atlanta, GA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Géorgie (États-Unis)</region>
</placeName>
<wicri:cityArea>Division of Cardiology, Emory University School of Medicine, Atlanta</wicri:cityArea>
</affiliation>
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<name sortKey="Gluckman, Ty J" sort="Gluckman, Ty J" uniqKey="Gluckman T" first="Ty J" last="Gluckman">Ty J. Gluckman</name>
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<nlm:affiliation>Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Portland, OR.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Oregon</region>
</placeName>
<wicri:cityArea>Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Portland</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Abdalla, Marwah" sort="Abdalla, Marwah" uniqKey="Abdalla M" first="Marwah" last="Abdalla">Marwah Abdalla</name>
<affiliation wicri:level="2">
<nlm:affiliation>Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York</wicri:cityArea>
</affiliation>
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<name sortKey="Albert, Michelle A" sort="Albert, Michelle A" uniqKey="Albert M" first="Michelle A" last="Albert">Michelle A. Albert</name>
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<nlm:affiliation>Division of Cardiology, University of California San Francisco, San Francisco, CA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Californie</region>
</placeName>
<wicri:cityArea>Division of Cardiology, University of California San Francisco, San Francisco</wicri:cityArea>
</affiliation>
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<name sortKey="Yancy, Clyde W" sort="Yancy, Clyde W" uniqKey="Yancy C" first="Clyde W" last="Yancy">Clyde W. Yancy</name>
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<nlm:affiliation>Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, IL.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Illinois</region>
</placeName>
<wicri:cityArea>Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago</wicri:cityArea>
</affiliation>
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<name sortKey="Wang, Tracy Y" sort="Wang, Tracy Y" uniqKey="Wang T" first="Tracy Y" last="Wang">Tracy Y. Wang</name>
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<nlm:affiliation>Duke Clinical Research Institute, Duke University, Durham NC.</nlm:affiliation>
<wicri:noCountry code="subField">Durham NC</wicri:noCountry>
</affiliation>
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<title level="j">Circulation</title>
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<div type="abstract" xml:lang="en">
<b>Background:</b>
The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19.
<b>Methods:</b>
The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital.
<b>Results:</b>
Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90).
<b>Conclusions:</b>
Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.</div>
</front>
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<DateRevised>
<Year>2020</Year>
<Month>11</Month>
<Day>17</Day>
</DateRevised>
<Article PubModel="Print-Electronic">
<Journal>
<ISSN IssnType="Electronic">1524-4539</ISSN>
<JournalIssue CitedMedium="Internet">
<PubDate>
<Year>2020</Year>
<Month>Nov</Month>
<Day>17</Day>
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<Title>Circulation</Title>
<ISOAbbreviation>Circulation</ISOAbbreviation>
</Journal>
<ArticleTitle>Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry.</ArticleTitle>
<ELocationID EIdType="doi" ValidYN="Y">10.1161/CIRCULATIONAHA.120.052278</ELocationID>
<Abstract>
<AbstractText>
<b>Background:</b>
The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19.
<b>Methods:</b>
The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital.
<b>Results:</b>
Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90).
<b>Conclusions:</b>
Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.</AbstractText>
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