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.
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.
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DOI：
10.1161/circulationaha.120.052278
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发表时间：
2021-06-15
期刊：
影响因子：
37.8
通讯作者：
Wang TY
中科院分区：
文献类型：
--
作者：
Rodriguez F;Solomon N;de Lemos JA;Das SR;Morrow DA;Bradley SM;Elkind MSV;Williams JH;Holmes D;Matsouaka RA;Gupta D;Gluckman TJ;Abdalla M;Albert MA;Yancy CW;Wang TY
补充数字内容可在正文中找到。冠状病毒病2019年(新冠肺炎)大流行暴露了美国在健康风险和结果方面长期存在的种族和族裔不平等。我们的目标是确定新冠肺炎患者在表现和预后方面的种族和民族差异。美国心脏协会新冠肺炎心血管疾病登记处是一个回顾性观察登记处，记录了连续使用新冠肺炎入院的患者。我们提供了2020年1月17日至2020年7月22日期间在全美88家医院接受治疗的首批7868名按种族/民族划分的患者的数据。主要结果是住院死亡率。次要结果包括主要心血管不良事件(死亡、心肌梗死、中风、心力衰竭)和新冠肺炎心肺疾病严重程度评分(从差到好：死亡、心脏骤停、机械循环支持下的机械通气、血管加压剂/肌力调节剂支持下的机械通气、不使用血流动力学支持的机械通气以及单独住院。采用多变量Logistic回归分析来评估种族/民族与每个结局之间的关系，调整了社会人口学、临床和表现特征的差异，并考虑了医院的聚集性。在7,868名因新冠肺炎入院的患者中，33.0%是西班牙裔，25.5%是非西班牙裔黑人，6.3%是亚洲人，35.2%是非西班牙裔白人。西班牙裔和黑人患者比非西班牙裔白人和亚洲患者年轻，而且更有可能没有保险。黑人患者肥胖症、高血压和糖尿病的患病率最高。黑人患者的机械通气率(23.2%)和肾脏替代疗法(6.6%)也是最高的，但急救使用率(6.1%)最低。总死亡率为18.4%，其中53%的死亡发生在黑人和西班牙裔患者中。与非西班牙裔白人患者相比，黑人患者调整后的死亡率优势比为0.93(95%CI，0.76-1.14)，拉美裔患者为0.90(95%CI，0.73-1.11)，亚洲患者为1.31(95%CI，0.96-1.80)。不同医院的中位优势比为1.99(95%可信区间，1.74-2.48)。主要不良心血管事件的结果类似。亚洲患者在发病时的新冠肺炎心肺严重程度最高(调整后的优势比，1.48[95%可信区间，1.16-1.90])。虽然调整后的住院死亡率和主要心血管不良事件没有种族/民族差异，但黑人和西班牙裔患者由于在新冠肺炎住院患者中所占比例不成比例，因此承担了更大的死亡率和发病率负担。
Supplemental Digital Content is available in the text. The coronavirus disease 2019 (COVID-19) pandemic has exposed longstanding racial and ethnic inequities in health risks and outcomes in the United States. We aimed to identify racial and ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. 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 7868 patients by race/ethnicity treated at 88 hospitals across the United States between January 17, 2020, and July 22, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events (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 alone. 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. Among 7868 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 for mortality were 0.93 (95% 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 odds ratio across hospitals was 1.99 (95% CI, 1.74–2.48). Results were similar for major adverse cardiovascular events. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted odds ratio, 1.48 [95% CI, 1.16–1.90]). Although in-hospital mortality and major adverse cardiovascular events did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity because of their disproportionate representation among COVID-19 hospitalizations.