Hospitalization and Mortality among Black Patients and White Patients with Covid-19
Hospitalization and Mortality among Black Patients and White Patients with Covid-19
复制标题
DOI：
10.1056/nejmsa2011686
复制
发表时间：
2020-06-25
影响因子：
158.5
通讯作者：
Seoane, Leonardo
中科院分区：
文献类型：
--
作者：
Price-Haywood, Eboni G.;Burton, M. P. H. Jeffrey;Seoane, Leonardo
许多关于2019冠状病毒病（Covid-19）的报告都强调了健康结果中与年龄和性别相关的差异。需要更多关于COVID-19结局的种族和民族差异的信息。方法在这项回顾性队列研究中，我们分析了综合医疗系统中的患者数据。（Ochsner Health）于2020年3月1日至4月11日在路易斯安那州，对严重急性呼吸综合征冠状病毒2检测呈阳性（SARS-CoV-2，导致Covid-19的病毒）的定性聚合酶链反应测定。Ochsner健康人口是31%的黑人非西班牙裔和65%的白色非西班牙裔。主要结局为住院和院内死亡。共有3626名患者的CRTSA检测结果为阳性，其中145名被排除（84名患者的种族或民族数据缺失，9名为西班牙裔，52名为亚洲人或其他种族或民族）。在我们的分析中纳入的3481名Covid-19阳性患者中，60.0%为女性，70.4%为非西班牙裔黑人，29.6%为非西班牙裔白色白人。与白色患者相比，黑人患者肥胖、糖尿病、高血压和慢性肾脏疾病的患病率更高。共有39.7%的Covid-19阳性患者（1382名患者）住院，其中76.9%是黑人。在多变量分析中，黑人种族、年龄增长、Charlson Comorbidity指数得分较高（表明疾病负担更大）、公共保险（医疗保险或医疗补助）、居住在低收入地区和肥胖与入院几率增加相关。在326名死于新冠肺炎的患者中，70.6%是黑人。在校正的至事件发生时间分析中，与较高的住院死亡率相关的变量是年龄增加和呼吸频率升高;静脉乳酸盐、肌酐或降钙素原水平升高;或血小板或淋巴细胞计数降低。然而，黑人种族与更高的死亡率并不独立相关（死亡与白色种族的风险比为0.89; 95%置信区间为0.68至1.17）。结论在路易斯安那州的一个大型队列中，76.9%的新冠肺炎住院患者和70.6%的死亡患者是黑人，而黑人仅占Ochsner Health人群的31%。在调整入院时的社会人口统计学和临床特征差异后，黑人与白色种族相比，住院死亡率并不高。
BACKGROUNDMany reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19.METHODSIn this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death.RESULTSA total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19-positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19-positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17).CONCLUSIONSIn a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in socio-demographic and clinical characteristics on admission.