COVID-19 outcomes, risk factors and associations by race: a comprehensive analysis using electronic health records data in Michigan Medicine

• DOI: 10.1101/2020.06.16.20133140
• Publication Date: 2020-06-18T16:15:20Z
• Authors: Tian Gu; Jasmine A. Mack; Maxwell Salvatore; Swaraaj Prabhu Sa...; Thomas S. Valley; Karandeep Singh; Brahmajee K. Nall...; Sachin Kheterpal; Lynda Lisabeth; Lars G. Fritsche; Bhramar Mukherjee
• Keywords: Health records; 2019-20 coronavirus outbreak; Electronic health record

Structured Abstract Importance Blacks/African-Americans are overrepresented in the number of COVID-19 infections, hospitalizations and deaths. Reasons for this disparity have not been well-characterized but may be due to underlying comorbidities or sociodemographic factors. Objective To systematically determine patient characteristics associated with racial/ethnic disparities outcomes. Design A retrospective cohort study comparative control groups. Setting Patients tested at University Michigan Medicine from March 10, 2020 April 22, 2020. Participants 5,698 patients two sets comparison groups who were COVID-19: randomly selected unmatched controls (n = 7,211) frequency-matched by race, age, sex 13,351). Main Outcomes Measures We identified factors testing positive COVID-19, being hospitalized, requiring intensive care unit (ICU) admission, mortality (in/out-patient during time frame). Factors included race/ethnicity, smoking, alcohol consumption, healthcare utilization, residential-level socioeconomic (SES; i.e., education, unemployment, population density, poverty rate). Medical defined International Classification Diseases (ICD) codes, aggregated into a comorbidity score. Results Of patients, (median 47 years; 38% male; mean BMI, 30.1), majority non-Hispanic Whites (NHW, 59.2%) Black/African-Americans (NHAA, 17.2%). Among 1,119 diagnosed, there 41.2% NHW 37.4% NHAA; 44.8% 20.6% admitted ICU, 3.8% died. Adjusting sex, SES, NHAA 1.66 times more likely hospitalized (95% CI, 1.09-2.52; P= .02), 1.52 enter ICU 0.92-2.52; P =.10). In addition older male obesity, high density neighborhood (OR, 1.27 one SD change [95% 1.20-1.76]; =.02) was hospitalization. Pre-existing kidney disease led 2.55 higher risk hospitalization 1.62-4.02; <.001) overall 11.9 2.2-64.7, =.004). Conclusions Relevance type II diabetes/kidney diseases living areas susceptibility poor prognosis. Association outcomes differed race. disproportionately affected obesity disease. Key Points Question What pre-existing health conditions how do they differ race/ethnicity? Findings such as hospitalization, obesity. covariates, Blacks ICUs than Whites. Meaning Targeted interventions support vulnerable populations needed. Racial existed that cannot explained after controlling status.