Impact of racial disparities on COVID-19 outcomes

By Bhavana KunkalikarMar 31 2022Reviewed by Aimee Molineux

A recent study published in the JAMA Network Open journal investigated the racial disparities in coronavirus disease 2019 (COVID-19) outcomes in Black and White patients diagnosed with cancer.

Background

To date, there have been over 483 million confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, including 6.1 million deaths, globally. Various studies have reported disproportionate COVID-19 outcomes among racially and ethnically minor groups, particularly non-Hispanic Black individuals in comparison to non-Hispanic White individuals.

About the study

The present retrospective cohort study explored the racial contrasts in manifestations of COVID-19 severity, its presentation, related clinical complications, and outcomes among Black patients and non-Hispanic White patients suffering from COVID-19 and cancer.

The study included patients diagnosed with cancer and having a confirmed SARS-CoV-2 diagnosis. All cases of laboratory-confirmed SARS-CoV-2 infection submitted to the COVID-19 and Cancer Consortium (CCC19) registry from 17 March 2020 to 8 November 2020 in the US were included in the study. The participants eligible for the study had a current or previous cancer diagnosis and belonged to the Black or White race. Demographic data were either self-reported or confirmed by the patient’s triage personnel or health care practitioner.

The primary outcome of the study was based on a five-level ordinal scale that classified COVID-19 severity according to the most severe disease status of the patient: (1) having none of the mentioned complications, (2) hospitalization, (3) intensive care unit (ICU) admission, (4) required mechanical ventilation, and (5) death. The team defined the index date for the analysis of the date of COVID-19 diagnosis.

The outcomes of the study were assessed through the entire follow-up period of the patient. A secondary outcome was also evaluated by the team by performing additional analysis to assess 30-day all-cause mortality.

Results

The study results showed that among the 3,506 eligible participants, 50% were women, while the median age of the study cohort was 67 years. Approximately 30% of the patients were Black and 70% of the patients were White. COVID-19 was diagnosed in patients of an average age of 65 years in Black patients and 68 years in White patients. At the time of COVID-19 diagnosis, 45% and 38% of the patients were obese and 38% and 24% of the patients had diabetes in the Black and the White cohorts, respectively. Also, 52% of the Black and 55% of the White patients were in remission.

The cancer statuses were considered to be active and responding in 12% of Black and 9% of the White patients, active and stable in 15% of Black and 16% of White patients, active and progressing in 13% of Black and 12% of White patients, and unknown in 8% of Black and 7% of White patients. Also, COVID-19 disease severity was considered moderate in 41% of Black and 34% of White patients and severe in 15% of Black and 11% of White patients.

The study showed that the most common symptom was pulmonary complications as observed in 37% of the total number of patients while 42% of these were Black and 35% were White patients. Also, higher rates were observed for acute kidney injury in 27% of Black patients as compared to 15% of White patients and for cardiovascular complications in 26% of Black patients and 22% of White patients. Furthermore, it was noted that only 6% of the Black patients were likely to be treated with remdesivir versus 10% of White patients while 24% and 15% of the Black and White patients were likely to be administered hydroxychloroquine, respectively.

Moreover, the team found increased ICU admission, hospitalization, and mechanical ventilation among Black patients compared to White patients. Also, 19% of the Black patients had a higher rate of all-cause mortality compared to 17% of the White patients. Approximately 82% of the patients who died during the follow-up, succumbed within 30 days of SARS-CoV-2 diagnosis and had a 30-day mortality rate of 17% and 13% among Black and White patients, respectively.

Conclusion

The study findings showed that Black patients suffering from COVID-19 and cancer had similar cancer status but exhibited worse preexisting comorbidities, COVID-19 severity during follow-up, and outcomes in comparison to the White patients with COVID-19 and cancer.

The researchers believe that this study calls for the need to eradicate systemic racism and reduce the unequal burden of disease severities and outcomes on Black patients and other racial and ethnic minority groups.