Eboni G. Price-Haywood, Jeffrey Burton, Daniel Fort, Leonardo Seoane
May 27, 2020
In 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.
A 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 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 sociodemographic and clinical characteristics on admission.
The racial differences in the frequency of Covid-19 observed in the study population are probably multifactorial. They may reflect underlying racial differences in the types of jobs that may have an increased risk of community exposure (e.g., service occupations). In a 2015 report on the civilian labor force in Louisiana, most service workers in New Orleans and surrounding areas were members of minority groups. Approximately 40% of service occupations in New Orleans were jobs related to food preparation and serving. Racial differences in Covid-19 that were observed may also reflect differences in the prevalence of chronic conditions that appear to increase the risk of severe illness. According to a 2018 Health Report Card, Louisiana ranked 45th of 50 states for obesity, 46th for heart disease or strokes, and 47th for diabetes. The report further showed that the incidences of obesity and diabetes were higher in the black population than in the white population. The incidences of these conditions are also higher among persons with lower education and low-income levels across all race groups.
New England Journal of Medicine – DOI: https://www.doi.org/10.1056/NEJMsa2011686