Comparison of influenza and COVID-19 disease burden among black patients at a large urban care center

RATIONALE: Studies have demonstrated racial disparities in COVID-19 outcomes, with black Americans having higher rates of infection, hospitalization, and death. Similarly, CDC data has shown higher Influenza-related mortality in the black American population. While COVID-19 is a deadlier viral respiratory illness, a comparison between influenza and COVID-19 can provide insight into racial disparities and clarify if there is excess disease burden of COVID-19 on black American communities compared with another viral pneumonia. METHODS: We performed a four-year retrospective cohort study (2016-2020) of adult inpatients tested with SARS-CoV-2 or Influenza (A or B) infection in a tertiary, academic referral center in Richmond, Virginia. We compared the unadjusted and adjusted positivity rate, and mortality between black and non-black patients. We performed multiple logistic regression to adjust for age and gender and applied the models to estimate and compare the predicted adjusted mortality. RESULTS: The proportion of black patients admitted for Influenza from 2016-2020 was significantly greater than the proportion of black patients admitted with COVID-19, 66.6% vs. 57.5% (p <0.01). The unadjusted mortality for Influenza + patients was 1.6% (31). The unadjusted mortality for SARSCoV- 2 + patients were 5.6% (125). Black patients had lower unadjusted OR for death for influenza (0.6 95% CI 0.6-0.64, p<0.001) and OR of death for SARS-CoV-2 (0.84, 95% 0.73-0.96, p=0.01). The findings persisted after adjusting for age and gender in influenza patients (OR 0.68 95% CI 0.64-0.74, p<0.001) but not in SARSCoV- 2 patients (OR 0.91 95% CI 0.8-1.05, p=0.2). CONCLUSION: In our predominantly black American cohort, we found no significant association between race and in-hospital adjusted mortality related to COVID-19. Our findings are contrary to larger cohorts and CDC data which shows increased mortality in the black American population. The higher proportion of black patients with Influenza than COVID-19 also indicates that in our population there is not an excess burden from COVID-19 compared to previous Influenza data, although for both COVID-19 and Influenza black patients are overrepresented compared to demographics of VCU's catchment area. The reason for these findings is not clear. Our cohort was composed predominantly of black Americans as is Richmond, VA. It is possible that in this setting the provision of community health or outreach regarding COVID-19 disease prevention to black communities was more effective, reducing excess COVID-19 disease burden. Further research to identify how structural racism and social determinants of health affect vulnerable communities and factors that mitigate these effects is necessary.