Characteristics and Factors Associated with COVID-19 Infection, Hospitalization, and Mortality Across Race and Ethnicity

Background: Data on the characteristics of COVID-19 patients disaggregated by race/ethnicity remain limited. We evaluated the sociodemographic and clinical characteristics of patients across the major racial/ethnic groups and assessed their associations with COVID-19 outcomes. Methods: This retrospective cohort study analyzed patients who were tested for SARS-CoV-2 in a large, integrated health system spanning California, Oregon, and Washington between March 1 and August 30, 2020. Sociodemographic and clinical characteristics were obtained from electronic health records. Odds of SARS-CoV-2 infection, COVID-19 hospitalization, and in-hospital death were assessed with multivariate logistic regression. Findings: 289,294 patients with known race/ethnicity were tested for SARS-CoV-2 by PCR, of whom 27.5% were non-White minorities. 15,605 persons tested positive, with minorities representing 58.0%. Disparities were widest among Hispanics, who represented 40.5% of infections but 12.8% of those tested. Hispanics were generally younger than white patients and had a higher rate of diabetes, but fewer other comorbidities. Of the 3,197 patients hospitalized, 58.9% were non-White. 459 patients died, of whom 49.8% were minorities. Racial/ethnic distributions of outcomes across the health system tracked with state-level statistics. Increased odds of testing positive and hospitalization were associated with all minority races/ethnicities except American Indian/Alaska Native. Hispanic patients had the highest odds of testing SARS-CoV-2 positive (OR [95% CI]: 3.68 [3.52-3.84]) and Native Hawaiian/Pacific Islander patients had the highest odds of COVID-19 hospitalization (2.13 [1.48 - 3.06]). Hispanic patients also exhibited increased morbidity, including need for mechanical ventilation. In multivariate modeling, Hispanic race/ethnicity was associated with increased odds of hospital mortality (1.75 [1.15-2.67]) among patients over age 70, but hospital mortality was not increased for any race/ethnicity sub-population in the multivariate model. Interpretation: Major healthcare disparities were evident, especially among Hispanics who tested positive at a higher rate, and required excess hospitalization despite younger age and need for mechanical ventilation compared to their expected demographic proportions. As characteristics of patients vary between race/ethnicity, targeted, culturally-responsive interventions are needed to address the increased risk of poor outcomes among minority populations with COVID-19. Funding: This study was supported by Biomedical Advanced Research and Development Authority under Contract HHSO10201600031C administered by Merck and Co. (JDG, JRH). J.H. and R.R. were funded by National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number OT2 TR003443. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The protocol for this study was reviewed and approved by the PSJH Institutional Review Board (IRB #: STUDY2020000203).