Background: As of 2020, COVID-19 is the third leading cause of death after heart disease and cancer. COVID-19 accounted for more than a million hospitalization in the USA since the onset of the pandemic. Our aim is to investigate the impact of racial disparities on the outcome of COVID-19 admissions.
Methods: We queried the National Inpatient Sample (NIS) 2020 database. The NIS is the largest inpatient hospitalization database in the US. The numbers in the database are weighted to optimize national estimates. The NIS was searched for hospitalization of adult patients with COVID-19 as a principal diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while secondary outcomes assessed included; odds of septic shock, need for mechanical ventilation, cardiac arrest, mean length of hospital stay (LOS), and mean total hospital charges (THC). Multivariate linear regression and logistic regression analysis were used to adjust for possible confounders for both primary and secondary outcomes.
Results: There were about 1,050,045 adult hospitalizations principally for COVID-19 of which 52.7% were non-Hispanic white, 18.5% were black and 28.8 account for other races. The mean age for white was 69 [CI 68.8-69.2] vs 61.3 [CI 61.1-61.5] for black, females (47% vs 53.4%), males (53% vs 46.6%) white vs black respectively. The overall inpatient mortality was 11.2% (117,270) for hospitalizations due to COVID-19. After adjusting for confounders there was no statistically significant difference in mortality (Adjusted odds ratio [aOR] 1.05 95% CI, 0.99-1.12; P=0.053) and septic shock (aOR 0.93 95% CI, 0.85-1.00; P=0.061) between both races. Non-Hispanic white had less odds of requiring mechanical ventilation (aOR 0.88 95% CI, 0.83-0.94; P< 0.0001) and cardiac arrest (aOR 0.64 95% CI, 0.57-0.71; P<.0001) compared to blacks. There was also a decreased length of stay and total hospital charges in the white population compared to the black, outcomes are detailed in Table 1.
Conclusions: In adult patients admitted for COVID-19, there was no difference in the mortality outcome when non-Hispanic white are compared to the black population. Black patients had a higher risk of cardiac arrest and requiring mechanical ventilation compared to white, the former also have a greater mean length of stay without a statistically significant difference in total hospital charges. There was no difference in the outcome of septic shock in both races.
