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Silver V, Chapple A, Feibus AH, Beckford J, Halapin N, Barua D, Gordon A, Baumgartner W, Vignes S, Clark C, Kamboj S, Lim S, Mackey S, Seal P, Kanter J, Clement ME. 57. clinical Characteristics and Outcomes of Patients Hospitalized with COVID-19 in New Orleans, LA: A Cohort Study. Open Forum Infect Dis 2020. [PMCID: PMC7777840 DOI: 10.1093/ofid/ofaa439.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In Louisiana, deaths related to COVID-19 have disproportionately occurred in Black persons. Granular data are needed to better understand inequities and develop prevention strategies to mitigate further impact on Black communities.
Methods
We conducted a retrospective cohort study of patients admitted to an urban safety net hospital in New Orleans, LA with reactive SARS-CoV-2 testing from March 9–31, 2020. Clinical characteristics and outcomes of Black and other racial/ethnic group patients were compared using Wilcoxon rank-sum test and Fisher’s exact tests. We examined Day-14 status using an ordinal scale to assess race and outcome.
Table 1. Demographics and Comorbidities by Race for Patients Hospitalized with COVID-19
Table 2. Clinical Characteristics at Presentation by Race for Patients Hospitalized with COVID-19, March 2020
Results
This study included 249 patients. Median age was 59, 44% were male, 86% were age ≥65 years or had ≥1 comorbidity. Overall, 87% were Black, relative to 55% Black patients typically hospitalized at our center. Black patients had longer symptom duration at presentation (6.41 versus 5.88 days, p=0.05), and were more likely to have asthma (p=0.008), but less likely to have dementia (p=0.002). There were no racial differences in initial respiratory status or laboratory values other than higher initial LDH in Black patients. Patient age and initial oxygen requirement, but not race (adjusted proportional odds ratio = 0.92, 95%CI: 0.70–1.20), were associated with worse Day-14 outcomes.
Figure 1: Admissions over time by Race
Figure 2a: Hospital outcomes by Race over the Follow-up period
Figure 2b: Day-14 Outcomes by Race
Conclusion
Our results demonstrate minor racial differences in comorbidities or disease severity at presentation, and Day-14 outcomes were not different between groups. However, Black patients were disproportionately represented in hospitalizations, suggesting that prevention efforts should include strategies to limit SARS-CoV-2 exposures in Black communities as one step towards reducing racial inequities related to COVID-19.
Figure 3a: Logistic Regression for Initial Oxygen Requirement
Figure 3b: Cumulative Logistic Regression for Ordinal Day-14 Outcomes
Disclosures
Meredith E. Clement, MD, FHI360 (Consultant)Gilead (Research Grant or Support)Janssen (Scientific Research Study Investigator)
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Affiliation(s)
| | | | | | - Jeremy Beckford
- LSU Health Sciences Center - New Orleans, New Orleans, Louisiana
| | | | | | | | | | - Seth Vignes
- LSU Internal Medicine, New Orleans, Louisiana
| | | | | | - Stephen Lim
- LSU Emergency Medicine, New Orleans, Louisiana
| | | | - Paula Seal
- Infectious Diseases Section, LSUHSC, New Orleans, Louisiana
| | | | - Meredith E Clement
- Louisiana State University Health Sciences Center - New Orleans, New Orleans, Louisiana
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Silver V, Chapple AG, Feibus AH, Beckford J, Halapin NA, Barua D, Gordon A, Baumgartner W, Vignes S, Clark C, Kamboj S, Lim SC, Mackey SP, Seal PS, Kanter JM, Bell C, Clement ME. Clinical Characteristics and Outcomes Based on Race of Hospitalized Patients With COVID-19 in a New Orleans Cohort. Open Forum Infect Dis 2020; 7:ofaa339. [PMID: 32884965 PMCID: PMC7454836 DOI: 10.1093/ofid/ofaa339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/05/2020] [Indexed: 11/27/2022] Open
Abstract
Background In Louisiana, deaths related to COVID-19 have disproportionately occurred in Black persons. Granular data are needed to better understand inequities and develop prevention strategies to mitigate further impact on Black communities. Methods We conducted a retrospective study of patients admitted to an urban safety net hospital in New Orleans, Louisiana, with reactive SARS-CoV-2 testing from March 9 to 31, 2020. Clinical characteristics of Black and other racial/ethnic group patients were compared using Wilcoxon rank-sum test and Fisher exact tests. The relationship between race and outcome was assessed using day 14 status on an ordinal scale. Results This study included 249 patients. The median age was 59, 44% were male, and 86% were age ≥65 years or had ≥1 comorbidity. Overall, 87% were Black, relative to 55% Black patients typically hospitalized at our center. Black patients had longer symptom duration at presentation (6.41 vs 5.88 days; P = .05) and were more likely to have asthma (P = .008) but less likely to have dementia (P = .002). There were no racial differences in initial respiratory status or laboratory values except for higher lactate dehydrogenase in Black patients. Patient age and initial oxygen requirement, but not race (adjusted proportional odds ratio, 0.92; 95% CI, 0.70–1.20), were associated with worse day 14 outcomes. Conclusions Our results demonstrate minor racial differences in comorbidities or disease severity at presentation, and day 14 outcomes were not different between groups. However, Black patients were disproportionately represented in hospitalizations, suggesting that prevention efforts should include strategies to limit SARS-CoV-2 exposures and transmission in Black communities as one step toward reducing COVID-19-related racial inequities.
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Affiliation(s)
- Victoria Silver
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Andrew G Chapple
- Biostatistics Program, LSUHSC School of Public Health, New Orleans, Louisiana, USA
| | - Allison H Feibus
- Louisiana State University Health Sciences Center, LSU School of Medicine, New Orleans, Louisiana, USA
| | - Jeremy Beckford
- Section of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Natalie A Halapin
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Delphi Barua
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Angellica Gordon
- Louisiana State University Health Sciences Center, LSU School of Medicine, New Orleans, Louisiana, USA
| | - Will Baumgartner
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Seth Vignes
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Cullen Clark
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Sanjay Kamboj
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Stephen C Lim
- LSU New Orleans Emergency Medicine, New Orleans, Louisiana, USA.,University Medical Center, New Orleans, Louisiana, USA
| | - Scott P Mackey
- LSU New Orleans Emergency Medicine, New Orleans, Louisiana, USA.,University Medical Center, New Orleans, Louisiana, USA
| | - Paula S Seal
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Section of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,University Medical Center, New Orleans, Louisiana, USA
| | - Joseph M Kanter
- LSU New Orleans Emergency Medicine, New Orleans, Louisiana, USA.,University Medical Center, New Orleans, Louisiana, USA.,Louisiana Department of Health, New Orleans, Louisiana
| | - Caryn Bell
- Tulane Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Meredith E Clement
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Section of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,University Medical Center, New Orleans, Louisiana, USA
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