Hispanic, Black patients with cirrhosis, COVID-19 have ‘significantly higher’ mortality
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CHICAGO — Hispanic and Black patients with cirrhosis who developed COVID-19 infection had higher rates of mortality, as well as higher hospital charges of more than $340 million in 2020, according to a presenter at Digestive Disease Week.
“COVID-19 unmasked significant racial disparities in rates of infection and mortality in the United States,” Syed Ali Amir Sherazi, MD, an internist at John H. Stroger Jr. Hospital of Cook County in Chicago, said. “There was a large, multicenter observational study of over 9,000 patients, which reported that Black and Hispanic patients have higher rates of COVID-19, are uninsured or underinsured, but there was not any significant difference in adjusted mortality rate.”
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Using 2020 data from the Unites States Healthcare Cost and Utilization Project’s National Inpatient Sample, Sherazi and colleagues compared health care utilization and outcomes among 24,245 patients with cirrhosis who developed COVID-19.
Researchers grouped individuals by ethnicity — white (n = 13,465; mean age, 64.5 years; 51.9% women), Hispanic (n = 7,375; mean age, 59.5 years; 35.7% women) and Black (n = 3,405; mean age, 62.8 years; 46.6% women) — and analyzed patient and hospital demographics, comorbidities, cirrhosis etiologies, complications, mean length of hospital stay, mean total hospital charges and all-cause mortality.
According to analysis, Hispanic and Black patients were more likely to come from the lowest quartile income zip codes and have Medicaid or no insurance compared with white patients. Hispanic patients had the highest rates of diabetes and the lowest rates of dyslipidemia, COPD, coronary artery disease, congestive heart failure, chronic kidney disease and smoking, while Black patients had the highest rates of coronary artery disease, congestive heart failure and chronic kidney disease. White patients had the highest rates of COPD, smoking and obesity.
Researchers reported the highest rates of chronic viral hepatitis among Black patients and alcoholic cirrhosis in Hispanic patients. White patients had the highest comorbid nonalcoholic steatohepatitis.
While there were similar lengths of stay reported between groups, Hispanic patients had the highest mean total hospital charges ($134,021) followed by Black ($110,894) and white patients ($95,098).
Further, overall mortality was 6.6% across groups, which jumped to 19.4% in patients with cirrhosis and COVID-19. Following adjustment, mortality was “significantly higher” among Black and Hispanic patients (adjusted OR = 1.21).
“There were significant racial disparities in patients with cirrhosis and COVID-19,” Sherazi concluded. “Hispanic and African American cirrhotic patients had significantly higher mortality than whites. Hispanics also had the highest total hospital charges despite similar length of stay, younger age and lower comorbidity burden.”
Sherazi added: “Higher charges in African American and Hispanics amounted to over $340 million in 2020 alone.”
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Sherazi SAA, et al. Abstract 338: Racial disparities in managing cirrhosis patients with COVID-19 – A nationwide analysis. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago (hybrid).
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