Black patients with cancer have worse COVID-19 outcomes
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Black patients with cancer had worse COVID-19 outcomes than white patients, according to results of a retrospective cohort study published in JAMA Network Open.
“As the COVID-19 pandemic caused morbidity and mortality across the United States in 2020 and now, the imbalanced burden between Black and non-Hispanic white patients was underscored,” Julie Fu, MD, MA, site director of cancer clinical trials at Stoneham Cancer Center at Tufts Medical Center, told Healio. “Despite Black individuals representing 13% of the U.S. population, they accounted for 20% to 23% of cases and deaths at the start of our research.”
Background and methodology
Fu and colleagues pursued the study with the knowledge that racial and ethnic minority groups experience cancer health disparities, and that preexisting conditions such as cancer increase risk for severe COVID-19 illness and death, according to Fu.
“At the time, there was no exploration on race/ethnicity, cancer and COVID-19, and we wanted to investigate and highlight any correlation and ultimately start the conversation on change,” Fu said.
The analysis included 3,506 patients (median age, 67 years; interquartile range, 58-77; 50% women; 70% white, 30% Black) in the COVID-19 and Cancer Consortium registry between March 17, 2020, and Nov. 18, 2020.
The study’s primary outcome consisted of a five-level ordinal scale of COVID-19 severity based on a patient’s most severe disease status, which included hospital admission, ICU admission, mechanical ventilation use and death due to any cause. Researchers also recorded 30-day all-cause mortality as a secondary outcome.
Key findings
Black patients had higher rates of preexisting comorbidities than white patients, including obesity (45% vs. 38%), diabetes (38% vs. 24%) and kidney disease (23% vs. 16%), whereas white patients had a higher rate of cardiovascular disease (37% vs. 32%). About 20% of patients overall had breast cancer, the most common solid tumor in both racial groups.
Results showed Black patients presented with worse illness and had significantly worse COVID-19 severity (unweighted OR = 1.34; 95% CI, 1.15-1.58; weighted OR = 1.21; 95% CI, 1.11-1.33) despite a similar distribution of cancer type, cancer status and anticancer therapy at COVID-19 diagnosis. Multivariate models also showed higher 30-day mortality among Black vs. white patients (OR = 1.59; 95% CI, 1.25-2.02) after adjustment for baseline covariates.
“These findings confirmed our suspicion that Black patients with cancer and COVID-19 experience worse outcomes, emphasizing the continued disproportionate burden of diseases in the context of structural racism in the U.S.” Fu said.
Implications
Researchers also found that, despite presenting with worse disease, Black patients with COVID-19 had a lower likelihood of receiving novel anti-COVID-19 therapies, such as remdesivir, than white patients, Sonya A. Reid, MD, MPH, assistant professor in the division of hematology/oncology at Vanderbilt University Medical Center, told Healio.
“This may reflect a persistent gap in health care access and equity for Black patients,” Reid said. “Unequal access and mistrust of the medical profession among vulnerable populations has resulted in lower rates of vaccine trial enrollment and COVID-19 vaccinations received in the Black community, all of which will further exacerbate racial disparities unless urgent remedial actions are undertaken.”
Future research should target the source of these inequities, according to Reid.
“This study highlights the need to prioritize community-engaged research to address the root causes of health disparities (eg, social determinants of health and inequity in access to quality health care) in order to achieve equitable care for all patients,” Reid said.
For more information:
Sonya A. Reid, MD, MPH, can be reached at sonya.reid@vumc.org.
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