Black individuals at higher risk for COVID-19 infection, hospitalization

Black individuals are twice as likely to test positive for SARS-CoV-2 and require hospitalization compared with white individuals, according to a retrospective analysis published in Annals of the American Thoracic Society.

“COVID-19 constitutes an enormous threat to public health and life expectancy in the U.S.,” Ayodeji Adegunsoye, MD, MS, assistant professor in the section of pulmonary and critical care medicine in the department of medicine at the University of Chicago, told Healio. “Our findings are directly relevant to ongoing clinical and public health efforts to understand and combat this challenging pandemic. The recognition of Black individuals as an especially high-risk population would help to direct targeted efforts to mitigate those socioeconomic and health-related factors that confer increased risk, thereby curbing the spread of the coronavirus across all populations.”

The retrospective analysis included 4,413 patients (mean age, 46 years; 57.6% Black) who underwent nasopharyngeal swab and SARS-CoV-2 polymerase chain reaction assays after clinical screening at the University of Chicago. Of those, 17.8% tested positive for SARS-CoV-2. Those who tested positive were more likely to be men (20.1% vs. 16.5%; P = .003), older (52 years vs. 44.5 years; P < .0001) and Black (24.3% vs. 8.9%; P < .0001). Black individuals who tested positive were disproportionately women (62.5% vs. 51.2%; P = .01), which the researchers noted is “consistent with published data.”

Individuals who tested positive for SARS-CoV-2 had a higher fatality rate overall (2.5% vs. 1.2%; P = .005) and also among those hospitalized (6% vs. 1.2%; P < .0001) compared with individuals who tested negative. The researchers reported no differences by sex (P = .48) or race (P = .34) in mortality among all patients who tested positive for SARS-CoV-2 in the cohort.

Univariate logistic regression model analyses showed Black race was associated with SARS-CoV-2 infection (OR = 3.3; 95% CI, 2.75-3.97) and hospitalization (OR = 3.77; 95% CI, 2.38-5.99); the same association was not observed for mortality.

When the researchers examined outcomes by age, the SARS-CoV-2 infection rate was 10-fold higher among individuals aged 30 to 50 years compared with those aged 18 years and younger (0.05 vs. 0.005). The age-adjusted positive rate remained higher among Black individuals compared with non-Black individuals (0.19 vs. 0.07), according to the results.

“The higher prevalence of infection in older adults and those with diabetes and cardiovascular disease suggests that less robust immune mechanisms may be an underlying factor in determining who gets severely ill and hospitalized with the virus,” Adegunsoye said. “It is possible that understanding these specific immune mechanisms in patients with COVID-19 and why these pathways get impaired with aging and specific comorbid diseases would be extremely important for developing vaccines and effective therapies across all populations.”

Reference:

Press Release.

For more information:

Ayodeji Adegunsoye, MD, MS, can be reached at deji@uchicago.edu.