Demographic disparities in clinical outcomes of COVID-19: data from a statewide cohort in South Carolina

YANG, X.; Zhang, J.; Chen, S.; Bruner, L.; Diedhiou, A.; Scott, C.; Mansaray, A.; Weissman, S.; Li, X.

Background: Current literature examining the clinical characteristics of COVID-19 patients underrepresent COVID-19 cases who were either asymptomatic or had a mild illness. Objective: To generate a state level description and examine the demographic disparities of clinical outcomes of COVID-19. Design: Statewide population-based cohort study Setting: COVID-19 surveillance facilities in South Carolina Patients: Adults COVID-19 cases reported to the SC DHEC by Case Report Form from March 04 to December 31, 2020 Measurements: The primary predictors were socio-demographic characteristics. The outcomes were COVID-19 disease severity, hospitalization, and mortality, which collected from the standardized CRF. Results: Among a total of 280,177 COVID-19 cases, 5.2% (14,451) were hospitalized and 1.9% (5,308) died. Individuals who were older, male gender, Blacks, Hispanic or Latino, and residing in small towns had higher odds for hospitalization and death from COVID-19 (Ps<0.0001). Regarding disease severity, 144,157 (51.5%) were asymptomatic, while 34.4% and 14.2% had mild and moderate/severe symptoms, respectively. Older individuals (OR: 1.14, 95%CI: 1.11, 1.18), Hispanic or Latino (OR: 2.07; 95%CI: 1.96, 2.18), and people residing in small towns (OR: 1.15; 95%CI: 1.08, 1.23) had higher odds of experiencing moderate/severe symptoms, while male and Asian (vs Whites) patients had lower odds of experiencing moderate/severe symptoms. Limitations: Potential misclassification of outcomes due to missing data; other variables were not evaluated, such as comorbidities. Conclusion: As the first statewide population-based study using data from multiple healthcare systems with a long follow up period in the US, we provide a more generalizable picture of COVID-19 symptoms and clinical outcomes. The findings from this study reinforce the fact that rural residence, racial and ethnic social determinants of health, unfortunately, remain predictors of poor health outcomes for COVID-19 patients.