Do disparities in cardiovascular comorbidities account for excess covid-19 morbidity and mortality in African Americans?

Dasa, O.; Cohen, S. A.; Zheng, Y.; Sajdeya, R.; Taha, M. B.; Hu, H.; Pearson, T. A.

Introduction: COVID-19 incidence, severity, and death in African Americans (AA) has been reported to markedly exceed those of White Americans (WA), but the epidemiologic basis for this is unclear. Hypothesis: We hypothesize that AA have an excess of comorbid conditions compared to WA accounting for the disparity in COVID-19 infection and death. Methods: We examined 67,094 COVID-19 cases with laboratory-confirmed COVID-19 and compared them to 135,188 controls (2:1 match by age, sex, and zip code) representing a state-wide sample of healthcare recipients from the 'OneFlorida' research consortium through August 3, 2020. We assessed the prevalence of preexisting comorbid conditions (e.g. cardiovascular disease, cancer), behavioral risk factors, and health outcomes in the electronic health records of COVID-19 cases compared to controls. Results: Cases included 25,443 (37.9%) WA, 11,709 (17.5%) AA, and 16,119 (24%) Hispanic Americans (HA). Among cases, there was a significant increase in the prevalence of several cardiovascular comorbidities in AA vs. WA, such as hypertension, diabetes, heart failure, and stroke, but not for common cancers, liver disease, and COPD (Table 1). Likewise, smoking and BMI were higher in AA. Similar disparities were also appreciated in matched controls. Compared to WA, AA and HA had higher odds of becoming infected with COVID-19 (Unadjusted OR, 1.08;CI [1.05-1.11]and OR, 1.17;[1.15-1.2]) respectively. The prevalence of severe COVID-19 outcomes (intubation and death) was higher in AA (3.6 and 2.7%) than WA (2.5% and 2.3%) or HA (1.3 and 1.4%),respectively. Conclusions: Excess comorbidities for cardiometabolic diseases are present in this population-based sample of COVID-19 cases and controls. Careful mediation analyses will determine whetherthese differences in cardiovascular comorbidities alone account for disparities in COVID-19 in AApatients. Such data would be important to identify high-risk subgroups benefitting from enhancedpreventive and early therapeutic interventions.