Risk Factors for In-hospital Mortality from COVID-19 Infection among Black Patients – An Urban Center Experience

Bhargava, Ashish; Sharma, Mamta; Riederer, Kathleen; Fukushima, Elisa Akagi; Szpunar, Susanna M; Saravolatz, Louis

BACKGROUND: Racial disparities are central in the national conversation about Covid-19. Black/African Americans are contracting and dying from COVID-19 disproportionately. We assessed risk factors for death from COVID-19 among black inpatients at an urban center in Detroit, MI. METHODS: This was a retrospective, single-center cohort study. We reviewed the electronic medical records of patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes COVID-19) on qualitative polymerase-chain-reaction assay, who were admitted between 3/8-5/6/2020. The primary outcome was in-hospital mortality. RESULTS: The case fatality rate was 29.1% (122/419). The mean duration of symptoms prior to hospitalization was 5.3 (3.9) days. Patients who died were older (mean [SD] age, 68.7 [14.8] years vs 60.3 [16.0] years; p <0.0001), had dementia (35 [28.7%] vs 34 [11.4%]; p <0.0001), hemiplegia (14 [11.5%] vs 12 [4.0%]; p=0.004), malignancy (11 [9.0%] vs 12 [4.0%]; p=0.04), and moderate-severe liver disease (4 [3.3%] vs 1 [0.3%]; p=0.01). The incidence of AMS on presentation was higher among patients who died than those who survived, 43% vs. 20.0%, respectively (p<0.0001). From multivariable analysis, the odds of death increased with age (≥60 yrs.), admission from a nursing facility, Charlson score, altered mental status, higher C-reactive protein on admission, need for mechanical ventilation, presence of shock, and acute respiratory distress syndrome. CONCLUSIONS: These demographic, clinical and laboratory factors should help healthcare providers identify black patients at highest risk for severe COVID-19-associated outcomes. Early and aggressive interventions among this at-risk population can help mitigate adverse outcomes.