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

Yang, Xueying; Zhang, Jiajia; Chen, Shujie; Olatosi, Bankole; Bruner, Larisa; Diedhiou, Abdoulaye; Scott, Cheryl; Mansaray, Ali; Weissman, Sharon; Li, Xiaoming

BACKGROUND: Current literature examining the clinical characteristics of COVID-19 patients under-represent COVID-19 cases who were either asymptomatic or had mild symtoms. METHODS: We analyzed statewide data from 280,177 COVID-19 cases from various health care facilities during March 04–December 31, 2020. Each COVID-19 case was reported using the standardized Case Report Form (CRF), which collected information on demographic characteristics, symptoms, hospitalization, and death. We used multivariable logistic regression to analyze the associations between socio-demographics and disease severity, hospitalization and mortality. RESULTS: Among a total of 280,177 COVID-19 cases, 5.2% (14,451) were hospitalized and 1.9% (5,308) died. Older adults, males, and Black individuals had higher odds for hospitalization and death from COVID-19 (Ps<0.0001). Particularly, individuals residing in rural areas experienced a high risk of death (OR: 1.16; 95%CI: 1.08, 1.25). Regarding disease severity, older adults (OR: 1.06, 95%CI: 1.03, 1.10) and Hispanic or Latino patients (OR: 2.06; 95%CI: 1.95, 2.18), had higher odds of experiencing moderate/severe symptoms, while male and Asian patients, compared to White patients, had lower odds of experiencing moderate/severe symptoms. CONCLUSIONS: 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 and racial/ethnic social determinants of health, unfortunately, remain predictors of adverse health outcomes for COVID-19 patients.