RACE/ETHNICITY ASSOCIATION WITH COVID-19 OUTCOMES IN RHEUMATIC DISEASE:
DATA FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN REGISTRY (Authors: Gianfrancesco MA, Leykina LA, Izadi Z et al)
(Contributors: Akpabio AA, Howard RA, Maheswaranathan M, Gianfrancesco MA on behalf of the lay summaries sub-group)
Recent research has shown that racial/ethnic minorities have a higher burden and worse outcomes of COVID-19 in the general US population. While this may reflect differences in social welfare or health insurance, this is superimposed on the already established fact that certain rheumatic diseases such as lupus have a higher occurrence and more severe manifestations among ethnic minorities such as Blacks and Latin Americans. This study aimed to look for an association between race/ethnicity and COVID-19 hospitalization, need for ventilation and death among patients with rheumatic diseases.
What was done?
Data of 1,380 patients diagnosed with COVID-19 from 25th March to 26th August 2020 were extracted from the Global Rheumatology Alliance (C19-GRA) physician registry and analyzed. Race/ethnicity was grouped as White (reference group), Black, Latinx, Asian and other/mixed race; outcomes tested for were – hospitalization status, need for ventilation and death. Ventilator use as further subdivided into: no oxygen, some oxygen and ventilator/heart- lung machine use.
Details of each patient such as age, sex, type of rheumatic disease, background medical conditions, and medications prior to COVID-19 were identified. Appropriate statistical tests were used to create models accounting for different sets of clinical variables. Patient consent was not required for the study.
What was found?
Of the 1,380 cases, 1,324 had race/ethnicity information comprising White (52.1%), Latinx (22.3%), Black (20.6%), Asian (3%) and other/mixed (2%). Overall, 36% were hospitalized while 6% died. A quarter of hospitalized patients required a ventilator/heart-lung machine. White patients were less likely to be hospitalized (29%) compared to Black (51%), Asian (43%), Latinx (37%) and other/mixed race (35%). Among those in hospital, Latinx patients had three-fold increased risk of requiring ventilatory support compared to other races. There were no differences in risk of death by race/ethnicity.
What does this mean?
Racial/ethnic minorities with rheumatic diseases and COVID-19 have increased odds of hospitalization and ventilatory support after adjusting for multiple factors. It mirrors a similar study that showed higher hospitalization among non-white lupus patients diagnosed with COVID-19. There are several limitations including: voluntary enrollment, intra-racial differences and lack of information regarding insurance or other socio-economic factors. These results however, illustrate significant racial/ethnic health disparities that need to be addressed proactively by the rheumatology community.