Hospital Factors Tied to Greater COVID-19 Mortality in Blacks

Higher mortality among Black patients hospitalized with COVID-19 is associated with the hospitals at which Black patients receive care, according to a study published online June 17 in JAMA Network Open.

David A. Asch, M.D., from the University of Pennsylvania in Philadelphia, and colleagues examined differences in COVID-19 hospital mortality rates between Black and White patients to assess whether the mortality rates reflect differences in patient or hospital characteristics. The analysis included 44,217 Medicare beneficiaries admitted with a diagnosis of COVID-19 to 1,188 U.S. hospitals from Jan. 1, 2020, through Sept. 21, 2020.

The researchers found that 8 percent of White patients and 10 percent of Black patients died as inpatients, while 5 and 3 percent, respectively, were discharged to hospice within 30 days of hospitalization, for a total mortality-equivalent rate of 12.86 percent for White patients and 13.48 percent for Black patients. When adjusting for clinical and sociodemographic patient characteristics, Black patients were more likely to die or be discharged to hospice (odds ratio, 1.11; 95 percent confidence interval, 1.03 to 1.19). However, this difference was no longer significant when adjusting for the hospitals where care was delivered (odds ratio, 1.02; 95 percent confidence interval, 0.94 to 1.10). Models showed that if Black patients were instead admitted to the same hospitals as White patients in the same distribution, their rate of mortality or discharge to hospice would decline from the observed rate of 13.48 percent to the simulated rate of 12.23 percent.

"Addressing hospital segregation and the uneven resourcing and quality of hospitals that provide care to a disproportionate number of Black patients may help address racial differences in the mortality rate," the authors write.