key: cord-0696302-j1eeeq0p
authors: Mehravaran, Shiva; Ahmed, Hussien; Chen, Yun-Chi
title: Disparities in COVID-19 outcomes for African Americans: more studies are warranted
date: 2021-05-26
journal: Clin Infect Dis
DOI: 10.1093/cid/ciab498
sha: 3497c0207fe26de775330d223d5210cff8eebffc
doc_id: 696302
cord_uid: j1eeeq0p

nan

generalizable results, the disparities that may exist in smaller individual settings could have been overlooked. The authors attributed the racial disparities in mortality observed in their study to differences in prescribing dexamethasone. Since the magnitude and attributes of COVID-19 racial disparities might be changing during the course of the pandemic [6] [7] [8] , the authors could assess the temporal variations in disparities by stratifying the data to different time periods (e.g., pre versus post dexamethasone). It would also be useful to assess whether the prevalence of certain underlying conditions and risk factors were higher among Black hospitalized patients, which might explain the higher risk of in-hospital mortality. Moreover, multivariate analyses should be performed separately in each racial group to identify potential differences in independent predictors (e.g., receipt of dexamethasone) of COVID-19 hospitalization or in-hospital mortality, even in the absence of outcome disparities between racial groups. Systematic reviews and meta-analyses are useful in addressing discrepancies in study findings.

To date, two relevant reviews have been published. One did not conduct meta-analysis due to the heterogeneity caused by combining data from ecological studies and public databases [9] . In the other paper, not only did the meta-analysis combine UK and US studies, which in itself is cause for concern, African Americans were underrepresented (<3%), and the major roles for social determinants were overlooked [10] . Also, the outcome measures were inadequately defined, and they were grouped as one without carefully examining the denominator (e.g., mortality among the infected, hospitalized, or intubated) or performing subgroup analyses. Precise definition of the outcome is important as the disparities in one outcome are likely to influence the disparities in the next event. We reviewed the descriptions of the outcomes in the original studies included in these two papers and found that some were being misrepresented, resulting in only a limited number of studies eligible for assessing the relative risk of each specific COVID-19 outcome for African A c c e p t e d M a n u s c r i p t Americans (Supplementary Table) . Notably, there has been no meta-analysis regarding racial disparities in COVID-19 hospitalization risk.

Thus, more studies, including systematic reviews and meta-analyses, are needed to further understand the trends in and dynamics of COVID-19-related racial disparities and possible reasons for inconsistent findings. These should include studies from smaller community hospitals to larger integrated healthcare databases. Racial disparities in comorbidities and other risk factors should be assessed for all well-defined outcomes along the COVID-19 health continuum to determine whether they correlate with or predict disparities in subsequent events. This will provide mechanistic insights into possible causes for disparities and aid in tailored public health strategies for eliminating disparities. To this end, future studies addressing COVID-19 health disparities should present data disaggregated by race, perform multivariate analyses stratified by race, and assess temporal and geographic variations and trends in disparities.

This work is supported by the United States National Institutes of Health, award number U54 MD013376 to Y-C.C.

None to declare

Racial and Ethnic Differences and Clinical Outcomes of COVID-19 Patients Presenting to the Emergency Department

Characteristics and Factors Associated with COVID-19 Infection, Hospitalization, and Mortality Across Race and Ethnicity

Racial Disparities in COVID-19 Testing and Outcomes : Retrospective Cohort Study in an Integrated Health System

Hospitalization and Mortality among Black Patients and White Patients with Covid-19

The Impact of Sociodemographic Factors, Comorbidities and Physiologic Response on 30-day Mortality in COVID-19 Patients in Metropolitan Detroit

Trends in Racial and Ethnic Disparities in COVID-19 Hospitalizations, by Region -United States

Risk of Clinical Severity by Age and Race/Ethnicity Among Adults Hospitalized for COVID-19-United States

Risk Factors Associated With In-Hospital Mortality in a US National Sample of Patients With COVID-19

Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths : A Systematic Review

Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis

A c c e p t e d M a n u s c r i p t