Disparities in COVID-19 Hospitalizations and Mortality among Black and Hispanic Patients: Cross-Sectional Analysis from the Greater Houston Metropolitan Area

Disparate racial and ethnic burdens of the Coronavirus Disease 2019 (COVID-19) pandemic may be attributable to higher susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or to factors such as differences in hospitalization and care provision. In our cross-sectional analysis of lab-confirmed COVID-19 cases from a tertiary, eight-hospital healthcare system (Houston Methodist) across greater Houston, multivariable logistic regression models were fitted to evaluate the odds of hospitalization and mortality for non-Hispanic Blacks (NHBs) vs. non-Hispanic Whites (NHWs) and Hispanics vs. non-Hispanics. Between March 3rd and July 18th, 2020, 70,496 individuals were tested for SARS-CoV-2; 12,084 (17.1%) tested positive, of whom 3,536 (29.3%) were hospitalized. Among positive cases, NHBs and Hispanics were significantly younger than NHWs and Hispanics, respectively (mean age NHBs vs. NHWs: 46.0 vs. 51.7 year and Hispanic vs. non-Hispanic: 44.0 vs. 48.7 years). Despite younger age, NHBs (vs. NHWs) had a higher prevalence of diabetes (25.2%), hypertension (47.7%), and chronic kidney disease (5.0%). Both minority groups resided in lower median income and higher population density areas. In fully adjusted models, NHBs and Hispanics had higher likelihoods of hospitalization, aOR (CI): 1.42 (1.24-1.63) and 1.61 (1.46-1.78), respectively. No differences were observed in intensive care unit (ICU) utilization or treatment parameters. Models adjusted for demographics, vital signs, laboratory parameters, hospital complications, and ICU admission demonstrated non-significantly lower likelihoods of in-hospital mortality among NHBs and Hispanics, aOR (CI): 0.65 (0.40-1.03) and 0.89 (0.59-1.31), respectively. Our data did not demonstrate racial and ethnic differences in care provision and hospital outcomes. Higher susceptibility of racial and ethnic minorities to SARS-CoV-2 and subsequent hospitalization may be driven primarily by social determinants.

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Disparities in COVID-19 hospitalizations and mortality among black and Hispanic patients: cross-sectional analysis from the greater Houston metropolitan area

BMC Public Health ◽

10.1186/s12889-021-11431-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alan P. Pan ◽

Osman Khan ◽

Jennifer R. Meeks ◽

Marc L. Boom ◽

Faisal N. Masud ◽

...

Keyword(s):

Population Density ◽

Minority Groups ◽

Vital Signs ◽

Median Income ◽

Care Provision ◽

Cross Sectional ◽

Logistic Regression Models ◽

Cross Sectional Analysis ◽

Hispanic Patients ◽

Sectional Analysis

Abstract Background Disparate racial/ethnic burdens of the Coronavirus Disease 2019 (COVID-19) pandemic may be attributable to higher susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or to factors such as differences in hospitalization and care provision. Methods In our cross-sectional analysis of lab-confirmed COVID-19 cases from a tertiary, eight-hospital healthcare system across greater Houston, multivariable logistic regression models were fitted to evaluate hospitalization and mortality odds for non-Hispanic Blacks (NHBs) vs. non-Hispanic Whites (NHWs) and Hispanics vs. non-Hispanics. Results Between March 3rd and July 18th, 2020, 70,496 individuals were tested for SARS-CoV-2; 12,084 (17.1%) tested positive, of whom 3536 (29.3%) were hospitalized. Among positive cases, NHBs and Hispanics were significantly younger than NHWs and Hispanics, respectively (mean age NHBs vs. NHWs: 46.0 vs. 51.7 years; p < 0.001 and Hispanic vs. non-Hispanic: 44.0 vs. 48.7 years; p < 0.001). Despite younger age, NHBs (vs. NHWs) had a higher prevalence of diabetes (25.2% vs. 17.6%; p < 0.001), hypertension (47.7% vs. 43.1%; p < 0.001), and chronic kidney disease (5.0% vs. 3.3%; p = 0.001). Both minority groups resided in lower median income (median income [USD]; NHBs vs. NHWs: 63,489 vs. 75,793; p < 0.001, Hispanic vs. non-Hispanic: 59,104 vs. 68,318; p < 0.001) and higher population density areas (median population density [per square mile]; NHBs vs. NHWs: 3257 vs. 2742; p < 0.001, Hispanic vs. non-Hispanic: 3381 vs. 2884; p < 0.001). In fully adjusted models, NHBs (vs. NHWs) and Hispanics (vs. non-Hispanic) had higher likelihoods of hospitalization, aOR (95% CI): 1.42 (1.24–1.63) and 1.61 (1.46–1.78), respectively. No differences were observed in intensive care unit (ICU) utilization or treatment parameters. Models adjusted for demographics, vital signs, laboratory parameters, hospital complications, and ICU admission vital signs demonstrated non-significantly lower likelihoods of in-hospital mortality among NHBs and Hispanic patients, aOR (95% CI): 0.65 (0.40–1.03) and 0.89 (0.59–1.31), respectively. Conclusions Our data did not demonstrate racial and ethnic differences in care provision and hospital outcomes. Higher susceptibility of racial and ethnic minorities to SARS-CoV-2 and subsequent hospitalization may be driven primarily by social determinants.

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Sex differences in susceptibility, severity, and outcomes of coronavirus disease 2019: Cross-sectional analysis from a diverse US metropolitan area

PLoS ONE ◽

10.1371/journal.pone.0245556 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245556 ◽

Cited By ~ 2

Author(s):

Farhaan S. Vahidy ◽

Alan P. Pan ◽

Hilda Ahnstedt ◽

Yashasvee Munshi ◽

Huimahn A. Choi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Nasopharyngeal Swab ◽

Median Income ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Time Period ◽

Hypoxic Respiratory Failure ◽

Comorbidity Index ◽

Sex Disparities ◽

Sectional Analysis

Introduction Sex is increasingly recognized as an important factor in the epidemiology and outcome of many diseases. This also appears to hold for coronavirus disease 2019 (COVID-19). Evidence from China and Europe has suggested that mortality from COVID-19 infection is higher in men than women, but evidence from US populations is lacking. Utilizing data from a large healthcare provider, we determined if males, as compared to females have a higher likelihood of SARS-CoV-2 susceptibility, and if among the hospitalized COVID-19 patients, male sex is independently associated with COVID-19 severity and poor in-hospital outcomes. Methods and findings Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, we conducted a cross-sectional analysis of data from a COVID-19 Surveillance and Outcomes Registry (CURATOR). Data were extracted from Electronic Medical Records (EMR). A total of 96,473 individuals tested for SARS-CoV-2 RNA in nasopharyngeal swab specimens via Polymerized Chain Reaction (PCR) tests were included. For hospital-based analyses, all patients admitted during the same time-period were included. Of the 96,473 patients tested, 14,992 (15.6%) tested positive, of whom 4,785 (31.9%) were hospitalized and 452 (9.5%) died. Among all patients tested, men were significantly older. The overall SARS-CoV-2 positivity among all tested individuals was 15.5%, and was higher in males as compared to females 17.0% vs. 14.6% [OR 1.20]. This sex difference held after adjusting for age, race, ethnicity, marital status, insurance type, median income, BMI, smoking and 17 comorbidities included in Charlson Comorbidity Index (CCI) [aOR 1.39]. A higher proportion of males (vs. females) experienced pulmonary (ARDS, hypoxic respiratory failure) and extra-pulmonary (acute renal injury) complications during their hospital course. After adjustment, length of stay (LOS), need for mechanical ventilation, and in-hospital mortality were significantly higher in males as compared to females. Conclusions In this analysis of a large US cohort, males were more likely to test positive for COVID-19. In hospitalized patients, males were more likely to have complications, require ICU admission and mechanical ventilation, and had higher mortality than females, independent of age. Sex disparities in COVID-19 vulnerability are present, and emphasize the importance of examining sex-disaggregated data to improve our understanding of the biological processes involved to potentially tailor treatment and risk stratify patients.

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The Relationship between Self-Reported Exposure to Sugar-Sweetened Beverage Promotions and Intake: Cross-Sectional Analysis of the 2017 International Food Policy Study

Nutrients ◽

10.3390/nu11123047 ◽

2019 ◽

Vol 11 (12) ◽

pp. 3047 ◽

Cited By ~ 1

Author(s):

Hannah Forde ◽

Martin White ◽

Louis Levy ◽

Felix Greaves ◽

David Hammond ◽

...

Keyword(s):

Food Policy ◽

Multinomial Logistic Regression ◽

Relative Risk Ratio ◽

Policy Study ◽

Cross Sectional ◽

Sugar Sweetened Beverage ◽

Logistic Regression Models ◽

Sweetened Beverage ◽

Cross Sectional Analysis ◽

Sectional Analysis

Sugar-sweetened beverage (SSB) consumption is independently associated with several non-communicable diseases, so policymakers are increasingly implementing measures, such as marketing regulation, to reduce intake. To help understand how such measures work, this study examined the association between SSB consumption and self-reported exposure to SSB promotions, both overall and by type of promotion, and whether these relationships vary between the UK, USA, Canada, Mexico, and Australia. Cross-sectional analysis of the online 2017 International Food Policy Study was performed (n = 15,515). Participants were grouped into 5265 (34%) non-, 5117 (33%) low-, and 5133 (33%) high-SSB consumers. Multinomial logistic regression models examined whether SSB consumption varied by exposure to total SSB promotion and by type: traditional, digital, recreational environment, and functional environment. Multiplicative interactions were included to investigate international variations. An additional unit of total self-reported SSB promotion exposure increased the likelihood of participants being low SSB consumers (relative risk ratio (RRR) = 1.08, 95% confidence interval (CI) = 1.06–1.10) and high SSB consumers (RRR = 1.13, 95% CI = 1.11–1.16). Only exposure to traditional and digital promotion increased the likelihood of participants being SSB consumers, though this may be explained by degree of exposure, which was not measured in this study. Some evidence illustrated international variation in these relationships.

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Abstract 16459: Racial and Ethnic Differences in Echocardiographic Abnormalities and Myocardial Injury in Patients With Covid-19: The CIRC-19 Registry

Circulation ◽

10.1161/circ.142.suppl_3.16459 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Michael S Miller ◽

Gennaro Giustino ◽

Annapoorna Kini ◽

Giulio Stefanini ◽

Renato Bragato ◽

...

Keyword(s):

New York ◽

Hospital Mortality ◽

Race And Ethnicity ◽

Myocardial Injury ◽

Minority Groups ◽

Racial And Ethnic Differences ◽

Logistic Regression Models ◽

Increased Risk ◽

Hispanic Patients ◽

Race Ethnicity

Introduction: Myocardial injury is common amongst patients hospitalized with Covid-19 and is associated with a poor prognosis. It is unknown whether its incidence and its mechanisms differ by race and ethnicity. Methods: We conducted a multicenter, international cohort study at 7 hospitals in New York (United States) and Milan (Italy) between March and May 2020. All patients were hospitalized, had laboratory-confirmed Covid-19, and received a transthoracic echocardiogram (TTE) during their hospitalization. We evaluated the association between race/ethnicity and myocardial injury in multivariable logistic regression models. Myocardial injury was defined as any cardiac troponin elevation above the upper limit of normal at each enrolling site. Results: A total of 305 consecutive patients were included, of whom 280 had self-reported race/ethnicity. Key demographic, laboratory and echocardiographic characteristics are presented in the Table. All minority groups had higher incidence of a composite of major echocardiographic abnormalities compared to whites, and Asian and Hispanic patients had increased incidence of RV dysfunction. In multivariable models, compared with Whites, Black (adjOR 2.7 [1.1-6.4]), Asian (adjOR 3.3 [1.1-10.2]), and Hispanic (adjOR 2.8 [1.4-5.8]) patients had increased odds of myocardial injury. After adjusting for baseline demographic and clinical variables, both Asian (adjOR 9.9 [2.6-38.6]) and Hispanic (adjOR 5.7 [2.1-15.6]) patients had increased odds of in-hospital mortality compared with White, but not Black (adjOR 2.0 [0.6-7.0]) patients. Conclusions: Among hospitalized patients with Covid-19 who received a TTE, minority groups had higher incidence of echocardiographic abnormalities and increased risk of myocardial injury. After adjustment for baseline confounders, only Asian and Hispanic patients remained at increased risk for in-hospital mortality.

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Racial and ethnic differences in perception of provider cultural competence among patients with depression and anxiety symptoms: a retrospective, population-based, cross-sectional analysis

The Lancet Psychiatry ◽

10.1016/s2215-0366(21)00285-6 ◽

2021 ◽

Author(s):

Hatice Nur Eken ◽

Edward Christopher Dee ◽

Albert Russell Powers ◽

Ayana Jordan

Keyword(s):

Cultural Competence ◽

Ethnic Differences ◽

Population Based ◽

Anxiety Symptoms ◽

Depression And Anxiety ◽

Cross Sectional ◽

Racial And Ethnic Differences ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Gender Differences in Clinicoepidemiological Features of Vitiligo: A Cross-Sectional Analysis

ISRN Dermatology ◽

10.1155/2014/186197 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Sharmila Patil ◽

Manjyot Gautam ◽

Nitin Nadkarni ◽

Neha Saboo ◽

Kiran Godse ◽

...

Keyword(s):

Social Consequences ◽

Cross Sectional ◽

Logistic Regression Models ◽

Factors Associated ◽

Cross Sectional Analysis ◽

Clinical Presentations ◽

History Of ◽

Duration Of Disease ◽

Males And Females ◽

Sectional Analysis

Background. Vitiligo has important clinical and social consequences particularly in the pigmented skin. The present study was conducted to assess the differences in clinicoepidemiological presentation of vitiligo in males and females and to understand the factors associated with spread of vitiligo in them. Methods. This is a cross-sectional analysis of secondary clinical data of 168 vitiligo patients at a tertiary medical centre at Navi Mumbai. We used logistic regression models to estimate the association between gender and clinical characteristics of vitiligo and to evaluate the factors associated with spread of vitiligo. Results. There were no significant differences between the mean ages of males and females; however, males reported a longer duration of disease (6.9 (10.4) years) compared with females (4.9 (7.4) years). Males were significantly more likely to report a family history of vitiligo compared with females (adjusted OR (aOR): 16.87, 95% CI: 2.16 to 131.69). Even though females were more likely to report spread of lesions, the association was not statistically significant (OR: 1.21, 95% CI: 0.62 to 2.36). Discussion. The differences in the clinical presentations between genders highlight the need to understand the different factors (possibly genetic) that may play a part in the pathogenesis of this multifactorial disease in males and females.

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Breaking the myths of competition: a cross-sectional analysis of injuries among CrossFit trained participants

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000750 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000750 ◽

Cited By ~ 1

Author(s):

Yuri Feito ◽

Evanette Burrows ◽

Loni Tabb ◽

Kerri-Anne Ciesielka

Keyword(s):

Logistic Regression ◽

Injury Rate ◽

Injury Incidence ◽

Cross Sectional ◽

Injury Rates ◽

Logistic Regression Models ◽

Cross Sectional Analysis ◽

Risk Of Injury ◽

Crossfit Training ◽

Sectional Analysis

ObjectivesThe purpose of this study was to examine the injury rates of individuals engaged in CrossFit training and examine the risk of injury associated with competition.Study designCross-sectional analysis.MethodsDescriptive statistics, including injury incidence and rates, were examined for individuals reporting participation in a CrossFit sanctioned competition between 2013 and 2017. To examine the odds of being injured, we considered logistic regression models, where the primary independent measure was participation length—individual measures of interest included age, sex, body mass index, CrossFit affiliation and competition status.Results3049 individuals completed the survey (60% completion rate). All competitors, regardless of competition level, had similar incidence of injury (χ2=1.1, p=0.571). For those who reported competing, our calculated injury rate was 0.21–0.54 injuries per 1000 training hours, while for those not competing, the injury rate was calculated as 0.39–1.30 injuries per 1000 training hours. Logistic regression demonstrated short length of participation in CrossFit training as the main factor associated with the odds of being injured (OR=1.82; 95% CI: 1.15 to 2.92). Additionally, training at an official CrossFit affiliate appeared to have a protective effect from injury (OR=0.85; 95% CI: 0.65, 1.10).ConclusionOur findings provide evidence of the low risk of injury related to these events. Moreover, these findings support the notion that musculoskeletal injuries may be the result of poor progression plans, which may be minimised by participating in an official CrossFit affiliate.

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Obesity, abdominal obesity and migraine: A cross-sectional analysis of ELSA-Brasil baseline data

Cephalalgia ◽

10.1177/0333102414544978 ◽

2014 ◽

Vol 35 (5) ◽

pp. 426-436 ◽

Cited By ~ 12

Author(s):

Itamar S Santos ◽

Alessandra C Goulart ◽

Valeria M Passos ◽

Maria del Carmen Molina ◽

Paulo A Lotufo ◽

...

Keyword(s):

Abdominal Obesity ◽

International Headache Society ◽

World Health ◽

Cross Sectional ◽

Logistic Regression Models ◽

Cross Sectional Analysis ◽

Validated Questionnaire ◽

Health Organization ◽

Sectional Analysis ◽

Standard Techniques

Background and aim: Most studies assessing the association between migraine and obesity have shown conflicting results. We aimed to evaluate the association between obesity and migraine in ELSA-Brasil, a cohort study of 15,105 individuals aged 35–74 years. Methods: We assessed migraine using a validated questionnaire based on International Headache Society criteria and anthropometric measurements using standard techniques. Migraine was categorized as daily and non-daily. World Health Organization criteria were used to categorize overweight, obesity and abdominal obesity (AbO). We performed a cross-sectional analysis using multivariate logistic regression models to study the association between migraine and obesity (body mass index (BMI) ≥ 30 kg/m2), compared to controls without migraine. Results: We found an association between daily migraine and obesity (odds ratio (OR) 1.86; 95% confidence interval (95% CI): 1.12–3.09). Although the presence of AbO was not associated with migraine, interaction models showed that the association between obesity and daily migraine remained strong only in the absence of AbO diagnosis, notably in individuals aged 35–49 years. Discussion: In our large sample of individuals aged 35 years or older, obesity, but not AbO, was associated with daily migraine. AbO influenced the association between BMI and daily migraine in migraineurs aged 35–49 years.

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