Disaggregating Asian Race Reveals COVID-19 Disparities among Asian Americans at New York City’s Public Hospital System

AbstractThere is growing recognition of the burden of COVID-19 among Asian Americans, but data on outcomes among Asian ethnic subgroups remain extremely limited. We conducted a retrospective analysis of 85,328 patients tested for COVID-19 at New York City’s public hospital system between March 1 and May 31, 2020, to describe characteristics and COVID-19 outcomes of Asian ethnic subgroups compared to Asians overall and other racial/ethnic groups. South Asians had the highest rates of positivity and hospitalization among Asians, second only to Hispanics for positivity and Blacks for hospitalization. Chinese patients had the highest mortality rate of all groups and were nearly 1.5 times more likely to die than Whites. The high burden of COVID-19 among South Asian and Chinese Americans underscores the urgent needs for improved data collection and reporting as well as public health program and policy efforts to mitigate the disparate impact of COVID-19 among these communities.

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Disaggregating Asian Race Reveals COVID-19 Disparities Among Asian American Patients at New York City’s Public Hospital System

Public Health Reports ◽

10.1177/00333549211061313 ◽

2021 ◽

pp. 003335492110613

Author(s):

Roopa Kalyanaraman Marcello ◽

Johanna Dolle ◽

Areeba Tariq ◽

Sharanjit Kaur ◽

Linda Wong ◽

...

Keyword(s):

New York ◽

Ethnic Groups ◽

South Asian ◽

Asian American ◽

Chinese Patients ◽

American People ◽

Hospital System ◽

Asian Patients ◽

Ethnic Subgroups ◽

Public Hospital System

Objectives: Data on the health burden of COVID-19 among Asian American people of various ethnic subgroups remain limited. We examined COVID-19 outcomes of people of various Asian ethnic subgroups and other racial and ethnic groups in an urban safety net hospital system. Methods: We conducted a retrospective analysis of 85 328 adults aged ≥18 tested for COVID-19 at New York City’s public hospital system from March 1 through May 31, 2020. We examined COVID-19 positivity, hospitalization, and mortality, as well as demographic characteristics and comorbidities known to worsen COVID-19 outcomes. We conducted adjusted multivariable regression analyses examining racial and ethnic disparities in mortality. Results: Of 9971 Asian patients (11.7% of patients overall), 48.2% were South Asian, 22.2% were Chinese, and 29.6% were in other Asian ethnic groups. South Asian patients had the highest rates of COVID-19 positivity (30.8%) and hospitalization (51.6%) among Asian patients, second overall only to Hispanic (32.1% and 45.8%, respectively) and non-Hispanic Black (27.5% and 57.5%, respectively) patients. Chinese patients had a mortality rate of 35.7%, highest of all racial and ethnic groups. After adjusting for demographic characteristics and comorbidities, only Chinese patients had significantly higher odds of mortality than non-Hispanic White patients (odds ratio = 1.44; 95% CI, 1.04-2.01). Conclusions: Asian American people, particularly those of South Asian and Chinese descent, bear a substantial and disproportionate health burden of COVID-19. These findings underscore the need for improved data collection and reporting and public health efforts to mitigate disparities in COVID-19 morbidity and mortality among these groups.

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HIV Diagnosis and the Clinical Course of COVID-19 Among Patients Seeking Care Within the New York City Public Hospital System During the Initial Pandemic Peak

AIDS Patient Care and STDs ◽

10.1089/apc.2021.0124 ◽

2021 ◽

Author(s):

Emma Kaplan-Lewis ◽

Jaspreet Banga ◽

Maria Khan ◽

Eunice Casey ◽

Medha Mazumdar ◽

...

Keyword(s):

New York ◽

New York City ◽

York City ◽

Public Hospital ◽

Clinical Course ◽

Hiv Diagnosis ◽

Hospital System ◽

Public Hospital System

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Racial and Ethnic Variation in Lipoprotein (a) Levels among Asian Indian and Chinese Patients

Journal of Lipids ◽

10.1155/2011/291954 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 18

Author(s):

Dipanjan Banerjee ◽

Eric C. Wong ◽

Jessica Shin ◽

Stephen P. Fortmann ◽

Latha Palaniappan

Keyword(s):

Asian Indian ◽

Asian Indians ◽

Clinical Care ◽

Chinese Americans ◽

Chinese Patients ◽

Lipoprotein A ◽

The Usa ◽

Ethnic Subgroups ◽

The Relationship ◽

Racial Ethnic

Background. Lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD) in Non-Hispanic Whites (NHW). There are known racial/ethnic differences in Lp(a) levels, and the association of Lp(a) with CVD outcomes has not been examined in Asian Americans in the USA.Objective. We hypothesized that Lp(a) levels would differ in Asian Indians and Chinese Americans when compared to NHW and that the relationship between Lp(a) and CVD outcomes would be different in these Asian racial/ethnic subgroups when compared to NHW.Methods. We studied the outpatient electronic health records of 2022 NHW, 295 Asian Indians, and 151 Chinese adults age≥18 y in Northern California in whom Lp(a) levels were assessed during routine clinical care from 2001 to 2008, excluding those who had received prescriptions for niacin (14.6%). Nonparametric methods were used to compare median Lp(a) levels. Significance was assessed at theP<.0001level to account for multiple comparisons. CVD outcomes were defined as ischemic heart disease (IHD) (265 events), stroke (122), or peripheral vascular disease (PVD) (87). We used logistic regression to determine the relationship between Lp(a) and CVD outcomes.Results. Both Asian Indians (36 nmol/L) and NHW (29 nmol/L) had higher median Lp(a) levels than Chinese (22 nmol/L,P≤.0001andP=.0032). When stratified by sex, the differences in median Lp(a) between these groups persisted in the 1761 men (AI v CH:P=.001, NHW v CH:P=.0018) but were not statistically significant in the 1130 women (AI v CH:P=.0402, NHW v CH:P=.0761). Asian Indians (OR=2.0) and Chinese (OR=4.8) exhibited a trend towards greater risk of IHD with high Lp(a) levels than NHW (OR=1.4), but no relationship was statistically significant.Conclusion. Asian Indian and NHW men have higher Lp(a) values than Chinese men, with a trend toward, similar associations in women. High Lp(a) may be more strongly associated with IHD in Asian Indians and Chinese, although we did not have a sufficient number of outcomes to confirm this. Further studies should strive to elucidate the relationship between Lp(a) levels, CVD, and race/ethnicity among Asian subgroups in the USA.

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Hypertension Prevalence in New York City Adults: Unmasking Undetected Racial/Ethnic Variation, NYC HANES 2004

Ethnicity & Disease ◽

10.18865/ed.26.3.339 ◽

2016 ◽

Vol 26 (3) ◽

pp. 339 ◽

Cited By ~ 3

Author(s):

Ashley E. Giambrone ◽

Linda M. Gerber ◽

Jesica S. Rodriguez-Lopez ◽

Chau Trinh-Shervin ◽

Nadia Islam ◽

...

Keyword(s):

New York ◽

New York City ◽

Sex Education ◽

York City ◽

South Asians ◽

Population Based ◽

Cross Sectional ◽

Ethnic Subgroups ◽

Nyc Hanes ◽

Racial Ethnic

Objective: Using 2004 New York City Health and Nutrition Examination Survey (NYC HANES) data, we sought to examine variation in hypertension (HTN) prevalence across eight Asian and Hispanic subgroups. Design: Cross-sectional Setting: New York City, 2004 Main Outcome Measures: Logistic regression was performed to identify differences in HTN prevalence between ethnic subgroups controlling for age, sex, education and BMI. Results: Overall HTN prevalence among NYC adults was 25.5% (95% CI: 23.4-27.8), with 21.1% (95% CI: 18.2-24.3) among Whites, 32.8% (95% CI: 28.7-37.2) Black, 26.4% (95% CI: 22.3-31.0) Hispanics, and 24.7% (95% CI: 19.9-30.3) Asians. Among Hispanic subgroups, Dominicans had the highest HTN prevalence (32.2%), followed by Puerto Ricans (27.7%), while Mexicans had the lowest prevalence (8.1%). Among Asian subgroups, HTN prevalence was slightly higher among South Asians (29.9%) than among Chinese (21.3%). Adjusting for age, Dominican adults were nearly twice as likely to have HTN as non-Hispanic (NH) Whites (OR=1.96, 95% CI: 1.24-3.12), but this was attenuated after adjusting for sex and education (OR=1.27, 95% CI: .76 – 2.12). When comparing South Asians with NH Whites, results were also non-significant after adjustment (OR=2.00, 95% CI: .90-4.43). Conclusion: When analyzing racial/ethnic subgroups, NH Black and Hispanic adults from Dominican Republic had the highest HTN prevalence followed by South Asian and Puerto Rican adults. Mexican adults had the lowest prevalence of all groups. These findings highlight that ethnic subgroup differences go undetected when stratified by broader racial/ ethnic categories. To our knowledge, this is the first population-based study using objective measures to highlight these differences. Ethn Dis. 2016;26(3):339-344; doi:10.18865/ed.26.3.339

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Outcomes among 6721 Hospitalized COVID-19 Patients across the New York City Public Hospital System: a Retrospective Cohort Study

Journal of General Internal Medicine ◽

10.1007/s11606-020-06437-2 ◽

2021 ◽

Author(s):

Nicholas Caputo ◽

◽

John Zhang ◽

Robert Chin ◽

Chad Meyers ◽

...

Keyword(s):

New York ◽

New York City ◽

Cohort Study ◽

Retrospective Cohort Study ◽

York City ◽

Retrospective Cohort ◽

Public Hospital ◽

Hospital System ◽

System A ◽

Public Hospital System

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Characteristics and outcomes of COVID-19 patients in New York City’s public hospital system

PLoS ONE ◽

10.1371/journal.pone.0243027 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243027

Author(s):

Roopa Kalyanaraman Marcello ◽

Johanna Dolle ◽

Sheila Grami ◽

Richard Adule ◽

Zeyu Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

New York ◽

New York City ◽

Kidney Disease ◽

Public Hospital ◽

Case Series ◽

Ethnically Diverse ◽

Hospital System ◽

Public Hospital System

Background New York City (NYC) bore the greatest burden of COVID-19 in the United States early in the pandemic. In this case series, we describe characteristics and outcomes of racially and ethnically diverse patients tested for and hospitalized with COVID-19 in New York City’s public hospital system. Methods We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed. Results 22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5–64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7–72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes. Conclusions and relevance This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in New York City to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

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Characteristics and Outcomes of COVID-19 Patients in New York City’s Public Hospital System

10.1101/2020.05.29.20086645 ◽

2020 ◽

Cited By ~ 7

Author(s):

Roopa Kalyanaraman Marcello ◽

Johanna Dolle ◽

Sheila Grami ◽

Richard Adule ◽

Zeyu Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

New York ◽

Kidney Disease ◽

Public Hospital ◽

Case Series ◽

Ethnically Diverse ◽

The United States ◽

Hospital System ◽

Public Hospital System

AbstractBackgroundNew York City (NYC) has borne the greatest burden of COVID-19 in the United States, but information about characteristics and outcomes of racially/ethnically diverse individuals tested and hospitalized for COVID-19 remains limited. In this case series, we describe characteristics and outcomes of patients tested for and hospitalized with COVID-19 in New York City’s public hospital system.MethodsWe reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed.Results22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes.Conclusions and RelevanceThis is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in the United States to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

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