Gender and Ethnic Disparities of Acute Kidney Injury in COVID-19 Infected Patients: A Literature Review

Coronavirus disease 2019(COVID-19) has become a public health emergency of concern worldwide. COVID-19 is a new infectious disease arising from Coronavirus 2 (SARS-CoV-2). It has a strong transmission capacity and can cause severe and even fatal respiratory diseases. It can also affect other organs such as the heart, kidneys and digestive tract. Clinical evidence indicates that kidney injury is a common complication of COVID-19, and acute kidney injury (AKI) may even occur in severely ill patients. Data from China and the United States showed that male sex, Black race, the elderly, chronic kidney disease, diabetes, hypertension, cardiovascular disease, and higher body mass index are associated with COVID-19‐induced AKI. In this review, we found gender and ethnic differences in the occurrence and development of AKI in patients with COVID-19 through literature search and analysis. By summarizing the mechanism of gender and ethnic differences in AKI among patients with COVID-19, we found that male and Black race have more progress to COVID-19-induced AKI than their counterparts.

Racial disparity in distant recurrence-free survival in localized breast cancer patients: A pooled analysis of NSABP trials

Background: Black race is associated with worse outcome in patients with breast cancer. We evaluated distant relapse-free survival (DRFS) between Black and White women with localized breast cancer who participated in NCI-sponsored clinical trials. Methods: We analyzed pooled data from eight National Surgical Adjuvant Breast and Bowel Project (NSABP) trials including 9,702 women with localized breast cancer treated with adjuvant chemotherapy (AC, n=7,485) or neoadjuvant chemotherapy (NAC, n=2,217), who self-reported as Black (n=1,070) or White (n=8,632). The association between race and DRFS was analyzed using log-rank tests and multivariate Cox regression. Results: After adjustment for covariates including age, tumor size, nodal status, body mass index and taxane use, and treatment (AC vs. NAC), Black race was associated with an inferior DRFS in ER-positive (HR 1.24 [95% CI 1.05-1.46], p=0.01), but not in ER-negative disease (HR 0.97 [95% CI 0.83-1.14], p=0.73), and significant interaction between race and ER status was observed (p=0.03). There was no racial disparity in DRFS among patients with pathologic complete response (pCR) (Log-rank p =0.8). For patients without pCR, black race was associated with worse DRFS in ER-positive (HR 1.67 [95% CI 1.14-2.45], p=0.01), but not in ER-negative disease (HR 0.91 [95% CI 0.65-1.28], p=0.59). Conclusion: Black race was associated with significantly inferior DRFS in ER-positive localized breast cancer treated with AC or NAC, but not in ER-negative disease. In the NAC group, racial disparity was also observed in patients with residual ER-positive breast cancer at surgery, but not in those who had a pathologic complete response.

Racial and Ethnic Variations in Mortality Associated with Common Pediatric Gastrointestinal Disorders in Children's Hospitals in the US

Background: The objective of this study is to determine the mortality, risk factors, and disease associations of eight common pediatric gastrointestinal (GI) disorders: cystic fibrosis (CF), cirrhosis, gastrointestinal bleeding (GIB), inflammatory bowel disease (IBD), liver failure (LF), liver transplant, acute pancreatitis, and short bowel syndrome (SBS). Methods: Diagnoses were found using the International Classification of Disease (ICD) codes from 2004 through 2020. We performed a retrospective cohort study using the Pediatric Health Information System (PHIS) database from 50 children’s hospitals in the US. We analyzed all encounters with ICD codes for these disorders, then determined the per-encounter mortality rate for each. We performed a mixed-effects logistic regression modeling hospital as a random effect, mortality as the dependent variable, and patient demographics and medical history as independent variables. We hypothesized that demographic factors such as Black race, Hispanic ethnicity, and markers of socioeconomic status would be associated with increased mortality. Results: The per-encounter mortality for each diagnosis was: cirrhosis (2.19%), CF (0.66%), GIB (4.22%), IBD (0.21%), LF (7.03%), liver transplant (0.37%), acute pancreatitis (2.23%), and SBS (1.13%). There was a higher (p<0.05) mortality for those of Asian race and mixed-race populations in GIB (OR 1.76 and 1.37, respectively) and acute pancreatitis (OR 1.94 and 1.34, respectively). For those of Black race, there was a higher mortality in liver transplant and liver failure (OR 1.31 and 1.65 respectively). Additionally, mortality was increased in Hispanic/Latino patients with CF, GIB, and SBS (OR 2.34, 1.39, and 1.41, respectively). Coincident cardiovascular, renal/urologic, and neurologic/neuromuscular abnormalities were also associated with a significant higher mortality. Conclusion: The degree of variation associated with race and ethnicity is unlikely to be accounted for by variation in clinical features, thus the impact of social determinants of health should be the focus of future study. Cirrhosis CF GIB IBD LF Liver Transplant Acute Pancreatitis SBS Mortality Rate 2.19% 0.66% 4.22% 0.21% 7.03% 0.37% 2.23% 1.13% Asian Race OR 1.10 3.77 1.76* 1.71 1.08 0.89 1.94* 1.35 Black Race OR 0.90 0.48 1.03 1.55 1.31* 1.65* 1.15 1.14 Mixed Race OR 1.16 1.12 1.37* 1.44 1.23 0.85 1.34* 1.16 Hispanic/Latino OR 1.13 2.34* 1.39* 1.53 1.16 1.65 1.13 1.41* *Significant OR numbers with an associated p<0.05

Evolution of SARS-CoV-2 Seroprevalence Among Employees of a United States Academic Children’s Hospital During the COVID-19 Pandemic

Objectives: Describe cumulative seroprevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among employees of a large pediatric healthcare system. Design, Setting, and Participants: Prospective observational cohort study open to adult employees at Children’s Hospital of Philadelphia, conducted April 20 – December 17, 2020. Methods: Employees were recruited starting with high-risk exposure groups, utilizing emails, flyers, and announcements at virtual town halls. At baseline, 1-month, 2-month, and 6-month timepoints, participants reported occupational and community exposures and gave a blood sample for SARS-CoV-2 antibody measurement by enzyme-linked immunosorbent assays (ELISAs). A post hoc Cox proportional hazards regression model was performed to identify factors associated with increased risk for seropositivity. Results: 1740 employees were enrolled. At 6-months, cumulative seroprevalence was 5.3%, below estimated community point seroprevalence; seroprevalence was 5.8% and 3.4% among employees with and without direct patient care, respectively. Most participants seropositive at baseline remained positive at follow-up assessments. In post hoc analysis, direct patient care (HR: 1.95, 95% CI: 1.03 to 3.68), Black race (HR: 2.70, 95% CI: 1.24 to 5.87), and exposure to a confirmed case in a non-healthcare setting (HR: 4.32, 95% CI: 2.71 to 6.88) were associated with statistically significant increased risk for seropositivity. Conclusions: Employee SARS-CoV-2 seroprevalence rates remained below the surrounding community’s point prevalence rates. Provision of direct patient care, Black race, and exposure to a confirmed case in non-healthcare setting conferred increased risk. These data can inform occupational protection measures to maximize protection of employees within the workplace during future COVID waves or other epidemics.

What’s Race got to do With it? How Palliative Care Consultation may Mitigate Racial Disparities in Future Care

It is unknown if care and cost outcomes differ by race and ethnicity following discharge from a hospitalization involving palliative care consultation to discuss goals-of-care (PCC). In this secondary analysis of 1,390 seriously-ill patients age 18+ alive at discharge who self-identified as Black, Hispanic, Asian, white, or other race and received PCC at an urban, academic medical center, we used binomial logistic regression and multiple linear regression controlling for demographic and clinical variables to identify factors associated with care experiences and costs following discharge from a hospitalization with PCC. In adjusted analyses, discharge to hospice was associated with Medicaid (p=0.016). Thirty-day readmission was associated with age 75+ (P=0.015), Medicaid (P=0.004), admission 30 days prior (P&lt;0.0001), and Black race compared to white (P=0.016). Number of future days hospitalized was associated with Medicaid (P=0.001), admission 30 days prior (P=0.017), and Black race compared to white (P=0.012). Having any future hospitalization cost was associated with patient ages 65-74 (P=0.022) and 75+ (P=0.023), Medicaid (P=0.014), admission 30-days prior (P&lt;0.0001), and Black race compared to white (P=0.021). Total future hospitalization costs were associated with female gender (P=0.025), Medicaid (P=0.009), admission 30 days prior (P=0.040), and Black race compared to white (P=0.037). Race or ethnicity was not a predictor of hospice enrollment. Randomized controlled trials are needed to understand if PCC is an intervention that reduces racial disparities in end-of-life care. Qualitative insights are needed to explain how PCC and socioeconomic factors such as Medicaid may mitigate future acute care use among racial and ethnic groups.