The study is the first of its kind examining the impact of medical comorbid conditions (pre-existing conditions) and neighbourhood socioeconomic status (SES) on the hospital outcomes for Black, Hispanic and Asian patients. Gbenga Ogedegbe, MD, MPH, Dr. Adolph and Margaret Berger Professor of Medicine and Population Health at NYU Langone Health, and the study's lead author states "We know that Black and Hispanic populations account for a disproportionate share of COVID-19-related deaths relative to their population size in New York and major cities across the country". However, Ogedegbe also talks about their surprise find that “Black and Hispanic patients were no more likely to be hospitalized across NYU Langone than White patients…”
This first of its kind study suggests that other factors are at play, such as poor housing conditions, unequal access to health care, differential employment opportunities and poverty. The data gathered was taken from NTU Langone Health’s electronic health record (EHR) of 9,722 patients tested for Covid-19.
For each patient who tested positive, researchers compiled race/ethnicity data and patient characteristics such as body mass index (BMI), age and sex. Alongside this data SES data was obtained through a weighed index of seven indicators which includes medical comorbidity, history of smoking, household income, level of education and housing value amongst others.
"They found that after adjustment for all covariates, Hispanic and Black patients were no more likely than White patients to be hospitalised."
The study found that of 4,843 patients who tested positive 2,623 patients were hospitalised. Of these 2,623 patients 39.9% were White, 14.3% were Black, 27.3% were Hispanic, 6.9% were Asian and 7.9% were multiracial/other. Figure 2, taken from the study, shows the proportion of Covid-19 positive patients by race/ethnicity and the outcomes by race/ethnicity of those hospitalised. They found that after adjustment for all covariates, Hispanic and Black patients were no more likely than White patients to be hospitalised.
Interestingly the researchers came across a paradox, Joseph Ravenell, MD, associate professor in the Department of Population Health and associate dean for Diversity Affairs and Inclusion at NYU Langone explains that “…we've found that once Black patients with COVID-19 make it to the hospital -- despite coming from lower-income neighbourhoods -- their odds of dying are similar to or lower than White patients. Meanwhile, we also know that Black and Hispanic people are disproportionately contracting and dying of COVID-19 across the country”.
This paradox could be explained according to Ogedegbe and Ravenell by Black populations being more likely to be uninsured and underinsured and therefore more likely to die at home rather than in hospital. It has also been found that a predictor for a poorer outcome is being male and of the Black cohort admitted to hospital 62% were female, this could explain the relatively better outcome.
Study senior author Leora Horwitz, MD, associate professor in the Departments of Population Health and Medicine and director of the Center for Healthcare Innovation and Delivery Science at NYU Langone, says “future studies need to better examine the direct impact of structural inequities on racial and ethnic disparities in COVID-19 related hospitalization, morbidity, and mortality”.
"During a pandemic surely insurance would be irrelevant?"
This study highlights the real problem here, the lack of access to healthcare due to lower economic backgrounds meaning many are not able to afford health insurance. If healthcare was accessible to all at an equal level, the outcomes would surely change. During a pandemic surely insurance would be irrelevant? Shouldn’t everybody have equal access especially during a worldwide pandemic?