Hospitalization and mortality among Black patients and White patients with Covid-19.
Open accessAbstract
BACKGROUND: Many reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19. METHODS: In this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death. RESULTS: A total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19-positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19-positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17). CONCLUSIONS: In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.
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The increase in Black patients affected by candidemia likely mirrors the disproportionate effect of the COVID-19 pandemic on Black patients.
“The percentage of Black patients affected by candidemia increased during the study period, likely mirroring the disproportionate effect of the COVID-19 pandemic on Black patients (3,17,25).”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — 10 Sites, United States, 2017–2021 (2025) · cites this paper as [25]
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Rapid Scaling Up of Covid-19 Diagnostic Testing in the United States — The NIH RADx Initiative
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Gregory, J. M., Slaughter, J. C., Duffus, S. H., Smith, T. J., LeStourgeon, L. M., Jaser, S. S., McCoy, A. B., Luther, J. M., Giovannetti, E. R., BOEDER, S. C., et al. (2020) · Diabetes Care · doi:10.2337/dc20-2260 · Cited by 256 · see citing works
“Whereas previous reports have indicated proportionally higher rates of hospitalizations from COVID-19 among Black patients and those with public insurance (17), this study is thefirst to showa similar finding in the population with type 1 diabetes.”
ResultMercadante, A. R., & Law, A. V. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2020.12.012 · Cited by 248 · see citing works
Acosta, A. M., Garg, S., Pham, H., WHITAKER, M. D., Anglin, O., O’Halloran, A. C., Milucky, J., Patel, K., Taylor, C. A., Wortham, J. M., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.30479 · Cited by 243 · see citing works
Impact of COVID-19 outbreak by income: hitting hardest the most deprived
Baena-Díez, J. M., Barroso, M., Cordeiro-Coelho, S. I., Díaz, J. L., & Grau, M. (2020) · Journal of Public Health · doi:10.1093/pubmed/fdaa136 · Cited by 242 · see citing works
The association of race and COVID-19 mortality
Golestaneh, L., Neugarten, J., Fisher, M. C., Billett, H. H., Gil, M. R., Johns, T. S., Yunes, M., Mokrzycki, M. H., Coco, M., Norris, K. C., et al. (2020) · EClinicalMedicine · doi:10.1016/j.eclinm.2020.100455 · Cited by 241 · see citing works
“This is similar to other reports of hospitalized COVID + cohorts [25,26].”
Bennett, T. D., Moffitt, R. A., Hajagos, J., Amor, B., Anand, A., Bissell, M. M., Bradwell, K. R., Bremer, C., Byrd, J. B., Denham, A., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.16901 · Cited by 230 · see citing works
“7) (n = 3106) Hospital LOS, median (IQR), d NR NR 4 (2-8) (n = 25 906) 23 (12-37) (n = 2790) 9 (4-18) (n = 3775)”
Subramanian, R., He, Q., & Pascual, M. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2019716118 · Cited by 225 · see citing works
“The alternative 254 approach of fitting the models to death data is not necessarily 255 exempt from biases in parameter estimates, due to changes 256 in hospital capacity over time(31, 32), co-morbidities in host 257 populations(33, 34), and the long delay between the onset of 258 infection and death(35).”
MethodClinical Outcomes in Young US Adults Hospitalized With COVID-19
Cunningham, J. W., Vaduganathan, M., Claggett, B. L., Jering, K., Bhatt, A. S., Rosenthal, N. A., & Solomon, S. D. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.5313 · Cited by 220 · see citing works
Treskova, M., Haas, L., Reda, S. A., Pilic, A., Borodova, A., Karimi, K., Koch, J., Nygren, T. M., Scholz, S. M., Schönfeld, V., et al. (2021) · BMC Medicine · doi:10.1186/s12916-021-02058-6 · Cited by 219 · see citing works
Male gender is a predictor of higher mortality in hospitalized adults with COVID-19
Nguyen, N. T., Chinn, J. O., FERRANTE, M. D., Kirby, K. A., Hohmann, S. F., & Amin, A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0254066 · Cited by 215 · see citing works
Dandachi, D., Geiger, G., Montgomery, M. W., Karmen-Tuohy, S., Golzy, M., Antar, A. A. R., Llibre, J. M., Camazine, M. N., de Santiago, A. D., Carlucci, P. M., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1339 · Cited by 215 · see citing works
Figueroa, J. F., Wadhera, R. K., Lee, D., Yeh, R. W., & Sommers, B. D. (2020) · Health Affairs · doi:10.1377/hlthaff.2020.01040 · Cited by 210 · see citing works
Acute Kidney Injury in a National Cohort of Hospitalized US Veterans with COVID-19
Bowe, B. C., Cai, M., Xie, Y., Gibson, A. K., Maddukuri, G. S., & Al‐Aly, Z. (2020) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.09610620 · Cited by 201 · see citing works
“These observations should also be considered along with findings in our cohort (and in other studies of hospitalized patients with COVID-19) that did not suggest higher adjusted overall risk of mortality in Blacks compared with Whites (45,46).”
ResultRenal complications in COVID-19: a systematic review and meta-analysis
Kunutsor, S. K., & Laukkanen, J. A. (2020) · Annals of Medicine · doi:10.1080/07853890.2020.1790643 · Cited by 209 · see citing works
Tenforde, M. W., Rose, E. B., Lindsell, C. J., Shapiro, N. I., Files, D. C., Gibbs, K. W., Prekker, M. E., Steingrub, J. S., Smithline, H. A., Gong, M. N., et al. (2020) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6926e3 · Cited by 191 · see citing works
Mahamat‐Saleh, Y., Fiolet, T., Rebeaud, M. E., Mulot, M., Guihur, A., Fatouhi, D. E., Laouali, N., Peiffer‐Smadja, N., Aune, D., & Severi, G. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-052777 · Cited by 205 · see citing works
Crouse, A. B., Grimes, T., Li, P., Might, M., Ovalle, F., & Shalev, A. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.600439 · Cited by 194 · see citing works
COVID-19 and excess mortality in the United States: A county-level analysis
Stokes, A. C., Lundberg, D. J., Elo, I. T., Hempstead, K., Bor, J. H., & Preston, S. H. (2021) · PLoS Medicine · doi:10.1371/journal.pmed.1003571 · Cited by 192 · see citing works
“Another factor is racial health inequities in asthma, chronic obstructive pulmonary disease (CAU : PleasenotethatCOPDhasbeendefinedaschronicobstructivepulmonarydiseaseinthesentenceAnotherfactorisracialhealth::::Pleasecheckandcorrectifnecessary: OPD), hyp rtension, and diabet s, which are risk fa tors for COVID-19 [52,…”
BackgroundEconomic Burden of COVID-19: A Systematic Review
Richards, F., Kodjamanova, P., Chen, X., Li, N., Atanasov, P. Y., Bennetts, L. E., Patterson, B. J., Yektashenas, B. H., Mesa‐Frias, M., Tronczyński, K., et al. (2022) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s338225 · Cited by 192 · see citing works
Predictors of willingness to get a COVID-19 vaccine in the U.S
Kelly, B., Southwell, B. G., Mccormack, L. A., Bann, C., MacDonald, P. D. M., Frasier, A. M., Bevc, C. A., Brewer, N. T., & Squiers, L. (2021) · BMC Infectious Diseases · doi:10.1186/s12879-021-06023-9 · Cited by 187 · see citing works
“Given that Black people have experienced disproportionately high rates of hospitalization and death from COVID-19 [12], the disparity in COVID-19 vaccine willingness raises the possibility that vaccination could amplify existing disparities.”
BackgroundThe interplay between HIV and COVID-19: summary of the data and responses to date
Brown, L. B., Spinelli, M. A., & Gandhi, M. (2020) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0000000000000659 · Cited by 186 · see citing works
COVID-19 and Obesity: Dangerous Liaisons
Caci, G., Albini, A., Malerba, M., Noonan, D. M., Pochetti, P., & Polosa, R. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9082511 · Cited by 189 · see citing works
“Obesity is also a marker of poverty and, therefore, inability to access to high-quality health care [80].”
BackgroundCOVID-19 vaccine intentions in the United States, a social-ecological framework
Latkin, C. A., Dayton, L., Yi, G. T., Konstantopoulos, A. D., Park, J. N., Maulsby, C. H., & Kong, X. (2021) · Vaccine · doi:10.1016/j.vaccine.2021.02.058 · Cited by 182 · see citing works
“In this analysis, we also assess how social norms of COVID-19 preventive behaviors may influence vaccine intentions, based on the proportion of social network members who appear to social distance, wear masks, and actively encourage or discourage COVID19 prevention behaviors.”
InfluentialCOVID-19 Point-of-Care Diagnostics: Present and Future
Valera, E., Jankelow, A. M., Lim, J., Kindratenko, V., Ganguli, A., White, K., Kumar, J. S., & Bashir, R. (2021) · ACS Nano · doi:10.1021/acsnano.1c02981 · Cited by 182 · see citing works
Socioeconomic inequalities and COVID-19 – A review of the current international literature
Wachtler, B., Michalski, N., Nowossadeck, E., Diercke, M., Wahrendorf, M., Hövener, C., Lampert, T., & Hoebel, J. (2020) · PubMed Central · doi:10.25646/7059 · Cited by 173 · see citing works
Omer, S. B., Benjamin, R. M., Brewer, N. T., Buttenheim, A. M., Callaghan, T., Caplan, A. L., Carpiano, R. M., Clinton, C., DiResta, R., Elharake, J. A., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)02507-1 · Cited by 173 · see citing works
COVID-19 among the inhabitants of the slums in the city of Buenos Aires: a population-based study
Macchia, A., Ferrante, D., Battistella, G., Mariani, J. A., & de Quirós, F. G. B. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-044592 · Cited by 171 · see citing works
The Task Force for the management of COVID-19 of the European Society of Cardiology, Baigent, C., Windecker, S., Andreini, D., Arbelo, E., Barbato, E., Bartorelli, A. L., Baumbach, A., Behr, E. R., Berti, S. L., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab697 · Cited by 173 · see citing works
Aging, Male Sex, Obesity, and Metabolic Inflammation Create the Perfect Storm for COVID-19
Mauvais‐Jarvis, F. (2020) · Diabetes · doi:10.2337/dbi19-0023 · Cited by 170 · see citing works
“A retrospective study of over 1,300 patients hospitalized for COVID-19 in Louisiana reported that nonHispanic Black patients were more likely than non-Hispanic White patients to exhibit increased inflammatory biomarkers such as CRP and procalcitonin (69).”
BackgroundBain, W., Yang, H., Shah, F. A., Suber, T. L., Drohan, C. M., Al‐Yousif, N., DeSensi, R., Bensen, N., Schaefer, C., Rosborough, B. R., et al. (2021) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202008-1026oc · Cited by 166 · see citing works
Racial Disparities in COVID-19 Testing and Outcomes
Escobar, G. J., Adams, A. S., Liu, V. X., Soltesz, L., Chen, Y.-F. I., Parodi, S. M., Ray, G. T., Myers, L. C., Ramaprasad, C., Dlott, R. S., et al. (2021) · Annals of Internal Medicine · doi:10.7326/m20-6979 · Cited by 164 · see citing works
“Like our study, articles providing risk-adjusted race- and ethnicityspecific mortality data in hospitalized patients with SARSCoV-2 infection have reported that the effect of race/ ethnicity is substantially decreased or even absent (20, 24).”
ResultShaw, J., Brewer, L. C., & Veinot, T. C. (2021) · JMIR Formative Research · doi:10.2196/23233 · Cited by 160 · see citing works
“In the state of Louisiana in the United States, Black patients made up 59% of deaths related to COVID-19 in the early months of the pandemic despite representing only 33% of the state’s population [1].”
BackgroundGe, E., Li, Y., Wu, S., Candido, E., & Wei, X. (2021) · PLoS ONE · doi:10.1371/journal.pone.0258154 · Cited by 165 · see citing works
“Variables of ethnicity and other socio-economic status such as education may also interact with each other [32, 33].”
BackgroundRodríguez, F., Solomon, N. C., de Lemos, J. A., Das, S. R., Morrow, D. A., Bradley, S. M., Elkind, M. S. V., Williams, J. H., Holmes, D. N., Matsouaka, R., et al. (2020) · Circulation · doi:10.1161/circulationaha.120.052278 · Cited by 160 · see citing works
The nature of cities and the Covid-19 pandemic
Lai, K. Y., Webster, C. J., Kumari, S., & Sarkar, C. (2020) · Current Opinion in Environmental Sustainability · doi:10.1016/j.cosust.2020.08.008 · Cited by 157 · see citing works
“Vulnerable communities comprise population subgroups of low SES, specific ethnic minority, age group (for example, outbreaks in care homes for elderly in UK [19]) and those with underlying chronic conditions (diabetes, CVD, chronic lung disease kidney disease etc) [20,21].”
Insights into disparities observed with COVID‐19
Carethers, J. M. (2020) · Journal of Internal Medicine · doi:10.1111/joim.13199 · Cited by 147 · see citing works
The human genetic epidemiology of COVID-19
Niemi, M., Daly, M. J., & Ganna, A. (2022) · Nature Reviews Genetics · doi:10.1038/s41576-022-00478-5 · Cited by 147 · see citing works
Mendy, A., Apewokin, S. K., Wells, A., & Morrow, A. L. (2020) · medRxiv · doi:10.1101/2020.06.25.20137323 · Cited by 147 · see citing works
COVID-19 and its cardiovascular effects: a systematic review of prevalence studies
Pellicori, P., Doolub, G., Wong, C. M., Lee, K. S., Mangion, K., Ahmad, M., Berry, C., Squire, I. B., Lambiase, P. D., Lyon, A. R., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013879 · Cited by 147 · see citing works
Singh, K., Kondal, D., Mohan, S., Jaganathan, S., Deepa, M., Venkateshmurthy, N. S., Jarhyan, P., Anjana, R. M., Narayan, K. M. V., Mohan, V., et al. (2021) · BMC Public Health · doi:10.1186/s12889-021-10708-w · Cited by 143 · see citing works
“Although some countries and regions are seeing improvements in hospitalization and death rates, COVID-19 remains a major concern for vulnerable and underserved populations globally [2, 3].”
BackgroundWright, L. J., Williams, S. E., & Zanten, J. V. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.580511 · Cited by 143 · see citing works
Social determinants of COVID-19 incidence and outcomes: A rapid review
Upshaw, T. L., Brown, C., Smith, R. W., Perri, M., Ziegler, C. P., & Pinto, A. D. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248336 · Cited by 142 · see citing works
The Landscape of Candidemia During the Coronavirus Disease 2019 (COVID-19) Pandemic
Seagle, E. E., Jackson, B. R., Lockhart, S. R., Georgacopoulos, O., Nunnally, N. S., Roland, J., Barter, D. M., Johnston, H. L., Czaja, C. A., Kayalioglu, H., et al. (2022) · Clinical Infectious Diseases · doi:10.1093/cid/ciab562 · Cited by 141 · see citing works
Jagannathan, P., Andrews, J. R., Bonilla, H. F., Hedlin, H., Jacobson, K. B., Balasubramanian, V., Purington, N., Kamble, S., de Vries, C. R., Quintero, O., et al. (2021) · Nature Communications · doi:10.1038/s41467-021-22177-1 · Cited by 140 · see citing works
Shen, W., Long, L. M., Shih, C.-H., & Ludy, M. (2020) · Nutrients · doi:10.3390/nu12092712 · Cited by 139 · see citing works
Sharafeldin, N., Bates, B. A., Song, Q., Madhira, V., Yan, Y., Dong, S., Lee, E., Kuhrt, N., Shao, Y. R., Liu, F., et al. (2021) · Journal of Clinical Oncology · doi:10.1200/jco.21.01074 · Cited by 139 · see citing works
Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis
Poly, T. N., Islam, M. M., Yang, H., Lin, M. C., Jian, W., Hsu, M., & Li, Y. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.620044 · Cited by 136 · see citing works
“Recent epidemiological studies have shown obesity to be associated with both neutral and increased risk of mortality among patients diagnosed with COVID-19 (15, 16), but mechanisms underlying this are still unclear.”
BackgroundBarron, G. C., Laryea-Adjei, G., Vike-Freiberga, V., Abubakar, I., Dakkak, H., Devakumar, D., Johnsson, A., Karabey, S., Labonté, R., Legido-Quigley, H., et al. (2022) · The Lancet Public Health · doi:10.1016/s2468-2667(21)00235-8 · Cited by 135 · see citing works
Long COVID and Health Inequities: The Role of Primary Care
Berger, Z. D., Jesus, V. V. A. D., Assoumou, S. A., & Greenhalgh, T. (2021) · Milbank Quarterly · doi:10.1111/1468-0009.12505 · Cited by 129 · see citing works
Overcoming COVID-19 vaccine hesitancy among ethnic minorities: A systematic review of UK studies
Hussain, B., Latif, A., Timmons, S., Nkhoma, K. B., & Nellums, L. B. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.04.030 · Cited by 135 · see citing works
- Authors
- Price-Haywood, E. G., Burton, J., Fort, D., & Seoane, L.
- Affiliations
- From the Ochsner Health Center for Outcomes and Health Services Research (E.G.P.-H., J.B., D.F.) and the University of Queensland Ochsner Clinical School (E.G.P.-H., L.S.) — both in New Orleans.
- Ochsner Health System (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-06-25
- Volume
- 382
- Issue
- 26
- Pages
- 2534-2543
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7269015
- OpenAlex
- W3031713996
- Cited by
- 1,660
- References
- 18
- Citations by year
- 2026: 31 · 2025: 56 · 2024: 103 · 2023: 194 · 2022: 282 · 2021: 681 · 2020: 312
- FWCI
- 48.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of General Medical Sciences (U54GM104940)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, SARS-CoV-2, racial disparities, Black patients, in-hospital mortality, hospitalization, comorbidities, obesity, Charlson Comorbidity Index, public insurance, age, prognostic factors, Louisiana, integrated health system, mortality risk factors
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Aged, Black or African American, Female, Hospitalization, Humans, Louisiana, Male, Middle Aged, Pneumonia, Viral, Retrospective Studies, Socioeconomic Factors, Comorbidity, Hospital Mortality, Coronavirus Infections, White People, Pandemics
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