Racial/ethnic disparities in post-acute sequelae of SARS-CoV-2 infection in New York: An EHR-based cohort study from the RECOVER Program
Khullar, D; Zhang, Y; Zang, C; et al., Journal of General Internal Medicine
Published
April 2023
Journal
Journal of General Internal Medicine
Abstract
Background: Compared to white individuals, Black and Hispanic individuals have higher rates of COVID-19 hospitalization and death. Less is known about racial/ethnic differences in post-acute sequelae of SARS-CoV-2 infection (PASC). Objective: Examine racial/ethnic differences in potential PASC symptoms and conditions among hospitalized and non-hospitalized COVID-19 patients. Design: Retrospective cohort study using data from electronic health records. Participants: 62,339 patients with COVID-19 and 247,881 patients without COVID-19 in New York City between March 2020 and October 2021. Main measures: New symptoms and conditions 31-180 days after COVID-19 diagnosis. Key results: The final study population included 29,331 white patients (47.1%), 12,638 Black patients (20.3%), and 20,370 Hispanic patients (32.7%) diagnosed with COVID-19. After adjusting for confounders, significant racial/ethnic differences in incident symptoms and conditions existed among both hospitalized and non-hospitalized patients. For example, 31-180 days after a positive SARS-CoV-2 test, hospitalized Black patients had higher odds of being diagnosed with diabetes (adjusted odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.50-2.56, q<0.001) and headaches (OR: 1.52, 95% CI: 1.11-2.08, q=0.02), compared to hospitalized white patients. Hospitalized Hispanic patients had higher odds of headaches (OR: 1.62, 95% CI: 1.21-2.17, q=0.003) and dyspnea (OR: 1.22, 95% CI: 1.05-1.42, q=0.02), compared to hospitalized white patients. Among non-hospitalized patients, Black patients had higher odds of being diagnosed with pulmonary embolism (OR: 1.68, 95% CI: 1.20-2.36, q=0.009) and diabetes (OR: 2.13, 95% CI: 1.75-2.58, q<0.001), but lower odds of encephalopathy (OR: 0.58, 95% CI: 0.45-0.75, q<0.001), compared to white patients. Hispanic patients had higher odds of being diagnosed with headaches (OR: 1.41, 95% CI: 1.24-1.60, q<0.001) and chest pain (OR: 1.50, 95% CI: 1.35-1.67, q < 0.001), but lower odds of encephalopathy (OR: 0.64, 95% CI: 0.51-0.80, q<0.001). Conclusions: Compared to white patients, patients from racial/ethnic minority groups had significantly different odds of developing potential PASC symptoms and conditions. Future research should examine the reasons for these differences.
Authors
Dhruv Khullar, Yongkang Zhang, Chengxi Zang, Zhenxing Xu, Fei Wang, Mark G Weiner, Thomas W Carton, Russell L Rothman, Jason P Block, Rainu Kaushal
Keywords
Humans; COVID-19/complications; Ethnicity; Cohort Studies; Post-Acute COVID-19 Syndrome; SARS-CoV-2; Retrospective Studies; COVID-19 Testing; Minority Groups; New York City/epidemiology; Headache/diagnosis/epidemiology; Brain Diseases
Short Summary
RECOVER researchers wanted to learn more about racial and ethnic differences in Long COVID. Researchers used patients’ electronic health records (EHRs) to compare people who had COVID based on their race or ethnicity, whether they were hospitalized due to COVID, and whether they had any health problems related to Long COVID. They looked at data from over 60,000 adults from 5 healthcare systems.
The researchers found that Black and Hispanic adults were more likely to have symptoms of Long COVID compared to White adults – this was true for adults who were and were not hospitalized. The reason for these differences is unclear.