(115) Racial and Ethnic Differences in Hospitalized and Critical COVID-19 Treatment, January 2021-April 2022

Publication Number: 452

Background: Characteristics of patients with COVID-19 and risk factors for severe disease are well-described, but as therapeutics have expanded, treatment patterns are less clear.

Objectives: To describe hospitalized and critical COVID-19 treatment by race/ethnicity from January 2021 to April 2022.

Methods: Within the Sentinel System, we performed a descriptive analysis for two cohorts of COVID-19 patients (hospitalized and critical) identified in the TriNetX Live™ EHR database during four trimesters from January 1, 2021 to April 30, 2022. We stratified by race and ethnicity to estimate counts of patients with evidence of: 1) remdesivir or systemic corticosteroids (standard of care); 2) monoclonal antibodies authorized for COVID-19 (mAbs); 3) tocilizumab; and 4) baricitinib, COVID-19 convalescent plasma, or IL-1 inhibitors (other treatments). Treatment rates were compared between cohorts and between racial and ethnic groups using standardized differences, risk ratios, and 95% CIs.

Results: We identified 189,230 patients hospitalized with COVID-19 and 32,960 with critical COVID-19 (17.4%). In both cohorts, most were White (~75%) and non-Hispanic (~83%), followed by ~20% Black or African American, ~3% Asian, and < 1% American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander (A/P).
Across all races, ethnicities, and cohorts, standard of care was the most common treatment (received by 65.2-85.2% of each cohort depending on race and ethnicity), followed by other treatments (5.4-22.2%), tocilizumab (2.2-14.8%), and mAbs (0.9-3.7%). In all races and ethnicities, more critical COVID-19 patients were treated with standard of care, other treatments, and tocilizumab compared to hospitalized patients (SMDs 0.2-0.3). A greater proportion of A/P patients received each of the treatment groups, while Asian and Black patients had the same or slightly lower treatment rates compared to White patients. The exception to Asian and Black patients’ treatment rates was for tocilizumab, where these minoritized patients were about 20% more likely to receive treatment compared to White patients. When comparing Hispanic to non-Hispanic patients, treatment differences existed only in the critical COVID-19 cohort but were similar in magnitude.

Conclusions: We identified ~200,000 patients hospitalized with COVID-19 in a large EHR database in the Sentinel System. Both hospitalized and critical cohorts were mainly of White race and non-Hispanic ethnicity, and treatment differences between minoritized and White/non-Hispanic individuals were more exaggerated among patients with critical COVID-19. Future work should adjust for known confounders and explore whether treatment differences are the result of racial and/or ethnic health disparities.