Racial Disparities Drive COVID-19 Infection and Mortality Rates

Doctor giving emotional support to a senior patient using face mask
Investigators assessed whether clinical outcomes among patients with COVID-19 differ by race and observed disparities associated with comorbidity and neighborhood characteristics.

Investigators observed large disparities in infection rates and clinical outcomes from coronavirus-2019 (COVID-19) in Black and Hispanic populations compared with White and Asian populations in New York City, New York. However, Black and Hispanic populations are not inherently more susceptible to having poor COVID-19 outcomes compared to other groups, according to findings published in JAMA Network Open.

Data from the New York University Langone Health system, comprising 260 outpatient clinics and 4 acute care hospitals, were retrospectively analyzed for this study. Medical records from all patients tested for COVID-19 (N=9722) between March 1 and April 8, 2020 were included.

Of the patients tested for COVID-19, 49.8% (n=4843) tested positive and 54.2% (n=2623) were hospitalized. Of the 2623 patients hospitalized, 39.9% were White, 14.3% were Black, 27.3% were Hispanic, and 6.9% were Asian. In this cohort of hospitalized patients, 36.3% experienced critical illness, 23.7% required mechanical ventilation, 23.8% were admitted to the intensive care unit, 24.7% died or were admitted to hospice, and 70.8% were discharged.

Comorbid hypertension was higher among Black populations (52.6%) compared with others (range, 20.6-44.0%) and diabetes was lower among White populations (19.3%) compared with Black (28.7%), Hispanic (28.9%), or Asian (26.4%) populations.

The risk for testing positive was increased among Black (odds ratio [OR], 1.6; 95% CI, 1.4-1.8) and Hispanic (OR, 1.8; 95% CI, 1.6-2.0) patients compared with White patients. After adjusting for age, sex, comorbidities, insurance status, and neighborhood, the risk remained elevated among Black (OR, 1.3; 95% CI, 1.2-1.6) and Hispanic (OR, 1.5; 95% CI, 1.3-1.7) patients. Risk for testing positive was reduced among Asian patients (OR, 0.9; 95% CI, 0.8-1.0).

After adjusting for all covariates, results indicated that compared with White patients, the risk for hospitalization was similar among Black (P =.23) and Hispanic (P =.90) patients, but was increased among Asian patients (P =.004).

Risk for critical illness was found to be decreased among Black patients (OR, 0.6; 95% CI, 0.4-0.8) compared with White patients. The risk for death was decreased among Black patients (OR, 0.7; 95% CI, 0.6-0.9), but no difference was seen among Hispanic patients (OR, 1.0; 95% CI, 0.8-1.2), and risk was increased among Asian patients (OR, 1.3; 95% CI, 0.9-1.7).

This study may have been limited by only including data from 1 health network. Patients who tested positive within this network may be hospitalized with another institution and would not have been included in this analysis.

These data indicated Black and Hispanic individuals were not more susceptible for poor clinical outcomes from COVID-19, making it more likely that inequalities between populations was driving ethnicity-specific COVID-19 infection and mortality rates. “[E]xisting structural determinants … that remain pervasive in Black and Hispanic communities should be addressed in order to improve outcomes in COVID-19-related mortality,” investigators concluded.


Ogedegbe G, Ravenell J, Adhikari S, et al. Assessment of racial/ethnic disparities in hospitalization and mortality in patients with covid-19 in New York City. JAMA Netw Open. 2020;3(12):e2026881. doi:10.1001/jamanetworkopen.2020.26881.