(H) Racial Differences in U.S. COVID-19 Testing, Positivity, Hospitalization, and Mortality

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1007

Presenting Author(s)

Sruthi Adimadhyam, PhD
– Research Scientist, Harvard Pilgrim Health Care Institute, Harvard Pilgrim Health Care Institute, Cambridge, Massachusetts, United States

Co-Author(s)

Adebola Ajao
– Epidemiologist, US Food and Drug Administration, Food and Drug Administration, Silver Spring, Maryland, United States
Maria Kempner, BA
– Senior Research Analyst, Harvard Pilgrim Health Care Institute, United States
Hye Seung Lee
– U.S. FOOD & DRUG ADMINISTRATION, United States
Caroline Jjingo
– U.S. Food and Drug Administration, United States
Jane Baumblatt
– U.S. Food and Drug Administration, United States
Danijela Stojanovic, PharmD, PhD
– U.S. Food and Drug Administration, Silver Spring, MD, United States
Yueqin Zhao, PhD
– US Food and Drug Administration, United States
Joy Kolonoski
– Harvard Pilgrim Healthcare Institute, United States
Efe Eworuke, PhD, MS, BPharm
– IQVIA, Falls Church, Virginia, United States

Background: From January 2020 to February 2022, COVID-19 has resulted in over 77 million US cases and over 910,000 deaths. Studies conducted earlier in the pandemic reported racial differences in COVID-19 positivity and hospitalization.

Objectives: To examine racial differences in COVID-19 testing, positivity, hospitalization, and mortality during the first year of the pandemic.

Methods: We identified all enrollees with at least 6 months of continuous medical and drug coverage from April 1, 2020, through March 31, 2021, in the Rapid Sentinel Distributed Database. We examined the incidence of COVID-19 testing, positivity, hospitalization including critical COVID, and death. We defined critical as COVID patients admitted to the ICU, on mechanical ventilator or ECMO, or with acute renal failure and receiving renal replacement therapy.

Results: Of 16,070,578 eligible enrollees, 47% were of unknown race, 42% White, 7% Black, 3% Asians, 0.5% Native Hawaiians or other Pacific Islanders, and 0.3% American Indians or Alaskan Natives. Of eligible enrollees, 2,270,701 (14%) were tested for COVID-19 (mean age: 49.8). Incidence of testing among eligible enrollees by race was 11% in unknown race, 15% in Native Hawaiians, 16% in Asians, 16% in Blacks, 17% in Whites, and 20% in American Indians. Among those tested, 383,447 (17%) were COVID positive and incidence by race was 14% in Asians, 15% in Whites, 16% in American Indians, 18% in Native Hawaiians, 19% in Blacks, and 19% in unknown race. Among 930,606 COVID-19 infections (positive test and/or diagnosis) (mean age: 53.9), 133,341 (14%) were hospitalized (mean age: 71.2) and incidence by race was 10% each in Asians and unknown race, 16% in American Indians, 17% in Whites, 22% in Native Hawaiians and 26% in Blacks. Among hospitalized persons, 74,389 (56%) were critical (mean age: 71.9) and 21,054 (16%) died. Incidence of critical COVID by race was 52% in American Indians, 55% each in Asians, Whites, and unknown race, 58% in Blacks, and 59% in Native Hawaiians. Incidence of death among COVID hospitalized persons by race was 14% in unknown race, 15% in Asians, 16% in Blacks, 17% each in Whites and American Indians, and 20% in Native Hawaiians.

Conclusions: Racial disparity in COVID positivity and hospitalization persisted one year into the pandemic. Among known race, Blacks and Native Hawaiians carry the highest burden of COVID hospitalizations including critical COVID, while deaths in Blacks following hospitalization is similar to Whites. This study is limited by large proportion of unknown race highlighting need for better race capture; FDA is conducting similar analyses in other large electronic health records databases with more complete race capture.