Analysis of Epic Electronic Health Record Data Shows People of Color Fare Worse than White Patients at Every Stage of the COVID-19 Pandemic, Including Higher Rates of Infection, Hospitalization and Death
Disparities in Hospitalization and Death Persist Even after Accounting for Differences in Sociodemographic Factors and Underlying Health Conditions, And People of Color are Sicker When They Test Positive
People of color were more likely to test positive for COVID-19 and to require a higher level of care at the time of diagnosis compared to White patients, according to a new analysis from Epic Health Research Network and KFF. They also were more likely to be hospitalized and die from the novel coronavirus than White patients were.
The racial disparities in illness and death are not fully explained by differences in underlying sociodemographic characteristics and health conditions, finds the study, which analyzed Epic electronic health record data for roughly 50 million patients from 53 health systems representing 399 hospitals across 21 states.
The findings suggest that people of color may face increased barriers to testing that contribute to delays in obtaining testing until they are in more serious condition compared to White patients. They also demonstrate that people of color are bearing a disproportionate burden of negative health outcomes related to the COVID-19 pandemic at every stage – risk of exposure, access to testing, severity of illness, and likelihood of death.
The analysis, a joint project of EHRN and KFF, builds upon the findings of other studies and contributes to the research by providing insight into the experiences of a large patient population across a range of states and health systems, examining variation in the level of care patients required at the time they tested positive for COVID-19 by race and ethnicity, and assessing the extent to which underlying sociodemographic characteristics and health conditions explain racial disparities in hospitalization and death.
Key findings include:
- Although testing rates differed little by race and ethnicity, among those tested, Hispanic patients were over two-and-a-half times more likely to have a positive result (311 per 1,000) and Black and Asian patients were nearly twice as likely to test positive (219 and 220 per 1,000, respectively) for COVID-19 compared to White patients (113 per 1,000). Further, larger shares of Black, Hispanic, and Asian patients were in an inpatient setting when they tested positive for COVID-19 compared to White patients. They also were more likely to require oxygen or ventilation at the time of diagnosis.
- COVID-19 infection rates among Hispanic and Black patients were over three and two times higher, respectively, compared to the rate for White patients (143 and 107 vs. 46 per 10,000).
- Hospitalization rates for Hispanic and Black patients with COVID-19 were more than four times and over three times higher, respectively, compared to the rate for White patients (30.4 and 24.6 vs. 7.4 per 10,000). Death rates for both groups were over twice as high as the rate for White patients (5.6 and 5.6 compared to 2.3 per 10,000). Asian patients also faced significant disparities in these measures.
- Among patients who tested positive for COVID-19, Black, Hispanic, and Asian patients remained at higher risk for hospitalization and death compared to White patients with similar sociodemographic characteristics and underlying health conditions, suggesting that other barriers, including racism and discrimination, are affecting outcomes through avenues not captured by these measures.
“Understanding the factors underlying COVID-19 infections and severe complications can help us devote resources appropriately to the most vulnerable communities,” said Christopher Alban, MD, Epic Vice President of Clinical Informatics. “This study adds nuance to our understanding of inequities in our COVID-19 response by showing racial and ethnic disparities that persist when comparing populations with similar health and socioeconomic status.”
“This analysis points to delays in testing for people of color, who are sicker and more likely to be infected when they do get tested,” said KFF President and CEO Drew Altman. “The findings highlight the continued importance of addressing racial disparities in responding to COVID-19 as in health care more broadly.”
About Epic Health Research Network
EHRN is a journal for the 21st century, designed for rapid sharing of knowledge with healthcare professionals, researchers, government, and learners to help solve medical problems. For more information, visit ehrn.org.
Filling the need for trusted information on national health issues, KFF (Kaiser Family Foundation) is a nonprofit organization based in San Francisco, California. KFF is not affiliated with Kaiser Permanente.