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Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study
BACKGROUND: Disease severity on chest radiographs (CXR) has been associated with higher risk of disease progression and adverse outcomes from COVID-19. Few studies have evaluated COVID-19-related racial/ethnic disparities in radiology. PURPOSE: To evaluate whether Non-White minority patients hospita...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Radiological Society of North America
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370353/ https://www.ncbi.nlm.nih.gov/pubmed/32673191 http://dx.doi.org/10.1148/radiol.2020202602 |
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author | Joseph, Nicholos P. Reid, Nicholas J. Som, Avik Li, Matthew D Hyle, Emily P. Dugdale, Caitlin M. Lang, Min Betancourt, Joseph R. Deng, Francis Mendoza, Dexter P. Little, Brent P. Narayan, Anand K. Flores, Efren J. |
author_facet | Joseph, Nicholos P. Reid, Nicholas J. Som, Avik Li, Matthew D Hyle, Emily P. Dugdale, Caitlin M. Lang, Min Betancourt, Joseph R. Deng, Francis Mendoza, Dexter P. Little, Brent P. Narayan, Anand K. Flores, Efren J. |
author_sort | Joseph, Nicholos P. |
collection | PubMed |
description | BACKGROUND: Disease severity on chest radiographs (CXR) has been associated with higher risk of disease progression and adverse outcomes from COVID-19. Few studies have evaluated COVID-19-related racial/ethnic disparities in radiology. PURPOSE: To evaluate whether Non-White minority patients hospitalized with confirmed COVID-19 infection presented with increased severity on admission CXR compared with White/Non-Hispanic patients. METHODS: Single-institution, retrospective cohort study approved by the IRB. Patients hospitalized with confirmed COVID-19 infection (3/27/20-4/10/20) were identified using the electronic medical record (EMR) (n=326, mean age: 59 years (SD: 17 years), M:F (188:138). Primary outcome was severity of lung disease on admission CXR, measured by modified Radiographic Assessment of Lung Edema (mRALE) score. Secondary outcome was a composite adverse clinical outcome of intubation, ICU admission, or death. Primary exposure was racial/ethnic category: White/Non-Hispanic versus Non-White [i.e., Hispanic, Black, Asian, Other]. Multivariable linear regression analyses were performed to evaluate the association between mRALE scores and race/ethnicity. RESULTS: Non-White patients had significantly higher mRALE scores (median 6.1, 95% CI 5.4–6.7) compared with White/Non-Hispanic patients (median 4.2, 95% CI 3.6–4.9) (unadjusted average difference 1.8, 95% CI 0.9–2.8, p<0.01). For both White (Adjusted HR, 1.3, 95%CI 1.2-1.4, p<0.001) and Non-White patients (Adjusted HR 1.2, 95%CI 1.1-1.3, p<0.001), increasing mRALE scores were associated with a higher likelihood of experiencing composite adverse outcome with no evidence of interaction (p = 0.16). Multivariable linear regression analyses demonstrated that Non-White patients presented with higher mRALE scores on admission CXR versus White/Non-Hispanic patients (adjusted average difference 1.6, 95% CI 0.5–2.7, p<0.01). Adjustment for hypothesized mediators revealed that the association between race/ethnicity and mRALE scores was mediated by limited English proficiency (p<0.01). CONCLUSION: Non-White patients hospitalized with COVID-19 infection were more likely to present with higher severity of disease on admission CXR than White/Non-Hispanic patients, and increased severity was associated with worse outcomes for all patients. |
format | Online Article Text |
id | pubmed-7370353 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Radiological Society of North America |
record_format | MEDLINE/PubMed |
spelling | pubmed-73703532020-07-20 Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study Joseph, Nicholos P. Reid, Nicholas J. Som, Avik Li, Matthew D Hyle, Emily P. Dugdale, Caitlin M. Lang, Min Betancourt, Joseph R. Deng, Francis Mendoza, Dexter P. Little, Brent P. Narayan, Anand K. Flores, Efren J. Radiology Thoracic Imaging BACKGROUND: Disease severity on chest radiographs (CXR) has been associated with higher risk of disease progression and adverse outcomes from COVID-19. Few studies have evaluated COVID-19-related racial/ethnic disparities in radiology. PURPOSE: To evaluate whether Non-White minority patients hospitalized with confirmed COVID-19 infection presented with increased severity on admission CXR compared with White/Non-Hispanic patients. METHODS: Single-institution, retrospective cohort study approved by the IRB. Patients hospitalized with confirmed COVID-19 infection (3/27/20-4/10/20) were identified using the electronic medical record (EMR) (n=326, mean age: 59 years (SD: 17 years), M:F (188:138). Primary outcome was severity of lung disease on admission CXR, measured by modified Radiographic Assessment of Lung Edema (mRALE) score. Secondary outcome was a composite adverse clinical outcome of intubation, ICU admission, or death. Primary exposure was racial/ethnic category: White/Non-Hispanic versus Non-White [i.e., Hispanic, Black, Asian, Other]. Multivariable linear regression analyses were performed to evaluate the association between mRALE scores and race/ethnicity. RESULTS: Non-White patients had significantly higher mRALE scores (median 6.1, 95% CI 5.4–6.7) compared with White/Non-Hispanic patients (median 4.2, 95% CI 3.6–4.9) (unadjusted average difference 1.8, 95% CI 0.9–2.8, p<0.01). For both White (Adjusted HR, 1.3, 95%CI 1.2-1.4, p<0.001) and Non-White patients (Adjusted HR 1.2, 95%CI 1.1-1.3, p<0.001), increasing mRALE scores were associated with a higher likelihood of experiencing composite adverse outcome with no evidence of interaction (p = 0.16). Multivariable linear regression analyses demonstrated that Non-White patients presented with higher mRALE scores on admission CXR versus White/Non-Hispanic patients (adjusted average difference 1.6, 95% CI 0.5–2.7, p<0.01). Adjustment for hypothesized mediators revealed that the association between race/ethnicity and mRALE scores was mediated by limited English proficiency (p<0.01). CONCLUSION: Non-White patients hospitalized with COVID-19 infection were more likely to present with higher severity of disease on admission CXR than White/Non-Hispanic patients, and increased severity was associated with worse outcomes for all patients. Radiological Society of North America 2020-07-16 /pmc/articles/PMC7370353/ /pubmed/32673191 http://dx.doi.org/10.1148/radiol.2020202602 Text en 2020 by the Radiological Society of North America, Inc. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. |
spellingShingle | Thoracic Imaging Joseph, Nicholos P. Reid, Nicholas J. Som, Avik Li, Matthew D Hyle, Emily P. Dugdale, Caitlin M. Lang, Min Betancourt, Joseph R. Deng, Francis Mendoza, Dexter P. Little, Brent P. Narayan, Anand K. Flores, Efren J. Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study |
title | Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study |
title_full | Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study |
title_fullStr | Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study |
title_full_unstemmed | Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study |
title_short | Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study |
title_sort | racial/ethnic disparities in disease severity on admission chest radiographs among patients admitted with confirmed covid-19: a retrospective cohort study |
topic | Thoracic Imaging |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370353/ https://www.ncbi.nlm.nih.gov/pubmed/32673191 http://dx.doi.org/10.1148/radiol.2020202602 |
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