Racial Disparities in Death Due to SARS-CoV-2 in the United States: An Analysis of the OPTN Database

PURPOSE: Racial disparities in severe acute respiratory syndrome coronavirus 2 (COVID) incidence and mortality have been demonstrated in the United States (U.S.). Transplant recipients represent a particularly vulnerable population given their comorbidities and immunosuppression. With this in mind, we aimed to evaluate the relationship between race and mortality due to COVID in lung transplant recipients. METHODS: Adult lung transplant recipients in the U.S. were identified using the Organ Procurement and Transplantation (OPTN) database. Multiorgan transplants and patients transplanted after December 31, 2020 were excluded. Recipients who were deceased or lost to follow-up prior to January 2020 were excluded as they were not at risk for death due to COVID. Lung transplant recipients were stratified by race (Black, Hispanic, White, and other race). Death due to COVID was the primary outcome while all-cause mortality and non-COVID mortality were secondary outcomes. Student's t-test, Chi-square test, and Cox proportional hazards models were used for comparisons. RESULTS: 17,198 recipients met inclusion criteria (1,598 Black, 1,353 Hispanic, 13,755 White, and 492 other race). 231 (1.34%) deaths due to COVID were reported. COVID mortality rate was significantly different (p=0.001) by race, being lowest in White recipients (n=162 [1.18%]) and highest in Hispanic recipients (n=30 [2.22%]). Non-COVID mortality was lowest in Hispanic recipients (n=129 [9.53%]) and highest in Black recipients (n=236 [14.77%]; p=0.008). There was no significant difference in all-cause mortality (p=0.054). After adjustment, Hispanic (HR=2.18; p=0.005) recipients experienced higher rates of mortality due to COVID compared to whites, but no significant difference in Black recipients (HR=1.73; p=0.066). See table 1 for additional predictors of death due to COVID. CONCLUSION: Racial disparities in death due to COVID persist in U.S. lung transplant recipients, despite adjusting for social determinants of health.