Racial and Ethnic Differences in Fatality Risk From COVID-19

INTRODUCTION: Studies have reported higher infection and mortality rates from coronavirus disease 2019 (COVID-19) for disadvantaged groups in the U.S. population. However, racial and ethnic differences in fatality rates, which measure deaths among those infected, are not as clear. OBJECTIVES: The objectives were to (1) estimate the fatality rate after COVID-19 infection by racial and ethnic groups and (2) determine the extent preexisting health conditions account for differences in fatality rate between the racial and ethnic groups. METHODS: Data for all adults aged 18 and older (n = 24,834) who had a confirmed COVID-19 infection captured in the electronic health records (EHRs) of a major health care organization (HCO) from the beginning of the pandemic to March 28, 2021 were used to estimate the fatality rates for three racial and ethnic groups: Hispanic, non-Hispanic African American, and non-Hispanic White. Elixhauser's comorbidity index was calculated using the enhanced ICD-9-CM and the ICD-10 diagnosis codes. Logistic regression models were used to compare differences in fatality between racial and ethnic groups. Odds ratios and 95% confidence intervals were reported for all models. RESULTS: The age-specific fatality rates non-Hispanic White, non-Hispanic African American, and Hispanic groups were 0.23%, 1.05%, 0.55% for age group 18–59 years old; 2.44%, 4.50%, 5.28% for 60–69; 5.42%, 10.11%, 8.49% for 70–79, and 17.33%, 20.79%, 20.39% for 80–90. After adjusting for age, sex, and preexisting conditions, the fatality risk remains significantly higher for non-Hispanic African American (adjusted odds ratio [adj. OR] = 1.85, 95% CI 1.41–2.44) and Hispanic individuals (adj. OR = 1.91, 95% CI = 1.53–2.39) compared to non-Hispanic White individuals. CONCLUSION: Hispanic and non-Hispanic African American individuals have a higher risk of fatality from COVID-19 compared to non-Hispanic White individuals. The higher risk remains after adjusting for sex, age, and preexisting conditions. Health care providers could help to increase vaccination rates in these vulnerable populations by addressing the social and cultural barriers with their patients.