Racial Disparities in COVID-19 Outcomes Among Black and White Patients With Cancer
Julie Fu, Sonya Reid, Benjamin French, Cassandra Hennessy, Clara Hwang, Na Tosha Gatson, Narjust Duma, Sanjay Mishra, Ryan Nguyen, Jessica E. Hawley, Sunny Singh, David D. Chism, Neeta K. Venepalli, Jeremy L. Warner, Toni K. Choueiri, Andrew Schmidt, Leslie A. Fecher, Jennifer Girard, Mehmet Asım Bilen, Deepak Ravindranathan, Sharad Goyal, Trisha M. Wise‐Draper, Cathleen Park, Corrie Painter, Sheila M. McGlown, Gilberto Lopes, Oscar K. Serrano, Dimpy P. Shah, Balázs Halmos, Amit Verma, Benjamin A. Gartrell, Sanjay Goel, Nitin Ohri, R. Alejandro Sica, Astha Thakkar, Keith Stockerl‐Goldstein, Omar H. Butt, Jian Campian, Mark A. Fiala, Ryan Monahan, Alice Y. Zhou, Jaymin Patel, Andrew J. Piper‐Vallillo, Poorva Bindal, Michael A. Thompson, Pamela Bohachek, Daniel Mundt, Mitrianna Streckfuss, Eyob Tadesse, Philip E. Lammers, Orestis A. Panagiotou, Pamela Egan, Dimitrios Farmakiotis, Hina Khan, Adam J. Olszewski, Arturo Loaiza‐Bonilla, Salvatore A. Del Prete, Anne H. Angevine, Michael Bär, Anthony P. Gulati, K. M. Steve Lo, Jamie Stratton, Paul L. Weinstein, Paolo F. Caimi, Jill S. Barnholtz‐Sloan, Jorge A. García, John Nakayama, Shilpa Gupta, Nathan A. Pennell, Manmeet S. Ahluwalia, Scott J. Dawsey, Christopher A. Lemmon, Amanda Nizam, Claire Hoppenot, Ang Li, Ziad Bakouny, Gabrielle Bouchard, Fiona Busser, Jean M. Connors, Catherine Curran, George D. Demetri, Antonio Giordano, Kaitlin M. Kelleher, Anju Nohria, Grace Shaw, Eli Van Allen, Pier Vitale Nuzzo, Vincent Xu, Rebecca L. Zon, Tian Zhang, Susan Halabi, John Leighton, Gary H. Lyman, Jerome Graber, Petros Grivas, Ali Raza Khaki, Elizabeth T. Loggers, Ryan C. Lynch, Elizabeth S. Nakasone, Michael T. Schweizer
Abstract
Importance: Non-Hispanic Black individuals experience a higher burden of COVID-19 than the general population; hence, there is an urgent need to characterize the unique clinical course and outcomes of COVID-19 in Black patients with cancer. Objective: To investigate racial disparities in severity of COVID-19 presentation, clinical complications, and outcomes between Black patients and non-Hispanic White patients with cancer and COVID-19. Design, Setting, and Participants: This retrospective cohort study used data from the COVID-19 and Cancer Consortium registry from March 17, 2020, to November 18, 2020, to examine the clinical characteristics and outcomes of COVID-19 in Black patients with cancer. Data analysis was performed from December 2020 to February 2021. Exposures: Black and White race recorded in patient's electronic health record. Main Outcomes and Measures: An a priori 5-level ordinal scale including hospitalization intensive care unit admission, mechanical ventilation, and all-cause death. Results: Among 3506 included patients (1768 women [50%]; median [IQR] age, 67 [58-77] years), 1068 (30%) were Black and 2438 (70%) were White. Black patients had higher rates of preexisting comorbidities compared with White patients, including obesity (480 Black patients [45%] vs 925 White patients [38%]), diabetes (411 Black patients [38%] vs 574 White patients [24%]), and kidney disease (248 Black patients [23%] vs 392 White patients [16%]). Despite the similar distribution of cancer type, cancer status, and anticancer therapy at the time of COVID-19 diagnosis, Black patients presented with worse illness and had significantly worse COVID-19 severity (unweighted odds ratio, 1.34 [95% CI, 1.15-1.58]; weighted odds ratio, 1.21 [95% CI, 1.11-1.33]). Conclusions and Relevance: These findings suggest that Black patients with cancer experience worse COVID-19 outcomes compared with White patients. Understanding and addressing racial inequities within the causal framework of structural racism is essential to reduce the disproportionate burden of diseases, such as COVID-19 and cancer, in Black patients.