LAUSR

Study Objectives: During the COVID-19 pandemic Black, Indigenous, Hispanic and Asian (BIPOC) populations were nearly three times more likely to have died of COVID-19 than White patients. These disparate outcomes compound existing health disparities which result in BIPOC patients experiencing larger burdens of disease and decreased life expectancy. The objective of our study was to examine racial and ethnic disparities in hospitalization, medication usage, ICU admission and in-hospital mortality for COVID-19 patients within an integrated health care system in New York City (NYC). Methods: In this retrospective cohort study, we analyzed adult patients with lab-confirmed COVID-19 diagnosis within a large urban health system in NYC between February 28, 2020 and August 28, 2020. Primary outcome was the rate of admission from the ED. Secondary outcomes were differences in medication administration, admission to an intensive care unit (ICU), and in-hospital mortality. We utilized multivariable logistic regression to test for differences by race/ethnicity in the odds of our primary and secondary outcomes accounting for hospital-level clustering. Results: A total of 4,717 adult patients with a positive SARS-CoV-2 test in the ED or inpatient setting were included in the primary analysis;3,219 (68.2%) were admitted to an inpatient setting. Black patients were the largest group (29.1%), followed by Hispanic (29.0%), White (22.9%), Asian (3.86%) and patients of other race-ethnicity (19.0%). Black patients were overrepresented at the community site in Brooklyn, while Asian and Hispanic patients were overrepresented at the community site in Queens. Overall, White patients (24.3%) were disproportionately overrepresented among admitted patients. Hispanic patients had an overall significantly lower adjusted rate of inpatient admission compared to White patients (OR= 0.51, 95% CI 0.34 - 0.76). Black (OR= 0.60, 95% CI, 0.43 - 0.84) and Asian patients (OR= 0.47;95% CI 0.25 - 0.89) were overall less likely to be admitted to an ICU setting. There were lower odds of inpatient admission (OR=0.68, 95% CI 0.46-0.99) at the community site located in Queens, where Asian and Hispanic patients were over-represented. There was significantly higher mortality at the community-based sites in Brooklyn (OR=4.38, 95% CI 2.66 - 7.24) and Queens (OR= 2.96, 95% CI 2.12 - 4.14), where Black, Asian, and Hispanic patients were over represented. Conclusion: BIPOC patients accounted for a larger proportion of COVID patients seeking care in the ED compared to the demographic composition of NYC, but were less likely to be admitted to the ICU or hospitalized. Hospitals serving a high proportion of BIPOC patients had significantly higher mortality even within an integrated health system with shared resources. Limited capacity during the COVID-19 pandemic likely exacerbated preexisting health disparities among racial and ethnic minority groups.