Racial Disparities in COVID-19 Outcomes Among Black and White Patients With Cancer

Julie Fu, Department of Internal Medicine, Hematology-Oncology, Tufts Medical Center Cancer Center, Stoneham, Massachusetts.
Sonya A. Reid, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
Benjamin French, Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
Cassandra Hennessy, Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
Clara Hwang, Department of Internal Medicine, Division of Hematology-Oncology, Henry Ford Cancer Institute, Detroit, Michigan.
Na Tosha Gatson, Geisinger Health System, Danville, Danville, Pennsylvania.
Narjust Duma, Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts.
Sanjay Mishra, Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, Tennessee.
Ryan Nguyen, Department of Hematology and Oncology, University of Illinois, Chicago.
Jessica E. Hawley, Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York.
Sunny R. Singh, Department of Internal Medicine, Division of Hematology-Oncology, Henry Ford Cancer Institute, Detroit, Michigan.
David D. Chism, Thompson Cancer Survival Center, Knoxville, Tennessee.
Neeta K. Venepalli, Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill.
Jeremy L. Warner, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
Toni K. Choueiri, Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts.
Andrew L. Schmidt, Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts.
Leslie A. Fecher, Rogel Cancer Center, University of Michigan, Ann Arbor.
Jennifer E. Girard, Rogel Cancer Center, University of Michigan, Ann Arbor.
Mehmet A. Bilen, Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
Deepak Ravindranathan, Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
Sharad Goyal, Department of Radiation Oncology, George Washington University, Washington, DC.
Trisha M. Wise-Draper, Department of Internal Medicine, Division of Hematology-Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio.
Cathleen Park, Department of Hematology-Oncology, University of California, Davis.
Corrie A. Painter, Count Me In, Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
Sheila M. McGlown, Patient advocate.
Gilberto de Lima Lopes, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami, Florida.
Oscar K. Serrano, Department of Surgery, Hartford HealthCare Cancer Institute, Hartford, Connecticut.
Dimpy P. Shah, Population Health Sciences, Mays Cancer Center at University of Texas Health San Antonio MD Anderson, San Antonio.

Document Type

Journal Article

Publication Date

3-1-2022

Journal

JAMA network open

Volume

5

Issue

3

DOI

10.1001/jamanetworkopen.2022.4304

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.

Department

Radiology

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