Black cancer patients had worst COVID-19 outcomes
The coronavirus pandemic has revealed and widened health disparities among marginalized populations. Black people make up 13% of the US population, but they account for 20% of COVID-19 infections and 23% of COVID-19-related deaths.
Non-Hispanic black people have disproportionately high rates of COVID-19 infection, so a study is examining whether this was also true in black cancer patients. Comorbidities, such as cancer, increase the risk of serious illness and death for patients with COVID-19.
The retrospective cohort studypublished yesterday in JAMA, examined the clinical features and disease outcomes of COVID-19 in black patients with cancer. The study included black or white patients with a current or past cancer diagnosis who tested positive for COVID-19 from March 17 to November 18, 2020.
The primary outcome of the study was a 5-level ordinal scale of COVID-19 severity based on patients’ disease status. Levels include: 1. None of the complications listed here, 2. Admission to hospital, 3. Admission to intensive care unit, 4. Use of mechanical ventilation, and 5. Death from any cause.
Patient data was collected from the COVID-19 and Cancer Consortium (CCC19) registry. The cohort study included 3506 patients, 50% of whom were women and the average age was 67 years. Overall, 30% of patients (n=1038) were black and 70% (n=2438) were white.
Black patients had significantly higher rates of comorbidities at the time of COVID-19 diagnosis, including obesity, diabetes and kidney disease. After adjusting results for comorbidities, cancer type, cancer status, and cancer therapies at the time of COVID-19 diagnosis, investigators found that black patients had worse disease and had worse COVID-19 outcomes. significantly worse than white patients.
Black patients were more likely than white patients to have moderate (41% versus 34%) or severe (14% versus 11%) COVID-19 disease at diagnosis. Black cancer patients had higher rates of lung complications, acute kidney injury and cardiovascular complications. All-cause mortality was 19% in black patients and 17% in white patients.
“We have seen worse COVID-19 disease at presentation, higher hospitalization rates, higher intensive care unit admission rates, higher mechanical ventilation rates and worse death rates in black patients compared to non-Hispanic white patients, even after making the two groups comparable in terms of cancer type, status and treatment by statistical analysis methods,” said Dimpy Shah, MD, PhD, professor Population Health Science Assistant at the University of Texas Health Sciences Center at San Antonio and study author.
Notably, investigators have identified differences in the treatments given to black and white COVID-19 patients with cancer. Hydroxychloroquine was prescribed more to black patients, while white patients were more likely to receive remdesivir. Remdesivir is an antiviral widely indicated to treat COVID-19 in adults and children over 12, while hydroxychloroquine is a malaria drug. The United States Food and Drug Administration (FDA) has revoked its Emergency Use Authorization (EUA) for hydroxychloroquine to treat COVID-19 after data showed it was ineffective.
“Some of the societal root causes of health disparities, including lack of access to health care, social determinants of health, pre-existing comorbidities, and access to clinical research, are common to cancer and COVID -19, and together these two diseases create a perfect storm,” Shah said.