AHA 2020: AHA COVID Registry Sheds Light on Pandemic’s Impact on Racial Minorities

Two presentations on the American Heart Association COVID Registry shared data about COVID-19 hospitalizations collected from over 100 hospitals.

Two late-breaking sessions on the American Heart Association COVID Registry presented today provided an overview of the design and initial results from the registry, as well as revealed deeper insights into impacts of the pandemic on underrepresented racial minority groups.

Both sessions were shared virtually at the American Heart Association Scientific Sessions 2020. The overview of initial results was presented by James de Lemos, MD, of UT Southwestern. The other presentation, which pulled data from the registry and was titled “Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19,” was presented by Fatima Rodriguez, MD, MPH, of Stanford University. As a member of the registry’s steering committee, the DCRI’s Tracy Wang, MD, MHS, MSc, was a collaborator on both presentations. For the presentation on racial and ethnic differences, which was published simultaneously in Circulation, she also served as senior author.

The AHA COVID Registry was launched in response to the COVID-19 pandemic with a goal of developing a better understanding of how hospitals were treating patients, even as clinical trials were ongoing to determine the best treatment options. The design and implementation processes were rapid, taking about half the time that setup of a clinical registry normally would, Wang said. Hospitals—both academic and non-academic—joined on a voluntary basis, and now more than 100 hospitals are part of the registry.

“Even though hospitals are overburdened with the actual care of COVID-19 patients, they are still eager for opportunities like this where they can learn from their own data and from one another,” Wang said.

The DCRI was the data analytics center for the racial/ethnicity disparities project, just as it is for other AHA Get With The Guidelines registries.

One of the key findings from the initial results presented by de Lemos is that the mortality rate for hospitalized COVID-19 patients is high—about 18 percent.

A Disproportionate Burden

Rodriguez, Wang, and colleagues examined the initial registry data to determine representation and outcomes of Black, Hispanic, and Asian patients in comparison to white patients.

Black and Latino patients are experiencing a disproportionately high number of COVID-19 hospitalizations in proportion to their representation in the population. When the team compared census data to hospitalization rates, they found that Black and Hispanic people make up only 20 percent of the population around participating hospitals, but 58 percent of COVID-19 patients admitted to these hospitals.

Black and Hispanic patients are also being hospitalized at much younger ages (average ages of 57 and 60 for Hispanic and Black, as compared to the average age of 69 for white patients). This is partially due to increased prevalence of comorbidities in Hispanic and Black patients, which may make them more susceptible to severe cases of COVID-19.

When all factors are adjusted, the mortality rates for Black and Hispanic patients are not significantly different from the mortality rates for white patients. However, Black and Hispanic patients represent over half of those who died—a measure disproportionately beyond their proportion of the population. One explanation for the similar in-hospital outcomes is the much younger age of Black and Hispanic patients.

Asian patients, too, are faring worse than white patients. Their average age of hospitalization is 64, and data show that of all the groups, they take the longest to come to the hospital, meaning that they wait longer for diagnosis and may be sicker when admitted. Asian patients are more likely to have greater disease severity than white patients.

Tracy Wang

“These findings show us that we have to work on eliminating disparities upstream from hospitalization,” Wang said. “Once we reach the hospitalization stage, it is too late, as nearly one in five patients are likely to die.”

One strategy for helping to alleviate disparities, Wang suggested, is to provide more testing to these groups. Many of the patients in the Black, Hispanic, and Asian populations received their first COVID-19 diagnosis at the hospital, meaning that they were not getting tested when they felt ill.

One effort that seeks to fill this testing gap is an NIH-funded program, RADx-UP, which seeks to increase testing and future vaccine uptake in historically marginalized populations. The DCRI is one of the institutions serving as the data and coordinating center for this initiative.