Study Finds Racial and Ethnic In-Hospital Mortality Disparities During Pandemic

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By Christopher Cheney

In a recent study of Medicare beneficiaries during the coronavirus pandemic, racial and ethnic disparities in mortality were found in COVID-19 hospitalizations and mortality disparities widened in non-COVID-19 hospitalizations.

Earlier U.S. research has documented racial and ethnic healthcare disparities during the pandemic. For example, an earlier study found that death rates linked to COVID-19 for Black and Hispanic populations have been about double the death rates for White populations.

The recent study, which was published by JAMA Health Forum, is based on an analysis of fee-for-service Medicare inpatient data for more than 31 million beneficiaries and more than 14 million hospitalizations from January 2019 through February 2021.

The study features several key data points:

  • Although in-hospital COVID-19 mortality was similar for Black and White patients, it was 3.5 percentage points higher for Hispanic patients and other racial and minority patients compared to White patients
  • For non-COVID-19 hospitalizations, in-hospital mortality for Black patients went up 0.5 percentage points higher than the increase for White patients
  • Unadjusted in-hospital mortality for COVID-19 hospitalizations was 16.6% for White patients, 17.0% for Black patients, 21.7% for Hispanic patients, and 21.0% for other racial and ethnic minority patients
  • In adjusted analyses, in-hospital mortality for non-COVID-19 Black patients increased 0.48 percentage points more than it increased for non-COVID-19 White patients
  • Non-COVID-19 hospitalizations for White patients decreased from 17.9 per 1,000 beneficiaries per month before the pandemic to 13.4 per 1,000 beneficiaries per month through February 2021, representing a 25.0% decrease
  • COVID-19 hospitalizations for White patients through February 2021 were 1.4 per 1,000 beneficiaries per month
  • Non-COVID-19 hospitalizations for Black, Hispanic, and other racial and ethnic minority patients through February 2021 decreased 22.9%, 30.6%, and 26.4%, respectively
  • COVID-19 hospitalizations for Black and Hispanic patients through February 2021 were 2.8 and 3.6 per 1,000 beneficiaries per month, respectively

“Among COVID-19 and non–COVID-19 hospitalizations, racial and ethnic disparities in mortality were evident. As the pandemic evolves, efforts to understand the sources of pandemic-associated disparities and to improve health equity are needed,” the study’s co-authors wrote.

The data shows three primary changes in hospital care linked to the pandemic, the study’s co-authors wrote:

  • Non-COVID-19 hospitalizations decreased sharply for all racial and ethnic groups, which is in line with other research that has shown decreased healthcare utilization during the pandemic.
  • Hispanic and other racial and ethnic minority patients experienced higher COVID-19 in-hospital mortality than White patients.
  • There were racial and ethnic disparities in non-COVID-19 in-hospital mortality during the pandemic. For example, Black patients experienced a nearly 0.5 percentage point differential increase in in-hospital mortality compared to White patients.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.