Abstract S09-02: Outcomes by race for cancer patients hospitalized with SARS-CoV-2 infection
Authors: Chang Steven S. , Hwang Clara , Elshaikh Mohamed A. , Tang Amy , Neslund-Dudas Christine M. , Levin Albert M. , Poisson Laila M. , Rybicki Benjamin A. 
Published: December 2020

Purpose: Disparities in COVID-19 outcomes have been widely reported, with disproportionate negative impacts on the African American (AA) population. The purpose of this study was to evaluate the impact of race on COVID-19 outcomes for cancer patients hospitalized in a large Michigan health care system.

Methods: A cohort of hospitalized, laboratory-confirmed SARS-CoV-2 positive patients was identified through the Henry Ford Health System Institutional COVID prospective patient registry between March 1st–May 2020. Those with a diagnosis of cancer were identified using our institutional tumor registry and electronic health record (EHR). Patient self-reported race/ethnicity data were extracted from the system’s centralized EHR, as were other demographic and clinical covariates. Racial differences in cumulative incidence of mortality and hospital discharge were tested. To further evaluate the effect of race on the mortality, Fine-Gray competing-risks model was performed with discharge alive as a competing event. A P&lt;0.05 was considered statistically significant.

Results: Out of the 204 COVID+ cancer patients hospitalized in our health care system, 69.6% were AA (N=142). AA patients were slightly younger than non-AA patients (70.35 v. 74.58, p=0.023). No difference in mean BMI was detected (30.33 AA v. 29.87 non-AA, p = 0.68). A smaller proportion of AA patients had active cancer (36.6% v. 40.3%, p = 0.73). Outcomes were generally inferior in the AA cohort, although these differences were not statistically significant. The rate of ICU admission was 41.5% in AA and 37.1% in non-AA (p=0.659). 34.5% of AA patients required intubation compared to 25.8% of non-AA patients (p=0.288). In our model, older age was the only variable that significantly increased the risk of death (standard hazard ratio SHR 1.05, p = 0.002). The risk of death was higher for AA patients (SHR 1.92, p=0.068) and males (SHR 1.62, p = 0.078) but did not meet statistical significance.

Discussion: COVID-19 outcomes were worse in the AA cancer population, but these differences did not meet statistical significance. Inferior outcomes for AA cancer patients were seen despite younger age and a smaller proportion of patients with active cancer. Our analysis focused on hospitalized patients, which would tend to select patients with similar disease severity. Notably, AA patients were significantly over-represented in our cohort (70% of hospitalizations compared to 14% of Michigan population). Our results suggest that racial disparities in outcomes for cancer patients with a SARS-CoV-2 infection may exist, but further study of larger, less selected populations is needed.

Citation Format: Steven S. Chang, Clara Hwang, Mohamed A. Elshaikh, Amy Tang, Christine M. Neslund-Dudas, Albert M. Levin, Laila M. Poisson, Benjamin A. Rybicki. Outcomes by race for cancer patients hospitalized with SARS-CoV-2 infection [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S09-02.