Racial Disparities in COVID-19 Outcomes Among Black and White Patients With Cancer
Authors: Julie Fu, Sonya A. Reid, Benjamin French, Cassandra Hennessy, Clara Hwang, Na Tosha Gatson, Narjust Duma, Sanjay Mishra, Ryan Nguyen, Jessica E. Hawley, Sunny R. K. Singh, David D. Chism, Neeta K. Venepalli, Jeremy L. Warner, Toni K. Choueiri, Andrew L. Schmidt, Leslie A. Fecher, Jennifer E. Girard, Mehmet A. Bilen, Deepak Ravindranathan, Sharad Goyal, Trisha M. Wise-Draper, Cathleen Park, Corrie A. Painter, Sheila M. McGlown, Gilberto de Lima Lopes, Oscar K. Serrano, Dimpy P. Shah, Balazs Halmos, Amit K. Verma, Benjamin A. Gartrell, Sanjay Goel, Nitin Ohri, R.Alejandro Sica, Astha Thakkar, Keith E. Stockerl-Goldstein, Omar Butt, Jian L. Campian, Mark A. Fiala, Ryan Monahan, Alice Y. Zhou, Jaymin M. Patel, Andrew J. Piper-Vallillo, Poorva Bindal, Michael A. Thompson, Pamela Bohachek, Daniel Mundt, Mitrianna Streckfuss, Eyob Tadesse, Philip E. Lammers, Orestis A. Panagiotou, Pamela C. Egan, Dimitrios Farmakiotis, Hina Khan, Adam J. Olszewski, Arturo Loaiza-Bonilla, Salvatore A. Del Prete, Anne H. Angevine, Michael H. Bar, Anthony P. Gulati, K. M. Steve Lo, Jamie Stratton, Paul L. Weinstein, Paolo F. Caimi, Jill S. Barnholtz-Sloan, Jorge A. Garcia, John M. Nakayama, Shilpa Gupta, Nathan A. Pennell, Manmeet S. Ahluwalia, Scott J. Dawsey, Christopher A. Lemmon, Amanda Nizam, Claire Hoppenot, Ang Li, Ziad Bakouny, Gabrielle Bouchard, Fiona J. Busser, Jean M. Connors, Catherine R. Curran, George D. Demetri, Antonio Giordano, Kaitlin Kelleher, Anju Nohria, Grace Shaw, Eli Van Allen, Pier Vitale Nuzzo, Vincent Xu, Rebecca L. Zon, Tian Zhang, Susan Halabi, John C. Leighton, Gary H. Lyman, Jerome J. Graber, Petros Grivas, Ali Raza Khaki, Elizabeth T. Loggers, Ryan C. Lynch, Elizabeth S. Nakasone, Michael T. Schweizer, Lisa Tachiki, Shaveta Vinayak, Michael J. Wagner, Albert Yeh, Minh-Phuong Huynh-Le, Lori J. Rosenstein, Peter Paul Yu, Jessica M. Clement, Ahmad Daher, Mark Dailey, Rawad Elias, Asha Jayaraj, Emily Hsu, Alvaro G. Menendez, Joerg Rathmann, Shirish M. Gadgeel, Dawn Hershman, Melissa K. Accordino, Divaya Bhutani, Gary K. Schwartz, Daniel Y. Reuben, Sarah Mushtaq, Eric H. Bernicker, John Deeken, Danielle Shafer, Mark A. Lewis, Terence D. Rhodes, David M. Gill, Clarke A. Low, Sandeep H. Mashru, Abdul-Hai Mansoor, Howard A. Zaren, Stephanie J. Smith, Gayathri Nagaraj, Mojtaba Akhtari, Eric Lau, Mark E. Reeves, Stephanie Berg, Destry Elms, Alicia K. Morgans, Firas H. Wehbe, Jessica Altman, Michael Gurley, Mary F. Mulcahy, Eric B. Durbin, Amit A. Kulkarni, Heather H. Nelson, Surbhi Shah, Rachel P. Rosovsky, Kerry Reynolds, Aditya Bardia, Genevieve Boland, Justin Gainor, Leyre Zubiri, Thorvardur R. Halfdanarson, Tanios Bekaii-Saab, Aakash Desai, Zhuoer Xie, Ruben A. Mesa, Mark Bonnen, Daruka Mahadevan, Amelie G. Ramirez, Mary Salazar, Pankil K. Shah, Bryan Faller, Rana R. McKay, Archana Ajmera, Angelo Cabal, Justin A. Shaya, Lisa B. Weissmann, Chinmay Jani, Jeanna Knoble, Mary Grace Glace, Cameron Rink, Karen Stauffer, Rosemary Zacks, Monika Joshi, Harry Menon, Marc A. Rovito, Elizabeth A. Griffiths, Amro Elshoury, Salma K. Jabbour, Mansi R. Shah, Babar Bashir, Christopher McNair, Sana Z. Mahmood, Vasil Mico, Chaim Miller, Andrea Verghese Rivera, Daniel B. Flora, Barbara B. Logan, Goetz Kloecker, Chaitanya Mandapakala, Sumit A. Shah, Elwyn C. Cabebe, Michael J. Glover, Alokkumar Jha, Lidia Schapira, Julie Tsu-Yu Wu, Suki Subbiah, Sanjay G. Revankar, Daniel G. Stover, Daniel Addison, James L. Chen, Margaret E. Gatti-Mays, Sachin R. Jhawar, Vidhya Karivedu, Maryam B. Lustberg, Joshua D. Palmer, Clement Pillainayagam, Sarah Wall, Nicole Williams, Elizabeth Wulff-Burchfield, Anup Kasi, Natasha Edwin, Melissa Smits, Susie Owenby, Deborah B. Doroshow, Matthew D. Galsky, Michael Wotman, Huili Zhu, Alyson Fazio, Jonathan Riess, Kanishka G. Patel, Samuel M. Rubinstein, William A. Wood, Jessica Yasmine Islam, Vaibhav Kumar, Syed A. Ahmad, Punita Grover, Shuchi Gulati, Jordan Kharofa, Michelle Marcum, Daniel W. Bowles, Christoper L. Geiger, Merry-Jennifer Markham, Rohit Bishnoi, Atlantis D. Russ, Chintan Shah, Jared D. Acoba, Young Soo Rho, Lawrence E. Feldman, Kent F. Hoskins, Gerald Gantt, Mahir Khan, Mary Pasquinelli, Candice Schwartz, Praveen Vikas, Christopher R. Friese, Blanche H. Mavromatis, Ragneel R. Bijjula, Qamar U. Zaman, Alex Cheng, Elizabeth J. Davis, Stephany N. Duda, Kyle T. Enriquez, Erin A. Gillaspie, Daniel Hausrath, Chih-Yuan Hsu, Douglas B. Johnson, Xuanyi Li, Brian I. Rini, David A. Slosky, Yu Shyr, Carmen C. Solorzano, Tianyi Sun, Matthew D. Tucker, Karen Vega-Luna, Lucy L. Wang, Matthew Puc, Theresa M. Carducci, Karen J. Goldsmith, Susan Van Loon, Umit Topaloglu, Saif I. Alimohamed, Robert L. Rice, Wilhelmina D. Cabalona, Christine Pilar, Prakash Peddi, Lane R. Rosen, Briana Barrow McCollough, Navid Hafez, Roy Herbst, Patricia LoRusso, Tyler Masters, Catherine Stratton, Vadim S. Koshkin, Daniel H. Kwon, Solange Peters
Journal: JAMA Network Open (2022)

<h3>Importance</h3> 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. <h3>Objective</h3> 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. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Black and White race recorded in patient's electronic health record. <h3>Main Outcomes and Measures</h3> An a priori 5-level ordinal scale including hospitalization intensive care unit admission, mechanical ventilation, and all-cause death. <h3>Results</h3> 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]). <h3>Conclusions and Relevance</h3> 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.