Black patients with cancer face worse COVID outcomes: study
by Tom Wilemon
Black patients with cancer experienced significantly worse outcomes after COVID-19 diagnosis than non-Hispanic white cancer patients in a study published March 28 in JAMA Network Open.
Investigators of the COVID-19 and Cancer Consortium, which includes more than 125 cancer centers and other organizations, studied the electronic health records of 3,506 patients for the analysis, including data of 1,068 Black patients and 2,438 non-Hispanic white patients.
Black patients had a 17% mortality rate 30 days after diagnosis compared to 13% for non-Hispanic whites. The investigators found that Black patients had worse preexisting comorbidities, severity of COVID-19 at presentation and outcomes. Black patients had worse outcomes even when cancer status and cancer treatments were similar between the two groups.
“We saw that Black patients with cancer and COVID-19 infection are facing a disproportionately higher burden of COVID-19 complications and death,” said Sonya Reid, MD, MPH, assistant professor of Medicine at Vanderbilt-Ingram Cancer Center, who was a lead author of the study. “This is unfortunately very similar to what we have seen with racial disparities in cancer outcomes. We now have to prioritize addressing the root causes of health disparities in order to achieve equitable care for all patients.”
Preexisting comorbidities, including obesity and diabetes, are associated with increased risk for severity of disease in COVID-19 patients. Among the study group, 45% of Black patients were obese compared to 38% for non-Hispanic whites, while 38% of Black patients were diabetic compared to 24% for non-Hispanic whites.
“We saw worse COVID-19 illness at presentation, higher rates of hospitalization, higher rates of intensive care unit admission, higher rates of mechanical ventilation and worse death rates in Black patients compared to non-Hispanic white patients, even after making the two groups comparable in terms of type, status and treatment of cancer by statistical analysis methods,” said senior and corresponding author Dimpy Shah, MD, PhD, assistant professor of population health sciences at The University of Texas Health Science Center at San Antonio.
A framework of structural racism in the U.S. can explain the increased COVID-19 burden in Black patients, Shah and her co-authors wrote. Structural racism refers to the ways in which societies reinforce systems of health care, law enforcement, education, employment, benefits, media and housing, perpetuating discriminatory distribution of resources and attitudes, the authors wrote, citing a 2017 article by ZD Bailey, et al.
“Race in medicine is largely a social construct because the majority of differences in health outcomes between Black patients and white patients are due to systematic racialization,” Shah said. “Some of the societal root causes of health disparities, including lack of access to health care, social determinants of health, preexisting comorbidities and access to clinical research, are common to both cancer and COVID-19, and together these two diseases create a perfect storm.”
The researchers also noted differences in COVID-19 treatments provided to the two groups. Hydroxychloroquine was prescribed more in Black patients, and white patients had higher administration of remdesivir.
Remdesivir is an antiviral drug approved by the U.S. Food and Drug Administration (FDA) to treat COVID-19 in adults and children 12 and older. Hydroxychloroquine, meanwhile, is a malaria drug. The FDA withdrew emergency use authorization of it after data indicated it is not effective in treating the coronavirus.
Although Black individuals represent 13% of the U.S. population, they account for 20% of COVID-19 cases and 23% of COVID-related deaths, the study authors noted.
Disparity is also seen in cancer epidemiology. The cancer burden is greater in Black individuals (461 new cancer cases per 100,000) than in white individuals (445 new cancer cases per 100,000). Mortality in Black individuals is higher (174 deaths per 100,000) than in white individuals (152 deaths per 100,000). This is a 15% difference in the cancer-associated death rate in Black patients compared to non-Hispanic 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 and other minorities,” the authors concluded.
Other Vanderbilt authors on the study included Benjamin French, PhD, Cassandra Hennessy, MS, Sanjay Mishra, PhD, and Jeremy Warner, MD, MS.
Analysis on behalf of the Consortium is facilitated by the Research Coordinating Center at Vanderbilt University Medical Center, which is supported by supplemental funding to the Cancer Center Support Grant of the Vanderbilt-Ingram Cancer Center, an NCI-Designated Comprehensive Cancer Center.