Personal care treatments

Black veterans hospitalized with COVID-19 are less likely to receive treatment than white veterans – Global Biodefense

Black veterans hospitalized with COVID-19 were less likely to receive evidence-based treatments than their white counterparts but did not have higher death or readmission rates, according to new research led by University of Pittsburgh School of Medicine doctors-researchers which was published today in Open JAMA Network.

The study, which looked at two years of data from 130 Department of Veterans Affairs Medical Centers (VAMC), found that treatment disparities were due to differences in care that occurred within and between hospitals. In other words, individual hospitals were providing different rates of treatment to their black and white patients, in addition to the differences in care between hospitals that treat a disproportionate number of black patients versus those that primarily treat white patients.

“Our study goes beyond demonstrating that there is a problem of racial disparities in COVID-19 medical care,” said lead author Alexander Castro, a fourth-year medical student at Pitt’s School of Medicine. “We outline where we need to focus our efforts to better understand why these racial disparities are happening and how we can counter them.”

The study looked at the records of 48,222 veterans – 28.1% Black – who had been hospitalized with COVID-19 at a VAMC between March 1, 2020 and February 28, 2022. Patients had a median age of 72 years and 94.2% were men.

Two-thirds of patients who needed respiratory support – either oxygen or mechanical ventilation – received systemic steroids, such as dexamethasone, which began being recommended in fall 2020 after a world trial determined that they improved the chances of survival for very sick COVID-19 patients. Black patients were 12% less likely to receive the drug than their white counterparts at the same VAMC hospital.

Similarly, black patients were 11% less likely to receive the antiviral remdesivir, which is recommended for most adults hospitalized with COVID-19 within a week of symptom onset. And they were 23% less likely to receive an immune-modulating drug, such as tocilizumab, which is recommended for moderately to severely ill hospitalized COVID-19 patients.

However, after adjusting for patient demographics, chronic health conditions, disease severity, and receipt of COVID-19 treatments, black and white patients had similar outcomes with respect to their likelihood. to die in hospital or be readmitted within 30 days.

The researchers said the lack of disparities in outcomes, despite the disparities in treatment, required further investigation and could not be explained by their study.

“We shouldn’t see racial disparities in treatment, even though those disparities may not lead to more deaths,” said co-author Florian Mayr, MD, MPH, assistant professor of critical care medicine at Pitt’s School of Medicine and intensive care VA Pittsburgh Health System. “When entire hospitals fail to provide evidence-based treatments, we can target hospital-wide interventions to address the problem. But addressing racial disparities in the delivery of care in hospitals requires a multi-layered approach”

Mayr said improvement efforts that could be considered include employing a more racially diverse mix of clinicians, which has been shown in studies to improve quality of care; field survey of physicians to better understand their treatment decisions; and examining whether devices such as thermometers and pulse oximeterswho studies have shown racial bias towards those with darker skin, could interfere with treatment decisions.

Additionally, VAMCs require clinicians to obtain consent to use various COVID-19 treatments before administering them. Mistrust of the medical community could skew consent to treatment and lead to some of the disparities, Mayr said.

The team noted that their study population was largely dominated by older men, so their results should not be extrapolated to hospitals that treat a younger population that includes more women, although these hospitals may use the study to trigger their own investigations.

“COVID-19 treatments aren’t the only example of racial disparities in care,” Castro said. “It occurs in sepsis, pneumonia, and nosocomial infections, among other measures. It’s a multi-faceted problem with no easy solutions, making it one of the toughest — and most important — questions facing clinical research.

This research was supported by National Institutes of Health grant K23GM132688 and VA Health Services Research and Development Service grant RES 13-457.

Variation in Clinical Treatment and Outcomes by Race Among U.S. Veterans Hospitalized with COVID-19. Open JAMA Network, October 25, 2022.