Racial/Ethnic Disparities in Post-acute Sequelae of SARS-CoV-2 Infection in New York: an EHR-Based Cohort Study from the RECOVER Program

Abstract

Abstract Background Compared to white individuals, Black and Hispanic individuals have higher rates of COVID-19 hospitalization and death. Less is known about racial/ethnic differences in post-acute sequelae of SARS-CoV-2 infection (PASC). Objective Examine racial/ethnic differences in potential PASC symptoms and conditions among hospitalized and non-hospitalized COVID-19 patients. Design Retrospective cohort study using data from electronic health records. Participants 62,339 patients with COVID-19 and 247,881 patients without COVID-19 in New York City between March 2020 and October 2021. Main Measures New symptoms and conditions 31–180 days after COVID-19 diagnosis. Key Results The final study population included 29,331 white patients (47.1%), 12,638 Black patients (20.3%), and 20,370 Hispanic patients (32.7%) diagnosed with COVID-19. After adjusting for confounders, significant racial/ethnic differences in incident symptoms and conditions existed among both hospitalized and non-hospitalized patients. For example, 31–180 days after a positive SARS-CoV-2 test, hospitalized Black patients had higher odds of being diagnosed with diabetes (adjusted odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.50—2.56, q<0.001) and headaches (OR: 1.52, 95% CI: 1.11—2.08, q=0.02), compared to hospitalized white patients. Hospitalized Hispanic patients had higher odds of headaches (OR: 1.62, 95% CI: 1.21—2.17, q=0.003) and dyspnea (OR: 1.22, 95% CI: 1.05—1.42, q=0.02), compared to hospitalized white patients. Among non-hospitalized patients, Black patients had higher odds of being diagnosed with pulmonary embolism (OR: 1.68, 95% CI: 1.20—2.36, q=0.009) and diabetes (OR: 2.13, 95% CI: 1.75—2.58, q<0.001), but lower odds of encephalopathy (OR: 0.58, 95% CI: 0.45—0.75, q<0.001), compared to white patients. Hispanic patients had higher odds of being diagnosed with headaches (OR: 1.41, 95% CI: 1.24—1.60, q<0.001) and chest pain (OR: 1.50, 95% CI: 1.35—1.67, q < 0.001), but lower odds of encephalopathy (OR: 0.64, 95% CI: 0.51—0.80, q<0.001). Conclusions Compared to white patients, patients from racial/ethnic minority groups had significantly different odds of developing potential PASC symptoms and conditions. Future research should examine the reasons for these differences.