Factors Contributing to Increased COVID-19 Risk in Blacks, Hispanics With Chronic Liver Diseases

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A team of investigators sought to determine the impact of social and economic inequities on racial and ethnic minority individuals with chronic liver disease and COVID-19.

Hispanic and non-Hispanic Black (NHB) individuals are disproportionately represented among patients with chronic liver diseases and coronavirus disease 2019 (COVID-19), with both groups having a lower household income and lower rates of private medical insurance, according to a study published in Gastroenterology.

An observational cohort study that included adult patients with chronic liver diseases and confirmed COVID-19 from 21 centers in the United States, as well as data on median income, poverty, and overcrowding from the US census, was conducted. Information on race and ethnicity was available for 879 patients: Hispanic (n=224 [25.5%]), non-Hispanic white (NHW, n=297 [33.8%]), NHB (n=276 [31.4%]), non-Hispanic Asian (n=44 [5.0%]), and non-Hispanic American Indian (n=11 [1.2%]).

Compared with the general population or patients with chronic liver diseases in 2 large national cohorts — the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS) — NHBs (P < .0001 for NHANES and NHIS) and Hispanics (P < .0001 for NHANES and P = .05 for NHIS) were disproportionately over-represented among patients with chronic liver diseases and COVID-19.

The investigators stratified the demographic and clinical features of patients with chronic liver diseases and COVID-19 by race/ethnicity. Hispanic patients with chronic liver diseases were found to be younger (P < .001) and were more likely to be female (P = .01). Diabetes was found to be more common in Hispanics (odds ratio [OR] 1.5 [1.1-2.1]), and hypertension was more prevalent in NHBs (OR 2.1 [1.5-2.9]). Rates of hospitalization were higher in Hispanic individuals compared with NHWs (OR 1.7 [1.2-2.4]).

The researchers also compared medical insurance status, housing status, and median household income among the race and ethnicity groups studied and found that patients with private insurance were less likely to be NHB or Hispanic compared with NHW (OR 0.5 [0.4-0.8] and OR 0.5 [0.3-0.7], respectively). Also, NHBs and Hispanics were found to have a higher odds of either having Medicare or Medicaid (OR 1.6 [1.1-2.2]) or being uninsured (OR 3.5 [1.5 – 8.2]).

The investigators found that patients who were living in multifamily housing units were more likely to be NHB (OR 2.3 [1.6-3.3]) or Hispanic (OR 2.8 [1.9-4.1]); NHWs were more likely to be living in single-family housing or nursing homes when they were diagnosed with COVID-19. Although Hispanics and NHBs were more likely to reside with 5 or more family members at home, complete data were not available for this variable. Hispanics were found to have higher odds of acquiring COVID-19 from a contact who was sick (P = .004).

NHBs and Hispanics lived in neighborhoods with a lower median household income compared with NHWs ($60K and $56K vs $70K, respectively; P < .001), a higher rate of poverty (P < .0001 for both), and overcrowding (P < .0001 for both).

The investigators noted that their study has limitations, including selection bias and missing data.

“Our study sheds light on important socioeconomic factors potentially contributing to the higher risk of COVID-19 in blacks and Hispanics,” stated the researchers. “Compared to NHWs, Hispanics had a higher prevalence of comorbidities like diabetes, hypertension, and obesity, but, conversely, were younger and had lower rates of known risk factors for COVID-19–related mortality like decompensated cirrhosis or alcohol use, which likely mitigated the adverse outcomes.”

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Adeniji N, Carr RM, Aby ES, Catana AM, Wegermann K, Dhanasekaran R. Socioeconomic factors contribute to the higher risk of COVID-19 in racial and ethnic minorities with chronic liver diseases (CLD). Gastroenterology. Published online November 20, 2 020. doi:https://doi.org/10.1053/ j.gastro.2020.11.035