Selby Johnson, MD
Anesthesiology Critical Care Fellow
Duke University Medical Center
Durham, North Carolina
Disclosure information not submitted.
Zachary Frere
Biostatistician
Duke University
Durham, North Carolina, United States
Disclosure information not submitted.
Matthew Fuller, MA, MS
Biostatistician
Duke University
Durham, North Carolina, United States
Disclosure information not submitted.
Tetsu Ohnuma, MD, PhD
Assistant Professor of Anesthesiology
Duke University
Durham, North Carolina, United States
Disclosure information not submitted.
Vijay Krishnamoorthy, MD, PhD
Assistant Professor of Surgery
Duke University, United States
Disclosure information not submitted.
Raquel Bartz, MD, MMCi
Co-director of Surgical Intensive Care Unit, Associate Professor of Anesthesiology
Duke University
Durham, North Carolina, United States
Disclosure information not submitted.
Karthik. Raghunathan, MD, MPH
Associate Professor of Anesthesiology
Duke University Hospital, United States
Disclosure information not submitted.
Title: Unexpected Racial/Ethnic Inequity in Medication Use for Adults Hospitalized with COVID-19 Infection
Introduction: Although minorities have higher rates of COVID-19-related hospitalizations, discharge rates do not differ across race/ethnicity. In this study we examine medication use in critically ill patients for possible racial/ethnic inequities.
Methods: With Premier Healthcare Database (PHD), adult critically ill patients discharged between April and June, 2020 with an ICD-10-CM diagnosis code U07.1 were grouped based on race/ethnicity as Black, White, or other, and Hispanic, non-Hispanic, or undefined. Remdesivir, adjuncts, and repurposed treatments were identified using hospital charges. We also examined age, gender, payer, the vanWallraven score, and hospital characteristics. Using a multivariable mixed logistic regression model, we estimated odds of medication use in various racial/ethnic groups (versus non-Hispanic White patients) adjusted for the characteristics listed above and for clustering of treatments (individual hospitals treated as random effects). Intraclass correlation coefficient was used to quantify between versus within hospital variation. We used similar models to estimate the odds of use of adjuncts, repurposed treatments, or remdesivir alone.
Results: The majority of the 14,745 adults from 438 hospitals, were non-Hispanic White patients, median 70 years old, and hospitalized in smaller non-teaching but were also less likely to receive medications than other racial/ethnic groups. The multivariable model odds [95% CI] of receiving medications was higher in non-Hispanic Black (1.29, [1.14-1.47]), non-Hispanic Other (1.41, [1.20-1.66]), Hispanic Other (1.69, [1.44-1.99]), and Hispanic White patients (1.76, [1.46-2.13]). Sensitivity analyses showed consistency without significant clustering of treatment (except for remdesivir where ICC was over 50%).
Conclusion: Minority patients were more likely to receive COVID-19 treatments in the ICU. Inequitable medication use does not translate into differences in mortality because certain drugs used early in the pandemic were ineffective. Our analyses are likely confounded by a lack of information on the more proximal determinants of medication use in critically ill patients in addition to missingness of data. More study is needed to understand whether there was actual equity in treatment once patients were hospitalized.