Who gets hospitalized for Covid-19? Report shows differences by race and sex

The first federal report on who requires hospital care for Covid-19 in the U.S. has found that more men than women have been hospitalized for the disease, and that African Americans disproportionately need hospital care.

An analysis published Wednesday by the Centers for Disease Control and Prevention includes hospitalization data from a surveillance network tracking Covid-19 in 14 states —  covering roughly 10% of the U.S. population — including statistics by race and sex. Reports from a small number of cities and states have suggested that the new disease is affecting Black Americans especially hard, prompting doctors, lawyers, public health officials, and lawmakers to call for a national breakdown of cases by race and ethnicity so that medical care can be matched to the greatest need.

The new findings are consistent with those earlier localized reports, as well as data from other countries on who is most at risk. But this CDC report, which stratifies hospital patients by sex and race, represents the first epidemiological evidence from U.S. health officials of what others have observed. 

In March, the CDC found, older people and those who had one or more chronic conditions — such as obesity, lung disease, high blood pressure, another cardiovascular disease, or diabetes — were more likely to be admitted to a hospital. 

When the researchers parsed the data further, they found disparities among the 1,482 people whose Covid-19 infection was confirmed by laboratory tests. While 49% were male and 51% female, those admitted to the hospital were split less evenly. Men made up 54% of the hospitalizations and women made up 46%, reflecting earlier case reports from China, Italy, and South Korea.

As for race and ethnicity, a deeper divide appeared: 18% of people in the study were Black and 14% Hispanic, but among the 580 hospitalized patients whose race or ethnicity was charted, 33% were Black and 8% were Hispanic, “suggesting that black populations might be disproportionately affected by COVID-19,” the researchers wrote. They cautioned that their findings on the potential impact by sex and race need to be confirmed with more data.

“This virus is exposing a lot of holes and gaps in our ability to deliver care,” Taison Bell, a physician who specializes in critical care and infectious diseases at the University of Virginia, told STAT. 

Bell said he’s been frustrated by the incomplete data on race, as evidenced by the majority of patients whose race wasn’t available for the CDC report. He compared the need for accurate data collection to the need to find ventilators for patients and personal protective equipment for their caregivers. “Getting accurate data is just as important as your logistics because the hospitals and agencies can plan more effectively for their surges when they know where the cases are and if they’re in certain communities.”

Cities and states have been releasing their own numbers showing racial disparities over recent days. In Chicago, more than half of the people who tested positive for Covid-19 and nearly three-quarters of those who died are African American, yet they make up less than one-third of the city’s population. In Illinois as a whole, 43% of people with confirmed Covid-19 and 28% of those who died are African American, although they account for only 15% of the state’s population.

In North Carolina, South Carolina, Michigan, Connecticut, and Louisiana, there’s a similar imbalance in who has fallen ill and died. 

Structural inequalities in income, housing, jobs, and health care contribute to the racial disparity, health experts say. A review of billing data by Rubix Life Sciences found that patients with possible Covid-19 symptoms were less likely to be tested if they were African American.

On Monday, the Lawyers’ Committee for Civil Rights Under Law demanded that the U.S. Department of Health and Human Services make public information on who’s being affected by the pandemic, citing civil rights law and the Affordable Care Act’s provisions barring discrimination in health care. On Tuesday, physician groups spearheaded by the American Medical Association called on the federal agency to collect, analyze, and report information on Covid-19 by race and ethnicity, saying “these data are essential to understanding the unique challenges and inequities facing communities of color.”

At a White House briefing Wednesday, Vice President Mike Pence said the Coronavirus Task Force has asked CDC to assemble data on “the unique impact that we’re seeing reported on African Americans from the coronavirus.” 

Asked by a reporter why the CDC wasn’t gathering racial data and responding to it, Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, acknowledged that African Americans have a greater proportion of the underlying conditions that heighten their risk for serious Covid-19 illness. 

“We are not going to solve the issues of health disparities this month or next month. This is something we should commit ourselves for years to do. But what we can do now, today, is to prevent people who are put at higher risk, because of the demographic group, from getting into a situation which is much more deleterious than the general population,” he said. “We want to double down and say to the young people, to the elderly people in that community, to please try as best as you can to protect yourself, if you’re a younger person, and to please protect the people who are susceptible.” 

The higher rate of men being hospitalized wasn’t discussed during the White House briefing, but the CDC data mirror early reports from the first pandemic hot spot in Wuhan, China, and more recent data from current hot spot New York City. Almost twice as many men as women are dying of Covid-19, according to city figures. But no one knows why. So far, scientists can only speculate about men smoking more, women having stronger immune systems, or some other as-yet unknown biological difference in lung function.

Bell, who directs the medical intensive care unit at the University of Virginia, said the need for more complete demographic information is not new. He cited a 1999 Morbidity and Mortality Weekly Report — the same publication that released Wednesday’s first U.S. hospitalization numbers for Covid-19 — that called for improved collection of disease data by race and ethnicity.

“Twenty years later, that’s unacceptable to me,” he said. “I recognize that it is hard to get accurate data, but it needs to be done. That it’s hard, in my opinion, is not good enough to justify not having it done at this point.”