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Since the beginning of the pandemic, black patients have accounted for a disproportionately high proportion of COVID-19 deaths.
Many studies have investigated the reasons behind this racial difference, but a new Pennsylvania medical study has shown for the first time that if black patients get more access to better-performing hospitals, their mortality will decrease.
Researchers from Perelman School of Medicine and OptumLabs, a unit of UnitedHealth Group, analyzed the data of 44,217 Medicare patients who were hospitalized with COVID-19 between January 1 and September 21, 2020. The data includes patient states and Washington, D.C., admitted to 1,188 of 41 hospitals.
The researchers’ findings are published in JAMA Internet Open, Confirming that the mortality rate of black patients is higher than that of white patients. But they also found that black patients tend to go to poorly performing hospitals.
The study concluded that if there were more opportunities to enter better-performing hospitals, the mortality rate of black patients would be reduced by 10%—lower than that of white patients.
“We found that it’s not that the hospital treats black and white patients differently,” Ash said in an interview with PhillyVoice. “This is a hospital where black patients are going to perform poorly.”
A study by the University of Pennsylvania found that the COVID-19 mortality rate among white patients was 12.9%. For black patients, this ratio is 13.5%.
Part of the difference in mortality is due to the lower income levels of black patients and the higher incidence of chronic health problems. Dr. David Asch, executive director of the Penn Medicine Healthcare Innovation Center, told PhillyVoice.
In previous studies, once researchers made statistical adjustments to these characteristics, black and white patients would get similar results. But in the University of Pennsylvania study, after making these adjustments, black patients are still 11% more likely to die than white patients. The remaining differences are mainly due to the hospitals that treat black and white patients.
In the published paper, the researchers emphasized, “Even if statistical adjustments to patient characteristics explain the racial differences in the results, if these factors are too high in the black population due to the power of racism, they cannot be an excuse. “
Researchers at the University of Pennsylvania conducted simulations and found that if black patients and white patients were admitted to the same hospital, their COVID-19 mortality rate would drop to 12.2%.
Dr. Rachel Warner, executive director of the Leonard Davis Institute for Health Economics at the University of Pennsylvania, said: “It is generally believed that the difference in mortality between blacks and whites is due to the higher incidence of chronic health conditions in black individuals.” But time and time again, studies have shown that where black patients get treatment is more important, and if you consider where people are hospitalized, the difference in mortality will disappear.”
Researchers said that the root cause of the inability to enter high-performance hospitals lies in historical injustice. Their findings highlight the long-term effects of apartheid in the United States.
Red lineIt is a form of loan discrimination where banks refuse to provide loans to people of color. This practice has been implemented for decades. Discriminatory practices limit their ability to rent and own houses and become upwardly mobile.
Experts say that the 1968 Fair Housing Act made the red line illegal, but its impact can still be felt today. A recent study found that three-quarters of redline communities still face financial difficulties, including lack of access to social resources such as medical care.
Asch compared the funding gap in hospitals with the gap in education. Affluent communities tend to have better-performing schools and hospitals.
“In poorly performing hospitals, more patients are uninsured or covered by medical insurance, so the hospital has fewer funds and fewer available resources,” Ash said. He added that policies need to be changed so that hospitals do not rely so much on local resources to maintain quality.
Researchers at the University of Pennsylvania have previously found that in communities with high coronavirus cases, hospital mortality rates are higher.
“This shows that the hospital is nervous about the level of the virus in the surrounding communities,” Ash said. The survival ability of a person after hospitalization depends in part on the burden of disease in the community.
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