Racial Disparities in the Incidence of Deep Venous Thrombosis and Pulmonary Embolism in COVID-19 Hospitalized Patients
Young Erben1, Christopher P. Marquez1, Mercedes Prudencio1, Susana Fortich1, Tania Gendron1, Devang Sanghavi1, Latonya Hickson1, Yupeng Li2, Michael A. Edwards1, Charles Ritchie1
1Mayo Clinic, Jacksonville, FL;2Rowan University, Glassboro, NJ
Objective: COVID-19 is associated with an increased risk of venous thromboembolic (VTE) events. The purpose of this study was to explore racial disparities in terms of the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hospitalized COVID-19 patients. Methods: A retrospective review of prospectively collected data on COVID-19 patients hospitalized at a tertiary referral center from 03/11/2020 to 05/27/2021 was performed. The primary outcome was incidence of DVT/PE according to race using the racial distribution noted in the demographic self-reported data entered by each patient when registering for care at our institution. The secondary outcomes included differences in hospitalization outcomes related to race. Multi-variable regression models were used to assess the risk of DVT/PE and acute kidney injury in vulnerable populations. Results: There were 876 hospitalized patients with COVID-19 infection at our tertiary referral center. 355 (40.5%) were female patients. Mean age at hospital admission was 64.4±16.2 years. According to race, 694 (79.2%) patients self-identified as white, 111 (12.7%) as black/African American, 48 (5.5%) as Asian and 23 (2.6%) as other, respectively. The overall incidence of DVT/PE was 8.7% and this was significantly different among races (p=0.03) and highest among black/African American with 18 (16.2%); followed by Asians with 5 (10.4%), whites with 52 (7.5%) and 1 (4.4%) under other. Hospitalization outcomes were no different according to race including length of hospitalization (p=0.33), need for intensive care unit (ICU) stay (p=0.20), readmission rate (p=0.52), and mortality (p=0.29). Acute kidney injury was different among races affecting in higher proportion black/African American patients (p=0.003). On multi-variable regression modeling, black/African American race (OR 2.0, 95% CI [1.0-3.8], p=0.03) and higher D-dimer (OR 1.1, 95% CI [1.1-1.2], p<0.0001) levels were predictors of DVT/PE; black/African American race (OR 1.7, 95% CI [1.1-2.7], p=0.02), higher body mass index (OR 1.0, 95% CI [0.96-1.0], p=0.02), lower hemoglobin levels (OR 0.86, 95% CI [0.8-0.9], p=<0.0001), and higher D-dimer levels (OR 1.04, 95% CI [1.0-1.1], p=0.02) were predictors of acute kidney injury. Conclusion: In our single-center retrospective review of prospectively collected data, we report racial disparities to the detriment of black/African American patients in terms of the incidence of DVT/PE. Although there is a disparity in the incidence of DVT/PE, patients’ hospitalization outcomes were not significantly different among races, except for acute kidney injury. On multi-variable regression modeling, black/African American race and D-dimer levels were independent predictors for DVT/PE and black/African American race, body mass index, hemoglobin and D-dimer levels were independent predictors of acute kidney injury.
| Outcome | White (n=694) | Black/African American (n=111) | Asian (n=48) | Other (n=23) | p-value |
| Length of hospitalization (median [IQR]), days | 5.0 [4.0;8.75] | 6.0 [4.0;9.5] | 6.0 [4.0;10.0] | 5.0 [4.0;8.75] | 0.33 |
| Need for intensive care unit (ICU) stay, n (%) | 98 (14.1) | 18 (16.2) | 12 (25.0) | 2 (8.7) | 0.20 |
| Readmission, n (%) | 32 (4.6) | 2 (1.8) | 1 (2.1) | 1 (4.4) | 0.52 |
| Mortality, n (%) | 41 (6.4) | 3 (3.1) | 1 (2.2) | 2 (11.1) | 0.29 |
| Hemorrhage, n (%) | 26 (3.8) | 5 (4.5) | 0 (0) | 2 (8.7) | 0.23 |
| Acute kidney injury, n (%) | 151 (21.8) | 40 (36.0) | 7 (14.6) | 7 (30.4) | 0.003 |
| Deep venous thrombosis/pulmonary embolism, n (%) | 52 (7.5) | 18 (16.2) | 5 (10.4) | 1 (4.4) | 0.03 |
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