New California Study Reveals Racial Disparities Among COVID-19 Patients, Highlights Differences in How People Access Care Contribute to Inequalities
African American COVID-19 patients were 2.7 times more likely to be hospitalized than Non-Hispanic White patients; African Americans are about 6% of the California population, but make up 10.3% of COVID-19 deaths where race/ethnicity is documented
SACRAMENTO, Calif., May 21, 2020 (GLOBE NEWSWIRE) -- A study published today in Health Affairs and conducted by Sutter Health’s Advancing Health Equity team revealed that African American COVID-19 patients in Northern California are 2.7 times more likely to be hospitalized than Non-Hispanic White patients and they tend to arrive at Sutter’s healthcare facilities sicker and with more severe symptoms. Despite having health coverage, African American COVID-19 patients may not seek testing and care until it is an emergency requiring hospitalization.
“The COVID-19 pandemic has ripped a Band-Aid off of the structural inequities that exist within our society. We must address these disparities right away because the cost of not addressing them is measured in human life,” said Stephen Lockhart, M.D., Ph.D., chief medical officer at Sutter Health. “With lives on the line, we as a state can and should do better in connecting minority patients to culturally competent care. That is why Sutter Health has committed to advancing health equity and this study is just one part of our mission and work. We have a moral obligation to do so and must work together to meet this moment and lean into the opportunity to advance health equity for generations to come.”
The study, “Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California,” was conducted using the health system’s electronic health record (EHR) data to characterize COVID-19 tested and confirmed cases by key sociodemographic and clinical characteristics, including self-reported race and ethnicity, across the 22 counties served by the Sutter Health network.
Among the 1,052 confirmed cases of COVID-19 within Sutter’s network from Jan. 1, 2020 – April 8, 2020, the study found that African American patients had nearly triple (2.7 times) the odds of hospitalization than their Non-Hispanic White counterparts after adjusting for age, sex, income and underlying conditions (comorbidities). These findings highlight the fact that race and ethnicity still play a pivotal role in determining how and when care is accessed,
Coverage Alone Will Not Eliminate Healthcare Disparities
California is a Medicaid expansion state, where 92.8% of residents are insured under either private or public (government) health plans. Since only about 7% of California residents lack healthcare coverage – a coverage rate unique to California as compared with other states around the country – researchers can evaluate factors beyond insurance coverage that may be perpetuating outcome disparities during this pandemic.
Coverage is not the same as access, and the higher hospital admissions and mortality rates for African American COVID-19 patients in California underscores that expanded healthcare coverage alone does not resolve health disparities. In California, African Americans are about 6% of the population, but make up 10.3% of COVID-19 deaths where race/ethnicity is documented.
“The real value of the study lies not in the disparities it reveals but in its utility to inform our work to develop solutions that will address the equity gaps we are seeing with programs such as community outreach and engagement in at-risk neighborhoods,” said Kristen M.J. Azar, R.N., MSN/MPH, Sutter Health’s lead author for the study and research scientist within the Sutter Health Center for Health Systems Research. “This pandemic underscores the need to develop innovative solutions that are specifically tailored to address the unmet needs of those at highest risk.”
Sutter Health Uniquely Positioned to Offer New Insights
As an integrated healthcare delivery network serving more than 3.5 million patients across 22 Northern California counties, Sutter Health had been studying healthcare disparities for close to three years when it became one of the first healthcare systems in the nation to begin treating COVID-19 patients.
Four factors positioned Sutter to offer unique early insights into the reasons for the disparities in health outcomes that have been noted nationally:
- Sutter Health’s network is located in the region of the country where community spread of COVID-19 was first documented in the United States.
- Its integrated system-wide EHR includes race/ethnicity data for one of the most diverse regions of the country.
- As of 2019, the patients across the Sutter network self-identified as 45.9% white, 15.6% Hispanic, 15.8% Asian, 4.9% Black/African American and 17.8% Other.
- Sutter Health operates in an environment that is one of the closest to universal healthcare coverage of any state in the country, mitigating one of the known causes of healthcare disparities, unequal rates of medical coverage, and making other factors driving disparities more visible.
- The health system has extensive prior experience looking for and analyzing disparities both within its own network, and within other organizations and geographic regions.
Provider organizations like Sutter Health are on the front lines and, while not able to address all of the complex societal factors at issue, can play a unique role in developing solutions. As part of its commitment to advancing health equity, Sutter Health developed a novel metric, the Health Equity Index (HEI), to identify and quantify disparities in outcomes across patient groups and develop targeted interventions to enhance equity. Through the HEI, Sutter’s Advancing Health Equity team is taking major steps to build on the benefits of Sutter’s integrated network of care to further health equity within the Sutter system and across the country.
The full study and associated data can be accessed for free on the Health Affairs website: healthaffairs.org/doi/full/10.1377/hlthaff.2020.00598
To find out more about Sutter Health’s work to advance health equity please visit: sutterhealth.org/about/health-equity
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Sutter Health is more than 60,000 people strong thanks to its integrated network of clinicians, employees and volunteers. Headquartered in Sacramento, Calif., Sutter Health provides access to high quality, affordable care for more than 3 million Northern Californians through its network of hospitals, medical foundations, urgent and walk-in care centers, home health and hospice services.
For more information about the Sutter Health network visit: sutterhealth.org | facebook.com/sutterhealth | youtube.com/sutterhealth | twitter.com/sutterhealth.
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Angie Sheets Sutter Health 916-494-9547 sheetsa@sutterhealth.org
