Risk factors among Black and White COVID-19 patients from a Louisiana Hospital System, March, 2020-August, 2021

ObjectivesTo investigate relationships between race and COVID-19 hospitalizations, intensive care unit (ICU) admissions, and mortality over time and which characteristics, may mediate COVID-19 associations. MethodsWe analyzed hospital admissions, ICU admissions, and mortality among positive COVID-19 cases within the ten-hospital Franciscan Ministries of Our Lady Health System around the Mississippi River Industrial Corridor in Louisiana over four waves of the pandemic from March 1, 2020 - August 31, 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race-outcome relationships. ResultsRace was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed these rates became greater in White patients. However, Black patients were still disproportionately represented in these measures. Age was a significant mediator for all outcomes across waves, while comorbidity and emissions of naphthalene and chloroprene acted as mediators for the full study period. ConclusionsThe role of race evolved throughout the pandemic in Louisiana, but Black patients bore a disproportionate impact. Naphthalene and chloroprene air pollution partially explained the long-term associations. Our findings imply that air pollution might contribute to the increased COVID-19 hospitalizations and mortality among Black residents in Louisiana but likely do not explain most of the effect of race. What is already known on this topicEarly in the pandemic, there was evidence of disparities in COVID-19 cases, hospitalizations, intensive care unit (ICU) admissions, and mortality due to race. Studies were emerging to indicate that strength of these relationships was waning over time. What this study addsThis study tests relationships between race and hospitalizations, ICU admissions, and mortality and finds that Black patients continue to be disproportionately represented, although that inequity diminished over time. This study, the first to use multiple mediation analysis to study COVID-19 associations, suggests that the relationship between race and health outcome can be explained by mediators including age and, to a lesser extent, comorbidity and air pollution. How this study might affect research, practice or policyThis study supports the need for healthcare resources to be available to Louisianas communities of color, for policy to support increased access to health care in the Industrial Corridor region, and for policy to support the reduction of air pollution emissions to disproportionately impacting the health of the Industrial Corridors communities of color.