Two new studies highlight a greater illness burden of COVID-19 in black cancer patients, with one showing a 57% higher rate of hospitalization for gynecologic cancer and the other demonstrating a 58% higher COVID-19 rate among all cancer patients and a 29% higher risk of a hospital stay.
Disparities in NYC gynecology cancer patients
Nearly 72% of black patients with gynecologic cancer and COVID-19 were hospitalized compared with 46% of non-black patients, a 56.5% higher level, according to the first study, which was published in Cancer. Black patients made up only 34.7% of the study cohort.
Out of 193 New York City adult patients who had gynecologic cancer and COVID-19, 106 (54.9%) needed hospitalization from Mar 1 to May 20. Black patients had a 71.6% hospitalization rate, compared with 46.0% for non-blacks and a 20.9% death rate, versus 15.9% for non-blacks.
Compared with non-black patients younger than 65, black patients younger were 4.87 times more likely to be hospitalized if they were younger than 65 and 3.44 times more likely if they were 65 or older (both adjusted for comorbidities, cancer conditions, and sociodemographics). Non-black older patients had a 2.64 adjusted odds ratio.
Black patients were also more likely to have three or more comorbidities (81.1% vs 59.2%), and the researchers noted that black patients under 65 were just as likely as older non-black patients to have more than three comorbidities (46.9% vs 48.4%). Overall, the black patients in the study had higher rates of high blood pressure (74.6% vs 51.6%), obesity (62.7% vs 44.4%), and diabetes (47.8% vs 30.2%).
Although smoking status was not a comorbidity, the study notes that it was the only factor significantly associated with mortality after adjustment, raising the likelihood 2.93-fold. Smoking history was comparable in both racial groups, with 24.6% of non-black patients and 26.9% of black patients identifying as former or current smokers.
Although the study authors note the higher prevalence of these underlying conditions in these black cancer patients, they note that many factors are at play.
"The underlying causes of racial disparities are multifactorial and include limited access to healthcare, social determinants of health, racism, and discrimination," said senior author Bhavana Pothuri, MD, MS, of NYU Langone Health in a press release from Wiley, the journal's publisher. "The COVID-19 pandemic has only heightened these and brought awareness."
Black cancer patients 58% more likely to get COVID-19
In the second study, published yesterday in JAMA Oncology, patients with a cancer diagnoses in the past year had higher rates of COVID-19 hospitalization (47.5%) and related mortality (14.9%) compared with patients who didn't have cancer (24.3% and 5.3%, respectively).
While any cancer diagnosis increased the risk for COVID-19 infection 1.46 times, a recent one increased the risk 7.14 times. The study also noted a higher COVID burden in black cancer patients.
The researchers looked at data via the IBM Watson Health Explorys system up through Aug 14, including in the study 16,570 patients with COVID-19, of whom 1,200 (7.2%) had any cancer diagnosis and 690 (4.2%) had one within the past year.
The highest rate of COVID-19 infection was in patients who had leukemia (adjusted odds ratio [AOR], 12.16), non-Hodgkin lymphoma (AOR, 8.54), and lung cancer (AOR, 7.66). However, even the least associated of the 13 cancers measured, thyroid cancer, increased the likelihood 3.10-fold. The researchers hypothesize that this variance is due to which body system is affected by the cancer and how it relates to COVID-19.
Black COVID-19 patients who were recently diagnosed as having cancer were also at higher risk, with 55.6% requiring hospitalization, versus 43.2% of non-black patients, reflecting a 28.7% increased risk. After adjusting for comorbidities, they also were 58% more likely to develop COVID-19, and they had a higher—although statistically insignificant—COVID-19 mortality rate (18.5% vs 13.5%).
Unlike other findings, the study's results did not implicate age as a significant factor.
"It is becoming quite clear that the solutions for disparities observed with COVID-19 relate primarily to public policy," said three US experts in a related JAMA Oncology commentary.
"Needed solutions require (1) large-scale, high-quality epidemiologic data; (2) policies that mitigate socioeconomic risk factors as well as health care access disparities; and (3) validated risk prediction tools to identify patients at greatest risk from COVID-19 and its complications."
