Black veterans hospitalised with COVID-19 receive poorer treatment than whites, study shows

Research by the University of Pittsburgh has revealed Black US veterans hospitalised with COVID-19 were less likely to receive evidence-based treatments than white patients.

The study, which examined two years of data from 130 Department of Veterans Affairs Medical Centers (VAMCs), found the disparities in treatment were driven by differences in care that occurred within and between hospitals.

However, experts found black US veterans did not have high rates of re-admission or death.

‘Our study goes beyond showing there is a problem with racial disparities in COVID-19 medical care,’ said lead author Alexander Castro, a fourth-year medical student in Pitt’s School of Medicine. ‘We are pointing to where we need to concentrate our efforts to better understand why these racial disparities are occurring and how we can counteract them.’

The study looked at records from 48,222 veterans – 28.1% of them Black – who were hospitalised with COVID-19 at a VAMC between March 1, 2020 and February 28, 2022. The patients had a median age of 72, and 94.2% were men.

Two-thirds of the patients who needed breathing support – either from oxygen or mechanical ventilation – received systemic steroids, such as dexamethasone – black patients had 12% lower odds of receiving the drug than their white counterparts at the same VAMC hospital.  

Experts also discovered black patients were 11% less likely to receive the antiviral remdesivir, which is recommended for most adults hospitalised with COVID-19 within a week of developing symptoms. 

However, researchers have warned the lack of disparities in outcomes, despite disparities in treatment, needs further investigation and couldn’t be explained by their study. 

‘We should not be seeing racial disparities in treatment, even if those disparities may not be resulting in more deaths,’ said co-author Florian Mayr, Assistant Professor of Critical Care Medicine in Pitt’s School of Medicine. ‘When entire hospitals are underperforming in providing evidence-based treatments, we can target hospital-wide interventions to address the problem. But correcting racial disparities in provision of treatment within hospitals requires a multilayer approach’.

Professor Mayr said improvement efforts that could be considered include employing a more racially diverse mix of clinicians, which has been shown in studies to improve the quality of care; boots-on-the-ground surveying of physicians to better understand their treatment decisions; and investigating whether devices like thermometers and pulse-oximeters, which studies have shown are racially biased toward those with darker skin, could be interfering with treatment decisions.  

In addition, the VAMCs require clinicians to get consent to use various COVID-19 treatments before administering them. Distrust in the medical community could be biasing consent for treatment and driving some of the disparities, Mayr said.  

The team noted that their study population was largely dominated by older men, so their results shouldn’t be extrapolated to hospitals that treat a younger population that includes more women, but those hospitals can use the study to prompt their own investigations.  

Research led by the University of Pittsburgh was based at their School of Medicine. 

Photo by Mika Baumeister