Black and Low-Income Individuals With Cancer May Be at a Higher Risk for COVID-19 Complications

Black and low-income patients with cancer were found to be at a higher risk of having severe complications after being diagnosed with COVID-19, according to findings from a retrospective observational cohort study that was published in Cancer Reports.¹

Findings from the study indicated that patients who lived in a zip code where the median household income was below $30,000 were twice as likely to be hospitalized for pneumonia, fluid balance disorders, cough, respiratory failure, or acute renal failure. Moreover, patients who lived in an area where the median household income was below $30,000 were more likely to be diagnosed with COVID-19 via International Classification of Diseases codes alone (62%) vs areas with a median household income of more than $30,000 (49%). Those with COVID-19 and active cancer or who reside in zip codes with a median household income of less than $30,000 had a higher incidence of death, hospital admission, and use of invasive respiratory support.

Black patients were more likely to be admitted for breathing abnormalities, pneumonia, fluid balance disorders, cough chronic kidney disease, and fever than any other group included in the study. Black patients were also more likely to undergo invasive respiratory support vs other racial and ethnic groups.

“The data analyzed demonstrates health disparities related to both race and income that are multi-factorial and already well-recognized in the US,” Clara Hwang, MD, a medical oncologist at Henry Ford Cancer Institute and principal investigator of the study, said in a press release.² “Our hope is [that] these findings will help inform the care provided for those who are at a higher risk of complications or death from COVID-19, and lead to continued research that will help us better understand why this disproportionate effect on Black patients exists.”

In the study, investigators analyzed the clinical outcomes of patients who had been diagnosed with COVID-19 in a hospital setting, as well as having active cancer or a history of cancer. Investigators analyzed data from 146,702 patients with cancer who had been diagnosed between 2015 to 2020, from which 1267 cases of COVID-19 were identified from February 2020 to July 2020.

The primary outcome of the study was all cause mortality, with key secondary outcomes including hospitalization and utilization of inpatient invasive mechanical ventilation.

Additional findings from the study indicated that male patients with COVID-19 and cancer were more likely to have breathing abnormalities than female patients. Conversely, female patients had a lesser chance of having active cancer, comorbidities, or the need to take antihypertensive medications. Female patients were also more likely to be younger with a lower risk of death, hospitalization, and invasive respiratory support.

“The findings from this study show that patients with cancer are more vulnerable to the effects of COVID-19, especially those with comorbidities and cancer that has been diagnosed in the past 12 months,” Shirish Gadgeel, MD, division head of Hematology/Oncology at Henry Ford Cancer Institute, and co-author of the study, said. “We found that people with cancer who were diagnosed with COVID-19 were more likely to have other chronic underlying illnesses compared [with] patients with cancer without COVID-19, such as chronic conditions affecting the kidneys, heart, lungs and blood vessels. Our findings indicate older people with cancer were more likely to die from COVID-19, which is consistent with what has been observed among those without cancer.”

In a study presented at the 2020 American Society of Clinical Oncology Quality Care Symposium, Black patients who were diagnosed with cancer were found to be more likely to have severe complications from COVID-19.³ The study examined 557 patients who tested positive for COVID-19 after they had at least 1 visit to the cancer center in the last year. Among the patients who were included in the study, 325 (58%) were female, 79 (14%) were Black, and 225 (40%) had 2 or more comorbidities. Additionally, investigators identified gastrointestinal cancer (n = 105) as the most common disease type.

From this group, 56 patients went to the emergency department, 26% of whom were Black (P = .002). Among patients who required an inpatient hospital visit (n = 96), 19% were Nlack (P = .13). Investigators also examined comorbidities, demographics, and cancer variables and reported that Black race was identified as being independently associated with higher odds of hospitalization (OR, 2.19; 95% CI, 1.2-3.8).

References:

1. Hwang C, Izano MA, Thompson MA, et al. Rapid real-world data analysis of patients with cancer, with and without COVID-19, across distinct health systems. Cancer Reports. 2021;e1388. doi:10.1002/cnr2.1388

2. Study of cancer patients and COVID-19 highlights health disparities. News Release. Henry Ford Health Systems. July 22, 2021. Accessed July 22, 2021. https://bit.ly/2WaRWTZ

3. Pandya C, Mwesigwa S, Dougherty DW. Racial differences in hospitalizations associated with COVID-19 in patients with cancer. J Clin Oncol. 2021;38(suppl 29):122-122. doi:10.1200/JCO.2020.38.29_suppl.122