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Buikema AR, Buzinec P, Paudel ML, Andrade K, Johnson JC, Edmonds YM, Jhamb SK, Chastek B, Raja H, Cao F, Hulbert EM, Korrer S, Mazumder D, Seare J, Solow BK, Currie UM. Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database. EClinicalMedicine 2021; 39:101075. [PMID: 34493997 PMCID: PMC8413267 DOI: 10.1016/j.eclinm.2021.101075] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. METHODS This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. FINDINGS Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620-1·763; Black: 1·810, 1·743-1·880; Asian: 1·503, 1·381-1·636) and during follow-up (Hispanic: 1·700, 1·638-1·764; Black: 1·578, 1·526-1·633; Asian: 1·391, 1·288-1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809-0·959) but higher for Asian patients (1·205, 1·000-1·452). INTERPRETATION Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19-related care, further analyses of disaggregated population-level COVID-19 data are needed.
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Affiliation(s)
- Ami R. Buikema
- Optum, Eden Prairie, MN, USA
- Corresponding author at: 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA.
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Rivera SR, Jhamb SK, Abdel-Hamid HZ, Acsadi G, Brandsema J, Ciafaloni E, Darras BT, Iannaccone ST, Konersman CG, Kuntz NL, McDonald CM, Parsons JA, Tesi Rocha C, Zaidman CM, Butterfield RJ, Connolly AM, Mathews KD. Medical management of muscle weakness in Duchenne muscular dystrophy. PLoS One 2020; 15:e0240687. [PMID: 33075081 PMCID: PMC7571693 DOI: 10.1371/journal.pone.0240687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/30/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction Duchenne muscular dystrophy (DMD) is a childhood onset muscular dystrophy leading to shortened life expectancy. There are gaps in published DMD care guidelines regarding recently approved DMD medications and alternative steroid dosing regimens. Methods A list of statements about use of currently available therapies for DMD in the United States was developed based on a systematic literature review and expert panel feedback. Panelists’ responses were collected using a modified Delphi approach. Results Among corticosteroid regimens, either deflazacort or prednisone weekend dosing was preferred when payer requirements do not dictate choice. Most patients with exon 51 skip-amenable mutations should be offered eteplirsen, before or with a corticosteroid. Discussion The options available for medical management of the motor symptoms of DMD are expanding rapidly. The choice of medical therapies should balance expected benefit with side effects.
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Affiliation(s)
- Sarah R. Rivera
- Department of Clinical Services, Optum Lifesciences Wolfeboro, Wolfeboro, New Hampshire, United States of America
- * E-mail:
| | - Sumit K. Jhamb
- Department of Clinical Services, Optum Global Solutions, Noida, Uttar Pradesh, India
| | - Hoda Z. Abdel-Hamid
- Division of Child Neurology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States of America
| | - Gyula Acsadi
- Department of Neurology, Connecticut Children's Medical Center, Farmington, Connecticut, United States of America
| | - John Brandsema
- Division of Neurology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Emma Ciafaloni
- Department of Pediatric Neuromuscular Medicine, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Basil T. Darras
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Susan T. Iannaccone
- Department of Pediatrics, UT Southwestern, Dallas, Texas, United States of America
| | - Chamindra G. Konersman
- Department of Neurosciences, University of California, San Diego, San Diego, California, United States of America
| | - Nancy L. Kuntz
- Department of Pediatrics, Ann & Robert H Lurie Children’s Hospital, Chicago, Illinois, United States of America
| | - Craig M. McDonald
- Department of Physical Medicine & Rehabilitation, UC Davis Health, Sacramento, California, United States of America
| | - Julie A. Parsons
- Department of Pediatrics and Neurology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Carolina Tesi Rocha
- Department of Neurology, Stanford University, Palo Alto, California, United States of America
| | - Craig M. Zaidman
- Department of Neurology, Divisions of Child Neurology and Neuromuscular, Washington, University in St. Louis School of Medicine, St. Louis, Missouri, United States of America
| | - Russell J. Butterfield
- Department of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Anne M. Connolly
- Department of Neurology, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Katherine D. Mathews
- Departments of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
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