Racial Disparities in Hospitalized COVID-19 Among US Medicare Beneficiaries

doctor with older Black patient wearing mask
Doctor giving emotional support to a senior patient using face mask
Study authors examined whether COVID-19 mortality rates between Black and White patients reflected differences in patient characteristics by race or by the admitting hospital.

Compared with White patients who are hospitalized with COVID-19, Black hospitalized patients have higher rates of mortality and discharge to hospice, according to adjusted findings published in JAMA Network Open.

Although Black individuals have been more likely to become infected with SARS-CoV-2, be hospitalized with COVID-19, and die, compared with White individuals, the differences in mortality by race have not been observed following statistical adjustments for characteristics at the patient level. Still, the disproportionately greater number of Black patients in these settings has led to concerns regarding potential discrimination in patient care.

A team of investigators conducted a cohort study of Medicare beneficiaries who were admitted to the hospital with COVID-19 to determine whether Black patients had worse outcomes than White patients and to compare the relation between worse outcomes and comorbidities vs the hospitals to which these patients were admitted.

Previous studies used data from a single health care system, but the present study compiled data from 44,217 adults who were hospitalized with COVID-19 at 1188 different US hospitals. The main outcome was inpatient death or discharge to hospice within 30 days of admission. Simulation modeling estimated the mortality rates among Black patients in hospitals where White patients were admitted instead.

Of the cohort, 55% were women, the mean age was 76.3 years, and 76% patients were White. Mortality occurred in 8% of White inpatients and 10% of Black inpatients. A total of 5% and 3% of White and Black patients, respectively, were discharged to hospice within 30 days of hospitalization. The total mortality-equivalent rates for White and Black patients were 12.86% and 13.48%, respectively.

In an unadjusted comparison, White and Black patients had similar odds of dying or being discharged to hospice (odds ratio [OR], 1.06); however, these outcomes were more likely in Black patients after adjustment for clinical and socioeconomic patient demographics (OR, 1.11). In contrast, differences in outcomes were not observed after adjustment for hospitals where care was delivered (OR, 1.02).

According to the simulation results, if Black patients were admitted in place of White patients at the same hospital, the mortality and discharge to hospice would have declined from an observed rate of 13.48% to an estimated rate of 12.23%.

“The findings of this cohort study suggest that differences in the mortality outcomes of Black and White patients were partly explained by adjustment for social, demographic, and clinical factors also associated with race,” the study authors noted.

“Addressing hospital segregation and the uneven resourcing and quality of hospitals that provide care to a disproportionate number of Black patients may help address racial differences in the mortality rate,” the investigators concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.


Asch DA, Islam MN, Sheils NE, et al. Patient and hospital factors associated with differences in mortality rates among black and white US Medicare beneficiaries hospitalized with COVID-19 infection. JAMA Netw Open. 2021;4(6):e2112842. doi:10.1001/jamanetworkopen.2021.12842