Sutter Health finds black patients get coronavirus diagnoses at later stage than white peers
The chief medical officer for Sutter Health is seeing a worrisome trend when it comes to COVID-19 diagnoses.
According to data reviewed by Dr. Stephen Lockhart, African Americans were almost three times more likely than their non-Hispanic white peers to learn they had the coronavirus-caused illness through an emergency room or hospital test.
The black patients also were far more likely to be admitted for care, leading Lockhart and research scientist Kristen Azar to postulate that they may be seen with more serious cases or at a more advanced stage than white patients.
The disparities persisted, they said, even after they had adjusted for an increased incidence of diabetes, congestive heart failure and other comorbidities.
In a paper published this week in the journal Health Affairs, Azar, Lockhart and other researchers who studied the data say it’s a distinct possibility that societal factors are creating barriers to accessing care or creating circumstances where delaying care seems like the most sensible option.
Looking for ways to counter the impact of those factors, Lockhart said he thought of the work Sutter has done to prevent African American asthma patients from suffering the life-threatening attacks that land them in hospital emergency rooms.
Often, patients would travel as far as eight miles to get care for asthma in an emergency room rather than seeking primary care at federally qualified health centers right in their own neighborhoods, Lockhart and Azar said.
“We were seeing a high number of people coming into the emergency department for asthma treatment and were able to...create through community-based partnerships a program to try and address that,” Azar said.
Lockhart explained that Sutter hired an African American respiratory therapist and embedded her in a federally qualified health center, along with community health workers skilled at tracking down patients and forging relationships. In the three years since the program began, they have connected with roughly 600 African American patients to educate them on medication and disease management, he said.
The Sutter data on the impact of COVID-19 on African Americans indicates that the same sort of cultural competence will be needed to ensure that black patients get help earlier in the progression of the disease, Lockhart said.
“Our goal in the (asthma) program was to really create something that matched the patients’ needs and was based in the community, so it felt comfortable and trusted,” Lockhart said, “and that’s what we heard from our patients and why we had success. I think those same principles apply here, in terms of COVID-19 and testing. You have to get into the community to create trusting relationships, have racially concordant or at least racially sensitive approaches that support patients.”
In addition to the Sutter results showing late-stage diagnoses, state data has shown that African Americans are dying of COVID-19 at disproportionately high rates when compared with their representation in the population. While African Americans make up about 6 percent of California residents, they comprised 10.2 percent of the state’s COVID-19 deaths.
While Sutter found that many of the African American patients lived in low-income neighborhoods of Vallejo, east Oakland and San Francisco’s Hunters Point, Lockhart said, they generally had some form of health care coverage.
Azar said that it’s entirely possible that working-class people could have delayed care because they couldn’t get time off to see a doctor or because they couldn’t afford to miss work. These and other factors should be considered, she and Lockhart said, as state and local leaders relax social prescriptions and interventions.
And, when African American patients are getting tested in the emergency department rather than in ambulatory environments, Lockhart said, that indicates that public health, government and medical leaders have to build trusting relationships with the African American community to encourage asymptomatic people to get tested.
Surveillance and contact tracing, he said, will be critical to managing the spread of COVID-19, and that means testing has to be embraced by all communities.
While testing in the United States initially focused on symptomatic people, studies have now shown that the new coronavirus, the virus that causes COVID-19, sheds at high concentrations before symptoms develop.
The late-stage testing of African Americans has serious consequences for their families and communities, Azar said, and it means that these patients aren’t on the radar of health care systems.
“When you are positive, it triggers a cascade of events within our health system where you are under our care,” she said, “and so even if that individual is early and doesn’t need to be hospitalized at that moment, they are still on the radar and they are still sent home with guidance and checked in on. It’s one of those things where, as they deteriorate, you catch them at an earlier stage and you hope that you can provide supportive therapies to avoid more severe therapies that may have been needed otherwise.”
At the same time, she said, health systems are doing resource planning for these patients.
The Sutter research looked at 1,052 patients who tested positive for COVID-19 between Jan. 1 and April 8, and because Sutter had electronic health records for its patients, researchers were able to track race or ethnicity, sex, age, health, and even socioeconomic information.
This story was originally published May 25, 2020 at 5:00 AM.
