What question did this study set out to answer?

This study aims to assess how race influences COVID-19 outcomes while controlling for various demographic, clinical, and socioeconomic factors.

April 25, 2026Open Access

Association Between Race and COVID-19 Outcomes During the Pre-Vaccination Period in the United States (2020–2021)

Key Points

This study aims to assess how race influences COVID-19 outcomes while controlling for various demographic, clinical, and socioeconomic factors.
Conducted a retrospective cohort study using administrative claims data from the Sentinel Distributed Database.
Identified 841,628 individuals diagnosed with COVID-19 and 133,773 hospitalized, requiring 6 months of prior health plan enrollment.
Used multivariable logistic regression to analyze associations between self-reported race and COVID-19 outcomes.
Individuals of American Indian or Alaska Native (AIAN), Asian, Black or African American, and NHOPI races had increased odds of hospitalization compared to Whites.
Over 58% of hospitalized patients progressed to critical COVID, with significant disparities among racial groups.
AIAN and NHOPI populations showed significantly higher odds (1.52 and 1.24 respectively) of 30-day inpatient mortality compared to the White population.

Abstract

Objective: To determine the association between race, a proxy for social determinants of health, and COVID-19 outcomes adjusted for demographic, clinical, and socioeconomic differences. Methods: We conducted a retrospective cohort study using administrative claims data in the Sentinel Distributed Database. We identified 841,628 individuals diagnosed with COVID-19; and separately, 133,773 individuals hospitalized with COVID-19 between April 1, 2020, and March 31, 2021, in the US. Eligible individuals required at least 6 months of enrollment in a health plan prior to cohort entry. Crude and adjusted associations between self-reported race (Asian, Black or African American, American Indian or Alaska Native AIAN, Native Hawaiian or Other Pacific Islander NHOPI, White, or Unknown) and COVID-19 outcomes (hospitalization with COVID-19; critical COVID; 30-day all-cause inpatient mortality) were determined using multivariable logistic regression. Results: Of the 841,628 individuals with COVID-19, 45.5% were White, 42.1% were of Unknown race, 9.5% Black or African American, 2% Asian, 0.5% NHOPI, and 0.3% AIAN. All subpopulations had increased odds of hospitalization compared to White population (AIAN, adjusted Odds Ratio 1.45 95% confidence interval 1.11– 1.90; Asian population 1.58 1.38– 1.80; Black or African American population 1.58 1.40– 1.78; NHOPI 1.32 1.22– 1.42). There were 133,773 individuals hospitalized with COVID-19, 56.2% of whom were White, 23.4% of Unknown race, 17.6% Black or African American, 1.5% Asian, 0.9% NHOPI, and 0.4% AIAN. Over half of all hospitalized individuals progressed to critical COVID (58%) and 14.2% died within 30 days. Progression to critical COVID was significantly higher in NHOPI population compared to White population (1.17 1.03– 1.32). AIAN population (1.52 1.20– 1.91), Asian population (1.30 1.13– 1.49), and NHOPI population (1.24 1.06– 1.45) had significantly higher odds of 30-day inpatient mortality compared to White population. Conclusion: We identified significant differences in COVID-19 outcomes in different subgroups within a diverse US population. Keywords: COVID-19, real-world data, multivariable analysis, health outcomes

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