Differences in COVID-19-Related Hospitalization, Treatment, Complications, and Death by Race and Ethnicity and Area-Level Measures Among Individuals with Cancer in the ASCO Registry

TL;DR

The study finds that cancer patients from racial minorities and disadvantaged areas faced worse outcomes from COVID-19 compared to non-Hispanic Whites.

Contribution

This study highlights the intersection of race, socioeconomic factors, and cancer in determining severe outcomes from COVID-19.

Findings

Non-Hispanic Black and Hispanic/Latinx cancer patients had a higher risk of developing COVID-19-related complications.

Residing in socioeconomically disadvantaged areas was linked to increased risk of adverse outcomes like death from COVID-19.

Hispanic/Latinx patients faced a 29% greater risk of complications during the acute phase of infection compared to non-Hispanic Whites.

Abstract

Individuals with cancer who are exposed to SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), are more likely to develop COVID-19 complications and die than persons without cancer. During the COVID-19 pandemic, racial and ethnic minorities were more likely than non-Hispanic Whites to contract the virus, be hospitalized, or die. Therefore, this study examines COVID-19-related hospitalization, supplemental oxygen need, multiorgan complications, and death in a large sample of multiethnic cancer patients with SARS-CoV-2 infection from the American Society of Clinical Oncology’s COVID-19 Registry. Cancer patients from racial and ethnic minority groups, as well as those living in socioeconomically disadvantaged areas, were identified to be at a significantly higher risk of poorer COVID-19-related outcomes than their non-Hispanic White counterparts and those living in less disadvantaged areas.

Background/Objectives: To evaluate the impact of social and structural drivers of health (SDOHs) at the intersection of COVID-19 and cancer, to understand the long-term impact of COVID-19 on cancer inequities. Methods: This retrospective, registry-based cohort study examined the associations between race and ethnicity and area-level SDOH measures and COVID-19-related hospitalization, supplemental oxygen need, the development of multiorgan complications, and death among 5146 cancer patients infected with SARS-CoV-2 from mid-2020 to mid-2022, with 3314 having follow-up data 1–3 months after a confirmed COVID-19 diagnosis (i.e., acute phase of infection). Results: At the time of SARS-CoV-2 infection, relative to non-Hispanic White (NHW) patients, non-Hispanic Black (NHB) and Hispanic/Latinx patients had a 17% (RR, 1.17; 95% CI: 1.07–1.29; p = 0.001) and 20% (RR, 1.20; 95% CI: 1.07–1.30; p = 0.001) greater risk, respectively, of developing COVID-19-related complications. From the time of SARS-CoV-2 infection to the end of the acute phase of infection, Hispanic/Latinx patients continued to face a 29% greater risk of COVID-19-related complications than NHWs (RR, 1.29; 95% CI: 1.13–1.47; p < 0.001). Residence in areas with higher proportions of residents with a lower education was associated with a greater risk of adverse COVID-19-related outcomes, like death (RR, Q4 vs. Q1, 2.12; 95% CI: 1.33–3.39; p = 0.002). Conclusions: These findings reiterate the impact of SDOHs—including race and place—on COVID-19-related outcomes among individuals with cancer. It is evident that social and structural issues need to be addressed to improve health equity and social justice, particularly as we grapple with the potential of future infectious disease outbreaks and their impact on long-term cancer outcomes and inequities.