Many racial and ethnic groups exhibit a variety of symptoms and diagnostic experiences, according to studies funded by the NIH.
According to new research funded by the National Institutes of Health, Black and Hispanic Americans appear to experience more symptoms and health problems related to long COVID, an umbrella term for a variety of symptoms and health problems, than white people, but are less likely to be diagnosed with the condition. The findings – from two separate studies conducted by the NIH’s Researching COVID to Enhance Recovery (RECOVER) Initiative – contribute to a growing body of research aimed at better understanding the complex symptoms and other issues associated with long-term COVID, which millions of people have experienced.
According to Mitchell S.V. Elkind, M.D., a professor of neurology and epidemiology at Columbia University in New York City and chief clinical science officer for the American Heart Association, “This new evidence suggests that there may be significant differences in the duration of COVID in different racial and ethnic groups.” “However, additional research is required to better understand the mechanisms underlying these differences in symptoms and access to care, as well as the potential role of diagnostic codes assigned by clinicians.”
In a study published in the Journal of General Internal Medicine, researchers examined the health records of 62,339 persons who tested positive for COVID-19 at one of five academic health institutions in New York City between March 2020 and October 2021. One to six months following a positive test, the researchers monitored the patients’ health and compared their findings to those of 247,881 persons who had never had COVID.
The researchers discovered that Black and Hispanic people were disproportionately represented among the 13,106 persons with severe COVID requiring hospitalization. One in four people with these severe cases were African-American, one in four were Hispanic, and one in seven were white.
In the months following infection, Black individuals with severe disease were more likely than white adults to be diagnosed with diabetes and to suffer from headaches, chest discomfort, and joint pain, but less likely to experience sleep disorders, cognitive difficulties, or exhaustion. Similar to white people, Hispanic individuals who required hospital care were more likely to have headaches, shortness of breath, joint pain, and chest discomfort, but less likely to have sleep disorders, cognitive issues, or exhaustion.
Similar trends were observed in patients with mild to moderate illness. Black adults were more likely to suffer from blood clots in the lungs, chest pain, joint pain, anemia, and malnutrition among outpatients. Hispanic adults were more likely to suffer from dementia, migraines, anemia, chest discomfort, and diabetes than white adults. In contrast, white adults had the highest prevalence of cognitive impairment (often referred to as “brain fog”) and weariness.
In addition, the researchers discovered that patients with COVID were more likely to suffer from illnesses affecting their nervous system, respiratory system, and circulation, as well as weariness and joint pain.
“It is unclear what causes these symptom variations,” said Dhruv Khullar, M.D., a physician and assistant professor of health policy and economics at Weill Cornell Medical in New York City and author of the study. “We hope that this study raises awareness of potential racial and ethnic differences, stimulates research into the potential mechanisms, and sparks discussion among patients, clinicians, and policymakers.”
In the second study, published in BMC Medicine, researchers reviewed the electronic health records of 33,782 adults and children diagnosed with extended COVID at one of 34 U.S. medical centers between October 2021 and May 2022. All had been diagnosed with Post COVID-19 condition, undefined, the code for which was introduced to U.S. health care systems for the first time in October 2021.
Several patterns were discovered by researchers in their examination of the patient profiles and symptoms. The majority of patients were white, female, non-Hispanic, and likely to reside in low-poverty areas with more access to health care.
The findings stood out in light of what researchers already knew about the disproportionate impact of COVID on persons of color and economically disadvantaged communities. Emily Pfaff, Ph.D., co-author of the study and assistant professor in the Division of Endocrinology and Metabolism at the University of North Carolina in Chapel Hill, warned that not all patients with extended COVID are being properly diagnosed.
The motives differ. In addition to well-documented health inequities based on race and other characteristics, women are more likely than men to seek health care, and individuals with the time and money to receive health care are overrepresented in clinical data.
“These diagnostic codes can provide insight in a variety of ways, but they can also distort the whole picture,” Pfaff explained.
Nonetheless, she added, the observations are helpful. She and her team discovered, for instance, that the majority of patients with protracted COVID exhibited only mild to moderate, not severe, acute infection symptoms. In addition, they discovered that long-term symptoms may be categorized by age and common clusters (cardiopulmonary, neurological, gastrointestinal, and concomitant illnesses).
Children and adolescents were more susceptible to gastrointestinal and upper respiratory issues, such as stomach aches and coughing. Individuals between the ages of 21 and 45 frequently encountered neurological issues such as brain fog and weariness. Individuals aged 66 and older were more likely to have comorbid diseases such as heart disease and diabetes, which the authors believe are more likely due to age than long-term COVID exposure.
The authors of both reports stated that additional research is required to validate and classify these tendencies.
The director of the National Heart, Lung, and Blood Institute, Gary H. Gibbons, M.D., stated, “This research contributes to our understanding of symptom clusters in long-term COVID that may be differentiated by race, ethnicity, and social determinants of health.” It also provides crucial insights into the utility and limitations of the diagnostic code currently employed for lengthy COVID.
RECOVER supported both trials (HL161847-01). The National Center for Advancing Translational Sciences provided further funding through the National COVID Cohort Collaboration (N3C) Data Vault for the review published in BMC Medicine (U24TR002306).
NHLBI: About the National Heart, Lung, and Blood Institute The NHLBI is the global leader in performing and supporting research that enhances scientific knowledge, improves public health, and saves lives in the areas of heart, lung, and blood illnesses and sleep disorders. For additional details, please visit www.nhlbi.nih.gov.
NIH stands for the National Institutes of Health. The National Institutes of Health (NIH), the nation’s medical research organization, consists of 27 Institutes and Centers and is part of the U.S. Department of Health and Human Services. The NIH is the principal government organization that conducts and supports basic, clinical, and translational medical research and investigates the causes, treatments, and cures for both common and rare diseases. Visit www.nih.gov for more information on the NIH and its initiatives.
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ER Pfaff, C Madlock-Brown, JM Baratta, and others. Coding lengthy COVID: Using ICD-10 to characterize a new disease. BMC Med. 2023; doi: 10.1186/s12916-023-02737-6.
Khullar D, Zhang Y, ang C, et al. Race and racial differences in the incidence of post-acute complications of SARS-CoV-2 infection among hospitalized and non-hospitalized patients in New York City: A cohort study based on electronic health record data from the RECOVER program. Journal of General Internal Medicine, 2023; DOI: 10.1007/s11606-022-07997-1
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