Perelman School of Medicine at the University of Pennsylvania

Higher COVID-19 Mortality Among Black Patients Linked to Unequal Hospital Quality

Newswise — PHILADELPHIA— The COVID-19 death rate for Black patients would be 10 percent lower if they had access to the same hospitals as white patients, a new study shows. Researchers from the Perelman School of Medicine at the University of Pennsylvania and OptumLabs, part of UnitedHealth Group, analyzed data from tens of thousands of hospitalized COVID-19 patients and found that Black patients died at higher rates than white patients. But the study, published today in JAMA Network Open, determined that didn’t have to be the case if more Black patients were able to get care at different hospitals.

“Our study reveals that Black patients have worse outcomes largely because they tend to go to worse-performing hospitals,” said the study’s first author, David Asch, MD, the executive director of Penn Medicine’s Center for Health Care Innovation. “Because patients tend to go to hospitals near where they live, these new findings tell a story of racial residential segregation and reflect our country’s racial history that has been highlighted by the pandemic.”

For many years, housing segregation was explicitly practiced in the United States. “Redlining,” a term for the systematic refusal of home financing in majority Black neighborhoods, resulted in the economic stagnation of communities and limitations of upward mobility among the people who live in them. Redlining has cast a long shadow into the decades since it was explicitly made illegal: a recent study showed that three of every four redlined neighborhoods still experience economic hardship, which often includes a lack of access to social resources – including medical care.

Recently, Asch and fellow researchers published another study showing the interwoven nature of where patients get care and whether they survive hospitalization with COVID-19. The study showed that the one factor most explaining differences in hospital mortality rates was the level of virus in a hospital’s surrounding community: If there were high COVID-19 case rates in the community, hospital mortality rates were worse.

In the present study, the researchers continued to examine hospital-level differences by examining 10 months of de-identified hospitalization data from more than 44,000 Medicare patients from 1,188 hospitals across 41 states and the District of Columbia. Roughly 33,500 patients were white and nearly 11,000 were Black. Examining inpatient mortality rate in the 30 days after admission for each group and including those discharged to hospice care, the researchers show that the overall mortality for white patients was approximately 12.9 percent and 13.5 percent for Black patients.

Increased mortality among Black patients was partly explained by lower income levels and more comorbid illness in those populations. However, the authors wrote in their paper that “even if statistical adjustment for patient characteristics explains racial differences in outcome, it does not excuse them if those factors are disproportionately represented in Black populations as a result of racist forces.”

Rachel Werner, MD, PhD, executive director of Penn’s Leonard Davis Institute of Health Economics and a study co-author, notes that this is not the only issue.

“People often assume that Black-white differences in mortality are due to higher rates of chronic health conditions among Black individuals,” she said. “But time and time again, research has shown that where Black patients get their care is much more important and that if you account for where people are hospitalized, differences in mortality vanish.”

As a final step, the researchers ran simulations modeling what would happen if the Black patients in the cohort had instead been admitted to the same hospitals as the white patients, and in the same proportion. The mortality rate among Black patients dropped from 13.5 percent to 12.2, a single percentage point drop that translated to the overall mortality risk declining by a tenth.

“Our analyses tell us that if Black patients went to the same hospitals white patients do and in the same proportions, we would see equal outcomes,” said Nazmul Islam, PhD, a statistician at OptumLabs who co-authored the study.

While they didn’t explicitly track where each patient lived, Asch said that the study provides an index for how residential segregation policies – such as the now illegal loan refusal policies known as “redlining” – continue to affect people of color’s access to social services like health care.

“It’s intolerable that we live in a society where Black patients are more likely to go to hospitals where death is also more likely,” said Asch. “Centuries of racism got us to this level of residential segregation, but a step we can take today is to change policies so that all hospitals are not so dependent on local resources to maintain their quality. COVID-19 has provided a lens through which we can see how much more we must travel to reach justice.”



Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $8.9 billion enterprise.

The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $496 million awarded in the 2020 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center—which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report—Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

Penn Medicine is powered by a talented and dedicated workforce of more than 44,000 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2020, Penn Medicine provided more than $563 million to benefit our community.

Filters close

Showing results

110 of 6075
Newswise: Don’t Let the Raging Virus Put Life in Jeopardy. Chula Recommends How to Build an Immunity for Your Heart Against Stress and Depression
Released: 28-Jul-2021 8:55 AM EDT
Don’t Let the Raging Virus Put Life in Jeopardy. Chula Recommends How to Build an Immunity for Your Heart Against Stress and Depression
Chulalongkorn University

Cumulative stress, denial, and chronic depression are the byproducts of the COVID-19 pandemic. The Center for Psychological Wellness, Chulalongkorn University recommends ways to cope by harnessing positive energy from our heart.

Newswise: Connect Chicago Initiative Expands Community COVID-19 Testing
Released: 27-Jul-2021 4:45 PM EDT
Connect Chicago Initiative Expands Community COVID-19 Testing
Rush University Medical Center

As COVID-19 cases rise in the U.S., Connect Chicago — new initiative between the Chicago Department of Public Health, Rush University Medical Center, and Esperanza Health Centers — is aiming to redouble testing efforts in Chicago communities that need it most.

Newswise: California State University to Implement COVID-19 Vaccination Requirement for Fall 2021 Term
Released: 27-Jul-2021 1:35 PM EDT
California State University to Implement COVID-19 Vaccination Requirement for Fall 2021 Term
California State University (CSU) Chancellor's Office

California State University to Implement COVID-19 Vaccination Requirement for Fall 2021 Term

Released: 27-Jul-2021 12:55 PM EDT
Behind the COVID-19 Diagnostic for Testing Hundreds of People at a Time
The Fannie and John Hertz Foundation

Hertz Fellow Cameron Myhrvold and colleagues are advancing research that started long before the pandemic.

Released: 27-Jul-2021 12:35 PM EDT
T cell response not critical for immune memory to SARS-CoV-2 or recovery from COVID-19
American Society for Microbiology (ASM)

New research conducted in monkeys reveals that T cells are not critical for the recovery of primates from acute COVID-19 infections.

Released: 27-Jul-2021 11:45 AM EDT
mRNA Vaccinations vs COVID-19 Risk in Teens – Vaccinations are Safer
Case Western Reserve University

Case Western Reserve University researchers have demonstrated that the risk for myocarditis/pericarditis (heart inflammation) among male teens (12-17) diagnosed with COVID-19 is nearly 6 times higher than their combined risk following first and second doses of an mRNA COVID-19 vaccination. The risk for myocarditis/pericarditis among girls (ages 12-17) is 21 times greater from COVID-19 than from vaccines.

Released: 27-Jul-2021 9:45 AM EDT
Twitter Study Tracks Early Days of COVID-19 Pandemic in U.S.
Binghamton University, State University of New York

Researchers at Binghamton University, State University of New York studied Twitter communications to understand the societal impact of COVID-19 in the United States during the early days of the pandemic.

Released: 27-Jul-2021 9:45 AM EDT
A First Report of COVID-19 Orbital Involvement Is Reported in the Journal of Craniofacial Surgery
Wolters Kluwer Health: Lippincott

A severe skin infection in the orbital area (around the eye) may represent an unusual complication of COVID-19, according to a patient report published in The Journal of Craniofacial Surgery. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Newswise: “Baiya Vaccine” from Chula — a Testament of Thai Mastery — Coming this September
Released: 27-Jul-2021 8:55 AM EDT
“Baiya Vaccine” from Chula — a Testament of Thai Mastery — Coming this September
Chulalongkorn University

Chula Pharmacy prepares to test “Baiya Vaccine” a Thai vaccine against COVID–19 by “Baiya Phytofarm“, a Chula startup. The vaccines have been produced at the first plant in Asia that manufactures plant–based vaccines for humans. Clinical trials with volunteers and the research for the second–generation vaccine to fight the virus variants are to commence in September 2021.

Showing results

110 of 6075