COVID-19-related hospitalization and mortality among Native Hawaiians and other Pacific Islanders in Hawaii

Abstract

OBJECTIVE. To examine associations between pre-existing health conditions and clinical outcomes among racial and ethnic groups of individuals hospitalized for COVID-19. METHODS. De-identified clinical data from the Queen’s Healthcare System (QHS) on COVID-19 patients admitted from March 15, 2020, to April 2, 2023, were reviewed (N=7,365). Selection criteria included all patients with a positive test for SARS-CoV-2 on qualitative polymerase chain reaction assay. The outcome measures of interest were ICU with mechanical ventilation (MV) and in-hospital death. Descriptive results on demographics, type of health insurance, vaccination status, clinical care outcomes, and comorbidities were analyzed. Comorbidities included asthma, atrial fibrillation, chronic kidney disease (CKD), diabetes, heart failure, hypertension, obesity III or body-mass index (BMI) of 40+ lbs/in2, pneumonia, and smoking history. Bivariate analysis was used to measure associations between clinical outcomes, comorbidities, and race/ethnicity. Odds ratios with 95% confidence intervals of comorbidities by clinical outcome among race and ethnic groups were calculated and adjusted for race, age, sex, insurance, and vaccination status. Statistical analysis was performed using R, version 4.2.2. Values of p≤0.05 were considered statistically significant. RESULTS. Of the 7,365 COVID-19 patients in this study, 18% self-reported as NH White, 13% as NH, 16% as OPI, 24% as Filipino, 11% as Japanese, 10% as Other Asian, and 8% as Others. Overall, NH patients were 51% female, aged 55 years, 39% relied on government insurance, 57% were unvaccinated, 7.5% died in hospital, 55% had a history of smoking, and had a BMI of 32 lbs/in2. OPI patients were 54% male, aged 53 years, 50% relied on Medicaid insurance, 71% were unvaccinated, 6.9% died, 47% had diabetes, and had a BMI of 35 lbs/in2. Of all study patients, 11% utilized MV in the ICU and 8% died. NH (aOR=1.7, CIs=1.3-2.2, p<0.001), and OPI (aORs=1.4, CIs=1.0-1.8, p=0.04) had higher odds of ICU ventilation. For in-hospital mortality, NH (aORs=1.6, CIs=1.1-2.3, p=0.01) and OPI (aORs=1.4, CIs=1.0-2.1, p=0.05) had higher odds. CONCLUSION. NHOPI COVID-19 patients hospitalized in Queens Healthcare System were significantly younger, had higher BMIs, and exhibited higher rates of hypertension, diabetes, CKD, and smoking history compared to other racial groups. Unvaccinated status, age 50 years and older, male sex, NH or OPI ethnicity, and the presence of pneumonia or heart failure were each independently associated with increased odds of severe COVID-19 clinical outcomes. The findings confirmed persistent health disparities and patient predictors of severe COVID-19. Culturally and linguistically tailored prevention and outreach strategies and efforts addressing the underlying causes of morbidity and mortality are critical for NHOPI communities in Hawaii.