Key Points Question Are rates of COVID-19–associated hospitalization, intensive care unit (ICU) admission, or in-hospital death higher among individuals who belong to racial and ethnic minority groups compared with those who identify as non-Hispanic White? Findings In this cross-sectional study of 143 342 individuals hospitalized with COVID-19, non-Hispanic American Indian or Alaska Native, Hispanic or Latino, non-Hispanic Black, and non-Hispanic Asian or Pacific Islander persons were more likely to have a COVID-19-associated hospitalization, ICU admission, or in-hospital death compared with non-Hispanic White individuals during the first year of the pandemic. Meaning In this study, US residents who belong to racial and ethnic minority groups experienced severe COVID-19–associated outcomes disproportionately; equitable access to preventive measures, such as COVID-19 vaccines, is needed for these populations. This cross-sectional study evaluates whether rates of COVID-19–associated hospitalization, intensive care unit admission, or in-hospital death are higher among racial and ethnic minority groups compared with non-Hispanic White persons. Importance Racial and ethnic minority groups are disproportionately affected by COVID-19. Objectives To evaluate whether rates of severe COVID-19, defined as hospitalization, intensive care unit (ICU) admission, or in-hospital death, are higher among racial and ethnic minority groups compared with non-Hispanic White persons. Design, Setting, and Participants This cross-sectional study included 99 counties within 14 US states participating in the COVID-19–Associated Hospitalization Surveillance Network. Participants were persons of all ages hospitalized with COVID-19 from March 1, 2020, to February 28, 2021. Exposures Laboratory-confirmed COVID-19–associated hospitalization, defined as a positive SARS-CoV-2 test within 14 days prior to or during hospitalization. Main Outcomes and Measures Cumulative age-adjusted rates (per 100 000 population) of hospitalization, ICU admission, and death by race and ethnicity. Rate ratios (RR) were calculated for each racial and ethnic group compared with White persons. Results Among 153 692 patients with COVID-19–associated hospitalizations, 143 342 (93.3%) with information on race and ethnicity were included in the analysis. Of these, 105 421 (73.5%) were 50 years or older, 72 159 (50.3%) were male, 28 762 (20.1%) were Hispanic or Latino, 2056 (1.4%) were non-Hispanic American Indian or Alaska Native, 7737 (5.4%) were non-Hispanic Asian or Pacific Islander, 40 806 (28.5%) were non-Hispanic Black, and 63 981 (44.6%) were White. Compared with White persons, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely to have higher cumulative age-adjusted rates of hospitalization, ICU admission, and death as follows: American Indian or Alaska Native (hospitalization: RR, 3.70; 95% CI, 3.54-3.87; ICU admission: RR, 6.49; 95% CI, 6.01-7.01; death: RR, 7.19; 95% CI, 6.47-7.99); Latino (hospitalization: RR, 3.06; 95% CI, 3.01-3.10; ICU admission: RR, 4.20; 95% CI, 4.08-4.33; death: RR, 3.85; 95% CI, 3.68-4.01); Black (hospitalization: RR, 2.85; 95% CI, 2.81-2.89; ICU admission: RR, 3.17; 95% CI, 3.09-3.26; death: RR, 2.58; 95% CI, 2.48-2.69); and Asian or Pacific Islander (hospitalization: RR, 1.03; 95% CI, 1.01-1.06; ICU admission: RR, 1.91; 95% CI, 1.83-1.98; death: RR, 1.64; 95% CI, 1.55-1.74). Conclusions and Relevance In this cross-sectional analysis, American Indian or Alaska Native, Latino, Black, and Asian or Pacific Islander persons were more likely than White persons to have a COVID-19–associated hospitalization, ICU admission, or in-hospital death during the first year of the US COVID-19 pandemic. Equitable access to COVID-19 preventive measures, including vaccination, is needed to minimize the gap in racial and ethnic disparities of severe COVID-19.
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