The Effect of Racial Disparities on Community-Acquired Pneumonia
Dr. James Bradley
Pneumonia is one of the most common reasons for hospitalization and ICU admission in the world, and disease burden increases with age.¹,² It is well recognized that racial, ethnic, and socioeconomic disparities have a significant impact on various clinical endpoints in patients with pneumonia, such as mortality, length of stay, and ICU admission. Although significant progress has been achieved over the past several decades in narrowing the gaps in outcomes, health disparities still exist and they have only been further highlighted by the recent COVID-19 pandemic.³,⁴
Large studies have illustrated the disproportionate morbidity and mortality among black Americans and Hispanics compared to white Americans with pneumonia. For example, in the 1990s, one study showed that the incidence of community-acquired pneumonia is higher in black adults than white adults (337.7/100,000 vs 253.9/100,000).⁵ A decade later, in the early 2000’s, Burton et al showed that the annual incidence of bacterial pneumonia in black adults was 24.2/100,000 versus 10.1/100,000 in white adults.⁶ A recent report that examined geographic variation in racial disparities in mortality from influenza and pneumonia from 1999-2018 found that age-adjusted mortality rates were higher in non-Hispanic blacks than non-Hispanic whites in every age group in the US. Interestingly, the authors also found that regions with the greatest racial disparities in mortality from influenza and pneumonia were hotspots of SARS-CoV-2 pneumonia.⁷ Compared to non-Hispanic whites, non-Hispanic blacks are more likely to be hospitalized with pneumonia and have a higher incidence of bacterial pneumonia compared to non-Hispanic whites even when controlled for age and poverty level.⁶ Additionally, evidence has shown that non-Hispanic blacks are less likely to receive their first dose of antibiotic within four hours, less likely to receive pneumococcal/influenza vaccination, and less likely to receive tobacco cessation counseling.⁸
The reason for these healthcare disparities is extremely complex. There is an interplay of biological, social, and structural mechanisms that contribute to the racial disparities seen in our healthcare system. When examining healthcare disparities and how they are associated with differences in race/ethnicity, it is important to assess differences in underlying comorbidities and access to care. For example, it has been recognized that there is a higher prevalence of hypertension in African Americans, and it tends to be more difficult to treat.⁹ African Americans also have a higher incidence of diabetes and are more likely to die from heart disease than non-Hispanic whites. These examples illustrate just some of the disparities in the management of chronic diseases, in part due to lack of access to care as well as differences in socioeconomic status. While the previous studies I have mentioned are very sobering, it is critical that we recognize these disparities so that our healthcare system can begin to address and support the various needs of all patients in our communities.
James Bradley, M.D.
Medical School: University of Louisville School of Medicine, Louisville, KY
Residency: University of Louisville Hospital, Louisville, KY
About James: Originally from eastern Kentucky, I moved to Louisville for medical school and married my wife. Since then, I have stayed here for residency and fellowship. My wife and I have three beautiful daughters and we enjoy taking them to the zoo, local farms, parks, and teaching them how to swim.
Research interests: Pneumonia, sepsis, shock, mechanical ventilation
References:
Shi T, Denouel A, Tietjen AK, et al. Global and Regional Burden of Hospital Admissions for Pneumonia in Older Adults: A Systematic Review and Meta-Analysis. J Infect Dis. 2020;222(Suppl 7):S570-s576.
Storms AD, Chen J, Jackson LA, et al. Rates and risk factors associated with hospitalization for pneumonia with ICU admission among adults. BMC Pulm Med. 2017;17(1):208.
Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States. Clin Infect Dis. 2021;72(4):703-706.
Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med. 2020;382(26):2534-2543.
Marston BJ, Plouffe JF, File TM, Jr., et al. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance Study in Ohio. The Community-Based Pneumonia Incidence Study Group. Arch Intern Med. 1997;157(15):1709-1718.
Burton DC, Flannery B, Bennett NM, et al. Socioeconomic and racial/ethnic disparities in the incidence of bacteremic pneumonia among US adults. Am J Public Health. 2010;100(10):1904-1911.
Donaldson SV, Thomas AN, Gillum RF, Mehari A. Geographic Variation in Racial Disparities in Mortality From Influenza and Pneumonia in the United States in the Pre-Coronavirus Disease 2019 Era. Chest. 2021;159(6):2183-2190.
Hausmann LR, Ibrahim SA, Mehrotra A, et al. Racial and ethnic disparities in pneumonia treatment and mortality. Med Care. 2009;47(9):1009-1017.
Spence JD, Rayner BL. Hypertension in Blacks: Individualized Therapy Based on Renin/Aldosterone Phenotyping. Hypertension. 2018;72(2):263-269.
