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Use of Real-World EHR to Identify Disparities for COVID-19 in Patients With Cancer

January 05, 2021

A recent article discusses disparities observed for COVID-19 in patients with cancer and offers potential solutions to address these disparities during the pandemic and beyond (JAMA Onc. 2020. doi:10.1001/jamaoncol.2020.5461).

In a previous article, researchers conducted a retrospective case-control study using EHR data to assess the association of cancer and demographic factors with COVID-19 outcomes (JAMA Onc. 2020. doi:10.1001/jamaoncol.2020.6178).

The study included 16,560 patients that were diagnosed with COVID-19 as of August 14, 2020; 1200 with any cancer diagnoses and 690 with a recent cancer diagnosis.

The study found that patients with cancer were at substantially increased risk for COVID-19 compared to those without cancer. Patients with concurrent COVID-19 and cancer diagnoses had higher rates of hospitalization and mortality than those with either diagnosis alone.

Additionally, researchers reported a higher mortality rate and higher risk for developing COVID-19 in Black patients without cancer than in White patients without cancer.

In this commentary, Aakash Desai, MBBS, MPH, Mayo Clinic, Rochester, Minnesota, and colleagues discussed the strengths and limitations of this study.

The noted strengths include the investigation of risk factors associated with diagnosis and the large sample size. However, limitations include the retrospective case-control study design and limited information on specific types of data.

Additionally, Dr Desai and colleagues highlighted the small representation of US patients with a COVID-19 diagnosis.

“It is becoming quite clear that the solutions for disparities observed with COVID-19 relate primarily to public policy,” wrote Dr Desai et al. The solutions recommended in the article include the following:

  1. Large-scale, high-quality epidemiologic data;
  2. Policies that mitigate socioeconomic risk factors as well as health care access disparities;
  3. Validated risk prediction tools to identify patients at greatest risk from COVID-19 and its complications.

“Clearly, the haunting spotlight of COVID-19 has dramatically illuminated known US health care and societal disparities. This situation should be a wake-up call that brings much-needed improvements in US equity policies, including but not limited to better health care access,” Dr Desai and colleagues concluded.—Marta Rybczynski

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