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Article

Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry

by
Jose-Manuel Ramos-Rincon
1,*,
Lidia Cobos-Palacios
2,3,
Almudena López-Sampalo
2,3,
Michele Ricci
2,3,
Manuel Rubio-Rivas
4,
Francisco Martos-Pérez
5,
Antonio Lalueza-Blanco
6,
Sergio Moragón-Ledesma
7,
Eva-María Fonseca-Aizpuru
8,
Gema-María García-García
9,
Jose-Luis Beato-Perez
10,
Claudia Josa-Laorden
11,
Francisco Arnalich-Fernández
12,
Sonia Molinos-Castro
13,
José-David Torres-Peña
14,15,
Arturo Artero
16,
Juan-Antonio Vargas-Núñez
17,
Manuel Mendez-Bailon
18,
Jose Loureiro-Amigo
19,
María-Soledad Hernández-Garrido
20,
Jorge Peris-García
21,
Manuel-Lorenzo López-Reboiro
22,
Bosco Barón-Franco
23,
Jose-Manuel Casas-Rojo
24,
Ricardo Gómez-Huelgas
2,3,15 and
on behalf of the SEMI-COVID-19 Network
†add Show full author list remove Hide full author list
1
Clinical Medicine Department, Miguel Hernandez University of Elche, 03550 Alicante, Spain
2
Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), 29010 Malaga, Spain
3
Medicine Department, University of Málaga, 29010 Malaga, Spain
4
Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
5
Internal Medicine Department, Costa del Sol Hospital, 29603 Marbella, Spain
6
Internal Medicine Department, Doce de Octubre University Hospital, 28041 Madrid, Spain
7
Internal Medicine Department, Gregorio Marañón General University Hospital, 28007 Madrid, Spain
8
Internal Medicine Department, Cabueñes University Hospital, 33394 Gijon, Spain
9
Internal Medicine Department, Badajoz University Hospital Complex, 06080 Badajoz, Spain
10
Internal Medicine Department, Albacete University Hospital Complex, 02006 Albacete, Spain
11
Internal Medicine Department, Royo Villanova Hospital, 50015 Zaragoza, Spain
12
Internal Medicine Department, La Paz University Hospital, 28046 Madrid, Spain
13
Internal Medicine Department, Santiago de Compostela Clinic Hospital, 15706 Santiago de Compostela, Spain
14
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain
15
Spain CIBER Fisiopatologia de la Obesidad y la Nutricion, Carlos III Health Institute, 28029 Madrid, Spain
16
Internal Medicine Department, Doctor Peset University Hospital, 46017 Valencia, Spain
17
Internal Medicine Department, Puerta de Hierro University Hospital, Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, 28222 Madrid, Spain
18
Internal Medicine Department, San Carlos Clinco Hospital, 28040 Madrid, Spain
19
Internal Medicine Department, Moisès Broggi Hospital, 08970 Sant Joan Despí, Spain
20
Internal Medicine Department, Elda General University Hospital, 03600 Alicante, Spain
21
Internal Medicine Department, de Sant Joan d’Alacant University Clínic Hospital, 03550 Alicante, Spain
22
Internal Medicine Department, Monforte de Lemos Hospital, 27400 Lugo, Spain
23
Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain
24
Internal Medicine Department, Infanta Cristina University Hospital, Parla, 28981 Madrid, Spain
 
add Show full affiliation list
 
remove Hide full affiliation list
*
Author to whom correspondence should be addressed.
†
A complete list of the SEMI-COVID-19 Network members is provided in the Appendix A.
J. Clin. Med. 2022, 11(7), 1949; https://doi.org/10.3390/jcm11071949
Submission received: 18 February 2022 / Revised: 26 March 2022 / Accepted: 28 March 2022 / Published: 31 March 2022
(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)
Review Reports Versions Notes

Abstract

:
(1) Background: This work aims to analyze clinical outcomes according to ethnic groups in patients hospitalized for COVID-19 in Spain. (2) Methods: This nationwide, retrospective, multicenter, observational study analyzed hospitalized patients with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from 1 March 2020 to 31 December 2021. Clinical outcomes were assessed according to ethnicity (Latin Americans, Sub-Saharan Africans, Asians, North Africans, Europeans). The outcomes were in-hospital mortality (IHM), intensive care unit (ICU) admission, and the use of invasive mechanical ventilation (IMV). Associations between ethnic groups and clinical outcomes adjusted for patient characteristics and baseline Charlson Comorbidity Index values and wave were evaluated using logistic regression. (3) Results: Of 23,953 patients (median age 69.5 years, 42.9% women), 7.0% were Latin American, 1.2% were North African, 0.5% were Asian, 0.5% were Sub-Saharan African, and 89.7% were European. Ethnic minority patients were significantly younger than European patients (median (IQR) age 49.1 (40.5–58.9) to 57.1 (44.1–67.1) vs. 71.5 (59.5–81.4) years, p < 0.001). The unadjusted IHM was higher in European (21.6%) versus North African (11.4%), Asian (10.9%), Latin American (7.1%), and Sub-Saharan African (3.2%) patients. After further adjustment, the IHM was lower in Sub-Saharan African (OR 0.28 (0.10–0.79), p = 0.017) versus European patients, while ICU admission rates were higher in Latin American and North African versus European patients (OR (95%CI) 1.37 (1.17–1.60), p < 0.001) and (OR (95%CI) 1.74 (1.26–2.41), p < 0.001). Moreover, Latin American patients were 39% more likely than European patients to use IMV (OR (95%CI) 1.43 (1.21–1.71), p < 0.001). (4) Conclusion: The adjusted IHM was similar in all groups except for Sub-Saharan Africans, who had lower IHM. Latin American patients were admitted to the ICU and required IMV more often.

1. Introduction

There have been over 404 million reported COVID-19 infections and more than 5.7 million deaths worldwide in the COVID-19 pandemic as of 8 February 2022 [1]. In the United States of America, the pandemic has disproportionately affected racial and ethnic minority populations, who are at an increased risk of infection, hospitalization, and death [2,3,4]. Differences in access to healthcare and exposure risk may be driving higher infection and mortality rates among these groups [2,5,6]. In the UK, clear differences have been found in the risk of COVID-19 hospitalization according to ethnicity [7,8]. However, little evidence is available from other countries on this matter.
Immigration, especially from Latin America, has changed the demographic landscape of Spain over the last two decades. The number of persons living in Spain on 1 January 2021 was 47.40 million, of whom 1.46 million were from Central and South America, 0.81 million were from North Africa, 0.43 million were from Asia, and 0.25 million were from Sub-Saharan Africa [9]. This influx of immigrants into Spain makes it necessary to study whether there are differences in the clinical progress of patients with COVID-19 according to their ethnicity. Few studies have analyzed the effect of ethnicity on patient progress in Spain [10,11,12,13,14,15] or other European Union countries [16]. Although the Spanish healthcare system is universal and accessibility is theoretically guaranteed to all [17,18], there is little information about ethnicity in health outcomes among patients in Spanish hospitals during the COVID-19 pandemic.
This work analyzes differences according to ethnicity in the adverse outcomes of in-hospital mortality (IHM), admission to the intensive care unit (ICU), the use of invasive mechanical ventilation (IMV), and a composite variable of the three using data from the SEMI-COVID-19 Registry, a large, geographically-diverse surveillance network for COVID-19-associated hospitalizations in 150 Spanish hospitals [19,20].

2. Materials and Methods

2.1. Study Design and Population

This retrospective cohort study analyzed a nationwide, multicenter registry of patients hospitalized with confirmed COVID-19 in Spain from 1 March 2020 to 30 April 2021. The patients were analyzed according to the pandemic wave in which they were admitted during the study period: the first wave or the second wave. The first wave included patients admitted from 1 March to 30 June 2020 and the second wave included patients admitted from 1 July 2020 to 31 January 2021.

2.2. Definition of Variables

All patient data were obtained from the Spanish Society of Internal Medicine’s SEMI-COVID-19 Registry, in which 150 Spanish hospitals participate. The SEMI-COVID-19 Registry prospectively compiles data on the index admission of patients ≥18 years of age with COVID-19 confirmed microbiologically through a reverse transcription polymerase chain reaction (RT-PCR) or antigen test. More in-depth information about the justification, objectives, methodology, and preliminary results of the SEMI-COVID-19 Registry have recently been published [19,20].
The data on ethnicity were determined based on the place of birth indicated on the patient’s electronic medical record (EMR). For this analysis, ethnicity was categorized as follows:
  • Latin Americans: individuals born in Central and South America
  • Asian: individuals born in Asia
  • Sub-Saharan Africans: individuals born in Sub-Saharan Africa
  • North Africans: individuals born in North African or Middle Eastern countries excluding Israel
  • European: individuals born in Europe and North America.
The degree of dependence was evaluated using the Barthel Index. Comorbidities were evaluated by means of the age-adjusted Charlson Comorbidity Index (CCI) [21]. Patients were classified as having dyslipidemia, diabetes mellitus, or hypertension if they had a previous diagnosis on their EMR or received pharmacological treatment for these conditions. Atherosclerotic cardiovascular disease was defined as a medical history of coronary heart disease (myocardial infarction, acute coronary syndrome, angina, or coronary revascularization), cerebrovascular disease (stroke, transient ischemic attack), or peripheral arterial disease (intermittent claudication, revascularization, lower limb amputation, or abdominal aortic aneurysm). Chronic pulmonary disease was defined as diagnosis of asthma and/or chronic obstructive pulmonary disease. Malignancy encompassed hematologic neoplasia and/or solid tumors (excluding non-melanoma skin cancer). All baseline comorbidities were gathered from EMR obtained from the hospitals.
The endpoints of the study were 30-day all-cause IHM; admission to the ICU; use of IMV; and a composite variable of IHM, admission to the ICU, and use of IMV.

2.3. Statistical Analysis

Each group’s characteristics were analyzed using descriptive statistics. Continuous and categorical variables were expressed as medians and interquartile ranges (IQR) and as absolute values and percentages, respectively. The differences between groups were analyzed using the Mann–Whitney U test and Kruskal–Wallis test for continuous variables, and Pearson’s chi-square test for categorical variables. Statistical significance was defined as p < 0.05.
Differences in IHM, ICU admission, use of IMV, and composite outcome were adjusted by age (0–44, 45–64, or 65+ years), sex, COVID-19 wave, nosocomial acquisition, and baseline CCI category (0–2, 3–4, 5+) using a multivariable regression analysis and a stepwise regression with a threshold of p < 0.10. These data are shown in Supplementary Tables S1–S4. The values are expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Statistical analyses were performed using IBM SPSS Statistics v25 (Armonk, NY, USA).

2.4. Ethical Aspects

This work was approved by the Institutional Research Ethics Committee of Málaga on 27 March 2020 (Ethics Committee code: SEMI-COVID-19 27-03-20), as per the guidelines of the Spanish Agency of Medicines and Medical Products. All patients gave informed consent. All data collected, processed, and analyzed in this work were anonymized and used only for the purposes of this project. All data were protected in accordance with the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data. This study was approved by the Institutional Research Ethics Committees of each participating hospital. The STROBE statement guidelines were adhered to in the execution and reporting of the study.

3. Results

3.1. Study Sample

Of the 23,254 hospitalized patients included in the SEMI-COVID-19 Registry, data on ethnicity were not available for 301. Therefore, the total population analyzed included 23,953 patients (median age 69.5 years, 42.9% women). Of them, 7.0% were Latin American, 1.2% were North African, 0.5% were Asian, 0.5% were Sub-Saharan African, and 89.7% were European (Table 1). The patients in the ethnic minority groups were significantly younger than European patients (median (IQR) age range 49.1 (40.5–58.9) to 57.1 (44.1–67.1) years vs. 71.5 (59.5–81.4) years, p < 0.001 for all pairwise comparisons of ethnic minority groups vs. European patients). There were significantly more women in the Latin American group (46.1%) and significantly fewer women in the Sub-Saharan African (38.7%), Asian (33.6%), and North African (33.6%) groups than in the European group (42.3%) (p < 0.001). Most of the patients were admitted in the first wave (73.5%); there were significantly fewer patients from the first wave in the North African (58.0%) and Sub-Saharan African (58.9%) than the Asian (69.1%), European (73.8%), and Latin American (74.8%) groups (p < 0.001).
The patients in ethnic minority groups had significantly fewer comorbidities as assessed by CCI than European patients (median (IQR) range 1 (0–2) to 2 (0–3.0) vs. 4 (2–5) European patients, p < 0.001) (Table 1). In general, the ethnic minority groups had lower rates of hypertension, dyslipidemia, non-atherosclerotic heart disease, atherosclerotic cardiovascular disease, diabetes mellitus, malignancy, dementia, and kidney disease than the European patients (Table 1).

3.2. Study Outcomes

3.2.1. In-Hospital Mortality

The unadjusted proportion of deaths during hospitalization differed across the ethnic groups, with higher IHM observed among European patients (21.6%) and lower IHM observed among Sub-Saharan African (3.2%), Latin American (7.1%), Asian (10.9%) and North African patients (11.4%) (Table 2; overall p < 0.001). After adjusting for demographic differences and CCI, Sub-Saharan African patients were 70% less likely to die during hospitalization than European patients (OR (95% CI) 0.28 (0.10–0.79), p = 0.017). The differences observed between the other ethnic minority groups compared to European patients were not statistically significant (Table 3, p > 0.05 for all). The results of IHM during the first wave and second wave data are shown in Supplementary Tables S5 and S6.

3.2.2. Admission to the ICU

The unadjusted proportion of patients admitted to the ICU differed across ethnic groups, with higher ICU admission rates observed among North African (16.8%), Asian (14.5%), and Latin American patients (10.3%), and lower ICU admission rates observed among Sub-Saharan African (10.3%) and European patients (9.1%) (Table 2; global p < 0.001). After adjusting for demographic differences and baseline clinical characteristics, Latin American and North African patients were 37% and 74% more likely to be admitted to the ICU than European patients (OR (95% CI) 1.37 (1.17–1.60), p < 0.001, and OR (95% CI) 1.74 (1.26–2.41), p = 0.001) (Table 3), while the differences between Sub-Saharan African and Asian patients compared to European patients were not statistically significant (Table 3, p > 0.05 for both). The results of admission to the ICU during the first wave and second wave data are shown in Supplementary Tables S5 and S6.

3.2.3. IMV

The unadjusted proportion of need for IMV differed across ethnic groups, with greater use of IMV observed among North African (10.8%) and Latin American (10.1%) patients and less use of IMV among European (7.0%), Sub-Saharan African (7.3%), and Asian (9.1%) patients (p < 0.001). After adjusting for demographic differences, Latin American patients were 43% more likely than European patients to use IMV (OR (95% CI) 1.43 (1.21–1.71), p < 0.001) (Table 3), while the differences between North African, Sub-Saharan African, and Asian patients compared to European patients were not statistically significant (Table 3, p > 0.05 for all). The results of IMV during the first wave and second wave data are shown in Supplementary Tables S5 and S6.

3.2.4. Composite Outcome

The unadjusted proportion of the composite outcome differed across ethnic groups. It was less common among Latin American (15.8%) and Sub-Saharan African (13.8%) patients and more common among European (27.2%), North African (21.9%), and Asian (21.8%) patients (p < 0.001). However, there were no differences among ethnic groups after adjusting for demographic differences (Table 3). The results of the composite outcome during the first wave and second wave data are shown in Supplementary Tables S5 and S6.

3.2.5. Other Outcomes

The median length of hospital stay for the total population was 9 days (IQR:5–14), with significant differences among the ethnic groups (Table 2, total p = 0.032). The median length of hospital stay among Latin Americans was significantly shorter than among Europeans (8 days (5–13) vs. 9 days (6–14); p = 0.024). The results of other outcomes during all periods of study, and the first wave and second wave data, are shown in Table 2 and Supplementary Tables S5 and S6.

4. Discussion

The main finding of this study is that the ethnicity of patients hospitalized with COVID-19 in Spain was not a determining factor of mortality. In this large, nationwide, retrospective study of nearly 24,000 patients hospitalized in Spain with confirmed COVID-19, around 10% of the patients were ethnic minorities, with Latin Americans being the predominant group. These epidemiological data are similar to other Spanish series of patients with COVID-19 [10,11,12,13,14,15,17].
As was expected, patients belonging to an ethnic minority group were significantly younger and had fewer comorbidities than the European patients, the group that includes the native Spanish population. This is likely due to the fact that most migrants are of working age and have settled in Spain in the last two decades [22,23].
This study also found that members of ethnic minority groups also had lower non-adjusted rates of mortality and adverse clinical outcomes than European patients. The more favorable COVID-19 outcomes observed in migrants could be justified by the fact that they are a younger, healthier population and it is well known that older age and comorbidities are among the most important risk factors for COVID-19-related complications and mortality [19,22]. However, even after adjusting for age and comorbidities, patients who belonged to ethnic minority groups were found not to have worse outcomes than European patients. These results are different to previous studies in populations in the USA [3,4,5,7,24,25,26] and the UK [27], where the racial and ethnic minority groups experienced disproportionately severe COVID-19-associated outcomes. A systematic review that analyzed ethnic disparities in COVID-19 in the USA concluded that African American/Black and Hispanic populations had higher rates of COVID-19-related mortality, but similar case fatality rates [2]. In another systematic review that included 52 studies (75.0% from the USA, 18.1% from the UK, and 6.9% from Brazil), the COVID-19 mortality rate was significantly higher among Blacks and Hispanics compared to Whites [28].
It has been hypothesized that this worse COVID-19 prognosis observed in ethnic minority populations is likely multifactorial [3]. First, some comorbidities such as hypertension, obesity, and chronic kidney disease, which are linked to worse clinical outcomes in COVID-19, are more prevalent in these populations [4,5,29,30,31]. Second, the differences in immune response and angiotensin-converting enzyme 2 expression and/or polymorphism observed among individuals of different ethnicities [32,33], as well as genetic variations that may lead to greater disease severity among individuals of certain ethnicities, have been proposed [34,35,36]. Finally, and probably most importantly, social vulnerability and social determinants of health (poverty, low education, and economic levels) are related to an increased risk of both infection and fatality in COVID-19 [37,38,39]. Additionally, inequities in access to healthcare must be considered as an underlying factor of the poor health outcomes observed [3].
The effect of different healthcare system models on clinical outcomes in COVID-19 has not been well studied. Spain has been ranked among the top countries in the world in regard to healthcare access and quality [40]. Spain’s universal public healthcare system guarantees equal access to all, including immigrants, regardless of their legal status [18,41]. Our results suggest that this universal public healthcare system was critical in minimizing the social determinants of health, palliating the socioeconomic inequalities and lack of access to healthcare that have been linked to ethnic disparities in rates of severe COVID-19 described in other countries [3,29].
The impact of COVID-19 on ethnic minority groups in Spain has been analyzed in a few previous studies. In a population-based study of a cohort of adult patients with PCR-confirmed COVID-19 conducted in Madrid, migrants from Sub-Saharan Africa and Latin America showed an increased risk for COVID-19 compared to Spaniards [11]. This higher risk of COVID-19 among minorities have been widely reported in other countries [2,28] and can likely be explained by socioeconomic determinants of health, as discussed previously.
Regarding the clinical outcomes of COVID-19 in immigrant populations in Spain, the results are not consistent. Several small and/or single-center studies have shown an increased risk of ICU admission and IHM in individuals born in Latin American countries, but the model was not adjusted for comorbidities in these studies [10,12,13]. In another multicenter study from 18 Spanish hospitals that included 10,100 patients hospitalized for COVID-19 during the first wave of infections, 14.8% of whom were not born in Spain, Latin American patients also had higher rates of ICU admission and IHM, but, yet again, no adjustment for comorbidities or clinical and treatment variables was performed [15]. In contrast, a single-center study conducted during the first wave of the pandemic in Madrid found a lower rate of IHM among migrants (73.5% from Latin American countries) after adjusting for comorbidities. Finally, findings similar to our study were reported in a multicenter study in four hospitals in Madrid and Barcelona, which included 5235 patients hospitalized with COVID-19 during the first wave. In that work, Latin American patients had a higher rate of ICU admission, but the IHM rate was not higher; however, comorbidities were not included in the multivariable analysis [14].
Interestingly, the Sub-Saharan African patients in our series showed a lower adjusted mortality rate than other ethnic groups. This good prognosis observed among Sub-Saharan Africans could have several hypothetical explanations. On the one hand, Black Africans, who are assumed to form the majority of the Sub-Saharan African group, have been found to be less likely to carry a gene cluster on chromosome 3 that has been associated with severe COVID-19 [36]. On the other hand, Black patients have also been found to have a lower proportion of abdominal adiposity than Latin American and White patients, and visceral fat has been related to a worse prognosis in COVID-19 [42].
Latin American and North African patients had higher adjusted rates of ICU admission with no associated increase in IHM in our study. The increased frequency of ICU admission in non-European patients could be a result of the younger age of this population, as well as the shortage of resources during the peak of the pandemic’s first wave, which is the period when most patients were included in this study. On the other hand, the high proportion of visceral fat and metabolic syndrome in Latin American [42,43] and North African patients could explain their worse outcomes [44]. Further studies investigating potential metabolic, immunological, and genetic markers in patients of different geographical origins are required to understand the determinants of COVID-19 clinical outcomes.
Our study is the largest series of hospitalized patients with COVID-19 in Spain. However, this work has several limitations. First, it has a retrospective cohort register. Second, most of our patients were included during the first wave of the pandemic. Third, there was a relatively low proportion of patients from Sub-Saharan Africa and Asia. Fourth, in Spain, like most European Union Member States, anti-discrimination laws based on the EU Data Protection Directive and Article 21 of the EU Charter do not permit data collection on the basis of racial and ethnic origin [45]. Paradoxically, this policy may limit the generation of evidence that could contribute to reducing disparities among ethnic groups. In our study, a patient’s ethnicity was approximated according to their country of birth. Finally, our conclusions may not be applicable to other settings with different healthcare system models.

5. Conclusions

In Spain, which has a universal public healthcare system, no differences in mortality were observed among minority ethnic groups despite socioeconomic disparities. More well-designed, longitudinal studies are needed to analyze the potential disparities in COVID-19 clinical outcomes among ethnic minority populations in order to identify factors that contribute to them, including the healthcare system model.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jcm11071949/s1, Table S1: Full multivariable logistic regression model for in-hospital mortality; Table S2: Full multivariable logistic regression model for intensive care unit admission; Table S3: Full multivariable logistic regression model for use of invasive mechanical ventilation; Table S4: Full multivariable logistic regression model for use of combined outcome; Table S5: Outcomes of patients with confirmed COVID-19 by ethnic group during first wave; Table S6: Outcomes of patients with confirmed COVID-19 by ethnic group during second wave.

Author Contributions

Conceptualization, J.-M.R.-R. and R.G.-H.; methodology, J.-M.R.-R. and R.G.-H.; software, J.-M.C.-R.; validation, J.-M.R.-R. and R.G.-H.; formal analysis, J.-M.R.-R. and R.G.-H.; investigation, L.C.-P., A.L.-S., M.R., M.R.-R., F.M.-P., A.L.-B., S.M.-L., E.-M.F.-A., G.-M.G.-G., J.-L.B.-P., C.J.-L., F.A.-F., S.M.-C., J.-D.T.-P., A.A., J.-A.V.-N., M.M.-B., J.L.-A., M.-S.H.-G., J.P.-G., M.-L.L.-R., B.B.-F. and J.-M.C.-R.; resources, J.-M.R.-R. and R.G.-H.; data curation, L.C.-P., A.L.-S., M.R., M.R.-R., F.M.-P., A.L.-B., S.M.-L., E.-M.F.-A., G.-M.G.-G., J.-L.B.-P., C.J.-L., F.A.-F., S.M.-C., J.-D.T.-P., A.A., J.-A.V.-N., M.M.-B., J.L.-A., M.-S.H.-G., J.P.-G., M.-L.L.-R., B.B.-F. and J.-M.C.-R.; writing—original draft preparation, J.-M.R.-R. and R.G.-H.; writing—review and editing, J.-M.R.-R. and R.G.-H.; visualization, R.G.-H.; supervision, J.-M.R.-R. and R.G.-H.; project administration, J.-M.C.-R. and R.G.-H. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The project was approved by the Institutional Research Ethics Committee of Málaga on 27 March 2020 (Ethics Committee code: SEMI-COVID-19 27-03-20), as per the guidelines of the Spanish Agency of Medicines and Medical Products. All patients gave informed consent.

Informed Consent Statement

Only patients who had previously given consent for their medical records to be used for medical research were included in this registry. Data confidentiality and patient anonymity were always maintained, in accordance with Spanish regulations on observational studies.

Data Availability Statement

J.-M.R.-R. and R.G.-H. have full access to the data and are the guarantors for the data.

Acknowledgments

We gratefully acknowledge all of the investigators who participated in the SEMICOVID-19 Registry.

Conflicts of Interest

The authors declare no conflict of interest.

Appendix A

Complete list of the SEMI-COVID-19 Network members: SEMI-COVID-19 Scientific Committee Members: José Manuel Casas Rojo, José Manuel Ramos Rincón, Carlos Lumbreras Bermejo, Jesús Millán Núñez-Cortés, Juan Miguel Antón Santos, Ricardo Gómez Huelgas. Members of the SEMI-COVID-19 Group H. Univ. de Bellvitge. L’Hospitalet de Llobregat (Barcelona): Xavier Corbella, Francesc Formiga Pérez, Narcís Homs, Abelardo Montero, Jose María Mora-Luján, Manuel Rubio-Rivas. H. U. 12 de Octubre. Madrid: Paloma Agudo de Blas, Coral Arévalo Cañas, Blanca Ayuso, José Bascuñana Morejón, Samara Campos Escudero, María Carnevali Frías, Santiago Cossio Tejido, Borja de Miguel Campo, Carmen Díaz Pedroche, Raquel Diaz Simon, Ana García Reyne, Laura Ibarra Veganzones, Lucia Jorge Huerta, Antonio Lalueza Blanco, Jaime Laureiro Gonzalo, Jaime Lora-Tamayo, Carlos Lumbreras Bermejo, Guillermo Maestro de la Calle, Rodrigo Miranda Godoy, Barbara Otero Perpiña, Diana Paredes Ruiz, Marcos Sánchez Fernández, Javier Tejada Montes H. Costa del Sol. Marbella (Málaga): Victoria Augustín Bandera, Javier García Alegría, Nicolás Jiménez-García, Jairo Luque del Pino, María Dolores Martín Escalante, Francisco Navarro Romero, Victoria Nuñez Rodriguez, Julián Olalla Sierra H. U. Gregorio Marañon. Madrid: Laura Abarca Casas, Álvaro Alejandre de Oña, Rubén Alonso Beato, Leyre Alonso Gonzalo, Jaime Alonso Muñoz, Crhistian Mario Amodeo Oblitas, Cristina Ausín García, Marta Bacete Cebrián, Jesús Baltasar Corral, Maria Barrientos Guerrero, Alejandro D. Bendala Estrada, María Calderón Moreno, Paula Carrascosa Fernández, Raquel Carrillo, Sabela Castañeda Pérez, Eva Cervilla Muñoz, Agustín Diego Chacón Moreno, Maria Carmen Cuenca Carvajal, Sergio de Santos, Andrés Enríquez Gómez, Eduardo Fernández Carracedo, María Mercedes Ferreiro-Mazón Jenaro, Francisco Galeano Valle, Alejandra Garcia, Irene Garcia Fernandez-Bravo, María Eugenia García Leoni, María Gómez Antúnez, Candela González San Narciso, Anthony Alexander Gurjian, Lorena Jiménez Ibáñez, Cristina Lavilla Olleros, Cristina Llamazares Mendo, Sara Luis García, Víctor Mato Jimeno, Clara Millán Nohales, Jesús Millán Núñez-Cortés, Sergio Moragón Ledesma, Antonio Muiño Míguez, Cecilia Muñoz Delgado, Lucía Ordieres Ortega, Susana Pardo Sánchez, Alejandro Parra Virto, María Teresa Pérez Sanz, Blanca Pinilla Llorente, Sandra Piqueras Ruiz, Guillermo Soria Fernández-Llamazares, María Toledano Macías, Neera Toledo Samaniego, Ana Torres do Rego, Maria Victoria Villalba Garcia, Gracia Villarreal, María Zurita Etayo H. de Cabueñes. Gijón (Asturias): Ana María Álvarez Suárez, Carlos Delgado Vergés, Rosa Fernandez-Madera Martínez, Eva Mª Fonseca Aizpuru, Alejandro Gómez Carrasco, Cristina Helguera Amezua, Juan Francisco López Caleya, Diego López Martínez, María del Mar Martínez López, Aleida Martínez Zapico, Carmen Olabuenaga Iscar, Lucía Pérez Casado, María Luisa Taboada Martínez, Lara María Tamargo Chamorro C. H. U. de Albacete Jose Luis Beato Pérez, Maria Lourdes Sáez Méndez C. H. U. de Badajoz Rafael Aragon Lara, Inmaculada Cimadevilla Fernandez, Juan Carlos Cira García, Gema Maria García García, Julia Gonzalez Granados, Beatriz Guerrero Sánchez, Francisco Javier Monreal Periáñez, Maria Josefa Pascual Perez. H. Royo Villanova. Zaragoza: Nicolás Alcalá Rivera, Anxela Crestelo Vieitez, Esther del Corral Beamonte, Jesús Díez Manglano, Isabel Fiteni Mera, Maria del Mar Garcia Andreu, Martin Gericó Aseguinolaza, Cristina Gallego Lezaun, Claudia Josa Laorden, Raul Martínez Murgui, Marta Teresa Matía Sanz H. Reg. Univ. de Málaga: Mª Mar Ayala-Gutiérrez, Rosa Bernal López, José Bueno Fonseca, Verónica Andrea Buonaiuto, Luis Francisco Caballero Martínez, Lidia Cobos Palacios, Clara Costo Muriel, Francis de Windt, Ana Teresa Fernandez-Truchaud Christophel, Paula García Ocaña, Ricardo Gómez Huelgas, Javier Gorospe García, José Antonio Hurtado Oliver, Sergio Jansen-Chaparro, Maria Dolores López-Carmona, Pablo López Quirantes, Almudena López Sampalo, Elizabeth Lorenzo-Hernández, Juan José Mancebo Sevilla, Jesica Martín Carmona, Luis Miguel Pérez-Belmonte, Iván Pérez de Pedro, Araceli Pineda-Cantero, Carlos Romero Gómez, Michele Ricci, Jaime Sanz Cánovas. H. U. La Paz. Madrid: Jorge Álvarez Troncoso, Francisco Arnalich Fernández, Francisco Blanco Quintana, Carmen Busca Arenzana, Sergio Carrasco Molina, Aranzazu Castellano Candalija, Germán Daroca Bengoa, Alejandro de Gea Grela, Alicia de Lorenzo Hernández, Alejandro Díez Vidal, Carmen Fernández Capitán, Maria Francisca García Iglesias, Borja González Muñoz, Carmen Rosario Herrero Gil, Juan María Herrero Martínez, Víctor Hontañón, Maria Jesús Jaras Hernández, Carlos Lahoz, Cristina Marcelo Calvo, Juan Carlos Martín Gutiérrez, Monica Martinez Prieto, Elena Martínez Robles, Araceli Menéndez Saldaña, Alberto Moreno Fernández, Jose Maria Mostaza Prieto, Ana Noblejas Mozo, Carlos Manuel Oñoro López, Esmeralda Palmier Peláez, Marina Palomar Pampyn, Maria Angustias Quesada Simón, Juan Carlos Ramos Ramos, Luis Ramos Ruperto, Aquilino Sánchez Purificación, Teresa Sancho Bueso, Raquel Sorriguieta Torre, Clara Itziar Soto Abanedes, Yeray Untoria Tabares, Marta Varas Mayoral, Julia Vásquez Manau H. Clínico de Santiago de Compostela (A Coruña): Maria del Carmen Beceiro Abad, Maria Aurora Freire Romero, Sonia Molinos Castro, Emilio Manuel Paez Guillan, María Pazo Nuñez, Paula Maria Pesqueira Fontan H. U. Puerta de Hierro. Madrid: Ane Andrés Eisenhofer, Ana Arias Milla, Isolina Baños Pérez, Laura Benítez Gutiérrez, Javier Bilbao Garay, Jorge Calderón Parra, Alejandro Callejas Díaz, Erika Camacho Da Silva, Mª Cruz Carreño Hernández, Raquel Castejón Díaz, María Jesús Citores Sánchez, Carmen Cubero Gozalo, Valentín Cuervas-Mons Martínez, Laura Dorado Doblado, Sara de la Fuente Moral, Alberto Díaz de Santiago, Itziar Diego Yagüe, Ignacio Donate Velasco, Ana María Duca, Pedro Durán del Campo, Gabriela Escudero López, Esther Expósito Palomo, Ana Fernández Cruz, Amy Galán Gómez, Sonia García Prieto, Beatriz García Revilla, Miguel Ángel García Viejo, Javier Gómez Irusta, Patricia González Merino, Edith Vanessa Gutiérrez Abreu, Isabel Gutiérrez Martín, Ángela Gutiérrez Rojas, Andrea Gutiérrez Villanueva, Jesús Herráiz Jiménez, Fátima Ibáñez Estéllez, Pedro Laguna del Estal, Mª Carmen Máinez Sáiz, Carmen de Mendoza Fernández, María Martínez Urbistondo, Fernando Martínez Vera, María Mateos Seirul-lo, Susana Mellor Pita, Patricia A. Mills Sánchez, Esther Montero Hernández, Alberto Mora Vargas, Victor Moreno-Torres Concha, Ignacio Morrás De La Torre, Elena Múñez Rubio, Rosa Muñoz de Benito, Alejandro Muñoz Serrano, Pablo Navarro Palomo, Ilduara Pintos Pascual, Arturo José Ramos Martín-Vegue, Antonio Ramos Martínez, Celia Rodríguez Olleros, Alberto Roldán Montaud, Yolanda Romero Pizarro, Silvia Rosado García, Diana Ruiz de Domingo, David Sánchez Ortiz, Enrique Sánchez Chica, Irene Solano Almena, Elena Suanzes Martin, Yale Tung Chen, Pablo Tutor de Ureta, Ángela Valencia Alijo, Jose Manuel Vázquez Comendador, Juan Antonio Vargas Núñez. H. Universitario Dr. Peset. Valencia: Juan Alberto Aguilera Ayllón, Arturo Artero, María del Mar Carmona Martín, María José Fabiá Valls, Maria de Mar Fernández Garcés, Ana Belén Gómez Belda, Ian López Cruz, Manuel Madrazo López, Elisabeth Mateo Sanchis, Jaume Micó Gandia, Laura Piles Roger, Adela Maria Pina Belmonte, Alba Viana García H. U. de A Coruña: Alicia Alonso Álvarez, Olaya Alonso Juarros, Ariadna Arévalo López, Carmen Casariego Castiñeira, Ana Cerezales Calviño, Marta Contreras Sánchez, Ramón Fernández Varela, Santiago J. Freire Castro, Ana Padín Trigo, Rafael Prieto Jarel, Fátima Raad Varea, Ignacio Ramil Freán, Laura Ramos Alonso, Francisco Javier Sanmartín Pensado, David Vieito Porto H. G. U. de Elda (Alicante): Carmen Cortés Saavedra, Jennifer Fernández Gómez, Borja González López, María Soledad Hernández Garrido, Ana Isabel López Amorós, Santiago López Gil, Maria de los Reyes Pascual Pérez, Nuria Ramírez Perea, Andrea Torregrosa García H. U. Infanta Cristina. Parla (Madrid): Juan Miguel Antón Santos, Ana Belén Barbero Barrera, Blanca Beamonte Vela, Coralia Bueno Muiño, Charo Burón Fernández, Ruth Calderón Hernáiz, Irene Casado López, José Manuel Casas Rojo, Andrés Cortés Troncoso, Pilar Cubo Romano, Francesco Deodati, Alejandro Estrada Santiago, Gonzalo García Casasola Sánchez, Elena García Guijarro, Francisco Javier García Sánchez, Pilar García de la Torre, Mayte de Guzmán García-Monge, Davide Luordo, María Mateos González, José A. Melero Bermejo, Cruz Pastor Valverde, José Luis Pérez Quero, Fernando Roque Rojas, Lorea Roteta García, Elena Sierra Gonzalo, Francisco Javier Teigell Muñoz, Juan Vicente de la Sota, Javier Villanueva Martínez. H. U. Son Llàtzer. Palma de Mallorca: Andrés de la Peña Fernández, Almudena Hernández Milián. C. A. U. de Salamanca: Gloria María Alonso Claudio, Víctor Barreales Rodríguez, Cristina Carbonell Muñoz, Adela Carpio Pérez, María Victoria Coral Orbes, Daniel Encinas Sánchez, Sandra Inés Revuelta, Miguel Marcos Martín, José Ignacio Martín González, José Ángel Martín Oterino, Leticia Moralejo Alonso, Sonia Peña Balbuena, María Luisa Pérez García, Ana Ramon Prados, Beatriz Rodríguez-Alonso, Ángela Romero Alegría, Maria Sanchez Ledesma, Rosa Juana Tejera Pérez. H. de Mataró. Barcelona: Raquel Aranega González, Ramon Boixeda, Javier Fernández Fernández, Carlos Lopera Mármol, Marta Parra Navarro, Ainhoa Rex Guzmán, Aleix Serrallonga Fustier C. H. U. de Ferrol (A Coruña): Hortensia Alvarez Diaz, Tamara Dalama Lopez, Estefania Martul Pego, Carmen Mella Pérez, Ana Pazos Ferro, Sabela Sánchez Trigo, Dolores Suarez Sambade, Maria Trigas Ferrin, Maria del Carmen Vázquez Friol, Laura Vilariño Maneiro. H. Público de Monforte de Lemos (Lugo): José López Castro, Manuel Lorenzo López Reboiro, Cristina Sardiña González H. General Defensa. Zaragoza: Anyuli Gracia Gutiérrez, Leticia Esther Royo Trallero H. Germans Trias i Pujol. Badalona (Barcelona): Elia Fernández Pedrega, Gemma Lladós Bertran, Xoel Pena Pérez. H. do Salnes. Vilagarcía de Arousa (Pontevedra): Vanesa Alende Castro, Ana María Baz Lomba, Ruth Brea Aparicio, Marta Fernández Morales, Jesús Manuel Fernández Villar, María Teresa López Monteagudo, Cristina Pérez García, Lorena Rodríguez Ferreira, Diana Sande Llovo, Maria Begoña Valle Feijoo. H. U. HM Montepríncipe: José F. Varona Arche.

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Table
Table 1. Demographic and clinical characteristics of patients with confirmed COVID-19 by ethnic group.
Table 1. Demographic and clinical characteristics of patients with confirmed COVID-19 by ethnic group.
MTotal
(n = 22,953)		Latin Americans
(n = 1839; 8.0%)		North Africans (n = 281; 1.2%)Sub-Saharan Africans
(n = 124; 0.5%)		Asians
(n = 110; 0.5%)		Europeans
(n = 20,599; 89.7%)		Global
p		LA vs. E
p		NA vs. E
p		SS vs. E
p		Asian vs. E
p
Age, years, median (IQR)069.5 (56.7–80.1)49.1 (40.5–58.9)57.1 (44.1–67.1)50.0 (42.3–61.3)49.7 (41.1–62.4)71.5 (59.5–81.4)<0.001<0.001<0.001<0.001<0.001
Age, years, n (%)
18–3901340 (5.8)433 (23.5)46 (16.4)23 (18.5)23 (20.9)815 (4.9)<0.001<0.001<0.001<0.001<0.001
40–6408054 (35.1)1151 (62.6)150 (53.4)73 (58.9)65 (59.1)6617 (32.1)<0.001<0.001<0.001<0.001<0.001
65+013,558 (59.1)255 (13.9)85 (30.2)28 (22.6)22 (20.0)13,168 (63.9)<0.001<0.001<0.001<0.001<0.001
Sex, female, n (%)09740 (42.4)847 (46.1)37 (33,6)48 (38.7)37 (33.6)8716 (42.3)<0.0010.0020.0010.4120.066
Wave, first, n (%)016,879 (73.5)1375 (74.8)163 (58.0)73 (58.9)76 (69.1)15,192 (73.8)<0.0010.341<0.001<0.0010.268
Nosocomial infection, n (%)01088 (4.7)44 (2.4)10 (3.6)5 (4.0)4 (3.6)1025 (5.0)<0.001<0.0010.2750.6400.517
Dependence, mild and severe, n (%)2181711 (7.5)22 (1.2)1 (0.4)2 (1.7)2 (1.8)1684 (8.3)<0.001<0.001<0.001<0.001<0.001
Baseline CCI, median (IQR)03 (2–5)1 (0–2)2 (0.0–3.0)1 (0–3)1.5 (0–2.5)4 (2–5)<0.001<0.001<0.001<0.001<0.001
Baseline CCI, n (%)
0–208595 (38.2)1468 (81.5)177 (64.4)82 (67.8)81 (75.0)6787 (33.6)<0.001<0.001<0.001<0.001<0.001
3–406328 (28.1)208 (81.5)60 (21.8)25 (20.7)16 (14.8)6019 (39.8)<0.001<0.001<0.001<0.001<0.001
5+07601 (33.7)126 (7.0)38 (13.8)14 (11.6)11 (10.2)7412 (36.7)<0.001<0.001<0.001<0.001<0.001
Comorbidities, n (%)
Hypertension2511,997 (52.3)402 (21.9)101 (35.9)49 (39.5)45 (31.3)11,997 (52.3)<0.001<0.001<0.001<0.0010.003
Dyslipidemia399091 (39.7)389 (21.2)89 (31.7)30 (24.2)25 (22.9)8558 (41.6)<0.001<0.0010.001<0.001<0.001
Non-atherosclerotic heart disease a543423 (14.9)46 (2.5)18 (6.4)6 (4.8)5 (4.6)3348 (16.3)<0.001<0.001<0.0010.0010.001
Atherosclerotic cardiovascular disease b 813895 (17.0)101 (5.5)32 (11.5)7 (5.7)12 (11.0)3743 (18.2)<0.001<0.0010.004<0.0010.051
Diabetes mellitus494782 (20.9)212 (11.6)73 (26.0)29 (23.8)19 (17.4)4449 (21.6)<0.001<0.0010.0800.5290.287
Obesity18064775 (22.6)469 (27.6)60 (22.4)28 (22.8)10 (9.7)4208 (22.2)<0.001<0.0010.9420.8810.002
Chronic pulmonary disease c533626 (15.8)175 (9.6)36 (12.8)19 (15.3)11 (10.1)3385 (16.5)<0.001<0.0010.1000.7320.073
Malignancy d332290 (10.0)72 (3.9)13 (4.6)8 (6.5)7 (6.4)2190 (10.7)<0.001<0.0010.0010.1360.152
Dementia392777 (9.9)24 (1.3)2 (0.7)2 (1.6)1 (0.9)2248 (10.9)<0.001<0.001<0.0010.0010.001
Chronic kidney disease e371481 (6.2)1358 (6.6)7 (2.5)41 (2.2)5 (4.6)1358 (6.6)<0.001<0.0010.0060.4300.398
HIV64122 (0.5)23 (1.3)2 (0.7)6 (4.8)0 (0.0)91 (0.4)<0.001<0.0010.499<0.0010.486
Obstructive sleep apnea1141363 (6.0)51 (2.8)11 (3.9)6 (4.9)3 (2.8)11 (3.9)<0.001<0.0010.1060.5300.128
Chronic liver disease60808 (3.5)60 (3.3)15 (5.4)2 (1.6)8 (7.4)723 (3.5)0.0580.6350.0980.2500.029
Baseline medication use, n (%)
ASA1103726 (16.3)78 (4.2)33 (11.8)11 (8.9)10 (9.3)3594 (17.5)<0.001<0.0010.0120.0110.024
Statin997317 (32.0)248 (13.5)20 (18.5)25 (20.2)248 (13.5)71 (25.3)<0.001<0.0010.0020.0010.001
ACE inhibitor883998 (17.5)152 (8.3)44 (15.7)16 (12.9)18 (16.7)3768 (18.4)<0.001<0.0010.2440.1170.649
ARB864617 (20.2)148 (8.1)31 (11.1)20 (16.3)8 (7.4)4410 (21.5)<0.001<0.001<0.0010.1590.002
Anticoagulant782565 (11.2)36 (2.0)15 (5.4)6 (4.8)4 (3.7)2504 (12.2)<0.001<0.001<0.0010.0120.007
n (%): number of cases (percentage); M: missing value; IQR: interquartile range; CCI: Charlson Comorbidity Index; E: Europeans; LA: Latino-Americans; NA: North Africans; SS: Sub-Saharans. HIV: human immunodeficiency virus. ASA: acetylsalicylic acid. ACE: angiotensin-converting enzyme. ARB: angiotensin receptor blockers. a Non-atherosclerotic heart disease includes atrial fibrillation and/or heart failure. b Atherosclerotic cardiovascular disease includes coronary, cerebrovascular, and/or peripheral vascular disease. c Chronic pulmonary disease includes chronic obstructive pulmonary diseases and/or asthma. d Malignancy includes solid tumors or hematological neoplasia. e Chronic kidney disease is defined as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 according to the CKD-EPI equation.
Table
Table 2. Outcomes of patients with confirmed COVID-19 by ethnic group.
Table 2. Outcomes of patients with confirmed COVID-19 by ethnic group.
MTotal
(n = 22,953) ϕ		Latin Americans
(n = 1839; 8.0%) ϕ		North Africans
(n = 281; 1.2%) ϕ		Sub-Saharan Africans
(n = 124; 0.5%) ϕ		Asians
(n = 110; 0.5%) ϕ		Europeans
(n = 20,599; 89.7%) ϕ		Global
p		LA vs. E pNA vs. E pSS vs. E pAsian vs. E p
Main outcomes, n (%)
In-hospital mortality04636 (20.2)130 (7.1)32 (11.4)4 (3.2)12 (10.9)4458 (21.6)<0.001<0.001<0.001<0.0010.006
Intensive care unit admission112186 (9.5)239(13.0)47 (16.8)13 (10.3)16 (14.5)1871 (9.1)<0.001<0.001<0.0010.5900.047
Invasive mechanical ventilation921664 (7.3)185 (10.1)30 (10.8)9 (7.3)10 (9.1)1430 (7.0)<0.001<0.0010.0140.8800.384
Composite outcome575983 (26.1)289 (15.8)61 (21.9)17 (13.8)24 (21.8)5592 (27.2)<0.0010.0010.0500.0010.205
Other outcomes, n (%)
Non-invasive mechanical ventilation1001325 (5.8)113 (6.2)24 (8.6)9 (7.3)7 (6.4)1172 (5.7)0.2550.4210.0400.4430.770
High-flow oxygen therapy1582199 (9.6)215 (11.8)45 (16.2)16 (13)11 (10.0)1912 (9.3)<0.0010.001<0.0010.1640.814
Length of hospital stay, days, median (IQR)1459 (5–14)8 (5–13)9 (6–15)9 (6–15)8 (5–16)9 (6–14)0.0230.0270.1040.2970.832
Length of hospital stay >10 days, n (%)14510,276 (45.1)762 (41.5)137 (49.3)61 (49.5)48 (43.6)9268 (45.3)0.0120.0020.1860.3410.772
ϕ All patients; M: missing value; E: Europeans; LA: Latin Americans; NA: North Africans; SS: Sub-Saharan Africans; IQR: Interquatile range.
Table
Table 3. Crude and multivariable logistic regression model for mortality, intensive care unit admission, and invasive mechanical ventilation among patients with confirmed COVID-19 by ethnicity.
Table 3. Crude and multivariable logistic regression model for mortality, intensive care unit admission, and invasive mechanical ventilation among patients with confirmed COVID-19 by ethnicity.
CrudeAdjusted Model a
Independent VariablesOdds Ratio (95% CI)pOdds Ratio (95% CI)p
In-hospital mortality
Latin Americans0.27 (0.23–0.33)<0.0011.11 (0.90–1.36)0.320
North Africans0.46 (0.32–0.67)<0.0011.05 (0.70–1.60)0.786
Sub-Saharan Africans0.12 (0.04–0.32)<0.0010.28 (0.10–0.79)0.017
Asians0.44 (0.24–0.80)0.0081.50 (0.77–2.93)0.320
EuropeansRef Ref
Intensive care unit admission
Latin Americans1.49 (1.29–1.72)<0.0011.37 (1.17–1.60)<0.001
North Africans2.01 (1.47–2.71)<0.0011.74 (1.26–2.41)0.001
Sub-Saharan Africans1.17 (0.65–2.08)0.5901.03 (0.57–1.86)0.903
Asians1.70 (1.00–2.90)0.0501.49 (0.87–2.56)0.145
EuropeansRef Ref
Invasive mechanical ventilation
Latin Americans1.50 (1.27–1.76)<0.0011.43 (1.21–1.71)<0.001
North Africans1.60 (1.10–2.36)0.0151.50 (1.01–2.21)0.051
Sub-Saharan Africans1.05 (0.53–2.08)0.8801.01 (0.50–2.01)0.974
Asians1.33 (0.68–2.56)1.3351.23 (0,63–2.38)0.534
EuropeansRef Ref.
Composite outcome
Latin Americans0.50 (0.44–0.57)<0.0011.13 (0.98–1.31)0.082
North Africans0.75 (0.57–1.00)0.0511.27 (0.93–1.72)0.122
Sub-Saharan Africans0.43 (0.26–0.71)0.0010.79 (0.46–1.35)0.398
Asians0.75 (0.47–1.17)0.2071.521 0.94–2.44)0.085
EuropeansRef Ref
Ref.: reference. a Adjusted for age group, sex, wave, place of acquisition, and baseline Charlson Comorbidity Index group. See Supplementary Tables S1–S4 for full models.
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Ramos-Rincon, J.-M.; Cobos-Palacios, L.; López-Sampalo, A.; Ricci, M.; Rubio-Rivas, M.; Martos-Pérez, F.; Lalueza-Blanco, A.; Moragón-Ledesma, S.; Fonseca-Aizpuru, E.-M.; García-García, G.-M.; et al. Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry. J. Clin. Med. 2022, 11, 1949. https://doi.org/10.3390/jcm11071949

AMA Style

Ramos-Rincon J-M, Cobos-Palacios L, López-Sampalo A, Ricci M, Rubio-Rivas M, Martos-Pérez F, Lalueza-Blanco A, Moragón-Ledesma S, Fonseca-Aizpuru E-M, García-García G-M, et al. Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry. Journal of Clinical Medicine. 2022; 11(7):1949. https://doi.org/10.3390/jcm11071949

Chicago/Turabian Style

Ramos-Rincon, Jose-Manuel, Lidia Cobos-Palacios, Almudena López-Sampalo, Michele Ricci, Manuel Rubio-Rivas, Francisco Martos-Pérez, Antonio Lalueza-Blanco, Sergio Moragón-Ledesma, Eva-María Fonseca-Aizpuru, Gema-María García-García, and et al. 2022. "Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry" Journal of Clinical Medicine 11, no. 7: 1949. https://doi.org/10.3390/jcm11071949

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