Descriptive Assessment of Race, Ethnicity, Comorbidities, and SARS-CoV-2 Infection- Fatality in North Carolina

Background SARS-CoV-2 infection has caused variable clinical outcomes including hospitalization and death. We analyzed state-level data from the North Carolina COVID-19 Surveillance System (NC COVID) to describe demographics of those infected with SARS-CoV-2 and to describe factors associated with infection-fatality in North Carolina. Methods This was a retrospective cohort study using surveillance data on positive SARS-CoV-2-infected individuals (N = 214,179) identified between March 1, 2020, and September 30, 2020. We present descriptive statistics and associations among demographics, medical comorbidities, and SARS-CoV-2 infection-fatality. Results Median age for residents with reported SARS-CoV-2 was 38 (IQR 23–54). Age was strongly correlated with SARS-CoV-2 infection-fatality. Greater infection-fatality was noted among those who identified as Black across all comorbidities. Coexisting chronic disease was associated with greater infection-fatality, with kidney disease demonstrating the strongest association. Limitations A high percentage of missing data for race/ethnicity and comorbidities limits the interpretation of our findings. Data were not available for socioeconomic measures that could aid in better understanding inequities associated with SARS-CoV-2 infection-fatality. Conclusions Among North Carolinians identified with SARS-CoV-2 via surveillance efforts, age, race, and comorbidities were associated with infection-fatality; these findings are similar to those of studies using different source populations in the United States. In addition to age and other nonmodifiable variables, systematic differences in social conditions and opportunity may increase the risk of SARS-CoV-2 infection-fatality among Black Americans compared to other races/ethnicities.