Racial/ethnic disparities in COVID-19 clinical outcomes: A comparison between Asian ethnic subgroups

Racial/ethnic disparities in COVID-19 clinical outcomes: A comparison between Asian ethnic subgroups | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Racial/ethnic disparities in COVID-19 clinical outcomes: A comparison between Asian ethnic subgroups Mahdieh Ahmadi Kamalabadi, Parvin Khalili, Hamid Ostadebrahimi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4175661/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Since the outbreak of COVID-19, general studies about relationship between COVID-19 clinical outcome and ethnicity have been performed on the overall ethnic groups, but studies on ethnic subgroups is limited. Methods We conducted a population-based retrospective cohort study on hospitalized patients with suspected/confirmed COVID-19 to evaluate whether ethnic background influences disease severity and clinical outcomes. Patients were categorized into three groups: mild, moderate, and severe to critical. Analyses were adjusted for socio-demographic and comorbidities. Results Among all hospitalized patients, in the unadjusted model, Afghans had a lower risk of severe to critical illness than Iranians (OR, 0.52; 95%CI, 0.41–0.64; P < 0.000). After adjusting for age, sex and comorbidities the risk remained lower in Afghans (OR, 0.69; 95%CI, 0.56–0.88; P < 0.003). But among positive cases was comparable even after full adjustment (OR, 0.86; 95%CI, 0.54–1.3; P < 0.547). Among all hospitalized patients, in the unadjusted model, the risk of death was comparable between Afghans and Iranians (OR, 1.037; 95%CI, 0.70–1.5; P < 0.003). After adjusting for age, sex and comorbidities, Afghans had a higher risk of death than Iranians (OR, 1.66; 95%CI, 1.08–2.55; P = 0.020). Similar results were observed in positive cases (OR, 2.34; 95%CI, 1.47–3.72; P = 0.000). Conclusions In this cohort study, Iranians represented more COVID-19-related symptoms and disease severity than Afghans; but mortality was higher in Afghans. The impact of COVID-19 may be different in various Asian ethnic groups COVID-19 Ethnicity Clinical outcome Background The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), also termed COVID-19, is now a global pandemic with destructing effects on the world population, health system, and economy. The manifestations of the disease are widely variable from asymptomatic to symptomatic, ranging from fever or cough to severe pneumonia followed by acute respiratory distress syndrome (ARDS) that requires admission in an intensive care unit (ICU), leading to death in severe cases ( 1 , 2 ). It has been proven that age, sex, and a previous underlying disease are risk factors for severe cases ( 1 ). Although most COVID-19 infections do not lead to hospitalization, several epidemiological studies have reported its higher prevalence in some regions and ethnic groups ( 2 ). Various studies have shown significant differences in clinical features based on ethnicity-related factors in some diseases, including tuberculosis, Ebola, and influenza H1N1 ( 3 – 6 ). Similarly, with the spread of Covid-19 worldwide, different health outcomes have been reported in many countries according to ethnicity, even in children. Furthermore, progression from pneumonia to ARDS, as a major cause of death, varies considerably among countries from 3–63% ( 7 – 9 ). The potential impact of ethnic disparity on COVID-19 outcomes has been raised with reports of multi-ethnic populations in Western Europe and North America. Evidence-based data from different countries indicate a higher risk of infection and severe outcomes among Black, Asian, and Minority Ethnic (BAME) groups. An extensive systematic review of 18,728,893 patients, which has investigated clinical outcomes for COVID-19 considering ethnicity, demonstrates an increased risk of infection in Black and Asian ethnicities compared to that of White. Even after adjusting for age, sex, and underlying diseases, the Asian population is at greater risk of being admitted to the intensive care unit and death. With increasing evidence of a higher risk of COVID-19 infection among Asian ethnic, the likelihood of its different impact on Asian ethnicity is highlighted ( 10 , 11 ). Of course, although this difference has been observed in various ethnicities, the cause and factors involved are not clear ( 12 , 13 ). Since the role of ethnicity is multifactorial, it is not well comprehended why certain ethnicities are prone to severe COVID-19 outcomes and whether ethnicity mainly impacts infection risk, disease progression, or survival after hospitalization with severe illness ( 1 , 11 ). On the other hand, some studies have shown that some ethnicities, despite being younger and having less comorbidity, experience more severe disease. Accordingly, for better understanding the impact of ethnicity on COVID-19 outcome, the results must be disaggregated and studies in ethnic subgroups considered separately, especially in Asian subgroups ( 14 , 15 ). Apart from this, some studies have suggested that due to the lack of a specific treatment protocol, the unequal effect of COVID-19 may be arising from different inter-hospital care. Thus, scientific studies that result in improved understanding of relation between COVID-19 and race/ethnicity could help improve health care, develop effective mitigation strategies, and obtain better clinical outcome ( 1 , 16 ). In this study, the two nationalities of Iranian and Afghan as Asian subgroups are assessed in a determined medical center. The aim is to compare the symptoms and clinical outcomes of COVID-19 in hospitalized patients according to ethnicity. Methods Study design and data collection This population-based retrospective cohort study was conducted on hospitalized patients with suspected/confirmed COVID-19 in Rafsanjan, from September 2020 to March 2020. All patients with a positive result of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of a specimen collected on a nasopharyngeal swab and/or typical findings at chest computed tomography were considered as confirmed COVID-19 cases; in contrast, those with only symptoms in favor of COVID-19 were considered suspected cases. All hospitalized patients were recruited in this study. People who had incomplete clinical data and did not require hospitalization were excluded. All data were retrieved from Hospital Information System (HIS). The following data were included: demographics, history of underlying disease, clinical symptoms, duration of hospitalization, and clinical outcomes. Ethnicity was recorded for all patients based on self-reported data at the initial referral to the emergency department. Patients were categorized into three groups: mild, moderate, and severe to critical. The mild illness was defined as having any COVID-19 signs and symptoms but with oxygen saturation higher than 93%. The moderate disease was defined as having oxygen saturation of less than 93% ( \({Spo}_{2}\) < 93) but not requiring supplemental oxygen. The severe to critical illness was defined as having oxygen saturation of less than 93% ( \({Spo}_{2}\) < 93), requiring non-invasive or mechanical ventilation. The outcome was defined as discharge to home or in-hospital mortality. Statistical Analysis To describe the data, frequency (%) for categorical was reported and as the chi-square test was used to analyze categorical variables across of racial and ethnic (Iranian vs. Afghans) categories. In addition, we used of multinomial logistic regression models to estimate odds ratios (ORs) with 95% confidence intervals (CIs) to assess the possible relationships of racial and ethnic with the Hospitalization among Covid-19 Patients. Confounders were identified Based on subject matter knowledge and the relevant epidemiological literature. These confounders were sequentially entered into models according to their hypothesized strengths of association with the Hospitalization of Covid-19 in patients and racial. To reach this goal, separate models at bivariate level were run to obtain variables associated with Hospitalization of Covid-19 in patients. Afterwards, variables with a p-value < 0.25 were considered for multivariate analysis. The crud model is stratified on the status of racial and ethnic. Adjusted model 1 included sociodemographic characteristics (age and gender) considered to be the most strongly related with Hospitalization of Covid-19 in patients. Adjusted model 2 included all variables in adjusted model 1 and additionally adjusted for underlying diseases, as these were hypothesized to be potential confounders on the causal pathways that could explain association with the Hospitalization of Covid-19 in patients and racial and ethnic. Furthermore, dichotomous Logistic regression models were used to compare the odds of death of Covid-19 in Iranians and Afghans. Results Characteristics of the study population A total of 9,422 hospitalized patients were recruited in this study, of whom 9034 (95.88%) were Iranian and 388 (4.12%) Afghan. Among them, 5,561 cases were confirmed, of whom 5,389 (96.91%) were Iranian and 172 (3.09%) Afghan. Table 1 presents the proportion of all hospitalized and COVID-19- positive patients in terms of race/ethnicity. Table 1 Proportion of Patients admitted by Race/Ethnicity Patients, No. (%) P Value Characteristics Iranian Afghan COVID-19 positive status by race Total, No (%) 9,034 (95.88) 388 (4.12) PCR positive result 3,532 (66.67) 85 (38.99) 0.000 CT Scan positive result 5,152 (61.75) 167 (56.04) 0.046 Positive 5,389 (96.91) 172 (3.09) PCR positive result 3,390 (71.32) 80 (51.28) 0.000 CT Scan positive result 5,152 (95.58) 167 (96.53) 0.549 Demographic and clinical characteristics of all hospitalized patients Patient characteristics (age, sex, signs and symptoms, clinical comorbidities, and hospital presentation) in terms of race/ethnicity are provided in Table 2 . The mean age of all hospitalized patients was 53.09 (29.18) and 50.36% were females. Afghan patients were younger than Iranians (e.g., age 18–49 years: 39.43% Afghan vs. 26.52% Iranian). The most frequently reported symptoms were respiratory distress, muscular pain, fever, and cough. Also, respiratory distress, muscular pain, anorexia, headache, convulsions, smell loss, chest pain, taste loss, and vertigo differed by race/ethnicity such that, apart from the convulsions being more common among Afghans, the other symptoms mentioned were more common in Iranians. Among comorbidities, hypertension, diabetes, and heart disease were more frequently observed among Iranian than Afghans. More Afghan patients showed temperature ≥ 37° C (P = 0.002) and the number of breaths ≥ 22 (P = 0.006) on hospital presentation than Iranian. A significant percentage of Iranian patients were in critical condition (63.75% vs. 48.98%; P < 0.000) and the need for oxygen therapy (62.88% vs. 47.45%) compared to Afghans. Race/ethnic differences were observed in the median duration of hospital stay (Afghan: 3.7 days vs. Iranian: 3.2 days) (P < 0.017). In the unadjusted model, Afghan patients had a lower risk of severe to critical illness than Iranians (OR, 0.52; 95%CI, 0.41–0.64; P < 0.000). After adjusting for age and sex, the risk remained lower in Afghan patients (OR, 0.7; 95%CI, 0.56–0.88; P < 0.003). Adding comorbidities to the model did not alter the lower risk (OR, 0.69; 95%CI, 0.56–0.88; P < 0.003) (Table 3 ). In the unadjusted model, the risk of death was comparable between Afghan and Iranian patients (OR, 1.037; 95%CI, 0.70–1.5; P < 0.003). After adjusting for age and sex, Afghan patients had a higher risk of death than Iranians (OR, 1.57; 95%CI, 1.03–2.4; P < 0.036). Risk of death remained higher for Afghans after additional adjustment for comorbidities (OR, 1.66; 95%CI, 1.08–2.55; P = 0.020) (Table 4 ). Table 2 Baseline and in-hospital characteristics by Race/Ethnicity among All Hospitalized Patients Patients, No. (%) P Value Characteristics Iranian Afghan Age( years) 0.000 =81 1,002 (11.09) 21 (5.41) Sex Men 4,484 (49.61) 197 (50.26) Women 4,554 (50.39) 195 (49.74) Presenting symptoms Fever 3,721 (41.17) 162 (41.33) 0.951 Cough 3,601 (39.84) 140 (35.71) 0.102 Muscular pain 4,234 (46.85) 143 (36.48) 0.000 respiratory distress 5,006 (55.39) 166 (42.35) 0.000 Loss consciousness 881 (9.75) 33 (8.42) 0.384 Sense smell 331 (3.66) 3 (0.77) 0.002 loss taste 286 (3.16) 4 (1.02) 0.016 Convulsions 58 (0.64) 8 (2.04) 0.001 Stomach ache 564 (6.40) 19 (5.00) 0.271 nausea 1,307 (14.84) 43 (11.32) 0.057 vomiting 825 (9.37) 35 (9.21) 0.918 diarrhea 618 (7.02) 20 (5.26) 0.188 anorexia 1,582 (17.97) 35 (9.21) 0.000 Headache 1,532 (17.67) 40 (10.72) 0.001 Vertigo 786 (9.06) 21 (5.63) 0.023 Parcy limbs 95 (1.10) 1 (0.27) 0.127 Organ lesion 13 (0.15) 0 (0.00) 0.454 Chest pain 946 (10.91) 23 (6.17) 0.004 Clinical comorbidities Diabetes 1,516 (16.77) 37 (9.44) 0.000 Cancer 167 (1.85) 4 (1.02) 0.229 Immune Deficiency 110 (1.22) 3 (0.77) 0.421 Heart disease 1,113 (12.31) 20 (5.10) 0.000 Chronic kidney 361 (3.99) 15 (3.83) 0.868 Asthma 153 (1.69) 3 (0.77) 0.159 Other chronic lung diseases 734 (8.12) 25 (6.38) 0.214 Chronic neurological disorders 527 (5.83) 19 (4.85) 0.414 hypertension 1,863 (20.61) 36 (9.18) 0.000 Hospital presentation Temperature, °C 0.002 ≤ 37 5,072 (76.13) 160 (67.51) 37–38 1,154 (17.32) 62 (26.16) > 38 436 (6.54) 15 (6.33) Missing Number of breathing 0.006 ≤ 22 5,853 (88.16) 192 (82.05) 22–28 487 (7.34) 22 (9.40) > 28 299 (4.50) 20 (8.55) Oxygen therapy 5,683 (62.88) 186 (47.45) 0.000 Duration of hospitalization (day) 3.2 3.7 0.017 Intubation 519 (5.74) 28 (7.14) 0.246 Disease severity 0.000 Mild 2,509 (27.76) 161 (41.07) Moderate 767 (8.49) 39 (9.95) Sever to critical 5,762 (63.75) 192 (48.98) Table 3 Baseline and in-hospital characteristics by Race/Ethnicity among 5,563 COVID-19–Positive Patients Patients, No. (%) P Value Characteristics Iranian Afghan Age( years) 0.000 =81 702 (13.03) 11 (6.40) Sex 0.639 Men 2,644 (49.05) 88 (50.87) Women 2,746 (50.95) 85 (49.13) Presenting symptoms Fever 2,392 (44.38) 80 (46.24) 0.627 Cough 2,377 (44.10) 73 (42.20) 0.620 Muscular pain 2,614 (48.50) 72 (41.62) 0.075 respiratory distress 3,978 (73.80) 112 (64.74) 0.008 Loss consciousness 800 (14.84) 28 (16.18) 0.625 Sense smell 266 (4.94) 2 (1.16) 0.022 loss taste 229 (4.25) 3 (1.73) 0.103 Convulsions 35 (0.65) 3 (1.73) 0.088 Stomach ache 382 (7.16) 10 (5.85) 0.511 nausea 978 (18.34) 28 (16.37) 0.514 vomiting 604 (11.32) 13 (7.60) 0.129 diarrhea 468 (8.77) 8 (4.68) 0.061 anorexia 1,192 (22.35) 25 (14.62) 0.017 Headache 1,138 (21.39) 27 (15.79) 0.078 Vertigo 573 (10.77) 15 (8.77) 0.405 Parcy limbs 67 (1.26) 1 (0.58) 0.432 Organ lesion 10 (0.19) 0 (0.00) 0.570 Chest pain 717 (13.48) 18 (10.53) 0.264 Clinical comorbidities Diabetes 1,272 (23.60) 26 (15.03) 0.009 Cancer 147 (2.73) 3 (1.73) 0.427 Immune Deficiency 96 (1.78) 3 (1.73) 0.963 Heart disease 885 (16.42) 11 (6.36) 0.000 Chronic kidney 289 (5.36) 11 (6.36) 0.568 Asthma 112 (2.08) 3 (1.73) 0.754 Other chronic lung diseases 548 (10.17) 21 (12.14) 0.400 Chronic neurological disorders 426 (7.90) 17 (9.83) 0.358 hypertension 1,579 (29.29) 28 (16.18) 0.000 Hospital presentation Temperature, °C 0.040 ≤ 37 3,658 (75.86) 104 (69.80) 37–38 881 (18.27) 39 (26.17) > 38 283 (5.87) 6 (4.03) Missing Number of breathing 0.488 ≤ 22 4,175 (86.73) 125 (83.89) 22–28 387 (8.04) 16 (10.74) > 28 252 (5.23) 8 (5.37) Oxygen therapy 4,407 (81.76) 134 (77.46) 0.150 Duration of hospitalization 4.5 5.9 0.0005 Intubation 471 (8.74) 26 (15.03) 0.004 Disease severity 0.139 Mild 491 (9.11) 23 (13.29) Moderate 438 (8.13) 11 (6.36) Sever to critical 4,461 (82.76) 139 (80.35) Table 2 Table 3 Table 4 In hospital Outcomes by Race and Ethnicity Patients, No. (%) P Value Population Outcome Iranian Afghan All Hospitalized Patients Discharge 8410 (93.1) 360 (92.86) Death 624 (6.90) 28 (7.14) 0.855 COVID-19 Positive Patients Discharge 4809 (89.24) 146 (84.97) Death 580 (10.76) 26 (15.03) 0.076 Demographic and clinical characteristics of the COVID-19-positive patients Patient characteristics (age, sex, signs and symptoms, clinical comorbidities, and hospital presentation) by race/ethnicity are provided in Table 5 . The mean age of COVID-19- positive patients was 56.75(19.84) and 50.89% were females. Afghan patients were younger than Iranians (e.g., age 18–49 years: 41.86% Afghan vs. 22.4% Iranian). The most frequently reported symptoms were respiratory distress, muscular pain, fever, and cough. Also, respiratory distress and anorexia differed by race/ethnicity, being more common in Iranians. Among comorbidities, hypertension, diabetes, and heart disease were more frequently observed among Iranians than Afghans. More Afghan patients showed temperature ≥ 37° C (P = 0.04), but the number of breaths was not differed by race/ethnicity (P = 0.488). No significant difference was observed in critical condition (P = 0.139) and the need for oxygen therapy (P = 0.15) between Afghan and Iranian patients; however, a significant difference was observed in intubation between two groups (Afghan: 15.03% vs. Iranian: 8.74%) (P = 0.004). Significant race/ethnic differences were observed in the median duration of hospital stay (Afghan: 5.9 days vs. Iranian: 4.5 days) (P < 0.000). In the unadjusted model, the risk of critical illness was comparable between Afghan and Iranian patients (OR, 0.66; 95%CI, 0.42–1.04; P = 0.076). After adjusting for age and sex, the risk did not change (OR, 0.87; 95%CI, 0.54–1.3; P < 0.573). Adding comorbidities to the model did not alter the risk (OR, 0.86; 95%CI, 0.54–1.3; P < 0.547) (Table 3 ). In the unadjusted model, the risk of death was comparable between Afghan and Iranian patients (OR, 1.46; 95%CI, 0.95–2.2; P < 0.078). After adjusting for age and sex, Afghan patients had a higher risk of death than Iranian patients (OR, 2.27; 95%CI, 1.43–3.6; P < 0.000). Risk of death remained higher for Afghans after additional adjustment for comorbidities (OR, 2.34; 95%CI, 1.47–3.72; P = 0.000) (Table 4 ). Table 5 Odds Ratios of disease severity by Race/Ethnicity Base Model (Unadjusted) Model 1 Model 2 Population Disease severity¹ Race/ethnicity OR (95% CI) P value OR (95% CI) P value OR (95% CI) P value All Hospitalized Patients Moderate Iranian 1 [Reference] > .99 1 [Reference] > .99 1 [Reference] > .99 Afghan 0.79 (0.55–1.1) 0.204 1.06 (0.73–1.5) 0.742 1.01 (0.69–1.4) 0.943 Severe to critical Iranian 1 [Reference] > .99 1 [Reference] > .99 1 [Reference] > .99 Afghan 0.52 (0.41–0.64) 0.000 0.7 (0.56–0.88) 0.003 0.69 (0.55–0.88) 0.003 COVID-19 Positive Patients Moderate Iranian 1 [Reference] > .99 1 [Reference] > .99 1 [Reference] > .99 Afghan 0.53 (0.25–1.1) 0.094 0.73 (0.34–1.5) 0.409 0 .72 (0.34–1.5) 0.387 Severe to critical Iranian 1 [Reference] > .99 1 [Reference] > .99 1 [Reference] > .99 Afghan 0.66 (0.42–1.04) 0.076 0.87 (0.54–1.3) 0.573 0.86 (0.54–1.3) 0.547 1. Mild severity considered as base outcome Table 5 Discussion In this retrospective cohort study, racial/ethnic differences were compared in the likelihood of COVID-19 positive, signs and symptoms, and clinical outcome (Table 6 ). We also investigated whether any differences in outcomes were associated with age, sex, and comorbidities. All assessments were performed in all hospitalized (suspected/confirmed COVID-19) and confirmed COVID-19 patients. First, we explain the racial differences in disease severity among all hospitalized patients, then among confirmed patients. In the following, we will describe the difference in the mortality rate among all hospitalized patients as well as confirmed patients. Table 6 Odds Ratios of death by Race/Ethnicity Base Model (Unadjusted) Model 1 Model 2 Population Race/ethnicity OR (95% CI) P value OR (95% CI) P value OR (95% CI) P value All Hospitalized Patients Iranian 1 [Reference] > .99 1 [Reference] > .99 1 [Reference] > .99 Afghan 1.037 (0.70–1.5) 0.855 1.57 (1.03–2.4) 0.036 1.66 (1.08–2.55) 0.020 COVID-19 Positive Patients Iranian 1 [Reference] > .99 1 [Reference] > .99 1 [Reference] > .99 Afghan 1.46 (0.95–2.2) 0.078 2.27 (1.43–3.6) 0.000 2.34 (1.47–3.72) 0.000 Table 6 The results showed the highest incidence of COVID-19 in Afghan patients at a younger age than Iranians. The findings were similar to other studies, which reported COVID-19 incidence to be highest among 20–40 years old Afghan patients ( 17 , 18 ). This may be since over half of the Afghan population is under the age of 20 ( 17 ). Based on PCR test and CT scan results, the prevalence of confirmed COVID-19 positive was significantly higher in Iranians than Afghans (P < 0.001). According to the present study, among all hospitalized (suspected/confirmed COVID-19) patients, signs and symptoms, respiratory distress, muscular pain, anorexia, headache, convulsions, smell loss, chest pain, taste loss, and vertigo were significantly more represented in Iranians than Afghans. Furthermore, the severe disease was more common in Iranians than Afghans (P < 0.001). Although several studies have reported that individuals with older age and comorbidities are facing a higher risk of COVID-19 susceptibility and severity, but in our study this difference could not be explained only by the higher mean age of Iranians or the underlying diseases; Because the risk of severity remains still high in Iranian patients after adjusting for age, sex, and comorbidities, (OR, 0.69; 95%CI, 0.56–0.88; P < 0.003) ( 19 – 21 ). This racial difference in disease severity may be related to the immune response to infection. This is well known that genetic differences contribute to individual variations in the immune response to pathogens ( 22 ). Recently, Upadhyai et al. have reported a significant variation in genetic variants involved in host immune-related pathways, such as innate and adaptive immune system, interleukin (IL) signaling, interferon (IFN) signaling, cytokine signaling, as well as antigen processing by major histocompatibility complex (MHC) between asymptomatic and severe COVID-19 patients ( 23 ). Cellular ACE2 expression varies among individuals and ethnicities. Differences in ACE2 expression and variants might influence susceptibility to SARS-CoV-2 infection and disease severity ( 24 , 25 ). Furthermore, the frequency of the ACE1 II genotype is inversely related to susceptibility to COVID-19. This genotype was less frequent among the Iranian population ( 26 , 27 ). Also, the TMPRSS2 gene serves as an activator of SARS-CoV entry into the host cells. Iranians showed more expression of TMPRSS2. These may be related to increased COVID-19 susceptibility and severity among them ( 28 , 29 ). In addition to genetic factors, some epigenetic factors, such as histone modification (H3K4me1, H3K4me3, H3K27Ac) in the ACE2 gene and decreased DNA methylation of the ACE2 promoter increase the expression of ACE2, affecting, in turn, the risk and severity of COVID disease ( 30 , 31 ). Among confirmed patients, respiratory distress and anorexia were more common in Iranians than Afghans. Although the rate of comorbidities was higher in Iranians, no significant race/ethnicity difference was observed in the severity of the disease among confirmed patients even after adjusting for age, sex, and comorbidities. No significant race/ethnicity disparity was observed concerning the mortality rate. However, by adjusting for age, sex, and comorbidity, a significant difference was observed in all hospitalized patients (OR, 1.66; 95%CI, 1.08–2.55; P = 0.020), with being more significant among confirmed COVID-19 patients (OR, 2.34; 95%CI, 1.47–3.72; P = 0.000). Indeed, Afghans suffered almost twice as many deaths as Iranians. Although some studies have linked differences in mortality to variations in treatment protocols in different health care centers, this is not the case with the present study; this is since this study was performed in a single hospital with a distinct treatment protocol for all patients ( 32 – 34 ). Therefore, other factors are involved in this difference. Researches shows that some medications taken by patients improved the survival rate of COVID-19 cases. Cardiovascular drugs (e.g., ACE inhibitors), statin and anticoagulant drugs, anti-diabetic drugs (e.g., Metformin and dipeptidyl peptidase 4 inhibitors mentioned (DPP4-I)) are among these medications ( 35 – 40 ). Since Iranian patients had more comorbidity than Afghans, consumption of cardiovascular, antihypertensive, and anti-diabetic drugs might have a protective effect against COVID-19 and improve survival. Some studies demonstrated that ARDS outcomes also differ in various ethnicities, even after adjusting for age, sex, disease severity, type of hospital and median household income ( 41 , 42 ). Candidate genes associated with ARDS have been identified to be including reactive oxygen species, innate immunity-related inflammation and endothelial vascular signaling pathways. Ethnicity might affect cytokine gene polymorphisms and inflammatory profiles in specific conditions, In a way some ethnic groups more disposed to a heightened inflammatory response ( 43 , 44 ). In addition, it should be noted that social and economic factors may also affect inflammatory pathways and gene expression that poorly understood and should be further considered in future studies ( 45 ). In addition to the above, another factor affecting the mortality rate due to covid-19 is the delay in diagnosis. Studies show that people who are diagnosed longer after the onset of symptoms face higher mortality. Some reasons for delayed care-seeking behavior could be prohibitory costs, lack of access to health care services and stigmatization ( 46 ). Social stigma can disrupt the process of diagnosis and treatment by negatively affecting social communication. People who feel stigmatized may avoid behaviors that increase stigma, including following health protocols and wearing masks to prevent covid-19. There has been a report of suspected covid-19 patients escaping from a hospital in Afghanistan ( 47 ). The people of Afghanistan considered the hospital environment to be more caring than therapeutic. Furthermore, the fear of social stigma prevented them from going to the hospital. Therefore, they prefer home care to visiting the hospital ( 48 ). On the other hand, Afghan immigrants have fragile economic conditions due to their daily work; also not having insurance, they incur high medical expenses. Therefore, delaying medical care due to social stigma and economic situation may explained more intubation and the increased median duration of hospital stay that lead to more mortality rate in afghans ( 49 – 51 ). Conclusion Our finding revealed that although Iranian represented more COVID-19-related symptoms and disease severity than Afghans but mortality was higher in Afghans. Future considerations should focus on understanding the impact of genetic or ethnicity related factors on covid-19 outcome for reducing the risk of death among some ethnicity groups. Limitations This study has several limitations. Since this study was based on patient data at Hospital Information System (HIS), we only had hospitalization records. Also we did not have socio-economic status, education, or other health conditions of migrants that might contribute to this difference. We did not consider laboratory results of patient that may explain observed outcomes. Abbreviations SARS-CoV-2: severe acute respiratory syndrome coronavirus ARDS: acute respiratory distress syndrome ICU: intensive care unit BAME: Black, Asian, and Minority Ethnic RT-PCR: reverse-transcriptase-polymerase-chain-reaction HIS: Hospital Information System ORs: odds ratios Cis: confidence intervals IL: interleukin IFN: interferon MHC: major histocompatibility complex DPP4-I: dipeptidyl peptidase 4 inhibitors Declarations Author contribution The FA contributed to the conception and design of the study. PKh performed the statistical analysis and interpreted of the data. MAK contributed to prepare manuscript writing. AJ and HO participated in data collection. All authors have read and approved the final manuscript. Acknowledgments All supports received from Rafsanjan University of Medical Sciences (RUMS). The authors would like to thank the clinical Research Development Unit (CRDU) of Ali-Ibn Abi Talib Hospital, Rafsanjan, Iran for their cooperation throughout the period of study. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Availability of Data and Materials The data is not publicly accessible, but it can be obtained from the corresponding author upon a reasonable request. Ethics approval and Consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Rafsanjan University of Medical Sciences (IR.RUMS.REC.1399.168). Informed consent was obtained from all subjects. All methods were performed in accordance with the relevant guidelines and regulations Consent for publication Not applicable. Competing Interests The authors declare no competing interests. References Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19? BMJ. 2020;369. Mendy A, Apewokin S, Wells AA, Morrow AL. Factors associated with hospitalization and disease severity in a racially and ethnically diverse population of COVID-19 patients. MedRxiv. 2020. Ali H, Alshukry A, Marafie SK, AlRukhayes M, Ali Y, Abbas MB, et al. Outcomes of COVID-19: Disparities by ethnicity. Infect Genet Evol. 2021;87:104639. Valdes AM, Moon JC, Vijay A, Chaturvedi N, Norrish A, Ikram A, et al. Longitudinal assessment of symptoms and risk of SARS-CoV-2 infection in healthcare workers across 5 hospitals to understand ethnic differences in infection risk. EClinicalMedicine. 2021;34:100835. Stead WW, Senner JW, Reddick WT, Lofgren JP. Racial differences in susceptibility to infection by Mycobacterium tuberculosis. N Engl J Med. 1990;322(7):422–7. Nahid P, Horne DJ, Jarlsberg LG, Reiner AP, Osmond D, Hopewell PC, et al. Racial differences in tuberculosis infection in United States communities: the coronary artery risk development in young adults study. Clin Infect Dis. 2011;53(3):291–4. Laverack G, Manoncourt E. Key experiences of community engagement and social mobilization in the Ebola response. Glob Health Promot. 2016;23(1):79–82. Zhao H, Harris R, Ellis J, Pebody R. Ethnicity, deprivation and mortality due to 2009 pandemic influenza A (H1N1) in England during the 2009/2010 pandemic and the first post-pandemic season. Epidemiol Infect. 2015;143(16):3375–83. Arena PJ, Malta M, Rimoin AW, Strathdee SA, Race. COVID-19 and deaths of despair. EClinicalMedicine. 2020;25. Goyal MK, Simpson JN, Boyle MD, Badolato GM, Delaney M, McCarter R et al. Racial and/or ethnic and socioeconomic disparities of SARS-CoV-2 infection among children. Pediatrics. 2020;146(4). Hsu C-Y, Lai C-C, Yeh Y-P, Chang-Chuan C, Chen H-H. Progression from Pneumonia to ARDS as a Predictor for Fatal COVID-19. J Infect Public Health. 2021;14(4):504–7. Sze S, Pan D, Nevill CR, Gray LJ, Martin CA, Nazareth J et al. Ethnicity and clinical outcomes in COVID-19: a systematic Review and Meta-analysis. EClinicalMedicine. 2020:100630. Zakeri R, Bendayan R, Ashworth M, Bean DM, Dodhia H, Durbaba S, et al. A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19. EClinicalMedicine. 2020;28:100574. Figueroa JF, Wadhera RK, Mehtsun WT, Riley K, Phelan J, Jha AK, editors. Association of race, ethnicity, and community-level factors with COVID-19 cases and deaths across US counties. Healthc (Amst). 2021;9(1):100495. Bassett IV, Triant VA, Bunda BA, Selvaggi CA, Shinnick DJ, He W, et al. 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Hospitalization and mortality among black patients and white patients with Covid-19. N Engl J Med. 2020;382(26):2534–43. Ebinger JE, Achamallah N, Ji H, Claggett BL, Sun N, Botting P, et al. Pre-existing traits associated with Covid-19 illness severity. PLoS ONE. 2020;15(7):e0236240. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect. 2020;80(6):656–65. Koch L. Impact of genetic ancestry on viral infection response. Nat Rev Genet. 2022;23(2):72. Upadhyai P, Suresh G, Parit R, Das R. Genomic and Ancestral Variation Underlies the Severity of COVID-19 Clinical Manifestation in Individuals of European Descent. Life. 2021;11(9):921. Chen J, Jiang Q, Xia X, Liu K, Yu Z, Tao W, et al. Individual variation of the SARS-CoV‐2 receptor ACE2 gene expression and regulation. Aging Cell. 2020;19(7):e13168. Devaux CA, Rolain J-M, Raoult D. ACE2 receptor polymorphism: Susceptibility to SARS-CoV-2, hypertension, multi-organ failure, and COVID-19 disease outcome. J Microbiol Immunol Infect. 2020;53(3):425–35. Yamamoto N, Ariumi Y, Nishida N, Yamamoto R, Bauer G, Gojobori T, et al. SARS-CoV-2 infections and COVID-19 mortalities strongly correlate with ACE1 I/D genotype. Gene. 2020;758:144944. Hatami N, Ahi S, Sadeghinikoo A, Foroughian M, Javdani F, Kalani N, et al. Worldwide ACE (I/D) polymorphism may affect COVID-19 recovery rate: an ecological meta-regression. Endocrine. 2020;68(3):479–84. Shulla A, Heald-Sargent T, Subramanya G, Zhao J, Perlman S, Gallagher T. A transmembrane serine protease is linked to the severe acute respiratory syndrome coronavirus receptor and activates virus entry. J Virol. 2011;85(2):873–82. Lanjanian H, Moazzam-Jazi M, Hedayati M, Akbarzadeh M, Guity K, Sedaghati-Khayat B, et al. SARS-CoV-2 infection susceptibility influenced by ACE2 genetic polymorphisms: insights from Tehran Cardio-Metabolic Genetic Study. Sci Rep. 2021;11(1):1–13. Pinto BG, Oliveira AE, Singh Y, Jimenez L, Gonçalves AN, Ogava RL, et al. ACE2 expression is increased in the lungs of patients with comorbidities associated with severe COVID-19. J Infect Dis. 2020;222(4):556–63. Sawalha AH, Zhao M, Coit P, Lu Q. Epigenetic dysregulation of ACE2 and interferon-regulated genes might suggest increased COVID-19 susceptibility and severity in lupus patients. Clin Immunol. 2020;215:108410. Bertsimas D, Lukin G, Mingardi L, Nohadani O, Orfanoudaki A, Stellato B, et al. COVID-19 mortality risk assessment: An international multi-center study. PLoS ONE. 2020;15(12):e0243262. Helvaci N, Eyupoglu ND, Karabulut E, Yildiz BO. Prevalence of obesity and its impact on outcome in patients with COVID-19: a systematic review and meta-analysis. Front Endocrinol. 2021;12:82. Read SH, Khachatryan A, Chandak A, Casciano R, Hodgkins P, Haubrich R, et al. Comparative effectiveness research in COVID-19 using real-world data: methodological considerations. J Comp Eff Res. 2021;10(17):1259–64. Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Engl J Med. 2020;382(25):e102. Gold MS, Sehayek D, Gabrielli S, Zhang X, McCusker C, Ben-Shoshan M. COVID-19 and comorbidities: a systematic review and meta-analysis. Postgrad Med. 2020;132(8):749–55. Mirani M, Favacchio G, Carrone F, Betella N, Biamonte E, Morenghi E, et al. Impact of comorbidities and glycemia at admission and dipeptidyl peptidase 4 inhibitors in patients with type 2 diabetes with COVID-19: a case series from an academic hospital in Lombardy, Italy. Diabetes Care. 2020;43(12):3042–9. Philipose Z, Smati N, Wong CSJ, Aspey K, Mendall MA. Obesity, old age and frailty are the true risk factors for COVID-19 mortality and not chronic disease or ethnicity. MedRxiv. 2020. Daniels LB, Sitapati AM, Zhang J, Zou J, Bui QM, Ren J, et al. Relation of statin use prior to admission to severity and recovery among COVID-19 inpatients. Am J Cardiol. 2020;136:149–55. Lukito AA, Pranata R, Henrina J, Lim MA, Lawrensia S, Suastika K. The Effect of Metformin Consumption on Mortality in Hospitalized COVID-19 patients: a systematic review and meta-analysis. Diabetes Metab Syndr. 2020;14(6):2177–83. Erickson SE, Shlipak MG, Martin GS, Wheeler AP, Ancukiewicz M, Matthay MA, et al. Racial and ethnic disparities in mortality from acute lung injury. Crit Care Med. 2009;37(1):1–6. Bime C, Poongkunran C, Borgstrom M, Natt B, Desai H, Parthasarathy S, et al. Racial differences in mortality from severe acute respiratory failure in the United States, 2008–2012. Ann Am Thorac Soc. 2016;13(12):2184–9. Lynn H, Sun X, Casanova N, Gonzales-Garay M, Bime C, Garcia JG. Genomic and genetic approaches to deciphering acute respiratory distress syndrome risk and mortality. Antioxid Redox Signal. 2019;31(14):1027–52. Hoffmann SC, Stanley EM, Cox ED, DiMercurio BS, Koziol DE, Harlan DM, et al. Ethnicity greatly influences cytokine gene polymorphism distribution. Am J Transpl. 2002;2(6):560–7. Thames AD, Irwin MR, Breen EC, Cole SW. Experienced discrimination and racial differences in leukocyte gene expression. Psychoneuroendocrinology. 2019;106:277–83. Graf LE, Peterson ER, Baumgartner J, Fine A, Thompson CN, Blaney K et al. Delays in COVID-19 Diagnosis and Hospitalization and Outcomes—New York City, New York, USA, October 2020–November 2021. medRxiv. 2022. Saeed F, Mihan R, Mousavi SZ, Reniers RL, Bateni FS, Alikhani R, et al. A narrative review of stigma related to infectious disease outbreaks: What can be learned in the face of the Covid-19 pandemic? Front Psychiatry. 2020;11:565919. Sadati AK, Mohammadi K. Illness Behavior in the Face of COVID-19 Infection: A Qualitative Study on Homecare in Afghanistan. SHIRAZ E-MED J. 2021;22(6). Mahmoodi Z, Bahrami G, Ghavidel N, Seddighi H. The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: a path analysis. BMC Psychiatry. 2023;23(1):1–8. Lebni JY, Enayat H, Irandoost SF, Dehghan AA. Exploring the Challenges of Afghan Refugee Women Facing COVID-19: A Qualitative Study in Iran. Front Public Health. 2022;10. González J, Benítez ID, de Gonzalo-Calvo D, Torres G, de Batlle J, Gómez S, et al. Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study. Crit Care. 2022;26(1):1–11. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4175661","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":287171033,"identity":"4331b00c-f7cc-4516-b38d-b7c4f0250f4e","order_by":0,"name":"Mahdieh Ahmadi Kamalabadi","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mahdieh","middleName":"Ahmadi","lastName":"Kamalabadi","suffix":""},{"id":287171035,"identity":"745391b9-ec0e-4332-9215-cac90f2a6a56","order_by":1,"name":"Parvin Khalili","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Parvin","middleName":"","lastName":"Khalili","suffix":""},{"id":287171037,"identity":"97aec224-5a27-407c-abe5-4c904da521b4","order_by":2,"name":"Hamid Ostadebrahimi","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hamid","middleName":"","lastName":"Ostadebrahimi","suffix":""},{"id":287171038,"identity":"15dbaaa4-a411-405a-8117-cd1f8b4cc723","order_by":3,"name":"Ahmad Jamalizadeh","email":"","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Jamalizadeh","suffix":""},{"id":287171039,"identity":"66ad3e11-e4a3-4418-86d7-46d8e5816256","order_by":4,"name":"Fatemeh Amin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYBAC9gYQacAgx8DAQ6QWnmMQLcakamFgSGwgXot8A+OnGwV30jccP3vwwQcGOzndBkJa2BiYpXMMnuVuOJOXbDiDIdnY7AABLfZsDAxALYdzNxzIMZPmYTiQuI2QFpAtv4Fa0g3OvyFeCxvIlgSDG8TbkthmDdRiOPPGG2PDGQZE+IWH+fDh2zl/Dsvznc8xfPChwk6OoBYGBsYGMKUAVmlAUDkSkG8gRfUoGAWjYBSMKAAA7y49jIYTXc4AAAAASUVORK5CYII=","orcid":"","institution":"Rafsanjan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Amin","suffix":""}],"badges":[],"createdAt":"2024-03-27 11:29:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4175661/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4175661/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55286558,"identity":"af763cab-e28b-4068-af1f-5de561ea1805","added_by":"auto","created_at":"2024-04-25 08:11:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":996061,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4175661/v1/147c88fe-52d0-48b3-a01f-e5942a7ff0dd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Racial/ethnic disparities in COVID-19 clinical outcomes: A comparison between Asian ethnic subgroups","fulltext":[{"header":"Background","content":"\u003cp\u003eThe novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), also termed COVID-19, is now a global pandemic with destructing effects on the world population, health system, and economy. The manifestations of the disease are widely variable from asymptomatic to symptomatic, ranging from fever or cough to severe pneumonia followed by acute respiratory distress syndrome (ARDS) that requires admission in an intensive care unit (ICU), leading to death in severe cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It has been proven that age, sex, and a previous underlying disease are risk factors for severe cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although most COVID-19 infections do not lead to hospitalization, several epidemiological studies have reported its higher prevalence in some regions and ethnic groups (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Various studies have shown significant differences in clinical features based on ethnicity-related factors in some diseases, including tuberculosis, Ebola, and influenza H1N1 (\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Similarly, with the spread of Covid-19 worldwide, different health outcomes have been reported in many countries according to ethnicity, even in children. Furthermore, progression from pneumonia to ARDS, as a major cause of death, varies considerably among countries from 3\u0026ndash;63% (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe potential impact of ethnic disparity on COVID-19 outcomes has been raised with reports of multi-ethnic populations in Western Europe and North America. Evidence-based data from different countries indicate a higher risk of infection and severe outcomes among Black, Asian, and Minority Ethnic (BAME) groups. An extensive systematic review of 18,728,893 patients, which has investigated clinical outcomes for COVID-19 considering ethnicity, demonstrates an increased risk of infection in Black and Asian ethnicities compared to that of White. Even after adjusting for age, sex, and underlying diseases, the Asian population is at greater risk of being admitted to the intensive care unit and death. With increasing evidence of a higher risk of COVID-19 infection among Asian ethnic, the likelihood of its different impact on Asian ethnicity is highlighted (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Of course, although this difference has been observed in various ethnicities, the cause and factors involved are not clear (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Since the role of ethnicity is multifactorial, it is not well comprehended why certain ethnicities are prone to severe COVID-19 outcomes and whether ethnicity mainly impacts infection risk, disease progression, or survival after hospitalization with severe illness (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). On the other hand, some studies have shown that some ethnicities, despite being younger and having less comorbidity, experience more severe disease. Accordingly, for better understanding the impact of ethnicity on COVID-19 outcome, the results must be disaggregated and studies in ethnic subgroups considered separately, especially in Asian subgroups (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Apart from this, some studies have suggested that due to the lack of a specific treatment protocol, the unequal effect of COVID-19 may be arising from different inter-hospital care. Thus, scientific studies that result in improved understanding of relation between COVID-19 and race/ethnicity could help improve health care, develop effective mitigation strategies, and obtain better clinical outcome (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the two nationalities of Iranian and Afghan as Asian subgroups are assessed in a determined medical center. The aim is to compare the symptoms and clinical outcomes of COVID-19 in hospitalized patients according to ethnicity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and data collection\u003c/h2\u003e \u003cp\u003eThis population-based retrospective cohort study was conducted on hospitalized patients with suspected/confirmed COVID-19 in Rafsanjan, from September 2020 to March 2020. All patients with a positive result of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of a specimen collected on a nasopharyngeal swab and/or typical findings at chest computed tomography were considered as confirmed COVID-19 cases; in contrast, those with only symptoms in favor of COVID-19 were considered suspected cases. All hospitalized patients were recruited in this study. People who had incomplete clinical data and did not require hospitalization were excluded. All data were retrieved from Hospital Information System (HIS). The following data were included: demographics, history of underlying disease, clinical symptoms, duration of hospitalization, and clinical outcomes. Ethnicity was recorded for all patients based on self-reported data at the initial referral to the emergency department. Patients were categorized into three groups: mild, moderate, and severe to critical. The mild illness was defined as having any COVID-19 signs and symptoms but with oxygen saturation higher than 93%. The moderate disease was defined as having oxygen saturation of less than 93% (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({Spo}_{2}\\)\u003c/span\u003e\u003c/span\u003e\u0026lt; 93) but not requiring supplemental oxygen. The severe to critical illness was defined as having oxygen saturation of less than 93% (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({Spo}_{2}\\)\u003c/span\u003e\u003c/span\u003e\u0026lt; 93), requiring non-invasive or mechanical ventilation. The outcome was defined as discharge to home or in-hospital mortality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eTo describe the data, frequency (%) for categorical was reported and as the chi-square test was used to analyze categorical variables across of racial and ethnic (Iranian vs. Afghans) categories. In addition, we used of multinomial logistic regression models to estimate odds ratios (ORs) with 95% confidence intervals (CIs) to assess the possible relationships of racial and ethnic with the Hospitalization among Covid-19 Patients. Confounders were identified Based on subject matter knowledge and the relevant epidemiological literature. These confounders were sequentially entered into models according to their hypothesized strengths of association with the Hospitalization of Covid-19 in patients and racial.\u003c/p\u003e \u003cp\u003eTo reach this goal, separate models at bivariate level were run to obtain variables associated with Hospitalization of Covid-19 in patients. Afterwards, variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were considered for multivariate analysis. The crud model is stratified on the status of racial and ethnic. Adjusted model 1 included sociodemographic characteristics (age and gender) considered to be the most strongly related with Hospitalization of Covid-19 in patients. Adjusted model 2 included all variables in adjusted model 1 and additionally adjusted for underlying diseases, as these were hypothesized to be potential confounders on the causal pathways that could explain association with the Hospitalization of Covid-19 in patients and racial and ethnic. Furthermore, dichotomous Logistic regression models were used to compare the odds of death of Covid-19 in Iranians and Afghans.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the study population\u003c/h2\u003e \u003cp\u003eA total of 9,422 hospitalized patients were recruited in this study, of whom 9034 (95.88%) were Iranian and 388 (4.12%) Afghan. Among them, 5,561 cases were confirmed, of whom 5,389 (96.91%) were Iranian and 172 (3.09%) Afghan. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the proportion of all hospitalized and COVID-19- positive patients in terms of race/ethnicity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProportion of Patients admitted by Race/Ethnicity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePatients, No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOVID-19 positive status by race\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal, No (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9,034 (95.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e388 (4.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCR positive result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,532 (66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85 (38.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT Scan positive result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,152 (61.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167 (56.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,389 (96.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172 (3.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCR positive result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,390 (71.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80 (51.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT Scan positive result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,152 (95.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167 (96.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDemographic and clinical characteristics of all hospitalized patients\u003c/h2\u003e \u003cp\u003ePatient characteristics (age, sex, signs and symptoms, clinical comorbidities, and hospital presentation) in terms of race/ethnicity are provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean age of all hospitalized patients was 53.09 (29.18) and 50.36% were females. Afghan patients were younger than Iranians (e.g., age 18\u0026ndash;49 years: 39.43% Afghan vs. 26.52% Iranian). The most frequently reported symptoms were respiratory distress, muscular pain, fever, and cough. Also, respiratory distress, muscular pain, anorexia, headache, convulsions, smell loss, chest pain, taste loss, and vertigo differed by race/ethnicity such that, apart from the convulsions being more common among Afghans, the other symptoms mentioned were more common in Iranians. Among comorbidities, hypertension, diabetes, and heart disease were more frequently observed among Iranian than Afghans. More Afghan patients showed temperature\u0026thinsp;\u0026ge;\u0026thinsp;37\u0026deg; C (P\u0026thinsp;=\u0026thinsp;0.002) and the number of breaths\u0026thinsp;\u0026ge;\u0026thinsp;22 (P\u0026thinsp;=\u0026thinsp;0.006) on hospital presentation than Iranian. A significant percentage of Iranian patients were in critical condition (63.75% vs. 48.98%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.000) and the need for oxygen therapy (62.88% vs. 47.45%) compared to Afghans. Race/ethnic differences were observed in the median duration of hospital stay (Afghan: 3.7 days vs. Iranian: 3.2 days) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.017). In the unadjusted model, Afghan patients had a lower risk of severe to critical illness than Iranians (OR, 0.52; 95%CI, 0.41\u0026ndash;0.64; P\u0026thinsp;\u0026lt;\u0026thinsp;0.000). After adjusting for age and sex, the risk remained lower in Afghan patients (OR, 0.7; 95%CI, 0.56\u0026ndash;0.88; P\u0026thinsp;\u0026lt;\u0026thinsp;0.003). Adding comorbidities to the model did not alter the lower risk (OR, 0.69; 95%CI, 0.56\u0026ndash;0.88; P\u0026thinsp;\u0026lt;\u0026thinsp;0.003) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the unadjusted model, the risk of death was comparable between Afghan and Iranian patients (OR, 1.037; 95%CI, 0.70\u0026ndash;1.5; P\u0026thinsp;\u0026lt;\u0026thinsp;0.003). After adjusting for age and sex, Afghan patients had a higher risk of death than Iranians (OR, 1.57; 95%CI, 1.03\u0026ndash;2.4; P\u0026thinsp;\u0026lt;\u0026thinsp;0.036). Risk of death remained higher for Afghans after additional adjustment for comorbidities (OR, 1.66; 95%CI, 1.08\u0026ndash;2.55; P\u0026thinsp;=\u0026thinsp;0.020) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline and in-hospital characteristics by Race/Ethnicity among All Hospitalized Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePatients, No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge( years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e305 (3.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (15.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,396 (26.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (39.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,615 (28.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (22.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,716 (30.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (17.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,002 (11.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,484 (49.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e197 (50.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,554 (50.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e195 (49.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresenting symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,721 (41.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162 (41.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,601 (39.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140 (35.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscular pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,234 (46.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143 (36.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erespiratory distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,006 (55.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166 (42.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e881 (9.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (8.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSense smell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e331 (3.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eloss taste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e286 (3.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConvulsions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (0.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStomach ache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e564 (6.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,307 (14.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (11.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e825 (9.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (9.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.918\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e618 (7.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eanorexia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,582 (17.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (9.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,532 (17.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (10.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertigo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e786 (9.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (5.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParcy limbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95 (1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrgan lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e946 (10.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (6.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical comorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,516 (16.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (9.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e167 (1.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmune Deficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110 (1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,113 (12.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (5.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic kidney\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e361 (3.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (3.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153 (1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther chronic lung diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e734 (8.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (6.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic neurological disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e527 (5.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (4.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,863 (20.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (9.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital presentation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTemperature, \u0026deg;C\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,072 (76.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (67.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u0026ndash;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,154 (17.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62 (26.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e436 (6.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (6.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of breathing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,853 (88.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192 (82.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u0026ndash;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e487 (7.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (9.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e299 (4.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (8.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,683 (62.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186 (47.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of hospitalization (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e519 (5.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (7.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisease severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,509 (27.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e161 (41.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e767 (8.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (9.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSever to critical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,762 (63.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192 (48.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline and in-hospital characteristics by Race/Ethnicity among 5,563 COVID-19\u0026ndash;Positive Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePatients, No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge( years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105 (1.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (7.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,102 (20.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (34.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,622 (30.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (27.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,858 (34.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (23.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e702 (13.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (6.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,644 (49.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (50.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,746 (50.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85 (49.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresenting symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,392 (44.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80 (46.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,377 (44.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (42.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscular pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,614 (48.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (41.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erespiratory distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,978 (73.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112 (64.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e800 (14.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (16.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSense smell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e266 (4.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eloss taste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229 (4.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConvulsions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStomach ache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e382 (7.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (5.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e978 (18.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (16.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e604 (11.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (7.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e468 (8.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (4.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eanorexia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,192 (22.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (14.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,138 (21.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (15.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVertigo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e573 (10.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (8.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParcy limbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67 (1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrgan lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e717 (13.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical comorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,272 (23.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (15.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e147 (2.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmune Deficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96 (1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e885 (16.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (6.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic kidney\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e289 (5.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (6.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther chronic lung diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e548 (10.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (12.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic neurological disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e426 (7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (9.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,579 (29.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (16.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital presentation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTemperature, \u0026deg;C\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,658 (75.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104 (69.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u0026ndash;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e881 (18.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (26.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e283 (5.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (4.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of breathing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,175 (86.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125 (83.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u0026ndash;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e387 (8.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (10.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e252 (5.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (5.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,407 (81.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134 (77.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e471 (8.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (15.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisease severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e491 (9.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (13.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e438 (8.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (6.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSever to critical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,461 (82.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139 (80.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIn hospital Outcomes by Race and Ethnicity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePatients, No. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eIranian\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAfghan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll Hospitalized Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDischarge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8410 (93.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e360 (92.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e624 (6.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (7.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOVID-19 Positive Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDischarge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4809 (89.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146 (84.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e580 (10.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (15.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eDemographic and clinical characteristics of the COVID-19-positive patients\u003c/b\u003e\u003c/h2\u003e \u003cp\u003ePatient characteristics (age, sex, signs and symptoms, clinical comorbidities, and hospital presentation) by race/ethnicity are provided in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The mean age of COVID-19- positive patients was 56.75(19.84) and 50.89% were females. Afghan patients were younger than Iranians (e.g., age 18\u0026ndash;49 years: 41.86% Afghan vs. 22.4% Iranian). The most frequently reported symptoms were respiratory distress, muscular pain, fever, and cough. Also, respiratory distress and anorexia differed by race/ethnicity, being more common in Iranians. Among comorbidities, hypertension, diabetes, and heart disease were more frequently observed among Iranians than Afghans. More Afghan patients showed temperature\u0026thinsp;\u0026ge;\u0026thinsp;37\u0026deg; C (P\u0026thinsp;=\u0026thinsp;0.04), but the number of breaths was not differed by race/ethnicity (P\u0026thinsp;=\u0026thinsp;0.488). No significant difference was observed in critical condition (P\u0026thinsp;=\u0026thinsp;0.139) and the need for oxygen therapy (P\u0026thinsp;=\u0026thinsp;0.15) between Afghan and Iranian patients; however, a significant difference was observed in intubation between two groups (Afghan: 15.03% vs. Iranian: 8.74%) (P\u0026thinsp;=\u0026thinsp;0.004). Significant race/ethnic differences were observed in the median duration of hospital stay (Afghan: 5.9 days vs. Iranian: 4.5 days) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.000). In the unadjusted model, the risk of critical illness was comparable between Afghan and Iranian patients (OR, 0.66; 95%CI, 0.42\u0026ndash;1.04; P\u0026thinsp;=\u0026thinsp;0.076). After adjusting for age and sex, the risk did not change (OR, 0.87; 95%CI, 0.54\u0026ndash;1.3; P\u0026thinsp;\u0026lt;\u0026thinsp;0.573). Adding comorbidities to the model did not alter the risk (OR, 0.86; 95%CI, 0.54\u0026ndash;1.3; P\u0026thinsp;\u0026lt;\u0026thinsp;0.547) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the unadjusted model, the risk of death was comparable between Afghan and Iranian patients (OR, 1.46; 95%CI, 0.95\u0026ndash;2.2; P\u0026thinsp;\u0026lt;\u0026thinsp;0.078). After adjusting for age and sex, Afghan patients had a higher risk of death than Iranian patients (OR, 2.27; 95%CI, 1.43\u0026ndash;3.6; P\u0026thinsp;\u0026lt;\u0026thinsp;0.000). Risk of death remained higher for Afghans after additional adjustment for comorbidities (OR, 2.34; 95%CI, 1.47\u0026ndash;3.72; P\u0026thinsp;=\u0026thinsp;0.000) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdds Ratios of disease severity by Race/Ethnicity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eBase Model\u003c/p\u003e \u003cp\u003e(Unadjusted)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDisease severity\u0026sup1;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRace/ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAll Hospitalized Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79 (0.55\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.06 (0.73\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.01 (0.69\u0026ndash;1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.943\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSevere to critical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52 (0.41\u0026ndash;0.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7 (0.56\u0026ndash;0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.69 (0.55\u0026ndash;0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCOVID-19 Positive Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.53 (0.25\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.73 (0.34\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 .72 (0.34\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSevere to critical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66 (0.42\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.87 (0.54\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.86 (0.54\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e1. Mild severity considered as base outcome\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective cohort study, racial/ethnic differences were compared in the likelihood of COVID-19 positive, signs and symptoms, and clinical outcome (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). We also investigated whether any differences in outcomes were associated with age, sex, and comorbidities. All assessments were performed in all hospitalized (suspected/confirmed COVID-19) and confirmed COVID-19 patients. First, we explain the racial differences in disease severity among all hospitalized patients, then among confirmed patients. In the following, we will describe the difference in the mortality rate among all hospitalized patients as well as confirmed patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdds Ratios of death by Race/Ethnicity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eBase Model\u003c/p\u003e \u003cp\u003e(Unadjusted)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRace/ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAll Hospitalized Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.037 (0.70\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.57 (1.03\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.66 (1.08\u0026ndash;2.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOVID-19 Positive Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIranian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 [Reference]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfghan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.46 (0.95\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.27 (1.43\u0026ndash;3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.34 (1.47\u0026ndash;3.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003c/p\u003e \u003cp\u003eThe results showed the highest incidence of COVID-19 in Afghan patients at a younger age than Iranians. The findings were similar to other studies, which reported COVID-19 incidence to be highest among 20\u0026ndash;40 years old Afghan patients (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This may be since over half of the Afghan population is under the age of 20 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Based on PCR test and CT scan results, the prevalence of confirmed COVID-19 positive was significantly higher in Iranians than Afghans (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAccording to the present study, among all hospitalized (suspected/confirmed COVID-19) patients, signs and symptoms, respiratory distress, muscular pain, anorexia, headache, convulsions, smell loss, chest pain, taste loss, and vertigo were significantly more represented in Iranians than Afghans. Furthermore, the severe disease was more common in Iranians than Afghans (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although several studies have reported that individuals with older age and comorbidities are facing a higher risk of COVID-19 susceptibility and severity, but in our study this difference could not be explained only by the higher mean age of Iranians or the underlying diseases; Because the risk of severity remains still high in Iranian patients after adjusting for age, sex, and comorbidities, (OR, 0.69; 95%CI, 0.56\u0026ndash;0.88; P\u0026thinsp;\u0026lt;\u0026thinsp;0.003) (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This racial difference in disease severity may be related to the immune response to infection. This is well known that genetic differences contribute to individual variations in the immune response to pathogens (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Recently, Upadhyai et al. have reported a significant variation in genetic variants involved in host immune-related pathways, such as innate and adaptive immune system, interleukin (IL) signaling, interferon (IFN) signaling, cytokine signaling, as well as antigen processing by major histocompatibility complex (MHC) between asymptomatic and severe COVID-19 patients (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Cellular ACE2 expression varies among individuals and ethnicities. Differences in ACE2 expression and variants might influence susceptibility to SARS-CoV-2 infection and disease severity (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Furthermore, the frequency of the ACE1 II genotype is inversely related to susceptibility to COVID-19. This genotype was less frequent among the Iranian population (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Also, the TMPRSS2 gene serves as an activator of SARS-CoV entry into the host cells. Iranians showed more expression of TMPRSS2. These may be related to increased COVID-19 susceptibility and severity among them (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In addition to genetic factors, some epigenetic factors, such as histone modification (H3K4me1, H3K4me3, H3K27Ac) in the ACE2 gene and decreased DNA methylation of the ACE2 promoter increase the expression of ACE2, affecting, in turn, the risk and severity of COVID disease (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong confirmed patients, respiratory distress and anorexia were more common in Iranians than Afghans. Although the rate of comorbidities was higher in Iranians, no significant race/ethnicity difference was observed in the severity of the disease among confirmed patients even after adjusting for age, sex, and comorbidities.\u003c/p\u003e \u003cp\u003eNo significant race/ethnicity disparity was observed concerning the mortality rate. However, by adjusting for age, sex, and comorbidity, a significant difference was observed in all hospitalized patients (OR, 1.66; 95%CI, 1.08\u0026ndash;2.55; P\u0026thinsp;=\u0026thinsp;0.020), with being more significant among confirmed COVID-19 patients (OR, 2.34; 95%CI, 1.47\u0026ndash;3.72; P\u0026thinsp;=\u0026thinsp;0.000). Indeed, Afghans suffered almost twice as many deaths as Iranians. Although some studies have linked differences in mortality to variations in treatment protocols in different health care centers, this is not the case with the present study; this is since this study was performed in a single hospital with a distinct treatment protocol for all patients (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Therefore, other factors are involved in this difference. Researches shows that some medications taken by patients improved the survival rate of COVID-19 cases. Cardiovascular drugs (e.g., ACE inhibitors), statin and anticoagulant drugs, anti-diabetic drugs (e.g., Metformin and dipeptidyl peptidase 4 inhibitors mentioned (DPP4-I)) are among these medications (\u003cspan additionalcitationids=\"CR36 CR37 CR38 CR39\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Since Iranian patients had more comorbidity than Afghans, consumption of cardiovascular, antihypertensive, and anti-diabetic drugs might have a protective effect against COVID-19 and improve survival. Some studies demonstrated that ARDS outcomes also differ in various ethnicities, even after adjusting for age, sex, disease severity, type of hospital and median household income (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Candidate genes associated with ARDS have been identified to be including reactive oxygen species, innate immunity-related inflammation and endothelial vascular signaling pathways. Ethnicity might affect cytokine gene polymorphisms and inflammatory profiles in specific conditions, In a way some ethnic groups more disposed to a heightened inflammatory response (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). In addition, it should be noted that social and economic factors may also affect inflammatory pathways and gene expression that poorly understood and should be further considered in future studies (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to the above, another factor affecting the mortality rate due to covid-19 is the delay in diagnosis. Studies show that people who are diagnosed longer after the onset of symptoms face higher mortality. Some reasons for delayed care-seeking behavior could be prohibitory costs, lack of access to health care services and stigmatization (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Social stigma can disrupt the process of diagnosis and treatment by negatively affecting social communication. People who feel stigmatized may avoid behaviors that increase stigma, including following health protocols and wearing masks to prevent covid-19. There has been a report of suspected covid-19 patients escaping from a hospital in Afghanistan (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). The people of Afghanistan considered the hospital environment to be more caring than therapeutic. Furthermore, the fear of social stigma prevented them from going to the hospital. Therefore, they prefer home care to visiting the hospital (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). On the other hand, Afghan immigrants have fragile economic conditions due to their daily work; also not having insurance, they incur high medical expenses. Therefore, delaying medical care due to social stigma and economic situation may explained more intubation and the increased median duration of hospital stay that lead to more mortality rate in afghans (\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur finding revealed that although Iranian represented more COVID-19-related symptoms and disease severity than Afghans but mortality was higher in Afghans. Future considerations should focus on understanding the impact of genetic or ethnicity related factors on covid-19 outcome for reducing the risk of death among some ethnicity groups.\u003c/p\u003e "},{"header":"Limitations","content":"\u003cp\u003eThis study has several limitations. Since this study was based on patient data at Hospital Information System (HIS), we only had hospitalization records. Also we did not have socio-economic status, education, or other health conditions of migrants that might contribute to this difference. We did not consider laboratory results of patient that may explain observed outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSARS-CoV-2: severe acute respiratory syndrome coronavirus\u003c/p\u003e\n\u003cp\u003eARDS: acute respiratory distress syndrome\u003c/p\u003e\n\u003cp\u003eICU: intensive care unit\u003c/p\u003e\n\u003cp\u003eBAME: Black, Asian, and Minority Ethnic\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRT-PCR: reverse-transcriptase-polymerase-chain-reaction\u003c/p\u003e\n\u003cp\u003eHIS: Hospital Information System\u003c/p\u003e\n\u003cp\u003eORs: odds ratios\u003c/p\u003e\n\u003cp\u003eCis: confidence intervals\u003c/p\u003e\n\u003cp\u003eIL: interleukin\u003c/p\u003e\n\u003cp\u003eIFN: interferon\u003c/p\u003e\n\u003cp\u003eMHC: major histocompatibility complex\u003c/p\u003e\n\u003cp\u003eDPP4-I: dipeptidyl peptidase 4 inhibitors\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe FA contributed to the conception and design of the study. PKh performed the statistical analysis and interpreted of the data. MAK contributed to prepare manuscript writing. AJ and HO participated in data collection. All authors have read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll supports received from Rafsanjan University of Medical Sciences (RUMS). The authors would like to thank the clinical Research Development Unit (CRDU) of Ali-Ibn Abi\u0026nbsp;Talib\u0026nbsp;Hospital, Rafsanjan, Iran for their cooperation throughout the period of study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data is not publicly accessible, but it can be obtained from the corresponding author upon a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and Consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Rafsanjan University of Medical Sciences (IR.RUMS.REC.1399.168). Informed\u0026nbsp;consent was obtained from all subjects. All methods were performed in accordance with the relevant guidelines and regulations\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19? BMJ. 2020;369.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMendy A, Apewokin S, Wells AA, Morrow AL. Factors associated with hospitalization and disease severity in a racially and ethnically diverse population of COVID-19 patients. 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A narrative review of stigma related to infectious disease outbreaks: What can be learned in the face of the Covid-19 pandemic? Front Psychiatry. 2020;11:565919.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadati AK, Mohammadi K. Illness Behavior in the Face of COVID-19 Infection: A Qualitative Study on Homecare in Afghanistan. SHIRAZ E-MED J. 2021;22(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahmoodi Z, Bahrami G, Ghavidel N, Seddighi H. The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: a path analysis. BMC Psychiatry. 2023;23(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLebni JY, Enayat H, Irandoost SF, Dehghan AA. Exploring the Challenges of Afghan Refugee Women Facing COVID-19: A Qualitative Study in Iran. Front Public Health. 2022;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez J, Ben\u0026iacute;tez ID, de Gonzalo-Calvo D, Torres G, de Batlle J, G\u0026oacute;mez S, et al. Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study. Crit Care. 2022;26(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Ethnicity, Clinical outcome","lastPublishedDoi":"10.21203/rs.3.rs-4175661/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4175661/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSince the outbreak of COVID-19, general studies about relationship between COVID-19 clinical outcome and ethnicity have been performed on the overall ethnic groups, but studies on ethnic subgroups is limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a population-based retrospective cohort study on hospitalized patients with suspected/confirmed COVID-19 to evaluate whether ethnic background influences disease severity and clinical outcomes. Patients were categorized into three groups: mild, moderate, and severe to critical. Analyses were adjusted for socio-demographic and comorbidities.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong all hospitalized patients, in the unadjusted model, Afghans had a lower risk of severe to critical illness than Iranians (OR, 0.52; 95%CI, 0.41\u0026ndash;0.64; P\u0026thinsp;\u0026lt;\u0026thinsp;0.000). After adjusting for age, sex and comorbidities the risk remained lower in Afghans (OR, 0.69; 95%CI, 0.56\u0026ndash;0.88; P\u0026thinsp;\u0026lt;\u0026thinsp;0.003). But among positive cases was comparable even after full adjustment (OR, 0.86; 95%CI, 0.54\u0026ndash;1.3; P\u0026thinsp;\u0026lt;\u0026thinsp;0.547). Among all hospitalized patients, in the unadjusted model, the risk of death was comparable between Afghans and Iranians (OR, 1.037; 95%CI, 0.70\u0026ndash;1.5; P\u0026thinsp;\u0026lt;\u0026thinsp;0.003). After adjusting for age, sex and comorbidities, Afghans had a higher risk of death than Iranians (OR, 1.66; 95%CI, 1.08\u0026ndash;2.55; P\u0026thinsp;=\u0026thinsp;0.020). Similar results were observed in positive cases (OR, 2.34; 95%CI, 1.47\u0026ndash;3.72; P\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn this cohort study, Iranians represented more COVID-19-related symptoms and disease severity than Afghans; but mortality was higher in Afghans. The impact of COVID-19 may be different in various Asian ethnic groups\u003c/p\u003e","manuscriptTitle":"Racial/ethnic disparities in COVID-19 clinical outcomes: A comparison between Asian ethnic subgroups","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-04 08:50:53","doi":"10.21203/rs.3.rs-4175661/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4d1c01b2-c4c2-45ce-be57-603cee2f0f2a","owner":[],"postedDate":"April 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-25T08:01:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-04 08:50:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4175661","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4175661","identity":"rs-4175661","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}