Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19.

Autor: Quan D; Wayne State University School of Medicine, Detroit, MI, USA., Luna Wong L; Wayne State University School of Medicine, Detroit, MI, USA., Shallal A; Department of Infectious Disease, Henry Ford Hospital, Detroit, MI, USA., Madan R; Wayne State University School of Medicine, Detroit, MI, USA., Hamdan A; Wayne State University School of Medicine, Detroit, MI, USA., Ahdi H; Wayne State University School of Medicine, Detroit, MI, USA., Daneshvar A; Wayne State University School of Medicine, Detroit, MI, USA., Mahajan M; Wayne State University School of Medicine, Detroit, MI, USA., Nasereldin M; Wayne State University School of Medicine, Detroit, MI, USA., Van Harn M; Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA., Opara IN; Department of Internal Medicine, Internal Medicine-Pediatrics Section, Wayne State University School of Medicine, Detroit, MI, USA., Zervos M; Global Affairs Professor of Medicine, Assistant Dean Wayne State University School of Medicine, MI, Detroit, USA. mzervos1@hfhs.org.; Infectious Diseases, Division Head Henry Ford Health System, MI, Detroit, USA. mzervos1@hfhs.org.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2021 May; Vol. 36 (5), pp. 1302-1309. Date of Electronic Publication: 2021 Jan 27.
DOI: 10.1007/s11606-020-06527-1
Abstrakt: Background: The impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19).
Objective: To evaluate the association between patient sociodemographics and neighborhood disadvantage with frequencies of death, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission in patients hospitalized with COVID-19.
Design: Retrospective cohort study.
Setting: Four hospitals in an integrated health system serving southeast Michigan.
Participants: Adult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction.
Main Measures: Patient sociodemographics, comorbidities, and clinical outcomes were collected. Neighborhood socioeconomic variables were obtained at the census tract level from the 2018 American Community Survey. Relationships between neighborhood median income and clinical outcomes were evaluated using multivariate logistic regression models, controlling for patient age, sex, race, Charlson Comorbidity Index, obesity, smoking status, and living environment.
Key Results: Black patients lived in significantly poorer neighborhoods than White patients (median income: $34,758 (24,531-56,095) vs. $63,317 (49,850-85,776), p < 0.001) and were more likely to have Medicaid insurance (19.4% vs. 11.2%, p < 0.001). Patients from neighborhoods with lower median income were significantly more likely to require IMV (lowest quartile: 25.4%, highest quartile: 16.0%, p < 0.001) and ICU admission (35.2%, 19.9%, p < 0.001). After adjusting for age, sex, race, and comorbidities, higher neighborhood income ($10,000 increase) remained a significant negative predictor for IMV (OR: 0.95 (95% CI 0.91, 0.99), p = 0.02) and ICU admission (OR: 0.92 (95% CI 0.89, 0.96), p < 0.001).
Conclusions: Neighborhood disadvantage, which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19. Measures of neighborhood disadvantage should be used to inform policies that aim to reduce COVID-19 disparities in the Black community.
Databáze: MEDLINE
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