The Influence of Social Determinants on Receiving Outpatient Treatment with Monoclonal Antibodies, Disease Risk, and Effectiveness for COVID-19.

Autor:	Ambrose N; The MITRE Corporation, Bedford, MA, USA., Amin A; Department of Medicine, University of California, Irvine, CA, USA.; Hospital Medicine Program, University of California, Irvine, CA, USA., Anderson B; The MITRE Corporation, Bedford, MA, USA., Bertagnolli M; Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Campion F; The MITRE Corporation, Bedford, MA, USA. fcampion@mitre.org.; Department of Population Medicine, Harvard Medical School, Boston, MA, USA. fcampion@mitre.org., Chow D; Department of Radiological Sciences, University of California, Irvine, CA, USA., Danan R; The MITRE Corporation, Bedford, MA, USA., D'Arinzo L; The MITRE Corporation, Bedford, MA, USA., Drews A; Division of Infectious Diseases, Department of Medicine, Houston Methodist, Houston, TX, USA.; Houston Methodist Academic Institute, Houston, TX, USA.; Weill Cornell Medical College, New York, NY, USA., Erlandson K; Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response, US Department of Health and Human Services, Washington, DC, USA., Fitzgerald K; The MITRE Corporation, Bedford, MA, USA., Gaspar F; The MITRE Corporation, Bedford, MA, USA., Gong C; Booz Allen Hamilton in Support of BARDA, Washington, DC, USA., Hanna G; Tunnell Government Services in Support of BARDA, Princeton, NJ, USA., Hawley H; The MITRE Corporation, Bedford, MA, USA., Jones S; Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, USA., Lopansri B; Division of Infectious Diseases and Clinical Epidemiology, Intermountain Health, Murray, UT, USA.; Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA., Mullen T; The MITRE Corporation, Bedford, MA, USA., Musser J; Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, TX, USA.; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.; Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY, USA., O'Horo J; Center for Individualized Medicine-Mayo Clinic Research, Rochester, MN, USA., Piantadosi S; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Pritt B; Center for Individualized Medicine-Mayo Clinic Research, Rochester, MN, USA., Razonable R; Center for Individualized Medicine-Mayo Clinic Research, Rochester, MN, USA., Rele S; The MITRE Corporation, Bedford, MA, USA.; Shabas Solutions LLC in Support of BARDA, Fairfax, VA, USA., Roberts S; The MITRE Corporation, Bedford, MA, USA., Sandmeyer S; Department of Biological Chemistry, School of Medicine, University of California, Irvine, CA, USA.; Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, CA, USA., Stein D; The MITRE Corporation, Bedford, MA, USA., Te J; The MITRE Corporation, Bedford, MA, USA., Vahidy F; Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, USA.; Department of Neurosurgery, Houston Methodist, Houston, TX, USA.; Department of Population Health Science, Weill Cornell Medical College, New York, NY, USA., Webb B; Division of Infectious Diseases and Clinical Epidemiology, Intermountain Health, Murray, UT, USA.; Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA., Welch N; The MITRE Corporation, Bedford, MA, USA., Wood A; The MITRE Corporation, Bedford, MA, USA., Yttri J; The MITRE Corporation, Bedford, MA, USA.
Jazyk:	angličtina
Zdroj:	Journal of general internal medicine [J Gen Intern Med] 2023 Dec; Vol. 38 (16), pp. 3472-3481. Date of Electronic Publication: 2023 Sep 15.
DOI:	10.1007/s11606-023-08324-y
Abstrakt:	Background: Limited research has studied the influence of social determinants of health (SDoH) on the receipt, disease risk, and subsequent effectiveness of neutralizing monoclonal antibodies (nMAbs) for outpatient treatment of COVID-19. Objective: To examine the influence of SDoH variables on receiving nMAb treatments and the risk of a poor COVID-19 outcome, as well as nMAb treatment effectiveness across SDoH subgroups. Design: Retrospective observational study utilizing electronic health record data from four health systems. SDoH variables analyzed included race, ethnicity, insurance, marital status, Area Deprivation Index, and population density. Participants: COVID-19 patients who met at least one emergency use authorization criterion for nMAb treatment. Main Measure: We used binary logistic regression to examine the influence of SDoH variables on receiving nMAb treatments and risk of a poor outcome from COVID-19 and marginal structural models to study treatment effectiveness. Results: The study population included 25,241 (15.1%) nMAb-treated and 141,942 (84.9%) non-treated patients. Black or African American patients were less likely to receive treatment than white non-Hispanic patients (adjusted odds ratio (OR) = 0.86; 95% CI = 0.82-0.91). Patients who were on Medicaid, divorced or widowed, living in rural areas, or living in areas with the highest Area Deprivation Index (most vulnerable) had lower odds of receiving nMAb treatment, but a higher risk of a poor outcome. For example, compared to patients on private insurance, Medicaid patients had 0.89 (95% CI = 0.84-0.93) times the odds of receiving nMAb treatment, but 1.18 (95% CI = 1.13-1.24) times the odds of a poor COVID-19 outcome. Age, comorbidities, and COVID-19 vaccination status had a stronger influence on risk of a poor outcome than SDoH variables. nMAb treatment benefited all SDoH subgroups with lower rates of 14-day hospitalization and 30-day mortality. Conclusion: Disparities existed in receiving nMAbs within SDoH subgroups despite the benefit of treatment across subgroups. (© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Databáze:	MEDLINE
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