39 Impact Of Socioeconomic Status On COVID-19 Disease Severity

Abstract

Study Objective: To determine the relationship between socioeconomic status and the severity of COVID-19 infection upon emergency department presentation and overall hospital course. Methods: This was a retrospective chart review of 235 randomly selected patients admitted to a major health care system with a diagnosis of PCR-confirmed COVID-19. Severe disease was defined as the presence of any of the following: respiratory rate ≥30, oxygen saturation ≤89% at rest, requirement of mechanical ventilation, non-respiratory organ failure, septic shock, or death. Presence of these symptoms were assessed for each patient upon initial presentation to the emergency department, and in their overall hospital course. Socioeconomic status was estimated by extrapolating US census data for median household income from each patient’s zip code. Household incomes were then separated into quintiles. The percentage of patients within each quintile who were severe upon presentation and severe overall was determined. Demographic data for each subject was collected and logistic regression was used to control for confounding variables. Results: Of the 235 patients, the income quintiles were as follows: q1: <source -38,100;q2: $38,101-46,700;q3: $46,701-56,600;q4: $56,601-72,000;q5: $72,001+. The population was 43% White, 24% American Indian or Alaska Native, 19% Black, 5% Asian, 1% Pacific Islander, 1% Middle Eastern, and 8% two or more races. 27% of the study population was of Hispanic or Latino ethnicity. Using a logistic regression to control for confounding variables, a statistically significant association was seen between median income and likelihood of severe disease on presentation (odds ratio with each increasing quintile 0.80;95% CI 0.66-0.96) as well as between median income and likelihood of severe disease overall (odds ratio with each increasing quintile 0.74;95% CI 0.59-0.93). Severe disease upon presentation to the emergency department was associated with a longer length of stay (3.6 days longer on average, p = 0.002) and an increased likelihood of death (odds ratio 3.6;95% CI 1.58-8.02). Conclusions: Lower socioeconomic status as measured by median household income for a person’s home zip code is associated with a higher rate of severe COVID-19 disease both on presentation to the emergency department and during their overall hospital course. For each 1-quintile increase in median household income, the odds of severe disease on presentation decreases by 20% (p = 0.018) and the odds of severe disease overall decreases by 26% (p = 0.009). Particular strengths of this data set include a large quantity of highly granular clinical data as well as a diverse population in both urban and rural settings. This data can better inform public health officials, medical professionals, and policymakers of the impact of socioeconomic status on vulnerability to disease and encourage progressive policy in providing vaccination and resources for these populations.