COVID-19 health inequities and association with mechanical ventilation and prolonged length of stay at an urban safety-net health system in Chicago.

Jacquelyn Jacobs,Arianna Boshara,Bijou Hunt,Javier Cruz,Christina Khouri,Amy K Johnson,Nancy Glick

doi:10.1371/journal.pone.0258243

Abstract

Millions of Americans have been infected with COVID-19 and communities of color have been disproportionately burdened. We investigated the relationship between demographic characteristics and COVID-19 positivity, and comorbidities and severe COVID-19 illness (use of mechanical ventilation and length of stay) within a racial/ethnic minority population. Patients tested for COVID-19 between March 2020 and January 2021 (N = 14171) were 49.9% (n = 7072) female; 50.1% (n = 7104) non-Hispanic Black; 33.2% (n = 4698) Hispanic; and 23.6% (n = 3348) aged 65+. Overall COVID-19 positivity was 16.1% (n = 2286). Compared to females, males were 1.1 times more likely to test positive (p = 0.014). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic persons were 1.4 (p = 0.003) and 2.4 (p<0.001) times more likely, respectively, to test positive. Compared to persons ages 18–24, the odds of testing positive were statistically significantly higher for every age group except 25–34, and those aged 65+ were 2.8 times more likely to test positive (p<0.001). Adjusted for race, sex, and age, COVID-positive patients with chronic obstructive pulmonary disease were 1.9 times more likely to require a ventilator compared to those without chronic obstructive pulmonary disease (p = 0.001). Length of stay was not statistically significantly associated with any of the comorbidity variables. Our findings emphasize the importance of documenting COVID-19 disparities in marginalized populations.

Highlights

As of April 5, 2021, there have been over 30.5 million cases of COVID-19 and over 550,000 COVID-19 associated deaths reported in the United States (US) [1]
Positivity differed by sex (p = 0.014), race/ethnicity (p
This study demonstrates the significant disparities in COVID-19 positivity by sex, race/ethnicity and age at a large safety-net hospital system on the south and west sides of Chicago

Summary

Introduction

As of April 5, 2021, there have been over 30.5 million cases of COVID-19 and over 550,000 COVID-19 associated deaths reported in the United States (US) [1]. Nationwide, patients over 65 represent less than 15% of COVID-19 cases but over 80% of COVID-19 deaths, and males account for 48% of COVID-19 cases but 54% of COVID-19 deaths [6]. In 2020, Hispanic individuals between the ages of 25–44 have experienced a 54% increase in deaths, compared to 2019, the largest excess of deaths associated with COVID-19, by age, race, and ethnicity [9]. In Chicago, the distribution and impact of COVID-19 mirrors national trends with those over the age of 65 accounting for 17% of cases but 59% of deaths, men accounting for 48% of cases but 59% of deaths, and non-Hispanic Black individuals representing 30% of the population, but 48% of COVID19 cases and 41% of COVID-related deaths [8, 10]

Methods

Results

Conclusion