Detrimental Impact of Social Determinants of Health on Hospitalized Patients with COVID-19

Abstract

Background: Sars-COV-2, the virus responsible for COVID-19, has a diverse clinical presentation and course that is amplified across different populations. It intensifies existing health outcome disparities that minorities and individuals in lower socioeconomic groups face when compared to the general population. However, the particular elements among these groups that contribute to health disparities with COVID-19 infections are unclear. Objective: To examine the relationship between various Social Determinants of Health (SDH) such as ethnicity, financial class, primary language, age and zip code have on the course and progression of COVID-19 infections. Design: A retrospective cohort analysis of data from patients who tested positive for the coronavirus admitted to the Emanate Health hospital system across all three campuses at Queen of the Valley Hospital, Inter-Community Hospital and Foothill Presbyterian Hospital. We extracted data from the hospital electronic medical records (EMR) and analyzed the following aspects of SDH including zip code, financial class, ethnicity, primary language and age as related to length of stay and mortality rate at Emanate Health. Participants: Patients (18 years of age or older) admitted to the Emanate Health hospital system in the San Gabriel Valley, California between 3/17/2020-6/30/2020 (n=400) who tested positive for the novel coronavirus via nasopharyngeal, oropharyngeal and/or serologic testing based on availability. Results: Statistical significance was noted for the SDH parameters of insurance status, primary language and ethnicity with respect to insurance. Medicare patients had the longest average length of stay in contrast to self pay patients with the lowest average days (P <0.0001). Hospital length of stay increased with increasing age when grouped by ages 19-29, ages 30-49, ages 50-69 or ages 70+ (p value <0.0001). English was the primary language of 75.25% of patients but mortality rate was higher for patients whose primary language was Spanish. The average length of stay for Hispanics when classified by financial class was statistically significant (p =0.0002) as well as the average hospital length of stay for Non-Hispanics when classified by financial class (p <0.0001). Conclusions: The environment in which people are born, live and age is long known to govern a wide degree of health outcomes. Our data specifically highlights the differences in the course of COVID-19 infections amongst people with different social determinants of health and how COVID-19 further unveiled these existing social disparities. We should be cognizant of the large Hispanic/Latino population that’s makes up the San Gabriel Valley and take heed of these particular socioeconomic factors that drive poorer health outcomes.