Elevated COVID-19 Related Mortality Risk Among Hospitalized Inpatients from Socially Vulnerable Census Tracts

Abstract

Background: There is a dearth of information about coronavirus disease (COVID-19) mortality risk factors in large urban health systems that predominantly serve African Americans. Methods: This registry-based cohort study includes consecutive adult COVID-19 patients admitted to emergency departments in a Detroit-based multihospital health system from 3/11/2020 through 4/6/2020. Regression models examine relationships between in-hospital mortality and residential census tract characteristics estimated by the CDC Social Vulnerability Index, patient demographics and medical history. Results: A total of 1015 COVID-19 patients are included. The majority (80%) was identified as black, 52% were male and 53% were ≥ 65 years of age. The median (interquartile range) body mass index and Charlson Comorbidity Index score was 30·4 (26-37) and 4 (IQR, 2-5), respectively. Of the 896 hospitalized patients, 75% was hospitalized. The in-hospital mortality rate was 38% (n=340/896). Mortality risk was significantly elevated by 50% among patients from census tracts in the 90 th percentile of vulnerability related to socioeconomic status or heightened household overcrowding and use of public transportation. Elderly patients, those residing in nursing homes prior to hospitalization, and patients with comorbid cardiometabolic disorders were also at 30%-to-90% elevated risk. Interpretation : Public health efforts focusing on increased testing and limiting contact with persons infected COVID-19 are needed for the elderly and people with cardiometabolic disorders in large urban health systems that predominately serve African Americans. If our findings are replicated, then priority should be given to areas with heightened vulnerability related to socioeconomic status, household crowding and use of public transportation. Funding: No funding was obtained to conduct this study. Declaration of Interests: Authors in the manuscript declare no competing interests. Ethics Approval Statement: This study was reviewed and approved by the Detroit Medical Center Clinical Research Office and the Wayne State University Institutional Review Boards.