Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19

Daniel Quan,Abel Hamdan,Ijeoma Nnodim Opara,Meredith Van Harn,Heaveen Ahdi,Anita Shallal,Manasi Mahajan,Lucía Luna Wong,Amir Daneshvar,Mohamed Nasereldin,Marcus Zervos,Raghav Madan

doi:10.1007/s11606-020-06527-1

Abstract

BackgroundThe impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19).ObjectiveTo evaluate the association between patient sociodemographics and neighborhood disadvantage with frequencies of death, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission in patients hospitalized with COVID-19.DesignRetrospective cohort study.SettingFour hospitals in an integrated health system serving southeast Michigan.ParticipantsAdult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction.Main MeasuresPatient sociodemographics, comorbidities, and clinical outcomes were collected. Neighborhood socioeconomic variables were obtained at the census tract level from the 2018 American Community Survey. Relationships between neighborhood median income and clinical outcomes were evaluated using multivariate logistic regression models, controlling for patient age, sex, race, Charlson Comorbidity Index, obesity, smoking status, and living environment.Key ResultsBlack patients lived in significantly poorer neighborhoods than White patients (median income: $34,758 (24,531–56,095) vs. $63,317 (49,850–85,776), p < 0.001) and were more likely to have Medicaid insurance (19.4% vs. 11.2%, p < 0.001). Patients from neighborhoods with lower median income were significantly more likely to require IMV (lowest quartile: 25.4%, highest quartile: 16.0%, p < 0.001) and ICU admission (35.2%, 19.9%, p < 0.001). After adjusting for age, sex, race, and comorbidities, higher neighborhood income ($10,000 increase) remained a significant negative predictor for IMV (OR: 0.95 (95% CI 0.91, 0.99), p = 0.02) and ICU admission (OR: 0.92 (95% CI 0.89, 0.96), p < 0.001).ConclusionsNeighborhood disadvantage, which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19. Measures of neighborhood disadvantage should be used to inform policies that aim to reduce COVID-19 disparities in the Black community.

Highlights

As of October 23, 2020, there are more than 8.3 million confirmed cases and 221,000 deaths from coronavirus disease 2019 (COVID-19) in the USA.[1]
The COVID-19 pandemic revealed the health disparities that exist between the Black and White populations of southeast Michigan, a population which can be generalized to other metropolitan areas
Our study builds on their work while factoring in the socioeconomic variables of a large cohort hospitalized with COVID-19 during the peak of the pandemic in Michigan

Summary

Introduction

As of October 23, 2020, there are more than 8.3 million confirmed cases and 221,000 deaths from coronavirus disease 2019 (COVID-19) in the USA.[1]. In the state of Michigan, Black Americans represent 37% of COVID-19 cases and 42% of deaths, despite making up 14% of Michigan’s population.[2,3,4] These discrepancies have been largely attributed to social and health disparities rendering Black Americans vulnerable to this novel coronavirus. This explanation is supported by reports that most patients who have been hospitalized and died from COVID-19 have medical comorbidities (e.g., hypertension, diabetes, chronic obstructive pulmonary disease (COPD), heart disease, obesity) that are disproportionately prevalent in the Black community.[4,5,6,7,8].

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