Abstract
ObjectivesThere is limited evidence on how clinical outcomes differ by socioeconomic conditions among patients with coronavirus disease 2019 (COVID-19). Most studies focused on COVID-19 patients from a single hospital. Results based on patients from multiple health systems have not been reported. The objective of this study is to examine variation in patient characteristics, outcomes, and healthcare utilization by neighborhood social conditions among COVID-19 patients.MethodsWe extracted electronic health record data for 23,300 community dwelling COVID-19 patients in New York City between March 1st and June 11th, 2020 from all care settings, including hospitalized patients, patients who presented to the emergency department without hospitalization, and patients with ambulatory visits only. Zip Code Tabulation Area—level social conditions were measured by the Social Deprivation Index (SDI). Using logistic regressions and Cox proportional-hazards models, we examined the association between SDI quintiles and hospitalization and death, controlling for race, ethnicity, and other patient characteristics.ResultsAmong 23,300 community dwelling COVID-19 patients, 60.7% were from neighborhoods with disadvantaged social conditions (top SDI quintile), although these neighborhoods only account for 34% of overall population. Compared to socially advantaged patients (bottom SDI quintile), socially disadvantaged patients (top SDI quintile) were older (median age 55 vs. 53, P<0.001), more likely to be black (23.1% vs. 6.4%, P<0.001) or Hispanic (25.4% vs. 8.5%, P<0.001), and more likely to have chronic conditions (e.g., diabetes: 21.9% vs. 10.5%, P<0.001). Logistic and Cox regressions showed that patients with disadvantaged social conditions had higher risk for hospitalization (odds ratio: 1.68; 95% confidence interval [CI]: [1.46, 1.94]; P<0.001) and mortality (hazard ratio: 1.91; 95% CI: [1.35, 2.70]; P<0.001), adjusting for other patient characteristics.ConclusionSubstantial socioeconomic disparities in health outcomes exist among COVID-19 patients in NYC. Disadvantaged neighborhood social conditions were associated with higher risk for hospitalization, severity of disease, and death.
Highlights
The COVID-19 pandemic is an unprecedented public health crisis globally, including in the United States, where New York City (NYC) became the initial epicenter in March 2020 [1,2,3,4]
Substantial socioeconomic disparities in health outcomes exist among COVID-19 patients in NYC
Disadvantaged neighborhood social conditions were associated with higher risk for hospitalization, severity of disease, and death
Summary
The COVID-19 pandemic is an unprecedented public health crisis globally, including in the United States, where New York City (NYC) became the initial epicenter in March 2020 [1,2,3,4]. Better understanding the clinical characteristics, outcomes, and patterns of healthcare utilization for COVID-19 patients is important to inform clinical decision-making and public health policy in the current pandemic, including for the growing number of individuals with long-term sequelae of the disease, and for future public-health crises. Most studies have not followed patients after hospital discharge, as data on post-discharge outcomes and utilization are often unavailable [3, 4, 6, 7]. Some studies have examined racial and ethnic disparities in COVID-19 outcomes [8,9,10,11,12,13,14,15,16,17], there is less data on how disadvantaged social conditions are associated with COVID-19 outcomes
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