Introduction: The recent spread of coronavirus disease 2019 (COVID-19) has disproportionately impacted racial and ethnic minority groups; however, the impact of healthcare utilization on outcome disparities remains unexplored. Our study examines racial and ethnic disparities in hospitalization, medication usage, intensive care unit (ICU) admission and in-hospital mortality for COVID-19 patients. Methods: In this retrospective cohort study, we analyzed data for adult patients within an integrated healthcare system in New York City between February 28–August 28, 2020, who had a lab-confirmed COVID-19 diagnosis. Primary outcome was likelihood of inpatient admission. Secondary outcomes were differences in medication administration, ICU admission, and in-hospital mortality. Results: Of 4717 adult patients evaluated in the emergency department (ED), 3219 (68.2%) were admitted to an inpatient setting. Black patients were the largest group (29.1%), followed by Hispanic/Latinx (29.0%), White (22.9%), Asian (3.86%), and patients who reported “other” race-ethnicity (19.0%). After adjusting for demographic, clinical factors, time, and hospital site, Hispanic/Latinx patients had a significantly lower adjusted rate of admission compared to White patients (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.34-0.76). Black (OR 0.60; 95% CI 0.43-0.84) and Asian patients (OR 0.47; 95% CI 0.25 - 0.89) were less likely to be admitted to the ICU. We observed higher rates of ICU admission (OR 2.96; 95% CI 1.43-6.15, and OR 1.83; 95% CI 1.26-2.65) and in-hospital mortality (OR 4.38; 95% CI 2.66-7.24; and OR 2.96; 95% CI 2.12-4.14) at two community-based academic affiliate sites relative to the primary academic site. Conclusion: Non-White patients accounted for a disproportionate share of COVID-19 patients seeking care in the ED but were less likely to be admitted. Hospitals serving the highest proportion of minority patients experienced the worst outcomes, even within an integrated health system with shared resources. Limited capacity during the COVID-19 pandemic likely exacerbated pre-existing health disparities across racial and ethnic minority groups.
Background: The ARUBA trial reported medical management was superior to intervention for unruptured cerebral arteriovenous malformations (cAVMs); however, open excision was underrepresented in the intervention arm. We investigated whether the ARUBA trial results influenced treatment modality rates for unruptured cAVMs within the United States. Methods: We queried the National Inpatient Sample (NIS), the largest all-payer inpatient care database in the United States, and identified 2,028 patients that underwent treatment for unruptured cAVMs between January 2011 and September 2015. All screened subjects had AVM ICD-9-CM diagnosis code 747.81 (anomalies of cerebrovascular system) and were excluded based on hemorrhage codes 430 (SAH) and/or 431 (ICH). ICD-9-CM principal procedure codes were used to identify treatment modalities: endovascular (39.72), open excision (01.59), and stereotactic radiosurgery (SRS) (92.30-.39). Univariate logistic regression was used to compare treatment rates for each modality before and after two ARUBA time points: 1) European Stroke Conference (ESC) presentation May 2013 and 2) The Lancet publication February 2014. Results: When unruptured cAVMs were treated, the rate of open excision was greater after, compared to before, the May 2013 ARUBA presentation (OR 1.22, p<0.05). Additionally, a trend for open excision was noted using the February 2014 publication date (OR 1.20, p=0.054). Endovascular and SRS did not show significant differences in treatment rates at either time point. Conclusions: Unruptured cAVMs within the NIS database that underwent treatment had open excision significantly more after, compared to before, the ARUBA results were presented at the ESC. When using The Lancet publication date, a non-significant trend for open excision was noted but likely resulted from insufficient numbers in the post-Lancet publication group. Our findings suggest that the ARUBA trial has influenced current treatment modality rates for unruptured cAVMs captured within the NIS.
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