Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID‐19

Abstract

BACKGROUND: Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths. OBJECTIVE: To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors. DESIGN, SETTING, PARTICIPANTS: Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020. EXPOSURES: Self-reported ethnicity and primary language. MAIN OUTCOMES AND MEASURES: Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes. RESULTS: 32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10-1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001). CONCLUSION: The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.

Evaluating Racial/Ethnic Differences in Care Escalation Among COVID-19 Patients in a Home-Based Hospital

“…First, although we did not find statistically significant differences in care escalation from AH-HaH to brick-and-mortar facilities for Hispanic vs. non-Hispanic White patients, other studies of patients hospitalized in traditional care settings indicate that Hispanics have been disproportionately impacted by poor COVID-19 outcomes [ 9 , 10 , 23 ]. Similar studies have shown that Hispanic patients have higher rates of hospitalization, severe disease requiring intensive care, intubation, and mortality [ 24 – 27 ].…”

Evaluating the Medication Regimen Complexity Score as a Predictor of Clinical Outcomes in the Critically Ill

“…For example, African American patients have the highest disease burden requiring intensive care treatments and are more likely to die from sepsis. During the COVID-19 pandemic, Hispanic patients have been found to have higher ICU utilization and mortality than non-Hispanic patients [ 41 ].…”

Lulled into a false sense of security: Mortality for vulnerable populations may remain elevated even during the lull between COVID‐19 waves

“…The authors declare no conflict of interest. Suchita S. Sata MD 1,2 S. Ryan Greysen MD, MHS Email: Suchita.shah.sata@duke.edu; Twitter: @SuchitaSata ORCID Suchita S. Sata http://orcid.org/0000-0002-9773-6174…”