Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System

Abstract

There is growing evidence that racial and ethnic minorities bear a disproportionate burden from COVID-19. Temporal changes in the pandemic epidemiology and diversity in the clinical course require careful study to identify determinants of poor outcomes. We analyzed 6255 hospitalized individuals with PCR-confirmed SARS-CoV-2 infection from one of 5 hospitals in the University of Pennsylvania Health System between March 2020 and March 2021, using electronic health records to assess risk factors and outcomes through 8 weeks post-admission. Discharge, readmission and mortality outcomes were analyzed in a multi-state model with multivariable Cox models for each transition. Mortality varied markedly over time, with cumulative incidence (95% CI) 30 days post-admission of 19.1% (16.9, 21.3) in March-April 2020, 5.7% (4.2, 7.5) in July-October 2020 and 10.5% (9.1,12.0) in January-March 2021; 26% of deaths occurred after discharge. Average age (SD) at admission varied from 62.7 (17.6) to 54.8 (19.9) to 60.5 (18.1); mechanical ventilation use declined from 21.3% to 9–11%. Compared to Caucasian, Black race was associated with more severe disease at admission, higher rates of co-morbidities and residing in a low-income zip code. Between-race risk differences in mortality risk diminished in multivariable models; while admitting hospital, increasing age, admission early in the pandemic, and severe disease and low blood pressure at admission were associated with increased mortality hazard. Hispanic ethnicity was associated with fewer baseline co-morbidities and lower mortality hazard (0.57, 95% CI: 0.37, .087). Multi-state modeling allows for a unified framework to analyze multiple outcomes throughout the disease course. Morbidity and mortality for hospitalized COVID-19 patients varied over time but post-discharge mortality remained non-trivial. Black race was associated with more risk factors for morbidity and with treatment at hospitals with lower mortality. Multivariable models suggest there are not between-race differences in outcomes. Future work is needed to better understand the identified between-hospital differences in mortality.

Dexamethasone for Inpatients With COVID-19 in a National Cohort

“…We did not have data on vaccination status or days since symptom onset, both of which could have affected the treatment response and our interpretation of several administered medications, including antivirals and corticosteroids. Furthermore, given that circulating SARS-CoV-2 variant strains and standard of care for both inpatient and outpatient management and prevention of COVID-19, including medication administration and vaccination, changed throughout the study period, 26 , 27 , 28 patient outcomes in our cohort varied over time, which could have affected our measured effect size, as well as the comparability of propensity-weighted data within this study period. In addition, dexamethasone was used so widely in this cohort that we had few control patients, and many of them later went on to receive corticosteroids during their hospital stay.…”

The Impact of Comorbidities among Ethnic Minorities on COVID-19 Severity and Mortality in Canada and the USA: A Scoping Review

“…Eight studies were conducted in Michigan [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], six in New York [ 45 , 46 , 47 , 48 , 49 , 50 ], four in Atlanta [ 51 , 52 , 53 , 54 ], and four in California [ 55 , 56 , 57 , 58 ]. The remaining studies were divided as follows: one in three states (California, Oregon, and Washington) [ 59 ], one in Massachusetts [ 60 ], one in Tennessee [ 61 ], two in Wisconsin [ 62 , 63 ], one in Mississippi [ 64 ], one in Cleveland [ 65 ], one in Pennsylvania [ 66 ], two in Louisiana [ 67 , 68 ], one in the Midwest [ 69 ], one near the Mexico border [ 70 ], one in New Orleans [ 71 ], one in Georgia [ 72 ], one in Northeast Ohio and South Florida [ 73 ], one in Milwaukee and Southeast Wisconsin [ 74 ], one in Florida [ 75 ], one in Missouri [ 76 ], and one in Illinois [ 77 ] ( Table 1 ).…”

“…Overall, the following races/ethnicities were examined in our included studies: Black/African American, Asian, Hispanic, White/Caucasian, and Indigenous people. Firstly, 58 studies included Black/African American patients [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , ...…”

Association between a Frailty Index from Common Laboratory Values and Vital Signs (FI-LAB) and Hospital and Post-Hospital Outcomes in Veterans with COVID-19 Infection

“…COVID-19 posed a disproportionately high threat to older adults worldwide ( 3 – 5 ). Older adults hospitalized with SARS-CoV-2 infection were more likely to suffer serious complications including higher rates of in-hospital and post-discharge morbidity and mortality ( 6 , 7 ). During the pandemic, hospital-based health care professionals often used chronological age as an objective and quickly obtained characteristic to estimate individuals’ prognosis and make appropriate clinical decisions ( 8 ).…”