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

Abstract

Background The impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19). Objective To 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. Design Retrospective cohort study. Setting Four hospitals in an integrated health system serving southeast Michigan. Participants Adult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction. Main Measures Patient 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 Results Black 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). Conclusions Neighborhood 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.

Resilience to COVID-19: Socioeconomic Disadvantage Associated With Higher Positive Parent-youth Communication and Youth Disease-prevention Behavior

“…To our knowledge, this is the rst study describing associations between how parents and their children are responding to COVID-19, with respect to disease burden, perceived risk, communication, emotional distress, and behaviors to reduce its spread, in the context of family-and neighborhood-level socioeconomic disadvantage. As in previous reports, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] we showed greater COVID-19 disease burden in households with lower incomes and/or living in more disadvantaged neighborhoods (Fig. 1).…”

“…Like the 1918 Spanish and 2009 H1N1 in uenzas, 1 the SARS-CoV-2 (COVID-19) pandemic has impacted lower-income populations more heavily than higher-income populations. 2,3 There is greater COVID-19 infection risk, prevalence, and disease severity in lower-income and more disadvantaged regions (i.e., neighborhoods, counties), [4][5][6][7][8][9][10][11][12][13] and state-level income inequality is associated with COVID-19-related deaths. 14 By the spring and summer of 2020, there was evidence that neighborhood disadvantage was associated with greater COVID-19 prevalence in several regions across the United States.…”

Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis

“…We examined two-way interactions between Swiss-SEP group and age, sex, epidemic wave, and canton (appendix pp [10][11][12]. The associations between SEP and outcomes became weaker with increasing age (appendix pp 10-12).…”

“…10 Studies in the USA showed that patients from neighbourhoods or counties with lower median income or higher deprivation were more likely to require intensive care, and more likely to die from COVID-19. 11,12 Inequalities and inequities in health care and infection control should be described and documented at the population level along the COVID-19 cascade-ie, from testing and testing positive to medical care and clinical outcomes. We analysed nationwide, population-based surveillance data from the Swiss Federal Office of Public Health (SFOPH) to examine the association of neighbourhood SEP with testing for SARS-CoV-2, testing positive, hospitalisation, intensive care unit (ICU) admission, and death.…”

Telemedicine disparities during COVID‐19: Provider offering and individual technology availability

“…2 These gaps in care have been felt particularly hard by people of color and those from the lower end of the socioeconomic spectrum. 3 While the proportion of physicians using telemedicine during the pandemic has dramatically increased, disparities appear to exist in the availability and use of telemedicine technologies. 4 We examined receipt of routine check-ups and preventative care among Medicare beneficiaries during the pandemic to determine provider and patient barriers to the use of telemedicine technologies.…”