Racial/Ethnic Differences In COVID-19 Screening, Hospitalization, And Mortality In Southeast Wisconsin

Egede, Leonard E.; Walker, Rebekah J.; Garacci, Emma; Raymond, John R.

doi:10.1377/hlthaff.2020.01081

Cited by 39 publications

(45 citation statements)

References 22 publications

(38 reference statements)

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“…Studies published since June 2020 tend to support our findings of disparities in COVID-19 infection, hospitalization, and mortality by race or ethnicity [88][89][90][91][92][93][94][95][96], socioeconomic status and deprivation [88-90, 92, 93, 97], and housing insecurity [95,96,98,99]. At least two recent studies did not find associations between race and mortality outcomes among those able to access hospital care [100,101], contrary to findings of most other research, including this review.…”

Section: Plos Onecontrasting

confidence: 51%

Social determinants of COVID-19 incidence and outcomes: A rapid review

et al. 2021

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Early reports indicate that the social determinants of health are implicated in COVID-19 incidence and outcomes. To inform the ongoing response to the pandemic, we conducted a rapid review of peer-reviewed studies to examine the social determinants of COVID-19. We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from December 1, 2019 to April 27, 2020. We also searched the bibliographies of included studies, COVID-19 evidence repositories and living evidence maps, and consulted with expert colleagues internationally. We included studies identified through these supplementary sources up to June 25, 2020. We included English-language peer-reviewed quantitative studies that used primary data to describe the social determinants of COVID-19 incidence, clinical presentation, health service use and outcomes in adults with a confirmed or presumptive diagnosis of COVID-19. Two reviewers extracted data and conducted quality assessment, confirmed by a third reviewer. Forty-two studies met inclusion criteria. The strongest evidence was from three large observational studies that found associations between race or ethnicity and socioeconomic deprivation and increased likelihood of COVID-19 incidence and subsequent hospitalization. Limited evidence was available on other key determinants, including occupation, educational attainment, housing status and food security. Assessing associations between sociodemographic factors and COVID-19 was limited by small samples, descriptive study designs, and the timeframe of our search. Systematic reviews of literature published subsequently are required to fully understand the magnitude of any effects and predictive utility of sociodemographic factors related to COVID-19 incidence and outcomes. PROSPERO: CRD4202017813.

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Section: Plos Onecontrasting

confidence: 51%

Social determinants of COVID-19 incidence and outcomes: A rapid review

et al. 2021

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“…Evidence suggests social risk factors such as low income and lack of access to care could explain some of this disparity [22]. Recently published studies have reported that African Americans are more likely to be tested for COVID-19 in the emergency department or inpatient settings and are more likely to be admitted to the hospital compared to non-Hispanic whites [23][24][25]. This is thought to reflect the lack of access to care and delay in seeking care due to lack of trust in the system which results in more advanced disease at the time of presentation [23].…”

Section: Discussionmentioning

confidence: 99%

AKI in Hospitalized Patients with COVID-19 and Seasonal Influenza: A Comparative Analysis

et al. 2021

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Background: Coronavirus disease 2019 (COVID-19) is often compared to seasonal influenza and the two diseases share similarities including the risk of systemic manifestations such as acute kidney injury (AKI). The aim of this study was to perform a comparative analysis of the prevalence, risk factors, and outcomes of AKI in hospitalized patients with COVID-19 and influenza. Methods: Retrospective cohort study of hospitalized patients with COVID-19 (n=325) or seasonal influenza (n=433). AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Baseline characteristics and hospitalization data were collected, and multivariable analysis was performed to determine the independent predictors for AKI. Results: AKI occurred in 32.6% of COVID-19 hospitalizations (COV-AKI) and 33.0% of influenza hospitalizations (FLU-AKI). After adjusting for age, gender, and comorbidity count, the risk of stage 3 AKI was significantly higher in COV-AKI (OR: 3.46; 95% CI 1.63, 7.37). Preexisting CKD was associated with a 6- to 7-fold increased likelihood for FLU-AKI and COV-AKI. Mechanical ventilation was associated with a higher likelihood of developing AKI in the COVID-19 cohort (OR: 5.85; 95% CI 2.30, 15.63). African American race, after adjustment for comorbidities, was an independent risk for COV-AKI. Conclusion: Pre-existing CKD was a major risk factor for AKI in both cohorts. African American race (independent of comorbidities) and mechanical ventilation were associated with a higher risk of developing COV-AKI which is characterized by a higher burden of stage 3 AKI and overall poorer prognosis.

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“…Yet, not all findings are consistent; e.g., there was no racial disparity in COVID19 mortality rates among ZIP codes grouped by the proportion of Black residents in a nearby (affluent) county [31] . Clinical studies have also provided evidence that African Americans who seek hospital care are at increased risk of COVID19 mortality; however, the racial disparities appear to be explained by social factors or differences in comorbidities in most [ [8] , [9] , [10] , [11] ], but not all [ 7 , 12 ], reports.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies of people able to access hospital care reported no Black-White people difference in COVID19 mortality risk after adjusting for sociodemographic factors and clinical comorbidities [ [8] , [9] , [10] , [11] ]. Yet, not all studies agree.…”

Section: Introductionmentioning

confidence: 99%

Elevated COVID19 mortality risk in Detroit area hospitals among patients from census tracts with extreme socioeconomic vulnerability

Sandhu¹,

Korzeniewski²,

Polistico³

et al. 2021

EClinicalMedicine

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Background the incidence of novel coronavirus disease (COVID19) is elevated in areas with heightened socioeconomic vulnerability. Early reports from US hospitals also implicated social disadvantage and chronic disease history as COVID19 mortality risk factors. However, the relationship between race and COVID19 mortality remains unclear. Methods we examined in-hospital COVID19 mortality risk factors in a multi-hospital tertiary health care system that serves greater Detroit, Michigan, a predominantly African American city with high rates of poverty and chronic disease. Consecutive adult patients who presented to emergency departments and tested positive for COVID19 from 3/11/2020 through 4/18/2020 were included. Using log-binomial regression, we assessed the relationship between in-hospital mortality and residence in census tracts that were flagged for extreme socioeconomic vulnerability, patient-level demographics, and clinical comorbidities. Findings a total of 1,015 adults tested positive for COVID19 during the study period; 80% identified as Black people, 52% were male and 53% were ≥ 65 years of age. The median body mass index was 30•4 and the median Charlson Comorbidity Index score was 4. Patients from census tracts that were flagged for vulnerability related to socioeconomic status had a higher mortality rate than their peers who resided in less vulnerable census tracts (β 0.26, standard error (SE) 0.11, degrees of freedom (df) 378, t -value ( t ) 2.27, exp(β) 1.29, p -value 0.02). Adjustment for age category, Black race, sex and/or the Charlson Comorbidity Index score category reduced the magnitude of association by less than 10% [exp(β) 1.29 vs. 1.21]. Black race [ p = 0.38] and sex [ p = 0.62] were not associated with mortality in this sample. Interpretation people who lived in areas flagged for extreme socioeconomic vulnerability had elevated mortality risk in our predominantly African-American cohort of COVID19 patients who were able to seek hospital care during the so-called ‘first wave’ of the pandemic. By contrast, Black race was not associated with mortality in our sample.

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Racial/Ethnic Differences In COVID-19 Screening, Hospitalization, And Mortality In Southeast Wisconsin

Cited by 39 publications

References 22 publications

Social determinants of COVID-19 incidence and outcomes: A rapid review

Social determinants of COVID-19 incidence and outcomes: A rapid review

AKI in Hospitalized Patients with COVID-19 and Seasonal Influenza: A Comparative Analysis

Elevated COVID19 mortality risk in Detroit area hospitals among patients from census tracts with extreme socioeconomic vulnerability

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