Social Determinants Predict Outcomes in Data From a Multi-Ethnic Cohort of 20,899 Patients Investigated for COVID-19

Abstract

Importance: The COVID-19 pandemic exploits existing inequalities in social determinants of health (SDOH) in disease burden and access to healthcare. Few studies have examined these emerging disparities using indicators of SDOH.Objective: To evaluate predictors of COVID-19 test positivity, morbidity, and mortality and their implications for inequalities in SDOH and for future policies and health care improvements.Design, Setting, and Participants: A cross sectional analysis was performed on all patients tested for COVID-19 on the basis of symptoms with either a history of travel to at risk regions or close contact with a confirmed case, across the Mount Sinai Health System (MSHS) up until April 26th 2020.Main Outcomes and Measures: Primary outcome was death from COVID-19 and secondary outcomes were test positivity, and morbidity (e.g., hospitalization and intubation caused by COVID-19).Results: Of 20,899 tested patients, 8,928 tested positive, 1,701 were hospitalized, 684 were intubated, and 1,179 died from COVID-19. Age, sex, race/ethnicity, New York City borough (derived from first 3 digits of zip-code), and English as preferred language were significant predictors of test positivity, hospitalization, intubation and COVID-19 mortality following multivariable logistic regression analyses.Conclusions and Relevance: People residing in poorer boroughs were more likely to be burdened by and die from COVID-19. Our results highlight the importance of integrating comprehensive SDOH data into healthcare efforts with at-risk patient populations.

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

“…Studies published since June 2020 tend to support our findings of disparities in COVID-19 infection, hospitalization, and mortality by race or ethnicity [ 88 – 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.…”

Factors Associated With SARS-CoV-2 Infection in Bogotá, Colombia: Results From a Large Epidemiological Surveillance Study

“…In the literature, it has been found that communities with higher poverty, lower-income, and lower social security coverage have shown a higher prevalence of COVID-19. 29 Environmental factors such as living in a neighbourhood with poor air quality, insecurity related to housing, insecurity related to transportation, 30 household size, low educational level, [31] , [32] and public social security 33 have also been associated with a higher probability of having COVID-19 at the community level. These results are consistent with our findings, where a larger household size was also positively associated with a higher risk of SARS-CoV-2 infection.…”

Treating Acute Leukemia During the COVID-19 Pandemic in an Environment With Limited Resources: A Multicenter Experience in Four Latin American Countries

“…It has been described in other populations that the educational status and the socioeconomic status are associated with a higher risk and worse outcomes with COVID-19 and these may contribute to the high rate of COVID-19 and the high mortality. 18 , 19 …”