The Impact of Sociodemographic Factors, Comorbidities, and Physiologic Responses on 30-Day Mortality in Coronavirus Disease 2019 (COVID-19) Patients in Metropolitan Detroit

Abstract

Background The relationship of health disparities and comorbidities in coronavirus disease 2019 (COVID-19) related outcomes are an ongoing area of interest. This report assesses risk factors associated with mortality in patients presenting with Covid-19 infection and healthcare disparities. Methods A retrospective cohort study of consecutive patients presenting to emergency departments within an integrated health system who tested positive for COVID-19 between March 7 and April 30, 2020 in Metropolitan Detroit. The primary outcomes were hospitalization and 30-day mortality. Results A total of 3,633 patients with mean age of 58 years were included. The majority were female and black non-Hispanic. Sixty-four percent required hospitalization, 56% of whom were black. Hospitalized patients were older, more likely to reside in a low-income area, and had a higher burden of comorbidities. By 30-days, 433 (18.7%) hospitalized patients died. In adjusted analyses, the presence of comorbidities, age >60 years and more severe physiological disturbance were associated with 30-day mortality. Residence in low income areas (odds ratio, 1.02; 95% confidence interval 0.76 – 1.36), and public insurance (odds ratio, 1.24; 95% confidence interval 0.76 – 2.01) were not independently associated with higher risk of mortality. Black female patients had a lower adjusted risk of mortality (odds ratio, 0.46; 95% confidence interval, 0.27 to 0.78). Conclusions In this large cohort of COVID-19 patients, those with comorbidities, advanced age, and physiological abnormalities on presentation had higher odds of death. Disparities in income or source of health insurance were not associated with outcomes. Black women had a lower risk of dying.

Association of Patient Characteristics, Diabetes, BMI, and Obesity With Severe COVID-19 in Metropolitan Detroit, MI

“…The etiology of an age-related effect on poor outcomes in patients with COVID-19 has been described to be related to increasing baseline inflammation, possibly resulting from increasing levels of senescent cells with age. Senescent cells can activate endothelial cells lining capillaries in the lungs and increase expression of natural killer cell receptor ligands that recruit natural killer- (56-72% Black patients in the Detroit metropolitan area) (15,17,37). In fact, our data suggested that Black patients had significantly lower odds of death than White patients, similar to results of a smaller study conducted at HFHS by Miller et al (37).…”

“…Senescent cells can activate endothelial cells lining capillaries in the lungs and increase expression of natural killer cell receptor ligands that recruit natural killer- (56-72% Black patients in the Detroit metropolitan area) (15,17,37). In fact, our data suggested that Black patients had significantly lower odds of death than White patients, similar to results of a smaller study conducted at HFHS by Miller et al (37).…”

Clinical Profile, Pharmacological Treatment, and Predictors of Death Among Hospitalized COVID-19 Patients With Acute Kidney Injury: A Population-Based Registry Analysis

“…Acute kidney injury (AKI) continues to affect between 10 and 40% of in-hospital coronavirus disease 2019 (COVID- 19) patients (1)(2)(3)(4). Since the beginning of the COVID-19 pandemic, mostly elderly individuals with many comorbidities have developed AKI and died (5,6). The adaptation of mechanisms to the kidneys that respond to hemodynamic changes, inflammation, and other stress-inducing situations, perform worse in cases of previous kidney affectation, diabetes, heart failure, etc.…”

Influenza and Anosmia: Important Prediction Factors for Severity and Death of COVID-19 

“…This trend supports previous studies in China, Italy, and the United States which reported that men and old age are two important risk factors. [12][13][14] In our paper, the proportion of underlying diseases is higher in men than in women, and the proportion of underlying diseases is particularly high in the elderly, which is the main reason for the severity and mortality of COVID-19. In our study, patients living in metropolitan areas did not have significantly increased severity of COVID-19 compared to other patients, and there were significantly lower mortality rates in metropolitan areas.…”