The impact of socioeconomic status on 30‐day mortality in hospitalized patients with COVID‐19 infection

Abstract

Socioeconomic status (SES) impacts outcome in a number of diseases. Our aim was to compare the outcome of hospitalized coronavirus disease 219 (COVID-19) patients in low and high SES group. Prospective cohort study of hospitalized patients with confirmed COVID-19 in three acute hospitals. Electronic case notes were analyzed for baseline characteristics and admission investigations. Scottish index for multiple deprivation (SIMD) was used to divide patients into two groups: more deprived (SIMD 1-5) and less deprived (SIMD 6-10) and results compared. Poor outcome was defined as either need for intubation and/or death. One hundred and seventy-three patients were identified, one was excluded. One hundred and eight (62.8%) were males, mean age was 68.5 ± 14.7 years. Commonest comorbidity was hypertension 87 (50.6%). One hundred and seventeen (68.0%) patients were in more deprived group. Baseline characteristics, admission blood profile and reason for admission were evenly matched in both groups. Outcomes were comparable in both groups: transfer to critical care (27.4% vs 27.3%; P = .991), intubation (18.8% vs 20.2%; P = .853), 30-day all-cause mortality (19.7% vs 14.5%; P = .416) and overall poor outcome (30.8% vs 30.9%; P = .985). Median time to discharge was 7 days longer (17 vs 10 days; P = .018) and median time to death was 4.5 days longer in more deprived group (17 vs 12.5 days; P = .388). Contrary to recent literature on COVID-19 in other geographical areas, our study suggests that the SES does not have any impact on outcome of hospitalized patients with COVID-19, however it negatively impacts length of stay.

Socio-Economic Patterns of COVID-19 During the Pandemic in Italy

“…These findings could reflect the known social gradient in co-morbidities and risk factors for COVID-19 severity, such as obesity, diabetes, cardiovascular disease or respiratory diseases, by which those living in the most deprived areas suffer the biggest burden. However, a study in Scotland on mortality in hospitalised patients with COVID-19 infection did not find differences in case-fatality according to deprivation in the area of residence (50). Equally, we did not find an association between the deprivation level of the municipality of residence and the risk of hospitalisation or death.…”

“…Another possible explanation may lie in the methodological differences across studies, as there is significant heterogeneity in the indicators used to assess deprivation and the geographical areas studied. This could explain why, for example, other studies carried out in the UK and the US have not found such association (53)(54)(55).…”

Socioeconomic patterns and COVID-19 outcomes before, during and after the lockdown in Italy (2020)

“…Another possible explanation may lie in the methodological differences across studies, as there is significant heterogeneity in the indicators used to assess deprivation and the geographical areas studied. This could explain why, for example, other studies carried out in the UK and the US have not found such association ( Guha et al, 2020 ; Apea et al, 2021 ; Khan et al, 2020b ). Further studies would help in clarifying the individual and contextual influence of deprivation on COVID-19 outcomes.…”

“…These findings could reflect the known social gradient in co-morbidities and risk factors for COVID-19 severity, such as obesity, diabetes, cardiovascular disease or respiratory diseases, by which those living in the most deprived areas suffer the biggest burden. However, a study in Scotland on mortality in hospitalized patients with COVID-19 infection did not find differences in case-fatality according to deprivation in the area of residence ( Khan et al, 2020a ). Equally, we did not find an association between the deprivation level of the municipality of residence and the risk of hospitalisation or death.…”

Obesity is independently associated with septic shock, renal complications, and mortality in a multiracial patient cohort hospitalized with COVID-19

“…Despite the fact that race, ethnicity, and socioeconomic status are known risk factors for obesity, we did not observe significant differences in these social determinants of health across BMI categories. Similarly, a prospective study conducted in Scotland did not find a difference in mortality or complications in hospitalized patients with COVID-19 with higher distress scores based on the Scottish Index for Multiple Deprivation (SIMD) [ 42 , 43 ]. Although there is a disproportionate burden of COVID-19 related outcomes among Black and Latinx individuals throughout the United States [ 6 , 44 – 54 ], like ours, the plurality of retrospective cohort studies have not demonstrated significant associations between race, ethnicity, and hospital mortality.…”