Open AccessPoverty, Comorbidity, and Ethnicity: COVID-19 Outcomes in a Safety Net Health System
Author(s) -
J. Philip Smith,
Amy B. Kressel,
Randall W. Grout,
Bree Weaver,
Megan Cheatham,
Wanzhu Tu,
Ruohong Li,
David W. Crabb,
Lisa E. Harris,
W. Graham Carlos
Publication year - 2022
Publication title -
ethnicity and disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.767
H-Index - 67
eISSN - 1945-0826
pISSN - 1049-510X
DOI - 10.18865/ed.32.2.113
Subject(s) - comorbidity , covid-19 , ethnic group , safety net , poverty , medicine , environmental health , psychiatry , virology , political science , disease , outbreak , infectious disease (medical specialty) , law
Objective: To determine if race-ethnicity is correlated with case-fatality rates among low-income patients hospitalized for COVID-19.Research Design: Observational cohort study using electronic health record data.Patients: All patients assessed for COVID-19 from March 2020 to January 2021 at one safety net health system.Measures: Patient demographic and clinical characteristics, and hospital care processes and outcomes.Results: Among 25,253 patients assessed for COVID-19, 6,357 (25.2%) were COVID-19 positive: 1,480 (23.3%) hospitalized; 334 (22.6%) required intensive care; and 106 (7.3%) died. More Hispanic patients tested positive (51.8%) than non-Hispanic Black (31.4%) and White patients (16.7%, P<.001]. Hospitalized Hispanic patients were younger, more often uninsured, and less likely to have comorbid conditions. Non-Hispanic Black patients had significantly more diabetes, hypertension, obesity, chronic kidney disease, and asthma (P<.05). Non-Hispanic White patients were older and had more cigarette smoking history, COPD, and cancer. Non- Hispanic White patients were more likely to receive intensive care (29.6% vs 21.1% vs 20.8%, P=.007) and more likely to die (12% vs 7.3% vs 3.5%, P<.001) compared with non-Hispanic Black and Hispanic patients, respectively. Length of stay was similar for all groups. In logistic regression models, Medicaid insurance status independently correlated with hospitalization (OR 3.67, P<.001) while only age (OR 1.076, P<.001) and cerebrovascular disease independently correlated with in-hospital mortality (OR 2.887, P=.002).Conclusions: Observed COVID-19 in-hospital mortality rate was lower than most published rates. Age, but not race-ethnicity, was independently correlated with in-hospital mortality. Safety net health systems are foundational in the care of vulnerable patients suffering from COVID-19, including patients from under-represented and low-income groups. Ethn Dis. 2022;32(2):113- 122;doi:10.18865/ed.32.2.113