Newton Sophia, Zollinger Benjamin, Freeman Jincong, Moran Seamus, Helfand Alexandra, Authelet Kayla, McHarg Matthew, Vargas Nataly Montano, Shesser Robert, Cohen Joanna, Cummings Derek, Ma Yan, Meltzer Andrew C
medRxiv. 2020 Dec 11:2020.12.08.20246017. doi: 10.1101/2020.12.08.20246017.
To measure the association of race, ethnicity, comorbidities, and insurance status with need for hospitalization of symptomatic Emergency Department (ED) patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection.
This study is a retrospective case-series of symptomatic patients presenting to a single ED with laboratory-confirmed SARS-CoV-2 infection from March 12-August 9, 2020. We collected patient-level information regarding demographics, public insurance status (Medicare or Medicaid), comorbidities, level of care, and mortality using a structured chart review. We compared demographics and comorbidities of patients who were (1) able to convalesce at home, (2) required admission to general medical service, (3) required admission to intensive care unit (ICU), or (4) died within 30 days of the index visit. Multivariable logistic regression analyses were performed to report adjusted odds ratios (aOR) and the associated 95% confidence intervals (95% CI) with hospital admission versus ED discharge home.
In total, 993 patients who presented to the ED with symptoms were included in the analysis with 370 (37.3%) patients requiring hospital admission and 70 (7.1%) patients requiring ICU care. Patients requiring admission were more likely to be Black or African American, to be Hispanic or Latino, or to have public insurance (either Medicaid or Medicare.) On multivariable logistic regression analysis comparing which patients required hospital admission, African-American race (aOR 1.4, 95% CI 0.7-2.8) and Hispanic ethnicity (aOR 1.1, 95% CI 0.5-2.0) were not associated with need for admission but, public insurance (Medicaid: aOR 3.4, 95% CI 2.2-5.4; Medicare: aOR 2.6, 95% CI 1.2-5.3; Medicaid and Medicare: aOR 3.6 95% CI 2.1-6.2) and the presence of hypertension (aOR 1.8, 95% CI 1.2-2.7), diabetes (aOR 1.6, 95% CI 1.1-2.5), obesity (aOR 1.7, 95% CI 1.1-2.5), heart failure (aOR 3.9, 95% CI 1.4-11.2), and hyperlipidemia (aOR 1.8, 95% CI 1.2-2.9) were identified as independent predictors of hospital admission.
Comorbidities and public insurance are predictors of more severe illness for patients with SARS-CoV-2. This study suggests that the disparities in severity seen in COVID-19 among African Americans and Hispanics are likely to be closely related to low socioeconomic status and chronic health conditions and do not reflect an independent predisposition to disease severity.
评估种族、族裔、合并症及保险状况与有症状的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染急诊科（ED）患者住院需求之间的关联。
本研究是一项回顾性病例系列研究，纳入了2020年3月12日至8月9日期间因实验室确诊的SARS-CoV-2感染而到单一急诊科就诊的有症状患者。我们通过结构化病历审查收集了患者层面的人口统计学信息、公共保险状况（医疗保险或医疗补助）、合并症、护理级别及死亡率。我们比较了以下患者的人口统计学和合并症情况：（1）能够在家康复的患者；（2）需要入住普通医疗服务病房的患者；（3）需要入住重症监护病房（ICU）的患者；或（4）在首次就诊后30天内死亡的患者。进行多变量逻辑回归分析以报告调整后的比值比（aOR）及与住院而非急诊科出院回家相关的95%置信区间（95%CI）。
总计993例有症状到急诊科就诊的患者纳入分析，其中370例（37.3%）患者需要住院，70例（7.1%）患者需要ICU护理。需要住院的患者更可能是黑人或非裔美国人、西班牙裔或拉丁裔，或拥有公共保险（医疗补助或医疗保险）。在比较哪些患者需要住院的多变量逻辑回归分析中，非裔美国人种族（aOR 1.4，95%CI 0.7 - 2.8）和西班牙裔族裔（aOR 1.1，95%CI 0.5 - 2.0）与住院需求无关，但公共保险（医疗补助：aOR 3.4，95%CI 2.2 - 5.4；医疗保险：aOR 2.6，95%CI 1.2 - 5.3；医疗补助和医疗保险：aOR 3.6，95%CI 2.1 - 6.2）以及高血压（aOR 1.8，95%CI 1.2 - 2.7）、糖尿病（aOR 1.6，95%CI 1.1 - 2.5）、肥胖（aOR 1.7，95%CI 1.1 - 2.5）、心力衰竭（aOR 3.9，95%CI 1.4 - 11.2）和高脂血症（aOR 1.8，95%CI 1.2 - 2.9）被确定为住院的独立预测因素。
合并症和公共保险是SARS-CoV-2患者病情更严重的预测因素。本研究表明，非裔美国人和西班牙裔在2019冠状病毒病（COVID-19）中所观察到的严重程度差异可能与社会经济地位低下和慢性健康状况密切相关，而不反映对疾病严重程度的独立易感性。
