Wayne State University School of Medicine, Detroit, MI, USA.
Department of Infectious Disease, Henry Ford Hospital, Detroit, MI, USA.
J Gen Intern Med. 2021 May;36(5):1302-1309. doi: 10.1007/s11606-020-06527-1. Epub 2021 Jan 27.
The impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19).
To evaluate the association between patient sociodemographics and neighborhood disadvantage with frequencies of death, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission in patients hospitalized with COVID-19.
Retrospective cohort study.
Four hospitals in an integrated health system serving southeast Michigan.
Adult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction.
Patient sociodemographics, comorbidities, and clinical outcomes were collected. Neighborhood socioeconomic variables were obtained at the census tract level from the 2018 American Community Survey. Relationships between neighborhood median income and clinical outcomes were evaluated using multivariate logistic regression models, controlling for patient age, sex, race, Charlson Comorbidity Index, obesity, smoking status, and living environment.
Black patients lived in significantly poorer neighborhoods than White patients (median income: $34,758 (24,531-56,095) vs. $63,317 (49,850-85,776), p < 0.001) and were more likely to have Medicaid insurance (19.4% vs. 11.2%, p < 0.001). Patients from neighborhoods with lower median income were significantly more likely to require IMV (lowest quartile: 25.4%, highest quartile: 16.0%, p < 0.001) and ICU admission (35.2%, 19.9%, p < 0.001). After adjusting for age, sex, race, and comorbidities, higher neighborhood income ($10,000 increase) remained a significant negative predictor for IMV (OR: 0.95 (95% CI 0.91, 0.99), p = 0.02) and ICU admission (OR: 0.92 (95% CI 0.89, 0.96), p < 0.001).
Neighborhood disadvantage, which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19. Measures of neighborhood disadvantage should be used to inform policies that aim to reduce COVID-19 disparities in the Black community.
种族和社会经济地位对新冠肺炎 2019 （COVID-19）住院患者临床结局的影响尚未量化。
评估患者社会人口统计学和社区劣势与 COVID-19 住院患者死亡率、有创机械通气（IMV）和重症监护病房（ICU）入住率的关系。
回顾性队列研究。
密歇根东南部一个综合卫生系统的 4 家医院。
经聚合酶链反应证实 COVID-19 诊断的成年住院患者。
收集患者的社会人口统计学、合并症和临床结局。从 2018 年美国社区调查中获得了按人口普查区划分的社区社会经济变量。使用多变量逻辑回归模型评估了社区中位数收入与临床结局之间的关系，模型控制了患者年龄、性别、种族、Charlson 合并症指数、肥胖、吸烟状况和生活环境。
黑人患者居住在明显贫困的社区，收入中位数低于白人患者（中位数收入：$34758（24531-56095）vs.$63317（49850-85776），p<0.001），且更有可能拥有医疗补助保险（19.4% vs. 11.2%，p<0.001）。收入中位数较低的社区的患者更有可能需要 IMV（最低四分位数：25.4%，最高四分位数：16.0%，p<0.001）和 ICU 入院（35.2%，19.9%，p<0.001）。在调整年龄、性别、种族和合并症后，较高的社区收入（$10000 增加）仍然是 IMV（OR：0.95（95%CI 0.91，0.99），p=0.02）和 ICU 入院（OR：0.92（95%CI 0.89，0.96），p<0.001）的显著负预测因素。
与种族密切相关的社区劣势是 COVID-19 不良临床结局的预测因素。应使用社区劣势指标来告知旨在减少黑人社区 COVID-19 差异的政策。
