From the Department of Medicine, Divisions of Infectious Diseases, Pulmonary, and Critical Care, and Hospital Medicine, and the Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson.
South Med J. 2021 Mar;114(3):144-149. doi: 10.14423/SMJ.0000000000001222.
To describe the demographics, clinical characteristics, and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) in an academic medical center in the southern United States.
Retrospective, observational cohort study of all adult patients (18 years and older) consecutively admitted with laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 infection between March 13 and April 25, 2020 at the University of Mississippi Medical Center. All of the patients either survived to hospital discharge or died during hospitalization. Demographics, body mass index, comorbidities, clinical manifestations, and laboratory findings were collected. Patient outcomes (need for invasive mechanical ventilation and in-hospital death) were analyzed.
One hundred patients were included, 53% of whom were women. Median age was 59 years (interquartile range 44-70) and 66% were younger than 65. Seventy-five percent identified themselves as Black, despite representing 58% of hospitalized patients at our institution in 2019. Common comorbid conditions included hypertension (68%), obesity (65%), and diabetes mellitus (31%). Frequent clinical manifestations included shortness of breath (76%), cough (75%), and fever (64%). Symptoms were present for a median of 7 days (interquartile range 4-7) on presentation. Twenty-four percent of patients required mechanical ventilation and, overall, 19% died (67% of those requiring mechanical ventilation). Eighty-four percent of those who died were Black. On multivariate analysis, ever smoking (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.2-28.6) and history of diabetes mellitus (OR 5.9, 95% CI 1.5-24.3) were associated with mortality, and those admitted from home were less likely to die (vs outside facility, OR 0.2, 95% CI 0.0-0.7). Neither age, sex, race, body mass index, insurance status, nor rural residence was independently associated with mortality.
Our study adds evidence that Black patients appear to be overrepresented in those hospitalized with and those who die from COVID-19, likely a manifestation of adverse social determinants of health. These findings should help guide preventive interventions targeting groups at higher risk of acquiring and developing severe COVID-19 disease.
描述美国南部一家学术医疗中心住院的 2019 年冠状病毒病（COVID-19）成年患者的人口统计学、临床特征和结局。
这是一项对 2020 年 3 月 13 日至 4 月 25 日期间在密西西比大学医学中心因实验室确诊的严重急性呼吸综合征冠状病毒 2 感染连续入院的所有成年患者（18 岁及以上）进行的回顾性、观察性队列研究。所有患者要么存活至出院，要么在住院期间死亡。收集人口统计学、体重指数、合并症、临床表现和实验室检查结果。分析患者结局（是否需要有创机械通气和院内死亡）。
共纳入 100 例患者，其中 53%为女性。中位年龄为 59 岁（四分位间距 44-70），66%年龄小于 65 岁。尽管在我们的机构中，黑人在 2019 年占住院患者的 58%，但有 75%的人自我认定为黑人。常见的合并症包括高血压（68%）、肥胖症（65%）和糖尿病（31%）。常见的临床表现包括呼吸急促（76%）、咳嗽（75%）和发热（64%）。症状在出现时中位持续 7 天（四分位间距 4-7）。24%的患者需要机械通气，总体死亡率为 19%（需要机械通气的患者中 67%死亡）。84%死亡患者为黑人。多变量分析显示，既往吸烟（比值比[OR]5.9，95%置信区间[CI]1.2-28.6）和糖尿病史（OR 5.9，95%CI 1.5-24.3）与死亡率相关，而从家中入院的患者死亡风险较低（vs 非医疗机构，OR 0.2，95%CI 0.0-0.7）。年龄、性别、种族、体重指数、保险状况或农村居住地均与死亡率无独立相关性。
本研究进一步证实，黑人患者在因 COVID-19 住院和死亡的患者中似乎占比过高，这可能是健康的社会决定因素不良的表现。这些发现应有助于指导针对感染和发展为严重 COVID-19 疾病风险较高的群体的预防干预措施。
