Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
Yale School of Medicine Physician Assistant Online Program, Yale Institute of Global Health, National Disaster Medical System, New Haven, CT, United States of America.
PLoS One. 2021 Sep 16;16(9):e0256763. doi: 10.1371/journal.pone.0256763. eCollection 2021.
The COVID-19 pandemic has had a devastating impact in the United States, particularly for Black populations, and has heavily burdened the healthcare system. Hospitals have created protocols to allocate limited resources, but there is concern that these protocols will exacerbate disparities. The sequential organ failure assessment (SOFA) score is a tool often used in triage protocols. In these protocols, patients with higher SOFA scores are denied resources based on the assumption that they have worse clinical outcomes. The purpose of this study was to assess whether using SOFA score as a triage tool among COVID-positive patients would exacerbate racial disparities in clinical outcomes.
We analyzed data from a retrospective cohort of hospitalized COVID-positive patients in the Yale-New Haven Health System. We examined associations between race/ethnicity and peak overall/24-hour SOFA score, in-hospital mortality, and ICU admission. Other predictors of interest were age, sex, primary language, and insurance status. We used one-way ANOVA and chi-square tests to assess differences in SOFA score across racial/ethnic groups and linear and logistic regression to assess differences in clinical outcomes by sociodemographic characteristics.
Our final sample included 2,554 patients. Black patients had higher SOFA scores compared to patients of other races. However, Black patients did not have significantly greater in-hospital mortality or ICU admission compared to patients of other races.
While Black patients in this sample of hospitalized COVID-positive patients had higher SOFA scores compared to patients of other races, this did not translate to higher in-hospital mortality or ICU admission. Results demonstrate that if SOFA score had been used to allocate care, Black COVID patients would have been denied care despite having similar clinical outcomes to white patients. Therefore, using SOFA score to allocate resources has the potential to exacerbate racial inequities by disproportionately denying care to Black patients and should not be used to determine access to care. Healthcare systems must develop and use COVID-19 triage protocols that prioritize equity.
COVID-19 大流行对美国造成了毁灭性影响，尤其是对黑人群体，使医疗系统负担沉重。医院制定了分配有限资源的协议，但人们担心这些协议会加剧差异。序贯器官衰竭评估 (SOFA) 评分是分诊协议中常用的工具。在这些协议中，SOFA 评分较高的患者会被拒绝提供资源，因为假设他们的临床结果更差。本研究的目的是评估在 COVID-19 阳性患者中使用 SOFA 评分作为分诊工具是否会加剧临床结果的种族差异。
我们分析了耶鲁-纽黑文医疗系统住院 COVID-19 阳性患者的回顾性队列数据。我们检查了种族/民族与峰值总体/24 小时 SOFA 评分、住院死亡率和 ICU 入院之间的关联。其他感兴趣的预测因素包括年龄、性别、主要语言和保险状况。我们使用单向方差分析和卡方检验评估不同种族/民族组之间 SOFA 评分的差异，使用线性和逻辑回归评估社会人口特征差异对临床结果的影响。
我们的最终样本包括 2554 名患者。与其他种族的患者相比，黑人患者的 SOFA 评分更高。然而，与其他种族的患者相比，黑人患者的住院死亡率或 ICU 入院率并没有显著更高。
虽然本样本中住院 COVID-19 阳性患者中的黑人患者的 SOFA 评分高于其他种族的患者，但这并未转化为更高的住院死亡率或 ICU 入院率。结果表明，如果使用 SOFA 评分来分配护理，尽管黑人 COVID 患者的临床结果与白人患者相似，但他们仍可能被拒绝护理。因此，使用 SOFA 评分来分配资源有可能不成比例地剥夺黑人患者的护理，从而加剧种族不平等，不应将其用于确定获得护理的机会。医疗保健系统必须制定和使用优先考虑公平的 COVID-19 分诊协议。
