医疗保健可及性与 COVID-19 住院的西班牙裔患者 ICU 利用和死亡率的关系。
Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19.
机构信息
Texas Health Resources, Arlington, Texas.
Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
J Hosp Med. 2021 Nov;16(11):659-666. doi: 10.12788/jhm.3717.
BACKGROUND
Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths.
OBJECTIVE
To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors.
DESIGN, SETTING, PARTICIPANTS: Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020.
EXPOSURES
Self-reported ethnicity and primary language.
MAIN OUTCOMES AND MEASURES
Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes.
RESULTS
32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10- 1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001).
CONCLUSION
The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.
背景
美国的少数族裔群体在 COVID-19 死亡人数方面承受着不成比例的负担。
目的
评估西班牙裔和非西班牙裔 COVID-19 住院患者之间是否存在结果差异，如果存在，确定主要的可改变的促成因素。
设计、地点、参与者：这是一项对 2020 年 3 月至 11 月期间在单一大型医疗保健系统内住院的 6097 名成年 COVID-19 患者进行的回顾性、横断面、观察性研究。
暴露情况
自我报告的种族和主要语言。
主要结果和措施
临床结果包括 ICU 利用和院内死亡。我们使用年龄调整后的优势比（OR）和多变量分析来评估种族/语言群体与结果之间的关联。
结果
32.1%的患者为西班牙裔，其中 38.6%报告使用非英语作为主要语言。与非西班牙裔患者相比，西班牙裔患者的保险覆盖率较低，拥有初级保健提供者的比例较低，在 COVID-19 入院前利用医疗保健系统的比例也较低。在调整年龄后，非英语组的 ICU 利用率较高（OR，1.75；95%置信区间，1.47-2.08；英语组：OR，1.13；95%置信区间，0.95-1.33）和死亡率较高（OR，1.43；95%置信区间，1.10-1.86；英语组：OR，1.53；95%置信区间，1.19-1.98）。在各组之间没有观察到治疗差异。在调整年龄后，西班牙裔患者入院时的疾病严重程度升高（非英语组：OR，2.27；95%置信区间，1.89-2.72；英语组：OR，1.33；95%置信区间，1.10-1.61）。在多变量分析中，在考虑到基线疾病严重程度后，种族/语言与临床结果之间的关联减少（P <.001）。
结论
种族与临床结果之间的关联可以通过入院时疾病严重程度的升高和西班牙裔患者，特别是非英语裔西班牙裔患者获得医疗保健的机会有限来解释。
Zotero 插件