Giovanatti Alexa, Elassar Heba, Karabon Patrick, Wunderlich-Barillas Tracy, Halalau Alexandra
Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA.
Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Int J Gen Med. 2021 Nov 20;14:8521-8526. doi: 10.2147/IJGM.S334593. eCollection 2021.
Several studies have relayed the disproportionate impact of COVID-19 on marginalized communities; however, few have specifically examined the association between social determinants of health and mechanical ventilation (MV).
To determine which demographics impact MV rates among COVID-19 patients.
This observational study included COVID-19 patient data from eight hospitals' electronic medical records (EMR) between February 25, 2020, to December 31, 2020. Associations between demographic data and MV rates were evaluated using uni- and multivariate analyses.
Multicenter (eight hospitals), largest health system in Southeast Michigan.
Inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab. Exclusion criteria were missing demographic data or non-permanent Michigan residents.
Patients were divided into two groups: MV and non-MV.
The primary outcome was MV rate per demographic. A multivariate model then predicted the odds of MV per demographic descriptor. Hypotheses were formulated prior to data collection.
Among 11,304 COVID-19 inpatients investigated, 1621 (14.34%) were MV, and 49.96% were male with a mean age of 63.37 years (17.79). Significant social determinants for MV included Black race (40.19% MV vs 31.31% non-MV, p<0.01), poverty (14.60% vs. 13.21%, p<0.01), and disability (12.65% vs 9.14%; p<0.01). Black race (AOR 1.61 (CI 1.41-1.83; p<0.01)), median income (AOR 0.99 (CI 0.99-0.99; p<0.01)), disability (AOR 1.55 (CI 1.26, 1.90; p<0.01)), and non-English-speaking status (AOR 1.26 (CI 1.05, 1.53)) had significantly higher odds of MV.
Black race, low socioeconomic status, disability, and non-English-speaking status were significant risk factors for MV from COVID-19. An urgent need remains for a pandemic response program that strategizes care for marginalized communities.
多项研究报告了新冠病毒病（COVID-19）对边缘化社区的不成比例影响；然而，很少有研究专门考察健康的社会决定因素与机械通气（MV）之间的关联。
确定哪些人口统计学因素会影响COVID-19患者的MV发生率。
这项观察性研究纳入了2020年2月25日至2020年12月31日期间来自八家医院电子病历（EMR）的COVID-19患者数据。使用单变量和多变量分析评估人口统计学数据与MV发生率之间的关联。
多中心（八家医院），密歇根州东南部最大的医疗系统。
鼻咽拭子SARS-CoV-2逆转录聚合酶链反应（RT-PCR）呈阳性的住院患者。排除标准为人口统计学数据缺失或非密歇根州常住居民。
患者分为两组：MV组和非MV组。
主要结局是各人口统计学因素的MV发生率。然后，一个多变量模型预测每个人口统计学描述符的MV几率。假设在数据收集之前制定。
在11304名接受调查的COVID-19住院患者中，1621人（14.34%）接受了MV，49.96%为男性，平均年龄为63.37岁（17.79）。MV的重要社会决定因素包括黑人种族（MV组为40.19%，非MV组为31.31%，p<0.01）、贫困（14.60%对13.21%，p<0.01）和残疾（12.65%对9.14%；p<0.01）。黑人种族（调整后比值比[AOR]1.61[可信区间（CI）1.41 - 1.83；p<0.01]）、收入中位数（AOR 0.99[CI 0.99 - 0.99；p<0.01]）、残疾（AOR 1.55[CI 特鲁索综合征（TS）是一种罕见但严重的疾病，其特征是在没有任何外部物理损伤的情况下，身体的某些部位出现疼痛、肿胀、发红等症状，同时伴有凝血功能异常。这种疾病通常与癌症、感染或其他严重疾病相关，并且可能导致血栓形成、器官损伤甚至死亡。
黑人种族、社会经济地位低下、残疾和非英语母语身份是COVID-19患者接受MV的重要危险因素。迫切需要一个大流行应对计划，为边缘化社区制定护理策略。
