Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York.
Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York, New York.
West J Emerg Med. 2022 Aug 11;23(5):601-612. doi: 10.5811/westjem.2022.3.53065.
The recent spread of coronavirus disease 2019 (COVID-19) has disproportionately impacted racial and ethnic minority groups; however, the impact of healthcare utilization on outcome disparities remains unexplored. Our study examines racial and ethnic disparities in hospitalization, medication usage, intensive care unit (ICU) admission and in-hospital mortality for COVID-19 patients.
In this retrospective cohort study, we analyzed data for adult patients within an integrated healthcare system in New York City between February 28-August 28, 2020, who had a lab-confirmed COVID-19 diagnosis. Primary outcome was likelihood of inpatient admission. Secondary outcomes were differences in medication administration, ICU admission, and in-hospital mortality.
Of 4717 adult patients evaluated in the emergency department (ED), 3219 (68.2%) were admitted to an inpatient setting. Black patients were the largest group (29.1%), followed by Hispanic/Latinx (29.0%), White (22.9%), Asian (3.86%), and patients who reported "other" race-ethnicity (19.0%). After adjusting for demographic, clinical factors, time, and hospital site, Hispanic/Latinx patients had a significantly lower adjusted rate of admission compared to White patients (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.34-0.76). Black (OR 0.60; 95% CI 0.43-0.84) and Asian patients (OR 0.47; 95% CI 0.25 - 0.89) were less likely to be admitted to the ICU. We observed higher rates of ICU admission (OR 2.96; 95% CI 1.43-6.15, and OR 1.83; 95% CI 1.26-2.65) and in-hospital mortality (OR 4.38; 95% CI 2.66-7.24; and OR 2.96; 95% CI 2.12-4.14) at two community-based academic affiliate sites relative to the primary academic site.
Non-White patients accounted for a disproportionate share of COVID-19 patients seeking care in the ED but were less likely to be admitted. Hospitals serving the highest proportion of minority patients experienced the worst outcomes, even within an integrated health system with shared resources. Limited capacity during the COVID-19 pandemic likely exacerbated pre-existing health disparities across racial and ethnic minority groups.
最近 2019 年冠状病毒病（COVID-19）的传播对少数族裔和族裔群体的影响不成比例；然而，医疗保健利用对结果差异的影响仍未得到探索。我们的研究检查了 COVID-19 患者住院、药物使用、重症监护病房（ICU）入院和住院死亡率方面的种族和族裔差异。
在这项回顾性队列研究中，我们分析了 2020 年 2 月 28 日至 8 月 28 日期间在纽约市一个综合医疗系统内接受治疗的成年患者的数据，这些患者的实验室确诊 COVID-19 诊断。主要结果是住院的可能性。次要结果是药物管理、ICU 入院和住院死亡率的差异。
在急诊科评估的 4717 名成年患者中，有 3219 名（68.2%）患者被收治住院。黑人患者是最大的群体（29.1%），其次是西班牙裔/拉丁裔（29.0%）、白人（22.9%）、亚洲人（3.86%）和报告“其他”种族/族裔的患者（19.0%）。调整人口统计学、临床因素、时间和医院地点后，与白人患者相比，西班牙裔/拉丁裔患者的住院调整率显著降低（比值比[OR]0.51；95%置信区间[CI]0.34-0.76）。黑人（OR0.60；95%CI0.43-0.84）和亚洲患者（OR0.47；95%CI0.25-0.89）不太可能被收治 ICU。我们观察到两个社区学术附属机构的 ICU 入院率（OR2.96；95%CI1.43-6.15 和 OR1.83；95%CI1.26-2.65）和住院死亡率（OR4.38；95%CI2.66-7.24；和 OR2.96；95%CI2.12-4.14）均高于主要学术机构。
在急诊科寻求治疗的 COVID-19 患者中，非白人患者所占比例不成比例，但住院的可能性较小。服务少数族裔患者比例最高的医院即使在拥有共享资源的综合卫生系统中，也经历了最糟糕的结果。COVID-19 大流行期间的能力有限，可能加剧了不同种族和族裔群体之间已存在的健康差距。
