Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Mbarara University of Science and Technology, Mbarara, Uganda.
Medicine (Baltimore). 2023 Mar 10;102(10):e33178. doi: 10.1097/MD.0000000000033178.
The COVID-19 pandemic has highlighted significant disparities in hospital outcomes when focusing on social determinants of health. Better understanding the drivers of these disparities is not only critical for COVID-19 care but also to ensure equitable treatment more generally. In this paper, we look at how hospital admission patterns, both to the medical ward and the intensive care unit (ICU), may have differed by race, ethnicity, and social determinants of health. We conducted a retrospective chart review of all patients who presented to the Emergency Department of a large quaternary hospital between March 8 and June 3, 2020. We built logistic regression models to analyze how race, ethnicity, area deprivation index, English as a primary language, homelessness, and illicit substance use impacted the likelihood of admission while controlling for disease severity and timing of admission in relation to the start of data collection. We had 1302 recorded Emergency Department visits of patients diagnosed with SARS-CoV-2. White, Hispanic, and African American patients made up 39.2%, 37.5%, and 10.4% of the population respectively. Primary language was recorded as English for 41.2% and non-English for 30% of patients. Among the social determinants of health assessed, we found that illicit drug use significantly increased the likelihood for admission to the medical ward (odds ratio 4.4, confidence interval 1.1-17.1, P = .04), and that having a language other than English as a primary language significantly increased the likelihood of ICU admission (odds ratio 2.6, confidence interval 1.2-5.7, P = .02). Illicit drug use was associated with an increased likelihood of medical ward admission, potentially due to clinician concerns for complicated withdrawal or blood-stream infections from intravenous drug use. The increased likelihood of ICU admission associated with a primary language other than English may have been driven by communication difficulties or differences in disease severity that our model did not detect. Further work is required to better understand drivers of disparities in hospital COVID-19 care.
新冠疫情突出了在关注健康的社会决定因素时，医院治疗结果存在显著差异。更好地了解这些差异的驱动因素不仅对新冠护理至关重要，而且对确保更公平的待遇也至关重要。在本文中，我们研究了医院入院模式，包括到医疗病房和重症监护病房（ICU）的入院模式，可能因种族、族裔和健康的社会决定因素而异。我们对 2020 年 3 月 8 日至 6 月 3 日期间在一家大型四级医院急诊科就诊的所有患者进行了回顾性图表审查。我们构建了逻辑回归模型，以分析种族、族裔、地区贫困指数、英语作为第一语言、无家可归和非法药物使用如何影响入院的可能性，同时控制疾病严重程度和入院时间与数据收集开始时间的关系。我们记录了 1302 例被诊断患有 SARS-CoV-2 的患者的急诊科就诊记录。白人、西班牙裔和非裔美国人患者分别占总人口的 39.2%、37.5%和 10.4%。30%的患者记录的第一语言为非英语。在所评估的健康的社会决定因素中，我们发现非法药物使用显著增加了入住医疗病房的可能性（优势比 4.4，置信区间 1.1-17.1，P=0.04），而英语以外的主要语言显著增加了入住 ICU 的可能性（优势比 2.6，置信区间 1.2-5.7，P=0.02）。非法药物使用与入住医疗病房的可能性增加有关，这可能是由于临床医生担心静脉吸毒引起的戒断并发症或血液感染。与英语以外的主要语言相关的 ICU 入院可能性增加可能是由于沟通困难或我们的模型未检测到的疾病严重程度差异所致。需要进一步的工作来更好地了解医院新冠护理差异的驱动因素。
