The MITRE Corporation, Bedford, MA, USA.
Department of Medicine, University of California, Irvine, CA, USA.
J Gen Intern Med. 2023 Dec;38(16):3472-3481. doi: 10.1007/s11606-023-08324-y. Epub 2023 Sep 15.
Limited research has studied the influence of social determinants of health (SDoH) on the receipt, disease risk, and subsequent effectiveness of neutralizing monoclonal antibodies (nMAbs) for outpatient treatment of COVID-19.
To examine the influence of SDoH variables on receiving nMAb treatments and the risk of a poor COVID-19 outcome, as well as nMAb treatment effectiveness across SDoH subgroups.
Retrospective observational study utilizing electronic health record data from four health systems. SDoH variables analyzed included race, ethnicity, insurance, marital status, Area Deprivation Index, and population density.
COVID-19 patients who met at least one emergency use authorization criterion for nMAb treatment.
We used binary logistic regression to examine the influence of SDoH variables on receiving nMAb treatments and risk of a poor outcome from COVID-19 and marginal structural models to study treatment effectiveness.
The study population included 25,241 (15.1%) nMAb-treated and 141,942 (84.9%) non-treated patients. Black or African American patients were less likely to receive treatment than white non-Hispanic patients (adjusted odds ratio (OR) = 0.86; 95% CI = 0.82-0.91). Patients who were on Medicaid, divorced or widowed, living in rural areas, or living in areas with the highest Area Deprivation Index (most vulnerable) had lower odds of receiving nMAb treatment, but a higher risk of a poor outcome. For example, compared to patients on private insurance, Medicaid patients had 0.89 (95% CI = 0.84-0.93) times the odds of receiving nMAb treatment, but 1.18 (95% CI = 1.13-1.24) times the odds of a poor COVID-19 outcome. Age, comorbidities, and COVID-19 vaccination status had a stronger influence on risk of a poor outcome than SDoH variables. nMAb treatment benefited all SDoH subgroups with lower rates of 14-day hospitalization and 30-day mortality.
Disparities existed in receiving nMAbs within SDoH subgroups despite the benefit of treatment across subgroups.
针对社会决定因素（SDoH）对门诊治疗 COVID-19 的中和单克隆抗体（nMAb）的接受率、疾病风险和后续效果的影响，相关研究较少。
研究 SDoH 变量对接受 nMAb 治疗的影响、COVID-19 不良结局的风险，以及 SDoH 亚组中 nMAb 治疗效果。
利用四个医疗系统的电子健康记录数据进行回顾性观察性研究。分析的 SDoH 变量包括种族、民族、保险、婚姻状况、区域贫困指数和人口密度。
符合 nMAb 治疗至少一项紧急使用授权标准的 COVID-19 患者。
我们使用二项逻辑回归来研究 SDoH 变量对接受 nMAb 治疗的影响和 COVID-19 不良结局的风险，并使用边际结构模型来研究治疗效果。
研究人群包括 25241 名（15.1%）接受 nMAb 治疗的患者和 141942 名（84.9%）未接受治疗的患者。黑人或非裔美国人患者接受治疗的可能性低于白人非西班牙裔患者（调整后比值比（OR）=0.86；95%置信区间（CI）=0.82-0.91）。接受医疗补助、离婚或丧偶、居住在农村地区或居住在区域贫困指数最高（最脆弱）地区的患者接受 nMAb 治疗的可能性较低，但 COVID-19 不良结局的风险较高。例如，与私人保险患者相比，医疗补助患者接受 nMAb 治疗的可能性低 0.89（95%CI=0.84-0.93），但 COVID-19 不良结局的可能性高 1.18（95%CI=1.13-1.24）。年龄、合并症和 COVID-19 疫苗接种状况对不良结局的风险影响大于 SDoH 变量。nMAb 治疗使所有 SDoH 亚组受益，住院 14 天和 30 天死亡率较低。
尽管 nMAb 治疗对所有亚组均有益，但在 SDoH 亚组内仍存在治疗接受方面的差异。
