Ganguly Anisha P, Battaile John T, Harms Michael, Murray Shannon, Gurley Tami, Haley Robert W, Jain Mamta K, Bhavan Kavita P
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Center of Innovation and Value, Parkland Health, Dallas, Texas, United States of America.
PLoS One. 2025 Sep 10;20(9):e0330533. doi: 10.1371/journal.pone.0330533. eCollection 2025.
Decreased access to care and social drivers of health have been implicated in COVID-19 disparities. The objective of this study was to test the association between county-funded charity coverage (CFCC) and mortality among uninsured patients hospitalized with COVID-19 in a highly uninsured county.
This retrospective cohort study compared electronic health record (EHR) data among uninsured patients hospitalized with COVID-19 in a high-volume safety-net health system in Dallas County, Texas between June 2020 and December 2021. Uninsured patients included CFCC recipients and self-pay patients. We compared mortality over 180 days of follow-up using Cox proportional hazards models, adjusting for gender, age, race/ethnicity, and co-morbidities. Additional outcomes included 90-day mortality, need for mechanical ventilation, and intubation within 24 hours of presentation.
Among 2,047 patients, 47.0% received CFCC and 53.0% were self-pay. Overall, CFCC patients were older, more likely Hispanic, and had more diagnosed co-morbidities. CFCC patients had decreased adjusted mortality compared to self-pay (aHR 0.61, 95% CI [0.45 to 0.82], p < 0.01), with an absolute risk reduction of 3.3% and a number needed to treat (NNT) with CFCC of 30.4 (95% CI 21.4-66.6). CFCC was associated with lower 90-day mortality compared to self-pay (OR = 0.64, 95% CI [0.45-0.92], p = 0.01), despite similar need for ventilation. Intubation within 24 hours of presentation was lower for CFCC compared to self-pay (OR = 0.46, 95% CI [0.22-0.93], p = 0.03).
CFCC was associated with decreased mortality among the uninsured hospitalized with COVID-19. The NNT for CFCC to prevent 1 death among uninsured patients was similar to that for standard medications to treat COVID-19. These findings support expanding coverage to improve COVID-19 outcomes.
医疗服务可及性下降和健康的社会驱动因素与新冠疫情差异有关。本研究的目的是检验在一个未参保率高的县，县级资助的慈善医保覆盖（CFCC）与新冠病毒感染住院未参保患者死亡率之间的关联。
这项回顾性队列研究比较了2020年6月至2021年12月期间在得克萨斯州达拉斯县一个高容量安全网医疗系统中因新冠病毒感染住院的未参保患者的电子健康记录（EHR）数据。未参保患者包括CFCC受益人和自费患者。我们使用Cox比例风险模型比较了180天随访期内的死亡率，并对性别、年龄、种族/族裔和合并症进行了调整。其他结果包括90天死亡率、机械通气需求以及就诊后24小时内插管情况。
在2047名患者中，47.0%接受了CFCC，53.0%为自费患者。总体而言，CFCC患者年龄更大，更可能是西班牙裔，且确诊的合并症更多。与自费患者相比，CFCC患者调整后的死亡率有所降低（风险比0.61，95%置信区间[0.45至0.82]，p<0.01），绝对风险降低3.3%，CFCC治疗所需人数（NNT）为30.4（95%置信区间21.4 - 66.6）。与自费患者相比，CFCC与较低的90天死亡率相关（比值比 = 0.64，95%置信区间[0.45 - 0.92]，p = 0.01），尽管通气需求相似。与自费患者相比，CFCC患者就诊后24小时内插管情况较少（比值比 = 0.46，95%置信区间[0.22 - 0.93]，p = 0.03）。
CFCC与新冠病毒感染住院未参保患者死亡率降低有关。CFCC预防未参保患者1例死亡的NNT与治疗新冠病毒感染的标准药物相似。这些发现支持扩大医保覆盖范围以改善新冠疫情相关结果。
