Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality

被引:8
|
作者
Walls, Morgan [1 ]
Priem, Jennifer S. [2 ]
Mayfield, Carlene A. [3 ]
Sparling, Alica [2 ]
Aneralla, Amanda [2 ]
Krinner, Lisa M. [2 ]
Taylor, Yhenneko J. [2 ]
机构
[1] Atrium Hlth, Dept Pediat, Div Acad Gen Pediat, 1350 S Kings Dr, Charlotte, NC 28207 USA
[2] Atrium Hlth, Ctr Outcomes Res & Evaluat, 1300 Scott Ave, Charlotte, NC 28203 USA
[3] Atrium Hlth, Dept Community Hlth, 4135 South Stream Blvd, Charlotte, NC 28217 USA
关键词
Health disparities; COVID-19; Virtual hospital; Social determinants of health; AREA DEPRIVATION; OUTPATIENT CARE; DISADVANTAGE; TELEMEDICINE; RISK; RACE;
D O I
10.1007/s40615-022-01274-x
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objective To examine the role of race/ethnicity and social determinants of health on COVID-19 care and outcomes for patients within a healthcare system that provided virtual hospital care. Methods This retrospective cohort study included 12,956 adults who received care for COVID-19 within an integrated healthcare system between 3/1/2020 and 8/31/2020. Multinomial models were used to examine associations between race/ethnicity, insurance, neighborhood deprivation measured by Area Deprivation Index (ADI), and outcomes of interest. Outcomes included (1) highest level of care: virtual observation (VOU), virtual hospitalization (VACU), or inpatient hospitalization; (2) intensive care (ICU); and (3) all-cause 30-day mortality. Results Patients were 41.8% White, 27.2% Black, and 31.0% Hispanic. Compared to White patients, Black patients had 1.86 higher odds of VACU admission and 1.43 higher odds of inpatient hospitalization (vs. VOU). Hispanic patients had 1.24 higher odds of inpatient hospitalization (vs. VOU). In models stratified by race/ethnicity, Hispanic and Black patients had higher odds of inpatient hospitalization (vs. VOU) if Medicaid insured compared to commercially insured. Hispanic patients living in the most deprived neighborhood had higher odds of inpatient hospitalization, compared to those in the least deprived neighborhood. Black and Hispanic patients had higher odds of ICU admission and 30-day mortality after adjustment for other social determinants. Conclusions Insurance and ADI were associated with COVID-19 outcomes; however, associations varied by race/ethnicity. Racial/ethnic disparities in outcomes are not fully explained by measured social determinants of health, highlighting the need for further investigation into systemic causes of inequities in COVID-19 outcomes.
引用
收藏
页码:859 / 869
页数:11
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