Coronavirus Disease 19 in Minority Populations of Newark, New Jersey

Abstract

BACKGROUND:The purpose of this study is to report the clinical features and outcomes of Black/African American (AA) and Latino Hispanic patients with Coronavirus disease 2019 (COVID-19) hospitalized in an inter-city hospital in the state of New Jersey. METHODS: This is a retrospective cohort study of AA and Latino Hispanic patients with COVID-19 admitted to a 665-bed quaternary care, teaching hospital located in Newark, New Jersey. The study included patients who had completed hospitalization between March 10, 2020, and April 10, 2020. We reviewed demographics, socioeconomic variables and incidence of in-hospital mortality and morbidity. Logistic regression was used to identify predictor of in-hospital death.RESULTS: Out of 416 patients, 251 (60%) had completed hospitalization as of April 10, 2020. The incidence of In-hospital mortality was 38.6% (n=97). Most common symptoms at initial presentation were dyspnea 39% (n=162) followed by cough 38%(n=156) and fever 38% (n=143). Patients were in the highest quartile for population’s density, number of housing units and disproportionately fell into the lowest median income quartile for the state of New Jersey. The incidence septic shock, acute kidney injury (AKI) requiring hemodialysis and admission to an intensive care unit (ICU) was 24% (n=59), 21% (n=52), 33% (n=82) respectively. Independent predictors of in-hospital mortality were older age, lower serum Hemoglobin <10mg/dl, elevated serum Ferritin and Creatinine phosphokinase levels >1200U/L and >1000 U/L.CONCLUSIONS: Findings from an inter-city hospital’s experience with COVID-19 among underserved minority populations showed that, more than one of every three patients were at risk for in-hospital death or morbidity. Older age and elevated inflammatory markers at presentation were associated with in-hospital death.

Decreasing Incidence of Acute Kidney Injury in Patients with COVID-19 Critical Illness in New York City

“…2,4,5,13 A recent meta-analysis suggested the prevalence of AKI was 17%, 14 and recent reports from the United States have consistently demonstrated even higher rates of AKI. [6][7][8][9] Consistent with these reports, we observed a markedly higher incidence of overall AKI among patients admitted with COVID-19 in New York compared with reports from China, and identified a rate of severe AKI requiring RRT comparable to the highest incidence of AKI in the previous reports and higher than those seen in earlier reports from China. 4 Reasons for the stark differences in the incidence of AKI in the United States and China are uncertain.…”

“…6 Several other publications have reported even higher rates, including a manuscript reporting on 3235 patients hospitalized in New York (AKI incidence 46%, 8.6% of all patients requiring RRT), 7 as well as smaller case series including a report from Philadelphia noting a 49% incidence of AKI with roughly 8% of AKI patients requiring RRT, 8 and a report from New Jersey finding RRT was required in 21% of minority patients. 9 These data establish AKI as a critical and frequent complication of COVID-19 disease, at least in the United States. However, it is unknown whether the rapid evolution in treatments, hospital practices, and public health measures during the initial months of the COVID pandemic has been associated with changes in the incidence of AKI.…”

Association Between Ethnicity and Severe COVID-19 Disease: a Systematic Review and Meta-analysis

“…Four studies (three unadjusted, one adjusted analyses) did not find an increase in mortality risk amongst non-White ethnicity [20][21][22][23]. Four studies reported lower mortality risk in Hispanic patients compared to that in non-Hispanic patients; two reported significant unadjusted analysis, and none reported significant ageadjusted analyses [24][25][26][27].…”

Erhöhtes Risiko eines COVID-19-bedingten Krankenhausaufenthaltes für Arbeitslose: Eine Analyse von Krankenkassendaten von 1,28 Mio. Versicherten in Deutschland

“…Zudem bestätigen sie bisherige Studien zu sozioökonomischen Unterschieden bei COVID-19 [ 10 – 12 ], insbesondere zu solchen, die die Schwere eines COVID-19-Krankheitsverlaufs (i.e. Krankenhausaufenthalt oder COVID-19-Mortalität) in Abhängigkeit vom Einkommen [ 21 , 23 ] oder dem Empfang staatlicher Fürsorge [ 24 ] untersucht haben. Allerdings sind diese Studien bisher auf andere Länder beschränkt.…”

“…2 weitere Studien stammen aus den USA und vergleichen COVID-19-Krankenhauspatienten mit der übrigen Bevölkerung. Sie zeigen einerseits, dass Patienten mit Krankenhausaufenthalt ein geringeres Einkommen als die Allgemeinbevölkerung haben [ 23 ] und dass COVID-19-Krankenhauspatienten häufiger EmpfängerInnen von staatlicher finanzieller Unterstützung (i.e. „Medicaid“ und „Medicare“) sind – Fürsorge, die in den USA nur Personen mit geringem Einkommen erhalten können [ 24 ].…”