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 34% (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 of 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 < 10 mg/dl, elevated serum Ferritin and Creatinine phosphokinase levels > 1200 U/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 …”

“… 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 …”

Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020

“…§ Although the racial and ethnic composition of pregnant women in the catchment area is unknown, this report and an earlier study ( 1 ) suggest that pregnant women who are Hispanic or Black might have disproportionately higher rates of COVID-19–associated hospitalization, compared with those of pregnant women of other races and ethnicities. Long standing inequities in the social determinants of health, such as occupation and housing circumstances that make physical distancing challenging, have put some racial and ethnic minority groups at increased risk for COVID-19–associated illness and death ( 4 , 5 ). Better understanding of the circumstances under which Hispanic and Black women of reproductive age are exposed to SARS-CoV-2 could inform prevention strategies.…”

Diagnosis, clinical characteristics, and outcomes of COVID-19 patients from a large healthcare system in northern New Jersey

“…Despite Northern NJ being an early epicenter (March, 2020) in the US for COVID-19, which rapidly engulfed the entire state, there has been a paucity of research on the epidemiology of this disease in the NJ population. At the time of writing, only three studies were published to fill this gap, with one describing the clinical features in a minority patient population, one investigating the impact of COVID-19 on mothers, infants and staff in a delivery service in NJ, and one focusing on the secondary bloodstream infections in severe COVID-19 patients 14 – 16 . Contributing to this growing knowledge base, our study describes the clinical characteristics and outcomes in a large hospitalized patient series in our hospital network covering Northern NJ, during the early phase of the COVID-19 pandemic.…”