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

Abstract

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.

Impact of Social Deprivation on Hospitalization and Intensive Care Unit Admission among COVID-19 Patients: A Systematic Review and Meta-Analysis

“…The characteristics of the included studies are shown in Table 1 . Four studies were conducted in the USA ( 19 , 21 , 24 , 27 ), five in the UK ( 22 , 23 , 26 , 28 , 29 ), one in New Zealand ( 20 ), and one in Canada ( 25 ). The sample sizes ranged from 964 (conducted in Canada) to 2,311,282 (conducted in UK) ( 25 , 26 ).…”

“…The sample sizes ranged from 964 (conducted in Canada) to 2,311,282 (conducted in UK) ( 25 , 26 ). Four studies used the IMD to assess social deprivation ( 22 , 26 , 28 , 29 ), two studies used the ADI ( 19 , 27 ), and five studies used other assessment tools, including the NZDI, HII, PMDI, TDI, and SDI ( 20 , 21 , 23 – 25 ).…”

Socioeconomic and clinical risk factors associated with moderate intensity physical activity before and during the COVID-19 pandemic

“…The lower odds of physical activity among those with less than high school education and low income during the pandemic is consistent with previous studies before the pandemic ( Scholes and Bann, 2007 , Kari et al, Jul 2020 , Droomers et al, 2001 , Armstrong et al, 2018 ). Other studies have found increased mortality and morbidity rates among certain racial and ethnic groups, suggesting the need to enhance health-related behaviors like physical activity to reduce racial/ethnic health-related disparities among these populations ( Habibdoust et al, 2022 , Nguyen et al, 2022 , Unruh et al, 2022 , Grosicki et al, 2022 , Walls et al, 2023 ). Furthermore, the significantly lower prevalence in moderate intensity physical activity behavior highlighted in this study among Black, Hispanic, and Asian individuals calls for greater efforts to encourage physical activity among these communities.…”

“What should I do? We still have to go to work”: Latino immigrant perceptions of the COVID-19 pandemic and vaccine

“…Since the onset of the COVID-19 pandemic, research on its implications has steadily increased, with most studies focused on clinical outcomes. Latinos had high rates of COVID-19 contraction (Turner et al , 2020), higher odds of inpatient hospitalization and lower odds of not receiving treatment, compared with non-Latino whites (Walls et al , 2022). Latinos also experienced higher rates of unemployment compared with other groups (Cleveland and Waslin, 2021), with Latina immigrants experiencing the highest unemployment rate at 22% in April 2020 (Capps et al , 2020).…”