Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City

Abstract

Background Coronavirus disease 2019 (COVID-19) affects vulnerable populations (VP) adversely. Purpose To evaluate overall imaging utilization in vulnerable subgroups (elderly, racial/ethnic minorities, socioeconomic status [SES] disadvantage) and determine if a particular subgroup has worse outcomes from COVID-19. Materials/Methods Of 4110 patients who underwent COVID-19 testing from March 3-April 4, 2020 at NewYork-Presbyterian Hospital (NYP) health system, we included 1121 COVID-19 positive adults (mean age 59±18 years, 59% male) from two academic hospitals and evaluated imaging utilization rates and outcomes, including mortality. Results Of 897 (80%) VP, there were 465 (41%) elderly, 380 (34%) racial/ethnic minorities, and 479 (43%) SES disadvantage patients. Imaging was performed in 88% of patients and mostly portable/bedside studies, with 87% of patients receiving chest radiographs. There were 83% hospital admissions, 25% ICU admissions, 23% intubations, and 13% deaths. Elderly patients had greater imaging utilization, hospitalizations, ICU/intubation requirement, longer hospital stays, and >4-fold increase in mortality compared to non-elderlies (adjusted hazard ratio[aHR] 4.79, p<0.001). Self-reported minorities had fewer ICU admissions (p=0.03) and reduced hazard for mortality (aHR 0.53, p=0.004; complete case analysis: aHR 0.39, p<0.001 excluding “not reported”; sensitivity analysis: aHR 0.61, p=0.005 “not reported” classified as minorities) with similar imaging utilization, compared to non-minorities. SES disadvantage patients had similar imaging utilization and outcomes as compared to their counterparts. Conclusions In a predominantly hospitalized New York City cohort, elderly patients are at highest mortality risk. Racial/ethnic minorities and SES disadvantage patients fare better or similarly to their counterparts, highlighting the critical role of access to inpatient medical care during the COVID-19 pandemic.

Addressing ethnic disparities in imaging utilization and clinical outcomes for COVID-19

“…These findings are especially significant given that outside of the hospital, Hispanic patients are disproportionately affected by COVID-19. 16 …”

“… 15 More recently, however, a study in a New York City healthcare system reported no disparity in image utilization in vulnerable subgroups with COVID-19 (elderly, racial/ethnic minorities, and socioeconomic underprivileged) as compared to their counterparts when given access to inpatient medical care. 16 …”

Incidence, clinical associations and outcomes of intrathoracic complications with and without ARDS in COVID-19 pneumonia

“…The details of the study population and design were previously reported. 32 In brief, as shown in Fig. 1, we excluded patients with RT-PCR test results that were negative, indeterminate or invalid (n = 1563), those whose medical records were unavailable for review (n = 1417; 1392 from other NYP Hospitals to which EMR access was inaccessible, 25 restricted healthcare workers), and pediatric cases (n = 9).…”