Population Risk Factors for Severe Disease and Mortality in COVID-19 in the United States during the Pre-Vaccine Era: A Retrospective Cohort Study of National Inpatient Sample

Abstract

Background: Previous studies on coronavirus disease 2019 (COVID-19) were limited to specific geographical locations and small sample sizes. Therefore, we used the National Inpatient Sample (NIS) 2020 database to determine the risk factors for severe outcomes and mortality in COVID-19. Methods: We included adult patients with COVID-19. Univariate and multivariate logistic regression was performed to determine the predictors of severe outcomes and mortality in COVID-19. Results: 1,608,980 (95% CI 1,570,803–1,647,156) hospitalizations with COVID-19 were included. Severe complications occurred in 78.3% of COVID-19 acute respiratory distress syndrome (ARDS) and 25% of COVID-19 pneumonia patients. The mortality rate for COVID-19 ARDS was 54% and for COVID-19 pneumonia was 16.6%. On multivariate analysis, age > 65 years, male sex, government insurance or no insurance, residence in low-income areas, non-white races, stroke, chronic kidney disease, heart failure, malnutrition, primary immunodeficiency, long-term steroid/immunomodulatory use, complicated diabetes mellitus, and liver disease were associated with COVID-19 related complications and mortality. Cardiac arrest, septic shock, and intubation had the highest odds of mortality. Conclusions: Socioeconomic disparities and medical comorbidities were significant determinants of mortality in the US in the pre-vaccine era. Therefore, aggressive vaccination of high-risk patients and healthcare policies to address socioeconomic disparities are necessary to reduce death rates in future pandemics.

Nationwide in-hospital mortality and morbidity analysis of COVID-19 in advanced chronic kidney disease, dialysis and kidney transplant recipients

“…The study also highlighted significant disparities influenced by race/ethnicity and socioeconomic status in COVID-19-related hospitalizations and fatalities. For instance, Native Americans had the highest mortality associated with COVID-19 among all ethnic groups, consistent with existing literature (22,23), emphasizing the need for targeted interventions and support for Native American populations. Although some studies suggest higher mortality rates among Black individuals (24), another national study by Pal et al (25) found similar mortality risks for Black and White individuals, aligning with our observations.…”

Prevalence and patient risk factors for pneumothorax in COVID-19 and in influenza pneumonia: a nationwide comparative analysis

“…The exact reason for this is unclear, but the data may be confounded by differences in socioeconomic status and access to health care ( 19 ). These racial differences could also be due to the severity of COVID-19 in non-white races ( 20 , 21 ).…”

“…Racial and ethnic inequities in the region might have led to delays in access to health care. The association between higher-income zip codes and better outcomes highlights socioeconomic healthcare impacts in the US ( 20 , 21 ). Ironically, it is unclear why Medicare or Medicaid patients had lower odds of pneumothorax than private insurance.…”

The Founder: Dispositional Greed, Showbiz, and the Commercial Determinants of Health

“…Consider the ways in which the COVID-19 pandemic has erased the rigid demarcations between infectious and non-infectious diseases-obesity, type 2 diabetes, and cardiovascular disease strongly predicted hospitalization and mortality from the SARS-CoV-2 infection [20][21][22][23][24]. It is now possible to make connections between the marketing of unhealthy products, especially to marginalized and disadvantaged communities, and COVID-19 outcomes; yet instead of considering their role in COVID-19 outcomes, the purveyors of unhealthy foods and beverages used the pandemic to bolster sales [25][26][27][28][29][30].…”