Social Determinants of Health Correlating with Mechanical Ventilation of COVID-19 Patients: A Multi-Center Observational Study

Giovanatti, Alexa; Elassar, Heba; Karabon, Patrick; Wunderlich-Barillas, Tracy; Halalau, Alexandra

doi:10.2147/ijgm.s334593

Cited by 9 publications

(5 citation statements)

References 14 publications

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“…20–23 Results are conflicting in patients with COVID-19 pneumonia. 24–27 No studies incorporated adjustment for time-varying severity, meaning that prior observed differences in rates of invasive ventilation by race/ethnicity could be explained by greater time-varying clinical severity.…”

Section: Discussionmentioning

confidence: 99%

Association between patient race/ethnicity and invasive ventilation in hypoxemic respiratory failure

Abdelmalek

Angriman

Moore

et al. 2022

Preprint

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Importance: Differential use of therapies for respiratory failure according to patient race/ethnicity may represent health inequity and could impact patient survival. Objective: Measure the association between patient race/ethnicity and the use of invasive ventilation, and the impact of any association on survival. Design: Retrospective cohort analysis using a Bayesian multistate model that adjusted for baseline covariates and time-varying severity. Setting: Multicenter study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) and Phillips eICU (eICU) databases from the USA. Participants: Non-intubated adults receiving oxygen within the first 24 hours of ICU admission. Exposure: Patient race/ethnicity (Asian, Black, Hispanic, white). Main outcomes and measures: Primary output was the cause-specific hazard ratio (HR) of invasive ventilation for patient race/ethnicity. Secondary output was change in 28-day survival mediated by differences in invasive ventilation rate. We reported posterior means and 95% credible intervals (CrI). Results: We studied 38,263 patients, 52% (20,033) from MIMIC-IV and 48% (18,230) from eICU, 2% Asian (892), 11% Black (4,289), 5% Hispanic (1,964), and 81% white (31,923). Invasive ventilation occurred in 3,511 (9.2%), and 2,869 (7.5%) died. The rate of invasive ventilation was lower in Asian (HR 0.82, CrI 0.70 to 0.95), Black (HR 0.78, CrI 0.71 to 0.86), and Hispanic (HR 0.70, CrI 0.61 to 0.79) patients as compared to white patients. For the average patient, lower rates of invasive ventilation did not mediate differences in survival. For a reference patient with inspired oxygen (FiO2) varied from 0.5 to 1.0, the change in survival mediated by lower rates of invasive ventilation ranged from probable benefit (probability 0.82 for Asian patients, 0.91 for Black patients, and 0.93 for Hispanic patients) at FiO2 0.5 to probable harm (probability 0.87 for Asian patients, 0.92 for Black patients, and 0.97 for Hispanic patients) at FiO2 1.0, although the mean absolute changes in mortality were all less than 1.5%. Conclusions: Asian, Black, and Hispanic patients had a lower rate of invasive ventilation than white patients. The changes in 28-day survival mediated by this difference ranged from slight benefit at lower inspired oxygen fractions to slight harm at inspired oxygen fraction of 1.0, and there was no difference in survival for the average patient.

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Section: Discussionmentioning

confidence: 99%

Association between patient race/ethnicity and invasive ventilation in hypoxemic respiratory failure

Abdelmalek

Angriman

Moore

et al. 2022

Preprint

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“…Although it has the second largest black population in the world (about 54%), in the country it remains marginalized, with precarious access to health care, diagnosis and treatment resources, resulting in more significant impacts in the pandemic context 11,12 . Recent studies have found that race and ethnicity are identified as risk factors for hospitalization due to COVID-19, reinforcing the existing disparities 13,14 .…”

Section: Introductionmentioning

confidence: 86%

Racial inequality in health care of adults hospitalized with COVID-19

Cardoso,

Gomes,

Silva

2023

Cad. Saúde Pública

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The objective was to analyze the association of race/skin color in health care, in adults hospitalized with severe acute respiratory syndrome (SARS)/COVID-19, between March 2020 and September 2022, with Brazil as the unit of analysis. This is a cross-sectional study that used the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) database and had a population composed of adults (≥ 18 years) and the final classification was SARS by COVID-19 or unspecified SARS. The direct effect of skin color on in-hospital mortality was estimated through logistic regression adjusted for age, gender, schooling level, health care system and period, stratified by vaccination status. This same model was also used to assess the effect of skin color on the variables related to access to health care services: intensive care unit (ICU), tomography, chest X-ray and ventilatory support. The results show that black, brown and indigenous people died more, regardless the schooling level and number of comorbidities, with 23%, 32% and 80% higher chances of death, respectively, when submitted to ventilatory support. Racial differences were observed in the use of health care services and in outcomes of death from COVID-19 or unspecified SARS, in which ethnic minorities had higher in-hospital mortality and lower use of hospital resources. These results suggest that black and indigenous populations have severe disadvantages compared to the white population, facing barriers to access health care services in the context of the COVID-19 pandemic.

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“…SDoH and health outcome studies examined a wide variety of health-related events and outcomes in relation to SDoH factors. A predominant focus was on infectious disease outcomes, with 16 studies examining drivers of COVID-19 hospitalization, mortality, treatment disparities and differences in positivity rates across social groups [132][133][134][135]. Another major category included healthcare utilization metrics like preventable hospital readmissions (n = 11) [136][137][138][139][140][141][142][143][144][145], ED reliance ( n = 16) , and telehealth adoption [169].…”

Section: Sdoh and Health Outcomesmentioning

confidence: 99%

Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions

Li,

Mowery,

et al. 2024

Preprint

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Background Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion Despite progress in identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfilling the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.

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Social Determinants of Health Correlating with Mechanical Ventilation of COVID-19 Patients: A Multi-Center Observational Study

Cited by 9 publications

References 14 publications

Association between patient race/ethnicity and invasive ventilation in hypoxemic respiratory failure

Association between patient race/ethnicity and invasive ventilation in hypoxemic respiratory failure

Racial inequality in health care of adults hospitalized with COVID-19

Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions

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