Sociodemographic variables as predictors of adverse outcome in SARS-CoV-2 infection: an Irish hospital experience

Abstract

Introduction Our hospital found itself at the epicentre of the Irish COVID-19 pandemic. We describe the organisational challenges faced in managing the surge and identified risk factors for mortality and ICU admission among hospitalised SARS-CoV-2-infected patients. Methods All hospitalised SARS-CoV-2 patients diagnosed between March 13 and May 1, 2020, were included. Demographic, referral, deprivation, ethnicity and clinical data were recorded. Multivariable regression, including age-adjusted hazard ratios (HR (95% CI), was used to explore risk factors associated with adverse outcomes. Results Of 257 inpatients, 174 were discharged (68%) and 39 died (15%) in hospital. Two hundred three (79%) patients presented from the community, 34 (13%) from care homes and 20 (8%) were existing inpatients. Forty-five percent of community patients were of a non-Irish White or Black, Asian or minority ethnic (BAME) population, including 34 Roma (13%) compared to 3% of care home and 5% of existing inpatients, ( p < 0.001). Twenty-two patients were healthcare workers (9%). Of 31 patients (12%) requiring ICU admission, 18 were discharged (58%) and 7 died (23%). Being overweight/obese HR (95% CI) 3.09 (1.32, 7.23), p = 0.009; a care home resident 2.68 (1.24, 5.6), p = 0.012; socioeconomically deprived 1.05 (1.01, 1.09), p = 0.012; and older 1.04 (1.01, 1.06), p = 0.002 were significantly associated with death. Non-Irish White or BAME were not significantly associated with death 1.31 (0.28, 6.22), p = 0.63 but were significantly associated with ICU admission 4.38 (1.38, 14.2), p = 0.014 as was being overweight/obese 2.37 (1.37, 6.83), p = 0.01. Conclusion The COVID-19 pandemic posed unprecedented organisational issues for our hospital resulting in the greatest surge in ICU capacity above baseline of any Irish hospital. Being overweight/obese, a care home resident, socioeconomically deprived and older were significantly associated with death, while ethnicity and being overweight/obese were significantly associated with ICU admission.

Older Age and Frailty are Associated with Higher Mortality but Lower ICU Admission with COVID-19

“…Obesity has been identified as an important risk factor in other studies. ( 20 , 21 ) Our findings contrast with other studies reporting a stronger increased risk associated with chronic conditions, ( 22 ) and indeed we did find stronger associations between comorbidities and mortality prior to adjusting for age and frailty in the multivariable models; this is consistent with other studies where frailty has been considered. For example, a Swedish study also reported that frailty is the strongest predictive factor for mortality in older adults.…”

Risk of Covid-19 Severe Outcomes and Mortality in Migrants and Ethnic Minorities Compared to the General Population in the European WHO Region: a Systematic Review

“…A study conducted in Spain (Norman, 2021 ) underlines that ICU admission was more frequent in non-Europeans (OR 1.43, 95% CI [1.03–1.98]). Also, in another study from Ireland (Farrell, 2021 ), compared with White Irish patients, all other ethnic groups, including other White and BAME, had an approximately fourfold increased risk of ICU admittance after adjusting for age (adjusted HR=4.22, 95% CI [1.45–12.31] and 4.58, 95% CI [1.33, 15.84], respectively).…”

“…Twenty-one studies did not report an increased mortality risk for people with an ethnic minority background (Aw, 2020 ; Bannaga, 2020 ; Canevelli, 2020 ; Davies, 2021 ; Dennis, 2021 ; Farrell, 2021 ; Galloway, 2020 ; Giorgi-Rossi, 2020 ; Gopal-Rao, 2021 ; Guijarro, 2021 ; Ken-Dror, 2020 ; Kolhe, 2020 ; Livingston, 2020 ; Moody, 2021 ; Norman, 2021 ; Santorelli, 2020 ; Staines, 2021 ; Saban & Wilf-Miron, 2020 ; Thompson, 2020 ; Zakeri, 2020 ), and although Thomson et al (Thomson, 2020 ) found an association in the univariable analysis between Asian ethnicity and death (OR 2.57, 95% CI 1.02–6.57), in the multivariable model, this finding was not significant (Asian OR 2.94, 95% CI 0.94–9.78).…”

“…Some authors justified the fact by clarifying that elderly European patients with severe disease were not being considered for ICU at the beginning of the pandemic, or that, since an increase in comorbidities in the non-European group admitted to ICU should probably have led to worse outcomes and a higher mortality, which was not observed; other determinants, such as genetic factors, may also be playing a role in the outcome for these patients (Norman, 2021 ). Some other authors left the finding without a proper explanation (Dennis, 2021 ; Farrell, 2021 ; Galloway, 2020 ). On the other hand, Patel addressed physiological factors—such as increased comorbidity burden and/or delayed hospital presentation, as precluding factors for MEM group from critical care.…”

Risk factors for SARS-CoV-2 related mortality and hospitalization before vaccination: A meta-analysis

“…Information regarding statistical analysis for individual studies as well as the raw data extracted from each study can be found in the supplement. Finally, most studies were peer reviewed and few included sensitivity analyses [16,37,40,[71][72][73][74] (Table 1).…”