1. Hospitalized Covid-19 patients presenting from socially vulnerable neighborhoods had greater illness severity and required more intensive treatment.
2. Hospitalized Covid-19 patients from socially vulnerable neighborhoods did not experience differences in-hospital mortality or discharge disposition.
Evidence Rating Level: 2 (Good)
Study Rundown: Black and Hispanic populations experience disproportionate burdens of Covid-19 infections, hospitalization, and overall mortality. Moreover, U.S. counties with higher levels of social vulnerability based on disadvantages in socioeconomic status and housing experienced greater Covid-19 incidence and mortality. However, there is a gap in knowledge as to understanding what factors influence disparities in Covid-19 outcomes from a multi-health care system level and how neighborhood contextual effects influence Covid-19 outcomes. This study found that Covid-19 hospitalizations from more socially vulnerable neighborhoods are more likely to present with greater illness severity and require more intensive treatment but do not have significant differences in-hospital mortality or discharge disposition. This study was limited by focusing on hospitalizations in one state and the observational nature of the data as well as missing documentation in chart abstraction. Nevertheless, these study’s findings are significant, as they demonstrate that patients with Covid-19 from socially vulnerable neighborhoods present to the hospital with increased illness severity and increased need for more intensive treatment, but once hospitalized, do not experience differences in-hospital mortality or discharge condition.
In-Depth [cross-sectional study]: This pooled cross-sectional study of patients hospitalized at 38 Michigan hospitals. There were 2309 patients included in the analysis who were hospitalized between March and December 2020 with Covid-19. Patients who had either a positive Covid-19 test result up to 21 days before the hospital encountered symptoms of cough, dyspnea, or fever or strong clinical suspicion of Covid-19 infection that could not be confirmed because of logistic constraints were included in the study. Patients who were pregnant, younger than 18 years old, left against medical advice or entered comfort care or hospice within 3 hours of hospital admission were excluded from the study. The primary outcome for Covid-19 included acute organ dysfunction, organ failure, invasive mechanical ventilation, intensive care unit stay, death, and discharge disposition. The social vulnerability was measured by the social vulnerability index (SVI), developed by the CDC which provides an aggregate measure of neighborhood social factors. Outcomes in the primary analysis were conducted via mixed-effects logistic regression models and the composite SVI was included as a continuous variable in separate models to avoid multicollinearity. Based on the analysis, compared with patients in low-vulnerability ZIP codes, patients living in high-vulnerability ZIP codes were more frequently treated in the intensive care unit (29.0% vs 24.5%), more frequently received mechanical ventilation (19.3% vs 14.2%), experienced higher rates of organ dysfunction (51.9% vs 48.6%), experienced higher rates of organ failure (54.7% vs 51.6%), and experienced higher rates of in-hospital death (19.4% vs 16.7%). Moreover, an increase in neighborhood SVI by 0.25 was associated with a 2.1% greater likelihood of mechanical ventilation, 2.8% greater likelihood of acute organ dysfunction, and 2.8% greater likelihood of acute organ failure. However, these patients were not associated with significant differences in intensive care unit stay, mortality, or discharge disposition. Overall, this study demonstrated that hospitalized patients with Covid-19 from socially vulnerable neighborhoods had greater illness severity and required more intensive care but did not have differences in mortality or discharge disposition. However, this finding should encourage policymakers to increase access to Covid-19 testing, treatment, and vaccination in socially vulnerable neighborhoods and to work to ameliorate disparities in Covid-19 health outcomes.
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