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Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City
Dennis Toy1, Syed S Mahmood1, Jessica Rotman1
1Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A).
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.
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