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Comparing Critical Care Admissions Among Urban Populations Before and During the COVID-19 Pandemic
Panagis Galiatsatos1, Kathleen R Page1, Souvik Chatterjee1
1Panagis Galiatsatos, MD, MHS, and Souvik Chatterjee, MD, are Assistant Professors and Edward S. Chen, MD, is an Associate Professor, Division of Pulmonary and Critical Care Medicine; Kathleen R. Page, MD, is an Associate Professor, Division of Infectious Diseases; Felicia Hill-Briggs, PhD, is a Professor, Division of General Internal Medicine; and Sherita H. Golden, MD, MHS, is a Professor, Division of Endocrinology, Diabetes, and Metabolism; all in the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Panagis Galiatsatos and Felicia Hill-Briggs are Co-Chairs, Johns Hopkins Health Equity Steering Committee; April Lugo is a Program Specialist; and Sherita H. Golden is Director; all in the Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is also Lead, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Panagis Galiatsatos is Co-Director, Medicine for the Greater Good; and Joyce Maygers, DNP, RN, is a Senior Clinical Outcomes Coordinator, Department of Care Management; both at Johns Hopkins Bayview Medical Center, Baltimore, MD. Sauradeep Sarker, MD, is an Internal Medicine Resident, Department of Medicine, Sinai Hospital, Baltimore, MD. Vanya Jones, PhD, is an Associate Professor, Health, Behavior, and Society; Felicia Hill-Briggs and Sherita H. Golden are Professors of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research; and Sherita H. Golden is a Professor, Department of Epidemiology; all at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Tina Tolson, RN, is Director, Johns Hopkins Medicine Language Services, Johns Hopkins Health System, Baltimore, MD.
Abstract:
In the context of the COVID-19 pandemic, reassessing intensive care unit (ICU) use by population should be a priority for hospitals planning for critical care resource allocation. In our study, we reviewed the impact of COVID-19 on a community hospital serving an urban region, comparing the sociodemographic distribution of ICU admissions before and during the pandemic. We executed a time-sensitive analysis to see if COVID-19 ICU admissions reflect the regional sociodemographic populations and ICU admission trends before the pandemic. Sociodemographic variables included sex, race, ethnicity, and age of adult patients (ages 18 years and older) admitted to the hospital's medical and cardiac ICUs, which were converted to COVID-19 ICUs. The time period selected was 18 months, which was then dichotomized into pre-COVID-19 admissions (December 1, 2018 to March 13, 2020) and COVID-19 ICU admissions (March 14 to May 31, 2020). Variables were compared using Fisher's exact tests and Wilcoxon tests when appropriate. During the 18-month period, 1,861 patients were admitted to the aforementioned ICUs. The mean age of the patients was 62.75 (SD 15.57), with the majority of these patients being male (52.23%), White (64.43%), and non-Hispanic/Latinx (95.75%). Differences were found in racial and ethnic distribution comparing pre-COVID-19 admissions to COVID-19 admissions. Compared with pre-COVID-19 ICU admissions, we found an increase in African American versus White admissions (P = .01) and an increase in Hispanic/Latinx versus non-Hispanic/Latinx admissions (P < .01), during the COVID-19 pandemic. During the first 3 months of admissions to COVID-19 ICUs, the number of admissions among Hispanic/Latinx and African American patients increased while the number of admissions among non-Hispanic/Latinx and White patient decreased, compared with the pre-COVID-19 period. These findings support development of strategies to enhance allocation of resources to bolster novel, equitable strategies to mitigate the incidence of COVID-19 in urban populations.
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