Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19

Area of Science:

• Health Services Research
• Health Equity
• Infectious Disease Epidemiology

Background:

• Racial disparities in healthcare outcomes are a significant concern.
• COVID-19 has disproportionately affected minority populations.
• Understanding post-discharge outcomes is crucial for improving patient care.

Purpose of the Study:

• To investigate racial disparities in 30-day composite outcomes (readmission and death) after COVID-19 hospitalization.
• To identify factors contributing to these disparities, including demographics, admission characteristics, post-acute care, and comorbidities.
• To examine the impact of different post-acute care settings on readmission and death rates.

Main Methods:

• Retrospective analysis of 1,174 patients admitted for COVID-19.
• Comparison of 30-day readmission or death odds between Black patients and other patients.
• Sequential logistic regression adjustment for demographic, clinical, and post-acute care variables.
• Stratification analysis based on discharge disposition (home without services, home with services, skilled nursing facility, acute rehab).

Main Results:

• Black patients had significantly higher odds of 30-day readmission or death (18.0% vs. 11.3%).
• Racial disparities persisted after adjusting for demographics, admission characteristics, and post-acute care type, but not comorbidities.
• Disparities were evident in patients discharged home without services, but not in those receiving home services or discharged to facilities.

Conclusions:

• Significant racial disparities in 30-day outcomes exist post-COVID-19 hospitalization, particularly for Black patients.
• Post-acute care decisions, especially discharge to home without services, appear to be a key factor in these disparities.
• Addressing racial disparities may involve carefully considering comorbidity burdens and tailoring post-acute care plans.