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Characteristics Associated With Disparities Among Older Adults in Coronavirus Disease 2019 Outcomes in an Academic
Laura P Gelfman1,2, Jaison Moreno1, Julia L Frydman1
1Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York.
Insights
Older adults with COVID-19 face higher mortality risks, with age and comorbidities being key predictors. However, older patients were less likely to be admitted to the ICU, warranting further investigation into resource allocation.
Area of Science:
- Gerontology
- Infectious Diseases
- Public Health
Background:
- Understanding predictors of outcomes in older adults with coronavirus disease 2019 (COVID-19) is crucial.
- The COVID-19 pandemic has disproportionately affected elderly populations, necessitating research into specific risk factors.
Purpose of the Study:
- To identify patient and health system factors associated with in-hospital mortality, intensive care unit (ICU) admission, and 30-day readmission among COVID-19 patients.
- To analyze the impact of age, comorbidities, and healthcare system variables on COVID-19 outcomes in adults.
Main Methods:
- A retrospective cohort study was conducted involving 7,556 adult patients discharged from five New York hospitals between March 1, 2020, and June 30, 2020.
- Data collected included patient demographics, comorbidities, viral load, illness severity scores, and hospital characteristics.
- Outcomes assessed were all-cause in-hospital mortality, ICU admission, and 30-day readmission.
Main Results:
- Increased age and comorbidities were significant independent risk factors for in-hospital mortality among COVID-19 patients.
- Older adults (aged 55 and above) and those with Medicaid were less likely to be admitted to the ICU.
- Race/ethnicity, crowding, and population density were not associated with adverse COVID-19 outcomes in this cohort.
Conclusions:
- Advanced age is the primary independent risk factor for mortality in COVID-19 patients.
- Comorbidities and serious illness are independently associated with increased mortality risk.
- The lower ICU admission rate among older adults suggests potential age-related treatment preferences or resource allocation factors that require further study.
Background:
An improved understanding of the coronavirus disease 2019 (COVID-19) pandemic is needed to identify predictors of outcomes among older adults with COVID-19.
Objective:
The objective of this study was to examine patient and health system factors predictive of in-hospital mortality, intensive care unit (ICU) admission, and readmission among patients with COVID-19.
Design, Setting, And Participants:
A cohort study of patients aged 18 years and older with COVID-19 discharged from 5 New York hospitals within the Mount Sinai Health System (March 1, 2020-June 30, 2020).
Measures:
Patient-level characteristics (age, sex, race/ethnicity, comorbidities/serious illness, transfer from skilled nursing facility, severe acute respiratory syndrome coronavirus 2 viral load, Sequential Organ Failure Assessment score, treatments); hospital characteristics.
Outcomes:
All-cause in-hospital mortality; ICU admission; 30-day readmission.
Results:
Among 7556 subjects, mean age 61.1 (62.0) years; 1556 (20.6%) died, 949 (12.6%) had an ICU admission, and 227 (9.1%) had a 30-day readmission. Increased age [aged 55-64: odds ratio (OR), 3.28; 95% confidence interval (CI), 2.41-4.46; aged 65-74: OR, 4.67; 95% CI, 3.43-6.35; aged 75-84: OR, 10.73; 95% CI, 7.77-14.81; aged 85 y and older: OR, 20.57; 95% CI, 14.46-29.25] and comorbidities (OR, 1.11; 95% CI, 1.16, 2.13) were independent risk factors for in-hospital mortality. Yet older adults (aged 55-64 y: OR, 0.56; 95% CI, 0.40-0.77; aged 65-74: OR, 0.46; 95% CI, 0.33-0.65; aged 75-84: OR, 0.27; 95% CI, 0.18-0.40; aged above 85 y: OR, 0.21; 95% CI, 0.13-0.34) and those with Medicaid (OR, 0.74; 95% CI, 0.56-0.99) were less likely to be admitted to the ICU. Race/ethnicity, crowding, population density, and health system census were not associated with study outcomes.
Conclusions:
Increased age was the single greatest independent risk factor for mortality. Comorbidities and serious illness were independently associated with mortality. Understanding these risk factors can guide medical decision-making for older adults with COVID-19. Older adults and those admitted from a skilled nursing facility were half as likely to be admitted to the ICU. This finding requires further investigation to understand how age and treatment preferences factored into resource allocation.
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