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Poverty, Comorbidity, and Ethnicity: COVID-19 Outcomes in a Safety Net Health System

Joseph P Smith1,2, Amy B Kressel3,2, Randall W Grout4,2,5

  • 1Department of Medicine, Division of Pulmonary, Critical Care, Sleep & Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN.

Ethnicity & Disease
|May 2, 2022
PubMed

Insights

This study found that while race-ethnicity influenced COVID-19 testing positivity, age and cerebrovascular disease, not race, independently predicted in-hospital mortality among low-income patients. Safety net health systems are vital for vulnerable populations during the pandemic.

Area of Science:

  • Public Health
  • Epidemiology
  • Health Disparities

Background:

  • COVID-19 disproportionately affects low-income and minority populations.
  • Understanding race-ethnicity correlations with COVID-19 case-fatality is crucial for targeted interventions.
  • Safety net health systems serve vulnerable patient groups, necessitating research into their outcomes.

Purpose of the Study:

  • To investigate the association between race-ethnicity and COVID-19 case-fatality rates in a low-income patient cohort.
  • To identify demographic and clinical factors influencing hospitalization and mortality in COVID-19 patients.
  • To assess the role of healthcare access and comorbidities in COVID-19 outcomes.

Main Methods:

  • An observational cohort study utilizing electronic health record data from a safety net health system.
  • Analysis included 25,253 patients assessed for COVID-19 between March 2020 and January 2021.
  • Logistic regression models were employed to determine independent predictors of hospitalization and mortality.

Main Results:

  • Hispanic patients had higher COVID-19 testing positivity rates. Non-Hispanic White patients were older and had higher intensive care and mortality rates.
  • Independent predictors for hospitalization included Medicaid insurance status. Age and cerebrovascular disease independently predicted in-hospital mortality.
  • Despite demographic differences, length of hospital stay was similar across racial-ethnic groups.

Conclusions:

  • COVID-19 in-hospital mortality rates observed were lower than previously published data.
  • Age and cerebrovascular disease, not race-ethnicity, were independently correlated with in-hospital mortality.
  • Safety net health systems play a critical role in managing COVID-19 care for vulnerable and under-represented populations.
Abstract

Keywords:
COVID-19CoronavirusHealth Care DisparitySafety-Net

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