COVID-19-related mortality in Texas border counties vs non-border counties

The state of Texas ranked second in total cases of coronavirus disease 2019 (COVID-19) in the United States during the pandemic. Counties near the US-Mexico border were severely impacted by the pandemic. Mortality and long-term consequences from COVID-19 are associated with comorbidities, illness severity, and patient demographics. However, differences in outcomes between border and non-border counties are unknown. In this retrospective observational study, data were obtained for analysis from the Texas hospital inpatient discharge public use data file from 2020 to 2021 for adult patients with COVID-19 based on the associated international classification of disease 10 codes. Patients were categorized into border or non-border counties. The clinical outcomes included mortality, length of stay, mortality risk, illness severity, and intensive care unit (ICU) or critical care unit (CCU) admissions. Cost differences between border and non-border counties were analyzed. Age, gender, race, ethnicity, admission type, location, and year of diagnosis were covariates. A total of 1,745,312 patients were included in this analysis. 25% of COVID-19 patients admitted in Texas were from border counties. Patient mortality was 5.35% in border counties compared to 3.87% in non-border counties (p = 0.003). In border counties, 36.51% and 32.96% of patients required ICU and CCU admissions compared to 32.96% and 10.72%, respectively in non-border counties. Border counties had significantly higher risk of mortality (relative risk (RR) = 1.26; 95% CI: 1.09-1.46, p = 0.002), ICU admission (RR = 1.15; 95% CI: 1.15; 95% CI: 1.01-1.32, p = 0.038), CCU admission (RR = 2.87; 95% CI: 1.93, 4.27, p < 0.001), and ICU/CCU admission (RR = 1.28; 95% CI: 1.10, 1.48, p < 0.001) which reflects health disparities in the management of COVID-19 in border counties of Texas.