Median Income and Clinical Outcomes of Hospitalized Persons With COVID-19 at an Urban Veterans Affairs Medical Center

The COVID-19 pandemic disproportionately affected minorities and individuals of low socioeconomic status (SES) with higher rates of severe illness and death. This disparity has been partly attributed to differences in health care access. This study sought to determine whether place of residence, as a marker of SES, health care access, and income, was predictive of disease severity in a large integrated health care system.

This retrospective cohort study included patients admitted to the Washington Veterans Affairs Medical Center (VAMC) with a COVID-19 diagnosis between March 1, 2020, and June 30, 2021. Patients' income was estimated using 2020 US Census Bureau data on median income by zip code. Univariable and multivariable logistic regression models were used to evaluate associations between receiving high-flow oxygen (HFO), intubation, and death with demographic characteristics, prehospitalization clinical risk factors, and comorbidities. Heat maps were used to visualize the geographic distribution of COVID-19 cases and median income.

The cohort included 348 patients with a mean (SD) age of 68.4 (13.9) years; 313 patients (90.2%) were male and 281 (83.4%) were Black. Eighty-six patients (32.8%) required HFO, 33 (10.5%) required intubation, and 57 (16.4%) died. Each $10,000 increase in median income was associated with 10% lower odds of receiving HFO (odds ratio, 0.90; 95% CI, 0.81-1.00). In multivariable models, race and zip code of residence were not associated with the need for HFO, intubation, or death.

In a hospitalized population at an urban VAMC, higher median income by zip code was associated with lower odds of needing HFO. However, race and income by zip code residence were not associated with severe COVID-19 outcomes or death. Access to Veterans Health Administration care may mitigate barriers to care that contribute to poorer COVID-19 outcomes among minorities and individuals of low SES.