Racial and Ethnic Differences in Fatality Risk From COVID-19.

Introduction: Studies have reported higher infection and mortality rates from coronavirus disease 2019 (COVID-19) for disadvantaged groups in the U.S. population. However, racial and ethnic differences in fatality rates, which measure deaths among those infected, are not as clear. Objectives: The objectives were to (1) estimate the fatality rate after COVID-19 infection by racial and ethnic groups and (2) determine the extent preexisting health conditions account for differences in fatality rate between the racial and ethnic groups. Methods: Data for all adults aged 18 and older (n = 24,834) who had a confirmed COVID-19 infection captured in the electronic health records (EHRs) of a major health care organization (HCO) from the beginning of the pandemic to March 28, 2021 were used to estimate the fatality rates for three racial and ethnic groups: Hispanic, non-Hispanic African American, and non-Hispanic White. Elixhauser's comorbidity index was calculated using the enhanced ICD-9-CM and the ICD-10 diagnosis codes. Logistic regression models were used to compare differences in fatality between racial and ethnic groups. Odds ratios and 95% confidence intervals were reported for all models. Results: The age-specific fatality rates non-Hispanic White, non-Hispanic African American, and Hispanic groups were 0.23%, 1.05%, 0.55% for age group 18-59 years old; 2.44%, 4.50%, 5.28% for 60-69; 5.42%, 10.11%, 8.49% for 70-79, and 17.33%, 20.79%, 20.39% for 80-90. After adjusting for age, sex, and preexisting conditions, the fatality risk remains significantly higher for non-Hispanic African American (adjusted odds ratio [adj. OR] = 1.85, 95% CI 1.41-2.44) and Hispanic individuals (adj. OR = 1.91, 95% CI = 1.53-2.39) compared to non-Hispanic White individuals. Conclusion: Hispanic and non-Hispanic African American individuals have a higher risk of fatality from COVID-19 compared to non-Hispanic White individuals. The higher risk remains after adjusting for sex, age, and preexisting conditions. Health care providers could help to increase vaccination rates in these vulnerable populations by addressing the social and cultural barriers with their patients.

Influence of the COVID-19 Pandemic on Emergency Room Visits for Burn Injury

Introduction The COVID-19 pandemic was a devastating occurrence that left millions in critical condition in emergency rooms (ER) across the country. While hospitalizations due to COVID-19 increased exponentially in the last year, several reports have indicated declines in ER use due to common non-COVID related problems. There is currently a dearth of literature examining the effect of the COVID-19 pandemic on emergency room use for acute burn injuries. Thus, we performed a retrospective database analysis using the TriNetX database to quantify the effects of COVID-19 on United States ER visits for acute burn injuries. We hypothesize that ER visits due to burn injury decreased, especially in patients with severe burn injuries- defined as burned total burn surface area (TBSA) >20%. Methods Patients who visited the ER from 2010-2020 due to burn injury were identified using ICD-10 codes. We then stratified these patients by age (< 18 and ≥18), severe ( >20% TBSA) vs. non-severe (< 20% TBSA) burn injury, and by change over time in 1-year intervals from 2010 to 2020. Extracted data was analyzed using chi-square with p< .05 considered significant. Results We identified a total of 24,620,393 ER visits from 2010-2020. Of these, 142,007 (0.58%) were due to burn injury. A large majority of burn-related ER visits were for non-severe burns (n=134,120, 94.4%). ER visits for acute burn injury decreased by 21.6% during 2020 when compared to years prior. Stratification by age group revealed that pediatric patients (< 18) had more significant decreases in ER Visits than adult patients (≥18). Pediatric patients visited the ER 71.6% less than adults during 2020. When stratified by burn severity, patients with severe burns ( >20% TBSA) and patients with non-severe burns (< 20% TBSA) had similar decreases in ER usage during 2020 when compared to years prior (21.7% and 24.6%, respectively). Further age analysis revealed that both pediatric patients with severe burns and pediatric patients with non-severe burns visited the ER less than their adult counterparts (71.4% and 60.9%, respectively). All of the above differences were statistically significant (p< .05). Conclusions During the COVID-19 pandemic in 2020, there was a sharp decrease in ER usage by patients with severe and non-severe burn injuries. This decrease was particularly salient in pediatric populations across all TBSA data points measured.

Synergies between centralized and federated approaches to data quality: a report from the national COVID cohort collaborative.

OBJECTIVE: In response to COVID-19, the informatics community united to aggregate as much clinical data as possible to characterize this new disease and reduce its impact through collaborative analytics. The National COVID Cohort Collaborative (N3C) is now the largest publicly available HIPAA limited dataset in US history with over 6.4 million patients and is a testament to a partnership of over 100 organizations. MATERIALS AND METHODS: We developed a pipeline for ingesting, harmonizing, and centralizing data from 56 contributing data partners using 4 federated Common Data Models. N3C data quality (DQ) review involves both automated and manual procedures. In the process, several DQ heuristics were discovered in our centralized context, both within the pipeline and during downstream project-based analysis. Feedback to the sites led to many local and centralized DQ improvements. RESULTS: Beyond well-recognized DQ findings, we discovered 15 heuristics relating to source Common Data Model conformance, demographics, COVID tests, conditions, encounters, measurements, observations, coding completeness, and fitness for use. Of 56 sites, 37 sites (66%) demonstrated issues through these heuristics. These 37 sites demonstrated improvement after receiving feedback. DISCUSSION: We encountered site-to-site differences in DQ which would have been challenging to discover using federated checks alone. We have demonstrated that centralized DQ benchmarking reveals unique opportunities for DQ improvement that will support improved research analytics locally and in aggregate. CONCLUSION: By combining rapid, continual assessment of DQ with a large volume of multisite data, it is possible to support more nuanced scientific questions with the scale and rigor that they require.