ABSTRACT
BACKGROUND: COVID-19 continues to be an ongoing problem worldwide, especially for those who are disproportionately affected due to their social determinants of health, as they are often at a socioeconomic disadvantage. We are primarily interested in evaluating how education level, income, race, ethnicity, and obesity are correlated with acute COVID-19 severity, and anxiety, depression, and quality of life ≥ 6 months post-infection. Specifically, obesity (BMI > 30), has been previously identified as a risk factor for COVID- 19 regarding severity and mortality. We found it imperative to further investigate these demographic variables, as they are vital in understanding how social determinants of health are impacting COVID-19 outcomes. Insights from this study can assist with identifying gaps in care for those with poor social determinants of health, as well as help shape care for those who have been disproportionately affected. METHODS: We examined records of COVID-19 patients through the COVID-19 Recovery Clinic at George Washington University in Washington, D.C. that has been collecting data on patient short and long-term COVID-19 outcomes in various domains along with demographic information since November 2020. Using RStudio with calculations of descriptive data, odds ratios, and p-values using Fisher's exact test, we assessed education level, income, race, ethnicity, and obesity and looked at how they correlated with COVID-19 severity at diagnosis, presence of anxiety, depression and quality of life ≥ 6 months after acute infection. RESULTS: From our sample (n=150), we found African Americans had greater acute COVID-19 severity (OR=7.56, 95% CI 2.22, 25.68, p=0.0015) relative to white individuals. We also found that obesity was associated with higher levels of acute COVID-19 severity (OR=4.89, 95% CI 1.36, 17.60, p=0.022).Additionally, during acute COVID-19 infection, 7/32 (21.9%) obese patients compared to 9/112 (8.0%) non-obese patients were hospitalized (OR=3.79, 95%CI=1.23, 11.68, p=0.03).No significant association was found between anxiety, depression, quality of life or COVID- 19 severity and persistent symptoms. CONCLUSIONS: We observed associations between the African American race and more severe acute COVID-19 infection. Further, in the acute phase, we observed that obese patients were more likely than non-obsese patients to have more severe infection and be hospitalized. These findings highlight preexisting gaps in healthcare outcomes regarding social determinants of health. It is essential to analyze many of the potential longer-term effects of COVID-19 infection, as they remain poorly understood. We conclude that larger studies are necessary to better understand the effects of social determinants of health on both short and long-term outcomes of COVID-19.
ABSTRACT
BACKGROUND: During the COVID-19 pandemic, most attention has been focused on the acute phase of the disease, but lingering symptoms from the postacute sequelae of COVID-19 (PASC) merit concern. The George Washington University COVID-19 Recovery Clinic is documenting these presentations to better understand PASC and its precipitating factors. The group implemented definitions for six phenotype categories: pulmonary, cardiac, connective tissue, vascular, central nervous system (CNS), and other. This research seeks to identify pre-existing factors that could affect disease severity, understand their effect on PASC symptoms at 6-15 months post-infection, and determine associations between patient history and PASC phenotypes. METHODS: An IRB-approved, retrospective cohort study was performed from charts of adult patients with persistent symptoms after acute COVID-19. Data were ed from clinical history prior to COVID-19 diagnosis, during acute COVID-19, and during the post-acute phase, including laboratory results and responses from mental health assessment tools. PASC phenotypes were determined clinically and hospitalization was used as a proxy for disease severity. Descriptive statistics, unadjusted odds ratios, and significance tests (Fisher's exact test, Chi-square test, and Mann-Whitney U test) were calculated using RStudio (4.1.1). RESULTS: Study participants with persistent symptoms at 6-15 months postinfection (n=116) had a mean age of 45.16 (SD 13.23), of which 70% were female, 60% were Caucasian, 12% were African-American, 9% were Asian, and 3% were Hispanic/Latino. When including all patients who had persistent symptoms at 1-15 months post-infection, those with obesity (BMI ≥30) or type 2 diabetes were much more likely to undergo a severe acute phase of COVID19 (OR 12.75;95% CI 1.91-84.95;p=0.02;n=61 and OR 34.67;95% CI 4.43-271.46;p<0.001;n=61 respectively). At 6-15 months post-infection, those suffering from a pulmonary PASC phenotype were more likely to have smoked (OR 3.27;95% CI 1.18-9.11;p=0.02;n=91). At the same period, those presenting with at least one CNS phenotype had a significantly higher level of C-reactive protein (CRP) than those without a CNS phenotype presentation (Mean 3.70 mg/L, SD 5.19 vs. Mean 1.26 mg/L, SD 2.36;p=0.009;n=53). Additionally, acute phase severity was not significantly associated with the presence of PASC. CONCLUSIONS: Our research further demonstrates the increased risk of severe acute COVID-19 among patients with obesity and type 2 diabetes. Furthermore, we show that those with a smoking history were more likely to continue to have pulmonary symptoms of COVID-19 at 6-15 months postinfection. Additionally, our study suggests that there may be a relationship between CRP and persistent CNS symptoms. A better understanding of these associations can help predict the full burden of COVID-19 and improve clinical guidance.