ABSTRACT
Introduction: A study examining the impact of social determinants of health on COVID-19 outcomes is necessary to identify which aspects of a vulnerable population make it more susceptible. We describe the epidemiological and clinical characteristics of a patient population disproportionately impacted by COVID-19 and situate the findings within the broader context of health determinants. Materials and Methods: A descriptive study of 527 laboratory-confirmed COVID-19 patients hospitalized from March 12 to April 13, 2020, evaluated patient demographics, comorbidities, presentation, and outcomes. The study took place at an academic medical center serving a low-income, Black community (predominantly Caribbean-born) in Brooklyn, New York. Results: Compared to previous studies, we report a higher median age of 70 (interquartile range 59-80), a higher percentage of Blacks (91%), a higher prevalence of comorbidities (hypertension [83%], diabetes [53%], and obesity [42%]), a higher prevalence of abnormal findings on presentation (altered mental status [30%], Quick sequential organ failure assessment score ≥2 [27%], elevated random-glucose [77%], elevated creatinine [57%]), and a higher incidence of negative in-hospital outcomes (intensive care unit admission [21%], mechanical ventilation [21%], acute kidney injury [31%], acute respiratory distress syndrome [17%] and acute cardiac injury [18%], and age-adjusted fatality rate [40%.]). Conclusions: This study shows the characteristics of a patient population disproportionately impacted by COVID-19. The intersectionality of the Black race, older age, a high prevalence of comorbidities, and residency in a locale severely affected by COVID-19, deserves further consideration to better address health outcomes in vulnerable patient groups. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and Procedural skills, Systems-based practice. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Rationale: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, has led to a global health crisis unlike any our contemporaries have witnessed before. SUNY Downstate Health Sciences University was designated as one of three COVID-19-only hospitals on March 28, 2020. This retrospective, single-center observational study grants a unique perspective surrounding the experience of the critical care service at a public institution serving a predominantly Afro-Caribbean, inner city population. Methods: Between March 11 and April 30, 2020, the critical care service was consulted for a total of 271 COVID-19 patients. We queried the electronic medical record for patient visits with critical care consult notes and collected data on demographics, comorbidities, ICU acceptance, treatment strategies, and clinical outcomes. Non-COVIDrelated consults were excluded. Chi-squared tests compared categorical variables, and independent samples ttest assessed differences in continuous variables based on mortality and ICU admission status. Logistic regression models determined if various factors independently predicted the odds of mortality. We conducted retrospective analyses to identify factors associated with survival and ICU acceptance. Results: Of the 271 patients with critical care consults, 33% (n=89) survived and 67% (n=182) expired. At the bivariate level, age, BUN, and neutrophil percentage were significantly associated with mortality, with age showing the strongest correlation (age: survivors, 61.62±1.50 vs. non-survivors, 68.98±0.85, p<0.001). There was a significant association between neutrophil percentage and mortality in the univariate logistic regression model (Q4 vs. Q1, OR 2.73, 95% CI (1.28-5.82), p trend = 0.044). In the multivariate analyses, procalcitonin exhibited a positive correlation with the odds of mortality, adjusting for age, sex, and race/ethnicity (procalcitonin: Q4 vs. Q1, OR 5.65, 95% CI (2.14-14.9), p trend <0.001). Adjusting for the same covariates, platelets exhibited a negative correlation with the odds of mortality (Q4 vs. Q1, OR 0.47, 95% CI (0.22-0.998), p trend = 0.010). Interestingly, of these factors, only elevated procalcitonin levels were associated with an increased likelihood of ICU acceptance. Conclusions: This retrospective, observational study during the first peak of the COVID-19 pandemic identified key factors linked to disease severity and outcomes. Of note, procalcitonin was the factor most strongly associated with both mortality and likelihood of ICU acceptance at the bivariate level. Respiratory failure is the primary cause of death in COVID-19, and our data suggests that procalcitonin is a useful marker that accurately reflects the severity of lung involvement during SARS-CoV-2 infection.