ABSTRACT
INTRODUCTION: African American and Hispanic patients have been disproportionately affected by infection with SARS-CoV-2 and subsequent coronavirus disease (COVID-19). Initial data suggests that these populations are more likely to suffer severe illness requiring hospitalization compared to Whites. We sought to further investigate the effects of race and ethnicity on critical care outcomes in hospitalized COVID-19 patients within the ethnically diverse area of the District of Columbia. METHODS: We performed a single-center, review of a prospective registry of 233 patients hospitalized with COVID-19 at an urban, academic hospital in Washington, D.C. Demographic and clinical data was gathered from chart review. We compared mean admission SOFA and APACHE scores, along with rates of ICU admission, intubation and mortality between White, Black, Hispanic, and Other ethnicities. RESULTS: Of the admitted patients 3.8% (n=9) were White, 70% (n=166) were Black, and 17% (n=41) Hispanic, with 7.7% (n=18) unknown or other race. The mean admission SOFA score for White, Black and Hispanic patients were 3.14, 2.65 and 1.88, respectively. The mean APACHE scores for Whites, Blacks, and Hispanics were 15.25, 17.85, and 14.75, respectively. 56% (n=5) of Whites, 29% (n=48) of Blacks, and 41% (n=17) of Hispanics were admitted to the ICU. Intubations occurred in 44% (n=4) of Whites, 17% (n=28) of Blacks, and 37% (n=15) of Hispanics. Mortality rates were 22% (n=2), 30% (n=49), and 29% (n=12) in Whites, Blacks, and Hispanics, respectively. CONCLUSIONS: According to estimates by the US census bureau, the population of the District of Columbia is 46% White, 46% Black, and 11.3% Hispanic. Our data demonstrates a disproportionate hospitalization rate in minorities affected by COVID-19. Despite lower ICU admission and intubation rates, Blacks had a high mortality rate. There was a disproportionately high utilization of the ICU care, intubation and mortality amongst Hispanics. Further investigation is necessary to examine causes of these significant health disparities and to prevent further health inequalities amongst minorities.
ABSTRACT
INTRODUCTION: Since the outbreak of the COVID-19 pandemic, advising patients on when to seek care for their symptoms has been a challenge. Patients may present to the hospital late in their disease course and only when symptom severity cannot be avoided any longer due to lack of access to healthcare or fear of hospitalization. It is unclear if these delays in care affect clinical treatments or hospital outcomes. We aimed to determine if the reported length of pre-admission symptoms in COVID-19 patients was associated with significant differences in critical care outcomes. We hypothesized that patients who delayed care would experience worse outcomes. METHODS: We utilized registry data on hospitalized COVID-positive patients from an urban, academic, medical center. All patients with a finalized dataset were included. Patients were stratified by length of symptoms (1-5 days, 6-10 days or more than 10 days) prior to admission. We compared the rate of ICU admission, SOFA and APACHE scores on admission, intubation status, and mortality. Chisquare tests and logistic regression models were used. RESULTS: A total of 247 patients were included. The mean age was 62 years and 47.87% were female. Of these patients, 78 (33.5%) were admitted to the ICU. There was no significant difference in ICU admission rate between groups (1-5 days: 26.9%;6-10 days: 35.3%;>10 days: 37.9%;p=0.30). There was no significant difference in SOFA or APACHE score categories by group (p=0.64 and p=0.90, respectively). Additionally, there were no significant differences in rate of intubation (p=0.12), or in-hospital mortality (p=0.33). After controlling for age, BMI, and gender, logistic regression analysis demonstrated no significant difference between groups for rate of ICU admission, rate of intubation, or in-hospital mortality. CONCLUSIONS: We have demonstrated that the reported length of pre-admission symptoms in COVID-positive patients was not a significant predictor of outcomes. We had hypothesized patients with longer duration of pre-admission symptoms would exhibit worse outcomes. However, we posit the expeditious development and implementation of remote monitoring programs and outpatient management by our institution could have allowed for timely intervention in patients whose clinical status was deteriorating.