Influence of health disparities on COVID-19 critical care admissions

ABSTRACT

INTRODUCTION: COVID-19 has brought attention to the health disparities even in a rural state such as Nebraska. COVID-19 patients admitted to CHI (Catholic Health Initiative) Health Nebraska had data collected concurrently to determine the intensive care unit (ICU) admissions. METHODS: Data from all patients with a positive SARSCoV- 2 polymerase-chain-reaction (PCR) test were collected regarding their health on admission, their progress during hospitalization, and their disposition after dismissal. Data were entered into an Excel spreadsheet and analyzed by SPSS-PC (ver 26.0). Emphasis was placed on critical care admission for patients. Continuous variables were analyzed using Student t-test and discrete variables were analyzed using Chi-square or Fisher's exact test. Apriori significance was p ≤ 0.05. RESULTS: From March 15, 2020, to July 15, 2020, 127 (29%) of 441 total COVID-19 positive patients were admitted to ICU beds in our healthcare system (CHI Health Nebraska;approximately 320 ICU beds). Significantly more male patients (58%;p<0.01) were admitted to ICU. Bodyweight (93.9 ± 32.6 vs. 83.1 ± 23.5 kg) and APACHE II score (12.6 ± 7.6 vs. 8.9 ± 5.6, P<0.01) on admission to ICU were also significantly (p<0.01) higher. Additionally, 50% of patients with COVID-19 positive PCR result belonged to minority race groups (African-American 21%;Asian 11%;Hispanic 68%;p < 0.001) when African-American represent 5%, Asian 2.7%, and Hispanics 10% of the Nebraska general population. For health disparities, significantly more (40%;p<0.03) ICU admissions were due to occupational exposure to COVID-19 (meatpacking plants). Total hospitalization length was significantly longer for ICU patients (18.6 ± 12.1 days) compared to non-ICU patients (12.5 ± 12.4 days, p<0.001). CONCLUSIONS: COVID-19 infection has resulted in significant health disparities with greater numbers of ICU admission from occupational exposure in a close workspace with minimal social distancing.