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Socioeconomic variation in characteristics, outcomes, and healthcare utilization of COVID-19 patients in New York City.
Zhang, Yongkang; Khullar, Dhruv; Wang, Fei; Steel, Peter; Wu, Yiyuan; Orlander, Duncan; Weiner, Mark; Kaushal, Rainu.
  • Zhang Y; Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America.
  • Khullar D; Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America.
  • Wang F; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
  • Steel P; NewYork-Presbyterian Hospital, New York, NY, United States of America.
  • Wu Y; Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America.
  • Orlander D; Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, United States of America.
  • Weiner M; Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America.
  • Kaushal R; Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America.
PLoS One ; 16(7): e0255171, 2021.
Article in English | MEDLINE | ID: covidwho-1332000
ABSTRACT

OBJECTIVES:

There is limited evidence on how clinical outcomes differ by socioeconomic conditions among patients with coronavirus disease 2019 (COVID-19). Most studies focused on COVID-19 patients from a single hospital. Results based on patients from multiple health systems have not been reported. The objective of this study is to examine variation in patient characteristics, outcomes, and healthcare utilization by neighborhood social conditions among COVID-19 patients.

METHODS:

We extracted electronic health record data for 23,300 community dwelling COVID-19 patients in New York City between March 1st and June 11th, 2020 from all care settings, including hospitalized patients, patients who presented to the emergency department without hospitalization, and patients with ambulatory visits only. Zip Code Tabulation Area-level social conditions were measured by the Social Deprivation Index (SDI). Using logistic regressions and Cox proportional-hazards models, we examined the association between SDI quintiles and hospitalization and death, controlling for race, ethnicity, and other patient characteristics.

RESULTS:

Among 23,300 community dwelling COVID-19 patients, 60.7% were from neighborhoods with disadvantaged social conditions (top SDI quintile), although these neighborhoods only account for 34% of overall population. Compared to socially advantaged patients (bottom SDI quintile), socially disadvantaged patients (top SDI quintile) were older (median age 55 vs. 53, P<0.001), more likely to be black (23.1% vs. 6.4%, P<0.001) or Hispanic (25.4% vs. 8.5%, P<0.001), and more likely to have chronic conditions (e.g., diabetes 21.9% vs. 10.5%, P<0.001). Logistic and Cox regressions showed that patients with disadvantaged social conditions had higher risk for hospitalization (odds ratio 1.68; 95% confidence interval [CI] [1.46, 1.94]; P<0.001) and mortality (hazard ratio 1.91; 95% CI [1.35, 2.70]; P<0.001), adjusting for other patient characteristics.

CONCLUSION:

Substantial socioeconomic disparities in health outcomes exist among COVID-19 patients in NYC. Disadvantaged neighborhood social conditions were associated with higher risk for hospitalization, severity of disease, and death.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Acceptance of Health Care / COVID-19 Type of study: Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0255171

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Acceptance of Health Care / COVID-19 Type of study: Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0255171