RESUMO
BackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic exposed and exacerbated health disparities between socioeconomic groups. Our purpose was to determine which disparities are most prevalent and their impact on length of stay (LoS) and in hospital mortality in patients diagnosed with Covid-19. MethodsDe-Identified data for patients who tested positive for COVID-19 was abstracted from the HCA enterprise database. Data was binned into summary tables. A negative binomial regression with LoS as the dependent variable and a logistic regression of in-hospital mortality data, using age, insurance status, sex, comorbidities as the dependent variables, were performed. ResultsFrom March 1, 2020 to August 23, 2020, of 111,849 covid testing patient records, excluding those with missing data (n=7), without confirmed COVID-19 (n=27,225), and those from a carceral environment (n=1,861), left 84,624 eligible patients. Compared to the US population, the covid cohort had more black patients (23.17% vs 13.4%). Compared to the white cohort, the black cohort had higher private insurance rates (28.52% vs. 23.68%), shorter LoS (IRR=0.97 CI=0.95-0.99, P<0.01) and lower adjusted mortality (OR 0.81, 95% CI 0.75-0.97). Increasing age was associated with increased mortality and LoS. Patients with Medicare or Medicaid had longer LoS (IRR=1.07, 95% CI=1.04-1.09) and higher adjusted mortality rates (OR=1.11, 95% CI=1-1.23) than those with private insurance ConclusionConclusions We found that when blacks have higher rates of private insurance, they have shorter hospitalizations and lower mortality than whites, when diagnosed with Covid-19. Some other psychiatric and medical conditions also significantly impacted outcomes in patients with Covid-19. Key PointsO_ST_ABSQuestionC_ST_ABSWhich social determinants of health and comorbidities are most prevalent and their impact on length of stay and in-hospital mortality in patients diagnosed with Covid-19? FindingsIn this retrospective cohort of 84,624 with the black cohort having higher private insurance rates (28.52% vs. 23.68%), there was shorter LoS (IRR=0.97 CI=0.95-0.99, P<0.01) and lower adjusted mortality (OR 0.81, 95% CI 0.75-0.97). Age and several other medical and psychiatric comorbidities were also found to correlate with length of stay and mortality. MeaningThe genetics of race is not important in predicting mortality and length of stay in COVID-19 patients, but age, comorbidities, and insurance status appear to have a significant difference in mortality and length of stay.
