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Kim SJ, Medina M, Park JH, Chang J. Racial and Regional Disparities Surrounding In-Hospital Mortality among Patients with 2019 Novel Coronavirus Disease (COVID-19): Evidence from NIS Sample in 2020. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01707-1. [PMID: 37420020 DOI: 10.1007/s40615-023-01707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE This study explores differences in COVID-19 in-hospital mortality rates by patient and geographic factors to identify at-risk populations and analyze how strained health disparities were exacerbated during the pandemic. METHODS The latest 2020 United States National Inpatient Sample (NIS) data was used to obtain a population-based estimate for patients with COVID-19. We conducted a cross-sectional retrospective data analysis, and sampling weights were used for all statistical analyses to represent nationwide in-hospital mortality of patients with COVID-19. We used multivariate logistic regression models to identify predictors for how patients with COVID-19 are associated with in-hospital death. RESULTS Of 200,531 patients, 88.9% did not have an in-hospital death (n=178,369), and 11.1% had in-hospital death (n=22,162). Patients older than 70 were 10 times more likely to have an in-hospital death than patients younger than 40 (p<0.001). Male patients were 37% more likely to have an in-hospital death than female patients (p<0.001). Hispanic patients were 25% more likely to have in-hospital deaths than White patients (p<0.001). In the sub-analysis, Hispanic patients in the 50-60, 60-70, and 70 age groups were 32%, 34%, and 24%, respectively, more likely to have in-hospital death than White patients (p<0.001). Patients with hypertension and diabetes were 69% and 29%, respectively, more likely to have in-hospital death than patients without hypertension and diabetes. CONCLUSION Health disparities in the COVID-19 pandemic occurred across races and regions and must be addressed to prevent future deaths. Age and comorbidities like diabetes have a well-established link to increased disease severity, and we have linked both to higher mortality risk. Low-income patients had a significantly increased risk of in-hospital death starting at over 40 years old.
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Affiliation(s)
- Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, Texas, USA
| | - Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, TX, College Station, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, Texas, USA.
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Joo PY, Wilhelm C, Adeclat G, Halperin SJ, Moran J, Elaydi A, Rubin LE, Grauer JN. Comparing Race/Ethnicity and Zip Code Socioeconomic Status for Surgical versus Nonsurgical Management of Proximal Humerus Fractures in a Medicare Population. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00011. [PMID: 37141180 PMCID: PMC10162786 DOI: 10.5435/jaaosglobal-d-22-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/24/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND This study evaluated the effect of race/ethnicity and socioeconomic status (SES) on surgical utilization after proximal humerus fractures in a large Medicare cohort. METHODS The PearlDiver Medicare claims database was used to identify patients aged 65years and older with isolated, closed proximal humerus fractures, for whom race/ethnicity data were available (65.5% of identified fractures). Patients with polytrauma or neoplasm were excluded. Patient demographic, race/ethnicity, comorbidity, and median household income were compared for surgical versus nonsurgical management. Univariate and multivariable logistic regressions were used to determine disparities of surgical utilization based on the abovementioned factors. RESULTS Of 133,218 patients with proximal humerus fracture identified, surgery was conducted for 4446 (3.3%). Those less likely to receive surgery were older (incrementally by increasing age bracket up to 85 years and older odds ratio [OR], 0.16, P < 0.001), male (OR, 0.79, P < 0.001), Black (OR, 0.51, P < 0.001) or Hispanic (0.61, P = 0.005), higher Elixhauser Comorbidity Index (per 2 increase OR, 0.86, P < 0.001), and low median household income (OR, 0.79, P < 0.001). CONCLUSIONS The independent significance of race/ethnicity and SES point to disparities in surgical decision making/access to care. These findings highlight the need for increased attention on initiatives and policies that seek to eliminate racial disparities and improve health equity independent of SES.
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Affiliation(s)
- Peter Y. Joo
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Christopher Wilhelm
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Giscard Adeclat
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Scott J. Halperin
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jay Moran
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Ali Elaydi
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Lee E. Rubin
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N. Grauer
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Riley JM, Moeller PJ, Crawford AG, Schaefer JW, Cheney-Peters DR, Venkataraman CM, Li CJ, Smaltz CM, Bradley CG, Lee CY, Fitzpatrick DM, Ney DB, Zaret DS, Chalikonda DM, Mairose JD, Chauhan K, Szot MV, Jones RB, Bashir-Hamidu R, Mitsuhashi S, Kubey AA. External validation of the COVID-19 4C mortality score in an urban United States cohort. Am J Med Sci 2022; 364:409-413. [PMID: 35500663 PMCID: PMC9054702 DOI: 10.1016/j.amjms.2022.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identifying patients at risk for mortality from COVID-19 is crucial to triage, clinical decision-making, and the allocation of scarce hospital resources. The 4C Mortality Score effectively predicts COVID-19 mortality, but it has not been validated in a United States (U.S.) population. The purpose of this study is to determine whether the 4C Mortality Score accurately predicts COVID-19 mortality in an urban U.S. adult inpatient population. METHODS This retrospective cohort study included adult patients admitted to a single-center, tertiary care hospital (Philadelphia, PA) with a positive SARS-CoV-2 PCR from 3/01/2020 to 6/06/2020. Variables were extracted through a combination of automated export and manual chart review. The outcome of interest was mortality during hospital admission or within 30 days of discharge. RESULTS This study included 426 patients; mean age was 64.4 years, 43.4% were female, and 54.5% self-identified as Black or African American. All-cause mortality was observed in 71 patients (16.7%). The area under the receiver operator characteristic curve of the 4C Mortality Score was 0.85 (95% confidence interval, 0.79-0.89). CONCLUSIONS Clinicians may use the 4C Mortality Score in an urban, majority Black, U.S. inpatient population. The derivation and validation cohorts were treated in the pre-vaccine era so the 4C Score may over-predict mortality in current patient populations. With stubbornly high inpatient mortality rates, however, the 4C Score remains one of the best tools available to date to inform thoughtful triage and treatment allocation.
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Affiliation(s)
- Joshua M. Riley
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Patrick J. Moeller
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Albert G. Crawford
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph W. Schaefer
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dianna R. Cheney-Peters
- Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Chantel M. Venkataraman
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Chris J. Li
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christa M. Smaltz
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Conor G. Bradley
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Crystal Y. Lee
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Danielle M. Fitzpatrick
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David B. Ney
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dina S. Zaret
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Divya M. Chalikonda
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Joshua D. Mairose
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kashyap Chauhan
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Margaret V. Szot
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert B. Jones
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rukaiya Bashir-Hamidu
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Shuji Mitsuhashi
- Internal Medicine Residency, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan A. Kubey
- Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA,Division of Hospital Internal Medicine, Department of Internal Medicine, Rochester, MN, USA,Corresponding author at: Alan A. Kubey, MD, Division of Hospital Medicine, Thomas Jefferson University Hospital, 833 Chestnut Street, Suite 701, Philadelphia, PA 19107, USA
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Ullah S, Haroon M, Hashmi F, Tayyab Z, Javed S. A Prospective Follow-Up Study on the Disease Course and Predictors of Poor Outcomes in a Random Population-Based Cohort of Newly Diagnosed Lupus Patients. Cureus 2022; 14:e27430. [PMID: 36051712 PMCID: PMC9420196 DOI: 10.7759/cureus.27430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective Systemic lupus erythematosus (SLE) is one of the most devastating systemic autoimmune connective tissue diseases. There is a paucity of prospective data on Pakistani SLE patients, and in this prospective study, we aimed to investigate the disease course, clinical outcomes, and the predictors of poor outcomes in a random population-based cohort of newly diagnosed SLE patients (diagnosed within the last one year). Methods This was a prospective observational study carried out in the rheumatology department of the Fatima Memorial Hospital, Lahore. Lupus patients are regularly reviewed in our dedicated lupus clinic every one to three months. For the purpose of this study, a focus group of newly diagnosed patients (diagnosed within the last one year) attending our lupus clinic was identified and prospectively followed up for 12 months. A wide range of demographical and clinical parameters was recorded. The association of clinical variables with the progressive disease was determined using univariate and multivariate logistic regressions. Results Prospective data of 89 newly diagnosed SLE patients regularly attending our dedicated lupus clinic were reviewed. During the study period, (January 2021 through January 2022), these patients had multiple visits overall - median: five, minimum: three, and maximum: nine visits [interquartile range (IQR) 4-7]. All 89 patients had completed one year of follow-up. Of note, 46% of the cohort was noted to have an ongoing active disease during the majority of visits in the study period. On multiple logistic regression analysis, there was a significant association between ongoing active disease ("progressors") and low education status [odds ratio (OR): 2.81, 95% confidence interval (CI): 1.01-7.76, p=0.046], stress at home (OR: 5.8, 95% CI: 2.13-15.8, p=0.001), and hematologic manifestations (OR: 3.0, 95% CI: 1.08-8.32, p=0.03). Conclusions Almost half of our cohort of lupus patients demonstrated active disease manifestations throughout the one-year prospective follow-up, and these were found to be associated with low education status, stress at home, and hematological manifestations.
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