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Hurwitz I, Yingling AV, Amirkabirian T, Castillo A, Khan JJ, Do A, Lundquist DK, Barnes O, Lambert CG, Fieck A, Mertz G, Onyango C, Anyona SB, Teixeira JP, Harkins M, Unruh M, Cheng Q, Leng S, Seidenberg P, Worsham A, Langsjoen JO, Schneider KA, Perkins DJ. Disproportionate impact of COVID-19 severity and mortality on hospitalized American Indian/Alaska Native patients. PNAS NEXUS 2023; 2:pgad259. [PMID: 37649584 PMCID: PMC10465079 DOI: 10.1093/pnasnexus/pgad259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/23/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023]
Abstract
Epidemiological data across the United States of America illustrate health disparities in COVID-19 infection, hospitalization, and mortality by race/ethnicity. However, limited information is available from prospective observational studies in hospitalized patients, particularly for American Indian or Alaska Native (AI/AN) populations. Here, we present risk factors associated with severe COVID-19 and mortality in patients (4/2020-12/2021, n = 475) at the University of New Mexico Hospital. Data were collected on patient demographics, infection duration, laboratory measures, comorbidities, treatment(s), major clinical events, and in-hospital mortality. Severe disease was defined by COVID-related intensive care unit requirements and/or death. The cohort was stratified by self-reported race/ethnicity: AI/AN (30.7%), Hispanic (47.0%), non-Hispanic White (NHW, 18.5%), and Other (4.0%, not included in statistical comparisons). Despite similar timing of infection and comparable comorbidities, admission characteristics for AI/AN patients included younger age (P = 0.02), higher invasive mechanical ventilation requirements (P = 0.0001), and laboratory values indicative of more severe disease. Throughout hospitalization, the AI/AN group also experienced elevated invasive mechanical ventilation (P < 0.0001), shock (P = 0.01), encephalopathy (P = 0.02), and severe COVID-19 (P = 0.0002), consistent with longer hospitalization (P < 0.0001). Self-reported AI/AN race/ethnicity emerged as the highest risk factor for severe COVID-19 (OR = 3.19; 95% CI = 1.70-6.01; P = 0.0003) and was a predictor of in-hospital mortality (OR = 2.35; 95% CI = 1.12-4.92; P = 0.02). Results from this study highlight the disproportionate impact of COVID-19 on hospitalized AI/AN patients, who experienced more severe illness and associated mortality, compared to Hispanic and NHW patients, even when accounting for symptom onset and comorbid conditions. These findings underscore the need for interventions and resources to address health disparities in the COVID-19 pandemic.
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Affiliation(s)
- Ivy Hurwitz
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Alexandra V Yingling
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Teah Amirkabirian
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Amber Castillo
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Jehanzaeb J Khan
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Alexandra Do
- School of Medicine, University of New Mexico, MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Dominic K Lundquist
- School of Medicine, University of New Mexico, MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - October Barnes
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Christophe G Lambert
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
- Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Annabeth Fieck
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Gregory Mertz
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Clinton Onyango
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Main Campus-Busia Road, PO Box Private Bag-40105, Maseno, Kenya
| | - Samuel B Anyona
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
- Department of Medical Biochemistry, School of Medicine, Maseno University, Main Campus-Busia Road, PO Box Private Bag-40105, Maseno, Kenya
| | - J Pedro Teixeira
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Michelle Harkins
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Qiuying Cheng
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Shuguang Leng
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
- Division of Epidemiology, Biostatistics, and Preventative Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Philip Seidenberg
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Anthony Worsham
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Jens O Langsjoen
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Kristan A Schneider
- Department of Applied Computer- and Biosciences, University of Applied Sciences Mittweida, Technikumplatz 17, 09648 Mittweida, Germany
| | - Douglas J Perkins
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
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