Imaging utilization and outcomes in vulnerable populations during COVID-19 in New York city

Abstract

Purpose: To evaluate overall imaging utilization in vulnerable subgroups (elderly, racial/ethnic minorities, socioeconomic status [SES] disadvantaged) and determine whether a particular subgroup has worse outcomes from coronavirus disease 2019 (COVID-19). Materials and Methods: Of 4110 patients who underwent COVID-19 testing from March 3 to April 4, 2020 at the NewYork-Presbyterian Hospital health system, 1121 adults who were positive for COVID-19 (mean age, 59 years ± 18 [standard devia-tion], 59% male) from two academic hospitals were included, and imaging utilization rates and outcomes, including mortality, were evaluated. Results: Of 897 (80%) patients who were considered to be vulnerable population (VP), there were 465 (41%) elderly, 380 (34%) racial/ethnic minorities, and 479 (43%) SES disadvantaged patients. Imaging was performed in 88% of patients and mostly consisted of bedside studies, with 87% of patients undergoing chest radiography. There were 83% hospital admissions, 25% intensive care unit (ICU) admissions, 23% intubations, and 13% deaths. Elderly patients had greater imaging utilization, hospitalizations, ICU/intuba-tion requirements, longer hospital stays, and a greater than fourfold increase in mortality compared with nonelderly patients (adjusted hazard ratio [aHR] 4.79, P < .001). Self-reported minorities had fewer ICU admissions (P = .03) and reduced hazard for mortality (aHR 0.53, P = .004; complete case analysis: aHR 0.39, P