The impact of disparities in social determinants of health on hospitalization rates for patients with covid-19 in michigan (USA)

Abstract

Importance: The COVID-19 pandemic continues to impact the health-care system in the United States and has brought further light on health disparities within it. However, only a few studies have examined hospitalization risk with regard to social determinants of health. Objective: We aimed to identify how health disparities affect hospitalization rates among patients with COVID-19. Design: This observational study included all individuals diagnosed with COVID-19 from February 25, 2020 to December 31, 2020. Uni-and multivariate analyses were utilized to evaluate associations between demographic data and inpatient versus outpatient status for patients with COVID-19. Setting: Multicenter (8 hospitals), largest size health system in Southeast Michigan, a region highly impacted by the pandemic. Participants: All outpatients and inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab were included. Exclusion criteria included missing demographic data or status as a non-permanent Michigan resident. Exposure: Patients who met inclusion and exclusion criteria were divided in 2 groups: outpatients and inpatients. Main Outcome and Measures: We described the comparative demographics and known disparities associated with hospitalization status. Results: Of 30,292 individuals who tested positive for SARS-CoV-2, 34.01% were admitted to the hospital. White or Caucasian race was most prevalent (57.49%), and 23.35% were African-American. The most common ethnicity was non-Hispanic or Latino (70.48%). English was the primary language for the majority of patients (91.60%). Private insurance holders made up 71.11% of the sample. Within the hospitalized patients, lower socioeconomic status, African-American race and Hispanic and Latino ethnicity, non-English speaking status, and Medicare and Medicaid were more likely to be admitted to the hospital. Conclusions and Relevance: Several health disparities were associated with greater rates of hospitalization due to COVID-19. Addressing these inequalities from an individual to system level may improve health-care outcomes for those with health disparities and COVID-19.