Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;36(5):1302-1309.
doi: 10.1007/s11606-020-06527-1. Epub 2021 Jan 27.

Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19

Daniel Quan  1 , Lucía Luna Wong  1 , Anita Shallal  2 , Raghav Madan  1 , Abel Hamdan  1 , Heaveen Ahdi  1 , Amir Daneshvar  1 , Manasi Mahajan  1 , Mohamed Nasereldin  1 , Meredith Van Harn  3 , Ijeoma Nnodim Opara  4 , Marcus Zervos  5   6
Affiliations

Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19

Daniel Quan et al. J Gen Intern Med. 2021 May.

Abstract

Background: The impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19).

Objective: To evaluate the association between patient sociodemographics and neighborhood disadvantage with frequencies of death, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission in patients hospitalized with COVID-19.

Design: Retrospective cohort study.

Setting: Four hospitals in an integrated health system serving southeast Michigan.

Participants: Adult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction.

Main measures: Patient sociodemographics, comorbidities, and clinical outcomes were collected. Neighborhood socioeconomic variables were obtained at the census tract level from the 2018 American Community Survey. Relationships between neighborhood median income and clinical outcomes were evaluated using multivariate logistic regression models, controlling for patient age, sex, race, Charlson Comorbidity Index, obesity, smoking status, and living environment.

Key results: Black patients lived in significantly poorer neighborhoods than White patients (median income: $34,758 (24,531-56,095) vs. $63,317 (49,850-85,776), p < 0.001) and were more likely to have Medicaid insurance (19.4% vs. 11.2%, p < 0.001). Patients from neighborhoods with lower median income were significantly more likely to require IMV (lowest quartile: 25.4%, highest quartile: 16.0%, p < 0.001) and ICU admission (35.2%, 19.9%, p < 0.001). After adjusting for age, sex, race, and comorbidities, higher neighborhood income ($10,000 increase) remained a significant negative predictor for IMV (OR: 0.95 (95% CI 0.91, 0.99), p = 0.02) and ICU admission (OR: 0.92 (95% CI 0.89, 0.96), p < 0.001).

Conclusions: Neighborhood disadvantage, which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19. Measures of neighborhood disadvantage should be used to inform policies that aim to reduce COVID-19 disparities in the Black community.

Keywords: COVID-19; disadvantage; disparities; race; socioeconomic status.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Comment in

References

    1. Centers for Disease Control and Prevention. CDC COVID Data Tracker; https://covid.cdc.gov/covid-data-tracker/#cases_casesinlast7days.
    1. Byrne P, McNamara B, Todd B, Tanner K. Michigan coronavirus cases: Tracking the pandemic. 2020.
    1. Whitmer G. Whitmer: Virus trains harsh spotlight on racial health disparities. 2020.
    1. The Covid Tracking Project . Racial Data Dashboard. 2020.
    1. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5). - PMC - PubMed