Race, Ethnicity, and 60-Day Outcomes After Hospitalization With COVID-19

Abstract

Objective: To examine racial and ethnic disparities in clinical, financial, and mental health outcomes within a diverse sample of hospitalized COVID-19-positive patients in the 60 days postdischarge.

Design: A cross-sectional study.

Setting and participants: A total of 2217 adult patients who were hospitalized with a COVID-19-positive diagnosis as evidenced by test (reverse-transcriptase polymerase chain reaction), a discharge diagnosis of COVID-19 (ICD-10 code U07.1), or strong documented clinical suspicion of COVID-19 but no testing completed or recorded owing to logistical constraints (n=24).

Methods: Patient records were abstracted for the Mi-COVID19 data registry, including the hospital and insurer data of patients discharged from one of 38 participating hospitals in Michigan between March 16, 2020, and July 1, 2020. Registry data also included patient responses to a brief telephone survey on postdischarge employment, mental and emotional health, persistence of COVID-19-related symptoms, and medical follow-up. Descriptive statistics were used to summarize data; analysis of variance and Pearson chi-squared test were used to evaluate racial and ethnic variances among patient outcomes and survey responses.

Results: Black patients experienced the lowest physician follow-up postdischarge (n = 65, 60.2%) and the longest delays in returning to work (average 35.5 days). More than half of hospital readmissions within the 60 days following discharge were among nonwhite patients (n = 144, 55%). The majority of postdischarge deaths were among white patients (n = 153, 21.5%), most of whom were discharged on palliative care (n = 103). Less than a quarter of patients discharged back to assisted living, skilled nursing facilities, or subacute rehabilitation facilities remained at those locations in the 60 days following discharge (n = 48).

Conclusions and implications: Increased attention to postdischarge care coordination is critical to reducing negative health outcomes following a COVID-19-related hospitalization.

Keywords: Continuity of patient care; Michigan; hospitalization; questionnaires; registries; surveys.

Fig. 1

Flow chart of patient follow-up process for the Mi-COVID19 registry. Overall, 80.6% (n=1787) of the initial sample were eligible for 60-day medical record review, and 62.9% (n=1395) of the sample were eligible for the 60-day phone call.