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Observational Study
. 2021 Nov;16(11):659-666.
doi: 10.12788/jhm.3717.

Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19

Ferdinand Velasco  1 , Donghan M Yang  2 , Minzhe Zhang  2 , Tanna Nelson  1 , Thomas Sheffield  2 , Tony Keller  1 , Yiqing Wang  2 , Clark Walker  1 , Chaitanya Katterapalli  1 , Kelli Zimmerman  1 , Andrew Masica  1 , Christoph U Lehmann  3 , Yang Xie  2 , John W Hollingsworth  4   5
Affiliations
Observational Study

Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19

Ferdinand Velasco et al. J Hosp Med. 2021 Nov.

Abstract

Background: Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths.

Objective: To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors.

Design, setting, participants: Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020.

Exposures: Self-reported ethnicity and primary language.

Main outcomes and measures: Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes.

Results: 32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10- 1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001).

Conclusion: The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.

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Figures

FIG 1
FIG 1
Intensive Care Unit Admission Rate and Mortality Rate Among Ethnic-Language Groups. P values are shown above the brackets. Abbreviations: ICU, intensive care unit; OR, odds ratio.
FIG 2
FIG 2
Baseline Disease Severity Among Ethnic-Language Groups. P values are shown above the brackets. Abbreviations: CRP, C-reactive protein; EDI, Epic Deterioration Index; ICU, intensive care unit; MSOFA, Modified Sequential Organ Failure Assessment; OR, odds ratio.
See this image and copyright information in PMC

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