New Paper (Other): Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California

[dziakj1]

Title: Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California

General Information

Please paste a link to the paper or a citation here:

Link: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00598

What is the paper's Manubot-style citation?

Citation: @doi:10.1377/hlthaff.2020.00598

Is this paper primarily relevant to Background or Pathogenesis?

• [x] Background
• [ ] Pathogenesis
• [ ] Methods

Please list some keywords (3-10) that help identify the relevance of this paper to COVID-19

• African Americans
• disparities
• electronic health records
• delay of care

Please note the publication / review status

• [ ] Pre-print
• [x] New Peer-Reviewed Paper
• [ ] Peer-Reviewed Paper Pre-2020

Which areas of expertise are particularly relevant to the paper?

• [ ] virology
• [x] epidemiology
• [ ] biostatistics
• [ ] immunology
• [ ] pharmacology
• [ ] other:

[dziakj1]

This paper is briefly summarized here: https://www.medicaleconomics.com/view/african-americans-covid-19-more-likely-be-hospitalized-whites

[dziakj1]

Summary

"...We conducted a retrospective cohort analysis of COVID-19 patients at Sutter Health, a large integrated health system in northern California, to measure potential disparities. We used Sutter’s integrated electronic health record to identify adults with suspected and confirmed COVID-19, and we used multivariable logistic regression to assess risk of hospitalization, adjusting for known risk factors, such as race/ethnicity, sex, age, health, and socioeconomic variables. We analyzed 1,052 confirmed cases of COVID-19 from the period January 1–April 8, 2020. Among our findings, we observed that compared with non-Hispanic white patients, non- Hispanic African American patients had 2.7 times the odds of hospitalization, after adjustment for age, sex, comorbidities, and income. We explore possible explanations for this, including societal factors that either result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option..."

Suggested questions to answer about each paper:

• What did they analyze?

Retrospective analysis of health system records for "1,052 confirmed cases of COVID-19 from the period January 1–April 8, 2020."

• What methods did they use?

Multivariate logistic regression, as well as univariate analyses, predicting likelihood of being hospitalized for COVID-19 conditional upon being diagnosed with COVID-19.

• Does this paper study COVID-19, SARS-CoV-2, or a related disease and/or virus? Yes, this is specifically COVID-19.

• What is the main finding (or a few main takeaways)?

  • "We found that African Americans with confirmed COVID-19 are significantly more likely to be admitted to the hospital than their white counterparts, after sociodemographics, clinical factors, and income are controlled for."
  • "We hypothesize that these results are primarily explained by societal factors that either result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option."
  • "The disparity ... might not be in who is tested, but in when testing occurs."

• What does this paper tell us about the background and/or diagnostics/therapeutics for COVID-19 / SARS-CoV-2? They seem to be suggesting that African Americans are less likely to receive help and testing in the early stage of the illness -- whether because of past bad experiences causing distrust of the medical system, or because of inflexible job responsibilities, or because of less access to clinics -- and that therefore they are less likely to be seen by medical professionals unless or until the condition is more serious.

• Do you have any concerns about methodology or the interpretation of these results beyond this analysis?

It seems to be well done and is in a very reputable journal. Note that it isn't a study of infection rate, but of what happens after infection.

[dziakj1]

Additional findings were that older age, congestive heart failure, and male sex, were also associated with higher adjusted odds of admission.

They don't appear to have used multiple comparisons correction.