Estimating the effects of race and social vulnerability on hospital admission and mortality from COVID-19.
Estimating the effects of race and social vulnerability on hospital admission and mortality from COVID-19.
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DOI：
10.1093/jamiaopen/ooab111
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发表时间：
2021-10
期刊：
影响因子：
2.1
通讯作者：
Foraker RE
中科院分区：
文献类型：
--
作者：
Landman JM;Steger-May K;Joynt Maddox KE;Hammond G;Gupta A;Rauseo AM;Zhao M;Foraker RE
估计患者因COVID-19住院和死亡的风险，并衡量种族和地区社会脆弱性与这些结果的关联。使用2020年4月至2020年10月在多地点医院系统收集的患者记录，使用广义估计方程分别估计了COVID-19检测呈阳性和因COVID-19入院的患者的入院风险和死亡风险，同时控制了患者种族、患者地区层面的社会脆弱性和大流行的时间进程。黑人住院的可能性是白色人的3.57倍（95%CI，3.18-4.00），生活在最贫困地区的患者住院的可能性是生活在最贫困地区的患者的2.61倍（95%CI，2.26-3.02）。虽然黑人患者的原始死亡率低于白色患者，但在控制合并症和社会脆弱性后，死亡率相似。我们的研究结果指出了种族和社会经济地位的强有力的相关性，包括资源分配，就业和共享的生活空间，这可能与不同种族患者之间的不公平疾病负担有关。公共卫生和政策干预措施在应对下一次大流行时应解决这些社会因素。我们使用来自多个地点和两个州的医院系统的记录，研究了患者在大流行的前6个月因COVID-19住院和死亡的风险。具体来说，我们测量了种族和社会脆弱性与入院和死亡可能性的关联。我们的统计模型显示，黑人患者住院的可能性是白色患者的3.57倍。我们还考虑到了特定美国人口普查区域的社会脆弱性，当将其纳入我们的模型时，我们估计生活在最贫困地区的患者住院的可能性是生活在最贫困地区的患者的2.61倍。我们发现，在控制潜在条件和社会脆弱性的情况下，不同种族的死亡率没有差异。这些研究结果表明，公共卫生和政策干预措施应该解决资源分配、就业和共享生活空间等问题，以及其他可能与种族、社会经济地位和不同种族患者之间不公平的疾病负担有关的社会因素。
To estimate the risk of hospital admission and mortality from COVID-19 to patients and measure the association of race and area-level social vulnerability with those outcomes. Using patient records collected at a multisite hospital system from April 2020 to October 2020, the risk of hospital admission and the risk of mortality were estimated for patients who tested positive for COVID-19 and were admitted to the hospital for COVID-19, respectively, using generalized estimating equations while controlling for patient race, patient area-level social vulnerability, and time course of the pandemic. Black individuals were 3.57 as likely (95% CI, 3.18–4.00) to be hospitalized than White people, and patients living in the most disadvantaged areas were 2.61 times as likely (95% CI, 2.26–3.02) to be hospitalized than those living in the least disadvantaged areas. While Black patients had lower raw mortality than White patients, mortality was similar after controlling for comorbidities and social vulnerability. Our findings point to potent correlates of race and socioeconomic status, including resource distribution, employment, and shared living spaces, that may be associated with inequitable burden of disease across patients of different races. Public health and policy interventions should address these social factors when responding to the next pandemic. Using records from a hospital system spanning multiple sites and 2 states, we examined patients’ risk of hospital admission and death due to COVID-19 over the first 6 months of the pandemic. Specifically, we measured the association of race and social vulnerability with the likelihood of admission and death. Our statistical models showed that Black patients were 3.57 times more likely than White patients to be hospitalized. We also took into account how socially vulnerable a given US Census tract is, and when incorporating that into our models, we estimated that patients living in the most disadvantaged areas were 2.61 times as likely to be hospitalized as those living in the least disadvantaged areas. We found no difference in mortality by race when controlling for underlying conditions and social vulnerability. These findings suggest that public health and policy interventions should address such things as resource distribution, employment, and shared living spaces, and other social factors that may be associated with race, socioeconomic status, and the inequitable burden of disease across patients of different races.
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影响因子：
13.8
作者：
Muñoz-Price LS;Nattinger AB;Rivera F;Hanson R;Gmehlin CG;Perez A;Singh S;Buchan BW;Ledeboer NA;Pezzin LE
通讯作者：
Pezzin LE
影响因子：
3.7
作者：
Fielding-Miller RK;Sundaram ME;Brouwer K
通讯作者：
Brouwer K
影响因子：
3
作者：
Moore, Brian J.;White, Susan;Elixhauser, Anne
通讯作者：
Elixhauser, Anne
DOI：
10.1177/1090198120929677
发表时间：
2020-08
期刊：
Health education & behavior : the official publication of the Society for Public Health Education
影响因子：
--
作者：
Kim SJ;Bostwick W
通讯作者：
Bostwick W
影响因子：
3.1
作者：
Harling G;Subramanian S;Bärnighausen T;Kawachi I
通讯作者：
Kawachi I