COVID-19 shutdown: impact of healthcare disruptions on cardiovascular health disparities among people with multiple chronic conditions in New York City.

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PROJECT SUMMARY In the first half of 2020, the SARS-CoV-2 (COVID-19) pandemic infected nearly 4 million persons in the U.S. and caused over 150,000 deaths. In the midst of the early phase of this pandemic, people with multiple chronic conditions (MCC) including diabetes, hypertension, obesity, and dyslipidemia, which are increasingly common with age, were left extremely vulnerable to disruptions in healthcare delivery; in New York City (NYC), the first U.S. epicenter of the COVID-19 outbreak, traditional ambulatory care ceased entirely for several months and then reopened at only limited capacity. Implementation of telemedicine and modified in-person visits to bridge this gap was attempted but adopted unevenly, and differential uptake may have worsened existing health disparities. In this context, the unprecedented pandemic-disruption in ambulatory care in NYC provides a singular opportunity to study the long-term effects of disasters on health care systems serving health disparity populations. Our institution, NYU Grossman School of Medicine (NYUGSOM), is uniquely positioned to answer these questions, having been at the center of the COVID-19 pandemic in NYC. We have robust existing data partnerships with the INSIGHT Clinical Research Network, which includes a standardized electronic health record (EHR) network of 5 NYC academic medical centers, and with the NYC Health and Hospitals Corporation (NYC-H+H), the largest public hospital system in the U.S. We will leverage these 2 sources to determine, among people age ≥50 with MCCs (≥2 chronic medical conditions), whether patterns of health system engagement during the acute pandemic disruption phase (3/7/20-7/9/2020) influenced trajectories of 2 chronic diseases (hypertension and diabetes) at 2 years, risk of cardiovascular events at 4 years, and whether disparities in engagement exacerbated health inequities. In Aim 1 we will characterize ambulatory healthcare utilization and quantify disruptions in healthcare services (total disruption vs. delayed care vs. sufficient care) during the acute pandemic phase, overall and by subgroup (e.g. racial/ethnic minority, economically disadvantaged). In Aim 2 we will then assess the impact of total disruption and delayed care in healthcare on 2-year trajectories of chronic disease measures (mean systolic blood pressure, hemoglobin A1c), and in Aim 3 we will measure the impact of healthcare disruptions on major adverse cardiovascular outcomes in the 4 years after the acute pandemic period, and identify their impacts on disparities in CVD outcomes using causal mediation analysis methods. Our findings will guide future disaster preparedness planning and allow health care systems to develop optimal care models to mitigate CVD risk and avoid worsening disparities among socioeconomically disadvantaged and/or minority populations. The MPIs for this project (Dr. Dodson and Dr. Thorpe) combine research experience in cardiovascular medicine, gerontology, epidemiology, and data science, and are joined by Co-I’s (Dr. Divers, Dr. Adhikari, Dr. Vedanthan, Dr. Blecker, Dr. Weiner) who bring expertise in health disparities research, implementation science, biostatistics, and use of EHRs.