Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Covariates
- a.
- Patient level: Age, comorbidities, insurance status, income in patient’s zip code, disposition.
- b.
- Hospital level: Location, teaching status, bed size, region.
- c.
- Illness severity: Length of stay (LOS), mortality, hospitalization cost, Elixhauser comorbidity score, in-hospital complications, mechanical ventilation, vasopressor use, acute kidney injury (AKI) requiring hemodialysis (HD).
2.3. Study Outcomes
2.4. Statistical Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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White (820,290) | Black (306,991) | Hispanics (345,935) | Asians (52,326) | Native Americans (16,560) | Others (69,050) | p Value | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Variables | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | |
N (%) | 432,293 (52.7%) | 387,997 (47.3%) | 144,900 (47.2%) | 162,091 (52.8%) | 186,113 (53.8%) | 159,822 (46.2%) | 27,628 (52.8%) | 24,698 (47.2%) | 7982 (48.2%) | 8578 (51.8%) | 38,806 (56.2%) | 30,244 (43.8%) | <0.001 |
Mean Age (SD) | 67.94 (15.08) | 68.29 (17.2) | 60.05 (15.78) | 60.03 (18.1) | 57.01 (16.2) | 54.76 (19.46) | 62.05 (16.2) | 62.58 (18.5) | 56.86 (16.35) | 55.95 (17.26) | 59.33 (16.32) | 58.51 (19.45) | <0.001 |
Age Groups | |||||||||||||
≥18–29 | 8214 (1.9%) | 15,132 (3.9%) | 6231 (4.3%) | 11,995 (7.4%) | 9120 (4.9%) | 21,097 (13.2%) | 884 (3.2%) | 1507 (6.1%) | 439 (5.5%) | 609 (7.1%) | 1630 (4.2%) | 3024 (10.0%) | <0.001 |
30–49 | 43,662 (10.1%) | 41,128 (10.6%) | 29,124 (20.1%) | 31,446 (19.4%) | 52,670 (28.3%) | 42,513 (26.6%) | 5387 (19.5%) | 4396 (17.8%) | 2235 (28.0%) | 2453 (28.6%) | 9119 (23.5%) | 6623 (21.9%) | <0.001 |
50–69 | 157,355 (36.4%) | 119,503 (30.8%) | 66,944 (46.2%) | 64,998 (40.1%) | 80,401 (43.2%) | 55,139 (34.5%) | 11,991 (43.4%) | 8817 (35.7%) | 3321 (41.6%) | 3526 (41.1%) | 16,842 (43.4%) | 10,737 (35.5%) | <0.001 |
≥70 | 223,062 (51.6%) | 212,622 (54.8%) | 42,601 (29.4%) | 53,652 (33.1%) | 44,109 (23.7%) | 41,234 (25.8%) | 9366 (33.9%) | 9978 (40.4%) | 1988 (24.9%) | 1990 (23.2%) | 11,215 (28.9%) | 9860 (32.6%) | <0.001 |
Median Household Income | |||||||||||||
<50,000$ | 115,855 (26.8%) | 107,087 (27.6%) | 70,277 (48.5%) | 80,883 (49.9%) | 69,048 (37.1%) | 62,331 (39.0%) | 4227 (15.3%) | 3976 (16.1%) | 4558 (57.1%) | 4975 (58.0%) | 10,400 (26.8%) | 8468 (28.0%) | <0.001 |
50,000–64,999$ | 126,230 (29.2%) | 114,459 (29.5%) | 25,502 (17.6%) | 30,959 (19.1%) | 50,623 (27.2%) | 42,832 (26.8%) | 6133 (22.2%) | 5878 (23.8%) | 1796 (22.5%) | 2024 (23.6%) | 9702 (25.0%) | 7349 (24.3%) | <0.001 |
65,000–85,999$ | 104,615 (24.2%) | 92,343 (23.8%) | 42,166 (29.1%) | 45,385 (28.0%) | 43,178 (23.2%) | 36,120 (22.6%) | 7984 (28.9%) | 6965 (28.2%) | 1030 (12.9%) | 1089 (12.7%) | 9236 (23.8%) | 7168 (23.7%) | <0.001 |
>86,000$ | 85,594 (19.8%) | 73,719 (19.0%) | 6955 (4.8%) | 4863 (3.0%) | 23,264 (12.5%) | 18,539 (11.6%) | 9283 (33.6%) | 7903 (32.0%) | 599 (7.5%) | 489 (5.7%) | 9469 (24.4%) | 7259 (24.0%) | <0.001 |
Insurance status | |||||||||||||
Medicare | 27,4506 (63.5%) | 257,630 (66.4%) | 72,450 (50.0%) | 85,421 (52.7%) | 63,465 (34.1%) | 53,381 (33.4%) | 11,106 (40.2%) | 10,867 (44.0%) | 3456 (43.3%) | 3689 (43.0%) | 14,746 (38.0%) | 12,370 (40.9%) | <0.001 |
Medicaid | 28,531 (6.6%) | 29,876 (7.7%) | 33,617 (23.2%) | 36,308 (22.4%) | 46,,342 (24.9%) | 53,700 (33.6%) | 4752 (17.2%) | 5038 (20.4%) | 2355 (29.5%) | 2788 (32.5%) | 8266 (21.3%) | 8015 (26.5%) | <0.001 |
Private | 119,745 (27.7%) | 94,671 (24.4%) | 23,039 (15.9%) | 24,962 (15.4%) | 58,253 (31.3%) | 41,234 (25.8%) | 10,803 (39.1%) | 8101 (32.8%) | 1924 (24.1%) | 1870 (21.8%) | 12,728 (32.8%) | 8378 (27.7%) | <0.001 |
Self-pay | 9510 (2.2%) | 6208 (1.6%) | 15,939 (11.0%) | 15,399 (9.5%) | 17,867 (9.6%) | 11,507 (7.2%) | 967 (3.5%) | 692 (2.8%) | 247 (3.1%) | 232 (2.7%) | 3066 (7.9%) | 1482 (4.9%) | <0.001 |
Hospital bedsize | |||||||||||||
Small | 110,667 (25.6%) | 101,267 (26.1%) | 34,051 (23.5%) | 38,415 (23.7%) | 41,131 (22.1%) | 33,882 (21.2%) | 5857 (21.2%) | 5458 (22.1%) | 1652 (20.7%) | 2016 (23.5%) | 8110 (20.9%) | 6109 (20.2%) | <0.001 |
Medium | 123,204 (28.5%) | 111,355 (28.7%) | 41,007 (28.3%) | 45,710 (28.2%) | 56,020 (30.1%) | 48,746 (30.5%) | 7763 (28.1%) | 6915 (28.0%) | 2187 (27.4%) | 2024 (23.6%) | 13,116 (33.8%) | 10,404 (34.4%) | <0.001 |
Large | 198,422 (45.9%) | 175,375 (45.2%) | 69,842 (48.2%) | 78,128 (48.2%) | 88,962 (47.8%) | 77,354 (48.4%) | 14,007 (50.7%) | 12,324 (49.9%) | 4143 (51.9%) | 4538 (52.9%) | 17,579 (45.3%) | 13,731 (45.4%) | <0.001 |
Hosptal teaching status | |||||||||||||
Rural | 59,656 (13.8%) | 55,872 (14.4%) | 9998 (6.9%) | 11,995 (7.4%) | 5583 (3.0%) | 5114 (3.2%) | 470 (1.7%) | 445 (1.8%) | 1373 (17.2%) | 1784 (20.8%) | 1281 (3.3%) | 1089 (3.6%) | <0.001 |
Urban non-teaching | 87,755 (20.3%) | 79,539 (20.5%) | 20,431 (14.1%) | 23,179 (14.3%) | 37,409 (20.1%) | 31,165 (19.5%) | 5028 (18.2%) | 4470 (18.1%) | 1133 (14.2%) | 1184 (13.8%) | 6403 (16.5%) | 4869 (16.1%) | <0.001 |
Urban teaching | 284,881 (65.9%) | 252,586 (65.1%) | 114,471 (79.0%) | 126,917 (78.3%) | 143,121 (76.9%) | 123,542 (77.3%) | 22,158 (80.2%) | 19,783 (80.1%) | 5476 (68.6%) | 5601 (65.3%) | 31,161 (80.3%) | 24,286 (80.3%) | <0.001 |
Comorbidities | |||||||||||||
CAD | 123,636 (28.6%) | 67,123 (17.3%) | 24,343 (16.8%) | 21,396 (13.2%) | 23,264 (12.5%) | 12,946 (8.1%) | 4559 (16.5%) | 2593 (10.5%) | 1317 (16.5%) | 695 (8.1%) | 6054 (15.6%) | 2813 (9.3%) | <0.001 |
CHF | 92,511 (21.4%) | 76,823 (19.8%) | 30,284 (20.9%) | 31,446 (19.4%) | 21,031 (11.3%) | 15,023 (9.4%) | 3675 (13.3%) | 2890 (11.7%) | 1317 (16.5%) | 1089 (12.7%) | 4851 (12.5%) | 3539 (11.7%) | <0.001 |
HTN uncomplicated | 170,323 (39.4%) | 153,647 (39.6%) | 55,931 (38.6%) | 66,457 (41.0%) | 64,953 (34.9%) | 54,180 (33.9%) | 11,079 (40.1%) | 10,052 (40.7%) | 2802 (35.1%) | 2736 (31.9%) | 14,009 (36.1%) | 10,979 (36.3%) | <0.001 |
HTN complicated | 131,849 (30.5%) | 105,923 (27.3%) | 55,062 (38.0%) | 51,707 (31.9%) | 36,664 (19.7%) | 26,530 (16.6%) | 4780 (17.3%) | 4470 (18.1%) | 1996 (25.0%) | 1819 (21.2%) | 8110 (20.9%) | 5474 (18.1%) | <0.001 |
DM uncomplicated | 57,927 (13.4%) | 48,888 (12.6%) | 22,749 (15.7%) | 27,880 (17.2%) | 29,964 (16.1%) | 26,690 (16.7%) | 8316 (30.1%) | 6644 (26.9%) | 1301 (16.3%) | 1570 (18.3%) | 6325 (16.3%) | 4839 (16.0%) | <0.001 |
DM complicated | 111,099 (25.7%) | 82,255 (21.2%) | 48,252 (33.3%) | 49,924 (30.8%) | 54,717 (29.4%) | 41,554 (26.0%) | 6824 (24.7%) | 5359 (21.7%) | 2786 (34.9%) | 2959 (34.5%) | 10,516 (27.1%) | 6835 (22.6%) | <0.001 |
Renal failure | 101,157 (23.4%) | 74,883 (19.3%) | 47,237 (32.6%) | 39,712 (24.5%) | 31,081 (16.7%) | 21,097 (13.2%) | 5968 (21.6%) | 4446 (18.0%) | 1572 (19.7%) | 1475 (17.2%) | 6830 (17.6%) | 4264 (14.1%) | <0.001 |
Chronic pulmonary disease | 105,479 (24.4%) | 112,519 (29.0%) | 27,676 (19.1%) | 41,009 (25.3%) | 20,659 (11.1%) | 25,572 (16.0%) | 4365 (15.8%) | 4001 (16.2%) | 1261 (15.8%) | 2024 (23.6%) | 5239 (13.5%) | 5293 (17.5%) | <0.001 |
Obesity | 98,131 (22.7%) | 99,327 (25.6%) | 35,501 (24.5%) | 58,839 (36.3%) | 47,459 (25.5%) | 47,787 (29.9%) | 3813 (13.8%) | 3606 (14.6%) | 2035 (25.5%) | 2762 (32.2%) | 7645 (19.7%) | 7138 (23.6%) | <0.001 |
Smoking | 153,464 (35.5%) | 100,103 (25.8%) | 42,456 (29.3%) | 32,580 (20.1%) | 40,945 (22.0%) | 17,421 (10.9%) | 6990 (25.3%) | 2149 (8.7%) | 2315 (29.0%) | 2162 (25.2%) | 8576 (22.1%) | 3508 (11.6%) | <0.001 |
White (820,290) | Black (306,991) | Hispanics (345,935) | Asians (52,326) | Native (16,560) | Others (69,050) | p Value | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | ||
Disposition | |||||||||||||
Home/Routine | 242,516 (56.1%) | 199,430 (51.4%) | 87,809 (60.6%) | 99,524 (61.4%) | 137,165 (73.7%) | 120,825 (75.6%) | 18,842 (68.2%) | 16,449 (66.6%) | 5532 (69.3%) | 6313 (73.6%) | 26,388 (68.0%) | 20,717 (68.5%) | <0.001 |
SNF/LTAC/Nursing home | 111,532 (25.8%) | 116,787 (30.1%) | 33,907 (23.4%) | 32,094 (19.8%) | 23,450 (12.6%) | 17,421 (10.9%) | 4448 (16.1%) | 4174 (16.9%) | 1477 (18.5%) | 1227 (14.3%) | 6558 (16.9%) | 4960 (16.4%) | <0.001 |
Home health | 71,761 (16.6%) | 68,675 (17.7%) | 19,562 (13.5%) | 28,366 (17.5%) | 21,961 (11.8%) | 19,658 (12.3%) | 4006 (14.5%) | 3927 (15.9%) | 790 (9.9%) | 884 (10.3%) | 5006 (12.9%) | 4264 (14.1%) | <0.001 |
AMA | 6052 (1.4%) | 3104 (0.8%) | 3623 (2.5%) | 2107 (1.3%) | 3350 (1.8%) | 1758 (1.1%) | 332 (1.2%) | 123 (0.5%) | 184 (2.3%) | 154 (1.8%) | 776 (2.0%) | 302 (1.0%) | 0.17 |
AKI | 138,766 (32.1%) | 92,731 (23.9%) | 64,046 (44.2%) | 52,355 (32.3%) | 48,762 (26.2%) | 27,649 (17.3%) | 8758 (31.7%) | 5557 (22.5%) | 2219 (27.8%) | 1673 (19.5%) | 11,758 (30.3%) | 6563 (21.7%) | <0.001 |
AKI with HD | 9078 (2.1%) | 4268 (1.1%) | 7390 (5.1%) | 5025 (3.1%) | 6700 (3.6%) | 2877 (1.8%) | 995 (3.6%) | 395 (1.6%) | 327 (4.1%) | 163 (1.9%) | 1358 (3.5%) | 514 (1.7%) | <0.001 |
Cardiac arrest | 10,807 (2.5%) | 6596 (1.7%) | 5941 (4.1%) | 4863 (3.0%) | 7631 (4.1%) | 4155 (2.6%) | 1077 (3.9%) | 519 (2.1%) | 295 (3.7%) | 172 (2.0%) | 1513 (3.9%) | 877 (2.9%) | <0.001 |
Intubation | 72,193 (16.7%) | 46,948 (12.1%) | 27,096 (18.7%) | 23,827 (14.7%) | 37,781 (20.3%) | 20,937 (13.1%) | 5940 (21.5%) | 3433 (13.9%) | 2099 (26.3%) | 1681 (19.6%) | 8110 (20.9%) | 4355 (14.4%) | <0.001 |
Vasopressor use | 10,807 (2.5%) | 6596 (1.7%) | 4782 (3.3%) | 4214 (2.6%) | 7072 (3.8%) | 3676 (2.3%) | 1326 (4.8%) | 766 (3.1%) | 216 (2.7%) | 146 (1.7%) | 1475 (3.8%) | 877 (2.9%) | <0.001 |
Stroke | 6917 (1.6%) | 5044 (1.3%) | 3043 (2.1%) | 2593 (1.6%) | 2978 (1.6%) | 1918 (1.2%) | 525 (1.9%) | 469 (1.9%) | 112 (1.4%) | 77 (0.9%) | 893 (2.3%) | 484 (1.6%) | <0.001 |
Died | 66,573 (15.4%) | 47,724 (12.3%) | 19,996 (13.8%) | 17,506 (10.8%) | 27,359 (14.7%) | 16,302 (10.2%) | 4476 (16.2%) | 2964 (12.0%) | 1509 (18.9%) | 1209 (14.1%) | 6054 (15.6%) | 3750 (12.4%) | <0.001 |
Mean LOS | 7.9 | 7.2 | 9.0 | 8.0 | 9.4 | 7.3 | 9.1 | 7.6 | 9.0 | 8.2 | 9.4 | 7.6 | <0.001 |
Mean TOTCHG | 84,639.4 | 69,127 | 98,138.8 | 82,105.2 | 136,746 | 99,750 | 12,8947.9 | 98,974.5 | 106,172 | 88,653 | 132,199.6 | 101,390.5 | <0.001 |
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Pal, S.; Gangu, K.; Garg, I.; Shuja, H.; Bobba, A.; Chourasia, P.; Shekhar, R.; Sheikh, A.B. Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample. Vaccines 2022, 10, 2036. https://doi.org/10.3390/vaccines10122036
Pal S, Gangu K, Garg I, Shuja H, Bobba A, Chourasia P, Shekhar R, Sheikh AB. Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample. Vaccines. 2022; 10(12):2036. https://doi.org/10.3390/vaccines10122036
Chicago/Turabian StylePal, Suman, Karthik Gangu, Ishan Garg, Hina Shuja, Aniesh Bobba, Prabal Chourasia, Rahul Shekhar, and Abu Baker Sheikh. 2022. "Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample" Vaccines 10, no. 12: 2036. https://doi.org/10.3390/vaccines10122036
APA StylePal, S., Gangu, K., Garg, I., Shuja, H., Bobba, A., Chourasia, P., Shekhar, R., & Sheikh, A. B. (2022). Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample. Vaccines, 10(12), 2036. https://doi.org/10.3390/vaccines10122036