The Impact of Sociodemographic Factors, Comorbidities and Physiologic Response on 30-day Mortality in COVID-19 Patients in Metropolitan Detroit

Miller, Joseph; Fadel, Raef A; Tang, Amy; Perrotta, Giuseppe; Herc, Erica; Soman, Sandeep; Nair, Sashi; Hanna, Zachary; Zervos, Marcus J; Alangaden, George; Brar, Indira; Suleyman, Geehan

BACKGROUND: The relationship of health disparities and comorbidities in coronavirus disease 2019 (COVID-19) related outcomes are an ongoing area of interest. This report assesses risk factors associated with mortality in patients presenting with Covid-19 infection and healthcare disparities. METHODS: A retrospective cohort study of consecutive patients presenting to emergency departments within an integrated health system who tested positive for COVID-19 between March 7 and April 30, 2020 in Metropolitan Detroit. The primary outcomes were hospitalization and 30-day mortality. RESULTS: A total of 3,633 patients with mean age of 58 years were included. The majority were female and black non-Hispanic. Sixty-four percent required hospitalization, 56% of whom were black. Hospitalized patients were older, more likely to reside in a low-income area, and had a higher burden of comorbidities. By 30-days, 433 (18.7%) hospitalized patients died. In adjusted analyses, the presence of comorbidities, age >60 years and more severe physiological disturbance were associated with 30-day mortality. Residence in low income areas (odds ratio, 1.02; 95% confidence interval 0.76 – 1.36), and public insurance (odds ratio, 1.24; 95% confidence interval 0.76 – 2.01) were not independently associated with higher risk of mortality. Black female patients had a lower adjusted risk of mortality (odds ratio, 0.46; 95% confidence interval, 0.27 to 0.78). CONCLUSIONS: In this large cohort of COVID-19 patients, those with comorbidities, advanced age, and physiological abnormalities on presentation had higher odds of death. Disparities in income or source of health insurance were not associated with outcomes. Black women had a lower risk of dying.