Distance and clinical outcomes of patients admitted for covid-19: Lessons learned from the neighbors of an inner-city hospital

Patel, S.; Kazmi, A.; Sherif, M.; Chennu, G.; Lee, S.; Khan, U.; Safoah, N.; Mallam, S.; Chakka, S.; Bustillo, J.; Okoh, A. K.

Background: In rural areas, the distance factor has been identified as key in the utilization of health services. We aim to determine whether distance to an inner-city hospital in Newark, was associated with mortality in patients admitted for COVID-19 during the peak of the pandemic. Methods: Patients who were admitted for COVID-19 at the Newark Beth Israel Medical Center (NBIMC) were stratified into two groups based on distance between the zip codes of their primary residence and the hospital. Baseline demographics, clinical characteristics and in-hospital outcomes were compared between subjects living within a 2-mile radius of the zip code of the hospital [Neighbors] and those living further than 2 miles [Distant]. The primary outcome was in-hospital mortality. Secondary outcomes were admission to the intensive care unit (ICU), length of hospitalization, and discharge disposition. Results: Between March 09 and May 04, 2020, a total of 769 patients were admitted for COVID-19 at NBIMC. 406 (53%) resided within a 2-mile radius of the hospital location. of these 44% were obese. History of hypertension, diabetes mellitus and coronary artery disease was documented in 69%, 48% and 23% respectively. Compared with distant patients, neighbors were older (59 vs. 69 yrs. P=0.048), mostly of Black/African American race (64% vs. 82%;p<0.001) and had a higherincidence of diabetes mellitus (40% vs. 48%;p=0.025) or coronary artery disease (17% vs. 23%;p=0.039). Visitors were more likely to report an exposure history to a COVID-19 patient thanneighbors (31% vs. 21%, p=0.001). In-hospital death rate were significantly higher in neighbors thanvisitors (32% vs. 22%, p=0.007). Admission to the ICU was similar between both groups (p=0.438).Among those who survived to discharge, distant patients had longer length of hospitalization (12 vs.10 days;p=0.006), than neighbors. Discharge disposition was comparable in both groups (p=0.249) Conclusions: In this cross-sectional study of patients admitted to an inner-city hospital for COVID-19, majority of patients living within a 2-mile radius were of Blacks/African Americans who had ahigher incidence of DM and CAD. A paradoxical association between distance to the hospital and in-hospital mortality was observed. Based on these findings, targeted interventions aimed at Impactingsocial determinants of health seem prudent.