• Renuka Tipirneni, Monita Karmakar, Megan O'Malley, Hallie C Prescott, and Vineet Chopra.
• Department of Internal Medicine, University of Michigan, and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan (R.T.).
• Ann. Intern. Med. 2022 Apr 1; 175 (4): 505-512.

BackgroundAlthough disparities in COVID-19 outcomes have been observed, factors contributing to these differences are not well understood.ObjectiveTo determine whether COVID-19 hospitalization outcomes are related to neighborhood-level social vulnerability, independent of patient-level clinical factors.DesignPooled cross-sectional study of prospectively collected data.Setting38 Michigan hospitals.PatientsAdults older than 18 years hospitalized for COVID-19 in a participating site between March and December 2020.MeasurementsCOVID-19 outcomes included acute organ dysfunction, organ failure, invasive mechanical ventilation, intensive care unit stay, death, and discharge disposition. Social vulnerability was measured by the social vulnerability index (SVI), a composite measure of social disadvantage.ResultsCompared with patients in low-vulnerability ZIP codes, those living in high-vulnerability ZIP codes were more frequently treated in the intensive care unit (29.0% vs. 24.5%); more frequently received mechanical ventilation (19.3% vs. 14.2%); and experienced higher rates of organ dysfunction (51.9% vs. 48.6%), organ failure (54.7% vs. 51.6%), and in-hospital death (19.4% vs. 16.7%). In mixed-effects regression analyses accounting for age, sex, and comorbid conditions, an increase in a patient's neighborhood SVI by 0.25 (1 quartile) was associated with greater likelihood of mechanical ventilation (increase of 2.1 percentage points), acute organ dysfunction (increase of 2.8 percentage points), and acute organ failure (increase of 2.8 percentage points) but was not associated with intensive care unit stay, mortality, or discharge disposition.LimitationObservational data focused on hospitalizations in a single state.ConclusionHospitalized patients with COVID-19 from socially vulnerable neighborhoods presented with greater illness severity and required more intensive treatment, but once hospitalized they did not experience differences in hospital mortality or discharge disposition. Policies that target socially vulnerable neighborhoods and access to COVID-19 care may help ameliorate health disparities.Primary Funding SourceBlue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network as part of the BCBSM Value Partnerships Program, the Michigan Public Health Institute, and the Michigan Department of Health & Human Services.

20 keywords...

hide…