Estimating the effects of race and social vulnerability on hospital admission and mortality from COVID-19

Abstract Objective To estimate the risk of hospital admission and mortality from COVID-19 to patients and measure the association of race and area-level social vulnerability with those outcomes. Materials and Methods Using patient records collected at a multisite hospital system from April 2020 to October 2020, the risk of hospital admission and the risk of mortality were estimated for patients who tested positive for COVID-19 and were admitted to the hospital for COVID-19, respectively, using generalized estimating equations while controlling for patient race, patient area-level social vulnerability, and time course of the pandemic. Results Black individuals were 3.57 as likely (95% CI, 3.18–4.00) to be hospitalized than White people, and patients living in the most disadvantaged areas were 2.61 times as likely (95% CI, 2.26–3.02) to be hospitalized than those living in the least disadvantaged areas. While Black patients had lower raw mortality than White patients, mortality was similar after controlling for comorbidities and social vulnerability. Discussion Our findings point to potent correlates of race and socioeconomic status, including resource distribution, employment, and shared living spaces, that may be associated with inequitable burden of disease across patients of different races. Conclusions Public health and policy interventions should address these social factors when responding to the next pandemic.

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Abstract P622: Racial Variation in White Matter Hyperintensity Progression in the ACCORDION MIND Study

Stroke ◽

10.1161/str.52.suppl_1.p622 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Alison L Herman ◽

Adam H De Havenon ◽

Guido J Falcone ◽

Shadi Yaghi ◽

Shyam Prabhakaran ◽

...

Keyword(s):

Blood Pressure ◽

White Matter ◽

Systolic Blood Pressure ◽

White Matter Hyperintensity ◽

Diabetic Patients ◽

Patient Race ◽

Black Patients ◽

The Mean ◽

White Patients

Introduction: White matter hyperintensities (WMH) are linked to cognitive decline and stroke. We hypothesized that Black race would be associated with greater WMH progression in the ACCORDION MIND trial. Methods: The primary outcome is WMH progression in mL, evaluated by fitting linear regression to WMH volume on the month 80 MRI and including the WMH volume on the baseline MRI. The primary predictor is patient race, with the exclusion of patients defined as “other” race. We also derived predicted probabilities of our outcome for systolic blood pressure (SBP) levels. Results: We included 276 patients who completed the baseline and month 80 MRI, of which 207 were white, 48 Black, and 21 Hispanic. During follow-up, the mean number of SBP, LDL, and A1c measurements per patient was 21, 8, and 15. The mean (SD) WMH progression was 3.3 (5.4) mL for blacks, 2.5 (3.2) mL for Hispanics, and 2.4 (3.3) mL for whites. In the multivariate regression model (Table 1), Black, compared to white, patients had significantly more WMH progression (β Coefficient 1.26, 95% CI 0.45-2.06, p=0.002). Hispanic, compared to white, patients did not have significantly different WMH progression (p=0.392), nor was there a difference when comparing Hispanic to Black patients (p=0.162). The predicted WMH progression was significantly higher for Black compared to white patients across a mean SBP of 117 to 139 mm Hg (Figure 1). Conclusions: Black diabetic patients in ACCORDION MIND have a higher risk of WMH progression than white patients across a normal range of systolic blood pressure.

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Effect of social factors on winter hospital admission for respiratory disease: a case–control study of older people in the UK

British Journal of General Practice ◽

10.3399/bjgp08x302682 ◽

2008 ◽

Vol 58 (551) ◽

pp. e1-e9 ◽

Cited By ~ 21

Author(s):

Rachel E Jordan ◽

Jeremy I Hawker ◽

Jon G Ayres ◽

Peymané Adab ◽

William Tunnicliffe ◽

...

Keyword(s):

Older People ◽

Hospital Admission ◽

Respiratory Disease ◽

Social Factors ◽

Case Control Study ◽

Case Control ◽

The Uk ◽

Control Study

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Abstract 164: Impact of Sex and Race on the Likelihood of Mortality, Cardiology Consultation, and Coronary Angiography Among Hospitalized Patients Evaluated With Cardiac Troponin

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.164 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

David E Winchester ◽

Christopher Estel ◽

Kristopher Kline ◽

Sean Taasan ◽

Ki Park ◽

...

Keyword(s):

Cardiac Catheterization ◽

Black Race ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Risk Of Mortality ◽

Black Patients ◽

Highly Sensitive ◽

Comorbidity Index ◽

Male Sex ◽

Cardiovascular Services

Introduction: Serum troponin (Tn) is a highly sensitive test useful in diagnosing acute myocardial infarction. Elevated Tn is associated with higher mortality and greater use of cardiovascular services. The effect of sex and race on these observations has not been well characterized. We hypothesize that sex and race will be independent predictors of cardiology consultation and cardiac catheterization. Methods: We analyzed adult patients hospitalized between 2012 and 2015 who had Tn testing. Patients were compared in 2 cohorts: those with and those without elevation in Tn. We extracted data on demographics, self-reported race, medical history, new inpatient diagnoses, Charlson comorbidity index (CCI), and mortality (up to 3 years). We developed a Cox proportional hazard model for mortality and used logistic regression to determine associations with cardiology consultation and cardiac catheterization. Results: Of the 26,663 included, 22.0% were black, 50.1% were women, 9.8% had diabetes, and 6.4% had pre-existing coronary disease. Cardiac catheterization was performed on 1,800 (6.8%), 3,672 (13.8%) had a cardiology consult, and 4,962 (18.6%) had elevated Tn. Among the variables associated with cardiology consultation were elevated Tn (odds ratio [OR] =3.44, 95% confidence interval [CI] 3.19-3.72, p<0.0001), male sex (OR=1.29, 95% CI 1.20-1.39, p<0.0001) and black race (OR=0.85, 95% CI 0.77-0.93, p=0.0006). Cardiac catheterization was associated with elevated Tn (OR=8.16, 95% CI 7.34-9.06, p<0.0001), male sex (OR=1.45, 95% CI 1.31-1.61, p<0.0001), CCI >4 (OR=0.44, 95% CI 0.35-0.54, p<0.0001), and black race (OR=0.72, 95% CI 0.63-0.82, p<0.0001). A total of 4,697 patients died during follow-up. Elevated Tn (hazard ratio [HR] =2.05, p<0.0001), male sex (HR=1.14, p<0.0001), and CCI >4 (HR=3.33, p<0.0001) were associated with a higher risk of death, while risk among black patients was lower (HR=0.86, p<0.0001). Conclusion: As observed in other investigations, elevated Tn is associated with a higher risk of mortality, cardiac catheterization, and cardiology consultation. We observed that men were more likely to undergo catheterization and consultation, while black patients were less likely to have either. Further investigation into reasons for the observed disparities is warranted.

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The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

United European Gastroenterology Journal ◽

10.1177/2050640617732651 ◽

2017 ◽

Vol 6 (3) ◽

pp. 367-381 ◽

Cited By ~ 4

Author(s):

Xian Feng Xia ◽

Philip Wai Yan Chiu ◽

Kelvin Kam Fai Tsoi ◽

Francis Ka Leung Chan ◽

Joseph Jao Yiu Sung ◽

...

Keyword(s):

Hospital Admission ◽

Gastrointestinal Hemorrhage ◽

Meta Analysis ◽

Biomedical Literature ◽

Upper Gastrointestinal Hemorrhage ◽

Risk Of Mortality ◽

Increased Risk ◽

Public Holidays ◽

To Receive ◽

Upper Gastrointestinal

Objective The objective of this article is to evaluate the relationship between off-hours hospital admission (weekends, public holidays or nighttime) and mortality for upper gastrointestinal hemorrhage (UGIH). Methods Medline, Embase, Scopus, and the Chinese Biomedical Literature were searched through December 2016 to identify eligible records for inclusion in this meta-analysis. A random-effects model was applied. Results Twenty cohort studies were included for analysis. Patients with UGIH who were admitted during off-hours had a significantly higher mortality and were less likely to receive endoscopy within 24 hours of admission. In comparison to variceal cases, patients with nonvariceal bleeding showed a higher mortality when admitted during off-hours. However, for studies conducted in hospitals that provided endoscopy outside normal hours, off-hours admission was not associated with an increased risk of mortality. Conclusion Our study showed a higher mortality for patients with nonvariceal UGIH who were admitted during off-hours, while this effect might be offset in hospitals with a formal out-of-hours endoscopy on-call rotation.

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Time-course of occupational psychological and social factors as predictors of new-onset and persistent neck pain: A three-wave prospective study over 4 years

Pain ◽

10.1016/j.pain.2014.03.021 ◽

2014 ◽

Vol 155 (7) ◽

pp. 1262-1271 ◽

Cited By ~ 19

Author(s):

Jan Olav Christensen ◽

Stein Knardahl

Keyword(s):

Neck Pain ◽

Prospective Study ◽

Social Factors ◽

Time Course ◽

New Onset

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Racial Differences in Pain Treatment and Empathy in a Canadian Sample

Pain Research and Management ◽

10.1155/2012/803474 ◽

2012 ◽

Vol 17 (6) ◽

pp. 381-384 ◽

Cited By ~ 28

Author(s):

Kimberley A Kaseweter ◽

Brian B Drwecki ◽

Kenneth M Prkachin

Keyword(s):

Racial Differences ◽

Facial Expressions ◽

Undergraduate Students ◽

Pain Treatment ◽

Black And White ◽

Racial Biases ◽

Patient Race ◽

Black Patients ◽

Treatment Bias ◽

White Patients

BACKGROUND: Evidence of inadequate pain treatment as a result of patient race has been extensively documented, yet remains poorly understood. Previous research has indicated that nonwhite patients are significantly more likely to be undertreated for pain.OBJECTIVE: To determine whether previous findings of racial biases in pain treatment recommendations and empathy are generalizable to a sample of Canadian observers and, if so, to determine whether empathy biases mediate the pain treatment disparity.METHODS: Fifty Canadian undergraduate students (24 men and 26 women) watched videos of black and white patients exhibiting facial expressions of pain. Participants provided pain treatment decisions and reported their feelings of empathy for each patient.RESULTS: Participants demonstrated both a prowhite treatment bias and a prowhite empathy bias, reporting more empathy for white patients than black patients and prescribing more pain treatment for white patients than black patients. Empathy was found to mediate the effect of race on pain treatment.CONCLUSIONS: The results of the present study closely replicate those from a previous study of American observers, providing evidence that a prowhite bias is not a peculiar feature of the American population. These results also add support to the claim that empathy plays a crucial role in racial pain treatment disparity.

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Interactive, on-line visualization tools to measure and drive equity in COVID-19 vaccine administrations

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocab180 ◽

2021 ◽

Author(s):

Amy W Shaheen ◽

Eileen Ciesco ◽

Kevin Johnson ◽

Greg Kuhnen ◽

Christopher Paolini ◽

...

Keyword(s):

Data Warehouse ◽

Social Vulnerability ◽

Large Hospital ◽

Equitable Distribution ◽

Hospital System ◽

Online Tools ◽

On Line ◽

Visualization Tools ◽

Race Ethnicity ◽

Data Elements

Abstract Equitable distribution of vaccines is necessary to ensure those at highest risk of illness are protected from COVID-19 (coronavirus disease 2019). Unfortunately, there is significant evidence that vaccines have not been reaching the most vulnerable. At our large hospital system, we created interactive online tools to measure and visualize equitability of vaccine administrations and to help stakeholders identify populations at highest risk within state-designated eligible vaccine groups. Using race, ethnicity, gender, and social vulnerability, we are able to measure and reflect our vaccine administration performance against the communities that we serve. With our visualization tools, stakeholders have been able to target interventions to improve equity in vaccine administrations, including improvements in race, ethnicity, and social vulnerability. We plan to use the data elements incorporated in our electronic health record and data warehouse due to the COVID-19 pandemic to guide further population health efforts at decreasing disparities.

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Mass-Casualty, Terrorist Bombings: Epidemiological Outcomes, Resource Utilization, and Time Course of Emergency Needs (Part I)

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00001096 ◽

2003 ◽

Vol 18 (3) ◽

pp. 220-234 ◽

Cited By ~ 46

Author(s):

Jeffrey L. Arnold ◽

Ming-Che Tsai ◽

Pinchas Halpern ◽

Howard Smithline ◽

Edita Stok ◽

...

Keyword(s):

Hospital Admission ◽

Resource Utilization ◽

Time Course ◽

Mass Casualty ◽

Time Interval ◽

Confined Space ◽

Structural Collapse ◽

Structural Fire ◽

Injury Frequency ◽

Vehicle Delivery

AbstractIntroduction:This article characterizes the epidemiological outcomes, resource utilization, and time course of emergency needs in mass-casualty, terrorist bombings producing 30 or more casualties.Methods:Eligible bombings were identified using a MEDLINE search of articles published between 1996 and October 2002 and a manual search of published references. Mortality, injury frequency, injury severity, emergency department (ED) utilization, hospital admission, and time interval data were abstracted and relevant rates were determined for each bombing. Median values for the rates and the inter-quartile ranges (IQR) were determined for bombing subgroups associated with: (1) vehicle delivery; (2) terrorist suicide; (3) confined-space setting; (4) open-air setting; (5) structural collapse sequela; and (6) structural fire sequela.Results:Inclusion criteria were met by 44 mass-casualty, terrorist bombings reported in 61 articles. Median values for the immediate mortality rates and IQRs were: vehicle-delivery, 4% (1–25%); terrorist-suicide, 19% (7–44%); confined-space 4% (1–11%); open-air, 1% (0–5%); structural-collapse, 18% (5–26%); structural fire 17% (1–17%); and overall, 3% (1–14%). A biphasic pattern of mortality and unique patterns of injury frequency were noted in all subgroups. Median values for the hospital admission rates and IQRs were: vehicle-delivery, 19% (14–50%); terrorist-suicide, 58% (38–77%); confined-space, 52% (36–71%); open-air, 13% (11–27%); structural-collapse, 41% (23–74%); structural-fire, 34% (25–44%); and overall, 34% (14–53%). The shortest reported time interval from detonation to the arrival of the first patient at an ED was five minutes. The shortest reported time interval from detonation to the arrival of the last patient at an ED was 15 minutes. The longest reported time interval from detonation to extrication of a live victim from a structural collapse was 36 hours.Conclusion:Epidemiological outcomes and resource utilization in mass-casualty, terrorist bombings vary with the characteristics of the event.

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Survival Experience of Semi-Skilled Disability Pensioners in Denmark

Scandinavian Journal of Social Medicine ◽

10.1177/140349488201000301 ◽

1982 ◽

Vol 10 (3) ◽

pp. 73-76 ◽

Cited By ~ 8

Author(s):

Bernard Jeune

Keyword(s):

Relative Risk ◽

Social Factors ◽

Disability Pension ◽

Control Group ◽

Mortality Level ◽

Ability To Work ◽

Survival Prognosis ◽

Risk Of Mortality ◽

Very High

The purpose of this study was to estimate the survival prognosis of semi-skilled disability pensioners. The survival experience of 1353 invalid male members of the Danish Semiskilled Workers Union (SID) awarded disability pensions in 1975 was compared with a control group of members of the same union, matched geographically and by age. The two groups were followed until Nov. 30, 1978. For the follow-up period as a whole, the mortality risk among disability pensioners was estimated to be 6.8 times as high as that of controls. The relative risk of mortality was higher at the period's inception than at the end. A very high mortality level was found among disability pensioners awarded the highest level of disability pension, but no differences in mortality were found between disability pensioners awarded the lower levels of disability pension and the corresponding control group. The significance of medical and social factors in reducing the ability to work is discussed, as it relates to grounds for the awarding of disability pensions. The prognosis of one category of disability pensioners is very poor, while the survival prognosis of another is not significantly worsened, despite a considerable deterioration in the ability to work.

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