The Relationship Between Age, Gender, Race, Diabetes and Obesity on Clinical Outcomes in a Large Cohort of Patients Hospitalized for Covid-19 in Metropolitan Detroit

The Severe Acute Respiratory Syndrome Coronavirus-2 infection has resulted in a global pandemic with survival statistics 95–99%, however severe disease has been described. This is a retrospective cohort study of patients > age 18 admitted to Henry Ford Health System in Detroit from March 1 - June 1, 2020 for COVID-19 infection with aims to: 1. Determine the incidence of poor outcomes (mechanical ventilation (MV), ICU admission, death, and venous thromboembolism (VTE)), 2. Describe the clinical characteristics of this group, and 3. Evaluate relationships between demographics, diabetes mellitus (DM), obesity, and inflammatory markers on outcomes. We hypothesized that older age, male gender, African American ethnicity, DM, obesity, and elevated inflammatory markers would predict poor outcomes. 8751 inpatients were included, of whom 682 (7.79%) required MV, 867 (9.91%) were admitted to the ICU, 753 (8.6%) died, and 430 (4.91%) had VTE. 4447 (50.8%) were African American, 4951 (56.6%) female, 5152 (58.9%) > age 50, and 2068 (23.6%) had DM. Of those who had BMI and A1c recorded, 2556 (50.2%) had BMI >30 kg/m(2) and 1138 (74.3%) had A1c >5.7%. Analyses controlling for demographics and comorbidities found that age and male gender were significant predictors of MV (OR = 1.031; CI= 1.025–1.037; P < 0.0001, OR =2.023; CI= 1.700–2.407; P<0.0001), ICU admission (OR 1.024; CI= 1.018–1.029; P<0.0001, OR 1.824; CI= 1.561–2.130; P<0.001), death (OR 1.077; CI= 1.069–1.085; P<0.0001, OR 1.823; CI= 1.521–2.185; P<0.0001), and VTE (OR 1.021; CI= 1.014–1.028; P<0.001, OR 1.293; CI= 1.043–1.603; P=0.0193). African American, compared to Caucasian ethnicity, was significantly associated with MV (OR 1.437; CI= 1.131–1.825; P=0.0009) and ICU admission (OR 1.428; CI= 1.150–1.773; P=0.0002), but not VTE. African Americans had significantly lower odds of death relative to Caucasians (OR 0.765; CI=0.604–0.969; P=0.0200). DM predicted MV (OR 1.999; CI= 1.677–2.383; P<0.0001), ICU admission (OR 2.014; CI= 1.717–2.364; P<0.0001), death (OR 1.501; CI= 1.250–1.803; P<0.0001), and VTE (OR 1.468; CI= 1.171–1.840; P=0.0009). Obesity predicted MV (OR 1.540; CI= 1.284–1.847; P<0.0001) and ICU admission (OR 1.395; CI= 1.186–1.642; P<0.0001) but not death or VTE. All inflammatory markers (D-dimer, ferritin, CRP, IL-6 and procalcitonin) were significantly correlated with MV and death. 3 of the 5 markers were also predictive of both ICU admission and VTE. This large retrospective study of a diverse population with a significant proportion of African Americans highlights the importance of taking age, male gender, African American ethnicity, presence of DM and obesity into account when determining risk of poor outcomes. These results contribute to the growing data on disparities in health care which have become more evident during this pandemic and the need to address this when designing public policy.