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Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System

There is growing evidence that racial and ethnic minorities bear a disproportionate burden from COVID-19. Temporal changes in the pandemic epidemiology and diversity in the clinical course require careful study to identify determinants of poor outcomes. We analyzed 6255 hospitalized individuals with...

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Autores principales: Shaw, Pamela A., Yang, Jasper B., Mowery, Danielle L., Schriver, Emily R., Mahoney, Kevin B., Bar, Katharine J., Ellenberg, Susan S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9119468/
https://www.ncbi.nlm.nih.gov/pubmed/35588434
http://dx.doi.org/10.1371/journal.pone.0268528
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author Shaw, Pamela A.
Yang, Jasper B.
Mowery, Danielle L.
Schriver, Emily R.
Mahoney, Kevin B.
Bar, Katharine J.
Ellenberg, Susan S.
author_facet Shaw, Pamela A.
Yang, Jasper B.
Mowery, Danielle L.
Schriver, Emily R.
Mahoney, Kevin B.
Bar, Katharine J.
Ellenberg, Susan S.
author_sort Shaw, Pamela A.
collection PubMed
description There is growing evidence that racial and ethnic minorities bear a disproportionate burden from COVID-19. Temporal changes in the pandemic epidemiology and diversity in the clinical course require careful study to identify determinants of poor outcomes. We analyzed 6255 hospitalized individuals with PCR-confirmed SARS-CoV-2 infection from one of 5 hospitals in the University of Pennsylvania Health System between March 2020 and March 2021, using electronic health records to assess risk factors and outcomes through 8 weeks post-admission. Discharge, readmission and mortality outcomes were analyzed in a multi-state model with multivariable Cox models for each transition. Mortality varied markedly over time, with cumulative incidence (95% CI) 30 days post-admission of 19.1% (16.9, 21.3) in March-April 2020, 5.7% (4.2, 7.5) in July-October 2020 and 10.5% (9.1,12.0) in January-March 2021; 26% of deaths occurred after discharge. Average age (SD) at admission varied from 62.7 (17.6) to 54.8 (19.9) to 60.5 (18.1); mechanical ventilation use declined from 21.3% to 9–11%. Compared to Caucasian, Black race was associated with more severe disease at admission, higher rates of co-morbidities and residing in a low-income zip code. Between-race risk differences in mortality risk diminished in multivariable models; while admitting hospital, increasing age, admission early in the pandemic, and severe disease and low blood pressure at admission were associated with increased mortality hazard. Hispanic ethnicity was associated with fewer baseline co-morbidities and lower mortality hazard (0.57, 95% CI: 0.37, .087). Multi-state modeling allows for a unified framework to analyze multiple outcomes throughout the disease course. Morbidity and mortality for hospitalized COVID-19 patients varied over time but post-discharge mortality remained non-trivial. Black race was associated with more risk factors for morbidity and with treatment at hospitals with lower mortality. Multivariable models suggest there are not between-race differences in outcomes. Future work is needed to better understand the identified between-hospital differences in mortality.
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spelling pubmed-91194682022-05-20 Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System Shaw, Pamela A. Yang, Jasper B. Mowery, Danielle L. Schriver, Emily R. Mahoney, Kevin B. Bar, Katharine J. Ellenberg, Susan S. PLoS One Research Article There is growing evidence that racial and ethnic minorities bear a disproportionate burden from COVID-19. Temporal changes in the pandemic epidemiology and diversity in the clinical course require careful study to identify determinants of poor outcomes. We analyzed 6255 hospitalized individuals with PCR-confirmed SARS-CoV-2 infection from one of 5 hospitals in the University of Pennsylvania Health System between March 2020 and March 2021, using electronic health records to assess risk factors and outcomes through 8 weeks post-admission. Discharge, readmission and mortality outcomes were analyzed in a multi-state model with multivariable Cox models for each transition. Mortality varied markedly over time, with cumulative incidence (95% CI) 30 days post-admission of 19.1% (16.9, 21.3) in March-April 2020, 5.7% (4.2, 7.5) in July-October 2020 and 10.5% (9.1,12.0) in January-March 2021; 26% of deaths occurred after discharge. Average age (SD) at admission varied from 62.7 (17.6) to 54.8 (19.9) to 60.5 (18.1); mechanical ventilation use declined from 21.3% to 9–11%. Compared to Caucasian, Black race was associated with more severe disease at admission, higher rates of co-morbidities and residing in a low-income zip code. Between-race risk differences in mortality risk diminished in multivariable models; while admitting hospital, increasing age, admission early in the pandemic, and severe disease and low blood pressure at admission were associated with increased mortality hazard. Hispanic ethnicity was associated with fewer baseline co-morbidities and lower mortality hazard (0.57, 95% CI: 0.37, .087). Multi-state modeling allows for a unified framework to analyze multiple outcomes throughout the disease course. Morbidity and mortality for hospitalized COVID-19 patients varied over time but post-discharge mortality remained non-trivial. Black race was associated with more risk factors for morbidity and with treatment at hospitals with lower mortality. Multivariable models suggest there are not between-race differences in outcomes. Future work is needed to better understand the identified between-hospital differences in mortality. Public Library of Science 2022-05-19 /pmc/articles/PMC9119468/ /pubmed/35588434 http://dx.doi.org/10.1371/journal.pone.0268528 Text en © 2022 Shaw et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Shaw, Pamela A.
Yang, Jasper B.
Mowery, Danielle L.
Schriver, Emily R.
Mahoney, Kevin B.
Bar, Katharine J.
Ellenberg, Susan S.
Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System
title Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System
title_full Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System
title_fullStr Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System
title_full_unstemmed Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System
title_short Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System
title_sort determinants of hospital outcomes for patients with covid-19 in the university of pennsylvania health system
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9119468/
https://www.ncbi.nlm.nih.gov/pubmed/35588434
http://dx.doi.org/10.1371/journal.pone.0268528
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