Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS‐CoV‐2 infection
Abstract Objective To measure the association of race, ethnicity, comorbidities, and insurance status with need for hospitalization of symptomatic emergency department patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Methods This study is a cohort study of sympto...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-08-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12453 |
| _version_ | 1818585123451305984 |
|---|---|
| author | Sophia Newton Benjamin Zollinger Jincong Freeman Seamus Moran Alexandra Helfand Kayla Authelet Matthew McHarg Nataly Montano Vargas Robert Shesser Joanna S. Cohen Derek A.T. Cummings Yan Ma Andrew C. Meltzer |
| author_facet | Sophia Newton Benjamin Zollinger Jincong Freeman Seamus Moran Alexandra Helfand Kayla Authelet Matthew McHarg Nataly Montano Vargas Robert Shesser Joanna S. Cohen Derek A.T. Cummings Yan Ma Andrew C. Meltzer |
| author_sort | Sophia Newton |
| collection | DOAJ |
| description | Abstract Objective To measure the association of race, ethnicity, comorbidities, and insurance status with need for hospitalization of symptomatic emergency department patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Methods This study is a cohort study of symptomatic patients presenting to a single emergency department (ED) with laboratory‐confirmed SARS‐CoV‐2 infection from March 7‐August 9, 2020. We collected patient‐level information regarding demographics, insurance status, comorbidities, level of care, and mortality using a structured chart review. We compared characteristics of patients categorized by (1) home discharge, (2) general hospital ward admission, and (3) intensive care unit (ICU) admission or death within 30 days of the index visit. Univariate and multivariable logistic regression analyses were performed to report odds ratios (OR) and 95% confidence intervals (95% CI) between hospital admission versus ED discharge home and between ICU care versus general hospital ward admission. Results In total, 994 patients who presented to the ED with symptoms were included in the analysis with 551 (55.4%) patients discharged home, 314 (31.6%) patients admitted to the general hospital ward, and 129 (13.0%) admitted to the ICU or dying. Patients requiring admission were more likely to be Black or to have public insurance (Medicaid and/or Medicare). Patients who were admitted to the ICU or dying were more likely aged ≥ 65 years or male. In multivariable logistic regression, old age, public insurance, diabetes, hypertension, obesity, heart failure, and hyperlipidemia were independent predictors of hospital admission. When comparing those who needed ICU care versus general hospital ward admission in univariate logistic regression, patients with Medicaid (OR 2.4, 95% CI 1.2–4.6), Medicare (OR 4.2, 95% CI 2.1–8.4), Medicaid and Medicare (OR 4.3, 95% CI 2.4–7.7), history of chronic obstructive pulmonary disease (OR 2.2, 95% CI 1.2–4.2), hypertension (OR 1.7, 95% CI 1.1–2.7), and heart failure (OR 2.6, 95% CI 1.4–4.7) were more likely to be admitted into the ICU or die; Black (OR 1.1, 95% CI 0.4–2.9) and Hispanic/Latino (OR 1.0, 95% CI 0.6–1.8) patients were less likely to be admitted into the ICU; however, the associations were not statistically significant. In multivariable logistic regression, old age, male sex, public insurance, and heart failure were independent predictors of ICU care/death. Conclusion Comorbidities and public insurance are predictors of more severe illness for patients with SARS‐CoV‐2. This study suggests that the disparities in severity seen in COVID‐19 among Black patients may be attributable, in part, to low socioeconomic status and chronic health conditions. |
| first_indexed | 2024-12-16T08:32:04Z |
| format | Article |
| id | doaj.art-514250a6a87d4c10b77ca021ce714422 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-12-16T08:32:04Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-514250a6a87d4c10b77ca021ce7144222022-12-21T22:37:51ZengWileyJournal of the American College of Emergency Physicians Open2688-11522021-08-0124n/an/a10.1002/emp2.12453Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS‐CoV‐2 infectionSophia Newton0Benjamin Zollinger1Jincong Freeman2Seamus Moran3Alexandra Helfand4Kayla Authelet5Matthew McHarg6Nataly Montano Vargas7Robert Shesser8Joanna S. Cohen9Derek A.T. Cummings10Yan Ma11Andrew C. Meltzer12School of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USADepartment of Biostatistics and Bioinformatics, George Washington University Milken Institute School of Public Health Washington District of Columbia USASchool of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USADivision of Emergency Medicine Children's National Medical Center Washington District of Columbia USADepartment of Biology and Emerging Pathogens Institute, University of Florida Gainesville Florida USADepartment of Biostatistics and Bioinformatics, George Washington University Milken Institute School of Public Health Washington District of Columbia USASchool of Medicine and Health Sciences Department of Emergency Medicine, The George Washington University Washington District of Columbia USAAbstract Objective To measure the association of race, ethnicity, comorbidities, and insurance status with need for hospitalization of symptomatic emergency department patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Methods This study is a cohort study of symptomatic patients presenting to a single emergency department (ED) with laboratory‐confirmed SARS‐CoV‐2 infection from March 7‐August 9, 2020. We collected patient‐level information regarding demographics, insurance status, comorbidities, level of care, and mortality using a structured chart review. We compared characteristics of patients categorized by (1) home discharge, (2) general hospital ward admission, and (3) intensive care unit (ICU) admission or death within 30 days of the index visit. Univariate and multivariable logistic regression analyses were performed to report odds ratios (OR) and 95% confidence intervals (95% CI) between hospital admission versus ED discharge home and between ICU care versus general hospital ward admission. Results In total, 994 patients who presented to the ED with symptoms were included in the analysis with 551 (55.4%) patients discharged home, 314 (31.6%) patients admitted to the general hospital ward, and 129 (13.0%) admitted to the ICU or dying. Patients requiring admission were more likely to be Black or to have public insurance (Medicaid and/or Medicare). Patients who were admitted to the ICU or dying were more likely aged ≥ 65 years or male. In multivariable logistic regression, old age, public insurance, diabetes, hypertension, obesity, heart failure, and hyperlipidemia were independent predictors of hospital admission. When comparing those who needed ICU care versus general hospital ward admission in univariate logistic regression, patients with Medicaid (OR 2.4, 95% CI 1.2–4.6), Medicare (OR 4.2, 95% CI 2.1–8.4), Medicaid and Medicare (OR 4.3, 95% CI 2.4–7.7), history of chronic obstructive pulmonary disease (OR 2.2, 95% CI 1.2–4.2), hypertension (OR 1.7, 95% CI 1.1–2.7), and heart failure (OR 2.6, 95% CI 1.4–4.7) were more likely to be admitted into the ICU or die; Black (OR 1.1, 95% CI 0.4–2.9) and Hispanic/Latino (OR 1.0, 95% CI 0.6–1.8) patients were less likely to be admitted into the ICU; however, the associations were not statistically significant. In multivariable logistic regression, old age, male sex, public insurance, and heart failure were independent predictors of ICU care/death. Conclusion Comorbidities and public insurance are predictors of more severe illness for patients with SARS‐CoV‐2. This study suggests that the disparities in severity seen in COVID‐19 among Black patients may be attributable, in part, to low socioeconomic status and chronic health conditions.https://doi.org/10.1002/emp2.12453COVID‐19 diseaseemergency medicineinfectious diseasesSARS‐CoV‐2 infectionsocioeconomic factors |
| spellingShingle | Sophia Newton Benjamin Zollinger Jincong Freeman Seamus Moran Alexandra Helfand Kayla Authelet Matthew McHarg Nataly Montano Vargas Robert Shesser Joanna S. Cohen Derek A.T. Cummings Yan Ma Andrew C. Meltzer Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS‐CoV‐2 infection Journal of the American College of Emergency Physicians Open COVID‐19 disease emergency medicine infectious diseases SARS‐CoV‐2 infection socioeconomic factors |
| title | Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS‐CoV‐2 infection |
| title_full | Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS‐CoV‐2 infection |
| title_fullStr | Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS‐CoV‐2 infection |
| title_full_unstemmed | Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS‐CoV‐2 infection |
| title_short | Factors associated with clinical severity in emergency department patients presenting with symptomatic SARS‐CoV‐2 infection |
| title_sort | factors associated with clinical severity in emergency department patients presenting with symptomatic sars cov 2 infection |
| topic | COVID‐19 disease emergency medicine infectious diseases SARS‐CoV‐2 infection socioeconomic factors |
| url | https://doi.org/10.1002/emp2.12453 |
| work_keys_str_mv | AT sophianewton factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT benjaminzollinger factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT jincongfreeman factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT seamusmoran factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT alexandrahelfand factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT kaylaauthelet factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT matthewmcharg factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT natalymontanovargas factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT robertshesser factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT joannascohen factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT derekatcummings factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT yanma factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection AT andrewcmeltzer factorsassociatedwithclinicalseverityinemergencydepartmentpatientspresentingwithsymptomaticsarscov2infection |