Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations
<h4>Background</h4> Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. <h4>Objective</h4> To characterize socioeconomic and chronic disease-r...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341486/?tool=EBI |
| _version_ | 1818833242915078144 |
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| author | Jarrod E. Dalton Douglas D. Gunzler Vardhmaan Jain Adam T. Perzynski Neal V. Dawson Douglas Einstadter Yasir Tarabichi Peter B. Imrey Michael Lewis Michael W. Kattan James Yao Glen Taksler Kristen A. Berg Nikolas I. Krieger David Kaelber Lara Jehi Ankur Kalra |
| author_facet | Jarrod E. Dalton Douglas D. Gunzler Vardhmaan Jain Adam T. Perzynski Neal V. Dawson Douglas Einstadter Yasir Tarabichi Peter B. Imrey Michael Lewis Michael W. Kattan James Yao Glen Taksler Kristen A. Berg Nikolas I. Krieger David Kaelber Lara Jehi Ankur Kalra |
| author_sort | Jarrod E. Dalton |
| collection | DOAJ |
| description | <h4>Background</h4> Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. <h4>Objective</h4> To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. <h4>Design</h4> Observational cohort study. <h4>Setting</h4> Outpatient and emergency care. <h4>Patients</h4> 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. <h4>Interventions</h4> Nasopharyngeal PCR test for SARS-CoV-2 infection. <h4>Measurements</h4> Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. <h4>Results</h4> We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91–3.59] times (at age 20) to 2.37 [1.54–3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive. <h4>Limitations</h4> Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. <h4>Conclusion</h4> Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates. |
| first_indexed | 2024-12-19T02:15:49Z |
| format | Article |
| id | doaj.art-fbfe7b3e7bc4482d919266b3753bb631 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-19T02:15:49Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-fbfe7b3e7bc4482d919266b3753bb6312022-12-21T20:40:25ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01168Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizationsJarrod E. DaltonDouglas D. GunzlerVardhmaan JainAdam T. PerzynskiNeal V. DawsonDouglas EinstadterYasir TarabichiPeter B. ImreyMichael LewisMichael W. KattanJames YaoGlen TakslerKristen A. BergNikolas I. KriegerDavid KaelberLara JehiAnkur Kalra<h4>Background</h4> Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. <h4>Objective</h4> To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. <h4>Design</h4> Observational cohort study. <h4>Setting</h4> Outpatient and emergency care. <h4>Patients</h4> 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. <h4>Interventions</h4> Nasopharyngeal PCR test for SARS-CoV-2 infection. <h4>Measurements</h4> Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. <h4>Results</h4> We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91–3.59] times (at age 20) to 2.37 [1.54–3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive. <h4>Limitations</h4> Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. <h4>Conclusion</h4> Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341486/?tool=EBI |
| spellingShingle | Jarrod E. Dalton Douglas D. Gunzler Vardhmaan Jain Adam T. Perzynski Neal V. Dawson Douglas Einstadter Yasir Tarabichi Peter B. Imrey Michael Lewis Michael W. Kattan James Yao Glen Taksler Kristen A. Berg Nikolas I. Krieger David Kaelber Lara Jehi Ankur Kalra Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations PLoS ONE |
| title | Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations |
| title_full | Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations |
| title_fullStr | Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations |
| title_full_unstemmed | Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations |
| title_short | Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations |
| title_sort | mechanisms of socioeconomic differences in covid 19 screening and hospitalizations |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341486/?tool=EBI |
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