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Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020.
MMWR Morb Mortal Wkly Rep. 2020 Jul 10; 69(27):864-869.MM

Abstract

As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with COVID-19 (2-4). Data also suggest a higher prevalence of infection with SARS-CoV-2, the virus that causes COVID-19, among persons experiencing homelessness (5). Safety-net hospitals, such as Boston Medical Center (BMC), which provide health care to persons regardless of their insurance status or ability to pay, treat higher proportions of these populations and might experience challenges during the COVID-19 pandemic. This report describes the characteristics and clinical outcomes of adult patients with laboratory-confirmed COVID-19 treated at BMC during March 1-May 18, 2020. During this time, 2,729 patients with SARS-CoV-2 infection were treated at BMC and categorized into one of the following mutually exclusive clinical severity designations: exclusive outpatient management (1,543; 56.5%), non-intensive care unit (ICU) hospitalization (900; 33.0%), ICU hospitalization without invasive mechanical ventilation (69; 2.5%), ICU hospitalization with mechanical ventilation (119; 4.4%), and death (98; 3.6%). The cohort comprised 44.6% non-Hispanic black (black) patients and 30.1% Hispanic or Latino (Hispanic) patients. Persons experiencing homelessness accounted for 16.4% of patients. Most patients who died were aged ≥60 years (81.6%). Clinical severity differed by age, race/ethnicity, underlying medical conditions, and homelessness. A higher proportion of Hispanic patients were hospitalized (46.5%) than were black (39.5%) or non-Hispanic white (white) (34.4%) patients, a finding most pronounced among those aged <60 years. A higher proportion of non-ICU inpatients were experiencing homelessness (24.3%), compared with homeless patients who were admitted to the ICU without mechanical ventilation (15.9%), with mechanical ventilation (15.1%), or who died (15.3%). Patient characteristics associated with illness and clinical severity, such as age, race/ethnicity, homelessness, and underlying medical conditions can inform tailored strategies that might improve outcomes and mitigate strain on the health care system from COVID-19.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

32644981

Citation

Hsu, Heather E., et al. "Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients With COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020." MMWR. Morbidity and Mortality Weekly Report, vol. 69, no. 27, 2020, pp. 864-869.
Hsu HE, Ashe EM, Silverstein M, et al. Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(27):864-869.
Hsu, H. E., Ashe, E. M., Silverstein, M., Hofman, M., Lange, S. J., Razzaghi, H., Mishuris, R. G., Davidoff, R., Parker, E. M., Penman-Aguilar, A., Clarke, K. E. N., Goldman, A., James, T. L., Jacobson, K., Lasser, K. E., Xuan, Z., Peacock, G., Dowling, N. F., & Goodman, A. B. (2020). Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(27), 864-869. https://doi.org/10.15585/mmwr.mm6927a3
Hsu HE, et al. Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients With COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020. MMWR Morb Mortal Wkly Rep. 2020 Jul 10;69(27):864-869. PubMed PMID: 32644981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020. AU - Hsu,Heather E, AU - Ashe,Erin M, AU - Silverstein,Michael, AU - Hofman,Melissa, AU - Lange,Samantha J, AU - Razzaghi,Hilda, AU - Mishuris,Rebecca G, AU - Davidoff,Ravin, AU - Parker,Erin M, AU - Penman-Aguilar,Ana, AU - Clarke,Kristie E N, AU - Goldman,Anna, AU - James,Thea L, AU - Jacobson,Karen, AU - Lasser,Karen E, AU - Xuan,Ziming, AU - Peacock,Georgina, AU - Dowling,Nicole F, AU - Goodman,Alyson B, Y1 - 2020/07/10/ PY - 2020/7/10/entrez PY - 2020/7/10/pubmed PY - 2020/7/11/medline SP - 864 EP - 869 JF - MMWR. Morbidity and mortality weekly report JO - MMWR Morb. Mortal. Wkly. Rep. VL - 69 IS - 27 N2 - As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with COVID-19 (2-4). Data also suggest a higher prevalence of infection with SARS-CoV-2, the virus that causes COVID-19, among persons experiencing homelessness (5). Safety-net hospitals,† such as Boston Medical Center (BMC), which provide health care to persons regardless of their insurance status or ability to pay, treat higher proportions of these populations and might experience challenges during the COVID-19 pandemic. This report describes the characteristics and clinical outcomes of adult patients with laboratory-confirmed COVID-19 treated at BMC during March 1-May 18, 2020. During this time, 2,729 patients with SARS-CoV-2 infection were treated at BMC and categorized into one of the following mutually exclusive clinical severity designations: exclusive outpatient management (1,543; 56.5%), non-intensive care unit (ICU) hospitalization (900; 33.0%), ICU hospitalization without invasive mechanical ventilation (69; 2.5%), ICU hospitalization with mechanical ventilation (119; 4.4%), and death (98; 3.6%). The cohort comprised 44.6% non-Hispanic black (black) patients and 30.1% Hispanic or Latino (Hispanic) patients. Persons experiencing homelessness accounted for 16.4% of patients. Most patients who died were aged ≥60 years (81.6%). Clinical severity differed by age, race/ethnicity, underlying medical conditions, and homelessness. A higher proportion of Hispanic patients were hospitalized (46.5%) than were black (39.5%) or non-Hispanic white (white) (34.4%) patients, a finding most pronounced among those aged <60 years. A higher proportion of non-ICU inpatients were experiencing homelessness (24.3%), compared with homeless patients who were admitted to the ICU without mechanical ventilation (15.9%), with mechanical ventilation (15.1%), or who died (15.3%). Patient characteristics associated with illness and clinical severity, such as age, race/ethnicity, homelessness, and underlying medical conditions can inform tailored strategies that might improve outcomes and mitigate strain on the health care system from COVID-19. SN - 1545-861X UR - https://www.unboundmedicine.com/medline/citation/32644981/Race/Ethnicity_Underlying_Medical_Conditions_Homelessness_and_Hospitalization_Status_of_Adult_Patients_with_COVID_19_at_an_Urban_Safety_Net_Medical_Center___Boston_Massachusetts_2020_ L2 - https://doi.org/10.15585/mmwr.mm6927a3 DB - PRIME DP - Unbound Medicine ER -