JMIR Publications

ABSTRACT

Background:

Because of the racial and regional inequalities regarding COVID-19, more research is required to deconstruct how pandemic impacted different populations.

Objective:

This study seeks to explore differences in COVID-19 in-hospital mortality rates by patient and hospital factors. Patient factors include differences in mortality by age, income, race/ethnicity, and sex assigned at birth. Hospital factors are differences in mortality by rurality level, region, and census division.

Methods:

The latest 2020 United States NIS data was used to obtain a population-based estimate for patients with COVID-19. We conducted a cross-sectional retrospective data analysis on the NIS dataset. Sampling weights were used for all statistical analyses to represent nationwide in-hospital mortality of patients with COVID-19. We investigated how patients with COVID-19 and other characteristics, like region or race, are associated with in-hospital death using the multivariate survey logistic regression analysis. Additionally, we ran the models using census divisions to determine more specific regional mortality variance. Finally, subgroup analysis was conducted by race.

Results:

Of 1,002,655 patients, 88.9% did not have an in-hospital death (n=178,369), and 11.1% died in-hospital (n=22,162). Among them, we used the weighted logistic regression results examining predictors of in-hospital death. Patients older than 70 years were 10 times more likely to have an in-hospital death than patient younger than 40 years old (p<0.001). Male patients were 37% more likely to have an in-hospital death than female patients (p<0.001). Hispanic patients were 25% more likely to have in-hospital deaths than white patients (p<0.001). In the sub-analysis, Hispanic patients in the 50-60, 60-70, and 70 age groups were 32%, 34%, and 24%, respectively, more likely to die in-hospital than white patients (p<0.001).

Conclusions:

Health disparities in the COVID-19 pandemic occurred across races and regions and must be addressed to prevent future deaths. Age and comorbidities like diabetes have a well-established link to increased disease severity, and we have linked both to higher mortality risk. Low-income patients had a significantly increased risk of in-hospital death starting at over 40 years old. In sum, Hispanic patients were at increased odds of mortality because of age and economics. Policy concerns should be raised to illuminate populations uniquely burdened by the COVID-19 pandemic to direct more significant research and funding to alleviate inequalities and mitigate future suffering.