tetano
Editor, Senior Moderator
Radiol Cardiothorac Imaging
. 2020 Dec 17;2(6):e200464.
doi: 10.1148/ryct.2020200464. eCollection 2020 Dec.
Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City
Dennis Toy[SUP] 1 [/SUP], Syed S Mahmood[SUP] 1 [/SUP], Jessica Rotman[SUP] 1 [/SUP], Stacey Verzosa Weisman[SUP] 1 [/SUP], Joanna G Escalon[SUP] 1 [/SUP], Alan C Legasto[SUP] 1 [/SUP], Edward P Cheng[SUP] 1 [/SUP], Anna Sophia McKenney[SUP] 1 [/SUP], Tarek Barbar[SUP] 1 [/SUP], Lauren Balkan[SUP] 1 [/SUP], Yunchan Chen[SUP] 1 [/SUP], Peyman Razavi[SUP] 1 [/SUP], Omar Zainul[SUP] 1 [/SUP], Sajjad Abedian[SUP] 1 [/SUP], James F Gruden[SUP] 1 [/SUP], Quynh A Truong[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) affects vulnerable populations (VP) adversely.
Purpose: To evaluate overall imaging utilization in vulnerable subgroups (elderly, racial/ethnic minorities, socioeconomic status [SES] disadvantage) and determine if a particular subgroup has worse outcomes from COVID-19.
Materials/methods: Of 4110 patients who underwent COVID-19 testing from March 3-April 4, 2020 at NewYork-Presbyterian Hospital (NYP) health system, we included 1121 COVID-19 positive adults (mean age 59?18 years, 59% male) from two academic hospitals and evaluated imaging utilization rates and outcomes, including mortality.
Results: Of 897 (80%) VP, there were 465 (41%) elderly, 380 (34%) racial/ethnic minorities, and 479 (43%) SES disadvantage patients. Imaging was performed in 88% of patients and mostly portable/bedside studies, with 87% of patients receiving chest radiographs. There were 83% hospital admissions, 25% ICU admissions, 23% intubations, and 13% deaths. Elderly patients had greater imaging utilization, hospitalizations, ICU/intubation requirement, longer hospital stays, and >4-fold increase in mortality compared to non-elderlies (adjusted hazard ratio[aHR] 4.79, p<0.001). Self-reported minorities had fewer ICU admissions (p=0.03) and reduced hazard for mortality (aHR 0.53, p=0.004; complete case analysis: aHR 0.39, p<0.001 excluding "not reported"; sensitivity analysis: aHR 0.61, p=0.005 "not reported" classified as minorities) with similar imaging utilization, compared to non-minorities. SES disadvantage patients had similar imaging utilization and outcomes as compared to their counterparts.
Conclusions: In a predominantly hospitalized New York City cohort, elderly patients are at highest mortality risk. Racial/ethnic minorities and SES disadvantage patients fare better or similarly to their counterparts, highlighting the critical role of access to inpatient medical care during the COVID-19 pandemic.
Keywords: COVID-19; Diagnostic Imaging; Healthcare Disparities; Mortality; Radiology; SARS Virus; severe acute respiratory syndrome coronavirus 2.
. 2020 Dec 17;2(6):e200464.
doi: 10.1148/ryct.2020200464. eCollection 2020 Dec.
Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City
Dennis Toy[SUP] 1 [/SUP], Syed S Mahmood[SUP] 1 [/SUP], Jessica Rotman[SUP] 1 [/SUP], Stacey Verzosa Weisman[SUP] 1 [/SUP], Joanna G Escalon[SUP] 1 [/SUP], Alan C Legasto[SUP] 1 [/SUP], Edward P Cheng[SUP] 1 [/SUP], Anna Sophia McKenney[SUP] 1 [/SUP], Tarek Barbar[SUP] 1 [/SUP], Lauren Balkan[SUP] 1 [/SUP], Yunchan Chen[SUP] 1 [/SUP], Peyman Razavi[SUP] 1 [/SUP], Omar Zainul[SUP] 1 [/SUP], Sajjad Abedian[SUP] 1 [/SUP], James F Gruden[SUP] 1 [/SUP], Quynh A Truong[SUP] 1 [/SUP]
Affiliations
- PMID: 33778647
- PMCID: PMC7751279
- DOI: 10.1148/ryct.2020200464
Abstract
Background: Coronavirus disease 2019 (COVID-19) affects vulnerable populations (VP) adversely.
Purpose: To evaluate overall imaging utilization in vulnerable subgroups (elderly, racial/ethnic minorities, socioeconomic status [SES] disadvantage) and determine if a particular subgroup has worse outcomes from COVID-19.
Materials/methods: Of 4110 patients who underwent COVID-19 testing from March 3-April 4, 2020 at NewYork-Presbyterian Hospital (NYP) health system, we included 1121 COVID-19 positive adults (mean age 59?18 years, 59% male) from two academic hospitals and evaluated imaging utilization rates and outcomes, including mortality.
Results: Of 897 (80%) VP, there were 465 (41%) elderly, 380 (34%) racial/ethnic minorities, and 479 (43%) SES disadvantage patients. Imaging was performed in 88% of patients and mostly portable/bedside studies, with 87% of patients receiving chest radiographs. There were 83% hospital admissions, 25% ICU admissions, 23% intubations, and 13% deaths. Elderly patients had greater imaging utilization, hospitalizations, ICU/intubation requirement, longer hospital stays, and >4-fold increase in mortality compared to non-elderlies (adjusted hazard ratio[aHR] 4.79, p<0.001). Self-reported minorities had fewer ICU admissions (p=0.03) and reduced hazard for mortality (aHR 0.53, p=0.004; complete case analysis: aHR 0.39, p<0.001 excluding "not reported"; sensitivity analysis: aHR 0.61, p=0.005 "not reported" classified as minorities) with similar imaging utilization, compared to non-minorities. SES disadvantage patients had similar imaging utilization and outcomes as compared to their counterparts.
Conclusions: In a predominantly hospitalized New York City cohort, elderly patients are at highest mortality risk. Racial/ethnic minorities and SES disadvantage patients fare better or similarly to their counterparts, highlighting the critical role of access to inpatient medical care during the COVID-19 pandemic.
Keywords: COVID-19; Diagnostic Imaging; Healthcare Disparities; Mortality; Radiology; SARS Virus; severe acute respiratory syndrome coronavirus 2.