17:00 PM

New study shows patient income does not predict disability or mortality in hospitalized COVID-19 patients throughout a large Chicago-based health system

Academic medical centers may mitigate detrimental effects of socioeconomic disparities on COVID-19 seen at the community level

Race, income, and their role in COVID-19 infection in the community have been extensively reported, but their impact on outcomes in hospitalized patients is less well defined. A new study accepted for publication in Journal of Health Care for the Poor and Underserved analyzed the first 509 COVID-19 patients hospitalized across the Northwestern Medicine health system and discovered income did not predict disability or mortality. The study conducted by Northwestern Medicine neurology and emergency medicine researchers examined associations between median household income, 30-day mortality, and ambulatory state at discharge from the hospital.

Of the 509 hospitalized COVID-19 patients between March 5 and April 6, 2020:

- Average age was 58
- Race
o White: 53%
o Black or African American: 30%
o Asian: 3%
o Native Hawaiian or Other Pacific Islander: 0.2%
o Other: 10%
- Ethnic group
o Not Hispanic or Latino: 75%
o Hispanic or Latino: 21%
- Median household income was $75,325
- Average length of hospital stay was seven days

The study found:

- Income did not predict mortality in patients hospitalized for COVID-19 infection.
- Higher income was associated with slightly increased odds of ability to walk or move at discharge, but this was true only when accounting for hospital type within the overall Northwestern Medicine health system, which includes Northwestern Memorial Hospital, an academic medical center and the largest hospital in the Chicago metropolitan area.
o At Northwestern Memorial, income and mortality were lower and functional outcomes more favorable.
- Academic medical centers may mitigate detrimental effects of socioeconomic disparities on COVID-19 seen at the community level.
- Patients with lower incomes had more comorbidities such as diabetes, obesity, neurological disorders, heart conditions and lung diseases.

“We were surprised and encouraged to find that income was not associated with measures of morbidity and mortality from COVID-19, given the preponderance of epidemiological data, particularly at the community level, demonstrating that COVID-19 hotspots were concentrated in areas of poverty, particularly in Chicago, and that mortality rates were linked to areas with higher poverty in multiple states, including Illinois,” said Brian Stamm, MD, chief neurology resident at Northwestern Medicine who co-authored the study. “Given the multitude of dynamic factors since the beginning of the pandemic, updated and ongoing analyses will be warranted as the pandemic continues to evolve.”

“One policy hypothesis arising from our study is that a higher-resourced academic institution within a health system has the potential to mitigate the detrimental effect of socioeconomic disparities on COVID-19 that are seen at the community level,” said Regina Royan, MD, MPH, emergency medicine physician at Northwestern Medicine who co-authored the study. “This hypothesis warrants further study, in other health care systems in distinct geographical areas to evaluate whether our findings are reproduced in other locations.”

View the full study: https://bit.ly/3u05yjQ