1 - median Income is Associated with Need for Mechanical Ventilation in COVID-19

Background: The coronavirus disease 2019 (COVID-19) pandemic unmasked the devastating impact of social and health disparities on communities of color. Black race, body mass index (BMI), and presence of comorbidities have been associated with increased severity of disease and need for mechanical ventilation (MV). We examined socioeconomic variables including social support, highest level of education, median income, housing, food insecurity, and employment status, and poverty rate to determine their impact on the need for MV.

Methods: Retrospective cohort study of 2,038 adult patients with positive SARS-CoV2 test admitted to four large hospitals within the Henry Ford Health System from March 12-April 24 and followed until May 27, 2020. Collected data included patient demographics, employment status, health insurance status, and comorbidities via Charlson Comorbidity Index (CCI). Census tracts were obtained from patient addresses and used to obtain socioeconomic data from the 2018 American Community Survey and the Food Access Research Atlas. The primary outcome assessed was frequency of MV. Univariate and multivariate analysis was performed on prehospital variables to identify independent predictors for mechanical ventilation.

Results: Patients who required MV were significantly more likely to be male (p=0.0006), black race (p=0.012), and have higher CCI (p< 0.0001) and BMI (p< 0.0001). Using census tract data, patients who required MV lived in neighborhoods with lower median income (p< 0.0001), educational attainment (p< 0.0001), and higher levels of food insecurity (p=0.0007). Multivariate analysis revealed male sex, high BMI, CCI, and lower median income to be independent predictors of need for MV. The remaining results are summarized in Tables 1 and 2.Table 1
Table 2


Conclusion: This study demonstrates the significant impact of socioeconomic status on frequency of MV in COVID-19 patients. Healthcare providers must be aware of disparities in order to address the systematic inequities that harm vulnerable populations.