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Racial and Regional Disparities Surrounding In-Hospital Mortality among Patients with 2019 Novel Coronavirus Disease (COVID-19): Evidence from NIS Sample in 2020

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Abstract

Objective

This study explores differences in COVID-19 in-hospital mortality rates by patient and geographic factors to identify at-risk populations and analyze how strained health disparities were exacerbated during the pandemic.

Methods

The latest 2020 United States National Inpatient Sample (NIS) data was used to obtain a population-based estimate for patients with COVID-19. We conducted a cross-sectional retrospective data analysis, and sampling weights were used for all statistical analyses to represent nationwide in-hospital mortality of patients with COVID-19. We used multivariate logistic regression models to identify predictors for how patients with COVID-19 are associated with in-hospital death.

Results

Of 200,531 patients, 88.9% did not have an in-hospital death (n=178,369), and 11.1% had in-hospital death (n=22,162). Patients older than 70 were 10 times more likely to have an in-hospital death than patients younger than 40 (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 have in-hospital death than White patients (p<0.001). Patients with hypertension and diabetes were 69% and 29%, respectively, more likely to have in-hospital death than patients without hypertension and diabetes.

Conclusion

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.

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Data Availability

All data generated or analyzed during this study are included in this published article.

Code Availability

Upon request.

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Funding

This paper was supported by Soonchunhyang University Research Fund, the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2022R1F1A1063423), BK21 FOUR (Fostering Outstanding Universities for Research, No. 5199990914048) by Korean Ministry of Education, and the seed grant at Texas A&M University, Irma Lerma Rangel School of Pharmacy. The funding sources did not have interventions such as study design and data interpretation.

Author information

Authors and Affiliations

  1. Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea

    Sun Jung Kim

  2. Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea

    Sun Jung Kim

  3. Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea

    Sun Jung Kim

  4. School of Pharmacy, University of Texas at El Paso, El Paso, Texas, USA

    Mar Medina

  5. Department of Health Behavior, School of Public Health, Texas A&M University, TX, College Station, USA

    Jeong-Hui Park

  6. Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, Texas, USA

    Jongwha Chang

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  1. Sun Jung Kim
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Contributions

JWC and SJK led the design and conception of the study, performed the data analysis, and wrote/reviewed the manuscript. MM and JHP contributed by writing the first draft of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jongwha Chang.

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Ethics Approval and Consent to Participate

We use secondary data, and all of the patient’s data is encrypted and unable to be identified. This study was approved for a waiver by the Institutional Review Board at Soonchunhyang University (202302-SB-014-01).

Competing Interests

The authors declare no competing interests.

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Kim, S.J., Medina, M., Park, JH. et al. Racial and Regional Disparities Surrounding In-Hospital Mortality among Patients with 2019 Novel Coronavirus Disease (COVID-19): Evidence from NIS Sample in 2020. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01707-1

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