When Given Equal Care, Minorities and Disadvantaged Fared the Same as Others During COVID-19

The COVID-19 pandemic has affected virtually every aspect of healthcare, shedding new light on disparities that have long existed but were exacerbated by the public health crisis.

But a new study involving patients seen in the pandemic’s early days in New York City shows that if given care on par with their most advantaged counterparts, minorities and socially disadvantaged patients can fare equally well.

A study published in Radiology: Cardiothoracic Imaging evaluated overall imaging utilization and outcomes in COVID-19 patients within vulnerable groups, and compared how much healthcare they used as well as their outcomes with those seen in groups not considered vulnerable.

The researchers also sought to learn whether any particular patient group had worse outcomes from COVID-19 than other vulnerable populations. Groups evaluated in the study included the elderly (65 years of age or older), racial or ethnic minorities, and those with vulnerable socioeconomic status, as defined by being on Medicaid, not having health insurance, being in prison, or being homeless).

New York City, an initial epicenter of the pandemic in the United States, has since made strides in reducing rates of the disease. But since the first weeks of the pandemic, evidence of unequal resource distribution and the virus’ disproportionate effects on vulnerable populations has become evident. Overall, the patient pool for the study included 1121 adults who tested positive for COVID-19 between March 3 and April 4, 2021, at centers in the New York Presbyterian Hospital (NYP) health system.

Of the 1121 patients included, 897 were considered part of a vulnerable population. Of those patients, 465 (41%) were elderly, 380 (34%) were racial or ethnic minorities, and 479 (43%) were considered to be at a socioeconomic disadvantage. Methods of imaging considered for the study included X-ray, CT, MRI, ultrasound, echocardiography, nuclear imaging, and invasive angiography. Some form of imaging was done in 88% of the patients, with scans mostly done bedside. Chest radiographs were done in 87% of patients.

Another aspect of treatment in the study was the highest level of care received, which researchers defined as 3 groups: outpatient, inpatient, and intensive care unit (ICU) admissions.

Among the vulnerable population subgroups, the biggest disparity in care and outcomes was seen among the elderly. They had more imaging performed, more hospitalizations with longer stays, a higher rate of ICU admissions, required intubation more often, and had a four-fold greater risk of mortality compared to non-elderly patients.

Minorities had a similar imaging rate compared with non-minority patients but were admitted to the ICU less frequently and had a lower risk of mortality compared with non-minorities. Those at with a socioeconomic disadvantage had outcomes similar to with no disadvantage.

The study stresses the importance of care availability, especially for the older population that fared worse in the analysis. The findings in regard to ethnic minority and socioeconomically disadvantaged patients surprised researchers given the overall disparity in vulnerable versus non-vulnerable populations. But the difference in this case was driven by the outcomes in elderly patients rather than the other subgroups.

“Our findings reinforce that racial health and social inequities, such as disproportionately high rates of poverty, medical comorbidities, and incarceration rates, are intimately connected and responsible for the disproportionate death rates among minorities, and highlight the importance of equitable access to inpatient medical care,” they wrote.