County-Level Social Vulnerability is Associated With In-Hospital Death and Major Adverse Cardiovascular Events in Patients Hospitalized With COVID-19: An Analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry

• Type of Material: Article
• Authors: Shabatun J Islam, Emory University; Gargya Malla, University of Alabama Birmingham; Robert W Yeh, Beth Israel Deaconess Medical Center; Arshed Quyyumi, Emory University; Dhruv S Kazi, Beth Israel Deaconess Medical Center; Wei Tian, Beth Israel Deaconess Medical Center; Yang Song, Beth Israel Deaconess Medical Center; Aditi Nayak, Emory University; Anurag Mehta, Emory University; Yi-An Ko, Emory University; James A de Lemos, UT Southwestern Medical Center; Fatima Rodriguez, Stanford University; Abhinav Goyal, Emory University; Rishi K Wadhera, University of Alabama Birmingham
• Language: English
• Date: 2022-08-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2022 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCOUTCOMES.121.008612
• Title of Journal or Parent Work: CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
• Volume: 15
• Issue: 8
• Start Page: 611
• End Page: 619
• Grant/Funding Information: The American Heart Association 0000031288, Abraham J. & Phyllis Katz Foundation, Byron Williams Jr, MD Fellowship Fund and the National Institutes of Health K23HL148525, R01HL164561, R01HL157530, T32 HL130025, and T32 HL007745-26A1.
• Keywords: Life Sciences & Biomedicine; AIR-POLLUTION; NEIGHBORHOOD; cardiovascular outcomes; IMPACT; pandemic; ethnicity; RISK; Science & Technology; health disparities; Cardiovascular System & Cardiology; MORTALITY; Cardiac & Cardiovascular Systems; COVID-19
• Research Categories: Biology, Biostatistics; Health Sciences, Medicine and Surgery

Abstract

Background: The COVID-19 pandemic has disproportionately affected low-income and racial/ethnic minority populations in the United States. However, it is unknown whether hospitalized patients with COVID-19 from socially vulnerable communities experience higher rates of death and/or major adverse cardiovascular events (MACEs). Thus, we evaluated the association between county-level social vulnerability and in-hospital mortality and MACE in a national cohort of hospitalized COVID-19 patients. Methods: Our study population included patients with COVID-19 in the American Heart Association COVID-19 Cardiovascular Disease Registry across 107 US hospitals between January 14, 2020 to November 30, 2020. The Social Vulnerability Index (SVI), a composite measure of community vulnerability developed by Centers for Disease Control and Prevention, was used to classify the county-level social vulnerability of patients' place of residence. We fit a hierarchical logistic regression model with hospital-level random intercepts to evaluate the association of SVI with in-hospital mortality and MACE. Results: Among 16 939 hospitalized COVID-19 patients in the registry, 5065 (29.9%) resided in the most vulnerable communities (highest national quartile of SVI). Compared with those in the lowest quartile of SVI, patients in the highest quartile were younger (age 60.2 versus 62.3 years) and more likely to be Black adults (36.7% versus 12.2%) and Medicaid-insured (31.1% versus 23.0%). After adjustment for demographics (age, sex, race/ethnicity) and insurance status, the highest quartile of SVI (compared with the lowest) was associated with higher likelihood of in-hospital mortality (OR, 1.25 [1.03-1.53]; P=0.03) and MACE (OR, 1.26 [95% CI, 1.05-1.50]; P=0.01). These findings were not attenuated after accounting for clinical comorbidities and acuity of illness on admission. Conclusions: Patients hospitalized with COVID-19 residing in more socially vulnerable communities experienced higher rates of in-hospital mortality and MACE, independent of race, ethnicity, and several clinical factors. Clinical and health system strategies are needed to improve health outcomes for socially vulnerable patients.