Characteristics and comparative clinical outcomes of prisoner versus non-prisoner populations hospitalized with COVID-19
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Abstract
Prisons in the United States have become a hotbed for spreading COVID-19 among incarcerated individuals. COVID-19 cases among prisoners are on the rise, with more than 143,000 confirmed cases to date. However, there is paucity of data addressing clinical outcomes and mortality in prisoners hospitalized with COVID-19. An observational study of all patients hospitalized with COVID-19 between March 10 and May 10, 2020 at two Henry Ford Health System hospitals in Michigan. Clinical outcomes were compared amongst hospitalized prisoners and non-prisoner patients. The primary outcomes were intubation rates, in-hospital mortality, and 30-day mortality. Multivariable logistic regression and Cox-regression models were used to investigate primary outcomes. Of the 706 hospitalized COVID-19 patients (mean age 66.7 ± 16.1 years, 57% males, and 44% black), 108 were prisoners and 598 were non-prisoners. Compared to non-prisoners, prisoners were more likely to present with fever, tachypnea, hypoxemia, and markedly elevated inflammatory markers. Prisoners were more commonly admitted to the intensive care unit (ICU) (26.9% vs. 18.7%), required vasopressors (24.1% vs. 9.9%), and intubated (25.0% vs. 15.2%). Prisoners had higher unadjusted inpatient mortality (29.6% vs. 20.1%) and 30-day mortality (34.3% vs. 24.6%). In the adjusted models, prisoner status was associated with higher in-hospital death (odds ratio, 2.32; 95% confidence interval (CI), 1.33 to 4.05) and 30-day mortality (hazard ratio, 2.00; 95% CI, 1.33 to 3.00). In this cohort of hospitalized COVID-19 patients, prisoner status was associated with more severe clinical presentation, higher rates of ICU admissions, vasopressors requirement, intubation, in-hospital mortality, and 30-day mortality.
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SciScore for 10.1101/2020.08.08.20170787: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study was reviewed and approved by the Henry Ford Health System (HFHS) Institutional Review Board (IRB). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources All statistical analyses were performed with the use of STATA 16 (State Corp LLC, College Station, Texas). STATAsuggested: (Stata, RRID:SCR_012763)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences …SciScore for 10.1101/2020.08.08.20170787: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study was reviewed and approved by the Henry Ford Health System (HFHS) Institutional Review Board (IRB). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources All statistical analyses were performed with the use of STATA 16 (State Corp LLC, College Station, Texas). STATAsuggested: (Stata, RRID:SCR_012763)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The study has several limitations. First, the observational study design makes selection bias inevitable, especially considering the potential discrepancy in hospital referral and admission threshold between the two study groups. However, our findings remained largely consistent after controlling for potential confounders related to demographics, comorbidities, clinical signs, and markers of disease severity. Second, the study population was limited to one healthcare system in Michigan admitting patients from certain prisons and communities, and therefore external generalizability requires validation. Finally, presented findings were based on data extracted from the electronic medical records of the health system, and hence, is subjected to the accuracy of documentation by the healthcare team, but the outcomes were adjudicated and all patients discharged alive were contacted directly or through their healthcare office. In conclusion, our study provides insight into the disparity in clinical outcomes among prisoners hospitalized with COVID-19. With COVID-19 becoming one of the leading causes of death in the U.S., findings on the association between imprisonment and COVID-19 mortality are alarming. Responding to the outbreaks in incarceration facilities is uniquely challenging and failure to mount an adequate response to ameliorate COVID-19 outbreaks in U.S prions has the potential to compromise the well-being of prisoners, correctional workforce, and people living in the commu...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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