Factors Associated with Hospitalization and Disease Severity in a Racially and Ethnically Diverse Population of COVID-19 Patients

  1. Angelico Mendy
  2. Senu Apewokin
  3. Anjanette A. Wells
  4. Ardythe L. Morrow

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Abstract

Background

The coronavirus disease (COVID-19) first identified in Wuhan in December 2019 became a pandemic within a few months of its discovery. The impact of COVID-19 is due to both its rapid spread and its severity, but the determinants of severity have not been fully delineated.

Objective

Identify factors associated with hospitalization and disease severity in a racially and ethnically diverse cohort of COVID-19 patients.

Methods

We analyzed data from COVID-19 patients diagnosed at the University of Cincinnati health system from March 13, 2020 to May 31, 2020. Severe COVID-19 was defined as admission to intensive care unit or death. Logistic regression modeling adjusted for covariates was used to identify the factors associated with hospitalization and severe COVID-19.

Results

Among the 689 COVID-19 patients included in our study, 29.2% were non-Hispanic White, 25.5% were non-Hispanic Black, 32.5% were Hispanic, and 12.8% were of ‘Other’ race/ethnicity. About 31.3% of patients were hospitalized and 13.2% had severe disease. In adjusted analyses, the sociodemographic factors associated with hospitalization and/or disease severity included older age, non-Hispanic Black or Hispanic race/ethnicity (compared non-Hispanic White), and smoking. The following comorbidities: diabetes, hypercholesterolemia, asthma, chronic obstructive pulmonary disease (COPD), chronic kidney disease, cardiovascular diseases, osteoarthritis, and vitamin D deficiency, were associated with hospitalization and/or disease severity. Hematological disorders such as anemia, coagulation disorders, and thrombocytopenia were associated with higher odds of both hospitalization and disease severity.

Conclusion

This study confirms race and ethnicity as predictors of severe COVID-19 and identifies clinical risk factors not previously reported such a vitamin D deficiency, hypercholesterolemia, osteoarthritis, and anemia.

Article activity feed

  1. Version published to 10.1101/2020.06.25.20137323v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2020.06.25.20137323: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The analyses were performed in SAS Version 9.4 (SAS Institute, Cary, NC) and two-sided p-values <0.05 were considered statistically significant in all analyses.
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    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:
    Our study has limitations. It included only patients from a single health system in the Midwest of the U.S. and may not be generalizable to the overall American population. Our study design was observational; therefore, temporality and causality between certain factors (anemia, coagulation defects, and thrombocytopenia for instance) and COVID-19 severity cannot be established. Smoking status was missing for 22.8% of the COVID-19 participants. Vitamin D deficiency was defined using electronic medical records and data on the serum vitamin D levels were not available. Nonetheless, our study has major strengths, it was conducted in a large and racially/ethnically diverse sample of COVID-19 patients. It also included factors formerly understudied in COVID-19 such as vitamin D deficiency, pure hypercholesterolemia, osteoarthritis, and anemia. In conclusion, the present study confirms previous reports that older age, non-Hispanic Black or Hispanic race/ethnicity, smoking, diabetes, COPD, chronic kidney disease, cardiovascular disease, coagulation defects, and thrombocytopenia are associated with severe COVID-19. It also identifies severe COVID-19 factors not previously reported such as vitamin D deficiency, pure hypercholesterolemia, osteoarthritis, and anemia. Our results are of public health relevance and have implications in the prioritization of COVID-19 patients at risk of severe disease and in the implementation of interventions to mitigate negative outcomes. Future studies sh...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.25.20137323v1 on medRxiv