The Impact of Disparities in Social Determinants of Health on Hospitalization Rates for Patients with COVID-19 in Michigan (USA)

Megan McCrohan,1,* Linnea Nierenberg,1,* Patrick Karabon,2 Tracy Wunderlich-Barillas,2 Alexandra Halalau1,3 1Oakland University William Beaumont School of Medicine, Rochester, MI, USA; 2Office of Research, Oakland University William Beaumont School of Medicine, Rochester, MI, USA; 3Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA*These authors contributed equally to this workCorrespondence: Linnea Nierenberg Email nierenberglinnea@gmail.comImportance: The COVID-19 pandemic continues to impact the health-care system in the United States and has brought further light on health disparities within it. However, only a few studies have examined hospitalization risk with regard to social determinants of health.Objective: We aimed to identify how health disparities affect hospitalization rates among patients with COVID-19.Design: This observational study included all individuals diagnosed with COVID-19 from February 25, 2020 to December 31, 2020. Uni- and multivariate analyses were utilized to evaluate associations between demographic data and inpatient versus outpatient status for patients with COVID-19.Setting: Multicenter (8 hospitals), largest size health system in Southeast Michigan, a region highly impacted by the pandemic.Participants: All outpatients and inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab were included. Exclusion criteria included missing demographic data or status as a non-permanent Michigan resident.Exposure: Patients who met inclusion and exclusion criteria were divided in 2 groups: outpatients and inpatients.Main Outcome and Measures: We described the comparative demographics and known disparities associated with hospitalization status.Results: Of 30,292 individuals who tested positive for SARS-CoV-2, 34.01% were admitted to the hospital. White or Caucasian race was most prevalent (57.49%), and 23.35% were African-American. The most common ethnicity was non-Hispanic or Latino (70.48%). English was the primary language for the majority of patients (91.60%). Private insurance holders made up 71.11% of the sample. Within the hospitalized patients, lower socioeconomic status, African-American race and Hispanic and Latino ethnicity, non-English speaking status, and Medicare and Medicaid were more likely to be admitted to the hospital.Conclusions and Relevance: Several health disparities were associated with greater rates of hospitalization due to COVID-19. Addressing these inequalities from an individual to system level may improve health-care outcomes for those with health disparities and COVID-19.Keywords: COVID-19, hospitalization, social determinants of health, disparitie