Does Race, Ethnicity, & Insurance Status Predict Functional Outcomes in Hospitalized COVID-19 Patients?

Physical function can predict important clinical outcomes in hospitalized individuals yet little is known on the influence of race, ethnicity, and insurance status on outcomes in patients hospitalized with COVID-19. The primary aim of this research study was to understand if race, ethnicity, and insurance status may predict functional outcomes in patients hospitalized with COVID-19. This is a retrospective analysis of an inpatient COVID-19 registry of a large urban academic medical center. Subjects were included in the analysis if they were 18+, admitted between 3/1/20 and 4/31/21, had COVID-19, and had 2 AM-PAC scores completed by an OT. Primary outcome variable of interest was categorized as either improvement or no-improvement/got worse based on the difference between the subjects first and last AM-PAC score, measured as the minimally clinically important difference. Logistic regression was performed to assess the prediction of known or hypothesized variables that impact COVID-19 outcomes against the dependent variable. A total of N = 2181 patients with COVID-19 were in the population, with n=565 patients meeting inclusion for sample analysis. A majority of the subjects (n = 394, 69.7%) experienced no change or worsening change in their physical function, were majority female (n = 205, 52%), black (n = 216, 54.8%), non-Hispanic (n = 378, 95.9%) and were a median of 68 years old (IQR 60, 67). The overall logistic regression model was statistically significant (p = .03). Of all co-variates in the model, insurance status (p = <.001), use of mechanical ventilation (p = .011) and Comorbodity Index (p = .007) were statistically significant. The results demonstrate that for those with Medicaid, the odds of getting worse/no change in function is about half for those with Medicare. This research suggest that insurance, and not necessarily race or ethnicity may impact on recovery and is important to advancing both practice and policy in the Occupational Therapy field.

References

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Robinson-Lane, S. G., Sutton, N. R., Chubb, H., Yeow, R. Y., Mazzara, N., DeMarco, et al. (2021). Race, Ethnicity, and 60-Day outcomes after hospitalization with COVID-19. Journal of the American Medical Directors Association, 22(11), 2245-2250. https://doi.org/10.1016/j.jamda.2021.08.02