Predictors of clinical decompensation in patients presenting with COVID-19 in an urban hospital health system

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic which has infected more than 128 million people and led to over 2.8 million deaths worldwide. Although the introduction of efficacious vaccines has led to overall declines in the incidence of SARS-CoV-2 infection, there has been a recent increase in infections once more due to the appearance of mutant strains with higher virulence. It therefore remains vital to identify predictors of poor outcomes in this patient population. Purpose The objective of our study was to identify predictors of prolonged hospitalization, intensive care unit (ICU) admission, intubation, and death in patients infected with SARS-CoV-2. Methods We conducted a retrospective analysis of all patients hospitalized with SARS-CoV-2 at our health system that includes one tertiary care center and two community hospitals located in the Chicago metropolitan area. The main outcome was a composite endpoint of hospitalization >28 days, ICU admission, intubation, and death. Explanatory variables associated with the primary outcome in the bivariate analysis (p<0.05) were included in the multivariable logistic regression model. Statistical analysis was performed using IBM SPSS 25.0. Results Between March 1, 2020 and May 31, 2020, 1029 patients hospitalized with SARS-CoV-2 were included in our analysis. Of these patients, 379 met the composite endpoint. Baseline demographics are described in Table 1. Of note, our cohort consisted of a predominantly minority patient population including 47% Hispanic, 17% African American, 16% Caucasian, and 16% other. In bivariate analysis, age, hypertension, tobacco and alcohol abuse, obesity, coronary artery disease, arrhythmias, valvular heart disease, dyslipidemia, hypertension, stroke, diabetes, documented thrombosis, troponin, CRP, ESR, ferritin, LDH, BNP, D-dimer >5x the upper limit of normal, lactate, and right ventricular outflow tract velocity time integral <9.5 were significant. After multivariable adjustment, explanatory variables associated with the composite endpoint included troponin (OR 2.36; 95% CI 1.08–5.17, p 0.03), D-dimer (OR 1.5; 95% CI 1.23–1.98, p<0.01, lactate (OR 1.58; 95% CI 1.28–1.95, p<0.01), and documented thrombosis (OR 3.56; 95% CI 1.30–8.70, p<.05). Race was not a predictor of poor outcomes in the bivariate or multivariate analysis (Table 2). Conclusions In a large urban cohort with a predominantly minority population, we identified several clinical predictors of poor outcomes. Of note, race was not a predictor of the primary endpoint in this study. While recent literature has demonstrated worse outcomes among racial minorities infected with SARS-CoV-2, our data suggests these variations are related to social determinants of health rather than biologic causes. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Loyola University Medical Center

Abstract MP64: Higher Visit-to-Visit Blood Pressure Variability In Early And Middle Childhood Is Associated With Higher Blood Pressure In Adolescence

Background: In young adults, higher blood pressure (BP) and visit-to-visit BP variability are independent risk factors for incident cardiovascular disease. No studies have examined if BP and visit-to-visit BP variability during early and middle childhood are independently associated with elevated BP during adolescence. Addressing this question can provide targets for primordial prevention of high BP. Hypotheses: Higher BP and BP variability in early and middle childhood are independently associated with higher BP in adolescence. Methods: We studied 476 children in the Boston Birth Cohort (enrolled 1998-2016) who had BP measured in early (1 to <6 y) or middle childhood (6 to <13y) and in adolescence (13 to <18 y). We modelled visit-to-visit BP variability using variability independent of the mean (VIM). We used linear regression models to examine the associations of mean BP and BP VIM in early and middle childhood (exposures) with mean BP in adolescence (outcome) and adjusted for potential confounders (see Table footnote). Results: After multivariable adjustment, a 1-SD higher level of systolic BP (SBP) in early and middle childhood was associated with a 1.89 (95% CI: 1.03, 2.75) and a 4.31 (95% CI: 3.58, 5.03) mmHg higher SBP in adolescence, respectively. A 1-SD higher level of SBP VIM in early and middle childhood was associated with a 1.46 (95% CI: 0.54, 2.38) and a 0.89 (95% CI: 0.05, 1.73) mmHg higher SBP in adolescence, respectively. Higher diastolic BP (DBP) in early and middle childhood was also associated with higher adolescence DBP, but the magnitude was smaller in comparison with SBP results ( Table ). Childhood DBP VIM was not associated with DBP in adolescence. Conclusion: In this prospective US predominantly minority birth cohort, both BP levels and variability during early and middle childhood are associated with higher BP in adolescence. Our findings underscore the need for health professionals to collect early-life BP data to facilitate opportunities for the primordial prevention of high BP in adolescence and beyond.

Pandemic Preparedness of Care Homes Serving Older Adults in the Wake of COVID-19: An Exploratory Study

Recent COVID-19 pandemic has disproportionately affected the older adult population worldwide. According to CDC, among older adults over 60 years the risk increases with age, with the highest risk of serious illness and death among those over 80 years. While public has been receiving messages about the risks and how to take preventive measures, it is not clear how the care homes serving older adults have been preparing. Data have been collected as part of an ongoing study from 30 independent living, assisted living, and memory care facilities across the United States. The centers were selected with a snowball sampling technique. Administrators of the centers were interviewed with a semi-structured questionnaire. It was apparent that although awareness of risks was high, preparation appears to be inadequate with little resources available at the time of the survey. Variation of preparedness based on the sociodemographic characteristics of the residents suggests that homes that serve predominantly minority and economically disadvantaged have greater likelihood of lacking preventive resources. It is critical that facilities serving older adults be prepared to ensure an effective healthcare response in the wake of novel viruses, such as COVID-19.

Racial and Ethnic Disparities in High-Quality Home Health Use Among Persons With Dementia

Prior research suggests minorities and racially-diverse neighborhoods have decreased access to high-quality hospitals, physicians, and nursing homes. It is not clear how this varies for persons with dementia (PWD) and home health agencies (HHAs). With the Medicare enrollment file, linked to the home health OASIS, the American Community Survey, and Home Health Compare, we examine the influence of individual’s race/ethnicity, as well as the racial/ethnic composition of neighborhoods, on the likelihood of high quality HHA use among PWD in 2016. Minority PWD receiving home health are significantly less likely to use high-quality HHAs than their white counterparts (33% vs 39%, respectively). PWD using HHA in predominantly minority neighborhoods are less likely to use high-quality HHAs compared to PWD in predominantly white neighborhoods (31% vs 40%, respectively). This study is the first to examine racial disparities in the use of HH for PWD. Policy and practice implications will be discussed.

Health Disparities and COVID-19: A Retrospective Study Examining Individual and Community Factors Causing Disproportionate COVID-19 Outcomes in Cook County, Illinois, March 16-May 31, 2020

Background: Early data from the COVID-19 pandemic suggests that the disease has had a disproportionate impact on communities of color causing higher infection and mortality rates within those communities. Methods: This study used demographic data from the 2018 US census estimates, mortality data from the Cook County Medical Examiners office, and testing results from the Illinois Department of Public Health to perform both bivariate and multivariate regression analyses to explore the role race plays in COVID-19 outcomes at the individual and community levels. Results: Principal findings show that: 1) while Black Americans make up 22% of Cook County population, they account for 36% of the county COVID-19 related deaths; 2) the average age of death from COVID-19 is seven years younger for minorities compared to Non-Hispanic White (White) decedents; 3) minorities were more likely than Whites to have seven of the top 10 co-morbidities at death; 4) residents of predominantly minority areas were twice as likely to test positive for COVID-19 (p = 0.0001, IRR 1.94, 95% CI 1.50, 2.50) than residents of predominantly White areas; and 5) residents of predominantly minority areas were 1.43 times more likely to die of COVID-19 than those in predominantly White areas (p = 0.03). Conclusions: There are notable differences in COVID-19 related outcomes between racial and ethnic groups at individual and community levels. We hope that this study will scientifically illustrate the health disparities experienced by communities of color and help to address the underlying systemic inequalities still prevalent within our country.

Is School Racial/Ethnic Composition Associated With Content Coverage in Algebra?

This brief utilizes data from the U.S. Trends in International Mathematics and Science Study of 2011 (TIMSS) to investigate the extent to which teacher reports of content coverage in eighth grade algebra classes vary according to school racial/ethnic composition. The analytic sample is comprised of eighth grade algebra classrooms in 111 schools across the country, with 9 schools that are predominantly Black, 20 schools that are predominantly Latinx, and 82 schools that are not predominantly minority. Results of regression analyses reveal that, net of school, teacher, and student characteristics, the time that teachers report spending on algebra and more advanced content in eighth grade algebra classes is significantly lower in schools that are predominantly Black compared to those that are not predominantly minority. Implications for future research are discussed.