Results

U.S. Department of Health & Human Services

09/24/2021 | Press release | Distributed by Public on 09/24/2021 18:28

COVID-19 Science Update released: September 24, 2021 Edition 106

PEER-REVIEWED

Equity and the uneven distribution of federal COVID-19 relief funds to US hospitalsexternal icon . Buxbaum et al. Health Affairs (September 8, 2021).

Key findings:

  • Hospitals serving areas with a higher percentage of Black residents received 45.2% higher provider relief funding in June 2020, and 70.4% higher funding in October 2020 and February 2021 than hospitals serving other areas.
  • Hospitals serving areas with a higher percentage of Hispanic residents received lower provider relief funding (40.3% lower in June 2020, 31.5% lower in October 2020, and 31.2% lower February 2021) than hospitals serving other areas.

Methods: Provider Relief Fund distribution records were matched to hospitals (n = 2,709); modeling correlated provider relief funding with community and hospital characteristics, controlling for hospital beds and hospital wages. Limitations: Excluded hospitals that returned the funding awards (e.g., HCA Healthcare and nearly all Kaiser hospitals), 1,350 rural critical access hospitals, and long-term care facilities.

Implications: Decisions about pandemic relief allocation to hospitals should consider community need to improve equitable distribution.

PREPRINTS (NOT PEER-REVIEWED)

COVID-19 mortality at the neighborhood level: racial and ethnic inequalities deepened in Minnesota in 2020external icon . Wrigley-Field et al. Health Affairs (October 2021).

Key findings:

  • Total mortality increased 41% among non-White BIPOC (Black, Indigenous, People of Color) populations and 14% among non-Hispanic White populations from 2017-2019 to 2020 in Minnesota.
  • Excess deaths directly attributed to COVID-19 were over 3 times higher in neighborhoods with the most disadvantage (Area Deprivation Index [ADI] of 10; 75/100,000) compared to those with the least disadvantage (ADI of 1; 23/100,000) (Figure).

Methods: Total mortality and COVID-19 mortality were examined over time by race/ethnicity and census tract. Area Deprivation Index (a composite of poverty, housing, employment, and education measures collected by the Census Bureau American Community Survey) and geography (metro/non-metro).Limitations: Possible cause of death misclassification may have resulted in an undercount of total COVID-19 mortality, and differences by race and geography.

Implications: Interventions to reduce COVID-19 mortality and address health disparities may need to consider neighborhood contexts.

Figure:

Note: Adapted from Wrigley-Field et al. Excess mortality in Minnesota, by race and ethnicity, region, and area deprivation, 2020. Results are adjusted for age and sex. White is non-Hispanic White. Metro is the 7-county Minneapolis/St. Paul Twin Cities Metro area. Outstate is all other census tracts outside that area. Trends in gold for Whites, blue for BIPOC; solid lines for Metro residents, dashed lines for non-Metro or "outstate." Permission request in process.

Comprehensive evaluation of COVID-19 patient short- and long-term outcomes: disparities in healthcare utilization and post-hospitalization outcomesexternal icon . Salerno et al. medRxiv (September 12, 2021).

Key findings:

  • After adjusting for comorbidities and other demographic conditions, Black or African American patients with COVID-19 had higher hospitalization (adjusted hazard ratio [aHR] 1.89, 95% CI 1.61-2.17) and mortality (aHR 1.52, 95% CI 1.02-2.22) rates compared to other populations with COVID-19.
  • Patients with fluid and electrolyte disorders (aHR 5.50, 95% CI 3.27-9.23) and with blood loss anemia (aHR 2.85, 95% CI 1.84-4.40) had higher mortality compared to those without those conditions.

Methods: A retrospective study of medical encounters, hospitalization, readmission, and mortality among patients with COVID-19 (N = 6,731) treated at a large Midwest university medical center (March 2020-March 2021). Limitations: Excluded patients admitted by transfer because of missing health histories; single hospital in 1 state may have biases in the patient mix and lack generalizability to other geographic areas.

Implications: Greater hospitalization and mortality risk among Black or African American patients likely represent the impact of structural determinants of health. Addressing structural inequities should be considered in efforts to prevent and control COVID-19.