Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City

Dennis Toy; Syed S Mahmood; Jessica Rotman; Stacey Verzosa Weisman; Joanna G Escalon; Alan C Legasto; Edward P Cheng; Anna Sophia McKenney; Tarek Barbar; Lauren Balkan; Yunchan Chen; Peyman Razavi; Omar Zainul; Sajjad Abedian; James F Gruden; Quynh A Truong

doi:10.1148/ryct.2020200464

Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City

Radiol Cardiothorac Imaging. 2020 Dec 17;2(6):e200464. doi: 10.1148/ryct.2020200464. eCollection 2020 Dec.

Authors

Dennis Toy¹, Syed S Mahmood¹, Jessica Rotman¹, Stacey Verzosa Weisman¹, Joanna G Escalon¹, Alan C Legasto¹, Edward P Cheng¹, Anna Sophia McKenney¹, Tarek Barbar¹, Lauren Balkan¹, Yunchan Chen¹, Peyman Razavi¹, Omar Zainul¹, Sajjad Abedian¹, James F Gruden¹, Quynh A Truong¹

Affiliation

¹ Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A).

Abstract

Background: Coronavirus disease 2019 (COVID-19) affects vulnerable populations (VP) adversely.

Purpose: To evaluate overall imaging utilization in vulnerable subgroups (elderly, racial/ethnic minorities, socioeconomic status [SES] disadvantage) and determine if a particular subgroup has worse outcomes from COVID-19.

Materials/methods: Of 4110 patients who underwent COVID-19 testing from March 3-April 4, 2020 at NewYork-Presbyterian Hospital (NYP) health system, we included 1121 COVID-19 positive adults (mean age 59±18 years, 59% male) from two academic hospitals and evaluated imaging utilization rates and outcomes, including mortality.

Results: Of 897 (80%) VP, there were 465 (41%) elderly, 380 (34%) racial/ethnic minorities, and 479 (43%) SES disadvantage patients. Imaging was performed in 88% of patients and mostly portable/bedside studies, with 87% of patients receiving chest radiographs. There were 83% hospital admissions, 25% ICU admissions, 23% intubations, and 13% deaths. Elderly patients had greater imaging utilization, hospitalizations, ICU/intubation requirement, longer hospital stays, and >4-fold increase in mortality compared to non-elderlies (adjusted hazard ratio[aHR] 4.79, p<0.001). Self-reported minorities had fewer ICU admissions (p=0.03) and reduced hazard for mortality (aHR 0.53, p=0.004; complete case analysis: aHR 0.39, p<0.001 excluding "not reported"; sensitivity analysis: aHR 0.61, p=0.005 "not reported" classified as minorities) with similar imaging utilization, compared to non-minorities. SES disadvantage patients had similar imaging utilization and outcomes as compared to their counterparts.

Conclusions: In a predominantly hospitalized New York City cohort, elderly patients are at highest mortality risk. Racial/ethnic minorities and SES disadvantage patients fare better or similarly to their counterparts, highlighting the critical role of access to inpatient medical care during the COVID-19 pandemic.

Keywords: COVID-19; Diagnostic Imaging; Healthcare Disparities; Mortality; Radiology; SARS Virus; severe acute respiratory syndrome coronavirus 2.

2020 by the Radiological Society of North America, Inc.