Coronavirus disease 19 in minority populations of Newark, New Jersey

Abstract

Background: The purpose of this study is to report the clinical features and outcomes of Black/African American (AA) and Latino Hispanic patients with Coronavirus disease 2019 (COVID-19) hospitalized in an inter-city hospital in the state of New Jersey.

Methods: This is a retrospective cohort study of AA and Latino Hispanic patients with COVID-19 admitted to a 665-bed quaternary care, teaching hospital located in Newark, New Jersey. The study included patients who had completed hospitalization between March 10, 2020, and April 10, 2020. We reviewed demographics, socioeconomic variables and incidence of in-hospital mortality and morbidity. Logistic regression was used to identify predictor of in-hospital death.

Results: Out of 416 patients, 251 (60%) had completed hospitalization as of April 10, 2020. The incidence of In-hospital mortality was 38.6% (n = 97). Most common symptoms at initial presentation were dyspnea 39% (n = 162) followed by cough 38%(n = 156) and fever 34% (n = 143). Patients were in the highest quartile for population's density, number of housing units and disproportionately fell into the lowest median income quartile for the state of New Jersey. The incidence of septic shock, acute kidney injury (AKI) requiring hemodialysis and admission to an intensive care unit (ICU) was 24% (n = 59), 21% (n = 52), 33% (n = 82) respectively. Independent predictors of in-hospital mortality were older age, lower serum Hemoglobin < 10 mg/dl, elevated serum Ferritin and Creatinine phosphokinase levels > 1200 U/L and > 1000 U/L.

Conclusions: Findings from an inter-city hospital's experience with COVID-19 among underserved minority populations showed that, more than one of every three patients were at risk for in-hospital death or morbidity. Older age and elevated inflammatory markers at presentation were associated with in-hospital death.

Keywords: African American; COVID-19; Hispanic, mortality, morbidity; Minority.

Fig. 1

Distribution of common presenting symptoms of underserved minority patients admitted to an inter-city hospital in Newark, New Jersey for COVID-19

Fig. 2

Heat map representation and histogram plots (separated into quartiles) of estimated population densities (A), Housing Units (B) and (C) median income level of patients. The map shows the known locations of coronavirus subjects by residence zip codes. Red circles are sized by the number of study patients who resided in the region displayed. Adapted from the U.S. Census Bureau. American Community Survey, 2018 5-year estimates. Prepared by Cubit Planning, Inc. April 2020

Fig. 3

Schematic representation of laboratory values including serum white cell count (A), Hemoglobin (B), Ferritin (C), International Normalized Ratio (D), albumin (E), creatinine phosphokinase (F), Lactate Dehydrogenase (G) and Procalcitonin (H) compared between survivors and non-survivors