Original Article

Epidemiology, Clinical Features, and Outcomes of Hospitalized Adults with COVID-19: Early Experience from an Academic Medical Center in Mississippi

Authors: Jose Lucar, MD, Mary Joyce B. Wingler, PharmD, David A. Cretella, PharmD, Lori M. Ward, PhD, MS, Courtney E. Sims Gomillia, MS-PHS, Nicholas Chamberlain, MD, Luis A. Shimose, MD, James B. Brock, MD, Jessie Harvey, MD, Andrew Wilhelm, MD, Lance T. Majors, MD, Joshua B. Jeter, MD, Maria X. Bueno, MD, Svenja Albrecht, MD, MPH, Bhagyashri Navalkele, MD, Leandro A. Mena, MD, MPH, Jason Parham, MD, MPH

Abstract

Objectives: To describe the demographics, clinical characteristics, and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) in an academic medical center in the southern United States.

Methods: Retrospective, observational cohort study of all adult patients (18 years and older) consecutively admitted with laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 infection between March 13 and April 25, 2020 at the University of Mississippi Medical Center. All of the patients either survived to hospital discharge or died during hospitalization. Demographics, body mass index, comorbidities, clinical manifestations, and laboratory findings were collected. Patient outcomes (need for invasive mechanical ventilation and in-hospital death) were analyzed.

Results: One hundred patients were included, 53% of whom were women. Median age was 59 years (interquartile range 44–70) and 66% were younger than 65. Seventy-five percent identified themselves as Black, despite representing 58% of hospitalized patients at our institution in 2019. Common comorbid conditions included hypertension (68%), obesity (65%), and diabetes mellitus (31%). Frequent clinical manifestations included shortness of breath (76%), cough (75%), and fever (64%). Symptoms were present for a median of 7 days (interquartile range 4–7) on presentation. Twenty-four percent of patients required mechanical ventilation and, overall, 19% died (67% of those requiring mechanical ventilation). Eighty-four percent of those who died were Black. On multivariate analysis, ever smoking (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.2–28.6) and history of diabetes mellitus (OR 5.9, 95% CI 1.5–24.3) were associated with mortality, and those admitted from home were less likely to die (vs outside facility, OR 0.2, 95% CI 0.0–0.7). Neither age, sex, race, body mass index, insurance status, nor rural residence was independently associated with mortality.

Conclusions: Our study adds evidence that Black patients appear to be overrepresented in those hospitalized with and those who die from COVID-19, likely a manifestation of adverse social determinants of health. These findings should help guide preventive interventions targeting groups at higher risk of acquiring and developing severe COVID-19 disease.
Posted in: Infectious Disease136

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Johns Hopkins University. COVID-19 United States cases by county. Johns Hopkins University COVID-19 tracking map. https://coronavirus.jhu.edu/us-map. Accessed June 12, 2020. 2. Centers for Disease Control and Prevention COVID-19 Response Team. Geographic Differences in COVID-19 Cases, Deaths, and Incidence—United States, February 12–April 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:465–471. 3. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323:2052–2059. 4. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med 2020;382:2372–2374. 5. Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020;395:1763–1770. 6. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020;369:m1966. 7. Centers for Disease Control and Prevention COVID-19 Response Team. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019—United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382–386. 8. Gold JAW, Wong KK, Szablewski CM, et al. Characteristics and clinical outcomes of adult patients hospitalized with COVID-19—Georgia, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:545–550. 9. Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clin Infect Dis 2020;71:896–897. 10. Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet 2020;395:1544–1545. 11. Artiga S, Damico A. Health and health coverage in the South: a data update. https://www.kff.org/disparities-policy/issue-brief/health-and-healthcoverage-in-the-south-a-data-update. Accessed June 12, 2020. 12. Mississippi State Department of Health. Health equity in Mississippi. https://msdh.ms.gov/msdhsite/_static/44,0,236.html#:~:text=Health%20Disparity%20Data&text=Many%20of%20Mississippi's%20poor%20health,populations%20having%20worse%20health%20outcomes. Accessed June 12, 2020. 13. Centers for Disease Control and Prevention, National Center for Health Statistics. Stats of the state of Mississippi. https://www.cdc.gov/nchs/pressroom/states/mississippi/mississippi.htm. Accessed June 12, 2020. 14. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. Adult Obesity Prevalence Maps—non-Hispanic Black adults. https://www.cdc.gov/obesity/data/prevalence-maps.html#nonhispanic-blackadults. Accessed June 12, 2020. 15. El-sadek L, Zhang L, Vargas R, et al. State of the state: Annual Mississippi Health Disparities and Inequalities Report. https://msdh.ms.gov/msdhsite/index.cfm/44,8072,236,63,pdf/HealthDisparities2015.pdf. Published October 2015. Accessed January 9, 2021. 16. The Kaiser Family Foundation. State health facts. Poverty Rate by Race/Ethnicity. 2018. https://www.kff.org/other/state-indicator/poverty-rate-byraceethnicity. Accessed June 22, 2020. 17. Price-Haywood EG, Burton J, Fort D, et al. Hospitalization and mortality among Black patients and White patients with COVID-19. N Engl J Med 2020;382:2534–2543. 18. Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity. Defining adult overweight and obesity. https://www.cdc.gov/obesity/adult/defining.html. Accessed June 12, 2020. 19. Centers for Disease Control and Prevention, National Center for Health Statistics. 2013 NCHS urban-rural classification scheme for counties. https://www.cdc.gov/nchs/data_access/urban_rural.htm. Accessed June 12, 2020. 20. Centers for Disease Control and Prevention. COVID-19-Associated Hospitalization Surveillance Network, COVID-NET. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covid-net/purpose-methods.html. Accessed June 12, 2020. 21. Mississippi State Department of Health. COVID-19 in Mississippi. https://msdh.ms.gov/msdhsite/_static/14,0,420.html#Mississippi. Accessed June 9, 2020. 22. Centers for Disease Control and Prevention, COVID-19. Health equity considerations and racial and ethnic minority groups. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html. Accessed January 9, 2021. 23. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. https://www.cdc.gov/brfss/brfssprevalence/. Accessed February 01, 2021. 24. Karanasos A, Aznaouridis K, Latsios G, et al. Impact of smoking status ondisease severity and  mortality of hospitalized patients with COVID-19 infection: a systematic review and meta-analysis. Nicotine Tob Res 2020;22:1657–1659. 25. Gallus S, Lugo A, Gorini G. No double-edged sword and no doubt about the relation between smoking and COVID-19 severity. Eur J Intern Med 2020;77:33–35. 26. Mosley D, DeBehnke D. Rural hospital sustainability: new analysis shows worsening situation for rural hospitals, residents. https://guidehouse.com/-/media/www/site/insights/healthcare/2019/navigant-rural-hospital-analysis22019.pdf. Accessed June 23, 2020. 27. Fallon A, Dukelow T, Kennelly SP, et al. COVID-19 in nursing homes. QJM 2020;113:391–392. 28. Fleishon HB, Itri JN, Boland GW, et al. Academic medical centers and community hospitals integration: trends and strategies. J Am Coll Radiol 2017;14:45–51.