In this month’s final COVID-19 Health Equity review, we discuss recent literature on the impact of COVID-19 among people who have certain chronic conditions, including psychiatric disorders, obesity, and HIV.

Psychiatric Disorders

Individuals who have major psychiatric disorders tend to have comorbidities associated with worse COVID-19 outcomes. A recent US cross-sectional study assessed the odds of testing positive for COVID-19 and related mortality among  patients with schizophrenia, mood disorders, and anxiety disorders utilizing 2020 data obtained from a national Optum COVID-19 Electronic Health Record (EHR) database. Of the 2,535,098 eligible participants, 1.2% had schizophrenia, 9.7% had mood disorders, and 6.1%  had anxiety disorders. The remainder of the study population (74.5%) comprised the reference group (individuals with no psychiatric conditions) referred to as the “general population”. Unadjusted and adjusted odds ratios (ORs) were estimated to compare likelihood of testing positive for COVID-19 and related mortality across the three psychiatric disorder groups and reference group. Findings indicated individuals with schizophrenia or mood disorders had significantly lower COVID-19 positivity rates (9.9%) than individuals with anxiety (11.2%) and the general population (11.9%). However, individuals with schizophrenia had ~4 times greater odds of dying from COVID-19 than the general population, while mood and anxiety disorders had ~3 and 2 times greater odds, respectfully.

Call to action: Study investigators call for alternative approaches for COVID-19 testing and interventions to improve clinical outcomes of individuals with psychiatric disorders.

Obesity

Obesity and related co-morbidities puts individuals at higher risk of severe COVID-19 morbidity and mortality. A recent US retrospective cohort study examined the association between prior bariatric surgery and COVID-19 mortality in patients with obesity. As bariatric surgery has been shown to treat obesity-related conditions, investigators hypothesized prior bariatric surgery results in lower rates of severe COVID-19 morbidity among individuals with obesity. Data were obtained from a national Vizient clinical database of 124,699 adults with obesity having a COVID-19 hospital admission between May 2020 to January 2021. Of the 124,699 eligible adults, 2,607 (2.1%) had previous bariatric surgery and 122,092 (97.9%) had no history of bariatric surgery. Study findings indicated overall inpatient mortality was significantly lower among patients with previous bariatric surgery than those with no history of bariatric surgery (7.8% vs. 11.2%, P < .0001).

Call to action: The authors urge for future studies to examine mechanisms that could potentially explain the relationship between bariatric surgery and lower rates of COVID-19 mortality and implications of postponing surgeries during the COVID-19 pandemic.

HIV

Like other chronic disease management clinics, many HIV clinics implemented telemedicine during the early stages of the COVID-19 pandemic. Although there are reports examining utilization of telemedicine, these reports generally limited to a short time frame at the beginning of the pandemic. Recently, a study was conducted at an a academic HIV clinic in Seattle, Washington, which examined visit trends and factors associated with telemedicine uptake among persons with HIV (PWH) from March – December 2020 of the COVID-19 pandemic. A total of 2,240 PWH met eligibility criteria (retained in care during the pandemic) and thus, their data were included in analyses. Of these 2,240 patients 33% completed at least 1 video visit, 31% at least one phone visit, 36% had only in-person visits. Multivariate analysis findings indicated older age (>50 (adjusted odds ratio [aOR], 0.75; 95% CI, 0.57–0.99; P = .04) or >65 years old (aOR, 0.56; 95% CI, 0.35–0.88; P = .01) compared with 18–35 years old), Black (aOR, 0.81; 95% CI, 0.65–0.99; P = .04), Asian or Pacific Islander race ((aOR, 0.67; 95% CI, 0.45–0.98; P = .045) compared with White race), and Medicaid insurance ((aOR, 0.73; 95% CI, 0.58–0.91; P = .01) compared with private insurance) were significantly associated with never completing a video visit.

Call to action: Investigators call for future qualitative research to further explore diverse PWH awareness and attitudes toward telemedicine to inform sources of disparities in video visit utilization.

From the author

It’s been a pleasure providing monthly reviews on COVID-19 health equity literature these past few months. I hope that you found the information to be insightful. A huge THANK YOU to WISE Indiana, my fellow COVID-19 Daily Digest contributors, and all of the frontline workers, educators and researchers working relentlessly to reduce health disparities during and beyond the COVID-19 pandemic!