Health Inequities

This article by Clay et al. adds further data and analysis exploring the relationship between COVID-19 severity and other factors, including race and ethnicity, health care access and affordability, and existing comorbid conditions. Several studies have indicated a disproportionate impact of the pandemic on Black, Hispanic, and American Indian or Alaska Native populations, as well as associations between severity of illness and several comorbidities (including cancer, diabetes, and obesity) that are more prevalent in these populations due to a variety of social determinants of health and structural inequities.

Using data from CDC’s national cross-sectional 2018 National health Interview Survey (NHIS) dataset, this study found that significant predictors associated with increased risk of severe COVID-19 infection included race, age, and issues related to health care accessibility and affordability, including further interactions between these variables and sex, marital status, employment status, and other factors. A higher proportion of Non-Hispanic Black persons with increased severity risk were female, not married, not employed for wages, had transportation accessibility issues, and had affordability issues in paying for medicine. A higher proportion of Hispanic persons with increased severity risk had a change in where they received health care, accessibility issues, longer wait times, a closed facility, and affordability issues.

This study further develops the literature on the interaction between existing the ongoing pandemic and preexisting inequalities related to race and health, among other factors. Such findings have significant implications for a range of policies and interventions, including resource allocation and outreach.

Resource Allocation

This article by Sablerolles et al. reports a study on the association between Clinical Frailty Scale (CFS) score and hospital mortality and between CFS score and ICU admission across 63 hospitals in 11 European countries. CFS is a commonly used measure consolidating several factors into a single scale to quantify degree of disability from frailty. It is also used in some resource allocation frameworks related to rationing of scarce resources as a means of considering patients’ relative likelihood of survival with treatment (other measures used for this purpose include SOFA score). The study found that patients with higher CFS scores (i.e., more frail) had significantly higher hospital mortaility. The authors conclude that CFS scores are generally a suitable risk marker for hospital mortality in adult patients with COVID-19, but that CFS scores are less useful predictors in patients under age 65, indicating that treatment decisions using CFS scores for such patients should be made with caution.

This article by Margolius et al. presents data from 5 weeks for a COVID-19 hotline operated 24/7 triage line staffed by registered nurses and physicians in northeast Ohio. The hotline fielded calls from over 10,000 patients, of whom 46% were either on Medicaid or were uninsured. The most common caller concerns were cough, fever, and shortness of breath, and 42% of patients were referred for a physician telehealth visit for additional evaluation. Of these, most (79%) were advised to self-isolate at home. Among patients advised to stay home, 83% had no further face-to-face visits. The authors conclude that the results indicate that a robust, comprehensive, and hospital-integrated telehealth system is an effective from of health services during acute phases of a pandemic, noting that telephone hotlines require minimal technological capabilities, can be rapidly implemented, and are accessible to persons without internet access. They note that there was no evidence in the study of disparities by race, ethnicity, or insurance type, supporting the hotline service as an accessible and equitable form of care delivery.