While declines in U.S. hospital admissions during the onset of COVID-19 have been well-documented, little is known about how admissions during the rebound varied by age, insurance coverage and socioeconomic groups.
As it turns out, the decline in non-COVID-19 admissions was similar across all demographic subgroups, but the partial rebound that followed shows that non-COVID-19 admissions for residents from Hispanic neighborhoods was significantly lower than for other groups.
The findings are reported in a new study in Health Affairs, conducted by a research team from Sound Physicians, Dartmouth College, and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth.
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With data showing that Hispanics did not experience the same rebound in non-coronavirus admissions as other groups, the numbers suggest a much broader issue of access and equity for lower-income and minority patients. That has likely contributed to higher in-hospital mortality rates in April for Hispanics than for other groups.
WHAT'S THE IMPACT?
The study drew on data from one million hospital admissions – from hospital administrative data and electronic medical and billing records – from Sound Physicians, a large nationally distributed medical group with hospitals throughout the U.S. The data came from 201 hospitals in 36 states, including areas hit hard early on by the pandemic, including Washington, Michigan, Ohio and the greater metropolitan area of New York.
The research team looked at non-COVID-19 admissions for the top 20 acute medical conditions, from early February through early July. They found that non-COVID-19 admissions fell in March and reached its lowest point in April. The rebound leveled off in June and July, when there was a resurgence of coronavirus cases in some regions.
From February to April, declines in non-COVID-19 admissions were similar across all demographic subgroups, exceeding 20% for all primary admission diagnoses. The lowest point in non-coronavirus admissions was in April, during which the overall decline was 43%.
By late June/early July, non-COVID-19 admissions had only made a partial rebound at 16% below pre-pandemic baseline volume. Updated data suggests this partial rebound continued through the summer.
During the June/July rebound period, non-coronavirus admissions were substantially lower for patients from majority-Hispanic neighborhoods (32% below baseline) and remained well below baseline for patients with pneumonia (44% below baseline), chronic obstructive pulmonary disease/asthma (40%), sepsis (25%), urinary tract infection (24%) and acute ST-elevation myocardial infarction/heart attack (22%).
These particular diseases are reported in the results, as these were the acute conditions for which the declines were the highest. Most of the majority-Hispanic neighborhoods in this dataset were located in the Southwest and South -- California, Arizona, Texas and Florida.
The research team speculates that the declines in medical admissions may have been due in part to a fear of contracting the virus by both physicians and patients, greater use of telehealth, and possibly lower transmission rates of non-COVID-19 diseases following stay-at-home orders.
THE LARGER TREND
Research published in Health Affairs in February, before the pandemic hit, showed that Hispanics typically have lower mortality rates than other minority groups, a phenomenon that was attributed to something known as the "Hispanic paradox," an accepted epidemiological finding that Hispanic Americans tend to have health outcomes that are comparable to, and often better than those of non-Hispanic whites, even though Hispanic Americans on average tend to have lower socioeconomic status.
Newer findings, published in August in JAMA Internal Medicine, showed Black, Hispanic, Native American and Alaskan Native populations in the U.S. are significantly more likely to be hospitalized due to COVID-19 than whites. Hispanics were hospitalized at higher rates than those who were white in 10 of the 11 states reporting this data, with Virginia (36.2% hospitalizations and 9.6% population), Utah (35.3% hospitalizations and 14.2% population), and Rhode Island (33% hospitalizations and 15.9% population) showing the biggest disparities.