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Importance: Several studies have relayed the disproportionate impact of COVID-19 on marginalized communities, however few have specifically examined the association between social determinants of health and mechanical ventilation (MV). Objective: To determine which demographics impact MV rates among COVID-19 patients. Design: This observational study included COVID-19 patient data from eight hospitals’ EMR between February 25, 2020 to December 31, 2020. Associations between demographic data and MV rates were evaluated using uni- and multivariate analyses. Setting: Multicenter (8 hospitals), largest health system in Southeast Michigan Participants: Inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab. Exclusion criteria were missing demographic data or non-permanent Michigan residents. Exposure: Patients were divided into two groups: MV and non-MV. Main Outcome and Measures: The primary outcome was MV rate per demographic. A multivariate model then predicted the odds of MV per demographic descriptor. Hypotheses were formulated prior to data collection. Results: Among 11,304 COVID-19 inpatients investigated, 1,621 (14.34%) were MV, 49.96% were male with a mean age of 63.37 years (17.79). Significant social determinants for MV included Black race (40.19% MV vs. 31.31% non-MV, p<0.0001), poverty (18.87% vs. 17.06%, p<0.0001), and disability (12.65% vs. 9.14%, p<0.0001). Black race AOR 1.61(CI 1.41-1.83), median income AOR 1.01(CI 1.01-1.01), disability AOR 1.55(CI 1.26, 1.90), and non-English speaking status AOR 1.26 (CI 1.05, 1.53) had significantly higher odds of MV. Conclusions and Relevance: Black race, low socioeconomic class, disability, and non-English speaking status were significant risk factors for MV from COVID-19. An urgent need remains for a pandemic response program that strategizes care for marginalized communities.


American College of Physicians-Michigan, 2021 Michigan Chapter Virtual Meeting. Oct. 14-17, 2021. Virtual. Oral Abstract.