Living in More Socially Vulnerable Neighborhood Linked to Worse Outcomes in Hospitalized COVID-19 Patients

Hospitalized patients with COVID-19 in the US who live in more socially vulnerable neighborhoods experienced higher rates of in-hospital death and major adverse cardiovascular events (MACE), regardless of race and ethnicity, according to new research.

Preliminary findings from the new study will be presented at the American Heart Association’s (AHA) Scientific Sessions 2021, held virtually from November 13-15, 2021.

“Based on what we have seen with COVID-19 infections, we expected worse outcomes among hospitalized patients from more vulnerable neighborhoods,” said lead author Shabatun Islam, MD, cardiology fellow, Emory University School of Medicine, Atlanta, Georgia in an AHA press release. “However, we thought the findings would be partially explained by the patients’ preexisting health conditions or how sick they were when they were admitted to the hospital, yet this was not the case.”

Research has shown that the COVID-19 pandemic has disproportionally impacted low-income and racial/ethnic minority populations in the US, however, it is unknown whether hospitalized COVID-19 patients from socially vulnerable communities are more likely to experience MACE and/or death.

To determine the association between neighborhood social vulnerability and in-hospital outcomes among hospitalized COVID-19 patients, Islam and colleagues used the AHA COVID-19 Cardiovascular Disease Registry to extract health data for persons hospitalized with COVID-19 between January 2020 and November 2020 across 107 US hospitals. The registry captures data from adults hospitalized with COVID-19, including those with and without a history of cardiovascular disease.

Researchers also used the Social Vulnerability Index (SVI), a composite measure of community vulnerability developed by the Centers for Disease Control and Prevention, to classify the social vulnerability of patients’ place of residence defined by zip codes, according to the study abstract.

Among the 20 925 hospitalized COVID-19 patients included in the analysis, 6083 (29.1%) lived in the most vulnerable communities (highest national quartile of SVI), according to the abstract.

Compared to patients in the lowest quartile of SVI, those in the highest quartile were younger (mean age, 59.7 years vs 62 years), more likely to be women (47.1% vs 43.2%) and to be Black (36.1% vs 13.3%), and less likely to have private insurance (29% vs 39.1%).

After adjusting for demographics (age, sex, race/ethnicity), insurance status, and comorbidities, researchers found that residing in neighborhoods ranked in the highest quartile of SVI, compared to the lowest, was associated with higher likelihood of in-hospital MACE (odds ratio [OR], 1.28; 95% CI, 1.12-1.46; p<.001) and in-hospital death (OR, 1.37; 95% CI, 1.21-1.54; p<.001).

“Unfortunately, I’m not surprised by the findings of this research,” said Michelle Albert, MD, MPH, president-elect of the AHA, who was not part of the current study, in the press release.

“Addressing health disparities is going to take a multi-pronged approach of societal solutions, such as building community relationships, increasing diversity in the health care workforce, and strengthening research funding and clinical care focused on social factors and their impact on health. These solutions will require sustained efforts over time; there’s a lot of work to be done,” concluded Albert, who is also professor medicine, associate dean of admissions, and director of the Center for the Study of Adversity and Cardiovascular Disease at the University of California, San Francisco.

Reference: Islam S, Malla G, Nayak A, et al. Neighborhood social vulnerability is associated with major adverse cardiovascular events and deaths among patients hospitalized with COVID-19: An analysis of the AHA COVID-19 Cardiovascular Disease Registry. Poster (P720) presented at: AHA Scientific Sessions 2021, held online November 13-15, 2021.