Socioeconomics Influence on COVID-19 Healthcare Outcomes

Shari Fisher Hinds, RN, MSN, FNP

Social and environmental factors have long been a contributor to negative health-related outcomes. The COVID-19 crisis has magnified the disparities seen within healthcare and this panel, “Socioeconomics and Outcomes in Healthcare: A COVID Focus,” held May 16 at the IARS 2021 Annual Meeting, presented perspectives related to these societal factors.

The panel began with Elizabeth Cotter, MD, from The University of Kansas School of Medicine, discussing the subject of socioeconomic status, which is one’s ability to access desirable resources within a society. Socioeconomic status is measured by occupation, education, income, wealth, and geography. Desirable resources, such as employment, food/nutrition, healthcare, and education, allow groups to prosper. Dr. Cotter explained that there are 5 categories that influence health within an individual or society. These are genetics, behavior, medical care, environmental/physical factors, and social factors. Social determinants of health account for the largest portion of health inequalities, which are strongly influenced by race and ethnicity. Socioeconomic status affects many service areas involving anesthesiologist care, and directly impacts outcomes in the critically ill. 

The COVID-19 pandemic has especially brought to light how socioeconomic status can directly increase a person’s risk for contracting the illness. Households with essential workers have more economic and health vulnerability. Essential workers tend to lack paid sick leave, have inadequate or no health insurance, and tend to rely on public transportation. This population also tends to live in high-density housing with multigenerational households. 

An additional topic of discussion was childhood poverty, where prepandemic rates were 14%, according to Brent Kidd, MD, from the University of Kansas. It will take years to understand the impacts of COVID-19 on this issue, but prior recessions have shown a sharp uptick in childhood poverty. In July 2020, 22% of children had at least one unemployed parent (the highest rate since 1967). The resulting stress this causes can increase behavioral problems and decrease academic performance. Throw in the impacts of distance learning and long-term success of these students, and even more concerns arise. A study on the effects of distance learning in younger children showed negative effects in math and language arts test scores that were sustained even after returning to brick-and-mortar school. Per Dr. Kidd, low academic achievement is a predictor of unemployment, total lifetime income and life expectancy.

Ibukunoluwa Adeleke, MD, from Northwestern University, discussed the risk factors for increased morbidity and mortality in COVID-19 patients. These include hypertension, diabetes, obesity, age older than 65, and male sex. Additionally, the American Indian, Black and Latino populations had a 2 to 3 times higher rate of infection, hospitalization and death. The initial thought was that there was a possible genetic predisposition leading to worse outcomes, but Africa has had low rates of infection and mortality.

Vivek Moitra, MD, from Columbia University, described how the rates of infection have been more concentrated along geographical lines where mean temperatures are between 5-11 degrees Celsius and humidity is low. In a cohort study looking for an association between mortality and patient characteristics, the outcomes of 11,000 patients in over 90 hospitals in 12 states were reviewed. Findings showed that there was no significant difference between Black and White hospitalized patients, after adjustments for age, sex, comorbidities, neighborhood deprivation, insurance type and site of care. Instead, it was determined that socioeconomic status is more related to negative outcomes versus racial or ethnic predisposition. More equitable hospital care may decrease mortality rates among ethnic/racially diverse patients. 

There will be much more data to come to better understand the variables related to poor outcomes in COVID-19-related infections, but the current understanding is that low socioeconomic status and age older than 65 seem to be the two most significant risk factors for negative outcomes. Age is nonmodifiable. However, providing more equitable care among patients regardless of factors related to socioeconomic status is key for improving outcomes for all patients. Additionally, focusing on preventative medicine, health education and accessibility to care can also pave a path to better outcomes.