Racial and ethnic disparities in COVID-19 hospital cost of care

• Published in: PloS one 2024-10, Vol.19 (10), p.e0309159
• Main Authors: Johnson, Tricia J, Longcoy, Joshua, Suzuki, Sumihiro, Isgor, Zeynep, Lynch, Elizabeth B
• Format: Article
• Language: English
• Subjects: Accounting; Accounting systems; Adult; Aged; Analysis; Biology and Life Sciences; Black or African American; Censuses; Chicago - epidemiology; Chronic illnesses; Chronic obstructive pulmonary disease; COVID-19; COVID-19 - economics; COVID-19 - epidemiology; COVID-19 - ethnology; COVID-19 - therapy; Cultural differences; Earth Sciences; Economic aspects; Electronic health records; Electronic medical records; Ethnicity; Evaluation; Female; Food stamps; Generalized linear models; Health care disparities; Health care facilities; Healthcare Disparities - economics; Healthcare Disparities - ethnology; Hispanic or Latino; Hospital costs; Hospital Costs - statistics & numerical data; Hospital patients; Hospitalization; Hospitalization - economics; Hospitals; Humans; Inflation (Finance); Intubation; Inverse Gaussian probability distribution; Length of stay; Male; Management; Marital status; Medical care, Cost of; Medical colleges; Medical records; Medical research; Medicine and Health Sciences; Medicine, Experimental; Middle Aged; Minority & ethnic groups; Neighborhoods; Pandemics; Patients; People and Places; Race; Racial Groups; Regression models; Research and Analysis Methods; Social Sciences; Sociodemographics; Spain; Statistical analysis; Statistical models; United Kingdom; White
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0309159

Although studies have evaluated the hospital cost of care associated with treating patients with COVID-19, there are no studies that compare the hospital cost of care among racial and ethnic groups based on detailed cost accounting data. The aims of this study were to provide a detailed description of the hospital costs of COVID-19 based on individual resources during the hospital stay and standardized costs that do not rely on inflation adjustment and evaluate the extent to which hospital total cost of care for patients with COVID-19 differs by race and ethnicity. This study used electronic medical record data from an urban academic medical center in Chicago, Illinois USA. Hospital cost of care was calculated using accounting data representing the cost of the resources used to the hospital (i.e., cost to the hospital, not payments). A multivariable generalized linear model with a log link function and inverse gaussian distribution family was used to calculate the average marginal effect (AME) for Black, White, and Hispanic patients. A second regression model further compared Hispanic patients by preferred language (English versus Spanish). In our sample of 1,853 patients, the average adjusted cost of care was significantly lower for Black compared to White patients (AME = -$5,606; 95% confidence interval (CI), -$10,711 to -$501), and Hispanic patients had higher cost of care compared to White patients (AME = $8,539, 95% CI, $3,963 to $13,115). In addition, Hispanic patients who preferred Spanish had significantly higher cost than Hispanic patients who preferred English (AME = $11,866; 95% CI $5,302 to $18,431). Total cost of care takes into account both the intensity of the treatment as well as the duration of the hospital stay. Thus, policy makers and health systems can use cost of care as a proxy for severity, especially when looking at the disparities among different race and ethnicity groups.