Avoidance of care: how health-care affordability influenced COVID-19 disease severity and outcomes

• Published in: American journal of epidemiology 2024-07, Vol.193 (7), p.987-995
• Main Authors: Okpara, Chinyere J, Divers, Jasmin, Winner, Megan
• Format: Article
• Language: English
• Subjects: COVID-19; Health care; Hospitals; Logit models; Polymerase chain reaction
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kwae022

Abstract In this study we examined the association between payor type, a proxy for health-care affordability, and presenting COVID-19 disease severity among 2108 polymerase chain reaction–positive nonelderly patients admitted to an acute-care hospital between March 1 and June 30, 2020. The adjacent-category logit model was used to fit pairwise odds of individuals’ having (1) an asymptomatic-to-mild modified sequential organ failure assessment (mSOFA) score (0-3) versus a moderate-to-severe mSOFA score (4-7) and (2) a moderate-to-severe mSOFA score (4-7) versus a critical mSOFA score (>7). Despite representing the smallest population, Medicare recipients experienced the highest in-hospital death rate (19%), a rate twice that of the privately insured. The uninsured had the highest rate of critical mSOFA score on admission and had twice the odds of presenting with a critical illness when compared with the privately insured (odds ratio = 2.08, P =.03). Because payor type was statistically related to the most severe presentations of COVID-19, we question whether policy changes affecting health-care affordability might have prevented deaths and rationing of scarce resources, such as intensive care unit beds and ventilators.