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Justice-Involved Status and In-Hospital Mortality Among Nonelderly Adults During the COVID-19 Pandemic, 2021 - 22/11/24

Doi : 10.1016/j.amjmed.2024.08.010 
Byron S. Kennedy, MD, PhD, MPH , Robert P. Richeson, DC, Amy J. Houde, LCSW, MSW
 Connecticut Department of Correction, Health Services Unit, Wethersfield, Connecticut 

Requests for reprints should be addressed to Byron S. Kennedy, MD, PhD, MPH, Connecticut Department of Correction, Health Services Unit, 24 Wolcott Hill Rd, Wethersfield, CT 06109.Connecticut Department of CorrectionHealth Services Unit24 Wolcott Hill RdWethersfieldCT06109

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Abstract

Objective

The purpose of this research is to examine the role of justice-involved status on in-hospital mortality among nonelderly adults during the second year of the COVID-19 pandemic.

Methods

This retrospective cohort study used data from the 2021 State Inpatient Databases for 20 US states, which included discharges from general acute care hospitals among adults aged 18-64 years hospitalized for at least 24 hours. The main outcome was all-cause in-hospital mortality and the primary comparison was justice-involved status. We used logistic regression to estimate the odds ratios and 95% confidence intervals (CIs), with adjustment for sociodemographic factors, Elixhauser comorbidities, COVID-19 diagnosis, admission acuity, other clinical features, metropolitan area, and seasonality. We randomly split the data into a 50% training and 50% validation set. With the latter, we evaluated the performance of our final model.

Results

The study population included 4,712,441 discharges (1.1% justice-involved; mean [SD] age 47.5 [12.8] years; 47.0% women; 63.6% White, 21.8% Black, 11.8% Hispanic, 1.8% Asian/Pacific Islander, and 1.0% American Indian/Alaska Native). Among these, 102,735 in-hospital deaths (2.2%) occurred. In the multivariate analysis, in-hospital mortality was about 40% less likely among justice-involved patients (odds ratios 0.6, 95% CI 0.5-0.7, P value <0.01). The final validated model showed excellent discrimination (area under the curve for the receiver operator characteristic 0.953, 95% CI 0.952-0.954) and good calibration (Brier score 0.014, calibration belt P value .186).

Conclusions

In this cohort study, justice-involved status was independently associated with lower in-hospital mortality. Future studies should examine preadmission and postdischarge outcomes.

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Keywords : American Indian or Alaska Native, COVID-19, Hospital mortality, Intubation, Jails, Multimorbidity, Prisons


Plan


 Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
 Conflict of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
 Authorship: All authors were involved in the conception, writing, and revising of the manuscript; BSK performed all data analysis; all authors read and approved submission of the manuscript. BSK: Writing—review and editing, Writing—original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization; RPR: Writing—review and editing, Writing—original draft, Investigation, Conceptualization, AJH: Writing—review and editing, Writing—original draft, Methodology, Investigation, Conceptualization
 Research Data: The data used in this analysis cannot be shared. However, the data are available from the Agency for Healthcare Research and Quality's Healthcare Cost Utilization Project.


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Vol 137 - N° 12

P. 1216-1226 - décembre 2024 Retour au numéro
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