Justice-Involved Status and In-Hospital Mortality Among Nonelderly Adults During the COVID-19 Pandemic, 2021 - 22/11/24
, Robert P. Richeson, DC, Amy J. Houde, LCSW, MSW
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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.
Le texte complet de cet article est disponible en PDF.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. |
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| 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. |
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| 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 |
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| 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. |
Vol 137 - N° 12
P. 1216-1226 - décembre 2024 Retour au numéro
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