(550) Relationship Between Household Income and In-Hospital COVID-19 Mortality: A Nationwide Study

Introduction: The COVID-19 pandemic disproportionately affected vulnerable populations, particularly those with low incomes. Despite CARES Act, many were left out of Unemployment Insurance benefits because they lacked knowledge on how to access the benefits. About 12 million people, primarily with very low incomes, who were not obligated to file taxes, did not automatically receive the Economic Impact Payments they were eligible for. Despite evidence of higher overall mortality in low-income populations, no study has specifically compared inpatient mortality rates in the US.

Methods: For this study, we utilized the 2020 National Inpatient Sample (NIS) database to identify a total of 1,018,915 patients aged above 18 years, who were admitted with COVID-19 as their primary diagnosis. Patients with income below household median income ($65,000) were compared to the ones with income above $65,000. Retrospective data analyses performed using both univariate and multivariable linear and logistic regression models, adjusting for age, sex, race, Charlson comorbidity index, insurance, hospital location, size, and teaching status. Secondary outcomes comprised of for non-invasive(NIV), invasive(IMV), and IMV within 24 hrs, hospitalization cost and length of stay. Stata (StataCorp; College Station, TX) was used for statistical analysis.

Results: Study shows inpatient mortality rates in low-income group were higher (OR 1.20 (1.15-1.25), p< 0.001) in comparison to high income group. Furthermore, need for NIV (OR 1.13 (1.05-1.21), p=0.001), IMV (OR 1.14 (1.10-1.20), p< 0.001), and early IMV (OR 1.14 (1.06-1.22), p< 0.001) was higher in low-income group indicating more severe illness. Low-income group also demonstrated longer lengths of stay and higher hospitalization when compared to high-income group.

Conclusions: Low income is associated with worse outcomes potentially due to factors such as low literacy rates, lack of health awareness, concerns about financial implications, illegal immigration status, and limited access to healthcare. This may have caused delay in seeking medical attention and, subsequently, late presentation in the course of the disease. During pandemic, systemic issues hindered low-income individuals from accessing financial benefits. Addressing these challenges is vital for a more equitable recovery.