(Research Hub Theater) Economic Hardship, Race, Language, Delirium, and Rehabilitation Outcomes in COVID-19

Objective: Economic hardship is associated with low COVID-19 vaccination rates. There are also data to suggest that COVID-19 disproportionately impacts certain demographics, namely African American, Latino, and Native American populations. Recent evidence reported race impacts acute inpatient rehabilitation outcomes in COVID-19 patients. The present study explored the association between hardship, race, and rehabilitation outcome.

Design: Archived electronic health information was reviewed for 159 patients receiving acute inpatient rehabilitation for COVID-19.

Setting: A free-standing inpatient rehabilitation facility.

Participants: 159 patients with COVID-19 who participated in acute inpatient rehabilitation.

Interventions: N/A.

Main Outcome Measures: Economic Hardship Index, CARE Tool CMS GG Self Care and Mobility Indicators, Chart-based Delirium Identification Instrument, Patient Health Questionnaire

Results: Our analysis yielded a group that was 61% male, 39% female with a mean age of 62. Hardship was higher in patients who were primarily Spanish speakers compared to English speakers. Hardship was higher in patients identifying as Black, Hispanic, or Other. Hardship was found to have a significant negative relationship with patient age, education, hours on mechanical ventilation, PHQ9 score. There was a negative relationship with patients’ independence at time of admission that was not statistically significant but may be clinically relevant (p=.055). Factors that did not demonstrate a significant correlation with hardship: length of stay, independence at time of discharge, independence gain, patient sex, history of mechanical ventilation, and history of delirium.

Conclusions: Previous evidence has suggested that inpatient rehabilitation may reduce health disparities between racial groups. This study provides additional context regarding the narrowing of health disparities. It suggests that, despite poor vaccination rates and greater incidence of COVID-19 in high hardship groups, these groups see similar clinical outcomes to less disadvantaged groups after inpatient rehabilitation.