March 12, 2021

Volunteering at COVID-19 test site leads medical students to publish study on role neighborhoods plays on hospital outcomes

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A team of eight fourth-year medical students at the Wayne State University School of Medicine have published a paper documenting the impact of socioeconomic disparities on clinical outcomes in patients hospitalized with COVID-19. The patient cohort consisted of more than 2,000 patients, making it one of the largest published cohorts in Michigan. 

“Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19” was published in the Journal of General Internal Medicine.

Last May, co-authors Daniel Quan and Lucia Luna Wong were working at the Detroit Health Department conducting rapid COVID-19 testing, where they saw many of the patients were from poorer neighborhoods and nursing homes. They hoped to quantify the effect of patients’ social and living environments on hospital outcomes. Around that time, Quan said, Gov. Gretchen Whitmer was speaking to media about how the COVID-19 pandemic has revealed the health disparities in the city of Detroit, and how race played a large role. “That motivated us even more to pursue the study,” Quan said.

The study concludes that after accounting for known risk factors -- including age, sex and comorbidities -- lower neighborhood income was still an independent predictor of poor clinical outcome. Race was not an independent predictor of clinical outcome. The effect of living in a poor neighborhood was more pronounced in Black patients than white patients, possibly due to the effects of systemic and structural racism.

“We were surprised that neighborhood income was still significant, even accounting for known risk factors, which has important implications for future pandemics and management of chronic conditions,” Quan added.

The study was a group effort among the Class of 2021 students, including Quan and Wong, as well as Raghav Madan, Abel Hamdan, Heaveen Ahdi, Amir Daneshvar, Manasi Mahajan and Mohamed Nasereldin, who assisted with data collection.

The students also received support from two faculty members. Assistant Dean of Global Affairs Marcus Zervos, M.D., was a “massive presence in both setting up effective testing measures and studying the pandemic early on. He was instrumental to getting our study off the ground in a timely manner,” Quan said. “Ijeoma Nnodim Opara, M.D., an expert in social determinants of health and the role of systemic and structural racism in patient outcomes, was very helpful in framing our findings in the context of societal inequities.”

Dr. Opara, an assistant professor of Internal Medicine, is founding director of the initiative and curriculum “Health Equity and Justice in Medicine” for Internal Medicine, Internal Medicine-Pediatrics and Pediatrics residents. The curriculum combines critical reflection, community engagement, scholarship and advocacy to address social and structural determinants of health and health disparities.

The study has also resulted in three accepted abstracts: two to the American College of Physicians and one to the prestigious Infectious Diseases Society of America IDWeek in October as a late-breaking abstract due to its high impact on COVID-19 research.

The students are also studying the role of environmental and air pollution in hospital outcomes, and have submitted an abstract of findings to the European Society of Clinical Microbiology and Infectious Diseases with Henry Ford Infectious Disease fellow Anita Shallal, M.D.

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