TY - JOUR
T1 - The Influence of Social Determinants on Receiving Outpatient Treatment with Monoclonal Antibodies, Disease Risk, and Effectiveness for COVID-19
AU - Ambrose, Nalini
AU - Amin, Alpesh
AU - Anderson, Brian
AU - Bertagnolli, Monica
AU - Campion, Francis
AU - Chow, Dan
AU - Danan, Risa
AU - D’Arinzo, Lauren
AU - Drews, Ashley
AU - Erlandson, Karl
AU - Fitzgerald, Kristin
AU - Gaspar, Fraser
AU - Gong, Carlene
AU - Hanna, George
AU - Hawley, Heather
AU - Jones, Stephen
AU - Lopansri, Bert
AU - Mullen, Ty
AU - Musser, James
AU - O’Horo, John
AU - Piantadosi, Steven
AU - Pritt, Bobbi
AU - Razonable, Raymund
AU - Rele, Shyam
AU - Roberts, Seth
AU - Sandmeyer, Suzanne
AU - Stein, David
AU - Te, Jerez
AU - Vahidy, Farhaan
AU - Webb, Brandon
AU - Welch, Nathan
AU - Wood, Alexander
AU - Yttri, Jennifer
N1 - Funding Information:
This work was performed by the mAb Real World Evidence Collaborative. Author order is listed alphabetically by last name. The authors would like to acknowledge Mark McClellan, M.D. from the Duke-Margolis Center for Health Policy and Scott Fox, M.S., MITRE Corporation for their contributions to the research design of our study. The views expressed are solely those of the authors and do not necessarily represent those of the U.S. Department of Health and Human Services.
Funding Information:
This study was supported wholly or in part with federal funds from the Administration for Strategic Preparedness and Response, Biomedical Advanced Research and Development Authority, under contract number 75FCMC18D0047 task order 75A50121F80012 awarded to The MITRE Corporation.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Society of General Internal Medicine.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Limited research has studied the influence of social determinants of health (SDoH) on the receipt, disease risk, and subsequent effectiveness of neutralizing monoclonal antibodies (nMAbs) for outpatient treatment of COVID-19. Objective: To examine the influence of SDoH variables on receiving nMAb treatments and the risk of a poor COVID-19 outcome, as well as nMAb treatment effectiveness across SDoH subgroups. Design: Retrospective observational study utilizing electronic health record data from four health systems. SDoH variables analyzed included race, ethnicity, insurance, marital status, Area Deprivation Index, and population density. Participants: COVID-19 patients who met at least one emergency use authorization criterion for nMAb treatment. Main Measure: We used binary logistic regression to examine the influence of SDoH variables on receiving nMAb treatments and risk of a poor outcome from COVID-19 and marginal structural models to study treatment effectiveness. Results: The study population included 25,241 (15.1%) nMAb-treated and 141,942 (84.9%) non-treated patients. Black or African American patients were less likely to receive treatment than white non-Hispanic patients (adjusted odds ratio (OR) = 0.86; 95% CI = 0.82–0.91). Patients who were on Medicaid, divorced or widowed, living in rural areas, or living in areas with the highest Area Deprivation Index (most vulnerable) had lower odds of receiving nMAb treatment, but a higher risk of a poor outcome. For example, compared to patients on private insurance, Medicaid patients had 0.89 (95% CI = 0.84–0.93) times the odds of receiving nMAb treatment, but 1.18 (95% CI = 1.13–1.24) times the odds of a poor COVID-19 outcome. Age, comorbidities, and COVID-19 vaccination status had a stronger influence on risk of a poor outcome than SDoH variables. nMAb treatment benefited all SDoH subgroups with lower rates of 14-day hospitalization and 30-day mortality. Conclusion: Disparities existed in receiving nMAbs within SDoH subgroups despite the benefit of treatment across subgroups.
AB - Background: Limited research has studied the influence of social determinants of health (SDoH) on the receipt, disease risk, and subsequent effectiveness of neutralizing monoclonal antibodies (nMAbs) for outpatient treatment of COVID-19. Objective: To examine the influence of SDoH variables on receiving nMAb treatments and the risk of a poor COVID-19 outcome, as well as nMAb treatment effectiveness across SDoH subgroups. Design: Retrospective observational study utilizing electronic health record data from four health systems. SDoH variables analyzed included race, ethnicity, insurance, marital status, Area Deprivation Index, and population density. Participants: COVID-19 patients who met at least one emergency use authorization criterion for nMAb treatment. Main Measure: We used binary logistic regression to examine the influence of SDoH variables on receiving nMAb treatments and risk of a poor outcome from COVID-19 and marginal structural models to study treatment effectiveness. Results: The study population included 25,241 (15.1%) nMAb-treated and 141,942 (84.9%) non-treated patients. Black or African American patients were less likely to receive treatment than white non-Hispanic patients (adjusted odds ratio (OR) = 0.86; 95% CI = 0.82–0.91). Patients who were on Medicaid, divorced or widowed, living in rural areas, or living in areas with the highest Area Deprivation Index (most vulnerable) had lower odds of receiving nMAb treatment, but a higher risk of a poor outcome. For example, compared to patients on private insurance, Medicaid patients had 0.89 (95% CI = 0.84–0.93) times the odds of receiving nMAb treatment, but 1.18 (95% CI = 1.13–1.24) times the odds of a poor COVID-19 outcome. Age, comorbidities, and COVID-19 vaccination status had a stronger influence on risk of a poor outcome than SDoH variables. nMAb treatment benefited all SDoH subgroups with lower rates of 14-day hospitalization and 30-day mortality. Conclusion: Disparities existed in receiving nMAbs within SDoH subgroups despite the benefit of treatment across subgroups.
KW - United States/epidemiology
KW - Humans
KW - COVID-19 Vaccines
KW - Outpatients
KW - Social Determinants of Health
KW - COVID-19/epidemiology
KW - Antibodies, Monoclonal
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U2 - 10.1007/s11606-023-08324-y
DO - 10.1007/s11606-023-08324-y
M3 - Article
C2 - 37715096
SN - 0884-8734
VL - 38
SP - 3472
EP - 3481
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 16
ER -