Background: The Coronavirus disease 2019 (COVID-19) was labeled a global pandemic rapidly. As of April 22nd, 2020, New York City became its epicenter, reporting differences in death rates among its 5 boroughs. The aim of this study was to investigate the mortality difference associated with hospital factors (teaching versus community hospital) in New York City.
Methods: We obtained medical records of hospitalized patients with laboratory-confirmed COVID-19 from the Mount Sinai Health System which included 4 teaching hospitals in Manhattan and 2 community hospitals located outside of Manhattan (Queens and Brooklyn) retrospectively; of which, 6,509 patients were analyzed for in-hospital mortality. Propensity score analysis using inverse probability treatment weight was performed to adjust for differences in baseline characteristics of patients in teaching and community hospitals, and those who were transferred from community hospitals to teaching hospitals.
Results: Among 6,509 patients, 4,742 (72.9%) were admitted in teaching hospitals, 1,471 (22.6%) were admitted in community hospitals, and 296 (4.5%) were transferred. Patients in community hospitals had significantly higher mortality (42.5%) than those in teaching hospitals (17.4%) and those with transfer (23.6%, P<0.001). Propensity analysis confirmed these findings (hazard ration (95% confidence interval [CI]): community hospitals 2.23 (1.86-2.67); transfers 0.73 (0.50-0.98) vs. teaching hospitals). After a propensity matching analysis in community hospitals or transfer, in-hospital mortality was significantly different between the matched populations (35.7% versus 24.3%; odds ratio (95% CI): 1.47 (1.12-1.93), P=0.007); absolute risk reduction was 11.4 (3.5-19.3) % and the number need to treat transfer patients to avoid 1 death was 8.8.
Conclusions: Patients admitted to community hospitals had higher mortality than those admitted to teaching hospitals. Hospital factors might contribute to the differences in patients’ outcomes during the pandemic of COVID-19.