Socioeconomic Status and COVID-19 Related Outcomes in India: Hospital Based Study

ABSTRACT Background & Objective: COVID-19 infection has disproportionately affected ethnic minorities and deprived populations in Europe and North America. Influence of socioeconomic status on COVID-19 related outcomes has not been studied in India. To determine association of educational status, as marker of socioeconomic status, with COVID-19 related outcomes we performed a study. Methods: Clinically and virologically confirmed successive patients of COVID-19 presenting at a government hospital in India were recruited. Demographic and clinical details were recorded. The cohort was classified according to educational status into Group 1- illiterate or < primary, Group 2- higher secondary, and Group 3- some college. To compare outcomes among groups we performed univariate and multivariate logistic regression and odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: From March-September 2020 we recruited 4645 patients (men 3386, women 1259) with laboratory confirmed COVID-19. Mean age was 46+18y, most lived in moderate or large households and 30.5% had low educational status. Smoking or tobacco use was in 29.5%, co-morbidities in 28.6% and low oxygen concentration (SpO2 <95%) at admission in 30%. Average length of hospital stay was 6.8+3.7 days, supplemental oxygen was provided in 18.4%, high flow oxygen or non-invasive ventilation 7.1%, and mechanical ventilation in 3.6%. 340 patients (7.3%) died. Group 1 patients were younger, more women, larger households, higher tobacco use and were more hypoxic at admission with lower lymphocyte counts, elevated liver enzymes and greater kidney dysfunction. In Group 1 vs Groups 2 and 3 requirement of oxygen (21.6 vs 16.7 and 17.0%), non-invasive ventilation (8.0 vs 5.9 and 7.1%), invasive ventilation (4.6 vs 3.5 and 3.1%) and deaths (10.0 vs 6.8 and 5.5%) were significantly greater (p<0.05). Compared to Group 3, OR for deaths were significantly higher in Group 1 (1.91, 1.46-2.51) and Group 2 (1.24, 0.93-1.66). Adjustment for age, sex, household size, risk factors and comorbidities led to attenuation in OR in Groups 1 (1.44, 1.07-1.93) and 2 (1.38, 1.02-1.85) that remained with adjustments for clinical and laboratory parameters and oxygen support in Groups 1 (1.38, 0.99-1.93) and 2 (1.52, 1.01-2.11). Conclusion: Illiterate and less educational (socioeconomic) status patients with COVID-19 in India have significantly greater adverse in-hospital outcomes and mortality. This is related to more severe disease at presentation.