Characteristics Associated with Disparities among Older Adults in Coronavirus Disease 2019 Outcomes in an Academic Health Care System

Laura P. Gelfman, Jaison Moreno, Julia L. Frydman, Joshua Singer, Jane Houldsworth, Carlos Cordon-Cardo, Meenakshi Mehrotra, Emily Chai, Melissa Aldridge, Rolfe S. Morrison

Research output: Contribution to journalArticlepeer-review


Background: An improved understanding of the coronavirus disease 2019 (COVID-19) pandemic is needed to identify predictors of outcomes among older adults with COVID-19. Objective: The objective of this study was to examine patient and health system factors predictive of in-hospital mortality, intensive care unit (ICU) admission, and readmission among patients with COVID-19. Design, Setting, and Participants: A cohort study of patients aged 18 years and older with COVID-19 discharged from 5 New York hospitals within the Mount Sinai Health System (March 1, 2020–June 30, 2020). Measures: Patient-level characteristics (age, sex, race/ethnicity, comorbidities/serious illness, transfer from skilled nursing facility, severe acute respiratory syndrome coronavirus 2 viral load, Sequential Organ Failure Assessment score, treatments); hospital characteristics. Outcomes: All-cause in-hospital mortality; ICU admission; 30-day readmission. Results: Among 7556 subjects, mean age 61.1 (62.0) years; 1556 (20.6%) died, 949 (12.6%) had an ICU admission, and 227 (9.1%) had a 30-day readmission. Increased age [aged 55–64: odds ratio (OR), 3.28; 95% confidence interval (CI), 2.41–4.46; aged 65–74: OR, 4.67; 95% CI, 3.43–6.35; aged 75–84: OR, 10.73; 95% CI, 7.77–14.81; aged 85 y and older: OR, 20.57; 95% CI, 14.46–29.25] and comorbidities (OR, 1.11; 95% CI, 1.16, 2.13) were independent risk factors for in-hospital mortality. Yet older adults (aged 55–64 y: OR, 0.56; 95% CI, 0.40–0.77; aged 65–74: OR, 0.46; 95% CI, 0.33–0.65; aged 75–84: OR, 0.27; 95% CI, 0.18–0.40; aged above 85 y: OR, 0.21; 95% CI, 0.13–0.34) and those with Medicaid (OR, 0.74; 95% CI, 0.56–0.99) were less likely to be admitted to the ICU. Race/ethnicity, crowding, population density, and health system census were not associated with study outcomes. Conclusions: Increased age was the single greatest independent risk factor for mortality. Comorbidities and serious illness were independently associated with mortality. Understanding these risk factors can guide medical decision-making for older adults with COVID-19. Older adults and those admitted from a skilled nursing facility were half as likely to be admitted to the ICU. This finding requires further investigation to understand how age and treatment preferences factored into resource allocation.

Original languageEnglish
Pages (from-to)332-341
Number of pages10
JournalMedical Care
Issue number5
StatePublished - 1 May 2022


  • COVID-19
  • ICU admission
  • mortality
  • older adults


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