Is Precariousness a Risk Factor for COVID-19 Mortality in Intensive Care?

Introduction:

During the SARS-CoV-2 pandemic, the first health crisis overwhelmed hospitals in Ile de France with a different impact depending on the territory . According to data on deaths registered in the civil registry published by the National Institute of Statistics and Economic Studies (INSEE), Seine-Saint-Denis has recorded the highest excess mortality rate in Ile-de-France, over the period from 1st March to 19th April. Seine-Saint-Denis has an excess mortality of over 130%, compared to over 74% in Paris and over 122% in Hauts-de-Seine. By considering the mortality rates according to the place of residence rather than the place of death, excess mortality has reached 134% in Seine-Saint-Denis, over 114% in Hauts-de-Seine, and over 99 % regarding Paris.

Seine-Saint-Denis is one of the French department most affected by poverty, which is a factor of vulnerability, and constitutes a risk factor for mortality after hospitalization in the context of traumatic, cardiovascular or cancer pathologies. In addition, precarious people have a reduced life expectancy, but it is not a risk factor for ICU mortality when considering severity on admission.

In Ile-de-France, the mortality rate in intensive care could significantly vary depending on the territory (10 to 60%), reflecting thus the disparities noticed in mortality from Covid-19. The opensafely study enumerates some of the primary mortality risk factors from Covid-19 such as age, sex, obesity, smoking, ethnicity, diabetes, solid and hematological cancers, kidney failure, chronic cardiorespiratory diseases but also precariousness independently and with a dose-response effect, whereas these risk factors could result from precariousness itself.

Knowing these risk factors for severe infection with Covid-19, investigators assume a link between precariousness and mortality in intensive care with Covid-19 pneumonia.