Introduction:

The COVID-19 pandemic exploits existing inequalities in the social determinants of health (SDOH) that influence disease burden and access to healthcare, particularly in patients with a genitourinary (GU) malignancy. This analysis of a multi-ethnic cohort of GU cancer patients aims to delineate the social and clinical determinants of COVID-19 outcomes to further improve the ability to recognize which urological patients are currently at the greatest risk. Specifically, we explore the impact of SDOH on COVID-19 mortality, test positivity, and intubation in GU cancer patients caused by COVID-19.

Methods:

Patients screened for COVID-19 across the Mount Sinai Health System (MSHS) from March 28th, 2020 to
June 10 th , 2020 were included. The primary outcome was death from COVID-19 and secondary outcomes
were test positivity and intubation in GU cancer patients caused by COVID-19. The
demographic and social determinants available to for analysis included age, sex, and first language
preference being English, as well as race/ethnicity, smoking status and city borough of residence
(derived from the first three digits of a patient’s zip code, and referred to in the models, as “zip code”).
Descriptive analyses and ensemble feature selection was performed to describe predictors of these
outcomes and compute a social determinants risk scale for GU cancer patients.

Results:

Out of 47,379 tested patients, 1,094 were patients with a GU cancer, of which 192 (17.6%) tested
positive for SARS-CoV-2 (Table 1). Ensemble feature selection identified social determinants including zip-code,
race/ethnicity, age, smoking status and English as preferred first language – being the most significant
predictors for each outcome (Figure 1). The simplified risk model demonstrates progressive
increases in risk of each outcome across the scale from 0 through to ≥4 for the risk of a positive test, risk
of intubation and risk of death. For GU cancer patients who scored 4 points or more on these scales,
>30% tested positive for COVID-19, >80% were intubated and >50% died.

Conclusion:

Social determinants of health have long been recognized as crucial influences on health outcomes in
both population-wide and individual arenas. In this large population-based cohort of patients tested for
COVID-19 from the epicenter of the pandemic in the US our results show that SDOH including zip code/
NYC borough, age, race/ethnicity, smoking status, and English as preferred language are significant
predictors of COVID-19 outcomes in patients with GU cancers. We have found that various medical and
social determinants, when used together in a point scoring system can risk stratify those GU cancer
patients at risk of Covid-19 diagnosis, intubation, and death. Our results highlight the importance of taking SDOH into consideration when addressing each individual patient’s risk factors in patients with GU cancers.

Funding: N/A