{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:18:53Z","timestamp":1777853933799,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Safety-net hospitals (SNH) provide care to a significant proportion of low-income, uninsured, and underserved populations disproportionately affected by the COVID-19 pandemic. We evaluated the impact of safety-net burden on outcomes of COVID-19 hospitalizations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified patients aged\u2009\u2265\u200918 years hospitalized with COVID-19 from the nationwide inpatient database using the International Classification of Diseases, Tenth Edition (ICD-10-CM) code U07.1. The primary study outcomes were inpatient mortality, respiratory failure requiring mechanical ventilation, and tracheostomy use. Secondary outcomes were total hospitalization costs (THC) and length of hospital stay (LOS). Multivariable logistic regression was used to compare the primary and secondary outcomes in HBH and medium safety-net burden (MBH) with lower-burden hospitals (LBH) (reference).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>An estimated 2,608,232 COVID-19 hospitalizations met the inclusion criteria, with 68.7% occurring in HBH, 22.8% in MBH, and 8.5% in LBH. On adjusted multivariable analysis, HBH was associated with increased odds of inpatient mortality (aOR 1.19, 95% CI 1.09-1.28) compared with LBH. Both HBH (aOR 1.30, 95% CI 1.21-1.40) and MBH (aOR 1.14, 95% CI 1.06-1.24) demonstrated increased odds of mechanical ventilation compared with LBH. THC was lower in HBH and MBH compared with LBH. The LOS was similar across safety net burden categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>After adjusting for patient- and hospital-level factors, COVID-19 hospitalizations at HBH had inferior inpatient outcomes compared with LBH. Targeted policy reforms are needed to address the underlying causes of these disparities and increase our health systems\u2019 readiness for future crises, particularly in underserved communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666251366167","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T08:27:31Z","timestamp":1754900851000},"page":"336-343","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital Safety-Net Burden and Outcomes of COVID-19 Hospitalizations in the US: Analysis of a National Multicenter Database"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8472-6970","authenticated-orcid":false,"given":"Titilope","family":"Olanipekun","sequence":"first","affiliation":[{"name":"Brigham and Women's Hospital\/Harvard Medical School"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Heaton","sequence":"additional","affiliation":[{"name":"Jersey Shore University Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Temidayo","family":"Abe","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7555-445X","authenticated-orcid":false,"given":"Abimbola","family":"Chris-Olaiya","sequence":"additional","affiliation":[{"name":"DCH Regional Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bekure B.","family":"Siraw","sequence":"additional","affiliation":[{"name":"Ascension Saint Joseph Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6613-6395","authenticated-orcid":false,"given":"Isha","family":"Shahin","sequence":"additional","affiliation":[{"name":"Ascension Saint Joseph Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ndausung","family":"Udongwo","sequence":"additional","affiliation":[{"name":"Morehouse School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iv\u00e1n A","family":"Huespe","sequence":"additional","affiliation":[{"name":"Hospital Italiano de Buenos Aires"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devang","family":"Sanghavi","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsb2021088"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.4770"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa815"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2114010"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06527-1"},{"issue":"3","key":"e_1_3_2_7_2","first-page":"143","article-title":"The healthcare cost and utilization project: An overview","volume":"5","author":"Steiner C","year":"2002","unstructured":"Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: An overview. Eff Clin Pract. 2002;5(3):143-151.","journal-title":"Eff Clin Pract"},{"key":"e_1_3_2_8_2","unstructured":"Mullner R. Healthcare Cost and Utilization Project (HCUP). In: Encyclopedia of Health Services Research; 2015."},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S335621"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2020.04.012"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000735"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2015.3209"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.2209"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12612"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2114767"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.02.018"},{"issue":"1","key":"e_1_3_2_19_2","article-title":"Impact of hospital safety-net burden on outcomes of in-hospital cardiac arrest in the United States","volume":"5","author":"Olanipekun T","year":"2023","unstructured":"Olanipekun T, Abe T, Chris-Olaiya A, et al. Impact of hospital safety-net burden on outcomes of in-hospital cardiac arrest in the United States. Crit Care Explor. 2023;5(1):E0838. doi:https:\/\/doi.org\/10.1097\/CCE.0000000000000838","journal-title":"Crit Care Explor"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.3566"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.8785"},{"issue":"1","key":"e_1_3_2_22_2","article-title":"The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: A 10-year nationwide analysis","volume":"3","author":"Rivera Perla KM","year":"2021","unstructured":"Rivera Perla KM, Lim RK, Weil RJ, Toms SA. The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: A 10-year nationwide analysis. Neuro-Oncology Adv. 2021;3(1):vdaa167. doi:https:\/\/doi.org\/10.1093\/noajnl\/vdaa167","journal-title":"Neuro-Oncology Adv"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005193"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2021.04.003"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2021.11.009"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2021.10.015"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06787-5"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.14978"},{"issue":"8","key":"e_1_3_2_29_2","article-title":"COVID-19-Related insurance coverage changes and disparities in access to care among low-income US adults in 4 southern states","volume":"2","author":"Figueroa JF","year":"2021","unstructured":"Figueroa JF, Khorrami P, Bhanja A, Orav EJ, Epstein AM, Sommers BD. COVID-19-Related insurance coverage changes and disparities in access to care among low-income US adults in 4 southern states. JAMA Heal Forum. 2021;2(8):E212007. doi:https:\/\/doi.org\/10.1001\/jamahealthforum.2021.2007","journal-title":"JAMA Heal Forum"},{"issue":"8","key":"e_1_3_2_30_2","article-title":"Safety net primary care capabilities after the COVID-19 pandemic","volume":"5","author":"Schifferdecker KE","year":"2024","unstructured":"Schifferdecker KE, Yang CWW, Mackwood MB, et al. Safety net primary care capabilities after the COVID-19 pandemic. JAMA Heal Forum. 2024;5(8):e242547. doi:https:\/\/doi.org\/10.1001\/jamahealthforum.2024.2547","journal-title":"JAMA Heal Forum"},{"issue":"7","key":"e_1_3_2_31_2","article-title":"Realigning reality with intent in funding safety-net hospitals","volume":"4","author":"Chatterjee P","year":"2023","unstructured":"Chatterjee P, Schpero WL. Realigning reality with intent in funding safety-net hospitals. JAMA Heal Forum. 2023;4(7):E232000. doi:https:\/\/doi.org\/10.1001\/jamahealthforum.2023.2000","journal-title":"JAMA Heal Forum"}],"container-title":["Journal of Intensive Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08850666251366167","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08850666251366167","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08850666251366167","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:58:37Z","timestamp":1777503517000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08850666251366167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1177\/08850666251366167"],"URL":"https:\/\/doi.org\/10.1177\/08850666251366167","relation":{},"ISSN":["0885-0666","1525-1489"],"issn-type":[{"value":"0885-0666","type":"print"},{"value":"1525-1489","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,11]]}}}