(40) Racial and Gender Disparities in Hospital-treated Odontogenic Infections During the COVID-19 Pandemic

Abstract: Study Objective

In March 2020, the American Dental Association recommended postponing elective dental procedures in accordance with CDC and federal guidelines aimed at thwarting the spread of COVID-19. Subsequent studies and case reports demonstrated an increase in severe head and neck space infections of odontogenic origin following widespread dental office closures (1,2). Racial and socioeconomic disparities in access to dental care have long been a topic of discussion and analysis among clinicians and public health experts. Furthermore, significant racial and socioeconomic disparities in COVID-19 outcomes have been demonstrated (3). Using computed tomography imaging reports, the purpose of this study was to characterize positive imaging studies obtained in the emergency departments of a tertiary health system in order to compare demographic characteristics and severity of odontogenic infections pre- and post-shutdown.

Materials and Methods / Data Analysis

All CT head, maxillofacial and / or neck studies performed in Northwell Health tertiary care emergency departments between the months of March and November of 2017, 2018, 2019 and 2020 were accessed. Imaging studies including positive mention of odontogenic infection or abscess in the report were included. A total of 736 studies were included. Positive studies were further characterized based upon presence of periapical disease, cellulitis / phlegmon or abscess collection. Patient demographic data was obtained from review of the associated electronic medical record and a comparison made between pre- and post-shutdown proportions. A fisher’s exact test was used to compare proportions of positive studies pre- and post-shutdown and to compare demographic characteristics as well as severity of infection pre- and post-shutdown.

Results and Outcomes Data

There was an overall increase in positive CT imaging studies during the months of March-November of 2020 when compared with the corresponding months of 2017-2019. The proportion of positive imaging studies demonstrating phlegmon or abscess collection decreased post-shutdown. The relative proportion of positive studies associated with racial and ethnic minorities was significantly increased post-shutdown (p=.001). The relative proportion of positive studies with a patient identified male gender was also significantly increased post-shutdown (p=.03). The relative proportion of white patients with positive studies decreased post-shutdown (Table 1).

Conclusions

Ethnic and racial minorities, patients of lower socioeconomic status and men were disproportionately affected by dental office closures during the first wave of the COVID-19 pandemic. Although office closures were widespread and the number of positive studies increased overall, the relative proportion of white patients with CT imaging findings significant for odontogenic infection or abscess decreased during the first wave of the pandemic. This further demonstrates the outsized health impact of the COVID-19 pandemic on minority and economically disadvantaged communities and prompts further questions about public health interventions to alleviate this burden during times of global health crisis.

References:

1. Drew S, Lazar A, Amin D, Abramowicz S. Odontogenic Infections are More Frequent and More Severe during COVID-19 Pandemic. J Oral Maxillofac Surg. 2021 Oct;79(10):e88–9. doi: 10.1016/j.joms.2021.08.122. Epub 2021 Oct 7. PMCID: PMC8496984.

2. Altıntaş E. Complications of dental infections due to diagnostic delay during COVID-19 pandemic. BMJ Case Rep. 2022 Apr 8;15(4):e247553. doi: 10.1136/bcr-2021-247553. PMID: 35396235; PMCID: PMC8996046.

3. Magesh S, John D, Li WT, Li Y, Mattingly-App A, Jain S, Chang EY, Ongkeko WM. Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status: A Systematic-Review and Meta-analysis. JAMA Netw Open. 2021 Nov 1;4(11):e2134147. doi: 10.1001/jamanetworkopen.2021.34147. Erratum in: JAMA Netw Open. 2021 Dec 1;4(12):e2144237. Erratum in: JAMA Netw Open. 2022 Feb 1;5(2):e222170. PMID: 34762110; PMCID: PMC8586903.

Figure 1. Proportion of Positive CT Results by Patient Reported Race
Figure 2. Proportion of Positive CT Results by Socioeconomic Status as Determined by Zip Code
Table 1. Results of Fisher's Exact Test from Pre- and Post-Shutdown Positive CT Results