Socioeconomic status and risk of COVID-19 hospitalization in the All of Us Research Program

Introduction: The relationship between socioeconomic status and COVID-19 related hospitalization has been widely examined, although findings differ across study settings and populations. This study used data from the NIH All of Us Research Program to explore the association between age, race, income, education, neighborhood deprivation, and risk of COVID-19 hospitalization while controlling for key covariates, including risk factors and vaccination status.

Methods: This cross-sectional analysis included 25,650 adults with confirmed COVID-19 between 2021 and 2023, including 662 hospitalized for COVID-19. Covariates were age, sex at birth, race/ethnicity, annual household income, education, and deprivation index score. Our analysis controlled for the following risk factors: BMI, smoking status at enrollment, COVID-19 vaccination status, and history of cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, and hypertension. Logistic regression was used to estimate odds ratios.

Results: Increased hospitalization risk was observed among participants aged 66–95 (OR: 1.81, 95% CI: 1.27, 2.58) and aged 51–65 (OR: 1.73, 95% CI: 1.24, 2.43), as well as Non-Hispanic Black/African American participants (OR: 2.48, 95% CI: 1.99, 3.10), and Hispanic participants (OR: 1.47, 95% CI: 1.15, 1.88). Increased risk was also observed among participants living in the highest deprivation areas (OR: 2.60, 95% CI: 2.04, 3.31), those with an annual income less than 25,000 USD (OR: 1.67, 95% CI: 1.15, 2.44), and those with an annual income of 25,000 USD to 50,000 USD (OR: 1.45, 95% CI: 1.06, 1.99).

Conclusion: Our findings indicate meaningful associations between the risk of COVID-19-associated hospitalization and socioeconomic factors including age, racial/ethnic minority status, lower income, and higher area deprivation.