LAUSR

Study Objectives: Ensuring equitable access to novel treatment modalities has been an ongoing challenge throughout the SARS-CoV-2 pandemic. By implementing a novel SARS-CoV-2 monoclonal antibody (MAB) distribution plan in the emergency department (ED), our health system aimed to improve therapeutic access to more diverse patient populations and limit potential barriers in referral-based outpatient infusion centers (OIC) offering the same treatment. Our study attempts to highlight the unique role the ED can play in the equitable distribution of novel SARS-CoV-2 therapeutics by evaluating the association between patient demographics and MAB infusion location. Methods: Retrospective cohort study of all COVID-19 infected patients who received MAB infusion at one of six different EDs or four OICs within a single 23-hospital health care system between December 28, 2020 and May 12, 2021. Patients were grouped by MAB infusion location (ED versus OIC). The ED group was defined as all treat-and-release patients presenting unscheduled to the ED who received MAB infusion during their visit. The OIC group was defined as all patients referred to an OIC for a scheduled appointment to receive MAB infusion. A single blinded abstractor gathered specific patient demographic data, defined a priori, from an electronic medical record. We compared race, ethnicity, sex, socioeconomic status (SES) score, and age between the two groups. Chi-square tests were performed to assess the associations between categorical variables and MAB infusion location. T-Tests were used to compare continuous variables between the two MAB infusion locations. Results: 5,165 patients were eligible for inclusion, of which 195 (4%) received MAB infusions in the ED and 4,970 (96%) received MAB infusions in the OIC. ED patients were more likely to be female (114/195 [58%] versus 2,531/4,970 [51%], p<0.05), more likely to be Black (22/188 [12%] versus 261/4,898 [5%], p<0.001), and less likely to be White (116/188 [62%] versus 3,621/4,898 [74%], p<0.001) when compared to OIC patients. There were no significant associations between the following demographic characteristics and MAB infusion location when comparing ED patients mean age in years (62 versus 62, p=0.827), Hispanic or Latinx ethnicity (20/188 [11%] versus 377/4730 [8%], p=0.188), and SES score (-18,900 versus -19,100, p=0.695) versus OIC patients. Racial and ethnic comparisons excluded 79 and 247 patients, respectively, due to unavailable data. Conclusion: Patient sex and race are associated with SARS-CoV-2 MAB infusion location. Compared to OIC patients, ED patients were more likely to be female and Black.