Study population and baseline characteristics
Out of the 683 patients admitted to both medical centers, 81 lived outside Jerusalem and hence were excluded from the study. The remaining 602 patients comprised the study population (Figure 1). Of them 361 (60%) were Ultra-Orthodox Jews; 166 (27.5%) non-Ultra-Orthodox Jews and 75 (12.5%) Arabs. Although Ultra-Orthodox Jews constitute only 22% of the total population and 36% of the Jewish population in Jerusalem, their admission rate among the total COVID-19 patients and among the Jewish COVID-19 patients was disproportionately high - (361/602) 60% and (361/527) 68.5% respectively. Arabs patients were younger than the Ultra-Orthodox Jews and the non-Ultra-Orthodox Jews (51±18 year-old, 57±21 and 59±19, respectively, p<0.01). Interestingly, more females were admitted among the Arabs than among Ultra-Orthodox and non-Ultra-Orthodox Jews (61.3% vs. 44.0% and 44.6%, respectively, p<0.05). Patients baseline characteristics and prior medical therapy are presented in Table 1. Arab patients suffered from significantly more co-morbidities such as dyslipidemia, hypertension, diabetes mellitus, smoking, prior atherosclerosis vascular disease, prior revascularization and heart failure than the two Jewish populations.
Presenting signs and symptoms
Patients presenting signs and symptoms at admission are listed in Table 2. Although the Arab patients had more co-morbidities, the main signs and symptoms at admission: fever, cough, dyspnea and fatigue, were more prominent in the Ultra-Orthodox and non-Ultra-Orthodox Jews patients as compare with the Arabs patients as presented in Figure 2.
Clinical course of admission
Length of admission was longer in the Ultra-Orthodox and the non-Ultra-Orthodox Jews patients as compared with the Arabs patients (10.70±11.18 days vs. 9.21±8.68 days vs. 6.41±11.2 days, respectively, p<0.01). During the course of admission, the rate of ACS, arrythmias, heart failure, VTE, CVA, revascularization and the use of mechanical support devices, cardiopulmonary resuscitation, acute respiratory distress syndromes, mechanical ventilation, acute kidney injury, the use of renal replacement therapy, co-infections were similar between groups. Nevertheless, hemodynamic shock, ischemic ECG changes and pathological chest x-ray were all more frequent in the Ultra-Orthodox patients as compared with the other groups as presented in Table 3. Interestingly, mean troponin I levels were similar between Ultra-Orthodox, non-Ultra-Orthodox Jews and Arabs patients (438.88±2606.63 vs. 214.33±1201.08 vs. 425.57±2343.17, respectively, p=0.2), although d-dimer levels were higher among Ultra-Orthodox patients as compared with the non-Ultra-Orthodox Jews and Arabs patients (1650.27±3785.47 vs. 1077.97±1250.13 vs. 927.03±1298.88, respectively, p<0.05). Medical treatment with low molecular weight heparin or heparin was administrated in similar rate between Ultra-Orthodox, non-Ultra-Orthodox Jews and Arabs patients during admission (39.8% vs. 40.9% vs. 44.6%, respectively, p=0.75).
Major Adverse Cardiovascular Events and Mortality
Fifty-four (9%) patients died during hospitalization and none during the 30-day follow-up period. Sixty (10%) patients experienced MACE. MACE rate was higher in Ultra-Orthodox patients as compared with non-Ultra-Orthodox Jews and Arabs patients (12.3% vs. 7.4% vs.5.5%, respectively, p<0.05). Multivariable logistic regression model for MACE found that being a Ultra-Orthodox was independently associated with a significantly higher rate of MACE [OR=1.96; 95% CI (1.03-3.71), p<0.05] as well as age and male gender [OR=1.04; 95% CI (1.02-1.07) and 2.34; 95% CI (1.25 - 4.37), respectively, p<0.01 for both] as shown in Table 4. Mortality rate was higher among older patients and was increased exponentially in relate to age as shown in Figure 3. It was also higher if the patient had any cardiovascular risk factor (9.2%) vs. none (0.9%), p<0.01. Moreover, it tended to be higher among Ultra-Orthodox Jews as compared with non-Ultra-Orthodox Jews and Arabs but did not reach statistical significance (10.2% vs. 7.2% vs. 6.7%, respectively, p=0.4). Finally, there was no difference in mortality rate in relate to gender (4.8% for female vs. 4.2% for male, p=0.2). Multivariable logistic regression model adjusted for age, any cardiovascular risk factor, gender and Ultra-Orthodox ethnicity, found that age was the only independent characteristic associated with increased mortality rate [OR=1.10; 95% CI (1.07 - 1.13), p<0.001].