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Campbell R, Javorka M, Engleton J, Goodman-Williams R, Gregory K. Post-Assault Health Care for Sexual Assault Survivors During COVID-19: A Mixed Methods Analysis of Service Rates in a Predominately African American Community. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP2112-NP2134. [PMID: 35532032 PMCID: PMC9082100 DOI: 10.1177/08862605221098963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study examined how the COVID-19 pandemic affected sexual assault healthcare services in a predominately African American U.S. city. In mixed methods research design, we used quantitative interrupted time series modeling to evaluate changes in service rates for three core post-assault healthcare services-medical forensic exams (MFEs), medical advocacy MFE accompaniment, and counseling-from January 2019 through June 2021. We also conducted qualitative interviews with 12 sexual assault advocates to understand how their clients were impacted by COVID and how their agency adapted services to respond to the needs of their community. Both the quantitative and qualitative data revealed marked disruptions in service provision. The number of MFEs, medical advocacy accompaniments, and counseling sessions significantly decreased during the pandemic's initial surge, and survivors feared seeking hospital-based health care due to concerns that they might contract COVID-19 in hospital emergency departments. The number of MFEs performed by program staff did not return to pre-pandemic levels during this study's observation period, but the number of medical advocacy accompaniments and counseling sessions did significantly rebound. Counseling services eventually exceeded pre-pandemic levels as agency staff supported clients with both assault- and COVID-related trauma and loss. These results underscore the need for community-based sexual assault healthcare services, so that if public health emergencies limit the availability, accessibility, and safety of hospital emergency department care, sexual assault survivors have other settings for obtaining post-assault health care.
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Affiliation(s)
- Rebecca Campbell
- Department of Psychology, Michigan State
University, East Lansing, MI, USA
| | - McKenzie Javorka
- Department of Psychology, Michigan State
University, East Lansing, MI, USA
| | - Jasmine Engleton
- Department of Psychology, Michigan State
University, East Lansing, MI, USA
| | | | - Katie Gregory
- Department of Psychology, Michigan State
University, East Lansing, MI, USA
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Codner A, Zack RM, Liu X, Bangham C, Nelson E, Hicks JM, Greece JA. Socio-demographic factors associated with hunger among food pantry users in Eastern Massachusetts. J Nutr Sci 2023; 12:e53. [PMID: 37180481 PMCID: PMC10173085 DOI: 10.1017/jns.2022.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 05/16/2023] Open
Abstract
To assess the determinants of hunger among food pantry users, the present study used a cross-sectional survey that included a modified Household Hunger Scale to quantify hunger. Mixed-effects logistic regression models were used to assess the relationship between hunger categories and various household socio-demographic and economic characteristics, such as age, race, household size, marital status and experience of any economic hardship. The survey was administered to food pantry users from June 2018 to August 2018 at various food pantries across Eastern Massachusetts with 611 food pantry users completing the questionnaire at any of the 10 food pantry sites. One-fifth (20⋅13 %) of food pantry users experienced moderate hunger and 19⋅14 % experienced severe hunger. Food pantry users who were single, divorced or separated; had less than a high school education; working part-time, unemployed or retired; or, who earned incomes less than $1000 per month were most likely to experience severe or moderate hunger. Pantry users who experienced any economic hardship had 4⋅78 the adjusted odds of severe hunger (95 % CI 2⋅49, 9⋅19), which was much larger than the odds of moderate hunger (AOR 1⋅95; 95 % CI 1⋅10, 3⋅48). Younger age and participation in WIC (AOR 0⋅20; 95 % CI 0⋅05-0⋅78) and SNAP (AOR 0⋅53; 95 % CI 0⋅32-0⋅88) were protective against severe hunger. The present study illustrates factors affecting hunger in food pantry users, which can help inform public health programmes and policies for people in need of additional resources. This is essential particularly in times of increasing economic hardships recently exacerbated by the COVID-19 pandemic.
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Affiliation(s)
- Alyson Codner
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Rachel M. Zack
- Greater Boston Food Bank, 70 S Bay Ave, Boston, MA 02118, USA
| | - Xinyang Liu
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Candice Bangham
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Eva Nelson
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Jacqueline Milton Hicks
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, USA
| | - Jacey A. Greece
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
- Corresponding author: Jacey A. Greece, email
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Executive Summary. Dela J Public Health 2022; 8:4. [PMID: 36751588 PMCID: PMC9894034 DOI: 10.32481/djph.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Matthews TA, Guardiano M, Omidakhsh N, Cushing L, Robbins W, Hong O, Li J. Associations of COVID-19 Related Work Stressors with Psychological Distress: Racial and Ethnic Disparities in Californian Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:144. [PMID: 36612463 PMCID: PMC9819092 DOI: 10.3390/ijerph20010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic continues to exert immense societal impacts, with recent data showing inequitable distribution of consequences among racial and ethnic groups. The objective of this study was to assess associations between COVID-related work stressors and psychological distress, with special emphasis on differences by race and ethnicity. Data were from the population-based California Health Interview Survey (CHIS) 2020. Associations of individual and cumulative work stressors, including job loss, reduced work hours, and working from home, with psychological distress in 12,113 workers were examined via multivariable linear regression, and stratified analyses were conducted for racial and ethnic subgroups. After adjustment for covariates, compared to workers with no work stressors, those who experienced either one or two/more work stressors had higher psychological distress (βs and 95% CIs were 0.80 [0.51, 1.09] and 1.98 [1.41, 2.56], respectively). Notably, experiencing cumulative (two/more) work stressors had much stronger effects on psychological distress among participants who were Black (β and 95% CI were 3.51 [1.09, 5.93]) or racial minorities (β and 95% CI were 3.57 [1.10, 6.05]). Occupational consequences of the COVID-19 pandemic were associated with increased psychological distress in Californian workers and inequitably distributed, with racial and ethnic minorities suffering the greatest burden.
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Affiliation(s)
- Timothy A. Matthews
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Megan Guardiano
- School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA
| | | | - Lara Cushing
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Wendie Robbins
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
- School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - OiSaeng Hong
- Occupational and Environmental Health Nursing Graduate Program, School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
- School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA
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Spence AB, Desale S, Lee J, Kumar P, Huang X, Cooper SE, Fernandez S, Kassaye SG. COVID-19 Outcomes in a US Cohort of Persons Living with HIV (PLWH). REPORTS 2022; 5:41. [PMID: 37063094 PMCID: PMC10104440 DOI: 10.3390/reports5040041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Reported coronavirus disease 2019 (COVID-19) outcomes in persons living with HIV (PLWH) vary across cohorts. We examined clinical characteristics and outcomes of PLWH with COVID-19 compared with a matched HIV-seronegative cohort in a mid-Atlantic US healthcare system. Multivariate logistic regression was used to explore factors associated with hospitalization and death/mechanical ventilation among PLWH. Among 281 PLWH with COVID-19, the mean age was 51.5 (SD 12.74) years, 63% were male, 86% were Black, and 87% had a HIV viral load <200 copies/mL. Overall, 47% of PLWH versus 24% (p < 0.001) of matched HIV-seronegative individuals were hospitalized. Rates of COVID-19 associated cardiovascular and thrombotic events, AKI, and infections were similar between PLWH and HIV-seronegative individuals. Overall mortality was 6% (n = 18/281) in PLWH versus 3% (n = 33/1124) HIV-seronegative, p < 0.0001. Among admitted patients, mortality was 14% (n = 18/132) for PLWH and 13% (n = 33/269) for HIV-seronegative, p = 0.75. Among PLWH, hospitalization associated with older age aOR 1.04 (95% CI 1.01, 1.06), Medicaid insurance aOR 2.61 (95% CI 1.39, 4.97) and multimorbidity aOR 2.98 (95% CI 1.72, 5.23). Death/mechanical ventilation associated with older age aOR 1.06 (95% CI 1.01, 1.11), Medicaid insurance aOR 3.6 (95% CI 1.36, 9.74), and multimorbidity aOR 4.4 (95% CI 1.55, 15.9) in adjusted analyses. PLWH were hospitalized more frequently than the HIV-seronegative group and had a higher overall mortality rate, but once hospitalized had similar mortality rates. Older age, multimorbidity and insurance status associated with more severe outcomes among PLWH suggesting the importance of targeted interventions to mitigate the effects of modifiable inequities.
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Affiliation(s)
- Amanda Blair Spence
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
- Correspondence:
| | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, MD 20782, USA
| | - Jennifer Lee
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Princy Kumar
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Xu Huang
- MedStar Health Research Institute, Hyattsville, MD 20782, USA
| | - Stanley Evan Cooper
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA
| | | | - Seble G. Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
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Wical W, Harfouche M, Lovelady N, Aguilar N, Ross D, Richardson JB. Exploring emergent barriers to hospital-based violence intervention programming during the COVID-19 pandemic. Prev Med 2022; 165:107232. [PMID: 36084752 PMCID: PMC9446660 DOI: 10.1016/j.ypmed.2022.107232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 11/24/2022]
Abstract
National rates of gun violence have risen during the COVID-19 pandemic. There are many contributing factors to this increase, including the compounding consequences of social isolation, unstable housing, decreased economic stability, and ineffective and violent policing of communities of color. The effects of these factors are exacerbated by the pandemic's impact on the provision and availability of psychosocial services for individuals in marginalized communities, particularly those who have been violently injured. Hospital-based violence intervention programs (HVIPs) have been identified as a crucial intervention strategy in reducing repeat violent injury. The ongoing COVID-19 pandemic has engendered, significant barriers in HVIPs' attempts to assist program participants in achieving their health-related and social goals. This research offers insight into the complexities of providing social services during the convergence of two public health crises-COVID-19 and gun violence-at the HVIPs associated with the two busiest trauma centers in the state of Maryland. In considering the effects of inadequate financial support and resources, issues with staffing, and the shift to virtual programming due to restrictions on in-person care, we suggest possible changes to violence prevention programming to increase the quality of care provided to participants in a manner reflective of their unique structural positions.
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Affiliation(s)
- William Wical
- Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD 20742, United States of America.
| | - Melike Harfouche
- Department of Surgery, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, United States of America.
| | - Nakita Lovelady
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, United States of America.
| | - Nathan Aguilar
- Columbia University School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, United States of America.
| | - David Ross
- Rebuild, Overcome, and Rise Center, University of Maryland, Baltimore, 520 W Fayette Street, Suite 320, Baltimore, MD 21201, United States of America.
| | - Joseph B Richardson
- Department of African American Studies and the Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD 20742, United States of America.
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Panda PK, Varkey RS, Ranjan P, Meher AK, Panda S. COVID 19 fatalities burden in Asian countries: An analysis of pattern and determinants. SOCIAL SCIENCES & HUMANITIES OPEN 2022; 7:100378. [PMID: 36466378 PMCID: PMC9708635 DOI: 10.1016/j.ssaho.2022.100378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
Covid 19 pandemic has severe implications on health and life of people. Asia being the most populous region has higher fatalities burden. Health infrastructure, stringent preventive measures by the government and public participation through adhering to social distancing have influence to check on fatalities' burden. The level of Social capital as well as voters' participation in a particular country can have influence on containment of COVID cases and fatalities. In this context, the main objectives of this study are to analyse pattern and trend of death burden for 45 Asian countries and impact of stringency measures by government, and voters' turnout ratio on death burden. However, for regression analysis only 32 countries are taken into account considering the availability of data for all variables. Multiple linear regression analysis is employed in a cross-sectional framework and Ordinary least square estimation technique with heteroscedastic adjusted standard errors have been used for estimation of coefficients. The results show that southern Asia contributes the highest share of fatality cases in total fatality cases of Asia with 71.43% share. It also has the highest share of confirmed cases in total confirmed cases of Asia with 71.72%. However, when we take the population into account, Western Asia leads in the share of confirmed COVID-19 cases and its associated fatality cases per million populations in Asia as compared to other Asian regions. The factors like health infrastructure and voters' turnover ratio are found to be significant and potential in reducing the new deaths per million populations. Though the coefficient of Stringency index has been negative and it did not emerge to be significant in Asian countries. The COVID related fatalities in Asian region are urban centric and urbanization proxy is found to be positive and significant. Diabetes prevalence rate has some heterogeneous result and in the present study its coefficient is not in the hypothesized direction. . The Countries should ramp up health infrastructure and necessary preparedness to deal with the subsequent waves and COVID related fatalities. Importance need to be given people's participation and their shared responsibilities in dealing with COVID cases and checking on fatalities. The realisation of social responsibility among the masses can lead to community participation and adhering to the protocols imposed by the government and helps in checking on spread of virus and associated death.
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Affiliation(s)
| | - Rittu Susan Varkey
- Department of Economics, CHRIST (Deemed to be University), Bengaluru, 560029, India
| | - Priya Ranjan
- Department of Economics, Pondicherry University, Puducherry, 605014, India
| | - Ashish Kumar Meher
- Department of Economics, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, 610101, India
| | - Soumyaranjan Panda
- Department of Computer Science and Information Technology, Mahatma Gandhi Central University, Motihari, Bihar, 845401, India
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58
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Luo Y, Li Q, Jeong H, Cheatham L. The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups. BMC Public Health 2022; 22:2193. [PMID: 36443734 PMCID: PMC9702892 DOI: 10.1186/s12889-022-14486-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). METHODS This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates-including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19-four sets of weighted binary logistic regressions were conducted. RESULTS The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05). CONCLUSION Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.
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Affiliation(s)
- Yan Luo
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA ,grid.410445.00000 0001 2188 0957The University of Hawaiʻi at Mānoa, HI Honolulu, USA
| | - Qingyi Li
- grid.5386.8000000041936877XDepartment of Psychology, Cornell University, Ithaca, NY 14850 USA
| | - Haelim Jeong
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
| | - Leah Cheatham
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
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Xiao Y, Sharma MM, Thiruvalluru RK, Gimbrone C, Weissman MM, Olfson M, Keyes KM, Pathak J. Trends in psychiatric diagnoses by COVID-19 infection and hospitalization among patients with and without recent clinical psychiatric diagnoses in New York city from March 2020 to August 2021. Transl Psychiatry 2022; 12:492. [PMID: 36414624 PMCID: PMC9681844 DOI: 10.1038/s41398-022-02255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Determining emerging trends of clinical psychiatric diagnoses among patients infected with the SARS-CoV-2 virus is important to understand post-acute sequelae of SARS-CoV-2 infection or long COVID. However, published reports accounting for pre-COVID psychiatric diagnoses have usually relied on self-report rather than clinical diagnoses. Using electronic health records (EHRs) among 2,358,318 patients from the New York City (NYC) metropolitan region, this time series study examined changes in clinical psychiatric diagnoses between March 2020 and August 2021 with month as the unit of analysis. We compared trends in patients with and without recent pre-COVID clinical psychiatric diagnoses noted in the EHRs up to 3 years before the first COVID-19 test. Patients with recent clinical psychiatric diagnoses, as compared to those without, had more subsequent anxiety disorders, mood disorders, and psychosis throughout the study period. Substance use disorders were greater between March and August 2020 among patients without any recent clinical psychiatric diagnoses than those with. COVID-19 positive patients (both hospitalized and non-hospitalized) had greater post-COVID psychiatric diagnoses than COVID-19 negative patients. Among patients with recent clinical psychiatric diagnoses, psychiatric diagnoses have decreased since January 2021, regardless of COVID-19 infection/hospitalization. However, among patients without recent clinical psychiatric diagnoses, new anxiety disorders, mood disorders, and psychosis diagnoses increased between February and August 2021 among all patients (COVID-19 positive and negative). The greatest increases were anxiety disorders (378.7%) and mood disorders (269.0%) among COVID-19 positive non-hospitalized patients. New clinical psychosis diagnoses increased by 242.5% among COVID-19 negative patients. This study is the first to delineate the impact of COVID-19 on different clinical psychiatric diagnoses by pre-COVID psychiatric diagnoses and COVID-19 infections and hospitalizations across NYC, one of the hardest-hit US cities in the early pandemic. Our findings suggest the need for tailoring treatment and policies to meet the needs of individuals with pre-COVID psychiatric diagnoses.
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Affiliation(s)
- Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine, NewYork-Presbyterian, New York, NY, USA.
| | - Mohit M Sharma
- Department of Population Health Sciences, Weill Cornell Medicine, NewYork-Presbyterian, New York, NY, USA
| | - Rohith K Thiruvalluru
- Department of Population Health Sciences, Weill Cornell Medicine, NewYork-Presbyterian, New York, NY, USA
| | - Catherine Gimbrone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Myrna M Weissman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, NewYork-Presbyterian, New York, NY, USA
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60
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Berkley-Patton J, Thompson CB, Templeton T, Burgin T, Derose KP, Williams E, Thompson F, Catley D, Simon SD, Allsworth JE. COVID-19 Testing in African American Churches Using a Faith-Health- Academic Partnership. Am J Public Health 2022; 112:S887-S891. [PMID: 36265094 PMCID: PMC9707720 DOI: 10.2105/ajph.2022.306981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/04/2022]
Abstract
Increasing access to COVID-19 testing in influential, accessible community settings is needed to address COVID-19 disparities among African Americans. We describe COVID-19 testing intervention approaches conducted in Kansas City, Missouri, African American churches via a faith-health-academic partnership. Trained faith leaders promoted COVID-19 testing with church and community members by implementing multilevel interventions using a tailored toolkit and standard education information. The local health department conducted more than 300 COVID-19 tests during or after Sunday church services and outreach ministry activities. (Am J Public Health. 2022;112(S9):S887-S891. https://doi.org/10.2105/AJPH.2022.306981).
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Affiliation(s)
- Jannette Berkley-Patton
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Carole Bowe Thompson
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Turquoise Templeton
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Tacia Burgin
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Kathryn P Derose
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Eric Williams
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Frank Thompson
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Delwyn Catley
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Stephen D Simon
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
| | - Jenifer E Allsworth
- Jannette Berkley-Patton, Carole Bowe Thompson, Turquoise Templeton, Tacia Burgin, Stephen D. Simon, and Jenifer E. Allsworth are with the School of Medicine, University of Missouri-Kansas City. Kathryn P. Derose is with the Department of Health Promotion & Policy, University of Massachusetts, Amherst. Eric Williams is with Calvary Community Outreach Network, Kansas City, MO. Frank Thompson is with the Kansas City Missouri Health Department. Delwyn Catley is with the Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy, Kansas City, MO
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McGowan VJ, Bambra C. COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities. Lancet Public Health 2022; 7:e966-e975. [PMID: 36334610 PMCID: PMC9629845 DOI: 10.1016/s2468-2667(22)00223-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has exacerbated endemic health inequalities resulting in a syndemic pandemic of higher mortality and morbidity rates among the most socially disadvantaged. We did a scoping review to identify and synthesise published evidence on geographical inequalities in COVID-19 mortality rates globally. We included peer-reviewed studies, from any country, written in English that showed any area-level (eg, neighbourhood, town, city, municipality, or region) inequalities in mortality by socioeconomic deprivation (ie, measured via indices of multiple deprivation: the percentage of people living in poverty or proxy factors including the Gini coefficient, employment rates, or housing tenure). 95 papers from five WHO global regions were included in the final synthesis. A large majority of the studies (n=86) found that COVID-19 mortality rates were higher in areas of socioeconomic disadvantage than in affluent areas. The subsequent discussion reflects on how the unequal nature of the pandemic has resulted from a syndemic of COVID-19 and endemic inequalities in chronic disease burden.
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Affiliation(s)
- Victoria J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.
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Mortimer AE, Sabatino MJ, Boama-Nyarko E, Castañeda-Avila M, Goulding M, Julce C, Labossiere S, Mabry G, McCullers A, McNicholas E, Moormann A, Schieber E, Walubita T, Forrester S. Investigating a key structural determinant of health, racism, and related social determinants of health in Massachusetts during the COVID-19 pandemic. FRONTIERS IN EPIDEMIOLOGY 2022; 2:1018186. [PMID: 38455280 PMCID: PMC10910901 DOI: 10.3389/fepid.2022.1018186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 03/09/2024]
Abstract
A disproportionate burden of the ongoing COVID-19 pandemic is being shouldered by members of racial and ethnic minorities and socially disadvantaged communities. Structural and social determinants of health have been recognized as key contributors to the inequalities observed. Racism, a major structural determinant of health that patterns related social determinants of health, in the USA, warrants further investigation. In this perspective piece we provide an overview of the historical context of racism, followed by preliminary findings from the ongoing COVIDStory study-a cross-sectional study addressing perceptions of COVID-19 and COVID-19 research-that highlights the experiences of non-Hispanic Black and Hispanic identifying adult participants, residing in Worcester Massachusetts, during the COVID-19 pandemic. We then discuss these findings in the context of current and past research considering racism and relevant social determinants of health. Our study results suggest that racism and its residuals (residential segregation, economic insecurity, discrimination, bias, and vigilance) are modern challenges for non-Hispanic Black and Hispanic participants, and these findings are supported by the existing literature. It is our hope that this perspective piece provides additional evidence for action on structural and social determinants affecting the health of minoritized people, especially those living in Massachusetts.
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Affiliation(s)
- Arvis E. Mortimer
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Meagan J. Sabatino
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Esther Boama-Nyarko
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Maira Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Melissa Goulding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Clevanne Julce
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Stephane Labossiere
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | | | - Asli McCullers
- Department of Epidemiology, University of Delaware, Newark, DE, United States
| | - Eileen McNicholas
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ann Moormann
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Elizabeth Schieber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Tubanji Walubita
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Sachs JD, Karim SSA, Aknin L, Allen J, Brosbøl K, Colombo F, Barron GC, Espinosa MF, Gaspar V, Gaviria A, Haines A, Hotez PJ, Koundouri P, Bascuñán FL, Lee JK, Pate MA, Ramos G, Reddy KS, Serageldin I, Thwaites J, Vike-Freiberga V, Wang C, Were MK, Xue L, Bahadur C, Bottazzi ME, Bullen C, Laryea-Adjei G, Ben Amor Y, Karadag O, Lafortune G, Torres E, Barredo L, Bartels JGE, Joshi N, Hellard M, Huynh UK, Khandelwal S, Lazarus JV, Michie S. The Lancet Commission on lessons for the future from the COVID-19 pandemic. Lancet 2022; 400:1224-1280. [PMID: 36115368 PMCID: PMC9539542 DOI: 10.1016/s0140-6736(22)01585-9] [Citation(s) in RCA: 262] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Jeffrey D Sachs
- Center for Sustainable Development, Columbia University, New York, NY, United States.
| | - Salim S Abdool Karim
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Lara Aknin
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Joseph Allen
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, United States
| | | | - Francesca Colombo
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | | | | | - Vitor Gaspar
- Fiscal Affairs Department, International Monetary Fund, Washington, DC, United States
| | | | - Andy Haines
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Phoebe Koundouri
- Department of International and European Economic Studies, Athens University of Economics and Business, Athens, Greece; Department of Technology, Management and Economics, Technical University of Denmark, Kongens Lyngby, Denmark; European Association of Environmental and Resource Economists, Athens, Greece
| | - Felipe Larraín Bascuñán
- Department of Economics and Administration, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jong-Koo Lee
- National Academy of Medicine of Korea, Seoul, Republic of Korea
| | - Muhammad Ali Pate
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, United States
| | | | | | | | - John Thwaites
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | | | - Chen Wang
- National Clinical Research Center for Respiratory Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | | | - Lan Xue
- Schwarzman College, Tsinghua University, Beijing, China
| | - Chandrika Bahadur
- The Lancet COVID-19 Commission Regional Task Force: India, New Delhi, India
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Yanis Ben Amor
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | - Ozge Karadag
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | | | - Emma Torres
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | - Lauren Barredo
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | - Juliana G E Bartels
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | - Neena Joshi
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | | | | | | | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
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Arigbede OM, Aladeniyi OB, Buxbaum SG, Arigbede OJ. The Use of Five Public Health Themes in Understanding the Roles of Misinformation and Education Toward Disparities in Racial and Ethnic Distribution of COVID-19. Cureus 2022; 14:e30008. [PMID: 36225248 PMCID: PMC9537595 DOI: 10.7759/cureus.30008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/20/2022] Open
Abstract
The distribution of coronavirus disease 2019 (COVID-19) infection across the historically marginalized populations in the United States (US) has consistently been inequitable. In addition, systemic racism and prejudice, which have existed for decades, have caused a lack of faith in public health and medical experts and have resulted in the epidemic of misinformation. To counteract the COVID-19 pandemic and widespread misinformation, the political establishment and public health experts must work collaboratively. And because they are closely associated, there had been a significant increase in the prevalence of the disease as well as a spike in the number of hospitalizations and fatalities. Public health professionals have investigated a number of epidemiological strategies to stop the spread of the virus and mitigate its effects, but false information released via various media sources has caused serious harm to a number of people. To create the framework and guidelines for protecting audiences from lies and deceit, and eradicating false information before taking root in society, it is essential to understand the types of misinformation that are being spread since the disadvantaged and uneducated communities suffer disproportionately as a result. According to studies, spreading false information could have a negative impact on a country's health outcomes, as well as its economic and social well-being, if not immediately refuted. Public health themes, such as evidence-based programs, health communication, and health policy, among others need to be evaluated and put into action in order to prevent the dissemination of incorrect information. This review examines a number of public health themes, such as policy and evidence-based strategies that might help in the fight against misinformation that has wreaked havoc on families and communities, particularly the underserved and uninformed populations.
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Affiliation(s)
- Olumide M Arigbede
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, USA
| | - Olabimpe B Aladeniyi
- School of Sciences, Department of Statistics, Federal University of Akure, Akure, NGA
| | - Sarah G Buxbaum
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, USA
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A Call to Action:. Dela J Public Health 2022; 8:4. [PMID: 36340942 PMCID: PMC9621583 DOI: 10.32481/djph.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Wong MS, Upchurch DM, Steers WN, Haderlein TP, Yuan AT, Washington DL. The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans. J Racial Ethn Health Disparities 2022; 9:1861-1872. [PMID: 34491563 PMCID: PMC8422953 DOI: 10.1007/s40615-021-01123-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES American Indian and Alaska Native (AI/AN) communities have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. This study examines whether neighborhood characteristics mediate AI/AN versus White-non-Hispanic Veteran COVID-19 infection disparities, and whether mediation differs based on proximity to reservations. METHODS Using Veteran Health Administration's (VHA) national database of VHA users evaluated for COVID-19 infection (3/1/2020-8/25/2020), we examined whether census tract neighborhood characteristics (percent households overcrowded, without complete plumbing, without kitchen plumbing, and neighborhood socioeconomic status [n-SES]) mediated racial disparities in COVID-19 infection, using inverse odds-weighted logistic models controlling for individual-level characteristics. Using moderated mediation analyses, we assessed whether neighborhood mediating effects on disparities differed for those residing in counties containing/near federally recognized tribal lands (i.e., Contract Health Service Delivery Area [CHSDA] counties) versus not. RESULTS The percent of households without complete plumbing, percent without kitchen plumbing, and n-SES partially mediated AI/AN-White-non-Hispanic COVID-19 infection disparities (accounting for 17-35% of disparity) to a similar extent in CHSDA and non-CHSDA counties. The percent of households without kitchen plumbing had stronger mediating effects for CHSDA than non-CHSDA residents. CONCLUSIONS Neighborhood-level social determinants of health may contribute to the disproportionate COVID-19 infection burden on AI/ANs; differences are exacerbated among AI/ANs living near reservations.
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Affiliation(s)
- Michelle S Wong
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - W Neil Steers
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Taona P Haderlein
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Anita T Yuan
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Donna L Washington
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA
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Dendir S. Race, ethnicity and mortality in the United States during the first year of the COVID-19 pandemic: an assessment. DISCOVER SOCIAL SCIENCE AND HEALTH 2022; 2:16. [PMID: 36187079 PMCID: PMC9511463 DOI: 10.1007/s44155-022-00019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/13/2022] [Indexed: 02/02/2023]
Abstract
The fact that a disproportionate share of the disease burden from COVID-19, including mortality, has been borne by racial and ethnic minority communities is well documented. The purpose of this paper is to reassess the "race/ethnicity effect" in COVID-19 mortality in the United States. Using an ecological regression framework and county-level data, the study aims to make two contributions. First, it estimates the race/ethnicity effect for all major racial/ethnic groups at four important junctures during the first year of the pandemic. In doing so, it seeks to provide the fullest possible picture of the nature and evolution of the race/ethnicity effect. Second, it estimates the race/ethnicity effect net of basic socioeconomic factors (SEF). This helps to identify the likely mechanisms through which the race/ethnicity effect operates. Racial/ethnic composition is flexibly measured in two ways-by percentage contributions to county population and by indicators of group plurality. The ecological regressions revealed a positive association between the size of three racial/ethnic groups-non-Hispanic Blacks, non-Hispanic American Indian and Alaskan Natives (AIAN) and Hispanics-and county mortality, although the association was stronger and more consistent for Blacks and AIANs. Furthermore, accounting for basic SEF had different impacts on the race/ethnicity-mortality association for the three groups. For Hispanics, it was almost fully mediated. For Blacks, it decreased but remained statistically significant [62-6% higher mortality associated with a 1-standard deviation increase in Black share of county population; 2.3-1.1 times higher mortality in the average Black plurality county]. For AIANs, it was largely unaffected or even increased [44-10% higher mortality associated with a 1-standard deviation increase in AIAN share; 6.2-1.8 times higher mortality in AIAN plurality county). For all groups, the race/ethnicity effect generally decreased as the pandemic wore on during the first year. Supplementary Information The online version contains supplementary material available at 10.1007/s44155-022-00019-9.
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Disparities in COVID-19 Mortality Rates: Implications for Rural Health Policy and Preparedness. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:478-485. [PMID: 35389953 PMCID: PMC9307261 DOI: 10.1097/phh.0000000000001507] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT It is well established that rural communities face geographic and socioeconomic challenges linked to higher rates of health disparities across the United States, though the coronavirus disease 2019 (COVID-19) impact on rural communities is less certain. OBJECTIVE To understand the COVID-19 pandemic's impact on rural communities in Tennessee, investigate differences in rural-urban mortality rates after controlling for confounding variables, and inform state pandemic response policy. DESIGN A cross-sectional analysis of cumulative COVID-19 morality rates. SETTING/PARTICIPANTS Tennessee county-level COVID-19 mortality data from March 1, 2020, to January 31, 2021, were matched with county-level sociodemographic and health data from public datasets: Agency for Healthcare Research and Quality Social Determinants of Health, PLACES: Local Data for Better Health County Data, and the US Census Bureau. County status was defined using the 2013 National Center for Health Statistics Urban-Rural Classification. MAIN OUTCOME MEASURES A negative binomial regression model estimated adjusted incidence rate ratio and 95% confidence intervals (CI) for rural compared with urban mortality. Unadjusted rate ratios and rate differences for COVID-19 mortality in rural versus urban counties were compared with those for influenza and pneumonia and all-cause mortality over the past 5 years. RESULTS During the study period, 9650 COVID-19 deaths occurred across 42 urban and 53 rural counties. Controlling for county-level sociodemographic characteristics, health care access, and comorbidities, incidence rate ratio was 1.13 (95% CI, 1.00-1.28, P < .05) for rural as compared with urban deaths. Unadjusted COVID-19 mortality risk difference between rural and urban counties was greater (61.85, 95% CI, 54.31-69.31) than 5-year influenza and pneumonia rural-urban risk difference (12.57, 95% CI, 11.16-13.00) during 2015-2019. CONCLUSIONS COVID-19 mortality rates were greater for populations living in Tennessee's rural as compared with urban counties during the study period. This differential impact must be considered in public health decision making to mitigate COVID-19.
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Boyer CJ, Ugarte E, Buhler‐Wassmann AC, Hibel LC. Latina mothers navigating COVID-19: Within- and between-family stress processes over time. FAMILY RELATIONS 2022; 72:FARE12748. [PMID: 36246208 PMCID: PMC9538364 DOI: 10.1111/fare.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/30/2022] [Indexed: 06/16/2023]
Abstract
Objective This study aimed to understand how periodic shifts in financial cutbacks and fears of contracting COVID-19 contributed to children's externalizing behaviors due to increases in maternal stress among low-income Latina mothers during the first 10 months of the COVID-19 pandemic. Background The COVID-19 pandemic caused widespread health, economic, and psychological consequences for families and children. The Latino community is particularly vulnerable to the economic and health risks of this pandemic as a consequence of systemic oppression. The family stress model suggests that these family stressors will have psychological repercussions to parents, and downstream behavioral consequences to children. Method We examined both the within- and between-person impacts of worry surrounding contracting the virus and the economic consequences of the pandemic on maternal stress and child externalizing behaviors. Participants were 73 Latina mothers who completed assessments an average eight times across the first 10 months of the COVID-19 pandemic. At each assessment time, the mother was asked about worries surrounding contracting the virus, economic cutbacks the family was making, her perceived stress, and her child's externalizing behaviors during a brief phone call. Results Between-families, higher economic cutbacks indirectly increased child externalizing behaviors through maternal stress. The within-family model revealed that at assessments when mothers expressed greater worry about contracting the COVID-19 virus, they also reported greater stress. Further, at the within-person level, a mother's greater experience of stress was associated with greater reports of child externalizing behaviors, though the indirect association between COVID-19 contract worry and child externalizing behaviors through maternal stress was not significant. Conclusions Across the first 10 months of the COVID-19 pandemic, the children in Latino families participating in this research exhibited more externalizing behaviors among families that engaged in more financial cutbacks as a function maternal stress. However, periodic spikes in Latina mothers' fears of contracting COVID-19 contributed to periodic spikes in stress, which predicted periodic spikes in child externalizing behaviors. Implications Greater effort toward social policy that provides economic support for vulnerable families before periods of increased societal stress and greater protections for workers with limited sick leave and schedule flexibility will help promote resilience to future crises among low-income Latino families.
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Affiliation(s)
- Chase J. Boyer
- Department of Human EcologyUniversity of California–DavisDavis, CA
| | - Elisa Ugarte
- Department of Human EcologyUniversity of California–DavisDavis, CA
| | | | - Leah C. Hibel
- Department of Human EcologyUniversity of California–DavisDavis, CA
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Allande-Cussó R, García-Iglesias JJ, Miranda-Plata R, Pichardo-Hexamer R, Ruiz-Frutos C, Gómez-Salgado J. Social Determinants of Health in the COVID-19 Pandemic Context of the Migrant Population Living in Settlements in Spain. Int J Public Health 2022; 67:1604628. [PMID: 35990191 PMCID: PMC9385961 DOI: 10.3389/ijph.2022.1604628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives: The aim of this study was to describe and evaluate the sociodemographic profile and assess the levels of anxiety and fear, work engagement, and psychological distress on a sample of migrants living in settlements in the province of Huelva (Spain) during the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted on a sample of 623 migrants during the months of April to June 2021, based on the Anxiety and Fear of COVID-19 (AMICO) assessment scale, the 9-item Utrecht Work Engagement Scale to assess work engagement, and the General Health Questionnaire (GHQ-12) to analyse psychological distress. Results: A low level of education, dwelling of less than 3 m2 and the desire to return to the country of origin may be related to the presence of anxiety and fear of COVID-19 and lower levels of work engagement. Conclusion: There is a need to improve the study of the concept of health of the migrant population residing in the settlements of Huelva (Spain) and the assessment of their physical and mental health, in an official way.
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Affiliation(s)
- Regina Allande-Cussó
- Department of Nursing, Faculty of Nursing, Podiatry and Physiotherapy, University of Seville, Seville, Spain
| | - Juan Jesús García-Iglesias
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
| | | | | | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Lee H, Andrasfay T, Riley A, Wu Q, Crimmins E. Do social determinants of health explain racial/ethnic disparities in COVID-19 infection? Soc Sci Med 2022; 306:115098. [PMID: 35759973 PMCID: PMC9162789 DOI: 10.1016/j.socscimed.2022.115098] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023]
Abstract
Racial/ethnic minorities have experienced higher COVID-19 infection rates than whites, but it is unclear how individual-level housing, occupational, behavioral, and socioeconomic conditions contribute to these disparities in a nationally representative sample. In this study, we assess the extent to which social determinants of health contribute to racial/ethnic differences in COVID-19 infection. Data are from the Understanding America Study's Understanding Coronavirus in America survey (UAS COVID-19 waves 7-29). UAS COVID-19 is one of the only nationally representative longitudinal data sources that collects information on household, work, and social behavioral context during the pandemic. We analyze onset of COVID-19 cases, defined as a positive test or a diagnosis of COVID-19 from a healthcare provider since the previous survey wave, over a year of follow-up (June 2020-July 2021). We consider educational attainment, economic resources, work arrangements, household size, and social distancing as key social factors that may be structured by racism. Cox hazard models indicate that Hispanic people have 48% higher risk of experiencing a COVID-19 infection than whites after adjustment for age, sex, local infection rate, and comorbidities, but we do not observe a higher risk of COVID-19 among Black respondents. Controlling for engagement in any large or small social gathering increases the hazard ratio for Hispanics by 9%, suggesting that had Hispanics had the same social engagement patterns as whites, they may have had even higher risk of COVID-19. Other social determinants-lower educational attainment, working away from home, and number of coresidents-all independently predict higher risk of COVID-19, but do not explain why Hispanic Americans have higher COVID-19 infection risk than whites.
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Affiliation(s)
- Haena Lee
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
| | - Theresa Andrasfay
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Alicia Riley
- Department of Sociology, University of California Santa Cruz, Santa Cruz, CA, USA
| | - Qiao Wu
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Eileen Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Chung YG, Person CM, O’Banion J, Primo SA. Coronavirus Disease 2019–Related Health Disparities in Ophthalmology with a Retrospective Analysis at a Large Academic Public Hospital. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2022; 7:311-323. [PMID: 35474943 PMCID: PMC9023339 DOI: 10.1016/j.yaoo.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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73
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Rabb N, Bowers J, Glick D, Wilson KH, Yokum D. The influence of social norms varies with "others" groups: Evidence from COVID-19 vaccination intentions. Proc Natl Acad Sci U S A 2022; 119:e2118770119. [PMID: 35858296 PMCID: PMC9303870 DOI: 10.1073/pnas.2118770119] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/27/2022] [Indexed: 01/13/2023] Open
Abstract
The theory that health behaviors spread through social groups implies that efforts to control COVID-19 through vaccination will succeed if people believe that others in their groups are getting vaccinated. But "others" can refer to many groups, including one's family, neighbors, fellow city or state dwellers, or copartisans. One challenge to examining these understudied distinctions is that many factors may confound observed relationships between perceived social norms (what people believe others do) and intended behaviors (what people themselves will do), as there are plausible common causes for both. We address these issues using survey data collected in the United States during late fall 2020 (n = 824) and spring 2021 (n = 996) and a matched design that approximates pair-randomized experiments. We find a strong relationship between perceived vaccination social norms and vaccination intentions when controlling for real risk factors (e.g., age), as well as dimensions known to predict COVID-19 preventive behaviors (e.g., trust in scientists). The strength of the relationship declines as the queried social group grows larger and more heterogeneous. The relationship for copartisans is second in magnitude to that of family and friends among Republicans but undetectable for Democrats. Sensitivity analysis shows that these relationships could be explained away only by an unmeasured variable with large effects (odds ratios between 2 and 15) on social norms perceptions and vaccination intentions. In addition, a prediction from the "false consensus" view that intentions cause perceived social norms is not supported. We discuss the implications for public health policy and understanding social norms.
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Affiliation(s)
| | - Jake Bowers
- Department of Political Science, University of Illinois Urbana–Champaign, Urbana, IL, 61801
| | - David Glick
- Department of Political Science, Boston University, Boston, MA, 02215
| | | | - David Yokum
- The Policy Lab, Brown University, Providence, RI, 02903
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74
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Social Determinants of Health Associated With the Development of Sepsis in Adults: A Scoping Review. Crit Care Explor 2022; 4:e0731. [PMID: 36818749 PMCID: PMC9937691 DOI: 10.1097/cce.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Evaluating risk for sepsis is complicated due to limited understanding of how social determinants of health (SDoH) influence the occurence of the disease. This scoping review aims to identify gaps and summarize the existing literature on SDoH and the development of sepsis in adults. DATA SOURCES A literature search using key terms related to sepsis and SDoH was conducted using Medline and PubMed. STUDY SELECTION Studies were screened by title and abstract and then full text in duplicate. Articles were eligible for inclusion if they: 1) evaluated at least one SDoH on the development of sepsis, 2) participants were 18 years or older, and 3) the studies were written in English between January 1970 and January 2022. Systematic reviews, meta-analyses, editorials, letters, commentaries, and studies with nonhuman participants were excluded. DATA EXTRACTION Data were extracted in duplicate using a standardized data extraction form. Studies were grouped into five categories according to the SDoH they evaluated (race, socioeconomic status [SES], old age and frailty, health behaviors, and social support). The study characteristics, key outcomes related to incidence of sepsis, mortality, and summary statements were included in tables. DATA SYNTHESIS The search identified 637 abstracts, 20 of which were included after full-text screening. Studies evaluating SES, old age, frailty, and gender demonstrated an association between sepsis incidence and the SDoH. Studies that examined race demonstrated conflicting conclusions as to whether Black or White patients were at increased risk of sepsis. Overall, a major limitation of this analysis was the methodological heterogeneity between studies. CONCLUSIONS There is evidence to suggest that SDoH impacts sepsis incidence, particularly SES, gender, old age, and frailty. Future prospective cohort studies that use standardized methods to collect SDoH data, particularly race-based data, are needed to inform public health efforts to reduce the incidence of sepsis and help clinicians identify the populations most at risk.
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75
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Wong MS, Steers WN, Frochen S, Washington DL. Assessment of Exposure to Environmental Toxins and Racial and Ethnic Disparities in COVID-19 Hospitalizations Among US Veterans. JAMA Netw Open 2022; 5:e2224249. [PMID: 35900766 PMCID: PMC9335138 DOI: 10.1001/jamanetworkopen.2022.24249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/12/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michelle S. Wong
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - W. Neil Steers
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Stephen Frochen
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Donna L. Washington
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles
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76
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Ramírez-Cervantes KL, Huerta-Álvarez C, Quintana-Díaz M. Thromboembolic Events in a Socio-Economically Disadvantaged Population with COVID-19 Admitted to a Medicalized Hotel in Madrid. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7816. [PMID: 35805474 PMCID: PMC9265549 DOI: 10.3390/ijerph19137816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023]
Abstract
Background: The social determinants of health (SDOH) of patients with COVID-19-related thrombosis have been scarcely explored. Our objective was to investigate the cases of thrombosis in a group of socially disadvantaged populations with COVID-19. Methods: We investigated the thrombotic events that occurred in a cohort of migrant and Spanish patients with COVID-19 that were admitted to a medicalized hotel in Madrid. Demographic data, past medical history, and socio-economic backgrounds, such as monthly household income, level of education, and living conditions, were explored to determine the factors related to thrombosis. Results: A cohort of 383 subjects (mean age 55.4 ± 14.6 years old, 69% male), of which 58% were migrants, was studied. Fourteen (3.6%) cases of thrombosis were reported. Thrombosis was more frequent in Spanish than in migrant individuals (OR 5.3, 95%CI 1.4-19.5, p = 0.005). Neither a low monthly household income nor a low education level showed a statistical association with thrombosis (p ≥ 0.05). History of venous thromboembolism (OR 8.1, 95%CI 2.2-28.6) and being a current smoker (OR 4.7, 95%CI 1.3-16.0) were factors associated with thrombosis. Conclusions: The SDOH studied were not associated with thrombosis; however, further investigation must be performed to investigate the socio-economic conditions of subjects with COVID-19 with adverse outcomes such as thrombotic events.
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Affiliation(s)
- Karen Lizzette Ramírez-Cervantes
- Department of Disease Prevention and Health Promotion, Spanish Association Against Cancer, 28040 Madrid, Spain
- Patient Blood Management Research Group, Research Institute of La Paz University Hospital, 28040 Madrid, Spain;
| | - Consuelo Huerta-Álvarez
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Manuel Quintana-Díaz
- Patient Blood Management Research Group, Research Institute of La Paz University Hospital, 28040 Madrid, Spain;
- Intensive Care Unit, La Paz University Hospital, 28046 Madrid, Spain
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Coulter K, Ingram M, Lohr A, Figueroa C, Coronado G, Espinoza C, Esparza M, Monge S, Velasco M, Itule-Klasen L, Bowen M, Wilkinson-Lee A, Carvajal S. Adaptation of a Community Clinical Linkages Intervention to the COVID-19 Pandemic: A Community Case Study. Front Public Health 2022; 10:877593. [PMID: 35812475 PMCID: PMC9256923 DOI: 10.3389/fpubh.2022.877593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
In this community case study, we describe the process within an academic-community partnership of adapting UNIDOS, a community health worker (CHW)-led community-clinical linkages (CCL) intervention targeting Latinx adults in Arizona, to the evolving landscape of the COVID-19 pandemic. Consistent with community-based participatory research principles, academic and community-based partners made decisions regarding changes to the intervention study protocol, specifically the intervention objectives, participant recruitment methods, CHW trainings, data collection measures and management, and mode of intervention delivery. Insights from this case study demonstrate the importance of community-based participatory research in successfully modifying the intervention to the conditions of the pandemic and also the cultural background of Latinx participants. This case study also illustrates how a CHW-led CCL intervention can address social determinants of health, in which the pandemic further exposed longstanding inequities along racial and ethnic lines in the United States.
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Affiliation(s)
- Kiera Coulter
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- *Correspondence: Kiera Coulter
| | - Maia Ingram
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Abby Lohr
- Department of Community Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Carlos Figueroa
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Gloria Coronado
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Cynthia Espinoza
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Maria Esparza
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Stacey Monge
- Pima County Health Department, Tucson, AZ, United States
| | - Maria Velasco
- El Rio Community Health Center, Tucson, AZ, United States
| | | | | | - Ada Wilkinson-Lee
- Department of Mexican American Studies, University of Arizona, Tucson, AZ, United States
| | - Scott Carvajal
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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78
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Williams DP, Jones NM, Holman EA. Racial and ethnic differences in perseverative cognition at the onset of the COVID-19 pandemic. Soc Sci Med 2022; 306:115105. [PMID: 35724589 PMCID: PMC9161684 DOI: 10.1016/j.socscimed.2022.115105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022]
Abstract
Rationale Coronavirus (COVID-19) disproportionately affects people of color (e.g., Black and Latinx individuals) in the U.S., increasing their morbidity and mortality relative to White people. Despite this greater threat to their well-being, the mental health impact of COVID-19 on people of color remains poorly understood. Perseverative cognition (PC; i.e., excessive worry and/or rumination), is a common psychological response to such threats that independently associates with poor mental and physical health. Objective To examine patterns of PC across race/ethnicity when the COVID-19 pandemic began. Methods This study surveyed 6,514 respondents from the NORC AmeriSpeak panel, a probability-based representative national sample of U.S. adults between 3/18/20-4/18/20. We employed traditional statistical analyses and natural language processing of open-ended data to examine pandemic-related worries. Results Weighted regression analyses with relevant covariates revealed group differences across specific domains of COVID-related worry. Relative to White respondents, Hispanic/Latino respondents reported more worries about social disarray, meeting basic needs, experiencing economic impacts, obtaining healthcare, and contracting COVID-19. Black respondents reported more worry about economic impacts relative to Whites. Additional group differences in worry emerged in open-ended data: Black respondents perseverated about death from COVID-19, whereas Hispanic/Latino respondents reported concerns about COVID-19 spread, and people refusing to uphold mitigation mandates. In contrast, White respondents expressed worry over compromised immune systems and economic collapse. Conclusions Results identify significant group differences in COVID-19 related PC, suggesting that people of color faced greater threat to mental well-being at the onset of the pandemic, and may be at greater risk for downstream PC-related physical health consequences.
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Affiliation(s)
- DeWayne P Williams
- Department of Psychological Science, University of California, Irvine, USA
| | - Nickolas M Jones
- Department of Psychological Science, University of California, Irvine, USA
| | - E Alison Holman
- Department of Psychological Science, University of California, Irvine, USA; Sue & Bill Gross School of Nursing, University of California, Irvine, USA.
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Connecting the Dots in Emerging Mast Cell Research: Do Factors Affecting Mast Cell Activation Provide a Missing Link between Adverse COVID-19 Outcomes and the Social Determinants of Health? Med Sci (Basel) 2022; 10:medsci10020029. [PMID: 35736349 PMCID: PMC9228930 DOI: 10.3390/medsci10020029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 02/07/2023] Open
Abstract
Evidence continues to emerge that the social determinants of health play a role in adverse outcomes related to COVID-19, including increased morbidity and mortality, increased risk of long COVID, and vaccine adverse effects. Therefore, a more nuanced understanding of the biochemical and cellular pathways of illnesses commonly associated with adverse social determinants of health is urgently needed. We contend that a commitment to understanding adverse outcomes in historically marginalized communities will increase community-level confidence in public health measures. Here, we synthesize emerging literature on mast cell disease, and the role of mast cells in chronic illness, alongside emerging research on mechanisms of COVID illness and vaccines. We propose that a focus on aberrant and/or hyperactive mast cell behavior associated with chronic underlying health conditions can elucidate adverse COVID-related outcomes and contribute to the pandemic recovery. Standards of care for mast cell activation syndrome (MCAS), as well as clinical reviews, experimental research, and case reports, suggest that effective and cost-efficient remedies are available, including antihistamines, vitamin C, and quercetin, among others. Primary care physicians, specialists, and public health workers should consider new and emerging evidence from the biomedical literature in tackling COVID-19. Specialists and researchers note that MCAS is likely grossly under-diagnosed; therefore, public health agencies and policy makers should urgently attend to community-based experiences of adverse COVID outcomes. It is essential that we extract and examine experiential evidence of marginalized communities from the broader political–ideological discourse.
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80
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Ozyilmaz A, Bayraktar Y, Toprak M, Isik E, Guloglu T, Aydin S, Olgun MF, Younis M. Socio-Economic, Demographic and Health Determinants of the COVID-19 Outbreak. Healthcare (Basel) 2022; 10:748. [PMID: 35455925 PMCID: PMC9031016 DOI: 10.3390/healthcare10040748] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE In this study, the effects of social and health indicators affecting the number of cases and deaths of the COVID-19 pandemic were examined. For the determinants of the number of cases and deaths, four models consisting of social and health indicators were created. METHODS In this quantitative research, 93 countries in the model were used to obtain determinants of the confirmed cases and determinants of the COVID-19 fatalities. RESULTS The results obtained from Model I, in which the number of cases was examined with social indicators, showed that the number of tourists, the population between the ages of 15 and 64, and institutionalization had a positive effect on the number of cases. The results obtained from the health indicators of the number of cases show that cigarette consumption affects the number of cases positively in the 50th quantile, the death rate under the age of five affects the number of cases negatively in all quantiles, and vaccination positively affects the number of cases in 25th and 75th quantile values. Findings from social indicators of the number of COVID-19 deaths show that life expectancy negatively affects the number of deaths in the 25th and 50th quantiles. The population over the age of 65 and CO2 positively affect the number of deaths at the 25th, 50th, and 75th quantiles. There is a non-linear relationship between the number of cases and the number of deaths at the 50th and 75th quantile values. An increase in the number of cases increases the number of deaths to the turning point; after the turning point, an increase in the number of cases decreases the death rate. Herd immunity has an important role in obtaining this finding. As a health indicator, it was seen that the number of cases positively affected the number of deaths in the 50th and 75th quantile values and the vaccination rate in the 25th and 75th quantile values. Diabetes affects the number of deaths positively in the 75th quantile. CONCLUSION The population aged 15-64 has a strong impact on COVID-19 cases, but in COVID-19 deaths, life expectancy is a strong variable. On the other hand, it has been found that vaccination and the number of cases interaction term has an effect on the mortality rate. The number of cases has a non-linear effect on the number of deaths.
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Affiliation(s)
- Ayfer Ozyilmaz
- Department of Foreign Trade, Kocaeli University, Kocaeli 41650, Turkey;
| | - Yuksel Bayraktar
- Department of Economics, Istanbul University, Istanbul 34452, Turkey;
| | - Metin Toprak
- Department of Economics, Istanbul Sabahattin Zaim University, Istanbul 34303, Turkey;
| | - Esme Isik
- Department of Optician, Malatya Turgut Ozal University, Malatya 44700, Turkey;
| | - Tuncay Guloglu
- Department of Labor Economics and Industrial Relations, Yalova University, Yalova 77100, Turkey;
| | - Serdar Aydin
- School of Health Sciences, Southern Illinois University Carbondale, 1365 Douglas, Drive, Carbondale, IL 62901, USA
| | | | - Mustafa Younis
- College of Health Sciences, Jackson State University, Jackson, MS 39217, USA;
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81
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Lin Q, Paykin S, Halpern D, Martinez-Cardoso A, Kolak M. Assessment of Structural Barriers and Racial Group Disparities of COVID-19 Mortality With Spatial Analysis. JAMA Netw Open 2022; 5:e220984. [PMID: 35244703 PMCID: PMC8897755 DOI: 10.1001/jamanetworkopen.2022.0984] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Although social determinants of health (SDOH) are important factors in health inequities, they have not been explicitly associated with COVID-19 mortality rates across racial and ethnic groups and rural, suburban, and urban contexts. OBJECTIVES To explore the spatial and racial disparities in county-level COVID-19 mortality rates during the first year of the pandemic. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data for all US counties in 50 states and the District of Columbia for the first full year of the COVID-19 pandemic (January 22, 2020, to February 28, 2021). Counties with a high concentration of a single racial and ethnic population and a high level of COVID-19 mortality rate were identified as concentrated longitudinal-impact counties. The SDOH that may be associated with mortality rate across these counties and in urban, suburban, and rural contexts were examined. The 3 largest racial and ethnic groups in the US were selected: Black or African American, Hispanic or Latinx, and non-Hispanic White populations. EXPOSURES County-level characteristics and community health factors (eg, income inequality, uninsured rate, primary care physicians, preventable hospital stays, severe housing problems rate, and access to broadband internet) associated with COVID-19 mortality. MAIN OUTCOMES AND MEASURES Data on county-level COVID-19 mortality rates (deaths per 100 000 population) reported by the US Centers for Disease Control and Prevention were analyzed. Four indexes were used to measure multiple dimensions of SDOH: socioeconomic advantage index, limited mobility index, urban core opportunity index, and mixed immigrant cohesion and accessibility index. Spatial regression models were used to examine the associations between SDOH and county-level COVID-19 mortality rate. RESULTS Of the 3142 counties included in the study, 531 were identified as concentrated longitudinal-impact counties. Of these counties, 347 (11.0%) had a large Black or African American population compared with other counties, 198 (6.3%) had a large Hispanic or Latinx population compared with other counties, and 33 (1.1%) had a large non-Hispanic White population compared with other counties. A total of 489 254 COVID-19-related deaths were reported. Most concentrated longitudinal-impact counties with a large Black or African American population compared with other counties were spread across urban, suburban, and rural areas and experienced numerous disadvantages, including higher income inequality (297 of 347 [85.6%]) and more preventable hospital stays (281 of 347 [81.0%]). Most concentrated longitudinal-impact counties with a large Hispanic or Latinx population compared with other counties were located in urban areas (114 of 198 [57.6%]), and 130 (65.7%) of these counties had a high percentage of people who lacked health insurance. Most concentrated longitudinal-impact counties with a large non-Hispanic White population compared with other counties were in rural areas (23 of 33 [69.7%]), included a large group of older adults (26 of 33 [78.8%]), and had limited access to quality health care (24 of 33 [72.7%]). In urban areas, the mixed immigrant cohesion and accessibility index was inversely associated with COVID-19 mortality (coefficient [SE], -23.38 [6.06]; P < .001), indicating that mortality rates in urban areas were associated with immigrant communities with traditional family structures, multiple accessibility stressors, and housing overcrowding. Higher COVID-19 mortality rates were also associated with preventable hospital stays in rural areas (coefficient [SE], 0.008 [0.002]; P < .001) and higher socioeconomic status vulnerability in suburban areas (coefficient [SE], -21.60 [3.55]; P < .001). Across all community types, places with limited internet access had higher mortality rates, especially in urban areas (coefficient [SE], 5.83 [0.81]; P < .001). CONCLUSIONS AND RELEVANCE This cross-sectional study found an association between different SDOH measures and COVID-19 mortality that varied across racial and ethnic groups and community types. Future research is needed that explores the different dimensions and regional patterns of SDOH to address health inequity and guide policies and programs.
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Affiliation(s)
- Qinyun Lin
- Center for Spatial Data Science, The University of Chicago, Chicago
| | - Susan Paykin
- Center for Spatial Data Science, The University of Chicago, Chicago
| | - Dylan Halpern
- Center for Spatial Data Science, The University of Chicago, Chicago
| | | | - Marynia Kolak
- Center for Spatial Data Science, The University of Chicago, Chicago
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Cancer Care at the Beginning of the COVID-19 Pandemic: Effects on Patients and Early Interventions to Mitigate Stresses on Care. Cancer J 2022; 28:107-110. [PMID: 35333494 PMCID: PMC9158728 DOI: 10.1097/ppo.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A multidisciplinary panel of experts convened to review the early effects of the COVID-19 pandemic on cancer care in the United States as part of a symposium convened by the National Cancer Policy Forum in July 2021.
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83
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Winship JM, Gendron T, Waters L, Chung J, Battle K, Cisewski M, Gregory M, Sargent L, Zanjani F, Slattum P, Mackiewicz M, Diallo A, Ford G, Falls K, Price ET, Parsons PL. COVID in Context: The Lived Experience of Richmond’s Low-Income Older Adults. Gerontol Geriatr Med 2022; 8:23337214221079208. [PMID: 35252474 PMCID: PMC8891881 DOI: 10.1177/23337214221079208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/15/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Taking a phenomenological approach, this qualitative study describes the lived experiences of low-income older adults during the COVID-19 pandemic. A socio-ecological model was used to organize the five identified themes describing the lived experience: socio-economic context, Black Lives Matter and the politics of race, COVID and polarized views of COVID, interpersonal context (social connections), and individual context (feelings, beliefs, and behaviors). Study findings illustrate the intersectionality of contextual influences on the experience of low-income older adults. Study participants demonstrated remarkable resilience and coping strategies developed in response to the challenges they experienced throughout their lifetime which benefited them when faced with the pandemic, social unrest, and political events that took place in 2020. This study highlights the importance of understanding the larger context of COVID-19 which has significant implications for policy makers and public health leaders.
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Affiliation(s)
- Jodi M. Winship
- Department of Occupational Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Tracey Gendron
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Leland Waters
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Kimberly Battle
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Melissa Cisewski
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Melody Gregory
- Department of Occupational Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Faika Zanjani
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Patrica Slattum
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Marissa Mackiewicz
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Ana Diallo
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Katherine Falls
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Elvin T. Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Pamela L. Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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84
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Landman JM, Steger-May K, Joynt Maddox KE, Hammond G, Gupta A, Rauseo AM, Zhao M, Foraker RE. Estimating the effects of race and social vulnerability on hospital admission and mortality from COVID-19. JAMIA Open 2022; 4:ooab111. [PMID: 35146378 PMCID: PMC8822405 DOI: 10.1093/jamiaopen/ooab111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022] Open
Abstract
Objective To estimate the risk of hospital admission and mortality from COVID-19 to patients and measure the association of race and area-level social vulnerability with those outcomes. Materials and Methods Using patient records collected at a multisite hospital system from April 2020 to October 2020, the risk of hospital admission and the risk of mortality were estimated for patients who tested positive for COVID-19 and were admitted to the hospital for COVID-19, respectively, using generalized estimating equations while controlling for patient race, patient area-level social vulnerability, and time course of the pandemic. Results Black individuals were 3.57 as likely (95% CI, 3.18–4.00) to be hospitalized than White people, and patients living in the most disadvantaged areas were 2.61 times as likely (95% CI, 2.26–3.02) to be hospitalized than those living in the least disadvantaged areas. While Black patients had lower raw mortality than White patients, mortality was similar after controlling for comorbidities and social vulnerability. Discussion Our findings point to potent correlates of race and socioeconomic status, including resource distribution, employment, and shared living spaces, that may be associated with inequitable burden of disease across patients of different races. Conclusions Public health and policy interventions should address these social factors when responding to the next pandemic. Using records from a hospital system spanning multiple sites and 2 states, we examined patients’ risk of hospital admission and death due to COVID-19 over the first 6 months of the pandemic. Specifically, we measured the association of race and social vulnerability with the likelihood of admission and death. Our statistical models showed that Black patients were 3.57 times more likely than White patients to be hospitalized. We also took into account how socially vulnerable a given US Census tract is, and when incorporating that into our models, we estimated that patients living in the most disadvantaged areas were 2.61 times as likely to be hospitalized as those living in the least disadvantaged areas. We found no difference in mortality by race when controlling for underlying conditions and social vulnerability. These findings suggest that public health and policy interventions should address such things as resource distribution, employment, and shared living spaces, and other social factors that may be associated with race, socioeconomic status, and the inequitable burden of disease across patients of different races.
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Affiliation(s)
- Joshua M Landman
- Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Division of Computational and Data Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Gmerice Hammond
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Aditi Gupta
- Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Adriana M Rauseo
- Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Min Zhao
- Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Randi E Foraker
- Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.,Division of General Medical Sciences, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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85
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Beltran RM, Holloway IW, Hong C, Miyashita A, Cordero L, Wu E, Burris K, Frew PM. Social Determinants of Disease: HIV and COVID-19 Experiences. Curr HIV/AIDS Rep 2022; 19:101-112. [PMID: 35107810 PMCID: PMC8808274 DOI: 10.1007/s11904-021-00595-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The differential impact of the COVID-19 and HIV pandemics on marginalized communities has renewed calls for more robust and deeper investigation into structural and social causes of health inequities contributing to these infections, including underlying factors related to systematic racism. Using the Social Determinants of Health (SDOH) framework, we analyzed parallel and divergent factors associated with COVID-19 and HIV/AIDS and the prevalence of disparate disease in diverse communities. We utilized PRISMA guidelines to identify relevant literature (N = 210 articles) that resulted in a review of 125 articles included in our synthesis. RECENT FINDINGS With racial health inequities as a core contributor to disease vulnerability, we also identified other factors such as economic stability, social and community support, the neighborhood and built environment, healthcare access and quality, and education access and quality as important socioecological considerations toward achieving health equity. Our review identifies structural and systematic factors that drive HIV and COVID-19 transmission. Our review highlights the importance of not solely focusing on biomedical interventions as solutions to ending HIV and COVID-19, but rather call for building a more just public health and social service safety net that meets the needs of people at the intersection of multiple vulnerabilities.
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Affiliation(s)
- Raiza M Beltran
- David Geffen School of Medicine, Department of Infectious Diseases, UCLA Global HIV Prevention Research Program, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA.
| | - Ian W Holloway
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Chenglin Hong
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Ayako Miyashita
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
| | - Luisita Cordero
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
| | - Elizabeth Wu
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Katherine Burris
- UNLV School of Public Health, UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Paula M Frew
- UNLV School of Public Health, UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
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86
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Li B, Quinn RJ, Meghani S, Chittams JL, Rajput V. Segregation Predicts COVID-19 Fatalities in Less Densely Populated Counties. Cureus 2022; 14:e21319. [PMID: 35186578 PMCID: PMC8848635 DOI: 10.7759/cureus.21319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/16/2022] [Indexed: 11/28/2022] Open
Abstract
Aim It is well known that social determinants of health (SDoH) have affected COVID-19 outcomes, but these determinants are broad and complex. Identifying essential determinants is a prerequisite to address widening health disparities during the evolving COVID-19 pandemic. Methods County-specific COVID-19 fatality data from California, Illinois, and New York, three US states with the highest county-cevel COVID-19 fatalities as of June 15, 2020, were analyzed. Twenty-three county-level SDoH, collected from County Health Rankings & Roadmaps (CHRR), were considered. A median split on the population-adjusted COVID-19 fatality rate created an indicator for high or low fatality. The decision tree method, which employs machine learning techniques, analyzed and visualized associations between SDoH and high COVID-19 fatality rate at the county level. Results Of the 23 county-level SDoH considered, population density, residential segregation (between white and non-white populations), and preventable hospitalization rates were key predictors of COVID-19 fatalities. Segregation was an important predictor of COVID-19 fatalities in counties of low population density. The model area under the curve (AUC) was 0.79, with a sensitivity of 74% and specificity of 76%. Conclusion Our findings, using a novel analytical lens, suggest that COVID-19 fatality is high in areas of high population density. While population density correlates to COVID-19 fatality, our study also finds that segregation predicts COVID-19 fatality in less densely populated counties. These findings have implications for COVID-19 resource planning and require appropriate attention.
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87
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Wong GJ, Douglas K, Fuest S, McDonnell PJ, Forget N. COVID-19 Home Monitoring: An Institutional Approach to Bridging Care During a Pandemic. Telemed J E Health 2022; 28:1044-1049. [PMID: 35012381 DOI: 10.1089/tmj.2021.0317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) has widened patient care gaps and created gaps in medical student clinical training. The care gaps are often most obvious in primary care medicine clinics (PCMCs) where residents and medical students care for a vulnerable population. Materials and Methods: We designed an outpatient telehealth program to support and monitor PCMC patients who had been diagnosed or were suspected to have COVID-19 and were confined to their homes due to public health mandated isolation. To support the program, we recruited medical student volunteers. We recruited patients from our institution's primary care clinic who were recently diagnosed with COVID-19 and were currently not hospitalized. Feasibility of the home monitoring program (HMP) was assessed and mortality data for all patients were collected. Results: Over 800 monitoring phone calls were placed during the 8-month study period to 296 patients, with an average of 2.79 calls per patient. A total of 30 medical students participated. A total of four patients died during the study period. Conclusions: Our institution was able to rapidly design and implement a COVID-19 HMP integrated with our primary care clinic to ensure continued access to care during a pandemic.
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Affiliation(s)
- Gregory J Wong
- Division of General Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine Douglas
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Fuest
- Division of General Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter J McDonnell
- Division of General Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nickole Forget
- Division of General Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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88
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Geana MV, Rabb N, Sloman S. Walking the party line: The growing role of political ideology in shaping health behavior in the United States. SSM Popul Health 2021; 16:100950. [PMID: 34761098 PMCID: PMC8566901 DOI: 10.1016/j.ssmph.2021.100950] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the extent to which political ideology affects COVID-19 preventive behaviors and related beliefs and attitudes in the U.S. METHODS Two surveys, one using a convenience sample and another using a nationally representative sample, were conducted in September and November 2020, respectively. Multiple regressions compared political ideology with identified COVID-19 risk factors and demographics as well as knowledge measures. Surveys were followed by a review of the emerging COVID-19 behavioral literature (completed in January 2021) to assess the frequency of ideological effects in publicly reported data. RESULTS In the survey data, political ideology was a significant predictor for all dependent variables in both surveys, and the strongest predictor for most of them. Out of 141 estimates from 44 selected studies, political ideology was a significant predictor of responses in 112 (79%) and showed the largest effect on COVID-19-related measures in close to half of these estimates (44%). CONCLUSIONS This study reinforces previous research that found partisan differences in engaging in behaviors with long-term health consequences by showing that these ideologically-driven differences manifest in situations where the possibility of severe illness or death is immediate and the potential societal impact is significant. The substantial implications for public health research and practice are both methodological and conceptual.
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Affiliation(s)
- Mugur V. Geana
- Center for Excellence in Health Communication to Underserved Populations (CEHCUP), William Allen White School of Journalism and Mass Communications, University of Kansas, USA
| | | | - Steven Sloman
- Cognitive, Linguistic & Psychological Sciences, Brown University, USA
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89
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Khallouq BAB, S Schellhammer S. Expanding Medical Findings to Include an Explanation of Social Determinants of Health. Respir Care 2021; 66:1924-1926. [PMID: 34789518 PMCID: PMC9993789 DOI: 10.4187/respcare.09711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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90
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Ingraham NE, Purcell LN, Karam BS, Dudley RA, Usher MG, Warlick CA, Allen ML, Melton GB, Charles A, Tignanelli CJ. Racial and Ethnic Disparities in Hospital Admissions from COVID-19: Determining the Impact of Neighborhood Deprivation and Primary Language. J Gen Intern Med 2021; 36:3462-3470. [PMID: 34003427 PMCID: PMC8130213 DOI: 10.1007/s11606-021-06790-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/01/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite past and ongoing efforts to achieve health equity in the USA, racial and ethnic disparities persist and appear to be exacerbated by COVID-19. OBJECTIVE Evaluate neighborhood-level deprivation and English language proficiency effect on disproportionate outcomes seen in racial and ethnic minorities diagnosed with COVID-19. DESIGN Retrospective cohort study SETTING: Health records of 12 Midwest hospitals and 60 clinics in Minnesota between March 4, 2020, and August 19, 2020 PATIENTS: Polymerase chain reaction-positive COVID-19 patients EXPOSURES: Area Deprivation Index (ADI) and primary language MAIN MEASURES: The primary outcome was COVID-19 severity, using hospitalization within 45 days of diagnosis as a marker of severity. Logistic and competing-risk regression models assessed the effects of neighborhood-level deprivation (using the ADI) and primary language. Within race, effects of ADI and primary language were measured using logistic regression. RESULTS A total of 5577 individuals infected with SARS-CoV-2 were included; 866 (n = 15.5%) were hospitalized within 45 days of diagnosis. Hospitalized patients were older (60.9 vs. 40.4 years, p < 0.001) and more likely to be male (n = 425 [49.1%] vs. 2049 [43.5%], p = 0.002). Of those requiring hospitalization, 43.9% (n = 381), 19.9% (n = 172), 18.6% (n = 161), and 11.8% (n = 102) were White, Black, Asian, and Hispanic, respectively. Independent of ADI, minority race/ethnicity was associated with COVID-19 severity: Hispanic patients (OR 3.8, 95% CI 2.72-5.30), Asians (OR 2.39, 95% CI 1.74-3.29), and Blacks (OR 1.50, 95% CI 1.15-1.94). ADI was not associated with hospitalization. Non-English-speaking (OR 1.91, 95% CI 1.51-2.43) significantly increased odds of hospital admission across and within minority groups. CONCLUSIONS Minority populations have increased odds of severe COVID-19 independent of neighborhood deprivation, a commonly suspected driver of disparate outcomes. Non-English-speaking accounts for differences across and within minority populations. These results support the ongoing need to determine the mechanisms that contribute to disparities during COVID-19 while also highlighting the underappreciated role primary language plays in COVID-19 severity among minority groups.
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Affiliation(s)
- Nicholas E. Ingraham
- Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN USA
| | - Laura N. Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, NC USA
| | - Basil S. Karam
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI USA
| | - R. Adams Dudley
- Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN USA
| | - Michael G. Usher
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN USA
| | | | - Michele L. Allen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN USA
| | - Genevieve B. Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, University of Minnesota, Minneapolis, MN USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, NC USA
- School of Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Christopher J. Tignanelli
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, North Memorial Health Hospital, Robbinsdale, MN USA
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91
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Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave. PLoS One 2021; 16:e0258308. [PMID: 34648525 PMCID: PMC8516194 DOI: 10.1371/journal.pone.0258308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/23/2021] [Indexed: 01/04/2023] Open
Abstract
The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.
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92
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Counties with Lower Insurance Coverage and Housing Problems Are Associated with Both Slower Vaccine Rollout and Higher COVID-19 Incidence. Vaccines (Basel) 2021; 9:vaccines9090973. [PMID: 34579210 PMCID: PMC8473044 DOI: 10.3390/vaccines9090973] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 01/07/2023] Open
Abstract
Equitable vaccination distribution is a priority for outcompeting the transmission of COVID-19. Here, the impact of demographic, socioeconomic, and environmental factors on county-level vaccination rates and COVID-19 incidence changes is assessed. In particular, using data from 3142 US counties with over 328 million individuals, correlations were computed between cumulative vaccination rate and change in COVID-19 incidence from 1 December 2020 to 6 June 2021, with 44 different demographic, environmental, and socioeconomic factors. This correlation analysis was also performed using multivariate linear regression to adjust for age as a potential confounding variable. These correlation analyses demonstrated that counties with high levels of uninsured individuals have significantly lower COVID-19 vaccination rates (Spearman correlation: −0.460, p-value: <0.001). In addition, severe housing problems and high housing costs were strongly correlated with increased COVID-19 incidence (Spearman correlations: 0.335, 0.314, p-values: <0.001, <0.001). This study shows that socioeconomic factors are strongly correlated to both COVID-19 vaccination rates and incidence rates, underscoring the need to improve COVID-19 vaccination campaigns in marginalized communities.
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93
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Hatipoğlu U. COVID-19 Outcomes in Underserved Populations: Reaping What One Sows. Respir Care 2021; 66:1041-1043. [PMID: 34039763 DOI: 10.4187/respcare.09135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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94
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Caron RM, Adegboye ARA. COVID-19: A Syndemic Requiring an Integrated Approach for Marginalized Populations. Front Public Health 2021; 9:675280. [PMID: 34046392 PMCID: PMC8144466 DOI: 10.3389/fpubh.2021.675280] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
The novel coronavirus, SARS-CoV-2, responsible for the COVID-19 pandemic, has challenged healthcare systems globally. The health inequities experienced by immigrants, refugees, and racial/ethnic minorities have been aggravated during the COVID-19 pandemic. The socioeconomic, political, and demographic profile of these vulnerable populations places them at increased risk of contracting COVID-19 and experiencing significant morbidity and mortality. Thus, the burden of the COVID-19 pandemic is disproportionally higher among these at-risk groups. The purpose of this perspective is to: (1) highlight the interactions among the social determinants of health (SDoH) and their bi-directional relationship with the COVID-19 pandemic which results in the current syndemic and; (2) offer recommendations that consider an integrated approach to mitigate COVID-19 risk for marginalized populations in general. For these at-risk populations, we discuss how individual, structural, sociocultural, and socioeconomic factors interact with each other to result in a disparate risk to contracting and transmitting COVID-19. Marginalized populations are the world's collective responsibility. We recommend implementing the Essential Public Health Services (EPHS) framework to promote those systems and policies that enable optimal health for all while removing systemic and structural barriers that have created health inequities. The pledge of “Health for All” is often well-accepted in theory, but the intricacy of its practical execution is not sufficiently recognized during this COVID-19 syndemic and beyond.
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Affiliation(s)
- Rosemary M Caron
- Department of Health Management and Policy, Master of Public Health Program, College of Health and Human Services, University of New Hampshire, Durham, NH, United States
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95
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Mitton JA, Urquieta de Hernandez B, Pasupuleti N, Hurley K, John R, Cole A. Disruptive Resilience: Harnessing Leadership to Build a More Equitable Health Care System After COVID-19. Popul Health Manag 2021; 24:646-647. [PMID: 33784488 DOI: 10.1089/pop.2021.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julian A Mitton
- Population Health, CommonSpirit Health, San Francisco, California, USA
| | | | - Nisha Pasupuleti
- Population Health, CommonSpirit Health, San Francisco, California, USA
| | - Kimm Hurley
- Population Health, CommonSpirit Health, San Francisco, California, USA
| | - Reena John
- Population Health, CommonSpirit Health, San Francisco, California, USA
| | - Alisahah Cole
- Population Health, CommonSpirit Health, San Francisco, California, USA
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96
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Guo AA, Crum MA, Fowler LA. Assessing the Psychological Impacts of COVID-19 in Undergraduate Medical Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2952. [PMID: 33805787 PMCID: PMC8001627 DOI: 10.3390/ijerph18062952] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022]
Abstract
Medical education has been uniquely affected by the Novel Coronavirus Disease 2019 (COVID-19). As the pandemic's psychological impacts on medical students remain unclear, this study assessed COVID-19's impacts on undergraduate medical students' stress and anxiety. A nationwide, online survey was administered via email chains between June-August 2020 to first-fourth year medical students in the United States. Demographics, 4-point Perceived Stress Scale that measures stress, 7-point Generalized Anxiety Disorder Scale that measures anxiety, and the impacts of social, health, and academic stressors due to COVID-19 were collected. Of the 852 students who participated, 66.1% experienced mild, moderate, or severe anxiety. Mean PSS-4 score was 7.25/16. Stress was highest in second- through fourth-year students. Students with preexisting mental health conditions had significantly higher stress and anxiety scores, and higher percentage of stress attributed to COVID-19. Trust in government institutions during COVID-19 was the highest stressor in first- and second-year students. Delay/availability of standardized exams was the highest stressor for third-year students. Impact on rotations/residencies was the highest stressor for fourth-year students. Understanding how students' anxiety and stress have changed due to COVID-19 will allow educators to identify students in need and guide recommendations on the implementation of psychological interventions and support strategies.
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Affiliation(s)
| | | | - Lauren A. Fowler
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (A.A.G.); (M.A.C.)
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97
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Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062921. [PMID: 33809240 PMCID: PMC8000338 DOI: 10.3390/ijerph18062921] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 12/17/2022]
Abstract
The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.
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98
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Jaworski BK, Taylor K, Ramsey KM, Heinz A, Steinmetz S, Pagano I, Moraja G, Owen JE. Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data. J Med Internet Res 2021; 23:e26559. [PMID: 33606656 PMCID: PMC7924218 DOI: 10.2196/26559] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
Background The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19–related stress. Objective The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement.
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Affiliation(s)
- Beth K Jaworski
- National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Katherine Taylor
- National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Kelly M Ramsey
- National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Adrienne Heinz
- National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States.,School of Medicine, Stanford University, Stanford, CA, United States
| | - Sarah Steinmetz
- National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | | | - Jason E Owen
- National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
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99
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Millar JA, Dao HDN, Stefopulos ME, Estevam CG, Fagan-Garcia K, Taft DH, Park C, Alruwaily A, Desai AN, Majumder MS. Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.02.24.21252135. [PMID: 33655256 PMCID: PMC7924276 DOI: 10.1101/2021.02.24.21252135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.
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Affiliation(s)
- Jess A. Millar
- University of Michigan - Department of Epidemiology, Department of Computational Medicine and Bioinformatics (Ann Arbor, MI, United States)
| | - Hanh Dung N. Dao
- University of Oklahoma Health Sciences Center - Department of Biostatistics and Epidemiology (Oklahoma City, OK, United States)
| | | | - Camila G. Estevam
- State University of Campinas - Department of Public Health (Campinas, SP, Brazil)
| | | | - Diana H. Taft
- University of California Davis - Department of Food Science and Technology (Davis, CA, United States)
| | - Christopher Park
- New York University - College of Global Public Health (New York, NY, United States)
| | - Amaal Alruwaily
- Saudi Center for Disease Prevention and Control - Department of Non-Communicable Disease (Riyadh, Saudi Arabia)
| | - Angel N. Desai
- Department of Internal Medicine, Division of Infectious Disease, University of California Davis Medical Center (Sacramento, CA, United States)
| | - Maimuna S. Majumder
- Harvard Medical School and Boston Children’s Hospital (Boston, MA, United States)
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