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Fuentes-Mayorga N, Cuecuecha Mendoza A. The Most Vulnerable Hispanic Immigrants in New York City: Structural Racism and Gendered Differences in COVID-19 Deaths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105838. [PMID: 37239564 DOI: 10.3390/ijerph20105838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
This paper explores the structural and group-specific factors explaining the excess death rates experienced by the Hispanic population in New York City during the peak years of the coronavirus pandemic. Neighborhood-level analysis of Census data allows an exploration of the relation between Hispanic COVID-19 deaths and spatial concentration, conceived in this study as a proxy for structural racism. This analysis also provides a more detailed exploration of the role of gender in understanding the effects of spatial segregation among different Hispanic subgroups, as gender has emerged as a significant variable in explaining the structural and social effects of COVID-19. Our results show a positive correlation between COVID-19 death rates and the share of Hispanic neighborhood residents. However, for men, this correlation cannot be explained by the characteristics of the neighborhood, as it is for women. In sum, we find: (a) differences in mortality risks between Hispanic men and women; (b) that weathering effects increase mortality risks the longer Hispanic immigrant groups reside in the U.S.; (c) that Hispanic males experience greater contagion and mortality risks associated with the workplace; and (d) we find evidence corroborating the importance of access to health insurance and citizenship status in reducing mortality risks. The findings propose revisiting the Hispanic health paradox with the use of structural racism and gendered frameworks.
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Affiliation(s)
- Norma Fuentes-Mayorga
- The Colin Powell School for Civic and Global Leadership, The City College New York (CCNY), New York, NY 10031, USA
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52
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Bledsoe J, Woller SC, Brooks M, Sciurba FC, Krishnan JA, Martin D, Hou P, Lin JY, Kindzelski A, Handberg E, Kirwan BA, Zaharris E, Castro L, Shapiro NL, Pepine CJ, Majercik S, Fu Z, Zhong Y, Venugopal V, Lai YH, Ridker PM, Connors JM. Clinically stable covid-19 patients presenting to acute unscheduled episodic care venues have increased risk of hospitalization: secondary analysis of a randomized control trial. BMC Infect Dis 2023; 23:325. [PMID: 37189091 PMCID: PMC10184108 DOI: 10.1186/s12879-023-08295-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/30/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Assessment for risks associated with acute stable COVID-19 is important to optimize clinical trial enrollment and target patients for scarce therapeutics. To assess whether healthcare system engagement location is an independent predictor of outcomes we performed a secondary analysis of the ACTIV-4B Outpatient Thrombosis Prevention trial. METHODS A secondary analysis of the ACTIV-4B trial that was conducted at 52 US sites between September 2020 and August 2021. Participants were enrolled through acute unscheduled episodic care (AUEC) enrollment location (emergency department, or urgent care clinic visit) compared to minimal contact (MC) enrollment (electronic contact from test center lists of positive patients).We report the primary composite outcome of cardiopulmonary hospitalizations, symptomatic venous thromboembolism, myocardial infarction, stroke, transient ischemic attack, systemic arterial thromboembolism, or death among stable outpatients stratified by enrollment setting, AUEC versus MC. A propensity score for AUEC enrollment was created, and Cox proportional hazards regression with inverse probability weighting (IPW) was used to compare the primary outcome by enrollment location. RESULTS Among the 657 ACTIV-4B patients randomized, 533 (81.1%) with known enrollment setting data were included in this analysis, 227 from AUEC settings and 306 from MC settings. In a multivariate logistic regression model, time from COVID test, age, Black race, Hispanic ethnicity, and body mass index were associated with AUEC enrollment. Irrespective of trial treatment allocation, patients enrolled at an AUEC setting were 10-times more likely to suffer from the adjudicated primary outcome, 7.9% vs. 0.7%; p < 0.001, compared with patients enrolled at a MC setting. Upon Cox regression analysis adjustment patients enrolled at an AUEC setting remained at significant risk of the primary composite outcome, HR 3.40 (95% CI 1.46, 7.94). CONCLUSIONS Patients with clinically stable COVID-19 presenting to an AUEC enrollment setting represent a population at increased risk of arterial and venous thrombosis complications, hospitalization for cardiopulmonary events, or death, when adjusted for other risk factors, compared with patients enrolled at a MC setting. Future outpatient therapeutic trials and clinical therapeutic delivery programs of clinically stable COVID-19 patients may focus on inclusion of higher-risk patient populations from AUEC engagement locations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04498273.
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Affiliation(s)
- Joseph Bledsoe
- Intermountain Healthcare, Emergency Medicine and Trauma, Salt Lake City, UT, USA.
- Intermountain Medical Center, Department of Medicine, 5121 S. Cottonwood Drive, Murray, UT, 84157, USA.
| | - Scott C Woller
- Intermountain Medical Center, Department of Medicine, 5121 S. Cottonwood Drive, Murray, UT, 84157, USA
| | - Maria Brooks
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, IL, USA
| | - Deborah Martin
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter Hou
- Brigham and Women's Hospital, Boston, MA, USA
| | - Janet Y Lin
- Department of Emergency Medicine, University of Illinois, Chicago, IL, USA
| | | | - Eileen Handberg
- School of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - Lauren Castro
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, IL, USA
| | - Nancy L Shapiro
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Carl J Pepine
- School of Medicine, University of Florida, Gainesville, FL, USA
| | - Sarah Majercik
- Intermountain Healthcare, Emergency Medicine and Trauma, Salt Lake City, UT, USA
| | - Zhuxuan Fu
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yongqi Zhong
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vidya Venugopal
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yu-Hsuan Lai
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Roubenoff E, Feehan D, Mahmud AS. Evaluating primary and booster vaccination prioritization strategies for COVID-19 by age and high-contact employment status using data from contact surveys. Epidemics 2023; 43:100686. [PMID: 37167836 PMCID: PMC10155422 DOI: 10.1016/j.epidem.2023.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/08/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
The debate around vaccine prioritization for COVID-19 has revolved around balancing the benefits from: (1) the direct protection conferred by the vaccine amongst those at highest risk of severe disease outcomes, and (2) the indirect protection through vaccinating those that are at highest risk of being infected and of transmitting the virus. While adults aged 65+ are at highest risk for severe disease and death from COVID-19, essential service and other in-person workers with greater rates of contact may be at higher risk of acquiring and transmitting SARS-CoV-2. Unfortunately, there have been relatively little data available to understand heterogeneity in contact rates and risk across these demographic groups. Here, we retrospectively analyze and evaluate vaccination prioritization strategies by age and worker status. We use a mathematical model of SARS-CoV-2 transmission and uniquely detailed contact data collected as part of the Berkeley Interpersonal Contact Survey to evaluate five vaccination prioritization strategies: (1) prioritizing only adults over age 65, (2) prioritizing only high-contact workers, (3) splitting prioritization between adults 65+ and high-contact workers, (4) tiered prioritization of adults over age 65 followed by high-contact workers, and (5) tiered prioritization of high-contact workers followed by adults 65+. We find that for the primary two-dose vaccination schedule, assuming 70% uptake, a tiered roll-out that first prioritizes adults 65+ averts the most deaths (31% fewer deaths compared to a no-vaccination scenario) while a tiered roll-out that prioritizes high contact workers averts the most number of clinical infections (14% fewer clinical infections compared to a no-vaccination scenario). We also consider prioritization strategies for booster doses during a subsequent outbreak of a hypothetical new SARS-CoV-2 variant. We find that a tiered roll-out that prioritizes adults 65+ for booster doses consistently averts the most deaths, and it may also avert the most number of clinical cases depending on the epidemiology of the SARS-CoV-2 variant and the vaccine efficacy.
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Affiliation(s)
- Ethan Roubenoff
- Department of Demography, University of California, Berkeley, United States of America.
| | - Dennis Feehan
- Department of Demography, University of California, Berkeley, United States of America
| | - Ayesha S Mahmud
- Department of Demography, University of California, Berkeley, United States of America
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Lundberg DJ, Wrigley-Field E, Cho A, Raquib R, Nsoesie EO, Paglino E, Chen R, Kiang MV, Riley AR, Chen YH, Charpignon ML, Hempstead K, Preston SH, Elo IT, Glymour MM, Stokes AC. COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022. JAMA Netw Open 2023; 6:e2311098. [PMID: 37129894 PMCID: PMC10155069 DOI: 10.1001/jamanetworkopen.2023.11098] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
Importance Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. Objective To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography. Design, Setting, and Participants This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Exposures Metropolitan vs nonmetropolitan areas and race and ethnicity. Main Outcomes and Measures Age-standardized death rates. Results There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. Conclusions and Relevance This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.
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Affiliation(s)
- Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Elizabeth Wrigley-Field
- Department of Sociology, University of Minnesota, Minneapolis
- Minnesota Population Center, University of Minnesota, Minneapolis
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University, Boston, Massachusetts
- Department of Political Science, Boston University, Boston, Massachusetts
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Center for Antiracist Research, Boston University, Boston, Massachusetts
| | - Eugenio Paglino
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Marie-Laure Charpignon
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge
| | | | - Samuel H. Preston
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Irma T. Elo
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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Sosin AN, Choo E, Lincoln M. The covid public health emergency is ending: it now joins the ordinary emergency that is American health. BMJ 2023; 381:949. [PMID: 37185817 DOI: 10.1136/bmj.p949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Anne N Sosin
- Nelson A. Rockefeller Center for Public Policy and the Social Sciences,Dartmouth College
| | - Esther Choo
- Center for Policy & Research in Emergency Care, Department of Emergency Medicine, Oregon Health & Science University, Oregon Health & Science University
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Roberts MT, Lim S, Reither EN. Declining life expectancy in the Great Lakes region: contributors to Black and white longevity change across educational attainment. BMC Public Health 2023; 23:769. [PMID: 37098511 PMCID: PMC10130305 DOI: 10.1186/s12889-023-15668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The East North Central Census division (aka the Great Lakes region) experienced a decrease in life expectancy of 0.3 years from 2014 to 2016 - one of the largest declines across the nine Census divisions. Disadvantaged groups that typically have below-average life expectancy, including Black individuals and those without a college education, may have been disproportionately affected by this longevity shift. This investigation examines life expectancy changes among different sex, race, and education groups in the Great Lakes region, and how specific causes of death contributed to within-group longevity changes over time and across age. METHODS We used 2008 to 2017 death counts from the National Center for Health Statistics and American Community Survey population estimates to measure within-group change in life expectancy at age 25 among non-Hispanic Black and white males and females by educational attainment. We decomposed life expectancy change over time for each subgroup by 24 causes of death and measured their contribution to longevity change across 13 age groups. RESULTS Among persons with ≤ 12 years of education, white males and females experienced 1.3- and 1.7-year longevity declines respectively, compared to a 0.6-year decline among Black males and a 0.3-year decline among Black females. Life expectancy declined among all groups with 13-15 years of education, but especially Black females, who experienced a 2.2-year loss. With the exception of Black males, all groups with 16 + years of education experienced longevity gains. Homicide contributed 0.34 years to longevity decline among Black males with ≤ 12 years of education. Drug poisoning made large contributions to longevity losses among Black females with ≤ 12 years of education (0.31 years), white males and females with 13-15 years of education (0.35 and 0.21 years, respectively), and white males and females with ≤ 12 years of education (0.92 and 0.65 years, respectively). CONCLUSIONS Public health efforts to reduce the risks of homicide among Black males without a college education and drug poisoning among all groups could improve life expectancy and reduce racial and educational longevity disparities in the Great Lakes region.
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Affiliation(s)
| | - Sojung Lim
- Utah State University, 0730 Old Main Hill, Logan, UT, 84322, USA
| | - Eric N Reither
- Utah State University, 0730 Old Main Hill, Logan, UT, 84322, USA
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57
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Puig X, Ginebra J. Mapping life expectancy loss in Barcelona in 2020. AM STAT 2023. [DOI: 10.1080/00031305.2023.2197022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Xavier Puig
- Departament of Statistics and O.R., Polytechnic University of Catalonia, Avgda. Diagonal 647, 6a Planta, 08028 Barcelona, Spain
| | - Josep Ginebra
- Departament of Statistics and O.R., Polytechnic University of Catalonia, Avgda. Diagonal 647, 6a Planta, 08028 Barcelona, Spain
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Farrelly C. Imagination and idealism in the medical sciences of an ageing world. JOURNAL OF MEDICAL ETHICS 2023; 49:271-274. [PMID: 35450970 DOI: 10.1136/medethics-2022-108129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Imagination and idealism are particularly important creative epistemic virtues for the medical sciences if we hope to improve the health of the world's ageing population. To date, imagination and idealism within the medical sciences have been dominated by a paradigm of disease control, a paradigm which has realised significant, but also limited, success. Disease control proved particularly successful in mitigating the early-life mortality risks from infectious diseases, but it has proved less successful when applied to the chronic diseases of late life (like cancer). The time is ripe for the emergence and prominence of a supplementary medical research paradigm, the paradigm of 'healthy ageing' which prioritises the goal of rate (of ageing) control rather than disease control. This is the difference between extending the human healthspan versus extending survival by managing (or trying to eliminate) the multi-morbidities, frailty and disability currently prevalent in late life. The idealism of the disease control paradigm is myopic because it ignores the health constraints imposed by the inborn ageing process itself, a biological reality which is already inflicting significant economic and disease burdens on the world's ageing populations. Unless the medical sciences retard the rate of biological ageing, these problems will continue to be amplified as larger numbers of persons survive into late life.
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Affiliation(s)
- Colin Farrelly
- Political Studies, Queen's University, Kingston, Ontario, Canada
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Espinosa A. A Psychometric and Relative Importance Evaluation of Health Literacy and Health Consciousness on COVID-19 Preventive Behaviors Among Hispanic Adults. HEALTH EDUCATION & BEHAVIOR 2023; 50:161-171. [PMID: 36703489 PMCID: PMC9892813 DOI: 10.1177/10901981221148960] [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] [Indexed: 01/28/2023]
Abstract
Given the COVID-19 pandemic's disproportionate impact on Hispanic individuals in the United States, research examining modifiable psychosocial correlates of COVID-19 preventive behaviors in this population is warranted. Prior research highlights health literacy and health consciousness as integral for the establishment of health-promoting behaviors. Notwithstanding, very little research has validated theory-based measures for health literacy and health consciousness and no research has investigated their relative importance in explaining behaviors that prevent COVID-19 illness among Hispanic individuals. This information is necessary for informing behavioral interventions seeking to promote the well-being of Hispanic people during the current pandemic and in future ones. This study provides a psychometric evaluation of the General Health Literacy Scale (GHLS) and the Health Consciousness Scale (HCS) and further examines their association with conventional COVID-19 preventive behaviors. Confirmatory factor analyses evaluated the psychometric properties of GHLS and HCS. Four separate hierarchical linear regressions, followed by dominance analyses, estimated the relative importance of health literacy and health consciousness on COVID-19 preventive behaviors, adjusting for sociodemographic characteristics. Both GHLS and HCS achieved adequate psychometric criteria, and holding constant sociodemographic characteristics, positively related to COVID-19 preventive behaviors. Although both health literacy and health consciousness were more important than sociodemographic characteristics in explaining COVID-19 preventive behaviors, health consciousness was most important, exceeding the explanatory power of health literacy in all regressions. COVID-19 public health campaigns that seek to raise health awareness among Hispanic people might prove more effective than campaigns that only seek to improve their health literacy.
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Ma N, Yip R, Lewis S, Dinani A, Wyatt C, Crane M, Jirapatnakul A, Li L, Aloman C, Bansal MB, Dieterich D, Wyatt B, Yankelevitz D, Henschke C, Branch AD. Environmental exposures are important risk factors for advanced liver fibrosis in African American adults. JHEP Rep 2023; 5:100696. [PMID: 36937989 PMCID: PMC10017423 DOI: 10.1016/j.jhepr.2023.100696] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 03/21/2023] Open
Abstract
Background & Aims The prevalence and aetiology of liver fibrosis vary over time and impact racial/ethnic groups unevenly. This study measured time trends and identified factors associated with advanced liver fibrosis in the United States. Methods Standardised methods were used to analyse data on 47,422 participants (≥20 years old) in the National Health and Nutrition Examination Survey (1999-2018). Advanced liver fibrosis was defined as Fibrosis-4 ≥2.67 and/or Forns index ≥6.9 and elevated alanine aminotransferase. Results The estimated number of people with advanced liver fibrosis increased from 1.3 million (95% CI 0.8-1.9) to 3.5 million (95% CI 2.8-4.2), a nearly threefold increase. Prevalence was higher in non-Hispanic Black and Mexican American persons than in non-Hispanic White persons. In multivariable logistic regression analysis, cadmium was an independent risk factor in all racial/ethnic groups. Smoking and current excessive alcohol use were risk factors in most. Importantly, compared with non-Hispanic White persons, non-Hispanic Black persons had a distinctive set of risk factors that included poverty (odds ratio [OR] 2.09; 95% CI 1.44-3.03) and susceptibility to lead exposure (OR 3.25; 95% CI 1.95-5.43) but did not include diabetes (OR 0.88; 95% CI 0.61-1.27; p =0.52). Non-Hispanic Black persons were more likely to have high exposure to lead, cadmium, polychlorinated biphenyls, and poverty than non-Hispanic White persons. Conclusions The number of people with advanced liver fibrosis has increased, creating a need to expand the liver care workforce. The risk factors for advanced fibrosis vary by race/ethnicity. These differences provide useful information for designing screening programmes. Poverty and toxic exposures were associated with the high prevalence of advanced liver fibrosis in non-Hispanic Black persons and need to be addressed. Impact and Implications Because liver disease often produces few warning signs, simple and inexpensive screening tests that can be performed by non-specialists are needed to allow timely diagnosis and linkage to care. This study shows that non-Hispanic Black persons have a distinctive set of risk factors that need to be taken into account when designing liver disease screening programs. Exposure to exogenous toxins may be especially important risk factors for advanced liver fibrosis in non-Hispanic Black persons.
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Key Words
- ALD, alcohol-associated liver disease
- ALT, alanine aminotransferase
- APC, annual percent change
- Aetiology
- BMI, body mass index
- CI, confidence interval
- Environmental toxins
- FIB-4, Fibrosis-4
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HR, hazard ratio
- KI, kidney insufficiency
- LF, liver fibrosis
- MA, Mexican American
- NAFLD, non-alcoholic fatty liver disease
- NEI, no exposure identified
- NHANES, National Health and Nutrition Evaluation Survey
- NHB, non-Hispanic Black
- NHW, non-Hispanic White
- Non-invasive scores
- O, other race
- PCB, polychlorinated biphenyl
- Q1–Q4, quartiles 1–4
- Racial disparities
- Screening
- ULN, upper limit of normal
- USFLI, US Fatty Liver Index
- VH, viral hepatitis
- WC, waist circumference
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Affiliation(s)
- Ning Ma
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Rowena Yip
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Artit Jirapatnakul
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Li
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Costica Aloman
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Meena B. Bansal
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Brooke Wyatt
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - David Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea D. Branch
- Division of Liver Diseases, Icahn School of Medicine Mount Sinai, New York, NY, USA
- Corresponding author. Address: Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1123, New York, NY 10029, USA. Tel.: +1-212-659-8371; Fax: +1-212-849-2574.
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Flaskerud JH. Declining Life Expectancy in the U.S. Issues Ment Health Nurs 2023:1-4. [PMID: 36972546 DOI: 10.1080/01612840.2023.2186113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Differential impact of the COVID-19 pandemic on excess mortality and life expectancy loss within the Hispanic population. DEMOGRAPHIC RESEARCH 2023. [PMID: 37489132 PMCID: PMC10364128 DOI: 10.4054/demres.2023.48.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The impact of the COVID-19 pandemic on the Hispanic population resulted in the almost complete elimination of the long-standing Hispanic mortality advantage relative to the non-Hispanic White population. However, it is unknown how COVID-19 mortality affected the diverse Hispanic subpopulations. OBJECTIVE We estimate life expectancy at birth in 2019 and 2020 by select Hispanic country/region of origin and explore how changes in age-specific all-cause and COVID-19 mortality affected changes in life expectancy between 2019 and 2020 for each group. METHODS We use final 2019 and 2020 mortality data from the National Center for Health Statistics and population estimates based on the 2019 and 2020 American Community Survey. We calculate life tables and apply decomposition techniques to explore the effects of changes in age- and cause-specific mortality on life expectancy. RESULTS Patterns of age- and cause-specific excess deaths and their impact on declines in life expectancy due to the COVID-19 pandemic differed substantially by Hispanic subgroup. Life expectancy losses ranged from 0.6 to 6.7 years among males and from 0.6 to 3.6 years among females. CONCLUSIONS Our findings highlight the heterogeneous impact of the COVID-19 pandemic within the Hispanic population. CONTRIBUTIONS Our findings contribute new information that will help future researchers identify the causes of the disproportionately severe impact of the COVID-19 pandemic on the Hispanic population. Our study underscores the importance of population disaggregation in endeavors to identify the multiple pathways by which the pandemic affected the Hispanic population.
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Luck AN, Stokes AC, Hempstead K, Paglino E, Preston SH. Associations between mortality from COVID-19 and other causes: A state-level analysis. PLoS One 2023; 18:e0281683. [PMID: 36877692 PMCID: PMC9987806 DOI: 10.1371/journal.pone.0281683] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/17/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the high death toll from COVID-19 was accompanied by a rise in mortality from other causes of death. The objective of this study was to identify the relationship between mortality from COVID-19 and changes in mortality from specific causes of death by exploiting spatial variation in these relationships across US states. METHODS We use cause-specific mortality data from CDC Wonder and population estimates from the US Census Bureau to examine relationships at the state level between mortality from COVID-19 and changes in mortality from other causes of death. We calculate age-standardized death rates (ASDR) for three age groups, nine underlying causes of death, and all 50 states and the District of Columbia between the first full year of the pandemic (March 2020-February 2021) and the year prior (March 2019-February 2020). We then estimate the relationship between changes in cause-specific ASDR and COVID-19 ASDR using linear regression analysis weighted by the size of the state's population. RESULTS We estimate that causes of death other than COVID-19 represent 19.6% of the total mortality burden associated with COVID-19 during the first year of the COVID-19 pandemic. At ages 25+, circulatory disease accounted for 51.3% of this burden while dementia (16.4%), other respiratory diseases (12.4%), influenza/pneumonia (8.7%) and diabetes (8.6%) also contribute. In contrast, there was an inverse association across states between COVID-19 death rates and changes in death rates from cancer. We found no state-level association between COVID-19 mortality and rising mortality from external causes. CONCLUSIONS States with unusually high death rates from COVID-19 experienced an even larger mortality burden than implied by those rates alone. Circulatory disease served as the most important route through which COVID-19 mortality affected death rates from other causes of death. Dementia and other respiratory diseases made the second and third largest contributions. In contrast, mortality from neoplasms tended to decline in states with the highest death rates from COVID-19. Such information may help to inform state-level responses aimed at easing the full mortality burden of the COVID-19 pandemic.
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Affiliation(s)
- Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | | | - Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
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Shaffer CW, Wyka K, Ewing J, Russ MJ, Kanellopoulos D, Brody BD. Low COVID-19 Vaccination Rates Among Psychiatric Inpatients: Implications for Institutional Settings and Outreach Efforts. Psychiatr Serv 2023; 74:320-323. [PMID: 36065578 DOI: 10.1176/appi.ps.20220222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to determine COVID-19 vaccination rates for individuals with serious mental illness admitted to a large health system in New York State. METHODS Vaccination rates among 12,714 patients admitted to psychiatric units and to medical and surgical units were compared between April 6, 2021, and September 30, 2021. RESULTS Only 40% (N=416 of 1,029) of patients admitted to psychiatric services had at least one COVID-19 vaccination, whereas 64.4% (7,523 of 11,685) of patients admitted to medical and surgical services had at least one vaccination. After adjustment for differences in key demographic and clinical characteristics, patients admitted to psychiatric services had a significantly lower likelihood of vaccination during the study period (risk ratio=0.78, 95% confidence interval=0.73-0.85, p<0.001). Black psychiatric patients had the lowest vaccination rate (28%). CONCLUSIONS Psychiatric patients with acute illness had low COVID-19 vaccination rates. Targeted outreach for COVID-19 vaccination is necessary to reach this population.
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Affiliation(s)
- Charles W Shaffer
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Katarzyna Wyka
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Julie Ewing
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Mark J Russ
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
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65
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Roesch PT, Saiyed NS, Laflamme E, De Maio FG, Benjamins MR. Life Expectancy Gaps Among Black and White Persons and Contributing Causes of Death in 3 Large US Cities, 2018-2019. JAMA Netw Open 2023; 6:e233146. [PMID: 36897586 DOI: 10.1001/jamanetworkopen.2023.3146] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
IMPORTANCE US cities have substantial, but varying, levels of racial mortality inequities, a consequence of structural racism. As committed partners increasingly pledge to eliminate health inequities, local data are required to focus and unify efforts. OBJECTIVE To analyze the contributions of 26 cause-of-death categories to Black to White life expectancy gaps within 3 large US cities. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, data were extracted from the 2018 and 2019 National Vital Statistics System Multiple Cause of Death Restricted Use data files for deaths by race, ethnicity, sex, age, place of residence, and underlying and contributing causes of death in Baltimore, Maryland; Houston, Texas; and Los Angeles, California. Life expectancy at birth was calculated for non-Hispanic Black and non-Hispanic White populations overall and by sex using abridged life tables with 5-year age intervals. Data analysis was performed from February to May 2022. MAIN OUTCOMES AND MEASURES Using the Arriaga method, the proportion of the Black to White life expectancy gap was calculated overall and by sex for each city that was attributable to 26 cause-of-death categories defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for underlying and contributing causes of death. RESULTS A total of 66 321 death records from 2018 to 2019 were analyzed, with 29 057 individuals (44%) were identified as Black, 34 745 (52%) as male, and 46 128 (70%) as aged 65 years and older. Black to White life expectancy gaps were 7.60 years for Baltimore, 8.06 years for Houston, and 9.57 years for Los Angeles. Circulatory diseases, cancer, injuries, and diabetes and endocrine disorders were top contributors to the gaps, although the order and magnitude varied by city. The contribution of circulatory diseases was 11.3 percentage points higher in Los Angeles than in Baltimore (3.76 years [39.3%] vs 2.12 years [28.0%]). The contribution of injuries to Baltimore's racial gap (2.22 years [29.3%]) was twice as large as in Houston (1.11 years [13.8%]) and Los Angeles (1.36 years [14.2%]). CONCLUSIONS AND RELEVANCE By assessing the composition of Black to White life expectancy gaps for 3 large US cities and categorizing deaths at a more granular level than past studies, this study provides insight into the differing underpinnings of urban inequities. This type of local data can support local resource allocation that more effectively addresses racial inequities.
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Affiliation(s)
| | | | - Emily Laflamme
- Center for Neighborhood Technology, Chicago, Illinois
- American Medical Association, Chicago, Illinois
| | - Fernando G De Maio
- American Medical Association, Chicago, Illinois
- DePaul University, Chicago, Illinois
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Maddocks S, Camp P, Tang C. Engaging Ethnically Diverse Populations in Self-Management Interventions for Chronic Respiratory Diseases: A Narrative Review. Pulm Ther 2023; 9:195-206. [PMID: 36773131 PMCID: PMC9922039 DOI: 10.1007/s41030-023-00218-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
The burden of chronic respiratory diseases continues to rise globally. Comprehensive management relies on a combination of treatment approaches including patient self-management, where health professionals are required to educate and support patients to take control of their disease. When self-management interventions are suitably directed and effectively executed, outcomes point to increases in quality of life and a reduction in unscheduled or emergency consultations for people living with chronic respiratory disease. However, despite these positive gains, the literature reveals poor trends of engagement with this management approach and reduced access to appropriately designed programs for people from ethnically diverse populations, including migrants and refugees. The purpose of this review article is to discuss factors influencing engagement in chronic respiratory disease self-management among people from ethnically diverse backgrounds and to propose strategies to improve the participation of this population in these interventions in the future.
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Affiliation(s)
- Stacy Maddocks
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada ,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada ,Physiotherapy University of KwaZulu-Natal, Durban, South Africa
| | - Pat Camp
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada ,Physiotherapy University of KwaZulu-Natal, Durban, South Africa
| | - Clarice Tang
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Allied Health, South Western Sydney Local Health District, Sydney, Australia.
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67
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Griffin C, Block R, Silverman JD, Croad J, Lennon RP. Race, employment, and the pandemic: An exploration of covariate explanations of COVID-19 case fatality rate variance. PLoS One 2023; 18:e0274470. [PMID: 36730260 PMCID: PMC9894486 DOI: 10.1371/journal.pone.0274470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/25/2022] [Indexed: 02/03/2023] Open
Abstract
We derive a simple asymptotic approximation for the long-run case fatality rate of COVID-19 (alpha and delta variants) and show that these estimations are highly correlated to the interaction between US State median age and projected US unemployment rate (Adj. r2 = 60%). We contrast this to the high level of correlation between point (instantaneous) estimates of per state case fatality rates and the interaction of median age, population density and current unemployment rates (Adj. r2 = 50.2%). To determine whether this is caused by a "race effect," we then analyze unemployment, race, median age and population density across US states and show that adding the interaction of African American population and unemployment explains 53.5% of the variance in COVID case fatality rates for the alpha and delta variants when considering instantaneous case fatality rate. Interestingly, when the asymptotic case fatality rate is used, the dependence on the African American population disappears, which is consistent with the fact that in the long-run COVID does not discriminate on race, but may discriminate on access to medical care which is highly correlated to employment in the US. The results provide further evidence of the impact inequality can have on case fatality rates in COVID-19 and the impact complex social, health and economic factors can have on patient survival.
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Affiliation(s)
- Christopher Griffin
- Applied Research Laboratory, Pen State University, University Park, State College, PA, United States of America
- * E-mail:
| | - Ray Block
- Departments of Political Science and African American Studies, Penn State University, University Park, State College, PA, United States of America
| | - Justin D. Silverman
- College of Information Science and Technology, Penn State University, University Park, State College, PA, United States of America
| | - Jason Croad
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States of America
| | - Robert P. Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States of America
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Hamilton JL, Hutchinson E, Evankovich MR, Ladouceur CD, Silk JS. Daily and average associations of physical activity, social media use, and sleep among adolescent girls during the COVID-19 pandemic. J Sleep Res 2023; 32:e13611. [PMID: 35535484 PMCID: PMC9347531 DOI: 10.1111/jsr.13611] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 02/03/2023]
Abstract
Adolescents' daily lives have been disrupted during the Coronavirus disease 2019 (COVID-19) pandemic. It remains unclear how changes in adolescents' daily physical and social behaviours affect their sleep. The present study examined the daily and average effects of physical activity and social media use (i.e., video chatting, texting, and social networking sites) on adolescent girls' sleep during the COVID-19 pandemic. Adolescent girls aged 12-17 years (N = 93; 69% White) from a larger longitudinal study completed a 10-day daily diary protocol during state-mandated stay-at-home orders. Girls reported on daily sleep (duration, timing, quality), physical activity, and social media use during COVID-19. Multilevel modelling was used to examine the within- and between-person effects of physical activity and social media on sleep duration, timing, and quality during the 10-day period. Between-person associations indicate that youth with greater social media use (texting, video chatting, and social networking) and less physical activity had later sleep timing across the 10-day study period. Only video chatting was associated with shorter sleep duration. There were no within-person effects of physical activity or social media activities on sleep outcomes. Findings indicate that physical activity and social media use may impact later adolescent sleep timing during the COVID-19 pandemic. It will be critical for research to examine the potential long-term costs of delayed sleep timing, and whether targeting specific youth behaviours associated with sleep and circadian disruption improve mental and physical health during the COVID-19 pandemic and beyond.
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Affiliation(s)
| | | | | | | | - Jennifer S. Silk
- Department of Psychology, University of Pittsburgh
- University of Pittsburgh School of Medicine
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Mai QD, Song L, Donnelly R. Precarious Employment and Well-Being: Insights from the COVID-19 Pandemic. WORK AND OCCUPATIONS 2023; 50:3-21. [PMID: 38603256 PMCID: PMC9726637 DOI: 10.1177/07308884221143063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
While precarious employment is not a new concept, it has been brought to the center of scholarly and public discourse worldwide by the unprecedented COVID-19 pandemic. This essay delineates how precarious employment shapes well-being and situates that relationship in the context of the COVID-19 pandemic. The essay also provides an overview of how the nine articles boldly investigate how these two layers of global risk-precarious employment and the pandemic-interact to shape individuals' well-being. In addition to advancing theoretical and empirical knowledge by analyzing timely data from diverse sources and populations, these articles call for more efforts on worker protection reforms and government financial support.
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Affiliation(s)
- Quan D Mai
- Rutgers University, New Brunswick, NJ, USA
| | - Lijun Song
- Vanderbilt University, Nashville, TN, USA
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Wang F, Lui J, Wang JD. Losses of Life Expectancy and Productivity Associated with COVID-19 Pandemic in Canada: Policy Implication for Future Communicable Disease Control. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2419. [PMID: 36767785 PMCID: PMC9916087 DOI: 10.3390/ijerph20032419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
This research examines whether the Coronavirus disease 2019 (COVID-19) did harm to the population's health through comparing the changes in the life expectancy of Canadians with those of Australians over the period from March 2019 to February 2021 by using a difference-in-differences (DID) estimation method. We found that the pandemic did cause differences in life expectancies between Canada and Australia, probably because of different initial control policies for COVID-19. This study uses the indicator of disability-adjusted life years (DALYs) to measure the societal health burden, which was corroborated by estimating temporal productivity loss (TPL) and permanent productivity loss (PPL) based on the human capital approach (HCA) using data from Health Canada. The societal health burden in Canada amounted to 6.493 DALYs per 1000 male persons and 5.316 DALYs per 1000 female persons. The economy's permanent productivity loss was around USD 5.3 billion, while the temporary productivity loss was around USD 3 billion from February 2020 to April 2022. The sum of the above two losses amounted to 0.477% of the GDP in 2019. Swift and decisive decisions at the very early stage of a pandemic can nip contagions in the bud before numbers get out of hand and would be less damaging to people's health and the economy, as seen in Australia, in contrast to what happened in Canada. We thus recommend that such policies plus telecommunication systems in healthcare services be implemented early on to cope with the future outbreak of any emerging infectious diseases such as COVID-19.
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Affiliation(s)
- Fuhmei Wang
- Department of Economics, College of Social Science, National Cheng Kung University, Tainan 704, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Jinwei Lui
- Department of Economics, College of Social Science, National Cheng Kung University, Tainan 704, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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Black men in white coats - Barriers black men face in medicine, implications to decreased representation, and potential interventions at the uniformed services university of the health sciences. J Natl Med Assoc 2023; 115:147-156. [PMID: 36717351 DOI: 10.1016/j.jnma.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/27/2022] [Accepted: 01/09/2023] [Indexed: 01/29/2023]
Abstract
The number of black male applicants to US medical schools has remained stagnant over the last 30 years. The etiology behind the lack of applicants is multifaceted and involves greater systemic barriers, specifically, educational and social barriers. The lack of representation of black males in medicine also has downstream implications for the health of the African American/black community. African Americans exhibit some of the lowest levels of trust in the healthcare system, have less access to care than their non-minority peers, and have, comparatively, poorer healthcare outcomes than other populations in the US. Research has demonstrated that patient-provider race concordance improves communication, outcomes, culturally competent care, and satisfaction with care. The greater the gap between these two populations, the harder it becomes to improve healthcare outcomes, maintain a medically ready fighting force in the US military, and improve trust in the healthcare system. This article provides an analysis of the multifactorial barriers black male applicants face applying, matriculating, and graduating medical school and how decreased representation may affect healthcare delivery. Furthermore, this review explores next steps and potential implementations at the Uniformed Services University of the Health Sciences to address the above deficiencies.
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Awareness of and Confidence to Address Equity-Related Concepts Across the US Governmental Public Health Workforce. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:S87-S97. [PMID: 36223509 PMCID: PMC9722375 DOI: 10.1097/phh.0000000000001647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the governmental public health (GPH) workforce's awareness of and confidence to address health equity , social determinants of health ( SDoH ), and social determinants of equity ( SDoE ) in their work. DESIGN, SETTING, AND PARTICIPANTS A nationally representative population of US local and state GPH employees (n = 41 890) were surveyed through the 2021 Public Health Workforce Interests and Needs Survey (PH WINS 2021). MAIN OUTCOME MEASURES Self-reported awareness and confidence were explored by self-identified racial and ethnic group identity, public health degree attainment, and supervisory status. RESULTS GPH employees reported higher levels of awareness across concepts ( health equity -71%, 95% confidence interval [CI]: 70.5-71.6; SDoH -62%, 95% CI: 62.3-63.5; SDoE -48%, 95% CI: 47.2-48.4) than confidence ( health equity -48%, 95% CI: 47.8-49.0; SDoH -46%, 95% CI: 45.4-46.7; SDoE -34%, 95% CI: 33.4-34.6). Self-identified Black or African American employees reported higher confidence across all concepts ( health equity -56%, 95% CI: 54.3-57.6; SDoH -52%, 95% CI: 50.8-54.1; SDoE -43%, 95% CI: 41.3-44.6) compared to other self-identified racial groups. Employees with a PH degree reported higher confidence across all concepts ( health equity -65%, 95% CI: 63.8-68.8; SDoH -73%, 95% CI: 71.3-74.1; SDoE -39%, 95% CI: 36.9-40.1) compared with employees without a PH degree ( health equity -45%, 95% CI: 44.8-46.1; SDoH -41%, 95% CI: 40.6-41.9; SDoE -33%, 95% CI: 32.6-33.8). We found an inverse relationship between supervisory status and confidence to address SDoE : Nonsupervisors reported higher confidence (35%, 95% CI: 29.2-31.9) than supervisors (31%, 95% CI: 29.2-31.9), managers (31%, 95% CI: 28.8-32.6), and executives (32%, 95% CI: 27.5-34.4). CONCLUSION PH WINS 2021 reveals that GPH employees are aware of equity-related concepts but lack confidence to address them. Public health agencies should build employees' confidence by prioritizing and operationalizing equity internally and externally in collaboration with communities and partners.
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Gao X, Lv F, He X, Zhao Y, Liu Y, Zu J, Henry L, Wang J, Yeo YH, Ji F, Nguyen MH. Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States. J Hepatol 2023; 78:16-27. [PMID: 35988691 PMCID: PMC9611810 DOI: 10.1016/j.jhep.2022.07.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/30/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The pandemic has resulted in an increase of deaths not directly related to COVID-19 infection. We aimed to use a national death dataset to determine the impact of the pandemic on people with liver disease in the USA, focusing on alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). METHODS Using data from the National Vital Statistic System from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) platform and ICD-10 codes, we identified deaths associated with liver disease. We evaluated observed vs. predicted mortality for 2020-2021 based on trends from 2010-2019 with joinpoint and prediction modelling analysis. RESULTS Among 626,090 chronic liver disease-related deaths between 2010 and 2021, Age-standardised mortality rates (ASMRs) for ALD dramatically increased between 2010-2019 and 2020-2021 (annual percentage change [APC] 3.5% to 17.6%, p <0.01), leading to a higher observed ASMR (per 100,000 persons) than predicted for 2020 (15.67 vs. 13.04) and 2021 (17.42 vs. 13.41). ASMR for NAFLD also increased during the pandemic (APC: 14.5%), whereas the rates for hepatitis B and C decreased. Notably, the ASMR rise for ALD was most pronounced in non-Hispanic Whites, Blacks, and Alaska Indians/Native Americans (APC: 11.7%, 10.8%, 18.0%, all p <0.05), with similar but less critical findings for NAFLD, whereas rates were steady for non-Hispanic Asians throughout 2010-2021 (APC: 4.9%). The ASMR rise for ALD was particularly severe for the 25-44 age group (APC: 34.6%, vs. 13.7% and 12.6% for 45-64 and ≥65, all p <0.01), which were also all higher than pre-COVID-19 rates (all p <0.01). CONCLUSIONS ASMRs for ALD and NAFLD increased at an alarming rate during the COVID-19 pandemic with the largest disparities among the young, non-Hispanic White, and Alaska Indian/Native American populations. IMPACT AND IMPLICATIONS The pandemic has led to an increase of deaths directly and indirectly related to SARS-CoV-2 infection. As shown in this study, age-standardised mortality rates for alcohol-associated liver disease and non-alcoholic fatty liver disease substantially increased during the COVID-19 pandemic in the USA and far exceeded expected levels predicted from past trends, especially among the young, non-Hispanic White, and Alaska Indian/Native American populations. However, much of this increase was not directly related to COVID-19. Therefore, for the ongoing pandemic as well as its recovery phase, adherence to regular monitoring and care for people with chronic liver disease should be prioritised and awareness should be raised among patients, care providers, healthcare systems, and public health policy makers.
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Affiliation(s)
- Xu Gao
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Fan Lv
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, PR China
| | - Xinyuan He
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yunyu Zhao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yi Liu
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jian Zu
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, PR China.
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jinhai Wang
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yee Hui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, PR China.
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA.
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Yang Y, Lu Y, Jiang B. Population-weighted exposure to green spaces tied to lower COVID-19 mortality rates: A nationwide dose-response study in the USA. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158333. [PMID: 36041607 PMCID: PMC9420198 DOI: 10.1016/j.scitotenv.2022.158333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 05/29/2023]
Abstract
The COVID-19 pandemic has caused a huge loss of human life globally. However, few studies investigated the link between exposure to green space and risk of COVID-19 mortality rate, while also distinguishing the effects of various types of green space, considering the spatial distribution of human population and green space, and identifying the optimal buffer distances of nearby green space. It is critical and pressing to fill these significant knowledge gaps to protect and promote billions of people's health and life across the world. This study adopted a negative binomial generalized linear mixed-effects model to examine the association between the ratios of various types of green space, population-weighted exposure to those various types of green space, and COVID-19 mortality rates across 3025 counties in the USA, adjusted for sociodemographic, pre-existing chronic disease, policy and regulation, behavioral, and environmental factors. The findings show that greater exposure to forest was associated with lower COVID-19 mortality rates, while developed open space had mixed associations with COVID-19 mortality rates. Forest outside park had the largest effect size across all buffer distances, followed by forest inside park. The optimal exposure buffer distance was 1 km for forest outside park, with per one-unit of increase in exposure associated with a 9.9 % decrease in COVID-19 mortality rates (95 % confidence interval (CI): 6.9 %-12.8 %). The optimal exposure buffer distance of forest inside park was 400 m, with per one-unit of increase in exposure associated with a 4.7 % decrease in mortality rates (95 % CI: 2.4 %-6.9 %). The results suggest that greater exposure to green spaces, especially to nearby forests, may mitigate the risk of COVID-19 mortality. Although findings of an ecological study cannot be directly used to guide medical interventions, this study may pave a critical new way for future research and practice across multiple disciplines.
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Affiliation(s)
- Yuwen Yang
- Urban Environments and Human Health Lab, HKUrbanLabs, Faculty of Architecture, The University of Hong Kong, Hong Kong SAR; Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong SAR
| | - Yi Lu
- Department of Architecture and Civil Engineering, College of Engineering, City University of Hong Kong, Hong Kong SAR
| | - Bin Jiang
- Urban Environments and Human Health Lab, HKUrbanLabs, Faculty of Architecture, The University of Hong Kong, Hong Kong SAR; Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong SAR.
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75
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CSmoothing: a web-tool for controlled smoothing by segments of mortality data. COMMUN STAT-SIMUL C 2022. [DOI: 10.1080/03610918.2022.2154794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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76
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Lv F, Gao X, Huang AH, Zu J, He X, Sun X, Liu J, Gao N, Jiao Y, Keane MG, Zhang L, Yeo YH, Wang Y, Ji F. Excess diabetes mellitus-related deaths during the COVID-19 pandemic in the United States. EClinicalMedicine 2022; 54:101671. [PMID: 36168320 PMCID: PMC9500386 DOI: 10.1016/j.eclinm.2022.101671] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a critical risk factor for severe SARS-CoV-2 infection, and SARS-CoV-2 infection contributes to worsening glycemic control. The COVID-19 pandemic profoundly disrupted the delivery of care for patients with diabetes. We aimed to determine the trend of DM-related deaths during the pandemic. METHODS In this serial population-based study between January 1, 2006 and December 31, 2021, mortality data of decedents aged ≥25 years from the National Vital Statistics System dataset was analyzed. Decedents with DM as the underlying or contributing cause of death on the death certificate were defined as DM-related deaths. Excess deaths were estimated by comparing observed versus expected age-standardized mortality rates derived from mortality during 2006-2019 with linear and polynomial regression models. The trends of mortality were quantified with joinpoint regression analysis. Subgroup analyses were performed by age, sex, race/ethnicity, and state. FINDINGS Among 4·25 million DM-related deaths during 2006-2021, there was a significant surge of more than 30% in mortality during the pandemic, from 106·8 (per 100,000 persons) in 2019 to 144·1 in 2020 and 148·3 in 2021. Adults aged 25-44 years had the most pronounced rise in mortality. Widened racial/ethnic disparity was observed, with Hispanics demonstrating the highest excess deaths (67·5%; 95% CI 60·9-74·7%), almost three times that of non-Hispanic whites (23·9%; 95% CI 21·2-26·7%). INTERPRETATION The United States saw an increase in DM-related mortality during the pandemic. The disproportionate rise in young adults and the widened racial/ethnic disparity warrant urgent preventative interventions from diverse stakeholders. FUNDING National Natural Science Foundation of China.
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Affiliation(s)
- Fan Lv
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
| | - Xu Gao
- Division of Gastroenterology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
| | - Amy Huaishiuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jian Zu
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
- Corresponding author at: School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, PRC.
| | - Xinyuan He
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
| | - Xiaodan Sun
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
| | - Jinli Liu
- China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, Peoples Republic of China
| | - Ning Gao
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
| | - Yang Jiao
- Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
| | - Margaret G. Keane
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Lei Zhang
- China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, Peoples Republic of China
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, Peoples Republic of China
| | - Yee Hui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Corresponding author at: Division of General Internal Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, California, USA.
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, Peoples Republic of China
| | - Fanpu Ji
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, Peoples Republic of China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, Peoples Republic of China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, Shaanxi, Peoples Republic of China
- Corresponding author at: Department of Infectious Diseases, The Second Affiliated Hospital of Xian Jiaotong University, No.157 Xi Wu Road, Xi'an 710004, Shaanxi Province, PRC.
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Schöley J, Aburto JM, Kashnitsky I, Kniffka MS, Zhang L, Jaadla H, Dowd JB, Kashyap R. Life expectancy changes since COVID-19. Nat Hum Behav 2022; 6:1649-1659. [PMID: 36253520 PMCID: PMC9755047 DOI: 10.1038/s41562-022-01450-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/17/2022] [Indexed: 01/14/2023]
Abstract
The COVID-19 pandemic triggered an unprecedented rise in mortality that translated into life expectancy losses around the world, with only a few exceptions. We estimate life expectancy changes in 29 countries since 2020 (including most of Europe, the United States and Chile), attribute them to mortality changes by age group and compare them with historic life expectancy shocks. Our results show divergence in mortality impacts of the pandemic in 2021. While countries in western Europe experienced bounce backs from life expectancy losses of 2020, eastern Europe and the United States witnessed sustained and substantial life expectancy deficits. Life expectancy deficits during fall/winter 2021 among people ages 60+ and <60 were negatively correlated with measures of vaccination uptake across countries (r60+ = -0.86; two-tailed P < 0.001; 95% confidence interval, -0.94 to -0.69; r<60 = -0.74; two-tailed P < 0.001; 95% confidence interval, -0.88 to -0.46). In contrast to 2020, the age profile of excess mortality in 2021 was younger, with those in under-80 age groups contributing more to life expectancy losses. However, even in 2021, registered COVID-19 deaths continued to account for most life expectancy losses.
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Affiliation(s)
- Jonas Schöley
- Max Planck Institute for Demographic Research, Rostock, Germany.
| | - José Manuel Aburto
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK.
- Nuffield College, University of Oxford, Oxford, UK.
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark.
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Ilya Kashnitsky
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Maxi S Kniffka
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Luyin Zhang
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK
| | - Hannaliis Jaadla
- Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
- Cambridge Group for the History of Population and Social Structure, Department of Geography, University of Cambridge, Cambridge, UK
| | - Jennifer B Dowd
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Ridhi Kashyap
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK.
- Nuffield College, University of Oxford, Oxford, UK.
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78
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Valdez A, Fontenot J, Millan A, McMurray P. Knowledge, skills, and attitudes about diversity, equity, and inclusion among nurse educators. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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79
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Agarwal R, Bjarnadottir M, Rhue L, Dugas M, Crowley K, Clark J, Gao G. Addressing Algorithmic Bias and the Perpetuation of Health Inequities: An AI Bias Aware Framework. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Breland AB, Carroll D, Denlinger-Apte R, Ross JC, Soto C, White C, Donny EC, Fagan P, Gardiner P, Eissenberg T, Guy MC. Centering racial justice for Black/African American and Indigenous American people in commercial tobacco product regulation. Prev Med 2022; 165:107117. [PMID: 35716811 PMCID: PMC9722549 DOI: 10.1016/j.ypmed.2022.107117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/29/2022] [Accepted: 06/12/2022] [Indexed: 01/13/2023]
Abstract
Although overall health in the United States (US) has improved dramatically during the past century, long-standing health inequities, particularly the unequal and unjust burden of tobacco-related disease and death among racialized populations, persist. A considerable gap exists in our understanding of how commercial tobacco product regulations and policies cause and/or exacerbate race-based health inequities among Black/African American (B/AA) and Indigenous American people. The purpose of this paper is to 1) describe how existing US commercial tobacco regulatory policies may contribute to structural racism and undermine the full benefits of tobacco prevention and control efforts among B/AA and Indigenous American groups; and 2) initiate a call to action for researchers and regulators of tobacco products to examine policies using an equity lens. These actions are imperative if empirically-informed regulation of commercial tobacco products is to address health equity.
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Affiliation(s)
- Alison B Breland
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA.
| | - Dana Carroll
- University of Minnesota, School of Public Health, Division of Environmental Health Sciences, 717 Delaware St SE, Minneapolis, MN 55414, USA.
| | - Rachel Denlinger-Apte
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Claradina Soto
- University of Southern California, Keck School of Medicine, Institute for Health Promotion and Disease Prevention Research, SSB 300 2001 N. Soto Street, Health Sciences Campus, Los Angeles, CA 90033, USA.
| | - Cassidy White
- Wake Forest School of Medicine, Department of Physiology and Pharmacology, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Eric C Donny
- Wake Forest School of Medicine, Department of Physiology and Pharmacology, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Pebbles Fagan
- University of Arkansas for Health Sciences, Fay W. Boozman College of Public Health, 4301 West Markham, # 820, Little Rock, AK 72205, USA.
| | - Phillip Gardiner
- African American Tobacco Control Leadership Council, 390 Fourth Street, San Francisco, CA 94107, USA
| | - Thomas Eissenberg
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA.
| | - Mignonne C Guy
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, 100 W. Franklin St., Suite 200, Richmond, VA 23220, USA; Virginia Commonwealth University, Department of African American Studies, 816 W. Franklin St., Box 842509, Richmond, VA 23284, USA.
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81
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Grasser LR, Jovanovic T. Neural Impacts of Stigma, Racism, and Discrimination. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1225-1234. [PMID: 35811064 DOI: 10.1016/j.bpsc.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/28/2022] [Accepted: 06/28/2022] [Indexed: 12/13/2022]
Abstract
Racism is a chronic stressor fueled by stigma that can result in significant distress and dysfunction as well as negatively affect emotions, behavior, quality of life, and brain health. The effects of stigma and discrimination emerge early in life and have long-term consequences. In this review, we sought to use neuroscience research to describe how stigma, racism, and discrimination can impact brain and mental health. Societal stigmas may be encoded by associative fear learning and pattern completion networks, and experiences of racial discrimination may similarly affect threat-responsive regions and circuits. Race-related differences in brain function and structure supporting threat circuitry are largely attenuated when negative life experiences and discrimination are taken into account. Downstream, chronic activation of the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis in the context of discrimination and stigma can contribute to physical health disparities in minoritized and marginalized groups. Finally, we discuss models that provide a framework for interventions and societal-level strategies across ecologic systems to build resilience and foster posttraumatic growth.
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Affiliation(s)
- Lana Ruvolo Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan.
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Kamp Dush CM, Manning WD, Berrigan MN, Hardeman RR. Stress and Mental Health: A Focus on COVID-19 and Racial Trauma Stress. THE RUSSELL SAGE FOUNDATION JOURNAL OF THE SOCIAL SCIENCES : RSF 2022; 8:104-134. [PMID: 37033679 PMCID: PMC10077922 DOI: 10.7758/rsf.2022.8.8.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In the United States, COVID-19 unfolded alongside profound racial trauma. Drawing on a population representative sample of 20-60 year-olds who were married or cohabiting, the National Couples' Health and Time Study (N =3,642), we examine two specific sources of stress: COVID-19 and racial trauma. We leverage the fully powered samples of respondents with racial/ethnic and sexual minority identities and find that COVID-19 and racial trauma stress were higher among individuals who were not White or heterosexual most likely due to racism, xenophobia, and cis-heterosexism at the individual and structural levels. Both COVID-19 and racial trauma stress were associated with poorer mental health outcomes even after accounting for a rich set of potential mechanistic indicators, including discrimination and social climate. We argue that the inclusion of assessments of stress are critical for understanding health and well-being among individuals impacted by systemic and interpersonal discrimination.
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Affiliation(s)
- Claire M Kamp Dush
- Minnesota Population Center and the Department of Sociology at the University of Minnesota. She is a family scholar with an interdisciplinary background that includes training in demography, psychology, sociology, and economics. Her research focuses on family functioning, including marriage and cohabitation, and its intersection with human development
| | - Wendy D Manning
- Dr. Howard E. and Penny Daum Aldrich Distinguished Professor in the Department of Sociology at Bowling Green State University. She is a family demographer focusing on trends in family formation and dissolution for same-gender and different-gender couples. Her research examines social relationships and the health and well-being of children, parents, and adults in the United States
| | - Miranda N Berrigan
- University of Minnesota. She is a human development and family studies scholar with interdisciplinary specializations in quantitative research methods and evaluation and demography. Her research focuses on the intersection of family, work, and well-being
| | - Rachel R Hardeman
- Blue Cross Endowed Professor of Health and Racial Equity in the Division of Health Policy and Management and Director of the Center for Antiracism Research for Health Equity at the University of Minnesota. Her program of research applies the tools of population health science and health services research to elucidate a critical and complex determinant of health inequity-racism. Her scholarship advances the field's conceptual and methodological tools for studying racism's relationship to health and healthcare
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83
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Willis DE, Montgomery BE, Selig JP, Andersen JA, Shah SK, Li J, Reece S, Alik D, McElfish PA. COVID-19 vaccine hesitancy and racial discrimination among US adults. Prev Med Rep 2022; 31:102074. [PMID: 36466305 PMCID: PMC9703864 DOI: 10.1016/j.pmedr.2022.102074] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Vaccination is a critical preventive measure to reduce COVID-19 health risks. We utilize full information maximum likelihood (FIML) logistic regression to analyze COVID-19 vaccine hesitancy in a national sample of United States (US) adults (N = 2,022). Online survey data was collected between September 7th and October 3rd, 2021. Before weighting, the racial composition of the sample was as follows: Asian American (15.0 %), Black/African American (20.0 %), Hispanic/Latino (20.0 %), American Indian or Alaska Native (12.6 %), Native Hawaiian or Pacific Islander (12.5 %), and White (20.0 %). Informed by the Increasing Vaccination Model (IVM), we assessed the relationship between COVID-19 vaccine hesitancy and experiences of racial discrimination (Krieger's 9-item measure). Odds of COVID-19 vaccine hesitancy were greater for most younger age groups, women (OR = 1.96; 95 % CI[1.54, 2.49]), Black/African American respondents (OR = 1.68; 95 % CI[1.18, 2.39]), those with a high school education or less (OR = 1.46; 95 % CI[1.08, 1.98]), Independent (OR = 1.77; 95 % CI[1.34, 2.35]) or Republican political affiliation (OR = 2.69; 95 % CI[1.92, 3.79]), and prior COVID-19 infection (OR = 1.78; 95 % CI[1.29, 2.45]). Odds of COVID-19 vaccine hesitancy were 1.04 greater for every-one unit increase in lifetime experiences of racial discrimination (95 % CI[1.02, 1.05]). Odds of COVID-19 vaccine hesitancy were lower for Asian American respondents (OR = 0.682; 95 % CI[0.480, 0.969]), and those who had a primary care doctor had reduced odds of COVID-19 vaccine hesitancy (OR = 0.735; 95 % CI[0.542, 0.998). Our primary finding provides support for a link between experiences of racial discrimination and hesitancy towards a COVID-19 vaccine among US adults. We discuss implications for public health officials and future research.
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Affiliation(s)
- Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Brooke E.E. Montgomery
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA,Corresponding author.
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84
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Sun Y, Wang P, Tang J. Impact of mental health, job insecurity, and COVID-19 symptoms on protective behavior changes among White, Black, and other minorities in the US. Front Psychol 2022; 13:1040413. [PMID: 36478929 PMCID: PMC9720273 DOI: 10.3389/fpsyg.2022.1040413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Job insecurity such as loss of jobs or reduced wages has become a serious social problem in the US since COVID-19 started. Combined with psychological distress and experience of COVID-19 symptoms, the changes of people's protective behaviors vary across states in the US. METHODS This research investigated racial differences in the COVID-19 related factors among White, Black, and other minorities in the US, and examined how mental health mediated the impact of job insecurity on protective behaviors, and how the COVID-19 symptoms moderated the mediation effect of mental health. The 731 valid responses in a cross-sectional survey from May 23 to 27, 2020, in the US were analyzed with independent sample t-tests, Pearson's chi-square tests, and path analysis. RESULTS The findings showed that there were significant differences in job insecurity and Nonpharmaceutical Interventions (NPIs) practice among White, Black, and other minorities. Job insecurity was significantly negatively associated with NPIs practice and was significantly positively associated with mental health. Mental health significantly partially mediated the effect of job insecurity on NPIs practice, in that job insecurity is a better predictor of NPIs practice for individuals with worse mental health than that for individuals with better mental health. Experience of COVID-19 symptoms moderates the mediation effect of mental health on the relationship between job insecurity and NPIs practice, in that mental health is a better predictor of NPIs practice for individuals with a higher experience of COVID-19 symptoms than for individuals with a lower experience of COVID-19 symptoms. DISCUSSION The findings in this study shed lights on psychological and behavioral studies of people's behavior changes during a pandemic. The study indicates the importance of treating mental health to promote protective behaviors during a pandemic, as well as advocating for employees by identifying the needs for those whose jobs were negatively impacted the most.
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Affiliation(s)
- Yingying Sun
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Ping Wang
- College of Business, James Madison University, Harrisonburg, VA, United States
| | - Jun Tang
- School of Public Administration and Policy, Renmin University of China, Beijing, China
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Paglino E, Lundberg DJ, Zhou Z, Wasserman JA, Raquib R, Luck AN, Hempstead K, Bor J, Preston SH, Elo IT, Stokes AC. Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.04.23.22274192. [PMID: 35547848 PMCID: PMC9094106 DOI: 10.1101/2022.04.23.22274192] [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
Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the overall impact of the Covid-19 pandemic that is not biased by differences in testing or cause-of-death assignment. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating and mitigating factors, and inform response efforts, including allocating resources to affected communities. We estimated all-cause excess mortality for the United States from March 2020 through February 2022 by county and month using a Bayesian hierarchical model trained on data from 2015 to 2019. An estimated 1,159,580 excess deaths occurred during the first two years of the pandemic (first: 620,872; second: 538,708). Overall, excess mortality decreased in large metropolitan counties, but increased in nonmetro counties, between the first and second years of the pandemic. Despite the initial concentration of mortality in large metropolitan Northeast counties, beginning in February 2021, nonmetro South counties had the highest cumulative relative excess mortality. These results highlight the need for investments in rural health as the pandemic's disproportionate impact on rural areas continues to grow.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Zhenwei Zhou
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | | | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA
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86
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Nguyen QD, Prokopenko M. A general framework for optimising cost-effectiveness of pandemic response under partial intervention measures. Sci Rep 2022; 12:19482. [PMID: 36376551 PMCID: PMC9662136 DOI: 10.1038/s41598-022-23668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic created enormous public health and socioeconomic challenges. The health effects of vaccination and non-pharmaceutical interventions (NPIs) were often contrasted with significant social and economic costs. We describe a general framework aimed to derive adaptive cost-effective interventions, adequate for both recent and emerging pandemic threats. We also quantify the net health benefits and propose a reinforcement learning approach to optimise adaptive NPIs. The approach utilises an agent-based model simulating pandemic responses in Australia, and accounts for a heterogeneous population with variable levels of compliance fluctuating over time and across individuals. Our analysis shows that a significant net health benefit may be attained by adaptive NPIs formed by partial social distancing measures, coupled with moderate levels of the society's willingness to pay for health gains (health losses averted). We demonstrate that a socially acceptable balance between health effects and incurred economic costs is achievable over a long term, despite possible early setbacks.
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Affiliation(s)
- Quang Dang Nguyen
- Centre for Complex Systems, Faculty of Engineering, University of Sydney, Darlington, NSW, 2008, Australia.
| | - Mikhail Prokopenko
- Centre for Complex Systems, Faculty of Engineering, University of Sydney, Darlington, NSW, 2008, Australia
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87
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Galvani-Townsend S, Martinez I, Pandey A. Is life expectancy higher in countries and territories with publicly funded health care? Global analysis of health care access and the social determinants of health. J Glob Health 2022; 12:04091. [PMID: 36370409 PMCID: PMC9653205 DOI: 10.7189/jogh.12.04091] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background To better understand factors influencing life expectancy, this paper examines how the availability of publicly funded health care in a country and multiple social determinants of health impact longevity of life. Methods In this descriptive statistical analysis, data regarding publicly funded health care, life expectancy, and social determinants of health were obtained for 196 countries and 4 territories. Social determinants included 10 indicators detailing country-level information to represent 5 key categories: economic stability, education, health & health care, neighbourhood & built environment, and social & community context. Analyses consisted of: 1) comparison of mean life expectancy among countries and territories with- and without- publicly funded health care; 2) correlations in life expectancy across social determinants by health care access and level of burden; and 3) correlations in life expectancy within social determinants for health care access by level of burden. Results Overall, life expectancy in countries and territories with- publicly funded health care (Mean (m) = 76.7 years) was significantly longer compared to countries and territories without- publicly funded health care (m = 66.8 years, P < 0.0001). For each social determinant, we observed longer life expectancy continued to be associated with publicly funded health care access across stratum (P < 0.0001), but difference in years of life expectancy existed both by burden of social determinant, as well as access to health care within quartiles of burden (Publicly funded care (yes): 68.12-80.88 years, (no): 62.39-77.33 years, all P < 0.05). Both social determinants as well as the availability of publicly funded health care were individually and simultaneously associated with mean longevity of life between countries and territories worldwide. Conclusions These findings demonstrate how, if made widely available, publicly funded health care could extend longevity of life. If combined with programs to reduce the burden of social determinants, a substantial impact can be made to promote more equitable distribution of life expectancies across the world. Ultimately, both access to publicly funded care and reducing inequalities in social determinants are needed in order to promote longer and healthier aging in populations worldwide.
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Affiliation(s)
- Sarah Galvani-Townsend
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
| | - Isabel Martinez
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, USA
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88
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Nauenberg E, Ng C, Zhu Q. A Tale of Two Countries: Changes to Canadian and U.S. Senior Population Projections due to the Pandemic—Implications for Health Care Planning in Canada and Other Western Countries. JOURNAL OF POPULATION AGEING 2022; 16:27-41. [PMID: 36373060 PMCID: PMC9638370 DOI: 10.1007/s12062-022-09397-z] [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: 07/04/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
To examine COVID-19 mortality demographics to determine if there will be any substantive shifts in population forecasts that will impact health and long-term care planning for seniors in both countries. Demographic data from Statistics Canada and the U.S. Census Bureau to 2060 are adjusted for COVID-19 age-group-specific mortality and then projected forward in five-year increments. These projections are then annualized using a linear imputation between each projected value. Consideration is given to the seniors 65 + , 75 + and 85 + as well as dependency ratios of each age category. Forecasts suggest that the proportion of seniors in the population will roughly plateau in 2035 at approximately 21% (U.S.) and 24% (Canada)–with another uptick observed beginning in 2050 for those aged 75 + . Adjustments due to the pandemic have had little impact on these projections suggesting that–unless there is a major shift in the demographics of pandemic-related mortality–the resource planning implications will be largely inconsequential. Investments in resources to serve seniors need not be done with the intention to repurpose these assets before they are fully depleted. While the demonstrated demographic plateau is likely to hold steady, there is uncertainty around the expected rate of decline in the health of seniors. Depending on this trajectory, community-level social supports could play a large role in lengthening the duration of senior health and independence.
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89
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Ferdinand KC. HDL-C in Black Adults for ASCVD Risk Calculation. J Am Coll Cardiol 2022; 80:2116-2118. [DOI: 10.1016/j.jacc.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/22/2022]
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Corbie G, D'Agostino EM, Knox S, Richmond A, Woods CW, Dave G, Perreira KM, Marsolo K, Wruck LM, Kibbe WA, Cohen-Wolkowiez M. RADx-UP Coordination and Data Collection: An Infrastructure for COVID-19 Testing Disparities Research. Am J Public Health 2022; 112:S858-S863. [PMID: 36194852 PMCID: PMC9707715 DOI: 10.2105/ajph.2022.306953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Giselle Corbie
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Emily M D'Agostino
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Susan Knox
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Al Richmond
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Christopher W Woods
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Gaurav Dave
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Krista M Perreira
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Keith Marsolo
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Lisa M Wruck
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Warren A Kibbe
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
| | - Michael Cohen-Wolkowiez
- Giselle Corbie and Krista M. Perreira are with the Center for Health Equity Research, Department of Social Medicine, University of North Carolina, Chapel Hill. Giselle Corbie is also a guest editor of this special issue. Emily M. D'Agostino is with the Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, and is also a guest editor of this special issue. Susan Knox, Lisa M. Wruck, and Michael Cohen-Wolkowiez are with the Duke Clinical Research Institute, Duke University School of Medicine. Michael Cohen-Wolkowiez is also a guest editor of this special issue. Al Richmond is with Community-Campus Partnerships for Health, Raleigh, NC. Christopher W. Woods is with the Hubert-Yeargan Center for Global Health, Duke University Department of Medicine, Duke University School of Medicine. Gaurav Dave is with the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill. Keith Marsolo is with the Department of Population Health Sciences, Duke University School of Medicine. Warren A. Kibbe is with the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, and is also a guest editor of this special issue
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Huang Y, Shin JE, Xu AM, Yao C, Joung S, Wu M, Zhang R, Shin B, Foley J, Mahov SB, Modes ME, Ebinger JE, Driver M, Braun JG, Jefferies CA, Parimon T, Hayes C, Sobhani K, Merchant A, Gharib SA, Jordan SC, Cheng S, Goodridge HS, Chen P. Evidence of premature lymphocyte aging in people with low anti-spike antibody levels after BNT162b2 vaccination. iScience 2022; 25:105209. [PMID: 36188190 PMCID: PMC9510055 DOI: 10.1016/j.isci.2022.105209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/22/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022] Open
Abstract
SARS-CoV-2 vaccines have unquestionably blunted the overall impact of the COVID-19 pandemic, but host factors such as age, sex, obesity, and other co-morbidities can affect vaccine efficacy. We identified individuals in a relatively healthy population of healthcare workers (CORALE study cohort) who had unexpectedly low peak anti-spike receptor binding domain (S-RBD) antibody levels after receiving the BNT162b2 vaccine. Compared to matched controls, "low responders" had fewer spike-specific antibody-producing B cells after the second and third/booster doses. Moreover, their spike-specific T cell receptor (TCR) repertoire had less depth and their CD4+ and CD8+T cell responses to spike peptide stimulation were less robust. Single cell transcriptomic evaluation of peripheral blood mononuclear cells revealed activation of aging pathways in low responder B and CD4+T cells that could underlie their attenuated anti-S-RBD antibody production. Premature lymphocyte aging may therefore contribute to a less effective humoral response and could reduce vaccination efficacy.
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Affiliation(s)
- Yapei Huang
- Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Juliana E. Shin
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Research Division of Immunology in the Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Alexander M. Xu
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Division of Hematology and Cellular Therapy, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Changfu Yao
- Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandy Joung
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Min Wu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Ruan Zhang
- Comprehensive Transplant Center, Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Bongha Shin
- Comprehensive Transplant Center, Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Joslyn Foley
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Division of Hematology and Cellular Therapy, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Simeon B. Mahov
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Division of Hematology and Cellular Therapy, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Matthew E. Modes
- Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Joseph E. Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Matthew Driver
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jonathan G. Braun
- Research Division of Immunology in the Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Caroline A. Jefferies
- Research Division of Immunology in the Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Tanyalak Parimon
- Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Chelsea Hayes
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Kimia Sobhani
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Akil Merchant
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Division of Hematology and Cellular Therapy, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sina A. Gharib
- Computational Medicine Core at Center for Lung Biology, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA 98109, USA
| | - Stanley C. Jordan
- Comprehensive Transplant Center, Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Helen S. Goodridge
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Research Division of Immunology in the Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Peter Chen
- Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Garcini LM, Ambriz AM, Vázquez AL, Abraham C, Sarabu V, Abraham C, Lucas-Marinelli AK, Lill S, Tsevat J. Vaccination for COVID-19 among historically underserved Latino communities in the United States: Perspectives of community health workers. Front Public Health 2022; 10:969370. [PMID: 36330116 PMCID: PMC9623251 DOI: 10.3389/fpubh.2022.969370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023] Open
Abstract
A critical step to reduce the spread of COVID-19 is vaccination. We conducted a mixed methods project that used online surveys and focus groups with 64 Community Health Workers and Promotor/as (CHW/Ps) located near the U.S.-Mexico border to identify barriers and facilitators to COVID-19 vaccination among Latino communities that have been historically underrepresented and medically underserved. Overall, personal barriers to vaccination included mistrust of manufacturers and administrators as well as fear of: becoming infected from the vaccine, discrimination/stigmatization from healthcare professionals administering the vaccine, exploitation/manipulation by the government or health authorities, and having personal information mishandled. Environmental and community barriers included being undocumented and fear-inducing myths and beliefs. Additional barriers included limited information and logistics pertaining to vaccination access. Targeted efforts are needed to overcome barriers in a culturally and contextually sensitive manner to prevent harm and reduce risk of infection among communities that have been historically underrepresented.
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Affiliation(s)
- Luz M. Garcini
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, TX, United States,Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States,Department of Psychiatry and Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States,Baker Institute Center for the United States and Mexico, Rice University, Houston, TX, United States,*Correspondence: Luz M. Garcini
| | - Arlynn M. Ambriz
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | | | - Cristina Abraham
- Department of Sciences, University of Texas at San Antonio, San Antonio, TX, United States
| | - Vyas Sarabu
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Ciciya Abraham
- Department of Sciences, University of Texas at San Antonio, San Antonio, TX, United States
| | | | - Sarah Lill
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Joel Tsevat
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, TX, United States,Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States,Department of Population Health and Internal Medicine, Dell Medical School, University of Texas, Austin, TX, United States
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93
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Bartoll-Roca X, Palència L, Calvo MJ, Pérez K. Trends and inequalities in (healthy) life expectancy by neighbourhood during the COVID-19 epidemic in Barcelona. GACETA SANITARIA 2022; 37:102267. [PMID: 36347169 PMCID: PMC9576221 DOI: 10.1016/j.gaceta.2022.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse the trend in life expectancy (LE), healthy life expectancy (HLE) and socio-economic inequalities by neighbourhood in Barcelona from the pre-pandemic period (2018-2019) to the pandemic period (2020-2021). METHOD LE and HLE at birth were computed using the municipal register of inhabitants and quality of life (EuroQol) from the Barcelona Health Survey of 2016. Inequalities were assessed with the gap between quantiles of neighbourhood income. RESULTS In 2020, there was a reduction in LE among men (-1.98 years) and women (-2.44) and in HLE among men (-1.44). Socio-economic inequalities in LE and HLE between neighbourhoods widened since 2019 to 2021 (LE: from 3.92 to 4.86 years for men, and from 1.30 to 3.60 for women; HLE: from 6.88 to 7.70 years for men, and from 7.85 to 9.31 for women). CONCLUSIONS The pandemic has substantially reduced LE and HLE, with larger effects among low-income neighbourhoods, especially among women.
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Affiliation(s)
- Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain.
| | - Laia Palència
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - María Jesús Calvo
- Oficina Municipal de Dades, Ajuntament de Barcelona, Barcelona, Spain
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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94
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Lee M, Miao E, Rapkin B, Halmos B, Shankar V, Goel S. Prevalence and Assessment of Factors Associated with COVID-19 Vaccine Hesitancy in an Ethnic Minority Oncology Patient Population. Vaccines (Basel) 2022; 10:1711. [PMID: 36298576 PMCID: PMC9611923 DOI: 10.3390/vaccines10101711] [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] [Received: 09/02/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Complicating the COVID-19 pandemic are the healthcare disparities experienced by ethnic minorities, especially those with comorbidities including cancer. The introduction of COVID-19 vaccines has been instrumental in blunting the morbidity and mortality from the pandemic; however, vaccine hesitancy, particularly among ethnic minorities, has been a major concern. Thus, we sought to evaluate the knowledge and perspectives of COVID-19 and vaccines among our ethnic minority cancer patient population. METHODS Following an IRB approved protocol, questionnaires were completed by patients in a predominantly ethnic minority population at a single institution between 1 February and 30 June 2021. Included were any adult cancer patients with either a solid or hematologic malignancy. RESULTS Among the 84 patients that were offered the questionnaires, 52 patients responded, with a median age of 63.5 years. Overall, 36% were non-Hispanic Blacks and 30% were Hispanics; 65% were receiving active treatment for their cancer. Seventy-nine percent believed COVID-19 to be dangerous or harmful to them, 61% were concerned about the side effects, yet 65% considered COVID-19 vaccines as safe. Among the seven patients that refused the vaccine, (71%, n = 5) cited side effects and/or (57%, n = 4) believed that the vaccine was not needed. Overall, there was a significantly higher chance of being vaccinated if patients were receiving active cancer treatment, believed COVID-19 was harmful, or that the vaccine was safe, and knew COVID-19 was a virus. CONCLUSIONS This exploratory study demonstrates that most ethnic minority cancer patients are receptive to vaccines, with a majority being vaccinated. However, we also discovered various reasons why this group of patients may not want be vaccinated, including concerns about side effects and perception that COVID-19 is not harmful. These findings can help us further understand the complex nature of vaccine hesitancy in ethnic minority cancer patients, and aid in developing future vaccine awareness strategies as the COVID-19 pandemic continues to evolve.
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Affiliation(s)
- Matthew Lee
- Department of Oncology, Montefiore Einstein Cancer Center (MECC), Bronx, NY 10461, USA
| | - Emily Miao
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Bruce Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Balazs Halmos
- Department of Oncology, Montefiore Einstein Cancer Center (MECC), Bronx, NY 10461, USA
| | - Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Sanjay Goel
- Department of Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
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95
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Burke-Garcia A, Berktold J, Rabinowitz L, Wagstaff L, W. Thomas C, Crick C, Walsh MS, Mitchell EW, Verlenden JMV, Puddy R, Mercado MC, Xia K, Aina T, Caicedo L, Nelson, BA P. Assessment of Mental Health and Coping Disparities Among Racial and Ethnic Groups Amid COVID-19 From the “How Right Now” Campaign. Public Health Rep 2022; 138:174-182. [PMID: 36113112 PMCID: PMC9482876 DOI: 10.1177/00333549221121667] [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] [Indexed: 11/16/2022] Open
Abstract
Objectives: How Right Now (HRN) is an evidence-based, culturally responsive communication campaign developed to facilitate coping and resilience among US groups disproportionately affected by the COVID-19 pandemic. To inform the development of this campaign, we examined patterns in emotional health, stress, and coping strategies among HRN’s audiences, focusing on differences among racial and ethnic groups. Methods: We used a national probability panel, AmeriSpeak, to collect survey data from HRN’s priority audience members in English and Spanish at 2 time points (May 2020 and May 2021). We conducted statistical testing to examine differences between time points for each subgroup (Hispanic, non-Hispanic Black, and non-Hispanic White) and differences among subgroups at each time point. Results: We found disparities in COVID-19–related mental health challenges and differences in coping strategies. Non-Hispanic Black respondents were more likely than non-Hispanic White respondents to report challenges related to the social determinants of health, such as affording food and housing (26.4% vs 9.4% in May 2020) and experiencing personal financial loss (46.6% vs 29.2% in May 2020). In May 2021, 30.6% of Hispanic respondents reported being unable to meet basic food or housing needs versus 8.2% of non-Hispanic White respondents, and 51.6% reported personal financial loss versus 26.5% of non-Hispanic White respondents. Conclusions: Our study further illuminates what is needed to build emotional well-being pathways for people who historically have been economically and socially marginalized. Our findings underscore the need for public health interventions to provide culturally responsive mental health support to populations disproportionately affected by COVID-19 during the pandemic and into the future, with a focus on racial and ethnic disparities.
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Affiliation(s)
| | | | | | | | - Craig W. Thomas
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Crick
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Richard Puddy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kanru Xia
- NORC at the University of Chicago, Chicago, IL, USA
| | - Tola Aina
- NORC at the University of Chicago, Chicago, IL, USA
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96
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Lo A, Pifarré i Arolas H, Renshon J, Liang S. The polarization of politics and public opinion and their effects on racial inequality in COVID mortality. PLoS One 2022; 17:e0274580. [PMID: 36107923 PMCID: PMC9477310 DOI: 10.1371/journal.pone.0274580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
Evidence from the early months of the COVID-19 pandemic in the U.S. indicated that the virus had vastly different effects across races, with black Americans faring worse on dimensions including illness, hospitalization and death. New data suggests that our understanding of the pandemic's racial inequities must be revised given the closing of the gap between black and white COVID-related mortality. Initial explanations for inequality in COVID-related outcomes concentrated on static factors-e.g., geography, urbanicity, segregation or age-structures-that are insufficient on their own to explain observed time-varying patterns in inequality. Drawing from a literature suggesting the relevance of political factors in explaining pandemic outcomes, we highlight the importance of political polarization-the partisan divide in pandemic-related policies and beliefs-that varies over time and across geographic units. Specifically, we investigate the role of polarization through two political factors, public opinion and state-level public health policies, using fine-grained data on disparities in public concern over COVID and in state containment/health policies to understand the changing pattern of inequality in mortality. We show that (1) apparent decreases in inequality are driven by increasing total deaths-mostly among white Americans-rather than decreasing mortality among black Americans (2) containment policies are associated with decreasing inequality, likely resulting from lower relative mortality among Blacks (3) as the partisan disparity in Americans who were "unconcerned" about COVID increased, racial inequality in COVID mortality decreased, generating the appearance of greater equality consistent with a "race to the bottom'' explanation as overall deaths increased and substantively swamping the effects of containment policies.
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Affiliation(s)
- Adeline Lo
- Department of Political Science, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Héctor Pifarré i Arolas
- La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jonathan Renshon
- Department of Political Science, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Siyu Liang
- Department of Political Science, University of California-Los Angeles, Los Angeles, California, United States of America
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97
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Flores AR, Tan TQ, Bryant KA. Creating a Diverse and Inclusive Pediatric Infectious Diseases Workforce. J Pediatric Infect Dis Soc 2022; 11:S125-S126. [PMID: 36099364 PMCID: PMC9494389 DOI: 10.1093/jpids/piac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Anthony R Flores
- To whom correspondence should be addressed: Anthony R. Flores, MD, MPH, PhD, UTHealth Houston, 6431 Fannin St, MSB 3.130, Houston, TX 77030;
| | - Tina Q Tan
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Kristina A Bryant
- Alternate corresponding author: Kristina A. Bryant, MD, University of Louisville Pediatric Infectious Diseases, 571 South Floyd Street, Suite 321, Louisville, KY 40202;
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98
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Bump JB, Aniebo I. Colonialism, malaria, and the decolonization of global health. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000936. [PMID: 36962810 PMCID: PMC10021769 DOI: 10.1371/journal.pgph.0000936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/31/2022] [Indexed: 11/19/2022]
Abstract
This paper explores the decolonization of global health through a focus on malaria and European colonialism in Africa. We employ an historical perspective to better articulate what "colonial" means and to specify in greater detail how colonial ideas, patterns, and practices remain an obstacle to progress in global health now. This paper presents a history of malaria, a defining aspect of the colonial project. Through detailed analysis of the past, we recount how malaria became a colonial problem, how malaria control rose to prominence as a colonial activity, and how interest in malaria was harnessed to create the first schools of tropical medicine and the academic specialization now known as global health. We discuss how these historical experiences shape malaria policy around the world today. The objective of this paper is to advance discussion about how malaria and other aspects of global health could be decolonized, and to suggest directions for future analysis that can lead to concrete steps for action.
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Affiliation(s)
- Jesse B. Bump
- Department of Global Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Initiative on the Future of Health and Economic Resiliency in Africa, Boston, Massachusetts, United States of America
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| | - Ifeyinwa Aniebo
- Initiative on the Future of Health and Economic Resiliency in Africa, Boston, Massachusetts, United States of America
- Health Strategy and Delivery Foundation, Lagos, Nigeria
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99
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Maruotti A, Ciccozzi M, Jona-Lasinio G. COVID-19-induced excess mortality in Italy during the Omicron wave. IJID REGIONS 2022; 4:85-87. [PMID: 35822189 PMCID: PMC9263599 DOI: 10.1016/j.ijregi.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
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100
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Swisher R, Garcia-Alexander G, Cossman L, Schaefer D. Explaining racial/ethnic and socioeconomic differences in COVID protective behavior. SSM Popul Health 2022; 19:101147. [PMID: 35721250 PMCID: PMC9197562 DOI: 10.1016/j.ssmph.2022.101147] [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: 02/21/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 12/02/2022] Open
Abstract
COVID-19 has had a disproportionate impact on Black, Hispanic, and lower socioeconomic status communities. Using data from the Community, Health and Politics Study (CHAPS 2021), collected in the midst of the pandemic, we examine differences in COVID-19 health promotion behavior (i.e., avoiding large gatherings, mask wearing, and vaccination status) across racial, ethnic, and socioeconomic status subgroups of the population. Moreover, we examine the degree to which observed differences are robust to controls for other health-related disparities, such as access to health insurance, underlying health conditions, personal exposure to COVID-19 (i.e., own diagnoses, knowing persons who have died from COVID-19), and perceived COVID-19 threat. Findings are consistent with arguments proposed by fundamental cause theory and disease stage theory as they indicate fewer differences on the basis of socioeconomic status or race and ethnicity for masking and social distancing, which may be thought of as less effective measures. In contrast, disparities were prominent in vaccination outcomes. Specifically, racial and ethnic minorities, those with lower levels of education, and those with lower incomes had lower odds of vaccination, after controlling for covariates. Private insurance and older age were also associated with higher odds of vaccination. Higher perceived threat of COVID-19 increased the likelihood of all protective behaviors. Our findings suggest that the need for ongoing efforts to increase vaccination uptake in socially disadvantaged communities.
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Affiliation(s)
- Raymond Swisher
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Lynne Cossman
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Drew Schaefer
- Department of Demography, MS Building 4.01.50, One UTSA Circle, San Antonio, TX, 78429, USA
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