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Crabtree SA, Captari LE, Hall EL, Sandage SJ, Jankowski PJ. Mental health symptoms, well‐being and experiences of the COVID‐19 pandemic: A mixed‐methods practice‐based study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sarah A. Crabtree
- The Albert & Jessie Danielsen InstituteBoston University Boston Massachusetts USA
| | - Laura E. Captari
- The Albert & Jessie Danielsen InstituteBoston University Boston Massachusetts USA
| | - Eugene L. Hall
- The Albert & Jessie Danielsen InstituteBoston University Boston Massachusetts USA
| | - Steven J. Sandage
- The Albert & Jessie Danielsen InstituteBoston University Boston Massachusetts USA
- School of Theology Boston University Boston Massachusetts USA
- MF Norwegian School of Theology Oslo Norway
| | - Peter J. Jankowski
- The Albert & Jessie Danielsen InstituteBoston University Boston Massachusetts USA
- Bethel Seminary Arden Hills Minnesota USA
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Oates GR, Juarez LD, Horswell R, Chu S, Miele L, Fouad MN, Curry WA, Fort D, Hillegass WB, Danos DM. The Association Between Neighborhood Social Vulnerability and COVID-19 Testing, Positivity, and Incidence in Alabama and Louisiana. J Community Health 2021; 46:1115-1123. [PMID: 33966116 PMCID: PMC8106900 DOI: 10.1007/s10900-021-00998-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
Racial/ethnic and socioeconomic disparities in COVID-19 burden have been widely reported. Using data from the state health departments of Alabama and Louisiana aggregated to residential Census tracts, we assessed the relationship between social vulnerability and COVID-19 testing rates, test positivity, and incidence. Data were cumulative for the period of February 27, 2020 to October 7, 2020. We estimated the association of the 2018 Social Vulnerability Index (SVI) overall score and theme scores with COVID-19 tests, test positivity, and cases using multivariable negative binomial regressions. We adjusted for rurality with 2010 Rural-Urban Commuting Area codes. Regional effects were modeled as fixed effects of counties/parishes and state health department regions. The analytical sample included 1160 Alabama and 1105 Louisiana Census tracts. In both states, overall social vulnerability and vulnerability themes were significantly associated with increased COVID-19 case rates (RR 1.57, 95% CI 1.45-1.70 for Alabama; RR 1.36, 95% CI 1.26-1.46 for Louisiana). There was increased COVID-19 testing with higher overall vulnerability in Louisiana (RR 1.26, 95% CI 1.14-1.38), but not in Alabama (RR 0.95, 95% CI 0.89-1.02). Consequently, test positivity in Alabama was significantly associated with social vulnerability (RR 1.66, 95% CI 1.57-1.75), whereas no such relationship was observed in Louisiana (RR 1.05, 95% CI 0.98-1.12). Social vulnerability is a risk factor for COVID-19 infection, particularly among racial/ethnic minorities and those in disadvantaged housing conditions without transportation. Increased testing targeted to vulnerable communities may contribute to reduction in test positivity and overall COVID-19 disparities.
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Affiliation(s)
- Gabriela R Oates
- School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.
| | - Lucia D Juarez
- School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | | | - San Chu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Lucio Miele
- Health Sciences Center, Louisiana State University, New Orleans, LA, USA
| | - Mona N Fouad
- School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - William A Curry
- School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Daniel Fort
- Ochsner Center for Outcomes Research, Ochsner Health, New Orleans, LA, USA
| | | | - Denise M Danos
- Health Sciences Center, Louisiana State University, New Orleans, LA, USA
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Shushtari ZJ, Salimi Y, Ahmadi S, Rajabi-Gilan N, Shirazikhah M, Biglarian A, Almasi A, Gharehghani MAM. Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review. Osong Public Health Res Perspect 2021; 12:346-360. [PMID: 34965686 PMCID: PMC8721272 DOI: 10.24171/j.phrp.2021.0180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/13/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022] Open
Abstract
Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization's conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.
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Affiliation(s)
- Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Yahya Salimi
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sina Ahmadi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Rajabi-Gilan
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marzieh Shirazikhah
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Almasi
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Joffe AR, Redman D. The SARS-CoV-2 Pandemic in High Income Countries Such as Canada: A Better Way Forward Without Lockdowns. Front Public Health 2021; 9:715904. [PMID: 34926364 PMCID: PMC8672418 DOI: 10.3389/fpubh.2021.715904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022] Open
Abstract
The SARS-CoV-2 pandemic has caused tragic morbidity and mortality. In attempt to reduce this morbidity and mortality, most countries implemented population-wide lockdowns. Here we show that the lockdowns were based on several flawed assumptions, including "no one is protected until everyone is protected," "lockdowns are highly effective to reduce transmission," "lockdowns have a favorable cost-benefit balance," and "lockdowns are the only effective option." Focusing on the latter, we discuss that Emergency Management principles provide a better way forward to manage the public emergency of the pandemic. Specifically, there are three priorities including the following: first, protect those most at risk by separating them from the threat (mitigation); second, ensure critical infrastructure is ready for people who get sick (preparation and response); and third, shift the response from fear to confidence (recovery). We argue that, based on Emergency Management principles, the age-dependent risk from SARS-CoV-2, the minimal (at best) efficacy of lockdowns, and the terrible cost-benefit trade-offs of lockdowns, we need to reset the pandemic response. We can manage risk and save more lives from both COVID-19 and lockdowns, thus achieving far better outcomes in both the short- and long-term.
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Affiliation(s)
- Ari R. Joffe
- Department of Pediatrics and John Dossetor Health Ethics Center, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - David Redman
- Retired LCol, Alberta Emergency Management Agency, St. Paul, AB, Canada
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Shannon J, Abraham A, Bagwell Adams G, Hauer M. Racial disparities for COVID19 mortality in Georgia: Spatial analysis by age based on excess deaths. Soc Sci Med 2021; 292:114549. [PMID: 34776290 PMCID: PMC8734109 DOI: 10.1016/j.socscimed.2021.114549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/28/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022]
Abstract
Introduction This study uses multiple measures of excess deaths to analyze racial disparities in COVID-19 mortality across Georgia. Methods The Georgia Department of Public Health provided monthly mortality data for 2010–2020 stratified by race/ethnicity, age, county, and recorded cause of death. We first calculate crude mortality rates by health district during the time period for all groups for March through June for our historical period to identify significant time-series outliers in 2020 distinguishable from general trend variations. We then calculate the mean and standard deviation of mortality rates by age and racial subgroup to create historic confidence intervals that contextualize rates in 2020. Lastly, we use risk ratios to identify disparities in mortality between Black and White mortality rates both in the 2010–2019 period and in 2020. Results Time-series analysis identified three health districts with significant increases in mortality in 2020, located in metro Atlanta and Southwest Georgia. Mortality rates decreased sharply in 2020 for children in both racial categories in all sections of the state, but rose in a majority of districts for both categories in adult and older populations. Risk ratios also increased significantly in 2020 for children and older populations, showing rising disparities in mortality during the pandemic even as crude mortality rates declined for children classified as Black. Conclusions Increased mortality during the COVID-19 outbreak disproportionately affected African-Americans, possibly due, in part, to pre-existing disparities prior to the pandemic linked to social determinants of health. The pandemic deepened these disparities, perhaps due to unequal resources to effectively shelter-in-place or access medical care. Future research may identify local factors underlying geographically heterogenous differences in mortality rates to inform future policy interventions.
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Affiliation(s)
- Jerry Shannon
- Department of Geography & Department of Financial Planning, Housing, and Consumer Economics University of Georgia, 210 Field St., Room 204, Athens, 30602, GA, USA.
| | - Amanda Abraham
- Department of Public Administration and Policy University of Georgia, 280F Baldwin Hall, Athens, 30602, GA, USA.
| | - Grace Bagwell Adams
- Department of Health Policy and Management University of Georgia, 211D Wright Hall, Athens, 30602, GA, USA.
| | - Mathew Hauer
- Department of Sociology Florida State University, Bellamy Building 0526, Tallahassee, FL, 32306, USA.
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Ashcroft R, Lam S, Kourgiantakis T, Begun S, Nelson MLA, Adamson K, Cadell S, Walsh B, Greenblatt A, Hussain A, Sur D, Sirotich F, Craig SL. Preparing social workers to address health inequities emerging during the COVID-19 pandemic by building capacity for health policy: a scoping review protocol. BMJ Open 2021; 11:e053959. [PMID: 34732499 PMCID: PMC8572402 DOI: 10.1136/bmjopen-2021-053959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has brought tremendous changes in healthcare delivery and exacerbated a wide range of inequities. Social workers across a broad range of healthcare settings bring an expertise in social, behavioural and mental healthcare needed to help address these health inequities. In addition, social workers integrate policy-directed interventions and solutions in clinical practice, which is a needed perspective for recovery from the COVID-19 pandemic. It remains unclear, however, what the most pressing policy issues are that have emerged during the COVID-19 pandemic. In addition, many social workers in health settings tend to underuse policy in their direct practice. The objectives of this scoping review are to: (1) systematically scope the literature on social work, COVID-19 pandemic and policy; and (2) describe the competencies required by social workers and the social work profession to address the policy issues emerging during the COVID-19 pandemic. METHODS AND ANALYSIS The scoping review follows Arksey and O'Malley's five-stage framework. Identification of literature published between 1 December 2019 and the search date, 31 March 2021, will take place in two stages: (1) title and abstract review, and (2) full-text review. In partnership with a health science librarian, the research team listed keywords related to social work and policy to search databases including Medline, Embase, PsycINFO, CINAHL, Social Services Abstract and Social Work Abstracts. Two graduate-level research assistants will conduct screening and full-text review. Data will then be extracted, charted, analysed and summarised to report on our results and implications on practice, policy and future research. ETHICS AND DISSEMINATION Results will help develop a policy practice competence framework to inform how social workers can influence policy. We will share our findings through peer-reviewed publications and conference presentations. This study does not require Research Ethics Board approval as it uses publicly available sources of data.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Susan Cadell
- Renison University College, Waterloo, Ontario, Canada
| | - Benjamin Walsh
- Robarts Library, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Greenblatt
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, Ontario, Canada
| | - Frank Sirotich
- Canadian Mental Health Association, Toronto, Ontario, Canada
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Schaffer DeRoo S, Torres RG, Ben-Maimon S, Jiggetts J, Fu LY. Attitudes about COVID-19 Testing among Black Adults in the United States. Ethn Dis 2021; 31:519-526. [PMID: 34720555 DOI: 10.18865/ed.31.4.519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Black Americans are disproportionately affected by coronavirus disease 2019 (COVID-19) hospitalizations and deaths. Decreasing health disparities requires widespread uptake of COVID-19 testing, but attitudes about COVID-19 testing among Black Americans have not been studied. We aimed to characterize knowledge, attitudes, and beliefs about COVID-19 testing among Black parents. Methods Semi-structured interviews were conducted and analyzed using a phenomenology approach with 26 self-identified Black parents after telemedicine visits with a children's health center. Interviews were recorded and transcribed; 65% were double coded with a resultant free-marginal interrater kappa score of 86.8%. Results Most participants were women, spent time inside the homes of friends or family members, and almost half knew someone diagnosed with COVID-19. Three central themes emerged regarding COVID-19 testing decision making, including: 1) perceived COVID-19 disease susceptibility; 2) barriers to testing, with subthemes including trust in test accuracy and safety, perceived stigma of a positive test result, and impact of racism on self-efficacy; and 3) cues to action. Conclusions When considering these themes as constructs of the Health Belief Model, we are better able to understand Black Americans' views of COVID-19 testing and motivations for accessing testing. Culturally responsive educational campaigns delivered by trusted community members should aim to improve understanding about disease transmission and types of tests available. Importantly, framing testing as a means to ensure safety may improve self-efficacy to obtain testing. Lastly, the health community should learn from these conversations with Black Americans so that disease prevention and mitigation strategies prioritize health equity.
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Affiliation(s)
- Sarah Schaffer DeRoo
- Children's National Hospital, Division of General and Community Pediatrics, Washington, DC
| | - Rachel G Torres
- Children's National Hospital, Center for Translational Research, Washington, DC
| | - Sivan Ben-Maimon
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Linda Y Fu
- Children's National Hospital, Division of General and Community Pediatrics, Washington, DC
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Mody A, Pfeifauf K, Bradley C, Fox B, Hlatshwayo MG, Ross W, Sanders-Thompson V, Joynt Maddox K, Reidhead M, Schootman M, Powderly WG, Geng EH. Understanding Drivers of Coronavirus Disease 2019 (COVID-19) Racial Disparities: A Population-Level Analysis of COVID-19 Testing Among Black and White Populations. Clin Infect Dis 2021; 73:e2921-e2931. [PMID: 33315066 PMCID: PMC7799327 DOI: 10.1093/cid/ciaa1848] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background Disparities in coronavirus disease 2019 (COVID-19) testing—the pandemic’s most critical but limited resource—may be an important but modifiable driver of COVID-19 inequities. Methods We analyzed data from the Missouri State Department of Health and Senior Services on all COVID-19 tests conducted in the St Louis and Kansas City regions. We adapted a well-established tool for measuring inequity—the Lorenz curve—to compare COVID-19 testing rates per diagnosed case among Black and White populations. Results Between 14/3/2020 and 15/9/2020, 606 725 and 328 204 COVID-19 tests were conducted in the St Louis and Kansas City regions, respectively. Over time, Black individuals consistently had approximately half the rate of testing per case than White individuals. In the early period (14/3/2020 to 15/6/2020), zip codes in the lowest quartile of testing rates accounted for only 12.1% and 8.8% of all tests in the St Louis and Kansas City regions, respectively, even though they accounted for 25% of all cases in each region. These zip codes had higher proportions of residents who were Black, without insurance, and with lower median incomes. These disparities were reduced but still persisted during later phases of the pandemic (16/6/2020 to 15/9/2020). Last, even within the same zip code, Black residents had lower rates of tests per case than White residents. Conclusions Black populations had consistently lower COVID-19 testing rates per diagnosed case than White populations in 2 Missouri regions. Public health strategies should proactively focus on addressing equity gaps in COVID-19 testing to improve equity of the overall response.
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Affiliation(s)
- Aaloke Mody
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Kristin Pfeifauf
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Cory Bradley
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Branson Fox
- Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Will Ross
- Washington University School of Medicine, St Louis, Missouri, USA
| | | | | | - Mat Reidhead
- Hospital Industry Data Institute, Missouri Hospital Association, St Louis, Missouri, USA
| | | | | | - Elvin H Geng
- Washington University School of Medicine, St Louis, Missouri, USA
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Andrasik MP, Broder GB, Wallace SE, Chaturvedi R, Michael NL, Bock S, Beyrer C, Oseso L, Aina J, Lucas J, Wilson DR, Kublin JG, Mensah GA. Increasing Black, Indigenous and People of Color participation in clinical trials through community engagement and recruitment goal establishment. PLoS One 2021; 16:e0258858. [PMID: 34665829 PMCID: PMC8525736 DOI: 10.1371/journal.pone.0258858] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
Longstanding social and economic inequities elevate health risks and vulnerabilities for Black, Indigenous and People of Color (BIPOC) communities. Engagement of BIPOC communities in infectious disease research is a critical component in efforts to increase vaccine confidence, acceptability, and uptake of future approved products. Recent data highlight the relative absence of BIPOC communities in vaccine clinical trials. Intentional and effective community engagement methods are needed to improve BIPOC inclusion. We describe the methods utilized for the successful enrollment of BIPOC participants in the U.S. Government (USG)-funded COVID-19 Prevention Network (CoVPN)-sponsored vaccine efficacy trials and analyze the demographic and enrollment data across the efficacy trials to inform future efforts to ensure inclusive participation. Across the four USG-funded COVID-19 vaccine clinical trials for which data are available, 47% of participants enrolled at CoVPN sites in the US were BIPOC. White enrollment outpaced enrollment of BIPOC participants throughout the accrual period, requiring the implementation of strategies to increase diverse and inclusive enrollment. Trials opening later benefitted considerably from strengthened community engagement efforts, and greater and more diverse volunteer registry records. Despite robust fiscal resources and a longstanding collaborative and collective effort, enrollment of White persons outpaced that of BIPOC communities. With appropriate resources, commitment and community engagement expertise, the equitable enrollment of BIPOC individuals can be achieved. To ensure this goal, intentional efforts are needed, including an emphasis on diversity of enrollment in clinical trials, establishment of enrollment goals, ongoing robust community engagement, conducting population-specific trials, and research to inform best practices.
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Affiliation(s)
- Michele P. Andrasik
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Gail B. Broder
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Stephaun E. Wallace
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Richa Chaturvedi
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Nelson L. Michael
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Sally Bock
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Chris Beyrer
- John’s Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Linda Oseso
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Jasmin Aina
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Jonathan Lucas
- HIV Prevention Trials Network, FHI360, Research Triangle, NC, United States of America
| | - David R. Wilson
- Tribal Health Research Office, National Institutes of Health, Bethesda, MD, United States of America
| | - James G. Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - George A. Mensah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
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Bijani M, Karimi S, Khaleghi A, Gholampoor Y, Fereidouni Z. Exploring senior managers' perceptions of the COVID-19 Crisis in Iran: a qualitative content analysis study. BMC Health Serv Res 2021; 21:1071. [PMID: 34627238 PMCID: PMC8501323 DOI: 10.1186/s12913-021-07108-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Identification of the experience of senior managers in tackling biological crises can be a roadmap for future crisis management planning. The aim of the present study was to investigate the experiences of senior managers during the COVID-19 crisis. METHODS This is a descriptive qualitative research. Data were collected using in-depth and semi-structured individual interviews. Accordingly, 20 senior managers of medical universities with experience in managing the COVID-19 crisis were enrolled in the study using purposive sampling. Data were collected from February 2020 to May 2021. For data analysis, qualitative content analytical approach was used. RESULTS According to the results, 4 main themes and 10 sub-themes were obtained; they included dealing with issues and challenges in the face of COVID-19 disease (Structural challenges, Cultural challenges, Educational challenges, COVID-19 complexity); individual and managerial competencies (Individual competencies, Managerial competencies); comprehensive, accountable, and efficient management (Comprehensive and accountable management, efficient management); and professional and organizational self-efficacy (Professional self-efficacy, organizational self-efficacy) were obtained. CONCLUSIONS In the present study, a number of senior managers' experiences in the COVID-19 crisis management were identified. Managers and policymakers of the health system are suggested to use the results of the present study to effectively manage the crisis and improve crisis management in various health-related areas by providing an effective cultural and organizational context.
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Affiliation(s)
- Mostafa Bijani
- Department of Medical Surgical Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Shahnaz Karimi
- Department of Medical Education, Medical Education Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Aliasghar Khaleghi
- NonCommunicable Diseases Research Center (NCDRC), Fasa University of Medical Sciences, Fasa, Iran
| | - Yousef Gholampoor
- NonCommunicable Diseases Research Center (NCDRC), Fasa University of Medical Sciences, Fasa, Iran
| | - Zhila Fereidouni
- Department of Medical Surgical Nursing, Fasa University of Medical Sciences, Fasa, Iran
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McLaughlin JM, Khan F, Pugh S, Angulo FJ, Schmitt HJ, Isturiz RE, Jodar L, Swerdlow DL. County-level Predictors of Coronavirus Disease 2019 (COVID-19) Cases and Deaths in the United States: What Happened, and Where Do We Go from Here? Clin Infect Dis 2021; 73:e1814-e1821. [PMID: 33211797 PMCID: PMC7717189 DOI: 10.1093/cid/ciaa1729] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The United States has been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. Understanding microlevel patterns in US rates of COVID-19 can inform specific prevention strategies. METHODS Using a negative binomial mixed-effects regression model, we evaluated the associations between a broad set of US county-level sociodemographic, economic, and health status-related characteristics and cumulative rates of laboratory-confirmed COVID-19 cases and deaths between 22 January 2020 and 31 August 2020. RESULTS Rates of COVID-19 cases and deaths were higher in US counties that were more urban or densely populated or that had more crowded housing, air pollution, women, persons aged 20-49 years, racial/ethnic minorities, residential housing segregation, income inequality, uninsured persons, diabetics, or mobility outside the home during the pandemic. CONCLUSIONS To our knowledge, this study provides results from the most comprehensive multivariable analysis of county-level predictors of rates of COVID-19 cases and deaths conducted to date. Our findings make clear that ensuring that COVID-19 preventive measures, including vaccines when available, reach vulnerable and minority communities and are distributed in a manner that meaningfully disrupts transmission (in addition to protecting those at highest risk of severe disease) will likely be critical to stem the pandemic.
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Affiliation(s)
| | - Farid Khan
- Pfizer Vaccines, Collegeville, Pennsylvania, USA
| | - Sarah Pugh
- Pfizer Vaccines, Collegeville, Pennsylvania, USA
| | | | | | | | - Luis Jodar
- Pfizer Vaccines, Collegeville, Pennsylvania, USA
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Ogbogu PU, Matsui EC, Apter AJ. COVID-19, health disparities, and what the allergist-immunologist can do. J Allergy Clin Immunol 2021; 148:1172-1175. [PMID: 34563546 PMCID: PMC8461003 DOI: 10.1016/j.jaci.2021.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Princess U Ogbogu
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School at University of Texas at Austin, Austin, Tex; Department of Pediatrics, Dell Medical School at University of Texas at Austin, Austin, Tex
| | - Andrea J Apter
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
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Gur-Arie R, Berger Z, Rubinstein Reiss D. COVID-19 Vaccine Uptake Through the Lived Experiences of Health Care Personnel: Policy and Legal Considerations. Health Equity 2021; 5:688-696. [PMID: 34909538 PMCID: PMC8665801 DOI: 10.1089/heq.2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: To investigate whether coronavirus disease 2019 (COVID-19) vaccination campaigns targeted at health care personnel (HCP) in the United States have addressed the lived experiences of HCP on the frontlines of the COVID-19 pandemic and to analyze policy and legal considerations for improving COVID-19 vaccine uptake among HCP. Methods: We conducted a literature and policy review to explore the lived experiences of different occupational groups of HCP on the frontlines of the COVID-19 pandemic-physicians, nurses, trainees, and nonclinical essential workers-in relation to ongoing COVID-19 vaccination campaigns. Finally, we discuss policy and legal considerations to improve the state of HCP COVID-19 vaccine uptake as the pandemic progresses. Results: COVID-19 vaccination campaigns have not achieved consistent high uptake among HCP for many reasons, including vaccine hesitancy, personal, professional considerations, and equity-rooted challenges. Conclusion: HCPs lived experiences during the COVID-19 pandemic reveal meaningful impediments to their COVID-19 vaccine uptake. We suggest that health care systems minimize inequity inherent in existing vaccination campaigns by providing financial and social support to HCP to raise HCP COVID-19 vaccine uptake.
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Affiliation(s)
- Rachel Gur-Arie
- Berman Institute of Bioethics and Johns Hopkins University, Baltimore, Maryland, USA
| | - Zackary Berger
- Berman Institute of Bioethics and Johns Hopkins University, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- The Esperanza Center, Catholic Charities, Baltimore, Maryland, USA
| | - Dorit Rubinstein Reiss
- College of the Law, University of California, Hastings College of the Law, San Francisco, California, USA
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Sun Q, McMahon DE, Ugwu-Dike PO, Sun Q, Tang K, Zhang H, Suchonwanit P, Oh CC, Chong AH, Willems A, Galván C, Dodiuk-Gad RP, Fantini F, Recalcati S, Avancini J, Miyamoto D, Sanches JA, Raboobee N, Bravo F, Freeman EE. How Coronavirus Disease 2019 Changed Dermatology Practice in 1 Year Around the World: Perspectives from 11 Countries. Dermatol Clin 2021; 39:639-651. [PMID: 34556253 PMCID: PMC8452267 DOI: 10.1016/j.det.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Qisi Sun
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Pearl O Ugwu-Dike
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Qiuning Sun
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng Qu, Beijing Shi, China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng Qu, Beijing Shi, China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng Qu, Beijing Shi, China
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Khwaeng Thung Phaya Thai, Khet Ratchathewi, Krung Thep Maha Nakhon 10400, Thailand
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Outram Rd, Singapore 169608, Singapore
| | - Alvin H Chong
- Skin Health Institute, level 1/80 Drummond St, Carlton, VIC 3053, Australia; Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, University of Melbourne, Parkville, VIC 3010, Australia
| | - Anneliese Willems
- Skin Health Institute, level 1/80 Drummond St, Carlton, VIC 3053, Australia
| | - Cristina Galván
- Department of Dermatology, Hospital Universitario de Móstoles, Calle Río Júcar, S/N, 28935 Móstoles, Madrid, Spain
| | - Roni P Dodiuk-Gad
- Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, 3200003, Israel; Department of Dermatology, Emek Medical Center, Yitshak Rabin Boulevard 21, Afula, 1834111, Israel; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Fabrizio Fantini
- Department of Dermatology, Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Via dell'Eremo, 9/11, 23900 Lecco LC, Italy
| | - Sebastiano Recalcati
- Department of Dermatology, Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Via dell'Eremo, 9/11, 23900 Lecco LC, Italy
| | - Joao Avancini
- Department of Dermatology, Hospital das Clínicas of the University of Sao Paulo, Rua, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo-SP, 05403-000, Brazil
| | - Denise Miyamoto
- Department of Dermatology, Hospital das Clínicas of the University of Sao Paulo, Rua, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo-SP, 05403-000, Brazil
| | - Jose A Sanches
- Department of Dermatology, Hospital das Clínicas of the University of Sao Paulo, Rua, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo-SP, 05403-000, Brazil
| | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, 7 Harry Gwala Rd, Westville, Durban, 3630, South Africa
| | - Francisco Bravo
- Department of Dermatology, Universidad Peruana Cayetano Heredia, Hospital Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres 15102, Peru; Department of Pathology, Universidad Peruana Cayetano Heredia, Hospital Cayetano Heredia, 1 CV Zac, Av. Honorio Delgado 262, San Martín de Porres 15102, Peru
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Vu M, Makelarski JA, Winslow VA, Christmas MM, Haider S, Lee NK, Pinkerton EA, Wroblewski KE, Lindau ST. Racial and Ethnic Disparities in Health-Related Socioeconomic Risks During the Early COVID-19 Pandemic: A National Survey of U.S. Women. J Womens Health (Larchmt) 2021; 30:1375-1385. [PMID: 34529520 DOI: 10.1089/jwh.2021.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Nearly half of U.S. women experienced new or worsening health-related socioeconomic risks (HRSRs) (food, housing, utilities and transportation difficulties, and interpersonal violence) early in the COVID-19 pandemic. We sought to examine racial/ethnic disparities in pandemic-related changes in HRSRs among women. Materials and Methods: We conducted a cross-sectional survey (04/2020) of 3200 women. Pre- and early pandemic HRSRs were described by race/ethnicity. Weighted, multivariable logistic regression models generated odds of incident and worsening HRSRs by race/ethnicity. Results: The majority of Black, East or Southeast (E/SE) Asian, and Hispanic women reported ≥1 prepandemic HRSR (51%-56% vs. 38% of White women, p < 0.001). By April 2020, 68% of Black, E/SE Asian, and Hispanic women and 55% of White women had ≥1 HRSR (p < 0.001). For most HRSRs, the odds of an incident or worsening condition were similar across racial/ethnic groups, except Black, E/SE Asian and Hispanic women had 2-3.6 times the odds of incident transportation difficulties compared with White women. E/SE Asian women also had higher odds of worsening transportation difficulties compared with White women (adjusted odds ratios = 2.5, 95% confidence interval 1.1-5.6). In the early pandemic, 1/19 Hispanic, 1/28 E/SE Asian, 1/36 Black and 1/100 White women had all 5 HRSRs (extreme health-related socioeconomic vulnerability). Conclusions: Prepandemic racial/ethnic disparities in HRSRs persisted and prevalence rates increased for all groups early in the pandemic. Disparities in transportation difficulties widened. White women were much less likely than others to experience extreme health-related socioeconomic vulnerability. An equitable COVID-19 response requires attention to persistent and widening racial/ethnic disparities in HRSRs among women.
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Affiliation(s)
- Milkie Vu
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA.,Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jennifer A Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Victoria A Winslow
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Monica M Christmas
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - El A Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences and The University of Chicago, Chicago, Illinois, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA.,Department of Medicine-Geriatrics, The University of Chicago, Chicago, Illinois, USA
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O'Kane M, Agrawal S, Binder L, Dzau V, Gandhi TK, Harrington R, Mate K, McGann P, Meyers D, Rosen P, Schreiber M, Schummers D. An Equity Agenda for the Field of Health Care Quality Improvement. NAM Perspect 2021; 2021:202109b. [PMID: 34901779 PMCID: PMC8654470 DOI: 10.31478/202109b] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paul Rosen
- Centers for Medicare & Medicaid Services
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Jeminiwa R, Hohmann NS, Hastings TJ, Hansen R, Qian J, Garza KB. Individuals' preference for financial over social incentives for medication adherence. J Am Pharm Assoc (2003) 2021; 62:134-141.e1. [PMID: 34561192 DOI: 10.1016/j.japh.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with chronic conditions continue to face financial and system-related barriers to medication adherence. Pharmacy, provider, and payer-based financial and social incentive-based interventions may reduce these barriers and improve adherence. However, it is unclear how patient demographics and clinical characteristics influence the type of incentives preferred by patients. OBJECTIVES To examine individuals' preference for financial versus social incentives and to explore the association between patient demographic and clinical characteristics with preferences for financial or social incentives. METHODS A cross-sectional survey of a nationally representative sample of patients was conducted with Qualtrics panelists (N = 909). U.S. adults taking at least 1 prescription medication for a chronic condition were included. Survey items elicited participants' demographic characteristics, preference for financial or social incentives, self-reported medication adherence, number of prescribed medications, and number of chronic conditions. Bivariate associations between patient characteristics and incentive preferences were tested using t and chi-square tests. Logistic regression was performed to determine patient characteristics associated with participants' preference for incentives. RESULTS When compared with those who were adherent to medications, individuals who were nonadherent were less likely to prefer financial incentives over social incentives (adjusted odds ratio [OR] 0.55 [95% CI 0.31-0.98]). Patient income, sex, and ethnicity were also associated with preferences for financial incentives. Those earning less than $50,000 per year were less likely to prefer financial incentives compared with social incentives (adjusted OR 0.44 [0.24-0.79]). Females were more likely to prefer financial incentives (adjusted OR 1.98 [1.16-3.37]). Hispanic/Latinos were less likely to prefer financial incentives compared to non-Hispanics/non-Latinos (adjusted OR 0.51 [0.29-0.89]). CONCLUSION Preferences for medication adherence incentives differed on the basis of adherence status and patients' demographic characteristics. Findings have implications for how incentive-based interventions can be structured to target certain patient groups.
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Churpek MM, Gupta S, Spicer AB, Parker WF, Fahrenbach J, Brenner SK, Leaf DE. Hospital-Level Variation in Death for Critically Ill Patients with COVID-19. Am J Respir Crit Care Med 2021; 204:403-411. [PMID: 33891529 PMCID: PMC8480242 DOI: 10.1164/rccm.202012-4547oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/22/2021] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Variation in hospital mortality has been described for coronavirus disease 2019 (COVID-19), but the factors that explain these differences remain unclear. OBJECTIVE Our objective was to utilize a large, nationally representative dataset of critically ill adults with COVID-19 to determine which factors explain mortality variability. METHODS In this multicenter cohort study, we examined adults hospitalized in intensive care units with COVID-19 at 70 United States hospitals between March and June 2020. The primary outcome was 28-day mortality. We examined patient-level and hospital-level variables. Mixed-effects logistic regression was used to identify factors associated with interhospital variation. The median odds ratio (OR) was calculated to compare outcomes in higher- vs. lower-mortality hospitals. A gradient boosted machine algorithm was developed for individual-level mortality models. MEASUREMENTS AND MAIN RESULTS A total of 4,019 patients were included, 1537 (38%) of whom died by 28 days. Mortality varied considerably across hospitals (0-82%). After adjustment for patient- and hospital-level domains, interhospital variation was attenuated (OR decline from 2.06 [95% CI, 1.73-2.37] to 1.22 [95% CI, 1.00-1.38]), with the greatest changes occurring with adjustment for acute physiology, socioeconomic status, and strain. For individual patients, the relative contribution of each domain to mortality risk was: acute physiology (49%), demographics and comorbidities (20%), socioeconomic status (12%), strain (9%), hospital quality (8%), and treatments (3%). CONCLUSION There is considerable interhospital variation in mortality for critically ill patients with COVID-19, which is mostly explained by hospital-level socioeconomic status, strain, and acute physiologic differences. Individual mortality is driven mostly by patient-level factors. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Affiliation(s)
- Matthew M Churpek
- University of Wisconsin Madison, 5228, Medicine; Division of Pulmonary and Critical Care, Madison, Wisconsin, United States;
| | - Shruti Gupta
- Brigham and Women's Hospital Department of Medicine, 370908, Division of Renal Medicine, Boston, Massachusetts, United States
| | - Alexandra B Spicer
- University of Wisconsin-Madison, 5228, Medicine; Division of Pulmonary and Critical Care, Madison, Wisconsin, United States
| | - William F Parker
- The University of Chicago, 2462, Department of Medicine, Chicago, Illinois, United States
| | - John Fahrenbach
- The University of Chicago, 2462, Department of Medicine, Chicago, Illinois, United States
| | - Samantha K Brenner
- Hackensack University Medical Center, 3673, Internal Medicine, Hackensack, New Jersey, United States
| | - David E Leaf
- Brigham and Women's Hospital, 1861, Division of Renal Medicine, Boston, Massachusetts, United States
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Lo CH, Nguyen LH, Drew DA, Warner ET, Joshi AD, Graham MS, Anyane-Yeboa A, Shebl FM, Astley CM, Figueiredo JC, Guo CG, Ma W, Mehta RS, Kwon S, Song M, Davies R, Capdevila J, Sudre CH, Wolf J, Cozier YC, Rosenberg L, Wilkens LR, Haiman CA, Marchand LL, Palmer JR, Spector TD, Ourselin S, Steves CJ, Chan AT. Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom. EClinicalMedicine 2021; 38:101029. [PMID: 34308322 PMCID: PMC8285255 DOI: 10.1016/j.eclinm.2021.101029] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is limited prior investigation of the combined influence of personal and community-level socioeconomic factors on racial/ethnic disparities in individual risk of coronavirus disease 2019 (COVID-19). METHODS We performed a cross-sectional analysis nested within a prospective cohort of 2,102,364 participants from March 29, 2020 in the United States (US) and March 24, 2020 in the United Kingdom (UK) through December 02, 2020 via the COVID Symptom Study smartphone application. We examined the contribution of community-level deprivation using the Neighborhood Deprivation Index (NDI) and the Index of Multiple Deprivation (IMD) to observe racial/ethnic disparities in COVID-19 incidence. ClinicalTrials.gov registration: NCT04331509. FINDINGS Compared with non-Hispanic White participants, the risk for a positive COVID-19 test was increased in the US for non-Hispanic Black (multivariable-adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18-1.47) and Hispanic participants (OR, 1.42; 95% CI, 1.33-1.52) and in the UK for Black (OR, 1.17; 95% CI, 1.02-1.34), South Asian (OR, 1.39; 95% CI, 1.30-1.49), and Middle Eastern participants (OR, 1.38; 95% CI, 1.18-1.61). This elevated risk was associated with living in more deprived communities according to the NDI/IMD. After accounting for downstream mediators of COVID-19 risk, community-level deprivation still mediated 16.6% and 7.7% of the excess risk in Black compared to White participants in the US and the UK, respectively. INTERPRETATION Our results illustrate the critical role of social determinants of health in the disproportionate COVID-19 risk experienced by racial and ethnic minorities.
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Affiliation(s)
- Chun-Han Lo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Long H. Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David A. Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erica T. Warner
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Harvard/MGH Center on Genomics, Vulnerable Populations, And Health Disparities, Massachusetts General Hospital, Boston, MA, USA
| | - Amit D. Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mark S. Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Adjoa Anyane-Yeboa
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Fatma M. Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christina M. Astley
- Computational Epidemiology Lab and Division of Endocrinology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Jane C. Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA
| | - Chuan-Guo Guo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Raaj S. Mehta
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sohee Kwon
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Carole H. Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Lynne R. Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Christopher A. Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Julie R. Palmer
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Corresponding author at: Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA.
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Sandoval M, Nguyen DT, Vahidy FS, Graviss EA. Risk factors for severity of COVID-19 in hospital patients age 18-29 years. PLoS One 2021; 16:e0255544. [PMID: 34329347 PMCID: PMC8323903 DOI: 10.1371/journal.pone.0255544] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since February 2020, over 2.5 million Texans have been diagnosed with COVID-19, and 20% are young adults at risk for SARS-CoV-2 exposure at work, academic, and social settings. This study investigated demographic and clinical risk factors for severe disease and readmission among young adults 18-29 years old, who were diagnosed at a hospital encounter in Houston, Texas, USA. METHODS AND FINDINGS A retrospective registry-based chart review was conducted investigating demographic and clinical risk factors for severe COVID-19 among patients aged 18-29 with positive SARS-CoV-2 tests within a large metropolitan healthcare system in Houston, Texas, USA. In the cohort of 1,853 young adult patients diagnosed with COVID-19 infection at a hospital encounter, including 226 pregnant women, 1,438 (78%) scored 0 on the Charlson Comorbidity Index, and 833 (45%) were obese (≥30 kg/m2). Within 30 days of their diagnostic encounter, 316 (17%) patients were diagnosed with pneumonia, 148 (8%) received other severe disease diagnoses, and 268 (14%) returned to the hospital after being discharged home. In multivariable logistic regression analyses, increasing age (adjusted odds ratio [aOR] 1.1, 95% confidence interval [CI] 1.1-1.2, p<0.001), male gender (aOR 1.8, 95% CI 1.2-2.7, p = 0.002), Hispanic ethnicity (aOR 1.9, 95% CI 1.2-3.1, p = 0.01), obesity (3.1, 95% CI 1.9-5.1, p<0.001), asthma history (aOR 2.3, 95% CI 1.3-4.0, p = 0.003), congestive heart failure (aOR 6.0, 95% CI 1.5-25.1, p = 0.01), cerebrovascular disease (aOR 4.9, 95% CI 1.7-14.7, p = 0.004), and diabetes (aOR 3.4, 95% CI 1.9-6.2, p<0.001) were predictive of severe disease diagnoses within 30 days. Non-Hispanic Black race (aOR 1.6, 95% CI 1.0-2.4, p = 0.04), obesity (aOR 1.7, 95% CI 1.0-2.9, p = 0.046), asthma history (aOR 1.7, 95% CI 1.0-2.7, p = 0.03), myocardial infarction history (aOR 6.2, 95% CI 1.7-23.3, p = 0.01), and household exposure (aOR 1.5, 95% CI 1.1-2.2, p = 0.02) were predictive of 30-day readmission. CONCLUSIONS This investigation demonstrated the significant risk of severe disease and readmission among young adult populations, especially marginalized communities and people with comorbidities, including obesity, asthma, cardiovascular disease, and diabetes. Health authorities must emphasize COVID-19 awareness and prevention in young adults and continue investigating risk factors for severe disease, readmission and long-term sequalae.
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Affiliation(s)
- Micaela Sandoval
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, United States of America
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center School of Public Health, Houston, TX, United States of America
| | - Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, United States of America
| | - Farhaan S. Vahidy
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States of America
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, United States of America
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States of America
- * E-mail:
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Mishra S, Ma H, Moloney G, Yiu KC, Darvin D, Landsman D, Kwong JC, Calzavara A, Straus S, Chan AK, Gournis E, Rilkoff H, Xia Y, Katz A, Williamson T, Malikov K, Kustra R, Maheu-Giroux M, Sander B, Baral SD. Increasing concentration of COVID-19 by socioeconomic determinants and geography in Toronto, Canada: an observational study. Ann Epidemiol 2021; 65:84-92. [PMID: 34320380 PMCID: PMC8730782 DOI: 10.1016/j.annepidem.2021.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Inequities in the burden of COVID-19 were observed early in Canada and around the world suggesting economically marginalized communities faced disproportionate risks. However, there has been limited systematic assessment of how heterogeneity in risks has evolved in large urban centers over time. PURPOSE To address this gap, we quantified the magnitude of risk heterogeneity in Toronto, Ontario from January-November, 2020 using a retrospective, population-based observational study using surveillance data. METHODS We generated epidemic curves by social determinants of health (SDOH) and crude Lorenz curves by neighbourhoods to visualize inequities in the distribution of COVID-19 and estimated Gini coefficients. We examined the correlation between SDOH using Pearson-correlation coefficients. RESULTS Gini coefficient of cumulative cases by population size was 0.41 (95% confidence interval [CI]:0.36-0.47) and estimated for: household income (0.20, 95%CI: 0.14-0.28); visible minority (0.21, 95%CI:0.16-0.28); recent immigration (0.12, 95%CI:0.09-0.16); suitable housing (0.21, 95%CI:0.14-0.30); multi-generational households (0.19, 95%CI:0.15-0.23); and essential workers (0.28, 95%CI:0.23-0.34). CONCLUSIONS There was rapid epidemiologic transition from higher to lower income neighbourhoods with Lorenz curve transitioning from below to above the line of equality across SDOH. Moving forward necessitates integrating programs and policies addressing socioeconomic inequities and structural racism into COVID-19 prevention and vaccination programs.
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Affiliation(s)
- Sharmistha Mishra
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.
| | - Huiting Ma
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - Gary Moloney
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - Kristy Cy Yiu
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - Dariya Darvin
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - David Landsman
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
| | - Jeffrey C Kwong
- ICES, Toronto, Canada; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Sharon Straus
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Adrienne K Chan
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Effie Gournis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Toronto Public Health, City of Toronto, Toronto, Canada.
| | | | - Yiqing Xia
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada.
| | - Alan Katz
- Departments of Community Health Sciences and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Centre for Health Informatics, University of Calgary, Calgary, Canada.
| | - Kamil Malikov
- Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada.
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada.
| | - Beate Sander
- ICES, Toronto, Canada; Public Health Ontario, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, United States.
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- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Toronto Public Health, City of Toronto, Toronto, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Canada; Departments of Community Health Sciences and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada; Centre for Health Informatics, University of Calgary, Calgary, Canada; Capacity Planning and Analytics Division, Ontario Ministry of Health, Toronto, Canada; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, United States
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73
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Thomas K, Browne AJ, Jiao S, Dooner C, Wright P, Slemon A, Diederich J, Wathen CN, Bungay V, Wilson E, Varcoe C. Media framing of emergency departments: a call to action for nurses and other health care providers. BMC Nurs 2021; 20:118. [PMID: 34217277 PMCID: PMC8254669 DOI: 10.1186/s12912-021-00606-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As part of a larger study focused on interventions to enhance the capacity of nurses and other health care workers to provide equity-oriented care in emergency departments (EDs), we conducted an analysis of news media related to three EDs. The purpose of the analysis was to examine how media writers frame issues pertaining to nursing, as well as the health and social inequities that drive emergency department contexts, while considering what implications these portrayals hold for nursing practice. METHODS We conducted a search of media articles specific to three EDs in Canada, published between January 1, 2018 and May 1, 2019. Media items (N = 368) were coded by story and theme attributes. A thematic analysis was completed to understand how writers in public media present issues pertaining to nursing practice within the ED context. RESULTS Two overarching themes were found. First, in ED-related media that portrays health care needs of people experiencing health and social inequities, messaging frequently perpetuates stigmatizing discourses. Second, media writers portray pressures experienced by nurses working in the ED in a way that evades structural determinants of quality of care. Underlying both themes is an absence of perspectives and authorship from practicing nurses themselves. CONCLUSIONS We recommend that frontline nurses be prioritized as experts in public media communications. Nurses must be supported to gain critical media skills to contribute to media, to destigmatize the health care needs of people experiencing inequity who attend their practice, and to shed light on the structural causes of pressures experienced by nurses working within emergency department settings.
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Affiliation(s)
- Kimberley Thomas
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Annette J Browne
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada.
| | - Sunny Jiao
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Caryn Dooner
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Patrice Wright
- The Faculty of Graduate and Postdoctoral Studies (Public Health/Nursing), The University of British Columbia, Vancouver, BC, Canada
| | - Allie Slemon
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Diederich
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - C Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Vicky Bungay
- Capacity Research Unit, School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Erin Wilson
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Colleen Varcoe
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
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74
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Lokken EM, Taylor GG, Huebner EM, Vanderhoeven J, Hendrickson S, Coler B, Sheng JS, Walker CL, McCartney SA, Kretzer NM, Resnick R, Kachikis A, Barnhart N, Schulte V, Bergam B, Ma KK, Albright C, Larios V, Kelley L, Larios V, Emhoff S, Rah J, Retzlaff K, Thomas C, Paek BW, Hsu RJ, Erickson A, Chang A, Mitchell T, Hwang JK, Gourley R, Erickson S, Delaney S, Kline CR, Archabald K, Blain M, LaCourse SM, Adams Waldorf KM. Higher severe acute respiratory syndrome coronavirus 2 infection rate in pregnant patients. Am J Obstet Gynecol 2021; 225:75.e1-75.e16. [PMID: 33607103 PMCID: PMC7884918 DOI: 10.1016/j.ajog.2021.02.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND During the early months of the coronavirus disease 2019 pandemic, risks associated with severe acute respiratory syndrome coronavirus 2 in pregnancy were uncertain. Pregnant patients can serve as a model for the success of clinical and public health responses during public health emergencies as they are typically in frequent contact with the medical system. Population-based estimates of severe acute respiratory syndrome coronavirus 2 infections in pregnancy are unknown because of incomplete ascertainment of pregnancy status or inclusion of only single centers or hospitalized cases. Whether pregnant women were protected by the public health response or through their interactions with obstetrical providers in the early months of pandemic is not clearly understood. OBJECTIVE This study aimed to estimate the severe acute respiratory syndrome coronavirus 2 infection rate in pregnancy and to examine the disparities by race and ethnicity and English language proficiency in Washington State. STUDY DESIGN Pregnant patients with a polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection diagnosed between March 1, 2020, and June 30, 2020 were identified within 35 hospitals and clinics, capturing 61% of annual deliveries in Washington State. Infection rates in pregnancy were estimated overall and by Washington State Accountable Community of Health region and cross-sectionally compared with severe acute respiratory syndrome coronavirus 2 infection rates in similarly aged adults in Washington State. Race and ethnicity and language used for medical care of pregnant patients were compared with recent data from Washington State. RESULTS A total of 240 pregnant patients with severe acute respiratory syndrome coronavirus 2 infections were identified during the study period with 70.7% from minority racial and ethnic groups. The principal findings in our study were as follows: (1) the severe acute respiratory syndrome coronavirus 2 infection rate was 13.9 per 1000 deliveries in pregnant patients (95% confidence interval, 8.3-23.2) compared with 7.3 per 1000 (95% confidence interval, 7.2-7.4) in adults aged 20 to 39 years in Washington State (rate ratio, 1.7; 95% confidence interval, 1.3-2.3); (2) the severe acute respiratory syndrome coronavirus 2 infection rate reduced to 11.3 per 1000 deliveries (95% confidence interval, 6.3-20.3) when excluding 45 cases of severe acute respiratory syndrome coronavirus disease 2 detected through asymptomatic screening (rate ratio, 1.3; 95% confidence interval, 0.96-1.9); (3) the proportion of pregnant patients in non-White racial and ethnic groups with severe acute respiratory syndrome coronavirus disease 2 infection was 2- to 4-fold higher than the race and ethnicity distribution of women in Washington State who delivered live births in 2018; and (4) the proportion of pregnant patients with severe acute respiratory syndrome coronavirus 2 infection receiving medical care in a non-English language was higher than estimates of pregnant patients receiving care with limited English proficiency in Washington State (30.4% vs 7.6%). CONCLUSION The severe acute respiratory syndrome coronavirus 2 infection rate in pregnant people was 70% higher than similarly aged adults in Washington State, which could not be completely explained by universal screening at delivery. Pregnant patients from nearly all racial and ethnic minority groups and patients receiving medical care in a non-English language were overrepresented. Pregnant women were not protected from severe acute respiratory syndrome coronavirus 2 infection in the early months of the pandemic. Moreover, the greatest burden of infections occurred in nearly all racial and ethnic minority groups. These data coupled with a broader recognition that pregnancy is a risk factor for severe illness and maternal mortality strongly suggested that pregnant people should be broadly prioritized for coronavirus disease 2019 vaccine allocation in the United States similar to some states.
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75
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Cheng P, Johnson DA. Moving beyond the "model minority" myth to understand sleep health disparities in Asian American and Pacific Islander communities. J Clin Sleep Med 2021; 17:1969-1970. [PMID: 34170239 DOI: 10.5664/jcsm.9500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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76
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Xian Z, Saxena A, Javed Z, Jordan JE, Alkarawi S, Khan SU, Shah K, Vahidy FS, Nasir K, Dubey P. COVID-19-related state-wise racial and ethnic disparities across the USA: an observational study based on publicly available data from The COVID Tracking Project. BMJ Open 2021; 11:e048006. [PMID: 34155078 PMCID: PMC8219486 DOI: 10.1136/bmjopen-2020-048006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA. METHODS Publicly available data from The COVID Tracking Project at The Atlantic were accessed between 9 September 2020 and 14 September 2020. For each state and the District of Columbia, % infection, % death, and % population proportion for subgroups of race (African American/black (AA/black), Asian, American Indian or Alaska Native (AI/AN), and white) and ethnicity (Hispanic/Latino, non-Hispanic) were recorded. Crude and normalised disparity estimates were generated for COVID-19 infection (CDI and NDI) and mortality (CDM and NDM), computed as absolute and relative difference between % infection or % mortality and % population proportion per state. Choropleth map display was created as thematic representation proportionate to CDI, NDI, CDM and NDM. RESULTS The Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median 158%, IQR 100%-200%). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median 50%, IQR 25%-100%). The AA population had the most disproportionate mortality, with a median of 46% higher mortality than the % population proportion (median 46%, IQR 18%-66%). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian populations, with 100% excess infections than the % population proportion seen in nine states for AI/AN and seven states for Asian populations. There was no disproportionate impact in the white population in any state. CONCLUSIONS There are racial/ethnic disparities in COVID-19 infection/mortality, with distinct state-wise patterns across the USA based on racial/ethnic composition. There were missing and inconsistently reported racial/ethnic data in many states. This underscores the need for standardised reporting, attention to specific regional patterns, adequate resource allocation and addressing the underlying social determinants of health adversely affecting chronically marginalised groups.
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Affiliation(s)
| | - Anshul Saxena
- Baptist Health South Florida, Coral Gables, Florida, USA
| | | | - John E Jordan
- Radiology, Providence Little Company of Mary Medical Center Torrance, Torrance, California, USA
- Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Safa Alkarawi
- Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Safi U Khan
- Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Karan Shah
- Strake Jesuit College Preparatory School, Houston, Texas, USA
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77
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Balmes JR. Place Matters: Residential Racial Segregation and COPD. Am J Respir Crit Care Med 2021; 204:496-498. [PMID: 34138685 PMCID: PMC8491254 DOI: 10.1164/rccm.202105-1209ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- John R Balmes
- University of California Berkeley, 1438, Environmental Health Sciences, School of Public Health, Berkeley, California, United States.,University of California San Francisco, 8785, Department of Medicine, San Francisco, California, United States;
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78
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Brown CC, Young SG, Pro GC. COVID-19 vaccination rates vary by community vulnerability: A county-level analysis. Vaccine 2021; 39:4245-4249. [PMID: 34167838 PMCID: PMC8215509 DOI: 10.1016/j.vaccine.2021.06.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
We used the COVID-19 Community Vulnerability Index and 7 theme scores to assess associations between vulnerability and county-level COVID-19 vaccination (n = 2415 counties) through May 25th, 2021. When comparing vaccination rates among quintiles of CCVI scores, Theme 3 (housing type, transportation, household composition, and disability) was associated with the largest disparity, with the least vulnerable counties (Q1) having 33% higher rates of vaccination among individuals aged 18+ (53.5% vs 40.2%) compared to counties with the highest vulnerability (Q5). Using generalized linear models with binomial distributions and log links, we found that a 10-point increase in the CCVI index, socioeconomic vulnerability, housing type and composition, and epidemiological factors were associated with at least a 1.0 percentage point decline in county-level vaccination. The association between community vulnerability and lower vaccination rates suggests the need for continued efforts for equitable COVID-19 vaccination across marginalized communities.
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Affiliation(s)
- Clare C Brown
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Fay W Boozman College of Public Health, 4301 West Markham Slot #820, Little Rock, AR 72205, United States.
| | - Sean G Young
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Fay W Boozman College of Public Health, 4301 West Markham Slot #820, Little Rock, AR 72205, United States.
| | - George C Pro
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Fay W Boozman College of Public Health, 4301 West Markham Slot #820, Little Rock, AR 72205, United States.
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79
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Holden TM, Richardson RAK, Arevalo P, Duffus WA, Runge M, Whitney E, Wise L, Ezike NO, Patrick S, Cobey S, Gerardin J. Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020. BMC Public Health 2021; 21:1105. [PMID: 34107947 PMCID: PMC8189821 DOI: 10.1186/s12889-021-11177-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. METHODS We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. RESULTS By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50-80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. CONCLUSIONS Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission.
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Affiliation(s)
- Tobias M Holden
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Reese A K Richardson
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL, USA
| | - Philip Arevalo
- Department of Ecology and Evolutionary Biology, University of Chicago, Chicago, IL, USA
| | - Wayne A Duffus
- Center for Preparedness and Response, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Illinois Department of Public Health, Springfield, IL, USA
| | - Manuela Runge
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Elena Whitney
- Department of Ecology and Evolutionary Biology, University of Chicago, Chicago, IL, USA
| | - Leslie Wise
- Illinois Department of Public Health, Springfield, IL, USA
| | - Ngozi O Ezike
- Illinois Department of Public Health, Springfield, IL, USA
| | - Sarah Patrick
- Illinois Department of Public Health, Springfield, IL, USA
| | - Sarah Cobey
- Department of Ecology and Evolutionary Biology, University of Chicago, Chicago, IL, USA
| | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA.
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80
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Living Near an Immigration Detention Center: Impact on Latinas' Health. J Immigr Minor Health 2021; 24:626-638. [PMID: 34097163 PMCID: PMC8181535 DOI: 10.1007/s10903-021-01219-2] [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] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
There is ample evidence that exposure to Immigration and Customs Enforcement (ICE) activities could widen Latinas’ health disparities. Whether or not residing near an ICE detention center (IDC) further impacts their health is unknown. During nationwide increased ICE activities Latinas (N=45) attended an intervention at two separate sites: one near and another one far from an IDC. A focus group discussion and an interview were conducted using a grounded theory approach. Quantitative data were collected and analyzed. Participants residing near an IDC benefited less from the intervention and reported changes in anxiety levels and in mobility, and a sense of powerlessness. They also requested resources to respond to ICE overreach and broadcasting of their reality. Our results suggest that proximity to IDCs impacts immigrant communities and public health programming, which is inevitably embedded in political realities. These need to be addressed when providing much needed interventions.
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81
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Celedón JC. Building a Diverse Workforce in Pulmonary, Critical Care, and Sleep Medicine. ATS Sch 2021; 2:145-148. [PMID: 34409404 PMCID: PMC8357065 DOI: 10.34197/ats-scholar.2021-0038ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
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82
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Reitsma MB, Claypool AL, Vargo J, Shete PB, McCorvie R, Wheeler WH, Rocha DA, Myers JF, Murray EL, Bregman B, Dominguez DM, Nguyen AD, Porse C, Fritz CL, Jain S, Watt JP, Salomon JA, Goldhaber-Fiebert JD. Racial/Ethnic Disparities In COVID-19 Exposure Risk, Testing, And Cases At The Subcounty Level In California. Health Aff (Millwood) 2021; 40:870-878. [PMID: 33979192 PMCID: PMC8458028 DOI: 10.1377/hlthaff.2021.00098] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With a population of forty million and substantial geographic variation in sociodemographics and health services, California is an important setting in which to study disparities. Its population (37.5 percent White, 39.1 percent Latino, 5.3 percent Black, and 14.4 percent Asian) experienced 59,258 COVID-19 deaths through April 14, 2021-the most of any state. We analyzed California's racial/ethnic disparities in COVID-19 exposure risks, testing rates, test positivity, and case rates through October 2020, combining data from 15.4 million SARS-CoV-2 tests with subcounty exposure risk estimates from the American Community Survey. We defined "high-exposure-risk" households as those with one or more essential workers and fewer rooms than inhabitants. Latino people in California are 8.1 times more likely to live in high-exposure-risk households than White people (23.6 percent versus 2.9 percent), are overrepresented in cumulative cases (3,784 versus 1,112 per 100,000 people), and are underrepresented in cumulative testing (35,635 versus 48,930 per 100,000 people). These risks and outcomes were worse for Latino people than for members of other racial/ethnic minority groups. Subcounty disparity analyses can inform targeting of interventions and resources, including community-based testing and vaccine access measures. Tracking COVID-19 disparities and developing equity-focused public health programming that mitigates the effects of systemic racism can help improve health outcomes among California's populations of color.
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Affiliation(s)
- Marissa B Reitsma
- Marissa B. Reitsma is a PhD student in the Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Freeman Spogli Institute for International Studies and the Stanford School of Medicine, Stanford University, in Stanford, California. She and Anneke Claypool contributed equally to this article
| | - Anneke L Claypool
- Anneke L. Claypool is a PhD candidate in the Department of Management Science and Engineering, Stanford University. She and Marissa Reitsma contributed equally to this article
| | - Jason Vargo
- Jason Vargo is a lead research scientist in the Climate Change and Health Equity Program, Coronavirus Sciences Branch, and the Office of Health Equity, California Department of Public Health (CDPH), in Richmond, California
| | - Priya B Shete
- Priya B. Shete is an assistant professor in the Division of Pulmonary and Critical Care Medicine and UCSF Center for Tuberculosis, University of California San Francisco, and the COVID-19 modeling and analytics lead in the Coronavirus Sciences Branch, CDPH
| | - Ryan McCorvie
- Ryan McCorvie is a statistician in the Coronavirus Sciences Branch, CDPH
| | - William H Wheeler
- William H. Wheeler is a clinical informatics specialist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - David A Rocha
- David A. Rocha is a clinical informatics specialist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Jennifer F Myers
- Jennifer F. Myers is a senior informatics specialist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Erin L Murray
- Erin L. Murray is an epidemiologist supervisor in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Brooke Bregman
- Brooke Bregman is a senior epidemiologist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Deniz M Dominguez
- Deniz M. Dominguez is a surveillance program manager in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Alyssa D Nguyen
- Alyssa D. Nguyen is a research scientist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Charsey Porse
- Charsey Porse is an epidemiologist in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Curtis L Fritz
- Curtis L. Fritz is the State Public Health Veterinarian in the Coronavirus Sciences Branch and the Division of Communicable Disease Control, CDPH
| | - Seema Jain
- Seema Jain is the chief of the Disease Investigations Section, Infectious Diseases Branch, the Coronavirus Sciences Branch, and the Division of Communicable Disease Control, CDPH
| | - James P Watt
- James P. Watt is the chief of the Division of Communicable Disease Control, Coronavirus Sciences Branch, and the Division of Communicable Disease Control, CDPH
| | - Joshua A Salomon
- Joshua A. Salomon is a professor in the Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Freeman Spogli Institute for International Studies and the Stanford School of Medicine, Stanford University
| | - Jeremy D Goldhaber-Fiebert
- Jeremy D. Goldhaber-Fiebert is an associate professor in the Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Freeman Spogli Institute for International Studies and the Stanford School of Medicine, Stanford University
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Rao DR, Kopp B, Kamerman-Kretzmer RJ, Afolabi F, Liptzin DR, Balasubramaniam V, Sadreameli SC. Advocacy Considerations for the Pediatric Pulmonologist in the Era of the COVID-19 Pandemic. Ann Am Thorac Soc 2021; 18:942-945. [PMID: 33544048 PMCID: PMC8456734 DOI: 10.1513/annalsats.202008-1022ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/04/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Devika R. Rao
- Division of Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin Kopp
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Rory John Kamerman-Kretzmer
- Division of Pediatric Pulmonology, Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Folashade Afolabi
- Division of Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deborah R. Liptzin
- Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Vivek Balasubramaniam
- Division of Pediatric Pulmonology and Sleep Medicine, University of Wisconsin–Madison, Madison, Wisconsin; and
| | - S. Christy Sadreameli
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland
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84
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Strategies to DAMPen COVID-19-mediated lung and systemic inflammation and vascular injury. Transl Res 2021; 232:37-48. [PMID: 33358868 PMCID: PMC7749994 DOI: 10.1016/j.trsl.2020.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
Approximately 15%-20% of patients infected with SARS-CoV-2 coronavirus (COVID-19) progress beyond mild and self-limited disease to require supplemental oxygen for severe pneumonia; 5% of COVID-19-infected patients further develop acute respiratory distress syndrome (ARDS) and multiorgan failure. Despite mortality rates surpassing 40%, key insights into COVID-19-induced ARDS pathology have not been fully elucidated and multiple unmet needs remain. This review focuses on the unmet need for effective therapies that target unchecked innate immunity-driven inflammation which drives unchecked vascular permeability, multiorgan dysfunction and ARDS mortality. Additional unmet needs including the lack of insights into factors predicting pathogenic hyperinflammatory viral host responses, limited approaches to address the vast disease heterogeneity in ARDS, and the absence of clinically-useful ARDS biomarkers. We review unmet needs persisting in COVID-19-induced ARDS in the context of the potential role for damage-associated molecular pattern proteins in lung and systemic hyperinflammatory host responses to SARS-CoV-2 infection that ultimately drive multiorgan dysfunction and ARDS mortality. Insights into promising stratification-enhancing, biomarker-based strategies in COVID-19 and non-COVID ARDS may enable the design of successful clinical trials of promising therapies.
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Key Words
- ace2, angiotensin converting enzyme 2
- ang-2, angiopoietin-2
- ards, acute respiratory distress syndrome
- covid-19, coronavirus disease 19 infection
- crp, c-reactive protein
- damps, damage-associated molecular pattern proteins
- enampt, extracellular nicotinamide phosphoribosyl-transferase
- ifnγ, interferon gamma
- il-1ra, interleukin 1 receptor antagonist
- il-6, interleukin 6
- ip-10, interferon gamma-induced protein 10
- irf7, interferon regulatory factor 7
- mcp1, monocyte chemoattractant protein 1
- mif, macrophage migration inhibition factor
- hmgb1, the high mobility group box 1 protein
- no, nitric oxide
- pamps, pathogen-associated molecular pattern proteins
- ripk1, receptor-interacting serine/threonine-protein kinase
- ros, reactive oxygen species
- sars-cov-2, severe acute respiratory syndrome-related coronavirus 2
- smi, small molecule inhibitor
- tlrs, toll-like family of receptors
- tnfα, tumor necrosis factor alpha
- vili, ventilator-induced lung injury
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85
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Gibbons J. Distancing the socially distanced: Racial/ethnic composition's association with physical distancing in response to COVID-19 in the U.S. PLoS One 2021; 16:e0251960. [PMID: 34038459 PMCID: PMC8153499 DOI: 10.1371/journal.pone.0251960] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/06/2021] [Indexed: 12/05/2022] Open
Abstract
Social distancing prescribed by policy makers in response to COVID-19 raises important questions as to how effectively people of color can distance. Due to inequalities from residential segregation, Hispanic and Black populations have challenges in meeting health expectations. However, segregated neighborhoods also support the formation of social bonds that relate to healthy behaviors. We evaluate the question of non-White distancing using social mobility data from Google on three sites: workplaces, grocery stores, and recreational locations. Employing hierarchical linear modeling and geographically weighted regression, we find the relation of race/ethnicity to COVID-19 distancing is varied across the United States. The HLM models show that compared to Black populations, Hispanic populations overall more effectively distance from recreation sites and grocery stores: each point increase in percent Hispanic was related to residents being 0.092 percent less likely (p< 0.05) to visit recreational sites and 0.127 percent less likely (p< 0.01) to visit grocery stores since the onset of COVID-19. However, the GWR models show there are places where the percent Black is locally related to recreation distancing while percent Hispanic is not. Further, these models show the association of percent Black to recreation and grocery distancing can be locally as strong as 1.057 percent (p< 0.05) and 0.989 percent (p< 0.05), respectively. Next, the HLM models identified that Black/White residential isolation was related to less distancing, with each point of isolation residents were 11.476 percent more likely (p< 0.01) to go to recreational sites and 7.493 percent more likely (p< 0.05) to visit grocery stores compared to before COVID-19. These models did not find a measurable advantage/disadvantage for Black populations in these places compared to White populations. COVID-19 policy should not assume disadvantage in achieving social distancing accrue equally to different racial/ethnic minorities.
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Affiliation(s)
- Joseph Gibbons
- Sociology, San Diego State University, San Diego, California, United States of America
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86
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Parent-Child Relationships and the COVID-19 Pandemic: An Exploratory Qualitative Study with Parents in Early, Middle, and Late Adulthood. JOURNAL OF ADULT DEVELOPMENT 2021; 28:251-263. [PMID: 34035642 PMCID: PMC8136369 DOI: 10.1007/s10804-021-09381-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/05/2022]
Abstract
The impact of the COVID-19 pandemic on families is currently unknown. Parents and children have experienced a variety of changes as public health interventions have been implemented to slow the spread of the virus. The current exploratory qualitative study recruited parents (n = 365) in early (ages 20–34), middle (ages 35–64), and late (ages 65 and older) adulthood to understand how the early weeks of the pandemic influenced their parent–child relationships. Participants completed an online survey between March 21 and 31, 2020. Three themes emerged through qualitative content analysis: (1) relational steadiness, (2) navigating COVID-19 challenges in relationships, and (3) relational enhancement.
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87
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Ma KC, Menkir TF, Kissler S, Grad YH, Lipsitch M. Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics. eLife 2021; 10:e66601. [PMID: 34003112 PMCID: PMC8221808 DOI: 10.7554/elife.66601] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background The impact of variable infection risk by race and ethnicity on the dynamics of SARS-CoV-2 spread is largely unknown. Methods Here, we fit structured compartmental models to seroprevalence data from New York State and analyze how herd immunity thresholds (HITs), final sizes, and epidemic risk change across groups. Results A simple model where interactions occur proportionally to contact rates reduced the HIT, but more realistic models of preferential mixing within groups increased the threshold toward the value observed in homogeneous populations. Across all models, the burden of infection fell disproportionately on minority populations: in a model fit to Long Island serosurvey and census data, 81% of Hispanics or Latinos were infected when the HIT was reached compared to 34% of non-Hispanic whites. Conclusions Our findings, which are meant to be illustrative and not best estimates, demonstrate how racial and ethnic disparities can impact epidemic trajectories and result in unequal distributions of SARS-CoV-2 infection. Funding K.C.M. was supported by National Science Foundation GRFP grant DGE1745303. Y.H.G. and M.L. were funded by the Morris-Singer Foundation. M.L. was supported by SeroNet cooperative agreement U01 CA261277.
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Affiliation(s)
- Kevin C Ma
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
| | - Tigist F Menkir
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public HealthBostonUnited States
| | - Stephen Kissler
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
- Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical SchoolBostonUnited States
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public HealthBostonUnited States
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public HealthBostonUnited States
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88
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Villalobos Dintrans P, Castillo C, de la Fuente F, Maddaleno M. COVID-19 incidence and mortality in the Metropolitan Region, Chile: Time, space, and structural factors. PLoS One 2021; 16:e0250707. [PMID: 33956827 PMCID: PMC8101927 DOI: 10.1371/journal.pone.0250707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/13/2021] [Indexed: 02/07/2023] Open
Abstract
Demographic, health, and socioeconomic factors significantly inform COVID-19 outcomes. This article analyzes the association of these factors and outcomes in Chile during the first five months of the pandemic. Using the municipalities Metropolitan Region's municipalities as the unit of analysis, the study looks at the role of time dynamics, space, and place in cases and deaths over a 100-day period between March and July 2020. As a result, common and idiosyncratic elements explain the prevalence and dynamics of infections and mortality. Social determinants of health, particularly multidimensional poverty index and use of public transportation play an important role in explaining differences in outcomes. The article contributes to the understanding of the determinants of COVID-19 highlighting the need to consider time-space dynamics and social determinants as key in the analysis. Structural factors are important to identify at-risk populations and to select policy strategies to prevent and mitigate the effects of COVID-19. The results are especially relevant for similar research in unequal settings.
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Affiliation(s)
- Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Estación Central, Santiago, Chile
| | - Claudio Castillo
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Estación Central, Santiago, Chile
| | - Felipe de la Fuente
- Departamento de Enfermería, Facultad de Medicina, Universidad de Chile, Independencia, Santiago, Chile
| | - Matilde Maddaleno
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Estación Central, Santiago, Chile
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89
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Sanford EL, Zagory J, Blackwell JM, Szmuk P, Ryan M, Ambardekar A. Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital. J Pediatr Surg 2021; 56:918-922. [PMID: 33516579 PMCID: PMC7817462 DOI: 10.1016/j.jpedsurg.2021.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Trauma is the leading cause of morbidity and mortality in the pediatric population. However, during the societal disruptions secondary to the coronavirus (COVID-19) stay-at-home regulations, there have been reported changes to the pattern and severity of pediatric trauma. We review our two-institution experience. METHODS Pediatric trauma emergency department (ED) encounters from the National Trauma Registry for a large, tertiary, metropolitan level 1 pediatric trauma center and pediatric burn admission at the regional burn center were extracted for children less than 19 years from March 15th thru May 15th during the years 2015-2020. The primary outcome was the difference in encounters during the COVID-19 (2020) epoch versus the pre-COVID-19 epoch (2015-2019). RESULTS There were 392 pediatric trauma encounters during the COVID-19 epoch as compared to 451, 475, 520, 460, 432 (mean 467.6) during the pre-COVID-19 epoch. Overall trauma admissions and ED trauma encounters were significantly lower (p < 0.001) during COVID-19. Burn injury admissions (p < 0.001) and penetrating trauma encounters (p = 0.002) increased during the COVID-19 epoch while blunt trauma encounters decreased (p < 0.001). Trauma occurred among more white (p = 0.01) and privately insured (p < 0.001) children, but no difference in suspected abuse, injury severity, mortality, age, or gender were detected. Sub-analysis showed significant decreases in motor vehicle crashes (p < 0.001), pedestrians struck by automobile (p < 0.001), all-terrain vehicle (ATV)/motorcross/bicycle/skateboard involved injuries (p = 0.02), falls (p < 0.001), and sports related injuries (p < 0.001). Fewer injuries occurring in the playground or home play equipment such as trampolines neared significance (p = 0.05). Interpersonal violence (assault, NAT, self-harm) was lower during the COVID-19 era (p = 0.04). For burn admissions, there was a significant increase in flame burns (p < 0.001). CONCLUSIONS Stay-at-home regulations alter societal patterns, leading to decreased overall and blunt traumas. However, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.
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Affiliation(s)
- Ethan L Sanford
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States; Children's Health, Division of Pediatric Critical Care, Dallas TX, United States; Outcome Research Consortium, Cleveland, OH, United States
| | - Jessica Zagory
- Department of Surgery, Division of Pediatric Surgery, Louisiana State University Health Sciences Center, New Orleans LA, United States; Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas TX, United States.
| | - James-Michael Blackwell
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Peter Szmuk
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States; Outcome Research Consortium, Cleveland, OH, United States
| | - Mark Ryan
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Aditee Ambardekar
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States
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90
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Community health workers and non-clinical patient navigators: A critical COVID-19 pandemic workforce. Prev Med 2021; 146:106464. [PMID: 33636194 PMCID: PMC7901305 DOI: 10.1016/j.ypmed.2021.106464] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/13/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic has resulted in substantial morbidity and mortality and challenged public health agencies and healthcare systems worldwide. In the U.S., physical distancing orders and other restrictions have had severe economic and societal consequences. Populations already vulnerable in the United States have experienced worse COVID-19 health outcomes. The World Health Organization has made recommendations to engage at risk populations and communicate accurate information about risk and prevention; to conduct contract tracing; and to support those affected by COVID-19. This Commentary highlights the ways in which an existing and cost-effective, but underutilized workforce, community health workers and non-clinical patient navigators, should be deployed to address the COVID-19 pandemic. Community health workers and non-clinical patient navigators have skills in community engagement and health communication and are able to gain the trust of vulnerable communities. Furthermore, many community health workers and non-clinical patient navigators have skills in assisting community members with meeting basic needs and with navigating public health and healthcare systems. Members of this workforce are more than prepared to conduct contact tracing. State, local, tribal, and territorial public health agencies and healthcare systems should be collaborating with national, state, and local organizations that represent and employ CHWs/non-clinical patient navigators to determine how to better mobilize this workforce to address the COVID-19 pandemic. Furthermore, Congress, the Centers for Medicare & Medicaid Services (CMS), and individual states need to adopt policies to sustainably fund their critically needed services in the long term.
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91
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Celedón JC. The American Thoracic Society Leadership in a Year Like No Other. Am J Respir Crit Care Med 2021; 203:1068-1069. [PMID: 33749544 PMCID: PMC8314906 DOI: 10.1164/rccm.202103-0640ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Juan C Celedón
- Division of Pediatric Pulmonary Medicine University of Pittsburgh Medical Center Children's Hospital of Pittsburgh and University of Pittsburgh Pittsburgh, Pennsylvania
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92
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Holden TM, Richardson RA, Arevalo P, Duffus WA, Runge M, Whitney E, Wise L, Ezike NO, Patrick S, Cobey S, Gerardin J. Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.14.21255476. [PMID: 33907762 PMCID: PMC8077585 DOI: 10.1101/2021.04.14.21255476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. Methods We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. Results By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50-80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. Conclusions Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission.
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Affiliation(s)
- Tobias M Holden
- Northwestern University Feinberg School of Medicine,
Chicago IL
| | - Reese A.K. Richardson
- Department of Chemical and Biological Engineering,
Northwestern University, Evanston IL
| | - Philip Arevalo
- Department of Ecology and Evolutionary Biology, University
of Chicago, Chicago IL
| | - Wayne A. Duffus
- Center for Preparedness and Response, Division of State and
Local Readiness, Centers for Disease Control and Prevention, Atlanta GA
- Illinois Department of Public Health, Springfield IL
| | - Manuela Runge
- Department of Preventive Medicine and Institute for Global
Health, Northwestern University, Chicago IL
| | - Elena Whitney
- Department of Ecology and Evolutionary Biology, University
of Chicago, Chicago IL
| | - Leslie Wise
- Illinois Department of Public Health, Springfield IL
| | | | - Sarah Patrick
- Illinois Department of Public Health, Springfield IL
| | - Sarah Cobey
- Department of Ecology and Evolutionary Biology, University
of Chicago, Chicago IL
| | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global
Health, Northwestern University, Chicago IL
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93
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Tangcharoensathien V, Yamamoto N, Topothai C, Pangkariya N, Patcharanarumol W, Suphanchaimat R. Lessons for effective COVID-19 policy responses: a call for papers. Bull World Health Organ 2021; 99:243-243A. [PMID: 36226907 PMCID: PMC8085626 DOI: 10.2471/blt.21.285877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Viroj Tangcharoensathien
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Nonthaburi 11000, Thailand
| | - Naoko Yamamoto
- Healthier Populations Division, World Health Organization, Geneva, Switzerland
| | - Chompoonut Topothai
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Nonthaburi 11000, Thailand
| | - Nattanicha Pangkariya
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Nonthaburi 11000, Thailand
| | - Walaiporn Patcharanarumol
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Nonthaburi 11000, Thailand
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Nonthaburi 11000, Thailand
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94
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Santhosh L, Block B, Kim SY, Raju S, Shah RJ, Thakur N, Brigham EP, Parker AM. Rapid Design and Implementation of Post-COVID-19 Clinics. Chest 2021; 160:671-677. [PMID: 33811910 PMCID: PMC8010340 DOI: 10.1016/j.chest.2021.03.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
Survivors of COVID-19 are a vulnerable population, with complex needs because of lingering symptoms and complications across multiple organ systems. Those who required hospitalization or intensive care are also at risk for post-hospital syndrome and post-ICU syndromes, with attendant cognitive, psychological, and physical impairments, and high levels of health care utilization. Effective ambulatory care for COVID-19 survivors requires coordination across multiple subspecialties, which can be burdensome if not well coordinated. With growing recognition of these needs, post-COVID-19 clinics are being created across the country. We describe the design and implementation of multidisciplinary post-COVID-19 clinics at two academic health systems, Johns Hopkins and the University of California-San Francisco. We highlight components of the model which should be replicated across sites, while acknowledging opportunities to tailor offerings to the local institutional context. Our goal is to provide a replicable framework for others to create these much-needed care delivery models for survivors of COVID-19.
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Affiliation(s)
| | - Brian Block
- University of California-San Francisco, San Francisco, CA
| | | | | | - Rupal J Shah
- University of California-San Francisco, San Francisco, CA
| | - Neeta Thakur
- Zuckerberg San Francisco General Hospital, San Francisco, CA
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95
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Addressing Systemic Racism in Nursing Homes: A Time for Action. J Am Med Dir Assoc 2021; 22:886-892. [PMID: 33775548 DOI: 10.1016/j.jamda.2021.02.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 11/22/2022]
Abstract
Long-term services and supports for older persons in the United States are provided in a complex, racially segregated system, with striking racial disparities in access, process, and outcomes of care for residents, which have been magnified during the Coronavirus Disease 2019 pandemic. These disparities are in large measure the result of longstanding patterns of structural, interpersonal, and cultural racism in US society, which in aggregate represent an underpinning of systemic racism that permeates the long-term care system's organization, administration, regulations, and human services. Mechanisms underlying the role of systemic racism in producing the observed disparities are numerous. Long-term care is fundamentally tied to geography, thereby reflecting disparities associated with residential segregation. Additional foundational drivers include a fragmented payment system that advantages persons with financial resources, and reimbursement policies that systematically undervalue long-term care workers. Eliminating disparities in health outcomes in these settings will therefore require a comprehensive approach to eliminating the role of systemic racism in promoting racial disparities.
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96
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Binns C, Low WY. The Rich Get Richer and the Poor Get Poorer: The Inequality of COVID-19. Asia Pac J Public Health 2021; 33:185-187. [PMID: 33759590 DOI: 10.1177/10105395211001662] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Colin Binns
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Wah Yun Low
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Asia-Europe Institute, University of Malaya, Kuala Lumpur, Malaysia
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97
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Neelon B, Mutiso F, Mueller NT, Pearce JL, Benjamin-Neelon SE. Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States. PLoS One 2021; 16:e0248702. [PMID: 33760849 PMCID: PMC7990180 DOI: 10.1371/journal.pone.0248702] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. METHODS We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. RESULTS At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. CONCLUSIONS The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.
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Affiliation(s)
- Brian Neelon
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, South Carolina, United States of America
| | - Fedelis Mutiso
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Noel T. Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - John L. Pearce
- Division of Environmental Health, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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98
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Boal WL, Li J, Silver SR. Health Care Access Among Essential Critical Infrastructure Workers, 31 States, 2017-2018. Public Health Rep 2021; 137:301-309. [PMID: 33715502 PMCID: PMC8900242 DOI: 10.1177/0033354921996688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Essential workers in the United States need access to health care services for preventive care and for diagnosis and treatment of illnesses (coronavirus disease 2019 [COVID-19] or other infectious or chronic diseases) to remain healthy and continue working during a pandemic. This study evaluated access to health care services among selected essential workers. METHODS We used the most recent data from the Behavioral Risk Factor Surveillance System, 2017-2018, to estimate the prevalence of 4 measures of health care access (having health insurance, being able to afford to see a doctor when needed, having a personal health care provider, and having a routine checkup in the past year) by broad and detailed occupation group among 189 208 adults aged 18-64. RESULTS Of all occupations studied, workers in farming, fishing, and forestry occupations were most likely to have no health insurance (46.4%). Personal care aides were most likely to have been unable to see a doctor when needed because of cost (29.3%). Construction laborers were most likely to lack a personal health care provider (51.1%) and to have not had a routine physical checkup in the past year (50.6%). Compared with workers in general, workers in 3 broad occupation groups-food preparation and serving; building and grounds cleaning and maintenance; and construction trades-had significantly lower levels of health care access for all 4 measures. CONCLUSION Lack of health insurance and underinsurance were common among subsets of essential workers. Limited access to health care might decrease essential workers' access to medical testing and needed care and hinder their ability to address underlying conditions, thereby increasing their risk of severe outcomes from some infectious diseases, such as COVID-19. Improving access to health care for all workers, including essential workers, is critical to ensure workers' health and workforce stability.
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Affiliation(s)
- Winifred L. Boal
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH, USA,Winifred L. Boal, MPH, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, 1090 Tusculum Ave, R-17, Cincinnati, OH 45226, USA;
| | - Jia Li
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Sharon R. Silver
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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99
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Ali SH, Tozan Y, Jones AM, Foreman J, Capasso A, DiClemente RJ. Regional and socioeconomic predictors of perceived ability to access coronavirus testing in the United States: results from a nationwide online COVID-19 survey. Ann Epidemiol 2021; 58:7-14. [PMID: 33691088 PMCID: PMC7937327 DOI: 10.1016/j.annepidem.2021.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/10/2021] [Accepted: 03/01/2021] [Indexed: 01/22/2023]
Abstract
Purpose Access to COVID-19 testing remained a salient issue during the early months of the pandemic, therefore this study aimed to identify 1) regional and 2) socioeconomic predictors of perceived ability to access Coronavirus testing. Methods An online survey using social media-based advertising was conducted among U.S. adults in April 2020. Participants were asked whether they thought they could acquire a COVID-19 test, along with basic demographic, socioeconomic and geographic information. Results A total of 6,378 participants provided data on perceived access to COVID-19 testing. In adjusted analyses, we found higher income and possession of health insurance to be associated with perceived ability to access Coronavirus testing. Geographically, perceived access was highest (68%) in East South Central division and lowest (39%) in West North Central. Disparities in health insurance coverage did not directly correspond to disparities in perceived access to COVID-19 testing. Conclusions Sex, geographic location, income, and insurance status were associated with perceived access to COVID-19 testing; interventions aimed at improving either access or awareness of measures taken to improve access are warranted. These findings from the pandemic's early months shed light on the importance of disaggregating perceived and true access to screening during such crises.
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Affiliation(s)
- Shahmir H Ali
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY
| | - Yesim Tozan
- Global Health Program, School of Global Public Health, New York University, New York, NY
| | - Abbey M Jones
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY
| | - Joshua Foreman
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Ariadna Capasso
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY
| | - Ralph J DiClemente
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY.
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100
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Baker CN, Peele H, Daniels M, Saybe M, Whalen K, Overstreet S, The New Orleans TISLC. The Experience of COVID-19 and Its Impact on Teachers’ Mental Health, Coping, and Teaching. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2020.1855473] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Courtney N. Baker
- Tulane University of Louisiana
- New Orleans Trauma-Informed Schools Learning Collaborative
| | | | | | | | - Kathleen Whalen
- Tulane University of Louisiana
- New Orleans Trauma-Informed Schools Learning Collaborative
| | - Stacy Overstreet
- Tulane University of Louisiana
- New Orleans Trauma-Informed Schools Learning Collaborative
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