101
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Danielsen AC, Lee KM, Boulicault M, Rushovich T, Gompers A, Tarrant A, Reiches M, Shattuck-Heidorn H, Miratrix LW, Richardson SS. Sex disparities in COVID-19 outcomes in the United States: Quantifying and contextualizing variation. Soc Sci Med 2022; 294:114716. [PMID: 35042136 PMCID: PMC8743486 DOI: 10.1016/j.socscimed.2022.114716] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 12/26/2022]
Abstract
This paper presents the first longitudinal study of sex disparities in COVID-19 cases and mortalities across U.S. states, derived from the unique 13-month dataset of the U.S. Gender/Sex COVID-19 Data Tracker. To analyze sex disparities, weekly case and mortality rates by sex and mortality rate ratios were computed for each U.S. state, and a multilevel crossed-effects conditional logistic binomial regression model was fitted to estimate the variation of the sex disparity in mortality over time and across states. Results demonstrate considerable variation in the sex disparity in COVID-19 cases and mortalities over time and between states. These data suggest that the sex disparity, when present, is modest, and likely varies in relation to context-sensitive variables, which may include health behaviors, preexisting health status, occupation, race/ethnicity, and other markers of social experience.
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Affiliation(s)
| | - Katharine Mn Lee
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Marion Boulicault
- Department of Linguistics and Philosophy, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA; Department of Philosophy, University of Adelaide, 259 North Terrace, Adelaide, SA, 5000, Australia
| | - Tamara Rushovich
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Amelia Tarrant
- Department of Human Evolutionary Biology, Harvard University, 11 Divinity Avenue, Cambridge, MA, 02138, USA
| | - Meredith Reiches
- Department of Anthropology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA, 02125, USA
| | - Heather Shattuck-Heidorn
- Women and Gender Studies, University of Southern Maine, 94 Bedford Street, Portland, ME, 04102, USA
| | - Luke W Miratrix
- Harvard Graduate School of Education, 13 Appian Way, Cambridge, MA, 02138, USA
| | - Sarah S Richardson
- Department of the History of Science, Harvard University, 1 Oxford St, Cambridge, MA, 02138, USA; Committee on Degrees in Studies of Women, Gender, and Sexuality, Harvard University, Boylston Hall, Cambridge, MA, 02138, USA
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102
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Abstract
In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ana V. Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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103
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Zalla LC, Mulholland GE, Filiatreau LM, Edwards JK. Racial/Ethnic and Age Differences in the Direct and Indirect Effects of the COVID-19 Pandemic on US Mortality. Am J Public Health 2022; 112:154-164. [PMID: 34936406 PMCID: PMC8713607 DOI: 10.2105/ajph.2021.306541] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 01/03/2023]
Abstract
Objectives. To estimate the direct and indirect effects of the COVID-19 pandemic on overall, race/ethnicity‒specific, and age-specific mortality in 2020 in the United States. Methods. Using surveillance data, we modeled expected mortality, compared it to observed mortality, and estimated the share of "excess" mortality that was indirectly attributable to the pandemic versus directly attributed to COVID-19. We present absolute risks and proportions of total pandemic-related mortality, stratified by race/ethnicity and age. Results. We observed 16.6 excess deaths per 10 000 US population in 2020; 84% were directly attributed to COVID-19. The indirect effects of the pandemic accounted for 16% of excess mortality, with proportions as low as 0% among adults aged 85 years and older and more than 60% among those aged 15 to 44 years. Indirect causes accounted for a higher proportion of excess mortality among racially minoritized groups (e.g., 32% among Black Americans and 23% among Native Americans) compared with White Americans (11%). Conclusions. The effects of the COVID-19 pandemic on mortality and health disparities are underestimated when only deaths directly attributed to COVID-19 are considered. An equitable public health response to the pandemic should also consider its indirect effects on mortality. (Am J Public Health. 2022;112(1):154-164. https://doi.org/10.2105/AJPH.2021.306541).
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Affiliation(s)
- Lauren C Zalla
- The authors are with the Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Grace E Mulholland
- The authors are with the Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Lindsey M Filiatreau
- The authors are with the Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Jessie K Edwards
- The authors are with the Department of Epidemiology, University of North Carolina at Chapel Hill
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104
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Hege A, Lane S, Spaulding T, Sugg M, Iyer LS. County-Level Social Determinants of Health and COVID-19 in Nursing Homes, United States, June 1, 2020-January 31, 2021. Public Health Rep 2022; 137:137-148. [PMID: 34788163 PMCID: PMC8721753 DOI: 10.1177/00333549211053666] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Nursing homes are a primary setting of COVID-19 transmission and death, but research has primarily focused only on factors within nursing homes. We investigated the relationship between US nursing home-associated COVID-19 infection rates and county-level and nursing home attributes. METHODS We constructed panel data from the Centers for Medicare & Medicaid Services (CMS) minimum dataset, CMS nursing home data, 2010 US Census data, 5-year (2012-2016) American Community Survey estimates, and county COVID-19 infection rates. We analyzed COVID-19 data from June 1, 2020, through January 31, 2021, during 7 five-week periods. We used a maximum likelihood estimator, including an autoregressive term, to estimate effects and changes over time. We performed 3 model forms (basic, partial, and full) for analysis. RESULTS Nursing homes with nursing (0.005) and staff (0.002) shortages had high COVID-19 infection rates, and locally owned (-0.007) or state-owned (-0.025) and nonprofit (-0.011) agencies had lower COVID-19 infection rates than privately owned agencies. County-level COVID-19 infection rates corresponded with COVID-19 infection rates in nursing homes. Racial and ethnic minority groups had high nursing home-associated COVID-19 infection rates early in the study. High median annual personal income (-0.002) at the county level correlated with lower nursing home-associated COVID-19 infection rates. CONCLUSIONS Communities with low rates of nursing home infections had access to more resources (eg, financial resources, staffing) and likely had better mitigation efforts in place earlier in the pandemic than nursing homes that had access to few resources and poor mitigation efforts. Future research should address the social and structural determinants of health that are leaving racial and ethnic minority populations and institutions such as nursing homes vulnerable during times of crises.
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Affiliation(s)
- Adam Hege
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Sandi Lane
- Department of Nutrition and Healthcare Management, Appalachian State University, Boone, NC, USA
| | - Trent Spaulding
- Department of Nutrition and Healthcare Management, Appalachian State University, Boone, NC, USA
| | - Margaret Sugg
- Department of Geography and Planning, Appalachian State University, Boone, NC, USA
| | - Lakshmi S. Iyer
- Department of Computer Information Systems, Appalachian State University, Boone, NC, USA
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105
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Luck AN, Preston SH, Elo IT, Stokes AC. The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality. SSM Popul Health 2021; 17:101012. [PMID: 34961843 PMCID: PMC8697426 DOI: 10.1016/j.ssmph.2021.101012] [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] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 12/18/2021] [Indexed: 11/24/2022] Open
Abstract
Despite a growing body of literature focused on racial/ethnic disparities in Covid-19 mortality, few previous studies have examined the pandemic's impact on 2020 cause-specific mortality by race and ethnicity. This paper documents changes in mortality by underlying cause of death and race/ethnicity between 2019 and 2020. Using age-standardized death rates, we attribute changes for Black, Hispanic, and White populations to various underlying causes of death and show how these racial and ethnic patterns vary by age and sex. We find that although Covid-19 death rates in 2020 were highest in the Hispanic community, Black individuals faced the largest increase in all-cause mortality between 2019 and 2020. Exceptionally large increases in mortality from heart disease, diabetes, and external causes of death accounted for the adverse trend in all-cause mortality within the Black population. Within Black and White populations, percentage increases in all-cause mortality were similar for men and women, as well as for ages 25–64 and 65+. Among the Hispanic population, however, percentage increases in mortality were greatest for working-aged men. These findings reveal that the overall impact of the pandemic on racial/ethnic disparities in mortality was much larger than that captured by official Covid-19 death counts alone.
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Affiliation(s)
- Anneliese N Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel H Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Irma T Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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106
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Not a token! A discussion on racial capitalism and its impact on academic librarians and libraries. REFERENCE SERVICES REVIEW 2021. [DOI: 10.1108/rsr-06-2021-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this article is to introduce the concept of racial capitalism in the context of academic libraries.
Design/methodology/approach
This paper draws on Leong's (2013) extended theory of racial capitalism and identifies how neoliberalism and racial capitalism are tied as well as how it is manifested in academic libraries through tokenism, racialized tasks, consuming racial trauma, cultural performance demands, workload demands and pay inequity.
Findings
The article ends with some suggestions in how to address these problematic practices though dismantling meritocratic systems, critical race theory in LIS education and training, and funding EDI work.
Originality/value
The article explores a concept in the academic library context and points to practices and structures that may commodify racialized identities.
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107
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Schnake-Mahl AS, Lazo M, Dureja K, Ehtesham N, Bilal U. Racial and ethnic inequities in occupational exposure across and between US cities. SSM Popul Health 2021; 16:100959. [PMID: 34805478 PMCID: PMC8590507 DOI: 10.1016/j.ssmph.2021.100959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022] Open
Abstract
Research suggests that racial/ethnic disparities in COVID-19 in the US are largely driven by higher rates of exposure to SARS-CoV-2 among Hispanic/Latino and Black populations. Occupational exposures play a large role in structuring risk of exposure, and essential workers are at elevated risk of COVID-19 infection. At a national-level, workers categorized as "essential" and "high-risk" are disproportionately Hispanic/Latino, but we lack analysis examining local-level racial/ethnic disparities in potential occupational exposures. Using the 2015-2019 5-year American Community Survey, we estimated disparities between the proportion of US Born Hispanic/Latino, foreign-born Hispanic/Latino, and non-Hispanic white (NHW) essential or high-risk workers in 27 of the largest metropolitan areas in the country. We found that, on average, 66.3%, 69.9%, and 62.6% of US-born Hispanics, foreign-born Hispanics, and NHW, respectively, are essential workers, while 50.7%, 49.9%, 49.5% are high exposure risk workers, respectively. The median absolute difference in proportions of US born Hispanic/Latino and NHW essential workers was 4.2%, and between foreign-born Hispanic/Latino and NHW essential workers was 7.5%, but these disparities varied widely by city. High likelihood of occupational transmission may help explain disparities in COVID-19 infection and mortality for Hispanic/Latino populations, especially foreign-born, and may also help explain heterogeneity in the magnitude of these disparities, with relevance for other acute infectious respiratory illnesses spread in the workplace.
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Affiliation(s)
- Alina S. Schnake-Mahl
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Mariana Lazo
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Kristina Dureja
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Nahian Ehtesham
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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108
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Shiels MS, Haque AT, Haozous EA, Albert PS, Almeida JS, García-Closas M, Nápoles AM, Pérez-Stable EJ, Freedman ND, Berrington de González A. Racial and Ethnic Disparities in Excess Deaths During the COVID-19 Pandemic, March to December 2020. Ann Intern Med 2021; 174:1693-1699. [PMID: 34606321 PMCID: PMC8489677 DOI: 10.7326/m21-2134] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although racial/ethnic disparities in U.S. COVID-19 death rates are striking, focusing on COVID-19 deaths alone may underestimate the true effect of the pandemic on disparities. Excess death estimates capture deaths both directly and indirectly caused by COVID-19. OBJECTIVE To estimate U.S. excess deaths by racial/ethnic group. DESIGN Surveillance study. SETTING United States. PARTICIPANTS All decedents. MEASUREMENTS Excess deaths and excess deaths per 100 000 persons from March to December 2020 were estimated by race/ethnicity, sex, age group, and cause of death, using provisional death certificate data from the Centers for Disease Control and Prevention (CDC) and U.S. Census Bureau population estimates. RESULTS An estimated 2.88 million deaths occurred between March and December 2020. Compared with the number of expected deaths based on 2019 data, 477 200 excess deaths occurred during this period, with 74% attributed to COVID-19. Age-standardized excess deaths per 100 000 persons among Black, American Indian/Alaska Native (AI/AN), and Latino males and females were more than double those in White and Asian males and females. Non-COVID-19 excess deaths also disproportionately affected Black, AI/AN, and Latino persons. Compared with White males and females, non-COVID-19 excess deaths per 100 000 persons were 2 to 4 times higher in Black, AI/AN, and Latino males and females, including deaths due to diabetes, heart disease, cerebrovascular disease, and Alzheimer disease. Excess deaths in 2020 resulted in substantial widening of racial/ethnic disparities in all-cause mortality from 2019 to 2020. LIMITATIONS Completeness and availability of provisional CDC data; no estimates of precision around results. CONCLUSION There were profound racial/ethnic disparities in excess deaths in the United States in 2020 during the COVID-19 pandemic, resulting in rapid increases in racial/ethnic disparities in all-cause mortality between 2019 and 2020. PRIMARY FUNDING SOURCE National Institutes of Health Intramural Research Program.
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Affiliation(s)
- Meredith S Shiels
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Anika T Haque
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Emily A Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico (E.A.H.)
| | - Paul S Albert
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Jonas S Almeida
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Montserrat García-Closas
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Anna M Nápoles
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland (A.M.N., E.J.P.)
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland (A.M.N., E.J.P.)
| | - Neal D Freedman
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
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109
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Wentzell E, Racila AM. Collective Care Amid US Individualism Through COVID-19 Vaccine Trial Participation. Med Anthropol 2021; 41:34-48. [PMID: 34781803 DOI: 10.1080/01459740.2021.1998041] [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: 10/19/2022]
Abstract
We analyze interviews with participants in a COVID-19 vaccine trial to show how Americans navigate conflicting discourses of individual rights and collective responsibility by using individual health behavior to care for others. We argue that interviewees drew on ideologies of "collective biology" - understanding themselves as parts of bio-socially interrelated groups affected by any member's behavior - to hope their participation would aid collectives cohering around kinship, sex, age, race and ethnicity. Benefits (protecting family, representing one's group in vaccine development and modeling vaccine acceptance) existed alongside drawbacks (strife, reifying groups), to illustrate the ambivalence of caregiving amid inequality.
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Affiliation(s)
- Emily Wentzell
- Department of Anthropology, The University of Iowa, Iowa City, Iowa, USA
| | - Ana-Monica Racila
- Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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110
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Case-control study of the association of chronic acid suppression and social determinants of health with COVID-19 infection. Sci Rep 2021; 11:20987. [PMID: 34697319 PMCID: PMC8545937 DOI: 10.1038/s41598-021-00367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Acid suppressants are widely-used classes of medications linked to increased risks of aerodigestive infections. Prior studies of these medications as potentially reversible risk factors for COVID-19 have been conflicting. We aimed to determine the impact of chronic acid suppression use on COVID-19 infection risk while simultaneously evaluating the influence of social determinants of health to validate known and discover novel risk factors. We assessed the association of chronic acid suppression with incident COVID-19 in a 1:1 case–control study of 900 patients tested across three academic medical centers in California, USA. Medical comorbidities and history of chronic acid suppression use were manually extracted from health records by physicians following a pre-specified protocol. Socio-behavioral factors by geomapping publicly-available data to patient zip codes were incorporated. We identified no evidence to support an association between chronic acid suppression and COVID-19 (adjusted odds ratio 1.04, 95% CI 0.92–1.17, P = 0.515). However, several medical and social features were positive (Latinx ethnicity, BMI ≥ 30, dementia, public transportation use, month of the pandemic) and negative (female sex, concurrent solid tumor, alcohol use disorder) predictors of new infection. These findings demonstrate the value of integrating publicly-available databases with medical data to identify critical features of communicable diseases.
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111
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Blair A, Parnia A, Shahidi FV, Siddiqi A. Social inequalities in protective behaviour uptake at the start of the COVID-19 pandemic: results from a national survey. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:818-830. [PMID: 34410654 PMCID: PMC8375287 DOI: 10.17269/s41997-021-00553-0] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/09/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We aimed to assess social patterns of handwashing, social distancing, and working from home at the start of the COVID-19 pandemic in Canada, and determine what proportions of the overall prevalence and social inequalities in handwashing and social distancing are related to inequalities in the opportunity to work from home, to guide pandemic preparedness and response. METHODS Using cross-sectional data from the Canadian Perspectives Survey Series, collected between March 29 and April 3, 2020, among Canadian adults (N=4455), we assessed prevalence of not working from home, social distancing in public, or practicing frequent handwashing, according to age, sex, marital status, immigration, education, chronic disease presence, and source of COVID-19 information. Multivariate regression, population attributable fraction estimation, and generalized product mediation analysis were applied. RESULTS Absence of frequent handwashing and distancing was more common among those working outside than within the home (prevalence differences of 7% (95% CI: 4, 10) and 7% (95% CI: 3, 10), respectively). Inequalities in handwashing and distancing were observed across education and immigration status. Over 40% of the prevalence of non-uptake of handwashing and distancing was attributable to populations not being able to work from home. If all worked from home, over 40% (95% CI: 8, 70) of education-based inequalities in handwashing and distancing could be eliminated, but differences by immigration status would likely remain. CONCLUSION For pandemic response, both workplace safety initiatives and mechanisms to address the inequitable distribution of health risks across socio-economic groups are needed to reduce broader inequalities in transmission risk.
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Affiliation(s)
- Alexandra Blair
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Abtin Parnia
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | | | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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112
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Đoàn LN, Chong SK, Misra S, Kwon SC, Yi SS. Immigrant Communities and COVID-19: Strengthening the Public Health Response. Am J Public Health 2021; 111:S224-S231. [PMID: 34709878 PMCID: PMC8561064 DOI: 10.2105/ajph.2021.306433] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has exposed the many broken fragments of US health care and social service systems, reinforcing extant health and socioeconomic inequities faced by structurally marginalized immigrant communities. Throughout the pandemic, even during the most critical period of rising cases in different epicenters, immigrants continued to work in high-risk-exposure environments while simultaneously having less access to health care and economic relief and facing discrimination. We describe systemic factors that have adversely affected low-income immigrants, including limiting their work opportunities to essential jobs, living in substandard housing conditions that do not allow for social distancing or space to safely isolate from others in the household, and policies that discourage access to public resources that are available to them or that make resources completely inaccessible. We demonstrate that the current public health infrastructure has not improved health care access or linkages to necessary services, treatments, or culturally competent health care providers, and we provide suggestions for how the Public Health 3.0 framework could advance this. We recommend the following strategies to improve the Public Health 3.0 public health infrastructure and mitigate widening disparities: (1) address the social determinants of health, (2) broaden engagement with stakeholders across multiple sectors, and (3) develop appropriate tools and technologies. (Am J Public Health. 2021;111(S3):S224-S231. https://doi.org/10.2105/AJPH.2021.306433).
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Affiliation(s)
- Lan N Đoàn
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
| | - Stella K Chong
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
| | - Supriya Misra
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
| | - Simona C Kwon
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
| | - Stella S Yi
- Lan N. Đoàn, Stella K. Chong, Simona C. Kwon, and Stella S. Yi are with the Department of Population Health Section for Health Equity, New York University Grossman School of Medicine, New York, NY. Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA
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113
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Karasek D, Baer RJ, McLemore MR, Bell AJ, Blebu BE, Casey JA, Coleman-Phox K, Costello JM, Felder JN, Flowers E, Fuchs JD, Gomez AM, Karvonen K, Kuppermann M, Liang L, McKenzie-Sampson S, McCulloch CE, Oltman SP, Pantell MS, Piao X, Prather AA, Schmidt RJ, Scott KA, Spellen S, Stookey JD, Tesfalul M, Rand L, Jelliffe-Pawlowski LL. The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California. LANCET REGIONAL HEALTH. AMERICAS 2021; 2:100027. [PMID: 34642685 PMCID: PMC8497178 DOI: 10.1016/j.lana.2021.100027] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Our understanding of the association between coronavirus disease 19 (COVID-19) and preterm or early term birth among racially and ethnically diverse populations and people with chronic medical conditions is limited. METHODS We determined the association between COVID-19 and preterm (PTB) birth among live births documented by California Vital Statistics birth certificates between July 2020 and January 2021 (n=240,147). We used best obstetric estimate of gestational age to classify births as very preterm (VPTB, <32 weeks), PTB (< 37 weeks), early term (37 and 38 weeks), and term (39-44 weeks), as each confer independent risks to infant health and development. Separately, we calculated the joint effects of COVID-19 diagnosis, hypertension, diabetes, and obesity on PTB and VPTB. FINDINGS COVID-19 diagnoses on birth certificates increased for all racial/ethnic groups between July 2020 and January 2021 and were highest for American Indian/Alaska Native (12.9%), Native Hawaiian/Pacific Islander (11.4%), and Latinx (10.3%) birthing people. COVID-19 diagnosis was associated with an increased risk of VPTB (aRR 1.6, 95% CI [1.4, 1.9]), PTB (aRR 1.4, 95% CI [1.3, 1.4]), and early term birth (aRR 1.1, 95% CI [1.1, 1.2]). There was no effect modification of the overall association by race/ethnicity or insurance status. COVID-19 diagnosis was associated with elevated risk of PTB in people with hypertension, diabetes, and/or obesity. INTERPRETATION In a large population-based study, COVID-19 diagnosis increased the risk of VPTB, PTB, and early term birth, particularly among people with medical comorbidities. Considering increased circulation of COVID-19 variants, preventative measures, including vaccination, should be prioritized for birthing persons. FUNDING UCSF-Kaiser Department of Research Building Interdisciplinary Research Careers in Women's Health Program (BIRCWH) National Institute of Child Health and Human Development (NICHD) and the Office of Research on Women's Health (ORWH) [K12 HD052163] and the California Preterm Birth Initiative, funded by Marc and Lynn Benioff.
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Affiliation(s)
- Deborah Karasek
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
| | - Rebecca J. Baer
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, USA
| | - Monica R. McLemore
- Department of Family Health Care Nursing, 2 Koret Way, San Francisco CA 94143, USA
| | - April J. Bell
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
| | - Bridgette E. Blebu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
| | - Joan A. Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 West 168th St. NY, NY 10032, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
| | - Jean M. Costello
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- Department of Biological and Medical Informatics, University of California San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
| | - Jennifer N. Felder
- Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero St, San Francisco, CA 94115, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 3333 California Street, San Francisco CA 94118, USA
| | - Elena Flowers
- Department of Physiological Nursing, University of California, San Francisco, Koret Way, San Francisco, CA 94143, USA
| | - Jonathan D. Fuchs
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- Center for Learning & Innovation, San Francisco Department of Public Health 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
| | - Anu Manchikanti Gomez
- School of Social Welfare, Sexual Health and Reproductive Equity Program, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Kayla Karvonen
- Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
| | - Liang Liang
- Department of Genetics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Safyer McKenzie-Sampson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
| | - Scott P. Oltman
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
| | - Matthew S Pantell
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- School of Social Welfare, Sexual Health and Reproductive Equity Program, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Xianhua Piao
- Newborn Brain Research Institute, Department of Pediatrics, Weill Institute for Neuroscience, University of California San Francisco, 1651 4th St, San Francisco, CA 94158, USA
| | - Aric A. Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 3333 California Street, San Francisco CA 94118, USA
| | - Rebecca J. Schmidt
- Department of Public Health Sciences and MIND Institute, School of Medicine, and Perinatal Origins of Disparities Center; University of California Davis, 123 Med Sci 1C, One Shields Ave, Davis, California 95616, USA
| | - Karen A. Scott
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, 490 Illinois Street, Flr 7, San Francisco, CA 94143, USA
| | - Solaire Spellen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
| | - Jodi D Stookey
- Maternal, Child & Adolescent Health, San Francisco Department of Public Health, 30 Van Ness Avenue, Suite 260B, San Francisco, CA, USA
| | - Martha Tesfalul
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
| | - Laura L. Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
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Njoku A, Joseph M, Felix R. Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9904. [PMID: 34574827 PMCID: PMC8470519 DOI: 10.3390/ijerph18189904] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.
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Affiliation(s)
- Anuli Njoku
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
| | - Marcelin Joseph
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
- Greater Bridgeport Area Prevention Program, 1470 Barnum Avenue, Suite 301, Bridgeport, CT 06610, USA
| | - Rochelle Felix
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
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A Direct Observation Video Method for Describing COVID-19 Transmission Factors on a Micro-Geographical Scale: Viral Transmission (VT)-Scan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179329. [PMID: 34501917 PMCID: PMC8431696 DOI: 10.3390/ijerph18179329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic severely affected many aspects of human life. While most health agencies agree mask wearing and physical distancing reduce viral transmission, efforts to improve the assessment of these behaviors are lacking. This study aimed to develop a direct observation video method [Viral Transmission (VT)-Scan] for assessing COVID-19 transmission behaviors and related factors (e.g., environmental setting). A wearable video device (WVD) was used to obtain videos of outdoor, public areas. The videos were examined to extract relevant information. All outcomes displayed good to excellent intra- and inter-reliability with intra-class correlation coefficients ranging from 0.836 to 0.997. The majority of people had a mask (60.8%) but 22.1% of them wore it improperly, 45.4% were not physical distancing, and 27.6% were simultaneously mask and physical distancing non-compliant. Transmission behaviors varied by demographics with white, obese males least likely to be mask-compliant and white, obese females least likely to physical distance. Certain environments (e.g., crosswalks) were identified as "hot spots" where higher rates of adverse transmission behaviors occurred. This study introduces a reliable method for obtaining objective data on COVID-19 transmission behaviors and related factors which may be useful for agent-based modeling and policy formation.
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116
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Riley AR, Chen YH, Matthay EC, Glymour MM, Torres JM, Fernandez A, Bibbins-Domingo K. Excess mortality among Latino people in California during the COVID-19 pandemic. SSM Popul Health 2021; 15:100860. [PMID: 34307826 PMCID: PMC8283318 DOI: 10.1016/j.ssmph.2021.100860] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Latino people in the US are experiencing higher excess deaths during the COVID-19 pandemic than any other racial/ethnic group, but it is unclear which sociodemographic subgroups within this diverse population are most affected. Such information is necessary to target policies that prevent further excess mortality and reduce inequities. Using death certificate data for January 1, 2016 through February 29, 2020 and time-series models, we estimated the expected weekly deaths among Latino people in California from March 1 through October 3, 2020. We quantified excess mortality as observed minus expected deaths and risk ratios (RR) as the ratio of observed to expected deaths. We considered subgroups categorized by age, sex, nativity, country of birth, educational attainment, occupation, and combinations of these factors. Our results indicate that during the first seven months of the pandemic, Latino deaths in California exceeded expected deaths by 10,316, a 31% increase. Excess death rates were greatest for individuals born in Mexico (RR 1.44; 95% PI, 1.41, 1.48) or a Central American country (RR 1.49; 95% PI, 1.37, 1.64), with less than a high school degree (RR 1.41; 95% PI, 1.35, 1.46), or in food-and-agriculture (RR 1.60; 95% PI, 1.48, 1.74) or manufacturing occupations (RR 1.59; 95% PI, 1.50, 1.69). Immigrant disadvantages in excess death were magnified among working-age Latinos in essential occupations. In sum, the COVID-19 pandemic has disproportionately impacted mortality among Latino immigrants, especially those in unprotected essential jobs. Interventions to reduce these inequities should include targeted vaccination, workplace safety enforcement, and expanded access to medical care and economic support.
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Affiliation(s)
- Alicia R. Riley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Yea-Hung Chen
- Institute for Global Health, University of California, San Francisco, CA, USA
| | - Ellicott C. Matthay
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Alicia Fernandez
- Department of Medicine, University of California, San Francisco, CA, USA
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Goldman N, Pebley AR, Lee K, Andrasfay T, Pratt B. Racial and ethnic differentials in COVID-19-related job exposures by occupational standing in the US. PLoS One 2021; 16:e0256085. [PMID: 34469440 PMCID: PMC8409606 DOI: 10.1371/journal.pone.0256085] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/29/2021] [Indexed: 12/19/2022] Open
Abstract
Researchers and journalists have argued that work-related factors may be partly responsible for disproportionate COVID-19 infection and death rates among vulnerable groups. We evaluate these issues by describing racial and ethnic differences in the likelihood of work-related exposure to COVID-19. We extend previous studies by considering 12 racial and ethnic groups and five types of potential occupational exposure to the virus: exposure to infection, physical proximity to others, face-to-face discussions, interactions with external customers and the public, and working indoors. Most importantly, we stratify our results by occupational standing, defined as the proportion of workers within each occupation with at least some college education. This measure serves as a proxy for whether workplaces and workers employ COVID-19-related risk reduction strategies. We use the 2018 American Community Survey to identify recent workers by occupation, and link 409 occupations to information on work context from the Occupational Information Network to identify potential COVID-related risk factors. We then examine the racial/ethnic distribution of all frontline workers and frontline workers at highest potential risk of COVID-19, by occupational standing and by sex. The results indicate that, contrary to expectation, White frontline workers are often overrepresented in high-risk jobs while Black and Latino frontline workers are generally underrepresented in these jobs. However, disaggregation of the results by occupational standing shows that, in contrast to Whites and several Asian groups, Latino and Black frontline workers are overrepresented in lower standing occupations overall and in lower standing occupations associated with high risk, and thus may be less likely to have adequate COVID-19 protections. Our findings suggest that greater work exposures likely contribute to a higher prevalence of COVID-19 among Latino and Black adults and underscore the need for measures to reduce potential exposure for workers in low standing occupations and for the development of programs outside the workplace.
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Affiliation(s)
- Noreen Goldman
- Office of Population Research, School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America
| | - Anne R. Pebley
- California Center for Population Research, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Keunbok Lee
- California Center for Population Research, University of California Los Angeles, Los Angeles, California, United States of America
| | - Theresa Andrasfay
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Boriana Pratt
- Office of Population Research, Princeton University, Princeton, New Jersey, United States of America
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Geng EH, Schwab J, Foraker R, Fox B, Hoehner CM, Schootman M, Mody A, Powderly W, Yount B, Woeltje K, Petersen M. Outcomes Associated With Social Distancing Policies in St Louis, Missouri, During the Early Phase of the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2123374. [PMID: 34468756 PMCID: PMC8411298 DOI: 10.1001/jamanetworkopen.2021.23374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023] Open
Abstract
Importance In the absence of a national strategy in response to the COVID-19 pandemic, many public health decisions fell to local elected officials and agencies. Outcomes of such policies depend on a complex combination of local epidemic conditions and demographic features as well as the intensity and timing of such policies and are therefore unclear. Objective To use a decision analytical model of the COVID-19 epidemic to investigate potential outcomes if actual policies enacted in March 2020 (during the first wave of the epidemic) in the St Louis region of Missouri had been delayed. Design, Setting, and Participants A previously developed, publicly available, open-source modeling platform (Local Epidemic Modeling for Management & Action, version 2.1) designed to enable localized COVID-19 epidemic projections was used. The compartmental epidemic model is programmed in R and Stan, uses bayesian inference, and accepts user-supplied demographic, epidemiologic, and policy inputs. Hospital census data for 1.3 million people from St Louis City and County from March 14, 2020, through July 15, 2020, were used to calibrate the model. Exposures Hypothetical delays in actual social distancing policies (which began on March 13, 2020) by 1, 2, or 4 weeks. Sensitivity analyses were conducted that explored plausible spontaneous behavior change in the absence of social distancing policies. Main Outcomes and Measures Hospitalizations and deaths. Results A model of 1.3 million residents of the greater St Louis, Missouri, area found an initial reproductive number (indicating transmissibility of an infectious agent) of 3.9 (95% credible interval [CrI], 3.1-4.5) in the St Louis region before March 15, 2020, which fell to 0.93 (95% CrI, 0.88-0.98) after social distancing policies were implemented between March 15 and March 21, 2020. By June 15, a 1-week delay in policies would have increased cumulative hospitalizations from an observed actual number of 2246 hospitalizations to 8005 hospitalizations (75% CrI: 3973-15 236 hospitalizations) and increased deaths from an observed actual number of 482 deaths to a projected 1304 deaths (75% CrI, 656-2428 deaths). By June 15, a 2-week delay would have yielded 3292 deaths (75% CrI, 2104-4905 deaths)-an additional 2810 deaths or a 583% increase beyond what was actually observed. Sensitivity analyses incorporating a range of spontaneous behavior changes did not avert severe epidemic projections. Conclusions and Relevance The results of this decision analytical model study suggest that, in the St Louis region, timely social distancing policies were associated with improved population health outcomes, and small delays may likely have led to a COVID-19 epidemic similar to the most heavily affected areas in the US. These findings indicate that an open-source modeling platform designed to accept user-supplied local and regional data may provide projections tailored to, and more relevant for, local settings.
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Affiliation(s)
- Elvin H. Geng
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, St Louis, Missouri
- Institute for Public Health, Washington University in St Louis
| | - Joshua Schwab
- Division Biostatistics, School of Public Health, University of California, Berkely
| | - Randi Foraker
- Division of General Internal Medicine, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Branson Fox
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Mario Schootman
- SSM Health Saint Louis University Hospital, St Louis, Missouri
| | - Aaloke Mody
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - William Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, St Louis, Missouri
- Institute for Public Health, Washington University in St Louis
| | | | - Keith Woeltje
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, St Louis, Missouri
- BJC HealthCare, St Louis, Missouri
| | - Maya Petersen
- Division of Biostatistics, School of Public Health, University of California at Berkeley, Berkeley
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Leitch S, Corbin JH, Boston-Fisher N, Ayele C, Delobelle P, Gwanzura Ottemöller F, Matenga TFL, Mweemba O, Pederson A, Wicker J. Black Lives Matter in health promotion: moving from unspoken to outspoken. Health Promot Int 2021; 36:1160-1169. [PMID: 33305322 PMCID: PMC7953963 DOI: 10.1093/heapro/daaa121] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Racism is a public health crisis. Black communities (including Africans, the African diaspora and people of African descent) experience worse health outcomes as demonstrated by almost any measure of health and wellbeing-e.g. life expectancy; disease prevalence; maternal mortality rates. While health promotion has its foundation in promoting equity and social justice, it is clear that however well-intended, we are not affecting meaningful change for Black communities quickly enough. Through this article, we outline the intersection of social determinants of health and anti-Black racism. We describe how in the first 8 months of 2020 Black communities around the globe have been disproportionately affected by COVID-19, while also having to respond to new instances of police brutality. We assert that the time has come for health promotion to stop neutralizing the specific needs of Black communities into unspoken 'good intentions'. Instead, we offer some concrete ways for the field to become outspoken, intentional and honest in acknowledging what it will take to radically shift how we promote health and wellbeing for Black people.
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Affiliation(s)
- Stephanie Leitch
- TT Black Lives Matter, WOMANTRA, University of the West Indies, Trinidad and Tobago, St. Ann's Port of Spain
| | | | | | - Christa Ayele
- IUHPE’s Student and Early Career Network, Philadelphia, PA, USA
| | - Peter Delobelle
- University of Cape Town and University of Western Cape, and Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | | - Ann Pederson
- University of British Columbia, British Columbia, Canada
| | - Josette Wicker
- IUHPE’s Student and Early Career Network, Seattle, WA, USA
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Bikomeye JC, Namin S, Anyanwu C, Rublee CS, Ferschinger J, Leinbach K, Lindquist P, Hoppe A, Hoffman L, Hegarty J, Sperber D, Beyer KMM. Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8420. [PMID: 34444169 PMCID: PMC8392137 DOI: 10.3390/ijerph18168420] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 01/14/2023]
Abstract
The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.
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Affiliation(s)
- Jean C. Bikomeye
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.C.B.); (S.N.); (C.A.)
| | - Sima Namin
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.C.B.); (S.N.); (C.A.)
| | - Chima Anyanwu
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.C.B.); (S.N.); (C.A.)
| | - Caitlin S. Rublee
- Department of Emergency Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Jamie Ferschinger
- Sixteenth Street Community Health Centers, Environmental Health & Community Wellness, 1337 S Cesar Chavez Drive, Milwaukee, WI 53204, USA;
| | - Ken Leinbach
- The Urban Ecology Center, 1500 E. Park Place, Milwaukee, WI 53211, USA;
| | - Patricia Lindquist
- Wisconsin Department of Natural Resources, Division of Forestry, 101 S. Webster Street, P.O. Box 7921, Madison, WI 53707, USA;
| | - August Hoppe
- The Urban Wood Lab, Hoppe Tree Service, 1813 S. 73rd Street, West Allis, WI 53214, USA;
| | - Lawrence Hoffman
- Department of GIS, Groundwork Milwaukee, 227 West Pleasant Street, Milwaukee, WI 53212, USA;
| | - Justin Hegarty
- Reflo—Sustainable Water Solutions, 1100 S 5th Street, Milwaukee, WI 53204, USA;
| | - Dwayne Sperber
- Wudeward Urban Forest Products, N11W31868 Phyllis Parkway, Delafield, WI 53018, USA;
| | - Kirsten M. M. Beyer
- Institute for Health & Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.C.B.); (S.N.); (C.A.)
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Chaudhuri MM, Mkumba L, Raveendran Y, Smith RD. Decolonising global health: beyond 'reformative' roadmaps and towards decolonial thought. BMJ Glob Health 2021; 6:bmjgh-2021-006371. [PMID: 34244205 PMCID: PMC8268885 DOI: 10.1136/bmjgh-2021-006371] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Laura Mkumba
- Science Facilitation, FHI 360, Durham, North Carolina, USA
| | | | - Robert D Smith
- Department of Anthropology and Sociology, Graduate Institute of International and Development Studies, Genève, Switzerland
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122
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Zalla LC, Martin CL, Edwards JK, Gartner DR, Noppert GA. A Geography of Risk: Structural Racism and Coronavirus Disease 2019 Mortality in the United States. Am J Epidemiol 2021; 190:1439-1446. [PMID: 33710272 PMCID: PMC7989642 DOI: 10.1093/aje/kwab059] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is disproportionately burdening racial and ethnic minority groups in the United States. Higher risks of infection and mortality among racialized minorities are a consequence of structural racism, reflected in specific policies that date back centuries and persist today. Yet our surveillance activities do not reflect what we know about how racism structures risk. When measuring racial and ethnic disparities in deaths due to COVID-19, the Centers for Disease Control and Prevention statistically accounts for the geographic distribution of deaths throughout the United States to reflect the fact that deaths are concentrated in areas with different racial and ethnic distributions from those of the larger United States. In this commentary, we argue that such an approach misses an important driver of disparities in COVID-19 mortality, namely the historical forces that determine where individuals live, work, and play, and that consequently determine their risk of dying from COVID-19. We explain why controlling for geography downplays the disproportionate burden of COVID-19 on racialized minority groups in the United States. Finally, we offer recommendations for the analysis of surveillance data to estimate racial disparities, including shifting from distribution-based to risk-based measures, to help inform a more effective and equitable public health response to the pandemic.
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Affiliation(s)
- Lauren C Zalla
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chantel L Martin
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Danielle R Gartner
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Grace A Noppert
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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123
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Bilal U, Tabb LP, Barber S, Diez Roux AV. Spatial Inequities in COVID-19 Testing, Positivity, Confirmed Cases, and Mortality in 3 U.S. Cities : An Ecological Study. Ann Intern Med 2021; 174:936-944. [PMID: 33780289 PMCID: PMC8029592 DOI: 10.7326/m20-3936] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Preliminary evidence has shown inequities in coronavirus disease 2019 (COVID-19)-related cases and deaths in the United States. OBJECTIVE To explore the emergence of spatial inequities in COVID-19 testing, positivity, confirmed cases, and mortality in New York, Philadelphia, and Chicago during the first 6 months of the pandemic. DESIGN Ecological, observational study at the ZIP code tabulation area (ZCTA) level from March to September 2020. SETTING Chicago, New York, and Philadelphia. PARTICIPANTS All populated ZCTAs in the 3 cities. MEASUREMENTS Outcomes were ZCTA-level COVID-19 testing, positivity, confirmed cases, and mortality cumulatively through the end of September 2020. Predictors were the Centers for Disease Control and Prevention Social Vulnerability Index and its 4 domains, obtained from the 2014-2018 American Community Survey. The spatial autocorrelation of COVID-19 outcomes was examined by using global and local Moran I statistics, and estimated associations were examined by using spatial conditional autoregressive negative binomial models. RESULTS Spatial clusters of high and low positivity, confirmed cases, and mortality were found, co-located with clusters of low and high social vulnerability in the 3 cities. Evidence was also found for spatial inequities in testing, positivity, confirmed cases, and mortality. Specifically, neighborhoods with higher social vulnerability had lower testing rates and higher positivity ratios, confirmed case rates, and mortality rates. LIMITATIONS The ZCTAs are imperfect and heterogeneous geographic units of analysis. Surveillance data were used, which may be incomplete. CONCLUSION Spatial inequities exist in COVID-19 testing, positivity, confirmed cases, and mortality in 3 large U.S. cities. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Usama Bilal
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.)
| | - Loni P Tabb
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.)
| | - Sharrelle Barber
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.)
| | - Ana V Diez Roux
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.)
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124
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Casanova F, Knaul FM, Rodriguez NM. Harvesting Health Knowledge: Breast Cancer Perceptions in the South Florida Latinx Farmworker Community. QUALITATIVE HEALTH RESEARCH 2021; 31:1423-1436. [PMID: 33834911 PMCID: PMC8277692 DOI: 10.1177/10497323211003542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
South Florida agricultural regions, home to Latinx immigrant farmworkers, report higher rates of late-stage breast cancer diagnosis than national, state, and county-level averages. We conducted a community-based qualitative study on the needs, health knowledge gaps, barriers to breast cancer screening, and the role of community health workers (CHWs) in supporting the community's access to early detection services. We conducted three CHW focus groups (FGs) (n = 25) and in-depth interviews (n = 15), two FGs (n = 18) and in-depth interviews (n = 3) with farmworker community members, and informal interviews with cancer clinicians (n = 7). Using a grounded theory approach, five core themes regarding the community's barriers to accessing health care services emerged: (a) lack of information; (b) social and economic barriers; (c) cultural factors; (d) fears and mistrust; and (e) psychosocial concerns. Findings yield implications for community health practice, the potential impact of CHWs, and the production of breast cancer education to improve health equity along with the care continuum.
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125
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Côté D, Durant S, MacEachen E, Majowicz S, Meyer S, Huynh A, Laberge M, Dubé J. A rapid scoping review of COVID-19 and vulnerable workers: Intersecting occupational and public health issues. Am J Ind Med 2021; 64:551-566. [PMID: 34003502 PMCID: PMC8212119 DOI: 10.1002/ajim.23256] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND This article reports the results of a rapid scoping review of the literature on COVID-19 transmission risk to workers in essential sectors such as retail, health care, manufacturing, and agriculture, and more particularly the experiences of workers in precarious employment and social situations. METHODS Following scoping review methods, we included 30 studies that varied in terms of methodology and theoretical approaches. The search included peer-reviewed articles and grey literature published between March and September 2020. RESULTS Based on the studies reviewed, we found that COVID-19 infection and death rates increased not only with age and comorbidities, but also with discrimination and structural inequities based on racism and sexism. Racial and ethnic minority workers, including migrant workers, are concentrated in high-risk occupations and this concentration is correlated to lower socioeconomic conditions. The COVID-19 pandemic appears in the occupational health and safety spotlight as an exacerbator of already existing socioeconomic inequalities and social inequalities in health, especially in light of the intersection of issues related to racism, ethnic minority status, and sexism. CONCLUSIONS This review provides early evidence about the limitations of institutions' responses to the pandemic, and their capacity to provide a safe and decent working environment for all workers, regardless of their employment status or the social protections they may enjoy under normal circumstances. It is also important to think about these issues in the postpandemic context, when conditions of precariousness and vulnerability persist and possibly worsen.
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Affiliation(s)
- Daniel Côté
- Institut de recherche Robert‐Sauvé en santé et en sécurité du travail (IRSST), MontréalQuébecCanada
- Department of AnthropologyUniversité de Montréal, MontréalQuébecCanada
| | - Steve Durant
- School of Public Health and Health SystemsUniversity of WaterlooOntarioCanada
| | - Ellen MacEachen
- School of Public Health and Health SystemsUniversity of WaterlooOntarioCanada
| | - Shannon Majowicz
- School of Public Health and Health SystemsUniversity of WaterlooOntarioCanada
| | - Samantha Meyer
- School of Public Health and Health SystemsUniversity of WaterlooOntarioCanada
| | - Ai‐Thuy Huynh
- Institut de recherche Robert‐Sauvé en santé et en sécurité du travail (IRSST), MontréalQuébecCanada
| | - Marie Laberge
- School of RehabilitationUniversité de MontréalQuébecCanada
| | - Jessica Dubé
- Institut de recherche Robert‐Sauvé en santé et en sécurité du travail (IRSST), MontréalQuébecCanada
- School of ManagementUniversité du Québec à Montréal (UQAM)QuébecCanada
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126
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Bilal U, Tabb LP, Barber S, Diez Roux AV. Spatial Inequities in COVID-19 Testing, Positivity, Confirmed Cases, and Mortality in 3 U.S. Cities : An Ecological Study. Ann Intern Med 2021; 174:936-944. [PMID: 33780289 DOI: 10.1101/2020.05.01.20087833] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Preliminary evidence has shown inequities in coronavirus disease 2019 (COVID-19)-related cases and deaths in the United States. OBJECTIVE To explore the emergence of spatial inequities in COVID-19 testing, positivity, confirmed cases, and mortality in New York, Philadelphia, and Chicago during the first 6 months of the pandemic. DESIGN Ecological, observational study at the ZIP code tabulation area (ZCTA) level from March to September 2020. SETTING Chicago, New York, and Philadelphia. PARTICIPANTS All populated ZCTAs in the 3 cities. MEASUREMENTS Outcomes were ZCTA-level COVID-19 testing, positivity, confirmed cases, and mortality cumulatively through the end of September 2020. Predictors were the Centers for Disease Control and Prevention Social Vulnerability Index and its 4 domains, obtained from the 2014-2018 American Community Survey. The spatial autocorrelation of COVID-19 outcomes was examined by using global and local Moran I statistics, and estimated associations were examined by using spatial conditional autoregressive negative binomial models. RESULTS Spatial clusters of high and low positivity, confirmed cases, and mortality were found, co-located with clusters of low and high social vulnerability in the 3 cities. Evidence was also found for spatial inequities in testing, positivity, confirmed cases, and mortality. Specifically, neighborhoods with higher social vulnerability had lower testing rates and higher positivity ratios, confirmed case rates, and mortality rates. LIMITATIONS The ZCTAs are imperfect and heterogeneous geographic units of analysis. Surveillance data were used, which may be incomplete. CONCLUSION Spatial inequities exist in COVID-19 testing, positivity, confirmed cases, and mortality in 3 large U.S. cities. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Usama Bilal
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.)
| | - Loni P Tabb
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.)
| | - Sharrelle Barber
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.)
| | - Ana V Diez Roux
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B., L.P.T., S.B., A.V.D.)
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127
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Banack HR, Lesko CR, Whitcomb BC, Kobayashi LC. Teaching Epidemiology Online (Pandemic Edition). Am J Epidemiol 2021; 190:1183-1189. [PMID: 33354713 PMCID: PMC7799241 DOI: 10.1093/aje/kwaa285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023] Open
Abstract
In response to the threat posed by the coronavirus disease 2019 (COVID-19) pandemic, many universities are encouraging or requiring online instruction. Teaching an epidemiology course online is different in many respects from teaching in person. In this article, we review specific approaches and strategies related to teaching epidemiology online during the pandemic and beyond, including a discussion of options for course format, grading and assessment approaches, pandemic-related contingencies, and the use of technology. Throughout this article we present practical, epidemiology-specific teaching examples. Moreover, we also examine 1) how the lessons learned about the practice of epidemiology during the pandemic can be integrated into the didactic content of epidemiology training programs and 2) whether epidemiologic pedagogy and teaching strategies should change in the long term, beyond the COVID-19 pandemic. The pandemic has served to heighten our awareness of concerns related to student health and safety, as well as issues of accessibility, equity, and inclusion. Our goal is to present a practical overview connecting pandemic-era online teaching with thoughts about the future of epidemiologic instruction.
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Affiliation(s)
- Hailey R Banack
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
- Correspondence to Dr. Hailey Banack, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, 14214 ph: 716-829-5358
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian C Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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128
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Chae DH, Yip T, Martz CD, Chung K, Richeson JA, Hajat A, Curtis DS, Rogers LO, LaVeist TA. Vicarious Racism and Vigilance During the COVID-19 Pandemic: Mental Health Implications Among Asian and Black Americans. Public Health Rep 2021; 136:508-517. [PMID: 34034574 PMCID: PMC8203039 DOI: 10.1177/00333549211018675] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Experiences of vicarious racism-hearing about racism directed toward one's racial group or racist acts committed against other racial group members-and vigilance about racial discrimination have been salient during the COVID-19 pandemic. This study examined vicarious racism and vigilance in relation to symptoms of depression and anxiety among Asian and Black Americans. METHODS We used data from a cross-sectional study of 604 Asian American and 844 Black American adults aged ≥18 in the United States recruited from 5 US cities from May 21 through July 15, 2020. Multivariable linear regression models examined levels of depression and anxiety by self-reported vicarious racism and vigilance. RESULTS Controlling for sociodemographic characteristics, among both Asian and Black Americans, greater self-reported vicarious racism was associated with more symptoms of depression (Asian: β = 1.92 [95% CI, 0.97-2.87]; Black: β = 1.72 [95% CI, 0.95-2.49]) and anxiety (Asian: β = 2.40 [95% CI, 1.48-3.32]; Black: β = 1.98 [95% CI, 1.17-2.78]). Vigilance was also positively related to symptoms of depression (Asian: β = 1.54 [95% CI, 0.58-2.50]; Black: β = 0.90 [95% CI, 0.12-1.67]) and anxiety (Asian: β = 1.98 [95% CI, 1.05-2.91]; Black: β = 1.64 [95% CI, 0.82-2.45]). CONCLUSIONS Mental health problems are a pressing concern during the COVID-19 pandemic. Results from our study suggest that heightened racist sentiment, harassment, and violence against Asian and Black Americans contribute to increased risk of depression and anxiety via vicarious racism and vigilance. Public health efforts during this period should address endemic racism as well as COVID-19.
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Affiliation(s)
- David H. Chae
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Tiffany Yip
- Department of Psychology, Fordham University, New York, NY, USA
| | - Connor D. Martz
- Department of Human Development and Family Science, Auburn University, Auburn, AL, USA
| | - Kara Chung
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jennifer A. Richeson
- Department of Psychology, Institution for Social and Policy Studies, Yale University, New Haven, CT, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - David S. Curtis
- Department of Family and Consumer Sciences, University of Utah, Salt Lake City, UT, USA
| | - Leoandra Onnie Rogers
- Department of Psychology, Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Thomas A. LaVeist
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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129
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Stiles S, Golightly D, Ryan B. Impact of COVID-19 on health and safety in the construction sector. HUMAN FACTORS AND ERGONOMICS IN MANUFACTURING 2021; 31:425-437. [PMID: 33821125 PMCID: PMC8013414 DOI: 10.1002/hfm.20882] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/17/2020] [Accepted: 12/05/2020] [Indexed: 05/08/2023]
Abstract
Construction has been significantly affected by COVID-19 yet is critical to the post-COVID economic recovery. Specifically, construction needs to be constantly aware of safety and risk balanced with timely project delivery. Guidance for COVID-19 must therefore be implemented in a way that reflects working practice and pressures. There is, however, a potential knowledge gap regarding the practical feasibility and impact of applying COVID-19 measures within construction, made more difficult by factors such as the temporary nature of projects and complex working arrangements. This article presents a commentary on safe construction during, and beyond, COVID-19, covering the human factors challenges and practicalities of implementing COVID-19 measures. We observe that while guidance is strong on risk management, understanding of how best to implement this guidance is not yet stable. Also, care must be taken that implementing guidance does not detract from general safety, which is also challenged by increased pressures on delivery arising from COVID-19. There may, however, be opportunities for safer working practice arising from new awareness of health, hygiene, and safety risk. The role of safety leadership is overlooked in guidance yet is vital to ensure safe application of COVID-19 working practices. The key message is that COVID-19 needs to be integrated and promoted within a general risk management approach, in part because this takes account of differing priorities regarding safety risks, rather than overly focussing on COVID-19, and also because the effectiveness of COVID-19 mitigations can be amplified by integration with pre-existing safety processes.
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Affiliation(s)
| | | | - Brendan Ryan
- Faculty of EngineeringUniversity of NottinghamNottinghamUK
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130
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Hirschtick JL, Titus AR, Slocum E, Power LE, Hirschtick RE, Elliott MR, McKane P, Fleischer NL. Population-based estimates of post-acute sequelae of SARS-CoV-2 infection (PASC) prevalence and characteristics. Clin Infect Dis 2021; 73:2055-2064. [PMID: 34007978 PMCID: PMC8240848 DOI: 10.1093/cid/ciab408] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 01/12/2023] Open
Abstract
Background Emerging evidence suggests many people have persistent symptoms after acute
COVID-19 illness. Our objective was to estimate the prevalence and
correlates of post-acute sequelae of SARS-CoV-2 infection (PASC). Methods We employed a population-based probability survey of adults with COVID-19 in
Michigan. Living non-institutionalized adults aged 18+ in the Michigan
Disease Surveillance System with COVID-19 onset through mid-April 2020 were
eligible for selection (n=28,000). Among 2,000 selected, 629 completed the
survey between June - December 2020. We estimated PASC prevalence, defined
as persistent symptoms 30+ (30-day COVID-19) or 60+ days (60-day COVID-19)
post COVID-19 onset, overall and by sociodemographic and clinical factors,
including self-reported symptom severity and hospitalization status. We used
modified Poisson regression to produce adjusted prevalence ratios (aPR) for
potential risk factors. Results The analytic sample (n=593) was predominantly female (56.1%), aged 45 and
older (68.2%), and Non-Hispanic White (46.3%) or Black (34.8%). 30- and
60-day COVID-19 were highly prevalent (52.5% and 35.0%), even among
non-hospitalized respondents (43.7% and 26.9%) and respondents reporting
mild symptoms (29.2% and 24.5%). Respondents reporting very severe (vs.
mild) symptoms had 2.25 times higher prevalence of 30-day COVID-19 ([aPR]
2.25, 95% CI 1.46-3.46) and 1.71 times higher prevalence of 60-day COVID-19
(aPR 1.71, 95% 1.02-2.88). Hospitalized (vs. non-hospitalized) respondents
had about 40% higher prevalence of both 30-day (aPR 1.37, 95% CI 1.12-1.69)
and 60-day COVID-19 (aPR 1.40, 95% CI 1.02-1.93). Conclusions PASC is highly prevalent among cases reporting severe initial symptoms, and,
to a lesser extent, cases reporting mild and moderate symptoms.
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Affiliation(s)
- Jana L Hirschtick
- Department of Epidemiology, University of Michigan School of Public Health, Washington Heights, Ann Arbor, MI, USA
| | - Andrea R Titus
- Department of Epidemiology, University of Michigan School of Public Health, Washington Heights, Ann Arbor, MI, USA
| | - Elizabeth Slocum
- Department of Epidemiology, University of Michigan School of Public Health, Washington Heights, Ann Arbor, MI, USA
| | - Laura E Power
- Department of Epidemiology, University of Michigan School of Public Health, Washington Heights, Ann Arbor, MI, USA
| | - Robert E Hirschtick
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael R Elliott
- Department of Biostatistics, University of Michigan School of Public Health, Washington Heights, Ann Arbor, MI, USA.,Survey Research Center, Institute for Social Research, Ann Arbor, MI, USA
| | - Patricia McKane
- Lifecourse Epidemiology and Genomics Division, Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, Washington Heights, Ann Arbor, MI, USA
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Pérez-Nebra A, Sklaveniti C, Islam G, Petrović I, Pickett J, Alija M, Matthijs Bal P, Tekeste M, Vukelić M, Bazana S, Sanderson Z. COVID-19 and the future of work and organisational psychology. SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2021. [PMCID: PMC8182441 DOI: 10.4102/sajip.v47i0.1854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Orientation The coronavirus disease 2019 (COVID-19) pandemic has caused a ‘coronafication’ of research and academia, including the instrumentalisation of academic research towards the demands of society and governments. Whilst an enormous number of special issues and articles are devoted on the topic, there are few fundamental reflections on how the current pandemic will affect science and work and organisational psychology in the long run. Research purpose The current overview, written by a group of members of the Future of Work and Organisational Psychology (FOWOP) Movement, focuses on the central issues relating to work and organisational psychology that have emerged as a result of the COVID-19 crisis. Motivation for the study The study discusses the inability of dominant theories in work and organisational psychology to understand contemporary problems and the need to advance the theoretical realm of work psychology. We also discuss the need for pluralism in methodologies to understand the post-COVID-19 workplace, the urgency of attending to neglected voices and populations during the COVID-19 crisis and teaching during COVID-19. Research approach/design and method This article uses conceptual argumentation. Main findings The COVID-19 crisis forces work psychology to address at least its theorising, methods, unheard voices and teaching in the COVID-19 crisis. Practical/managerial implications On the basis of this article, researchers and practitioners may be better aware of the neglected perspectives in the current pandemic. Contribution/value-add This article adds to the understanding of the future directions for a sustainable Work and Organisational Psychology as an applied scientific discipline during and beyond the COVID-19 crisis.
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Affiliation(s)
| | - Chrysavgi Sklaveniti
- Institute of Organizational Psychology, School of Management, University of St. Gallen, St. Gallen, Switzerland
| | - Gazi Islam
- Department of People, Organizations and Society, Grenoble Ecole de Management, Grenoble, France
- Institute for Research in Management and Economics (IREGE), Savoie Mont Blanc University, Geneva, Switzerland
| | - Ivana Petrović
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Jennifer Pickett
- Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - P. Matthijs Bal
- Lincoln International Business School, Brayford Wharf, University of Lincoln, Lincoln, United Kingdom
| | - Milena Tekeste
- School of Business and Management, Faculty of Organisation Studies, Royal Holloway University of London, London, United Kingdom
| | - Milica Vukelić
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Sandiso Bazana
- Department of People, Organizations and Society, Grenoble Ecole de Management, Grenoble, France
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa
| | - Zoe Sanderson
- School of Management, Social Sciences and Law, University of Bristol, Bristol, United Kingdom
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de Havenon A, Ney JP, Callaghan B, Hohmann S, Shippey E, Yaghi S, Anadani M, Majersik JJ. Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2110314. [PMID: 33999162 PMCID: PMC8129817 DOI: 10.1001/jamanetworkopen.2021.10314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. OBJECTIVE To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. EXPOSURE Ischemic stroke and laboratory-confirmed COVID-19. MAIN OUTCOMES AND MEASURES Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. RESULTS Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged ≥80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged ≥80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged ≥80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554) discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or pulmonary embolus (1.9% vs 2.4% vs 6.8%) and to require intubation (11.3% vs 12.3% vs 37.6%). After adjusting for baseline factors, patients with IS and COVID-19 were more likely to die in the hospital than were patients with IS in 2019 (adjusted odds ratio, 5.17; 95% CI, 4.83-5.53; National Institutes of Health Stroke Scale adjusted odds ratio, 3.57; 95% CI, 3.15-4.05). CONCLUSIONS AND RELEVANCE In this cohort study, after the emergence of COVID-19, hospital discharges of patients with IS decreased in the US but returned to prepandemic levels by July 2020. Among patients with IS between April and December 2020, comorbid COVID-19 was relatively common, particularly among Black and Hispanic populations, and morbidity was high.
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Affiliation(s)
| | - John P. Ney
- Department of Neurology, Boston University, Boston, Massachusetts
| | | | | | | | - Shadi Yaghi
- Department of Neurology, New York University, New York
| | - Mohammad Anadani
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
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Ingram M, Wolf AMA, López-Gálvez NI, Griffin SC, Beamer PI. Proposing a social ecological approach to address disparities in occupational exposures and health for low-wage and minority workers employed in small businesses. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:404-411. [PMID: 33774651 PMCID: PMC8003897 DOI: 10.1038/s41370-021-00317-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/12/2021] [Indexed: 05/25/2023]
Abstract
Occupational disease and injuries are the 8th leading cause of death in the United States. Low-wage and minority workers are more likely to work in hazardous industries and are thus at greater risk. Within the small business sector, in particular, the health of low-wage and minority workers is threatened by a multitude of complex and interrelated factors that increase their risk for injuries, death, and even chronic disease. The COVID-19 pandemic has amplified these concerns, as many low-wage and minority workers are essential workers, and many small businesses are reopening with little to no guidance. The article describes work-related health risks and reviews current research on occupational and social ecological approaches to improving the health of minority and low-wage workers primarily employed by small businesses. We propose a conceptual framework that integrates the social ecological model with the hierarchy of controls to address work-related health among low-wage and minority workers specifically in the small business sector. Community-based strategies are recommended to engage small business owners and workers in efforts to address their immediate needs, while building towards sustainable policy change over time. These strategies are of particular importance as small businesses reopen in the ongoing pandemic.
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Affiliation(s)
- Maia Ingram
- College of Public Health, University of Arizona, Tucson, AZ, USA.
| | | | | | | | - Paloma I Beamer
- College of Public Health, University of Arizona, Tucson, AZ, USA
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Brandt K, Goel V, Keeler C, Bell GJ, Aiello AE, Corbie-Smith G, Wilson E, Fleischauer A, Emch M, Boyce RM. SARS-CoV-2 testing in North Carolina: Racial, ethnic, and geographic disparities. Health Place 2021; 69:102576. [PMID: 33915376 PMCID: PMC8212571 DOI: 10.1016/j.healthplace.2021.102576] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 01/03/2023]
Abstract
SARS-CoV-2 testing data in North Carolina during the first three months of the state's COVID-19 pandemic were analyzed to determine if there were disparities among intersecting axes of identity including race, Latinx ethnicity, age, urban-rural residence, and residence in a medically underserved area. Demographic and residential data were used to reconstruct patterns of testing metrics (including tests per capita, positive tests per capita, and test positivity rate which is an indicator of sufficient testing) across race-ethnicity groups and urban-rural populations separately. Across the entire sample, 13.1% (38,750 of 295,642) of tests were positive. Within racial-ethnic groups, 11.5% of all tests were positive among non-Latinx (NL) Whites, 22.0% for NL Blacks, and 66.5% for people of Latinx ethnicity. The test positivity rate was higher among people living in rural areas across all racial-ethnic groups. These results suggest that in the first three months of the COVID-19 pandemic, access to COVID-19 testing in North Carolina was not evenly distributed across racial-ethnic groups, especially in Latinx, NL Black and other historically marginalized populations, and further disparities existed within these groups by gender, age, urban-rural status, and residence in a medically underserved area.
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Affiliation(s)
- Katerina Brandt
- UNC Department of Geography, Chapel Hill, NC, USA; Carolina Population Center, Chapel Hill, NC, USA
| | - Varun Goel
- UNC Department of Geography, Chapel Hill, NC, USA; Carolina Population Center, Chapel Hill, NC, USA
| | | | | | - Allison E Aiello
- Carolina Population Center, Chapel Hill, NC, USA; UNC Department of Epidemiology, Chapel Hill, NC, USA
| | | | - Erica Wilson
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Aaron Fleischauer
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Michael Emch
- UNC Department of Geography, Chapel Hill, NC, USA; Carolina Population Center, Chapel Hill, NC, USA; UNC Department of Epidemiology, Chapel Hill, NC, USA.
| | - Ross M Boyce
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC, USA.
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Goldman N, Pebley AR, Lee K, Andrasfay T, Pratt B. Racial and ethnic differentials in COVID-19-related job exposures by occupational standing in the US. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2020.11.13.20231431. [PMID: 33236022 PMCID: PMC7685333 DOI: 10.1101/2020.11.13.20231431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Researchers and journalists have argued that work-related factors may be partly responsible for disproportionate COVID-19 infection and death rates among vulnerable groups. We evaluate these claims by examining racial and ethnic differences in the likelihood of work-related exposure to COVID-19. We extend previous studies by considering 12 racial and ethnic groups and five types of potential occupational exposure to the virus: exposure to infection, physical proximity to others, face-to-face discussions, interactions with external customers and the public, and working indoors. Most importantly, we stratify our results by occupational standing, defined as the proportion of workers within each occupation with at least some college education. This measure serves as a proxy for whether workplaces and workers employ significant COVID-19-related risk reduction strategies. We use the 2018 American Community Survey to identify recent workers by occupation, and link 409 occupations to information on work context from the Occupational Information Network to identify potential COVID-related risk factors. We then examine the racial/ethnic distribution of all frontline workers and frontline workers at highest potential risk of COVID-19, by occupational standing and by sex. The results indicate that, contrary to expectation, White frontline workers are often overrepresented in high-risk jobs while Black and Latino frontline workers are generally underrepresented in these jobs. However, disaggregation of the results by occupational standing shows that, in contrast to Whites and several Asian groups, Latino and Black frontline workers are overrepresented in lower status occupations overall and in lower status occupations associated with high risk, and are thus less likely to have adequate COVID-19 protections. Our findings suggest that greater work exposures likely contribute to a higher prevalence of COVID-19 among Latino and Black adults and underscore the need for measures to reduce potential exposure for workers in low status occupations and for the development of programs outside the workplace.
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Affiliation(s)
- Noreen Goldman
- Office of Population Research, School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America
| | - Anne R. Pebley
- California Center for Population Research, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Keunbok Lee
- California Center for Population Research, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Theresa Andrasfay
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Boriana Pratt
- Office of Population Research, Princeton University, Princeton, New Jersey, United States of America
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Using race- and age-specific COVID-19 case data to investigate the determinants of the excess COVID-19 mortality burden among Hispanic Americans. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.44.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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137
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Nagata JM, Ganson KT, Whittle HJ, Chu J, Harris OO, Tsai AC, Weiser SD. Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic. Am J Prev Med 2021; 60:453-461. [PMID: 33602534 PMCID: PMC9067067 DOI: 10.1016/j.amepre.2020.12.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, the rates of food insecurity and mental illness have been projected to increase in the U.S. owing to significant social and economic disruption. This study aims to estimate the prevalence of food insufficiency (often the most extreme form of food insecurity), the correlates of food insufficiency, and the associations between food insufficiency and symptoms of poor mental health in the U.S. during the COVID-19 pandemic. METHODS Cross-sectional data from 63,674 participants of the U.S. Census Household Pulse Survey were collected and analyzed in 2020. Multiple Poisson regression models were used to estimate associations with food insufficiency. RESULTS Food insufficiency rose from 8.1% to 10.0% from March to June 2020. Factors associated with food insufficiency included lower age, Black/African American or Latinx race/ethnicity, being unmarried, larger household size, recent employment loss, income below the federal poverty line, and lower education (all p<0.001). Food insufficiency was independently associated with all symptoms of poor mental health, adjusting for socioeconomic and demographic factors (adjusted RRs ranged from 1.16 to 1.42, all p<0.001). The association between food insufficiency and poor mental health was attenuated among people who received free groceries or meals. CONCLUSIONS Food insufficiency has increased during the COVID-19 pandemic and affects vulnerable populations, placing individuals at higher risk for symptoms of poor mental health. Particularly in the current crisis, clinicians should regularly screen patients for food insufficiency and mental health outcomes as well as provide support in accessing appropriate resources.
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Affiliation(s)
- Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California.
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Henry J Whittle
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jonathan Chu
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Orlando O Harris
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases & Global Medicine, School of Medicine, University of California San Francisco, San Francisco, California
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138
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Lopez CA, Cunningham CH, Pugh S, Brandt K, Vanna UP, Delacruz MJ, Guerra Q, Goldstein SJ, Hou YJ, Gearhart M, Wiethorn C, Pope C, Amditis C, Pruitt K, Newberry-Dillon C, Schmitz J, Premkumar L, Adimora AA, Emch M, Boyce R, Aiello AE, Fosdick BK, Larremore DB, de Silva AM, Juliano JJ, Markmann AJ. Disparities in SARS-CoV-2 seroprevalence among individuals presenting for care in central North Carolina over a six-month period. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.25.21254320. [PMID: 33791743 PMCID: PMC8010775 DOI: 10.1101/2021.03.25.21254320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Robust community-level SARS-CoV-2 prevalence estimates have been difficult to obtain in the American South and outside of major metropolitan areas. Furthermore, though some previous studies have investigated the association of demographic factors such as race with SARS-CoV-2 exposure risk, fewer have correlated exposure risk to surrogates for socioeconomic status such as health insurance coverage. Methods We used a highly specific serological assay utilizing the receptor binding domain of the SARS-CoV-2 spike-protein to identify SARS-CoV-2 antibodies in remnant blood samples collected by the University of North Carolina Health system. We estimated the prevalence of SARS-CoV-2 in this cohort with Bayesian regression, as well as the association of critical demographic factors with higher prevalence odds. Findings Between April 21st and October 3rd of 2020, a total of 9,624 unique samples were collected from clinical sites in central NC and we observed a seroprevalence increase from 2·9 (1·7, 4·3) to 9·1 (7·2, 11·1) over the study period. Individuals who identified as Latinx were associated with the highest odds ratio of SARS-CoV-2 exposure at 7·77 overall (5·20, 12·10). Increased odds were also observed among Black individuals and individuals without public or private health insurance. Interpretation Our data suggests that for this care-accessing cohort, SARS-CoV-2 seroprevalence was significantly higher than cumulative total cases reported for the study geographical area six months into the COVID-19 pandemic in North Carolina. The increased odds of seropositivity by ethnoracial grouping as well as health insurance highlights the urgent and ongoing need to address underlying health and social disparities in these populations.
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Affiliation(s)
- Cesar A. Lopez
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Clark H. Cunningham
- Department of Genetics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill NC 27599, USA
| | - Sierra Pugh
- Department of Statistics, Colorado State University, Fort Collins, CO, 80523, USA
| | - Katerina Brandt
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Carolina Population Center, Chapel Hill, NC 27516, USA
| | - Usaphea P. Vanna
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Matthew J. Delacruz
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Quique Guerra
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Samuel Jacob Goldstein
- Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Yixuan J. Hou
- Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Margaret Gearhart
- McLendon Clinical Laboratories, UNC Healthcare, Chapel Hill, NC 27599, USA
| | | | - Candace Pope
- Johnston Health Laboratories, Johnston Health, Smithfield, NC 27577
| | - Carolyn Amditis
- Rex Healthcare Laboratory, UNC Healthcare, Chapel Hill, NC 27607, USA
| | - Kathryn Pruitt
- Chatham Clinical Laboratory, Chatham Hospital, Siler City, NC 27344, USA
| | | | - John Schmitz
- Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Adaora A. Adimora
- Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Michael Emch
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Carolina Population Center, Chapel Hill, NC 27516, USA
| | - Ross Boyce
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Allison E. Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bailey K. Fosdick
- Department of Statistics, Colorado State University, Fort Collins, CO, 80523, USA
| | - Daniel B. Larremore
- Department of Computer Science & BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, 80303, USA
| | - Aravinda M. de Silva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Jonathan J Juliano
- Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
| | - Alena J. Markmann
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill NC 27599, USA
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Zelner J, Trangucci R, Naraharisetti R, Cao A, Malosh R, Broen K, Masters N, Delamater P. Racial Disparities in Coronavirus Disease 2019 (COVID-19) Mortality Are Driven by Unequal Infection Risks. Clin Infect Dis 2021; 72:e88-e95. [PMID: 33221832 PMCID: PMC7717213 DOI: 10.1093/cid/ciaa1723] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/09/2020] [Indexed: 01/20/2023] Open
Abstract
Background As of 1 November 2020, there have been >230 000 deaths and 9 million confirmed and probable cases attributable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States. However, this overwhelming toll has not been distributed equally, with geographic, race/ethnic, age, and socioeconomic disparities in exposure and mortality defining features of the US coronavirus disease 2019 (COVID-19) epidemic. Methods We used individual-level COVID-19 incidence and mortality data from the state of Michigan to estimate age-specific incidence and mortality rates by race/ethnic group. Data were analyzed using hierarchical Bayesian regression models, and model results were validated using posterior predictive checks. Results In crude and age-standardized analyses we found rates of incidence and mortality more than twice as high than for Whites for all groups except Native Americans. Blacks experienced the greatest burden of confirmed and probable COVID-19 (age-standardized incidence, 1626/100 000 population) and mortality (age-standardized mortality rate, 244/100 000). These rates reflect large disparities, as Blacks experienced age-standardized incidence and mortality rates 5.5 (95% posterior credible interval [CrI], 5.4–5.6) and 6.7 (95% CrI, 6.4–7.1) times higher than Whites, respectively. We found that the bulk of the disparity in mortality between Blacks and Whites is driven by dramatically higher rates of COVID-19 infection across all age groups, particularly among older adults, rather than age-specific variation in case-fatality rates. Conclusions This work suggests that well-documented racial disparities in COVID-19 mortality in hard-hit settings, such as Michigan, are driven primarily by variation in household, community, and workplace exposure rather than case-fatality rates.
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Affiliation(s)
- Jon Zelner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Rob Trangucci
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ramya Naraharisetti
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alex Cao
- Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan Malosh
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kelly Broen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nina Masters
- Center for Social Epidemiology and Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Paul Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Amutah C, Greenidge K, Mante A, Munyikwa M, Surya SL, Higginbotham E, Jones DS, Lavizzo-Mourey R, Roberts D, Tsai J, Aysola J. Misrepresenting Race - The Role of Medical Schools in Propagating Physician Bias. N Engl J Med 2021; 384:872-878. [PMID: 33406326 DOI: 10.1056/nejmms2025768] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christina Amutah
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Kaliya Greenidge
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Adjoa Mante
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Michelle Munyikwa
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Sanjna L Surya
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Eve Higginbotham
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - David S Jones
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Risa Lavizzo-Mourey
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Dorothy Roberts
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Jennifer Tsai
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
| | - Jaya Aysola
- From the Perelman School of Medicine (C.A., A.M., M.M., S.L.S., E.H., R.L.-M., J.A.), School of Arts and Sciences (K.G., D.R.), the Penn Medicine Center for Health Equity Advancement (K.G., J.A.), the Leonard Davis Institute of Health Economics (E.H., R.L.-M., J.A.), Carey Law School (D.R.), and the Penn Program on Race, Science, and Society (D.R.), University of Pennsylvania, Philadelphia; Harvard Medical School, Boston (D.S.J.); the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (J.T.); and the Warren Alpert Medical School of Brown University, Providence, RI (J.T.)
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141
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Taylor T, Yazdany J, Gianfrancesco MA. The racial/ethnic and sociocultural aspects of the pandemic in rheumatology. Best Pract Res Clin Rheumatol 2021; 35:101665. [PMID: 33648855 PMCID: PMC7891072 DOI: 10.1016/j.berh.2021.101665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The disproportionate impact of coronavirus-2019 (COVID-19) on communities of color is gaining global attention. Current research demonstrates that historically marginalized populations are experiencing disproportionate levels of SARS-Cov-2 infection and adverse clinical outcomes. However, research examining whether COVID-19 outcomes vary by race and ethnicity within the rheumatic disease population is limited. This paper will review data showing how SARS-CoV-2 infection has differentially affected racial and ethnic minorities in the general population and those with rheumatic disease. We will also highlight disparities in rheumatic disease risk and severity that existed prior to the pandemic, and discuss recent work examining severe outcomes of COVID-19 in rheumatic disease patients by race and ethnicity. Finally, we propose several actionable steps for the rheumatology community to address COVID-19 health disparities, which may have long-term effects on patients with rheumatic disease.
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Affiliation(s)
- Tiffany Taylor
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Milena A Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA.
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142
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Popejoy AB. Truth and Reconciliation of Racial and Ethnic Health Disparities: A Case Study of COVID-19. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:79-83. [PMID: 33616495 DOI: 10.1080/15265161.2020.1871116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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143
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Labgold K, Hamid S, Shah S, Gandhi NR, Chamberlain A, Khan F, Khan S, Smith S, Williams S, Lash TL, Collin LJ. Estimating the Unknown: Greater Racial and Ethnic Disparities in COVID-19 Burden After Accounting for Missing Race and Ethnicity Data. Epidemiology 2021; 32:157-161. [PMID: 33323745 PMCID: PMC8641438 DOI: 10.1097/ede.0000000000001314] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black, Hispanic, and Indigenous persons in the United States have an increased risk of SARS-CoV-2 infection and death from COVID-19, due to persistent social inequities. However, the magnitude of the disparity is unclear because race/ethnicity information is often missing in surveillance data. METHODS We quantified the burden of SARS-CoV-2 notification, hospitalization, and case fatality rates in an urban county by racial/ethnic group using combined race/ethnicity imputation and quantitative bias analysis for misclassification. RESULTS The ratio of the absolute racial/ethnic disparity in notification rates after bias adjustment, compared with the complete case analysis, increased 1.3-fold for persons classified Black and 1.6-fold for those classified Hispanic, in reference to classified White persons. CONCLUSIONS These results highlight that complete case analyses may underestimate absolute disparities in notification rates. Complete reporting of race/ethnicity information is necessary for health equity. When data are missing, quantitative bias analysis methods may improve estimates of racial/ethnic disparities in the COVID-19 burden.
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Affiliation(s)
- Katie Labgold
- From the Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Sarah Hamid
- From the Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Sarita Shah
- From the Department of Epidemiology, Rollins School of Public Health, Emory University
- Department of Global Health, Rollins School of Public Health, Emory University
- Division of Infectious Diseases, Emory School of Medicine, Emory University
| | - Neel R Gandhi
- From the Department of Epidemiology, Rollins School of Public Health, Emory University
- Department of Global Health, Rollins School of Public Health, Emory University
- Division of Infectious Diseases, Emory School of Medicine, Emory University
| | - Allison Chamberlain
- From the Department of Epidemiology, Rollins School of Public Health, Emory University
| | | | | | | | | | - Timothy L Lash
- From the Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Lindsay J Collin
- From the Department of Epidemiology, Rollins School of Public Health, Emory University
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah
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144
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Islam JY, Vidot DC, Camacho-Rivera M. Determinants of COVID-19 preventive behaviours among adults with chronic diseases in the USA: an analysis of the nationally representative COVID-19 impact survey. BMJ Open 2021; 11:e044600. [PMID: 33563624 PMCID: PMC7874902 DOI: 10.1136/bmjopen-2020-044600] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Preventive behaviours have been recommended to control the spread of SARS-CoV-2. Adults with chronic diseases (CDs) are at higher risk of COVID-19-related mortality compared to the general population. Our objective was to evaluate adherence to COVID-19 preventive behaviours among adults without CDs compared with those with CDs and identify determinants of non-adherence to COVID-19 preventive behaviours. STUDY DESIGN Cross-sectional. SETTING AND PARTICIPANTS We used data from the nationally representative COVID-19 Impact Survey (n=10 760) conducted in the USA. PRIMARY MEASURES Adults with CDs were categorised based on a self-reported diagnosis of diabetes, high blood pressure, heart disease/heart attack/stroke, asthma, chronic obstructive pulmonary disease (COPD), bronchitis or emphysema, cystic fibrosis, liver disease, compromised immune system, or cancer (54%). RESULTS Compared with adults without CDs, adults with CDs were more likely to adhere to preventive behaviours including wearing a face mask (χ2-p<0.001), social distancing (χ2-p<0.001), washing or sanitising hands (χ2-p<0.001), and avoiding some or all restaurants (χ2-p=0.002) and public or crowded places (χ2-p=0.001). Adults with a high school degree or below [Adjusted prevalence ratio (aPR):1.82, 95% Confidence interval (CI)1.04 to 3.17], household income CONCLUSION Adults with CDs are more likely to adhere to recommended COVID-19 preventive behaviours. Public health messaging targeting specific demographic groups and geographic areas, such as adults without CD or adults living in rural areas, should be prioritised.
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Affiliation(s)
- Jessica Y Islam
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel HIll, Chapel Hill, North Carolina, USA
| | - Denise C Vidot
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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145
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Hedman HD, Krawczyk E, Helmy YA, Zhang L, Varga C. Host Diversity and Potential Transmission Pathways of SARS-CoV-2 at the Human-Animal Interface. Pathogens 2021; 10:180. [PMID: 33567598 PMCID: PMC7915269 DOI: 10.3390/pathogens10020180] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023] Open
Abstract
Emerging infectious diseases present great risks to public health. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), has become an urgent public health issue of global concern. It is speculated that the virus first emerged through a zoonotic spillover. Basic research studies have suggested that bats are likely the ancestral reservoir host. Nonetheless, the evolutionary history and host susceptibility of SARS-CoV-2 remains unclear as a multitude of animals has been proposed as potential intermediate or dead-end hosts. SARS-CoV-2 has been isolated from domestic animals, both companion and livestock, as well as in captive wildlife that were in close contact with human COVID-19 cases. Currently, domestic mink is the only known animal that is susceptible to a natural infection, develop severe illness, and can also transmit SARS-CoV-2 to other minks and humans. To improve foundational knowledge of SARS-CoV-2, we are conducting a synthesis review of its host diversity and transmission pathways. To mitigate this COVID-19 pandemic, we strongly advocate for a systems-oriented scientific approach that comprehensively evaluates the transmission of SARS-CoV-2 at the human and animal interface.
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Affiliation(s)
- Hayden D. Hedman
- Summit County Local Public Health Agency, Summit County, Frisco, CO 80443, USA;
| | - Eric Krawczyk
- Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Yosra A. Helmy
- Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH 44691, USA;
| | - Lixin Zhang
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA;
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA
| | - Csaba Varga
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
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146
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de Havenon A, Ney JP, Callaghan B, Delic A, Hohmann S, Shippey E, Esper GJ, Stulberg E, Tirschwell D, Frontera J, Yaghi S, Anadani M, Majersik JJ. Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States. J Stroke Cerebrovasc Dis 2021; 30:105535. [PMID: 33310595 PMCID: PMC7832426 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105535] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes. METHODS We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW). RESULTS In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p<0.05). Black and Hispanic patients accounted for 21.7% and 7.4% of IS controls, respectively, but 33.7% and 18.5% of IS-COVID (p<0.001). IS-COVID, versus IS controls, were less likely to receive alteplase (1.8% vs 5.6%, p<0.001), mechanical thrombectomy (4.4% vs. 6.7%, p<0.001), to have favorable discharge (33.9% vs. 66.4%, p<0.001), but more likely to die (30.4% vs. 6.5%, p<0.001). In the matched cohort of patients with IS-COVID and IS-PNA, IS-COVID had a higher risk of death (IPW-weighted OR 1.56, 95% CI 1.33-1.82) and lower odds of favorable discharge (IPW-weighted OR 0.63, 95% CI 0.54-0.73). CONCLUSIONS Ischemic stroke patients with COVID-19 are more likely to be male, younger, and Black or Hispanic, with significant increases in morbidity and mortality compared to both ischemic stroke controls from 2019 and to patients with ischemic stroke and pneumonia.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT 84132, United States.
| | - John P Ney
- Department of Neurology, Boston University, United States.
| | - Brian Callaghan
- Department of Neurology, University of Michigan, United States.
| | - Alen Delic
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT 84132, United States.
| | | | | | | | - Eric Stulberg
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT 84132, United States.
| | - David Tirschwell
- Department of Neurology, University of Washington, United States.
| | | | - Shadi Yaghi
- Department of Neurology, New York University, United States.
| | | | - Jennifer J Majersik
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT 84132, United States.
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147
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Snowden LR, Graaf G. COVID-19, Social Determinants Past, Present, and Future, and African Americans' Health. J Racial Ethn Health Disparities 2021; 8:12-20. [PMID: 33230737 PMCID: PMC7682952 DOI: 10.1007/s40615-020-00923-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/09/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
As the COVID-19 pandemic progresses, more African Americans than whites are falling ill and dying from the virus and more are losing livelihoods from the accompanying recession. The virus thereby exploits structural disadvantages, rooted partly in historical and contemporary anti-Black sentiments, working against African Americans. These include higher rates of comorbid illness and more limited health care access, higher rates of disadvantageous labor market positioning and community and housing conditions, greater exposure to long-term care residence, and higher incarceration rates. COVID-19 also exposes African Americans' greater vulnerability to recession, and possibly greater susceptibility to accompanying behavioral health problems. If they are left unaddressed, the very vulnerabilities COVID-19 exploits may perpetuate themselves. However, continuing and supplementing health and economic COVID mitigation policies can disproportionately benefit African Americans and reduce short- and long-term adverse effects. The greater impact of COVID-19 on African Americans demonstrates the consequences of pervasive social and economic inequality and marks this as a critical time to prevent further compounding of adverse effects.
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Affiliation(s)
- Lonnie R. Snowden
- School of Public Health, University of California, Berkeley, University Hall #235, Berkeley, CA 94720 USA
| | - Genevieve Graaf
- School of Social Work, University of Texas, Arlington, Arlington, TX USA
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148
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Tsai J. COVID-19 is Not a Story of Race, but a Record of Racism-Our Scholarship Should Reflect That Reality. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:43-47. [PMID: 33534670 DOI: 10.1080/15265161.2020.1861377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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149
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Burgess RA, Osborne RH, Yongabi KA, Greenhalgh T, Gurdasani D, Kang G, Falade AG, Odone A, Busse R, Martin-Moreno JM, Reicher S, McKee M. The COVID-19 vaccines rush: participatory community engagement matters more than ever. Lancet 2021; 397:8-10. [PMID: 33308484 PMCID: PMC7832461 DOI: 10.1016/s0140-6736(20)32642-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Kenneth A Yongabi
- AU-ASRIC Afro-centric COVID-19 Working Group, Faculty of Health Sciences, Imo State University, Owerri, Nigeria
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deepti Gurdasani
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences Christian Medical College, Vellore, TN, India
| | - Adegoke G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Reinhard Busse
- Department of Health Care Management, Technical University Berlin, Germany
| | - Jose M Martin-Moreno
- Department of Preventive Medicine and INCLIVA, University of Valencia, Valencia, Spain
| | - Stephen Reicher
- School of Psychology and Neuroscience, St Andrews University, Fife, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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150
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Sorensen G, Dennerlein JT, Peters SE, Sabbath EL, Kelly EL, Wagner GR. The future of research on work, safety, health and wellbeing: A guiding conceptual framework. Soc Sci Med 2021; 269:113593. [PMID: 33341740 PMCID: PMC10868656 DOI: 10.1016/j.socscimed.2020.113593] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023]
Abstract
Work plays a central role in health. A conceptual model can help frame research priorities and questions to explore determinants of workers' safety, health, and wellbeing. A previous conceptual model focused on the workplace setting to emphasize the role of conditions of work in shaping workers' safety, health and wellbeing. These conditions of work include physical, organizational, and psychosocial factors. This manuscript presents and discusses an updated and expanded conceptual model, placing the workplace and the conditions of work within the broader context of socio-political-economic environments and consequent trends in employment and labor force patterns. Social, political and economic trends, such as growing reliance on technology, climate change, and globalization, have significant implications for workers' day-to-day experiences. These structural forces in turn shape employment and labor patterns, with implications for the availability and quality of jobs; the nature of relationships between employers and workers; and the benefits and protections available to workers. Understanding these patterns will be critical for anticipating the consequences of future changes in the conditions of work, and ultimately help inform decision-making around policies and practices intended to protect and promote worker safety, health, and wellbeing. This model provides a structure for anticipating research needs in response to the changing nature of work, including the formation of research priorities, the need for expanded research methods and measures, and attention to diverse populations of enterprises and workers. This approach anticipates changes in the way work is structured, managed, and experienced by workers and can effectively inform policies and practices needed to protect and promote worker safety, health and wellbeing.
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Affiliation(s)
- Glorian Sorensen
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jack T Dennerlein
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Susan E Peters
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Erika L Sabbath
- Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Erin L Kelly
- MIT Sloan School of Management, Cambridge, MA, USA
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