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Chang MC, Wen TH. The Mediating Role of Human Mobility in Temporal-Lagged Relationships Between Risk Perception and COVID-19 Dynamics in Taiwan: Statistical Modeling for Comparing the Pre-Omicron and Omicron Eras. JMIR Public Health Surveill 2024; 10:e55183. [PMID: 39166531 DOI: 10.2196/55183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 08/23/2024] Open
Abstract
Background The COVID-19 pandemic has profoundly impacted all aspects of human life for over 3 years. Understanding the evolution of public risk perception during these periods is crucial. Few studies explore the mechanisms for reducing disease transmission due to risk perception. Thus, we hypothesize that changes in human mobility play a mediating role between risk perception and the progression of the pandemic. Objective The study aims to explore how various forms of human mobility, including essential, nonessential, and job-related behaviors, mediate the temporal relationships between risk perception and pandemic dynamics. Methods We used distributed-lag linear structural equation models to compare the mediating impact of human mobility across different virus variant periods. These models examined the temporal dynamics and time-lagged effects among risk perception, changes in mobility, and virus transmission in Taiwan, focusing on two distinct periods: (1) April-August 2021 (pre-Omicron era) and (2) February-September 2022 (Omicron era). Results In the pre-Omicron era, our findings showed that an increase in public risk perception correlated with significant reductions in COVID-19 cases across various types of mobility within specific time frames. Specifically, we observed a decrease of 5.59 (95% CI -4.35 to -6.83) COVID-19 cases per million individuals after 7 weeks in nonessential mobility, while essential mobility demonstrated a reduction of 10.73 (95% CI -9.6030 to -11.8615) cases after 8 weeks. Additionally, job-related mobility resulted in a decrease of 3.96 (95% CI -3.5039 to -4.4254) cases after 11 weeks. However, during the Omicron era, these effects notably diminished. A reduction of 0.85 (95% CI -1.0046 to -0.6953) cases through nonessential mobility after 10 weeks and a decrease of 0.69 (95% CI -0.7827 to -0.6054) cases through essential mobility after 12 weeks were observed. Conclusions This study confirms that changes in mobility serve as a mediating factor between heightened risk perception and pandemic mitigation in both pre-Omicron and Omicron periods. This suggests that elevating risk perception is notably effective in impeding virus progression, especially when vaccines are unavailable or their coverage remains limited. Our findings provide significant value for health authorities in devising policies to address the global threats posed by emerging infectious diseases.
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Affiliation(s)
- Min-Chien Chang
- Department of Geography, National Taiwan University, Taipei, Taiwan
| | - Tzai-Hung Wen
- Department of Geography, National Taiwan University, Taipei, Taiwan
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Chen AS, Brown M, Arekelyan A, Wennemann S, Shamie N, Holly L, Liu JC, Wang JC, Buser Z. A Tale of Two Institutions: COVID-19 Positive Rates in Asymptomatic Patients Pre-Screened for Spine Procedures and Surgeries in Los Angeles, California. Global Spine J 2023; 13:1865-1870. [PMID: 34870486 PMCID: PMC10556893 DOI: 10.1177/21925682211057489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The coronavirus disease (COVID-19), caused by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2), has created an unprecedented global public health emergency. The aim of the current study was to report on COVID-19 rates in an asymptomatic population prior to undergoing spine procedures or surgeries at two large Los Angeles healthcare systems. METHODS Elective spine procedures and surgeries from May 1, 2020 to January 31, 2021 were included. Results from SARS-CoV-2 virus RT-PCR nasopharyngeal testing within 72 hours prior to elective spine procedures were recorded. Los Angeles County COVID-19 rates were calculated using data sets from Los Angeles County Department of Public Health. Chi-squared test and Stata/IC were used for statistical analysis. RESULTS A total of 4,062 spine procedures and surgeries were scheduled during this time period. Of these, 4,043 procedures and surgeries were performed, with a total of 19 patients testing positive. Nine positive patients were from UCLA, and 10 from USC. The overall rate of positive tests was low at .47% and reflected similarities with Los Angeles County COVID-19 rates over time. CONCLUSIONS The current study shows that pre-procedure COVID-19 testing rates remains very low, and follows similar patterns of community rates. While pre-procedure testing increases the safety of elective procedures, universal COVID-19 pre-screening adds an additional barrier to receiving care for patients and increases cost of delivering care. A combination of pre-screening, pre-procedure self-quarantine, and consideration of overall community COVID-19 positivity rates should be further studied.
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Affiliation(s)
- Allen S. Chen
- Department of Orthopaedic Surgery, UCLA Spine Center, Santa Monica, CA, USA
| | - Matthew Brown
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Anush Arekelyan
- Department of Neurological Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA
| | - Sophie Wennemann
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern CaliforniaLos Angeles, CA, USA
| | - Nick Shamie
- Department of Orthopaedic Surgery, UCLA Spine Center, Santa Monica, CA, USA
| | - Langston Holly
- Department of Neurological Surgery, UCLA Spine Center, Santa Monica, CA, USA
| | - John C. Liu
- Department of Neurological Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern CaliforniaLos Angeles, CA, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern CaliforniaLos Angeles, CA, USA
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Pensieroso L, Sommacal A, Spolverini G. Intergenerational coresidence and the Covid-19 pandemic in the United States. ECONOMICS AND HUMAN BIOLOGY 2023; 49:101230. [PMID: 36738638 PMCID: PMC9876014 DOI: 10.1016/j.ehb.2023.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/14/2022] [Accepted: 01/17/2023] [Indexed: 05/06/2023]
Abstract
This paper investigates the relation between intergenerational coresidence and mortality from Covid-19 in 2020. Using a cross-section of U.S. counties, we show that this association is positive, sizeable, significant, and robust to the inclusion of several demographic and socio-economic controls. Furthermore, using evidence from past, pre-pandemic years, we argue that this positive, sizeable and significant association is somewhat specific to the Covid-19 pandemic.
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Affiliation(s)
| | | | - Gaia Spolverini
- IRES/LIDAM, UCLouvain, Belgium; Fonds de la Recherche Scientifique - FNRS, Belgium.
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Harris JE. Concentric regulatory zones failed to halt surging COVID-19: Brooklyn 2020. Front Public Health 2022; 10:970363. [PMID: 36568788 PMCID: PMC9768182 DOI: 10.3389/fpubh.2022.970363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
Methods We relied on reports of confirmed case incidence and test positivity, along with data on the movements of devices with location-tracking software, to evaluate a novel scheme of three concentric regulatory zones introduced by then New York Governor Cuomo to address an outbreak of COVID-19 in South Brooklyn in the fall of 2020. The regulatory scheme imposed differential controls on access to eating places, schools, houses of worship, large gatherings and other businesses within the three zones, but without restrictions on mobility. Results Within the central red zone, COVID-19 incidence temporarily declined from 131.2 per 100,000 population during the week ending October 3 to 62.5 per 100,000 by the week ending October 31, but then rebounded to 153.6 per 100,000 by the week ending November 28. Within the intermediate orange and peripheral yellow zones combined, incidence steadily rose from 28.8 per 100,000 during the week ending October 3 to 109.9 per 100,000 by the week ending November 28. Data on device visits to pairs of eating establishments straddling the red-orange boundary confirmed compliance with access controls. More general analysis of device movements showed stable patterns of movement between and beyond zones unaffected by the Governor's orders. A geospatial regression model of COVID-19 incidence in relation to device movements across zip code tabulation areas identified a cluster of five high-movement ZCTAs with estimated reproduction number 1.91 (95% confidence interval, 1.27-2.55). Discussion In the highly populous area of South Brooklyn, controls on access alone, without restrictions on movement, were inadequate to halt an advancing COVID-19 outbreak.
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Affiliation(s)
- Jeffrey E. Harris
- Massachusetts Institute of Technology, Cambridge, MA, United States,Eisner Health, Los Angeles, CA, United States,*Correspondence: Jeffrey E. Harris
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Cristini A, Trivin P. Close encounters during a pandemic: Social habits and inter-generational links in the first two waves of COVID-19. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101180. [PMID: 36095863 PMCID: PMC9436881 DOI: 10.1016/j.ehb.2022.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Social habits are ingrained in a community and affect human behaviour. Have they played any role in the spread of the pandemic? We use high-frequency data for 220 regions in 15 European countries from March to December 2020 to compare the association between social contacts outside the family and within inter-generational families, on the one hand, and cases and excess mortality on the other. We find that a standard deviation increase in the percentage of people having daily face-to-face contacts outside the household is associated with 5 new daily cases and 2.6 additional weekly deaths, while the incidence of inter-generational households exhibits a less robust association with both COVID-19 transmission and mortality. We compare results across the first and the second wave of pandemic and show that differences are related to the average age of the most affected groups. Our findings are robust to the inclusion of a number of controls, fixed effects, the chosen sample of countries, and the estimation method. We argue that type and frequency of social interactions are interweaved with a region culture and habits and are informative on the potential transmission of contagion and on its lethality.
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Affiliation(s)
- Annalisa Cristini
- Department of Economics, University of Bergamo, 24127 Bergamo, Italy.
| | - Pedro Trivin
- Department of Economics, University of Bergamo, 24127 Bergamo, Italy.
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Mullachery PH, Li R, Melly S, Kolker J, Barber S, Diez Roux AV, Bilal U. Inequities in spatial accessibility to COVID-19 testing in 30 large US cities. Soc Sci Med 2022; 310:115307. [PMID: 36049353 PMCID: PMC9420026 DOI: 10.1016/j.socscimed.2022.115307] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Testing for SARS-CoV-2 infection has been a key strategy to mitigate and control the COVID-19 pandemic. Wide spatial and racial/ethnic disparities in COVID-19 outcomes have emerged in US cities. Previous research has highlighted the role of unequal access to testing as a potential driver of these disparities. We described inequities in spatial accessibility to COVID-19 testing locations in 30 large US cities. We used location data from Castlight Health Inc corresponding to October 2021. We created an accessibility metric at the level of the census block group (CBG) based on the number of sites per population in a 15-minute walkshed around the centroid of each CBG. We also calculated spatial accessibility using only testing sites without restrictions, i.e., no requirement for an appointment or a physician order prior to testing. We measured the association between the social vulnerability index (SVI) and spatial accessibility using a multilevel negative binomial model with random city intercepts and random SVI slopes. Among the 27,195 CBG analyzed, 53% had at least one testing site within a 15-minute walkshed, and 36% had at least one site without restrictions. On average, a 1-decile increase in the SVI was associated with a 3% (95% Confidence Interval: 2% - 4%) lower accessibility. Spatial inequities were similar across various components of the SVI and for sites with no restrictions. Despite this general pattern, several cities had inverted inequity, i.e., better accessibility in more vulnerable areas, which indicates that some cities may be on the right track when it comes to promoting equity in COVID-19 testing. Testing is a key component of the strategy to mitigate transmission of SARS-CoV-2 and efforts should be made to improve accessibility to testing, particularly as new and more contagious variants become dominant.
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Affiliation(s)
- Pricila H. Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Health Services Administration and Policy, Temple University College of Public Health, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA,Corresponding author. 1301 Cecil B. Moore Ave., 539, Philadelphia, PA, 19122, United States
| | - Ran Li
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Steven Melly
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Jennifer Kolker
- Department of Health Management and Policy, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Sharrelle Barber
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA,Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
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Harris JE. Mobility was a significant determinant of reported COVID-19 incidence during the Omicron Surge in the most populous U.S. Counties. BMC Infect Dis 2022; 22:691. [PMID: 35971063 PMCID: PMC9376582 DOI: 10.1186/s12879-022-07666-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Significant immune escape by the Omicron variant, along with the emergence of widespread worry fatigue, have called into question the robustness of the previously observed relation between population mobility and COVID-19 incidence. METHODS We employed principal component analysis to construct a one-dimensional summary indicator of six Google mobility categories. We related this mobility indicator to case incidence among 111 of the most populous U.S. counties during the Omicron surge from December 2021 through February 2022. RESULTS Reported COVID-19 incidence peaked earlier and declined more rapidly among those counties exhibiting more extensive decline in mobility between December 20 and January 3. Based upon a fixed-effects, longitudinal cohort model, we estimated that every 1% decline in mobility between December 20 and January 3 was associated with a 0.63% decline in peak incidence during the week ending January 17 (95% confidence interval, 0.40-0.86%). Based upon a cross-sectional analysis including mean household size and vaccination participation as covariates, we estimated that the same 1% decline in mobility was associated with a 0.36% decline in cumulative reported COVID-19 incidence from January 10 through February 28 (95% CI, 0.18-0.54%). CONCLUSION Omicron did not simply sweep through the U.S. population until it ran out of susceptible individuals to infect. To the contrary, a significant fraction managed to avoid infection by engaging in risk-mitigating behaviors. More broadly, the behavioral response to perceived risk should be viewed as an intrinsic component of the natural course of epidemics in humans.
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Affiliation(s)
- Jeffrey E Harris
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. .,Eisner Health, Los Angeles, CA, 90015, USA.
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Harris JE. Geospatial Analysis of a COVID-19 Outbreak at the University of Wisconsin - Madison: Potential Role of a Cluster of Local Bars. Epidemiol Infect 2022; 150:1-31. [PMID: 35380104 PMCID: PMC9043656 DOI: 10.1017/s0950268822000498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/10/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
We combined smartphone mobility data with census track-based reports of positive case counts to study a coronavirus disease 2019 (COVID-19) outbreak at the University of Wisconsin–Madison campus, where nearly 3000 students had become infected by the end of September 2020. We identified a cluster of twenty bars located at the epicentre of the outbreak, in close proximity to campus residence halls. Smartphones originating from the two hardest-hit residence halls (Sellery-Witte), where about one in five students were infected, were 2.95 times more likely to visit the 20-bar cluster than smartphones originating in two more distant, less affected residence halls (Ogg-Smith). By contrast, smartphones from Sellery-Witte were only 1.55 times more likely than those from Ogg-Smith to visit a group of 68 restaurants in the same area [rate ratio 1.91, 95% confidence interval (CI) 1.29–2.85, P < 0.001]. We also determined the per-capita rates of visitation to the 20-bar cluster and to the 68-restaurant comparison group by smartphones originating in each of 21 census tracts in the university area. In a multivariate instrumental variables regression, the visitation rate to the bar cluster was a significant determinant of the per-capita incidence of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests in each census tract (elasticity 0.88, 95% CI 0.08–1.68, P = 0.032), while the restaurant visitation rate showed no such relationship. The potential super-spreader effects of clusters or networks of places, rather than individual sites, require further attention.
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Affiliation(s)
- Jeffrey E Harris
- Professor of Economics, Emeritus, Massachusetts Institute of Technology, Cambridge MA 02139; Physician, Eisner Health, Los AngelesCA90015.
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Harris JE. Critical Role of the Subways in the Initial Spread of SARS-CoV-2 in New York City. Front Public Health 2022; 9:754767. [PMID: 35004575 PMCID: PMC8733200 DOI: 10.3389/fpubh.2021.754767] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/29/2021] [Indexed: 12/24/2022] Open
Abstract
We studied the possible role of the subways in the spread of SARS-CoV-2 in New York City during late February and March 2020. Data on cases and hospitalizations, along with phylogenetic analyses of viral isolates, demonstrate rapid community transmission throughout all five boroughs within days. The near collapse of subway ridership during the second week of March was followed within 1–2 weeks by the flattening of COVID-19 incidence curve. We observed persistently high entry into stations located along the subway line serving a principal hotspot of infection in Queens. We used smartphone tracking data to estimate the volume of subway visits originating from each zip code tabulation area (ZCTA). Across ZCTAs, the estimated volume of subway visits on March 16 was strongly predictive of subsequent COVID-19 incidence during April 1–8. In a spatial analysis, we distinguished between the conventional notion of geographic contiguity and a novel notion of contiguity along subway lines. We found that the March 16 subway-visit volume in subway-contiguous ZCTAs had an increasing effect on COVID-19 incidence during April 1–8 as we enlarged the radius of influence up to 5 connected subway stops. By contrast, the March 31 cumulative incidence of COVID-19 in geographically-contiguous ZCTAs had an increasing effect on subsequent COVID-19 incidence as we expanded the radius up to three connected ZCTAs. The combined evidence points to the initial citywide dissemination of SARS-CoV-2 via a subway-based network, followed by percolation of new infections within local hotspots.
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Affiliation(s)
- Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, MA, United States.,Eisner Health, Los Angeles, CA, United States
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Ma KPK, Bacong AM, Kwon SC, Yi SS, Ðoàn LN. The Impact of Structural Inequities on Older Asian Americans During COVID-19. Front Public Health 2021; 9:690014. [PMID: 34490181 PMCID: PMC8417937 DOI: 10.3389/fpubh.2021.690014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/21/2021] [Indexed: 12/27/2022] Open
Abstract
Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health-namely immigration, language and telehealth access, and economic conditions-lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of "public charge" rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Adrian Matias Bacong
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Simona C. Kwon
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Stella S. Yi
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Lan N. Ðoàn
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
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Horn AL, Jiang L, Washburn F, Hvitfeldt E, de la Haye K, Nicholas W, Simon P, Pentz M, Cozen W, Sood N, Conti DV. An integrated risk and epidemiological model to estimate risk-stratified COVID-19 outcomes for Los Angeles County: March 1, 2020-March 1, 2021. PLoS One 2021; 16:e0253549. [PMID: 34166416 PMCID: PMC8224896 DOI: 10.1371/journal.pone.0253549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023] Open
Abstract
The objective of this study was to use available data on the prevalence of COVID-19 risk factors in subpopulations and epidemic dynamics at the population level to estimate probabilities of severe illness and the case and infection fatality rates (CFR and IFR) stratified across subgroups representing all combinations of the risk factors age, comorbidities, obesity, and smoking status. We focus on the first year of the epidemic in Los Angeles County (LAC) (March 1, 2020-March 1, 2021), spanning three epidemic waves. A relative risk modeling approach was developed to estimate conditional effects from available marginal data. A dynamic stochastic epidemic model was developed to produce time-varying population estimates of epidemic parameters including the transmission and infection observation rate. The epidemic and risk models were integrated to produce estimates of subpopulation-stratified probabilities of disease progression and CFR and IFR for LAC. The probabilities of disease progression and CFR and IFR were found to vary as extensively between age groups as within age categories combined with the presence of absence of other risk factors, suggesting that it is inappropriate to summarize epidemiological parameters for age categories alone, let alone the entire population. The fine-grained subpopulation-stratified estimates of COVID-19 outcomes produced in this study are useful in understanding disparities in the effect of the epidemic on different groups in LAC, and can inform analyses of targeted subpopulation-level policy interventions.
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Affiliation(s)
- Abigail L. Horn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Lai Jiang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Faith Washburn
- Los Angeles County Department of Public Health, Los Angeles, CA, United States of America
| | - Emil Hvitfeldt
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Kayla de la Haye
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - William Nicholas
- Los Angeles County Department of Public Health, Los Angeles, CA, United States of America
| | - Paul Simon
- Los Angeles County Department of Public Health, Los Angeles, CA, United States of America
| | - Maryann Pentz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Wendy Cozen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Neeraj Sood
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, United States of America
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States of America
| | - David V. Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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