Racial Disparities in COVID-19 Impacts in Michigan, USA

Third- and First-Person Effects of COVID News in HBCU Students' Risk Perception and Behavioral Intention: Social Desirability, Social Distance, and Social Identity

With COVID-19's unprecedented impact and ongoing debates on prosocial social distancing and antisocial beach crowd gathering, this study examined the roles of social desirability, social distance marked by race, and social identity in the third-person effect (TPE) of COVID-related news concerning risk perception among Historically Black College and University (HBCU) students. The findings confirmed third- and first-person effects with the perceived influence of antisocial (beach partying) news greater for others than themselves, whereas the self was perceived to be more responsive to the influence of prosocial (social distancing) news. A symmetric interaction between social desirability and social identity indicated that the racial out-group, non-HBCU students in Florida were perceived as more affected by antisocial beach party news, whereas the in-group HBCU peers were perceived as more influenced by desirable social distancing warning news and COVID news in general. The first-person perception and shrunk self-other gap in COVID news influence on HBCU students" concerns may be associated with perceived personal vulnerability and responsibility as well as a political reflection on the government's handling of COVID. While they presumed favorable media influence on self and the in-group to preserve collective self-esteem, they made realistic threat judgments from perceiving undesirable media influence on their in-group peers' risky behavior tendency and intended to take preventive actions (staying home) to avoid the health risk. Further, it was the first-person perceptual gap between themselves and the out-group, non-HBCU students that influenced them to heed social distancing warnings.

The Shift: COVID-19-Associated Deaths are Now Trending Lower Among Blacks and Hispanics Compared to Whites

BACKGROUND

Throughout the coronavirus (COVID-19) pandemic, research revealed people of color were more likely to be infected, have severe illness, and die due to the virus. However, some areas in the USA are now reporting a new shift; lower Black and Hispanic COVID-19 mortality rates compared to their White counterparts. Research indicates that this shift is the result of COVID-19's impact on disparities by race. In this paper, we analyze death data to determine if the new shift has occurred locally. Specifically, we examined COVID-19 prevalence and related death data in Connecticut by comparing race/ethnicity through two periods of time: one before and one after the first case of the Omicron variant of COVID-19.

METHODS

This cross-sectional epidemiological analysis to examine cases and deaths by racial/ethnic status utilizes Connecticut data from March 2020 to February 2022. The following assumption is applied: expected pre-Omicron cases and deaths from March 5, 2020 to November 27, 2021 are equal to the number of cases and deaths during Omicron cases and deaths from November 28, 2021 to February 17, 2022. Race/ethnicity are operationalized as non-Hispanic White, non-Hispanic Black, and Hispanic.

RESULTS

Pre-Omicron (March 5, 2020 to November 27, 2021) compared to the monthly aged adjusted COVID-19 case rate for Whites (394/10,000 populations), Blacks had a higher rate (501/10,000 populations), and Hispanics had the highest (585/10,000 populations). During the Omicron period (November 28 to February 17, 2022), significant changes in COVID-19 case rates were observed in all three ethnic groups, but the biggest changes were observed in Hispanics, followed by Blacks, and then Whites. The rate ratios further showed a remarkable reduction of 47% in case rates (from 1.0 pre-Omicron and from 1.47 during Omicron, p < 0.0001) for Hispanics, when compared to that of Whites. While Blacks showed a significant, smaller reduction of 5% in case rates (from 1.27 pre-Omicron and from 1.22 during the Omicron, p < 0.001) when compared to Whites. Regarding COVID-19-related mortality, the racial differences were similar.

CONCLUSIONS AND RELEVANCE

By examining Connecticut's COVID-19 death and case data, this study identified the new shift that occurred locally. The current shift may be anchored in the evolution of the COVID-19 virus, public health guidelines/policies, and the degree to which populations have complied with public health recommendations.

Retrospective Analysis of Vaccinated and Unvaccinated COVID-19 Patients Treated with Monoclonal Antibodies (mAb) and Their Emergent Needs (RAVEN)

Strategies to combat COVID-19 include vaccines and Monoclonal Antibody Therapy. While vaccines aim to prevent development of symptoms, Monoclonal Antibody Therapy aims to prevent the progression of mild to severe disease. An increasing number of COVID-19 infections in vaccinated patients raised the question of whether vaccinated and unvaccinated COVID-19 positive patients respond differently to Monoclonal Antibody Therapy. The answer can help prioritize patients if resources are scarce. We performed a retrospective study to evaluate and compare the outcomes and risks for disease progression between vaccinated and unvaccinated COVID-19 patients treated with Monoclonal Antibody Therapy by measuring the number of Emergency Department visits and hospitalizations within 14 days as well as the progression to severe disease, defined through the Intensive Care Unit admissions within 14 days, and death within 28 days from the Monoclonal Antibody infusion. From 3898 included patients, 2009 (51.5%) were unvaccinated at the time of Monoclonal Antibody infusion. Unvaccinated patients had more Emergency Department visits (217 vs. 79, p < 0.0001), hospitalizations (116 vs. 38, p < 0.0001), and progression to severe disease (25 vs. 19, p = 0.016) following treatment with Monoclonal Antibody Therapy. After adjustment for demographics and comorbidities, unvaccinated patients were 2.45 times more likely to seek help in the Emergency Department and 2.70 times more likely to be hospitalized. Our data suggest the added benefit between the COVID-19 vaccine and Monoclonal Antibody Therapy.

An exploration of structural determinants driving racial disparities in COVID-19 deaths in Michigan

Aim

Racial disparities in COVID-19 death rates have largely been driven by structural racism in health, housing, and labor systems that place Black, Brown, and Indigenous populations at greater risk for COVID-19 exposure, transmission, and severe illness, compared to non-Hispanic White populations. Here we examine the association between taxable property values per capita, an indicator influenced by historical and contemporary housing policies that have disproportionately impacted people of color, and COVID-19 deaths.

Methods

Taxable values serve as a proxy for fiscal health providing insight on the county's ability to address imminent needs, including COVID-19 responses. Therefore, higher taxable values indicate local governments that are better equipped to deliver these public services. We used county-level data from the American Community Survey, the Michigan Community Financial Dashboard, The Atlantic's COVID Tracking Project, and the Community Health Rankings and Roadmap for this cross-sectional study. Maps were created to examine the geographic distribution of cumulative death rates and taxable values per capita, and regression models were used to examine the association between the two while controlling for population density, age, education, race, income, obesity, diabetes, and smoking rates.

Results

Seventy-five counties were included. The mean taxable value per capita was $43,764.50 and the mean cumulative death rate was 171.86. Findings from the regression analysis showed that counties with higher taxable values were associated with lower COVID-19 death rates (B = -2.45, P < 0.001).

Conclusion

Our findings reveal a need to reevaluate current policies surrounding taxable property values in the state of Michigan, not solely for their inequitable impact on local governments' financial solvency and service quality, but also for their negative consequences for population health and racial health equity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01817-w.

Neighborhood satisfaction and reproductive status

Both urban planners and urban scholars have been keenly interested in identifying the characteristics associated with neighborhood satisfaction. One robust but surprising pattern is that the presence or number of children in a household has no effect on neighborhood satisfaction. To clarify this pattern, we measured the neighborhood satisfaction of a representative sample of 1,000 Michigan adults, whom we divided into six distinct reproductive statuses: co-parents, single-parents, empty nesters, not-yet-parents, childless individuals, and childfree individuals. We found that a simple parent vs. non-parent dichotomy hides significant heterogeneity among these groups. Specifically, we found that single parents and childfree individuals experience significantly less neighborhood satisfaction than other groups. We conclude by reflecting on the methodological and practical implications of differences in neighborhood satisfaction when more nuanced reproductive statuses are considered.

Prevalence and Correlates of SARS CoV-2 Among a Community-Based Sample Recruited Using Randomized Venue-Based Sampling. Essex County, NJ, 2020

Disparities in morbidity and mortality related to COVID-19 based on race and ethnicity have been documented in the USA. However, it is unclear if these disparities also exist at the exposure stage. To determine this, studies are needed to document the underlying burden of disease, potential disparities through serologic surveillance. Additionally, such studies can help identify where along the disease spectrum (e.g., exposure, infection, diagnosis, treatment, death) and with regard to the structural factors that necessitate public health and/or clinical interventions. Our objectives in this study were to estimate the true burden of SARS CoV-2 in the community of Essex County, NJ, an early and hard hit area, to determine the correlates of SARS CoV-2 prevalence and to determine if COVID-19 disparities seen by race/ethnicity were also reflected in SARS CoV-2 burden. We utilized venue-based-sampling (VBS) to sample members of the community in Essex County. Participants completed a short electronic survey and provided finger stick blood samples for testing. We sampled 924 residents of Essex County, New Jersey. Testing conducted in this study identified 83 (9.0%) participants as positive for SARS-CoV-2 antibodies. Importantly, our findings suggest that the true burden of SARS-Cov-2 and the pool of persons potentially spreading the virus are slightly more than six times than that suggested by PCR testing Notably, there were no significant differences in odds of testing positive for SARS CoV-2 antibodies in terms of race/ethnicity where we compared Black and Latinx participants to other race participants. Our study suggests that disparities in COVID-19 outcomes stem from potential upstream issues such as underlying conditions, access to testing, and access to care rather than disparities in exposure to the virus.

Associations of Race/Ethnicity and Food Insecurity With COVID-19 Infection Rates Across US Counties

IMPORTANCE

Food insecurity is prevalent among racial/ethnic minority populations in the US. To date, few studies have examined the association between pre-COVID-19 experiences of food insecurity and COVID-19 infection rates through a race/ethnicity lens.

OBJECTIVE

To examine the associations of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates and the interactions of race/ethnicity and food insecurity, while controlling for demographic, socioeconomic, risk exposure, and geographic confounders.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study examined the associations of race/ethnicity and food insecurity with cumulative COVID-19 infection rates in 3133 US counties, as of July 21 and December 14, 2020. Data were analyzed from November 2020 through March 2021.

EXPOSURES

Racial/ethnic minority groups who experienced food insecurity.

MAIN OUTCOMES AND MEASURES

The dependent variable was COVID-19 infections per 1000 residents. The independent variables of interest were race/ethnicity, food insecurity, and their interactions.

RESULTS

Among 3133 US counties, the mean (SD) racial/ethnic composition was 9.0% (14.3%) Black residents, 9.6% (13.8%) Hispanic residents, 2.3% (7.3%) American Indian or Alaska Native residents, 1.7% (3.2%) Asian American or Pacific Islander residents, and 76.1% (20.1%) White residents. The mean (SD) proportion of women was 49.9% (2.3%), and the mean (SD) proportion of individuals aged 65 years or older was 19.3% (4.7%). In these counties, large Black and Hispanic populations were associated with increased COVID-19 infection rates in July 2020. An increase of 1 SD in the percentage of Black and Hispanic residents in a county was associated with an increase in infection rates per 1000 residents of 2.99 (95% CI, 2.04 to 3.94; P < .001) and 2.91 (95% CI, 0.39 to 5.43; P = .02), respectively. By December, a large Black population was no longer associated with increased COVID-19 infection rates. However, a 1-SD increase in the percentage of Black residents in counties with high prevalence of food insecurity was associated with an increase in infections per 1000 residents of 0.90 (95% CI, 0.33 to 1.47; P = .003). Similarly, a 1-SD increase in the percentage of American Indian or Alaska Native residents in counties with high levels of food insecurity was associated with an increase in COVID-19 infections per 1000 residents of 0.57 (95% CI, 0.06 to 1.08; P = .03). By contrast, a 1-SD increase in Hispanic populations in a county remained independently associated with a 5.64 (95% CI, 3.54 to 7.75; P < .001) increase in infection rates per 1000 residents in December 2020 vs 2.91 in July 2020. Furthermore, while a 1-SD increase in the proportion of Asian American or Pacific Islander residents was associated with a decrease in infection rates per 1000 residents of -1.39 (95% CI, -2.29 to 0.49; P = .003), the interaction with food insecurity revealed a similar association (interaction coefficient, -1.48; 95% CI, -2.26 to -0.70; P < .001).

CONCLUSIONS AND RELEVANCE

This study sheds light on the association of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates in the United States. These findings suggest that the channels through which various racial/ethnic minority population concentrations were associated with COVID-19 infection rates were markedly different during the pandemic.

Assessing Attitudes Toward COVID-19 Prevention: Defining Two Attitudes Crucial for Understanding Systemic and Social Variables Associated with Disparities

This study tested a conceptual model identifying two distinct types of attitudes people may have toward following recommendations to prevent COVID-19. These attitudes were expected to be important for understanding types of systemic and social variables associated with health disparities such as racial discrimination, residential environment, lack of healthcare access, and negative healthcare experiences. The conceptual model was drawn from previous work examining adherence to medical recommendations that identified two distinct and consequential attitudes that influence behavior: perceived benefit (believing recommendations are effective and necessary) and perceived burden (experiencing recommendations as unpleasant or difficult). Approximately equal proportions of Black and White individuals living in the USA (N = 194) were recruited to complete an online survey. A psychometric analysis indicated that perceived benefit and burden attitudes were two distinct and meaningful dimensions that could be assessed with high validity, and scales demonstrated measurement invariance across Black and White groups. In correlation analyses, benefit and burden attitudes were robustly associated with neighborhood violence, healthcare access, and healthcare experiences (but not with experiences of discrimination), and all these associations remained significant after accounting for subjective stress and political affiliation. These findings have implications for increasing compliance to public health recommendations and addressing health disparities.