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Lee J. Correlates of and Disparities in Cancellations or Delays of Prenatal Visits During the Covid-19 Pandemic: Emphasis on Racial/Ethnic Minorities and Persons with Low Socioeconomic Status. J Racial Ethn Health Disparities 2024; 11:1564-1577. [PMID: 37160575 PMCID: PMC10169131 DOI: 10.1007/s40615-023-01632-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To investigate barriers and disparities in prenatal visits across population subgroups. METHODS This pooled cross-sectional study was conducted using Pregnancy Risk Assessment Monitoring System for 2020 through 2021. Women who reported their experiences of cancellation or delay in prenatal visits were included. A multivariable regression analysis estimated adjusted prevalence ratios (aPR) for cancellations or delays in prenatal care. RESULTS Of a total of 11,427, one-third had cancelled or delayed care. Hispanics, compared to their white counterparts, were 22% likelier to have cancelled or delayed care. Women covered by Medicaid and those with depression had 17% and 34% greater likelihoods of cancellation or delay, respectively. Cancellations or delays were comparable for the years 2020 and 2021 across reasons, except for facility closures, which were more common in 2020 than in 2021. Hispanics tended to cancel or delay prenatal visits more often than whites for reasons, such as facility closures, COVID-19-related reasons, a lack of transportation, and loss of insurance, while transportation and insurance issues were greater barriers for blacks. Women with less than a high school diploma were more likely to report cancellations or delays due to transportation issues (aPR 2.86, 95%CI 1.47-5.57; p = 0.002) and loss of insurance (aPR 4.82, 95%CI 1.64-14.23; P = 0.004). CONCLUSIONS While a large proportion of women experienced disruptions in prenatal care, subsets of the population, including racial/ethnic minorities and the low socioeconomically disadvantaged, faced disproportionate challenges. The current findings provide practical implications for a tailored approach to reducing barriers and disparities in prenatal care.
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Affiliation(s)
- Jusung Lee
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
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2
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Zona EE, Gibes ML, Jain AS, Danobeitia JS, Garonzik-Wang J, Smith JA, Mandelbrot DA, Parajuli S. Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection among Kidney Transplant Recipients: A Large Single-Center Experience. Crit Care Res Pract 2024; 2024:7140548. [PMID: 38725586 PMCID: PMC11081755 DOI: 10.1155/2024/7140548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Background Kidney transplant recipients (KTRs) are a vulnerable immunocompromised population at risk of severe COVID-19 disease and mortality after SARS-CoV-2 infection. We sought to characterize the post-infection sequelae in KTRs at our center. Methods We studied all adult KTRs (with a functioning allograft) who had their first episode of SARS-CoV-2 infection between 04/2020 and 04/2022. Outcomes of interest included risk factors for hospitalization, all-cause mortality, COVID-19-related mortality, and allograft failure. Results Of 979 KTRs with SARS-CoV-2 infection, 381 (39%) were hospitalized. In the multivariate analysis, risk factors for hospitalization included advanced age/year (HR: 1.03, 95% CI: 1.02-1.04), male sex (HR: 1.29, 95% CI: 1.04-1.60), non-white race (HR: 1.48, 95% CI: 1.17-1.88), and diabetes as a cause of ESKD (HR: 1.77, 95% CI: 1.41-2.21). SARS-CoV-2 Vaccination was associated with decreased risk of hospitalization (HR: 0.73, 95% CI: 0.59-0.90), all-cause mortality (HR: 0.52, 95% CI: 0.37-0.74), and COVID-19-related mortality (HR: 0.47, 95% CI: 0.31-0.71) in the univariate and multivariate analyses. Risk factors for both all-cause and COVID-19-related mortality in the multivariate analyses included advanced age, hospitalization, and respiratory symptoms for hospital admission. Furthermore, additional risk factors for all-cause mortality in the multivariate analysis included being a non-white recipient and diabetes as a cause of ESKD, with being a recipient of a living donor as protective. Conclusions Hospitalization due to COVID-19-associated symptoms is associated with increased mortality. Vaccination is a protective factor against hospitalization and mortality.
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Affiliation(s)
- Emily E. Zona
- Division of Nephrology, Department of Medicine, University of Wisconsin Health, Madison, WI, USA
| | - Mina L. Gibes
- Division of Nephrology, Department of Medicine, University of Wisconsin Health, Madison, WI, USA
| | - Asha S. Jain
- Division of Nephrology, Department of Medicine, University of Wisconsin Health, Madison, WI, USA
| | - Juan S. Danobeitia
- Baylor University Medical Center, Dallas, Texas, USA
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jacqueline Garonzik-Wang
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jeannina A. Smith
- Department of Infectious Disease, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Didier A. Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin Health, Madison, WI, USA
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin Health, Madison, WI, USA
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3
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Rayner DG, Wang E, Su C, Patel OD, Aleluya S, Giglia A, Zhu E, Siddique M. Risk factors for long COVID in children and adolescents: a systematic review and meta-analysis. World J Pediatr 2024; 20:133-142. [PMID: 38055113 DOI: 10.1007/s12519-023-00765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/26/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized. This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the pediatric population. METHODS We searched six databases from January 2020 to May 2023 for observational studies reporting on risk factors for long COVID or persistent symptoms those were present 12 or more weeks post-infection using multivariable regression analyses. Trial registries, reference lists of included studies, and preprint servers were hand-searched for relevant studies. Random-effects meta-analyses were conducted to pool odds ratios for each risk factor. Individual study risk of bias was rated using QUIPS, and the GRADE framework was used to assess the certainty of evidence for each unique factor. RESULTS Sixteen observational studies (N = 46,262) were included, and 19 risk factors were amenable to meta-analysis. With moderate certainty in the evidence, age (per 2-year increase), allergic rhinitis, obesity, previous respiratory diseases, hospitalization, severe acute COVID-19, and symptomatic acute COVID-19 are probably associated with an increased risk of long COVID. Female sex, asthma, comorbidity, and heart diseases may be associated with an increased risk of long COVID, and Asian and Black races may be associated with a decreased risk of long COVID. We did not observe any credible subgroup effects for any risk factor. CONCLUSIONS The current body of literature presents several compelling risk factors for the development of long COVID in the pediatric population. Further research is necessary to elucidate the pathophysiology of long COVID.
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Affiliation(s)
- Daniel G Rayner
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
| | - Elaine Wang
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Cloris Su
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Om D Patel
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Stephanie Aleluya
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Alessandra Giglia
- Faculty of Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Evelyn Zhu
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Maha Siddique
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
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4
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Foster TB, Fernandez L, Porter SR, Pharris-Ciurej N. Racial and Ethnic Disparities in Excess All-Cause Mortality in the First Year of the COVID-19 Pandemic. Demography 2024; 61:59-85. [PMID: 38197462 DOI: 10.1215/00703370-11133943] [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] [Indexed: 01/11/2024]
Abstract
Research on the COVID-19 pandemic in the United States has consistently found disproportionately high mortality among ethnoracial minorities, but reports differ with respect to the magnitude of mortality disparities and reach different conclusions regarding which groups were most impacted. We suggest that these variations stem from differences in the temporal scope of the mortality data used and difficulties inherent in measuring race and ethnicity. To circumvent these issues, we link Social Security Administration death records for 2010 through 2021 to decennial census and American Community Survey race and ethnicity responses. We use these linked data to estimate excess all-cause mortality for age-, sex-, race-, and ethnicity-specific subgroups and examine ethnoracial variation in excess mortality across states and over the course of the pandemic's first year. Results show that non-Hispanic American Indians and Alaska Natives experienced the highest excess mortality of any ethnoracial group in the first year of the pandemic, followed by Hispanics and non-Hispanic Blacks. Spatiotemporal and age-specific ethnoracial disparities suggest that the socioeconomic determinants driving health disparities prior to the pandemic were amplified and expressed in new ways in the pandemic's first year to disproportionately concentrate excess mortality among racial and ethnic minorities.
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5
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Anderson A. "Messengers matter": Assessing the impact of racially concordant care on vaccine hesitation. Soc Sci Med 2023; 338:116335. [PMID: 37913746 DOI: 10.1016/j.socscimed.2023.116335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
With the rise in COVID-related deaths among the unvaccinated, understanding coronavirus vaccine hesitancy is critical to maintaining public health. Previous research has shown that sociodemographic factors, such as race, are essential for understanding vaccine hesitancy; yet, the specific factors driving racial disparities in vaccination continue to be a matter of intense debate. This study uses a novel survey experiment to uncover the linkages between race, physician trust, and vaccine hesitancy. Using a standard prompt on the release of the COVID-19 vaccine, it tests whether patient-physician race concordance affects the likelihood of vaccine uptake among US citizens. Analyses reveal that racially concordant care has a negligible effect on vaccine hesitancy, but does ameliorate other harmful beliefs regarding one's likelihood of experiencing discrimination and racism in healthcare more generally. These findings suggest that increasing diversity in the medical field should be paired with efforts to address systemic inequalities to promote increased vaccination.
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Affiliation(s)
- Ashley Anderson
- University of North Carolina at Chapel Hill, 205 South Building, Chapel Hill, NC, 27599, USA.
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6
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Muñoz-Del-Carpio-Toia A, Bartolo-Marchena M, Benites-Zapata VA, Herrera-Añazco P. Mortality from COVID-19 in Amazonian and Andean original indigenous populations of Peru. Travel Med Infect Dis 2023; 56:102658. [PMID: 37944653 PMCID: PMC10823918 DOI: 10.1016/j.tmaid.2023.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To compare the mortality rates from COVID-19 among indigenous populations of the Amazon and Andean regions of Peru during the years 2020, 2021 and 2022. METHODS Secondary analysis of 33,567 data from the COVID-19 Notification System of the National Epidemiology Center, Prevention and Control of Diseases (CDC-Peru), from the years 2020-2022. The variables were age, sex, belonging to the Andean or Amazonian ethnic group, number and type of symptoms and risk conditions, abnormal findings in chest X-rays, year of data collection for hospitalization and death from COVID-19. Poisson family generalized linear regression models with logarithmic linkage and robust variance were used to establish differences in mortality between ethnic groups. Crude and adjusted risk ratio (RR) with 95 % confidence intervals (CI) were calculated. RESULTS 33,567 participants with an average age of 33.6 years were included, 44.4 % were men and 70.2 % belonged to the Amazonian ethnic group. Most of those affected by COVID-19 presented 2 symptoms (38.8 %), 4.8 % presented some risk condition, 1451 (4.3 %) were hospitalized, and 433 (1.3 %) died. The adjusted analysis showed that the Andean group, compared to the Amazonian, tended to have a higher probability of death, and this association was statistically significant, RR =7.6, 95 % CI (5.5-10.5). CONCLUSIONS Patients from Andean indigenous communities had an almost 8 times higher risk of death from COVID-19.
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Affiliation(s)
| | - Marco Bartolo-Marchena
- Subdirección de Medicina Tradicional, Interculturalidad e investigación social en salud del CENSI del Instituto Nacional de Salud, Lima, Peru.
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Velez T, Wang T, Garibaldi B, Singman E, Koutroulis I. Identification and Prediction of Clinical Phenotypes in Hospitalized Patients With COVID-19: Machine Learning From Medical Records. JMIR Form Res 2023; 7:e46807. [PMID: 37642512 PMCID: PMC10589836 DOI: 10.2196/46807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND There is significant heterogeneity in disease progression among hospitalized patients with COVID-19. The pathogenesis of SARS-CoV-2 infection is attributed to a complex interplay between virus and host immune response that in some patients unpredictably and rapidly leads to "hyperinflammation" associated with increased risk of mortality. The early identification of patients at risk of progression to hyperinflammation may help inform timely therapeutic decisions and lead to improved outcomes. OBJECTIVE The primary objective of this study was to use machine learning to reproducibly identify specific risk-stratifying clinical phenotypes across hospitalized patients with COVID-19 and compare treatment response characteristics and outcomes. A secondary objective was to derive a predictive phenotype classification model using routinely available early encounter data that may be useful in informing optimal COVID-19 bedside clinical management. METHODS This was a retrospective analysis of electronic health record data of adult patients (N=4379) who were admitted to a Johns Hopkins Health System hospital for COVID-19 treatment from 2020 to 2021. Phenotypes were identified by clustering 38 routine clinical observations recorded during inpatient care. To examine the reproducibility and validity of the derived phenotypes, patient data were randomly divided into 2 cohorts, and clustering analysis was performed independently for each cohort. A predictive phenotype classifier using the gradient-boosting machine method was derived using routine clinical observations recorded during the first 6 hours following admission. RESULTS A total of 2 phenotypes (designated as phenotype 1 and phenotype 2) were identified in patients admitted for COVID-19 in both the training and validation cohorts with similar distributions of features, correlations with biomarkers, treatments, comorbidities, and outcomes. In both the training and validation cohorts, phenotype-2 patients were older; had elevated markers of inflammation; and were at an increased risk of requiring intensive care unit-level care, developing sepsis, and mortality compared with phenotype-1 patients. The gradient-boosting machine phenotype prediction model yielded an area under the curve of 0.89 and a positive predictive value of 0.83. CONCLUSIONS Using machine learning clustering, we identified and internally validated 2 clinical COVID-19 phenotypes with distinct treatment or response characteristics consistent with similar 2-phenotype models derived from other hospitalized populations with COVID-19, supporting the reliability and generalizability of these findings. COVID-19 phenotypes can be accurately identified using machine learning models based on readily available early encounter clinical data. A phenotype prediction model based on early encounter data may be clinically useful for timely bedside risk stratification and treatment personalization.
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Affiliation(s)
- Tom Velez
- Computer Technology Associates, Cardiff, CA, United States
| | - Tony Wang
- Imedacs, Ann Arbor, MI, United States
| | - Brian Garibaldi
- Biocontainment Unit, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric Singman
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ioannis Koutroulis
- Division of Emergency Medicine, Childrens National Hospital, Washington, DC, United States
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8
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Duong KNC, Le LM, Veettil SK, Saidoung P, Wannaadisai W, Nelson RE, Friedrichs M, Jones BE, Pavia AT, Jones MM, Samore MH, Chaiyakunapruk N. Disparities in COVID-19 related outcomes in the United States by race and ethnicity pre-vaccination era: an umbrella review of meta-analyses. Front Public Health 2023; 11:1206988. [PMID: 37744476 PMCID: PMC10513444 DOI: 10.3389/fpubh.2023.1206988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Background Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US. Methods In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805. Results Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant (p ≤ 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60-2.71), which was supported by highly suggestive evidence; with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60-2.70) with highly suggestive evidence which remained after sensitivity analyses. Conclusion Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization compared to their White counterparts. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.
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Affiliation(s)
- Khanh N. C. Duong
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Lan M. Le
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Sajesh K. Veettil
- International Medical University, School of Pharmacy, Department of Pharmacy Practice, Kuala Lumpur, Malaysia
| | - Pantakarn Saidoung
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | | | - Richard E. Nelson
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Mike Friedrichs
- Utah Department of Health, Salt Lake City, UT, United States
| | - Barbara E. Jones
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Pulmonary & Critical Care, University of Utah, Salt Lake City, UT, United States
| | - Andrew T. Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, UT, United States
| | - Makoto M. Jones
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Matthew H. Samore
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
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Khalfaoui A, Garcia-Espinel T, Macías-Aranda F, Molina Roldán S. How Can the Roma Deal with the Health and Social Crisis Generated by the COVID-19 Pandemic? Inequalities, Challenges, and Successful Actions in Catalonia (Spain). J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01736-w. [PMID: 37535239 DOI: 10.1007/s40615-023-01736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
The Roma is the most excluded non-migrant ethnic minority in Europe, facing prejudice, intolerance, discrimination, and social exclusion in their daily lives. This has led to a huge gap in several social domains between the Roma and non-Roma created for centuries. The COVID-19 pandemic has only increased the social and health inequalities that the Roma faced. In this context, it is important to identify actions that have been successful in mitigating the effects that the COVID-19 has had in increasing such inequalities. This paper presents the findings of a mixed-method study carried out in Catalonia (Spain) with the participation of more than 500 Roma, who reported their experience. The study results confirm the significant vulnerability and the negative impact of the COVID-19 pandemic on the Roma communities. Our research also highlights several successful actions developed by the Integrated Plan for the Roma of the Catalan Government, such as health literacy and adult education, as having a positive impact on the quality of life of many Roma during the health and social crisis generated by the COVID-19 pandemic. This paper suggests that the lessons learned from Catalonia could be transferred to other contexts across Europe and guide decision makers to promote the social inclusion and quality of life of the Roma, protecting Roma communities during current and future pandemics.
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Affiliation(s)
- Andrea Khalfaoui
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
- Faculty of Education and Sport, University of Deusto, Bilbao, Spain
| | - Tania Garcia-Espinel
- Roma and Social Innovation Programme, Department of Social Rights, Government of Catalonia, Barcelona, Spain
| | - Fernando Macías-Aranda
- Department of Teaching and Learning and Educational Organization, University of Barcelona, Barcelona, Spain
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Luck AN, Elo IT, Preston SH, Paglino E, Hempstead K, Stokes AC. COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:71. [PMID: 37780841 PMCID: PMC10540502 DOI: 10.1007/s11113-023-09817-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/14/2023] [Indexed: 10/03/2023]
Abstract
Racial/ethnic and age disparities in COVID-19 and all-cause mortality during 2020 are well documented, but less is known about their evolution over time. We examine changes in age-specific mortality across five pandemic periods in the United States from March 2020 to December 2022 among four racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) for ages 35+. We fit Gompertz models to all-cause and COVID-19 death rates by 5-year age groups and construct age-specific racial/ethnic mortality ratios across an Initial peak (Mar-Aug 2020), Winter peak (Nov 2020-Feb 2021), Delta peak (Aug-Oct 2021), Omicron peak (Nov 2021-Feb 2022), and Endemic period (Mar-Dec 2022). We then compare to all-cause patterns observed in 2019. The steep age gradients in COVID-19 mortality in the Initial and Winter peak shifted during the Delta peak, with substantial increases in mortality at working ages, before gradually returning to an older age pattern in the subsequent periods. We find a disproportionate COVID-19 mortality burden on racial and ethnic minority populations early in the pandemic, which led to an increase in all-cause mortality disparities and a temporary elimination of the Hispanic mortality advantage at certain age groups. Mortality disparities narrowed over time, with racial/ethnic all-cause inequalities during the Endemic period generally returning to pre-pandemic levels. Black and Hispanic populations, however, faced a younger age gradient in all-cause mortality in the Endemic period relative to 2019, with younger Hispanic and Black adults in a slightly disadvantageous position and older Black adults in a slightly advantageous position, relative to before the pandemic.
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Affiliation(s)
- Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | | | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, USA
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McConnell KH, Hajat A, Sack C, Mooney SJ, Khosropour CM. Associations Between Insurance, Race and Ethnicity, and COVID-19 Hospitalization, Beyond Underlying Health Conditions: A Retrospective Cohort Study. AJPM FOCUS 2023; 2:100120. [PMID: 37362398 PMCID: PMC10260262 DOI: 10.1016/j.focus.2023.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Introduction : People of lower socioeconomic position (SEP) and people of color (POC) experience higher risks of severe COVID-19, but understanding of these associations beyond the effect of underlying health conditions (UHCs) is limited. Moreover, few studies have focused on young adults, who have had the highest incidence of COVID-19 during much of the pandemic. Methods : We conducted a retrospective cohort study using electronic health record data from the University of Washington Medicine healthcare system. Our study population included individuals aged 18-39 years who tested positive for SARS-CoV-2 from February 2020 to March 2021. Using regression modeling, we estimated adjusted risk ratios (aRRs) and differences (aRDs) of COVID-19 hospitalization by SEP (using health insurance as a proxy) and race and ethnicity. We adjusted for any UHC to examine these associations beyond the effect of UHCs. Results: Among 3,101 individuals, the uninsured/publicly insured had a 1.9-fold higher risk of hospitalization (aRR [95% CI]=1.9 [1.0, 3.6]) and 9 additional hospitalizations per 1,000 SARS-CoV-2 positive persons (aRD [95% CI]=9 [-1, 20]) compared to the privately insured. Hispanic or Latine, non-Hispanic (NH) Asian, NH Black, and NH Native Hawaiian or Pacific Islander patients had a 1.5-, 2.7-, 1.4-, and 2.1-fold-higher risk of hospitalization (aRR [95% CI]=1.5 [0.7, 3.1]; 2.7 [1.1, 6.5]; 1.4 [0.6, 3.3]; 2.1 [0.5, 9.1]), respectively, compared to NH White patients. Conclusions: Though they should be interpreted with caution given low precision, our findings suggest the increased risk of COVID-19 hospitalization among young adults of lower SEP and young adults of color may be driven by forces other than UHCs, including social determinants of health.
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Affiliation(s)
- Kate H. McConnell
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Coralynn Sack
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Christine M. Khosropour
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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Floyd JS, Walker RL, Kuntz JL, Shortreed SM, Fortmann SP, Bayliss EA, Harrington LB, Fuller S, Albertson-Junkans LH, Powers JD, Lee MH, Temposky LA, Dublin S. Association Between Diabetes Severity and Risks of COVID-19 Infection and Outcomes. J Gen Intern Med 2023; 38:1484-1492. [PMID: 36795328 PMCID: PMC9933797 DOI: 10.1007/s11606-023-08076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Little is known about whether diabetes increases the risk of COVID-19 infection and whether measures of diabetes severity are related to COVID-19 outcomes. OBJECTIVE Investigate diabetes severity measures as potential risk factors for COVID-19 infection and COVID-19 outcomes. DESIGN, PARTICIPANTS, MEASURES In integrated healthcare systems in Colorado, Oregon, and Washington, we identified a cohort of adults on February 29, 2020 (n = 1,086,918) and conducted follow-up through February 28, 2021. Electronic health data and death certificates were used to identify markers of diabetes severity, covariates, and outcomes. Outcomes were COVID-19 infection (positive nucleic acid antigen test, COVID-19 hospitalization, or COVID-19 death) and severe COVID-19 (invasive mechanical ventilation or COVID-19 death). Individuals with diabetes (n = 142,340) and categories of diabetes severity measures were compared with a referent group with no diabetes (n = 944,578), adjusting for demographic variables, neighborhood deprivation index, body mass index, and comorbidities. RESULTS Of 30,935 patients with COVID-19 infection, 996 met the criteria for severe COVID-19. Type 1 (odds ratio [OR] 1.41, 95% CI 1.27-1.57) and type 2 diabetes (OR 1.27, 95% CI 1.23-1.31) were associated with increased risk of COVID-19 infection. Insulin treatment was associated with greater COVID-19 infection risk (OR 1.43, 95% CI 1.34-1.52) than treatment with non-insulin drugs (OR 1.26, 95% 1.20-1.33) or no treatment (OR 1.24; 1.18-1.29). The relationship between glycemic control and COVID-19 infection risk was dose-dependent: from an OR of 1.21 (95% CI 1.15-1.26) for hemoglobin A1c (HbA1c) < 7% to an OR of 1.62 (95% CI 1.51-1.75) for HbA1c ≥ 9%. Risk factors for severe COVID-19 were type 1 diabetes (OR 2.87; 95% CI 1.99-4.15), type 2 diabetes (OR 1.80; 95% CI 1.55-2.09), insulin treatment (OR 2.65; 95% CI 2.13-3.28), and HbA1c ≥ 9% (OR 2.61; 95% CI 1.94-3.52). CONCLUSIONS Diabetes and greater diabetes severity were associated with increased risks of COVID-19 infection and worse COVID-19 outcomes.
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Affiliation(s)
- James S. Floyd
- Department of Medicine, University of Washington, Seattle, WA USA
- Department of Epidemiology, University of Washington, Seattle, WA USA
- Cardiovascular Health Research Unit, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA 98101 USA
| | - Rod L. Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | | | - Susan M. Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
- Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Stephen P. Fortmann
- Kaiser Permanente Center for Health Research, Portland, OR USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Elizabeth A. Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO USA
| | - Laura B. Harrington
- Department of Epidemiology, University of Washington, Seattle, WA USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Sharon Fuller
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | | | - John D. Powers
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO USA
| | - Mi H. Lee
- Kaiser Permanente Center for Health Research, Portland, OR USA
| | - Lisa A. Temposky
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | - Sascha Dublin
- Department of Epidemiology, University of Washington, Seattle, WA USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
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Adinkrah EK, Cobb S, Bazargan M. Delayed Medical Care of Underserved Middle-Aged and Older African Americans with Chronic Disease during COVID-19 Pandemic. Healthcare (Basel) 2023; 11:595. [PMID: 36833128 PMCID: PMC9956154 DOI: 10.3390/healthcare11040595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Background: While African American middle-aged and older adults with chronic disease are particularly vulnerable during the COVID-19 pandemic, it is unknown which subgroups of this population may delay seeking care. The aim of this study was to examine demographic, socioeconomic, COVID-19-related, and health-related factors that correlate with delayed care in African American middle-aged and older adults with chronic disease. Methods: In this cross-sectional study, 150 African American middle-aged and older adults who had at least one chronic disease were recruited from faith-based organizations. We measured the following exploratory variables: demographic factors (age and gender), socioeconomic status (education), marital status, number of chronic diseases, depressive symptoms, financial strain, health literacy, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 knowledge, and COVID-19 perceived threat. The outcome was delay in chronic disease care. Results: According to the Poisson log-linear regression, higher level of education, higher number of chronic diseases, and depressive symptoms were associated with a higher level of delayed care. Age, gender, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 perceived threat, COVID-19 knowledge, financial strain, marital status, and health literacy were not correlated with delayed care. Discussion: Given that higher healthcare needs in terms of multiple chronic medical diseases and depressive symptomatology but not COVID-19-related constructs (i.e., vaccination history, diagnosis history, and perceived threat) were associated with delayed care, there is a need for programs and interventions that assist African American middle-aged and older adults with chronic disease to seek the care that they need. More research is needed to understand why educational attainment is associated with more delayed care of chronic disease in African American middle-aged and older adults with chronic illness.
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Affiliation(s)
- Edward K. Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), 1731 E. 120th St., Los Angeles, CA 90059, USA
| | - Sharon Cobb
- Mervyn M. Dymally School of Nursing (MMDSON), CDU, Los Angeles, CA 90059, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), 1731 E. 120th St., Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90059, USA
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Ekwegh T, Cobb S, Adinkrah EK, Vargas R, Kibe LW, Sanchez H, Waller J, Ameli H, Bazargan M. Factors Associated with Telehealth Utilization among Older African Americans in South Los Angeles during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2675. [PMID: 36768041 PMCID: PMC9915549 DOI: 10.3390/ijerph20032675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic transformed healthcare delivery with the expansive use of telemedicine. However, health disparities may result from lower adoption of telehealth among African Americans. This study examined how under-resourced, older African Americans with chronic illnesses use telehealth, including related sociodemographic and COVID-19 factors. METHODS Using a cross-sectional design, 150 middle-aged and older African Americans were recruited from faith-based centers from March 2021 to August 2022. Data collected included sociodemographics, comorbidities, technological device ownership, internet usage, and attitudes toward COVID-19 disease and vaccination. Descriptive statistics and multivariable regression models were conducted to identify factors associated with telehealth use. RESULTS Of the 150 participants, 32% had not used telehealth since the COVID-19 pandemic, with 75% reporting no home internet access and 38% having no cellular/internet network on their mobile device. Age, access to a cellular network on a mobile device, and wireless internet at home were significantly associated with the utilization of telehealth care. Higher anxiety and stress with an increased perceived threat of COVID-19 and positive attitudes toward COVID-19 vaccination were associated with telehealth utilization. DISCUSSION Access and integration of telehealth services were highlighted as challenges for this population of African Americans. To reduce disparities, expansion of subsidized wireless internet access in marginalized communities is necessitated. Education outreach and training by healthcare systems and community health workers to improve uptake of telehealth currently and post-COVID-19 should be considered.
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Affiliation(s)
- Tavonia Ekwegh
- Mervyn M. Dymally School of Nursing (MMDSON), Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Sharon Cobb
- Mervyn M. Dymally School of Nursing (MMDSON), Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Edward K. Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Roberto Vargas
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Lucy W. Kibe
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Humberto Sanchez
- Office of Research, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Joe Waller
- Office of Research, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Hoorolnesa Ameli
- Department of Emergency Medicine, Mellie’s Bank Hospital, Tehran 1135933763, Iran
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90059, USA
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Lalika M, Woods C, Patel A, Scott C, Lee A, Weis J, Jones C, Abbenyi A, Brockman TA, Sia IG, White RO, Doubeni CA, Brewer LC. Factors Associated With COVID-19 Vaccine Acceptance Among Patients Receiving Care at a Federally Qualified Health Center. J Prim Care Community Health 2023; 14:21501319231181881. [PMID: 37350465 PMCID: PMC10291217 DOI: 10.1177/21501319231181881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND COVID-19 vaccine hesitancy in the United States is high, with at least 63 million unvaccinated individuals to date. Socioeconomically disadvantaged populations experience lower COVID-19 vaccination rates despite facing a disproportionate COVID-19 burden. OBJECTIVE To assess the factors associated with COVID-19 vaccine acceptance among under-resourced, adult patients. METHODS Participants were patients receiving care at a Federally Qualified Health Center (FQHC) in St. Paul, Minnesota. Data were collected via multiple modes over 2 phases in 2020 (self-administered electronic survey) and 2021 (study team-administered survey by telephone, self-administered written survey) to promote diversity and inclusion for study participation. The primary outcome was COVID-19 vaccine acceptance. Using logistic regression analysis, associations between vaccine acceptance and factors including risk perception, concerns about the COVID-19 vaccine, social determinants of health (SDOH), co-morbidities, pandemic-induced hardships, and stress were assessed by adjusted odds ratios (AORs) and 95% confidence intervals (CI). RESULTS One hundred sixty-eight patients (62.5% female; mean age [SD]: 49.9 [17.4] years; 32% <$20 000 annual household income; 69% CONCLUSIONS Our study in a socioeconomically disadvantaged population suggests that risk perception is associated with an increased likelihood of vaccine acceptance, while concerns about the COVID-19 vaccine are associated with a lower likelihood of vaccine acceptance. As these factors could impact vaccine uptake, consistent, innovative, and context-specific risk communication strategies may improve vaccine coverage in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Chyke A. Doubeni
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Spence AB, Desale S, Lee J, Kumar P, Huang X, Cooper SE, Fernandez S, Kassaye SG. COVID-19 Outcomes in a US Cohort of Persons Living with HIV (PLWH). REPORTS 2022; 5:41. [PMID: 37063094 PMCID: PMC10104440 DOI: 10.3390/reports5040041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Reported coronavirus disease 2019 (COVID-19) outcomes in persons living with HIV (PLWH) vary across cohorts. We examined clinical characteristics and outcomes of PLWH with COVID-19 compared with a matched HIV-seronegative cohort in a mid-Atlantic US healthcare system. Multivariate logistic regression was used to explore factors associated with hospitalization and death/mechanical ventilation among PLWH. Among 281 PLWH with COVID-19, the mean age was 51.5 (SD 12.74) years, 63% were male, 86% were Black, and 87% had a HIV viral load <200 copies/mL. Overall, 47% of PLWH versus 24% (p < 0.001) of matched HIV-seronegative individuals were hospitalized. Rates of COVID-19 associated cardiovascular and thrombotic events, AKI, and infections were similar between PLWH and HIV-seronegative individuals. Overall mortality was 6% (n = 18/281) in PLWH versus 3% (n = 33/1124) HIV-seronegative, p < 0.0001. Among admitted patients, mortality was 14% (n = 18/132) for PLWH and 13% (n = 33/269) for HIV-seronegative, p = 0.75. Among PLWH, hospitalization associated with older age aOR 1.04 (95% CI 1.01, 1.06), Medicaid insurance aOR 2.61 (95% CI 1.39, 4.97) and multimorbidity aOR 2.98 (95% CI 1.72, 5.23). Death/mechanical ventilation associated with older age aOR 1.06 (95% CI 1.01, 1.11), Medicaid insurance aOR 3.6 (95% CI 1.36, 9.74), and multimorbidity aOR 4.4 (95% CI 1.55, 15.9) in adjusted analyses. PLWH were hospitalized more frequently than the HIV-seronegative group and had a higher overall mortality rate, but once hospitalized had similar mortality rates. Older age, multimorbidity and insurance status associated with more severe outcomes among PLWH suggesting the importance of targeted interventions to mitigate the effects of modifiable inequities.
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Affiliation(s)
- Amanda Blair Spence
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
- Correspondence:
| | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, MD 20782, USA
| | - Jennifer Lee
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Princy Kumar
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Xu Huang
- MedStar Health Research Institute, Hyattsville, MD 20782, USA
| | - Stanley Evan Cooper
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA
| | | | - Seble G. Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
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17
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Cheng J, Tsoh JY, Guan A, Luu M, Nguyen IV, Tan R, Thao C, Yu E, Lor D, Pham M, Choi J, Kim M, Stewart SL, Burke NJ. Engaging Asian American Communities During the COVID-19 Era Tainted With Anti-Asian Hate and Distrust. Am J Public Health 2022; 112:S864-S868. [PMID: 36108257 PMCID: PMC9707711 DOI: 10.2105/ajph.2022.306952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 09/07/2023]
Affiliation(s)
- Joyce Cheng
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Janice Y Tsoh
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Alice Guan
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Michelle Luu
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Isabel V Nguyen
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Rose Tan
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Chia Thao
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Edgar Yu
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Dao Lor
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Mai Pham
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - JiWon Choi
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Minji Kim
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Susan L Stewart
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
| | - Nancy J Burke
- Joyce Cheng and Rose Tan are with the Chinese Community Health Resource Center, San Francisco, CA. Janice Y. Tsoh, Isabel V. Nguyen, and Edgar Yu are with the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Alice Guan is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Michelle Luu is with the Department of Medicine, University of California, San Francisco. Chia Thao and Nancy J. Burke are with the Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced. Dao Lor is with The Fresno Center, Fresno, CA. Mai Pham is with the Immigrant Resettlement and Cultural Center, Inc, San Jose, CA. JiWon Choi is with the Institute for Health & Aging, University of California, San Francisco. Minji Kim is with the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia. Susan L. Stewart is with the Division of Biostatistics, University of California, Davis
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Kaholokula JK, AuYoung M, Chau M, Sambamoorthi U, Carson S, Thao C, Nguyen M, Alo A, Riklon S, Lepule T, Ma GX. Unified in Our Diversity to Address Health Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders. Health Equity 2022; 6:540-545. [PMID: 36186617 PMCID: PMC9518805 DOI: 10.1089/heq.2022.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic disproportionately impacted Asian Americans, Native Hawaiians, and Pacific Islanders (AA/NHPIs) in the United States. AA/NHPIs have historically been subjected to discrimination, which was exacerbated by the pandemic. To bring attention to their unique concerns, an AA/NHPI Interest Group of the National Institutes of Health Community Engagement Alliance Against COVID-19 Disparities (CEAL) was formed. This article highlights major concerns raised by the Interest Group: The pervasive and arbitrary practice of data aggregation by public health agencies and health-related researchers, the lack of culturally responsive services in the context of cultural safety, and leadership underrepresentation.
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Affiliation(s)
- Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawai'i, USA
| | - Mona AuYoung
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Michelle Chau
- Department of Population Health, Grossman School of Medicine, New York University, New York City, New York, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy and Texas Center for Health Disparities, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
| | - Savanna Carson
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Chia Thao
- Department of Public Health, University of California, Merced, California, USA
| | - May Nguyen
- Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston College of Medicine, Houston, Texas, USA
| | - Audrey Alo
- Pacific Islander Health Partnership, Garden Grove, California, USA
| | - Sheldon Riklon
- Department of Family and Preventive Medicine and Center for Pacific Islander Health, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Tana Lepule
- Pacific Islander Collective of San Diego, San Diego, California, USA
| | - Grace X. Ma
- Department of Urban Health and Population Science, Center for Asian Health and Fox Chase Cancer Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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