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Montez JK, Monnat SM, Wiemers EE, Wolf DA, Zhang X. Stability and Volatility in the Contextual Predictors of Working-Age Mortality in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241271072. [PMID: 39268944 DOI: 10.1177/00221465241271072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
The contextual predictors of mortality in the United States are well documented, but the COVID-19 pandemic may have upended those associations. Informed by the social history of disease framework (SHDF), this study examined how the importance of county contexts on adult deaths from all causes, drug poisonings, and COVID-19-related causes fluctuated during the pandemic. Using 2018 to 2021 vital statistics data, for each quarter, we estimated associations between county-level deaths among adults ages 25 to 64 and prepandemic county-level contexts (economic conditions, racial-ethnic composition, population health profile, and physician supply). The pandemic significantly elevated the importance of county contexts-particularly median household income and counties' preexisting health profile-on all-cause and drug poisoning deaths. The elevated importance of household income may be long-lasting. Contextual inequalities in COVID-19-related deaths rose and then fell, as the SHDF predicts, but rose again along with socio-political disruptions. The findings support and extend the SHDF.
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Rabiee Rad M, Abbasi M, Salimian E, Norouzi M, Emamjomeh A, Haghighatdoost F, Mahmoudi S, Najafian J, Masoudi S, Ghasempour Dabaghi G, Mohammadifard N, Sarrafzadegan N. Baseline socioeconomic status predicting post-COVID-19 symptoms: Results from Isfahan COVID Cohort (ICC) study. Prev Med Rep 2024; 45:102814. [PMID: 39070708 PMCID: PMC11283077 DOI: 10.1016/j.pmedr.2024.102814] [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: 02/17/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives Patients experience complications following their recovery from COVID-19, known as post-COVID-19. This study aimed to investigate the association between baseline socioeconomic status (SES) and post-COVID-19 symptoms among hospitalized and non-hospitalized patients. Methods In the study, we used data from the Isfahan COVID Cohort (ICC) study, a 5-year longitudinal cohort study started from March 10, 2020. SES was measured using short form of SES questionnaire (SES-SQ), consisting of employment status, house room number, the number of trips taken, and using notebooks, laptop, or tablet in the house. Cox proportional hazard analysis was used to examine the association between baseline SES and post-COVID-19 symptoms including general, cardiovascular and respiratory systems, adjusting for potential confounders. Results Out of the 3912 patients included in the study, 66.4 % reported post-COVID-19 symptoms. There was an association between low SES and increased risk of post-COVID-19 cardiovascular symptoms in the whole population (HR = 1.15; 95 CI, 1.01-1.31, p = 0.039). Considering the hospitalization status revealed that hospitalized patients with low SES had a higher risk of experiencing post-COVID-19 cardiovascular symptoms (HR = 1.96; 95 CI, 1.23-3.12, p = 0.004), while in non-hospitalized, low SES patients a lower risk was observed (HR = 0.82; 95 CI, 0.70-0.97, p = 0.017). No significant association was found between SES and other post-COVID-19 symptoms including general and respiratory symptoms. Conclusions We concluded an association between higher SES and increased post-COVID-19 cardiovascular symptoms. Low SES was associated with higher risk of post-COVID-19 cardiovascular symptoms in hospitalized patients, while in non-hospitalized, it was associated with a lower risk.
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Affiliation(s)
- Mehrdad Rabiee Rad
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Abbasi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Emad Salimian
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Matin Norouzi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Emamjomeh
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Mahmoudi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Najafian
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soraya Masoudi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghazal Ghasempour Dabaghi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Carballo RR, León CJ, Carballo MM. A longitudinal analysis of the effects of COVID-19 on tourists' health risk perceptions. Soc Sci Med 2024; 357:117230. [PMID: 39153236 DOI: 10.1016/j.socscimed.2024.117230] [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: 02/12/2024] [Revised: 07/26/2024] [Accepted: 08/10/2024] [Indexed: 08/19/2024]
Abstract
The COVID-19 pandemic provoked a large impact on tourism because of the enforcement of harsh travel restrictions and the increased global health risks caused by international mobility. This paper utilizes a longitudinal analysis to tests the impact of COVID-19 on tourists' health risk perceptions, and their relationships with destination image perception and visiting intentions. Tourists are surveyed at two different points of time, before and after the COVID-19 pandemic. Multi-group structural equation modeling is utilized for the comparison of the relationships at the two points of time. The results show that the negative influence of health risk perceptions on destination image perception and visiting intentions are significantly larger after the COVID-19 pandemic while there are no significant differences in the impact of destination image perception on visiting intentions. Thus, not only are tourists more sensitive to health risk perceptions after COVID-19, but this higher sensitivity has larger impacts both on their perceptions of destination image and on the behavioural implication. The results have useful implications in terms of the need to dedicate more efforts for the management of health conditions of destinations after COVID-19.
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Affiliation(s)
- Rita R Carballo
- University Institute of Tourism and Sustainable Economic Development-TIDES, University of Las Palmas de Gran Canaria, Campus de Tafira, CP35017, LPGC. FEET. D3.09, Canary Island, Spain.
| | - Carmelo J León
- University Institute of Tourism and Sustainable Economic Development-TIDES, University of Las Palmas de Gran Canaria, Campus de Tafira, CP35017, LPGC. FEET. D3.09, Canary Island, Spain.
| | - María M Carballo
- University Institute of Tourism and Sustainable Economic Development-TIDES, University of Las Palmas de Gran Canaria, Campus de Tafira, CP35017, LPGC. FEET. D3.09, Canary Island, Spain.
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Zhou L, Nutakor JA, Larnyo E, Addai-Dansoh S, Cui Y, Gavu AK, Kissi J. Exploring socioeconomic status, lifestyle factors, and cardiometabolic disease outcomes in the United States: insights from a population-based cross-sectional study. BMC Public Health 2024; 24:2174. [PMID: 39134948 PMCID: PMC11318151 DOI: 10.1186/s12889-024-19685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 08/02/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Cardiometabolic diseases are a major global health concern. This study aims to identify areas for targeted interventions and investigate the impact of socioeconomic status and lifestyle as a potential mediator in the context of the US. METHODS Our study analyzed data from the Health Information National Trends Survey 5, a nationwide survey by the National Cancer Institute. Using standardized scales and questions, we examined cardiometabolic disease outcomes, lifestyle factors, and socioeconomic status of non-institutionalized civilians aged 18 + in the US. We analyzed the data using structural equation modelling. RESULTS Our findings show that socioeconomic status and lifestyle significantly predict cardiometabolic disease outcomes. However, our analysis did not support lifestyle as the primary mediating factor in the association between socioeconomic status and cardiometabolic diseases, suggesting that other factors may significantly influence this relationship. CONCLUSIONS Cardiometabolic diseases require lifestyle and structural interventions addressing socioeconomic factors. Policymakers must consider multifaceted factors to prevent, detect, and manage these diseases effectively and equitably.
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Affiliation(s)
- Lulin Zhou
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | | | - Ebenezer Larnyo
- Center for Black Studies Research, University of California, Santa Barbara, CA, United States of America
| | | | - Yupeng Cui
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Alexander Kwame Gavu
- Department of Educational Administration, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jonathan Kissi
- Department of Health Information Management, College of Health and Allied Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
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5
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Pohl R, Stallmann C, Marquardt P, Bank U, Färber J, Scheibler L, Heuft HG, Kaasch AJ, Apfelbacher C. Sociodemographic influences on private and professional contact behaviour during the COVID-19 pandemic in Germany: cross-sectional analysis based on a Regional Blood Donor Cohort. BMC Res Notes 2024; 17:206. [PMID: 39068489 PMCID: PMC11283687 DOI: 10.1186/s13104-024-06867-9] [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: 03/22/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE The COVID-19 pandemic has had significant health and socioeconomic impacts worldwide. Extensive measures, including contact restrictions, were implemented to control the spread of the virus. This study aims to examine the factors that influenced private and professional contact behaviour during the COVID-19 pandemic. RESULTS We used baseline data (January-April 2021) from the SeMaCo study (Serologische Untersuchungen bei Blutspendern des Großraums Magdeburg auf Antikörper gegen SARS-CoV-2), a longitudinal, regional cohort study assessing COVID-19 seroprevalence in blood donors from Magdeburg and surrounding areas in Germany. In the blood donor cohort (n = 2,195), there was a general reduction in private contacts (by 78.9%) and professional contacts (by 54.4%) after March 18, 2020. Individuals with higher education reduced both private (by 84.1%) and professional (by 70.1%) contacts more than those with lower education levels (private contacts 59.5%; professional contacts 37%). Younger age groups (18-30 years) reduced private contacts more frequently (by 85.4%) than older individuals (61-83 years, by 68.6%) and demonstrated a higher likelihood of private contact reduction compared to older age groups (51-60 years: odds ratio (OR) 0.45 [95% [CI] 0.32-0.65]; 61-83 years: OR 0.33 [95% [CI] 0.22-0.48]).
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Affiliation(s)
- Robert Pohl
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Christoph Stallmann
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Pauline Marquardt
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Ute Bank
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jacqueline Färber
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Lotte Scheibler
- Institute for Transfusion Medicine and Immunohaematology, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Hans-Gert Heuft
- Institute for Transfusion Medicine and Immunohaematology, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Kayı İ, Gönen M, Sakarya S, Eryiğit ÖY, Ergönül Ö. Gender-Based Socio-Economic Inequalities in the Pre-Vaccination Era of the COVID-19 Pandemic in Istanbul: A Neighborhood-Level Analysis of Excess Mortality. Healthcare (Basel) 2024; 12:1406. [PMID: 39057549 PMCID: PMC11276765 DOI: 10.3390/healthcare12141406] [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: 04/24/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Worldwide excess mortality (EM) data have the potential to provide a better estimation of the impact of the pandemic. This study aims to investigate and map the inequalities in EM in Istanbul during the pre-vaccination era of the COVID-19 pandemic in 2020 and its association with selected demographic and socio-economic variables at the neighborhood level according to gender. This ecological study was conducted with the EM data of Istanbul. The EM data were obtained from the Istanbul Metropolitan Municipality (IMM) and analyzed according to socio-demographic indicators (gender, age), neighborhood-level indicators (population density, educational attainment) and neighborhood vulnerability (socio-economic and transportation) for the 808 neighborhoods, then presented separately according to gender to examine gender-specific factors. Socio-economic and transportation vulnerability indexes are provided the IMM. The excess mortality rate per 1000 (EMR) in 2020 has been calculated by using the number of deaths in the years 2018-2019. We have mapped EMRs of each neighborhood and used linear regression analysis in three datasets to examine gender specific factors. EMRs in Istanbul showed two peaks one in April and one in November. Male EMRs were higher compared to females in Istanbul during the pre-vaccination era of the pandemic. Higher EMRs were observed in neighborhoods with a higher share of 50+ year old age groups and higher neighborhood socio-economic vulnerability scores. Neighborhood socio-economic vulnerability was significantly associated with EMRs in males but not in females. Unequal distribution of EM between neighborhoods underlines the need for gender-specific pandemic measures to alleviate the burden of the COVID-19 pandemic, especially in socio-economically vulnerable settings. Increased use of area-based indicators with a gender perspective can enhance pandemic measures.
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Affiliation(s)
- İlker Kayı
- Department of Public Health, School of Medicine, Koc University, Istanbul 34010, Türkiye;
- Department of Global Health, Graduate School of Health Sciences, Koc University, Istanbul 34450, Türkiye
| | - Mehmet Gönen
- Department of Industrial Engineering, College of Engineering, Koc University, Istanbul 34450, Türkiye;
- Koc University Is Bank Research Center for Infectious Diseases, Koc University Hospital, Istanbul 34010, Türkiye;
| | - Sibel Sakarya
- Department of Public Health, School of Medicine, Koc University, Istanbul 34010, Türkiye;
- Department of Global Health, Graduate School of Health Sciences, Koc University, Istanbul 34450, Türkiye
| | | | - Önder Ergönül
- Koc University Is Bank Research Center for Infectious Diseases, Koc University Hospital, Istanbul 34010, Türkiye;
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Koc University, Istanbul 34450, Turkey
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Spreco A, Dahlström Ö, Nordvall D, Fagerström C, Blomqvist E, Gustafsson F, Andersson C, Sjödahl R, Eriksson O, Hinkula J, Schön T, Timpka T. Integrated Surveillance of Disparities in Vaccination Coverage and Morbidity during the COVID-19 Pandemic: A Cohort Study in Southeast Sweden. Vaccines (Basel) 2024; 12:763. [PMID: 39066401 PMCID: PMC11281347 DOI: 10.3390/vaccines12070763] [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: 06/07/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
We aimed to use the digital platform maintained by the local health service providers in Southeast Sweden for integrated monitoring of disparities in vaccination and morbidity during the COVID-19 pandemic. The monitoring was performed in the adult population of two counties (n = 657,926) between 1 February 2020 and 15 February 2022. The disparities monitored were relocated (internationally displaced), substance users, and suffering from a psychotic disorder. The outcomes monitored were COVID-19 vaccination, SARS-CoV-2 test results, and hospitalization with COVID-19. Relocated residents displayed an increased likelihood of remaining unvaccinated and a decreased likelihood of testing as well as increased risks of primary SARS-CoV-2 infection and hospitalization compared with the general population. Suffering from a major psychiatric disease was associated with an increased risk of remaining unvaccinated and an increased risk of hospitalization but a decreased risk of SARS-CoV-2 infection. From the digital monitoring, we concluded that the relocated minority received insufficient protection during the pandemic, suggesting the necessity for comprehensive promotion of overall social integration. Persons with major psychiatric diseases underused vaccination, while they benefitted from proactively provided testing, implying a need for active encouragement of vaccination. Further research is warranted on legal and ethical frameworks for digital monitoring in vaccination programs.
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Affiliation(s)
- Armin Spreco
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
| | - Örjan Dahlström
- Department of Behavioral Sciences and Learning, Linköping University, 58183 Linköping, Sweden;
| | - Dennis Nordvall
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Qulturum Development Department, Region Jönköping County, 55305 Jönköping, Sweden;
| | | | - Eva Blomqvist
- Department of Computer and Information Science, Linköping University, 58183 Linköping, Sweden;
| | - Fredrik Gustafsson
- Department of Electrical Engineering, Linköping University, 58183 Linköping, Sweden;
| | - Christer Andersson
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
| | - Rune Sjödahl
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
| | - Olle Eriksson
- Qulturum Development Department, Region Jönköping County, 55305 Jönköping, Sweden;
| | - Jorma Hinkula
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
| | - Thomas Schön
- Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden; (J.H.); (T.S.)
- Department of Infectious Diseases, County of Östergötland and Kalmar, Linköping University, 58183 Linköping, Sweden
| | - Toomas Timpka
- Department of Health, Medicine, and Caring Sciences, Linköping University, 58183 Linköping, Sweden; (A.S.); (D.N.); (C.A.)
- Regional Executive Office, Region Östergötland, 58225 Linköping, Sweden;
- Department of Computer and Information Science, Linköping University, 58183 Linköping, Sweden;
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Stafford E, Dimitrov D, Trinidad SB, Matrajt L. Evaluating equity-promoting interventions to prevent race-based inequities in influenza outcomes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.20.24307635. [PMID: 39040204 PMCID: PMC11261914 DOI: 10.1101/2024.05.20.24307635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Importance Seasonal influenza hospitalizations pose a considerable burden in the United States, with BIPOC (Black, Indigenous, and other People of Color) communities being disproportionately affected. Objective To determine and quantify the effects of different types of mitigation strategies on inequities in influenza outcomes (symptomatic infections and hospitalizations). Design In this simulation study, we fit a race-stratified agent-based model of influenza transmission to demographic and hospitalization data of the United States. Participants We consider five racial-ethnic groups: non-Hispanic White persons, non- Hispanic Black persons, non-Hispanic Asian persons, non-Hispanic American Indian or Alaska Native persons, and Hispanic or Latino persons. Setting We tested five idealized equity-promoting interventions to determine their effectiveness in reducing inequity in influenza outcomes. The interventions assumed (i) equalized vaccination rates, (ii) equalized comorbidities, (iii) work-risk distribution proportional to the distribution of the population, (iv) reduced work contacts for all, or (v) a combination of equalizing vaccination rates and comorbidities and reducing work contacts. Main Outcomes and Measures Reduction in symptomatic or hospitalization risk ratios, defined as the ratio of the number of symptomatic infections (hospitalizations respectively) in each age- and racial-ethnic group and their corresponding white counterpart. We also evaluated the reduction in the absolute mean number of symptomatic infections or hospitalizations in each age- and racial-ethnic group compared to the fitted scenario (baseline). Results Our analysis suggests that symptomatic infections were equalized and reduced (by up to 17% in BIPOC adults aged 18-49) by strategies reducing work contacts or equalizing vaccination rates. Reducing comorbidities resulted in significant decreases in hospitalizations, with a reduction of over 40% in BIPOC groups. All tested interventions reduced the inequity in influenza hospitalizations in all racial-ethnic groups, but interventions reducing comorbidities in marginalized populations were the most effective. Notably, these interventions resulted in better outcomes across all racial-ethnic groups, not only those prioritized by the interventions. Conclusions and Relevance In this simulation modeling study, equalizing vaccination rates and reducing number of work contacts (which are relatively simple strategies to implement) reduced the both the inequity in hospitalizations and the absolute number of symptomatic infections and hospitalizations in all age and racial-ethnic groups.
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Affiliation(s)
- Erin Stafford
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
- Current address: Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE
| | - Dobromir Dimitrov
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Susan Brown Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | - Laura Matrajt
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
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López-Bazo E. The complex link between socioeconomic deprivation and COVID-19. Evidence from small areas of Catalonia. Spat Spatiotemporal Epidemiol 2024; 49:100648. [PMID: 38876561 DOI: 10.1016/j.sste.2024.100648] [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: 05/30/2023] [Revised: 01/20/2024] [Accepted: 03/11/2024] [Indexed: 06/16/2024]
Abstract
This ecological study assesses the association between the incidence rate of COVID-19 confirmed cases and socioeconomic deprivation in the Catalan small areas for the first six waves of the pandemic. The association is estimated using Poisson regressions and, in contrast to previous studies, considering that the relationship is not linear but rather depends on the degree of deprivation. The results show that the association between deprivation and incidence varied between waves, not only in intensity but also in its sign. Although it was insignificant in the first, third and fourth waves, the association was positive and significant in the second, becoming significantly negative in the fifth and sixth waves. Interestingly, the evidence suggests that the link between both magnitudes was not homogeneous throughout the distribution of deprivation, the pattern also varying between waves. The results are discussed in view of the role of non-pharmacological interventions and vaccination, as well as potential biases (for example that associated with differences between population groups in the propensity to be tested in each wave).
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Affiliation(s)
- Enrique López-Bazo
- AQR-University of Barcelona, Av. Diagonal 690, Barcelona E-08034, Spain.
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10
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Link BG, García SJ, Firat R, La Scalla S, Phelan JC. Socioeconomic-Status-Based Disrespect, Discrimination, Exclusion, and Shaming: A Potential Source of Health Inequalities? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241232658. [PMID: 38491866 DOI: 10.1177/00221465241232658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
Observing an association between socioeconomic status (SES) and health reliably leads to the question, "What are the pathways involved?" Despite enormous investment in research on the characteristics, behaviors, and traits of people disadvantaged with respect to health inequalities, the issue remains unresolved. We turn our attention to actions of more advantaged groups by asking people to self-report their exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. We developed measures of these phenomena and administered them to a cross-sectional U.S. national probability sample (N = 1,209). Consistent with the possibility that DDES represents a pathway linking SES and health, the SES→health coefficient dropped substantially when DDES variables were controlled: 112.9% for anxiety, 43.8% for self-reported health, and 49.4% for cardiovascular-related conditions. These results illustrate a need for a relational approach emphasizing the actions of more advantaged groups in shaping health inequities.
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11
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Sorci G. Social inequalities and the COVID-19 pandemic. Soc Sci Med 2024; 340:116484. [PMID: 38064821 DOI: 10.1016/j.socscimed.2023.116484] [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: 07/24/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024]
Abstract
Social inequality has been identified as an important determinant of the outcome of infectious diseases and the recent SARS-CoV-2 pandemic has vividly reminded us that there are no "equal opportunity infectors". In a recent article, Chakrabarty et al. (2023) reported the finding of a cross-country comparison of COVID-19 cases and social deprivation, using up-to-date statistical modelling. These results add to the extensive evidence showing that vulnerable populations are consistently at higher risk of contracting the infection and to suffer from more severe symptoms, whatever the spatial scale used (from the country to the neighborhood). Spatial clustering of socially deprived groups, preexisting pathologies and hotspots of COVID-19 cases and deaths indicate that the SARS-CoV-2 should be seen as a syndemic, where both the infection dynamics and the outcome of the disease strongly depend on the three-way interaction between the virus, preexisting pathologies, and the socioeconomic environment.
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Affiliation(s)
- Gabriele Sorci
- Biogéosciences, CNRS UMR 6282, Université de Bourgogne, 6 Boulevard Gabriel, 21000, Dijon, France.
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12
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Mercer KH, Mollborn S. Distinction through distancing: Norm formation and enforcement during the COVID-19 pandemic. Soc Sci Med 2023; 338:116334. [PMID: 37866175 DOI: 10.1016/j.socscimed.2023.116334] [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: 04/21/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
The unequal spread of COVID-19 was accompanied by disparities in adherence to social distancing. Research is needed on social processes that facilitated widespread adherence to distancing, how they connected with existing resource access and belief systems, and how they potentially strengthened intergroup boundaries. We integrated insights from research on social norms and cultural capital to analyze early pandemic (April-August 2020) qualitative interviews with parents and their teenage children in two higher-resource communities in the United States. Our findings uncovered four interrelated processes that facilitated the rapid establishment of norms around distancing, concurrently strengthening group boundaries. Community members: 1) drew on existing cultural capital to smooth the establishment of new social norms, 2) associated social distancing with individual moral worth and community identity, 3) applied double standards that granted certain exceptions to ingroup members to maintain social cohesion, and 4) drew strong distinctions between their own and outsiders' social distancing behaviors and moral worth. Our findings articulate social processes that allowed for rapid cohesion around distancing and show how these mechanisms strengthened existing community social boundaries.
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Affiliation(s)
- Katie Holstein Mercer
- Institute of Behavioral Science and Department of Sociology, University of Colorado Boulder, UCB 483, Boulder, CO 80309-0483, USA
| | - Stefanie Mollborn
- Institute of Behavioral Science and Department of Sociology, University of Colorado Boulder, UCB 483, Boulder, CO 80309-0483, USA; Department of Sociology, Stockholm University, Stockholm, Sweden.
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Zacher M, Raker EJ, Meadows MC, Ramírez S, Woods T, Lowe SR. Mental health during the COVID-19 pandemic in a longitudinal study of Hurricane Katrina survivors. SSM - MENTAL HEALTH 2023; 3:100198. [PMID: 36844796 PMCID: PMC9940480 DOI: 10.1016/j.ssmmh.2023.100198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
While the COVID-19 pandemic is known to have caused widespread mental health challenges, it remains unknown how the prevalence, presentation, and predictors of mental health adversity during the pandemic compare to other mass crises. We shed light on this question using longitudinal survey data (2003-2021) from 424 low-income mothers who were affected by both the pandemic and Hurricane Katrina, which struck the U.S. Gulf Coast in 2005. The prevalence of elevated posttraumatic stress symptoms was similar 1-year into the pandemic (41.6%) as 1-year post-Katrina (41.9%), while elevated psychological distress was more prevalent 1-year into the pandemic (48.3%) than 1-year post-Katrina (37.2%). Adjusted logistic regression models showed that pandemic-related bereavement, fear or worry, lapsed medical care, and economic stressors predicted mental health adversity during the pandemic. Similar exposures were associated with mental health adversity post-Katrina. Findings underscore the continued need for pandemic-related mental health services and suggest that preventing traumatic or stressful exposures may reduce the mental health impacts of future mass crises.
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Affiliation(s)
- Meghan Zacher
- Population Studies and Training Center, Brown University, Providence, RI, 02912, USA
| | - Ethan J Raker
- Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Marie-Claire Meadows
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Saúl Ramírez
- Department of Sociology, Harvard University, Cambridge, MA, 02138, USA
| | - Tyler Woods
- Department of Sociology, Harvard University, Cambridge, MA, 02138, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
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McKenney EE, Cucchiara CL, Gotham KO. Transitioning to college during COVID-19: A brief report on incoming students' self-reports of mental health from 2020 to 2022. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-7. [PMID: 38015180 PMCID: PMC11130076 DOI: 10.1080/07448481.2023.2283742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
Objective: Depression and anxiety have been identified as growing concerns for many populations in the United States, including young adults. We investigated how internalizing symptoms may have changed throughout the COVID-19 pandemic among students transitioning to college.Participants: Participants were incoming undergraduates in Fall 2020, 2021, and 2022 at Northeastern Universities (N = 263).Methods: Participants completed self-reports of mood, repetitive thinking, and social satisfaction within two weeks of beginning their first college semester.Results: Depression and anxiety symptoms appear to differ by year, such that both have increased over time. These results seem to be co-occurring with an increase in repetitive negative thinking - a known predictor of depression and anxiety.Conclusions: These preliminary results suggest that mental health concerns in young adults may be worsening despite the resumption of in-person activities post-initial pandemic onset. This highlights the need to monitor and intervene on mental health in students transitioning to college.
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Portela MC, Martins M, Lima SML, de Andrade CLT, de Aguiar Pereira CC. COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data. Int J Equity Health 2023; 22:238. [PMID: 37978531 PMCID: PMC10655483 DOI: 10.1186/s12939-023-02037-8] [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: 06/10/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS. METHODS This cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS' Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it. RESULTS About 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021. CONCLUSIONS COVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | - Mônica Martins
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sheyla Maria Lemos Lima
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Claudia Cristina de Aguiar Pereira
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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16
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Altmejd A, Östergren O, Björkegren E, Persson T. Inequality and COVID-19 in Sweden: Relative risks of nine bad life events, by four social gradients, in pandemic vs. prepandemic years. Proc Natl Acad Sci U S A 2023; 120:e2303640120. [PMID: 37943837 PMCID: PMC10655217 DOI: 10.1073/pnas.2303640120] [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: 03/06/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023] Open
Abstract
The COVID-19 pandemic struck societies directly and indirectly, not just challenging population health but disrupting many aspects of life. Different effects of the spreading virus-and the measures to fight it-are reported and discussed in different scientific fora, with hard-to-compare methods and metrics from different traditions. While the pandemic struck some groups more than others, it is difficult to assess the comprehensive impact on social inequalities. This paper gauges social inequalities using individual-level administrative data for Sweden's entire population. We describe and analyze the relative risks for different social groups in four dimensions-gender, education, income, and world region of birth-to experience three types of COVID-19 incidence, as well as six additional negative life outcomes that reflect general health, access to medical care, and economic strain. During the pandemic, the overall population faced severe morbidity and mortality from COVID-19 and saw higher all-cause mortality, income losses and unemployment risks, as well as reduced access to medical care. These burdens fell more heavily on individuals with low income or education and on immigrants. Although these vulnerable groups experienced larger absolute risks of suffering the direct and indirect consequences of the pandemic, the relative risks in pandemic years (2020 and 2021) were conspicuously similar to those in prepandemic years (2016 to 2019).
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Affiliation(s)
- Adam Altmejd
- Swedish Institute for Social Research, Stockholm University, Stockholm106 91, Sweden
- Department of Finance, Stockholm School of Economics, Stockholm106 91, Sweden
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University, Stockholm106 91, Sweden
- Aging Research Center, Karolinska Institutet, Stockholm171 77, Sweden
| | | | - Torsten Persson
- Institute for International Economic Studies, Stockholm University, Stockholm106 91, Sweden
- Suntory and Toyota International Centres for Economics and Related Disciplines, London School of Economics, LondonWC2A 2AE, United Kingdom
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17
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Crowe RP, Kennel J, Fernandez AR, Burton BA, Wang HE, Van Vleet L, Bourn SS, Myers JB. Racial, Ethnic, and Socioeconomic Disparities in Out-of-Hospital Pain Management for Patients With Long Bone Fractures. Ann Emerg Med 2023; 82:535-545. [PMID: 37178100 DOI: 10.1016/j.annemergmed.2023.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/20/2023] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
STUDY OBJECTIVE To evaluate racial and ethnic disparities in out-of-hospital analgesic administration, accounting for the influence of clinical characteristics and community socioeconomic vulnerability, among a national cohort of patients with long bone fractures. METHODS Using the 2019-2020 ESO Data Collaborative, we retrospectively analyzed emergency medical services (EMS) records for 9-1-1 advanced life support transport of adult patients diagnosed with long bone fractures at the emergency department. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for out-of-hospital analgesic administration by race and ethnicity, accounting for age, sex, insurance, fracture location, transport time, pain severity, and scene Social Vulnerability Index. We reviewed a random sample of EMS narratives without analgesic administration to identify whether other clinical factors or patient preferences could explain differences in analgesic administration by race and ethnicity. RESULTS Among 35,711 patients transported by 400 EMS agencies, 81% were White, non-Hispanic, 10% were Black, non-Hispanic, and 7% were Hispanic. In crude analyses, Black, non-Hispanic patients with severe pain were less likely to receive analgesics compared with White, non-Hispanic patients (59% versus 72%; Risk Difference: -12.5%, 95% CI: -15.8% to -9.9%). After adjustment, Black, non-Hispanic patients remained less likely to receive analgesics compared with White, non-Hispanic patients (aOR:0.65, 95% CI:0.53 to 0.79). Narrative review identified similar rates of patients declining analgesics offered by EMS and analgesic contraindications across racial and ethnic groups. CONCLUSIONS Among EMS patients with long bone fractures, Black, non-Hispanic patients were substantially less likely to receive out-of-hospital analgesics compared with White, non-Hispanic patients. These disparities were not explained by differences in clinical presentations, patient preferences, or community socioeconomic conditions.
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Affiliation(s)
| | - Jamie Kennel
- Oregon Health and Science University, Portland, OR; Oregon Institute of Technology, Wilsonville, OR
| | | | | | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
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Larsen SL, Shin I, Joseph J, West H, Anorga R, Mena GE, Mahmud AS, Martinez PP. Quantifying the impact of SARS-CoV-2 temporal vaccination trends and disparities on disease control. SCIENCE ADVANCES 2023; 9:eadh9920. [PMID: 37531439 PMCID: PMC10396293 DOI: 10.1126/sciadv.adh9920] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023]
Abstract
SARS-CoV-2 vaccines have been distributed at unprecedented speed. Still, little is known about temporal vaccination trends, their association with socioeconomic inequality, and their consequences for disease control. Using data from 161 countries/territories and 58 states, we examined vaccination rates across high and low socioeconomic status (SES), showing that disparities in coverage exist at national and subnational levels. We also identified two distinct vaccination trends: a rapid initial rollout, quickly reaching a plateau, or sigmoidal and slow to begin. Informed by these patterns, we implemented an SES-stratified mechanistic model, finding profound differences in mortality and incidence across these two vaccination types. Timing of initial rollout affects disease outcomes more substantially than final coverage or degree of SES disparity. Unexpectedly, timing is not associated with wealth inequality or GDP per capita. While socioeconomic disparity should be addressed, accelerating initial rollout for all over focusing on increasing coverage is an accessible intervention that could minimize the burden of disease across socioeconomic groups.
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Affiliation(s)
- Sophie L. Larsen
- Program in Ecology, Evolution, and Conservation Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Ikgyu Shin
- Department of Statistics, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jefrin Joseph
- Department of Microbiology, School of Molecular and Cellular Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Haylee West
- Department of Microbiology, School of Molecular and Cellular Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Rafael Anorga
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | | | - Ayesha S. Mahmud
- Department of Demography, University of California, Berkeley, CA, USA
| | - Pamela P. Martinez
- Department of Statistics, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Microbiology, School of Molecular and Cellular Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
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19
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Racape J, Dauby N, Goffard JC, Abdellaoui K, Radulescu C, Coppieters Y, Rea A. Distinct socioeconomic profile of patients hospitalised with severe COVID-19 and prepandemic respiratory infections in Brussels's deprived areas: a case-control study. BMJ Open 2023; 13:e072914. [PMID: 37479511 PMCID: PMC10364187 DOI: 10.1136/bmjopen-2023-072914] [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: 07/23/2023] Open
Abstract
OBJECTIVE Belgium has been hit harder by COVID-19 than other countries in Europe. While clinical risk factors are well studied, socioeconomic risk factors remained underexplored. This study's objective was to analyse the social and clinical profile of patients hospitalised for COVID-19 during the two waves of 2020, compared with a control population in 2019 in two hospitals located in Brussels' most deprived area. DESIGN AND METHODS We did a case-control study by using the minimal clinical data set in two Brussels hospitals. All patients hospitalised for COVID-19 in 2020, divided into two waves (n=3220), were compared with all patients hospitalised for viral pneumonia and respiratory diseases in 2019 (control population n=2950). Multinomial regression models were used to estimate the relative risk ratios of the association between the COVID-19 hospitalised populations (waves 1 and 2) and risk factors (social and clinical) stratified by age. RESULTS Patients under 65 years of age and hospitalised for COVID-19 presented significantly higher rates (relative rate ratio (95% CI)), especially for the first wave, of obesity 1.6 (1.2-2.2), African nationalities 1.4 (1.0-1.8), lack of health insurance 1.6 (1.3-2.1), living in high-density population areas 1.6 (1.3-2.1) and low incomes 1.7 (1.4-2.1), compared with the control population For patients over 65 years of age, we did not observe significant excess of COVID-19 hospitalisations for any risk factors, except diabetes during for the second wave but we have a significant excess mortality rate than the control population for both waves (p<0.002). CONCLUSIONS The social and clinical profile of patients hospitalised for COVID-19 compared with a population hospitalised for viral respiratory diseases differed between age groups and waves. For younger patients, risk factors were linked to patients' precarious situations. This study underlines the role of selected social health determinants and the importance of routinely collecting social data, along with clinical data, particularly among vulnerable populations.
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Affiliation(s)
- Judith Racape
- Chair in Health and Precarity, Faculty of Medicine, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Bruxelles, Belgium
- Environmental Health Research Center, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Hopital Erasme, Universite libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Kaoutar Abdellaoui
- Department of Minimal Clinical Data, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Brussels, Belgium
| | - Cristina Radulescu
- Department of Minimal Clinical Data, Hopital Erasme, Universite libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Yves Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Andrea Rea
- Group for Research on Ethnic Relations, Migrations & Equality, Faculte de Philosophie et Sciences sociales, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
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Zelner J, Naraharisetti R, Zelner S. Invited Commentary: To Make Long-Term Gains Against Infection Inequity, Infectious Disease Epidemiology Needs to Develop a More Sociological Imagination. Am J Epidemiol 2023; 192:1047-1051. [PMID: 36843044 PMCID: PMC10505408 DOI: 10.1093/aje/kwad044] [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: 09/23/2022] [Revised: 12/16/2022] [Accepted: 02/22/2023] [Indexed: 02/28/2023] Open
Abstract
In a recent article in the Journal, Noppert et al. (Am J Epidemiol. 2023;192(3):475-482) articulated in detail the mechanisms connecting high-level "fundamental social causes" of health inequity to inequitable infectious disease outcomes, including infection, severe disease, and death. In this commentary, we argue that while intensive focus on intervening mechanisms is welcome and necessary, it cannot occur in isolation from examination of the way that fundamental social causes-including racism, socioeconomic inequity, and social stigma-sustain infection inequities even when intervening mechanisms are addressed. We build on the taxonomy of intervening mechanisms laid out by Noppert et al. to create a road map for strengthening the connection between fundamental cause theory and infectious disease epidemiology and discuss its implications for future research and intervention.
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Affiliation(s)
- Jon Zelner
- Correspondence to Dr. Jon Zelner, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 (e-mail: )
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21
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Rahal D, Shaw ST, Stigler JW. Lower socioeconomic status is related to poorer emotional well-being prior to academic exams. ANXIETY, STRESS, AND COPING 2023; 36:502-518. [PMID: 36018365 PMCID: PMC9968358 DOI: 10.1080/10615806.2022.2110588] [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: 04/09/2021] [Revised: 06/22/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND People of lower social status tend to have greater emotional responses to stress. The present study assessed whether lower social status was related to greater emotional responses in anticipation of a naturalistic stressor: academic exams among college students. METHODS College students in an introductory statistics class (N = 252; 75.81% female; 18.41% Latino, 25.10% White, 43.93% Asian, 12.56% different racial backgrounds) completed two course exams as part of this naturalistic prepost-experimental design. They provided four reports of positive, depressive, and anxious emotion - one the day before and one immediately after each exam. RESULTS As hypothesized, multilevel models (ratings nested within participants) predicting emotion indicated that students with lower mother's education had less positive emotion, more depressive emotion, and more anxious emotion the day prior to academic exams than students with higher mother's education (proportional reductions in variance [PRV] = .013-.020). Specifically, lower mother's education was associated with poorer well-being before but not after the exam. Exploratory models revealed that differences in emotion by mother's education were strongest for students with lower exam scores (PRV = .030-.040). CONCLUSIONS Socioeconomic status may influence college students' anticipatory distress prior to academic exams, which may impact health and academic performance.
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Affiliation(s)
- Danny Rahal
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, PA, USA
| | - Stacy T. Shaw
- Department of Psychological and Cognitive Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - James W. Stigler
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, PA, USA
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Wei R, Zhang Y, Gao S, Brown BJ, Hu S, Link BG. Health disparity in the spread of COVID-19: Evidence from social distancing, risk of interactions, and access to testing. Health Place 2023; 82:103031. [PMID: 37120950 PMCID: PMC10126219 DOI: 10.1016/j.healthplace.2023.103031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE - To identify and assess whether three major risk factors that due to differential access to flexible resources might help explain disparities in the spread of COVID-19 across communities with different socioeconomic status, including socioeconomic inequalities in social distancing, the potential risk of interpersonal interactions, and access to testing. METHODS Analysis uses ZIP code level weekly COVID-19 new cases, weekly population movement flows, weekly close-contact index, and weekly COVID-19 testing sites in Southern California from March 2020 to April 2021, merged with the U.S. census data to measure ZIP code level socioeconomic status and cofounders. This study first develops the measures for social distancing, the potential risk of interactions, and access to testing. Then we employ a spatial lag regression model to quantify the contributions of those factors to weekly COVID-19 case growth. RESULTS Results identify that, during the first COVID-19 wave, new case growth of the low-income group is two times higher than that of the high-income group. The COVID-19 case disparity widens to four times in the second COVID-19 wave. We also observed significant disparities in social distancing, the potential risk of interactions, and access to testing among communities with different socioeconomic status. In addition, all of them contribute to the disparities of COVID-19 incidences. Among them, the potential risk of interactions is the most important contributor, whereas testing accessibility contributes least. We also found that close-contact is a more effective measure of social distancing than population movements in examining the spread of COVID-19. CONCLUSION - This study answers critically unaddressed questions about health disparities in the spread of COVID-19 by assessing factors that might explain why the spread is different in different groups.
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Affiliation(s)
- Ran Wei
- School of Public Policy, University of California, Riverside, CA, 92521, USA.
| | - Yujia Zhang
- School of Public Policy, University of California, Riverside, CA, 92521, USA.
| | - Song Gao
- GeoDS Lab, Department of Geography, University of Wisconsin, Madison, WI, 53706, USA.
| | - Brandon J Brown
- Department of Social Medicine, Population and Public Health, University of California, Riverside, CA, USA.
| | - Songhua Hu
- Maryland Transportation Institute, Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, 20742, USA.
| | - Bruce G Link
- School of Public Policy, University of California, Riverside, CA, 92521, USA.
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23
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Lefebvre G, Haddad S, Moncion-Groulx D, Saint-Onge M, Dontigny A. Socioeconomic disparities and concentration of the spread of the COVID-19 pandemic in the province of Quebec, Canada. BMC Public Health 2023; 23:1096. [PMID: 37280572 DOI: 10.1186/s12889-023-15983-3] [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: 12/20/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Recent studies suggest that the risk of SARS-CoV-2 infection may be greater in more densely populated areas and in cities with a higher proportion of persons who are poor, immigrant, or essential workers. This study examines spatial inequalities in SARS-CoV-2 exposure in a health region of the province of Quebec in Canada. METHODS The study was conducted on the 1206 Canadian census dissemination areas in the Capitale-Nationale region of the province of Quebec. The observation period was 21 months (March 2020 to November 2021). The number of cases reported daily in each dissemination area was identified from available administrative databases. The magnitude of inequalities was estimated using Gini and Foster-Greer-Thorbecke (FGT) indices. The association between transmission and socioeconomic deprivation was identified based on the concentration of transmission in socially disadvantaged areas and on nonparametric regressions relating the cumulative incidence rate by area to ecological indicators of spatial disadvantage. Quantification of the association between median family income and degree of exposure of dissemination areas was supplemented by an ordered probit multiple regression model. RESULTS Spatial disparities were elevated (Gini = 0.265; 95% CI [0.251, 0.279]). The spread was more limited in the less densely populated areas of the Quebec City agglomeration and outlying municipalities. The mean cumulative incidence in the subsample made up of the areas most exposed to the pandemic was 0.093. The spread of the epidemic was concentrated in the most disadvantaged areas, especially in the densely populated areas. Socioeconomic inequality appeared early and increased with each successive pandemic wave. The models showed that areas with economically disadvantaged populations were three times more likely to be among the areas at highest risk for COVID-19 (RR = 3.55; 95% CI [2.02, 5.08]). In contrast, areas with a higher income population (fifth quintile) were two times less likely to be among the most exposed areas (RR = 0.52; 95% CI [0.32, 0.72]). CONCLUSION As with the H1N1 pandemics of 1918 and 2009, the SARS-CoV-2 pandemic revealed social vulnerabilities. Further research is needed to explore the various manifestations of social inequality in relation to the pandemic.
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Affiliation(s)
| | - Slim Haddad
- Direction de santé publique du CIUSSS-CN, Quebec City, QC, Canada.
- Centre de Recherche en Santé Durable VITAM, Quebec City, QC, Canada.
| | | | | | - André Dontigny
- Direction de santé publique du CIUSSS-CN, Quebec City, QC, Canada
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Isasi CR, Gallo LC, Cai J, Gellman MD, Xie W, Heiss G, Kaplan RC, Talavera GA, Daviglus ML, Pirzada A, Wassertheil-Smoller S, Llabre MM, Youngblood ME, Schneiderman N, Pérez-Stable EJ, Napoles AM, Perreira KM. Economic and Psychosocial Impact of COVID-19 in the Hispanic Community Health Study/Study of Latinos. Health Equity 2023; 7:206-215. [PMID: 37007686 PMCID: PMC10061327 DOI: 10.1089/heq.2022.0211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives To examine the prevalence and correlates of economic hardship and psychosocial distress experienced during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in a large cohort of Hispanic/Latino adults. Methods The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), an ongoing multicenter study of Hispanic/Latino adults, collected information about COVID-19 illness and psychosocial and economic distress that occurred during the pandemic (N=11,283). We estimated the prevalence of these experiences during the initial phase of the pandemic (May 2020 to May 2021) and examined the prepandemic factors associated with pandemic-related economic hardship and emotional distress using multivariable log linear models with binomial distributions to estimate prevalence ratios. Results Almost half of the households reported job losses and a third reported economic hardship during the first year of the pandemic. Pandemic-related household job losses and economic hardship were more pronounced among noncitizens who are likely to be undocumented. Pandemic-related economic hardship and psychosocial distress varied by age group and sex. Contrary to the economic hardship findings, noncitizens were less likely to report pandemic-related psychosocial distress. Prepandemic social resources were inversely related to psychosocial distress. Conclusions The study findings underscore the economic vulnerability that the pandemic has brought to ethnic minoritized and immigrant populations in the United States, in particular noncitizens. The study also highlights the need to incorporate documentation status as a social determinant of health. Characterizing the initial economic and mental health impact of the pandemic is important for understanding the pandemic consequences on future health. Clinical Trial Registration Number: NCT02060344.
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Affiliation(s)
- Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marc D. Gellman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Wenyi Xie
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gregory A. Talavera
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Maria M. Llabre
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Marston E. Youngblood
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities and Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Anna M. Napoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Krista M. Perreira
- Department of Social Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Silver H, Morris R. Homelessness, Politics, and Policy: Predicting Spatial Variation in COVID-19 Cases and Deaths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3265. [PMID: 36833960 PMCID: PMC9965687 DOI: 10.3390/ijerph20043265] [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: 01/01/2023] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
When COVID-19 began to spread in the United States, the first public health orders were to hunker down at home. But for the vulnerable people experiencing homelessness, especially those sleeping outdoors, retreating to a private dwelling was not possible. This suggests that places with greater homelessness would also have elevated COVID-19 infections. This paper examines how spatial variation in unsheltered homelessness was related to the cumulative number of cases and deaths from COVID-19. Although Continuums of Care (CoCs) with more households receiving welfare, without internet service, and more disabled residents had a higher rate of COVID-19-related cases and deaths, CoCs with more unsheltered homelessness had fewer COVID-19-related deaths. More research is needed to explain this counterintuitive result, but it may reflect the bicoastal pattern of homelessness which is higher where government intervention, community sentiment, and compliance with rules to promote the common welfare are greater. In fact, local politics and policies mattered. CoCs with more volunteering and a higher share of votes for the 2020 Democratic presidential candidate also had fewer COVID-19 cases and deaths. Yet, other policies did not matter. Having more homeless shelter beds, publicly assisted housing units, residents in group quarters, or greater use of public transportation had no independent associations with pandemic outcomes.
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Affiliation(s)
- Hilary Silver
- Department of Sociology, Columbian College of Arts & Sciences, George Washington University, Washington, DC 20052, USA
| | - Rebecca Morris
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
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26
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Arango-Londoño D, Ortega-Lenis D, Moraga P, Torres M, Rodríguez-Cortés FJ. Spatial modeling and socioeconomic inequities of COVID-19 in the urban area of the city of Cali, Colombia. Spat Spatiotemporal Epidemiol 2023; 44:100561. [PMID: 36707197 PMCID: PMC9756648 DOI: 10.1016/j.sste.2022.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
COVID-19 has spread worldwide with a high variability in cases and mortality between populations. This research aims to assess socioeconomic inequities of COVID-19 in the city of Cali, Colombia, during the first and second peaks of the pandemic in this city. An ecological study by neighborhoods was carried out, were COVID-19 cases were analyzed using a Bayesian hierarchical spatial model that includes potential risk factors such as the index of unsatisfied basic needs and socioeconomic variables as well as random effects to account for residual variation. Maps showing the geographic patterns of the estimated relative risks as well as exceedance probabilities were created. The results indicate that in the first wave, the neighborhoods with the greatest unsatisfied basic needs and low socioeconomic strata, were more likely to report positive cases for COVID-19. For the second wave, the disease begins to spread through different neighborhoods of the city and middle socioeconomic strata presents the highest risk followed by the lower strata. These findings indicate the importance of measuring social determinants in the study of the distribution of cases due to COVID-19 for its inclusion in the interventions and measures implemented to contain contagions and reduce impacts on the most vulnerable populations.
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Affiliation(s)
- David Arango-Londoño
- Faculty of Engineering and Science, Pontificia Universidad Javeriana, Cali, Colombia.
| | - Delia Ortega-Lenis
- Department of Public Health and Epidemiology, Pontificia Universidad Javeriana, Cali, Colombia.
| | - Paula Moraga
- Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia.
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27
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Gibbs L, Thomas AJ, Coelho A, Al-Qassas A, Block K, Meagher N, Eisa L, Fletcher-Lartey S, Ke T, Kerr P, Kwong EJL, MacDougall C, Malith D, Marinkovic Chavez K, Osborne D, Price DJ, Shearer F, Stoove M, Young K, Zhang Y, Gibney KB, Hellard M. Inclusion of Cultural and Linguistic Diversity in COVID-19 Public Health Research: Research Design Adaptations to Seek Different Perspectives in Victoria, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2320. [PMID: 36767686 PMCID: PMC9916203 DOI: 10.3390/ijerph20032320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
Participation of people from culturally and linguistically diverse (CALD) communities in public health research is often limited by challenges with recruitment, retention and second-language data collection. Consequently, people from CALD communities are at risk of their needs being marginalised in public health interventions. This paper presents intrinsic case analyses of two studies which were adapted to increase the cultural competence of research processes. Both cases were part of the Optimise study, a major mixed methods research study in Australia which provided evidence to inform the Victorian state government's decision-making about COVID-19 public health measures. Case study 1 involved the core Optimise longitudinal cohort study and Case study 2 was the CARE Victorian representative survey, an Optimise sub-study. Both case studies engaged cultural advisors and bilingual staff to adjust the survey measures and research processes to suit target CALD communities. Reflexive processes provided insights into the strengths and weaknesses of the inclusive strategies. Selected survey results are provided, demonstrating variation across CALD communities and in comparison to participants who reported speaking English at home. While in most cases a gradient of disadvantage was evident for CALD communities, some patterns were unexpected. The case studies demonstrate the challenge and value of investing in culturally competent research processes to ensure research guiding policy captures a spectrum of experiences and perspectives.
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Affiliation(s)
- Lisa Gibbs
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | | | | | | | - Karen Block
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Niamh Meagher
- Peter Doherty Institute for Infection & Immunity, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Limya Eisa
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | | | - Tianhui Ke
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Phoebe Kerr
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Edwin Jit Leung Kwong
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Colin MacDougall
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Deng Malith
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Katitza Marinkovic Chavez
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | | | - David J. Price
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
- Peter Doherty Institute for Infection & Immunity, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Freya Shearer
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Mark Stoove
- The Burnet Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3083, Australia
| | - Kathryn Young
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Yanqin Zhang
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Katherine B. Gibney
- Peter Doherty Institute for Infection & Immunity, The University of Melbourne, Parkville, VIC 3052, Australia
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28
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Marlow EC, Jemal A, Thomson B, Wiese D, Zhao J, Siegel RL, Islami F. Mortality by Education Before and During the COVID-19 Pandemic, U.S., 2017-2020. Am J Prev Med 2023; 64:105-116. [PMID: 36528352 PMCID: PMC9556603 DOI: 10.1016/j.amepre.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Mortality disparities by SES, including education, have steadily increased in the U.S. over the past decades. This study examined whether these disparities overall and for 7 major causes of death were exacerbated in 2020, coincident with the emergence of the COVID-19 pandemic. METHODS Using data on 7,123,254 U.S. deaths from 2017 to 2020, age-standardized death rates and mortality rate differences per 100,000 population and rate ratios comparing least with most educated were calculated by sex and race/ethnicity. RESULTS All-cause death rates were approximately 2 times higher among adults with least than among those with most education. Disparities in all-cause mortality by educational attainment slightly increased from 2017 (rate ratio=1.97; 95% CI=1.95, 1.98; rate difference=739.9) to 2019 (rate ratio=2.04; 95% CI=2.03, 2.06; rate difference=761.3) and then greatly increased in 2020 overall (rate ratio=2.32; 95% CI=2.30, 2.33; rate difference=1,042.9) and when excluding COVID-19 deaths (rate ratio=2.27; 95% CI=2.25, 2.28; rate difference=912.3). Similar patterns occurred across race/ethnicity and sex, although Hispanic individuals had the greatest relative increase in disparities for all-cause mortality from 2019 (rate ratio=1.47; 95% CI=1.43, 1.51; rate difference=282.4) to 2020 overall (rate ratio=2.00; 95% CI=1.94, 2.06; rate difference=652.3) and when excluding COVID-19 deaths (rate ratio=1.84; 95% CI=1.79, 1.90; rate difference=458.7). Disparities in cause-specific mortality by education were generally stable from 2017 to 2019, followed by a considerable increase from 2019 to 2020 for heart disease, cancer, cerebrovascular disease, and unintentional injury. Among these causes of death, the relative increase in rate ratio from 2019 to 2020 was greatest for unintentional injury (24.8%; from 3.41 [95% CI=3.23, 3.60] to 4.26 [95% CI=3.99, 4.53]). CONCLUSIONS Mortality disparities by education widened in the U.S. in 2020, during the COVID-19 pandemic. Further research is warranted to understand the reasons for these widened disparities.
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Affiliation(s)
- Emily C Marlow
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia.
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Daniel Wiese
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jingxuan Zhao
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Farhad Islami
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
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29
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Michael Gaddis S, Carey CM, DiRago NV. Changes over Time in COVID-19 Vaccination Inequalities in Eight Large U.S. Cities. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2023; 9:23780231231161045. [PMID: 36945229 PMCID: PMC10020851 DOI: 10.1177/23780231231161045] [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: 05/01/2023]
Abstract
The authors estimate the associations between community socioeconomic composition and changes in coronavirus disease 2019 (COVID-19) vaccination levels in eight large cities at three time points. In March, communities with high socioeconomic status (SES) had significantly higher vaccination rates than low-SES communities. Between March and April, low-SES communities had significantly lower changes in percentage vaccinated than high-SES communities. Between April and May, this difference was not significant. Thus, the large vaccination gap between communities during restricted vaccine eligibility did not narrow when eligibility opened up. The link between COVID-19 vaccination and community disadvantage may lead to a bifurcated recovery whereby advantaged communities move on from the pandemic more quickly while disadvantaged communities continue to suffer.
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Affiliation(s)
- S. Michael Gaddis
- NWEA, Portland, OR, USA
- University of California, Los Angeles,
Los Angeles, CA, USA
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30
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Luxenburg O, Singer C, Kaim A, Saban M, Wilf‐Miron R. Socioeconomic and ethnic disparities along five waves of the COVID-19 pandemic: Lessons we have not yet learnt. J Nurs Scholarsh 2023; 55:45-55. [PMID: 36218245 PMCID: PMC9874613 DOI: 10.1111/jnu.12816] [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: 05/30/2022] [Revised: 07/30/2022] [Accepted: 08/16/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE The COVID-19 pandemic, now in its third year, has served as a magnifying glass, exposing the inequitable impact of the outbreak. The study aims to analyze the relationships between the socioeconomic and ethnic characteristics of the population and COVID-19 testing, infection, and vaccination throughout the first five pandemic waves. DESIGN A secondary analysis of an existing national database was conducted in Israel from March 2020 to May 2022. During the study period, Israel underwent 5 pandemic peaks or waves (March-April 2020, September-October 2020, January-February 2021, September 2021, and January-February 2022). METHODS Data on tests performed, confirmed COVID-19 cases, and uptake of vaccine doses one through four during the study period, were analyzed by the socioeconomic (SE) cluster (scale of 1 to 10) and ethnicity (Jewish, Arab, mixed Jewish- Arab ethnicity) of the residents' local authority. RESULTS COVID-19 testing rate gradually increased from the lowest to the highest SE clusters, with rates 3.2 times higher in the second highest, compared with the lowest cluster. People living in Jewish localities were tested twice more than those in Arab or mixed localities. The rate of confirmed cases was 1.9, 3.0, 6.3, and 4.3 times higher, respectively, among cluster 1 (the lowest) compared with cluster 9 (second highest) in the first, second, third, and fourth pandemic waves, respectively. Rates among people living in Arab or mixed localities were higher compared with those living in Jewish localities in 3 of the 5 waves. Vaccine uptake revealed a clear social gradient, with the percentage of the population being vaccinated gradually increasing from cluster 1 (the lowest) to the higher clusters. The relative difference between the lowest and highest SE clusters increased from 2.4 in the first vaccine dose to 5.5 in the third and fourth doses. Ethnic disparities also grew with vaccine dose, with a Jewish to an Arab rate ratio of 1.1, 1.2, 1.6, and 4.5 for vaccine doses 1,2,3, and 4, respectively. CONCLUSIONS Covering 26 consecutive months of the COVID-19 pandemic at the national level, the current study demonstrates that despite high accessibility of tests and vaccines to the entirety of the population and tailored outreach efforts, socioeconomic, and ethnic disparities not only failed to diminish, but they even widened along the five pandemic waves. CLINICAL RELEVANCE The pandemic exposed the vulnerability of the weakest segments of the population. Therefore, the combined action of the Ministry of Health, health providers, and local authorities is required to further adapt health messages to the cultural characteristics of diverse populations, to equip the health professionals with practical tools to promote healthy choices among the vulnerable populations, and to build communities that promote healthy lifestyles. The pandemic has highlighted the importance of reducing health disparities and building trust between vulnerable populations and the healthcare system during "normal" or routine times, to better prepare for times of emergencies, such as the current pandemic.
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Affiliation(s)
- Osnat Luxenburg
- Medical TechnologyHealth Information and Research DirectorateMinistry of HealthJerusalemIsrael
| | - Clara Singer
- The Gertner Institute for Epidemiology and Health Policy ResearchRamat GanIsrael
| | - Arielle Kaim
- The Gertner Institute for Epidemiology and Health Policy ResearchRamat GanIsrael,Department of Emergency Management and Disaster MedicineSchool of Public HealthSackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Mor Saban
- The Gertner Institute for Epidemiology and Health Policy ResearchRamat GanIsrael
| | - Rachel Wilf‐Miron
- The Gertner Institute for Epidemiology and Health Policy ResearchRamat GanIsrael,Department of Health PromotionSchool of Public HealthSackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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31
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Tolia M, Symvoulakis EK, Matalliotakis E, Kamekis A, Adamou M, Kountourakis P, Mauri D, Dakanalis A, Alexidis P, Varveris A, Antoniadis C, Matthaios D, Paraskeva M, Giaginis C, Kamposioras K. COVID-19 Emotional and Mental Impact on Cancer Patients Receiving Radiotherapy: An Interpretation of Potential Explaining Descriptors. Curr Oncol 2023; 30:586-597. [PMID: 36661695 PMCID: PMC9857784 DOI: 10.3390/curroncol30010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Significant changes in the accessibility and viability of health services have been observed during the COVID-19 period, particularly in vulnerable groups such as cancer patients. In this study, we described the impact of radical practice and perceived changes on cancer patients’ mental well-being and investigated potential outcome descriptors. Methods: Generalized anxiety disorder assessment (GAD-7), patient health (PHQ-9), and World Health Organization-five well-being index (WHO-5) questionnaires were used to assess anxiety, depression, and mental well-being. Information on participants, disease baseline information, and COVID-19-related questions were collected, and related explanatory variables were included for statistical analysis. Results: The mean score values for anxiety, depression, and mental well-being were 4.7 ± 5.53, 4.9 ± 6.42, and 72.2 ± 18.53, respectively. GAD-7 and PHQ-9 scores were statistically associated (p < 0.001), while high values of GAD-7 and PHQ-9 questionnaires were related to low values of WHO-5 (p < 0.001).Using the GAD-7 scale, 16.2% of participants were classified as having mild anxiety (GAD-7 score: 5−9).Mild to more severe anxiety was significantly associated with a history of mental health conditions (p = 0.01, OR = 3.74, 95% CI [1.372−10.21]), and stage category (stage III/IV vs. I/II, p = 0.01, OR = 3.83, 95% CI [1.38−10.64]. From the participants, 36.2% were considered to have depression (PHQ-9 score ≥ 5). Depression was related with older patients (p = 0.05, OR = 1.63, 95% CI [1.16−2.3]), those with previous mental health conditions (p = 0.03, OR = 14.24, 95% CI [2.47−81.84]), those concerned about the COVID-19 impact on their cancer treatment (p = 0.027, OR = 0.19, 95% CI [0.045−0.82]) or those who felt that COVID-19 pandemic has affected mental health (p = 0.013, OR = 3.56, 95% CI [1.30−9.72]). Additionally, most participants (86.7%) had a good well-being score (WHO-5 score ≥ 50). Mental well-being seemed more reduced among stage I−III patients than stage IV patients (p = 0.014, OR = 0.12, 95% CI [0.023−0.65]). Conclusion: There is a necessity for comprehensive cancer care improvement. These patients’ main concern related to cancer therapy, yet the group of patients who were mentally affected by the pandemic should be identified and supported.
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Affiliation(s)
- Maria Tolia
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Emmanouil Matalliotakis
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | | | - Marios Adamou
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | | | - Davide Mauri
- Medical Oncology, University of Ioannina, 45500 Ioannina, Greece
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Petros Alexidis
- Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Antonios Varveris
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Chrysostomos Antoniadis
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | | | - Maria Paraskeva
- Oncology Department, General Hospital of Rhodes, 85133 Rhodes, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
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32
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Waldhauer J, Beese F, Wachtler B, Haller S, Koschollek C, Pförtner TK, Hoebel J. Socioeconomic differences in the reduction of face-to-face contacts in the first wave of the COVID-19 pandemic in Germany. BMC Public Health 2022; 22:2419. [PMID: 36564783 PMCID: PMC9780616 DOI: 10.1186/s12889-022-14811-4] [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: 07/14/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to physical distancing measures to control the spread of SARS-CoV-2. Evidence on contact dynamics in different socioeconomic groups is still sparse. This study aimed to investigate the association of socioeconomic status with private and professional contact reductions in the first COVID-19 wave in Germany. METHODS Data from two especially affected municipalities were derived from the population-based cross-sectional seroepidemiological CORONA-MONITORING lokal study (data collection May-July 2020). The study sample (n = 3,637) was restricted to working age (18-67 years). We calculated the association of educational and occupational status (low, medium, high) with self-reported private and professional contact reductions with respect to former contact levels in the first wave of the pandemic. Multivariate Poisson regressions were performed to estimate prevalence ratios (PR) adjusted for municipality, age, gender, country of birth, household size, contact levels before physical distancing measures, own infection status, contact to SARS-CoV-2 infected people and working remotely. RESULTS The analyses showed significant differences in the initial level of private and professional contacts by educational and occupational status. Less private contact reductions with lower educational status (PR low vs. high = 0,79 [CI = 0.68-0.91], p = 0.002; PR medium vs. high = 0,93 [CI = 0.89-0.97], p = 0.001) and less professional contact reductions with lower educational status (PR low vs. high = 0,87 [CI = 0.70-1.07], p = 0.179; PR medium vs. high = 0,89 [CI = 0.83-0.95], p = 0.001) and lower occupational status (PR low vs. high = 0,62 [CI = 0.55-0.71], p < 0.001; PR medium vs. high = 0,82 [CI = 0.77-0.88], p < 0.001) were observed. CONCLUSIONS Our results indicate disadvantages for groups with lower socioeconomic status in private and professional contact reductions in the first wave of the pandemic. This may be associated with the higher risk of infection among individuals in lower socioeconomic groups. Preventive measures that a) adequately explain the importance of contact restrictions with respect to varying living and working conditions and b) facilitate the implementation of these reductions especially in the occupational setting seem necessary to better protect structurally disadvantaged groups during epidemics.
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Affiliation(s)
- Julia Waldhauer
- grid.13652.330000 0001 0940 3744Department of Epidemiology and Health Monitoring, Division of Social Determinants of Health, Robert Koch Institute, Berlin, Germany
| | - Florian Beese
- grid.13652.330000 0001 0940 3744Department of Epidemiology and Health Monitoring, Division of Social Determinants of Health, Robert Koch Institute, Berlin, Germany
| | - Benjamin Wachtler
- grid.13652.330000 0001 0940 3744Department of Epidemiology and Health Monitoring, Division of Social Determinants of Health, Robert Koch Institute, Berlin, Germany
| | - Sebastian Haller
- grid.13652.330000 0001 0940 3744Department of Infectious Disease Epidemiology, Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Berlin, Germany
| | - Carmen Koschollek
- grid.13652.330000 0001 0940 3744Department of Epidemiology and Health Monitoring, Division of Social Determinants of Health, Robert Koch Institute, Berlin, Germany
| | - Timo-Kolja Pförtner
- grid.6190.e0000 0000 8580 3777Research Methods Division, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Jens Hoebel
- grid.13652.330000 0001 0940 3744Department of Epidemiology and Health Monitoring, Division of Social Determinants of Health, Robert Koch Institute, Berlin, Germany
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Guise A, Burridge S, Annand P, Burrows M, Platt L, Rathod SD, Hosseini P, Cornes M. Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100038. [PMID: 35036989 PMCID: PMC8744008 DOI: 10.1016/j.ssmqr.2021.100038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 01/12/2023]
Abstract
High rates of COVID-19 infections and deaths amongst people who are homeless in London, UK were feared. Rates however stayed much lower than expected throughout 2020; an experience that compares to other settings globally. This study sought a community level perspective to explore this rate of infections, and through this explore relationships between COVID-19 and existing health inequalities. Analyses are reported from ongoing qualitative studies on COVID-19 and homeless health service evaluation in London, UK. Repeated in-depth telephone interviews were implemented with people experiencing homelessness in London (n=17; 32 interviews in total) as well as street outreach workers, nurses and hostel staff (n=10) from September 2020 to early 2021. Thematic analysis generated three themes to explore peoples' experiences of, and perspectives on, low infections: people experiencing homelessness following, creating and breaking social distancing and hygiene measures; social distancing in the form of social exclusion as a long-running feature of life; and a narrative of 'street immunity' resulting from harsh living conditions. Further study is needed to understand how these factors combine to prevent COVID-19 and how they relate to different experiences of homelessness. This community perspective can ensure that emerging narratives of COVID-19 prevention success don't ignore longer running causes of homelessness and reinforce stigmatising notions of people who are homeless as lacking agency. Our findings aid theorisation of how health inequalities shape pandemic progression: severe exclusion may substantially delay epidemics in some communities, although with considerable other non-COVID-19 impacts.
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Affiliation(s)
- Andy Guise
- King's College London, Guy's Campus, London, SE1 3UZ, UK,Corresponding author. King's College London, 5th Floor, Addison House, Guy's Campus, London, SE1 3UZ, UK
| | | | - P.J. Annand
- King's College London, Guy's Campus, London, SE1 3UZ, UK
| | - Martin Burrows
- Groundswell, St Matthews, Brixton Hill, London, SW2 1JF, UK
| | - Lucy Platt
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
| | - Sujit D. Rathod
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
| | - Paniz Hosseini
- London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1X 9SH, UK
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Jiang B, Yang Y, Chen L, Liu X, Wu X, Chen B, Webster C, Sullivan WC, Larsen L, Wang J, Lu Y. Green spaces, especially nearby forest, may reduce the SARS-CoV-2 infection rate: A nationwide study in the United States. LANDSCAPE AND URBAN PLANNING 2022; 228:104583. [PMID: 36158763 PMCID: PMC9485427 DOI: 10.1016/j.landurbplan.2022.104583] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 05/10/2023]
Abstract
The coronavirus pandemic is an ongoing global crisis that has profoundly harmed public health. Although studies found exposure to green spaces can provide multiple health benefits, the relationship between exposure to green spaces and the SARS-CoV-2 infection rate is unclear. This is a critical knowledge gap for research and practice. In this study, we examined the relationship between total green space, seven types of green space, and a year of SARS-CoV-2 infection data across 3,108 counties in the contiguous United States, after controlling for spatial autocorrelation and multiple types of covariates. First, we examined the association between total green space and SARS-CoV-2 infection rate. Next, we examined the association between different types of green space and SARS-CoV-2 infection rate. Then, we examined forest-infection rate association across five time periods and five urbanicity levels. Lastly, we examined the association between infection rate and population-weighted exposure to forest at varying buffer distances (100 m to 4 km). We found that total green space was negative associated with the SARS-CoV-2 infection rate. Furthermore, two forest variables (forest outside park and forest inside park) had the strongest negative association with the infection rate, while open space variables had mixed associations with the infection rate. Forest outside park was more effective than forest inside park. The optimal buffer distances associated with lowest infection rate are within 1,200 m for forest outside park and within 600 m for forest inside park. Altogether, the findings suggest that green spaces, especially nearby forest, may significantly mitigate risk of SARS-CoV-2 infection.
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Affiliation(s)
- Bin Jiang
- Urban Environments and Human Health Lab, HKUrbanLabs, Faculty of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
- Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yuwen Yang
- Urban Environments and Human Health Lab, HKUrbanLabs, Faculty of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
- Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Long Chen
- Department of Architecture and Civil Engineering, College of Engineering, City University of Hong Kong, Hong Kong Special Administrative Region
| | - Xueming Liu
- Urban Environments and Human Health Lab, HKUrbanLabs, Faculty of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
- Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Xueying Wu
- Department of Architecture and Civil Engineering, College of Engineering, City University of Hong Kong, Hong Kong Special Administrative Region
| | - Bin Chen
- Future Urbanity & Sustainable Environment (FUSE) Lab, Division of Landscape Architecture, Department of Architecture, Faculty of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
- Urban Systems Institute, The University of Hong Kong, Hong Kong Special Administrative Region
- HKU Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Chris Webster
- HKUrbanLabs, Faculty of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
| | - William C Sullivan
- Smart, Healthy Communities Initiative, University of Illinois at Urbana-Champaign, USA
- Department of Landscape Architecture, University of Illinois at Urbana-Champaign, USA
| | - Linda Larsen
- Smart Energy Design Assistance Center, University of Illinois at Urbana-Champaign, USA
| | - Jingjing Wang
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region
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Evaluating the Effect of Socioeconomic Status on Complex Abdominal Wall Reconstruction Outcomes. Ann Plast Surg 2022; 89:670-674. [DOI: 10.1097/sap.0000000000003332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rangel JC, Crath RD, Renade S. A breach in the social contract: Limited participation and limited evidence in COVID-19 responses. J Eval Clin Pract 2022; 28:934-940. [PMID: 36193623 PMCID: PMC9874905 DOI: 10.1111/jep.13775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023]
Abstract
Medically trained health professionals have been central to the development of policy responses to the coronavirus 2019 (COVID-19) crisis. In their multiple roles-as clinicians, public health leaders, members of scientific advisory boards, and also as media pundits and health professionals-they have helped shape discourses of science-based policy options during the first 2 years of the pandemic. In particular, health professionals as a collective voice insisted on the necessity of society-wide measures of social control to curb the morbidity and mortality of the virus. These measures, in turn, informed the political and moral imagination of the political class, the media and the larger public. Yet, as emerging evidence suggests, measures of social control posed a serious and long-term risk for health equity. In this discussion piece on the first 2 years of COVID-related public health directives, we interrogate the tensions that advocating for extensive and protracted measures of social control can pose to the social contract between medicine and society, health equity and democracy. To illustrate these tensions, we discuss the public fallout between vocal members of the OSAT, an ad hoc biomedical-led organization, and the Government of Ontario in light of the disagreement on the scope of 'stay home' orders to manage the third wave of the pandemic in the Spring of 2021 and, more recently, the mass protest against mass-scale public health measures in Ottawa, Canada. We argue that while decision making under emergency conditions is a difficult task, the legitimacy of the social contract between medicine and society depends on medical experts' judicious exercise of public health ethics principles. We offer a set of recommendations for building a more collaborative response to future health crises.
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Affiliation(s)
- Jamie Cristian Rangel
- Department of Innovation in Medical Education, Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Rory D Crath
- School for Social Work, Smith College, Northampton, Massachusetts, USA
| | - Sudit Renade
- Lambton Public Health, Point Edward, Ontario, Canada
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Abstract
The COVID-19 pandemic has taken a large toll on population health and well-being. We examine the consequences of prenatal exposure for infant health, through which the pandemic may have lasting intergenerational effects. We examine multiple pathways by which the pandemic shaped birth outcomes and socioeconomic disparities in these consequences. Analysis of more than 3.5 million birth records in California with universal information on COVID infection among persons giving birth at the time of delivery reveals deep inequalities in infection by education, race/ethnicity, and place-based socioeconomic disadvantage. COVID infection during pregnancy, in turn, predicts a large increase in the probability of preterm birth, by approximately one third. At the population level, a surprising reduction in preterm births during the first months of the pandemic was followed by an increase in preterm births during the surge in COVID infections in the winter of 2021. Whereas the early-pandemic reduction in preterm births benefited primarily highly educated mothers, the increase in preterm births during the winter infection surge was entirely concentrated among mothers with low levels of schooling. The COVID-19 pandemic is expected to exacerbate U.S. inequality in multiple ways. Our findings highlight a particularly enduring pathway: the long-term legacy of prenatal exposure to an unequal pandemic environment.
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Affiliation(s)
| | - Jenna Nobles
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
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Chen Y, Zhang L, Li T, Li L. Amplified effect of social vulnerability on health inequality regarding COVID-19 mortality in the USA: the mediating role of vaccination allocation. BMC Public Health 2022; 22:2131. [PMID: 36402963 PMCID: PMC9675971 DOI: 10.1186/s12889-022-14592-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022] Open
Abstract
Background Vaccination reduces the overall burden of COVID-19, while its allocation procedure may introduce additional health inequality, since populations characterized with certain social vulnerabilities have received less vaccination and been affected more by COVID-19. We used structural equation modeling to quantitatively evaluate the extent to which vaccination disparity would amplify health inequality, where it functioned as a mediator in the effect pathways from social vulnerabilities to COVID-19 mortality. Methods We used USA nationwide county (n = 3112, 99% of the total) level data during 2021 in an ecological study design. Theme-specific rankings of social vulnerability index published by CDC (latest data of 2018, including socioeconomic status, household composition & disability, minority status & language, and housing type & transportation) were the exposure variables. Vaccination coverage rate (VCR) during 2021 published by CDC was the mediator variable, while COVID-19 case fatality rate (CFR) during 2021 published by John Hopkinson University, the outcome variable. Results Greater vulnerabilities in socioeconomic status, household composition & disability, and minority status & language were inversely associated with VCR, together explaining 11.3% of the variance of VCR. Greater vulnerabilities in socioeconomic status and household composition & disability were positively associated with CFR, while VCR was inversely associated with CFR, together explaining 10.4% of the variance of CFR. Our mediation analysis, based on the mid-year data (30th June 2021), found that 37.6% (mediation/total effect, 0.0014/0.0037), 10% (0.0003/0.0030) and 100% (0.0005/0.0005) of the effects in the pathways involving socioeconomic status, household composition & disability and minority status & language, respectively, were mediated by VCR. As a whole, the mediation effect significantly counted for 30.6% of COVID-19 CFR disparity. Such a mediation effect was seen throughout 2021, with proportions ranging from 12 to 32%. Conclusions Allocation of COVID-19 vaccination in the USA during 2021 led to additional inequality with respect to COVID-19 mortality. Viable public health interventions should be taken to guarantee an equitable deployment of healthcare recourses across different population groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14592-w.
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Kwon RH, Jung M. Associations Between Conventional Healthy Behaviors and Social Distancing During the COVID-19 Pandemic: Evidence From the 2020 Community Health Survey in Korea. J Prev Med Public Health 2022; 55:568-577. [PMID: 36475322 DOI: 10.3961/jpmph.22.351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Many studies have shown that social distancing, as a non-pharmaceutical intervention (NPI) that is one of the various measures against coronavirus disease 2019 (COVID-19), is an effective preventive measure to suppress the spread of infectious diseases. This study explored the relationships between traditional health-related behaviors in Korea and social distancing practices during the COVID-19 pandemic. METHODS Data were obtained from the 2020 Community Health Survey conducted by the Korea Disease Control and Prevention Agency (n=98 149). The dependent variable was the degree of social distancing practice to cope with the COVID-19 epidemic. Independent variables included health-risk behaviors and health-promoting behaviors. The moderators were vaccination and unmet medical needs. Predictors affecting the practice of social distancing were identified through hierarchical multiple logistic regression analysis. RESULTS Smokers (adjusted odds ratio [aOR], 0.924) and frequent drinkers (aOR, 0.933) were more likely not to practice social distancing. A greater degree of physical activity was associated with a higher likelihood of practicing social distancing (aOR, 1.029). People who were vaccinated against influenza were more likely to practice social distancing than those who were not (aOR, 1.150). However, people with unmet medical needs were less likely to practice social distancing than those who did not experience unmet medical needs (aOR, 0.757). CONCLUSIONS Social distancing practices were related to traditional health behaviors such as smoking, drinking, and physical activity. Their patterns showed a clustering effect of health inequality. Therefore, when establishing a strategy to strengthen social distancing, a strategy to protect the vulnerable should be considered concomitantly.
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Affiliation(s)
- Rang Hee Kwon
- Department of Health Science, Dongduk Women's University College of Natural Science, Seoul, Korea
| | - Minsoo Jung
- Department of Health Science, Dongduk Women's University College of Natural Science, Seoul, Korea.,Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
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Dayton L, Song W, Kaloustian I, Eschliman EL, Strickland JC, Latkin C. A longitudinal study of COVID-19 disclosure stigma and COVID-19 testing hesitancy in the United States. Public Health 2022; 212:14-21. [PMID: 36182746 PMCID: PMC9411141 DOI: 10.1016/j.puhe.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/21/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examines the relationship between COVID-19 disclosure stigma and COVID-19 testing hesitancy and assesses their changes between November 2020 and 2021. STUDY DESIGN This was a longitudinal cohort. METHODS A total of 355 participants completed four study waves between November 2020 and November 2021. Factor analyses and Cronbach's alpha assessed the factor structure and internal consistency of the COVID-19 Disclosure Stigma scale. Paired t-tests and McNemar's Chi-squared test assessed change between the study waves. Multivariable logistic regression models examined the relationship between COVID-19 disclosure stigma and testing hesitancy at four study waves. RESULTS COVID-19 disclosure stigma declined significantly between the last study waves (P = 0.030). The greatest disclosure concern was reporting a positive test to close contacts (range: 19%-21%) followed by disclosure to friends (range: 10%-15%) and family (range: 4%-10%). Over the course of the four study waves, COVID-19 testing hesitancy when symptomatic ranged from 23% to 30%. Older age, female gender, and having received a COVID-19 vaccine were associated with decreased odds of testing hesitancy. Greater COVID-19 disclosure stigma and more conservative political ideology showed a consistent relationship with increased odds of COVID-19 testing hesitancy. CONCLUSIONS Study findings suggest that many people anticipate feeling stigmatized when disclosing positive test results, especially to close contacts. A substantial percentage of study participants reported hesitancy to be tested when symptomatic. This study identifies a need for interventions that normalize COVID-19 testing (e.g. engaging leaders with conservative followings), provide strategies for disclosing positive results, and allow anonymous notification of potential COVID-19 exposure.
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Affiliation(s)
- L Dayton
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA.
| | - W Song
- Department of Applied Mathematics and Statistics, Johns Hopkins University, USA
| | - I Kaloustian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - E L Eschliman
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - J C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, USA
| | - C Latkin
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
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McGowan VJ, Bambra C. COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities. Lancet Public Health 2022; 7:e966-e975. [PMID: 36334610 PMCID: PMC9629845 DOI: 10.1016/s2468-2667(22)00223-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has exacerbated endemic health inequalities resulting in a syndemic pandemic of higher mortality and morbidity rates among the most socially disadvantaged. We did a scoping review to identify and synthesise published evidence on geographical inequalities in COVID-19 mortality rates globally. We included peer-reviewed studies, from any country, written in English that showed any area-level (eg, neighbourhood, town, city, municipality, or region) inequalities in mortality by socioeconomic deprivation (ie, measured via indices of multiple deprivation: the percentage of people living in poverty or proxy factors including the Gini coefficient, employment rates, or housing tenure). 95 papers from five WHO global regions were included in the final synthesis. A large majority of the studies (n=86) found that COVID-19 mortality rates were higher in areas of socioeconomic disadvantage than in affluent areas. The subsequent discussion reflects on how the unequal nature of the pandemic has resulted from a syndemic of COVID-19 and endemic inequalities in chronic disease burden.
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Affiliation(s)
- Victoria J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.
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Rahal D, Shaw S. Impacts of the COVID-19 Transition to Remote Instruction for University Students. JOURNAL OF STUDENT AFFAIRS RESEARCH AND PRACTICE 2022; 60:108-122. [PMID: 36818329 PMCID: PMC9937512 DOI: 10.1080/19496591.2022.2111519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In March 2020, 234 students (77.50% female; 63.09% second-year, 28.33% third-year) enrolled in a psychological statistics course at a public university described their experiences during the first week of the COVID-19-related transition to remote instruction. Qualitative responses indicated 13 common concerns including financial, housing, and food insecurity; social life concerns; distress; sleep difficulties; and academic problems. Students with lower socioeconomic status were more likely to experience financial instability, food insecurity, and difficulty focusing academically.
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Albani V, Welsh CE, Brown H, Matthews FE, Bambra C. Explaining the deprivation gap in COVID-19 mortality rates: A decomposition analysis of geographical inequalities in England. Soc Sci Med 2022; 311:115319. [PMID: 36088725 PMCID: PMC9441468 DOI: 10.1016/j.socscimed.2022.115319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022]
Abstract
One of the most consistent and worrying features of the COVID-19 pandemic globally has been the disproportionate burden of the epidemic in the most deprived areas. Most of the literature so far though has focused on estimating the extent of these inequalities. There has been much less attention paid to exploring the main pathways underpinning them. In this study, we employ the syndemic pandemic theoretical framework and apply novel decomposition methods to investigate the proportion of the COVID-19 mortality gap by area-level deprivation in England during the first wave of the pandemic (January to July 2020) was accounted for by pre-existing inequalities in the compositional and contextual characteristics of place. We use a decomposition approach to explicitly quantify the independent contribution of four inequalities pathways (vulnerability, susceptibility, exposure and transmission) in explaining the more severe COVID-19 outcomes in the most deprived local authorities compared to the rest. We find that inequalities in transmission (73%) and in vulnerability (49%) factors explained the highest proportion of mortality by deprivation. Our results suggest that public health agencies need to develop short- and long-term strategies to alleviate these underlying inequalities in order to alleviate the more severe impacts on the most vulnerable communities.
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Affiliation(s)
- Viviana Albani
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Claire E Welsh
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Heather Brown
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
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Alfaro T, Martinez-Folgar K, Vives A, Bilal U. Excess Mortality during the COVID-19 Pandemic in Cities of Chile: Magnitude, Inequalities, and Urban Determinants. J Urban Health 2022; 99:922-935. [PMID: 35688966 PMCID: PMC9187147 DOI: 10.1007/s11524-022-00658-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
We estimated excess mortality in Chilean cities during the COVID-19 pandemic and its association with city-level factors. We used mortality, and social and built environment data from the SALURBAL study for 21 Chilean cities, composed of 81 municipalities or "comunas", grouped in 4 macroregions. We estimated excess mortality by comparing deaths from January 2020 up to June 2021 vs 2016-2019, using a generalized additive model. We estimated a total of 21,699 (95%CI 21,693 to 21,704) excess deaths across the 21 cities. Overall relative excess mortality was highest in the Metropolitan (Santiago) and the North regions (28.9% and 22.2%, respectively), followed by the South and Center regions (17.6% and 14.1%). At the city-level, the highest relative excess mortality was found in the Northern cities of Calama and Iquique (around 40%). Cities with higher residential overcrowding had higher excess mortality. In Santiago, capital of Chile, municipalities with higher educational attainment had lower relative excess mortality. These results provide insight into the heterogeneous impact of COVID-19 in Chile, which has served as a magnifier of preexisting urban health inequalities, exhibiting different impacts between and within cities. Delving into these findings could help prioritize strategies addressed to prevent deaths in more vulnerable communities.
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Affiliation(s)
- Tania Alfaro
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Independencia 939, Santiago, Chile.
| | - Kevin Martinez-Folgar
- Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Alejandra Vives
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, CEDEUS, Santiago, Chile
| | - Usama Bilal
- Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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Gontijo CC, Brito RND, Teixeira AIP, Romero GAS, Pedrette P, Ramalho WM, Noronha E, Haddad R, Araújo WND. Accuracy of point-of-care Panbio™ SARS-CoV-2 antigen-detection test in a socioeconomically vulnerable population in Brazil. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.929524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundDevelopment and validation of point-of-care (POC) diagnostic tests with high accuracy is critical for underrepresented populations, allowing for wider access to diagnosis. Here, we evaluate the performance of the Panbio™ antigen-rapid test device (Ag-RTD) for SARS-CoV-2, our index test, having RT-qPCR as the reference standard.MethodsThis phase III validation study was conducted concomitantly with a primary health care center routine tending to a low-income Brazilian population. Eligibility criteria were residing at Cidade Estrutural and presenting flu-like/respiratory symptoms for 3-10 days.ResultsAmong the 505 participants, 45.15% (228/505) tested positive for RT-qPCR and 54.85% (277/505) for the Ag-RTD. Overall sensitivity was 76.32% (CI95% 70.39-81.37) and specificity was 98.92% (96.02-99.82).ConclusionsOur results show that the Panbio™ Ag-RTD does not meet the minimum performance requirements established by the World Health Organization (≥ 80% sensitivity and ≥ 97% specificity compared to a reference test in suspected COVID-19 cases). Thus, we do not recommend the implementation of Panbio™Ag-RTD as a single diagnostic tool in underrepresented and disadvantaged populations. Finally, we discuss a possible setting for the use of Panbio™Ag-RTD under combined sensitivity.
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Arias Cubas M, Paul AM, Ramírez J, Roohi S, Scholten P. Comparative perspectives on migration, diversities and the pandemic. COMPARATIVE MIGRATION STUDIES 2022; 10:38. [PMID: 36068857 PMCID: PMC9437390 DOI: 10.1186/s40878-022-00306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Magdalena Arias Cubas
- Alfred Deakin Institute for Citizenship and Globalisation, 21 Burwood Hwy, Burwood, VIC 3125 Australia
| | - Anju Mary Paul
- Sociology and Public Policy, Yale-NUS College Singapore, 16 #01-220, College Ave West, Singapore, 138527 Singapore
| | - Jacques Ramírez
- Programa de Antropología de Lo Contemporáneo, Facultad de Filosofía, Universidad de Cuenca, Av. 12 de Abril, Cuenca, Ecuador
| | - Sanam Roohi
- CeMIS, Georg-August Universtat, Wilhelmsplatz 1, 37073 Göttingen, Germany
| | - Peter Scholten
- Governance of Migration and Diversity, ESSB Faculty, Erasmus University Rotterdam, Burg. Oudlaan 50, 3000 DR Rotterdam, The Netherlands
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Prevalence of surgery cancelation and challenges in restarting elective surgery in the pandemic: A cross-sectional study. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2022; 28:100271. [PMID: 35765516 PMCID: PMC9221740 DOI: 10.1016/j.pcorm.2022.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022]
Abstract
Objectives The COVID-19 pandemic caused primary disruption of health services, especially to elective surgery. As the pandemic goes in waves of high and low infection rates in a country, restarting elective surgery must be dynamic while balancing patients’ needs, staff safety and the hospital capacity. We aim to report the prevalence of elective surgery and minimally invasive procedures cancelation due to positive Covid-19 screening and describe steps in restarting elective cases after the third wave of Covid-19 infection. Methods This study was a descriptive cross-sectional study in Indonesia's tertiary referral and teaching hospital from January to September 2021. Subjects were patients scheduled for elective surgery or minimally invasive procedures from our outpatient clinic. Subjects were screened for SARS-CoV-2 using real-time polymerase chain reaction (rRT-PCR) 24-48 hours before scheduled surgery or intervention. Data was taken from the hospital information system and the central operating theatre online surgical list. Statistical analysis is presented in percentage. Results There were 5286 subjects identified for the study, and 3088 were included with an available PCR result from the outpatient department. The average elective cancelation rate was 7.4%, and the highest cancelation was on August 2021, with 14.7%. All subjects with positive results were asymptomatic, with more than 90% cycle time rRT-PCR above 30. Conclusion Elective surgery cancelation can reflect a trend in community infection, and monitoring its values is crucial for saving elective surgery plans during a pandemic.
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Halpern-Manners A, McLeod JD, Anderson EM, Ekl EA. COVID-19 and changes in college student educational expectations and health by disability status. SSM Popul Health 2022; 19:101195. [PMID: 35992965 PMCID: PMC9375263 DOI: 10.1016/j.ssmph.2022.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022] Open
Abstract
This study examines the implications of the coronavirus pandemic for college students' health and education, with special attention to variation by disability status. Disaster research supports the hypothesis that students with disabilities will experience higher-than-usual levels of pandemic-related stress, which could lead to re-evaluations of their educational expectations and declines in health. We evaluate this hypothesis by modeling changes in students' (1) mental and physical health and (2) educational expectations during the first year (spring of 2020 to spring of 2021) of the pandemic, using survey data collected from a population-based sample of college students in the state of Indiana. Although we observe across-the-board declines in both domains, students with disabilities were especially vulnerable. Mediation analyses suggest that differential exposure to financial and illness-related stressors is partially to blame, explaining a significant portion of the group differences between students with and without disabilities. We interpret these results as evidence of the unique vulnerabilities associated with disability status and its wide-ranging importance as a dimension of social stratification.
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Affiliation(s)
| | | | | | - Emily A. Ekl
- Department of Sociology, Indiana University, USA
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Swisher R, Garcia-Alexander G, Cossman L, Schaefer D. Explaining racial/ethnic and socioeconomic differences in COVID protective behavior. SSM Popul Health 2022; 19:101147. [PMID: 35721250 PMCID: PMC9197562 DOI: 10.1016/j.ssmph.2022.101147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 12/02/2022] Open
Abstract
COVID-19 has had a disproportionate impact on Black, Hispanic, and lower socioeconomic status communities. Using data from the Community, Health and Politics Study (CHAPS 2021), collected in the midst of the pandemic, we examine differences in COVID-19 health promotion behavior (i.e., avoiding large gatherings, mask wearing, and vaccination status) across racial, ethnic, and socioeconomic status subgroups of the population. Moreover, we examine the degree to which observed differences are robust to controls for other health-related disparities, such as access to health insurance, underlying health conditions, personal exposure to COVID-19 (i.e., own diagnoses, knowing persons who have died from COVID-19), and perceived COVID-19 threat. Findings are consistent with arguments proposed by fundamental cause theory and disease stage theory as they indicate fewer differences on the basis of socioeconomic status or race and ethnicity for masking and social distancing, which may be thought of as less effective measures. In contrast, disparities were prominent in vaccination outcomes. Specifically, racial and ethnic minorities, those with lower levels of education, and those with lower incomes had lower odds of vaccination, after controlling for covariates. Private insurance and older age were also associated with higher odds of vaccination. Higher perceived threat of COVID-19 increased the likelihood of all protective behaviors. Our findings suggest that the need for ongoing efforts to increase vaccination uptake in socially disadvantaged communities.
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Affiliation(s)
- Raymond Swisher
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Lynne Cossman
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Drew Schaefer
- Department of Demography, MS Building 4.01.50, One UTSA Circle, San Antonio, TX, 78429, USA
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Widyastari DA, Khanawapee A, Charoenrom W, Saonuam P, Katewongsa P. Refining index to measure physical activity inequality: which group of the population is the most vulnerable? Int J Equity Health 2022; 21:123. [PMID: 36045368 PMCID: PMC9428882 DOI: 10.1186/s12939-022-01725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The existing body of research mostly discusses inequality in physical activity (PA) based on the difference in the level of moderate-to-vigorous physical activity (MVPA). Evidence is lacking on the quantified inequality measures (e.g., how big the inequality is, and the distribution) in order to identify the most vulnerable groups of a population. This study measured PA inequality among Thai adults by using three parameters to construct an inequality index: (1) Proportion of the population with sufficient MVPA; (2) Cumulative minutes of MVPA; and (3) The Gini coefficient. METHODS This study employed three rounds of data from Thailand's Surveillance on Physical Activity (SPA) 2019-2021. In each round, over 6,000 individuals age 18-64 years were selected as nationally-representative samples, and were included in the analysis. PA inequality was constructed by using three parameters, with a combination of the three as the final measure, to identify the sub-groups of the Thai adults who are most vulnerable: groups with the least MVPA, highest insufficiency, and highest inequality index (Gini). RESULTS Covid-19 containment measures have widened the gap in PA inequality, as shown by a declining proportion of the population meeting the recommended guidelines, from 74.3% in 2019 to 56.7% in 2020 and 65.5% in 2021. PA inequality existed in all sub-populations. However, by combining three parameters, the most vulnerable groups during the Covid-19 epidemic were identified as follows: (1) Those with no income; (2) The unemployed; (3) Those who have no access to PA facilities; (4) Older adults aged 60 + years; and (5) Those earning < 3,500 baht per month. Further, residents of Bangkok, young adults aged 18-24, individuals who attained primary level education or less, those who had no exposure to a PA awareness campaign and those who have a debilitating chronic disease also had elevated risk of PA insufficiency. CONCLUSION A concerning level of PA inequality existed in all sub-populations. The use of combined indicators in measuring PA inequality should aid in determining the most vulnerable groups of the population with a refined procedure. This method can be applied in many settings since the baseline data used to measure inequality (i.e., percent sufficient and cumulative minutes of MVPA) are widely available.
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Affiliation(s)
- Dyah Anantalia Widyastari
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
- Thailand Physical Activity Knowledge Development Centre (TPAK), Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Aunyarat Khanawapee
- Thailand Physical Activity Knowledge Development Centre (TPAK), Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Wanisara Charoenrom
- Thailand Physical Activity Knowledge Development Centre (TPAK), Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | | | - Piyawat Katewongsa
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
- Thailand Physical Activity Knowledge Development Centre (TPAK), Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
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