1
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Cohen S, Metcalf E, Brown MJ, Ahmed NH, Nash C, Greaney ML. A closer examination of the "rural mortality penalty": Variability by race, region, and measurement. J Rural Health 2024. [PMID: 39198995 DOI: 10.1111/jrh.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/13/2024] [Accepted: 08/18/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Racial health disparities are well documented and pervasive across the United States. Evidence suggests there is a "rural mortality penalty" whereby rural residents experience poorer health outcomes than their urban counterparts. However, whether this penalty is uniform across demographic groups and U.S. regions is unknown. OBJECTIVE To assess how rural-urban differences in mortality differ by race (Black vs. White), U.S. region, poverty status, and how rural-urban status is measured. METHODS Age-standardized mortality rates (ASMRs)/100,000 by U.S. county (2015-2019) were obtained by race (Black/White) from the CDC Wonder National Vital Statistics System (2015-2019) and were merged with county-level social determinants from the US Census Bureau and County Health Rankings. Multivariable generalized linear models assessed the associations between rurality (index of relative rurality [IRR] decile, rural-urban continuum codes, and population density) and race-specific ASMR, overall, and by Census region and poverty level. RESULTS Overall, average ASMR was significantly higher in rural areas than urban areas for both Black (rural ASMR = 949.1 per 100,000 vs. urban ASMR = 857.7 per 100,000) and White (rural ASMR = 903.0 per 100,000 vs. urban ASMR = 791.6 per 100,000) populations. The Black-White difference was substantially higher (p < 0.001) in urban than in rural counties (65.1 per 100,000 vs. 46.1 per 100,000). Black-White differences and patterns in ASMR varied notably by poverty status and U.S. region. CONCLUSION Policies and interventions designed to reduce racial health disparities should consider and address key contextual factors associated with geographic location, including rural-urban status and socioeconomic status.
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Affiliation(s)
- Steven Cohen
- Associate Professor, Department of Public Health, University of Rhode Island, Kingston, Rhode Island, USA
| | - Emily Metcalf
- Research Assistant, Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Monique J Brown
- Associate Professor, Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Neelam H Ahmed
- Research Assistant, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Caitlin Nash
- Associate Teaching Professor, Department of Public Health, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L Greaney
- Professor & Chairperson, Department of Public Health, University of Rhode Island, Kingston, Rhode Island, USA
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2
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Musolino C, Baum F, Flavel J, Freeman T, McKee M, Chi C, Giugliani C, Falcão MZ, De Ceukelaire W, Howden-Chapman P, Huong NT, Serag H, Kim S, Dardet CA, Gesesew HA, London L, Popay J, Paremoer L, Tangcharoensathien V, Sundararaman T, Nandi S, Villar E. Caring During COVID-19: A Study of Intersectionality and Inequities in the Care Economy in 16 Countries. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241269198. [PMID: 39129232 DOI: 10.1177/27551938241269198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Carers were disproportionately harmed in the COVID-19 pandemic. Despite facing an increased risk of contracting the virus, they continued in frontline roles in care services and acted as "shock absorbers" for their families and communities. In this article, we apply an intersectional lens to examine care work and the structural factors disadvantaging carers during COVID-19 through a comparative case study analysis of 16 low-, middle-, and high-income countries. Data on each country was collected through a qualitative framework during 2021-2022. We found that while carers everywhere were predominantly women with low incomes and precarious employment, other factors were at play in shaping their experiences. Moreover, government responses to mitigate the direct impact of the pandemic have created local and global disparities affecting those working in this sector. Our findings reveal how oppressive social structures such as race, class, caste, and migration status converged in contextually specific ways to shape the gendered nature of care within and between different countries. We call for a better understanding of the multiple axes of inequalities experienced by carers to inform crisis mitigations, coupled with long-term strategies to address social inequities in the care economy and to promote gender equality.
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Affiliation(s)
- Connie Musolino
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Fran Baum
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Joanne Flavel
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Toby Freeman
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Chunhuei Chi
- Center for Global Health, Oregon State University, Corvallis, OR 7331, USA
| | - Camila Giugliani
- Social Medicine Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2400 CEP 90035-003, Porto Alegre, Brazil
| | - Matheus Zuliane Falcão
- Health Law Research Centre, University of São Paulo, Av. Dr. Arnaldo, 715 - 211 - Cerqueira César, São Paulo, SP 01246- 904, Brazil
| | | | | | - Nguyen Thanh Huong
- Faculty of Social Science and Behavior, Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Hani Serag
- Department of Internal Medicine, University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, Texas, 77555, USA
| | - Sun Kim
- People's Health Movement South Korea, Seoul, South Korea
| | - Carlos Alvarez Dardet
- CIBERESP, Center for Research in Epidemiology and Public Health, Public Health Research Group University of Alicante, Madrid, Spain
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Leslie London
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Jennie Popay
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK
| | - Lauren Paremoer
- Political Studies, University of Cape Town, Cape Town, South Africa
| | | | | | - Sulakshana Nandi
- Public Health Researcher, Ebertsgade 6, 2300 Copenhagen, Denmark
| | - Eugenio Villar
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martín de Porres 15102, Peru
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3
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Gupta A, Hathi P, Banaji M, Gupta P, Kashyap R, Paikra V, Sharma K, Somanchi A, Sudharsanan N, Vyas S. Large and unequal life expectancy declines during the COVID-19 pandemic in India in 2020. SCIENCE ADVANCES 2024; 10:eadk2070. [PMID: 39028821 PMCID: PMC11259167 DOI: 10.1126/sciadv.adk2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 06/17/2024] [Indexed: 07/21/2024]
Abstract
Global population health during the COVID-19 pandemic is poorly understood because of weak mortality monitoring in low- and middle-income countries. High-quality survey data on 765,180 individuals, representative of one-fourth of India's population, uncover patterns missed by incomplete vital statistics and disease surveillance. Compared to 2019, life expectancy at birth was 2.6 years lower and mortality was 17% higher in 2020, implying 1.19 million excess deaths in 2020. Life expectancy declines in India were larger and had a younger age profile than in high-income countries. Increases in mortality were greater than expected based on observed seroprevalence and international infection fatality rates, most prominently among the youngest and older age groups. In contrast to global patterns, females in India experienced a life expectancy decline that was 1 year larger than losses for males. Marginalized social groups experienced greater declines than the most privileged social group. These findings uncover large and unequal mortality impacts during the pandemic in the world's most populous country.
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Affiliation(s)
- Aashish Gupta
- Department of Sociology, University of Oxford, 42-43 Park End Street, Oxford OX1 1JD, England
- Nuffield College, New Road, Oxford OX1 1NF, England
- Leverhulme Centre for Demographic Science, University of Oxford, 42-43 Park End Street, Oxford OX1 1JD, England
- Research Institute for Compassionate Economics, 472 Old Colchester Rd., Amston, CT 06231, USA
| | - Payal Hathi
- Research Institute for Compassionate Economics, 472 Old Colchester Rd., Amston, CT 06231, USA
- Department of Demography and Sociology, University of California, Berkeley, 310 Social Sciences Building, Berkeley, CA 94720, USA
| | - Murad Banaji
- Mathematical Institute, University of Oxford, Andrew Wiles Building, Radcliffe Observatory Quarter (550), Woodstock Road, Oxford OX2 6GG, England
| | - Prankur Gupta
- Department of Economics, University of Texas at Austin, 2225 Speedway, Austin, TX 78712, USA
| | - Ridhi Kashyap
- Department of Sociology, University of Oxford, 42-43 Park End Street, Oxford OX1 1JD, England
- Nuffield College, New Road, Oxford OX1 1NF, England
- Leverhulme Centre for Demographic Science, University of Oxford, 42-43 Park End Street, Oxford OX1 1JD, England
| | - Vipul Paikra
- Research Institute for Compassionate Economics, 472 Old Colchester Rd., Amston, CT 06231, USA
| | - Kanika Sharma
- Department of Sociology, Emory University, 1555 Dickey Dr, Atlanta, GA 30322, USA
| | - Anmol Somanchi
- Paris School of Economics, 48 Boulevard Jourdan, 75014 Paris, France
| | - Nikkil Sudharsanan
- TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 60, 80992 Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Sangita Vyas
- Research Institute for Compassionate Economics, 472 Old Colchester Rd., Amston, CT 06231, USA
- Department of Economics, Hunter College (CUNY), 695 Park Ave., New York, NY 10065, USA
- CUNY Institute for Demographic Research, 135 E. 22nd St., New York, NY 10010, USA
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4
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Borrell LN, Markides KS. Will the Health Status of the Changing Hispanic Population Remain 'Paradoxical'? Am J Public Health 2024; 114:S431-S435. [PMID: 39083746 PMCID: PMC11292279 DOI: 10.2105/ajph.2024.307697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Luisa N Borrell
- Luisa N. Borrell is a distinguished professor of epidemiology & biostatistics at the Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, and an associate editor of AJPH. Kyriakos S. Markides is with the School of Public and Population Health, University of Texas Medical Branch, Galveston. Luisa N. Borrell is also a guest editor for this supplemental issue
| | - Kyriakos S Markides
- Luisa N. Borrell is a distinguished professor of epidemiology & biostatistics at the Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, and an associate editor of AJPH. Kyriakos S. Markides is with the School of Public and Population Health, University of Texas Medical Branch, Galveston. Luisa N. Borrell is also a guest editor for this supplemental issue
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5
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Willis DE, Moore R, Selig JP, CarlLee S, Gurel-Headley MP, Cornett LE, McElfish PA. COVID-19 Booster Uptake: Are Hesitant Adopters Less Likely to Get a Booster Shot Than Nonhesitant Adopters? Behav Med 2024; 50:260-268. [PMID: 37722699 PMCID: PMC11229423 DOI: 10.1080/08964289.2023.2249168] [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: 10/11/2022] [Revised: 05/10/2023] [Accepted: 08/09/2023] [Indexed: 09/20/2023]
Abstract
The main objective of this study was to assess whether hesitancy toward receiving the initial COVID-19 vaccine was associated with uptake of the COVID-19 booster several months after it became available to all US adults. We ask whether hesitancy toward the initial COVID-19 vaccine was significantly associated with lower odds of COVID-19 booster uptake among adults. We test this association within the context of the highly rural state of Arkansas. By January 2022, the US had set a global record of nearly 1 million daily cases. The purpose of this study was to advance our understanding of vaccine hesitancy among those who have already received a dose of the COVID-19 vaccine and how that hesitancy may shape COVID-19 booster uptake. We analyzed data from a random sample survey of Arkansan adults (N = 2,201) between March 1 and March 28, 2022 and constrained our analytical sample to those who had received a vaccine (N = 1,649). Nearly two-thirds of vaccinated Arkansas residents had received a COVID-19 booster. Hesitancy was common even among vaccinated individuals and was significantly associated with reduced odds of COVID-19 booster uptake, even after controlling for other factors. Findings provide further support for conceptualizing vaccine hesitancy as an attitude related to-but separate from-the behavior of vaccination, as opposed to conflating vaccination with being nonhesitant. Public health interventions aimed at increasing COVID-19 booster uptake should pay attention to vaccine hesitancy indicated at the initiation of the series and should not ignore the vaccinated as an important population to target for intervention.
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Affiliation(s)
- Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72762, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72762, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72762, USA
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72762, USA
| | - Morgan P. Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Lawrence E. Cornett
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR 72762, USA
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6
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Strayhorn-Carter SM, Batai K, Gachupin FC. Types of Racism and Health Disparities and Inequalities among Cancer Patients: An Editorial Reflection of Articles in This Special Issue of IJERPH. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:785. [PMID: 38929031 PMCID: PMC11203658 DOI: 10.3390/ijerph21060785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Racism has been a long-standing influential factor that has negatively impacted both past and current health disparities within the United Sates population. Existing problems of racism and its impact on both health disparities and health inequalities were only amplified during the COVID-19 pandemic. The pandemic allowed both clinicians and researchers to recognize a growing list of health concerns at the macro-, meso-, and micro-level among underserved racially minoritized patients with specific chronic illnesses such as cancer. Based on these concerns, this Special Issue was designed to highlight the challenges of cancer screening, cancer treatment, and cancer-centered educational outreach among racially minoritized communities.
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Affiliation(s)
- Shaila M. Strayhorn-Carter
- Department of Public Health, School of Health & Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC 28403, USA;
| | - Ken Batai
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85721, USA;
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7
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Shenoy ES, Banach DB, Batshon LJ, Branch-Elliman W, Dumyati G, Haessler S, Hsu VP, Jump RLP, Malani AN, Mathew TA, Murthy RK, Pergam SA, Seeger MW, Weber DJ. SHEA position statement on pandemic preparedness for policymakers: the role of healthcare epidemiologists in communicating during infectious diseases outbreaks. Infect Control Hosp Epidemiol 2024:1-5. [PMID: 38836649 DOI: 10.1017/ice.2024.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Erica S Shenoy
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mass General Brigham, Boston, MA, USA
| | - David B Banach
- School of Medicine, University of Connecticut, Farmington, CT, USA
- Public Health, Yale School, New Haven, CT, USA
| | | | - Westyn Branch-Elliman
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ghinwa Dumyati
- University of Rochester Medical Center, Rochester, NY, USA
- Center for Community Health, Rochester, NY, USA
| | - Sarah Haessler
- Baystate Medical Center, Springfield, MA, USA
- University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA
| | - Vincent P Hsu
- AdventHealth, Altamonte Springs, FL, USA
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC) at the Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Trini A Mathew
- HealthTAMCycle3, PLLC, Troy, MI, USA
- Corewell Health, Taylor, MI, USA
- School of Medicine, Wayne State University, Detroit, and Oakland University William Beaumont, Rochester, MI, USA
| | - Rekha K Murthy
- Cedars-Sinai, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven A Pergam
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
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8
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Yuan AY, Atanasov V, Barreto N, Franchi L, Whittle J, Weston B, Meurer J, Luo Q(E, Black B. Understanding racial/ethnic disparities in COVID-19 mortality using a novel metric: COVID excess mortality percentage. Am J Epidemiol 2024; 193:853-862. [PMID: 38375671 PMCID: PMC11145910 DOI: 10.1093/aje/kwae007] [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: 01/04/2023] [Revised: 11/25/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
Prior research on racial/ethnic disparities in COVID-19 mortality has often not considered to what extent they reflect COVID-19-specific factors, versus preexisting health differences. This study examines how racial/ethnic disparities in COVID-19 mortality vary with age, sex, and time period over April-December 2020 in the United States, using mortality from other natural causes as a proxy for underlying health. We study a novel measure, the COVID excess mortality percentage (CEMP), defined as the COVID-19 mortality rate divided by the non-COVID natural mortality rate, converted to a percentage, where the CEMP denominator controls (albeit imperfectly) for differences in population health. Disparities measured using CEMP deviate substantially from those in prior research. In particular, we find very high disparities (up to 12:1) in CEMP rates for Hispanics versus Whites, particularly for nonelderly men. Asians also have elevated CEMP rates versus Whites, which were obscured in prior work by lower overall Asian mortality. Native Americans and Blacks have significant disparities compared with White populations, but CEMP ratios to Whites are lower than ratios reported in other work. This is because the higher COVID-19 mortality for Blacks and Native Americans comes partly from higher general mortality risk and partly from COVID-specific risk.
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Affiliation(s)
- Andy Ye Yuan
- Corresponding author: Andy Ye Yuan, Pritzker School of Law, Northwestern University, 375 E Chicago Avenue, Chicago, IL 60611 ()
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9
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Ramkumar D, Marty A, Ramkumar J, Rosencranz H, Vedantham R, Goldman M, Meyer E, Steinmetz J, Weckle A, Bloedorn K, Rosier C. Food for thought: Making the case for food produced via regenerative agriculture in the battle against non-communicable chronic diseases (NCDs). One Health 2024; 18:100734. [PMID: 38711478 PMCID: PMC11070632 DOI: 10.1016/j.onehlt.2024.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024] Open
Abstract
Non-communicable diseases (NCDs) pose a global health challenge, leading to substantial morbidity, mortality, and economic strain. Our review underscores the escalating incidence of NCDs worldwide and highlights the potential of regenerative agriculture (RA) products in mitigating these diseases. We also explore the efficacy of dietary interventions in NCD management and prevention, emphasizing the superiority of plant-based diets over those high in processed foods and red meat. Examining the role of the gut microbiome in various diseases, including liver disorders, allergies, metabolic syndrome, inflammatory bowel disease, and colon cancer, we find compelling evidence implicating its influence on disease development. Notably, dietary modifications can positively affect the gut microbiome, fostering a symbiotic relationship with the host and making this a critical strategy in disease prevention and treatment. Investigating agricultural practices, we identify parallels between soil/plant and human microbiome studies, suggesting a crucial link between soil health, plant- and animal-derived food quality, and human well-being. Conventional/Industrial agriculture (IA) practices, characterized in part by use of chemical inputs, have adverse effects on soil microbiome diversity, food quality, and ecosystems. In contrast, RA prioritizes soil health through natural processes, and includes avoiding synthetic inputs, crop rotation, and integrating livestock. Emerging evidence suggests that food from RA systems surpasses IA-produced food in quality and nutritional value. Recognizing the interconnection between human, plant, and soil microbiomes, promoting RA-produced foods emerges as a strategy to improve human health and environmental sustainability. By mitigating climate change impacts through carbon sequestration and water cycling, RA offers dual benefits for human and planetary health and well-being. Emphasizing the pivotal role of diet and agricultural practices in combating NCDs and addressing environmental concerns, the adoption of regional RA systems becomes imperative. Increasing RA integration into local food systems can enhance food quality, availability, and affordability while safeguarding human health and the planet's future.
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Affiliation(s)
- Davendra Ramkumar
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, 506 South Matthews Ave, Urbana, IL 61801, USA
- Illinois Water Resources Center, University of Illinois Urbana Champaign, Natural Resources Building 615 E. Peabody Dr Champaign, IL 61820, USA
| | - Aileen Marty
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Japhia Ramkumar
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, 506 South Matthews Ave, Urbana, IL 61801, USA
- Illinois Water Resources Center, University of Illinois Urbana Champaign, Natural Resources Building 615 E. Peabody Dr Champaign, IL 61820, USA
| | - Holly Rosencranz
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, 506 South Matthews Ave, Urbana, IL 61801, USA
- Illinois Water Resources Center, University of Illinois Urbana Champaign, Natural Resources Building 615 E. Peabody Dr Champaign, IL 61820, USA
| | - Radhika Vedantham
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, 506 South Matthews Ave, Urbana, IL 61801, USA
- Illinois Water Resources Center, University of Illinois Urbana Champaign, Natural Resources Building 615 E. Peabody Dr Champaign, IL 61820, USA
| | - Modan Goldman
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, 506 South Matthews Ave, Urbana, IL 61801, USA
- Illinois Water Resources Center, University of Illinois Urbana Champaign, Natural Resources Building 615 E. Peabody Dr Champaign, IL 61820, USA
| | - Erin Meyer
- Basil's Harvest, 227 W Monroe St, Suite 2100, Chicago, IL 60606, USA
| | - Jasia Steinmetz
- University of Wisconsin – Stevens Point 202 College of Professional Studies, Stevens Point, WI 54481-3897, USA
| | - Amy Weckle
- Illinois Water Resources Center, University of Illinois Urbana Champaign, Natural Resources Building 615 E. Peabody Dr Champaign, IL 61820, USA
| | - Kelly Bloedorn
- Basil's Harvest, 227 W Monroe St, Suite 2100, Chicago, IL 60606, USA
| | - Carl Rosier
- Basil's Harvest, 227 W Monroe St, Suite 2100, Chicago, IL 60606, USA
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10
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Gordon BA, Azer L, Bennett K, Edelman LS, Long M, Goroncy A, Alexander C, Lee JA, Rosich R, Severance JJ. Agents of Change: Geriatrics Workforce Programs Addressing Systemic Racism and Health Equity. THE GERONTOLOGIST 2024; 64:gnae038. [PMID: 38666608 DOI: 10.1093/geront/gnae038] [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: 09/16/2023] [Indexed: 05/22/2024] Open
Abstract
Many factors affect how individuals and populations age, including race, ethnicity, and diversity, which can contribute to increased disease risk, less access to quality healthcare, and increased morbidity and mortality. Systemic racism-a set of institutional policies and practices within a society or organization that perpetuate racial inequalities and discrimination-contributes to health inequities of vulnerable populations, particularly older adults. The National Association for Geriatrics Education (NAGE) recognizes the need to address and eliminate racial disparities in healthcare access and outcomes for older adults who are marginalized due to the intersection of race and age. In this paper, we discuss an anti-racist framework that can be used to identify where an organization is on a continuum to becoming anti-racist and to address organizational change. Examples of NAGE member Geriatric Workforce Enhancement Programs (GWEPs) and Geriatrics Academic Career Awards (GACAs) activities to become anti-racist are provided to illustrate the framework and to guide other workforce development programs and healthcare institutions as they embark on the continuum to become anti-racist and improve the care and health of vulnerable older adults.
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Affiliation(s)
- Barbara A Gordon
- University of Louisville Trager Institute Optimal Aging Clinic, University of Louisville, Louisville, Kentucky, USA
| | - Lilian Azer
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, California, USA
| | - Katherine Bennett
- Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, Washington, USA
| | - Linda S Edelman
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Monica Long
- Department of Geriatrics & Palliative Medicine, Share Network, University of Chicago Medicine, Chicago, Illinois, USA
| | - Anna Goroncy
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles Alexander
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jung-Ah Lee
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
| | - Rosellen Rosich
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Jennifer J Severance
- Department of Internal Medicine and Geriatrics, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
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11
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Roux J, Faisant M, François D, Retel O, Le Tertre A. Age at death during the Covid-19 lockdown in French metropolitan regions: a non parametric quantile regression approach. BMC Public Health 2024; 24:1251. [PMID: 38714971 PMCID: PMC11075327 DOI: 10.1186/s12889-024-18699-0] [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: 09/21/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Lockdowns have been implemented to limit the number of hospitalisations and deaths during the first wave of 2019 coronavirus disease. These measures may have affected differently death characteristics, such age and sex. France was one of the hardest hit countries in Europe with a decreasing east-west gradient in excess mortality. This study aimed at describing the evolution of age at death quantiles during the lockdown in spring 2020 (17 March-11 May 2020) in the French metropolitan regions focusing on 3 representatives of the epidemic variations in the country: Bretagne, Ile-de-France (IDF) and Bourgogne-Franche-Comté (BFC). METHODS Data were extracted from the French public mortality database from 1 January 2011 to 31 August 2020. The age distribution of mortality observed during the lockdown period (based on each decile, plus quantiles 1, 5, 95 and 99) was compared with the expected one using Bayesian non-parametric quantile regression. RESULTS During the lockdown, 5457, 5917 and 22 346 deaths were reported in Bretagne, BFC and IDF, respectively. An excess mortality from + 3% in Bretagne to + 102% in IDF was observed during lockdown compared to the 3 previous years. Lockdown led to an important increase in the first quantiles of age at death, irrespective of the region, while the increase was more gradual for older age groups. It corresponded to fewer young people, mainly males, dying during the lockdown, with an increase in the age at death in the first quantile of about 7 years across regions. In females, a less significant shift in the first quantiles and a greater heterogeneity between regions were shown. A greater shift was observed in eastern region and IDF, which may also represent excess mortality among the elderly. CONCLUSIONS This study focused on the innovative outcome of the age distribution at death. It shows the first quantiles of age at death increased differentially according to sex during the lockdown period, overall shift seems to depend on prior epidemic intensity before lockdown and complements studies on excess mortality during lockdowns.
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Affiliation(s)
- Jonathan Roux
- Santé Publique France (SpF), Cellule Régionale Bretagne, Direction Des Régions 6 Place Des Colombes, Rennes Cedex, 35042, France
| | - Marlène Faisant
- Santé Publique France (SpF), Cellule Régionale Bretagne, Direction Des Régions 6 Place Des Colombes, Rennes Cedex, 35042, France
| | - Diane François
- Santé Publique France (SpF), Cellule Régionale Bourgogne-Franche-Comté, Direction Des Régions, 21035, Dijon, France
| | - Olivier Retel
- Santé Publique France (SpF), Cellule Régionale Bourgogne-Franche-Comté, Direction Des Régions, 21035, Dijon, France
| | - Alain Le Tertre
- Santé Publique France (SpF), Cellule Régionale Bretagne, Direction Des Régions 6 Place Des Colombes, Rennes Cedex, 35042, France.
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12
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Guadamuz JS. Sociodemographic inequities in COVID-19 vaccination among adults in the United States, 2022. J Am Pharm Assoc (2003) 2024; 64:102064. [PMID: 38432482 DOI: 10.1016/j.japh.2024.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Despite the availability of COVID-19 vaccines since December 2020, sociodemographic inequities in vaccination and preventable COVID-related deaths persist. To inform efforts for equitable COVID-19 vaccination campaigns, a comprehensive national evaluation of existing inequities is necessary. OBJECTIVE To examine sociodemographic inequities in COVID-19 vaccination receipt using data from the 2022 National Health Interview Survey (NHIS). METHODS This secondary data analysis used cross-sectional nationally-representative data from the 2022 NHIS to assess vaccination inequities among 27,126 adults. Separate Poisson regressions adjusted for clinical factors (e.g., age, sex, high-risk health conditions) were used to evaluate vaccination inequities across sociographic factors (e.g., race/ethnicity, poverty, health insurance). RESULTS In 2022, 79.6% of adults received at ≥ 1 vaccine dose, 75.0% received ≥ 2 doses ("fully vaccinated"), 45.7% received ≥ 3 doses (≥ 1 booster), and 17.2% received ≥ 4 doses (≥ 2 boosters). Marked inequities were evident in COVID-19 vaccination across primary and booster doses, especially receipt of at least 1 booster dose (≥ 3 doses). Black (35.7%, prevalence ratio [PR] 0.78 [95% CI 0.74-0.83]) and Latinx (35.5%, PR 0.82 [CI 0.78-0.86]) adults were less likely to receive ≥ 3 doses than Asian (66.5%, PR 1.41 [CI 1.35-1.48]) and White (48.8%) adults. Poverty (31.1% [PR 0.65 {CI 0.61-0.69}] vs. 50.7%) and food insecurity (27.1% [PR 0.63 {CI 0.58-0.68}] vs. 47.3%) were negatively associated with receipt of ≥ 3 vaccine doses. Adults without usual source of care (24.9%, PR 0.61 [CI 0.57-0.65]) or health insurance (17.4%, PR 0.40 [CI 0.36-0.45]) had much lower rates of ≥ 3 doses than those with appropriate health care access (48.7% and 51.9%, respectively). CONCLUSION As of 2022, 1-in-5 U.S. adults remain unvaccinated, and more than half have not received any recommended booster doses. Economically/socially marginalized populations-including Black and Latinx adults and those with structural barriers such as poverty, food insecurity, and poor health care access-were less likely to receive a booster. Addressing these vaccination inequities is crucial to achieve equitable COVID-19 protection and reduce preventable deaths among economically/socially marginalized populations.
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13
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Shkolnikov VM, Jdanov DA, Majeed A, Islam N. Making sense of national and international disparities in excess mortality from the COVID-19 pandemic. BMJ Glob Health 2024; 9:e015737. [PMID: 38637122 PMCID: PMC11029358 DOI: 10.1136/bmjgh-2024-015737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
| | - Dmitri A Jdanov
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Nazrul Islam
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of Southampton, Southampton, UK
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14
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Tilstra AM, Polizzi A, Wagner S, Akimova ET. Projecting the long-term effects of the COVID-19 pandemic on U.S. population structure. Nat Commun 2024; 15:2409. [PMID: 38499539 PMCID: PMC10948855 DOI: 10.1038/s41467-024-46582-4] [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: 02/24/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
The immediate, direct effects of the COVID-19 pandemic on the United States population are substantial. Millions of people were affected by the pandemic: many died, others did not give birth, and still others could not migrate. Research that has examined these individual phenomena is important, but fragmented. The disruption of mortality, fertility, and migration jointly affected U.S. population counts and, consequently, future population structure. We use data from the United Nations World Population Prospects and the cohort component projection method to isolate the effect of the pandemic on U.S. population estimates until 2060. If the pandemic had not occurred, we project that the population of the U.S. would have 2.1 million (0.63%) more people in 2025, and 1.7 million (0.44%) more people in 2060. Pandemic-induced migration changes are projected to have a larger long-term effect on future population size than mortality, despite comparable short-term effects.
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Affiliation(s)
- Andrea M Tilstra
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, OX1 1JD, UK.
- Department of Sociology, University of Oxford, Oxford, OX1 1JD, UK.
| | - Antonino Polizzi
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, OX1 1JD, UK
- Department of Sociology, University of Oxford, Oxford, OX1 1JD, UK
| | - Sander Wagner
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, OX1 1JD, UK
| | - Evelina T Akimova
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, OX1 1JD, UK
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15
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Huang G, Guo F, Liu L, Taksa L, Cheng Z, Tani M, Zimmermann KF, Franklin M, Silva SSM. Changing impact of COVID-19 on life expectancy 2019-2023 and its decomposition: Findings from 27 countries. SSM Popul Health 2024; 25:101568. [PMID: 38144442 PMCID: PMC10746558 DOI: 10.1016/j.ssmph.2023.101568] [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: 10/13/2023] [Revised: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Background The World Health Organization declared COVID-19 no longer a global health emergency on 5th May 2023; however, the impact of COVID-19 on life expectancy throughout the pandemic period is not clear. This study aimed to quantify and decompose the changes in life expectancy during 2019-2023 and corresponding age and gender disparities in 27 countries. Methods Data were sourced from the Human Mortality Database, the World Population Prospects 2022 and the United Kingdom's Office for National Statistics. Life expectancy was estimated using the abridged life table method, while differentials of life expectancies were decomposed using the age-decomposition algorithm. Results There was an overall reduction in life expectancy at age 5 among the 27 countries in 2020. Life expectancy rebounded in Western, Northern and Southern Europe in 2021 but further decreased in the United States, Chile and Eastern Europe in the same year. In 2022 and after, lost life expectancy years in the United States, Chile and Eastern Europe were slowly regained; however, as of 7th May 2023, life expectancy in 22 of the 27 countries had not fully recovered to its pre-pandemic level. The reduced life expectancy in 2020 was mainly driven by reduced life expectancy at age 65+, while that in subsequent years was mainly driven by reduced life expectancy at age 45-74. Women experienced a lower reduction in life expectancy at most ages but a greater reduction at age 85+. Conclusions The pandemic has caused substantial short-term mortality variations during 2019-2023 in the 27 countries studied. Although most of the 27 countries experienced increased life expectancy after 2022, life expectancy in 22 countries still has not entirely regained its pre-pandemic level by May 2023. Threats of COVID-19 are more prominent for older adults and men, but special attention is needed for women aged 85+ years.
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Affiliation(s)
- Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Fei Guo
- Department of Management, Macquarie University, Australia
| | - Lihua Liu
- Keck School of Medicine, University of Southern California, USA
| | - Lucy Taksa
- Deakin Business School, Deakin University, Australia
| | - Zhiming Cheng
- Department of Management, Macquarie University, Australia
- Global Labor Organization (GLO), Germany
- Social Policy Research Centre, University of New South Wales, Australia
| | | | | | | | - S. Sandun Malpriya Silva
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
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16
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Bowser DM, Maurico K, Ruscitti BA, Crown WH. American clusters: using machine learning to understand health and health care disparities in the United States. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae017. [PMID: 38756919 PMCID: PMC10986293 DOI: 10.1093/haschl/qxae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 05/18/2024]
Abstract
Health and health care access in the United States are plagued by high inequality. While machine learning (ML) is increasingly used in clinical settings to inform health care delivery decisions and predict health care utilization, using ML as a research tool to understand health care disparities in the United States and how these are connected to health outcomes, access to health care, and health system organization is less common. We utilized over 650 variables from 24 different databases aggregated by the Agency for Healthcare Research and Quality in their Social Determinants of Health (SDOH) database. We used k-means-a non-hierarchical ML clustering method-to cluster county-level data. Principal factor analysis created county-level index values for each SDOH domain and 2 health care domains: health care infrastructure and health care access. Logistic regression classification was used to identify the primary drivers of cluster classification. The most efficient cluster classification consists of 3 distinct clusters in the United States; the cluster having the highest life expectancy comprised only 10% of counties. The most efficient ML clusters do not identify the clusters with the widest health care disparities. ML clustering, using county-level data, shows that health care infrastructure and access are the primary drivers of cluster composition.
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Affiliation(s)
- Diana M Bowser
- Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Kaili Maurico
- Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Brielle A Ruscitti
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, United States
| | - William H Crown
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, United States
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17
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Hajdu T, Krekó J, Tóth CG. Inequalities in regional excess mortality and life expectancy during the COVID-19 pandemic in Europe. Sci Rep 2024; 14:3835. [PMID: 38360870 PMCID: PMC10869827 DOI: 10.1038/s41598-024-54366-5] [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: 06/16/2023] [Accepted: 02/12/2024] [Indexed: 02/17/2024] Open
Abstract
Using data for 201 regions (NUTS 2) in Europe, we examine the mortality burden of the COVID-19 pandemic and how the mortality inequalities between regions changed between 2020 and 2022. We show that over the three years of the pandemic, not only did the level of excess mortality rate change considerably, but also its geographical distribution. Focusing on life expectancy as a summary measure of mortality conditions, we find that the variance of regional life expectancy increased sharply in 2021 but returned to the pre-pandemic level in 2022. The 2021 increase was due to a much higher-than-average excess mortality in regions with lower pre-pandemic life expectancy. While the life expectancy inequality has returned to its pre-pandemic level in 2022, the observed life expectancy in almost all regions is far below that expected without the pandemic.
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Affiliation(s)
- Tamás Hajdu
- HUN-REN Centre for Economic and Regional Studies, Budapest, Hungary
| | - Judit Krekó
- HUN-REN Centre for Economic and Regional Studies, Hungary and Budapest Institute for Policy Analysis, Budapest, Hungary
| | - Csaba G Tóth
- HUN-REN Centre for Economic and Regional Studies, Hungary and Corvinus University of Budapest, Budapest, Hungary.
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18
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Foster TB, Fernandez L, Porter SR, Pharris-Ciurej N. Racial and Ethnic Disparities in Excess All-Cause Mortality in the First Year of the COVID-19 Pandemic. Demography 2024; 61:59-85. [PMID: 38197462 DOI: 10.1215/00703370-11133943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Research on the COVID-19 pandemic in the United States has consistently found disproportionately high mortality among ethnoracial minorities, but reports differ with respect to the magnitude of mortality disparities and reach different conclusions regarding which groups were most impacted. We suggest that these variations stem from differences in the temporal scope of the mortality data used and difficulties inherent in measuring race and ethnicity. To circumvent these issues, we link Social Security Administration death records for 2010 through 2021 to decennial census and American Community Survey race and ethnicity responses. We use these linked data to estimate excess all-cause mortality for age-, sex-, race-, and ethnicity-specific subgroups and examine ethnoracial variation in excess mortality across states and over the course of the pandemic's first year. Results show that non-Hispanic American Indians and Alaska Natives experienced the highest excess mortality of any ethnoracial group in the first year of the pandemic, followed by Hispanics and non-Hispanic Blacks. Spatiotemporal and age-specific ethnoracial disparities suggest that the socioeconomic determinants driving health disparities prior to the pandemic were amplified and expressed in new ways in the pandemic's first year to disproportionately concentrate excess mortality among racial and ethnic minorities.
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19
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Atanasov V, Barreto N, Franchi L, Whittle J, Meurer J, Weston BW, Luo Q(E, Yuan AY, Zhang R, Black B. Evidence on COVID-19 Mortality and Disparities Using a Novel Measure, COVID excess mortality percentage: Evidence from Indiana, Wisconsin, and Illinois. PLoS One 2024; 19:e0295936. [PMID: 38295114 PMCID: PMC10829977 DOI: 10.1371/journal.pone.0295936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
COVID-19 mortality rates increase rapidly with age, are higher among men than women, and vary across racial/ethnic groups, but this is also true for other natural causes of death. Prior research on COVID-19 mortality rates and racial/ethnic disparities in those rates has not considered to what extent disparities reflect COVID-19-specific factors, versus preexisting health differences. This study examines both questions. We study the COVID-19-related increase in mortality risk and racial/ethnic disparities in COVID-19 mortality, and how both vary with age, gender, and time period. We use a novel measure validated in prior work, the COVID Excess Mortality Percentage (CEMP), defined as the COVID-19 mortality rate (Covid-MR), divided by the non-COVID natural mortality rate during the same time period (non-Covid NMR), converted to a percentage. The CEMP denominator uses Non-COVID NMR to adjust COVID-19 mortality risk for underlying population health. The CEMP measure generates insights which differ from those using two common measures-the COVID-MR and the all-cause excess mortality rate. By studying both CEMP and COVID-MRMR, we can separate the effects of background health from Covid-specific factors affecting COVID-19 mortality. We study how CEMP and COVID-MR vary by age, gender, race/ethnicity, and time period, using data on all adult decedents from natural causes in Indiana and Wisconsin over April 2020-June 2022 and Illinois over April 2020-December 2021. CEMP levels for racial and ethnic minority groups can be very high relative to White levels, especially for Hispanics in 2020 and the first-half of 2021. For example, during 2020, CEMP for Hispanics aged 18-59 was 68.9% versus 7.2% for non-Hispanic Whites; a ratio of 9.57:1. CEMP disparities are substantial but less extreme for other demographic groups. Disparities were generally lower after age 60 and declined over our sample period. Differences in socio-economic status and education explain only a small part of these disparities.
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Affiliation(s)
- Vladimir Atanasov
- William & Mary, Mason School of Business, Williamsburg, Virginia, United States of America
| | - Natalia Barreto
- University of Illinois, Champaign-Urbana, Illinois, United States of America
| | - Lorenzo Franchi
- Northwestern University, Evanston, Illinois, United States of America
| | - Jeff Whittle
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - John Meurer
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Benjamin W. Weston
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Qian (Eric) Luo
- George Washington University, Washington, DC, United States of America
| | - Andy Ye Yuan
- Northwestern University, Pritzker School of Law, Evanston, Illinois, United States of America
| | - Ruohao Zhang
- Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Bernard Black
- Northwestern University, Pritzker School of Law and Kellogg School of Management, Evanston, Illinois, United States of America
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20
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Donnelly R, Remani B, Erving CL. Dual pandemics? Assessing associations between area racism, COVID-19 case rates, and mental health among U.S. adults. SSM - MENTAL HEALTH 2023; 4:100248. [PMID: 38125912 PMCID: PMC10732532 DOI: 10.1016/j.ssmmh.2023.100248] [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] [Indexed: 12/23/2023] Open
Abstract
Mental health worsened during the COVID-19 pandemic, especially among racially minoritized adults. Population-level racial attitudes, or area racism, may be associated with mental health, particularly during this historical moment, but this possibility has not been tested in prior research. In the present study, we use nationally representative data from the Household Pulse Survey (April-October 2020) to document associations between area racism and depression/anxiety in the United States among non-Hispanic Black, non-Hispanic Asian, Hispanic, non-Hispanic White, and other racial/ethnic minority adults. We further consider the national COVID-19 case rate to examine an additional macro-level stressor. Findings indicate that area racism was positively associated with depression and/or anxiety for Black, Hispanic, White, and other racial/ethnic minority adults. Moreover, COVID-19 cases posed an additional, independent mental health threat for most groups. This study points to area racism as a macro-level stressor and an antecedent of mental health for racially diverse groups of Americans.
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21
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Yang TC, Kim S, Matthews SA, Shoff C. Social Vulnerability and the Prevalence of Opioid Use Disorder Among Older Medicare Beneficiaries in U.S. Counties. J Gerontol B Psychol Sci Soc Sci 2023; 78:2111-2121. [PMID: 37788567 PMCID: PMC10699735 DOI: 10.1093/geronb/gbad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES Recent research has investigated the factors associated with the prevalence of opioid use disorder (OUD) among older adults (65+), which has rapidly increased in the past decade. However, little is known about the relationship between social vulnerability and the prevalence of OUD, and even less is about whether the correlates of the prevalence of OUD vary across the social vulnerability spectrum. This study aims to fill these gaps. METHODS We assemble a county-level data set in the contiguous United States (U.S.) by merging 2021 Medicare claims with the CDC's social vulnerability index and other covariates. Using the total number of older beneficiaries with OUD as the dependent variable and the total number of older beneficiaries as the offset, we implement a series of nested negative binomial regression models and then analyze by social vulnerability quartiles. RESULTS Higher social vulnerability is associated with higher prevalence of OUD in U.S. counties. This association cannot be fully explained by the differences in the characteristics of older Medicare beneficiaries (e.g., average age) and/or other social conditions (e.g., social capital) across counties. Moreover, the group comparison tests indicate correlates of the prevalence of OUD vary across social vulnerability quartiles in that the average number of mental disorders is positively related to OUD prevalence in the least and the most vulnerable counties and social capital benefits the less vulnerable counties. DISCUSSION A perspective drawing upon contextual factors, especially social vulnerability, may be more effective in reducing OUD among older adults in U.S. counties than a one-size-fits-all approach.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, New York, USA
| | - Seulki Kim
- Department of Sociology, University of Nebraska—Lincoln, Lincoln, Nebraska, USA
| | - Stephen A Matthews
- Departments of Sociology and Criminology, and Anthropology, The Pennsylvania State University, University Park, Pennsylvania, USA
- Population Research Institute, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Carla Shoff
- Independent Consultant, Baltimore, Maryland, USA
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22
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Cheng TL. The Impact of Violence on Child and Adolescent Health. Pediatr Clin North Am 2023; 70:xv-xvi. [PMID: 37865443 DOI: 10.1016/j.pcl.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Affiliation(s)
- Tina L Cheng
- Director, Cincinnati Children's Research Foundation, Chief Medical Officer, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 3016, Cincinnati, OH 45229-3026, USA.
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23
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Erler KS, Robinson EM, Bandini JI, Regel EV, Zwirner M, Cremens C, McCoy TH, Romain F, Courtwright A. Clinical Ethics Consultation During the First COVID-19 Pandemic Surge at an Academic Medical Center: A Mixed Methods Analysis. HEC Forum 2023; 35:371-388. [PMID: 35290566 PMCID: PMC8922390 DOI: 10.1007/s10730-022-09474-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters.
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Affiliation(s)
- Kimberly S Erler
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- School of Health and Rehabilitation Science, MGH Institute of Health Professions, Boston, MA, USA.
| | - Ellen M Robinson
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Patient Care Services Office of Quality, Safety and Practice, Boston, MA, USA
| | - Julia I Bandini
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- RAND Corporation, Boston, MA, USA
| | - Eva V Regel
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Mary Zwirner
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Cornelia Cremens
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas H McCoy
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Fred Romain
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Respiratory Care, Mass General Hospital, Boston, MA, USA
| | - Andrew Courtwright
- Optimum Care Committee, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Pulmonary and Critical Care Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA
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Park SS, Goldman N, Beltrán-Sánchez H, Andrasfay T. The impact of COVID-19 on life expectancy among four Asian American subgroups. SSM Popul Health 2023; 24:101480. [PMID: 37692836 PMCID: PMC10485147 DOI: 10.1016/j.ssmph.2023.101480] [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: 03/13/2023] [Revised: 05/11/2023] [Accepted: 07/30/2023] [Indexed: 09/12/2023] Open
Abstract
Background and objective To date, the impact of the COVID-19 pandemic on life expectancy for the Asian American (AA) population has been reported in aggregate. This study provides estimates of life expectancy at birth before and during the pandemic, with a set of demographic, health, and socioeconomic risk factors for the four largest subgroups: Asian Indians, Chinese, Filipinos, and Vietnamese. These estimates are placed in context of the broader U.S. population. Methods This study uses age-specific all-cause mortality from CDC WONDER and population counts from the American Community Surveys. We apply methodologies to address variability in population sizes over time (smoothing) and data quality issues at older ages (Brass relational model life table system) to produce three sets of sex-specific life expectancy estimates by subgroup for 2019, 2020, and 2021. Results Almost all estimates show that the four AA subgroups experienced greater losses between 2019 and 2020 than Whites. These losses ranged from 1.1 to 3.9 years, with the largest drops among Chinese women (2.0-2.4) and Filipino men (3.5-3.9). Under all scenarios, losses in life expectancy were considerably smaller in 2021 than in 2020 among the four subgroups - with several subgroups experiencing a modest rebound - but these improvements did not compensate for the large increases in death rates in 2020. Filipino men had the largest decline in life expectancy from 2019 to 2021 among the four subgroups (3.4-4.2 years), and Vietnamese men and women experienced large losses which continued into the second year of the pandemic. Conclusions Despite high pre-pandemic life expectancies, AAs suffered a large, and rarely acknowledged, increase in mortality during the pandemic, with substantial heterogeneity across subgroups and between women and men. This variability is due in part to the pronounced differences in risk factors for infection and severity which have been documented within the AA population.
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Affiliation(s)
- Sung S. Park
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, 02125, USA
| | - Noreen Goldman
- Office of Population Research and Princeton School of Public and International Affairs, Princeton University, Princeton, NJ, 08544, USA
| | - Hiram Beltrán-Sánchez
- Fielding School of Public Health and California Center for Population Research, University of California Los Angeles (UCLA), Los Angeles, CA, 90095, USA
| | - Theresa Andrasfay
- Department of Public Health, California State University San Marcos, San Marcos, CA, 92096, USA
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25
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Freeberg KA, Ludwig KR, Chonchol M, Seals DR, Rossman MJ. NAD +-boosting compounds enhance nitric oxide production and prevent oxidative stress in endothelial cells exposed to plasma from patients with COVID-19. Nitric Oxide 2023; 140-141:1-7. [PMID: 37657532 PMCID: PMC10840929 DOI: 10.1016/j.niox.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/03/2023]
Abstract
SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), induces vascular endothelial dysfunction, but the mechanisms are unknown. We tested the hypothesis that the "circulating milieu" (plasma) of patients with COVID-19 would cause endothelial cell dysfunction (characterized by lower nitric oxide (NO) production), which would be linked to greater reactive oxygen species (ROS) bioactivity and depletion of the critical metabolic co-substrate, nicotinamide adenine dinucleotide (NAD+). We also investigated if treatment with NAD+-boosting compounds would prevent COVID-19-induced reductions in endothelial cell NO bioavailability and oxidative stress. Human aortic endothelial cells (HAECs) were exposed to plasma from men and women (age 18-85 years) who were hospitalized and tested positive (n = 34; 20 M) or negative (n = 13; 10 M) for COVID-19. HAECs exposed to plasma from patients with COVID-19 also were co-incubated with NAD+ precursors nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN). Acetylcholine-stimulated NO production was 27% lower and ROS bioactivity was 54% higher in HAECs exposed to plasma from patients with COVID-19 (both p < 0.001 vs. control); these responses were independent of age and sex. NAD+ concentrations were 30% lower in HAECs exposed to plasma from patients with COVID-19 (p = 0.001 vs. control). Co-incubation with NR abolished COVID-19-induced reductions in NO production and oxidative stress (both p > 0.05 vs. control). Co-treatment with NMN produced similar results. Our findings suggest the circulating milieu of patients with COVID-19 promotes endothelial cell dysfunction, characterized by lower NO bioavailability, greater ROS bioactivity, and NAD+ depletion. Supplementation with NAD+ precursors may exert a protective effect against COVID-19-evoked endothelial cell dysfunction and oxidative stress.
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Affiliation(s)
- Kaitlin A Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, 80309, USA
| | - Katelyn R Ludwig
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, 80309, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, 80309, USA
| | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, 80309, USA.
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González-Leonardo M, Spijker J. The impact of Covid-19 on demographic components in Spain, 2020-31: A scenario approach. POPULATION STUDIES 2023; 77:497-513. [PMID: 36377742 DOI: 10.1080/00324728.2022.2138521] [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: 09/15/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022]
Abstract
While considerable attention has been paid to the impact of Covid-19 on mortality and fertility, few studies have attempted to evaluate the pandemic's effect on international migration. We analyse the impact of Covid-19 on births, deaths, and international migration in Spain during 2020, comparing observed data with estimated values assuming there had been no pandemic. We also assess the consequences of three post-pandemic scenarios on the size and structure of the population to 2031. Results show that in 2020, excess mortality equalled 16.2 per cent and births were 6.5 per cent lower than expected. Immigration was the most affected component, at 36.0 per cent lower than expected, while emigration was reduced by 23.8 per cent. If net migration values recover to pre-pandemic levels in 2022, the size and structure of the population in 2031 will be barely affected. Conversely, if levels do not recover until 2025, there will be important changes to Spain's age structure.
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27
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Nguyen QD, Chang SL, Jamerlan CM, Prokopenko M. Measuring unequal distribution of pandemic severity across census years, variants of concern and interventions. Popul Health Metr 2023; 21:17. [PMID: 37899455 PMCID: PMC10613397 DOI: 10.1186/s12963-023-00318-6] [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: 06/27/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic stressed public health systems worldwide due to emergence of several highly transmissible variants of concern. Diverse and complex intervention policies deployed over the last years have shown varied effectiveness in controlling the pandemic. However, a systematic analysis and modelling of the combined effects of different viral lineages and complex intervention policies remains a challenge due to the lack of suitable measures of pandemic inequality and nonlinear effects. METHODS Using large-scale agent-based modelling and a high-resolution computational simulation matching census-based demographics of Australia, we carried out a systematic comparative analysis of several COVID-19 pandemic scenarios. The scenarios covered two most recent Australian census years (2016 and 2021), three variants of concern (ancestral, Delta and Omicron), and five representative intervention policies. We introduced pandemic Lorenz curves measuring an unequal distribution of the pandemic severity across local areas. We also quantified pandemic biomodality, distinguishing between urban and regional waves, and measured bifurcations in the effectiveness of interventions. RESULTS We quantified nonlinear effects of population heterogeneity on the pandemic severity, highlighting that (i) the population growth amplifies pandemic peaks, (ii) the changes in population size amplify the peak incidence more than the changes in density, and (iii) the pandemic severity is distributed unequally across local areas. We also examined and delineated the effects of urbanisation on the incidence bimodality, distinguishing between urban and regional pandemic waves. Finally, we quantified and examined the impact of school closures, complemented by partial interventions, and identified the conditions when inclusion of school closures may decisively control the transmission. CONCLUSIONS Public health response to long-lasting pandemics must be frequently reviewed and adapted to demographic changes. To control recurrent waves, mass-vaccination rollouts need to be complemented by partial NPIs. Healthcare and vaccination resources need to be prioritised towards the localities and regions with high population growth and/or high density.
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Affiliation(s)
- Quang Dang Nguyen
- Centre for Complex Systems, Faculty of Engineering, The University of Sydney, Camperdown, NSW, Australia
| | - Sheryl L Chang
- Centre for Complex Systems, Faculty of Engineering, The University of Sydney, Camperdown, NSW, Australia.
- Sydney Institute for Infectious Diseases, The University of Sydney, Westmead, NSW, Australia.
| | - Christina M Jamerlan
- Centre for Complex Systems, Faculty of Engineering, The University of Sydney, Camperdown, NSW, Australia
| | - Mikhail Prokopenko
- Centre for Complex Systems, Faculty of Engineering, The University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Westmead, NSW, Australia
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Clark KM, Ray TR. Recent Advances in Skin-Interfaced Wearable Sweat Sensors: Opportunities for Equitable Personalized Medicine and Global Health Diagnostics. ACS Sens 2023; 8:3606-3622. [PMID: 37747817 PMCID: PMC11211071 DOI: 10.1021/acssensors.3c01512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Recent advances in skin-interfaced wearable sweat sensors enable the noninvasive, real-time monitoring of biochemical signals associated with health and wellness. These wearable platforms leverage microfluidic channels, biochemical sensors, and flexible electronics to enable the continuous analysis of sweat-based biomarkers such as electrolytes, metabolites, and hormones. As this field continues to mature, the potential of low-cost, continuous personalized health monitoring enabled by such wearable sensors holds significant promise for addressing some of the formidable obstacles to delivering comprehensive medical care in under-resourced settings. This Perspective highlights the transformative potential of wearable sweat sensing for providing equitable access to cutting-edge healthcare diagnostics, especially in remote or geographically isolated areas. It examines the current understanding of sweat composition as well as recent innovations in microfluidic device architectures and sensing strategies by showcasing emerging applications and opportunities for innovation. It concludes with a discussion on expanding the utility of wearable sweat sensors for clinically relevant health applications and opportunities for enabling equitable access to innovation to address existing health disparities.
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Affiliation(s)
- Kaylee M. Clark
- Department of Mechanical Engineering, University of Hawai’i at Mãnoa, Honolulu, HI 96822, USA
| | - Tyler R. Ray
- Department of Mechanical Engineering, University of Hawai’i at Mãnoa, Honolulu, HI 96822, USA
- Department of Cell and Molecular Biology, John. A. Burns School of Medicine, University of Hawai’i at Mãnoa, Honolulu, HI 96813, USA
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29
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Cao G, Liu J, Liu M, Liang W. Effects of the COVID-19 pandemic on life expectancy at birth at the global, regional, and national levels: A joinpoint time-series analysis. J Glob Health 2023; 13:06042. [PMID: 37862617 PMCID: PMC10588978 DOI: 10.7189/jogh.13.06042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Background Current estimates indicate that coronavirus disease 2019 (COVID-19) caused 14.9 million excess deaths in 2020 and 2021. Thus, estimating the change in life expectancy at birth due to the COVID-19 pandemic could aid in understanding its impact and implementing public health initiatives. Methods We collected data on the life expectancy at birth of the combined population between 1990 and 2021 at the global, regional, and national levels from the 2022 Revision of World Population Prospects. In this time series study, we estimated the trend segments, the change of trend years (joinpoints), the annual percentage change (APC) in life expectancy at birth within each trend segment, and the average APC (AAPC) in life expectancy at birth during the full study period using joinpoint regression analysis. Results The global life expectancy at birth decreased from 72.8 years in 2019 to 71.0 years in 2021, with an annual decrease of 1.2% (95% confidence interval (CI) = 1.0, 1.5) during the 2019-2021 period, despite an overall increasing trend during the entire period from 1990 to 2021 (AAPC = 0.3%; 95% CI = 0.3, 0.4). We observed a significantly increasing trend in life expectancy at birth in all regions and nearly 87.7% (207/236) of the world's countries and areas during the entire period (1990-2021). All continental regions except Africa and Oceania experienced a significant decreasing trend in life expectancy at birth in 2019-2021, with an APC of -1.2% (95% CI = -1.5, -0.9) for Asia, -2.1% (95% CI = -2.7, -1.6) for Latin America and the Caribbean, -1.1% (95% CI = -1.6, -0.6) for Northern America, and -1.4% (95% CI = -1.9, -0.9) for Europe. Among all countries and areas, 107 countries and areas (45.3%) experienced a significant decreasing trend in life expectancy at birth in the most recent time segment, with 77 countries and areas (32.6%) experiencing a significant decreasing trend during the 2019-2021 period. Conclusions The world experienced a significant decreasing trend in life expectancy at birth in 2019-2021, with a decrease of 1.8 years; all continental regions except Africa and Oceania and 77 countries and areas experienced a significant decreasing trend in life expectancy at birth. These decreasing trends at global, regional, and national levels during the 2019-2021 period reflected the COVID-19 pandemic's direct and indirect adverse effects on life expectancy at birth.
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Affiliation(s)
- Guiying Cao
- School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Beijing, China
| | - Min Liu
- School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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30
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Sanderson WC, Scherbov S. The effect of the COVID-19 pandemic on life expectancy in the USA: An application of hybrid life expectancy. Biol Methods Protoc 2023; 8:bpad025. [PMID: 37929068 PMCID: PMC10621591 DOI: 10.1093/biomethods/bpad025] [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: 08/21/2023] [Revised: 10/07/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023] Open
Abstract
Pandemics are, by definition, temporary intervals of substantially increased mortality rates experienced across a wide geographic area. One way of assessing the magnitude of the COVID-19 pandemic in the USA has been to compute the differences in life expectancy at birth during a pandemic year and the year before the pandemic. Such comparisons are misleading because they do not account for the duration of the pandemic. The computation of life expectancy in 2019 assumes that people spend their entire lives experiencing prepandemic mortality rates. The computation of life expectancy in 2021 assumes that people live their entire lives in a permanent pandemic. However, people do not live their entire lives experiencing the elevated mortality rates of 2021. This article introduces a method for calculating life expectancy that reflects the experience of people enduring pandemic-level mortality rates for fixed durations. We call the new quantity hybrid life expectancy because it integrates both pandemic and prepandemic mortality rates. The difference in life expectancy at birth in the USA in 2019 with and without a 3-year-long pandemic is 0.01 years. This is because mortality rates at ages 0, 1, and 2 in the pandemic were essentially unchanged from their prepandemic levels. Life expectancy at age 65 incorporating a 3-year pandemic is 0.18 years lower than life expectancy would have been without it. Reductions in life expectancy due to the COVID-19 pandemic using hybrid life expectancy are dramatically lower than differences in life expectancy that do not take the duration of the pandemic into account.
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Affiliation(s)
- Warren C Sanderson
- Department of Economics, Stony Brook University; Stony Brook, NY 11794, United States
- Center of Demographic Research, Baruch College, New York, NY 10010, United States
- Population and Just Societies Program, International Institute for Applied Systems Analysis, Laxenburg A-2361, Austria
| | - Sergei Scherbov
- Population and Just Societies Program, International Institute for Applied Systems Analysis, Laxenburg A-2361, Austria
- College of Population Studies, Chulalongkorn University, Bangkok 10330, Thailand
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31
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Holleyman RJ, Barnard S, Bauer-Staeb C, Hughes A, Dunn S, Fox S, Newton JN, Fitzpatrick J, Waller Z, Deehan DJ, Charlett A, Gregson CL, Wilson R, Fryers P, Goldblatt P, Burton P. Adjusting expected deaths for mortality displacement during the COVID-19 pandemic: a model based counterfactual approach at the level of individuals. BMC Med Res Methodol 2023; 23:241. [PMID: 37853353 PMCID: PMC10585864 DOI: 10.1186/s12874-023-01984-8] [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: 06/28/2022] [Accepted: 06/23/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Near-real time surveillance of excess mortality has been an essential tool during the COVID-19 pandemic. It remains critical for monitoring mortality as the pandemic wanes, to detect fluctuations in the death rate associated both with the longer-term impact of the pandemic (e.g. infection, containment measures and reduced service provision by the health and other systems) and the responses that followed (e.g. curtailment of containment measures, vaccination and the response of health and other systems to backlogs). Following the relaxing of social distancing regimes and reduction in the availability of testing, across many countries, it becomes critical to measure the impact of COVID-19 infection. However, prolonged periods of mortality in excess of the expected across entire populations has raised doubts over the validity of using unadjusted historic estimates of mortality to calculate the expected numbers of deaths that form the baseline for computing numbers of excess deaths because many individuals died earlier than they would otherwise have done: i.e. their mortality was displaced earlier in time to occur during the pandemic rather than when historic rates predicted. This is also often termed "harvesting" in the literature. METHODS We present a novel Cox-regression-based methodology using time-dependent covariates to estimate the profile of the increased risk of death across time in individuals who contracted COVID-19 among a population of hip fracture patients in England (N = 98,365). We use these hazards to simulate a distribution of survival times, in the presence of a COVID-19 positive test, and then calculate survival times based on hazard rates without a positive test and use the difference between the medians of these distributions to estimate the number of days a death has been displaced. This methodology is applied at the individual level, rather than the population level to provide a better understanding of the impact of a positive COVID-19 test on the mortality of groups with different vulnerabilities conferred by sociodemographic and health characteristics. Finally, we apply the mortality displacement estimates to adjust estimates of excess mortality using a "ball and urn" model. RESULTS Among the exemplar population we present an end-to-end application of our methodology to estimate the extent of mortality displacement. A greater proportion of older, male and frailer individuals were subject to significant displacement while the magnitude of displacement was higher in younger females and in individuals with lower frailty: groups who, in the absence of COVID-19, should have had a substantial life expectancy. CONCLUSION Our results indicate that calculating the expected number of deaths following the first wave of the pandemic in England based solely on historical trends results in an overestimate, and excess mortality will therefore be underestimated. Our findings, using this exemplar dataset are conditional on having experienced a hip fracture, which is not generalisable to the general population. Fractures that impede mobility in the weeks that follow the accident/surgery considerably shorten life expectancy and are in themselves markers of significant frailty. It is therefore important to apply these novel methods to the general population, among whom we anticipate strong patterns in mortality displacement - both in its length and prevalence - by age, sex, frailty and types of comorbidities. This counterfactual method may also be used to investigate a wider range of disruptive population health events. This has important implications for public health monitoring and the interpretation of public health data in England and globally.
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Affiliation(s)
- Richard James Holleyman
- UK Health Security Agency, Wellington House; 133-155 Waterloo Road, London, SE1 8UG, UK.
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK.
| | - Sharmani Barnard
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Clarissa Bauer-Staeb
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Andrew Hughes
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Samantha Dunn
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Sebastian Fox
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - John N Newton
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Justine Fitzpatrick
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Zachary Waller
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - David John Deehan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
| | - Andre Charlett
- UK Health Security Agency, Wellington House; 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU, UK
| | - Rebecca Wilson
- Department of Public Health, Policy and Systems, University of Liverpool Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL, UK
| | - Paul Fryers
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Peter Goldblatt
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
- Department of Epidemiology & Public Health, UCL Institute of Health Equity, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Paul Burton
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
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Lundberg CE, Santosa A, Björk J, Brandén M, Cronie O, Lindgren M, Edqvist J, Åberg M, Adiels M, Rosengren A. Age and sex differences in cause-specific excess mortality and years of life lost associated with COVID-19 infection in the Swedish population. Eur J Public Health 2023; 33:916-922. [PMID: 37263601 PMCID: PMC10567253 DOI: 10.1093/eurpub/ckad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic. METHODS In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017-19 in the whole Swedish population. RESULTS COVID-19 deaths contributed 9.9% of total deaths (98 441 deaths, 960 305 YLL) in 2020, accounting for 75 151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19 141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65-110 years and women aged 75-110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020. CONCLUSIONS Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.
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Affiliation(s)
- Christina E Lundberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Maria Brandén
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
- Institute for Analytical Sociology, Linköping University, Norrköping, Sweden
| | - Ottmar Cronie
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Jon Edqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Martin Adiels
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Region Västra Götaland, Gothenburg, Sweden
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Parenteau AM, Boyer CJ, Campos LJ, Carranza AF, Deer LK, Hartman DT, Bidwell JT, Hostinar CE. A review of mental health disparities during COVID-19: Evidence, mechanisms, and policy recommendations for promoting societal resilience. Dev Psychopathol 2023; 35:1821-1842. [PMID: 36097815 PMCID: PMC10008755 DOI: 10.1017/s0954579422000499] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Social and economic inequality are chronic stressors that continually erode the mental and physical health of marginalized groups, undermining overall societal resilience. In this comprehensive review, we synthesize evidence of greater increases in mental health symptoms during the COVID-19 pandemic among socially or economically marginalized groups in the United States, including (a) people who are low income or experiencing homelessness, (b) racial and ethnic minorities, (c) women and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) communities, (d) immigrants and migrants, (e) children and people with a history of childhood adversity, and (f) the socially isolated and lonely. Based on this evidence, we propose that reducing social and economic inequality would promote population mental health and societal resilience to future crises. Specifically, we propose concrete, actionable recommendations for policy, intervention, and practice that would bolster five "pillars" of societal resilience: (1) economic safety and equity, (2) accessible healthcare, including mental health services, (3) combating racial injustice and promoting respect for diversity, equity, and inclusion, (4) child and family protection services, and (5) social cohesion. Although the recent pandemic exposed and accentuated steep inequalities within our society, efforts to rebuild offer the opportunity to re-envision societal resilience and policy to reduce multiple forms of inequality for our collective benefit.
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Affiliation(s)
- Anna M. Parenteau
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
| | - Chase J. Boyer
- Department of Human Ecology, University of California-Davis
| | | | | | - LillyBelle K. Deer
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
| | | | - Julie T. Bidwell
- Betty Irene Moore School of Nursing, University of California-Davis
| | - Camelia E. Hostinar
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
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Oweidat KA, Toubasi AA, Alghrabli A, Khater Y, Saleh N, Albtoosh AS, Batarseh RS. Alterations in Patients' Clinical Outcomes and Respiratory Viral Pathogen Activity following the COVID-19 Pandemic. Viruses 2023; 15:1975. [PMID: 37896754 PMCID: PMC10611370 DOI: 10.3390/v15101975] [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: 07/18/2023] [Revised: 08/25/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Before the COVID-19 pandemic, respiratory pathogens such as influenza, parainfluenza, and respiratory syncytial virus were the most commonly detected viruses among hospitalized patients with respiratory tract infections. METHODS This was a retrospective observational study of inpatients and outpatients who attended Jordan University Hospital and underwent Nasopharyngeal Aspiration (NPA) in the periods from December 2017 to December 2018 and from December 2021 to December 2022. The results of multiplex respiratory pathogen real-time PCR tests for nasopharyngeal swab specimens were extracted from the electronic-based molecular diagnostic laboratory record of JUH. We compared the prevalence of the detected viruses as well as the patients' characteristics and outcomes between the two periods. RESULTS The total number of included patients was 695. Our analysis showed that a higher percentage of patients with hypertension and diabetes presented before the pandemic compared to the same period after it (p-value < 0.001). The need for O2 devices, white blood cell counts, diastolic blood pressure, and the length of hospital stay were significantly higher among patients who presented before the pandemic (p-value < 0.050). Influenza H1N1 (8.70% vs. 4.03%), influenza B (1.67% vs. 0.25%), parainfluenza (1.00% vs. 0.00%), human metapneumovirus (5.35% vs. 0.76%), adenoviruses (6.35% vs. 3.02%), and coronaviruses (8.70% vs. 3.53%) were detected with higher frequency in the period before the pandemic (p-value = 0.011, 0.045, 0.045, 0.000, 0.035, 0.004). These results were similar in terms of changes in the detection rates of viruses after matching the number of tested patients between the periods before and after the pandemic. CONCLUSIONS We have demonstrated a reduction in the detection of several viruses, which might be due to the increase in public awareness toward infection protection measures after the COVID-19 pandemic.
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Affiliation(s)
- Khaled Al Oweidat
- Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (K.A.O.); (N.S.); (A.S.A.)
| | - Ahmad A. Toubasi
- Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Ahmad Alghrabli
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (A.A.); (Y.K.)
| | - Yasmeen Khater
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (A.A.); (Y.K.)
| | - Noor Saleh
- Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (K.A.O.); (N.S.); (A.S.A.)
| | - Asma S. Albtoosh
- Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (K.A.O.); (N.S.); (A.S.A.)
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Willis DE, Moore R, Andersen JA, Li J, Selig JP, McKinnon JC, Gurel-Headley M, Reece S, McElfish PA. Correlates of COVID-19 vaccine coverage in Arkansas: Results from a weighted random sample survey. Vaccine 2023; 41:6120-6126. [PMID: 37661536 PMCID: PMC10574122 DOI: 10.1016/j.vaccine.2023.08.075] [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: 02/03/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
We assessed COVID-19 vaccination (≥1 dose) status as influenced by sociodemographic factors (i.e., age, gender, race/ethnicity, education, income, and parent or guardian status), healthcare provider recommendation, and personal vaccine hesitancy among Arkansas residents in October 2022. We asked: did the likelihood of vaccination differ across sociodemographic groups of Arkansas during this period of the pandemic? Is COVID-19 vaccination associated with recommendations from healthcare providers and/or COVID-19 vaccine hesitancy? We analyzed data from a random sample survey of adults in Arkansas (N = 2,201). Three in four adults self-reported vaccination against COVID-19 in October 2022. We found both positive and negative association between COVID-19 vaccination and age, gender, race/ethnicity, education, income, healthcare provider recommendation, and vaccine hesitancy. We highlight racial differences in COVID-19 coverage and the higher odds of COVID-19 vaccination among Black adults compared to White adults in particular, which has broad implications for the study of vaccine coverage and hesitancy. We also discuss implications of our findings regarding healthcare provider recommendations to be vaccinated against COVID-19.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Joshua C McKinnon
- College of Nursing, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Morgan Gurel-Headley
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA.
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Tang C, Camp P. Supporting the Respiratory Health of Migrants and Refugees. Clin Chest Med 2023; 44:605-612. [PMID: 37517838 DOI: 10.1016/j.ccm.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Migrants and refugees are at risk of developing acute and chronic respiratory diseases at their destination countries. Yet, people from these populations are also least likely to access care within the current health care system across the world. Although biological, psychological, and social factors play a role in influencing risk of respiratory diseases among these populations, the influences from cultural differences on health behaviors cannot be ignored. Cultural differences are influential in affecting an individual's level of health literacy. Health professionals can contribute to the provision of equitable care to diverse communities through addressing issues related to linguistic and cultural differences.
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Affiliation(s)
- Clarice Tang
- Physiotherapy, Western Sydney University, Sydney, Australia; Allied Health, South Western Sydney Local Health District, Sydney, Australia.
| | - Pat Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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Malika N, Roberts LR, Casiano CA, Montgomery S. A Health Profile of African Immigrant Men in the United States. J Migr Health 2023; 8:100202. [PMID: 37664414 PMCID: PMC10470375 DOI: 10.1016/j.jmh.2023.100202] [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: 02/18/2021] [Revised: 08/04/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
African immigrants (AI) are the fastest growing group of immigrants to the U.S. however, their health and health practices remains poorly characterized. Thus, this study aimed to describe the health profile of this under-described U.S. population. In order to contextualize their health profiles, we compared AI (n=95) to other U.S. Black populations, namely African Americans (AA, n=271) and Caribbean American (CA, n=203) immigrants. We used cross-sectional survey data from a prostate cancer health study with 569 Black adult male participants, ages 21 years or older. Demographic characteristics were compared using Chi-square tests and prevalence ratios, and prevalence odds ratios (POR) were estimated for AIs compared to AA and CA immigrants using a log-binomial regression model. Results revealed that AI exhibited significantly lower prevalence of asthma and diabetes, when compared to AA and CA immigrants. Furthermore, AI reported lower consumption of alcohol than AA (POR, 0.43, 95%CI 0.24, 0.75) and lower smoking prevalence than AA (POR, 0.19, 95%CI 0.05, 0.70) and CA immigrants (POR, 0.21, 95%CI 0.05, 0.76). Additionally, AI reported significantly lower medical mistrust than CA (POR, 0.51, 95%CI 0.26, 0.95), significantly low financial strain than CAs immigrants (POR, 1.66, 95%CI 1.00, 2.75) and significantly higher levels of religious coping than both AA (POR, 2.43, 95%CI 1.43, 4.12) and CA immigrant men (POR, 1.78, 95%CI 1.03, 3.08). This study further supports emerging evidence that Blacks in the U.S. are not a monolithic group and that it is necessary to assess the Black subgroups separately. In addition, as one of the fastest growing immigrant populations, it is critical for future research to understand African immigrant's health needs and its correlates.
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Affiliation(s)
- Nipher Malika
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, USA
| | - Lisa R. Roberts
- Loma Linda University School of Nursing, 11262 Campus Street, West Hall, Loma Linda, CA 92350 USA
| | - Carlos A. Casiano
- Center for Health Disparities and Molecular Medicine, Departments of Basic Sciences and Medicine, Loma Linda University School of Medicine, Mortensen Hall, 11085 Campus Street, Loma Linda, CA 92350 USA
| | - Susanne Montgomery
- Loma Linda University, School of Behavioral Health, 11065 Campus St., Loma Linda, CA 92350 USA
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Jo Y, Kim SB, Jung J. A Model-Based Cost-Effectiveness Analysis of Long-Acting Monoclonal Antibody (Tixagevimab and Cilgavimab: Evusheld) Preventive Treatment for High-Risk Populations Against SARS-CoV-2 in Korea. J Korean Med Sci 2023; 38:e250. [PMID: 37582500 PMCID: PMC10427216 DOI: 10.3346/jkms.2023.38.e250] [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: 11/14/2022] [Accepted: 04/07/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Tixagevimab and cilgavimab (Evusheld) administration is a recommended strategy for unvaccinated patients with immunocompromised conditions and severe allergic reaction conditions to protect high-risk individuals and control the coronavirus disease 2019 (COVID-19) epidemic. We estimated the cost-effectiveness of Evusheld in key risk populations: 1) immunocompromised (vaccinated/unvaccinated), 2) severe allergic reaction, and 3) unvaccinated elderly high-risk groups. METHODS Based on the estimated target risk group population, we used a model of COVID-19 transmission to estimate the size of the risk group population for whom Evusheld treatment may help prevent symptomatic COVID-19 (and deaths) in 2022. We projected Evusheld intervention costs, quality-adjusted life year (QALY) lost, cost averted and QALY gained by reduced COVID-19 incidence, and incremental cost-effectiveness (cost per QALY gained) in each modeled population from the healthcare system perspective. RESULTS Our study demonstrated that Evusheld treatment for COVID-19 infection in South Korea is highly cost-effective for unvaccinated risk groups ($18,959 per QALY gained for immunocompromised and $23,978 per QALY gained for high-risk elderly groups) and moderately cost-effective among individuals who are vaccinated immunocompromised ($46,494 per QALY gained), or have severe allergic reactions ($45,996 per QALY gained). Evusheld's cost-effectiveness may be subject to risk-group-specific COVID-19 disease progression and Evusheld efficacy and cost, which may change in future epidemic scenarios. CONCLUSION As the COVID-19 variants and risk group-specific durable efficacy, toxicity (and/or resistance) and optimal dosing of Evusheld remain uncertain, better empirical estimates to inform these values in different epidemiological contexts are needed. These results may help decision-makers prioritize resources toward more equitable and effective COVID-19 control efforts.
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Affiliation(s)
- Youngji Jo
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea.
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Dush CMK, Manning WD, Berrigan MN, Marlar J, VanBergen A, Theodorou A, Tsabutashvili D, Chattopadhyay M. National Couples' Health and Time Study: Sample, Design, and Weighting. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:62. [PMID: 37859760 PMCID: PMC10586714 DOI: 10.1007/s11113-023-09799-7] [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: 07/22/2022] [Accepted: 05/09/2023] [Indexed: 10/21/2023]
Abstract
The National Couples' Health and Time Study (NCHAT) is the first fully powered, population-representative study of couples in America containing large samples of sexual, gender, and racial and ethnic diverse individuals. Drawn from the Gallup Panel and the Gallup Recontact Sample, when weighted, the data are population representative of individuals in the United States who (1) are married or cohabiting, (2) are between 20 and 60, (3) speak English or Spanish, and (4) have internet access. The data were collected between September 2020 and April 2021 in the midst of a global pandemic as well as racial and political upheaval. NCHAT includes surveys of 3,642 main respondents and 1,515 partners along with time diaries. We describe the sampling process, challenges weighting a diverse population-representative samples, and sociodemographic characteristics of the NCHAT study. These data will provide opportunities for new research on the health and well-being of American families.
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Affiliation(s)
- Claire M Kamp Dush
- Department of Sociology, The University of Minnesota Twin Cities
- Minnesota Population Center, The University of Minnesota Twin Cities
| | - Wendy D Manning
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University
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40
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Oduro MS, Peprah P, Morgan AK, Agyemang-Duah W. Staying in or out? COVID-19-induced healthcare utilization avoidance and associated socio-demographic factors in rural India. BMC Public Health 2023; 23:1439. [PMID: 37501140 PMCID: PMC10375657 DOI: 10.1186/s12889-023-16282-7] [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: 01/12/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Although evidence on healthcare utilization avoidance during COVID-19 pandemic is emerging, such knowledge is limited in rural settings. An effective policy to the COVID-19 shocks and stresses in rural settings require empirical evidence to inform the design of health policies and programmes. To help overcome this evidence gap and also contribute to policy decisions, this study aimed at examining COVID-19-induced healthcare utilization avoidance and associated factors in rural India. METHODS This study used the third-round data from the COVID-19-Related Shocks in Rural India survey conducted between 20-24 September, 2020 across six states. The outcome variable considered in this study was COVID-19-induced healthcare utilization avoidance. Multivariable Binary Logistic Regression Model via Multiple Imputation was used to assess the factors influencing COVID-19-induced healthcare utilization avoidance. RESULTS Data on 4,682 respondents were used in the study. Of this, the prevalence of COVID-19-induced healthcare utilization avoidance was 15.5% in rural India across the six states. After adjusting for relevant covariates, participants from the Bihar State have significantly higher likelihood of COVID-19-induced healthcare utilization avoidance compared to those from the Andhra Pradesh. Also, participants whose educational level exceeds high school, those who use government hospital/clinic, engage in daily wage labour in agriculture have significantly higher odds of COVID-19-induced healthcare utilization avoidance compared to their counterparts. CONCLUSION Our study revealed that state of residence, type of health facility used, primary work activity and educational level were associated with COVID-19-induced healthcare utilization avoidance in rural India. The findings suggest that policy makers and public health authorities need to formulate policies and design interventions that acknowledge socioeconomic and demographic factors that influence healthcare use avoidance.
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Affiliation(s)
- Michael Safo Oduro
- Pfizer, Inc., Pharm Sci and PGS Statistics, 445 Eastern Point Rd, Groton, Connecticut, USA
| | - Prince Peprah
- Social Policy Research Center, UNSW, Sydney, Australia
- Center for Primary Health Care and Equity, UNSW, Sydney, Australia
| | - Anthony Kwame Morgan
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Williams Agyemang-Duah
- Department of Geography and Planning, Queen's University, K7L 3N6, Kingston, Ontario, Canada
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41
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Bauldry S, Thomas P, Sauerteig-Rolston M, Ferraro K. Racial-Ethnic Disparities in Dual-Function Life Expectancy. J Gerontol A Biol Sci Med Sci 2023; 78:1269-1275. [PMID: 36800307 PMCID: PMC10329220 DOI: 10.1093/gerona/glad059] [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: 10/05/2022] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND This study develops a new concept, dual functionality, that integrates physical and cognitive function. We use the concept to define a measure of dual-function life expectancy (2FLE) and assess racial-ethnic inequalities in aging. METHODS Drawing on data from the National Health Interview Survey Linked Mortality Files and the Health and Retirement Study, we define dual functionality as having no limitations in activities of daily living and being free of dementia. We use this measure and Sullivan life tables to estimate age-50 total life expectancy and age-50 2FLE for women and men across 4 racial-ethnic and nativity groups. RESULTS At ages 50-54, between 79.0% (95% CI: 73.5, 84.5) and 87.6% (95% CI: 84.0, 91.2) of (non-Hispanic) Black, foreign-born Hispanic, and U.S.-born Hispanic women and men remain dual functional as compared with 90.4% (95% CI: 89.3, 91.4) and 91.4% (95% CI: 90.2, 92.5) of (non-Hispanic) White women and men, respectively. These and corresponding racial-ethnic disparities in dual functionality through ages 85 and older translate into substantial inequalities in 2FLE. For instance, the Black-White gap in age-50 2FLE is 6.9 years (95% CI: -7.5, -6.4) for women and 6.0 years (95% CI: -6.6, -5.4) for men. CONCLUSIONS Black, foreign-born Hispanic, and U.S.-born Hispanic older adults are estimated to live a smaller percentage of their remaining years with dual functionality than White older adults. These results reveal stark racial-ethnic inequalities in aging that have significant implications for quality of life, caregiving, and health needs.
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Affiliation(s)
- Shawn Bauldry
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Patricia A Thomas
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Madison R Sauerteig-Rolston
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Kenneth F Ferraro
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
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Hittle M, Culpepper WJ, Langer-Gould A, Marrie RA, Cutter GR, Kaye WE, Wagner L, Topol B, LaRocca NG, Nelson LM, Wallin MT. Population-Based Estimates for the Prevalence of Multiple Sclerosis in the United States by Race, Ethnicity, Age, Sex, and Geographic Region. JAMA Neurol 2023; 80:693-701. [PMID: 37184850 PMCID: PMC10186207 DOI: 10.1001/jamaneurol.2023.1135] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/04/2023] [Indexed: 05/16/2023]
Abstract
Importance Racial, ethnic, and geographic differences in multiple sclerosis (MS) are important factors to assess when determining the disease burden and allocating health care resources. Objective To calculate the US prevalence of MS in Hispanic, non-Hispanic Black (hereafter referred to as Black), and non-Hispanic White individuals (hereafter referred to as White) stratified by age, sex, and region. Design, Setting, and Participants A validated algorithm was applied to private, military, and public (Medicaid and Medicare) administrative health claims data sets to identify adult cases of MS between 2008 and 2010. Data analysis took place between 2019 and 2022. The 3-year cumulative prevalence overall was determined in each data set and stratified by age, sex, race, ethnicity, and geography. The insurance pools included 96 million persons from 2008 to 2010. Insurance and stratum-specific estimates were applied to the 2010 US Census data and the findings combined to calculate the 2010 prevalence of MS cumulated over 10 years. No exclusions were made if a person met the algorithm criteria. Main Outcomes and Measurements Prevalence of MS per 100 000 US adults stratified by demographic group and geography. The 95% CIs were approximated using a binomial distribution. Results A total of 744 781 persons 18 years and older were identified with MS with 564 426 cases (76%) in females and 180 355 (24%) in males. The median age group was 45 to 54 years, which included 229 216 individuals (31%), with 101 271 aged 18 to 24 years (14%), 158 997 aged 35 to 44 years (21%), 186 758 aged 55 to 64 years (25%), and 68 539 individuals (9%) who were 65 years or older. White individuals were the largest group, comprising 577 725 cases (77%), with 80 276 Black individuals (10%), 53 456 Hispanic individuals (7%), and 33 324 individuals (4%) in the non-Hispanic other category. The estimated 2010 prevalence of MS per 100 000 US adults cumulated over 10 years was 161.2 (95% CI, 159.8-162.5) for Hispanic individuals (regardless of race), 298.4 (95% CI, 296.4-300.5) for Black individuals, 374.8 (95% CI, 373.8-375.8) for White individuals, and 197.7 (95% CI, 195.6-199.9) for individuals from non-Hispanic other racial and ethnic groups. During the same time period, the female to male ratio was 2.9 overall. Age stratification in each of the racial and ethnic groups revealed the highest prevalence of MS in the 45- to 64-year-old age group, regardless of racial and ethnic classification. With each degree of latitude, MS prevalence increased by 16.3 cases per 100 000 (95% CI, 12.7-19.8; P < .001) in the unadjusted prevalence estimates, and 11.7 cases per 100 000 (95% CI, 7.4-16.1; P < .001) in the direct adjusted estimates. The association of latitude with prevalence was strongest in women, Black individuals, and older individuals. Conclusions and Relevance This study found that White individuals had the highest MS prevalence followed by Black individuals, individuals from other non-Hispanic racial and ethnic groups, and Hispanic individuals. Inconsistent racial and ethnic classifications created heterogeneity within groups. In the United States, MS affects diverse racial and ethnic groups. Prevalence of MS increases significantly and nonuniformly with latitude in the United States, even when adjusted for race, ethnicity, age, and sex. These findings are important for clinicians, researchers, and policy makers.
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Affiliation(s)
- Michael Hittle
- Stanford University School of Medicine, Stanford, California
| | - William J. Culpepper
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence, Baltimore, Maryland
- University of Maryland School of Medicine, Baltimore
| | | | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Barbara Topol
- Stanford University School of Medicine, Stanford, California
| | | | | | - Mitchell T. Wallin
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence, Baltimore, Maryland
- University of Maryland School of Medicine, Baltimore
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Browne A, Jenkins T, Berlinger N, Buchbinder L, Buchbinder M. The impact of health inequities on physicians' occupational well-being during COVID-19: A qualitative analysis from four US cities. J Hosp Med 2023; 18:595-602. [PMID: 37070735 PMCID: PMC10783652 DOI: 10.1002/jhm.13107] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/16/2023] [Accepted: 03/31/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The aim of this study is to describe frontline physicians' perceptions of the impact of racial-ethnic and socioeconomic disparities in COVID-19 infection and mortality on their occupational well-being. METHODS One hundred and forty-five qualitative, semistructured interviews were conducted between February 2021 and June 2022 with hospital medicine, emergency medicine, pulmonary/critical care, and palliative care physicians caring for hospitalized COVID-19 patients in four US cities. RESULTS Physicians reported encountering COVID-related health disparities and inequities at the societal, organizational, and individual levels. Encountering these inequities, in turn, contributed to stress among frontline physicians, whose concerns revealed how structural conditions both shaped COVID disparities and constrained their ability to protect populations at risk from poor outcomes. Physicians reported feeling complicit in the perpetuation of inequities or helpless to mitigate observed inequities and experienced feelings of grief, guilt, moral distress, and burnout. CONCLUSIONS Health inequities are an under-acknowledged source of physicians' occupational stress that requires solutions beyond the clinical context.
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Affiliation(s)
- Alyssa Browne
- Department of Sociology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tania Jenkins
- Department of Sociology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Liza Buchbinder
- Center for Social Medicine and Humanities and Semel Institute, UCLA, Los Angeles, California, USA
| | - Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
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Pulgaron ER, D’Agostino EM, Johnson SB, Ko LK, Drain PK, Duran MC, Keener Mast D, Kay S, Layer MA, Kenworthy T, Dozier A. Reflections From School Communities in Underserved Populations on Childhood COVID-19 Vaccination. Pediatrics 2023; 152:e2022060352M. [PMID: 37394501 PMCID: PMC10312275 DOI: 10.1542/peds.2022-060352m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Outbreaks in vaccine-preventable diseases among children have increased, primarily among under- or unvaccinated subgroups. The influence and interaction of a child's school community on parental health care decisions, such as vaccination, has not been explored. Our study examined childhood coronavirus disease 2019 (COVID-19) vaccine hesitancy within the context of school communities. METHODS This study combines data from 4 independent research studies funded by the National Institutes of Health Rapid Acceleration of Diagnostics Underserved Populations Return to School Initiative. We examined focus group data to better understand the apprehension surrounding parental and child COVID-19 vaccination among underserved school populations. RESULTS Across all study sites, 7 main themes emerged with regard to COVID-19-related vaccination concerns for children: (1) potential side effects, (2) vaccine development, (3) misinformation (subthemes: content of vaccine and negative intent of the vaccine), (4) vaccine effectiveness, (5) timing of vaccine administration/availability for children, (6) fear of needles, and (7) mistrust. CONCLUSIONS School settings offered unique access to youth and family perspectives in underserved communities. Our studies highlighted several factors contributing to COVID-19 vaccine hesitancy in school communities, which align with existing literature on vaccine hesitancy. These concerns centered primarily on potential harm of vaccines, as well as misinformation, mistrust, and timing of vaccines. Related recommendations for increasing vaccination rates are provided. Developing specific strategies that address parent and child concerns will be critical to reducing health inequities related to COVID-19 vaccination.
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Affiliation(s)
- Elizabeth R. Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Emily M. D’Agostino
- Departments of Orthopedic Surgery
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sara B. Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Linda K. Ko
- Department of Health Systems and Population Health
| | - Paul K. Drain
- Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | | | | | | | | | - Tara Kenworthy
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Ann Dozier
- Public Health Sciences, University of Rochester, Rochester, New York
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Paglino E, Lundberg DJ, Zhou Z, Wasserman JA, Raquib R, Luck AN, Hempstead K, Bor J, Preston SH, Elo IT, Stokes AC. Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022. SCIENCE ADVANCES 2023; 9:eadf9742. [PMID: 37352359 PMCID: PMC10289647 DOI: 10.1126/sciadv.adf9742] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/18/2023] [Indexed: 06/25/2023]
Abstract
Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the COVID-19 pandemic's mortality impact. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating factors, and inform response efforts. We estimated all-cause excess mortality for the United States from March 2020 through February 2022 by county and month using a Bayesian hierarchical model trained on data from 2015 to 2019. An estimated 1,179,024 excess deaths occurred during the first 2 years of the pandemic (first: 634,830; second: 544,194). Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Despite the initial concentration of mortality in large metropolitan Northeastern counties, nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. These results highlight the need for investments in rural health as the pandemic's rural impact grows.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Zhenwei Zhou
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Huang G, Guo F, Zimmermann KF, Liu L, Taksa L, Cheng Z, Tani M, Franklin M. The effect of the COVID-19 pandemic on life expectancy in 27 countries. Sci Rep 2023; 13:8911. [PMID: 37264048 DOI: 10.1038/s41598-023-35592-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
The expected year-on-year intrinsic mortality variations/changes are largely overlooked in the existing research when estimating the effect of the COVID-19 pandemic on mortality patterns. To fill this gap, this study provides a new assessment of the loss of life expectancy caused by COVID-19 in 27 countries considering both the actual and the expected changes in life expectancy between 2019 and 2020. Life expectancy in 2020 and the expected life expectancy in the absence of COVID-19 are estimated using the Lee-Carter model and data primarily from the Human Mortality Database. The results show that life expectancy in 21 of the 27 countries was expected to increase in 2020 had COVID-19 not occurred. By considering the expected mortality changes between 2019 and 2020, the study shows that, on average, the loss of life expectancy among the 27 countries in 2020 amounted to 1.33 year (95% CI 1.29-1.37) at age 15 and 0.91 years (95% CI 0.88-0.94) at age 65. Our results suggest that if the year-on-year intrinsic variations/changes in mortality were considered, the effects of COVID-19 on mortality are more profound than previously understood. This is particularly prominent for countries experiencing greater life expectancy increase in recent years.
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Affiliation(s)
- Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Fei Guo
- Department of Management, Macquarie Business School, Macquarie University, Sydney, Australia
| | | | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Lucy Taksa
- Deakin University Business School, Deakin University, Burwood, Australia
| | - Zhiming Cheng
- Department of Management, Macquarie Business School, Macquarie University, Sydney, Australia
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Massimiliano Tani
- School of Business, University of New South Wales, Canberra, Australia
| | - Marika Franklin
- Deakin University Business School, Deakin University, Burwood, Australia
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Ludwig VU, Crone D, Clifton JDW, Rebele RW, Schor J, Platt ML. Resilience of primal world beliefs to the initial shock of the COVID-19 pandemic. J Pers 2023; 91:838-855. [PMID: 36156253 PMCID: PMC9538916 DOI: 10.1111/jopy.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 09/08/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION People hold general beliefs about the world called primals (e.g., the world is Safe, Intentional), which are strongly linked to individual differences in personality, behavior, and mental health. How such beliefs form or change across the lifespan is largely unknown, although theory suggests that beliefs become more negative after disruptive events. The COVID-19 pandemic provided an opportunity to test whether dramatic world changes and personal adversity affect beliefs. METHOD In a longitudinal, quasi-experimental, pre-registered design, 529 US participants (51% female, 76% White) provided ratings of primals before and several months after pandemic onset, and information about personal adversity (e.g., losing family, financial hardship). Data were compared to 398 participants without experience of the pandemic. RESULTS The average person in our sample showed no change in 23 of the 26 primals, including Safe, in response to the early pandemic, and only saw the world as slightly less Alive, Interactive, and Acceptable. Higher adversity, however, was associated with slight declines in some beliefs. One limitation is that participants were exclusively American. CONCLUSION Primals were remarkably stable during the initial shock wrought by a once-in-a-century pandemic, supporting a view of primals as stable lenses through which people interpret the world.
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Affiliation(s)
- Vera U. Ludwig
- Present address:
Department of NeurosciencePerelman School of Medicine, University of Pennsylvania
- Wharton Neuroscience InitiativeUniversity of Pennsylvania
| | - Damien Crone
- Present address:
Department of NeurosciencePerelman School of Medicine, University of Pennsylvania
- Positive Psychology CenterUniversity of Pennsylvania
| | | | - Reb W. Rebele
- Melbourne School of Psychological SciencesThe University of Melbourne
- Wharton People AnalyticsThe Wharton School, University of Pennsylvania
| | - Jordyn Schor
- Present address:
Department of NeurosciencePerelman School of Medicine, University of Pennsylvania
| | - Michael L. Platt
- Present address:
Department of NeurosciencePerelman School of Medicine, University of Pennsylvania
- Wharton Neuroscience InitiativeUniversity of Pennsylvania
- Marketing DepartmentWharton School of Business, University of Pennsylvania
- Department of Psychology, School of Arts and SciencesUniversity of Pennsylvania
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Bor J, Stokes AC, Raifman J, Venkataramani A, Bassett MT, Himmelstein D, Woolhandler S. Missing Americans: Early death in the United States-1933-2021. PNAS NEXUS 2023; 2:pgad173. [PMID: 37303714 PMCID: PMC10257439 DOI: 10.1093/pnasnexus/pgad173] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/11/2023] [Indexed: 06/13/2023]
Abstract
We assessed how many US deaths would have been averted each year, 1933-2021, if US age-specific mortality rates had equaled the average of 21 other wealthy nations. We refer to these excess US deaths as "missing Americans." The United States had lower mortality rates than peer countries in the 1930s-1950s and similar mortality in the 1960s and 1970s. Beginning in the 1980s, however, the United States began experiencing a steady increase in the number of missing Americans, reaching 622,534 in 2019 alone. Excess US deaths surged during the COVID-19 pandemic, reaching 1,009,467 in 2020 and 1,090,103 in 2021. Excess US mortality was particularly pronounced for persons under 65 years. In 2020 and 2021, half of all US deaths under 65 years and 90% of the increase in under-65 mortality from 2019 to 2021 would have been avoided if the United States had the mortality rates of its peers. In 2021, there were 26.4 million years of life lost due to excess US mortality relative to peer nations, and 49% of all missing Americans died before age 65. Black and Native Americans made up a disproportionate share of excess US deaths, although the majority of missing Americans were White.
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Affiliation(s)
- Jacob Bor
- To whom correspondence should be addressed:
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Julia Raifman
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Atheendar Venkataramani
- Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA
- Medical Ethics and Health Policy, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Mary T Bassett
- François-Xavier Bagnoud (FXB) Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - David Himmelstein
- Hunter College, City University of New York, 695 Park Avenue New York, NY 10065, USA
- Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, USA
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Willis DE, Andersen JA, Montgomery BEE, Selig JP, Shah SK, Zaller N, Bryant-Moore K, Scott AJ, Williams M, McElfish PA. COVID-19 Vaccine Hesitancy and Experiences of Discrimination Among Black Adults. J Racial Ethn Health Disparities 2023; 10:1025-1034. [PMID: 35391714 PMCID: PMC8989097 DOI: 10.1007/s40615-022-01290-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 01/12/2023]
Abstract
Early in the COVID-19 vaccine rollout, Black adults consistently reported more hesitancy than White adults, but few studies have examined variation in hesitancy among Black adults or its associations with racial discrimination. Data were collected from Black Arkansas residents age 18 and older (n = 350) between July 12th and July 30th, 2021, as part of a larger survey of Arkansans (N = 1500). Participants were recruited through random digit dialing of both landline and cell phones, with oversampling of Black and Hispanic residents. Respondents reported COVID-19 vaccine hesitancy, sociodemographic information, influenza vaccination history, pandemic-related experiences, and experiences of racial discrimination. Almost half (48.9%) of Black adults in Arkansas were not hesitant towards COVID-19 vaccines, while the remainder reported some level of hesitancy. Nearly a quarter were very hesitant (22.4%), while fewer reported being somewhat (14.0%) and a little (14.7%) hesitant. Using an ordered logistic regression with partial proportional odds, we find odds of COVID-19 vaccine hesitancy decreased as age and influenza vaccination increased. Odds of COVID-19 vaccine hesitancy were 1.70 times greater for Black adults who experienced the death of a close friend/family member due to COVID-19 and 2.61 times greater for individuals reporting discrimination with police or in the courts. Within-group analysis revealed nearly half of Black adults did not report any COVID-19 vaccine hesitancy and heterogeneity among those who were hesitant. Findings suggest there may be an important link between racial discrimination in the criminal justice system and COVID-19 vaccine hesitancy among Black adults.
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Affiliation(s)
- Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Brooke E E Montgomery
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Nickolas Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Keneshia Bryant-Moore
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Mark Williams
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA.
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Durham Walker C, McCray GG, Wimes A, Levine D, Rivers D. Training Medical Students to Recognize, Understand, and Mitigate the Impact of Racism in a Service-Learning Course. Prev Chronic Dis 2023; 20:E41. [PMID: 37200501 DOI: 10.5888/pcd20.220367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
The Morehouse School of Medicine's Community Health Course (CHC) trains first-year medical students to work with people of racial and ethnic minorities and economically and medically disadvantaged communities. This service-learning course includes the diagnosis/assessment of the health of a community and the development, implementation, and evaluation of a plan to improve some aspect of the community's health. The CHC teaches about the impact of racism on the health of communities through lectures, educational games, and videos focused on social determinants of health, cultural competence, and effective community engagement. Students complete small group assessments, interventions, and service activities at assigned sites. This pedagogical approach integrates the Association of Medical Colleges' Diversity, Equity, and Inclusion competencies and engages many community partners. The course's strengths include a multidisciplinary faculty, a culturally and educationally diverse student body, and community partners with varied backgrounds and resources. Opportunities exist for collaborations with other degree programs to sustain and increase the impact of community interventions and link this community-based educational activity to clinical training years. Course evaluations, exams, and short essays assess students' awareness of racism and the extent to which unconscious bias affects students' completion and interpretation of community assessment data and their engagement with community partners.
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Affiliation(s)
- Carla Durham Walker
- Morehouse School of Medicine, Department of Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA 30310-1495
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