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Anaduaka US, Ferdinands A, Knoop J, Barber S, Mayan MJ. Edmonton's Race-based Data Table: A municipal approach to addressing systemic racism through the collection and use of disaggregated, race-based data. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:577-584. [PMID: 38839742 DOI: 10.17269/s41997-024-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024]
Abstract
Recent events, such as the COVID-19 pandemic, have drawn nationwide attention to systemic racism as a serious threat to public health in Canada. One promising approach to address such racism is through developing and implementing standardized procedures for collecting and using disaggregated, race-based data. In this commentary, we summarize why this approach is necessary to address systemic racism in Canada, and highlight municipal actions being taken in Edmonton, Alberta, to move this approach forward. In 2021, a Race-based Data Table, comprising 24 institutions and organizations affiliated with health, education, and policing systems, was formed in Edmonton. It aimed to engage practitioners, systems representatives, academics, and community members in collective advocacy around accessing race-based data to better understand and address disparate health outcomes associated with COVID-19 for racialized communities. Further, the Table intends to co-create a charter and toolkit outlining best practices for ethical, race-based data collection and use with local stakeholders and knowledge users. In documenting the beginning stages of the Table, and in evaluating its ongoing progress, we contribute to national conversations regarding the need for government institutions and other organizations to consistently collect and use race-based data as a means of increasing transparency and accountability in their actions.
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Affiliation(s)
| | - Alexa Ferdinands
- Faculty of Science and Technology, Athabasca University, Athabasca, AB, Canada
| | - Janelle Knoop
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sarah Barber
- United Way of the Alberta Capital Region, Edmonton, AB, Canada
| | - Maria J Mayan
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Learoyd A, Nicholas J, Hart N, Douiri A. Application of information from external data to correct for collider bias in a Covid-19 hospitalised cohort. BMC Med Res Methodol 2024; 24:149. [PMID: 39014348 PMCID: PMC11250979 DOI: 10.1186/s12874-023-02129-7] [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: 02/27/2023] [Accepted: 12/14/2023] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Throughout the Covid-19 pandemic, researchers have made use of electronic health records to research this disease in a rapidly evolving environment of questions and discoveries. These studies are prone to collider bias as they restrict the population of Covid-19 patients to only those with severe disease. Inverse probability weighting is typically used to correct for this bias but requires information from the unrestricted population. Using electronic health records from a South London NHS trust, this work demonstrates a method to correct for collider bias using externally sourced data while examining the relationship between minority ethnicities and poor Covid-19 outcomes. METHODS The probability of inclusion within the observed hospitalised cohort was modelled based on estimates from published national data. The model described the relationship between patient ethnicity, hospitalisation, and death due to Covid-19 - a relationship suggested to be susceptible to collider bias. The obtained probabilities (as applied to the observed patient cohort) were used as inverse probability weights in survival analysis examining ethnicity (and covariates) as a risk factor for death due to Covid-19. RESULTS Within the observed cohort, unweighted analysis of survival suggested a reduced risk of death in those of Black ethnicity - differing from the published literature. Applying inverse probability weights to this analysis amended this aberrant result to one more compatible with the literature. This effect was consistent when the analysis was applied to patients within only the first wave of Covid-19 and across two waves of Covid-19 and was robust against adjustments to the modelled relationship between hospitalisation, patient ethnicity, and death due to Covid-19 made as part of a sensitivity analysis. CONCLUSIONS In conclusion, this analysis demonstrates the feasibility of using external publications to correct for collider bias (or other forms of selection bias) induced by the restriction of a population to a hospitalised cohort using an example from the recent Covid-19 pandemic.
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Affiliation(s)
- Annastazia Learoyd
- School of Life Course and Population Sciences, King College London, London, UK.
| | - Jennifer Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Abdel Douiri
- School of Life Course and Population Sciences, King College London, London, UK
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Razai MS, Berendes S, Nagraj S, Oakeshott P, Khalil A. As whooping cough rates rise, we urgently need to increase maternal vaccination rates. BMJ 2024; 385:q1289. [PMID: 38871363 DOI: 10.1136/bmj.q1289] [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: 06/15/2024]
Affiliation(s)
| | - Sima Berendes
- London School of Hygiene and Tropical Medicine, London
| | - Shobhana Nagraj
- Department of Public Health and Primary Care, University of Cambridge
- East London NHS Foundation Trust
| | - Pippa Oakeshott
- Population Health Research, St George's University of London
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London
- Royal College of Obstetricians and Gynaecologists, London
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Smart A, Williams R, Weiner K, Cheng L, Sobande F. Ethico-racial positioning in campaigns for COVID-19 research and vaccination featuring public figures. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:984-1003. [PMID: 38234078 DOI: 10.1111/1467-9566.13748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024]
Abstract
This article analyses a set of videos which featured public figures encouraging racially minoritised people in the UK to take the COVID-19 vaccine or get involved in related research. As racially targeted health communication has both potentially beneficial and problematic consequences, it is important to examine this uniquely high-profile case. Using a purposive sample of 10 videos, our thematic content analysis aimed to reveal how racially minoritised people were represented and the types of concerns about the vaccine that were expressed. We found representations of racialised difference that centred on 'community' and invoked shared social experiences. The expressed concerns centred on whether ethnic difference was accounted for in the vaccine's design and development, plus the overarching issue of trust. Our analysis adopts and develops the concept of 'racialisation'; we explore how 'mutuality' underpinned normative calls to action ('ethico-racial imperatives') and how the videos 'responsibilised' racially minoritised people. We discuss two points of tension in this case: the limitations for addressing the causes of mistrust and the risks of reductivism that accompanied the ambiguous notion of community. Our analysis develops scholarship on racialisation in health contexts and provides public health practitioners with insights into the socio-political considerations of racially targeted communications.
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Affiliation(s)
- Andrew Smart
- School of Sciences, Bath Spa University, Bath, UK
| | - Ros Williams
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Kate Weiner
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Lijiaozi Cheng
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Francesca Sobande
- School of Journalism, Media and Culture, Cardiff University, Cardiff, UK
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Gonzalez-Jaramillo N, Abbühl D, Roa-Díaz ZM, Kobler-Betancourt C, Frahsa A. COVID-19 vaccine acceptance in the general population and under-resourced communities from high-income countries: realist review. BMJ Open 2024; 14:e084560. [PMID: 38631831 PMCID: PMC11029206 DOI: 10.1136/bmjopen-2024-084560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To compare vaccination willingness before rollout and 1 year post-rollout uptake among the general population and under-resourced communities in high-income countries. DESIGN A realist review. DATA SOURCES Embase, PubMed, Dimensions ai and Google Scholar. SETTING High-income countries. DEFINITIONS We defined vaccination willingness as the proportion of participants willing or intending to receive vaccines prior to availability. We defined vaccine uptake as the real proportion of the population with complete vaccination as reported by each country until November 2021. RESULTS We included data from 62 studies and 18 high-income countries. For studies conducted among general populations, the proportion of vaccination willingness was 67% (95% CI 62% to 72%). In real-world settings, the overall proportion of vaccine uptake among those countries was 73% (95% CI 69% to 76%). 17 studies reported pre-rollout willingness for under-resourced communities. The summary proportion of vaccination willingness from studies reporting results among people from under-resourced communities was 52% (95% CI 0.46% to 0.57%). Real-world evidence about vaccine uptake after rollout among under-resourced communities was limited. CONCLUSION Our review emphasises the importance of realist reviews for assessing vaccine acceptance. Limited real-world evidence about vaccine uptake among under-resourced communities in high-income countries is a call to context-specific actions and reporting.
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Affiliation(s)
| | - Dominik Abbühl
- ISPM, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Zayne Milena Roa-Díaz
- ISPM, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
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Furness A, Fair F, Higginbottom G, Oddie S, Soltani H. A review of the current policies and guidance regarding Apgar scoring and the detection of jaundice and cyanosis concerning Black, Asian and ethnic minority neonates. BMC Pediatr 2024; 24:198. [PMID: 38515076 PMCID: PMC10956215 DOI: 10.1186/s12887-024-04692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Ethnic inequalities in maternal and neonatal health in the UK are well documented. Concerns exist regarding the use of skin colour in neonatal assessments. Healthcare professionals should be trained to recognise symptoms of diverse skin tones, and comprehensive, and inclusive guidance is necessary for the safe assessment of all infants. Disparities in healthcare provision have been emphasised during the COVID-19 pandemic, and additional research is needed to determine whether such policies adequately address ethnic minority neonates. METHODS A desktop search included searches of guidance produced for the United Kingdom (UK). Further searches of the Cochrane and World Health Organization (WHO) were used to identify any international guidance applicable in the UK context. RESULTS Several policies and one training resource used descriptors 'pink,' 'pale,' 'pallor,' and 'blue' about neonatal skin and mucous membrane colour. No policies provided specific guidance on how these colour descriptors may appear in neonates with different skin pigmentation. Only the NICE guidance and HEE e-learning resource acknowledged the challenges of assessing jaundice in infants with diverse skin tones, while another guideline noted differences in the accuracy of bilirubin measurements for the assessment of jaundice. Three policies and one training resource advised against relying on visual observation of skin colour when diagnosing neonatal conditions. The training resource included images of ethnic minority neonates, although most images included white infants. CONCLUSIONS Inadequate consideration of ethnicity in UK policy and training perpetuates disparities, leading to inaccurate assessments. A review is needed for inclusivity in neonatal care, regardless of skin pigmentation.
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Affiliation(s)
| | | | | | - Sam Oddie
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Ekezie W, Cassambai S, Czyznikowska B, Curtis F, O'Mahoney LL, Willis A, Chudasama Y, Khunti K, Farooqi A. Health and social care experience and research perception of different ethnic minority populations in the East Midlands, United Kingdom (REPRESENT study). Health Expect 2024; 27:e13944. [PMID: 39102736 PMCID: PMC10733974 DOI: 10.1111/hex.13944] [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] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Ethnic minority populations experience significant health and social care disparities; despite experiencing a greater burden of diseases, these groups are underrepresented in health and social care research. Consequently, related research can be less applicable to these population groups. The REPRESENT study aims to explore the health and social care experiences of ethnic minorities and other minoritised populations, their research interests and appropriate research practices. METHODS Focus groups and semistructured interviews were conducted between May and September 2022 with members of a number of ethnic minority communities in England. Data were audio recorded, transcribed and thematically coded using NVivo 12. Rigour was determined through extensive sampling, iterative data collection and analysis. FINDINGS Fifty-two ethnic minority members were engaged in group interviews and one-to-one interviews. Participants included representatives of the following groups: African Caribbean, Eastern European, Gypsy Travellers, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual+, Refugee/Asylum Seekers, Somali and South Asian communities. Interviews were also conducted with ethnic minority healthcare providers and researchers. Three overarching categories were identified: health information, medical service experiences, health and social care concerns and health research. Health and social care services challenges were mostly attributed to discrimination, delayed services, poor cultural relevance and language and cultural barriers. The most influential information sources were local community organisations and word-of-mouth. The main health and social care concerns were chronic long-term health conditions, mental health, maternal health and child development. Recommendations for research involved understanding the motivations for participation, improving communication and empowering communities. Top research priorities were long-term health conditions, health promotion and education, early care interventions and understanding community needs. INTERPRETATION Discrimination and bias in health and social care provision have severe implications for worsening ethnic health inequalities. Healthcare commissioning authorities and policymakers can leverage the preference of ethnic minority groups for pharmacy services and community organisations to improve access to care. Improving research interest and engagement requires understanding individual community needs, community sensitivity, research relevance and cultural appropriateness. PATIENT OR PUBLIC CONTRIBUTION Members of ethnic minority Patient and Public Involvement and Engagement group and Community Advisory Board supported the REPRESENT study design, conceptualisation and report development.
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Affiliation(s)
- Winifred Ekezie
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Department of Sociology and PolicyAston UniversityBirminghamUK
| | - Shabana Cassambai
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
| | - Barbara Czyznikowska
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
| | - Ffion Curtis
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Liverpool Reviews and Implementation Group (LRiG)University of Liverpool, Institute of Population HealthLiverpoolUK
| | - Lauren L. O'Mahoney
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Andrew Willis
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- HRB Clinical Research Facility & School of Public HealthUniversity College CorkIreland
| | - Yogini Chudasama
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Leicester Real World EvidenceUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Leicester Real World EvidenceUniversity of LeicesterLeicesterUK
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8
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Martinez AB, Lau JYF, Morillo HM, Brown JSL. 'C'mon, let's talk: a pilot study of mental health literacy program for Filipino migrant domestic workers in the United Kingdom. Soc Psychiatry Psychiatr Epidemiol 2024; 59:385-401. [PMID: 36575338 PMCID: PMC9794465 DOI: 10.1007/s00127-022-02405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This pilot study of a culturally adapted online mental health literacy (MHL) program called 'Tara, Usap Tayo!' (C'mon, Let's Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK). METHODS Using mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt's (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants' attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants' feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions. RESULTS The online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group. CONCLUSION By improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.
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Affiliation(s)
- Andrea B Martinez
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of Behavioral Science, College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines.
| | - Jennifer Y F Lau
- Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hannah Misha Morillo
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - June S L Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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So N, Price K, O'Mara P, Rodrigues MA. The importance of cultural humility and cultural safety in health care. Med J Aust 2024; 220:12-13. [PMID: 38049948 DOI: 10.5694/mja2.52182] [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: 08/01/2022] [Accepted: 09/18/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Neda So
- Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Karen Price
- Monash University, Melbourne, VIC
- Moorabbin Medical Clinic, Melbourne, VIC
| | | | - Michelle A Rodrigues
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
- Chroma Dermatology, Melbourne, VIC
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Phillips A. Call to action on diabetes care: reaching communities facing health inequalities, health inequities and deprivation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:16-20. [PMID: 38194328 DOI: 10.12968/bjon.2024.33.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
This article presents evidence and policy on the importance of reaching out into local communities with inclusive approaches to try to reduce and prevent inequities and inequalities in diabetes care. The global emergency diabetes is causing and the risks and disproportionately high ethnic disparities are investigated. The article includes some suggestions on changing approaches to reduce health inequalities to enable diabetes care to become more accessible for those who need it the most.
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Affiliation(s)
- Anne Phillips
- Professor in Diabetes Care, Birmingham City University
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11
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Routen A, Lekas HM, Harrison J, Khunti K. Intersectionality in health equity research. BMJ 2023; 383:2953. [PMID: 38158221 DOI: 10.1136/bmj.p2953] [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: 01/03/2024]
Affiliation(s)
- Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Julian Harrison
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
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12
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Clarke G, Hussain JA, Allsop MJ, Bennett MI. Ethnicity and palliative care: we need better data - five key considerations. BMJ Support Palliat Care 2023; 13:429-431. [PMID: 35589123 PMCID: PMC10803990 DOI: 10.1136/bmjspcare-2022-003565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/13/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Insitute of Health Sciences, University of Leeds School of Medicine, Leeds, UK
| | | | - Matthew John Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Borchert RJ, Azevedo T, Badhwar A, Bernal J, Betts M, Bruffaerts R, Burkhart MC, Dewachter I, Gellersen HM, Low A, Lourida I, Machado L, Madan CR, Malpetti M, Mejia J, Michopoulou S, Muñoz-Neira C, Pepys J, Peres M, Phillips V, Ramanan S, Tamburin S, Tantiangco HM, Thakur L, Tomassini A, Vipin A, Tang E, Newby D, Ranson JM, Llewellyn DJ, Veldsman M, Rittman T. Artificial intelligence for diagnostic and prognostic neuroimaging in dementia: A systematic review. Alzheimers Dement 2023; 19:5885-5904. [PMID: 37563912 DOI: 10.1002/alz.13412] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) and neuroimaging offer new opportunities for diagnosis and prognosis of dementia. METHODS We systematically reviewed studies reporting AI for neuroimaging in diagnosis and/or prognosis of cognitive neurodegenerative diseases. RESULTS A total of 255 studies were identified. Most studies relied on the Alzheimer's Disease Neuroimaging Initiative dataset. Algorithmic classifiers were the most commonly used AI method (48%) and discriminative models performed best for differentiating Alzheimer's disease from controls. The accuracy of algorithms varied with the patient cohort, imaging modalities, and stratifiers used. Few studies performed validation in an independent cohort. DISCUSSION The literature has several methodological limitations including lack of sufficient algorithm development descriptions and standard definitions. We make recommendations to improve model validation including addressing key clinical questions, providing sufficient description of AI methods and validating findings in independent datasets. Collaborative approaches between experts in AI and medicine will help achieve the promising potential of AI tools in practice. HIGHLIGHTS There has been a rapid expansion in the use of machine learning for diagnosis and prognosis in neurodegenerative disease Most studies (71%) relied on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset with no other individual dataset used more than five times There has been a recent rise in the use of more complex discriminative models (e.g., neural networks) that performed better than other classifiers for classification of AD vs healthy controls We make recommendations to address methodological considerations, addressing key clinical questions, and validation We also make recommendations for the field more broadly to standardize outcome measures, address gaps in the literature, and monitor sources of bias.
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Affiliation(s)
- Robin J Borchert
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tiago Azevedo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - AmanPreet Badhwar
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Canada
- Centre de recherche de l'Institut Universitaire de Gériatrie (CRIUGM), Montreal, Canada
| | - Jose Bernal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Matthew Betts
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, University of Magdeburg, Magdeburg, Germany
| | - Rose Bruffaerts
- Computational Neurology, Experimental Neurobiology Unit, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Ilse Dewachter
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Helena M Gellersen
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Audrey Low
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Luiza Machado
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Maura Malpetti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jhony Mejia
- Department of Biomedical Engineering, Universidad de Los Andes, Bogotá, Colombia
| | - Sofia Michopoulou
- Imaging Physics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carlos Muñoz-Neira
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Artificial Intelligence & Computational Neuroscience Group (AICN Group), Sheffield Institute for Translational Neuroscience (SITraN), Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Jack Pepys
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marion Peres
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Lokendra Thakur
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, UK
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Tomassini
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Eugene Tang
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - David J Llewellyn
- University of Exeter Medical School, Exeter, UK
- Alan Turing Institute, London, UK
| | - Michele Veldsman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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14
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Carson J, Gunda A, Qasim K, Allen R, Bradley M, Prescott J. Losing a Loved One During the Covid-19 Pandemic: An On-Line Survey Looking at the Effects on Traumatic Stress, Coping and Post-Traumatic Growth. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:653-667. [PMID: 34637339 DOI: 10.1177/00302228211049683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Covid-19 pandemic has had a devastating effect across the world. In the UK alone, the death toll is 132,742, with 207 people dying the previous day and a total of 6,825,074 cases of Covid-19 thus far (September 1st, 2021). The aim of this study was to look at post-traumatic stress, coping skills and post-traumatic growth in relatives, who lost a loved one during the pandemic. Some 185 individuals took part in a Qualtrics survey. Participants completed a demographic questionnaire, the Impact of Event Scale-Revised, the Coping Assessment for Bereavement and Loss (CABLE) and the Post-Traumatic Growth Questionnaire. There were two major findings. First, there were very high levels of post-traumatic stress, with 94.6% of the sample scoring above the threshold of 33 for a diagnosis of post-traumatic stress disorder (PTSD). Second, levels of post-traumatic growth were very low. Losing a relative during the Covid-19 pandemic may lead to more PTSD. The circumstances surrounding many Covid deaths, may have long term negative consequences for the bereaved relatives.
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Affiliation(s)
- Jerome Carson
- Professor of Psychology, University of Bolton, University of Bolton, Bolton, UK
| | - Austin Gunda
- University of Bolton, Bolton, UK Psychology student
| | - Komal Qasim
- Honorary Research Worker, University of Bolton, Bolton, UK
| | - Rosie Allen
- Doctoral candidate, University of Bolton, Bolton, UK
| | | | - Julie Prescott
- Reader in Psychology, University of Bolton, University of Bolton, Bolton, UK
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15
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Buck E, Burt J, Karampatsas K, Hsia Y, Whyte G, Amirthalingam G, Skirrow H, Le Doare K. 'Unable to have a proper conversation over the phone about my concerns': a multimethods evaluation of the impact of COVID-19 on routine childhood vaccination services in London, UK. Public Health 2023; 225:229-236. [PMID: 37944278 DOI: 10.1016/j.puhe.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Investigating the completion rate of 12-month vaccinations and parental perspectives on vaccine services during COVID-19. STUDY-DESIGN Service evaluation including parental questionnaire. METHODS Uptake of 12-month vaccinations in three London general practices during three periods: pre-COVID (1/3/2018-28/2/2019, n = 826), during COVID (1/3/2019-28/2/2020, n = 775) and post-COVID first wave (1/8/2020-31/1/2021, n = 419). Questionnaire of parents whose children were registered at the practices (1/4/2019-1/22/2021, n = 1350). RESULTS Comparing pre-COVID and both COVID cohorts, the completion rates of 12-month vaccines were lower. Haemophilus influenzae type B/meningococcal group C (Hib/MenC) vaccination uptake was 5.6% lower (89.0% vs 83.4%, P=<0.001), meningococcal group B (MenB) booster uptake was 4.4% lower (87.3% vs 82.9%, P = 0.006), pneumococcal conjugate vaccine (PCV) booster uptake was 6% lower (88.0% vs 82.0%, P < 0.001) and measles, mumps and rubella (MMR) vaccine uptake was 5.2% lower (89.1% vs 83.9%, P = 0.003). Black/Black-British ethnicity children had increased odds of missing their 12-month vaccinations compared to White ethnicity children (adjusted odds ratio 0.43 [95% confidence interval 0.24-0.79, P = 0.005; 0.36 [0.20-0.65], P < 0.001; 0.48 [0.27-0.87], P = 0.01; 0.40 [0.22-0.73], P = 0.002; for Hib/MenC, MenB booster, PCV booster and MMR. Comparing pre-COVID and COVID periods, vaccinations coded as not booked increased for MMR (10%), MenB (7%) and PCV booster (8%). Parents reported changes to vaccination services during COVID-19, including difficulties booking and attending appointments and lack of vaccination reminders. CONCLUSION A sustained decrease in 12-month childhood vaccination uptake disproportionally affected Black/Black British ethnicity infants during the first wave of the pandemic. Vaccination reminders and availability of healthcare professionals to discuss parental vaccine queries are vital to maintaining uptake.
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Affiliation(s)
- Eleanor Buck
- St George's Hospital Medical School, St. George's, University of London, London, United Kingdom.
| | - J Burt
- Ashford and St Peter's Hospital NHS Foundation Trust, United Kingdom
| | - K Karampatsas
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Y Hsia
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom; School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
| | - G Whyte
- North Croydon Medical Centre, United Kingdom
| | - G Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - H Skirrow
- School of Public Health, Imperial College London, United Kingdom
| | - K Le Doare
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom; MRC/UVRI @LHSTM Uganda Research Unit, Entebbe, Uganda; Pathogen Immunity Group, UK Health Security Agency, Porton Down, United Kingdom
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16
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Zougheibe R, Dewan A, Norman R, Gudes O. Insights into parents' perceived worry before and during the COVID-19 pandemic in Australia: inequality and heterogeneity of influences. BMC Public Health 2023; 23:1944. [PMID: 37805455 PMCID: PMC10559437 DOI: 10.1186/s12889-023-16337-9] [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: 11/02/2022] [Accepted: 07/18/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Excessive worry is an invisible disruptive force that has adverse health outcomes and may advance to other forms of disorder, such as anxiety or depression. Addressing worry and its influences is challenging yet crucial for informing public health policy. METHODS We examined parents' worries, influences, and variability before and during COVID-19 pandemic and across geography. Parents (n = 340) and their primary school-aged children from five Australian states completed an anonymous online survey in mid-2020. After literature review, we conceptualised the influences and performed a series of regression analyses. RESULTS Worry levels and the variables contributing to parents' worry varied before to during the pandemic. The proportion of parents who were "very worried all the time" increased by 14.6% in the early days of the pandemic. During the pandemic, ethnic background modified parents' worry and parents' history of daily distress symptoms was a significant contributor (p < 0.05). Excessive exposure to news remained significant both before and during the pandemic. The primary predictor of parents' worry before COVID-19 was perceived neighbourhood safety, while the main predictor during COVID-19 was financial risk due to income change. Some variable such as neighbourhood safety and financial risk varied in their contribution to worry across geographical regions. The proportion of worried children was higher among distraught parents. CONCLUSION Parents' worry during the health pandemic was not triggered by the health risks factors but by the financial risk due to income change. The study depicts inequality in the impact of COVID-19 by ethnic background. Different policies and reported virus case numbers across states may have modified the behaviour of variables contributing to the geography of parents' worry. Exposure to stressors before the COVID-19 pandemic may have helped parents develop coping strategies during stressful events. Parents are encouraged to limit their exposure to stressful news. We advocate for parents-specific tailored policies and emphasise the need for access to appropriate mental health resources for those in need. Advancing research in geographical modelling for mental health may aid in devising much-needed location-targeted interventions and prioritising resources in future events.
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Affiliation(s)
- Roula Zougheibe
- School of Earth and Planetary Sciences, Curtin University, Kent Street, Perth, WA, 6102, Australia.
| | - Ashraf Dewan
- School of Earth and Planetary Sciences, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Ori Gudes
- School of Population Health, UNSW Medicine, New South Wales, Australia
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17
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Wong R, Lovier MA. Racial and ethnic disparities in COVID-19 diagnosis and adherence to mitigation behaviours in a national United States older adult sample. Epidemiol Infect 2023; 151:e175. [PMID: 37799056 PMCID: PMC10600897 DOI: 10.1017/s0950268823001607] [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: 06/08/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
Older adults and people of colour are vulnerable to the COVID-19 pandemic, and mitigation behaviours reduce COVID-19 infection. We examined racial and ethnic differences in COVID-19 diagnosis and adherence to COVID-19 mitigation behaviours among U.S. older adults. Data were retrieved from the National Health and Aging Trends Study, a nationally representative prospective cohort with 3257 U.S. Medicare beneficiaries aged 65+. COVID-19 variables were collected in 2020; all other data in 2019. Odds of COVID-19 diagnosis and adherence to mitigation behaviours (handwashing, masking, social distancing) were analysed using logistic regression. Compared to White older adults, only Hispanic respondents had 2.7 times significantly higher odds of COVID-19 after adjusting for sociodemographics, health, and mitigation behaviours (aOR = 2.71, 95% CI = 1.20-6.12). Black older adults had 7.9 times significantly higher odds of masking (aOR = 7.94, 95% CI = 2.33-27.04) and 2.3 times higher odds of social distancing (aOR = 2.33, 95% CI = 1.28-4.24), after adjusting for sociodemographics and health. Among all racial and ethnic groups, only Hispanic older adults had a significantly elevated COVID-19 diagnosis. Despite higher adherence to COVID-19 mitigation behaviours among racial and ethnic minorities, especially Black older adults, odds of COVID-19 remained elevated. Research is needed to explore potential mechanisms for higher odds of COVID-19 among minority older adults.
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Affiliation(s)
- Roger Wong
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Margaret Anne Lovier
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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18
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Yan C, Zhang X, Yang Y, Kang K, Were MC, Embí P, Patel MB, Malin BA, Kho AN, Chen Y. Differences in Health Professionals' Engagement With Electronic Health Records Based on Inpatient Race and Ethnicity. JAMA Netw Open 2023; 6:e2336383. [PMID: 37812421 PMCID: PMC10562942 DOI: 10.1001/jamanetworkopen.2023.36383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 10/10/2023] Open
Abstract
Importance US health professionals devote a large amount of effort to engaging with patients' electronic health records (EHRs) to deliver care. It is unknown whether patients with different racial and ethnic backgrounds receive equal EHR engagement. Objective To investigate whether there are differences in the level of health professionals' EHR engagement for hospitalized patients according to race or ethnicity during inpatient care. Design, Setting, and Participants This cross-sectional study analyzed EHR access log data from 2 major medical institutions, Vanderbilt University Medical Center (VUMC) and Northwestern Medicine (NW Medicine), over a 3-year period from January 1, 2018, to December 31, 2020. The study included all adult patients (aged ≥18 years) who were discharged alive after hospitalization for at least 24 hours. The data were analyzed between August 15, 2022, and March 15, 2023. Exposures The actions of health professionals in each patient's EHR were based on EHR access log data. Covariates included patients' demographic information, socioeconomic characteristics, and comorbidities. Main Outcomes and Measures The primary outcome was the quantity of EHR engagement, as defined by the average number of EHR actions performed by health professionals within a patient's EHR per hour during the patient's hospital stay. Proportional odds logistic regression was applied based on outcome quartiles. Results A total of 243 416 adult patients were included from VUMC (mean [SD] age, 51.7 [19.2] years; 54.9% female and 45.1% male; 14.8% Black, 4.9% Hispanic, 77.7% White, and 2.6% other races and ethnicities) and NW Medicine (mean [SD] age, 52.8 [20.6] years; 65.2% female and 34.8% male; 11.7% Black, 12.1% Hispanic, 69.2% White, and 7.0% other races and ethnicities). When combining Black, Hispanic, or other race and ethnicity patients into 1 group, these patients were significantly less likely to receive a higher amount of EHR engagement compared with White patients (adjusted odds ratios, 0.86 [95% CI, 0.83-0.88; P < .001] for VUMC and 0.90 [95% CI, 0.88-0.92; P < .001] for NW Medicine). However, a reduction in this difference was observed from 2018 to 2020. Conclusions and Relevance In this cross-sectional study of inpatient EHR engagement, the findings highlight differences in how health professionals distribute their efforts to patients' EHRs, as well as a method to measure these differences. Further investigations are needed to determine whether and how EHR engagement differences are correlated with health care outcomes.
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Affiliation(s)
- Chao Yan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xinmeng Zhang
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yuyang Yang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kaidi Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Martin C. Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter Embí
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mayur B. Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research and Education Clinical Center, Veterans Affairs, Tennessee Valley Healthcare System, Nashville
- Division of Acute Care Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bradley A. Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Abel N. Kho
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
- Department of Medicine-General Internal Medicine, Northwestern University, Chicago, Illinois
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
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19
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Urdiales T, Dernie F, Català M, Prats-Uribe A, Prats C, Prieto-Alhambra D. Association between ethnic background and COVID-19 morbidity, mortality and vaccination in England: a multistate cohort analysis using the UK Biobank. BMJ Open 2023; 13:e074367. [PMID: 37734898 PMCID: PMC10514643 DOI: 10.1136/bmjopen-2023-074367] [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: 04/11/2023] [Accepted: 07/26/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES Despite growing evidence suggesting increased COVID-19 mortality among people from ethnic minorities, little is known about milder forms of SARS-CoV-2 infection. We sought to explore the association between ethnic background and the probability of testing, testing positive, hospitalisation, COVID-19 mortality and vaccination uptake. DESIGN A multistate cohort analysis. Participants were followed between 8 April 2020 and 30 September 2021. SETTING The UK Biobank, which stores medical data on around half a million people who were recruited between 2006 and 2010. PARTICIPANTS 405 541 subjects were eligible for analysis, limited to UK Biobank participants living in England. 23 891 (6%) of participants were non-white. PRIMARY AND SECONDARY OUTCOME MEASURES The associations between ethnic background and testing, testing positive, hospitalisation and COVID-19 mortality were studied using multistate survival analyses. The association with single and double-dose vaccination was also modelled. Multistate models adjusted for age, sex and socioeconomic deprivation were fitted to estimate adjusted HRs (aHR) for each of the multistate transitions. RESULTS 18 172 (4.5%) individuals tested positive, 3285 (0.8%) tested negative and then positive, 1490 (6.9% of those tested positive) were hospitalised, and 129 (0.6%) tested positive at the moment of hospital admission (ie, direct hospitalisation). Finally, 662 (17.4%) died after admission. Compared with white participants, Asian participants had an increased risk of negative to positive transition (aHR 1.24 (95% CI 1.02 to 1.52)), testing positive (95% CI 1.44 (1.33 to 1.55)) and direct hospitalisation (1.61 (95% CI 1.28 to 2.03)). Black participants had an increased risk of hospitalisation following a positive test (1.71 (95% CI 1.29 to 2.27)) and direct hospitalisation (1.90 (95% CI 1.51 to 2.39)). Although not the case for Asians (aHR 1.00 (95% CI 0.98 to 1.02)), black participants had a reduced vaccination probability (0.63 (95% CI 0.62 to 0.65)). In contrast, Chinese participants had a reduced risk of testing negative (aHR 0.64 (95% CI 0.57 to 0.73)), of testing positive (0.40 (95% CI 0.28 to 0.57)) and of vaccination (0.78 (95% CI 0.74 to 0.83)). CONCLUSIONS We identified inequities in testing, vaccination and COVID-19 outcomes according to ethnicity in England. Compared with whites, Asian participants had increased risks of infection and admission, and black participants had almost double hospitalisation risk, and a 40% lower vaccine uptake.
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Affiliation(s)
- Tomás Urdiales
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
- Department of Energy Technology, Royal Institute of Technology, Stockholm, Sweden
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francesco Dernie
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Martí Català
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Albert Prats-Uribe
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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20
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Ali S, Mactier H, Morelli A, Hurd M, Placzek A, Knight M, Ladhani SN, Draper ES, Sharkey D, Doherty C, Kurinczuk JJ, Quigley MA, Gale C. Neonatal outcomes of maternal SARS-CoV-2 infection in the UK: a prospective cohort study using active surveillance. Pediatr Res 2023; 94:1203-1208. [PMID: 36899124 PMCID: PMC10000338 DOI: 10.1038/s41390-023-02527-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Newborns may be affected by maternal SARS-CoV-2 infection during pregnancy. We aimed to describe the epidemiology, clinical course and short-term outcomes of babies admitted to a neonatal unit (NNU) following birth to a mother with confirmed SARS-CoV-2 infection within 7 days of birth. METHODS This is a UK prospective cohort study; all NHS NNUs, 1 March 2020 to 31 August 2020. Cases were identified via British Paediatric Surveillance Unit with linkage to national obstetric surveillance data. Reporting clinicians completed data forms. Population data were extracted from the National Neonatal Research Database. RESULTS A total of 111 NNU admissions (1.98 per 1000 of all NNU admissions) involved 2456 days of neonatal care (median 13 [IQR 5, 34] care days per admission). A total of 74 (67%) babies were preterm. In all, 76 (68%) received respiratory support; 30 were mechanically ventilated. Four term babies received therapeutic hypothermia for hypoxic ischaemic encephalopathy. Twenty-eight mothers received intensive care, with four dying of COVID-19. Eleven (10%) babies were SARS-CoV-2 positive. A total of 105 (95%) babies were discharged home; none of the three deaths before discharge was attributed to SARS-CoV-2. CONCLUSION Babies born to mothers with SARS-CoV-2 infection around the time of birth accounted for a low proportion of total NNU admissions over the first 6 months of the UK pandemic. Neonatal SARS-CoV-2 was uncommon. STUDY REGISTRATION ISRCTN60033461; protocol available at http://www.npeu.ox.ac.uk/pru-mnhc/research-themes/theme-4/covid-19 . IMPACT Neonatal unit admissions of babies born to mothers with SARS-CoV-2 infection comprised only a small proportion of total neonatal admissions in the first 6 months of the pandemic. A high proportion of babies requiring neonatal admission who were born to mothers with confirmed SARS-CoV-2 infection were preterm and had neonatal SARS-CoV-2 infection and/or other conditions associated with long-term sequelae. Adverse neonatal conditions were more common in babies whose SARS-CoV-2-positive mothers required intensive care compared to those whose SARS-CoV-2-positive mothers who did not.
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Affiliation(s)
- Shohaib Ali
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Helen Mactier
- Princess Royal Maternity and the University of Glasgow, Glasgow, UK
| | - Alessandra Morelli
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Madeleine Hurd
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Placzek
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Knight
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Shamez N Ladhani
- Paediatric Infectious Diseases and Vaccinology, St. George's University of London, London, UK
| | - Elizabeth S Draper
- Department of Health Sciences, Centre for Medicine, University of Leicester, University Road, Leicester, UK
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Jennifer J Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chris Gale
- School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Campus, 369 Fulham Road, London, SW10 9NH, UK.
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21
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Meskell P, Biesty LM, Dowling M, Roche K, Meehan E, Glenton C, Devane D, Shepperd S, Booth A, Cox R, Chan XHS, Houghton C. Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 9:MR000065. [PMID: 37655964 PMCID: PMC10472890 DOI: 10.1002/14651858.mr000065.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The World Health Organization declared the COVID-19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. OBJECTIVES To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was June 2021. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. DATA COLLECTION AND ANALYSIS We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data-rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessment to assess our confidence in each finding and develop implications for practice. MAIN RESULTS We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID-19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE-CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over-representation of HIV studies, our GRADE-CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. AUTHORS' CONCLUSIONS This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic.
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Affiliation(s)
- Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | | | - Elaine Meehan
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, ScHARR, Sheffield, UK
| | - Rebecca Cox
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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O'Reilly J. Fear, loss and disconnection: the emotional impact of the Covid-19 pandemic upon staff working in mental health services and how the organization can help - a psychoanalytic perspective. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2023; 104:628-656. [PMID: 37722910 DOI: 10.1080/00207578.2023.2221717] [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] [Accepted: 05/30/2023] [Indexed: 09/20/2023]
Abstract
This paper describes the work of a psychoanalyst working within NHS mental health services in the UK . The central contribution of a psychoanalytic approach within psychiatric care in offering a committed attempt towards understanding the patients' presentation, rather than treatment primarily aimed at symptom control, is described. Beyond this, the specific contribution of psychoanalytic ideas in establishing a containing framework for staff, and how this strengthens the capacity of the organisation as a whole to contain anxiety and to metabolize complex projective processes is outlined. Examples are given with clinical illustrations of activities which enhance this capacity in ordinary times.The author then turns to the impact of the covid-19 pandemic upon staff and patients, describing how fear, threat and experiences of multiple losses have permeated all areas of our lives and activated primitive defences. The pandemic starkly revealed profoundly disturbing questions about our assumptions and habits, adding to the intensity and multi-layered quality of the anxieties evoked . Urgent attention has been drawn to our deeply problematic relationship with the natural world, our own habitat, and indefensible social inequities have been crudely exposed. Staff have been caught between their own fear, the need to contain increased disturbance in their patients, already struggling with fragmented and disordered states of mind, and pressures from an organisation under intense strain. The capacity of mental health staff to act as containers for their patient's distress has been profoundly challenged and compromised.This paper outlines how the pandemic has highlighted the crucial role of the organisation as a container for anxiety and in supporting staff to do their work in mental health care. In order to strengthen this capacity during the crisis, the author describes how ideas derived from psychoanalytic principles were developed into guidance for NHS Mental Health Trusts during the early days of the pandemic . This guidance was adopted nationally by the Royal College of Psychiatrists and is summarised in this paper.
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Affiliation(s)
- Jo O'Reilly
- Consultant Psychiatrist in Medical Psychotherapy, Member of the British Psychoanalytic Society, Chair of the Medical Psychotherapy Faculty, Royal College of Psychiatrists London, London, UK
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Corrigan O, Hughes S, Danielsen S, Doherty S, Kabir R. The impact of engaging with community groups: asset-based approaches and the lived experience of socially vulnerable populations in the UK. Front Public Health 2023; 11:1156422. [PMID: 37533527 PMCID: PMC10393127 DOI: 10.3389/fpubh.2023.1156422] [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: 02/01/2023] [Accepted: 06/06/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Asset-based approaches to improve citizen wellbeing and address inequalities are now being adopted by public health practitioners. There is some evidence that participatory approaches and the promotion of community assets have the capacity to mitigate against the social determinants that generate health disparities. However, questions remain about how they work in practice. This paper reports on research carried out to provide insight into how a diverse range of community assets support (or not) the wellbeing of vulnerable citizens and to provide an improved understanding of people's lived experiences including the challenges of citizens who belong to community assets face. Two subsequent studies were undertaken in a region of England comprising of two neighboring municipalities where health inequalities are stark. Both municipalities contain within them areas of social deprivation. The initial study was completed in March 2020, 1 week before England's first COVID-19 lockdown restrictions were introduced and the subsequent study was conducted to explore the impact of social restrictions on the community assets forum members. Methods A combined phenomenological and ethnographic methodological approach was adopted for both studies. For the initial study ethnographic methods were used including 42 qualitative face-to-face interviews focusing on the lived experience of participants. Observations, informal conversations, photographs, and field notes were also carried out to allow researchers to become familiar with the setting, to build rapport and trust provide a contextual understanding of the relationship between the activity or place and participants' experiences of wellbeing. For the subsequent study thirty-six interviews (including interviews with community assets leaders) were conducted online or by phone due to COVID-19 social restrictions. Results and discussion The studies' findings support the supposition that these groups are community assets which help ameliorate against the social detriments of health and wellbeing that have led to widening health inequalities in the region. The findings from both studies clearly illustrate the importance of sociality for wellbeing, and that participation in these groups are an important determinant of wellbeing. The data demonstrates how social capital is generated within a range of community groups and spaces. It also conveys the needs and deficits existing within groups highlighting the need to provide more assistance to vulnerable citizens. While most themes were common to all community forums, there were some noticeable place-based differences.
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Affiliation(s)
- Oonagh Corrigan
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Suzanne Hughes
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Scott Danielsen
- Wellbeing and Prevention Team, Colchester City Council, Colchester, United Kingdom
| | - Shannon Doherty
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Russell Kabir
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
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Chilunga FP, Campman S, Galenkamp H, Boyd A, Bolijn R, Leenstra T, Agyemang C, Uiters E, Prins M, Stronks K. Relative contributions of pre-pandemic factors and intra-pandemic activities to differential COVID-19 risk among migrant and non-migrant populations in the Netherlands: lessons for future pandemic preparedness. Int J Equity Health 2023; 22:127. [PMID: 37403097 DOI: 10.1186/s12939-023-01936-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Although risk factors for differences in SARS-CoV-2 infections between migrant and non-migrant populations in high income countries have been identified, their relative contributions to these SARS-CoV-2 infections, which could aid in the preparation for future viral pandemics, remain unknown. We investigated the relative contributions of pre-pandemic factors and intra-pandemic activities to differential SARS-CoV-2 infections in the Netherlands by migration background (Dutch, African Surinamese, South-Asian Surinamese, Ghanaians, Turkish, and Moroccan origin). METHODS We utilized pre-pandemic (2011-2015) and intra-pandemic (2020-2021) data from the HELIUS cohort, linked to SARS-CoV-2 PCR test results from Public Health Service of Amsterdam (GGD Amsterdam). Pre-pandemic factors included socio-demographic, medical, and lifestyle factors. Intra-pandemic activities included COVID-19 risk aggravating and mitigating activities such as physical distancing, use of face masks, and other similar activities. We calculated prevalence ratios (PRs) in the HELIUS population that was merged with GGD Amsterdam PCR test data using robust Poisson regression (SARS-CoV-2 PCR test result as outcome, migration background as predictor). We then obtained the distribution of migrant and non-migrant populations in Amsterdam as of January 2021 from Statistics Netherlands. The migrant populations included people who have migrated themselves as well as their offspring. We used PRs and the population distributions to calculate population attributable fractions (PAFs) using the standard formula. We used age and sex adjusted models to introduce pre-pandemic factors and intra-pandemic activities, noting the relative changes in PAFs. RESULTS From 20,359 eligible HELIUS participants, 8,595 were linked to GGD Amsterdam PCR test data and included in the study. Pre-pandemic socio-demographic factors (especially education, occupation, and household size) resulted in the largest changes in PAFs when introduced in age and sex adjusted models (up to 45%), followed by pre-pandemic lifestyle factors (up to 23%, especially alcohol consumption). Intra-pandemic activities resulted in the least changes in PAFs when introduced in age and sex adjusted models (up to 16%). CONCLUSION Interventions that target pre-pandemic socio-economic status and other drivers of health inequalities between migrant and non-migrant populations are urgently needed at present to better prevent infection disparities in future viral pandemics.
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Affiliation(s)
- Felix P Chilunga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sophie Campman
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam Infection, and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Renee Bolijn
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Tjalling Leenstra
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
- Centre for Infectious Disease Control, National Coordination Centre for Communicable Disease Control, National Institute for Public Health, and the Environment, Bilthoven, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam Infection, and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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25
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Farooqi R, Kooner JS, Zhang W. Associations between polygenic risk score and covid-19 susceptibility and severity across ethnic groups: UK Biobank analysis. BMC Med Genomics 2023; 16:150. [PMID: 37386504 PMCID: PMC10311902 DOI: 10.1186/s12920-023-01584-x] [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: 11/30/2022] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND COVID-19 manifests with huge heterogeneity in susceptibility and severity outcomes. UK Black Asian and Minority Ethnic (BAME) groups have demonstrated disproportionate burdens. Some variability remains unexplained, suggesting potential genetic contribution. Polygenic Risk Scores (PRS) can determine genetic predisposition to disease based on Single Nucleotide Polymorphisms (SNPs) within the genome. COVID-19 PRS analyses within non-European samples are extremely limited. We applied a multi-ethnic PRS to a UK-based cohort to understand genetic contribution to COVID-19 variability. METHODS We constructed two PRS for susceptibility and severity outcomes based on leading risk-variants from the COVID-19 Host Genetics Initiative. Scores were applied to 447,382 participants from the UK-Biobank. Associations with COVID-19 outcomes were assessed using binary logistic regression and discriminative power was validated using incremental area under receiver operating curve (ΔAUC). Variance explained was compared between ethnic groups via incremental pseudo-R2 (ΔR2). RESULTS Compared to those at low genetic risk, those at high risk had a significantly greater risk of severe COVID-19 for White (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.42-1.74), Asian (OR 2.88, 95% CI 1.63-5.09) and Black (OR 1.98, 95% CI 1.11-3.53) ethnic groups. Severity PRS performed best within Asian (ΔAUC 0.9%, ΔR2 0.98%) and Black (ΔAUC 0.6%, ΔR2 0.61%) cohorts. For susceptibility, higher genetic risk was significantly associated with COVID-19 infection risk for the White cohort (OR 1.31, 95% CI 1.26-1.36), but not for Black or Asian groups. CONCLUSIONS Significant associations between PRS and COVID-19 outcomes were elicited, establishing a genetic basis for variability in COVID-19. PRS showed utility in identifying high-risk individuals. The multi-ethnic approach allowed applicability of PRS to diverse populations, with the severity model performing well within Black and Asian cohorts. Further studies with larger sample sizes of non-White samples are required to increase statistical power and better assess impacts within BAME populations.
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Affiliation(s)
- Raabia Farooqi
- Department of Epidemiology and Biostatistics, Imperial College London, London, W2 1PG, UK.
| | - Jaspal S Kooner
- Department of Cardiology, Ealing Hospital, London North West University Healthcare NHS Trust, Middlesex, UB1 3HW, UK
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
- Imperial College Healthcare NHS Trust, London, W12 0HS, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK
| | - Weihua Zhang
- Department of Epidemiology and Biostatistics, Imperial College London, London, W2 1PG, UK
- Department of Cardiology, Ealing Hospital, London North West University Healthcare NHS Trust, Middlesex, UB1 3HW, UK
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Saini P, Porcellato L, Hunt A, Timpson H, Harrison R, Bigland C, Levy C, Brett CE, Forshaw MJ, Hope VD. Impact of the government's restrictions and guidance in relation to "social distancing" on the lives of ethnic minority populations: A mixed methods study. Health Sci Rep 2023; 6:e1356. [PMID: 37347094 PMCID: PMC10279946 DOI: 10.1002/hsr2.1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
Background and Aims The impacts of the COVID-19 pandemic have not been equal, with a disproportionate impact among ethnic minority communities. Structural inequalities in social determinants of health such as housing and employment have contributed to COVID-19's impact on deprived communities, including many ethnic minority communities. To compare (1) how the UK government's "social distancing" restrictions and guidance were perceived and implemented by ethnic minority populations compared to white populations, (2) the impact of restrictions and guidance upon these groups. Methods An explanatory sequential mixed methods study incorporated a quantitative survey and qualitative semi-structured interviews to explore individual perceptions and experiences of COVID-19 and the national restrictions. Survey participants (n = 1587) were recruited from North West England; 60 (4%) participants were from ethnic minority communities. Forty-nine interviews were conducted; 19 (39%) participants were from ethnic minority communities. Interviews were transcribed verbatim and analysed using a thematic approach. Data collection was between April and August 2020. Results Significant differences in demographics and household overcrowding were observed between white vs ethnic minority survey respondents, who were also significantly less confident in their knowledge of COVID-19, less likely to be high-risk drinkers, and marginally more likely to have experienced job loss and/or reduced household income. There were no group differences in wellbeing, perceptions, or nonfinancial impacts. Two inter-related themes included: (1) government guidance, incorporating people's knowledge and understanding of the guidance and their confusion/frustration over messaging; (2) the impacts of restrictions on keyworkers, home-schooling, working from home and changes in lifestyle/wellbeing. Conclusions Further research is needed on the long-term impacts of COVID-19 on ethnic minority communities. If policy responses to COVID-19 are to benefit ethnic minority communities, there is a need for future studies to consider fundamental societal issues, such as the role of housing and economic disadvantage.
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Affiliation(s)
- Pooja Saini
- School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Lorna Porcellato
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | - Anna Hunt
- School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Hannah Timpson
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | - Rebecca Harrison
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | | | - Conan Levy
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | | | - Mark J. Forshaw
- School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Vivian D. Hope
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
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Buffel T, Yarker S, Phillipson C, Lang L, Lewis C, Doran P, Goff M. Locked down by inequality: Older people and the COVID-19 pandemic. URBAN STUDIES (EDINBURGH, SCOTLAND) 2023; 60:1465-1482. [PMID: 37273496 PMCID: PMC10230293 DOI: 10.1177/00420980211041018] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper develops the argument that post-COVID-19 recovery strategies need to focus on building back fairer cities and communities, and that this requires a strong embedding of 'age-friendly' principles to support marginalised groups of older people, especially those living in deprived urban neighbourhoods, trapped in poor quality housing. It shows that older people living in such areas are likely to experience a 'double lockdown' as a result of restrictions imposed by social distancing combined with the intensification of social and spatial inequalities. This argument is presented as follows: first, the paper examines the disproportionate impact of COVID-19 on older people, highlighting how the pandemic is both creating new and reinforcing existing inequalities in ageing along the lines of gender, class, ethnicity, race, ability and sexuality. Second, the paper explores the role of spatial inequalities in the context of COVID-19, highlighting how the pandemic is having a disproportionate impact on deprived urban areas already affected by cuts to public services, the loss of social infrastructure and pressures on the voluntary sector. Finally, the paper examines how interrelated social inequalities at both the individual and spatial level are affecting the lives of older people living in deprived urban neighbourhoods during the pandemic. The paper concludes by developing six principles for 'age-friendly' community recovery planning aimed at maintaining and improving the quality of life and wellbeing of older residents in the post-pandemic city.
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Wiśniowski A, Allen R, Aparicio-Castro A, Olsen W, Islam M. The economic impact of the COVID-19 pandemic on ethnic minorities in Manchester: lessons from the early stage of the pandemic. FRONTIERS IN SOCIOLOGY 2023; 8:1139258. [PMID: 37274606 PMCID: PMC10237338 DOI: 10.3389/fsoc.2023.1139258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
This review summarizes the economic impacts of the pandemic on ethnic minorities, focusing on the city of Manchester. It utilizes multiple reporting sources to explore various dimensions of the economic shock in the UK, linking this to studies of pre-COVID-19 economic and ethnic composition in Manchester and in the combined authority area of Greater Manchester. We then make inferences about the pandemic's short-term impact specific to the city region. Greater Manchester has seen some of the highest rates of COVID-19 and as a result faced particularly stringent "lockdown" regulations. Manchester is the sixth most deprived Local Authority in England, according to 2019 English Indices of Multiple Deprivation. As a consequence, many neighborhoods in the city were always going to be less resilient to the economic shock caused by the pandemic compared with other, less-deprived, areas. Particular challenges for Manchester include the high rates of poor health, low-paid work, low qualifications, poor housing conditions and overcrowding. Ethnic minority groups also faced disparities long before the onset of the pandemic. Within the UK, ethnic minorities were found to be most disadvantaged in terms of employment and housing-particularly in large urban areas containing traditional settlement areas for ethnic minorities. Further, all Black, Asian, and Minority ethnic (BAME) groups in Greater Manchester were less likely to be employed pre-pandemic compared with White people. For example, people of Pakistani and Bangladeshi ethnic backgrounds, especially women, have the lowest levels of employment in Greater Manchester. Finally, unprecedented cuts to public spending as a result of austerity have also disproportionately affected women of an ethnic minority background alongside disabled people, the young and those with no or low-level qualifications. This environment has created and sustained a multiplicative disadvantage for Manchester's ethnic minority residents through the course of the COVID-19 pandemic.
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Affiliation(s)
- Arkadiusz Wiśniowski
- Social Statistics Department, The University of Manchester, Manchester, United Kingdom
| | - Ruth Allen
- Social Statistics Department, The University of Manchester, Manchester, United Kingdom
| | | | - Wendy Olsen
- Social Statistics Department, The University of Manchester, Manchester, United Kingdom
| | - Maydul Islam
- Policy@Manchester, The University of Manchester, Manchester, United Kingdom
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Forbes L, Armes J, Shafi S, Mohamed A, Mustafa R, Dar O, Vandrevala T, Amlôt R, Hayward A, Asaria M, Pirani T, Weston D, Shah S, Zumla A, Ala A. Novel intervention to promote COVID-19 protective behaviours among Black and South Asian communities in the UK: protocol for a mixed-methods pilot evaluation. BMJ Open 2023; 13:e061207. [PMID: 37041047 PMCID: PMC10105914 DOI: 10.1136/bmjopen-2022-061207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Culturally appropriate interventions to promote COVID-19 health protective measures among Black and South Asian communities in the UK are needed. We aim to carry out a preliminary evaluation of an intervention to reduce risk of COVID-19 comprising a short film and electronic leaflet. METHODS AND ANALYSIS This mixed methods study comprises (1) a focus group to understand how people from the relevant communities interpret and understand the intervention's messages, (2) a before-and-after questionnaire study examining the extent to which the intervention changes intentions and confidence to carry out COVID-19 protective behaviours and (3) a further qualitative study exploring the views of Black and South Asian people of the intervention and the experiences of health professionals offering the intervention. Participants will be recruited through general practices. Data collection will be carried out in the community. ETHICS AND DISSEMINATION The study received Health Research Authority approval in June 2021 (Research Ethics Committee Reference 21/LO/0452). All participants provided informed consent. As well as publishing the findings in peer-reviewed journals, we will disseminate the findings through the UK Health Security Agency, NHS England and the Office for Health Improvement and Disparities and ensure culturally appropriate messaging for participants and other members of the target groups.
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Affiliation(s)
- Lindsay Forbes
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Shuja Shafi
- Mass Gatherings and Global Health Network, Harrow, UK
| | - Amran Mohamed
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Reham Mustafa
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Osman Dar
- Global Public Health Directorate, UK Health Security Agency, London, UK
| | - Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, UK
| | - Richard Amlôt
- Epidemiological and Behavioural Sciences Directorate, UK Health Security Agency, London, UK
| | - Andrew Hayward
- Epidemiology and Public Health, University College London, London, UK
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics, London, UK
| | - Tasneem Pirani
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Dale Weston
- Epidemiological and Behavioural Sciences Directorate, UK Health Security Agency, London, UK
| | | | - Alimuddin Zumla
- Infection and Immunity, University College London, London, UK
| | - Aftab Ala
- Gastroenterology and Hepatology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Institute of Liver Studies, King's College Hospital, London, UK
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30
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Lokugamage AU, Rix EL, Fleming T, Khetan T, Meredith A, Hastie CR. Translating Cultural Safety to the UK. JOURNAL OF MEDICAL ETHICS 2023; 49:244-251. [PMID: 34282043 DOI: 10.1136/medethics-2020-107017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.
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Affiliation(s)
- Amali U Lokugamage
- Department of Clinical and Professional Practice, University College London Medical School, London, UK
- Department of Women's Health, Whittington Health NHS Trust, London, UK
| | - Elizabeth Liz Rix
- Faculty of Health, Southern Cross University, Gold Coast Campus, Bilinga, Queensland, Australia
| | - Tania Fleming
- School of Midwifery, Auckland University of Technology, Auckland, New Zealand
| | - Tanvi Khetan
- University College London Medical School Alumni, University College London, London, UK
| | - Alice Meredith
- University College London Medical School Alumni, University College London, London, UK
| | - Carolyn Ruth Hastie
- Department of Nursing and Midwifery, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
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Murali M, Gumber L, Jethwa H, Ganesh D, Hartmann-Boyce J, Sood H, Zaccardi F, Khunti K. Ethnic minority representation in UK COVID-19 trials: systematic review and meta-analysis. BMC Med 2023; 21:111. [PMID: 36978166 PMCID: PMC10049782 DOI: 10.1186/s12916-023-02809-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted health disparities affecting ethnic minority communities. There is growing concern about the lack of diversity in clinical trials. This study aimed to assess the representation of ethnic groups in UK-based COVID-19 randomised controlled trials (RCTs). METHODS A systematic review and meta-analysis were undertaken. A search strategy was developed for MEDLINE (Ovid) and Google Scholar (1st January 2020-4th May 2022). Prospective COVID-19 RCTs for vaccines or therapeutics that reported UK data separately with a minimum of 50 participants were eligible. Search results were independently screened, and data extracted into proforma. Percentage of ethnic groups at all trial stages was mapped against Office of National Statistics (ONS) statistics. Post hoc DerSimonian-Laird random-effects meta-analysis of percentages and a meta-regression assessing recruitment over time were conducted. Due to the nature of the review question, risk of bias was not assessed. Data analysis was conducted in Stata v17.0. A protocol was registered (PROSPERO CRD42021244185). RESULTS In total, 5319 articles were identified; 30 studies were included, with 118,912 participants. Enrolment to trials was the only stage consistently reported (17 trials). Meta-analysis showed significant heterogeneity across studies, in relation to census-expected proportions at study enrolment. All ethnic groups, apart from Other (1.7% [95% CI 1.1-2.8%] vs ONS 1%) were represented to a lesser extent than ONS statistics, most marked in Black (1% [0.6-1.5%] vs 3.3%) and Asian (5.8% [4.4-7.6%] vs 7.5%) groups, but also apparent in White (84.8% [81.6-87.5%] vs 86%) and Mixed 1.6% [1.2-2.1%] vs 2.2%) groups. Meta-regression showed recruitment of Black participants increased over time (p = 0.009). CONCLUSIONS Asian, Black and Mixed ethnic groups are under-represented or incorrectly classified in UK COVID-19 RCTs. Reporting by ethnicity lacks consistency and transparency. Under-representation in clinical trials occurs at multiple levels and requires complex solutions, which should be considered throughout trial conduct. These findings may not apply outside of the UK setting.
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Affiliation(s)
- Mayur Murali
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Leher Gumber
- Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Hannah Jethwa
- London North West University Healthcare NHS Trust, London, UK
| | | | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Guraya SS, Menezes P, Lawrence IN, Guraya SY, Rashid-Doubell F. Evaluating the impact of COVID-19 pandemic on the physicians' psychological health: A systematic scoping review. Front Med (Lausanne) 2023; 10:1071537. [PMID: 37056734 PMCID: PMC10086257 DOI: 10.3389/fmed.2023.1071537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundCOVID-19 has endangered healthcare systems at multiple levels worldwide. Published data suggests that moral dilemmas faced during these unprecedented times have placed physicians at the intersections of ethical and unethical considerations. This phenomenon has questioned the physicians' morality and how that has affected their conduct. The purpose of our review is to tap into the spectrum of the transforming optics of patient care during the pandemic and its impact on psychological wellbeing of physicians.MethodsWe adopted the Arksey and O'Malley's framework, defining research questions, identifying relevant studies, selecting the studies using agreed inclusion and exclusion criteria, charting the data, and summarizing and reporting results. Databases of PubMed/Medline, Web of Science, Scopus, Science Direct, CINAHL, and PsycInfo were searched using a predefined search string. The retrieved titles and abstracts were reviewed. Later, a detailed full-text analysis of the studies which matched our inclusion criteria was performed.ResultsOur first search identified 875 titles and abstracts. After excluding duplicates, irrelevant, and incomplete titles, we selected 28 studies for further analysis. The sample size in 28 studies was 15,509 with an average size of 637 per study. Both quantitative and qualitative approaches were used, with cross-sectional surveys being utilized in all 16 quantitative studies. Using the data from semi-structured interviews, several discrete codes were generated, which led to the identification of five main themes; mental health, individual challenges, decision-making, change in patient care, and support services.ConclusionThis scoping review reports an alarming rise in psychological distress, moral injury, cynicism, uncertainty, burnout, and grief among physicians during the pandemic. Decision-making and patient care were mostly regulated by rationing, triaging, age, gender, and life expectancy. Poor professional controls and institutional services potentially led to physicians' crumbling wellbeing. This research calls for the remediation of the deteriorating mental health and a restoration of medical profession's advocacy and equity.
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Affiliation(s)
- Shaista S. Guraya
- School of Medicine, Royal College of Surgeons Ireland – Medical University Bahrain, Muharraq, Bahrain
| | - Prianna Menezes
- School of Medicine, Royal College of Surgeons Ireland – Medical University Bahrain, Muharraq, Bahrain
| | | | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Salman Yousuf Guraya
| | - Fiza Rashid-Doubell
- School of Medicine, Royal College of Surgeons Ireland – Medical University Bahrain, Muharraq, Bahrain
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Zaccardi F, Tan PS, Shah BR, Everett K, Clift AK, Patone M, Saatci D, Coupland C, Griffin SJ, Khunti K, Dambha-Miller H, Hippisley-Cox J. Ethnic disparities in COVID-19 outcomes: a multinational cohort study of 20 million individuals from England and Canada. BMC Public Health 2023; 23:399. [PMID: 36849983 PMCID: PMC9969387 DOI: 10.1186/s12889-023-15223-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Heterogeneous studies have demonstrated ethnic inequalities in the risk of SARS-CoV-2 infection and adverse COVID-19 outcomes. This study evaluates the association between ethnicity and COVID-19 outcomes in two large population-based cohorts from England and Canada and investigates potential explanatory factors for ethnic patterning of severe outcomes. METHODS We identified adults aged 18 to 99 years in the QResearch primary care (England) and Ontario (Canada) healthcare administrative population-based datasets (start of follow-up: 24th and 25th Jan 2020 in England and Canada, respectively; end of follow-up: 31st Oct and 30th Sept 2020, respectively). We harmonised the definitions and the design of two cohorts to investigate associations between ethnicity and COVID-19-related death, hospitalisation, and intensive care (ICU) admission, adjusted for confounders, and combined the estimates obtained from survival analyses. We calculated the 'percentage of excess risk mediated' by these risk factors in the QResearch cohort. RESULTS There were 9.83 million adults in the QResearch cohort (11,597 deaths; 21,917 hospitalisations; 2932 ICU admissions) and 10.27 million adults in the Ontario cohort (951 deaths; 5132 hospitalisations; 1191 ICU admissions). Compared to the general population, pooled random-effects estimates showed that South Asian ethnicity was associated with an increased risk of COVID-19 death (hazard ratio: 1.63, 95% CI: 1.09-2.44), hospitalisation (1.53; 1.32-1.76), and ICU admission (1.67; 1.23-2.28). Associations with ethnic groups were consistent across levels of deprivation. In QResearch, sociodemographic, lifestyle, and clinical factors accounted for 42.9% (South Asian) and 39.4% (Black) of the excess risk of COVID-19 death. CONCLUSION International population-level analyses demonstrate clear ethnic inequalities in COVID-19 risks. Policymakers should be cognisant of the increased risks in some ethnic populations and design equitable health policy as the pandemic continues.
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Affiliation(s)
- Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, England
| | - Pui San Tan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Baiju R Shah
- Department of Medicine, University of Toronto; Division of Endocrinology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Karl Everett
- Department of Medicine, University of Toronto; Division of Endocrinology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Ash Kieran Clift
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
- Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, England
| | - Martina Patone
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Defne Saatci
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Carol Coupland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, England
| | - Simon J Griffin
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, England
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, England
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, England
| | | | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England.
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Valero-Martínez C, Martínez-Rivera C, Zhen-Duan J, Fukuda M, Alegría M. Attitudes toward COVID-19 Vaccine Uptake: A Qualitative Study of Mostly Immigrant Racial/Ethnic Minority Older Adults. Geriatrics (Basel) 2023; 8:17. [PMID: 36826359 PMCID: PMC9956127 DOI: 10.3390/geriatrics8010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
(1) Background: Few qualitative studies address diverse older adults' perceptions of COVID-19 vaccination in the United States, including non-English speakers and immigrant populations. This study aims to understand the attitudes of diverse, primarily immigrant older adults in the U.S. toward the COVID-19 vaccine and its influences on their vaccination decision-making. (2) Methods: The research team conducted semi-structured interviews (N = 100) in 2021 focused on understanding ethnically/racially diverse older adults' perceptions of the COVID-19 vaccine. Interviews were recorded, coded, and analyzed using a thematic analysis approach. (3) Results: Thematic analyses identified three themes. (1) Older adults showed mixed attitudes toward the COVID-19 vaccine associated with information consumed and trust in healthcare systems; (2) health concerns and underlying medical conditions were the most influential factors of vaccine uptake; and (3) systemic barriers and trusted figures impacted vaccination decision-making of older adults. (4) Conclusions: Accessible information in diverse languages tailored to the community's fears is needed to combat vaccine mistrust. Vaccine rollout programs need to tackle the fear of vaccine side effects. Attitudes of religious leaders, family members, and physicians considerably influenced vaccine uptake, suggesting their role as trusted members for vaccine messaging for older, primarily immigrant adults. Systemic barriers, namely lack of transportation and inaccessible vaccination sites, contributed to vaccine deterrence.
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Affiliation(s)
- Carla Valero-Martínez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychology, Faculty of Social Sciences, Río Piedras Campus, University of Puerto Rico, San Juan, PR 00925, USA
| | - Christopher Martínez-Rivera
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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Majee W, Anakwe A, Onyeaka K, Harvey IS. The Past Is so Present: Understanding COVID-19 Vaccine Hesitancy Among African American Adults Using Qualitative Data. J Racial Ethn Health Disparities 2023; 10:462-474. [PMID: 35182372 PMCID: PMC8857529 DOI: 10.1007/s40615-022-01236-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND African Americans (AAs) are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. OBJECTIVE The present study aims to explore vaccine attitudes and intentions among program participants, understand the role of an African American faith-based wellness program in COVID-19 awareness and vaccine uptake, and solicit potential solutions for this deep-rooted public health problem. METHODS Data were collected through 21 in-depth interviews among individuals involved within a community-based wellness program. Sixteen phone and five in-person interviews were conducted with church leaders, lifestyle coaches, and program participants. All interviews were audio-recorded, transcribed verbatim, and inductively and thematically analyzed by three researchers. FINDINGS Live Well by Faith (LWBF) acted as a trusted information source for COVID-19 resources for the AA community. Services provided by Live Well by Faith included enrolling community members for vaccines, negotiating vaccine provision to and facilitating the establishment of vaccine clinics at AA churches, and connecting community members to healthcare providers. Despite the role Live Well by Faith played, VH was a significant concern due, in part, to historical mistrust of government and pharmaceutical companies conducting unethical healthcare research among Black populations. Other factors included uncertainty about vaccination (vaccines' safety, efficacy, and necessity), social media misinformation, and political affiliation. Participants expressed the need for government to commit resources towards addressing historical factors and building trust with minority populations. CONCLUSION Resource targeting programs such as Live Well by Faith that engage faith and community leaders in co-designed shared and culturally grounded interventions can help restore and strengthen trust in vaccines and governments and reduce vaccine hesitancy.
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Affiliation(s)
- Wilson Majee
- Department of Health Sciences, University of Missouri, Columbia, MO USA ,Department of Occupational Therapy, Faculty of Community & Health Science, University of the Western Cape, Cape Town, South Africa
| | - Adaobi Anakwe
- Department of Health Sciences, University of Missouri, Columbia, MO USA
| | - Kelechi Onyeaka
- Masters of Public Health Program, University of Missouri, Columbia, MO USA
| | - Idethia S. Harvey
- Department of Health Sciences, University of Missouri, Columbia, MO USA
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Hernandez-Salinas C, Marsiglia FF, Oh H, Campos AP, De La Rosa K. Community Health Workers as Puentes/Bridges to Increase COVID-19 Health Equity in Latinx Communities of the Southwest U.S. J Community Health 2022; 48:398-413. [PMID: 36536085 PMCID: PMC9762869 DOI: 10.1007/s10900-022-01182-5] [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] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.
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Affiliation(s)
- Christopher Hernandez-Salinas
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Flavio F. Marsiglia
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Hyunsung Oh
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Ana Paola Campos
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
| | - Kate De La Rosa
- Global Center for Applied Health Research, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 720, Mail Code 4320, Phoenix, AZ 85004 USA
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Deane J, Norris R, O’Hara J, Patterson J, Sharp L. Who Presents Where? A Population-Based Analysis of Socio-Demographic Inequalities in Head and Neck Cancer Patients' Referral Routes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16723. [PMID: 36554605 PMCID: PMC9779534 DOI: 10.3390/ijerph192416723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Head and neck cancers (HNC) are often late stage at diagnosis; stage is a major determinant of prognosis. The urgent cancer referral pathway (two week wait; 2WW) within England's National Health Service aims to reduce time to diagnosis. We investigated factors associated with HNC route to diagnosis. Data were obtained from the English population-based cancer registry on 66,411 primary invasive HNCs (ICD C01-14 and C31-32) diagnosed 2006-2014. Multivariable logistic regression determined the likelihood of different diagnosis routes by patients' demographic and clinical characteristics. Significant socio-demographic inequalities were observed. Emergency presentations declined over time and 2WW increased. Significant socio-demographic inequalities were observed. Non-white patients, aged over 65, residing in urban areas with advanced disease, were more likely to have emergency presentations. White males aged 55 and older with an oropharynx cancer were more likely to be diagnosed via 2WW. Higher levels of deprivation were associated with both emergency and 2WW routes. Dental referral was more likely in women, with oral cancers and lower stage disease. Despite the decline over time in emergency presentation and the increased use of 2WW, socio-demographic variation is evident in routes to diagnosis. Further work exploring the reasons for these inequalities, and the consequences for patients' care and outcomes, is urgently required.
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Affiliation(s)
- Jennifer Deane
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
| | - Ruth Norris
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
| | - James O’Hara
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
- Freeman Hospital, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne NE7 7DN, UK
| | - Joanne Patterson
- School of Health Sciences, Institute of Population Health, University of Liverpool, Liverpool L69 7ZX, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
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Wing K, Grint DJ, Mathur R, Gibbs HP, Hickman G, Nightingale E, Schultze A, Forbes H, Nafilyan V, Bhaskaran K, Williamson E, House T, Pellis L, Herrett E, Gautam N, Curtis HJ, Rentsch CT, Wong AYS, MacKenna B, Mehrkar A, Bacon S, Douglas IJ, Evans SJW, Tomlinson L, Goldacre B, Eggo RM. Association between household composition and severe COVID-19 outcomes in older people by ethnicity: an observational cohort study using the OpenSAFELY platform. Int J Epidemiol 2022; 51:1745-1760. [PMID: 35962974 PMCID: PMC9384728 DOI: 10.1093/ije/dyac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/22/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Ethnic differences in the risk of severe COVID-19 may be linked to household composition. We quantified the association between household composition and risk of severe COVID-19 by ethnicity for older individuals. METHODS With the approval of NHS England, we analysed ethnic differences in the association between household composition and severe COVID-19 in people aged 67 or over in England. We defined households by number of age-based generations living together, and used multivariable Cox regression stratified by location and wave of the pandemic and accounted for age, sex, comorbidities, smoking, obesity, housing density and deprivation. We included 2 692 223 people over 67 years in Wave 1 (1 February 2020-31 August 2020) and 2 731 427 in Wave 2 (1 September 2020-31 January 2021). RESULTS Multigenerational living was associated with increased risk of severe COVID-19 for White and South Asian older people in both waves [e.g. Wave 2, 67+ living with three other generations vs 67+-year-olds only: White hazard ratio (HR) 1.61 95% CI 1.38-1.87, South Asian HR 1.76 95% CI 1.48-2.10], with a trend for increased risks of severe COVID-19 with increasing generations in Wave 2. There was also an increased risk of severe COVID-19 in Wave 1 associated with living alone for White (HR 1.35 95% CI 1.30-1.41), South Asian (HR 1.47 95% CI 1.18-1.84) and Other (HR 1.72 95% CI 0.99-2.97) ethnicities, an effect that persisted for White older people in Wave 2. CONCLUSIONS Both multigenerational living and living alone were associated with severe COVID-19 in older adults. Older South Asian people are over-represented within multigenerational households in England, especially in the most deprived settings, whereas a substantial proportion of White older people live alone. The number of generations in a household, number of occupants, ethnicity and deprivation status are important considerations in the continued roll-out of COVID-19 vaccination and targeting of interventions for future pandemics.
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Affiliation(s)
- Kevin Wing
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel J Grint
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hamish P Gibbs
- Department of Geography, University College London, London, UK
| | - George Hickman
- The DataLab, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Emily Nightingale
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Schultze
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Harriet Forbes
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Vahé Nafilyan
- Health Modelling Hub, Office of National Statistics, Newport, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Williamson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas House
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Lorenzo Pellis
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Emily Herrett
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nileesa Gautam
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Aetion Inc, Boston, USA
| | - Helen J Curtis
- The DataLab, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Angel Y S Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Brian MacKenna
- The DataLab, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Amir Mehrkar
- The DataLab, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Seb Bacon
- The DataLab, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Ian J Douglas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen J W Evans
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Laurie Tomlinson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Goldacre
- The DataLab, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Rosalind M Eggo
- The DataLab, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
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Implicit and explicit ethnic biases in multicultural primary care: the case of trainee general practitioners. BMC PRIMARY CARE 2022; 23:91. [PMID: 35448943 PMCID: PMC9027448 DOI: 10.1186/s12875-022-01698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
General Practitioners (GPs) are the first point of contact for people from ethnic and migrant groups who have health problems. Discrimination can occur in this health care sector. Few studies, however, have investigated implicit and explicit biases in general practice against ethnic and migrant groups. This study, therefore, investigated the extent of implicit ethnic biases and willingness to adapt care to migrant patients among trainee GPs, and the factors involved therein, in order to measure explicit bias and explore a dimension of cultural competence.
Methods
In 2021, data were collected from 207 trainee GPs in the French-speaking part of Belgium. The respondents passed an Implicit Association Test (IAT), a validated tool used to measure implicit biases against ethnic groups. An explicit attitude of willingness to adapt care to diversity, one of the dimensions of cultural competence, was measured using the Hudelson scale.
Results
The overwhelming majority of trainee GPs (82.6%, 95% CI: 0.77 – 0.88) had implicit preferences for their ingroup to the detriment of ethnic and migrant groups. Overall, the majority of respondents considered it the responsibility of GPs to adapt their attitudes and practices to migrants’ needs. More than 50% of trainee GPs, however, considered it the responsibility of migrant patients to adapt to the values and habits of the host country.
Conclusions
This study found that the trainee GPs had high to very high levels of implicit ethnic bias and that they were not always willing to adapt care to the values of migrants. We therefore recommend that they are made aware of this bias and we recommend using the IAT and Hudelson scales as educational tools to address ethnic biases in primary care.
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Masters NB, Zhou T, Meng L, Lu PJ, Kriss JL, Black C, Omari A, Boone K, Weiss D, Carter RJ, Brewer NT, Singleton JA. Geographic Heterogeneity in Behavioral and Social Drivers of COVID-19 Vaccination. Am J Prev Med 2022; 63:883-893. [PMID: 36404022 PMCID: PMC9296705 DOI: 10.1016/j.amepre.2022.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/27/2022] [Accepted: 06/27/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Little is known about how the drivers of COVID-19 vaccination vary across the U.S. To inform vaccination outreach efforts, this study explores geographic variation in correlates of COVID-19 nonvaccination among adults. METHODS Participants were a nationally representative sample of U.S. adults identified through random-digit dialing for the National Immunization Survey-Adult COVID Module. Analyses examined the geographic and temporal landscape of constructs in the Behavioral and Social Drivers of Vaccination Framework among unvaccinated respondents from May 2021 to December 2021 (n=531,798) and sociodemographic and geographic disparities and Behavioral and Social Drivers of Vaccination predictors of COVID-19 nonvaccination from October 2021 to December 2021 (n=187,756). RESULTS National coverage with at least 1 dose of COVID-19 vaccine was 79.3% by December 2021, with substantial geographic heterogeneity. Regions with the largest proportion of unvaccinated persons who would probably get a COVID-19 vaccine or were unsure resided in the Southeast and Midwest (Health and Human Services Regions 4 and 5). Both regions had similar temporal trends regarding concerns about COVID-19 and confidence in vaccine importance, although the Southeast had especially low confidence in vaccine safety in December 2021, lowest in Florida (5.5%) and highest in North Carolina (18.0%). The strongest Behavioral and Social Drivers of Vaccination correlate of not receiving a COVID-19 vaccination was lower confidence in COVID-19 vaccine importance (adjusted prevalence ratio=5.19, 95% CI=4.93, 5.47; strongest in the Northeast, Southwest, and Mountain West and weakest in the Southeast and Midwest). Other Behavioral and Social Drivers of Vaccination correlates also varied by region. CONCLUSIONS Contributors to nonvaccination showed substantial geographic heterogeneity. Strategies to improve COVID-19 vaccination uptake may need to be tailored regionally.
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Affiliation(s)
- Nina B Masters
- The Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Tianyi Zhou
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Leidos Inc., Atlanta, Georgia
| | - Lu Meng
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L Kriss
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carla Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amel Omari
- The Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Kwanza Boone
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debora Weiss
- Career Epidemiology Field Officer, Wyoming Department of Health, Cheyenne, Wyoming
| | - Rosalind J Carter
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Noel T Brewer
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; The UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James A Singleton
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Marie Reinhart A, Tian Y, Lilly AE. The role of trust in COVID-19 vaccine hesitancy and acceptance among Black and White Americans. Vaccine 2022; 40:7247-7254. [PMID: 36333223 PMCID: PMC9618447 DOI: 10.1016/j.vaccine.2022.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Mass vaccination has been identified as the easiest way to combat the deadly spread of the coronavirus (COVID-19) disease, yet many Americans are still hesitant to be vaccinated. To understand motivations behind why someone is vaccine hesitant, we conceptualized a theoretical model in which demographic variables are positively associated with four types of trust (i.e., trust in institutions, physicians, non-discrimination, and social media). These trust variables, in turn, are positively associated with the outcome variable of vaccine acceptance. A multi-group structural equation modeling analysis of survey data from 1008 U.S. adults suggested that trust in institutions and physicians were important for both White and Black Americans in whether they were vaccine accepting or hesitant, while trust in non-discrimination was important for Black Americans and trust in social media was important for White Americans. Implications of the findings and how they can inform future vaccine campaigns are discussed.
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Affiliation(s)
| | - Yan Tian
- University of Missouri, Saint Louis, USA.
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Paul E, Fancourt D, Razai M. Racial discrimination, low trust in the health system and COVID-19 vaccine uptake: a longitudinal observational study of 633 UK adults from ethnic minority groups. J R Soc Med 2022; 115:439-447. [PMID: 35512716 PMCID: PMC9723809 DOI: 10.1177/01410768221095241] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To examine whether racial/ethnic discrimination predicts future COVID-19 vaccine refusal, and whether this association is explained by trust in government and the health system. DESIGN Longitudinal observational study of racial/ethnic discrimination occurring since the start of the first lockdown (measured in July 2020) and later COVID-19 vaccine status. SETTING UK (England, Scotland, Wales and Northern Ireland). PARTICIPANTS A total of 633 adults belonging to ethnic minority groups who took part in the UCL COVID-19 Social Study. MAIN OUTCOME MEASURES COVID-19 vaccine refusal (vs. accepted/waiting/had at least one dose) between 23 December 2020 and 14 June 2021. RESULTS Nearly 1 in 10 (6.69%) who had refused a COVID-19 vaccine had experienced racial/ethnic discrimination in a medical setting since the start of the pandemic and had experienced twice as many incidents of racial/ethnic discrimination than those who had accepted the vaccine. Structural equation modelling results indicated a nearly four fold (odds ratio = 3.91, 95% confidence interval = 1.40 to 10.92) total effect of racial/ethnic discrimination on refusing the vaccine which was mediated by low trust in the health system to handle the pandemic (odds ratio = 2.49, 95% confidence interval = 1.12 to 5.39). Analyses adjusted for a range of demographic and COVID-19 related factors. CONCLUSIONS Findings underscore the importance of addressing racial/ethnic discrimination and the role the National Health Service in regaining trust from ethnic minority groups to increase COVID-19 vaccine uptake among ethnic minority adults.
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Affiliation(s)
- Elise Paul
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health, University College London, London, WC1E 7HB, UK
| | - Daisy Fancourt
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
| | - Mohammad Razai
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
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Arday J, Jones C. Same storm, different boats: the impact of COVID-19 on Black students and academic staff in UK and US higher education. HIGHER EDUCATION 2022:1-22. [PMID: 36310611 PMCID: PMC9593978 DOI: 10.1007/s10734-022-00939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
The permanence of systemic racism in the UK and USA means that Black people are disadvantaged in myriad ways, including within the Academy. While the disproportionate impact of COVID-19, alongside the Black Lives Matter movement, has increased awareness of the challenges faced by Black communities, these issues remain, both in and beyond higher education. Furthermore, there is still a paucity of research individualising the experiences of Black people, who are often homogenised with other ethnic minority groups. This paper explores the impact of COVID-19 on UK and US Black students and academic staff, utilising a critical race theory (CRT) framework. Analysis revealed that Black students and staff experienced COVID-19 against the backdrop of racism as a "pandemic within a pandemic" (Laurencin and Walker, Cell Systems 11:9-10, 2020), including racial (re)traumatisation, loneliness and isolation. Other themes included precarious employment and exploitation. Recommendations are offered for penetrative interventions that can support Black students and staff in the wake of strained race relations neglecting their adverse experiences and a global pandemic.
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Affiliation(s)
- Jason Arday
- School of Education, St Andrew’s Building, University of Glasgow, 11 Eldon Street, Glasgow, G3 6NH UK
| | - Christopher Jones
- Department of Sociology, Higher Education and Social Inequalities, Durham University, 32 Old Elvet, Durham, DH1 3HN UK
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44
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Nguyen HA. The 3%: Positive action for positive change. EDUCATION FOR INFORMATION 2022. [DOI: 10.3233/efi-220053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In 2019 The King’s Fund Library Service in the UK created a positive action graduate traineeship aimed at correcting the lack of ethnic diversity within the library and information profession in the United Kingdom. This commentary, anchored in the critical race theory tenet of counter-narrative, examines the establishment of this post through the lens of critical race theory, providing insight into how white supremacy presents itself in the implementation of anti-racist recruitment practices.
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Jayasinghe K, Jayasinghe T, Wijethilake C, Adhikari P. Bio-Politics and Calculative Technologies in COVID-19 Governance: Reflections From England. Int J Health Policy Manag 2022; 11:2189-2197. [PMID: 34814665 PMCID: PMC9808288 DOI: 10.34172/ijhpm.2021.134] [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: 03/04/2021] [Accepted: 09/19/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Through the extensive use of public media, the government of England was heavily involved in encouraging and instructing people on how to manage their life during coronavirus disease 2019 (COVID-19). This model of health emergency governance replicates the practice of 'calculative technologies' and 'bio-politics' embedded in population management. Previous research on COVID-19 governance both in the United Kingdom and beyond provides varied revelations on broader 'technologies of government' and bio-politics by numerous governments. However, rarely have any studies explicitly and distinctively highlighted the unique 'calculative technologies' mobilised by governments within their bio-politically designed "technologies of government" to compel the populations to manage their lives under their COVID-19 guidance. The paper therefor examines how the UK government deployed "calculative technologies," as part of its strategies of health governance and governmentality during the first wave of COVID-19 in England. METHODS This study uses document analysis as its data collection method. Its review includes documents, press releases, social media disclosures and health guidance issued by the UK government from March to December, 2020. The data are analysed employing the Foucault's governmentality and bio-political scholarship. RESULTS The paper's findings reveal the UK government's use of integrated calculative technologies of self-governance in the form of risk calculations and metrices/statistics (eg, death tolls, infection rates), performance management (eg, two metre social distancing, and hand washing for twenty seconds) and discipline and control (eg, fourteen days self-isolation), in addition to a more conventional top-down, managerial decision-making process adopted in the past. By these newly initiated "calculative technologies," the government has "bio-politically" governed the behaviours and lifestyles of vulnerable community members, health workers and general public at a distance, inculcating self-management and individualisation of responsibility. CONCLUSION The newly adopted calculative technologies used by the UK government created a multi-faceted discourse of obligations, entitlements and scale of engagement, and facilitated directions about what people should do to protect themselves and others from the spread of the virus. Overall, the overtly and idiosyncratically used calculative technologies resemble a unique 'art of government' and produce a set of 'bio-political' interventions enforcing the populations to manage their own wellbeing and governing them at a distance during COVID-19.
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Affiliation(s)
| | | | | | - Pawan Adhikari
- Faculty of Social Sciences, University of Essex, Colchester, UK
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Chandok RS, Madar P, Majeed A. A qualitative study of factors influencing COVID-19 vaccine hesitancy among South Asians in London. JRSM Open 2022; 13:20542704221123430. [PMID: 36213844 PMCID: PMC9536136 DOI: 10.1177/20542704221123430] [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] [Indexed: 11/17/2022] Open
Abstract
Objectives This qualitative study sought to elicit the views and experiences of patients and health-care professionals to identify the factors associated with COVID-19 vaccine hesitancy among South Asians in London. Design In-depth semi-structured telephone and virtual interviews. Setting UK. Participants Convenience and purposive sample of 12 individuals including patients, clinicians, and a medical receptionist. Main Outcome Measures Our dataset identifies and explains the reasons for distinguishing between those individuals who are COVID-19 vaccine-hesitant, and those who are COVID-19 vaccine-anxious. Results COVID-19 vaccine hesitancy and the decision on whether to - or not to - vaccinate against COVID-19 involves ongoing and unresolved inner conflict about COVID-19 vaccines. Our findings therefore suggest that some individuals may be existing in a state of inbetweeness; where they are neither pro nor anti vaccination, while simultaneously questioning the many 'truths' surrounding COVID-19 and not just one truth such as the safety of COVID-19 vaccines. We argue that this in-between state is intensified by technology and social media; culminating in the Rashomon Effect, whereby a combination of truths, fractured truths, subjective realities, and unreliable or contradictory sources impact on our perceptions of COVID-19. Conclusions Given the complexities arising from the multiple factors influencing vaccine hesitancy and scepticism, 'quick fixes' and 'one size fits all' solutions to address COVID-19 vaccine hesitancy will be ineffective. Therefore, promoting trust and prioritising good after-care as well as on-going care as a response to the effects of the pandemic is vital.
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Affiliation(s)
- Raj S. Chandok
- Department of Primary Care & Public Health, Imperial College London, London, UK,Raj S. Chandok.
| | - Poonam Madar
- Department of International Politics, City, University of London, London, UK
| | - Azeem Majeed
- Department of Primary Care & Public Health, Imperial College London, London, UK
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Nuwarda RF, Ramzan I, Weekes L, Kayser V. Vaccine Hesitancy: Contemporary Issues and Historical Background. Vaccines (Basel) 2022; 10:vaccines10101595. [PMID: 36298459 PMCID: PMC9612044 DOI: 10.3390/vaccines10101595] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination, despite being recognized as one of the most effective primary public health measures, is viewed as unsafe and unnecessary by an increasing number of individuals. Anxiety about vaccines and vaccination programs leading to vaccine hesitancy results from a complex mix of social and political influences, cultural and religious beliefs, the availability of and ability to interpret health and scientific information, and personal and population experiences of health systems and government policies. Vaccine hesitancy is becoming a serious threat to vaccination programs, and was identified as one of the World Health Organization’s top ten global health threats in 2019. The negative impact of anti-vaccination movements is frequently cited as one of the major reasons for rising vaccine hesitancy amongst the general public world-wide. This review discusses the various issues surrounding vaccine hesitancy and the anti-vaccine movement, starting with the definitions of vaccine hesitancy and the anti-vaccine movement in their early history and in the modern era, before discussing the key drivers of vaccine hesitancy, particularly across different regions of the world, with a focus on various countries with low-, middle-, or high-income economies with different socio-economic populations. The review concludes with the impact of vaccine hesitancy on herd immunity and social, psychological, and public health measures to counter vaccine hesitancy.
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48
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Mullins E, McCabe R, Bird SM, Randell P, Pond MJ, Regan L, Parker E, McClure M, Donnelly CA. Tracking the incidence and risk factors for SARS-CoV-2 infection using historical maternal booking serum samples. PLoS One 2022; 17:e0273966. [PMID: 36054212 PMCID: PMC9439206 DOI: 10.1371/journal.pone.0273966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
The early transmission dynamics of SARS-CoV-2 in the UK are unknown but their investigation is critical to aid future pandemic planning. We tested over 11,000 anonymised, stored historic antenatal serum samples, given at two north-west London NHS trusts in 2019 and 2020, for total antibody to SARS-CoV-2 receptor binding domain (anti-RBD). Estimated prevalence of seroreactivity increased from 1% prior to mid-February 2020 to 17% in September 2020. Our results show higher prevalence of seroreactivity to SARS-CoV-2 in younger, non-white ethnicity, and more deprived groups. We found no significant interaction between the effects of ethnicity and deprivation. Derived from prevalence, the estimated incidence of seroreactivity reflects the trends observed in daily hospitalisations and deaths in London that followed 10 and 13 days later, respectively. We quantified community transmission of SARS-CoV-2 in London, which peaked in late March / early April 2020 with no evidence of community transmission until after January 2020. Our study was not able to determine the date of introduction of the SARS-CoV-2 virus but demonstrates the value of stored antenatal serum samples as a resource for serosurveillance during future outbreaks.
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Affiliation(s)
- Edward Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The George Institute for Global Health, Queen Charlotte’s and Chelsea Hospital, London, United Kingdom
| | - Ruth McCabe
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- NIHR Health Research Protection Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Sheila M. Bird
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology, London, United Kingdom
| | - Marcus J. Pond
- Department of Infection and Immunity, North West London Pathology, London, United Kingdom
| | - Lesley Regan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Department of Obstetrics & Gynaecology, St Mary’s Hospital, London, United Kingdom
| | - Eleanor Parker
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Myra McClure
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Christl A. Donnelly
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- NIHR Health Research Protection Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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49
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Moledina SM, Shoaib A, Weston C, Aktaa S, Van Spall HGC, Kassam A, Kontopantelis E, Banerjee S, Rashid M, Gale CP, Mamas MA. Ethnic disparities in care and outcomes of non-ST-segment elevation myocardial infarction: a nationwide cohort study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:518-528. [PMID: 33892502 DOI: 10.1093/ehjqcco/qcab030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/29/2022]
Abstract
AIMS Little is known about ethnic disparities in care and clinical outcomes of patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) in national cohorts from universal healthcare systems derived from Europe. METHODS AND RESULTS We identified 280 588 admissions with NSTEMI in the UK Myocardial Infarction National Audit Project (MINAP), 2010-2017, including White patients (n = 258 364) and Black, Asian, and Minority Ethnic (BAME) patients (n = 22 194). BAME patients were younger (66 years vs. 73 years, P < 0.001) and more frequently had hypertension (66% vs. 54%, P < 0.001), hypercholesterolaemia (49% vs. 34%, P < 0.001), and diabetes (48% vs. 24%, P < 0.001). BAME patients more frequently received invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (PCI) (52% vs. 43%, P < 0.001), and coronary artery bypass graft surgery (9% vs. 7%, P < 0.001). Following propensity score matching, BAME compared with White patients had similar in-hospital all-cause mortality [odds ratio (OR) 0.91, confidence interval (CI) 0.76-1.06; P = 0.23], major bleeding (OR 0.99, CI 0.75-1.25; P = 0.95), re-infarction (OR 1.15, CI 0.84-1.46; P = 0.34), and major adverse cardiovascular events (MACE) (OR 0.94, CI 0.80-1.07; P = 0.35). CONCLUSION BAME patients with NSTEMI had higher cardiometabolic risk profiles and were more likely to undergo invasive angiography and revascularization, with similar clinical outcomes as those of their White counterparts. Among the quality indicators assessed, there is no evidence of care disparities among BAME patients presenting with NSTEMI.
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Affiliation(s)
- Saadiq M Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Clive Weston
- Glangwili General Hospital, Carmarthen, Wales, UK
| | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, Population Health Research Institute, Hamilton and ICES, Hamilton, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary, Canada
| | | | - Shrilla Banerjee
- Department of Cardiology, Surrey and Sussex Healthcare, NHS Trust, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
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50
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Exploring COVID-19 Vaccine Confidence with People from Black and Asian Backgrounds in England. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01372-w. [PMID: 35913541 PMCID: PMC9341420 DOI: 10.1007/s40615-022-01372-w] [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: 05/26/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 12/05/2022]
Abstract
Aims Little research has examined factors underlying COVID-19 vaccine hesitancy or refusal in Black and Asian individuals in England, among whom hesitancy tends to be higher than in the general population. This qualitative study aimed to gain an understanding of factors affecting hesitancy in Black and Asian individuals in England, to help address concerns about having the vaccine. Method Ninety-five participants (51 women, 42 men, 2 other; 58% were aged between 30 and 49) recruited via a market recruitment agency, local Healthwatch networks, and using a snowballing method, participated in four activities on an online engagement platform, sharing their attitudes towards the COVID-19 vaccine roll-out, and factors shaping their beliefs and concerns, over 5 weeks from April to March 2021. Results Inductive thematic analysis revealed five themes: (1) a variety of views on the COVID-19 vaccine, (2) targeted messaging for Black and Asian people as counterproductive, (3) confusion over the purpose of the vaccine roll-out, (4) hesitancy to take the vaccine, and (5) local networks as a trusted source of information. Conclusions Our findings suggest that respecting individuals’ agency, transparency of information provided, and the independence of the bodies providing this information are important. Instead of targeted messaging, local networks should be used in campaigns to increase COVID-19 vaccine uptake among Black and Asian individuals. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01372-w.
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