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Dimri I, Roguin A, Hamuda N, Abu Fanne R, Barel M, Leshem E, Kobo O, Margolis G. The Trends in Atrial Fibrillation-Related Mortality before, during, and after the COVID-19 Pandemic Peak in the United States. J Clin Med 2024; 13:4813. [PMID: 39200954 PMCID: PMC11355373 DOI: 10.3390/jcm13164813] [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: 07/17/2024] [Revised: 08/04/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Background: During the first months of the COVID-19 outbreak, an increase was observed in atrial fibrillation (AF)-related mortality in the United States (U.S). We aimed to investigate AF-related mortality trends in the U.S. before, during, and after the COVID-19 pandemic peak, stratified by sociodemographic factors. Methods: using the Wide-Ranging Online Data for Epidemiologic Research database of the Centers for Disease Control and Prevention, we compared the AF-related age-adjusted mortality rate (AAMR) among different subgroups in the two years preceding, during, and following the pandemic peak (2018-2019, 2020-2021, 2022-2023). Result: By analyzing a total of 1,267,758 AF-related death cases, a significant increase of 24.8% was observed in AF-related mortality during the pandemic outbreak, followed by a modest significant decrease of 1.4% during the decline phase of the pandemic. The most prominent increase in AF-related mortality was observed among males, among individuals younger than 65 years, and among individuals of African American and Hispanic descent, while males, African American individuals, and multiracial individuals experienced a non-statistically significant decrease in AF-related mortality during the pandemic decline period. Conclusions: Our findings suggest that in future healthcare crises, targeted healthcare policies and interventions to identify AF, given its impact on patients' outcomes, should be developed while addressing disparities among different patient populations.
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Affiliation(s)
- Inon Dimri
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera 3820302, Israel; (I.D.); (R.A.F.); (E.L.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera 3820302, Israel; (I.D.); (R.A.F.); (E.L.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
| | - Nashed Hamuda
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera 3820302, Israel; (I.D.); (R.A.F.); (E.L.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
| | - Rami Abu Fanne
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera 3820302, Israel; (I.D.); (R.A.F.); (E.L.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
| | - Maguli Barel
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera 3820302, Israel; (I.D.); (R.A.F.); (E.L.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
| | - Eran Leshem
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera 3820302, Israel; (I.D.); (R.A.F.); (E.L.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera 3820302, Israel; (I.D.); (R.A.F.); (E.L.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
| | - Gilad Margolis
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera 3820302, Israel; (I.D.); (R.A.F.); (E.L.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3525433, Israel
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LeBrón AMW, Montiel GI, Arpero S, Jimenez J, Torres G, Ortiz H, Mejía N, Bracho A. Talents, Tears, Stories of Our Identities, and Community Building: Toward Community-Based Ecosystems of Latiné Health Driven by Promotores. Am J Public Health 2024; 114:S525-S533. [PMID: 39083749 PMCID: PMC11292289 DOI: 10.2105/ajph.2024.307763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 08/02/2024]
Abstract
This essay describes a process for integrating US Latiné communities as drivers of a grassroots vision for healthy Latiné communities and health equity planning that addresses racial injustices. Transforming structural conditions to promote Latiné community health happens alongside creating conditions for community-level self-determination to foster community-based ecosystems of health. Integrating a life course perspective, we describe a vision for community-based ecosystems of Latiné health that is rooted in forging connections and cultivating community; building community power to address structural drivers of health; leveraging the expertise and assets of promotores to reach, engage, and mobilize communities; scaling solutions through policy, system, and environment changes; and grounding research processes in community-driven priorities. Such processes must affirm the expertise of promotores and Latiné communities and recognize the interconnectedness of communities and systems (e.g., food, housing, living wages) to nurture health at local levels. Research can advance the science and evidence-based models that support community-based ecosystems of Latiné health. (Am J Public Health. 2024;114(S6):S525-S533. https://doi.org/10.2105/AJPH.2024.307763) [Formula: see text].
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Affiliation(s)
- Alana M W LeBrón
- Alana M. W. LeBrón is with the Department of Health, Society, and Behavior in the Program in Public Health and the Department of Chicano/Latino Studies in the School of Social Sciences, University of California, Irvine. Gloria I. Montiel is with AltaMed Health Services Corporation and Latino Health Access, Santa Ana, CA. S. Arpero, J. Jimenez, G. Torres, H. Ortiz, N. Mejía, and A. Bracho are with Latino Health Access
| | - Gloria Itzel Montiel
- Alana M. W. LeBrón is with the Department of Health, Society, and Behavior in the Program in Public Health and the Department of Chicano/Latino Studies in the School of Social Sciences, University of California, Irvine. Gloria I. Montiel is with AltaMed Health Services Corporation and Latino Health Access, Santa Ana, CA. S. Arpero, J. Jimenez, G. Torres, H. Ortiz, N. Mejía, and A. Bracho are with Latino Health Access
| | - Saraí Arpero
- Alana M. W. LeBrón is with the Department of Health, Society, and Behavior in the Program in Public Health and the Department of Chicano/Latino Studies in the School of Social Sciences, University of California, Irvine. Gloria I. Montiel is with AltaMed Health Services Corporation and Latino Health Access, Santa Ana, CA. S. Arpero, J. Jimenez, G. Torres, H. Ortiz, N. Mejía, and A. Bracho are with Latino Health Access
| | - Josefina Jimenez
- Alana M. W. LeBrón is with the Department of Health, Society, and Behavior in the Program in Public Health and the Department of Chicano/Latino Studies in the School of Social Sciences, University of California, Irvine. Gloria I. Montiel is with AltaMed Health Services Corporation and Latino Health Access, Santa Ana, CA. S. Arpero, J. Jimenez, G. Torres, H. Ortiz, N. Mejía, and A. Bracho are with Latino Health Access
| | - Gina Torres
- Alana M. W. LeBrón is with the Department of Health, Society, and Behavior in the Program in Public Health and the Department of Chicano/Latino Studies in the School of Social Sciences, University of California, Irvine. Gloria I. Montiel is with AltaMed Health Services Corporation and Latino Health Access, Santa Ana, CA. S. Arpero, J. Jimenez, G. Torres, H. Ortiz, N. Mejía, and A. Bracho are with Latino Health Access
| | - Hilda Ortiz
- Alana M. W. LeBrón is with the Department of Health, Society, and Behavior in the Program in Public Health and the Department of Chicano/Latino Studies in the School of Social Sciences, University of California, Irvine. Gloria I. Montiel is with AltaMed Health Services Corporation and Latino Health Access, Santa Ana, CA. S. Arpero, J. Jimenez, G. Torres, H. Ortiz, N. Mejía, and A. Bracho are with Latino Health Access
| | - Nancy Mejía
- Alana M. W. LeBrón is with the Department of Health, Society, and Behavior in the Program in Public Health and the Department of Chicano/Latino Studies in the School of Social Sciences, University of California, Irvine. Gloria I. Montiel is with AltaMed Health Services Corporation and Latino Health Access, Santa Ana, CA. S. Arpero, J. Jimenez, G. Torres, H. Ortiz, N. Mejía, and A. Bracho are with Latino Health Access
| | - America Bracho
- Alana M. W. LeBrón is with the Department of Health, Society, and Behavior in the Program in Public Health and the Department of Chicano/Latino Studies in the School of Social Sciences, University of California, Irvine. Gloria I. Montiel is with AltaMed Health Services Corporation and Latino Health Access, Santa Ana, CA. S. Arpero, J. Jimenez, G. Torres, H. Ortiz, N. Mejía, and A. Bracho are with Latino Health Access
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Okeafor IN, Hair NL, Chen B, Hung P. Racial and Ethnic Disparities in Postpartum Depressive Symptoms Before and During the COVID-19 Pandemic. J Womens Health (Larchmt) 2024. [PMID: 38757651 DOI: 10.1089/jwh.2023.0908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background: Existing evidence regarding the impact of the COVID-19 pandemic on postpartum mental health is mixed, with disparate studies showing increased, stable, or even reduced risk of postpartum depression (PPD) amid the pandemic. Furthermore, although it is plausible that the pandemic impacted the mental health of mothers from vulnerable and underserved communities differentially, few studies have characterized racial and ethnic differences in the impact of the COVID-19 pandemic on PPD. Materials and Methods: Pregnancy Risk Assessment Monitoring System data for 2018-2019 (pre-pandemic period) and 2020 (peri-pandemic period) from 40 sites (n = 110,779, representing 5,485,137 postpartum women) were used to determine whether rates of PPD changed during the first year of the pandemic. Postpartum depressive symptoms were assessed using the Patient Health Questionnaire 2-item. Average marginal effects and contrasts of predictive margins derived from a multivariable logistic regression model were used to compare the risk of PPD before and during the pandemic in the overall sample and across racial/ethnic subgroups. Results: Adjusting for sociodemographic and clinical characteristics, we found that the overall risk for PPD remained stable (0.0 percentage points [pp]; 95% confidence interval [CI]: -0.7, 0.6 pp) in the first year of the pandemic. We detected no statistically significant changes in risk for PPD across seven of eight racial/ethnic groups considered; however, the risk of PPD among non-Hispanic Black women fell by 2.0 pp (95% CI: -3.5, -0.4 pp) relative to the pre-pandemic period. Conclusion: We identified important subgroup differences in pandemic-related changes in risk for PPD.
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Affiliation(s)
- Ibitein N Okeafor
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Nicole L Hair
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Brian Chen
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
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Smith ML, Chi G, Hennighausen H, Holen D, Howe EL. Differences in Perceptions of COVID-19 Risks in a Fishing Community in Alaska, 2020-2021. MARINE POLICY 2024; 161:106045. [PMID: 38435099 PMCID: PMC10906804 DOI: 10.1016/j.marpol.2024.106045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Bristol Bay in Alaska is home to the world's largest commercial salmon fishery. During an average fishing season, the population of the Bristol Bay region more than doubles as thousands of workers from out of state converge on the fishery. In the months leading up to the 2020 commercial fishery opening, as the COVID-19 pandemic exploded worldwide, great uncertainty existed about the health risks of opening the fishery. Bristol Bay residents had not yet experienced any cases of COVID-19, yet the livelihoods of most were closely tied to the commercial fishery opening. To better understand how COVID-19 risk perceptions affected decisions to participate in the fishery, we administered an online survey to community members and fishery participants. We collected standard socioeconomic data and posed questions to gauge risk perceptions related to COVID-19. We find that COVID-19 risk perceptions vary across race/ethnic groups by residency and income. People with below median income who are members of minority groups-notably, non-resident Hispanic workers and resident Alaska Native respondents-reported the highest risk perceptions related to COVID-19. This study highlights the important linkages among risk perceptions, socioeconomic characteristics, and employment decisions during an infectious disease outbreak.
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Affiliation(s)
- M. Luke Smith
- Social Science Research Institute, The Pennsylvania State University, University Park, PA 16802, USA
| | - Guangqing Chi
- Social Science Research Institute, The Pennsylvania State University, University Park, PA 16802, USA
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA 16802, USA
- Population Research Institute, The Pennsylvania State University, University Park, PA 16802, USA
| | - Hannah Hennighausen
- Department of Economics, University of Alaska Anchorage, Anchorage, AK 99508, USA
| | - Davin Holen
- Alaska Sea Grant and Alaska Center for Climate Assessment and Policy, International Arctic Research Center, University of Alaska Fairbanks, USA
| | - E. Lance Howe
- Department of Economics, University of Alaska Anchorage, Anchorage, AK 99508, USA
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Kranzler EC, Ihongbe TO, Marshall MC, Denison B, Dahlen H, Hoffman B, Seserman K, Xie J, Hoffman L. Racial and ethnic differences in COVID-19 vaccine readiness among adults in the United States, January 2021-April 2023. Vaccine 2024; 42:410-414. [PMID: 38182461 DOI: 10.1016/j.vaccine.2023.12.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/07/2024]
Abstract
Racial and ethnic minority groups have been disproportionately affected by COVID-19 and have experienced systemic, attitudinal, and access-related barriers to COVID-19 vaccination. We examined differences in COVID-19 vaccine readiness-a composite measure of vaccination intention and behavior-between non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian American/Pacific Islander, and American Indian/Alaska Native U.S. adults. Using data from a cross-sectional survey administered to nationally representative samples of ∼ 5,000 U.S. adults each month from January 2021 to April 2023 (n = 135,989), we conducted weighted ttests comparing the monthly percentage of participants from racial/ethnic groups who were "Vaccine Ready." Initial racial/ethnic disparities in vaccine readiness were attenuated within a 7-month period, after which adults from most minority racial/ethnic groups became equally or more vaccine ready compared to non-Hispanic White adults (p < 0.05). Findings suggest that barriers to vaccine readiness that were more prevalent in non-White racial/ethnic groups may have largely been addressed.
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Affiliation(s)
| | | | | | - Benjamin Denison
- Fors Marsh, 4250 Fairfax Drive, Ste 520, Arlington, VA 22203, USA
| | - Heather Dahlen
- Fors Marsh, 4250 Fairfax Drive, Ste 520, Arlington, VA 22203, USA
| | - Blake Hoffman
- Fors Marsh, 4250 Fairfax Drive, Ste 520, Arlington, VA 22203, USA
| | - Kate Seserman
- Fors Marsh, 4250 Fairfax Drive, Ste 520, Arlington, VA 22203, USA
| | - Jingyuan Xie
- Fors Marsh, 4250 Fairfax Drive, Ste 520, Arlington, VA 22203, USA
| | - Leah Hoffman
- Fors Marsh, 4250 Fairfax Drive, Ste 520, Arlington, VA 22203, USA
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Bonnell LN, Clifton J, Natkin LW, Hitt JR, Littenberg B. The association of self-perceived changes due to COVID-19 with mental and physical health among adult primary care patients with multiple chronic conditions: A US-based longitudinal study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565231222148. [PMID: 38250744 PMCID: PMC10798126 DOI: 10.1177/26335565231222148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024]
Abstract
Introduction This study explores the association between self-perceived personal and community changes due to COVID-19 and health among vulnerable primary care patients experiencing multiple chronic conditions. Methods Between September 2017 and February 2021, we obtained data from 2,426 primary care patients managing multiple chronic conditions from across the United States. We assessed the relationship between self-perceived personal and community changes due to COVID-19 and change in health measured by the PROMIS-29 mental and physical health summary scores, GAD-7 (anxiety), andPHQ-9 (depression), and DASI (functional capacity) adjusting for relevant demographic, neighborhood characteristics, and county covariates. Results After adjustment, self-perceived personal and community changes due to COVID-19 were associated with significantly worse mental health summary scores (ß = -0.55; 95% Confidence Interval (CI) = -0.72, -0.37), anxiety (ß = 0.28; 95% CI = 0.16, 0.39), depression (ß = 0.35; 95% CI = 0.22, 0.47), and physical health summary scores (ß = -0.44; 95% CI = 0.88, 0.00). There was no association with functional capacity (ß = - 0.05; 95% CI = -0.16, 0.05). Discussion Among adults managing multiple chronic conditions, self-perceived personal and community changes due to COVID-19 were associated with health. This vulnerable population may be particularly susceptible to the negative effects of COVID-19. As we do not know the long-term health effects of COVID, this paper establishes a baseline of epidemiological data on COVID-19 burden and health among primary care patients with multiple chronic conditions.
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Affiliation(s)
- Levi N Bonnell
- University of Vermont College of Medicine, Burlington VT, USA
| | - Jessica Clifton
- University of Vermont College of Medicine, Burlington VT, USA
| | - Lisa W Natkin
- University of Vermont College of Medicine, Burlington VT, USA
| | - Juvena R Hitt
- University of Vermont College of Medicine, Burlington VT, USA
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Douglas MD, Li C, Josiah Willock R, Baltrus P, Caplan L, Immergluck L, McKinney T, Hopkins J, Mack D, Gaglioti AH. Population-Level Disparities in Exposure to COVID-19 Mitigation Policies, April 2020-April 2021. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:874-881. [PMID: 37498523 PMCID: PMC10549887 DOI: 10.1097/phh.0000000000001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
CONTEXT Studies have found that COVID-19 stay-at-home orders (SHOs) and face mask policies (FMPs) were associated with reduced COVID-19 transmission and deaths. But it is unknown whether exposure to these policies varied by sociodemographic characteristics across the US population. OBJECTIVE The goal of this study was to quantify and characterize the sociodemographic characteristics and geographic distribution of populations exposed to evidence-based COVID-19 mitigation policies. DESIGN We obtained statewide SHOs and FMPs for all US counties from April 10, 2020, to April 10, 2021, calculated median policy lengths, and categorized counties into 4 groups based on length of policy exposure: low SHO-low FMP, high SHO-low FMP, low SHO-high FMP, and high SHO-high FMP. We described exposure groups by COVID-19 cumulative case/death and vaccination rates and county sociodemographic characteristics. SETTING In total, 3142 counties from all 50 states and Washington, District of Columbia, were included in the analysis. MAIN OUTCOME MEASURES County-level sociodemographic factors and county cumulative rates for COVID-19 cases, deaths, and vaccinations. RESULTS The largest percentage of the US population lived in counties with high exposure to SHOs and FMPs. However, populations living in high SHO-high FMP counties had the lowest percent non-Hispanic Black (NHB) and highest percent non-Hispanic White (NHW) populations. Populations living in high SHO-low FMP counties had the highest percent NHB and Hispanic populations and the lowest percent NHW population. CONCLUSION This study identified county-level racial, ethnic, and sociodemographic disparities in exposure to evidence-based statewide COVID-19 mitigation policies. POLICY IMPLICATIONS Exposure to evidence-based policies is an important consideration for studies evaluating the root causes of health inequities.
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Affiliation(s)
- Megan D. Douglas
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Chaohua Li
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Robina Josiah Willock
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Peter Baltrus
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Lee Caplan
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Lilly Immergluck
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Tonyka McKinney
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Jammie Hopkins
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Dominic Mack
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
| | - Anne H. Gaglioti
- National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti and Mr Li), Department of Community Health and Preventive Medicine (Drs Douglas, Josiah Willock, Baltrus, Caplan, and Hopkins), Department of Microbiology, Biochemistry & Immunology (Dr Immergluck), Satcher Health Leadership Institute (Drs McKinney and Hopkins), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute at MetroHealth and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
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Francis J, West K. Physical Activity Message Framing and Ethnicity Before and During COVID-19. HEALTH COMMUNICATION 2023; 38:2419-2429. [PMID: 35593173 DOI: 10.1080/10410236.2022.2074344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People of Black ethnicities are well known to be disproportionately burdened by coronavirus and have poorer health outcomes. Public health messages encouraged physical activity during the pandemic as it is evidenced to positively affect the immune system, however people of Black ethnicities are often reported as failing to achieve the recommended daily amount. Health message framing during COVID-19 specifically in relation to ethnicity and physical activity motivation has yet to be investigated. Two studies examined message frame effect on physical activity motivation prior to and at the onset of the pandemic and how this differed by ethnicity. Gain framed messages were found to positively affect physical activity motivation pre-COVID-19 and during the pandemic fear framed messages were found to positively affect physical activity motivation. Neither of these effects differed by ethnicity. Implications for future physical activity health message framing are discussed.
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Affiliation(s)
| | - Keon West
- Department of Psychology, Goldsmiths, University of London
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Silver H, Morris R. Homelessness, Politics, and Policy: Predicting Spatial Variation in COVID-19 Cases and Deaths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3265. [PMID: 36833960 PMCID: PMC9965687 DOI: 10.3390/ijerph20043265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
When COVID-19 began to spread in the United States, the first public health orders were to hunker down at home. But for the vulnerable people experiencing homelessness, especially those sleeping outdoors, retreating to a private dwelling was not possible. This suggests that places with greater homelessness would also have elevated COVID-19 infections. This paper examines how spatial variation in unsheltered homelessness was related to the cumulative number of cases and deaths from COVID-19. Although Continuums of Care (CoCs) with more households receiving welfare, without internet service, and more disabled residents had a higher rate of COVID-19-related cases and deaths, CoCs with more unsheltered homelessness had fewer COVID-19-related deaths. More research is needed to explain this counterintuitive result, but it may reflect the bicoastal pattern of homelessness which is higher where government intervention, community sentiment, and compliance with rules to promote the common welfare are greater. In fact, local politics and policies mattered. CoCs with more volunteering and a higher share of votes for the 2020 Democratic presidential candidate also had fewer COVID-19 cases and deaths. Yet, other policies did not matter. Having more homeless shelter beds, publicly assisted housing units, residents in group quarters, or greater use of public transportation had no independent associations with pandemic outcomes.
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Affiliation(s)
- Hilary Silver
- Department of Sociology, Columbian College of Arts & Sciences, George Washington University, Washington, DC 20052, USA
| | - Rebecca Morris
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
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Khunti K, Feldman EL, Laiteerapong N, Parker W, Routen A, Peek M. The Impact of the COVID-19 Pandemic on Ethnic Minority Groups With Diabetes. Diabetes Care 2023; 46:228-236. [PMID: 35944272 PMCID: PMC10090266 DOI: 10.2337/dc21-2495] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/10/2022] [Indexed: 02/03/2023]
Abstract
Major ethnic disparities in diabetes care, especially for intermediate outcomes and diabetes complications, were evident prior to the coronavirus disease 2019 (COVID-19) pandemic. Diabetes is a risk factor for severe COVID-19, and the combination of these ethnic disparities in diabetes care and outcomes may have contributed to the inequity in COVID-19 outcomes for people with diabetes. Overall, ethnic minority populations have suffered disproportionate rates of COVID-19 hospitalization and mortality. Results from the limited number of studies of COVID-19 in ethnic minority populations with diabetes are mixed, but there is some suggestion that rates of hospitalization and mortality are higher than those of White populations. Reasons for the higher incidence and severity of COVID-19-related outcomes in minority ethnic groups are complex and have been shown to be due to differences in comorbid conditions (e.g., diabetes), exposure risk (e.g., overcrowded living conditions or essential worker jobs), and access to treatment (e.g., health insurance status and access to tertiary care medical centers), which all relate to long-standing structural inequities that vary by ethnicity. While guidelines and approaches for diabetes self-management and outpatient and inpatient care during the pandemic have been published, few have recommended addressing wider structural issues. As we now plan for the recovery and improved surveillance and risk factor management, it is imperative that primary and specialist care services urgently address the disproportionate impact the pandemic has had on ethnic minority groups. This should include a focus on the larger structural barriers in society that put ethnic minorities with diabetes at potentially greater risk for poor COVID-19 outcomes.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Eva L. Feldman
- Department of Neurology, School of Medicine, University of Michigan, Ann Arbor, MI
| | | | - William Parker
- Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Monica Peek
- Department of Medicine, University of Chicago, Chicago, IL
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11
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Valenzuela JM, Dimentstein K, Yee S, Pan B, Snyder MC, Wolf RM. Psychosocial Impact of the COVID-19 Pandemic in Racially/Ethnically Diverse Youth With Diabetes. J Pediatr Psychol 2023; 48:17-28. [PMID: 36137256 PMCID: PMC9673468 DOI: 10.1093/jpepsy/jsac070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE This study examined caregiver perceived impact of the Coronavirus Disease 2019 (COVID-19) pandemic on a diverse sample of U.S. youth with diabetes and their families. METHODS Caregivers of youth with diabetes completed an electronic survey in English or Spanish at two sites. Participants provided demographic and disease characteristics and completed the COVID-19 Exposure and Family Impact Scales (CEFIS). Glycemic health was assessed via Hemoglobin A1c (HbA1c) from medical chart review. Analysis of variance and analyses of covariance were utilized to examine racial/ethnic differences in glycemic health and in COVID-19 Exposure, Impact, and Distress scales. Hierarchical linear regression was conducted to predict HbA1c. Thematic analysis was conducted on open-ended responses regarding the effects of COVID-19 on youth and families' overall and diabetes-related well-being. RESULTS Caregivers (n = 114) of youth with diabetes (M = 12.6 ± 3.5 years) completed study measures. Mean HbA1c for Non-Hispanic White youth was lowest and significantly different from Hispanic and Non-Hispanic Black youth. Exposure to COVID-19 stressors differed by race/ethnicity (p < .05) with Hispanic caregivers reporting greatest exposure. CEFIS scales did not predict HbA1c after controlling for demographic/disease variables. Caregivers described child/family changes during COVID (e.g., more time together, health-related hypervigilance), as well as differences in diabetes management during COVID-19. CONCLUSIONS Findings indicate differences in COVID-19 exposure but did not demonstrate other racial/ethnic disparities in COVID-19 impact or distress. Household income was the most important predictor of glycemic health. Addressing structural inequalities experienced by youth with diabetes and their families is critical. Recommendations to support families with diabetes are made.
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Affiliation(s)
- Jessica M Valenzuela
- College of Psychology, Department of Clinical & School Psychology, Nova
Southeastern University, USA
- Salah Foundation Children’s Hospital, Broward Health Medical
Center, USA
| | - Karen Dimentstein
- College of Psychology, Department of Clinical & School Psychology, Nova
Southeastern University, USA
| | - Shanique Yee
- College of Psychology, Department of Clinical & School Psychology, Nova
Southeastern University, USA
| | - Bernard Pan
- Division of Pediatric Endocrinology, Johns Hopkins School of
Medicine, USA
| | - Meg C Snyder
- Division of Pediatric Endocrinology, Johns Hopkins School of
Medicine, USA
- Department of Behavioral Psychology, Kennedy Krieger
Institute, USA
| | - Risa M Wolf
- Division of Pediatric Endocrinology, Johns Hopkins School of
Medicine, USA
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12
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DiPiro JT, Allen DD, Lin A, Scott SA, Sorensen TD, Maine LL. Impact of Social Forces and Environmental Factors on Healthcare and Pharmacy Education: The Report of the 2021-2022 AACP Argus Commission. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe9452. [PMID: 36781186 PMCID: PMC10159613 DOI: 10.5688/ajpe9452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
| | - David D Allen
- University of Health Sciences and Pharmacy, St. Louis, Missouri
| | - Anne Lin
- Notre Dame of Maryland University, Baltimore, Maryland
| | - Steven A Scott
- Purdue University, College of Pharmacy, West Lafayette, Indiana
| | - Todd D Sorensen
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | - Lucinda L Maine
- American Association of Colleges of Pharmacy, Arlington, Virginia
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13
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Kupferwasser D, Flores EA, Merino P, Phan Tran D, Bolaris M, Gonzales M, Nguyen MH, Balo A, Abueg A, Da Silva W, Astorga-Cook L, Liu H, Mason H, Freund D, Nightingale J, Orr J, Xie B, Miller LG. Characterization of COVID-19 Vaccine Hesitancy Among Essential Workforce Members of a Large Safety Net Urban Medical Center. J Prim Care Community Health 2023; 14:21501319231159814. [PMID: 36941757 PMCID: PMC10028456 DOI: 10.1177/21501319231159814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES Vaccine hesitancy among essential workers remains a significant public health challenge. We examined psychological constructs of perceived susceptibility, threat, and self-efficacy and their associations with COVID-19 vaccine hesitancy among a racially and ethnically diverse essential workforce population. METHODS We performed a cross-sectional survey of essential workers from September-December 2020 at a large Los Angeles safety-net medical center as part of a program offering free COVID-19 serology testing. Program participants completed a standardized survey at the time of phlebotomy. Hierarchical logistic regression was utilized to determine factors independently associated with vaccine hesitancy. RESULTS Among 1327 persons who had serology testing, 1235 (93%) completed the survey. Of these, 958 (78%) were healthcare workers. Based on expressed intent, 22% were vaccine-hesitant 78% were vaccine acceptors. In our multivariate model, vaccine hesitancy was associated with female gender [aOR = 2.09; 95% CI (1.44-3.05)], African American race [aOR = 4.32; (2.16-8.62)], LatinX ethnicity [aOR = 2.47; 95% CI (1.51-4.05)] and history of not/sometimes receiving influenza vaccination [aOR = 4.39; 95% CI (2.98-6.48)]. Compared to nurses, vaccine hesitancy was lower among physicians [aOR = 0.09; 95% CI (0.04-0.23)], non-nursing/non-physician healthcare workers [aOR = 0.55; 95% CI (0.33-0.92)], and non-healthcare care workers [aOR = 0.53; 95% CI (0.36-0.78)]. CONCLUSIONS Among a racially/ethnically diverse group of safety net medical center essential workers, COVID-19 vaccine hesitancy was associated with racial/ethnic minority groups, employment type, and prior influenza vaccination hesitancy. Interestingly, we found no association with the Health Belief Model construct measures of perceived susceptibility, threat, and self-efficacy. Psychological constructs not assessed may be drivers of vaccine hesitancy in our population.
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Affiliation(s)
- Deborah Kupferwasser
- Harbor-UCLA Medical Center, Torrance, CA, USA
- Claremont Graduate University, Claremont, CA, USA
| | | | | | | | | | - Mildred Gonzales
- Los Angeles County College of Nursing and Allied Health, Los Angeles, CA, USA
| | | | - Arlene Balo
- Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Angel Abueg
- Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | - Honghu Liu
- University of California, Los Angeles, Los Angeles CA, USA
| | - Holli Mason
- Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | - Jay Orr
- Claremont Graduate University, Claremont, CA, USA
| | - Bin Xie
- Claremont Graduate University, Claremont, CA, USA
| | - Loren G Miller
- Harbor-UCLA Medical Center, Torrance, CA, USA
- University of California, Los Angeles, Los Angeles CA, USA
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14
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Liu Y, Wang H, Hughes MC. Health Behaviors, Financial Difficulties, and Depressive Symptoms Among Older Adults Across Gender and Race During the COVID-19 Pandemic. Gerontol Geriatr Med 2023; 9:23337214231192820. [PMID: 37565025 PMCID: PMC10411279 DOI: 10.1177/23337214231192820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
Background: COVID-19 deeply affected the health and well-being of older adults. This study examines health behavior change and the interrelationships between health behaviors, financial difficulties, and depressive symptoms among older adults across gender and race during the pandemic. Methods: Using Rounds 1, 5, and 10 of the National Health and Aging Trends Study (NHATS) linked with the NHATS COVID-19 dataset, our sample included Medicare beneficiaries aged 65 or older in the U.S. (N = 3,118). We modeled the interrelationships between health behaviors, financial difficulties, and depressive symptoms using a structural equation model. Results: Female participants reported less walking, more changes in eating habits, less sleeping, and less alcohol consumption during the pandemic than before the pandemic compared to male participants. Compared to White, Non-White participants showed higher proportions of experiencing financial difficulties, less walking, less vigorous activity, and changes in time spent eating and sleeping during than before the pandemic. Financial difficulties was positively associated with depressive symptoms and sedentary behavior. Active behavior was negatively associated with depressive symptoms, while sedentary behavior was positively associated with more depressive symptoms. Discussion: Health professionals should consider health behaviors and financial difficulties when intervening on depressive symptoms experienced by older adults since the pandemic.
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Affiliation(s)
- Yujun Liu
- Northern Illinois University, DeKalb, USA
| | - Heng Wang
- Rush University Medical Center, Chicago, IL, USA
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15
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Liao TF. A Study of Cumulative COVID-19 Mortality Trends Associated with Ethnic-Racial Composition, Income Inequality, and Party Inclination among US Counties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15803. [PMID: 36497877 PMCID: PMC9740998 DOI: 10.3390/ijerph192315803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
This research analyzes the association between cumulative COVID-19 mortality and ethnic-racial composition, income inequality, and political party inclination across counties in the United States. The study extends prior research by taking a long view-examining cumulative mortality burdens over the first 900 days of the COVID-19 pandemic at five time points (via negative binomial models) and as trajectories of cumulative mortality trends (via growth curve models). The analysis shows that counties with a higher Republican vote share display a higher cumulative mortality, especially over longer periods of the pandemic. It also demonstrates that counties with a higher composition of ethnic-racial minorities, especially Blacks, bear a much higher cumulative mortality burden, and such an elevated burden would be even higher when a county has a higher level of income inequality. For counties with a higher proportion of Hispanic population, while the burden is lower than that for counties with a higher proportion of Blacks, the cumulative COVID-19 mortality burden still is elevated and compounded by income inequality, at any given time point during the pandemic.
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Affiliation(s)
- Tim F Liao
- Department of Sociology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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16
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Offodile AC, Gibbons JB, Murrell S, Kinzer D, Sharfstein JM, Sharfstein J. A Global Equity Model (GEM) for the Advancement of Community Health and Health Equity. NAM Perspect 2022; 2022:202211b. [PMID: 36713771 PMCID: PMC9875856 DOI: 10.31478/202211b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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McGowan VJ, Bambra C. COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities. Lancet Public Health 2022; 7:e966-e975. [PMID: 36334610 PMCID: PMC9629845 DOI: 10.1016/s2468-2667(22)00223-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has exacerbated endemic health inequalities resulting in a syndemic pandemic of higher mortality and morbidity rates among the most socially disadvantaged. We did a scoping review to identify and synthesise published evidence on geographical inequalities in COVID-19 mortality rates globally. We included peer-reviewed studies, from any country, written in English that showed any area-level (eg, neighbourhood, town, city, municipality, or region) inequalities in mortality by socioeconomic deprivation (ie, measured via indices of multiple deprivation: the percentage of people living in poverty or proxy factors including the Gini coefficient, employment rates, or housing tenure). 95 papers from five WHO global regions were included in the final synthesis. A large majority of the studies (n=86) found that COVID-19 mortality rates were higher in areas of socioeconomic disadvantage than in affluent areas. The subsequent discussion reflects on how the unequal nature of the pandemic has resulted from a syndemic of COVID-19 and endemic inequalities in chronic disease burden.
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Affiliation(s)
- Victoria J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.
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18
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Federal Food Assistance Program Participation during the COVID-19 Pandemic: Participant Perspectives and Reasons for Discontinuing. Nutrients 2022; 14:nu14214524. [PMID: 36364785 PMCID: PMC9654117 DOI: 10.3390/nu14214524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022] Open
Abstract
This study aims to describe reasons for discontinuing participation and experiences participating in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) during the COVID-19 pandemic. We analyzed data from a cross-sectional online survey distributed to a national sample, restricted to (1) households that discontinued participating in SNAP (n = 146) or WIC (n = 149) during the pandemic and (2) households that participated in SNAP (n = 501) or WIC (n = 141) during spring 2021—approximately one year into the pandemic. We conducted thematic analyses of open-ended survey questions and descriptive statistics for Likert-scale items. Themes raised by respondents who discontinued participating in SNAP or WIC included difficulty recertifying and virus exposure concerns. Former WIC participants reported the program was not worth the effort and former SNAP participants reported failing to requalify. Respondents participating in WIC or SNAP during the pandemic mentioned transportation barriers and insufficient benefit value. WIC participants had trouble redeeming benefits in stores and SNAP participants desired improved online grocery purchasing experiences. These results suggest that enhancements to WIC and SNAP, such as expanded online purchasing options, program flexibilities, and benefit increases, can improve program participation to ensure access to critical nutrition supports, especially during emergencies.
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Shanahan KH, Subramanian SV, Burdick KJ, Monuteaux MC, Lee LK, Fleegler EW. Association of Neighborhood Conditions and Resources for Children With Life Expectancy at Birth in the US. JAMA Netw Open 2022; 5:e2235912. [PMID: 36239940 PMCID: PMC9568807 DOI: 10.1001/jamanetworkopen.2022.35912] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
Importance To address inequities in life expectancy, we must understand the associations of modifiable socioeconomic and structural factors with life expectancy. However, the association of limited neighborhood resources and deleterious physical conditions with life expectancy is not well understood. Objective To evaluate the association of community social and economic conditions and resources for children with life expectancy at birth. Design, Setting, and Participants This cross-sectional study examined neighborhood child opportunity and life expectancy using data from residents of 65 662 US Census tracts in 2015. The analysis was conducted from July 6 to October 1, 2021. Exposures Neighborhood conditions and resources for children in 2015. Main Outcomes and Measures The primary outcome was life expectancy at birth at the Census tract level based on data from the US Small-Area Life Expectancy Estimates Project (January 1, 2010, to December 31, 2015). Neighborhood conditions and resources for children were quantified by Census tract Child Opportunity Index (COI) 2.0 scores for 2015. This index captures community conditions associated with children's health and long-term outcomes categorized into 5 levels, from very low to very high opportunity. It includes 29 indicators in 3 domains: education, health and environment, and social and economic factors. Mixed-effects and simple linear regression models were used to estimate the associations between standardized COI scores (composite and domain-specific) and life expectancy. Results The study included residents from 65 662 of 73 057 US Census tracts (89.9%). Life expectancy at birth across Census tracts ranged from 56.3 years to 93.6 years (mean [SD], 78.2 [4.0] years). Life expectancy in Census tracts with very low COI scores was lower than life expectancy in Census tracts with very high COI scores (-7.06 years [95% CI, -7.13 to -6.99 years]). Stepwise associations were observed between COI scores and life expectancy. For each domain, life expectancy was shortest in Census tracts with very low compared with very high COI scores (education: β = -2.02 years [95% CI, -2.12 to -1.92 years]); health and environment: β = -2.30 years [95% CI, -2.41 to -2.20 years]; social and economic: β = -4.16 years [95% CI, -4.26 to -4.06 years]). The models accounted for 41% to 54% of variability in life expectancy at birth (R2 = 0.41-0.54). Conclusions and Relevance In this study, neighborhood conditions and resources for children were significantly associated with life expectancy at birth, accounting for substantial variability in life expectancy at the Census tract level. These findings suggest that community resources and conditions are important targets for antipoverty interventions and policies to improve life expectancy and address health inequities.
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Affiliation(s)
- Kristen H. Shanahan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Michael C. Monuteaux
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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20
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Sansone NMS, Boschiero MN, Valencise FE, Palamim CVC, Marson FAL. Characterization of demographic data, clinical signs, comorbidities, and outcomes according to the race in hospitalized individuals with COVID-19 in Brazil: An observational study. J Glob Health 2022; 12:05027. [PMID: 35871427 PMCID: PMC9309002 DOI: 10.7189/jogh.12.05027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Brazil is a multiracial country with five major official races: White, Black, individuals with multiracial backgrounds, Asian, and Indigenous. Brazil is also one of the epicentres of the Coronavirus Disease (COVID)-19 pandemic. Thus, we evaluated how the races of the Brazilian population contribute to the outcomes in hospitalized individuals with COVID-19, and we also described the clinical profile of the five official Brazilian races. Methods We performed an epidemiological analysis for the first 67 epidemiological weeks of the COVID-19 pandemic in Brazil (from February 22, 2020, to April 04, 2021) using the data available at OpenDataSUS of the Brazilian Ministry of Health, a data set containing data from Brazilian hospitalized individuals. We evaluated more than 30 characteristics, including demographic data, clinical symptoms, comorbidities, need for intensive care unit and mechanical ventilation, and outcomes. Results In our data, 585 655 hospitalized individuals with a positive result in SARS-CoV-2 real-time chain reaction (RT-PCR) were included. Of these total, 309 646 (52.9%) identified as White, 31 872 (5.4%) identified as Black, 7108 (1.2%) identified as Asian, 235 108 (40.1%) identified as individuals with multiracial background, and 1921 (0.3%) identified as Indigenous. The multivariate analysis demonstrated that race was significative to predict the death being that Black (OR = 1.43; 95% CI = 1.39-1.48), individuals with multiracial background (OR = 1.36; 95% CI = 1.34-1.38), and Indigenous (OR = 1.91; 95% CI = 1.70-2.15) races were more prone to die compared to the White race. The Asian individuals did not have a higher chance of dying due to SARS-CoV-2 infection compared to White individuals (OR = 0.99; 95% CI = 0.94-1.06). In addition, other characteristics contributed as such as being male (OR = 1.17; 95% CI = 1.16-1.19), age (mainly, +85 years old – OR = 23.02; 95% CI = 20.05-26.42) compared to 1-year-old individuals, living in rural areas (OR = 1.22; 95% CI = 1.18-1.26) or in peri-urban places (OR = 1.25; 95% CI = 1.11-1.40), and the presence of nosocomial infection (OR = 1.91; 95% CI = 1.82-2.01). Among the clinical symptoms, the main predictors were dyspnoea (OR = 1.25; 95% CI = 1.23-1.28), respiratory discomfort (OR = 1.30; 95% CI = 1.28-1.32), oxygen saturation <95% (OR = 1.40; 95% CI = 1.38-1.43). Also, among the comorbidities, the main predictors were the presence of immunosuppressive disorder (OR = 1.44; 95% CI = 1.39-1.49), neurological disorder (OR = 1.21; 95% CI = 1.17-1.25), hepatic disorder (OR = 1.41; 95% CI = 1.34-1.50), diabetes mellitus (OR = 1.40; 95% CI = 1.37-1.42), cardiopathy (OR = 1.13; 95%CI = 1.11-1.14), hematologic disorder (OR = 1.34; 95% CI = 1.24-1.43), Down syndrome (OR = 1.61; 95% CI = 1.43-1.81), renal disease (OR = 1.15; 95% CI = 1.11-1.18), and obesity (OR = 1.18; 95% CI = 1.15-1.21). Individuals on intensive care unit (OR = 2.25; 95% CI = 2.22-2.29) and on invasive (OR = 10.92; 95% CI = 10.66-11.18) or non-invasive (OR = 1.33; 95% CI = 1.30-1.35) mechanical ventilation were more prone to die. Conclusions Alongside several clinical symptoms and comorbidities, we associated race with an enhanced risk of death in Black individuals, individuals with multiracial backgrounds, and Indigenous peoples.
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Affiliation(s)
- Nathália MS Sansone
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Matheus N Boschiero
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Felipe E Valencise
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Camila VC Palamim
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Fernando AL Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
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21
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Khanam R, Islam S, Rahman S, Ahmed S, Islam A, Hasan T, Hasan E, Chowdhury NH, Roy AD, Jaben IA, Nehal AA, Yoshida S, Manu AA, Raqib R, McCollum ED, Shahidullah M, Jehan F, Sazawal S, Bahl R, Baqui AH. Sero-prevalence and risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 infection in women and children in a rural district of Bangladesh: A cohort study. J Glob Health 2022; 12:05030. [PMID: 35866222 PMCID: PMC9304923 DOI: 10.7189/jogh.12.05030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Bangladesh reported its first COVID-19 case on March 8, 2020. Despite lockdowns and promoting behavioural interventions, as of December 31, 2021, Bangladesh reported 1.5 million confirmed cases and 27 904 COVID-19-related deaths. To understand the course of the pandemic and identify risk factors for SARs-Cov-2 infection, we conducted a cohort study from November 2020 to December 2021 in rural Bangladesh. Methods After obtaining informed consent and collecting baseline data on COVID-19 knowledge, comorbidities, socioeconomic status, and lifestyle, we collected data on COVID-like illness and care-seeking weekly for 54 weeks for women (n = 2683) and their children (n = 2433). Between March and July 2021, we tested all participants for SARS-CoV-2 antibodies using ROCHE's Elecsys® test kit. We calculated seropositivity rates and 95% confidence intervals (95% CI) separately for women and children. In addition, we calculated unadjusted and adjusted relative risk (RR) and 95% CI of seropositivity for different age and risk groups using log-binomial regression models. Results Overall, about one-third of women (35.8%, 95% CI = 33.7-37.9) and one-fifth of children (21.3%, 95% CI = 19.2-23.6) were seropositive for SARS-CoV-2 antibodies. The seroprevalence rate doubled for women and tripled for children between March 2021 and July 2021. Compared to women and children with the highest household wealth (HHW) tertile, both women and children from poorer households had a lower risk of infection (RR, 95% CI for lowest HHW tertile women (0.83 (0.71-0.97)) and children (0.75 (0.57-0.98)). Most infections were asymptomatic or mild. In addition, the risk of infection among women was higher if she reported chewing tobacco (RR = 1.19,95% CI = 1.03-1.38) and if her husband had an occupation requiring him to work indoors (RR = 1.16, 95% CI = 1.02-1.32). The risk of infection was higher among children if paternal education was >5 years (RR = 1.37, 95% CI = 1.10-1.71) than in children with a paternal education of ≤5 years. Conclusions We provided prospectively collected population-based data, which could contribute to designing feasible strategies against COVID-19 tailored to high-risk groups. The most feasible strategy may be promoting preventive care practices; however, collecting data on reported practices is inadequate. More in-depth understanding of the factors related to adoption and adherence to the practices is essential.
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Affiliation(s)
- Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | - Tarik Hasan
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Emran Hasan
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | | | | | - Asim A Nehal
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Sachiyo Yoshida
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization, Geneva, Switzerland
| | - Alexander A Manu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Rubhana Raqib
- International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Eric D McCollum
- Global Program for Pediatric Respiratory Sciences, Eudowood Division of Paediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Sunil Sazawal
- Public Health Laboratory-IDC, Chake Chake, Pemba, Tanzania
| | - Rajiv Bahl
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization, Geneva, Switzerland
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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22
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Wiley Z, Kulshreshtha A, Li D, Kubes J, Kandiah S, Leung S, Kobaidze K, Shin SR, Moanna A, Perkins J, Hogan M, Sims KM, Amzat T, Cantos VD, Elutilo-Ayoola T, Hanna J, Harris NM, Henry TL, Iheaku O, Japaridze M, Lanka V, Johnson TA, Mbaezue N, Rebolledo PA, Sexton ME, Surapaneni PK, Franks N. Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19. J Investig Med 2022; 70:1406-1415. [PMID: 35649686 PMCID: PMC9195155 DOI: 10.1136/jim-2022-002344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/15/2022]
Abstract
COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of discharge from index admission was performed at eight Atlanta hospitals from March to December 2020. The objective was to describe COVID-19 patient-level demographics and clinical characteristics, and community-level social determinants of health (SDoH) that contribute to 30-day readmissions. Demographics, comorbidities, COVID-19 treatment, and discharge disposition data were extracted from the index admission. ZIP codes were linked to a demographic/lifestyle database interpolating to community-level SDoH. Of 7155 patients with COVID-19, 463 (6.5%) had 30-day, unplanned, all-cause hospital readmissions. Statistically significant differences were not found in readmissions stratified by age, sex, race, or ethnicity. Patients with a high-risk Charlson Comorbidity Index had higher odds of readmission (OR 4.8 (95% CI: 2.1 to 11.0)). Remdesivir treatment and intensive care unit (ICU) care were associated with lower odds of readmission (OR 0.5 (95% CI: 0.4 to 0.8) and OR 0.5 (95% CI: 0.4 to 0.7), respectively). Patients residing in communities with larger average household size were less likely to be readmitted (OR 0.7 (95% CI: 0.5 to 0.9). In this cohort, patients who received remdesivir, were cared for in an ICU, and resided in ZIP codes with higher proportions of residents with increased social support had lower odds of readmission. These patient-level factors and community-level SDoH may be used to identify patients with COVID-19 who are at increased risk of readmission.
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Affiliation(s)
- Zanthia Wiley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dong Li
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julianne Kubes
- Office of Quality and Risk, Emory Healthcare, Atlanta, Georgia, USA
| | - Sheetal Kandiah
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serena Leung
- Kaiser Permanente of Georgia, Atlanta, Georgia, USA
| | - Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Abeer Moanna
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Health Care System, Decatur, Georgia, USA
| | - Jonathan Perkins
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Hogan
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kanika M Sims
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tolu Amzat
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jasmah Hanna
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nadine M Harris
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Onyinye Iheaku
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mariam Japaridze
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Vaishnavi Lanka
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nkechi Mbaezue
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Elizabeth Sexton
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nicole Franks
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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23
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Yang X, Yelton B, Chen S, Zhang J, Olatosi BA, Qiao S, Li X, Friedman DB. Examining Social Determinants of Health During a Pandemic: Clinical Application of Z Codes Before and During COVID-19. Front Public Health 2022; 10:888459. [PMID: 35570965 PMCID: PMC9098923 DOI: 10.3389/fpubh.2022.888459] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
Recognition of the impact of social determinants of health (SDoH) on healthcare outcomes, healthcare service utilization, and population health has prompted a global shift in focus to patient social needs and lived experiences in assessment and treatment. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provides a list of non-billable “Z codes” specific to SDoH for use in electronic health records. Using population-level analysis, this study aims to examine clinical application of Z codes in South Carolina before and during the COVID-19 pandemic. The study population consists of South Carolina residents who had a healthcare visit and had their COVID-19 test result reported to the state's Department of Health and Environmental Control before January 14, 2021. Of the 1,190,531 individuals in the overall sample, Z codes were used only for 14,665 (1.23%) of the patients, including 2,536 (0.97%) COVID-positive patients and 12,129 (1.30%) COVID-negative patients. Compared with hospitals that did not use Z codes, those that did were significantly more likely to have higher bed capacity (p = 0.017) and to be teaching hospitals (p = 0.03), although this was significant only among COVID-19 positive individuals. Those at inpatient visits were most likely to receive Z codes (OR: 5.26; 95% CI: 5.14, 5.38; p < 0.0001) compared to those at outpatient visits (OR: 0.07; 95%CI: 0.06, 0.07; p < 0.0001). There was a slight increase of Z code use from 2019 to 2020 (OR: 1.33, 95% CI: 1.30, 1.36; p < 0.0001), which was still significant when stratified by facility type across time. As one of the first studies to examine Z code use among a large patient population, findings clearly indicate underutilization by providers. Additional study is needed to understand the potentially long-lasting health effects related to SDoH among underserved populations.
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Affiliation(s)
- Xueying Yang
- Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Brooks Yelton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shujie Chen
- Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jiajia Zhang
- Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Bankole A. Olatosi
- Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Office for the Study of Aging, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- *Correspondence: Daniela B. Friedman
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24
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Abstract
Racial and ethnic disparities in healthcare and health outcomes are longstanding. The real-time emergence of COVID-19 disparities has heightened the public and scientific discourse about structural inequities contributing to the greater risk of morbidity and mortality among racial and ethnic minority populations and other underserved groups. A key aspect of assuring health equity is addressing social determinants that lead to adverse health outcomes among minoritized groups. This article presents an exploratory social determinants of health (SDOH) conceptual framework for understanding racial and ethnic COVID-19 disparities, including factors related to health and healthcare, socioeconomics, and environmental determinants. The model also illustrates the backdrop of structural racism and discrimination, which directly affect health and COVID-19 exposure risk, and thus transmission, infection, and death. We also describe a special SDOH collection in the PhenX Toolkit (consensus measures for Phenotypes and eXposures), which includes established measures to promote standardization of assessment and the use of common data elements in research contexts. The use of common constructs, measures, and data elements are important for data integration, understanding the causes of health disparities, and evaluating interventions to reduce them. Substandard SDOH are among the primary drivers of health disparities-and scientific approaches to address these key concerns require identification and leveled alignment with the root causes. The overarching goal of this discussion is to broaden the consideration of mechanisms by which populations with health disparities face additional SARS-CoV-2 exposure risks, and to encourage research to develop interventions to reduce SDOH-associated disparities in COVID-19 and other conditions and behaviors.
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Affiliation(s)
- Monica Webb Hooper
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)
| | - Vanessa Marshall
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)
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25
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Matthay EC, Duchowny KA, Riley AR, Thomas MD, Chen YH, Bibbins-Domingo K, Glymour MM. Occupation and Educational Attainment Characteristics Associated With COVID-19 Mortality by Race and Ethnicity in California. JAMA Netw Open 2022; 5:e228406. [PMID: 35452107 PMCID: PMC9034406 DOI: 10.1001/jamanetworkopen.2022.8406] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Racial and ethnic inequities in COVID-19 mortality may be driven by occupation and education, but limited evidence has assessed these mechanisms. OBJECTIVE To estimate whether occupational characteristics or educational attainment explained the associations between race and ethnicity and COVID-19 mortality. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study of Californians aged 18 to 65 years linked COVID-19 deaths to population estimates within strata defined by race and ethnicity, gender, age, nativity in the US, region of residence, education, and occupation. Analysis was conducted from September 2020 to February 2022. EXPOSURES Education and occupational characteristics associated with COVID-19 exposure (essential sector, telework option, wages). MAIN OUTCOMES AND MEASURES All confirmed COVID-19 deaths in California through February 12, 2021. The study estimated what COVID-19 mortality would have been if each racial and ethnic group had (1) the COVID-19 mortality risk associated with the education and occupation distribution of White people and (2) the COVID-19 mortality risk associated with the lowest-risk educational and occupational positions. RESULTS Of 25 235 092 participants (mean [SD] age, 40 [14] years; 12 730 395 [50%] men), 14 783 died of COVID-19, 8 125 565 (32%) had a Bachelor's degree or higher, 13 345 829 (53%) worked in essential sectors, 11 783 017 (47%) could not telework, and 12 812 095 (51%) had annual wages under $51 700. COVID-19 mortality ranged from 15 deaths per 100 000 for White women and Asian women to 139 deaths per 100 000 for Latinx men. Accounting for differences in age, nativity, and region of residence, if all races and ethnicities had the COVID-19 mortality associated with the occupational characteristics of White people (sector, telework, wages), COVID-19 mortality would be reduced by 10% (95% CI, 6% to 14%) for Latinx men, but increased by 5% (95% CI, -8% to 17%) for Black men. If all working-age Californians had the COVID-19 mortality associated with the lowest-risk educational and occupational position (Bachelor's degree, nonessential, telework, and highest wage quintile), there would have been 43% fewer COVID-19 deaths among working-age adults (8441 fewer deaths; 95% CI, 32%-54%), with the largest absolute risk reductions for Latinx men (3755 deaths averted; 95% CI, 3304-4255 deaths) and Latinx women (2329 deaths averted; 95% CI, 2038-2621 deaths). CONCLUSIONS AND RELEVANCE In this population-based cohort study of working-age California adults, occupational disadvantage was associated with excess COVID-19 mortality for Latinx men. For all racial and ethnic groups, excess risk associated with low-education, essential, on-site, and low-wage jobs accounted for a substantial fraction of COVID-19 mortality.
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Affiliation(s)
| | - Kate A. Duchowny
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz
| | - Marilyn D. Thomas
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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26
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Polo G, Soler-Tovar D, Villamil Jimenez LC, Ortiz EB, Acosta CM. SARS-CoV-2 transmission dynamics in the urban-rural interface⋆. Public Health 2022; 206:1-4. [PMID: 35306192 PMCID: PMC8849864 DOI: 10.1016/j.puhe.2022.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 11/02/2022]
Abstract
Objectives Study design Methods Results Conclusions
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27
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Jensen A, Lopez-Carmen VA. The "Elephants in the Room" in U.S. global health: Indigenous nations and white settler colonialism. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000719. [PMID: 36962477 PMCID: PMC10021300 DOI: 10.1371/journal.pgph.0000719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Anpotowin Jensen
- Oglala Lakota Nation, Oceti Sakowin Land, United States of America
- School of Engineering, Stanford University, Stanford, California, United States of America
| | - Victor A Lopez-Carmen
- Hunkpati Dakota Nation, Oceti Sakowin Land, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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28
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Differences in COVID-19 Risk by Race and County-Level Social Determinants of Health among Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413140. [PMID: 34948748 PMCID: PMC8701661 DOI: 10.3390/ijerph182413140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/17/2022]
Abstract
COVID-19 disparities by area-level social determinants of health (SDH) have been a significant public health concern and may also be impacting U.S. Veterans. This retrospective analysis was designed to inform optimal care and prevention strategies at the U.S. Department of Veterans Affairs (VA) and utilized COVID-19 data from the VAs EHR and geographically linked county-level data from 18 area-based socioeconomic measures. The risk of testing positive with Veterans’ county-level SDHs, adjusting for demographics, comorbidities, and facility characteristics, was calculated using generalized linear models. We found an exposure–response relationship whereby individual COVID-19 infection risk increased with each increasing quartile of adverse county-level SDH, such as the percentage of residents in a county without a college degree, eligible for Medicaid, and living in crowded housing.
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29
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Magesh S, John D, Li WT, Li Y, Mattingly-app A, Jain S, Chang EY, Ongkeko WM. Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status: A Systematic-Review and Meta-analysis. JAMA Netw Open 2021; 4:e2134147. [PMID: 34762110 PMCID: PMC8586903 DOI: 10.1001/jamanetworkopen.2021.34147] [Citation(s) in RCA: 402] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE COVID-19 has disproportionately affected racial and ethnic minority groups, and race and ethnicity have been associated with disease severity. However, the association of socioeconomic determinants with racial disparities in COVID-19 outcomes remains unclear. OBJECTIVE To evaluate the association of race and ethnicity with COVID-19 outcomes and to examine the association between race, ethnicity, COVID-19 outcomes, and socioeconomic determinants. DATA SOURCES A systematic search of PubMed, medRxiv, bioRxiv, Embase, and the World Health Organization COVID-19 databases was performed for studies published from January 1, 2020, to January 6, 2021. STUDY SELECTION Studies that reported data on associations between race and ethnicity and COVID-19 positivity, disease severity, and socioeconomic status were included and screened by 2 independent reviewers. Studies that did not have a satisfactory quality score were excluded. Overall, less than 1% (0.47%) of initially identified studies met selection criteria. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Associations were assessed using adjusted and unadjusted risk ratios (RRs) and odds ratios (ORs), combined prevalence, and metaregression. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES The main measures were RRs, ORs, and combined prevalence values. RESULTS A total of 4 318 929 patients from 68 studies were included in this meta-analysis. Overall, 370 933 patients (8.6%) were African American, 9082 (0.2%) were American Indian or Alaska Native, 101 793 (2.4%) were Asian American, 851 392 identified as Hispanic/Latino (19.7%), 7417 (0.2%) were Pacific Islander, 1 037 996 (24.0%) were White, and 269 040 (6.2%) identified as multiracial and another race or ethnicity. In age- and sex-adjusted analyses, African American individuals (RR, 3.54; 95% CI, 1.38-9.07; P = .008) and Hispanic individuals (RR, 4.68; 95% CI, 1.28-17.20; P = .02) were the most likely to test positive for COVID-19. Asian American individuals had the highest risk of intensive care unit admission (RR, 1.93; 95% CI, 1.60-2.34, P < .001). The area deprivation index was positively correlated with mortality rates in Asian American and Hispanic individuals (P < .001). Decreased access to clinical care was positively correlated with COVID-19 positivity in Hispanic individuals (P < .001) and African American individuals (P < .001). CONCLUSIONS AND RELEVANCE In this study, members of racial and ethnic minority groups had higher risks of COVID-19 positivity and disease severity. Furthermore, socioeconomic determinants were strongly associated with COVID-19 outcomes in racial and ethnic minority populations.
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Affiliation(s)
- Shruti Magesh
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Daniel John
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Wei Tse Li
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Yuxiang Li
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Aidan Mattingly-app
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Sharad Jain
- The University of California Davis School of Medicine, Sacramento
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego
- Radiology Service, VA San Diego Healthcare System, San Diego, California
| | - Weg M. Ongkeko
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
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30
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Pirkle CM, Saiki KN, Yamauchi J, Irvin LH. Advancing Health Equity in Hawai'i: Critical Reflections on COVID-19, Chronic Conditions, and Health Disparities. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:3-5. [PMID: 34704061 PMCID: PMC8538109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI
| | - Kara N Saiki
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI
| | | | - Lola H Irvin
- Hawai'i State Department of Health, Honolulu, HI
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31
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TeleHealth or TeleWealth? Equity challenges for the future of cystic fibrosis care (Commentary). J Cyst Fibros 2021; 20 Suppl 3:55-56. [PMID: 34507897 PMCID: PMC8442253 DOI: 10.1016/j.jcf.2021.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
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