Disparities in COVID-19 related outcomes in the United States by race and ethnicity pre-vaccination era: an umbrella review of meta-analyses

Background

Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US.

Methods

In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805.

Results

Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant (p ≤ 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60-2.71), which was supported by highly suggestive evidence; with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60-2.70) with highly suggestive evidence which remained after sensitivity analyses.

Conclusion

Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization compared to their White counterparts. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.

[Participant structure and economic benefit of prevention bonus programmes in company health insurance funds]

OBJECTIVE

This study investigates differences in sex, age, and educational level between participants and non-participants of prevention bonus programmes. The differences in the utilisation of drugs, hospital care, and sickness absence before the start of the programmes between these groups are also shown. Finally the economic benefit of the health insurance funds attributed to these programmes is estimated.

METHODS

Data from some 5.2 million insured subjects of 74 company health insurance funds in Germany were linked to information on enrollment into a prevention bonus programme anonymously. In a descriptive analysis the differences in the sociodemographic patterns between both groups are shown as well as the differences in costs to the health insurances in the three sectors mentioned above. The benefit to the health insurance funds is estimated by means of an analysis of covariance.

RESULTS

Prevention bonus programmes yields an annual benefit of at least 129 euro per participant. Men aged 40 and older and women aged 30 and older are more likely to opt into such a programme. The same is true for persons with a higher educational level. There are only few differences in health-care utilisation between the participants and non-participants of the programmes before enrollment. Only 1.4% of all insured persons participated in the programmes.

CONCLUSION

There is at least a short-term gain to both involved parties: the insured and the health insurance funds. The programmes are not dominated by deadweight effects. Long-term effects and effectiveness of prevention bonus programmes still have to be investigated.

Using a representative sample of elementary school students to determine the statewide prevalence of childhood overweight and obesity in Utah

Utah's Height and Weight Measurement Project was conducted with elementary school students periodically from 2002 to 2008. The 2002 pilot project was performed to establish variability rates between schools and within schools. It allowed us to accurately determine both the sample size and the number of schools that were required to calculate a reliable statewide estimate based on a random sample of schools and to establish sentinel grades. The sentinel grades identified were grades 1, 3, and 5. Use of randomly selected classes in the sentinel grades resulted in decreased sample size and less school disruption while maintaining sufficient precision. Standardized, calibrated equipment was purchased and given to school nurses for safekeeping. Lessons learned included establishing strong relationships with partners, especially school nurses, and obtaining support from upper management at the schools, school districts, and the Utah Department of Health. A significant difference in participation rates and obesity rates at the individual school level was observed depending on parental consent type; active consent was associated with lower student participation rates and lower observed obesity rates. Data were presented to both participating and nonparticipating schools, school nurses, district superintendents, and principals. For surveillance purposes, sampling is an efficient, cost-effective way to estimate childhood overweight and obesity rates.

Do parents accurately perceive their child's weight status?

INTRODUCTION

Few studies have evaluated the accuracy of parental perceptions of their child's weight status.

METHODS

A cross-sectional sample of children aged 5 to 12 years and their parents (n = 576 parent-child pairs) was enrolled from four schools. Child height and weight were measured. The parents classified their child on Likert scales ranging from "extremely overweight" to "extremely underweight." Parental perceptions were compared with their child's weight status according to body mass index (BMI) age-gender percentiles. Fisher-Halton-Freeman tests, chi(2), and logistic regression were used to compare demographic factors between parents who inaccurately estimated and those who accurately estimated child weight status.

RESULTS

Misclassification occurred 25% of the time (95% confidence interval: 21.4-28.5). All parents of children with a BMI greater than or equal to the 95th percentile classified their child in a category other than "extremely overweight," and 75% of children with a BMI from the 85th to less than the 95th percentile were misclassified as "about right" or "underweight." Boys were more likely to be misclassified than were girls (29% vs 21%, P = .03).

CONCLUSIONS

The majority of parents of obese and overweight children underestimate their child's weight status. Parents of boys are more likely to perceive their child's weight incorrectly.

1H, 13C, and 15N NMR assignments and global folding pattern of the RNA-binding domain of the human hnRNP C proteins

The hnRNP C1 and C2 proteins are abundant nuclear proteins that bind avidly to heterogeneous nuclear RNAs (hnRNAs) and appear to be involved with pre-mRNA processing. The RNA-binding activity of the hnRNP C proteins is contained in the amino-terminal 94 amino acid RNA-binding domain (RBD) that is identical for these two proteins. We have obtained the 1H, 13C, and 15N NMR assignments for the RBD of the human hnRNP C proteins. The assignment process was facilitated by extensive utilization of three- and four-dimensional heteronuclear-edited spectra. Sequential assignments of the backbone resonances were made using a combination of 15N-edited 3D NOESY-HMQC, 3D TOCSY-HMQC, and 3D TOCSY-NOESY-HSQC as well as 3D HNCA, HNCO, and HCACO spectra. Side-chain resonances were assigned using 3D HCCH-COSY and 3D HCH-TOCSY spectra. Four-dimensional 13C/13C-edited NOESY and 13C/15N-edited NOESY experiments were used to unambigously resolve NOEs. The overall global folding pattern was established by calculating a set of preliminary structures using constraints derived from the sequential NOEs and a small number of long-range NOEs. The beta alpha beta-beta alpha beta domain structure exhibits an antiparallel beta-sheet with the conserved RNP 1 and RNP 2 sequences [Dreyfuss et al. (1988) Trends Biochem. Sci. 13, 86-91] located adjacent to one another as the two inner strands of the beta-sheet.