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Olanlesi-Aliu A, Tulli M, Kemei J, Bonifacio G, Reif LC, Cardo V, Roche H, Hurley N, Salami B. A scoping review on the operationalization of intersectional health research methods in studies related to the COVID-19 pandemic. Int J Qual Stud Health Well-being 2024; 19:2302305. [PMID: 38207090 PMCID: PMC10786425 DOI: 10.1080/17482631.2024.2302305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
PURPOSE The COVID-19 pandemic began in early 2020 and became a global health crisis with devastating impacts. This scoping review maps the key findings of research about the pandemic that has operationalized intersectional research methods around the world. It also tracks how these studies have engaged with methodological tenets of oppression, comparison, relationality, complexity, and deconstruction. METHODS Our search resulted in 14,487 articles, 5164 of which were duplicates, and 9297 studies that did not meet the inclusion criteria were excluded. In total, 14 articles were included in this review. We used thematic analysis to analyse themes within this work and Misra et al. (2021) intersectional research framework to analyse the uptake of intersectional methods within such studies. RESULTS The research related to the COVID-19 pandemic globally is paying attention to issues around the financial impacts of the pandemic, discrimination, gendered impacts, impacts of and on social ties, and implications for mental health. We also found strong uptake of centring research in the context of oppression, but less attention is being paid to comparison, relationality, complexity, and deconstruction. CONCLUSIONS Our findings show the importance of intersectional research within public health policy formation, as well as room for greater rigour in the use of intersectional methods.
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Affiliation(s)
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Janet Kemei
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Glenda Bonifacio
- Women and Gender Studies, Arts and Science, University of Lethbridge, Lethbridge, Canada
| | - Linda C. Reif
- CN Professor of International Trade, Law, University of Alberta, Edmonton, Canada
| | - Valentina Cardo
- Politics and Identity, University of Southampton, Southampton, United Kingdom
| | - Hannah Roche
- Department of English and Related Literature, University of York, Heslington, United Kingdom
| | - Natasha Hurley
- Dean of Humanities and Social Sciences, Memorial University¸Newfoundland and Labrador’s University, St. John’s Newfoundland, Canada
| | - Bukola Salami
- Intersections of Gender Signature Area, Intersections of Gender, Nursing, Fellow, Canadian Academy of Nursing, Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Canada
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Ahrens KA, Rossen LM, Milkowski C, Gelsinger C, Ziller E. Excess deaths associated with COVID-19 by rurality and demographic factors in the United States. J Rural Health 2024; 40:491-499. [PMID: 38082546 PMCID: PMC11164822 DOI: 10.1111/jrh.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/21/2023] [Accepted: 11/30/2023] [Indexed: 06/12/2024]
Abstract
PURPOSE To estimate percent excess deaths during the COVID-19 pandemic by rural-urban residence in the United States and to describe rural-urban disparities by age, sex, and race/ethnicity. METHODS Using US mortality data, we used overdispersed Poisson regression models to estimate monthly expected death counts by rurality of residence, age group, sex, and race/ethnicity, and compared expected death counts with observed deaths. We then summarized excess deaths over 6 6-month time periods. FINDINGS There were 16.9% (95% confidence interval [CI]: 16.8, 17.0) more deaths than expected between March 2020 and February 2023. The percent excess varied by rurality (large central metro: 18.2% [18.1, 18.4], large fringe metro: 15.6% [15.5, 15.8], medium metro: 18.1% [18.0, 18.3], small metro: 15.5% [15.3, 15.7], micropolitan rural: 16.3% [16.1, 16.5], and noncore rural: 15.8% [15.6, 16.1]). The percent excess deaths were 20.2% (20.1, 20.3) for males and 13.6% (13.5, 13.7) for females, and highest for Hispanic persons (49% [49.0, 49.6]), followed by non-Hispanic Black persons (28% [27.5, 27.9]) and non-Hispanic White persons (12% [11.6, 11.8]). The 6-month time periods with the highest percent excess deaths for large central metro areas were March 2020-August 2020 and September 2020-February 2021; for all other areas, these time periods were September 2020-February 2021 and September 2021-February 2022. CONCLUSION Percent excess deaths varied by rurality, age group, sex, race/ethnicity, and time period. Monitoring excess deaths by rurality may be useful in assessing the impact of the pandemic over time, as rural-urban patterns appear to differ.
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Affiliation(s)
- Katherine A. Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Lauren M. Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA
| | - Carly Milkowski
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Catherine Gelsinger
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Erika Ziller
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
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Auderset D, Amiguet M, Clair C, Riou J, Pittet V, Schwarz J, Mueller Y. Gender/Sex Disparities in the COVID-19 Cascade From Testing to Mortality: An Intersectional Analysis of Swiss Surveillance Data. Int J Public Health 2024; 69:1607063. [PMID: 38835806 PMCID: PMC11148283 DOI: 10.3389/ijph.2024.1607063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives This study investigates gender and sex disparities in COVID-19 epidemiology in the Canton of Vaud, Switzerland, focusing on the interplay with socioeconomic position (SEP) and age. Methods We analyzed COVID-19 surveillance data from March 2020 to June 2021, using an intersectional approach. Negative binomial regression models assessed disparities between women and men, across SEP quintiles and age groups, in testing, positivity, hospitalizations, ICU admissions, and mortality (Incidence Rate Ratios [IRR], with 95% Confidence Intervals [CI]). Results Women had higher testing and positivity rates than men, while men experienced more hospitalizations, ICU admissions, and deaths. The higher positivity in women under 50 was mitigated when accounting for their higher testing rates. Within SEP quintiles, gender/sex differences in testing and positivity were not significant. In the lowest quintile, women's mortality risk was 68% lower (Q1: IRR 0.32, CI 0.20-0.52), with decreasing disparities with increasing SEP quintiles (Q5: IRR 0.66, CI 0.41-1.06). Conclusion Our findings underscore the complex epidemiological patterns of COVID-19, shaped by the interactions of gender/sex, SEP, and age, highlighting the need for intersectional perspectives in both epidemiological research and public health strategy development.
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Affiliation(s)
- Diane Auderset
- Department of Family Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Michaël Amiguet
- Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Carole Clair
- Department of Ambulatory Care, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Julien Riou
- Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Valérie Pittet
- Department of Epidemiology and Health Systems, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Joelle Schwarz
- Department of Ambulatory Care, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Yolanda Mueller
- Department of Family Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
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Perna B, Raparelli V, Tordo Caprioli F, Blanaru OT, Malacarne C, Crosetti C, Portoraro A, Zanotto A, Strocchi FM, Rapino A, Costanzini A, Maritati M, Lazzari R, Spampinato MD, Contini C, De Giorgio R, Guarino M. Sex- and Gender-Based Analysis on Norepinephrine Use in Septic Shock: Why Is It Still a Male World? Microorganisms 2024; 12:821. [PMID: 38674765 PMCID: PMC11052153 DOI: 10.3390/microorganisms12040821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Sex and gender are fundamental health determinants and their role as modifiers of treatment response is increasingly recognized. Norepinephrine is a cornerstone of septic shock management and its use is based on the highest level of evidence compared to dopamine. The related 2021 Surviving Sepsis Campaign (SCC) recommendation is presumably applicable to both females and males; however, a sex- and gender-based analysis is lacking, thus not allowing generalizable conclusions. This paper was aimed at exploring whether sex- and gender-disaggregated data are available in the evidence supporting this recommendation. For all the studies underpinning it, four pairs of authors, including a woman and a man, extracted data concerning sex and gender, according to the Sex and Gender Equity in Research guidelines. Nine manuscripts were included with an overall population of 2126 patients, of which 43.2% were females. No sex analysis was performed and gender was never reported. In conclusion, the present manuscript highlighted that the clinical studies underlying the SCC recommendation of NE administration in septic shock have neglected the likely role of sex and gender as modifiers of treatment response, thus missing the opportunity of sex- and gender-specific guidelines.
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Affiliation(s)
- Benedetta Perna
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Valeria Raparelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Federica Tordo Caprioli
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Oana Teodora Blanaru
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Cecilia Malacarne
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Cecilia Crosetti
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Andrea Portoraro
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Alex Zanotto
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Francesco Maria Strocchi
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Alessandro Rapino
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Anna Costanzini
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Martina Maritati
- Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.M.); (C.C.)
| | - Roberto Lazzari
- Emergency Department, Hospital de la Santa Creu I Sant Pau, 08041 Barcelona, Spain;
| | - Michele Domenico Spampinato
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
- Emergency Department, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Carlo Contini
- Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.M.); (C.C.)
| | - Roberto De Giorgio
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
| | - Matteo Guarino
- Department of Translational Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.P.); (F.T.C.); (O.T.B.); (C.M.); (C.C.); (A.P.); (A.Z.); (F.M.S.); (A.R.); (A.C.); (M.D.S.); (M.G.)
- Emergency Department, University Hospital of Ferrara, 44124 Ferrara, Italy
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Willie TC, Sharpless L, Katague M, Kershaw T. A Mixed-Methods Analysis of Coercive Control and COVID-19 Stress Among Black Women Experiencing Intimate Partner Violence During the COVID-19 Pandemic. Public Health Rep 2024:333549241238895. [PMID: 38519862 DOI: 10.1177/00333549241238895] [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: 03/25/2024] Open
Abstract
OBJECTIVE During times of crises, women are at elevated risk for intimate partner violence (IPV), but extant discourse fails to consider how this landscape amplifies disparities for Black women. This study examined the prevalence and associations of COVID-19 pandemic-specific coercive control and COVID-19-related stress among Black women experiencing IPV. METHODS Fifty-five Black women reporting past-year IPV participated in a prospective cohort study in 2020 and completed surveys on pandemic-specific coercive control, COVID-19-related stress, and sociodemographic characteristics. A subset of 15 participants completed semi-structured interviews in 2021. We conducted multivariable regression analyses to examine associations between coercive control and stress. We used interpretive phenomenological analysis to contextualize women's experiences of coercive control and stress during the pandemic. RESULTS In the past 3 months, 76% (42 of 55) of women had a partner blame them for exposing them to COVID-19, 74% (41 of 55) had a partner minimize their pandemic concerns, and 52% (29 of 55) had a partner prevent them from getting a COVID-19 test. A higher average of pandemic-specific coercive control was associated with greater severity of COVID-19-related traumatic stress (b [SE] = 0.033 [0.009]; P = .001) and socioeconomic consequences related to COVID-19 (b [SE] = 0.019 [0.008]; P = .03). We identified 3 superordinate themes that illustrated Black women's experiences: (1) coercive control, (2) pandemic-driven shifts in relational context, and (3) women's structural and psychosocial stressors. CONCLUSIONS Experiencing coercive control during the pandemic interfered with Black women's engagement in preventive behaviors, which exacerbated distress. Intersectional public health efforts should address sociostructural and relational factors to prevent coercive control and stress among Black women experiencing IPV.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laurel Sharpless
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marina Katague
- San Diego State University and University of California, San Diego, San Diego, CA, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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Franco K, Patler C, Pirtle WL. COVID-19's Unequal Toll: Differences in Health-Related Quality of Life by Gendered and Racialized Groups. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:60-74. [PMID: 37830769 PMCID: PMC10908199 DOI: 10.1177/00221465231199734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
We examine whether the COVID-19 pandemic was associated with changes to daily activity limitations due to poor physical or mental health and whether those changes were different within and between gendered and racialized groups. We analyze 497,302 observations across the 2019 and 2020 waves of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System survey. Among White men and women, the COVID-19 pandemic was associated with fewer days of health-related activity limitations and decreased frequent activity limitation (≥14 days in the past month) compared to the prepandemic period. By contrast, Latina and Black women experienced increased days of activity limitation and greater likelihood of frequent activity limitation, and these changes were significantly different than for White women. These findings are robust to the inclusion of structural inequality measures and demonstrate how systemic racism and sexism likely exacerbate a myriad of pandemic-related health problems.
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Elhommosani MR, Sakr MM, Abbas RM, Aboshanab KM. Evaluation of clinically relevant serum proteins as biomarkers for monitoring COVID-19 severity, and end-organ damage among hospitalized unvaccinated patients. BMC Infect Dis 2024; 24:231. [PMID: 38378528 PMCID: PMC10880310 DOI: 10.1186/s12879-024-09113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The extensive variability and conflicting information in Coronavirus Disease 2019 (COVID-19) patient data have made it difficult for the medical community to gain a comprehensive understanding and develop clear, reliable guidelines for managing COVID-19 cases. As the world uncovers the diverse side effects of the pandemic, the pursuit of knowledge about COVID-19 has become crucial. The present study aimed to evaluate some clinically relevant serum proteins, providing analysis of the obtained results to employ them in the diagnosis, prognosis, and disease monitoring among COVID-19 patients. METHODS Samples were collected from 262 COVID-19 unvaccinated hospitalized patients. Measurement of certain serum proteins, namely C-reactive protein (CRP), ferritin, D-dimer, procalcitonin, interleukin-6 (IL-6), serum creatinine (SCr), alanine transaminase (ALT), aspartate transaminase (AST) was done using standard methods. Statistical analysis was performed on the obtained data and the results were correlated to the severity and prognosis. RESULTS The calculated Mortality rate was found to be 30% with a higher percentage observed among females. The results showed elevation in serum CRP, ferritin, D-dimer, and procalcitonin in most of the patients, also some patients had elevated SCr, ALT, and AST levels indicating end-organ damage. The statistical analysis displayed a strong correlation between serum levels of CRP and ferritin, between D-dimer and ferritin, and between ferritin and procalcitonin. No significant difference was observed between male and female patients' serum levels of the tested serum proteins. A significant correlation between increased serum procalcitonin and mortality was observed. CONCLUSION The levels of measured serum proteins were impacted by SARS-CoV-2 infection. Serum ferritin, CRP, D-dimer, and procalcitonin are good predicting tools for end-organ damage and acute kidney impairment in COVID-19. Procalcitonin is a strong indicator of severity and mortality in hospitalized COVID-19 patients.
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Affiliation(s)
- Mahetab R Elhommosani
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, 11566, Egypt
| | - Masarra M Sakr
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, 11566, Egypt
| | - Rania M Abbas
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, 11566, Cairo, Egypt
| | - Khaled M Aboshanab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, 11566, Egypt.
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Willie TC, Linton SL, Whittaker S, Phillips KA, Knight D, Gray MC, Gardner G, Overstreet NM. Housing insecurity among black women surviving intimate partner violence during the COVID-19 pandemic: an intersectional qualitative approach. BMC Public Health 2024; 24:501. [PMID: 38365688 PMCID: PMC10873942 DOI: 10.1186/s12889-024-17965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/03/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Housing instability is highly prevalent among intimate partner violence (IPV) survivors, and the coupling consequences of structural racism, sexism, classism, and the COVID-19 pandemic, may create more barriers to safe and adequate housing, specifically for Black women IPV survivors. In particular, the consequences of the COVID-19 pandemic had the potential to amplify disadvantages for Black women IPV survivors, yet very little research has acknowledged it. Therefore, the current study sought to assess the experiences of housing insecurity among Black women experiencing intimate partner violence (IPV) while navigating racism, sexism, and classism during the COVID-19 pandemic. METHODS From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity. RESULTS Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors' ability to obtain and sustain safe housing. We derived five themes to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; and strategies to maintain housing. CONCLUSIONS Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Interventions are needed to reduce the impact of these intersecting systems of oppression and power to facilitate the resources necessary for Black women IPV survivors to identify safe housing.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA.
| | - Sabriya L Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Shannon Whittaker
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Karlye A Phillips
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Deja Knight
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mya C Gray
- School of Law, North Carolina Central University, Durham, NC, USA
| | - Gretta Gardner
- Ujima, The National Center on Violence Against Women in the Black Community, Washington, DC, USA
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Chen Z, Yuan Y, Hu Q, Zhu A, Chen F, Li S, Guan X, Lv C, Tang T, He Y, Cheng J, Zheng J, Hu X, Zhao J, Zhao J, Sun J. SARS-CoV-2 immunity in animal models. Cell Mol Immunol 2024; 21:119-133. [PMID: 38238440 PMCID: PMC10806257 DOI: 10.1038/s41423-023-01122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
The COVID-19 pandemic, which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide health crisis due to its transmissibility. SARS-CoV-2 infection results in severe respiratory illness and can lead to significant complications in affected individuals. These complications encompass symptoms such as coughing, respiratory distress, fever, infectious shock, acute respiratory distress syndrome (ARDS), and even multiple-organ failure. Animal models serve as crucial tools for investigating pathogenic mechanisms, immune responses, immune escape mechanisms, antiviral drug development, and vaccines against SARS-CoV-2. Currently, various animal models for SARS-CoV-2 infection, such as nonhuman primates (NHPs), ferrets, hamsters, and many different mouse models, have been developed. Each model possesses distinctive features and applications. In this review, we elucidate the immune response elicited by SARS-CoV-2 infection in patients and provide an overview of the characteristics of various animal models mainly used for SARS-CoV-2 infection, as well as the corresponding immune responses and applications of these models. A comparative analysis of transcriptomic alterations in the lungs from different animal models revealed that the K18-hACE2 and mouse-adapted virus mouse models exhibited the highest similarity with the deceased COVID-19 patients. Finally, we highlighted the current gaps in related research between animal model studies and clinical investigations, underscoring lingering scientific questions that demand further clarification.
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Affiliation(s)
- Zhao Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Yaochang Yuan
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Qingtao Hu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
- GMU-GIBH Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, 510000, China
| | - Airu Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Fenghua Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Shu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Xin Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Chao Lv
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Tian Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Yiyun He
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Jinling Cheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Jie Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Xiaoyu Hu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Jingxian Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China.
- Guangzhou National Laboratory, Guangzhou, Guangdong, 510005, China.
| | - Jincun Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China.
- Guangzhou National Laboratory, Guangzhou, Guangdong, 510005, China.
- Shanghai Institute for Advanced Immunochemical Studies, School of Life Science and Technology, ShanghaiTech University, Shanghai, 201210, China.
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, the Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, 518005, China.
| | - Jing Sun
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510182, China.
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Shannon EM, Haderlein TP, Neil Steers W, Wong MS, Washington DL. Comparison of Racial and Ethnic Disparities in COVID-19 Mortality Between Veterans Health Administration and US Populations. J Gen Intern Med 2023; 38:3657-3659. [PMID: 37740169 PMCID: PMC10713933 DOI: 10.1007/s11606-023-08430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Evan M Shannon
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
| | - Taona P Haderlein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, USA
| | - W Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Michelle S Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
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Kyosei Y, Yoshimura T, Ito E. Removal of Soluble ACE2 in VeroE6 Cells by 17β-Estradiol Reduces SARS-CoV-2 Infectivity. Biol Pharm Bull 2023; 46:1842-1845. [PMID: 37866890 DOI: 10.1248/bpb.b23-00568] [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: 10/24/2023]
Abstract
Women are less susceptible than men to coronavirus disease 2019 (COVID-19), which might be due to the female steroid hormone 17β-estradiol. We hypothesized that 17β-estradiol removes the soluble portion of angiotensin-converting enzyme 2 (sACE2) to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds in host cells and that sACE2 then binds to the virus, thereby reducing the infectivity. In the present study, VeroE6/serine protease 2 transmembrane protein (TMPRSS2) cells were infected with pseudo SARS-CoV-2 viruses and used as our model system. This infectivity was reduced by the application of 17β-estradiol. After applying 17β-estradiol to the VeroE6/TMPRSS2 cells, we used a sandwich enzyme-linked immunosorbent assay (ELISA) to measure the sACE2 concentration in the culture medium. Our findings revealed that 17β-estradiol removes sACE2 from VeroE6/TMPRSS2 cells. Furthermore, the pseudo SARS-CoV-2 viruses were incubated in culture medium with ACE2 collected from 17β-estradiol-treated VeroE6/TMPRSS2 cells, and the viruses were measured with an ultrasensitive ELISA using anti-spike protein antibodies. The amount of spike proteins decreased according to the concentration of 17β-estradiol applied. These results clearly demonstrated that the soluble portion of ACE2, which was removed from 17β-estradiol-treated VeroE6/TMPRSS2 cells, bound to the spike proteins of SARS-CoV-2, thereby reducing COVID-19 infectivity.
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Affiliation(s)
| | - Teruki Yoshimura
- School of Pharmaceutical Sciences, Health Sciences University of Hokkaido
| | - Etsuro Ito
- Department of Biology, Waseda University
- Graduate Institute of Medicine, Kaohsiung Medical University
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Brown J, Xia C, Tazelaar H, Crow J, Telionis A, Anson-Dwamena R, Landen M. COVID-19 Case, Death, and Vaccination Rate Disparities by Race and Ethnicity in Virginia. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01856-3. [PMID: 38012433 DOI: 10.1007/s40615-023-01856-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
This paper tracks trends in COVID-19 case, death, and vaccination rate disparities by race and ethnicity in Virginia during the COVID-19 pandemic. COVID-19 case, death, and vaccination rates were obtained from electronic state health department records from March 2020 to February 2022. Rate ratios were then utilized to quantify racial and ethnic disparities for several time periods during the pandemic. The Hispanic population had the highest COVID-19 case and age-adjusted death rates, and the lowest vaccination rates at the beginning of the pandemic in Virginia. These disparities resolved later in the pandemic. COVID-19 case and death rates among the Black population were also higher than those of the White population and these disparities remained throughout the pandemic. Racial and ethnic disparities changed over time in Virginia as vaccination coverage and public health policies evolved. Year 2 of the analysis saw lower case and death rates, and higher vaccination rates for non-White populations in Virginia. Public health strategies need to be addressed during the pandemic and developed before the next pandemic to ensure that large racial and ethnic disparities are not again present at the outset.
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Affiliation(s)
- Juwairiyah Brown
- Office of Health Equity, Virginia Department of Health, Richmond, VA, USA.
| | - Chenyang Xia
- Office of Health Equity, Virginia Department of Health, Richmond, VA, USA
| | - Helen Tazelaar
- Office of Information Management, Virginia Department of Health, Richmond, VA, USA
| | - Justin Crow
- Office of Emergency Preparedness, Virginia Department of Health, Richmond, VA, USA
| | - Alex Telionis
- Office of Emergency Preparedness, Virginia Department of Health, Richmond, VA, USA
| | | | - Michael Landen
- Office of Epidemiology, Virginia Department of Health, Richmond, VA, USA
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13
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Zelaya CM, Francis DB, Williams LB. Understanding COVID-19 Vaccine Knowledge, Beliefs, and Trusted Information Sources Among Black Women in Kentucky: Implications for Vaccine Uptake. JOURNAL OF HEALTH COMMUNICATION 2023; 28:680-688. [PMID: 37667624 PMCID: PMC10592059 DOI: 10.1080/10810730.2023.2252367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
To optimize COVID-19 vaccination rates among Black women in the United States, it is crucial to understand their vaccine beliefs and determine the most effective communication sources and messages to encourage vaccination. Consequently, we conducted seven focus groups with 20 Black women from Kentucky (aged 18-37 years) between October and November 2020. We identified five themes reflecting the participants' level of awareness, knowledge of the vaccine and vaccine development process; their uncertainty about vaccine safety and clinical trials; their willingness to get vaccinated, and their preferences for trusted sources and persuasive messages to motivate vaccine uptake. Despite the participants' high level of awareness about the vaccine's development, significant concerns were identified regarding the speed of the vaccine's development and clinical trials, known medical injustices against Black people, political influence, vaccine efficacy, and potential side effects that fed their unwillingness to vaccinate. Based on our findings, we recommend vaccination campaigns targeting Black women should prioritize messaging highlighting the benefits and limitations of the vaccine while emphasizing its protective benefits for self, family, and community. Campaigns should also include Black healthcare providers as sources of messages. The findings have additional implications for encouraging continued confidence in the vaccine and improving uptake.
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14
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Li JX, Liao PL, Wei JCC, Hsu SB, Yeh CJ. A chronological review of COVID-19 case fatality rate and its secular trend and investigation of all-cause mortality and hospitalization during the Delta and Omicron waves in the United States: a retrospective cohort study. Front Public Health 2023; 11:1143650. [PMID: 37799149 PMCID: PMC10548482 DOI: 10.3389/fpubh.2023.1143650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has caused more than 690 million deaths worldwide. Different results concerning the death rates of the Delta and Omicron variants have been recorded. We aimed to assess the secular trend of case fatality rate (CFR), identify risk factors associated with mortality following COVID-19 diagnosis, and investigate the risks of mortality and hospitalization during Delta and Omicron waves in the United States. Methods This study assessed 2,857,925 individuals diagnosed with COVID-19 in the United States from January 2020, to June 2022. The inclusion criterion was the presence of COVID-19 diagnostic codes in electronic medical record or a positive laboratory test of the SARS-CoV-2. Statistical analysis was bifurcated into two components, longitudinal analysis and comparative analysis. To assess the discrepancies in hospitalization and mortality rates for COVID-19, we identified the prevailing periods for the Delta and Omicron variants. Results Longitudinal analysis demonstrated four sharp surges in the number of deaths and CFR. The CFR was persistently higher in males and older age. The CFR of Black and White remained higher than Asians since January 2022. In comparative analysis, the adjusted hazard ratios for all-cause mortality and hospitalization were higher in Delta wave compared to the Omicron wave. Risk of all-cause mortality was found to be greater 14-30 days after a COVID-19 diagnosis, while the likelihood of hospitalization was higher in the first 14 days following a COVID-19 diagnosis in Delta wave compared with Omicron wave. Kaplan-Meier analysis revealed the cumulative probability of mortality was approximately 2-fold on day 30 in Delta than in Omicron cases (log-rank p < 0.001). The mortality risk ratio between the Delta and Omicron variants was 1.671 (95% Cl 1.615-1.729, log-rank p < 0.001). Delta also had a significantly increased mortality risk over Omicron in all age groups. The CFR of people aged above 80 years was extremely high as 17.33%. Conclusion Male sex and age seemed to be strong and independent risk factors of mortality in COVID-19. The Delta variant appears to cause more hospitalization and death than the Omicron variant.
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Affiliation(s)
- Jing-Xing Li
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Shu-Bai Hsu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
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Jimbo M, Saito S, Uematsu T, Hanaki H, Otori K, Shibuya K, Ando W. Risk analysis of COVID-19 hospitalization and critical care by race and region in the United States: a cohort study. BMC Public Health 2023; 23:1489. [PMID: 37542210 PMCID: PMC10401821 DOI: 10.1186/s12889-023-16401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND This study aimed to identify the current risk factors for coronavirus disease 2019 severity and examine its association with medication use. METHODS We used data from a large United States electronic health record database to conduct an anonymized cohort study of 171,491 patients with coronavirus disease 2019. The study was conducted from January 1, 2020, to August 27, 2021. Data on age, race, sex, history of diseases, and history of medication prescriptions were analyzed using the Cox proportional hazards model analysis to calculate hazard ratios for hospitalization and severe risk. RESULTS Factors that increased the risk of hospitalization and critical care were age ≥ 65 years, male sex, type 2 diabetes, hypertension, interstitial pneumonia, and cardiovascular disease. In particular, age ≥ 65 years significantly increased the risk of hospitalization (hazard ratio, 2.81 [95% confidence interval, 2.58-3.07]; P < 0.001) and critical care (hazard ratio, 3.45 [2.88-4.14]; P < 0.001). In contrast, patients with hyperlipidemia had a reduced risk. However, patients with hyperlipidemia who were not taking statins had a significantly increased risk of hospitalization (hazard ratio, 1.24 [1.16-1.34]; P < 0.001). Sodium-glucose cotransporter-2 inhibitors, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, glucocorticoids, and statins significantly reduced the risk of hospitalization and critical care. The risk of hospitalization and critical care increased in patients of all ethnicities with type 2 diabetes. The factors that significantly increased the risk of hospitalization in all regions were older age, hypertension, chronic obstructive pulmonary disease, and cardiovascular disease. CONCLUSION This study identified factors that increase or reduce the risk of severe coronavirus disease. The provision of appropriate drug treatment and modification of lifestyle-related risk factors may reduce coronavirus disease severity.
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Affiliation(s)
- Mitsuki Jimbo
- Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of Pharmacy, Minato-Ku, Tokyo, Japan
| | - Sakae Saito
- Department of Pharmacy, Kitasato University Medical Center, Kitamoto City, Saitama, Japan
| | - Takayuki Uematsu
- Biomedical Laboratory, Division of Biomedical Research, Kitasato University Medical Center, Kitamoto City, Saitama, Japan
| | - Hideaki Hanaki
- Infection Control Research Center, Ōmura Satoshi Memorial Institute, Kitasato University, Minato-Ku, Tokyo, Japan
| | - Katsuya Otori
- Laboratory of Pharmacy Practice and Science 1, Division of Clinical Pharmacy, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Japan
| | - Kiyoshi Shibuya
- Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of Pharmacy, Minato-Ku, Tokyo, Japan
- Department of Pharmacy, Kitasato University Medical Center, Kitamoto City, Saitama, Japan
| | - Wataru Ando
- Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of Pharmacy, Minato-Ku, Tokyo, Japan.
- Department of Pharmacy, Kitasato University Medical Center, Kitamoto City, Saitama, Japan.
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Zhang J, Zhang Y, Xia Y, Sun J. Microbiome and intestinal pathophysiology in post-acute sequelae of COVID-19. Genes Dis 2023; 11:S2352-3042(23)00223-4. [PMID: 37362775 PMCID: PMC10278891 DOI: 10.1016/j.gendis.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 06/28/2023] Open
Abstract
Long COVID, also known for post-acute sequelae of COVID-19, describes the people who have the signs and symptoms that continue or develop after the acute COVID-19 phase. Long COVID patients suffer from an inflammation or host responses towards the virus approximately 4 weeks after initial infection with the SARS CoV-2 virus and continue for an uncharacterized duration. Anyone infected with COVID-19 before could experience long-COVID conditions, including the patients who were infected with SARS CoV-2 virus confirmed by tests and those who never knew they had an infection early. People with long COVID may experience health problems from different types and combinations of symptoms over time, such as fatigue, dyspnea, cognitive impairments, and gastrointestinal (GI) symptoms (e.g., nausea, vomiting, diarrhea, decreased or loss of appetite, abdominal pain, and dysgeusia). The critical role of the microbiome in these GI symptoms and long COVID were reported in clinical patients and experimental models. Here, we provide an overall view of the critical role of the GI tract and microbiome in the development of long COVID, including the clinical GI symptoms in patients, dysbiosis, viral-microbiome interactions, barrier function, and inflammatory bowel disease patients with long COVID. We highlight the potential mechanisms and possible treatment based on GI health and microbiome. Finally, we discuss challenges and future direction in the long COVID clinic and research.
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Affiliation(s)
- Jilei Zhang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, IL 60612, USA
| | - Yongguo Zhang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, IL 60612, USA
| | - Yinglin Xia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, IL 60612, USA
| | - Jun Sun
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Chicago, IL 60612, USA
- UIC Cancer Center, Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, IL 60612, USA
- Jesse Brown VA Medical Center, Chicago, IL 60612, USA
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Pongou R, Ahinkorah BO, Mabeu MC, Agarwal A, Maltais S, Boubacar Moumouni A, Yaya S. Identity and COVID-19 in Canada: Gender, ethnicity, and minority status. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001156. [PMID: 37224115 PMCID: PMC10208517 DOI: 10.1371/journal.pgph.0001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, growing evidence from the United States, the United Kingdom, and China has demonstrated the unequal social and economic burden of this health crisis. Yet, in Canada, studies assessing the socioeconomic and demographic determinants of COVID-19, and how these determinants vary by gender and ethnic minority status, remain scarce. As new strains of COVID-19 emerge, it is important to understand the disparities to be able to initiate policies and interventions that target and prioritise the most at-risk sub-populations. AIM The objective of this study is to assess the socioeconomic and demographic factors associated with COVID-19-related symptoms in Canada, and how these determinants vary by identity factors including gender and visible minority status. METHODS We implemented an online survey and collected a nationally representative sample of 2,829 individual responses. The original data collected via the SurveyMonkey platform were analysed using a cross-sectional study. The outcome variables were COVID-19-related symptoms among respondents and their household members. The exposure variables were socioeconomic and demographic factors including gender and ethnicity as well as age, province, minority status, level of education, total annual income in 2019, and number of household members. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed to test the associations. The results were presented as adjusted odds ratios (aORs) at p < 0.05 and a 95% confidence interval. RESULTS We found that the odds of having COVID-19-related symptoms were higher among respondents who belong to mixed race [aOR = 2.77; CI = 1.18-6.48] and among those who lived in provinces other than Ontario and Quebec [aOR = 1.88; CI = 1.08-3.28]. There were no significant differences in COVID-19 symptoms between males and females, however, we did find a significant association between the province, ethnicity, and reported COVID-19 symptoms for female respondents but not for males. The likelihood of having COVID-19-related symptoms was also lower among respondents whose total income was $100,000 or more in 2019 [aOR = 0.18; CI = 0.07-0.45], and among those aged 45-64 [aOR = 0.63; CI = 0.41-0.98] and 65-84 [aOR = 0.42; CI = 0.28-0.64]. These latter associations were stronger among non-visible minorities. Among visible minorities, being black or of the mixed race and living in Alberta were associated with higher odds of COVID-19-related symptoms. CONCLUSION We conclude that ethnicity, age, total income in 2019, and province were significantly associated with experiencing COVID-19 symptoms in Canada. The significance of these determinants varied by gender and minority status. Considering our findings, it will be prudent to have COVID-19 mitigation strategies including screening, testing, and other prevention policies targeted toward the vulnerable populations. These strategies should also be designed to be specific to each gender category and ethnic group, and to account for minority status.
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Affiliation(s)
- Roland Pongou
- Department of Economics, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Marie Christelle Mabeu
- Department of Economics, Stanford University, Stanford, California, United States of America
| | - Arunika Agarwal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Stéphanie Maltais
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
- The Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | | | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Sprague Martinez L, Scott JC, Rocco M, Rajabiun S, Flores Rodriguez C, Cummings R, McKinney-Prupis E, Minott M, Walker-Jones J, Downes A, Wangari Walter A. Policies enacted during COVID-19 came with unintended health benefits: why go back? BMC Health Serv Res 2023; 23:496. [PMID: 37194099 DOI: 10.1186/s12913-023-09448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES To explore the impact of COVID-19 on the implementation of bundled interventions to improve the engagement and retention of Black women in HIV care. METHODS Pre-implementation interviews conducted between January and April 202 L with 12 demonstration sites implementing bundled interventions for Black women with HIV. Directed content analysis was employed to examine the site interview transcripts. RESULTS The pandemic intensified barriers to care and harmful social conditions. However, COVID-19 also forced pivots in health care and social service delivery and some of these changes benefited Black women living with HIV. CONCLUSIONS The continuation of policies that support the material needs of Black women with HIV and ease access to care is critical. Racial capitalism impedes the enactment of these policies and thus threatens public health.
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Affiliation(s)
| | | | - Melanie Rocco
- Boston University School of Social Work, Boston, MA, US
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19
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Boulicault M. How Medical Technologies Materialize Oppression. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:40-43. [PMID: 37011349 DOI: 10.1080/15265161.2023.2186528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
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20
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Willie T, Linton S, Whittaker S, Phillips K, Knight D, Gray M, Gardner G, Overstreet N. Housing Insecurity among Black Women Surviving Intimate Partner Violence during the COVID-19 Pandemic: An Intersectional Qualitative Approach. RESEARCH SQUARE 2023:rs.3.rs-2662616. [PMID: 36993320 PMCID: PMC10055545 DOI: 10.21203/rs.3.rs-2662616/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background To investigate housing experiences during the COVID-19 pandemic among Black women experiencing intimate partner violence (IPV) who are also navigating racism, sexism, and classism. Methods From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity. Results Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors' ability to obtain and sustain safe housing. Five themes were derived to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; mental toll of eviction; and strategies to maintain housing. Conclusions Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Structural-level interventions are needed to reduce the impact of these intersecting systems of oppression and power in order to facilitate the resources necessary for Black women IPV survivors to identify safe housing.
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Affiliation(s)
| | | | | | | | | | - Mya Gray
- North Carolina Central University
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21
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Martin BE, Garrett MR. Race and Sex Differences in Vital Signs Associated with COVID-19 and Flu Diagnoses in Mississippi. J Racial Ethn Health Disparities 2023; 10:228-236. [PMID: 35066856 PMCID: PMC8783800 DOI: 10.1007/s40615-021-01213-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
Early detection of viral infections, such as COVID-19 and flu, have potential to reduce risk of morbidity, mortality, and disease transmission through earlier intervention strategies. For example, detecting changes in vital signs have the potential to more rapidly diagnose respiratory virus diseases. The objective of this study was to utilize the University of Mississippi Medical Center's extensive clinical database (EPIC) to investigate associations between temperature, pulse rate, blood pressure (BP), and respiration rate in COVID-19 and flu diagnosed patients. Data from 1,363 COVID-19 (March 3, 2020, to February 27, 2021) and 507 flu (October 1, 2017, to September 30, 2018) diagnosed patients with reported demographic dimensions (age, first race, and sex) and office visit dimensions (BMI, diastolic BP, pulse rate, respiration rate, systolic BP, and temperature) was obtained, including day of diagnosis and additional encounter visits 60 days before and after first unique diagnosis. Patients with COVID-19 or flu were disproportionately obese, with 93% of COVID-19 and 79% of flu patients with BMI ≥ 30. Most striking, Black women 50-64 years of age disproportionately carried the burden of disease. At the time of diagnosis, temperature was significantly increased for all patients, yet pulse rate was only significantly increased for flu diagnosis, and BP was not significantly different in either. Our findings show the need for more complete demographic and office visit dimension data from patients during epidemic and pandemic events and support further studies needed to understand association between vital signs and predicting respiratory disease.
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Affiliation(s)
- Brigitte E Martin
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Michael R Garrett
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
- Department of Medicine (Nephrology), University of Mississippi Medical Center, Jackson, MS, USA.
- Department of Pediatrics (Genetics), University of Mississippi Medical Center, Jackson, MS, USA.
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22
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Jenks JD, Aneke CI, Al-Obaidi MM, Egger M, Garcia L, Gaines T, Hoenigl M, Thompson GR. Race and ethnicity: Risk factors for fungal infections? PLoS Pathog 2023; 19:e1011025. [PMID: 36602962 DOI: 10.1371/journal.ppat.1011025] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Racial and ethnic identities, largely understood as social rather than biologic constructs, may impact risk for acquiring infectious diseases, including fungal infections. Risk factors may include genetic and immunologic differences such as aberrations in host immune response, host polymorphisms, and epigenomic factors stemming from environmental exposures and underlying social determinants of health. In addition, certain racial and ethnic groups may be predisposed to diseases that increase risk for fungal infections, as well as disparities in healthcare access and health insurance. In this review, we analyzed racial and ethnic identities as risk factors for acquiring fungal infections, as well as race and ethnicity as they relate to risk for severe disease from fungal infections. Risk factors for invasive mold infections such as aspergillosis largely appear related to environmental differences and underlying social determinants of health, although immunologic aberrations and genetic polymorphisms may contribute in some circumstances. Although black and African American individuals appear to be at high risk for superficial and invasive Candida infections and cryptococcosis, the reasons for this are unclear and may be related to underling social determinants of health, disparities in access to healthcare, and other socioeconomic disparities. Risk factors for all the endemic fungi are likely largely related to underlying social determinants of health, socioeconomic, and health disparities, although immunologic mechanisms likely play a role as well, particularly in disseminated coccidioidomycosis.
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Affiliation(s)
- Jeffrey D Jenks
- Durham County Department of Public Health, Durham, North Carolina, United States of America
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Chioma Inyang Aneke
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, Nigeria
| | - Mohanad M Al-Obaidi
- Division of Infectious Diseases, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Matthias Egger
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
| | - Lorena Garcia
- Department of Public Health Sciences, UC Davis School of Medicine, Davis, California, United States of America
| | - Tommi Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, California, United States of America
| | - Martin Hoenigl
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, California, United States of America
| | - George R Thompson
- University of California Davis Center for Valley Fever, Sacramento, California, United States of America
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of America
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23
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Bhatta TR, Lekhak N, Goler TD, Kahana E, Rathi S. The intersection of race and financial strain: The pain of social disconnection among women in the United States. J Women Aging 2023; 35:38-48. [PMID: 35226586 DOI: 10.1080/08952841.2022.2041154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Considerable attention has been directed at increased social isolation and loneliness during the COVID-19 pandemic and their impact on later-life psychological well-being. There is a dearth of research on the effect of financial strain and associated psychosocial mechanisms on loneliness among women across racial groups. It is unclear how racial status and financial strain intersect to impact later-life loneliness amid immense uncertainty, social isolation, and anxiety induced by the pandemic.Methods: Based on our nationwide Web-based survey (n = 1,301), we used ordinary least square regression to examine the effects of financial strain on loneliness among Black and White women and assessed the role of emotional support in contributing to such effects.Results: We found that Black women face significantly more financial strain than White women but also receive more emotional support and experience less loneliness. Findings show that women experiencing financial strain report increased loneliness, but the negative effects of financial strain are significantly greater for Black women than for White women. Our mediation analysis revealed that emotional support made a significant contribution to the effects of financial strain on loneliness in White women but not in Black women.Discussion: Despite shared vulnerability and social isolation across the general population, our findings suggest that negative effects of financial strain on loneliness among women continue to differ across race, even amid the pandemic. Our findings demonstrate how emotional support explains the relationship between financial strain and later-life loneliness in a racially distinct manner.
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Affiliation(s)
- Tirth R Bhatta
- Department of Sociology, University of Nevada, Las Vegas, Nevada, USA
| | - Nirmala Lekhak
- School of Nursing, University of Nevada, Las Vegas, Nevada, USA
| | - Timothy D Goler
- Department of Sociology, Norfolk State University, Norfolk, Virginia, USA
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sfurti Rathi
- School of Public Health, University of Nevada, Las Vegas, Nevada, USA
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24
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Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample. Vaccines (Basel) 2022; 10:vaccines10122036. [PMID: 36560446 PMCID: PMC9781042 DOI: 10.3390/vaccines10122036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022] Open
Abstract
COVID-19 has brought the disparities in health outcomes for patients to the forefront. Racial and gender identity are associated with prevalent healthcare disparities. In this study, we examine the health disparities in COVID-19 hospitalization outcome from the intersectional lens of racial and gender identity. The Agency for Healthcare Research and Quality (AHRQ) 2020 NIS dataset for hospitalizations from 1 January 2020 to 31 December 2020 was analyzed for primary outcome of in-patient mortality and secondary outcomes of intubation, acute kidney injury (AKI), AKI requiring hemodialysis (HD), cardiac arrest, stroke, and vasopressor use. A multivariate regression model was used to identify associations. A p value of <0.05 was considered significant. Men had higher rates of adverse outcomes. Native American men had the highest risk of in-hospital mortality (aOR 2.0, CI 1.7−2.4) and intubation (aOR 1.8, CI 1.5−2.1), Black men had highest risk of AKI (aOR 2.0, CI 1.9−2.0). Stroke risk was highest in Asian/Pacific Islander women (aOR 1.5, p = 0.001). We note that the intersection of gender and racial identities has a significant impact on outcomes of patients hospitalized for COVID-19 in the United States with Black, Indigenous, and people of color (BIPOC) men have higher risks of adverse outcomes.
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25
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Frisina Doetter L, Frisina PG, Preuß B. Pandemic Meets Endemic: The Role of Social Inequalities and Failing Public Health Policies as Drivers of Disparities in COVID-19 Mortality among White, Black, and Hispanic Communities in the United States of America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14961. [PMID: 36429679 PMCID: PMC9690946 DOI: 10.3390/ijerph192214961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic placed the United States of America (U.S.) under enormous strain, leaving it with higher deaths during the first wave of the outbreak compared to all other advanced economies. Blacks and Hispanics were among those hardest hit by the virus-a fact attributed to enduring problems related to the social determinants of health adversely affecting Communities of Color (CoC). In this study, we ask which distinct factors relating to policy stringency and community vulnerability influenced COVID-19 mortality among Whites, Blacks, and Hispanics during the first year of the pandemic. To address this question, we utilized a mix of correlational and regression analyses. Findings point to the highly divergent impact of public policy and vulnerability on COVID-19 mortality. Specifically, we observed that state-led measures aimed at controlling the spread of the virus only improved mortality for Whites. However, pre-existing social determinants of health (i.e., population density, epidemiological and healthcare system factors) played a significant role in determining COVID-19 outcomes for CoC, even in the face of stringent containment measures by states. This suggests that state-led policy to address present and/or future public health crises need to account for the particular nature of vulnerability affecting Blacks and Hispanics in the U.S.
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Affiliation(s)
- Lorraine Frisina Doetter
- Collaborative Research Centre (CRC) 1342 & Research Center on Inequality and Social Policy (SOCIUM), The University of Bremen, 28359 Bremen, Germany
| | | | - Benedikt Preuß
- Research Center on Inequality and Social Policy (SOCIUM), The University of Bremen, 28359 Bremen, Germany
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26
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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: 72] [Impact Index Per Article: 36.0] [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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27
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Danielsen AC, Boulicault M, Gompers A, Rushovich T, Lee KMN, Richardson SS. How Cumulative Statistics Can Mislead: The Temporal Dynamism of Sex Disparities in COVID-19 Mortality in New York State. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14066. [PMID: 36360943 PMCID: PMC9658081 DOI: 10.3390/ijerph192114066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Overall, men have died from COVID-19 at slightly higher rates than women. But cumulative estimates of mortality by sex may be misleading. We analyze New York State COVID-19 mortality by sex between March 2020 and August 2021, demonstrating that 72.7% of the total difference in the number of COVID-19 deaths between women and men was accrued in the first seven weeks of the pandemic. Thus, while the initial surge in COVID-19 mortality was characterized by stark sex disparities, this article shows that disparities were greatly attenuated in subsequent phases of the pandemic. Investigating changes over time could help illuminate how contextual factors contributed to the development of apparent sex disparities in COVID-19 outcomes.
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Affiliation(s)
| | - Marion Boulicault
- College of Computing, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Linguistics and Philosophy, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Annika Gompers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Tamara Rushovich
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | | | - Sarah S. Richardson
- Department of the History of Science, Harvard University, Cambridge, MA 02138, USA
- Committee on Degrees in Studies of Women, Gender, and Sexuality, Harvard University, Cambridge, MA 02138, USA
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28
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Versey HS, Russell CN. The impact of COVID-19 and housing insecurity on lower-income Black women. THE JOURNAL OF SOCIAL ISSUES 2022; 79:JOSI12555. [PMID: 36711011 PMCID: PMC9874908 DOI: 10.1111/josi.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
During the COVID-19 pandemic, multiple groups faced increased risks for negative health and mortality. Using an intersectional framework, the current study explores how the global pandemic impacted lower-income women living in the United States through access to housing. Findings indicate several challenges remaining stably housed during the pandemic. Major themes included: (1) High-Risk Survival Economies, (2) Landlord Stress, Deception, and Exclusion, (3) Landlord Harassment, (4) Low Levels of Formal and Informal Support, (5) Housing as a Health Risk Factor, and (6) Resilience. These themes are explored through four in-depth narrative accounts. Implications for health and policy are discussed. Future research that examines and engages with both direct (e.g., material scarcity) and indirect (e.g., discrimination) pathways that connect housing to health are strongly encouraged.
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29
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Dunn LF, Mirzaie IA. Gender Differences in Consumer Debt Stress: Impacts on Job Performance, Family Life and Health. JOURNAL OF FAMILY AND ECONOMIC ISSUES 2022; 44:1-18. [PMID: 36189082 PMCID: PMC9514182 DOI: 10.1007/s10834-022-09862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
During periods of economic instability, women may suffer uniquely from economic stress compared to men. We examine stress effects from financial debts by gender with monthly national-level household data starting in 2006, going through the Great Recession in the U.S and into the recovery period. We find that women on average in the sample exhibit approximately 30% overall greater debt stress scores than men after controlling for income, debt levels and other socioeconomic variables. Underlying factors for both genders are examined, including impacts on job performance, family life and health. Sources of disadvantage for women and implied policy needs are explored. Our findings and their consequences are examined relative to economic circumstances for women that have been documented as a result of the pandemic-induced recession.
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Affiliation(s)
- Lucia F. Dunn
- Department of Economics, Ohio State University, 1945 N. High St., Columbus, OH 43210 USA
| | - Ida A. Mirzaie
- Department of Economics, Ohio State University, 1945 N. High St., Columbus, OH 43210 USA
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30
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Sullivan AL. Overcoming Disaster Through Critical Consciousness and Ideological Change. SCHOOL PSYCHOLOGY REVIEW 2022. [DOI: 10.1080/2372966x.2022.2093127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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31
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The sex and gender dimensions of COVID-19: A narrative review of the potential underlying factors. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 103:105338. [PMID: 35863677 PMCID: PMC9288935 DOI: 10.1016/j.meegid.2022.105338] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 12/17/2022]
Abstract
Multiple lines of evidence indicate that the male sex is a significant risk factor for severe disease and mortality due to coronavirus disease 2019 (COVID-19). However, the precise explanation for the discrepancy is currently unclear. Immunologically, the female-biased protection against COVID-19 could presumably be due to a more rapid and robust immune response to viruses exhibited by males. The female hormones, e.g., estrogens and progesterone, may have protective roles against viral infections. In contrast, male hormones, e.g., testosterone, can act oppositely. Besides, the expression of the ACE-2 receptor in the lung and airway lining, which the SARS-CoV-2 uses to enter cells, is more pronounced in males. Estrogen potentially plays a role in downregulating the expression of ACE-2, which could be a plausible biological explanation for the reduced severity of COVID-19 in females. Comorbidities, e.g., cardiovascular diseases, diabetes, and kidney disorders, are considered significant risk factors for severe outcomes in COVID-19. Age-adjusted data shows that males are statistically more predisposed to these morbidities-amplifying risks for males with COVID-19. In addition, many sociocultural factors and gender-constructed behavior of men and women impact exposure to infections and outcomes. In many parts of the world, women are more likely to abide by health regulations, e.g., mask-wearing and handwashing, than men. In contrast, men, in general, are more involved with high-risk behaviors, e.g., smoking and alcohol consumption, and high-risk jobs that require admixing with people, which increases their risk of exposure to the infection. Overall, males and females suffer differently from COVID-19 due to a complex interplay between many biological and sociocultural factors.
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32
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Jiwani Z, Raval VV, Steele M, Goldberg SB. Caste and COVID-19: Psychosocial disparities amongst rural Indian women during the coronavirus pandemic. THE JOURNAL OF SOCIAL ISSUES 2022; 79:JOSI12532. [PMID: 35945958 PMCID: PMC9353364 DOI: 10.1111/josi.12532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has exacerbated preexisting mental health disparities. In India, marginalization based on caste membership, gender, and rural residence are critical determinants of inequity across the lifespan. Guided by the theoretical frameworks of minority stress and intersectionality, this study examined caste-based disparities in fear of coronavirus (FOC), mental health symptoms, and perceived loneliness amongst rural women in north India during the COVID-19 pandemic. Participants (N = 316) completed self-report measures and were classified into three groups based on their responses: General caste (GC, n = 124), other backward castes (OBC, n = 122), and scheduled caste or tribe (SC/ST, n = 71). Using a three-way ANOVA and Tukey t-tests, women in SC/ST and OBC groups reported greater FOC (OBC d = .37; SC/ST d = .40) and greater mental health symptoms (OBC d = .58; SC/ST d = .43) relative to the GC group. OBC, but not SC/ST, group also reported higher perceived loneliness (d = .32). The results were consistent after adjusting for demographic variables such as wealth and highlight caste as an important social determinant for well-being during the COVID-19 pandemic amongst rural Indian women.
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33
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Bertocchi G, Dimico A. JUE Insight: COVID-19, Race, and Gender. JOURNAL OF URBAN ECONOMICS 2022:103484. [PMID: 35847552 PMCID: PMC9272662 DOI: 10.1016/j.jue.2022.103484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
The evidence on the demographics of COVID-19 fatalities points to an overrepresentation of minorities and an underrepresentation of women. We investigate the joint impact of race and gender using individual-level georeferenced death data collected by the Cook County Medical Examiner, which we structure as a cell-level panel at a race, block group, week, and year level. Through an event study approach, we establish that Black individuals are affected more harshly than White and that the effect is driven by Black women. The Black female bias is associated with occupational segregation in the health care and transportation sectors and by commuting on public transport.
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Affiliation(s)
- Graziella Bertocchi
- University of Modena and Reggio Emilia, EIEF, CEPR, CHILD, Dondena, GLO, and IZA
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34
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Abstract
After more than 20 years of studying sex differences in viral pathogenesis and immunity to vaccines, the COVID‐19 pandemic provided me with a unique opportunity to raise awareness about biological sex differences. The scientific community and public, alike, embraced the clinical and epidemiological data and supported inquiries into how males are twice as likely to be hospitalized and die from COVID‐19. Immunological changes associated with pregnancy also contribute to worse outcomes from COVID‐19. Collectively, we are finding that inflammation is a critical mediator of worse outcomes for males and pregnant females. The pandemic gave me a platform to discuss and address sex differences on a bigger stage, but two decades of studies working with other viruses prepared me for this moment in history.
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Affiliation(s)
- Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Biochemistry and Molecular Biology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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35
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White J, Clayton J. The gender health innovation gap: A perspective from the NIH Office of Research on Women’s Health. MED 2022; 3:298-301. [DOI: 10.1016/j.medj.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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DiMarco M, Zhao H, Boulicault M, Richardson SS. Why "sex as a biological variable" conflicts with precision medicine initiatives. Cell Rep Med 2022; 3:100550. [PMID: 35492240 PMCID: PMC9043982 DOI: 10.1016/j.xcrm.2022.100550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Policies that require male-female sex comparisons in all areas of biomedical research conflict with the goal of improving health outcomes through context-sensitive individualization of medical care. Sex, like race, requires a rigorous, contextual approach in precision medicine. A "sex contextualist" approach to gender-inclusive medicine better aligns with this aim.
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Affiliation(s)
- Marina DiMarco
- Department of History & Philosophy of Science, University of Pittsburgh, 1101 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA 15260, USA.
| | - Helen Zhao
- Department of Philosophy, Columbia University, 708 Philosophy Hall, MC: 4971, 1150 Amsterdam Avenue, New York, NY 10027, USA
| | - Marion Boulicault
- Department of Linguistics and Philosophy, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Sarah S. Richardson
- Department of History of Science, Harvard University, 1 Oxford Street, Cambridge, MA 02138, USA,Committee on Degrees in Studies of Women, Gender, and Sexuality, Harvard University Boylston Hall, Cambridge, MA 02138, USA
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37
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Boulicault M, Gompers A, Lee K, Shattuck-Heidorn H. A Feminist Approach to Analyzing Sex Disparities in COVID-19 Outcomes. INTERNATIONAL JOURNAL OF FEMINIST APPROACHES TO BIOETHICS 2022; 15:167-174. [PMID: 35812763 PMCID: PMC9262278 DOI: 10.3138/ijfab-15.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Marion Boulicault
- Harvard GenderSci Lab and the Distinguished Postdoctoral Scholar in Ethics & Technology at the Massachusetts Institute of Technology
| | - Annika Gompers
- Research Division of the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center
| | - Katharine Lee
- Division of Public Health Sciences at Washington University School of Medicine
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38
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Martin CE, Thakkar B, Taylor DDH, Chapman DA. Disparities by Sex in COVID-19 Risk and Related Harms Among People with Opioid Use Disorder. J Womens Health (Larchmt) 2022; 31:640-647. [PMID: 35171036 PMCID: PMC9133966 DOI: 10.1089/jwh.2021.0457] [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: 11/13/2022] Open
Abstract
Objectives: (1) Report sex-specific prevalence of coronavirus disease 2019 (COVID-19) test positivity among an opioid use disorder (OUD) cohort (2) Assess sex-specific rates of opioid overdose and mortality. Methods: A retrospective cohort study was performed on all adult patients with OUD who received a COVID-19 test in calendar year 2020 at a large academic medical center in Richmond, Virginia. Our study outcomes were positive COVID-19 test, opioid overdose, and all-cause in-hospital mortality. Sex-stratified multivariable logistic regression assessed sociodemographic factors associated with COVID-19 test positivity. Results: A total of 2,600 patients (males = 1,294, females = 1,306) with OUD received a COVID-19 test. Approximately 5% across both sexes tested positive for COVID-19 (p = 0.420), whereas 7% presented with an opioid overdose (males 10%; females 4%; p < 0.0001). However, mortality rates were similar across sex. Among males, individuals in the other racial group had increased odds of COVID-19 test positivity (adjusted odds ratio or AOR: 5.03, 95% confidence interval [CI]: 1.70-14.88), whereas black females had higher odds of COVID-19 test positivity (AOR: 1.92, 95% CI: 1.01-3.62) compared to their white counterparts. Conclusions: Opioid overdose, more often than COVID-19, impacted the health of patients with OUD presenting to a public safety net health system. Despite a female advantage documented in the general population for COVID-19 susceptibility, COVID-19 test positivity rates were similar across sex in an OUD cohort; yet, racial disparities emerged with notable sex-related variation. Sex and gender are important variables that modify health outcomes, including OUD and COVID-19, and should be further investigated using an intersectionality framework.
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Affiliation(s)
- Caitlin E Martin
- Department of Obstetrics and Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bhushan Thakkar
- Department of Obstetrics and Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - DaShaunda D H Taylor
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Derek A Chapman
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia, USA
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39
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Abstract
The National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) was established in 1990. With the completion of the office's 30th anniversary year, we look back and recount some of the key events and overall zeitgeist that led to ORWH's formation, and how it became the focal point at the nation's primary biomedical research agency for coordinating research on science to improve the health of women. We discuss ORWH's mission and signature programs and the bold vision that drives the NIH-wide strategic, interdisciplinary, and collaborative approach to research on women's health and efforts to promote women in biomedical careers. Also discussed are several of the many scientific advances in research on the health of women, policy innovations and their effects, and career advancements made by women in medicine and related scientific fields. We also highlight key challenges for the health of women, the need to continue pushing for equity in biomedical research careers, and NIH's approach to addressing these problems to ensure progress for the next 30 years and beyond.
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Affiliation(s)
- Regine Douthard
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Janine Austin Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland, USA
- Address correspondence to: Janine Austin Clayton, MD, FARVO, Office of Research on Women's Health, National Institutes of Health, 6707 Democracy Blvd., Suite #400, Bethesda, MD 20892, USA
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Danielsen AC, Lee KM, Boulicault M, Rushovich T, Gompers A, Tarrant A, Reiches M, Shattuck-Heidorn H, Miratrix LW, Richardson SS. Sex disparities in COVID-19 outcomes in the United States: Quantifying and contextualizing variation. Soc Sci Med 2022; 294:114716. [PMID: 35042136 PMCID: PMC8743486 DOI: 10.1016/j.socscimed.2022.114716] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 12/26/2022]
Abstract
This paper presents the first longitudinal study of sex disparities in COVID-19 cases and mortalities across U.S. states, derived from the unique 13-month dataset of the U.S. Gender/Sex COVID-19 Data Tracker. To analyze sex disparities, weekly case and mortality rates by sex and mortality rate ratios were computed for each U.S. state, and a multilevel crossed-effects conditional logistic binomial regression model was fitted to estimate the variation of the sex disparity in mortality over time and across states. Results demonstrate considerable variation in the sex disparity in COVID-19 cases and mortalities over time and between states. These data suggest that the sex disparity, when present, is modest, and likely varies in relation to context-sensitive variables, which may include health behaviors, preexisting health status, occupation, race/ethnicity, and other markers of social experience.
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Affiliation(s)
| | - Katharine Mn Lee
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Marion Boulicault
- Department of Linguistics and Philosophy, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA; Department of Philosophy, University of Adelaide, 259 North Terrace, Adelaide, SA, 5000, Australia
| | - Tamara Rushovich
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Amelia Tarrant
- Department of Human Evolutionary Biology, Harvard University, 11 Divinity Avenue, Cambridge, MA, 02138, USA
| | - Meredith Reiches
- Department of Anthropology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA, 02125, USA
| | - Heather Shattuck-Heidorn
- Women and Gender Studies, University of Southern Maine, 94 Bedford Street, Portland, ME, 04102, USA
| | - Luke W Miratrix
- Harvard Graduate School of Education, 13 Appian Way, Cambridge, MA, 02138, USA
| | - Sarah S Richardson
- Department of the History of Science, Harvard University, 1 Oxford St, Cambridge, MA, 02138, USA; Committee on Degrees in Studies of Women, Gender, and Sexuality, Harvard University, Boylston Hall, Cambridge, MA, 02138, USA
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41
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Thompson K, Vassallo A, Finfer S, Woodward M. Renewed rationale for sex- and gender-disaggregated research: A COVID-19 commentary review. WOMEN'S HEALTH 2022; 18:17455065221076738. [PMID: 35107040 PMCID: PMC8814978 DOI: 10.1177/17455065221076738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic provides a contemporaneous illustration of the need to consider sex and gender in research. Using surveillance, treatment and vaccine research examples, in this commentary review, we highlight opportunities for innovation in sex- and gender-sensitive and transformative health and medical research.
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Affiliation(s)
- Kelly Thompson
- The George Institute for Global Health, University of New South Wales (UNSW), Newtown, NSW, Australia
| | - Amy Vassallo
- The George Institute for Global Health, University of New South Wales (UNSW), Newtown, NSW, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales (UNSW), Newtown, NSW, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales (UNSW), Newtown, NSW, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
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42
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State-level political partisanship strongly correlates with health outcomes for US children. Eur J Pediatr 2022; 181:273-280. [PMID: 34272984 DOI: 10.1007/s00431-021-04203-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
The Cook Partisan Voting Index (PVI) determines how strongly a state leans toward the Democratic or Republican Party in US presidential elections compared to the nation. We set out to determine the correlation between childhood health outcomes and state-level partisanship using PVI. Sixteen measures of childhood health were obtained from several US governmental agencies for 2003-2017. The median PVI for every state was calculated for the same time period. Pearson's rho determined the correlation between PVI and each health outcome. Multiple regression was also conducted, adjusting for educational attainment and percentage of non-White residents. We also compared childhood health in moderately Democratic and Republican states (5-9.9% more Democratic/Republican than the national mean) and, similarly, for extremely Democratic and Republican states (10% or more Democratic/Republican than the national mean), using Wilcoxon tests. For all 16 health measures, the median values in Democratic-leaning states represented better outcomes than Republican-leaning states (9/16 had a beta value for linear regression associated with P < 0.05). When compared to Republican states, the median values in moderately Democratic states represented better outcomes for 14 of 16 health measures (9/14 associated with P < 0.05). Similarly, the median values for extremely Democratic states represented better outcomes with regard to all 16 health measures, when compared to Republican-leaning states (8/16 associated with P < 0.05).Conclusions: Democratic-leaning states displayed superior outcomes for multiple childhood health measures when compared to Republican counterpart states. Future research should investigate the significance of these findings and attempt to determine which state-level policies may have contributed to such disparate health outcomes. What is Known: • In the United States, many health disparities exist among children along racial, economic and geographic lines. • Many US states lean strongly towards either the Democratic or Republican political parties in federal elections. What is New: • Trends for multiple measures of childhood health vary in association with the political partisanship of the state being examined. • Multiple barometers of childhood health are superior in Democratic-leaning states, while no measures are better in Republican-leaning states.
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43
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Barr E, Whitaker D, Stratton P. Pregnancy and SARS-CoV-2: an opportunity to systematically study the complexity of maternal health. Lancet Digit Health 2022; 4:e76-e77. [PMID: 35034864 PMCID: PMC8758151 DOI: 10.1016/s2589-7500(21)00277-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 10/26/2022]
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44
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Gompers A, Bruch JD, Richardson SS. Are COVID-19 Case Fatality Rates a Reliable Measure of Sex Disparities? Womens Health Issues 2021; 32:87-89. [PMID: 34930640 PMCID: PMC8616740 DOI: 10.1016/j.whi.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Joseph D Bruch
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Sarah S Richardson
- Committee on Degrees in Studies of Women, Gender, and Sexuality, Harvard University, Cambridge, Massachusetts; Department of the History of Science, Harvard University, Cambridge, Massachusetts
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45
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Nimgaonkar V, Thompson JC, Pantalone L, Cook T, Kontos D, McCarthy AM, Carpenter EL. Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19. Front Med (Lausanne) 2021; 8:750650. [PMID: 34796186 PMCID: PMC8592899 DOI: 10.3389/fmed.2021.750650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022] Open
Abstract
We investigated racial disparities in a 30-day composite outcome of readmission and death among patients admitted across a 5-hospital health system following an index COVID-19 admission. A dataset of 1,174 patients admitted between March 1, 2020 and August 21, 2020 for COVID-19 was retrospectively analyzed for odds of readmission among Black patients compared to all other patients, with sequential adjustment for demographics, index admission characteristics, type of post-acute care, and comorbidities. Tabulated results demonstrated a significantly greater odds of 30-day readmission or death among Black patients (18.0% of Black patients vs. 11.3% of all other patients; Univariate Odds Ratio: 1.71, p = 0.002). Sequential adjustment via logistic regression revealed that the odds of 30-day readmission or death were significantly greater among Black patients after adjustment for demographics, index admission characteristics, and type of post-acute care, but not comorbidities. Stratification by type of post-acute care received on discharge revealed that the same disparity in odds of 30-day readmission or death existed among patients discharged home without home services, but not those discharged to home with home services or to a skilled nursing facility or acute rehab facility. Collectively, the findings suggest that weighing comorbidity burdens in post-acute care decisions may be relevant in addressing racial disparities in 30-day outcomes following discharge from an index COVID-19 admission.
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Affiliation(s)
- Vivek Nimgaonkar
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey C Thompson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Thoracic Oncology Group, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Lauren Pantalone
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Tessa Cook
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Despina Kontos
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Erica L Carpenter
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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46
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Shattuck-Heidorn H, Danielsen AC, Gompers A, Bruch JD, Zhao H, Boulicault M, Marsella J, Richardson SS. A finding of sex similarities rather than differences in COVID-19 outcomes. Nature 2021; 597:E7-E9. [PMID: 34552251 DOI: 10.1038/s41586-021-03644-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Heather Shattuck-Heidorn
- Women and Gender Studies Program, University of Southern Maine, Portland, ME, USA. .,Studies of Women, Gender and Sexuality, Harvard University, Cambridge, MA, USA.
| | - Ann Caroline Danielsen
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joseph Dov Bruch
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Helen Zhao
- Department of Philosophy, Columbia University, New York, NY, USA
| | - Marion Boulicault
- Department of Linguistics and Philosophy, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jamie Marsella
- Department of the History of Science, Cambridge, MA, USA
| | - Sarah S Richardson
- Studies of Women, Gender and Sexuality, Harvard University, Cambridge, MA, USA.,Department of the History of Science, Cambridge, MA, USA
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47
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Lachowicz-Scroggins ME, Vuga LJ, Laposky AD, Brown M, Banerjee K, Croxton TL, Kiley JP. The intersection of women's health, lung health, and disease. Am J Physiol Lung Cell Mol Physiol 2021; 321:L624-L627. [PMID: 34431414 DOI: 10.1152/ajplung.00333.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Marrah E Lachowicz-Scroggins
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Louis J Vuga
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aaron D Laposky
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Marishka Brown
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Koyeli Banerjee
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Thomas L Croxton
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - James P Kiley
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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48
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Abstract
The ongoing COVID-19 pandemic has increased awareness about sex-specific differences in immunity and outcomes following SARS-CoV-2 infection. Strong evidence of a male bias in COVID-19 disease severity is hypothesized to be mediated by sex differential immune responses against SARS-CoV-2. This hypothesis is based on data from other viral infections, including influenza viruses, HIV, hepatitis viruses, and others that have demonstrated sex-specific immunity to viral infections. Although males are more susceptible to most viral infections, females possess immunological features that render them more vulnerable to distinct immune-related disease outcomes. Both sex chromosome complement and related genes as well as sex steroids play important roles in mediating the development of sex differences in immunity to viral infections.
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Affiliation(s)
| | - Sabra L. Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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49
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Mude W, Oguoma VM, Nyanhanda T, Mwanri L, Njue C. Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: A systematic review and meta-analysis. J Glob Health 2021; 11:05015. [PMID: 34221360 PMCID: PMC8248751 DOI: 10.7189/jogh.11.05015] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background People from racial minority groups in western countries experience disproportionate socioeconomic and structural determinants of health disadvantages. These disadvantages have led to inequalities and inequities in health care access and poorer health outcomes. We report disproportionate disparities in prevalence, hospitalisation, and deaths from COVID-19 by racial minority populations. Methods We conducted a systematic literature search of relevant databases to identify studies reporting on prevalence, hospitalisations, and deaths from COVID-19 by race groups between 01 January 2020 – 15 April 2021. We grouped race categories into Blacks, Hispanics, Whites and Others. Random effects model using the method of DerSimonian and Laird were fitted, and forest plot with respective ratio estimates and 95% confidence interval (CI) for each race category, and subgroup meta-regression analyses and the overall pooled ratio estimates for prevalence, hospitalisation and mortality rate were presented. Results Blacks experienced significantly higher burden of COVID-19: prevalence ratio 1.79 (95% confidence interval (CI) = 1.59-1.99), hospitalisation ratio 1.87 (95% CI = 1.69-2.04), mortality ratio 1.68 (95% CI = 1.52-1.83), compared to Whites: prevalence ratio 0.70 (95% CI = 0.0.64-0.77), hospitalisation ratio 0.74 (95% CI = 0.65-0.82), mortality ratio 0.82 (95% CI = 0.78-0.87). Also, Hispanics experienced a higher burden: prevalence ratio 1.78 (95% CI = 1.63-1.94), hospitalisation ratio 1.32 (95% CI = 1.08-1.55), mortality ratio 0.94 (95% CI = 0.84-1.04) compared to Whites. A higher burden was also observed for Other race groups: prevalence ratio 1.43 (95% CI = 1.19-1.67), hospitalisation ratio 1.12 (95% CI = 0.89-1.35), mortality ratio 1.06 (95% CI = 0.89-1.23) compared to Whites. The disproportionate burden among Blacks and Hispanics remained following correction for publication bias. Conclusions Blacks and Hispanics have been disproportionately affected by COVID-19. This is deeply concerning and highlights the systemically entrenched disadvantages (social, economic, and political) experienced by racial minorities in western countries; and this study underscores the need to address inequities in these communities to improve overall health outcomes.
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Affiliation(s)
- William Mude
- School of Health, Medical and Applied Sciences, Central Queensland University, Cairns, Australia
| | - Victor M Oguoma
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Tafadzwa Nyanhanda
- School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Carolyne Njue
- The Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, Australia
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50
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Morgan R, Baker P, Griffith DM, Klein SL, Logie CH, Mwiine AA, Scheim AI, Shapiro JR, Smith J, Wenham C, White A. Beyond a Zero-Sum Game: How Does the Impact of COVID-19 Vary by Gender? FRONTIERS IN SOCIOLOGY 2021; 6:650729. [PMID: 34212026 PMCID: PMC8239350 DOI: 10.3389/fsoc.2021.650729] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
Epidemics and pandemics, like COVID-19, are not gender neutral. Much of the current work on gender, sex, and COVID-19, however, has seemed implicitly or explicitly to be attempting to demonstrate that either men or women have been hardest hit, treating differences between women and men as though it is not important to understand how each group is affected by the virus. This approach often leaves out the effect on gender and sexual minorities entirely. Believing that a more nuanced approach is needed now and for the future, we brought together a group of gender experts to answer the question: how are people of different genders impacted by COVID-19 and why? Individuals working in women's, men's, and LGBTQ health and wellbeing wrote sections to lay out the different ways that women, men, and gender and sexual minorities are affected by COVID-19. We demonstrate that there is not one group "most affected," but that many groups are affected, and we need to move beyond a zero-sum game and engage in ways to mutually identify and support marginalized groups.
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Affiliation(s)
- Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter Baker
- Global Action on Men’s Health, London, United Kingdom
| | - Derek M Griffith
- Founder and Director of the Center for Research on Men’s Health and Professor of Medicine, Health and Society, Vanderbilt University, Nashville, TN, United States
| | - Sabra L. Klein
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- W. Harry Feinstone Department of Molecular Microbiology and Immunology and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, Canada and Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Amon Ashaba Mwiine
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Janna R. Shapiro
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Julia Smith
- Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, Leeds, United Kingdom
| | - Alan White
- Emeritus Professor of Men’s Health, Leeds Beckett University, Leeds, United Kingdom
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