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Varghese JS, Ali MK, Guo Y, Donahoo WT, Chakkalakal RJ. Risk of New-Onset Diabetes Before and During the COVID-19 Pandemic: A Real-World Cohort Study. J Gen Intern Med 2024:10.1007/s11606-024-09035-8. [PMID: 39302562 DOI: 10.1007/s11606-024-09035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Studies of new-onset diabetes as a post-acute sequela of SARS-CoV-2 infection are difficult to generalize to all socio-demographic subgroups. OBJECTIVE To study the risk of new-onset diabetes after SARS-CoV-2 infection in a socio-demographically diverse sample. DESIGN Retrospective cohort study of electronic health record (EHR) data available from the OneFlorida + clinical research network within the National Patient-Centered Clinical Research Network (PCORnet). SUBJECTS Persons aged 18 or older were included as part of an Exposed cohort (positive SARS-CoV-2 test or COVID-19 diagnosis between 1 March 2020 and 29 January 2022; n = 43,906), a contemporary unexposed cohort (negative SARS-CoV-2 test; n = 162,683), or an age-sex matched historical control cohort (index visits between 2 Mar 2018 and 30 Jan 2020; n = 40,957). MAIN MEASURES The primary outcome was new-onset type 2 diabetes ≥ 30 days after index visit. Hazard ratios and cases per 1000 person-years of new-onset diabetes were studied using target trial approaches for observational data. Associations were reported by sex, race/ethnicity, age, and hospitalization status subgroups. KEY RESULTS The sample was 62% female, 21.4% non-Hispanic Black, and 21.4% Hispanic; mean age was 51.8 (SD, 18.9) years. Relative to historical controls (cases, 28.2 [26.0-30.5]), the unexposed (HR, 1.28 [95% CI, 1.18-1.39]; excess cases, [5.1-10.3]), and exposed cohorts (HR, 1.64 [95% CI, 1.50-1.80]; excess cases, 17.3 [13.7-20.8]) had higher risk of new-onset T2DM. Relative to the unexposed cohort, the exposed cohort had a higher risk (HR, 1.28 [1.19-1.37]); excess cases, 9.5 [6.4-12.7]). Findings were similar across subgroups. CONCLUSION The pandemic period was associated with increased T2DM cases across all socio-demographic subgroups; the greatest risk was observed among individuals exposed to SARS-CoV-2.
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Affiliation(s)
- Jithin Sam Varghese
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, 30322, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, 30322, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - William T Donahoo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Rosette J Chakkalakal
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, 30322, USA.
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, USA.
- Department of Medicine, School of Medicine, Emory University, Atlanta, USA.
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Varghese JS, Guo Y, Ali MK, Donahoo WT, Chakkalakal RJ. Body mass index changes and their association with SARS-CoV-2 infection: a real-world analysis. Int J Obes (Lond) 2024:10.1038/s41366-024-01628-x. [PMID: 39277656 DOI: 10.1038/s41366-024-01628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/29/2024] [Accepted: 09/02/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To study body mass index (BMI) changes among individuals aged 18-99 years with and without SARS-CoV-2 infection. SUBJECTS/METHODS Using real-world data from the OneFlorida+ Clinical Research Network of the National Patient-Centered Clinical Research Network, we compared changes over time in BMI in an Exposed cohort (positive SARS-CoV-2 test between March 2020-January 2022), to a contemporary Unexposed cohort (negative SARS-CoV-2 tests), and an age/sex-matched Historical control cohort (March 2018-January 2020). BMI (kg/m2) was retrieved from objective measures of height and weight in electronic health records. We used target trial approaches to estimate BMI at start of follow-up and change per 100 days of follow-up for Unexposed and Historical cohorts relative to the Exposed cohort by categories of sex, race & ethnicity, age, and hospitalization status. RESULTS The study sample consisted of 249,743 participants (19.2% Exposed, 61.5% Unexposed, 19.3% Historical cohort) of whom 62% were women, 21.5% Non-Hispanic Black, 21.4% Hispanic and 5.6% Non-Hispanic other and had an average age of 51.9 years (SD: 18.9). At start of follow-up, relative to the Unexposed cohort (mean BMI: 29.3 kg/m2 [95% CI: 29.1, 29.4]), the Exposed (0.07 kg/m2 [95% CI; 0.01, 0.12]) had higher mean BMI and Historical controls (-0.20 kg/m2 [95% CI; -0.25, -0.15]) had lower mean BMI. Over 100 days, BMI did not change (0 kg/m2 [95% CI: -0.03, 0.03]) for the Exposed cohort, decreased (-0.04 kg/m2 [95% CI; -0.05, -0.02]) for the Unexposed cohort and increased (0.03 kg/m2 [95% CI; 0.01, 0.04]) for the Historical cohort. Observed differences in BMI at start of follow-up and over 100 days were consistent between Unexposed and Exposed cohorts for most subgroups, except at start of follow-up period among Males and those 65 years or older who had lower BMI among Exposed. CONCLUSIONS In a diverse real-world cohort of adults, mean BMI of those with and without SARS-CoV2 infection varied in their trajectories. The mechanisms and implications of weight retention following SARS-CoV-2 infection remain unclear.
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Affiliation(s)
- Jithin Sam Varghese
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - W Troy Donahoo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine University of Florida, Gainesville, FL, USA
| | - Rosette J Chakkalakal
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA.
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
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Shields RK, Chevan J, Kennedy K, Bailey C, Dudley-Javoroski S. National Benchmarks to Understand How Doctor of Physical Therapy Learners From Minoritized Race and Ethnicity Groups Perceive Their Physical Therapist Education Program. Phys Ther 2024; 104:pzae047. [PMID: 38519116 DOI: 10.1093/ptj/pzae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The demographic homogeneity of the physical therapist workforce and its educational pathway may undermine the profession's potential to improve the health of society. Building academic environments that support the development of all learners is fundamental to building a workforce to meet societal health care needs. The Benchmarking in Physical Therapy Education study uses the Physical Therapy Graduation Questionnaire to comprehensively assess learner perceptions of the physical therapist academic environment. The present report examined whether racial and ethnic minoritized (REM) physical therapist learners perceive their doctor of physical therapy education differently from their non-REM peers. METHODS Five thousand and eighty graduating doctor of physical therapy learners in 89 institutions provided demographic data and perceptions of a range of learning environment domains. Analyses included REM versus non-REM comparisons as well as comparisons among individual race and ethnicity groups. RESULTS Compared with their non-minoritized peers, REM respondents expressed less satisfaction with their education and lower confidence in their preparedness for entry-level practice. REM respondents observed more faculty professionalism disconnects and demonstrated less agreement that their program had fostered their overall psychological well-being. REM respondents experienced higher rates of mistreatment than their peers and reported higher rates of exhaustion and disengagement, the 2 axes of academic burnout. Black/African American and Hispanic/Latino/a/x (Hispanic, Latino, Latina, and/or Latinx) respondents incurred significantly more educational debt than Asian and White respondents. REM respondents reported greater empathy and greater interest in working in underserved communities. CONCLUSION REM respondents perceived the physical therapist learning environment more negatively than their non-minoritized peers but expressed strong interest in serving people from underserved communities. These national benchmarks offer academic institutions the opportunity to self-assess their own environment and to work to improve the quality of the educational experience for all learners. IMPACT In a nationwide benchmarking study, learners from minoritized race and ethnicity backgrounds reported more negative experiences and outcomes during physical therapist education than their non-minoritized peers. These same learners demonstrated high empathy and interest in serving people from underserved (under-resourced) communities. Learning environments that permit all individuals to thrive may be an essential avenue to improve the health of a rapidly diversifying society.
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Affiliation(s)
- Richard K Shields
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Julia Chevan
- Department of Physical Therapy, Springfield College, Springfield, Massachusetts, USA
| | - Kai Kennedy
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Charlotte Bailey
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Shauna Dudley-Javoroski
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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Brown KM, Lewis-Owona J, Sealy-Jefferson S, Onwuka A, Davis SK. Still Separate, Still Not Equal: An Ecological Examination of Redlining and Racial Segregation with COVID-19 Vaccination Administration in Washington D.C. J Urban Health 2024; 101:672-681. [PMID: 38926219 PMCID: PMC11329462 DOI: 10.1007/s11524-024-00862-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 06/28/2024]
Abstract
Racial residential segregation has been deemed a fundamental cause of health inequities. It is a result of historical and contemporary policies such as redlining that have created a geographic separation of races and corresponds with an inequitable distribution of health-promoting resources. Redlining and racial residential segregation may have contributed to racial inequities in COVID-19 vaccine administration in the early stages of public accessibility. We use data from the National Archives (historical redlining), Home Mortgage Disclosure Act (contemporary redlining), American Community Survey from 1940 (historical racial residential segregation) and 2015-2019 (contemporary racial residential segregation), and Washington D.C. government (COVID-19 vaccination administration) to assess the relationships between redlining, racial residential segregation, and COVID-19 vaccine administration during the early stages of vaccine distribution when a tiered system was in place due to limited supply. Pearson correlation was used to assess whether redlining and racial segregation, measured both historically and contemporarily, were correlated with each other in Washington D.C. Subsequently, linear regression was used to assess whether each of these measures associate with COVID-19 vaccine administration. In both historical and contemporary analyses, there was a positive correlation between redlining and racial residential segregation. Further, redlining and racial residential segregation were each positively associated with administration of the novel COVID-19 vaccine. This study highlights the ongoing ways in which redlining and segregation contribute to racial health inequities. Eliminating racial health inequities in American society requires addressing the root causes that affect access to health-promoting resources.
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Affiliation(s)
- Kristen M Brown
- Urban Institute, Washington D.C., USA.
- National Institutes of Health, Bethesda, MD, USA.
| | - Jessica Lewis-Owona
- Drexel University, Philadelphia, PA, USA
- National Institutes of Health, Bethesda, MD, USA
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Gebreegziabher E, Bui D, Cummings KJ, Frederick M, Nguyen A, Collins C, Melton D, Yang A, Jain S, Vergara X. Demographic changes in COVID-19 mortality during the pandemic: analysis of trends in disparities among workers using California's mortality surveillance system. BMC Public Health 2024; 24:1822. [PMID: 38977988 PMCID: PMC11232202 DOI: 10.1186/s12889-024-19257-4] [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: 01/14/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND There is limited information on the extent and patterns of disparities in COVID-19 mortality throughout the pandemic. We aimed to examine trends in disparities by demographics over variants in the pre- and post-vaccine availability period among Californian workers using a social determinants of health lens. METHODS Using death certificates, we identified all COVID-19 deaths that occurred between January 2020 and May 2022 among workers aged 18-64 years in California (CA). We derived estimates for at-risk worker populations using the Current Population Survey. The waves of COVID-19 mortality in the pre-vaccine availability period were March 2020-June 2020 (wave 1), and July 2020-November 2020 (wave 2), and in the post-vaccine availability period: December 2020-May 2021 (wave 3), June 2021-January 2022 (wave 4), and February 2022-May 2022 (wave 5). Poisson regression models with robust standard errors were used to determine wave-specific mortality rate ratios (MRRs). We examined the change in MRR across waves by including an interaction term between each demographic characteristic and wave period in different models. The role of potential misclassification of Race/ethnicity on death certificates was examined using probabilistic quantitative bias analysis as sensitivity analysis. RESULTS Among the 24.1 million working age CA population included in the study, there were 26,068 COVID-19 deaths in the period between January 2020 and May 2022. Compared with their respective reference groups, workers who were 50-64 years old, male, Native Hawaiian, Latino, or African American, foreign-born; individuals who had lower education; and unmarried were disproportionately affected by COVID-19 mortality. While disparities by sex, race/ethnicity and foreign-born status narrowed in later waves (post-vaccine availability), disparities by age, education level and marital status did not change substantially across waves. CONCLUSION Demographic disparities in COVID-19 mortality narrowed in the post-vaccine availability waves. However, the existence of disparities across all waves of the pandemic, even in an era of widespread vaccine coverage, could indicate remaining gaps in prevention and differential vulnerability. Addressing the underlying social, structural, and occupational factors that contribute to these disparities is critical for achieving health equity.
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Affiliation(s)
- Elisabeth Gebreegziabher
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA.
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA.
| | - David Bui
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA
| | - Matthew Frederick
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA
- Public Health Institute, Oakland, CA, 94607, USA
| | - Alyssa Nguyen
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Caroline Collins
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - David Melton
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Alice Yang
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Seema Jain
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Ximena Vergara
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA
- Heluna Health, 13300 Crossroads Pkwy. N #450, City of Industry, CA, 91746, USA
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Johnson K, Biddell CB, Gora Combs K, Wiesman J, Valdes Lupi M, Hassmiller Lich K. Local Health Department Values and Organizational Authorities Guiding Cross-Sector Work During COVID-19. Health Promot Pract 2024; 25:589-601. [PMID: 37649378 PMCID: PMC11264535 DOI: 10.1177/15248399231192989] [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] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The COVID-19 pandemic highlighted the role that local health departments (LHDs) have in cross sector can address alone, including the work of value alignment and the strategic use of organizational authorities. The practices by which LHDs used their authorities to conduct cross-sector work during the pandemic need exploration. METHOD We conducted semi-structured interviews with 19 public health leaders from metropolitan LHDs across the United States. Our interview guide assessed the values that LHD leadership prioritized in their cross-sector work as well as the range of organizational authorities they leveraged to influence external decision-making in other sectors. RESULTS We found that LHDs approached cross-sector work by leaning on diverse values and authorities, each with unique implications for their work. The LHDs emphasized their approach to value alignment on a sector-by-sector basis, strategically using diverse organizational authorities-economic, political, moral, scientific, and logistical. While each authority and value we assessed was present across all interviewees, how each shaped action varied. Internally, LHDs emphasized certain authorities more than others to the degree that they more closely aligned with prioritized core values. CONCLUSION Our findings highlight the ongoing need for LHD leadership to improve their ability to effectively communicate public health values and the unique authorities by which health-supporting work can be facilitated, including how this message must be adapted, depending on the specific sectors with which the LHD needs to partner and the governance arrangement in which the LHD is situated.
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Affiliation(s)
- Karl Johnson
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - John Wiesman
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Vázquez E, Juturu P, Burroughs M, McMullin J, Cheney AM. Continuum of Trauma: Fear and Mistrust of Institutions in Communities of Color During the COVID-19 Pandemic. Cult Med Psychiatry 2024; 48:290-309. [PMID: 37776491 PMCID: PMC11217119 DOI: 10.1007/s11013-023-09835-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/02/2023]
Abstract
Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions.
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Affiliation(s)
- Evelyn Vázquez
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, 900 University Avenue, Riverside, CA, 92521-9800, USA
| | - Preeti Juturu
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Michelle Burroughs
- Center for Healthy Communities, University of California, Riverside, USA
| | - Juliet McMullin
- Department of Family Medicine, School of Medicine, University of California, Irvine, USA
| | - Ann M Cheney
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, 900 University Avenue, Riverside, CA, 92521-9800, USA.
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Ingram BM, DeFreese JD, Kerr ZY, Oyesanya TO, Picha KJ, Register-Mihalik JK. Applying the National Institute on Minority Health and Health Disparities Research Framework to Social Determinants of Health in the Context of Sport-Related Concussion: A Clinical Commentary. J Athl Train 2024; 59:447-457. [PMID: 38446622 PMCID: PMC11127672 DOI: 10.4085/1062-6050-0370.23] [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: 03/08/2024]
Abstract
Sport-related concussion (SRC) is a prevalent injury. Significant disparities in SRC outcomes exist across racial and ethnic groups. These disparities may be attributed to the unequal distribution of political power (or influence) and resource allocation in various communities, shaping individuals' social determinants of health (SDOH). However, the influence of SDOH on SRC outcomes remains understudied. In this clinical commentary, we use the National Institute on Minority Health and Health Disparities Research Framework and describe how its application can help address gaps in our understanding of SDOH and SRC. This framework provides a comprehensive approach to investigating and addressing health disparities by considering SDOH along multiple levels and domains of influence. Using this framework, athletic trainers can identify areas requiring intervention and better understand how SDOH influence SRC outcomes. This understanding can help athletic trainers develop tailored interventions to promote equitable care for patients with SRC.
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Affiliation(s)
- Brittany M. Ingram
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Kelsey J. Picha
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
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Mandelbaum J, Almeda J, Blackwell S, Hopkins JW, Myers K, Hicks S, Daguise VG. An Analysis of the Social Determinants of Health in South Carolina's I-95 Corridor. Health Promot Pract 2024; 25:335-345. [PMID: 36546686 DOI: 10.1177/15248399221142517] [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: 02/17/2024]
Abstract
BACKGROUND One in four South Carolinians lives in a county along a nearly 200-mile stretch of Interstate 95 (I-95). Stretching from North Carolina to Georgia, this region is among the most rural, economically depressed, and racially/ethnically diverse in the state. Research is needed to identify social factors contributing to adverse health outcomes along the I-95 corridor, guide interventions, and establish a baseline for measuring progress. This study assessed social determinants of health in counties in South Carolina's I-95 corridor relative to the rest of the state. METHOD Data for South Carolina's 46 counties were extracted from the Centers for Disease Control and Prevention Minority Health Social Vulnerability Index (SVI), which grouped 34 census variables into six themes: socioeconomic status, household composition and disability, minority status and language, housing type and transportation, health care infrastructure, and medical vulnerability. Each theme was ranked from 0 (least vulnerable) to 1 (most vulnerable). Measures between regions were compared using the Wilcoxon-Mann-Whitney test. RESULTS Compared with counties outside the I-95 corridor (n = 29), counties in the corridor (n = 17) scored higher on socioeconomic status vulnerability (.67 and .82, respectively) and medical vulnerability (.65 and .79, respectively). No statistically significant differences were found across other themes. CONCLUSION Identifying social determinants of health in South Carolina's I-95 corridor is a crucial first step toward alleviating health disparities in this region. Interventions and policies should be developed in collaboration with local stakeholders to address distal social factors that create and reinforce health disparities.
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Affiliation(s)
- Jennifer Mandelbaum
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
- University of South Carolina, Columbia, SC, USA
| | - Jennifer Almeda
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - Shanikque Blackwell
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - John W Hopkins
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - Kristian Myers
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - Shauna Hicks
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
| | - Virginie G Daguise
- South Carolina Department of Health and Environmental Control, Columbia, SC, USA
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Islam JY, Hathaway CA, Hume E, Turner K, Hallanger-Johnson J, Tworoger SS, Camacho-Rivera M. Racial and Ethnic Inequities in Cancer Care Continuity During the COVID-19 Pandemic Among Those With SARS-CoV-2. JAMA Netw Open 2024; 7:e2412050. [PMID: 38767916 PMCID: PMC11107297 DOI: 10.1001/jamanetworkopen.2024.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 05/22/2024] Open
Abstract
Importance Racially and ethnically minoritized US adults were disproportionately impacted by the COVID-19 pandemic and experience poorer cancer outcomes, including inequities in cancer treatment delivery. Objective To evaluate racial and ethnic disparities in cancer treatment delays and discontinuations (TDDs) among patients with cancer and SARS-CoV-2 during different waves of the COVID-19 pandemic in the United States. Design, Setting, and Participants This cross-sectional study used data from the American Society of Clinical Oncology Survey on COVID-19 in Oncology Registry (data collected from April 2020 to September 2022), including patients with cancer also diagnosed with SARS-CoV-2 during their care at 69 US practices. Racial and ethnic differences were examined during 5 different waves of the COVID-19 pandemic in the United States based on case surge (before July 2020, July to November 2020, December 2020 to March 2021, April 2021 to February 2022, and March to September 2022). Exposures Race and ethnicity. Main Outcomes and Measures TDD was defined as any cancer treatment postponed more than 2 weeks or cancelled with no plans to reschedule. To evaluate TDD associations with race and ethnicity, adjusted prevalence ratios (aPRs) were estimated using multivariable Poisson regression, accounting for nonindependence of patients within clinics, adjusting for age, sex, body mass index, comorbidities, cancer type, cancer extent, and SARS-CoV-2 severity (severe defined as death, hospitalization, intensive care unit admission, or mechanical ventilation). Results A total of 4054 patients with cancer and SARS-CoV-2 were included (143 [3.5%] American Indian or Alaska Native, 176 [4.3%] Asian, 517 [12.8%] Black or African American, 469 [11.6%] Hispanic or Latinx, and 2747 [67.8%] White; 2403 [59.3%] female; 1419 [35.1%] aged 50-64 years; 1928 [47.7%] aged ≥65 years). The analysis focused on patients scheduled (at SARS-CoV-2 diagnosis) to receive drug-based therapy (3682 [90.8%]), radiation therapy (382 [9.4%]), surgery (218 [5.4%]), or transplant (30 [0.7%]), of whom 1853 (45.7%) experienced TDD. Throughout the pandemic, differences in racial and ethnic inequities based on case surge with overall TDD decreased over time. In multivariable analyses, non-Hispanic Black (third wave: aPR, 1.56; 95% CI, 1.31-1.85) and Hispanic or Latinx (third wave: aPR, 1.35; 95% CI, 1.13-1.62) patients with cancer were more likely to experience TDD compared with non-Hispanic White patients during the first year of the pandemic. By 2022, non-Hispanic Asian patients (aPR, 1.51; 95% CI, 1.08-2.12) were more likely to experience TDD compared with non-Hispanic White patients, and non-Hispanic American Indian or Alaska Native patients were less likely (aPR, 0.37; 95% CI, 0.16-0.89). Conclusions and Relevance In this cross-sectional study of patients with cancer and SARS-CoV-2, racial and ethnic inequities existed in TDD throughout the pandemic; however, the disproportionate burden among racially and ethnically minoritized patients with cancer varied across SARS-CoV-2 waves. These inequities may lead to downstream adverse impacts on cancer mortality among minoritized adults in the United States.
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Affiliation(s)
- Jessica Y. Islam
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Cassandra A. Hathaway
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Emma Hume
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Shelley S. Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Division of Oncological Sciences, School of Medicine, Oregon Health & Science University, Portland
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, New York, New York
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11
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Rokicki S, Patel M, Suplee PD, D'Oria R. Racial and ethnic disparities in access to community-based perinatal mental health programs: results from a cross-sectional survey. BMC Public Health 2024; 24:1094. [PMID: 38643069 PMCID: PMC11031973 DOI: 10.1186/s12889-024-18517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/03/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Perinatal mental health is a major public health problem that disproportionately affects people from racial and ethnic minority groups. Community-based perinatal mental health programs, such as peer support groups, are essential tools for the prevention and treatment of perinatal depression. Yet, little is known about racial and ethnic disparities in accessibility and utilization of community-based perinatal mental health programs. METHODS We conducted a cross-sectional study using an online survey with program administrators representing perinatal mental health community-based services and support programs throughout New Jersey. Descriptive analysis and mapping software was used to analyze the data. RESULTS Thirty-three program administrators completed the survey. Results showed substantial racial and ethnic disparities in availability and utilization of community-based programs. In the majority of programs, Black, Hispanic, and Asian individuals made up less than 10% of total annual participants and less than 10% of facilitators. There were also geographic disparities in program accessibility and language availability across counties. Program administrators identified mental health stigma, lack of support from family, fear of disclosure of mental health challenges, social determinants, lack of language-concordant options in programs, and limited awareness of programs in the community as significant barriers to participation of racial and ethnic minorities. Strategies to address barriers included adding language options, improving program outreach, and increasing diversity of facilitators. CONCLUSIONS This study provides new evidence on racial and ethnic disparities in access to community-based perinatal mental health programs. Efforts to build the resources and capacities of community-based programs to identify equity gaps, increase diversity of staff, and address barriers to participation is critical to reducing racial and ethnic inequities in perinatal mental health.
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Affiliation(s)
- Slawa Rokicki
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA.
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland.
| | - Mitu Patel
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | | | - Robyn D'Oria
- Central Jersey Family Health Consortium, North Brunswick Township, NJ, USA
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12
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Javed Z, Valero-Elizondo J, Cainzos-Achirica M, Sharma G, Mossialos E, Parekh T, Hagan K, Hyder AA, Kash B, Nasir K. Race, Social Determinants of Health, and Risk of All-Cause and Cardiovascular Mortality in the United States. J Racial Ethn Health Disparities 2024; 11:853-864. [PMID: 37017921 DOI: 10.1007/s40615-023-01567-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To examine the independent and interdependent effects of race and social determinants of health (SDoH) and risk of all-cause and cardiovascular disease (CVD) mortality in the US. DATA SOURCE/STUDY DESIGN Secondary analysis of pooled data for 252,218 participants of the 2006-2018 National Health Interview Survey, linked to the National Death Index. METHODS Age-adjusted mortality rates (AAMR) were reported for non-Hispanic White (NHW) and non-Hispanic Black (NHB) individuals overall, and by quintiles of SDoH burden, with higher quintiles representing higher cumulative social disadvantage (SDoH-Qx). Survival analysis was used to examine the association between race, SDoH-Qx, and all-cause and CVD mortality. FINDINGS AAMRs for all-cause and CVD mortality were higher for NHB and considerably higher at higher levels of SDoH-Qx, however, with similar mortality rates at any given level of SDoH-Qx. In multivariable models, NHB experienced 20-25% higher mortality risk relative to NHW (aHR = 1.20-1.26); however, no association was observed after adjusting for SDoH. In contrast, higher SDoH burden was associated with up to nearly threefold increased risk of all-cause (aHR, Q5 vs Q1 = 2.81) and CVD mortality (aHR, Q5 vs Q1 = 2.90); the SDoH effect was observed similarly for NHB (aHR, Q5:all-cause mortality = 2.38; CVD mortality = 2.58) and NHW (aHR, Q5:all-cause mortality = 2.87; CVD mortality = 2.93) subgroups. SDoH burden mediated 40-60% of the association between NHB race and mortality. CONCLUSIONS These findings highlight the critical role of SDoH as upstream drivers of racial inequities in all-cause and CVD mortality. Population level interventions focused on addressing adverse SDoH experienced by NHB individuals may help mitigate persistent disparities in mortality in the US.
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Affiliation(s)
- Zulqarnain Javed
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, 77030, USA.
- Houston Methodist Academic Institute, Houston, TX, 77030, USA.
- Houston Methodist Research Institute, 7550 Greenbriar Dr, Houston, TX, 77030, USA.
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX, USA.
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Hospital del Mar / Parc de Salut Mar, Barcelona, Spain
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garima Sharma
- Division of Cardiology, Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics, London, UK
| | - Tarang Parekh
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, 77030, USA
| | - Kobina Hagan
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, 77030, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Bita Kash
- Center for Health and Nature, Houston Methodist, Houston, TX, USA
- Texas A&M University School of Public Health, College Station, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, 77030, USA
- Houston Methodist Academic Institute, Houston, TX, 77030, USA
- Houston Methodist Research Institute, 7550 Greenbriar Dr, Houston, TX, 77030, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX, USA
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13
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Martinez Leal I, Acquati C, Rogova A, Chen TA, Connors SK, Agrawal P, McNeill LH, Reitzel LR. Negotiating cancer alone: A qualitative study exploring care experiences of racially and ethnically diverse women diagnosed with breast cancer during COVID-19. J Health Psychol 2024; 29:367-381. [PMID: 38009435 PMCID: PMC11005304 DOI: 10.1177/13591053231214517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
COVID-19 has critically impacted cancer care services including reduced screenings, diagnoses, and surgeries; particularly among Black and Latina/x women who already suffer worse outcomes. This qualitative study explored the care experiences of a diverse sample of breast cancer survivors (N = 21; 7 Black, 4 Hispanic, 10 White) undergoing treatment during the pandemic via online semi-structured interviews. Grounded theory analysis yielded the core category "negotiating cancer alone," that included: (1) psychological distress, negotiating the cancer trajectory in isolation; (2) provider/healthcare system diagnostic and treatment delays; (3) heightened anxiety about treatment delays causing cancer progression; (4) supportive care limitations; and (5) disparate experiences of cancer care disruptions. Black and Latina/x women described greater delays in care, financial challenges, treatment complications, and insurance limitations than White women. The study identifies cancer patients' pandemic-related psychological, healthcare system, and health equity challenges and suggests recommendations to support their increased psychological needs during oncologic care disruptions.
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Affiliation(s)
| | - Chiara Acquati
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| | - Anastasia Rogova
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
| | | | | | | | | | - Lorraine R Reitzel
- University of Texas MD Anderson Cancer Center, USA
- University of Houston, USA
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14
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Lewis TJ, Herring RP, Chinnock RE, Nelson A. Ending the HIV Epidemic in Black America: Qualitative Insights Following COVID-19. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01925-1. [PMID: 38386258 DOI: 10.1007/s40615-024-01925-1] [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: 05/29/2023] [Revised: 01/01/2024] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The disproportionate effects of the human immunodeficiency virus (HIV) and the Coronavirus 2019 (COVID-19) on Black American communities highlight structural systems rooted in racism and must be addressed with national strategies that improve both biomedicine and social determinants of health. PURPOSE The purpose of this study was to qualitatively examine the experiences and interpretations of experts in the HIV workforce (local, state, and national HIV-related organizations) regarding the state of HIV and COVID-19 among Black Americans. METHODS Within key informant interviews and a focus group recorded and transcribed verbatim, fifteen members of the HIV workforce and Black community described their experiences and provided insights to inform ending the negative outcomes resulting from HIV and COVID-19. RESULTS Data were analyzed using NVivo software, and eight themes emerged to address disease disproportionality through a Black lens. Themes reflected (1) accessing information and care; (2) key potential partners/stakeholders; (3) investing in Black communities; (4) governmental support; (5) increasing engagement and advocacy; (6) HIV-related community conversations; (7) developments since COVID-19; and (8) the Ending the HIV Epidemic (EHE) trajectory. CONCLUSIONS Themes directly speak to recommendations to adjust education and policy strategies for HIV and COVID-19 prevention and intervention. Such recommendations, (1) amplifying Black voices, (2) investing sustainable dollars into Black communities, and (3) leaning into advocacy, can bolster the foundation for the HIV workforce and Black community to break ineffective response patterns and lead the fight against these systemic issues of inequity.
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Affiliation(s)
- Tenesha J Lewis
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA, 92350, USA.
| | - R Patti Herring
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA, 92350, USA
| | - Richard E Chinnock
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA, 92350, USA
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Anna Nelson
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA, 92350, USA
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15
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Varghese JS, Guo Y, Ali MK, Troy Donahoo W, Chakkalakal RJ. Body mass index changes and their association with SARS-CoV-2 infection: a real-world analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.12.24302697. [PMID: 38405934 PMCID: PMC10888974 DOI: 10.1101/2024.02.12.24302697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objective To study body mass index (BMI) changes among individuals aged 18-99 years with and without SARS-CoV-2 infection. Subjects/Methods Using real-world data from the OneFlorida+ Clinical Research Network of the National Patient-Centered Clinical Research Network, we compared changes over time in BMI in an Exposed cohort (positive SARS-CoV-2 test between March 2020 - January 2022), to a contemporary Unexposed cohort (negative SARS-CoV-2 tests), and an age/sex-matched Historical control cohort (March 2018 - January 2020). Body mass index (kg/m2) was retrieved from objective measures of height and weight in electronic health records. We used target trial approaches to estimate BMI at baseline and change per 100 days of follow-up for Unexposed and Historical cohorts relative to the Exposed cohort by categories of sex, race-ethnicity, age, and hospitalization status. Results The study sample consisted of 44,436 (Exposed cohort), 164,118 (Unexposed cohort), and 41,189 (Historical cohort). Cumulatively, 62% were women, 21.5% Non-Hispanic Black, 21.4% Hispanic and 5.6% Non-Hispanic Other. Patients had an average age of 51.9 years (SD: 18.9). At baseline, relative to the Exposed cohort (mean BMI: 29.3 kg/m2 [95%CI: 29.0, 29.7]), the Unexposed (-0.07 kg/m2 [95%CI; -0.12, -0.01]) and Historical controls (-0.27 kg/m2 [95%CI; -0.34, -0.20]) had lower BMI. Relative to no change in the Exposed over 100 days (0.00 kg/m2 [95%CI; -0.03,0.03]), the BMI of those Unexposed decreased (-0.04 kg/m2 [95%CI; -0.06, -0.01]) while the Historical cohort's BMI increased (+0.03 kg/m2 [95%CI;0.00,0.06]). BMI changes were consistent between Exposed and Unexposed cohorts for most population groups, except at start of follow-up period among Males and those 65 years or older, and in changes over 100 days among Males and Hispanics. Conclusions In a diverse real-world cohort of adults, mean BMI of those with and without SARS-CoV2 infection varied in their trajectories. The mechanisms and implications of weight retention following SARS-CoV-2 infection remain unclear.
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Affiliation(s)
- Jithin Sam Varghese
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mohammed K. Ali
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, USA
| | - W. Troy Donahoo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine University of Florida Gainesville FL USA
| | - Rosette J. Chakkalakal
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, USA
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16
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Foster TB, Fernandez L, Porter SR, Pharris-Ciurej N. Racial and Ethnic Disparities in Excess All-Cause Mortality in the First Year of the COVID-19 Pandemic. Demography 2024; 61:59-85. [PMID: 38197462 DOI: 10.1215/00703370-11133943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Research on the COVID-19 pandemic in the United States has consistently found disproportionately high mortality among ethnoracial minorities, but reports differ with respect to the magnitude of mortality disparities and reach different conclusions regarding which groups were most impacted. We suggest that these variations stem from differences in the temporal scope of the mortality data used and difficulties inherent in measuring race and ethnicity. To circumvent these issues, we link Social Security Administration death records for 2010 through 2021 to decennial census and American Community Survey race and ethnicity responses. We use these linked data to estimate excess all-cause mortality for age-, sex-, race-, and ethnicity-specific subgroups and examine ethnoracial variation in excess mortality across states and over the course of the pandemic's first year. Results show that non-Hispanic American Indians and Alaska Natives experienced the highest excess mortality of any ethnoracial group in the first year of the pandemic, followed by Hispanics and non-Hispanic Blacks. Spatiotemporal and age-specific ethnoracial disparities suggest that the socioeconomic determinants driving health disparities prior to the pandemic were amplified and expressed in new ways in the pandemic's first year to disproportionately concentrate excess mortality among racial and ethnic minorities.
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17
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Blaser C, Gautier L, Brousseau É, Auger N, Frohlich KL. Inequality in COVID-19 mortality in Quebec associated with neighbourhood-level vulnerability domains. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:53-66. [PMID: 38100050 PMCID: PMC10868572 DOI: 10.17269/s41997-023-00829-7] [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: 04/20/2023] [Accepted: 10/24/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES We measured disparities in COVID-19 mortality associated with increasing vulnerability to severe outcomes of infectious disease at the neighbourhood level to identify domains for prioritization of public interventions. METHODS In this retrospective ecological study, we calculated COVID-19 mortality rate ratios (RR) comparing neighbourhoods with the greatest vulnerability relative to lowest vulnerability using the five domains from the COVID-19 vulnerability index for Quebec using hospital data from the first year of the pandemic and vulnerability levels from 13,182 neighbourhoods. We estimated the attributable fraction to assess disparities in COVID-19 mortality associated with vulnerability. Domains covered biological susceptibility, sociocultural characteristics, socioeconomic characteristics, and indoor and outdoor risk factors for exposure to SARS-CoV-2. RESULTS Vulnerable neighbourhoods accounted for 60.7% of COVID-19 deaths between March 2020 and February 2021. Neighbourhoods with biological susceptibility accounted for 46.1% and indoor exposure for 44.6% of deaths. Neighbourhoods with socioeconomic vulnerability experienced 23.5%, outdoor exposure 14.6%, and sociocultural vulnerability 9.0% of deaths. Neighbourhoods with high relative vulnerability had 4.66 times greater risk of COVID-19 mortality compared with those with low vulnerability (95%CI 3.82-5.67). High vulnerability in the biological (RR 3.33; 95%CI 2.71-4.09), sociocultural (RR 1.50; 95%CI 1.27-1.77), socioeconomic (RR 2.08; 95%CI 1.75-2.48), and indoor (RR 3.21; 95%CI 2.74-3.76) exposure domains were associated with elevated risks of mortality compared with the least vulnerable neighbourhoods. Outdoor exposure was unassociated with mortality (RR 1.17; 95%CI 0.96-2.43). CONCLUSION Public intervention to protect vulnerable populations should be adapted to focus on domains most associated with COVID-19 mortality to ensure addressing local needs.
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Affiliation(s)
- Christine Blaser
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, QC, Canada.
| | - Lara Gautier
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Émilie Brousseau
- University of Montreal Hospital Research Centre, Montréal, QC, Canada
| | - Nathalie Auger
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, QC, Canada
- University of Montreal Hospital Research Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | - Katherine L Frohlich
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
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Kandula S, Keyes KM, Yaari R, Shaman J. Excess Mortality in the United States, 2020-21: County-level Estimates for Population Groups and Associations with Social Vulnerability. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.14.24301290. [PMID: 38293208 PMCID: PMC10827264 DOI: 10.1101/2024.01.14.24301290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
To assess the excess mortality burden of Covid-19 in the United States, we estimated sex, age and race stratified all-cause excess deaths in each county of the US during 2020 and 2021. Using spatial Bayesian models trained on all recorded deaths between 2003-2019, we estimated 463,187 (95% uncertainty interval (UI): 426,139 - 497,526) excess deaths during 2020, and 544,105 (95% UI: 492,202 - 592,959) excess deaths during 2021 nationally, with considerable geographical heterogeneity. Excess mortality rate (EMR) nearly doubled for each 10-year increase in age and was consistently higher among men than women. EMR in the Black population was 1.5 times that of the White population nationally and as high as 3.8 times in some states. Among the 25-54 year population excess mortality was highest in the American Indian/Alaskan Native (AI/AN) population among the four racial groups studied, and in a few states was as high as 6 times that of the White population. Strong association of EMR with county-level social vulnerability was estimated, including positive associations with prevalence of disability (standardized effect: 40.6 excess deaths per 100,000), older population (37.6), poverty (23.6), and unemployment (18.5), whereas population density (-50), higher education (-38.6), and income (-35.4) were protective. Together, these estimates provide a more reliable and comprehensive understanding of the mortality burden of the pandemic in the US thus far. They suggest that Covid-19 amplified social and racial disparities. Short-term measures to protect more vulnerable groups in future Covid-19 waves and systemic corrective steps to address long-term societal inequities are necessary.
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Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | | | - Rami Yaari
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY
- Columbia Climate School, Columbia University, New York, NY
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Lopez AR, Slanetz PJ, Narayan A, Tran NT, Porras AR, Miles RC. Assessing the Relationship between Radiology Department Research Funding and Institutional Community Inclusion and Investment. Radiology 2024; 310:e231469. [PMID: 38259205 DOI: 10.1148/radiol.231469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Health care access disparities and lack of inclusion in clinical research have been well documented for marginalized populations. However, few studies exist examining the research funding of institutions that serve historically underserved groups. Purpose To assess the relationship between research funding awarded to radiology departments by the National Institutes of Health (NIH) and Lown Institute Hospitals Index rankings for inclusivity and community benefit. Materials and Methods This retrospective study included radiology departments awarded funding from the NIH between 2017 and 2021. The 2021 Lown Institute Hospitals Index rankings for inclusivity and community benefit were examined. The inclusivity metric measures how similar a hospital's patient population is to the surrounding community in terms of income, race and ethnicity, and education level. The community benefit metric measures charity care spending, Medicaid as a proportion of patient revenue, and other community benefit spending. Linear regression and Pearson correlation coefficients (r values) were used to evaluate the relationship between aggregate NIH radiology department research funding and measures of inclusivity and community benefit. Results Seventy-five radiology departments that received NIH funding ranging from $195 000 to $216 879 079 were included. A negative correlation was observed between the amount of radiology department research funding received and institutional rankings for serving patients from racial and/or ethnic minorities (r = -0.34; P < .001), patients with low income (r = -0.44; P < .001), and patients with lower levels of education (r = -0.46; P < .001). No correlation was observed between the amount of radiology department research funding and institutional rankings for charity care spending (r = -0.19; P = .06), community investment (r = -0.04; P = .68), and Medicaid as a proportion of patient revenue (r = -0.10; P = .22). Conclusion Radiology departments that received more NIH research funding were less likely to serve patients from racial and/or ethnic minorities and patients who had low income or lower levels of education. © RSNA, 2024 See also the editorial by Mehta and Rosen in this issue.
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Affiliation(s)
- Antonio R Lopez
- From Drexel University College of Medicine, Philadelphia, Pa (A.R.L.); Department of Radiology, Boston Medical Center, Boston, Mass (P.J.S.); Boston University Chobanian & Avedisian School of Medicine, Boston, Mass (P.J.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.N.); Department of Radiology, Denver Health, 777 Bannock St, Denver, CO 80204 (N.T.T., R.C.M.); Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.); Departments of Pediatric Plastic & Reconstructive Surgery and Neurosurgery, Children's Hospital Colorado, Aurora, Colo (A.R.P.); and Departments of Pediatrics, Surgery, and Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.)
| | - Priscilla J Slanetz
- From Drexel University College of Medicine, Philadelphia, Pa (A.R.L.); Department of Radiology, Boston Medical Center, Boston, Mass (P.J.S.); Boston University Chobanian & Avedisian School of Medicine, Boston, Mass (P.J.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.N.); Department of Radiology, Denver Health, 777 Bannock St, Denver, CO 80204 (N.T.T., R.C.M.); Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.); Departments of Pediatric Plastic & Reconstructive Surgery and Neurosurgery, Children's Hospital Colorado, Aurora, Colo (A.R.P.); and Departments of Pediatrics, Surgery, and Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.)
| | - Anand Narayan
- From Drexel University College of Medicine, Philadelphia, Pa (A.R.L.); Department of Radiology, Boston Medical Center, Boston, Mass (P.J.S.); Boston University Chobanian & Avedisian School of Medicine, Boston, Mass (P.J.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.N.); Department of Radiology, Denver Health, 777 Bannock St, Denver, CO 80204 (N.T.T., R.C.M.); Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.); Departments of Pediatric Plastic & Reconstructive Surgery and Neurosurgery, Children's Hospital Colorado, Aurora, Colo (A.R.P.); and Departments of Pediatrics, Surgery, and Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.)
| | - Nhat-Tuan Tran
- From Drexel University College of Medicine, Philadelphia, Pa (A.R.L.); Department of Radiology, Boston Medical Center, Boston, Mass (P.J.S.); Boston University Chobanian & Avedisian School of Medicine, Boston, Mass (P.J.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.N.); Department of Radiology, Denver Health, 777 Bannock St, Denver, CO 80204 (N.T.T., R.C.M.); Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.); Departments of Pediatric Plastic & Reconstructive Surgery and Neurosurgery, Children's Hospital Colorado, Aurora, Colo (A.R.P.); and Departments of Pediatrics, Surgery, and Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.)
| | - Antonio R Porras
- From Drexel University College of Medicine, Philadelphia, Pa (A.R.L.); Department of Radiology, Boston Medical Center, Boston, Mass (P.J.S.); Boston University Chobanian & Avedisian School of Medicine, Boston, Mass (P.J.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.N.); Department of Radiology, Denver Health, 777 Bannock St, Denver, CO 80204 (N.T.T., R.C.M.); Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.); Departments of Pediatric Plastic & Reconstructive Surgery and Neurosurgery, Children's Hospital Colorado, Aurora, Colo (A.R.P.); and Departments of Pediatrics, Surgery, and Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.)
| | - Randy C Miles
- From Drexel University College of Medicine, Philadelphia, Pa (A.R.L.); Department of Radiology, Boston Medical Center, Boston, Mass (P.J.S.); Boston University Chobanian & Avedisian School of Medicine, Boston, Mass (P.J.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.N.); Department of Radiology, Denver Health, 777 Bannock St, Denver, CO 80204 (N.T.T., R.C.M.); Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.); Departments of Pediatric Plastic & Reconstructive Surgery and Neurosurgery, Children's Hospital Colorado, Aurora, Colo (A.R.P.); and Departments of Pediatrics, Surgery, and Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (A.R.P.)
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20
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Freelander L, Rickless DS, Anderson C, Curriero F, Rockhill S, Mirsajedin A, Colón CJ, Lusane J, Vigo-Valentín A, Wong D. The impact of COVID-19 on healthcare coverage and access in racial and ethnic minority populations in the United States. GEOSPATIAL HEALTH 2023; 18:10.4081/gh.2023.1222. [PMID: 38150046 PMCID: PMC10790404 DOI: 10.4081/gh.2023.1222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023]
Abstract
This study described spatiotemporal changes in health insurance coverage, healthcare access, and reasons for non-insurance among racial/ethnic minority populations in the United States during the COVID-19 pandemic using four national survey datasets. Getis-Ord Gi* statistic and scan statistics were used to analyze geospatial clusters of health insurance coverage by race/ethnicity. Logistic regression was used to estimate odds of reporting inability to access healthcare across two pandemic time periods by race/ethnicity. Racial/ethnic differences in insurance were observed from 2010 through 2019, with the lowest rates being among Hispanic/Latino, African American, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander populations. Pre-pandemic insurance coverage rates were geographically clustered. The percentage of adults citing change in employment status as the reason for non-insurance increased by about 7% after the start of the pandemic, with a small decrease observed among African American adults. Almost half of adults reported reduced healthcare access in June 2020, with 38.7% attributing reduced access to the pandemic; however, by May 2021, the percent of respondents reporting reduced access for any reason and due to the pandemic fell to 26.9% and 12.7%, respectively. In general, racial/ethnic disparities in health insurance coverage and healthcare access worsened during the pandemic. Although coverage and access improved over time, pre-COVID disparities persisted with African American and Hispanic/Latino populations being the most affected by insurance loss and reduced healthcare access. Cost, unemployment, and eligibility drove non-insurance before and during the pandemic.
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Affiliation(s)
- Lauren Freelander
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - David S Rickless
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - Corey Anderson
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - Frank Curriero
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
| | - Sarah Rockhill
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - Amir Mirsajedin
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Office of Innovation and Analytics, Geospatial Research, Analysis, and Services, Atlanta, GA.
| | - Caleb J Colón
- US Department of Health and Human Services, Office of Minority Health, Rockville, MD.
| | - Jasmine Lusane
- US Department of Health and Human Services, Office of Minority Health, Rockville, MD.
| | | | - David Wong
- US Department of Health and Human Services, Office of Minority Health, Rockville, MD.
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21
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Meudec M, Affun-Adegbulu C, Cosaert T. Review of health research and data on/with racially minoritised groups: Implications for addressing racism and racial disparities in public health practice and policies in Europe: a study protocol. F1000Res 2023; 12:57. [PMID: 38434645 PMCID: PMC10904934 DOI: 10.12688/f1000research.128331.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 03/05/2024] Open
Abstract
Historically, across Europe, data and research on/with racially minoritised groups have not been collected or carried out in a sufficient, adequate, or appropriate manner. Yet, to understand emerging and existing health disparities among such groups, researchers and policymakers must obtain and use data to build evidence that informs decision-making and action on key structural and social determinants of health. This systematic search and review aims to contribute to closing this gap and promote a race-conscious approach to health research, strengthening the utilisation and deployment of data and research on/with racially minoritised groups in Europe. Its ultimate goal is to improve equality and equity in health*. Concretely, the study will do so by reviewing and critically analysing the usage of the concepts of race, ethnicity, and their related euphemisms and proxies in health-related research. It will examine the collection, use, and deployment of data and research on/with racially minoritised groups in this area. The study will focus on Belgium, France, and the Netherlands, three countries with graphical proximity and several similarities, one of which is the limited attention that is given to racism and racial inequalities in health in research and policy. This choice is also justified by practical knowledge of the context and languages. The results of the review will be used to develop guidance on how to use and deploy data and research on/with racially minoritised groups. The review is part of a larger project which aims to promote race-conscious research and data. The project does this by a three-pronged approach which: 1) highlights the need for a race-conscious approach when collecting and using data, carrying out research on/with racially minoritised groups; 2) builds expertise for their effective use and deployment, and; 3) creates a knowledge network and community of practice for public health researchers working in Europe.
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Affiliation(s)
- Marie Meudec
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Clara Affun-Adegbulu
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Theo Cosaert
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
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22
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Oh DL, Meltzer D, Wang K, Canchola AJ, DeRouen MC, McDaniels-Davidson C, Gibbons J, Carvajal-Carmona L, Nodora JN, Hill L, Gomez SL, Martinez ME. Neighborhood Factors Associated with COVID-19 Cases in California. J Racial Ethn Health Disparities 2023; 10:2653-2662. [PMID: 36376642 PMCID: PMC9662780 DOI: 10.1007/s40615-022-01443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a need to assess neighborhood-level factors driving COVID-19 disparities across racial and ethnic groups. OBJECTIVE To use census tract-level data to investigate neighborhood-level factors contributing to racial and ethnic group-specific COVID-19 case rates in California. DESIGN Quasi-Poisson generalized linear models were used to identify neighborhood-level factors associated with COVID-19 cases. In separate sequential models for Hispanic, Black, and Asian, we characterized the associations between neighborhood factors on neighborhood COVID-19 cases. Subanalyses were conducted on neighborhoods with majority Hispanic, Black, and Asian residents to identify factors that might be unique to these neighborhoods. Geographically weighted regression using a quasi-Poisson model was conducted to identify regional differences. MAIN MEASURES All COVID-19 cases and tests reported through January 31, 2021, to the California Department of Public Health. Neighborhood-level data from census tracts were obtained from American Community Survey 5-year estimates (2015-2019), United States Census (2010), and United States Department of Housing and Urban Development. KEY RESULTS The neighborhood factors associated with COVID-19 case rate were racial and ethnic composition, age, limited English proficiency (LEP), income, household size, and population density. LEP had the largest influence on the positive association between proportion of Hispanic residents and COVID-19 cases (- 2.1% change). This was also true for proportion of Asian residents (- 1.8% change), but not for the proportion of Black residents (- 0.1% change). The influence of LEP was strongest in areas of the Bay Area, Los Angeles, and San Diego. CONCLUSION Neighborhood-level contextual drivers of COVID-19 burden differ across racial and ethnic groups.
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Affiliation(s)
- Debora L Oh
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA.
| | - Dan Meltzer
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
| | - Katarina Wang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
| | - Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
| | - Corinne McDaniels-Davidson
- School of Public Health, San Diego State University, San Diego, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Joseph Gibbons
- Department of Sociology, San Diego State University, San Diego, CA, USA
| | - Luis Carvajal-Carmona
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, CA, USA
| | - Jesse N Nodora
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Linda Hill
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
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23
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Ruhm CJ. The Evolution of Excess Deaths in the United States During the First 2 Years of the COVID-19 Pandemic. Am J Epidemiol 2023; 192:1949-1959. [PMID: 37222463 PMCID: PMC10988222 DOI: 10.1093/aje/kwad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 09/01/2022] [Accepted: 05/20/2023] [Indexed: 05/25/2023] Open
Abstract
Understanding consequences of the COVID-19 pandemic requires information on the excess mortality resulting from it. Multiple studies have examined excess deaths during the pandemic's initial stages, but how these have changed over time is unclear. National- and state-level death counts and population data from 2009 to 2022 were used in this analysis to evaluate excess fatalities from March 2020 to February 2021 and March 2021 to February 2022, with deaths from earlier years used to project baseline counts. The outcomes were total, group-specific, cause-specific, and age-by-cause excess fatalities, and numbers and percentages directly involving COVID-19. Excess deaths declined from 655,735 (95% confidence interval: 619,028, 691,980) during the first pandemic year to 586,505 (95% confidence interval: 532,823, 639,205) in the second. The reductions were particularly large for Hispanics, Blacks, Asians, seniors, and residents of states with high vaccination rates. Excess deaths increased from the first to second year for persons younger than 65 years and in low-vaccination states. Excess mortality from some diseases declined, but those from alcohol, drug, vehicle, and homicide causes likely increased between the first and second pandemic year, especially for prime-age and younger individuals. The share of excess fatalities involving COVID-19 decreased modestly over time, with little change in its role as an underlying versus contributing cause of death.
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Affiliation(s)
- Christopher J Ruhm
- Correspondence to Prof. Christopher J. Ruhm, Frank Batten School of Leadership & Public Policy, University of Virginia, 235 McCormick Road, P.O. Box 400893, Charlottesville, VA 22904-4893 (e-mail: )
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24
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Taylor JY, Barcelona V, Magny-Normilus C, Wright ML, Jones-Patten A, Prescott L, Potts-Thompson S, Santos HP. A roadmap for social determinants of health and biological nursing research in the National Institute of Nursing Research 2022-2026 Strategic Plan: Optimizing health and advancing health equity using antiracist framing. Nurs Outlook 2023; 71:102059. [PMID: 37863707 PMCID: PMC10803078 DOI: 10.1016/j.outlook.2023.102059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Health equity is essential for improving the well-being of all individuals and groups, and research remains a critical element for understanding barriers to health equity. While considering how to best support research that acknowledges current health challenges, it is crucial to understand the role of social justice frameworks within health equity research and the contributions of minoritized researchers. Additionally, there should be an increased understanding of the influence of social determinants of health on biological mechanisms. PURPOSE Biological health equity research seeks to understand and address health disparities among historically excluded populations. DISCUSSION While there are examples of studies in this area led by minoritized researchers, some individuals and groups remain understudied due to underfunding. Research within minoritized populations must be prioritized to authentically achieve health equity. Furthermore, there should be increased funding from National Institutes of Health to support minoritized researchers working in this area.
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Affiliation(s)
- Jacquelyn Y Taylor
- Center for Research on People of Color, Columbia University School of Nursing, New York, NY.
| | - Veronica Barcelona
- Center for Research on People of Color, Columbia University School of Nursing, New York, NY
| | | | | | | | - Laura Prescott
- Center for Research on People of Color, Columbia University School of Nursing, New York, NY
| | | | - Hudson P Santos
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL
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25
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Nguyen AA, Habiballah SB, LaBere B, Day-Lewis M, Elkins M, Al-Musa A, Chu A, Jones J, Fried AJ, McDonald D, Hoytema van Konijnenburg DP, Rockowitz S, Sliz P, Oettgen HC, Schneider LC, MacGinnitie A, Bartnikas LM, Platt CD, Ohsumi TK, Chou J. Rethinking Immunological Risk: A Retrospective Cohort Study of Severe SARS-Cov-2 Infections in Individuals With Congenital Immunodeficiencies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3391-3399.e3. [PMID: 37544429 PMCID: PMC10839118 DOI: 10.1016/j.jaip.2023.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/22/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Debates on the allocation of medical resources during the coronavirus disease 2019 (COVID-19) pandemic revealed the need for a better understanding of immunological risk. Studies highlighted variable clinical outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in individuals with defects in both adaptive and innate immunity, suggesting additional contributions from other factors. Notably, none of these studies controlled for variables linked with social determinants of health. OBJECTIVE To determine the contributions of determinants of health to risk of hospitalization for SARS-CoV-2 infection among individuals with inborn errors of immunodeficiencies. METHODS This is a retrospective, single-center cohort study of 166 individuals with inborn errors of immunity, aged 2 months through 69 years, who developed SARS-CoV-2 infections from March 1, 2020, through March 31, 2022. Risks of hospitalization were assessed using a multivariable logistic regression analysis. RESULTS The risk of SARS-CoV-2-related hospitalization was associated with underrepresented racial and ethnic populations (odds ratio [OR] 4.50; 95% confidence interval [95% CI] 1.57-13.4), a diagnosis of any genetically defined immunodeficiency (OR 3.32; 95% CI 1.24-9.43), obesity (OR 4.24; 95% CI 1.38-13.3), and neurological disease (OR 4.47; 95% CI 1.44-14.3). The COVID-19 vaccination was associated with reduced hospitalization risk (OR 0.52; 95% CI 0.31-0.81). Defects in T cell and innate immune function, immune-mediated organ dysfunction, and social vulnerability were not associated with increased risk of hospitalization after controlling for covariates. CONCLUSIONS The associations between race, ethnicity, and obesity with increased risk of hospitalization for SARS-CoV-2 infection indicate the importance of variables linked with social determinants of health as immunological risk factors for individuals with inborn errors of immunity.
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Affiliation(s)
- Alan A Nguyen
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Saddiq B Habiballah
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Brenna LaBere
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Megan Day-Lewis
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Megan Elkins
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Amer Al-Musa
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Anne Chu
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Jennifer Jones
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Ari J Fried
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Douglas McDonald
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | | | - Shira Rockowitz
- Research Computing, Information Technology, Boston Children's Hospital, Boston, Mass; The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Mass
| | - Piotr Sliz
- Research Computing, Information Technology, Boston Children's Hospital, Boston, Mass; The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Mass; Division of Molecular Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Hans C Oettgen
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Andrew MacGinnitie
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | | | - Janet Chou
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
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26
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Nyachoti DO, Ranjit N, Ramphul R, Whigham LD, Springer AE. Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6985. [PMID: 37947543 PMCID: PMC10647229 DOI: 10.3390/ijerph20216985] [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: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Despite the key role of social vulnerability such as economic disadvantage in health outcomes, research is limited on the impact of social vulnerabilities on COVID-19-related deaths, especially at the state and county level in the USA. METHODS We conducted a cross-sectional ecologic analysis of COVID-19 mortality by the county-level Minority Health Social Vulnerability Index (MH SVI) and each of its components in Texas. Negative binomial regression (NBR) analyses were used to estimate the association between the composite MH SVI (and its components) and COVID-19 mortality. RESULTS A 0.1-unit increase in the overall MH SVI (IRR, 1.27; 95% CI, 1.04-1.55; p = 0.017) was associated with a 27% increase in the COVID-19 mortality rate. Among the MH SVI component measures, only low socioeconomic status (IRR, 1.55; 95% CI, 1.28-1.89; p = 0.001) and higher household composition (e.g., proportion of older population per county) and disability scores (IRR, 1.47; 95% CI, 1.29-1.68; p < 0.001) were positively associated with COVID-19 mortality rates. CONCLUSIONS This study provides further evidence of disparities in COVID-19 mortality by social vulnerability and can inform decisions on the allocation of social resources and services as a strategy for reducing COVID-19 mortality rates and similar pandemics in the future.
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Affiliation(s)
- Dennis Ogeto Nyachoti
- Epidemiology and Surveillance Unit, Texas Department of State Health Services, 201 W Howard Ln, Austin, TX 78753, USA
- Department of Health Promotion and Behavioral Sciences, Center for Community Health Impact, The University of Texas Health Science Center at Houston School of Public Health, 5130 Gateway Boulevard East MCA 110, El Paso, TX 79905, USA;
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
| | - Ryan Ramphul
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA;
| | - Leah D. Whigham
- Department of Health Promotion and Behavioral Sciences, Center for Community Health Impact, The University of Texas Health Science Center at Houston School of Public Health, 5130 Gateway Boulevard East MCA 110, El Paso, TX 79905, USA;
| | - Andrew E. Springer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
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Oh H. Racial Capitalism and Neighborhood Health Disparities: the COVID-19 in California Counties. J Racial Ethn Health Disparities 2023; 10:2338-2343. [PMID: 36097313 PMCID: PMC9466309 DOI: 10.1007/s40615-022-01413-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE This article explores the association between racial capitalism and neighborhood-level health disparities, with a particular focus on COVID-19 in California. METHODS This article investigates COVID-19 incidence in 58 California counties. To account for racial capitalism, the study looks at the per capita incomes ratios (1) between whites and Blacks and (2) between whites and Hispanics. Other county-level neighborhood characteristics were controlled. RESULTS Findings from spatial autoregressive models indicate that increases in white-Black and white-Hispanic income disadvantages lead to an increase in COVID-19 incidence in 58 California counties. Findings also reveal that the disadvantage that results from the white-Black income ratio in COVID-19 spread decreases in counties that report high levels of income inequality between whites and Hispanics. DISCUSSION Findings indicate that a greater income disadvantage for racial minorities is connected to a more COVID-19 incidence. With regard to racial demographics in California, the interaction effect between measures for racial income disadvantages is discussed.
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Affiliation(s)
- Hyunsu Oh
- Department of Sociology, McDaniel College, 2 College Hill, Westminster, MD, 21157, USA.
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Cook SH, Wood EP, Risner E, Weng CA, Xin Y. A national examination of discrimination, resilience, and depressive symptoms during the COVID-19 pandemic: the All of Us Research Program. Front Psychol 2023; 14:1175452. [PMID: 37823074 PMCID: PMC10562571 DOI: 10.3389/fpsyg.2023.1175452] [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: 02/27/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
Objective To examine the impact of resilience on the association between discrimination and trajectories of depressive symptoms during the COVID-19 pandemic across racial and ethnic groups. Methods Data were drawn from 5 waves of the All of Us Research Program's survey on the impact of COVID-19 on the lives of American adults. Linear mixed-effects models were fitted to assess the association between discrimination exposure throughout the pandemic and depressive symptoms over time. An interaction term was introduced between resilience and discrimination exposure to assess if resilience buffered the association between discrimination and depressive symptoms over time. Race-stratified linear mixed-effects models examined racial/ethnic differences in the association between resilience, discrimination, and depressive symptoms over time. Results Fifty-one thousand nine hundred fifty-eight participants completed surveys between May and December of 2020. Results indicated that exposure to more discrimination was associated with increasing trajectories of depressive symptoms over time (b = 0.48, p < 0.001). However, resilience moderated the association between discrimination and well-being over time such that higher resilience mitigated the detrimental effect of experiencing discrimination on depressive symptoms across time (b = -0.02, p < 0.001). Conclusion Identifying protective features such as resilience can promote the development of culturally tailored interventions to address mental health in the context of discrimination.
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Affiliation(s)
- Stephanie H. Cook
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, United States
| | - Erica P. Wood
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States
| | - Emma Risner
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, United States
| | - Chenziheng Allen Weng
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, United States
| | - Yao Xin
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, United States
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Yan X, Schneider JA, Modali L, Korban C, Tabidze I. Racial-ethnic, gender identity, and sexual orientation disparities in COVID-19-related social and health outcomes: A decomposition analysis. SSM Popul Health 2023; 23:101474. [PMID: 37560090 PMCID: PMC10407278 DOI: 10.1016/j.ssmph.2023.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
Despite the growing literature on racial-ethnic disparities during the pandemic, less is known about the explanatory mechanisms of these disparities and inequalities across other axes, such as gender and sexual identities. We studied the levels and sources of racial-ethnic, gender identity, and sexual minority disparities in social (i.e., unmet resource needs) and health (i.e., hospitalization) outcomes among individuals diagnosed with COVID-19, hypothesizing differential age structure, underlying health, and work and living arrangements as contributors to inequalities. Using large-scale administrative data from Chicago and adjusting for covariates, we found substantial racial-ethnic and gender identity disparities in both outcomes, and weak evidence of sexual minority disparities in unmet needs. Subsequent decomposition analyses revealed that living in larger households, having a higher share of non-adult cases, and facing higher burdens of chronic illness, obesity, and unemployment each statistically significantly drove racial-ethnic disparities in unmet needs, but these together explained less than 15% of the disparities. Similarly, about 20% of the Black-White gap in hospitalization resulted from disparities in underlying health and unemployment, whereas a higher proportion of non-adult cases or higher unemployment rates respectively proved the only significant pathways to partially explain transgender individuals' disadvantages in unmet needs (12%) or hospitalization (6%). These findings highlight the importance of considering multiple dimensions of social differences in studying health disparities, the vulnerabilities of transgender and non-adult communities during the pandemic, and the valid yet quite limited roles of previously suggested sociodemographic factors in accounting for COVID-19-related categorical inequalities.
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Affiliation(s)
- Xuewen Yan
- Department of Sociology, Cornell University, Chicago Department of Public Health, USA
| | - John A. Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago Department of Public Health, USA
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Lindenfeld Z, Pagán JA, Silver D, McNeill E, Mostafa L, Zein D, Chang JE. Stakeholder Perspectives on Data-Driven Solutions to Address Cardiovascular Disease and Health Equity in New York City. AJPM FOCUS 2023; 2:100093. [PMID: 37790665 PMCID: PMC10546603 DOI: 10.1016/j.focus.2023.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction There is growing recognition of the importance of addressing the social determinants of health in efforts to improve health equity. In dense urban environments such as New York City, disparities in chronic health conditions (e.g., cardiovascular disease) closely mimic inequities in social factors such as income, education, and housing. Although there is a wealth of data on these social factors in New York City, little is known about how to rapidly use available data sources to address health disparities. Methods Semistructured interviews were conducted with key stakeholders (N=11) from across the public health landscape in New York City (health departments, healthcare delivery systems, and community-based organizations) to assess perspectives on how social determinants of health data can be used to address cardiovascular disease and health equity, what data-driven tools would be useful, and challenges to using these data sources and developing tools. A matrix analysis approach was used to analyze the interview data. Results Stakeholders were optimistic about using social determinants of health data to address health equity by delivering holistic care, connecting people with additional resources, and increasing investments in under-resourced communities. However, interviewees noted challenges related to the quality and timeliness of social determinants of health data, interoperability between data systems, and lack of consistent metrics related to cardiovascular disease and health equity. Conclusions Future research on this topic should focus on mitigating the barriers to using social determinants of health data, which includes incorporating social determinants of health data from other sectors. There is also a need to assess how data-driven solutions can be implemented within and across communities and organizations.
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Affiliation(s)
- Zoe Lindenfeld
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - José A. Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Diana Silver
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Elizabeth McNeill
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Logina Mostafa
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Dina Zein
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Ji Eun Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
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Gearhart R, Michieka N, Anders A. The effectiveness of COVID deaths to COVID policies: A robust conditional approach. ECONOMIC ANALYSIS AND POLICY 2023; 79:376-394. [PMID: 37363405 PMCID: PMC10276656 DOI: 10.1016/j.eap.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
This paper examines the effectiveness of four major COVID-19 social distancing policies, (i) shelter-in-place orders (SIPO), (ii) non-essential business closures, (iii) mandatory quarantine for travelers, and (iv) bans on large gatherings, on both COVID cases and COVID deaths. Results indicate that states are highly ineffective in producing the fraction of the population that does not have COVID-19 or the fraction of the population that does not die from COVID-19. We find that having any form of social distancing policies increases the fraction of the population not considered a positive COVID-19 case by 23.5 percentage points. Results also show that having any of the four major social distancing policies reduces the fraction of the population who has died of COVID-19 by 1.3 percentage points between March 1, 2020 and September 1, 2020; during the first 100 days, effectiveness would improve by 2.1 percentage points. Evidence suggests that there is no effective uniform national COVID-19 social distancing policy. Furthermore, conditional efficiency regressions after 100 days suggest that behavioral noncompliance and premature expiration of social distancing policies both negatively impact effectiveness. Partial regression plots suggest that bans on large gatherings and the closure of non-essential businesses were the two most impactful COVID-19 social distancing policies.
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Affiliation(s)
- Richard Gearhart
- School of Business and Public Administration, Department of Economics, California State University, 20 BDC, 9001 Stockdale Highway, Bakersfield, CA 93311, USA
| | - Nyakundi Michieka
- School of Business and Public Administration, Department of Economics, California State University, 20 BDC, 9001 Stockdale Highway, Bakersfield, CA 93311, USA
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Stafford E, Dimitrov D, Ceballos R, Campelia G, Matrajt L. Retrospective analysis of equity-based optimization for COVID-19 vaccine allocation. PNAS NEXUS 2023; 2:pgad283. [PMID: 37693211 PMCID: PMC10492235 DOI: 10.1093/pnasnexus/pgad283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
Marginalized racial and ethnic groups in the United States were disproportionally affected by the COVID-19 pandemic. To study these disparities, we construct an age-and-race-stratified mathematical model of SARS-CoV-2 transmission fitted to age-and-race-stratified data from 2020 in Oregon and analyze counterfactual vaccination strategies in early 2021. We consider two racial groups: non-Hispanic White persons and persons belonging to BIPOC groups (including non-Hispanic Black persons, non-Hispanic Asian persons, non-Hispanic American-Indian or Alaska-Native persons, and Hispanic or Latino persons). We allocate a limited amount of vaccine to minimize overall disease burden (deaths or years of life lost), inequity in disease outcomes between racial groups (measured with five different metrics), or both. We find that, when allocating small amounts of vaccine (10% coverage), there is a trade-off between minimizing disease burden and minimizing inequity. Older age groups, who are at a greater risk of severe disease and death, are prioritized when minimizing measures of disease burden, and younger BIPOC groups, who face the most inequities, are prioritized when minimizing measures of inequity. The allocation strategies that minimize combinations of measures can produce middle-ground solutions that similarly improve both disease burden and inequity, but the trade-off can only be mitigated by increasing the vaccine supply. With enough resources to vaccinate 20% of the population the trade-off lessens, and with 30% coverage, we can optimize both equity and mortality. Our goal is to provide a race-conscious framework to quantify and minimize inequity that can be used for future pandemics and other public health interventions.
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Affiliation(s)
- Erin Stafford
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Dobromir Dimitrov
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Rachel Ceballos
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT, USA
| | - Georgina Campelia
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Laura Matrajt
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
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Ali SMA, Sherman-Morris K, Meng Q, Ambinakudige S. Longitudinal disparities in social determinants of health and COVID-19 incidence and mortality in the United States from the three largest waves of the pandemic. Spat Spatiotemporal Epidemiol 2023; 46:100604. [PMID: 37500229 DOI: 10.1016/j.sste.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 06/01/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
The United States experienced at least five COVID-19 waves linked with different mutated SARS-CoV-2 variants including Alpha, Delta and Omicron. In addition to the variants, the intensity, geographical distribution, and risk factors related to those waves also vary within socio-demographic characteristics and timeframes. In this project, we have examined the spatial and temporal pattern of COVID-19 in the USA and its associations with Social Determinants of Health (SDoH) by utilizing the County Health Rankings & Roadmaps (CHRR) dataset. Our epidemiologic investigation at the county level showed that the burden of COVID-19 cases and deaths is higher in counties with high percentages of smoking, number of preventable hospital stays, primary care physician rate, the average daily density of PM2.5 and percentages of high proportions of Hispanic residents. In addition, the analysis also demonstrated that COVID-19 incidence and mortality had distinct characteristics in their association with SDoH variables. For example, the percentages of the population 65 and older had negative associations with incidence while a significant positive association with mortality. In addition to the elderly population, median household income, unemployment, and number of drug overdose deaths showed a mixed association with COVID-19 incidence and mortality. Our findings validate several influential factors found in the existing social epidemiology literature and highlight temporal associations between SDoH variables and COVID-19 incidence and mortality not yet frequently studied.
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Affiliation(s)
- S M Asger Ali
- Polis Center, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, USA.
| | | | - Qingmin Meng
- Department of Geosciences, Mississippi State University, Starkville, USA.
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Murray TA. Race-Based Pedagogy in Nursing Education. J Nurs Educ 2023; 62:431-432. [PMID: 37561903 DOI: 10.3928/01484834-20230712-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Teri A Murray
- Professor, Dean Emerita, Chief, Diversity, and Inclusion Officer, Trudy Busch Valentine School of Nursing, Saint Louis University, Associate Editor, Journal of Nursing Education
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35
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Swietek K, Gianattasio KZ, Henderson S, Khanna S, Ubri P, Douglas M, Baltrus P, Freij M, Mack DH, Gaglioti A. Association Between Racial Segregation and COVID-19 Vaccination Rates. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:572-579. [PMID: 36943401 DOI: 10.1097/phh.0000000000001738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To examine the association between county-level Black-White residential segregation and COVID-19 vaccination rates. DESIGN Observational cross-sectional study using multivariable generalized linear models with state fixed effects to estimate the average marginal effects of segregation on vaccination rates. SETTING National analysis of county-level vaccination rates. MAIN OUTCOME MEASURE County-level vaccination rates across the United States. RESULTS We found an overall positive association between county-level segregation and the proportion population fully vaccinated, with a 6.8, 11.3, and 12.8 percentage point increase in the proportion fully vaccinated by May 3, September 27, and December 6, 2021, respectively. Effects were muted after adjustment for sociodemographic variables. Furthermore, in analyses including an interaction term between the county proportion of Black residents and the county dissimilarity index, the association between segregation and vaccination is positive in counties with a lower proportion of Black residents (ie, 5%) but negative in counties with the highest proportions of Black residents (ie, 70%). CONCLUSIONS Findings highlight the importance of methodological decisions when modeling disparities in COVID-19 vaccinations. Researchers should consider mediating and moderating factors and examine interaction effects and stratified analyses taking racial group distributions into account. Results can inform policies around the prioritization of vaccine distribution and outreach.
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Affiliation(s)
- Karen Swietek
- NORC at the University of Chicago, Chicago, Illinois (Drs Swietek, Gianattasio, and Freij, Ms Henderson, Khanna, and Ubri); National Center for Primary Care (Drs Douglas, Baltrus, Mack, and Gaglioti), Department of Community Health and Preventive Medicine (Drs Douglas and Baltrus), and Department of Family Medicine (Dr Mack), Morehouse School of Medicine, Atlanta, Georgia; and Population Health Research Institute and Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio (Dr Gaglioti)
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Allen B, Basaraba C, Corbeil T, Rivera BD, Levin FR, Martinez DM, Schultebraucks K, Henry BF, Pincus HA, Arout C, Krawczyk N. Racial differences in COVID-19 severity associated with history of substance use disorders and overdose: Findings from multi-site electronic health records in New York City. Prev Med 2023; 172:107533. [PMID: 37146730 PMCID: PMC10155467 DOI: 10.1016/j.ypmed.2023.107533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
Substance use disorders (SUD) are associated with increased risk of worse COVID-19 outcomes. Likewise, racial/ethnic minority patients experience greater risk of severe COVID-19 disease compared to white patients. Providers should understand the role of race and ethnicity as an effect modifier on COVID-19 severity among individuals with SUD. This retrospective cohort study assessed patient race/ethnicity as an effect modifier of the risk of severe COVID-19 disease among patients with histories of SUD and overdose. We used merged electronic health record data from 116,471 adult patients with a COVID-19 encounter between March 2020 and February 2021 across five healthcare systems in New York City. Exposures were patient histories of SUD and overdose. Outcomes were risk of COVID-19 hospitalization and subsequent COVID-19-related ventilation, acute kidney failure, sepsis, and mortality. Risk factors included patient age, sex, and race/ethnicity, as well as medical comorbidities associated with COVID-19 severity. We tested for interaction between SUD and patient race/ethnicity on COVID-19 outcomes. Findings showed that Non-Hispanic Black, Hispanic/Latino, and Asian/Pacific Islander patients experienced a higher prevalence of all adverse COVID-19 outcomes compared to non-Hispanic white patients. Past-year alcohol (OR 1.24 [1.01-1.53]) and opioid use disorders (OR 1.91 [1.46-2.49]), as well as overdose history (OR 4.45 [3.62-5.46]), were predictive of COVID-19 mortality, as well as other adverse COVID-19 outcomes. Among patients with SUD, significant differences in outcome risk were detected between patients of different race/ethnicity groups. Findings indicate that providers should consider multiple dimensions of vulnerability to adequately manage COVID-19 disease among populations with SUDs.
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Affiliation(s)
- Bennett Allen
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, United States of America.
| | - Cale Basaraba
- Area Mental Health Data Science, New York State Psychiatric Institute, United States of America
| | - Thomas Corbeil
- Area Mental Health Data Science, New York State Psychiatric Institute, United States of America
| | - Bianca D Rivera
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, United States of America
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, United States of America; Columbia University Vagelos College of Physicians and Surgeons, United States of America
| | - Diana M Martinez
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, United States of America; Columbia University Vagelos College of Physicians and Surgeons, United States of America
| | - Katharina Schultebraucks
- Department of Psychiatry, NYU Grossman School of Medicine, United States of America; Department of Population Health, NYU Grossman School of Medicine, United States of America
| | - Brandy F Henry
- College of Education, Consortium on Substance Use and Addiction, Social Science Research Institute, Pennsylvania State University, United States of America
| | - Harold A Pincus
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, United States of America; Columbia University Vagelos College of Physicians and Surgeons, United States of America; Irving Institute for Clinical and Translational Research, Columbia University, United States of America
| | - Caroline Arout
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, United States of America
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, United States of America
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Nguyen AA, Habiballah SB, LaBere B, Day-Lewis M, Elkins M, Al-Musa A, Chu A, Jones J, Fried AJ, McDonald D, van Konijnenburg DPH, Rockowitz S, Sliz P, Oettgen HC, Schneider LC, MacGinnitie A, Bartnikas LM, Platt CD, Ohsumi TK, Chou J. Rethinking immunologic risk: a retrospective cohort study of severe SARS-CoV-2 infections in individuals with congenital immunodeficiencies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.01.23290843. [PMID: 37333367 PMCID: PMC10275008 DOI: 10.1101/2023.06.01.23290843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Debates on the allocation of medical resources during the COVID-19 pandemic revealed the need for a better understanding of immunologic risk. Studies highlighted variable clinical outcomes of SARS-CoV-2 infections in individuals with defects in both adaptive and innate immunity, suggesting additional contributions from other factors. Notably, none of these studies controlled for variables linked with social determinants of health. Objective To determine the contributions of determinants of health to risk of hospitalization for SARS-CoV-2 infection among individuals with inborn errors of immunodeficiencies. Methods This is a retrospective, single-center cohort study of 166 individuals with inborn errors of immunity, aged two months through 69 years, who developed SARS-CoV-2 infections from March 1, 2020 through March 31, 2022. Risks of hospitalization was assessed using a multivariable logistic regression analysis. Results The risk of SARS-CoV-2-related hospitalization was associated with underrepresented racial and ethnic populations (odds ratio [OR] 5.29; confidence interval [CI], 1.76-17.0), a diagnosis of any genetically-defined immunodeficiency (OR 4.62; CI, 1.60-14.8), use of B cell depleting therapy within one year of infection (OR 6.1; CI, 1.05-38.5), obesity (OR 3.74; CI, 1.17-12.5), and neurologic disease (OR 5.38; CI, 1.61-17.8). COVID-19 vaccination was associated with reduced hospitalization risk (OR 0.52; CI, 0.31-0.81). Defective T cell function, immune-mediated organ dysfunction, and social vulnerability were not associated with increased risk of hospitalization after controlling for covariates. Conclusions The associations between race, ethnicity, and obesity with increased risk of hospitalization for SARS-CoV-2 infection indicate the importance of variables linked with social determinants of health as immunologic risk factors for individuals with inborn errors of immunity. Highlights What is already known about this topic? Outcomes of SARS-CoV-2 infections in individuals with inborn errors of immunity (IEI) are highly variable. Prior studies of patients with IEI have not controlled for race or social vulnerability. What does this article add to our knowledge ? For individuals with IEI, hospitalizations for SARS-CoV-2 were associated with race, ethnicity, obesity, and neurologic disease. Specific types of immunodeficiency, organ dysfunction, and social vulnerability were not associated with increased risk of hospitalization. How does this study impact current management guidelines? Current guidelines for the management of IEIs focus on risk conferred by genetic and cellular mechanisms. This study highlights the importance of considering variables linked with social determinants of health and common comorbidities as immunologic risk factors.
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King WM, Jadwin-Cakmak L, Trammell R, Gamarel KE. Structural vulnerability as a conceptual framework for transgender health research: findings from a community needs assessment of transgender women of colour in Detroit. CULTURE, HEALTH & SEXUALITY 2023; 25:681-697. [PMID: 35736653 PMCID: PMC9780405 DOI: 10.1080/13691058.2022.2086709] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/02/2022] [Indexed: 06/02/2023]
Abstract
The concept of structural vulnerability explains how systems of oppression drive health inequities by reducing access to survival resources (e.g. food, housing) for marginalised populations. Indicators of structural vulnerability such as housing instability, violent victimisation and poverty are often interconnected and result from intersectional oppression. We sought to demonstrate the utility of the structural vulnerability framework for transgender health research by examining patterns of structural vulnerability indicators among transgender women of colour in Detroit. We conducted latent class analysis and tested associations between classes and mental health and substance use outcomes. Membership to the Lowest Vulnerability class was negatively associated with post-traumatic stress disorder (PTSD) (aOR = 0.10, 95% CI: 0.02-0.59). High Economic Vulnerability membership was associated with daily marijuana use (aOR = 4.61, 95% CI: 1.31-16.16). Complex Multi-Vulnerability membership was associated with PTSD (aOR = 9.75, 95% CI: 2.55-37.29), anxiety (aOR = 4.12, 95% CI: 1.22-13.97), suicidality (aOR = 6.20, 95% CI: 1.39-27.70), and club drug use (aOR = 4.75, 95% CI: 1.31-17.29). Substantively different findings emerged when testing relationships between each indicator and each outcome, highlighting the value of theoretically grounded quantitative approaches to understanding health inequities. Community-driven interventions and policy changes that reduce structural vulnerability may improve mental health and substance use outcomes among structurally vulnerable trans women of colour.
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Affiliation(s)
- Wesley M King
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Racquelle Trammell
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Trans Sistas of Colour Project, Detroit, MI, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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Stafford E, Dimitrov D, Ceballos R, Campelia G, Matrajt L. Retrospective Analysis of Equity-Based Optimization for COVID-19 Vaccine Allocation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.08.23289679. [PMID: 37214988 PMCID: PMC10197793 DOI: 10.1101/2023.05.08.23289679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Marginalized racial and ethnic groups in the United States were disproportionally affected by the COVID-19 pandemic. To study these disparities, we construct an age-and-race-stratified mathematical model of SARS-CoV-2 transmission fitted to age-and-race-stratified data from 2020 in Oregon and analyze counter-factual vaccination strategies in early 2021. We consider two racial groups: non-Hispanic White persons and persons belonging to BIPOC groups (including non-Hispanic Black persons, non-Hispanic Asian persons, non-Hispanic American Indian or Alaska Native persons, and Hispanic or Latino persons). We allocate a limited amount of vaccine to minimize overall disease burden (deaths or years of life lost), inequity in disease outcomes between racial groups (measured with five different metrics), or both. We find that, when allocating small amounts of vaccine (10% coverage), there is a trade-off between minimizing disease burden and minimizing inequity. Older age groups, who are at a greater risk of severe disease and death, are prioritized when minimizing measures of disease burden, and younger BIPOC groups, who face the most inequities, are prioritized when minimizing measures of inequity. The allocation strategies that minimize combinations of measures can produce middle-ground solutions that similarly improve both disease burden and inequity, but the trade-off can only be mitigated by increasing the vaccine supply. With enough resources to vaccinate 20% of the population the trade-off lessens, and with 30% coverage, we can optimize both equity and mortality. Our goal is to provide a race-conscious framework to quantify and minimize inequity that can be used for future pandemics and other public health interventions.
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Affiliation(s)
- Erin Stafford
- Department of Applied Mathematics, University of Washington, Seattle, WA
| | - Dobromir Dimitrov
- Department of Applied Mathematics, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Rachel Ceballos
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Georgina Campelia
- Department of Bioethics and Humanities, University of Washington, Seattle, WA
| | - Laura Matrajt
- Department of Applied Mathematics, University of Washington, Seattle, WA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
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Pattath P. Social Determinants of Health and Racial/Ethnic Disparities in COVID-19 Mortality at the County Level in the Commonwealth of Virginia. FAMILY & COMMUNITY HEALTH 2023; 46:143-150. [PMID: 36455199 DOI: 10.1097/fch.0000000000000330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Mortality due to coronavirus disease-2019 (COVID-19) among Black and Hispanic populations is disproportionately high compared to white populations. This study aimed to explore the association between COVID-19 mortality and social determinants of health (SDOH) among Black and Hispanic populations in Virginia. METHOD County-level publicly available COVID-19 mortality data from Virginia, covariates, and SDOH indicators were used. An independent t-test and hierarchical multiple regression analysis were performed to assess the association between SDOH and COVID-19 death rates, with a focus on racial/ethnic disparities. RESULTS Counties in the lowest quartile had a mean death rate of 44.72 (SD = 13.8), while those in the highest quartile had a mean death rate of 239.02 (SD = 123.9) per 100, 000 people ( P < .001). Counties with the highest death rates had significantly lower mean socioeconomic status. The regression analysis revealed that 32% of the variance in the COVID-19 mortality rate was associated with SDOH after controlling for the covariates ( P < .01). Identifying as Hispanic ethnicity accounted for 8.5% of the variance, while median household income, being uninsured, and education accounted for 32.7%, 12.9%, and 7.1%, respectively. CONCLUSIONS The findings provide evidence that disparities in SDOH experienced by Hispanic populations play a significant role in increased COVID-19 mortality, thus highlighting the social needs of low-income, low-education, and Hispanic populations to advance equity in health outcomes.
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Wagner KM, Chatham AA, Prado K, Walsdorf AA, Villatoro AP, Garcia D, de Snyder NS, Valdez CR. Emotional wellbeing and coping among Latinx young adults in the time of COVID-19. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1217-1232. [PMID: 36573877 PMCID: PMC9880755 DOI: 10.1002/jcop.22983] [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: 08/26/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has disrupted the wellbeing of the general US population, but even more so among Latinx young adults. The current study provides a detailed picture of the emotional wellbeing and coping of Latinx young adults during the first summer of the pandemic. Six virtual focus groups (n = 21) were conducted between May and August of 2020 with a community-based sample of Latinx young adults to explore (1) how the pandemic affected wellbeing and (2) how they coped with pandemic-related stress. Contextualistic thematic analysis identified important themes and subthemes. Perceived stressors impacting emotional wellbeing yielded one overarching theme: COVID-related disruptions in the participants' environment. To manage this heightened stress, another overarching theme was self-care and intentionality during the pandemic. Future studies should examine the wellbeing of young adults across social contexts and at more recent stages of the pandemic. Findings from this study suggest culturally- and developmentally-tailored interventions are needed as this population navigates contextual stress during a sensitive period in their life.
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Affiliation(s)
- Kevin M. Wagner
- Department of Educational PsychologyThe University of TexasAustinTexasUSA
- Department of Population Health, Dell Medical SchoolThe University of TexasAustinTexasUSA
| | - Ana A. Chatham
- Department of Population Health, Dell Medical SchoolThe University of TexasAustinTexasUSA
- Steve Hicks School of Social WorkThe University of TexasAustinTexasUSA
| | - Kimberly Prado
- Steve Hicks School of Social WorkThe University of TexasAustinTexasUSA
| | - Ashley A. Walsdorf
- Couple and Family TherapyAlliant International UniversitySan DiegoCaliforniaUSA
- The Latino Research InstituteThe University of TexasAustinTexasUSA
| | | | | | - Nelly Salgado de Snyder
- The Latino Research InstituteThe University of TexasAustinTexasUSA
- Instituto Nacional de Salud PúblicaCuernavacaMexico
| | - Carmen R. Valdez
- Department of Population Health, Dell Medical SchoolThe University of TexasAustinTexasUSA
- Steve Hicks School of Social WorkThe University of TexasAustinTexasUSA
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Lukkahatai N, Rodney T, Ling C, Daniel B, Han HR. Long COVID in the context of social determinants of health. Front Public Health 2023; 11:1098443. [PMID: 37056649 PMCID: PMC10088562 DOI: 10.3389/fpubh.2023.1098443] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
The COVID-19 pandemic has been a challenge for the public health system and has highlighted health disparities. COVID-19 vaccines have effectively protected against infection and severe disease, but some patients continue to suffer from symptoms after their condition is resolved. These post-acute sequelae, or long COVID, continues to disproportionately affect some patients based on their social determinants of health (SDOH). This paper uses the World Health Organization's (WHO) SDOH conceptual framework to explore how SDOH influences long COVID outcomes.
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Affiliation(s)
- Nada Lukkahatai
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Nada Lukkahatai
| | - Tamar Rodney
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Catherine Ling
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Brittany Daniel
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Wong MS, Brown AF, Washington DL. Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users. JAMA Netw Open 2023; 6:e231471. [PMID: 36867407 PMCID: PMC9984969 DOI: 10.1001/jamanetworkopen.2023.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/18/2023] [Indexed: 03/04/2023] Open
Abstract
Importance Despite complexities of racial and ethnic residential segregation (hereinafter referred to as segregation) and neighborhood socioeconomic deprivation, public health studies, including those on COVID-19 racial and ethnic disparities, often rely on composite neighborhood indices that do not account for residential segregation. Objective To examine the associations by race and ethnicity among California's Healthy Places Index (HPI), Black and Hispanic segregation, Social Vulnerability Index (SVI), and COVID-19-related hospitalization. Design, Setting, and Participants This cohort study included veterans with positive test results for COVID-19 living in California who used Veterans Health Administration services between March 1, 2020, and October 31, 2021. Main Outcomes and Measures Rates of COVID-19-related hospitalization among veterans with COVID-19. Results The sample available for analysis included 19 495 veterans with COVID-19 (mean [SD] age, 57.21 [17.68] years), of whom 91.0% were men, 27.7% were Hispanic, 16.1% were non-Hispanic Black, and 45.0% were non-Hispanic White. For Black veterans, living in lower-HPI (ie, less healthy) neighborhoods was associated with higher rates of hospitalization (odds ratio [OR], 1.07 [95% CI, 1.03-1.12]), even after accounting for Black segregation (OR, 1.06 [95% CI, 1.02-1.11]). Among Hispanic veterans, living in lower-HPI neighborhoods was not associated with hospitalization with (OR, 1.04 [95% CI, 0.99-1.09]) and without (OR, 1.03 [95% CI, 1.00-1.08]) Hispanic segregation adjustment. For non-Hispanic White veterans, lower HPI was associated with more frequent hospitalization (OR, 1.03 [95% CI, 1.00-1.06]). The HPI was no longer associated with hospitalization after accounting for Black (OR, 1.02 [95% CI, 0.99-1.05]) or Hispanic (OR, 0.98 [95% CI, 0.95-1.02]) segregation. Hospitalization was higher for White (OR, 4.42 [95% CI, 1.62-12.08]) and Hispanic (OR, 2.90 [95% CI, 1.02-8.23]) veterans living in neighborhoods with greater Black segregation and for White veterans in more Hispanic-segregated neighborhoods (OR, 2.81 [95% CI, 1.96-4.03]), adjusting for HPI. Living in higher SVI (ie, more vulnerable) neighborhoods was associated with greater hospitalization for Black (OR, 1.06 [95% CI, 1.02-1.10]) and non-Hispanic White (OR, 1.04 [95% CI, 1.01-1.06]) veterans. Conclusions and Relevance In this cohort study of US veterans with COVID-19, HPI captured neighborhood-level risk for COVID-19-related hospitalization for Black, Hispanic, and White veterans comparably with SVI. These findings have implications for the use of HPI and other composite neighborhood deprivation indices that do not explicitly account for segregation. Understanding associations between place and health requires ensuring composite measures accurately account for multiple aspects of neighborhood deprivation and, importantly, variation by race and ethnicity.
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Affiliation(s)
- Michelle S. Wong
- Veterans Affairs (VA) Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
- Olive View–UCLA Medical Center, Sylmar, California
| | - Donna L. Washington
- Veterans Affairs (VA) Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
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De Cos O, Castillo V, Cantarero D. The Role of Functional Urban Areas in the Spread of COVID-19 Omicron (Northern Spain). J Urban Health 2023; 100:314-326. [PMID: 36829090 PMCID: PMC9955519 DOI: 10.1007/s11524-023-00720-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/26/2023]
Abstract
This study focuses on the space-time patterns of the COVID-19 Omicron wave at a regional scale, using municipal data. We analyze the Basque Country and Cantabria, two adjacent regions in the north of Spain, which between them numbered 491,816 confirmed cases in their 358 municipalities from 15th November 2021 to 31st March 2022. The study seeks to determine the role of functional urban areas (FUAs) in the spread of the Omicron variant of the virus, using ESRI Technology (ArcGIS Pro) and applying intelligence location methods such as 3D-bins and emerging hot spots. Those methods help identify trends and types of problem area, such as hot spots, at municipal level. The results demonstrate that FUAs do not contain an over-concentration of COVID-19 cases, as their location coefficient is under 1.0 in relation to population. Nevertheless, FUAs do have an important role as drivers of spread in the upward curve of the Omicron wave. Significant hot spot patterns are found in 85.0% of FUA area, where 98.9% of FUA cases occur. The distribution of cases shows a spatially stationary linear correlation linked to demographically progressive areas (densely populated, young profile, and with more children per woman) which are well connected by highways and railroads. Based on this research, the proposed GIS methodology can be adapted to other case studies. Considering geo-prevention and WHO Health in All Policies approaches, the research findings reveal spatial patterns that can help policymakers in tackling the pandemic in future waves as society learns to live with the virus.
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Affiliation(s)
- Olga De Cos
- Department of Geography, Urban and Regional Planning, Universidad de Cantabria, 39005 Santander, Spain
- Research Group on Health Economics and Health Services Management – Valdecilla Biomedical Research Institute (IDIVAL), 39011 Santander, Spain
| | - Valentín Castillo
- Department of Geography, Urban and Regional Planning, Universidad de Cantabria, 39005 Santander, Spain
- Research Group on Health Economics and Health Services Management – Valdecilla Biomedical Research Institute (IDIVAL), 39011 Santander, Spain
| | - David Cantarero
- Research Group on Health Economics and Health Services Management – Valdecilla Biomedical Research Institute (IDIVAL), 39011 Santander, Spain
- Department of Economics, Universidad de Cantabria, 39005 Santander, Spain
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Lindenfeld Z, Pagán JA, Chang JE. Utilizing Publicly Available Community Data to Address Social Determinants of Health: A Compendium of Data Sources. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231152318. [PMID: 36803137 PMCID: PMC9940168 DOI: 10.1177/00469580231152318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
To compile a compendium of data sources representing different areas of social determinants of health (SDOH) in New York City. We conducted a PubMed search of the peer-reviewed and gray literature using the terms "social determinants of health" and "New York City," with the Boolean operator "AND." We then conducted a search of the "gray literature," defined as sources outside of standard bibliographic databases, using similar terms. We extracted publicly available data sources containing NYC-based data. In defining SDOH, we used the framework outlined by the CDC's Healthy People 2030, which uses a place-based framework to categorize 5 domains of SDOH: (1) healthcare access and quality; (2) education access and quality; (3) social and community context; (4) economic stability; and (5) neighborhood and built environment. We identified 29 datasets from the PubMed search, and 34 datasets from the gray literature, resulting in 63 datasets related to SDOH in NYC. Of these, 20 were available at the zip code level, 18 at the census tract-level, 12 at the community-district level, and 13 at the census block or specific address level. Community-level SDOH data are readily attainable from many public sources and can be linked with health data on local geographic-levels to assess the effect of social and community factors on individual health outcomes.
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Affiliation(s)
- Zoe Lindenfeld
- New York University School of Global Public Health, New York, NY, USA,Zoe Lindenfeld, Department of Public Health Policy and Management, School of Global Public Health, New York University, 726 Broadway, New York, NY10012, USA.
| | - José A. Pagán
- New York University School of Global Public Health, New York, NY, USA
| | - Ji Eun Chang
- New York University School of Global Public Health, New York, NY, USA
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Sun Y, Bisesti EM. Political Economy of the COVID-19 Pandemic: How State Policies Shape County-Level Disparities in COVID-19 Deaths. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2023; 9:23780231221149902. [PMID: 36777497 PMCID: PMC9902801 DOI: 10.1177/23780231221149902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors examine how two state-level coronavirus disease 2019 (COVID-19) policy indices (one capturing economic support and one capturing stringency measures such as stay-at-home orders) were associated with county-level COVID-19 mortality from April through December 2020 and whether the policies were more beneficial for certain counties. Using multilevel negative binominal regression models, the authors found that high scores on both policy indices were associated with lower county-level COVID-19 mortality. However, the policies appeared to be most beneficial for counties with fewer physicians and larger shares of older adults, low-educated residents, and Trump voters. They appeared to be less effective in counties with larger shares of non-Hispanic Black and Hispanic residents. These findings underscore the importance of examining how state and local factors jointly shape COVID-19 mortality and indicate that the unequal benefits of pandemic policies may have contributed to county-level disparities in COVID-19 mortality.
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Affiliation(s)
- Yue Sun
- Syracuse University, Syracuse, NY, USA,Yue Sun, Syracuse University, Maxwell School of Citizenship and Public Affairs, Sociology Department, 314 Lyman Hall, Syracuse, NY 13244, USA.
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Lucchini M, Bekelman TA, Li M, Knapp EA, Dong Y, Ballard S, Deoni S, Dunlop AL, Elliott AJ, Ferrara A, Friedman C, Galarce M, Gilbert-Diamond D, Glueck D, Hedderson M, Hockett CW, Karagas MR, LeBourgeois MK, Margolis A, McDonald J, Ngai P, Pellerite M, Sauder K, Ma T, Dabelea D. Impact of the COVID-19 pandemic on children's sleep habits: an ECHO study. Pediatr Res 2023; 93:586-594. [PMID: 36195633 PMCID: PMC9531212 DOI: 10.1038/s41390-022-02309-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/04/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sleep in childhood is affected by behavioral, environmental, and parental factors. We propose that these factors were altered during the COVID-19 pandemic. This study investigates sleep habit changes during the pandemic in 528 children 4-12 years old in the US, leveraging data from the Environmental Influences on Child Health Outcomes (ECHO) Program. METHODS Data collection occurred in July 2019-March 2020 (pre-pandemic) and two pandemic periods: December 2020-April 2021 and May-August 2021. Qualitative interviews were performed in 38 participants. RESULTS We found no changes in sleep duration, but a shift to later sleep midpoint during the pandemic periods. There was an increase in latency at the first pandemic collection period but no increase in the frequency of bedtime resistance, and a reduced frequency of naps during the pandemic. Qualitative interviews revealed that parents prioritized routines to maintain sleep duration but were more flexible regarding timing. Children from racial/ethnic minoritized communities slept less at night, had later sleep midpoint, and napped more frequently across all collection periods, warranting in-depth investigation to examine and address root causes. CONCLUSIONS The COVID-19 pandemic significantly impacted children sleep, but parental knowledge of the importance of sleep might have played a significant protective role. IMPACT During the COVID-19 pandemic, US children changed their sleep habits, going to bed and waking up later, but their sleep duration did not change. Sleep latency was longer. Parental knowledge of sleep importance might have played a protective role. Regardless of data collection periods, children from racial/ethnic minoritized communities slept less and went to bed later. This is one of the first study on this topic in the US, including prospective pre-pandemic qualitative and quantitative data on sleep habits. Our findings highlight the pandemic long-term impact on childhood sleep. Results warrants further investigations on implications for overall childhood health.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
| | - Traci A Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mingyi Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yanan Dong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Suyin Ballard
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sean Deoni
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Amy J Elliott
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Assiamira Ferrara
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Chloe Friedman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Maren Galarce
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Deborah Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Monique Hedderson
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Christine W Hockett
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Margaret R Karagas
- Department of Epidemiology, Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Monique K LeBourgeois
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Amy Margolis
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia McDonald
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Pakkay Ngai
- Division of Pediatric Pulmonology, Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | | | - Katherine Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tengfei Ma
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Mehta JM, Chakrabarti C, De Leon J, Homan P, Skipton T, Sparkman R. Assessing the role of collectivism and individualism on COVID-19 beliefs and behaviors in the Southeastern United States. PLoS One 2023; 18:e0278929. [PMID: 36662888 PMCID: PMC9858878 DOI: 10.1371/journal.pone.0278929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/23/2022] [Indexed: 01/21/2023] Open
Abstract
America's unique response to the global COVID-19 pandemic has been both criticized and applauded across political and social spectrums. Compared to other developed nations, U.S. incidence and mortality rates were exceptionally high, due in part to inconsistent policies across local, state, and federal agencies regarding preventive behaviors like mask wearing and social distancing. Furthermore, vaccine hesitancy and conspiracy theories around COVID-19 and vaccine safety have proliferated widely, making herd immunity that much more challenging. What factors of the U.S. culture have contributed to the significant impact of the pandemic? Why have we not responded better to the challenges of COVID-19? Or would many people in the U.S. claim that we have responded perfectly well? To explore these questions, we conducted a qualitative and quantitative study of Florida State University faculty, staff, and students. This study measured their perceptions of the pandemic, their behaviors tied to safety and community, and how these practices were tied to beliefs of individualism and collectivism. We found that collectivist orientations were associated with a greater likelihood of wearing masks consistently, severe interruptions of one's social life caused by the pandemic, greater concern for infecting others, and higher levels of trust in medical professionals for behavioral guidelines surrounding the pandemic. These associations largely persist even after adjusting for political affiliation, which we find is also a strong predictor of COVID-19 beliefs and behaviors.
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Affiliation(s)
- Jayur Madhusudan Mehta
- Department of Anthropology, Florida State University, Tallahassee, Florida, United States of America
| | - Choeeta Chakrabarti
- Department of Anthropology, Florida State University, Tallahassee, Florida, United States of America
| | - Jessica De Leon
- Department of Family Medicine and Rural Health, Florida State University College of Medicine, Tallahassee, Florida, United States of America
| | - Patricia Homan
- Public Health Program, Department of Sociology, Florida State University, Tallahassee, Florida, United States of America
| | - Tara Skipton
- Department of Anthropology, University of Texas, Austin, Austin, Texas, United States of America
| | - Rachel Sparkman
- Public Health Program, Department of Sociology, Florida State University, Tallahassee, Florida, United States of America
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Jackson JE, Rajasekar G, Vukcevich O, Coakley BA, Nuño M, Saadai P. Association Between Race, Gender, and Pediatric Postoperative Outcomes: An Updated Retrospective Review. J Surg Res 2023; 281:112-121. [PMID: 36155268 DOI: 10.1016/j.jss.2022.08.027] [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: 11/18/2021] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION There has not been a recent evaluation of the association between racial and gender and surgical outcomes in children. We aimed to evaluate improvements in race- and gender-related pediatric postoperative outcomes since a report utilizing the Kids' Inpatient Database data from 2003 to 2006. METHODS Using Kids' Inpatient Database (2009, 2012, 2016), we identified 245,976 pediatric patients who underwent appendectomy for acute appendicitis (93.6%), pyloromyotomy for pyloric stenosis (2.7%), empyema decortication (1.6%), congenital diaphragmatic hernia repair (0.7%), small bowel resection for intussusception (0.5%), or colonic resection for Hirschsprung disease (0.2%). The primary outcome was the development of postoperative complications. Multivariable logistic regression was used to evaluate risk-adjusted associations among race, gender, income, and postoperative complications. RESULTS Most patients were male (61.5%) and 45.7% were White. Postoperative complications were significantly associated with male gender (P < 0.0001) and race (P < 0.0001). After adjustment, Black patients were more likely to experience any complication than White patients (adjusted odds ratio 1.3, confidence interval 1.2-1.4), and males were more likely than females (adjusted odds ratio 1.3, confidence interval 1.2-1.4). CONCLUSIONS No clear progress has been made in eliminating race- or gender-based disparities in pediatric postoperative outcomes. New strategies are needed to better understand and address these disparities.
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Affiliation(s)
- Jordan E Jackson
- Department of Pediatric Surgery, University of California, Davis Medical Center, Sacramento, California
| | - Ganesh Rajasekar
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, California
| | - Olivia Vukcevich
- Department of Pediatric Surgery, University of California, Davis Medical Center, Sacramento, California
| | - Brian A Coakley
- Division of Pediatric Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Miriam Nuño
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, California
| | - Payam Saadai
- Department of Pediatric Surgery, University of California, Davis Medical Center, Sacramento, California.
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Azan A, Stephens J, Xie X, Fiori K, Gover M. COVID-19 and Changes in Reported Social Risk Factors at a Primary Care Practice in the South Bronx. J Prim Care Community Health 2023; 14:21501319221147136. [PMID: 36625253 PMCID: PMC9834620 DOI: 10.1177/21501319221147136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Historically, Black and Hispanic patient populations in the Bronx Borough of New York City have experienced the highest rates of social risk factors, and associated poor health outcomes, in New York State. During the pandemic, Bronx communities disproportionately experienced high rates of COVID-19 illness and death. To date, little is known regarding the COVID-19 pandemic's impact on social risk factors in urban, at-risk communities. This study aimed to determine how social risk factors changed during the pandemic in a Bronx-based patient population. METHODS Study participants were adult patients seen at a Federally Qualified Health Center in the South Bronx. Using a paired longitudinal study design, 300 participants were randomly selected for telephonic outreach during the pandemic from a sample of 865 participants who had been offered a social risk factor screener in the year prior to the pandemic. The outreach survey used included the social risk factor screener and questions regarding COVID-19 illness burden and prior engagement in social services. The McNemar test was used to analyze trends in reported social risks. RESULTS Housing quality needs, food insecurity, and legal care needs significantly increased during the pandemic. Participants who reported COVID-19 illness burden were 1.47 times more likely to report a social risk factor (P = .02). No significant relationship was found between prior enrollment in clinic-based social services and degree of reported social risk (P = .06). CONCLUSION Housing quality needs, food insecurity, and legal care needs increased during the COVID-19 pandemic in a predominantly Black and Hispanic identifying urban patient population. Urgently addressing this increase is imperative to achieving health equity in ongoing COVID-19 mitigation efforts.
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Affiliation(s)
- Alexander Azan
- Montefiore Medical Center, NY,
USA
- NYU Langone Health, New York, NY,
USA
| | | | - Xianhong Xie
- Albert Einstein College of Medicine,
Bronx, NY, USA
| | - Kevin Fiori
- Montefiore Medical Center, NY,
USA
- Albert Einstein College of Medicine,
Bronx, NY, USA
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