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Rahmani A, Najand B, Maharlouei N, Zare H, Assari S. COVID-19 Pandemic as an Equalizer of the Health Returns of Educational Attainment for Black and White Americans. J Racial Ethn Health Disparities 2024; 11:1223-1237. [PMID: 37490210 PMCID: PMC11101502 DOI: 10.1007/s40615-023-01601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND COVID-19 pandemic has immensely impacted the social and personal lives of individuals around the globe. Marginalized-related diminished returns (MDRs) theory suggests that educational attainment shows a weaker protective effect for health and behavioral outcomes for Black individuals compared to White individuals. Previous studies conducted before the COVID-19 pandemic demonstrated diminished returns of educational attainment for Black individuals compared to White individuals. OBJECTIVES The study has three objectives: First, to test the association between educational attainment and cigarette smoking, e-cigarette vaping, presence of chronic medical conditions (CMC), self-rated health (SRH), depressive symptoms, and obesity; second, to explore racial differences in these associations in the USA during the COVID-19 pandemic; and third, to compare the interaction of race and return of educational attainment pre- and post-COVID-19 pandemic. METHODS This study utilized data from the Health Information National Trends Survey (HINTS) 2020. Total sample included 1313 adult American; among them, 77.4% (n = 1017) were non-Hispanic White, and 22.6% (n = 296) were non-Hispanic Black. Educational attainment was the independent variable operationalized as years of education. The main outcomes were cigarette smoking, e-cigarette vaping, CMC, SRH, depressive symptoms, and obesity. Age, gender, and baseline physical health were covariates. Race/ethnicity was an effect modifier. RESULTS Educational attainment was significantly associated with lower CMC, SRH, depressive symptoms, obesity, cigarette smoking, and e-cigarette vaping. Educational attainment did not show a significant interaction with race on any of our outcomes, suggesting that the health returns of education is similar between non-Hispanic White and non-Hispanic Black individuals. CONCLUSION COVID-19 may have operated as an equalizer of the returns of educational attainment. This observation may be because White may have more to lose; Black communities may be more resilient or have economic and social policies that buffered unemployment and poverty regardless of historical anti-Black oppression.
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Affiliation(s)
- Arash Rahmani
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Babak Najand
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Najmeh Maharlouei
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, 20783, USA
| | - Shervin Assari
- Marginalized-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA.
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, 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 DOI: 10.1001/jamanetworkopen.2024.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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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Siegel M, Nicholson-Robinson V. Association Between Changes in Racial Residential and School Segregation and Trends in Racial Health Disparities, 2000-2020: A Life Course Perspective. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01960-y. [PMID: 38421509 DOI: 10.1007/s40615-024-01960-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Most studies of the relationship between racial segregation and racial health disparities have focused on residential segregation. School-based racial segregation is an additional form of segregation that may be associated with racial disparities in health. This study examines the relationship between both residential segregation and school segregation and racial health disparities among non-Hispanic Black compared to non-Hispanic White persons at the county level in the United States. It also examines the relationship between changes in residential and school segregation and subsequent trajectories in a variety of racial health disparities across the life course. METHODS Using the CDC WONDER Multiple Case of Death database, we derived an annual estimate of race-specific death rates and rate ratios for each county during the period 2000-2020. We then examined the relationship between baseline levels of residential and school segregation in 1991 as well as changes between 1991-2000 and the trajectories of the observed racial health disparities between 2000 and 2020. We used latent trajectory analysis to identify counties with similar patterns of residential and school segregation over time and to identify counties with similar trajectories in each racial health disparity. Outcomes included life expectancy, early mortality (prior to age 65), infant mortality, firearm homicide, total homicide, and teenage pregnancy rates. RESULTS During the period 1991-2020, racial residential segregation remained essentially unchanged among the 1051 counties in our sample; however, racial school segregation increased during this period. Increases in school segregation from 1991 to 2000 were associated with higher racial disparities in each of the health outcomes during the period 2000-2020 and with less progress in reducing these disparities. CONCLUSION This paper provides new evidence that school segregation is an independent predictor of racial health disparities and that reducing school segregation-even in the face of high residential segregation-could have a long-term impact on reducing racial health disparities. Furthermore, it suggests that the health consequences of residential segregation have not been eliminated from our society but are now being exacerbated by a new factor: school-based segregation. Throughout this paper, changes in school-based segregation not only show up as a consistent significant predictor of greater racial disparities throughout the life course, but at times, an even stronger predictor of health inequity than residential segregation.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Vanessa Nicholson-Robinson
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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Donnelly R, Remani B, Erving CL. Dual pandemics? Assessing associations between area racism, COVID-19 case rates, and mental health among U.S. adults. SSM Ment Health 2023; 4:100248. [PMID: 38125912 PMCID: PMC10732532 DOI: 10.1016/j.ssmmh.2023.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Mental health worsened during the COVID-19 pandemic, especially among racially minoritized adults. Population-level racial attitudes, or area racism, may be associated with mental health, particularly during this historical moment, but this possibility has not been tested in prior research. In the present study, we use nationally representative data from the Household Pulse Survey (April-October 2020) to document associations between area racism and depression/anxiety in the United States among non-Hispanic Black, non-Hispanic Asian, Hispanic, non-Hispanic White, and other racial/ethnic minority adults. We further consider the national COVID-19 case rate to examine an additional macro-level stressor. Findings indicate that area racism was positively associated with depression and/or anxiety for Black, Hispanic, White, and other racial/ethnic minority adults. Moreover, COVID-19 cases posed an additional, independent mental health threat for most groups. This study points to area racism as a macro-level stressor and an antecedent of mental health for racially diverse groups of Americans.
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Siegel M, Rieders M, Rieders H, Moumneh J, Asfour J, Oh J, Oh S. Measuring Structural Racism and Its Association with Racial Disparities in Firearm Homicide. J Racial Ethn Health Disparities 2023; 10:3115-3130. [PMID: 36508134 PMCID: PMC9744051 DOI: 10.1007/s40615-022-01485-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Structural racism is strongly related to racial health disparities. However, surprisingly few studies have developed empirical tools to measure structural racism. In addition, the few measures that have been employed have only considered structural racism at the neighborhood level. To expand upon previous studies, this paper uses a novel measure to measure structural racism at the county level for the non-Hispanic Black population. METHODS We used confirmatory factor analysis to create a model to measure the latent construct of structural racism for 1181 US counties. The model included five indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status/wealth. Structural equation modeling and factor analysis were used to generate factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each county. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. RESULTS Our calculations revealed striking geographic differences across counties in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Structural racism was significantly associated with higher Black firearm homicide rates, lower White homicide rates, and a higher Black-White racial disparity in firearm homicide. CONCLUSIONS These new measures can be utilized by researchers to relate structural racism to racial health disparities at the county level.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinan Moumneh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Julia Asfour
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinseo Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Seungjin Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
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Siegel M, Rieders M, Rieders H, Dergham L, Iyer R. Association Between Changes in Racial Residential Segregation and Trends in Racial Disparities in Early Mortality in 220 Metropolitan Areas, 2001-2018. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01830-z. [PMID: 37855998 DOI: 10.1007/s40615-023-01830-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Racial residential segregation has been shown to affect the absolute levels of racial disparities in a wide variety of health outcomes in the USA but it is not known whether changes in segregation also influence these racial health disparities. This study examines the relationship between changes in racial residential segregation over four decades (1980-2020) and trends in racial disparities in early mortality (under age 65) rates among non-Hispanic Black and non-Hispanic White persons across a wide range of health outcomes in 220 metropolitan statistical areas (MSAs) during the period 2001-2018. METHODS Using the CDC WONDER Underlying Cause of Death database, we derived annual estimates of race-specific death rates and rate ratios for each MSA. We used latent trajectory analysis to examine the relationship between the level of segregation and changes in segregation over time in an MSA and trends in death rate disparities in that MSA. RESULTS The trajectory analysis resulted in a linear, three group model in which trajectory Groups 1 and 2 had decreasing trends in the ratios of Black to White death rates over time while in Group 3, the disparity remained almost constant over time. Increases in the level of segregation in an MSA from 1980 to 2000 were significantly associated with the likelihood that the MSA was in Group 3 and experienced no improvement in racial health disparities in mortality over time. CONCLUSION This paper provides new evidence that changes in segregation are related to trends in racial health disparities in mortality rates over time.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Leighla Dergham
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Rohan Iyer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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Obasanya M, Igenoza O, Gupta S, McElroy K, Brannon GE, Brown K. Racial and Ethnic Differences in Maternal and Child COVID-19 Vaccination Intent Among Pregnant and Postpartum Women in the USA (April-June 2020): an Application of Health Belief Model. J Racial Ethn Health Disparities 2023; 10:2540-2551. [PMID: 36352345 PMCID: PMC9645740 DOI: 10.1007/s40615-022-01434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/17/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022]
Abstract
This study investigated racial/ethnic differences in pregnant and postpartum women's intentions to receive the COVID-19 vaccination (maternal COVID-19 vaccination intent) and intentions to vaccinate their children against COVID-19 (child COVID-19 vaccination intent) during the early months of the COVID-19 pandemic (April-June 2020). This study also assessed Health Belief Model constructs to examine their influence on maternal and child COVID-19 vaccination intent by race/ethnicity. This study includes 489 US pregnant and postpartum women (18-49 years) recruited via Prolific Academic to complete a 55-item cross-sectional online survey. Crude and adjusted logistic regression analyses were conducted to determine the associations between race/ethnicity, maternal COVID-19 vaccination intent, and child COVID-19 vaccination intent. Among pregnant women, the odds of maternal COVID-19 vaccination intent (aOR = 2.20, 95% CI: .862, 5.61) and child COVID-19 vaccination intent (aOR = .194, 95% CI: .066, .565) among NH Black women were statistically significantly lower than that of NH White women after adjustment for demographic, health, and health belief model variables. Among postpartum women, although some racial differences in maternal or child COVID-19 vaccination intent were observed, these differences were not statistically significant in unadjusted and adjusted models. The findings have implications for future research and interventions which should adopt a racial health equity lens and identify strategies grounded in institutional trustworthiness and systems perspectives to address racial/ethnic disparities in COVID-19 vaccination intent among pregnant and postpartum women during novel pandemics.
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Affiliation(s)
- Mercy Obasanya
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA
| | | | | | - Kristin McElroy
- Maternal and Child Health Epidemiologist, Division of Epidemiology and Health Information, Tarrant County Public Health, 1101 S. Main Street, Fort Worth, TX, 76104, USA
| | - Grace E Brannon
- Department of Communication, College of Liberal Arts, University of Texas at Arlington, 700 W. Greek Row Drive, Arlington, TX, 76019, USA
| | - Kyrah Brown
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA.
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Campbell J, Kaur A, Gamino D, Benoit E, Amos B, Windsor L. Individual and structural determinants of COVID-19 vaccine uptake in a marginalized community in the United States. Vaccine 2023; 41:5706-5714. [PMID: 37550145 PMCID: PMC10560547 DOI: 10.1016/j.vaccine.2023.07.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
Socially and medically vulnerable groups (e.g., people 65 years or older, minoritized racial groups, non-telework essential workers, and people with comorbid conditions) experience barriers to COVID-19 prevention and treatment, increased burden of disease, and increased risk of death from COVID-19. Researchers are paying increased attention to social determinants of health (SDH) in explaining inequities in COVID-19-related health outcomes and rates of vaccine uptake. The purpose of the present manuscript is to identify clinically significant predictors of COVID-19 vaccine uptake among people who were socially and medically vulnerable to SARs-CoV-2 infection. Analysis was informed by the SDH framework and included a sample of 641 baseline surveys from participants in a clinical trial designed to increase COVID-19 testing. All participants were at high risk of developing COVID-19-related complications or dying from COVID-19. Following community-based participatory research principles, a well-established community collaborative board conducted every aspect of the study. Multiple logistic regressions were conducted to examine the relationships between individual and structural factors and COVID-19 vaccine uptake. In the final time adjusted model, we found that vaccine uptake was only predicted by specific individual-level factors: being 65 years and older, living with HIV/AIDS, and having previously received a flu vaccine or a COVID-19 test. Those reporting to believe in COVID-19-conspiracy theories were less likely to get the COVID-19 vaccine. More research is needed to identify predictors of vaccine uptake among people with comorbidities that make them more vulnerable to COVID-19 complications or death.
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Affiliation(s)
- Jeanna Campbell
- School of Social Work, University of Illinois Urbana-Champaign, 1010 W Nevada St, Urbana, IL 61801, United States.
| | - Amandeep Kaur
- Interdisciplinary Health Sciences Institute, University of Illinois Urbana-Champaign, 901 W University Ave Ste 201 C-261, Urbana, IL 61801, United States
| | - Danilo Gamino
- North Jersey Community Research Initiative, 393 Central Ave, Newark, NJ 07103, United States
| | - Ellen Benoit
- North Jersey Community Research Initiative, 393 Central Ave, Newark, NJ 07103, United States
| | - Brianna Amos
- Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, United States
| | - Liliane Windsor
- School of Social Work, University of Illinois Urbana-Champaign, 1010 W Nevada St, Urbana, IL 61801, United States; North Jersey Community Research Initiative, 393 Central Ave, Newark, NJ 07103, United States
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D'Inverno AS, Myles RL, Jamison CR, Williams SP, Hagan LM, Handanagic S, Lambert LA, Clarke KEN, Allen J, Beard O, Dusseau C, Feldman R, Huebsch R, Hutchinson J, Kall D, King-Mohr J, Long M, McClure ES, Meddaugh P, Pontones P, Rose J, Sredl M, VonBank B, Zipprich J. Racial, Ethnic, Sex, and Age Differences in COVID-19 Cases, Hospitalizations, and Deaths Among Incarcerated People and Staff in Correctional Facilities in Six Jurisdictions, United States, March-July 2020. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01746-8. [PMID: 37610647 PMCID: PMC10902790 DOI: 10.1007/s40615-023-01746-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To examine disparities by sex, age group, and race and ethnicity in COVID-19 confirmed cases, hospitalizations, and deaths among incarcerated people and staff in correctional facilities. METHODS Six U.S. jurisdictions reported data on COVID-19 confirmed cases, hospitalizations, and deaths stratified by sex, age group, and race and ethnicity for incarcerated people and staff in correctional facilities during March 1- July 31, 2020. We calculated incidence rates and rate ratios (RR) and absolute rate differences (RD) by sex, age group, and race and ethnicity, and made comparisons to the U.S. general population. RESULTS Compared with the U.S. general population, incarcerated people and staff had higher COVID-19 case incidence (RR = 14.1, 95% CI = 13.9-14.3; RD = 6,692.2, CI = 6,598.8-6,785.5; RR = 6.0, CI = 5.7-6.3; RD = 2523.0, CI = 2368.1-2677.9, respectively); incarcerated people also had higher rates of COVID-19-related deaths (RR = 1.6, CI = 1.4-1.9; RD = 23.6, CI = 14.9-32.2). Rates of COVID-19 cases, hospitalizations, and deaths among incarcerated people and corrections staff differed by sex, age group, and race and ethnicity. The COVID-19 hospitalization (RR = 0.9, CI = 0.8-1.0; RD = -48.0, CI = -79.1- -16.8) and death rates (RR = 0.8, CI = 0.6-1.0; RD = -11.8, CI = -23.5- -0.1) for Black incarcerated people were lower than those for Black people in the general population. COVID-19 case incidence, hospitalizations, and deaths were higher among older incarcerated people, but not among staff. CONCLUSIONS With a few exceptions, living or working in a correctional setting was associated with higher risk of COVID-19 infection and resulted in worse health outcomes compared with the general population; however, Black incarcerated people fared better than their U.S. general population counterparts.
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Affiliation(s)
- Ashley S D'Inverno
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Ranell L Myles
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Office of the Director, Centers for Disease Control and Prevention, National Center For HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Calla R Jamison
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samantha P Williams
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, National Center For HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Liesl M Hagan
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center For HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Senad Handanagic
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center For HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Lauren A Lambert
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, National Center For HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Kristie E N Clarke
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Office of the Director, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Olivia Beard
- Indiana Department of Corrections, Indianapolis, IN, USA
| | | | | | | | | | - Denise Kall
- Vermont Department of Health, Burlington, Vermont, USA
| | | | | | | | - Paul Meddaugh
- Vermont Department of Health, Burlington, Vermont, USA
| | - Pam Pontones
- Indiana State Department of Health, Indianapolis, IN, USA
| | | | - Megan Sredl
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
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Blake MJ, Marka NA, Steer CJ, Ravdin JI. Cause of Death by Race and Ethnicity in Minnesota Before and During the COVID-19 Pandemic, 2019-2020. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01709-z. [PMID: 37548856 DOI: 10.1007/s40615-023-01709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To measure changes in cause of death dynamics in 2019 and 2020 and the relationship between the concurrent occurrence of the COVID-19 pandemic and mortality outcome by race and ethnicity. PATIENTS AND METHODS We used resident mortality data from the Minnesota Department of Health (MDH) to conduct a retrospective statistical analysis of deaths in Minnesota in 2019 relative to 2020 to assess changes in mortality in a pre-pandemic and pandemic period. RESULTS COVID-19 strongly contributed to ethnicity-related mortality disparities in Minnesota. Not only was there a greater proportion of COVID-19 decedents within Black and Hispanic populations, but their average decedent age was markedly lower relative to the White population. The Black population experienced a disproportionate increase in decedents with a 34% increase during 2020 compared to 2019. CONCLUSIONS This retrospective analysis of death dynamics and mortality outcomes in Minnesota from 2019 to 2020 demonstrated an increase in adverse mortality outcomes relative to the pre-pandemic period that disproportionately impacted Black and Hispanic minority populations.
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Affiliation(s)
- Madelyn J Blake
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, 55347, USA.
| | - Nicholas A Marka
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Clifford J Steer
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan I Ravdin
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
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11
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Siegel M, Rieders M, Rieders H, Moumneh J, Asfour J, Oh J, Oh S. Structural racism and racial health disparities at the state level: A latent variable approach. J Natl Med Assoc 2023; 115:338-352. [PMID: 37500328 DOI: 10.1016/j.jnma.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Introduction Structural racism is increasingly being recognized as a fundamental cause of racial health disparities. We used a novel measure of structural racism at the state level to examine the relationship between structural racism and disparities in death rates from firearm homicide, infant mortality, HIV, diabetes, stroke, hypertension, asthma, and kidney disease between non-Hispanic Black and non-Hispanic White people in the United States. Methods We used confirmatory factor analysis to measure the latent construct of structural racism for all 50 states. The model included seven indicators across the structural racism domains of residential segregation, economic status/employment, education, incarceration, political participation and representation, environmental racism, and racial equity inclusion. Weights for each of the indicators were determined by examining alternative models and selecting the model with the best fit statistics. The resulting factor scores, representing the level of structural racism in each state across the seven domains, were then used as predictor variables in a series of linear regressions with the ratio of Black to White death rates for each health outcome as the dependent variables. Results We found significant relationships between higher levels of the latent structural racism measure and greater disparities between non-Hispanic Black and non-Hispanic White people in age-adjusted death rates for firearm homicide, infant mortality, HIV, asthma, and obesity. The magnitude of this relationship was greatest for firearm homicide, with each one standard deviation increase in a state's structural racism factor score being associated with an increase of 4.54 (95% CI, 2.91-6.17) in that state's Black-White firearm homicide rate ratio. Conclusions This research provides further evidence that structural racism is a fundamental cause of racial health disparities and that to repair these inequities, macro-level changes in societal structures, institutions, resource allocation, representation, and power will be necessary.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Jinan Moumneh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Julia Asfour
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Jinseo Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
| | - Seungjin Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA 02111, USA
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12
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Siegel M, Rieders M, Rieders H, Moumneh J, Asfour J, Oh J, Oh S. Using a Latent Variable Method to Develop a Composite, Multidimensional Measure of Structural Racism at the City Level. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01695-2. [PMID: 37382871 DOI: 10.1007/s40615-023-01695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Although structural racism is strongly related to racial health disparities, we are not aware of any composite, multidimensional measure of structural racism at the city level in the United States. However, many of the policies, programs, and institutions that create and maintain structural racism are located at the city level. To expand upon previous research, this paper uses a novel measure to measure structural racism at the city level for the non-Hispanic Black population. METHODS We used confirmatory factor analysis to model the latent construct of structural racism for 776 U.S. cities. The model included six indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status. We generated factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each city. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. RESULTS There were profound differences in the magnitude of structural racism across cities. There were also striking differences in the magnitude of the racial disparity in firearm homicide across cities. Structural racism was a significant predictor of the magnitude of these racial disparities in firearm homicide. Each one standard deviation increase in the structural racism factor score increased the firearm homicide rate ratio by a factor of approximately 1.2 (95% confidence interval, 1.1-1.3). CONCLUSIONS These new measures can be utilized by researchers to relate structural racism to racial health disparities at the city level.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinan Moumneh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Julia Asfour
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinseo Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Seungjin Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
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Lundberg DJ, Wrigley-Field E, Cho A, Raquib R, Nsoesie EO, Paglino E, Chen R, Kiang MV, Riley AR, Chen YH, Charpignon ML, Hempstead K, Preston SH, Elo IT, Glymour MM, Stokes AC. COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022. JAMA Netw Open 2023; 6:e2311098. [PMID: 37129894 PMCID: PMC10155069 DOI: 10.1001/jamanetworkopen.2023.11098] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
Importance Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. Objective To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography. Design, Setting, and Participants This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Exposures Metropolitan vs nonmetropolitan areas and race and ethnicity. Main Outcomes and Measures Age-standardized death rates. Results There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. Conclusions and Relevance This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.
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Affiliation(s)
- Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Elizabeth Wrigley-Field
- Department of Sociology, University of Minnesota, Minneapolis
- Minnesota Population Center, University of Minnesota, Minneapolis
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University, Boston, Massachusetts
- Department of Political Science, Boston University, Boston, Massachusetts
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Center for Antiracist Research, Boston University, Boston, Massachusetts
| | - Eugenio Paglino
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Marie-Laure Charpignon
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge
| | | | - Samuel H. Preston
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - Irma T. Elo
- Department of Sociology, University of Pennsylvania, Philadelphia
- Population Studies Center, University of Pennsylvania, Philadelphia
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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14
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Scott JL, Lee-Johnson NM, Danos D. Place, Race, and Case: Examining Racialized Economic Segregation and COVID-19 in Louisiana. J Racial Ethn Health Disparities 2023; 10:775-787. [PMID: 35239176 PMCID: PMC8893059 DOI: 10.1007/s40615-022-01265-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
Abstract
Early COVID-19 pandemic data suggested racial/ethnic minority and low-income earning people bore the greatest burden of infection. Structural racism, the reinforcement of racial and ethnic discrimination via policy, provides a framework for understanding disparities in health outcomes like COVID-19 infection. Residential racial and economic segregation is one indicator of structural racism. Little attention has been paid to the relationship of infection to relative overall concentrations of risk (i.e., segregation of the most privileged from the most disadvantaged). We used ordinary least squares and geographically weighted regression models to evaluate the relationship between racial and economic segregation, measured by the Index of Concentration at the Extremes, and COVID-19 cases in Louisiana. We found a significant global association between racial segregation and cumulative COVID-19 case rate in Louisiana and variation across the state during the study period. The northwest and central regions exhibited a strong negative relationship indicating greater risk in areas with high concentrations of Black residents. On the other hand, the southeastern part of the state exhibited more neutral or positive relationships indicating greater risk in areas with high concentrations of White residents. Our findings that the relationship between racial segregation and COVID-19 cases varied within a state further support evidence that social and political determinants, not biological, drive racial disparities. Small area measures and measures of polarization provide localized information better suited to tailoring public health policy according to the dynamics of communities at the census tract level, which may lead to better health outcomes.
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Affiliation(s)
- Jennifer L Scott
- School of Social Work, Louisiana State University, 2167 Pleasant Hall, Baton Rouge, LA, 70803, USA.
| | - Natasha M Lee-Johnson
- School of Social Work, Louisiana State University, 2167 Pleasant Hall, Baton Rouge, LA, 70803, USA
| | - Denise Danos
- School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
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15
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Nicole B. Katz. Addressing Rehabilitation Healthcare Disparities During the COVID-19 Pandemic and Beyond. Phys Med Rehabil Clin N Am 2023. [ DOI: 10.1016/j.pmr.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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16
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Usman M, Yuyan L, Husnain M, Akhtar MW. COVID-19, travel restrictions and environmental consequences. Environ Dev Sustain 2023:1-21. [PMID: 37363034 PMCID: PMC10024297 DOI: 10.1007/s10668-023-03146-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/10/2023] [Indexed: 06/28/2023]
Abstract
The component of human life that has been most significantly altered by the COVID-19 epidemic is travel. Due to the upheaval produced by the pandemic breakout, countries are becoming increasingly avaricious and are scrambling to stockpile vaccines. The world has been locked down to reduce/control the pandemic outbreak, driving countries to shut their doors to other people from countries. The recent pandemic has had a short-term, positive effect on the environment, but travel restrictions have caused problems for the common person and are expected to deteriorate more soon, necessitating longer quarantines, vaccination requirements, vaccine passports, and immunization certificates required by countries for safe travel. Thus, this study has three objectives. First, we investigate the impact of COVID-19 on travel and the environment, as well as the role that tourists play in the transmission of the virus. Second, we examine how countries are handling COVID-19 vaccines. Finally, we pinpoint differences in vaccination coverage.
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Affiliation(s)
- Muhammad Usman
- UE Business School, Division of Management and Administrative Sciences, University of Education Lahore, Lahore, Pakistan
| | - Li Yuyan
- Zhengzhou Shengda University, Zhengzhou, People’s Republic of China
| | - Mudassir Husnain
- UE Business School, Division of Management and Administrative Sciences, University of Education Lahore, Lahore, Pakistan
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17
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Blake MJ, Marka NA, Steer CJ, Ravdin JI. Cause of Death by Race and Ethnicity in Minnesota Before and During the COVID-19 Pandemic, 2019-2020. medRxiv 2023:2023.03.09.23287048. [PMID: 36945486 PMCID: PMC10029070 DOI: 10.1101/2023.03.09.23287048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Objectives To measure changes in cause of death dynamics in 2019 and 2020 and the relationship between concurrent occurrence of the COVID-19 pandemic and mortality outcome by race and ethnicity. Patients and Methods We used resident mortality data from the Minnesota Department of Health (MDH) to conduct retrospective statistical analysis of deaths in Minnesota in 2019 relative to 2020 to assess changes in mortality in a pre-pandemic and pandemic period. Results COVID-19 strongly contributed to ethnicity-related mortality disparities in Minnesota. Not only was there a greater proportion of COVID-19 decedents within the Black and Hispanic populations, but their average decedent age was markedly lower relative to the White population. The Black population experienced a disproportionate increase in decedents with a 34% increase during 2020 compared to 2019. Conclusions This retrospective analysis of death dynamics and mortality outcomes in Minnesota from 2019 to 2020 demonstrated an increase in adverse mortality outcomes relative to the pre-pandemic period that disproportionately impacted Black and Hispanic minority populations. Access to non-pharmaceutical interventions combating COVID-19 infection in Black and Hispanic communities should be expanded in Minnesota.
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Affiliation(s)
- Madelyn J Blake
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN
| | - Nicholas A Marka
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Clifford J Steer
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN
| | - Jonathan I Ravdin
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN
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18
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Siegel M, Wiklund E. The relationship between state-level structural racism and disparities between the non-hispanic black and non-hispanic white populations in multiple health outcomes. J Natl Med Assoc 2023; 115:207-222. [PMID: 36801076 DOI: 10.1016/j.jnma.2023.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
AIMS While several studies have examined the impact of individual indicators of structural racism on single health outcomes, few have explicitly modeled racial disparities in a wide range of health outcomes using a multidimensional, composite structural racism index. This paper builds on the previous research by examining the relationship between state-level structural racism and a wider array of health outcomes, focusing on racial disparities in mortality from firearm homicide, infant mortality, stroke, diabetes, hypertension, asthma, HIV, obesity, and kidney disease. METHODS We used a previously developed state structural racism index that consists of a composite score derived by averaging eight indicators across five domains: (1) residential segregation; (2) incarceration; (3) employment; (4) economic status/wealth; and (5) education. Indicators were obtained for each of the 50 states using Census data from 2020. We estimated the Black-White disparity in each health outcome in each state by dividing the age-adjusted mortality rate for the non-Hispanic Black population by the age-adjusted mortality rate for the non-Hispanic White population. These rates were obtained from the CDC WONDER Multiple Cause of Death database for the combined years 1999-2020. We conducted linear regression analyses to examine the relationship between the state structural racism index and the Black-White disparity in each health outcome across the states. In multiple regression analyses, we controlled for a wide range of potential confounding variables. RESULTS Our calculations revealed striking geographic differences in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Higher levels of structural racism were significantly associated with greater racial disparities in mortality for all but two of the health outcomes. CONCLUSIONS There is a robust relationship between structural racism and Black-White disparities in multiple health outcomes across states. Programs and policies to reduce racial heath disparities must include strategies to help dismantle structural racism and its consequences.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Emma Wiklund
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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19
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Kushniruk A, Sangha P, Cooper L, Sedoc J, White S, Gretz S, Toledo A, Lahav D, Hartner AM, Martin NM, Lee JH, Slonim N, Bar-Zeev N. Usability and Credibility of a COVID-19 Vaccine Chatbot for Young Adults and Health Workers in the United States: Formative Mixed Methods Study. JMIR Hum Factors 2023; 10:e40533. [PMID: 36409300 PMCID: PMC9947824 DOI: 10.2196/40533] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/22/2022] [Accepted: 11/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic raised novel challenges in communicating reliable, continually changing health information to a broad and sometimes skeptical public, particularly around COVID-19 vaccines, which, despite being comprehensively studied, were the subject of viral misinformation. Chatbots are a promising technology to reach and engage populations during the pandemic. To inform and communicate effectively with users, chatbots must be highly usable and credible. OBJECTIVE We sought to understand how young adults and health workers in the United States assessed the usability and credibility of a web-based chatbot called Vira, created by the Johns Hopkins Bloomberg School of Public Health and IBM Research using natural language processing technology. Using a mixed method approach, we sought to rapidly improve Vira's user experience to support vaccine decision-making during the peak of the COVID-19 pandemic. METHODS We recruited racially and ethnically diverse young people and health workers, with both groups from urban areas of the United States. We used the validated Chatbot Usability Questionnaire to understand the tool's navigation, precision, and persona. We also conducted 11 interviews with health workers and young people to understand the user experience, whether they perceived the chatbot as confidential and trustworthy, and how they would use the chatbot. We coded and categorized emerging themes to understand the determining factors for participants' assessment of chatbot usability and credibility. RESULTS In all, 58 participants completed a web-based usability questionnaire and 11 completed in-depth interviews. Most questionnaire respondents said the chatbot was "easy to navigate" (51/58, 88%) and "very easy to use" (50/58, 86%), and many (45/58, 78%) said its responses were relevant. The mean Chatbot Usability Questionnaire score was 70.2 (SD 12.1) and scores ranged from 40.6 to 95.3. Interview participants felt the chatbot achieved high usability due to its strong functionality, performance, and perceived confidentiality and that the chatbot could attain high credibility with a redesign of its cartoonish visual persona. Young people said they would use the chatbot to discuss vaccination with hesitant friends or family members, whereas health workers used or anticipated using the chatbot to support community outreach, save time, and stay up to date. CONCLUSIONS This formative study conducted during the pandemic's peak provided user feedback for an iterative redesign of Vira. Using a mixed method approach provided multidimensional feedback, identifying how the chatbot worked well-being easy to use, answering questions appropriately, and using credible branding-while offering tangible steps to improve the product's visual design. Future studies should evaluate how chatbots support personal health decision-making, particularly in the context of a public health emergency, and whether such outreach tools can reduce staff burnout. Randomized studies should also be conducted to measure how chatbots countering health misinformation affect user knowledge, attitudes, and behavior.
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Affiliation(s)
| | - Pooja Sangha
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lyra Cooper
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - João Sedoc
- Stern School of Business, New York University, New York, NY, United States.,Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Sydney White
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Johns Hopkins Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | | | - Anna-Maria Hartner
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nina M Martin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jae Hyoung Lee
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Naor Bar-Zeev
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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20
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Gurewich D, Beilstein-Wedel E, Shwartz M, Davila H, Rosen AK. Disparities in Wait Times for Care Among US Veterans by Race and Ethnicity. JAMA Netw Open 2023; 6:e2252061. [PMID: 36689224 PMCID: PMC9871804 DOI: 10.1001/jamanetworkopen.2022.52061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/30/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Prior studies indicate that Black and Hispanic vs White veterans wait longer for care. However, these studies do not capture the COVID-19 pandemic, which caused care access disruptions, nor implementation of the US Department of Veterans Affairs (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks Act (MISSION), which is intended to improve care access by increasing veterans' options to use community clinicians. Objective To determine whether wait times increased differentially for Black and Hispanic compared with White veterans from the pre-COVID-19 to COVID-19 periods given concurrent MISSION implementation. Design, Setting, and Participants This cross-sectional study used data from the VA's Corporate Data Warehouse for fiscal years 2019 to 2021 (October 1, 2018, to September 30, 2021). Participants included Black, Hispanic, and White veterans with a new consultation for outpatient cardiology and/or orthopedic services during the study period. Multivariable mixed-effects models were used to estimate individual-level adjusted wait times and a likelihood ratio test of the significance of wait time disparity change over time. Main Outcomes and Measures Overall mean wait times and facility-level adjusted relative mean wait time ratios. Results The study included 1 162 148 veterans (mean [SD] age, 63.4 [14.4] years; 80.8% men). Significant wait time disparities were evident for orthopedic services (eg, Black veterans had wait times 2.09 [95% CI, 1.57-2.61] days longer than those for White veterans) in the pre-COVID-19 period, but not for cardiology services. Mean wait times increased from the pre-COVID-19 to COVID-19 periods for both services for all 3 racial and ethnic groups (eg, Hispanic wait times for cardiology services increased 5.09 [95% CI, 3.62-6.55] days). Wait time disparities for Black veterans (4.10 [95% CI, 2.44-5.19] days) and Hispanic veterans (4.40 [95% CI, 2.76-6.05] days) vs White veterans (3.75 [95% CI, 2.30-5.19] days) increased significantly from the pre-COVID-19 to COVID-19 periods (P < .001). During the COVID-19 period, significant disparities were evident for orthopedic services (eg, mean wait times for Hispanic vs White veterans were 1.98 [95% CI, 1.32-2.64] days longer) but not for cardiology services. Although there was variation in wait time ratios across the 140 facilities, only 6 facility wait time ratios were significant during the pre-COVID-19 period and 26 during the COVID-19 period. Conclusions and Relevance These findings suggest that wait time disparities increased from the pre-COVID-19 to COVID-19 periods, especially for orthopedic services for both Black and Hispanic veterans, despite MISSION's goal to improve access. Facility-level analyses identified potential sites that could be targeted to reduce disparities.
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Affiliation(s)
- Deborah Gurewich
- Center for Health Care Organization and Implementation Research, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Erin Beilstein-Wedel
- Center for Health Care Organization and Implementation Research, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts
| | - Michael Shwartz
- Center for Health Care Organization and Implementation Research, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts
| | - Heather Davila
- Center for Access & Delivery Research and Evaluation, VA Iowa City Health Care System, Iowa City, Iowa
- General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Amy K. Rosen
- Center for Health Care Organization and Implementation Research, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
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21
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Geisenberger RJ, Moriello NA; RHU2. Executive Summary. Dela J Public Health 2022; 8:4. [PMID: 36751588 DOI: 10.32481/djph.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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22
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Brown TH, Kamis C, Homan P. Empirical evidence on structural racism as a driver of racial inequities in COVID-19 mortality. Front Public Health 2022; 10:1007053. [PMID: 36483257 PMCID: PMC9723349 DOI: 10.3389/fpubh.2022.1007053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study contributes to the literature by empirically testing the extent to which place-based structural racism is a driver of state-level racial inequalities in COVID-19 mortality using theoretically-informed, innovative approaches. Methods CDC data are used to measure cumulative COVID-19 death rates between January 2020 and August 2022. The outcome measure is a state-level Black-White (B/W) ratio of age-adjusted death rates. We use state-level 2019 administrative data on previously validated indicators of structural racism spanning educational, economic, political, criminal-legal and housing to identify a novel, multi-sectoral latent measure of structural racism (CFI = 0.982, TLI = 0.968, and RMSEA = 0.044). We map B/W inequalities in COVID-19 mortality as well as the latent measure of structural racism in order to understand their geographic distribution across U.S. states. Finally, we use regression analyses to estimate the extent to which structural racism contributes to Black-White inequalities in COVID-19 mortality, net of potential confounders. Results Results reveal substantial state-level variation in the B/W ratio of COVID-19 death rates and structural racism. Notably, regression estimates indicate that the relationship between the structural racism and B/W inequality in COVID-19 mortality is positive and statistically significant (p < 0.001), both in the bivariate model (adjusted R2 = 0.37) and net of the covariates (adjusted R2 = 0.54). For example, whereas states with a structural racism value 2 standard deviation below the mean have a B/W ratio of approximately 1.12, states with a structural racism value 2 standard deviation above the mean have a ratio of just above 2.0. Discussion Findings suggest that efficacious health equity solutions will require bold policies that dismantle structural racism across numerous societal domains.
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Affiliation(s)
- Tyson H. Brown
- Department of Sociology, Duke University, Durham, NC, United States
| | - Christina Kamis
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, United States
| | - Patricia Homan
- Department of Sociology, Florida State University, Tallahassee, FL, United States
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23
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24
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Lundberg DJ, Cho A, Raquib R, Nsoesie EO, Wrigley-Field E, Stokes AC. Geographic and Temporal Patterns in Covid-19 Mortality by Race and Ethnicity in the United States from March 2020 to February 2022. medRxiv 2022:2022.07.20.22277872. [PMID: 35898347 PMCID: PMC9327633 DOI: 10.1101/2022.07.20.22277872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Prior research has established that American Indian, Alaska Native, Black, Hispanic, and Pacific Islander populations in the United States have experienced substantially higher mortality rates from Covid-19 compared to non-Hispanic white residents during the first year of the pandemic. What remains less clear is how mortality rates have changed for each of these racial/ethnic groups during 2021, given the increasing prevalence of vaccination. In particular, it is unknown how these changes in mortality have varied geographically. In this study, we used provisional data from the National Center for Health Statistics (NCHS) to produce age-standardized estimates of Covid-19 mortality by race/ethnicity in the United States from March 2020 to February 2022 in each metro-nonmetro category, Census region, and Census division. We calculated changes in mortality rates between the first and second years of the pandemic and examined mortality changes by month. We found that when Covid-19 first affected a geographic area, non-Hispanic Black and Hispanic populations experienced extremely high levels of Covid-19 mortality and racial/ethnic inequity that were not repeated at any other time during the pandemic. Between the first and second year of the pandemic, racial/ethnic inequities in Covid-19 mortality decreased-but were not eliminated-for Hispanic, non-Hispanic Black, and non-Hispanic AIAN residents. These inequities decreased due to reductions in mortality for these populations alongside increases in non-Hispanic white mortality. Though racial/ethnic inequities in Covid-19 mortality decreased, substantial inequities still existed in most geographic areas during the pandemic's second year: Non-Hispanic Black, non-Hispanic AIAN, and Hispanic residents reported higher Covid-19 death rates in rural areas than in urban areas, indicating that these communities are facing serious public health challenges. At the same time, the non-Hispanic white mortality rate worsened in rural areas during the second year of the pandemic, suggesting there may be unique factors driving mortality in this population. Finally, vaccination rates were associated with reductions in Covid-19 mortality for Hispanic, non-Hispanic Black, and non-Hispanic white residents, and increased vaccination may have contributed to the decreases in racial/ethnic inequities in Covid-19 mortality observed during the second year of the pandemic. Despite reductions in mortality, Covid-19 mortality remained elevated in nonmetro areas and increased for some racial/ethnic groups, highlighting the need for increased vaccination delivery and equitable public health measures especially in rural communities. Taken together, these findings highlight the continued need to prioritize health equity in the pandemic response and to modify the structures and policies through which systemic racism operates and has generated racial health inequities.
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Affiliation(s)
| | - Ahyoung Cho
- Center for Antiracist Research, Boston University
- Department of Political Science, Boston University
| | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health
| | - Elaine O. Nsoesie
- Department of Global Health, Boston University School of Public Health
- Center for Antiracist Research, Boston University
| | | | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health
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25
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Andrea SB, Eisenberg-Guyot J, Blaikie KJ, Owens S, Oddo VM, Peckham T, Minh A, Hajat A. The inequitable burden of the COVID-19 pandemic among marginalized older workers in the United States: an intersectional approach. J Gerontol B Psychol Sci Soc Sci 2022; 77:1928-1937. [PMID: 35863041 PMCID: PMC9384534 DOI: 10.1093/geronb/gbac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives The COVID-19 pandemic has profoundly affected the lives of people globally, widening long-standing inequities. We examined the COVID-19 pandemic’s impact on employment conditions by race/ethnicity, gender, and educational attainment and the association between such conditions and well-being in older adults in the United States. Methods Using data from the Health and Retirement Study respondents interviewed between May 2020 and May 2021 when they were ≥55 years of age, we examined intersectional patterns in COVID-19-related changes in employment conditions among 4,107 participants working for pay at the start of the pandemic. We also examined the compounding nature of changes in employment conditions and their association with financial hardship, food insecurity, and poor self-rated health. Results Relative to non-Hispanic White men with greater than high school education (>HS), Black and Latinx men and women were more likely to experience job loss irrespective of education; among those who did not experience job loss, men with ≤HS reporting Black, Latinx, or “other” race were >90% less likely to transition to remote work. Participants who experienced job loss with decreased income or continued in-person employment with decreased income/shift changes had greater prevalence of financial hardship, food insecurity, and poor/fair self-rated health than others. Discussion The impact of COVID-19 on employment conditions is inequitably patterned and is associated with financial hardship, food insecurity, and adverse health in older adults. Policies to improve employment quality and expand social insurance programs among this group are needed to reduce growing inequities in well-being later in life.
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Affiliation(s)
| | | | - Kieran J Blaikie
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA
| | - Shanise Owens
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA
| | - Vanessa M Oddo
- University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, IL, USA
| | - Trevor Peckham
- University of Washington School of Public Health, Department of Environmental and Occupational Health Sciences, Seattle, WA, USA
| | - Anita Minh
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA.,University of British Columbia, Department of Sociology, Vancouver, BC, Canada
| | - Anjum Hajat
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA
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Gwadz M, Cleland CM, Lizardo M, Hawkins RL, Bangser G, Parameswaran L, Stanhope V, Robinson JA, Karim S, Hollaway T, Ramirez PG, Filippone PL, Ritchie AS, Banfield A, Silverman E. Using the multiphase optimization strategy (MOST) framework to optimize an intervention to increase COVID-19 testing for Black and Latino/Hispanic frontline essential workers: A study protocol. BMC Public Health 2022; 22:1235. [PMID: 35729622 PMCID: PMC9210062 DOI: 10.1186/s12889-022-13576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022] Open
Abstract
Background Among those at highest risk for COVID-19 exposure is the large population of frontline essential workers in occupations such food service, retail, personal care, and in-home health services, among whom Black and Latino/Hispanic persons are over-represented. For those not vaccinated and at risk for exposure to COVID-19, including frontline essential workers, regular (approximately weekly) COVID-19 testing is recommended. However, Black and Latino/Hispanic frontline essential workers in these occupations experience serious impediments to COVID-19 testing at individual/attitudinal- (e.g., lack of knowledge of guidelines), social- (e.g., social norms), and structural-levels of influence (e.g., poor access), and rates of testing for COVID-19 are insufficient. Methods/design The proposed community-engaged study uses the multiphase optimization strategy (MOST) framework and an efficient factorial design to test four candidate behavioral intervention components informed by an integrated conceptual model that combines critical race theory, harm reduction, and self-determination theory. They are A) motivational interview counseling, B) text messaging grounded in behavioral economics, C) peer education, and D) access to testing (via navigation to an appointment vs. a self-test kit). All participants receive health education on COVID-19. The specific aims are to: identify which components contribute meaningfully to improvement in the primary outcome, COVID-19 testing confirmed with documentary evidence, with the most effective combination of components comprising an “optimized” intervention that strategically balances effectiveness against affordability, scalability, and efficiency (Aim 1); identify mediators and moderators of the effects of components (Aim 2); and use a mixed-methods approach to explore relationships among COVID-19 testing and vaccination (Aim 3). Participants will be N = 448 Black and Latino/Hispanic frontline essential workers not tested for COVID-19 in the past six months and not fully vaccinated for COVID-19, randomly assigned to one of 16 intervention conditions, and assessed at 6- and 12-weeks post-baseline. Last, N = 50 participants will engage in qualitative in-depth interviews. Discussion This optimization trial is designed to yield an effective, affordable, and efficient behavioral intervention that can be rapidly scaled in community settings. Further, it will advance the literature on intervention approaches for social inequities such as those evident in the COVID-19 pandemic. Trial registration ClinicalTrials.gov: NCT05139927; Registered on 11/29/2021. Protocol version 1.0. May 2, 2022, Version 1.0 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13576-0.
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Affiliation(s)
- Marya Gwadz
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA. .,Center for Drug Use and HIV Research (CDUHR), NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.,Division of Biostatistics, Department of Population Health at NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Maria Lizardo
- Northern Manhattan Improvement Corporation (NMIC), 45 Wadsworth Avenue, New York, NY, 10033, USA
| | - Robert L Hawkins
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Greg Bangser
- Northern Manhattan Improvement Corporation (NMIC), 45 Wadsworth Avenue, New York, NY, 10033, USA
| | - Lalitha Parameswaran
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Victoria Stanhope
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Jennifer A Robinson
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Shristi Karim
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Tierra Hollaway
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Paola G Ramirez
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Prema L Filippone
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Amanda S Ritchie
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | | | - Elizabeth Silverman
- SUNY Research Foundation, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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Weeks R, Cooper L, Sangha P, Sedoc J, White S, Toledo A, Gretz S, Lahav D, Martin N, Michel A, Lee JH, Slonim N, Bar-Zeev N. COVID-19 Vaccine Communication via Chatbot: A Qualitative Study on Message Preferences of Young Adults and Public Health Workers in Urban American Communities. J Med Internet Res 2022; 24:e38418. [PMID: 35737898 PMCID: PMC9301547 DOI: 10.2196/38418] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/25/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Automated conversational agents, or chatbots, have a role in reinforcing evidence-based guidance delivered through other media and offer an accessible, individually tailored channel for public engagement. In early-to-mid 2021, young adults and minority populations disproportionately affected by COVID-19 in the United States were more likely to be hesitant toward COVID-19 vaccines, citing concerns regarding vaccine safety and effectiveness. Successful chatbot communication requires purposive understanding of user needs. Objective We aimed to review the acceptability of messages to be delivered by a chatbot named VIRA from Johns Hopkins University. The study investigated which message styles were preferred by young, urban-dwelling Americans as well as public health workers, since we anticipated that the chatbot would be used by the latter as a job aid. Methods We conducted 4 web-based focus groups with 20 racially and ethnically diverse young adults aged 18-28 years and public health workers aged 25-61 years living in or near eastern-US cities. We tested 6 message styles, asking participants to select a preferred response style for a chatbot answering common questions about COVID-19 vaccines. We transcribed, coded, and categorized emerging themes within the discussions of message content, style, and framing. Results Participants preferred messages that began with an empathetic reflection of a user concern and concluded with a straightforward, fact-supported response. Most participants disapproved of moralistic or reasoning-based appeals to get vaccinated, although public health workers felt that such strong statements appealing to communal responsibility were warranted. Responses tested with humor and testimonials did not appeal to the participants. Conclusions To foster credibility, chatbots targeting young people with vaccine-related messaging should aim to build rapport with users by deploying empathic, reflective statements, followed by direct and comprehensive responses to user queries. Further studies are needed to inform the appropriate use of user-customized testimonials and humor in the context of chatbot communication.
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Affiliation(s)
- Rose Weeks
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, US
| | - Lyra Cooper
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, US
| | - Pooja Sangha
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, US
| | - João Sedoc
- Stern School of Business, New York University, New York, US
| | - Sydney White
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, US
| | | | | | | | - Nina Martin
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, US
| | - Alexandra Michel
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, US
| | - Jae Hyoung Lee
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, US
| | | | - Naor Bar-Zeev
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, US
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Cummings KJ, Beckman J, Frederick M, Harrison R, Nguyen A, Snyder R, Chan E, Gibb K, Rodriguez A, Wong J, Murray EL, Jain S, Vergara X. Disparities in COVID-19 fatalities among working Californians. PLoS One 2022; 17:e0266058. [PMID: 35349589 PMCID: PMC8963556 DOI: 10.1371/journal.pone.0266058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/11/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Information on U.S. COVID-19 mortality rates by occupation is limited. We aimed to characterize 2020 COVID-19 fatalities among working Californians to inform preventive strategies. METHODS We identified laboratory-confirmed COVID-19 fatalities with dates of death in 2020 by matching death certificates to the state's COVID-19 case registry. Working status for decedents aged 18-64 years was determined from state employment records, death certificates, and case registry data and classified as "confirmed working," "likely working," or "not working." We calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators. RESULTS COVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18-64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as "confirmed working." The remainder were classified as "likely working" (n = 4,121 [51.2%]) or "not working" (n = 1,443 [17.9%]) using death certificate and case registry data. Confirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3-30.8). Workers in nine occupational groups had age-adjusted mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7-88.2); material moving (77.8; 95% CI, 70.2-85.9); construction (62.4; 95% CI, 57.7-67.4); production (60.2; 95% CI, 55.7-65.0); and transportation (57.2; 95% CI, 52.2-62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers. CONCLUSION Californians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers; these occupational group should be prioritized for prevention.
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Affiliation(s)
- Kristin J. Cummings
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
| | - John Beckman
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Matthew Frederick
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Robert Harrison
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Alyssa Nguyen
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Robert Snyder
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Elena Chan
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Kathryn Gibb
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Andrea Rodriguez
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Jessie Wong
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Public Health Institute, Oakland, CA, United States of America
| | - Erin L. Murray
- Immunization Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Seema Jain
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Ximena Vergara
- Occupational Health Branch, California Department of Public Health, Richmond, CA, United States of America
- Heluna Health, City of Industry, CA, United States of America
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Wild LE, Walters M, Powell A, James KA, Corlin L, Alderete TL. County-Level Social Vulnerability Is Positively Associated with Cardiometabolic Disease in Colorado. Int J Environ Res Public Health 2022; 19:ijerph19042202. [PMID: 35206386 PMCID: PMC8872484 DOI: 10.3390/ijerph19042202] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023]
Abstract
Cardiometabolic diseases are a group of interrelated diseases that pose greater burden among socially vulnerable communities. The social vulnerability index (SVI) identifies communities vulnerable to emergencies and may also help determine communities at risk of adverse chronic health outcomes. However, no studies have examined the relationship between the SVI and cardiometabolic health outcomes in Colorado or focused on rural settings. The aim of this ecological study was to determine whether the county-level SVI is associated with county-level cardiometabolic health indicators with a particular focus on rurality and racial/ethnic diversity. We obtained 2014 SVI scores from the Centers for Disease Control and Prevention (scored 0–1; higher = more vulnerable) and 2013–2015 cardiometabolic health estimates from the Colorado Department of Public Health and Environment. The distribution of social determinants of health was spatially evaluated. Bivariate relationships between the SVI and cardiometabolic indicators were estimated using simple linear regression models. The highest SVI scores were observed in rural areas, including the San Luis Valley (mean: 0.78, median: 0.91), Southeast (mean: 0.72, median: 0.73), and Northeast (mean: 0.66, median: 0.76) regions. Across Colorado, the SVI accounted for 41% of the variability in overweight and obesity prevalence (p < 0.001), 17% of the variability in diabetes prevalence (p = 0.001), and 58% of the age-adjusted myocardial infarction hospitalization rate (p < 0.001). SVI values may be useful in determining a community’s burden of cardiometabolic diseases.
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Affiliation(s)
- Laura E. Wild
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
| | - McKailey Walters
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, USA; (M.W.); (L.C.)
| | - Alaina Powell
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
| | - Katherine A. James
- Department Environmental and Occupational Health, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA;
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, USA; (M.W.); (L.C.)
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA
| | - Tanya L. Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
- Correspondence:
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Siegel M, Critchfield-Jain I, Boykin M, Owens A, Muratore R, Nunn T, Oh J. Racial/Ethnic Disparities in State-Level COVID-19 Vaccination Rates and Their Association with Structural Racism. J Racial Ethn Health Disparities 2022; 9:2361-2374. [PMID: 34713336 PMCID: PMC8553106 DOI: 10.1007/s40615-021-01173-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Racial disparities in COVID-19 morbidity and mortality have been well-documented. However, there may also be racial disparities in COVID-19 vaccination rates which, if present, would further exacerbate the existing disparities. No previously published articles have identified and quantified potential racial disparities in vaccination throughout the USA at any geography lower than the national level. METHODS Using data compiled from state health departments, we calculated racial disparities in COVID-19 vaccination for the Black and Hispanic populations compared to the White population in each state. We explored the relationship between a state-level index of structural racism and the observed differences in the racial disparities in COVID-19 vaccination across states for both the Black and Hispanic populations by conducting linear regression analyses. RESULTS Racial disparities in COVID-19 vaccination were present for both the Black and Hispanic populations in the overwhelming majority of states. There were vast differences between the states in the magnitude of the racial disparity in race-specific vaccination rates. These differences were largely explained by differences in the level of structural racism in each state. The relationship between structural racism and the racial disparities in vaccination was not entirely explained by racial differences in vaccine hesitancy or political affiliation. CONCLUSIONS There are marked racial disparities in COVID-19 vaccination throughout the USA, and structural racism is strongly associated with the magnitude of these disparities. Efforts to reduce these disparities must address not only individual behavior but must also confront the structural barriers that are inhibiting equitable vaccine distribution.
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Affiliation(s)
- Michael Siegel
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Avenue, Boston, MA 02118 USA ,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Isabella Critchfield-Jain
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Avenue, Boston, MA 02118 USA ,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Matthew Boykin
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Avenue, Boston, MA 02118 USA ,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Alicia Owens
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Avenue, Boston, MA 02118 USA ,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Rebeckah Muratore
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Avenue, Boston, MA 02118 USA ,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Taiylor Nunn
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Avenue, Boston, MA 02118 USA ,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Joanne Oh
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Avenue, Boston, MA 02118 USA ,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
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Tai DBG, Sia IG, Doubeni CA, Wieland ML. Disproportionate Impact of COVID-19 on Racial and Ethnic Minority Groups in the United States: a 2021 Update. J Racial Ethn Health Disparities 2022; 9:2334-9. [PMID: 34647273 DOI: 10.1007/s40615-021-01170-w] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022]
Abstract
The COVID-19 pandemic's disproportionate impact on people from some racial and ethnic groups in the U.S. persisted throughout 2021. Black, Latinx, and American Indian persons have been hospitalized and died at a higher rate than White persons consistently from the start of the pandemic. Early data show that hospitalization and mortality rates for Black, Latinx, and American Indian children are higher than White children in a worrying trend. The pandemic has likely worsened the gaps in wealth, employment, housing, and access to health care: the social determinants of health that caused the disparities in the first place. School closures will have a long-lasting impact on the widening achievement gaps between Black and Latinx students and White students. In the earlier vaccination phase, Black and Latinx persons were being vaccinated at a lower rate than their proportion of cases due to vaccine hesitancy, misinformation, and barriers to access. Vaccine hesitancy rates among these groups have since decreased and are now comparable to White persons. Aggregated data make it challenging to paint a picture of the actual impact of COVID-19 on Asian Americans as they are a diverse group with significant disparities. All of this highlights that we have much work to do in dismantling systemic racism, engaging communities we serve, and advancing health equity to prepare us for future pandemics and a more just healthcare system.
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Wrigley-Field E, Garcia S, Leider JP, Van Riper D. COVID-19 Mortality At The Neighborhood Level: Racial And Ethnic Inequalities Deepened In Minnesota In 2020. Health Aff (Millwood) 2021; 40:1644-1653. [PMID: 34524913 PMCID: PMC8562777 DOI: 10.1377/hlthaff.2021.00365] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Substantial racial and ethnic disparities in COVID-19 mortality have been observed at the state and national levels. However, less is known about how race and ethnicity and neighborhood-level disadvantage may intersect to contribute to both COVID-19 mortality and excess mortality during the pandemic. To assess this potential interaction of race and ethnicity with neighborhood disadvantage, we link death certificate data from Minnesota from the period 2017-20 to the Area Deprivation Index to examine hyperlocal disparities in mortality. Black, Indigenous, and people of color (BIPOC) standardized COVID-19 mortality was 459 deaths per 100,000 population in the most disadvantaged neighborhoods compared with 126 per 100,000 in the most advantaged. Total mortality increased in 2020 by 14 percent for non-Hispanic White people and 41 percent for BIPOC. Statistical decompositions show that most of this growth in racial and ethnic disparity is associated with mortality gaps between White people and communities of color within the same levels of area disadvantage, rather than with the fact that White people live in more advantaged areas. Policy interventions to reduce COVID-19 mortality must consider neighborhood context.
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Affiliation(s)
- Elizabeth Wrigley-Field
- Elizabeth Wrigley-Field is an assistant professor in the Department of Sociology and the Minnesota Population Center, University of Minnesota, Twin Cities, in Minneapolis, Minnesota
| | - Sarah Garcia
- Sarah Garcia is a PhD candidate in the Department of Sociology, University of Minnesota, Twin Cities
| | - Jonathon P Leider
- Jonathon P. Leider is a senior lecturer in the Division of Health Policy and Management, University of Minnesota School of Public Health, in Minneapolis, Minnesota, and an associate faculty member at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - David Van Riper
- David Van Riper is the director of spatial analysis at the Institute for Social Research and Data Innovation, University of Minnesota, Twin Cities
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Siegel M, Critchfield-Jain I, Boykin M, Owens A, Nunn T, Muratore R. Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 353 US Counties and Their Association with Structural Racism. J Racial Ethn Health Disparities 2021; 9:1697-1725. [PMID: 34462902 PMCID: PMC8404537 DOI: 10.1007/s40615-021-01109-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 01/03/2023]
Abstract
Introduction Although disparities in COVID-19 mortality have been documented at the national and state levels, no previous study has quantified such disparities at the county level by explicitly measuring race-specific COVID-19 death rates. In this paper, we quantify the racial/ethnic disparities in COVID-19 mortality between the non-Hispanic Black and non-Hispanic White populations at the county level by estimating age-adjusted, race-specific death rates. Methods Using COVID-19 case data from the Centers for Disease Control and Prevention, we calculated crude and indirect age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each of 353 counties for the period February 2, 2020, through January 30, 2021. Using linear regression analysis, we examined the relationship between several county-level measures of structural racism and the observed differences in racial disparities in COVID-19 mortality across counties. Results Ninety-three percent of the counties in our study experienced higher death rates among the Black compared to the White population, with an average ratio of Black to White death rates of 1.9 and a 17.5-fold difference between the disparity in the lowest and highest counties. Three traditional measures of structural racism were significantly related to the magnitude of the Black-White racial disparity in COVID-19 mortality rates across counties. Conclusions There are large disparities in COVID-19 mortality rates between the Black and White populations at the county level, there are profound differences in the level of these disparities, and those differences are directly related to the level of structural racism in a given county.
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Affiliation(s)
- Michael Siegel
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Isabella Critchfield-Jain
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Matthew Boykin
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Alicia Owens
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Taiylor Nunn
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Rebeckah Muratore
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
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Rosenberg ES, Tesoriero JM. A Tale of Many New York Cities. J Infect Dis 2021; 224:185-187. [PMID: 34086945 PMCID: PMC8194901 DOI: 10.1093/infdis/jiab297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eli S Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York, USA.,Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer, New York, USA
| | - James M Tesoriero
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer, New York, USA.,New York State Department of Health, Albany, New York, USA
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Last K, Power NR, Dellière S, Velikov P, Šterbenc A, Antunovic IA, Lopes MJ, Schweitzer V, Barac A. Future developments in training. Clin Microbiol Infect 2021; 27:1595-1600. [PMID: 34197928 PMCID: PMC8280350 DOI: 10.1016/j.cmi.2021.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the value of highly skilled and extensively trained specialists in clinical microbiology (CM) and infectious diseases (ID). Training curricula in CM and ID must constantly evolve to prepare trainees for future pandemics and to allow trainees to reach their full clinical and academic potential. OBJECTIVES In this narrative review, we aim to outline necessary future adaptations in CM and ID training curricula and identify current structural barriers in training with the aim of discussing possibilities to address these shortcomings. SOURCES We reviewed literature from PubMed and included selected books and online publications as appropriate. There was no time constraint on the included publications. CONTENT Drawing from the lessons learnt during the pandemic, we summarize novel digital technologies relevant to CM and ID trainees and highlight interdisciplinary teamwork and networking skills as important competencies. We centre CM and ID training within the One Health framework and discuss gender inequalities and structural racism as barriers in both CM and ID training and patient care. IMPLICATIONS CM and ID trainees should receive training and support developing skills in novel digital technologies, leadership, interdisciplinary teamwork and networking. Equally important is the need for equity of opportunity, with firm commitments to end gender inequality and structural racism in CM and ID. Policy-makers and CM and ID societies should ensure that trainees are better equipped to achieve their professional goals and are better prepared for the challenges awaiting in their fields.
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Affiliation(s)
- Katharina Last
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.
| | - Nicholas R Power
- Royal College of Physicians of Ireland, Setanta House, 1 Setanta Pl, Dublin 2, Ireland
| | - Sarah Dellière
- Université de Paris, Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Petar Velikov
- Infectious Diseases Hospital Prof. Ivan Kirov and Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Anja Šterbenc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivana Antal Antunovic
- Department of Clinical Microbiology, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Maria João Lopes
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Valentijn Schweitzer
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
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