Racial and Ethnic Disparities in the Observed COVID-19 Case Fatality Rate Among the U.S. Population

Racial and Ethnic Disparities in Accessing High-Quality Home Health Care among Older Adults with and Without Dementia

OBJECTIVES

Home health care (HHC) plays a pivotal role in serving millions of US adults aging in place. Although the HHC population is growing rapidly in both size and diversity, driven by an aging US population and a changing demographic profile, there are increasing concerns of equity in HHC, particularly regarding how vulnerable populations are affected under current HHC practices. The purpose of this study was to examine the variations in accessing high-quality HHC in racial and ethnic minority groups and persons living with dementia.

DESIGN

Cross-sectional, secondary analysis.

SETTING AND PARTICIPANTS

Older adults who received HHC in 2016 from agencies with a star rating of overall care quality from the Home Health Compare program.

METHODS

Start of care data from the 2016 HHC Outcome and Assessment Information Set was linked to Master Beneficiary Summary File, Home Health Compare, and Provider of Services file to address the aim. Multinomial regressions were used in analysis when risk-adjusting for individual and agency characteristics.

RESULTS

Our risk-adjusted estimates, based on data from 574,682 older adults aged ≥65 years served by 8634 HHC agencies nationwide (2290 offering high-quality care, 4023 providing moderate-quality care, and 2321 delivering low-quality care), revealed significant disparities. Non-Hispanic Blacks (relative risk ratio, 0.62; 95% CI, 0.61-0.64) and Hispanics (relative risk ratio, 0.72; 95% CI, 0.70-0.74) were significantly less likely to receive care from high-quality agencies. Additionally, having dementia exacerbated disparities in accessing high-quality HHC between racial and ethnic minorities and white Americans.

CONCLUSIONS AND IMPLICATIONS

Racial and ethnic minority individuals face significant disadvantages in accessing high-quality HHC, with persons living with dementia from these groups being the most disadvantaged. Further research is warranted to investigate the referral and admission processes for HHC. Our findings highlight the need for actions from clinicians and policymakers to tackle potential biases in the aforementioned care processes.

COVID-19 Case-Fatality Rates in Michigan Are Higher for Arab Americans Compared With Non-Hispanic White Individuals for the Oldest Age Groups

The aim of this study was to estimate and compare the age-specific and sex-adjusted case-fatality rates (CFRs) among Arab Americans to Hispanic, non-Hispanic Black, non-Hispanic White, and Asian adults living in Michigan. Data from Michigan's vital records, surveillance data (March 2020-July 2021), and an Arab/Chaldean surname algorithm were used. We used χ2 tests to determine statistically significant differences between groups. Logistic regression was used to estimate age-specific and sex-adjusted CFRs. Arab Americans had a lower CFR of 1.54% compared with Asian (1.97%), non-Hispanic White (2.17%), and non-Hispanic Black adults (3.36%), regardless of sex. For those 80 years of age or older, Arab American (30.72%) and Asian adults (31.47%) had higher CFR compared with the other racial or ethnic groups, with non-Hispanic White adults displaying a lower CFR of 18.28%. An Arab American ethnic identifier would likely increase the visibility of this population so that they can be included in the efforts to increase awareness, testing, and prevention strategies of COVID-19 or similar pandemics that might be facing us in the future.

Increased Mortality in Kidney Transplant Recipients During the Delta/Omicron Era of the COVID-19 Pandemic Despite Widespread Vaccination

INTRODUCTION

The incidence of mortality late in the pandemic, particularly after widespread vaccine availability, is not well understood. Herein, we elucidate the effect of this impact of the COVID pandemic as well as risk factors for mortality during it.

METHODS

The primary end point was death with a functioning graft with secondary endpoints of mortality rates in subgroups and at different time intervals during the pandemic.

RESULTS

Despite widespread vaccination, mortality rates for kidney transplant (KTx) recipients almost doubled during the COVID-19 era (6.40 deaths per 100 person years vs. 3.54 pre-COVID). Mortality increased in all racial/ethnic groups but increased more in Native Americans, Hispanics, and African Americans compared to non-Hispanic Caucasians. The highest mortality rate occurred during the Delta and Omicron time frames. In contrast to the general population, mortality was more evenly spread across age groups in KTx recipients.

CONCLUSIONS

Mortality rates during the COVID-19 era were extremely high, more than doubling in some racial/ethnic groups. We conclude that the KTx population was a particularly vulnerable group during the COVID-19 era and suggests the need for further research into the management of variants in the future.

The Pandemic Response Commons

Objectives

A data commons is a software platform for managing, curating, analyzing, and sharing data with a community. The Pandemic Response Commons (PRC) is a data commons designed to provide a data platform for researchers studying an epidemic or pandemic.

Methods

The PRC was developed using the open source Gen3 data platform and is based upon consortium, data, and platform agreements developed by the not-for-profit Open Commons Consortium. A formal consortium of Chicagoland area organizations was formed to develop and operate the PRC.

Results

The consortium developed a general PRC and an instance of it for the Chicagoland region called the Chicagoland COVID-19 Commons. A Gen3 data platform was set up and operated with policies, procedures, and controls for a NIST SP 800-53 revision 4 Moderate system. A consensus data model for the commons was developed, and a variety of datasets were curated, harmonized and ingested, including statistical summary data about COVID cases, patient level clinical data, and SARS-CoV-2 viral variant data.

Discussion and conclusions

Given the various legal and data agreements required to operate a data commons, a PRC is designed to be in place and operating at a low level prior to the occurrence of an epidemic, with the activities increasing as required during an epidemic. A regional instance of a PRC can also be part of a broader data ecosystem or data mesh consisting of multiple regional commons supporting pandemic response through sharing regional data.

Diversity in Urology, Are We Moving in the Right Direction?: Analysis of American Urologic Association Urology Residency Match Statistics 2019-2023

Analysis of the urology match statistics provides a window into the future of the urology workforce. Match statistics from 2019 to 2023 were analyzed to determine whether the efforts to promote diversity in 2020 have been impactful. The popularity in the field of urology among all racial/ethnic groups peaked interest in application in 2022. However despite an increase in URIM applicants over the last 5 years, 2023 URM applicants have 1/3 the odds of matching into urology as white applicants.

A chronological review of COVID-19 case fatality rate and its secular trend and investigation of all-cause mortality and hospitalization during the Delta and Omicron waves in the United States: a retrospective cohort study

Introduction

Coronavirus disease 2019 (COVID-19) has caused more than 690 million deaths worldwide. Different results concerning the death rates of the Delta and Omicron variants have been recorded. We aimed to assess the secular trend of case fatality rate (CFR), identify risk factors associated with mortality following COVID-19 diagnosis, and investigate the risks of mortality and hospitalization during Delta and Omicron waves in the United States.

Methods

This study assessed 2,857,925 individuals diagnosed with COVID-19 in the United States from January 2020, to June 2022. The inclusion criterion was the presence of COVID-19 diagnostic codes in electronic medical record or a positive laboratory test of the SARS-CoV-2. Statistical analysis was bifurcated into two components, longitudinal analysis and comparative analysis. To assess the discrepancies in hospitalization and mortality rates for COVID-19, we identified the prevailing periods for the Delta and Omicron variants.

Results

Longitudinal analysis demonstrated four sharp surges in the number of deaths and CFR. The CFR was persistently higher in males and older age. The CFR of Black and White remained higher than Asians since January 2022. In comparative analysis, the adjusted hazard ratios for all-cause mortality and hospitalization were higher in Delta wave compared to the Omicron wave. Risk of all-cause mortality was found to be greater 14-30 days after a COVID-19 diagnosis, while the likelihood of hospitalization was higher in the first 14 days following a COVID-19 diagnosis in Delta wave compared with Omicron wave. Kaplan-Meier analysis revealed the cumulative probability of mortality was approximately 2-fold on day 30 in Delta than in Omicron cases (log-rank p < 0.001). The mortality risk ratio between the Delta and Omicron variants was 1.671 (95% Cl 1.615-1.729, log-rank p < 0.001). Delta also had a significantly increased mortality risk over Omicron in all age groups. The CFR of people aged above 80 years was extremely high as 17.33%.

Conclusion

Male sex and age seemed to be strong and independent risk factors of mortality in COVID-19. The Delta variant appears to cause more hospitalization and death than the Omicron variant.