Differential COVID-19 testing, admissions, and mortality for Arab Americans in Southern California

Improving the Collection of National Health Data: the Case for the Middle Eastern and North African Checkbox for Communities in the USA

INTRODUCTION

The Office of Management and Budget (OMB) is reviewing current minimum standards for collecting race/ethnicity data on federal forms. This review is extremely important for Middle Eastern and North African (MENA) Americans, who have been overlooked and unable to receive federal funding for their communities for decades. MENA individuals are defined as "White," which is particularly concerning given that research continues to identify that their health and lived experiences differ from Whites. From January to April 2023, the OMB requested public comments on a separate MENA checkbox. The purpose of this research was to describe public comments regarding the addition of the MENA checkbox on the US Census and other federal forms.

METHODS

A public comment period outlining changes to the collection of race/ethnicity data on the US Census and other federal forms opened in January 2023. Public comments were reviewed to determine whether MENA was mentioned, whether comments supported a MENA checkbox, and whether comments mentioned acceptance for health-related reasons.

RESULTS

There were 6700 comments reviewed. Most (73.88%) mentioned adding a MENA checkbox. Of those, 99.31% accepted adding the checkbox. Among the comments that accepted adding a MENA checkbox, 29.09% mentioned health, 44.75% mentioned linguistic/language services, and 44.75% mentioned education-related reasons.

CONCLUSIONS

Overall, the comments reviewed demonstrated strong acceptance of the addition of a MENA checkbox on federal forms. These findings are encouraging, yet further review is needed to contribute to the OMB's final decision on whether to add the checkbox and uncover the health of this population.

Risk factors for SARS-CoV-2 infection during the early stages of the COVID-19 pandemic: a systematic literature review

Introduction

Identifying SARS-CoV-2 infection risk factors allows targeted public health and social measures (PHSM). As new, more transmissible variants of concern (VoC) emerge, vaccination rates increase and PHSM are eased, it is important to understand any potential change to infection risk factors. The aim of this systematic literature review is to describe the risk factors for SARS-CoV-2 infection by VoC.

Methods

A literature search was performed in MEDLINE, PubMed and Embase databases on 5 May 2022. Eligibility included: observational studies published in English after 1 January 2020; any age group; the outcome of SARS-CoV-2 infection; and any potential risk factors investigated in the study. Results were synthesized into a narrative summary with respect to measures of association, by VoC. ROBINS-E tool was utilized for risk of bias assessment.

Results

Of 6,197 studies retrieved, 43 studies were included after screening. Common risk factors included older age, minority ethnic group, low socioeconomic status, male gender, increased household size, occupation/lower income level, inability to work from home, public transport use, and lower education level. Most studies were undertaken when the ancestral strain was predominant. Many studies had some selection bias due to testing criteria and limited laboratory capacity.

Conclusion

Understanding who is at risk enables the development of strategies that target priority groups at each of the different stages of a pandemic and helps inform vaccination strategies and other interventions which may also inform public health responses to future respiratory infection outbreaks. While it was not possible to determine changes to infection risk by recent VoC in this review, the risk factors identified will add to the overall understanding of the groups who are at greatest risk of infection in the early stages of a respiratory virus outbreak.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022330706, PROSPERO [CRD42022330706].

Improving the Collection of National Health Data: The Case for the Middle Eastern and North African Checkbox in the United States

Objectives To describe public comments posted in relation to the Office of Management and Budget (OMB) Statistical Policy Directive 15 proposals regarding the addition of a separate Middle Eastern and North African (MENA) checkbox on the US Census and other required federal forms. Methods A public comment period outlining changes to the collection of race and ethnicity data on the US Census and other federal forms opened in January 2023. Public comments posted in February and March 2023 were reviewed to determine whether MENA was mentioned, whether comments supported a MENA checkbox, and whether comments mentioned support for health-related reasons. Results There were 3,062 comments reviewed. Most (71.49%) mentioned adding a MENA checkbox. Of those, 98.86% supported adding a MENA checkbox. Among those, 31.98% mentioned adding a MENA checkbox for health-related reasons. Conclusions Overall, the comments reviewed demonstrated strong support for the addition of a MENA checkbox on federal forms. These findings are encouraging yet further review is needed to contribute to the OMB’s final decision on whether to add the checkbox and uncover the health of this underrepresented population.

Risk Factors for COVID-19 Positivity and Hospital Admission Among Arab American Adults in Southern California

Objective:

Little is known about risk factors associated with COVID-19 infection among Arab American people. We aimed to understand the predictors of receiving a positive COVID-19 test result and being admitted to the hospital for COVID-19 among Arab American adults using data from a hospital near an Arab ethnic enclave.

Methods:

We used electronic medical record data for Arab American adults aged ≥18 years from March 1, 2020, through January 31, 2021, at Sharp Grossmont Hospital in La Mesa, California. The primary outcomes were receiving a positive COVID-19 test result and being admitted to the hospital for COVID-19. We ran logistic regression models with individual- and population-level risk factors to determine the odds of each primary outcome.

Results:

A total of 2744 Arab American adults were tested for COVID-19, of whom 783 (28.5%) had a positive test result. In the fully adjusted model, women had lower odds of receiving a positive test result than men (adjusted odds ratio [aOR] = 0.77; 95% CI, 0.64-0.92), and adults living in high-poverty areas had higher odds of receiving a positive test result than adults in lower-poverty areas (aOR = 1.25; 95% CI, 1.04-1.51). Of the 783 Arab American adults with data on admission, 131 (16.7%) were admitted. For every 1-unit increase in the Charlson Comorbidity Index, the odds of admission increased by 66% (aOR = 1.66; 95% CI, 1.36-2.04).

Conclusion:

The risk of receiving a positive test result for COVID-19 was higher among Arab American adults living in high-poverty areas than in lower-poverty areas. The risk of admission was directly related to overall health status. Future work should aim to understand the barriers to prevention and testing in this population.