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Rishworth A, Wilson K, Adams M, Galloway T. Landscapes of inequities, structural racism, and disease during the COVID-19 pandemic: Experiences of immigrant and racialized populations in Canada. Health Place 2024; 87:103214. [PMID: 38520992 DOI: 10.1016/j.healthplace.2024.103214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
The COVID-19 pandemic has disproportionately affected immigrant and racialized communities globally and revealed another public health crisis - structural racism. While structural racism is known to foster discrimination via mutually reinforcing systems, the unevenness of COVID-19 infections, hospitalizations, and deaths across societies has precipitated attention to the impacts of structural racism. Research highlights the inequitable burden of COVID-19 among immigrant and racialized groups; however, little is known about the synergistic impacts of structural racism and COVID-19 on the health and wellbeing of these groups. Fewer studies examine how structural racism and COVID-19 intersect within neighbourhoods to co-produce landscapes of disease exposure and management. This article examines the pathways through which structural racism shapes access, use, and control of environmental resources among immigrant and racialized individuals in the neighbourhoods of the Peel Region and how they converged to shape health and disease dynamics during the height of Canada's COVID-19 pandemic. Findings from in-depth interviews reveal that mutually reinforcing inequitable systems created environments for COVID-19 to reinscribe disparities in access, use, and control of key resources needed to manage health and disease, and created new forms of disparities and landscapes of inequality for immigrants and racialized individuals. We close with a discussion on the impacts for policy and practice.
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Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Matthew Adams
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, ON, Canada.
| | - Tracey Galloway
- Department of Anthropology, University of Toronto, Mississauga, ON, Canada.
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2
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Mac C, Cheung K, Alzoubi T, Atacan C, Sehar H, Liyanage S, AlShurman BA, Butt ZA. The Impact of Comorbidities among Ethnic Minorities on COVID-19 Severity and Mortality in Canada and the USA: A Scoping Review. Infect Dis Rep 2024; 16:407-422. [PMID: 38804440 DOI: 10.3390/idr16030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
(1) Current literature on ethnic minorities, comorbidities, and COVID-19 tends to investigate these factors separately, leaving gaps in our understanding about their interactions. Our review seeks to identify a relationship between ethnicity, comorbidities, and severe COVID-19 outcomes (ICU admission and mortality). We hope to enhance our understanding of the various factors that exacerbate COVID-19 severity and mortality in ethnic minorities in Canada and the USA. (2) All articles were received from PubMed, Scopus, CINAHL, and Ovid EMBASE from November 2020 to June 2022. Included articles contain information regarding comorbidities among ethnic minorities in relation to COVID-19 severity and mortality. (3) A total of 59 articles were included that examined various ethnic groups, including Black/African American, Asian, Hispanic, White/Caucasian, and Indigenous people. We found that the most examined comorbidities were diabetes, hypertension, obesity, and chronic kidney disease. A total of 76.9% of the articles (40 out of 52) found a significant association between different races and COVID-19 mortality, whereas 21.2% of the articles (11 out of 52) did not. (4) COVID-19 ICU admissions and mortality affect various ethnic groups differently, with Black patients generally having the most adverse outcomes. These outcomes may also interact with sex and age, though more research is needed assessing these variables together with ethnicity.
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Affiliation(s)
- Christina Mac
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Kylem Cheung
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | - Tala Alzoubi
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Can Atacan
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Hibah Sehar
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Shefali Liyanage
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | | | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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3
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Nanaw J, Sherchan JS, Fernandez JR, Strassle PD, Powell W, Forde AT. Racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19. BMC Public Health 2024; 24:1084. [PMID: 38641573 PMCID: PMC11027359 DOI: 10.1186/s12889-024-18526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Trust in the healthcare system may impact adherence to recommended healthcare practices, including willingness to test for and vaccinate against COVID-19. This study examined racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19 during the first year of the pandemic. METHODS This cross-sectional study used data from the REACH-US study, a nationally representative online survey conducted among a diverse sample of U.S. adults from January 26, 2021-March 3, 2021 (N = 5,121). Multivariable logistic regression estimated the associations between trust in the U.S. healthcare system (measured as "Always", "Most of the time", "Sometimes/Almost Never", and "Never") and willingness to test for COVID-19, and willingness to receive the COVID-19 vaccine. Racial/ethnic differences in these associations were examined using interaction terms and multigroup analyses. RESULTS Always trusting the U.S. healthcare system was highest among Hispanic/Latino Spanish Language Preference (24.9%) and Asian (16.7%) adults and lowest among Multiracial (8.7%) and Black/African American (10.7%) adults. Always trusting the U.S. healthcare system, compared to never, was associated with greater willingness to test for COVID-19 (AOR: 3.20, 95% CI: 2.38-4.30) and greater willingness to receive the COVID-19 vaccine (AOR: 2.68, 95% CI: 1.97-3.65). CONCLUSIONS Trust in the U.S. healthcare system was associated with greater willingness to test for COVID-19 and receive the COVID-19 vaccine, however, trust in the U.S. healthcare system was lower among most marginalized racial/ethnic groups. Efforts to establish a more equitable healthcare system that increases trust may encourage COVID-19 preventive behaviors.
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Affiliation(s)
- Judy Nanaw
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Juliana S Sherchan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jessica R Fernandez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | | | - Allana T Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
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Oremus M, Tyas SL, Zeng L, Newall N, Maxwell CJ. The association between memory, COVID-19 testing, and COVID-19 incidence in middle-aged and older adults: a prospective analysis of the CLSA. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024:1-18. [PMID: 38623833 DOI: 10.1080/13825585.2024.2342500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
We investigated the association between pre-COVID-19 memory function and (a) receipt of a COVID-19 test and (b) incidence of COVID-19 using the COVID-19 Questionnaire Study (CQS) of the Canadian Longitudinal Study on Aging (CLSA). The CQS included 28,565 middle-aged and older adults. We regressed receipt of a COVID-19 test on participants' immediate and delayed recall memory scores and re-ran the regression models with COVID-19 incidence as the outcome. All regression models were adjusted for sociodemographic, lifestyle, and health covariates. In the analytical sample (n = 21,930), higher delayed recall memory (better memory) was significantly associated with lower COVID-19 incidence. However, this association was not significant for immediate recall memory. Immediate and delayed recall memory were not associated with receipt of a COVID-19 test. Health policymakers and practitioners may viewmemory status as a potential risk for COVID-19. Memory status may not be a barrier to COVID-19 testing.
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Affiliation(s)
- Mark Oremus
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Leilei Zeng
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Nancy Newall
- Department of Psychology, Brandon University, Brandon, MB, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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5
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Baymon DE, Vakkalanka JP, Krishnadasan A, Mohr NM, Talan DA, Hagen MB, Wallace K, Harland KK, Aisiku IP, Hou PC. Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers. JAMA Netw Open 2024; 7:e245697. [PMID: 38598239 PMCID: PMC11007575 DOI: 10.1001/jamanetworkopen.2024.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Access to COVID-19 testing is critical to reducing transmission and supporting early treatment decisions; when made accessible, the timeliness of testing may also be an important metric in mitigating community spread of the infection. While disparities in transmission and outcomes of COVID-19 have been well documented, the extent of timeliness of testing and the association with demographic factors is unclear. Objectives To evaluate demographic factors associated with delayed COVID-19 testing among health care personnel (HCP) during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study used data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing study, a multicenter, test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms and testing between December 2020 and April 2022. Data analysis was conducted from March 2022 to Junne 2023. Exposure Displaying COVID-19-like symptoms and polymerase chain reaction testing occurring from the first day symptoms occurred up to 14 days after symptoms occurred. Main Outcomes and Measures Variables of interest included patient demographics (sex, age, and clinical comorbidities) and COVID-19 characteristics (vaccination status and COVID-19 wave). The primary outcome was time from symptom onset to COVID-19 testing, which was defined as early testing (≤2 days) or delayed testing (≥3 days). Associations of demographic characteristics with delayed testing were measured while adjusting for clinical comorbidities, COVID-19 characteristics, and test site using multivariable modeling to estimate relative risks and 95% CIs. Results A total of 5551 HCP (4859 female [82.9%]; 1954 aged 25-34 years [35.2%]; 4233 non-Hispanic White [76.3%], 370 non-Hispanic Black [6.7%], and 324 non-Hispanic Asian [5.8%]) were included in the final analysis. Overall, 2060 participants (37.1%) reported delayed testing and 3491 (62.9%) reported early testing. Compared with non-Hispanic White HCP, delayed testing was higher among non-Hispanic Black HCP (adjusted risk ratio, 1.18; 95%CI, 1.10-1.27) and for non-Hispanic HCP of other races (adjusted risk ratio, 1.17; 95% CI, 1.03-1.33). Sex and age were not associated with delayed testing. Compared with clinical HCP with graduate degrees, all other professional and educational groups had significantly delayed testing. Conclusions and Relevance In this cross-sectional study of HCP, compared with non-Hispanic White HCP and clinical HCP with graduate degrees, non-Hispanic Black HCP, non-Hispanic HCP of other races, and HCP all other professional and education backgrounds were more likely to have delayed COVID-19 testing. These findings suggest that time to testing may serve as a valuable metric in evaluating sociodemographic disparities in the response to COVID-19 and future health mitigation strategies.
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Affiliation(s)
- DaMarcus E. Baymon
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - J. Priyanka Vakkalanka
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Anusha Krishnadasan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
| | - Nicholas M. Mohr
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
- Department of Anesthesia Critical Care, Carver College of Medicine, University of Iowa, Iowa City
| | - David A. Talan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
- David Geffen School of Medicine, University of California, Los Angeles
| | - Melissa Briggs Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Kelli Wallace
- University of Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City
| | - Karisa K. Harland
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Imoigele P. Aisiku
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter C. Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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6
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Bell K, White S, Diaz A, Bahria P, Sima F, Al-Delaimy WK, dosReis S, Hassan O, Drabarek D, Nisha M, Baptiste-Roberts K, Gwiazdon K, Raynes-Greenow C, Taylor Wilson R, Gaudino JA, da Silveira Moreira R, Jennings B, Gulliver P. Can evidence drive health equity in the COVID-19 pandemic and beyond? J Public Health Policy 2024; 45:137-151. [PMID: 38216689 PMCID: PMC10920204 DOI: 10.1057/s41271-023-00452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/14/2024]
Abstract
Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.
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Affiliation(s)
- Katy Bell
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia.
- International Network for Epidemiology in Policy, Sydney, NSW, Australia.
| | - Sam White
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Abbey Diaz
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- First Nations Cancer and Wellbeing Research Team, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Priya Bahria
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- European Medicines Agency, Amsterdam, The Netherlands
| | - Fiona Sima
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Institute for Health Research, University of Bedfordshire, Luton, England, UK
| | - Wael K Al-Delaimy
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Susan dosReis
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- University of Maryland School of Pharmacy, Pharmaceutical Health Services Research, Baltimore, MD, USA
| | - Omar Hassan
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Dorothy Drabarek
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Monjura Nisha
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Kesha Baptiste-Roberts
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Katy Gwiazdon
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Center for Environmental Ethics and Law, Vienna, VA, USA
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- International Network for Epidemiology in Policy, Sydney, NSW, Australia
| | - Robin Taylor Wilson
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Department of Epidemiology & Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
| | - James A Gaudino
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- School of Public Health, Oregon Health & Sciences University and Portland State University, Portland, OR, USA
| | - Rafael da Silveira Moreira
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Area of Social Medicine, Faculty of Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Bruce Jennings
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
| | - Pauline Gulliver
- Sydney School of Public Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Camperdown, Sydney, NSW, 2006, Australia
- Section of Social and Community Health, University of Auckland, Auckland, New Zealand
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Young BR, Ho F, Lin Y, Lau EHY, Cowling BJ, Wu P, Tsang TK. Estimation of the Time-Varying Effective Reproductive Number of COVID-19 Based on Multivariate Time Series of Severe Health Outcomes. J Infect Dis 2024; 229:502-506. [PMID: 37815808 DOI: 10.1093/infdis/jiad445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
The time-varying effective reproduction number (Rt at time t) measures the transmissibility of SARS-CoV-2 and is conventionally based on daily case counts, which may suffer from time-varying ascertainment. We analyzed Rt estimates from case counts and severe COVID-19 (intensive care unit admissions, severe or critical cases, and mortality) across 2022 in Hong Kong's fifth and sixth waves of infection. Within the fifth wave, the severe disease-based Rt (3.5) was significantly higher than the case-based Rt (2.4) but not in the sixth wave. During periods with fluctuating underreporting, data based on severe diseases may provide more reliable Rt estimates.
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Affiliation(s)
- Benjamin R Young
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Faith Ho
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Yun Lin
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Eric H Y Lau
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- Laboratory of Data Discovery for Health Ltd, Hong Kong Science and Technology Park, China
| | - Benjamin J Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- Laboratory of Data Discovery for Health Ltd, Hong Kong Science and Technology Park, China
| | - Peng Wu
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- Laboratory of Data Discovery for Health Ltd, Hong Kong Science and Technology Park, China
| | - Tim K Tsang
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- Laboratory of Data Discovery for Health Ltd, Hong Kong Science and Technology Park, China
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8
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Lee NS, Keddem S, Sorrentino AE, Jenkins KA, Long JA. Health Equity in the Veterans Health Administration From Veterans' Perspectives by Race and Sex. JAMA Netw Open 2024; 7:e2356600. [PMID: 38373000 PMCID: PMC10877456 DOI: 10.1001/jamanetworkopen.2023.56600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Importance Advancing equitable patient-centered care in the Veterans Health Administration (VHA) requires understanding the differential experiences of unique patient groups. Objective To inform a comprehensive strategy for improving VHA health equity through the comparative qualitative analysis of care experiences at the VHA among veterans of Black and White race and male and female sex. Design, Setting, and Participants This qualitative study used a technique termed freelisting, an anthropologic technique eliciting responses in list form, at an urban academic VHA medical center from August 2, 2021, to February 9, 2022. Participants included veterans with chronic hypertension. The length of individual lists, item order in those lists, and item frequency across lists were used to calculate a salience score for each item, allowing comparison of salient words and topics within and across different groups. Participants were asked about current perceptions of VHA care, challenges in the past year, virtual care, suggestions for change, and experiences of racism. Data were analyzed from February 10 through September 30, 2022. Main Outcomes and Measures The Smith salience index, which measures the frequency and rank of each word or phrase, was calculated for each group. Results Responses from 49 veterans (12 Black men, 12 Black women, 12 White men, and 13 White women) were compared by race (24 Black and 25 White) and sex (24 men and 25 women). The mean (SD) age was 64.5 (9.2) years. Some positive items were salient across race and sex, including "good medical care" and telehealth as a "comfortable/great option," as were some negative items, including "long waits/delays in getting care," "transportation/traffic challenges," and "anxiety/stress/fear." Reporting "no impact" of racism on experiences of VHA health care was salient across race and sex; however, reports of race-related unprofessional treatment and active avoidance of race-related conflict differed by race (present among Black and not White participants). Experiences of interpersonal interactions also diverged. "Impersonal/cursory" telehealth experiences and the need for "more personal/attentive" care were salient among women and Black participants, but not men or White participants, who associated VHA care with courtesy and respect. Conclusions and Relevance In this qualitative freelist study of veteran experiences, divergent experiences of interpersonal care by race and sex provided insights for improving equitable, patient-centered VHA care. Future research and interventions could focus on identifying differences across broader categories both within and beyond race and sex and bolstering efforts to improve respect and personalized care to diverse veteran populations.
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Affiliation(s)
- Natalie S. Lee
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus
| | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Anneliese E. Sorrentino
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Kevin Ahmaad Jenkins
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judith A. Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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9
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Atanasov V, Barreto N, Franchi L, Whittle J, Meurer J, Weston BW, Luo Q(E, Yuan AY, Zhang R, Black B. Evidence on COVID-19 Mortality and Disparities Using a Novel Measure, COVID excess mortality percentage: Evidence from Indiana, Wisconsin, and Illinois. PLoS One 2024; 19:e0295936. [PMID: 38295114 PMCID: PMC10829977 DOI: 10.1371/journal.pone.0295936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
COVID-19 mortality rates increase rapidly with age, are higher among men than women, and vary across racial/ethnic groups, but this is also true for other natural causes of death. Prior research on COVID-19 mortality rates and racial/ethnic disparities in those rates has not considered to what extent disparities reflect COVID-19-specific factors, versus preexisting health differences. This study examines both questions. We study the COVID-19-related increase in mortality risk and racial/ethnic disparities in COVID-19 mortality, and how both vary with age, gender, and time period. We use a novel measure validated in prior work, the COVID Excess Mortality Percentage (CEMP), defined as the COVID-19 mortality rate (Covid-MR), divided by the non-COVID natural mortality rate during the same time period (non-Covid NMR), converted to a percentage. The CEMP denominator uses Non-COVID NMR to adjust COVID-19 mortality risk for underlying population health. The CEMP measure generates insights which differ from those using two common measures-the COVID-MR and the all-cause excess mortality rate. By studying both CEMP and COVID-MRMR, we can separate the effects of background health from Covid-specific factors affecting COVID-19 mortality. We study how CEMP and COVID-MR vary by age, gender, race/ethnicity, and time period, using data on all adult decedents from natural causes in Indiana and Wisconsin over April 2020-June 2022 and Illinois over April 2020-December 2021. CEMP levels for racial and ethnic minority groups can be very high relative to White levels, especially for Hispanics in 2020 and the first-half of 2021. For example, during 2020, CEMP for Hispanics aged 18-59 was 68.9% versus 7.2% for non-Hispanic Whites; a ratio of 9.57:1. CEMP disparities are substantial but less extreme for other demographic groups. Disparities were generally lower after age 60 and declined over our sample period. Differences in socio-economic status and education explain only a small part of these disparities.
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Affiliation(s)
- Vladimir Atanasov
- William & Mary, Mason School of Business, Williamsburg, Virginia, United States of America
| | - Natalia Barreto
- University of Illinois, Champaign-Urbana, Illinois, United States of America
| | - Lorenzo Franchi
- Northwestern University, Evanston, Illinois, United States of America
| | - Jeff Whittle
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - John Meurer
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Benjamin W. Weston
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Qian (Eric) Luo
- George Washington University, Washington, DC, United States of America
| | - Andy Ye Yuan
- Northwestern University, Pritzker School of Law, Evanston, Illinois, United States of America
| | - Ruohao Zhang
- Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Bernard Black
- Northwestern University, Pritzker School of Law and Kellogg School of Management, Evanston, Illinois, United States of America
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Myers LC, Lawson BL, Escobar GJ, Daly KA, Chen YFI, Dlott R, Lee C, Liu V. Evaluation of an outreach programme for patients with COVID-19 in an integrated healthcare delivery system: a retrospective cohort study. BMJ Open 2024; 14:e073622. [PMID: 38191255 PMCID: PMC10806839 DOI: 10.1136/bmjopen-2023-073622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES In the first year of the COVID-19 pandemic, health systems implemented programmes to manage outpatients with COVID-19. The goal was to expedite patients' referral to acute care and prevent overcrowding of medical centres. We sought to evaluate the impact of such a programme, the COVID-19 Home Care Team (CHCT) programme. DESIGN Retrospective cohort. SETTING Kaiser Permanente Northern California. PARTICIPANTS Adult members before COVID-19 vaccine availability (1 February 2020-31 January 2021) with positive SARS-CoV-2 tests. INTERVENTION Virtual programme to track and treat patients with 'CHCT programme'. OUTCOMES The outcomes were (1) COVID-19-related emergency department visit, (2) COVID-19-related hospitalisation and (3) inpatient mortality or 30-day hospice referral. MEASURES We estimated the average effect comparing patients who were and were not treated by CHCT. We estimated propensity scores using an ensemble super learner (random forest, XGBoost, generalised additive model and multivariate adaptive regression splines) and augmented inverse probability weighting. RESULTS There were 98 585 patients with COVID-19. The majority were followed by CHCT (n=80 067, 81.2%). Patients followed by CHCT were older (mean age 43.9 vs 41.6 years, p<0.001) and more comorbid with COmorbidity Point Score, V.2, score ≥65 (1.7% vs 1.1%, p<0.001). Unadjusted analyses showed more COVID-19-related emergency department visits (9.5% vs 8.5%, p<0.001) and hospitalisations (3.9% vs 3.2%, p<0.001) in patients followed by CHCT but lower inpatient death or 30-day hospice referral (0.3% vs 0.5%, p<0.001). After weighting, there were higher rates of COVID-19-related emergency department visits (estimated intervention effect -0.8%, 95% CI -1.4% to -0.3%) and hospitalisation (-0.5%, 95% CI -0.9% to -0.1%) but lower inpatient mortality or 30-day hospice referral (-0.5%, 95% CI -0.7% to -0.3%) in patients followed by CHCT. CONCLUSIONS Despite CHCT following older patients with higher comorbidity burden, there appeared to be a protective effect. Patients followed by CHCT were more likely to present to acute care and less likely to die inpatient.
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Affiliation(s)
- Laura C Myers
- Division of Research, Kaiser Permanente, Oakland, California, USA
- The Permanente Medical Group Inc, Oakland, California, USA
| | - Brian L Lawson
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Gabriel J Escobar
- Division of Research, Kaiser Permanente, Oakland, California, USA
- The Permanente Medical Group Inc, Oakland, California, USA
| | - Kathleen A Daly
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | | | - Richard Dlott
- The Permanente Medical Group Inc, Oakland, California, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Vincent Liu
- Division of Research, Kaiser Permanente, Oakland, California, USA
- The Permanente Medical Group Inc, Oakland, California, USA
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11
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Nguyen A, Rajski B, Furey V, Duffner L, Young B, Husain IA. Upper airway and tracheostomy management in patients with COVID-19: A long-term acute care hospital (LTACH). Am J Otolaryngol 2024; 45:104029. [PMID: 37659226 DOI: 10.1016/j.amjoto.2023.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/17/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Describe the tracheostomy and ventilation management of patients admitted due to COVID-19 as facilitated by speech language pathologists (SLPs) and otolaryngologists within the long-term acute care hospital (LTACH) setting. STUDY DESIGN Retrospective cohort study. SETTING Long-term acute care hospital. SUBJECTS AND METHODS A retrospective chart review was conducted on all patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to November 30, 2021. Demographic information, laryngeal findings, and tracheostomy management was reviewed. Descriptive statistics and chi-square analysis were performed. RESULTS Amongst the 213 subjects, 80.0 % arrived on mechanical ventilation. 23.0 % required otolaryngology consultation during LTACH stay due to poor Passy Muir Valve (PMV) or tracheostomy capping tolerance. 35 (71.4 %) of those consulted had abnormal laryngeal findings on exam with subglottic/tracheal stenosis and laryngeal edema being most common at 38.8 % and 20.4 %, respectively. 28.6 % of those with laryngeal findings were decannulated by discharge. Mechanical ventilator weaning and decannulation success were 86.6 % and 62.5 %, respectively. No association (p > 0.05) between number of intubations and abnormal laryngeal findings were found. No association (p > 0.05) between number of intubations or prone-positioning and decannulation success at discharge were found. CONCLUSION LTACHs can serve a specific role in upper airway rehabilitation and tracheostomy care in the post COVID-19 period. SLPs and otolaryngologists should be involved in the care of these patients to help facilitate decannulation and return to normal laryngeal function.
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Affiliation(s)
- Alvin Nguyen
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America.
| | - Barbara Rajski
- RML Specialty Hospital - Department of Rehabilitation, Hinsdale, IL, United States of America
| | - Vicki Furey
- RML Specialty Hospital - Department of Rehabilitation, Hinsdale, IL, United States of America
| | - Lisa Duffner
- RML Specialty Hospital - Office of Clinical Research, Hinsdale, IL, United States of America
| | - Bryce Young
- Midwestern University Chicago of Osteopathic Medicine, Downers Grove, IL, United States of America
| | - Inna A Husain
- Community Hospital, Department of Otolaryngology, Munster, IN, United States of America
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12
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Dahleh A, Bean AJ, Johnson TJ. Racial, socioeconomic, and neighborhood characteristics in relation to COVID-19 severity of illness for adolescents and young adults. PNAS NEXUS 2023; 2:pgad396. [PMID: 38034092 PMCID: PMC10682970 DOI: 10.1093/pnasnexus/pgad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
This study tests the hypotheses that insurance status, race and ethnicity, and neighborhood characteristics are associated with hospital admission and severe health outcomes (Intensive Care Unit [ICU] admission and oxygen assistance) for youth and young adults who present to the emergency department (ED) with COVID-19 in a single, academic health system in Illinois, Rush University System for Health (RUSH). Demographic and clinical data from the electronic health record were collected for all 13- to 24-y-old patients seen at RUSH who tested positive for COVID-19 between March 2020 and 2021. Individual-level and neighborhood characteristics were analyzed to determine their association with hospital admission and severe health outcomes through generalized estimating equations. As of March 2021, 1,057 patients were seen in the ED within RUSH in which non-Hispanic White (odds ratio [OR], 2.96; 95% CI, 1.61-5.46; P = 0.001) and Hispanic (OR, 3.34; 95% CI, 1.84-6.10; P < 0.001) adolescents and youth were more likely to be admitted to the hospital compared with non-Hispanic Black/other adolescents and youth. Patients with public insurance or who were uninsured were less likely to be admitted to the ICU compared with those with private insurance (OR, 0.24; 95% CI, 0.09-0.64; P = 0.004). None of the neighborhood characteristics were significantly associated with hospital admission or severe health outcomes after adjusting for covariates. Our findings demonstrated that race and ethnicity were related to hospitalization, while insurance was associated with presentation severity due to COVID-19 for adolescents and young adults. These findings can aid public health investigators in understanding COVID-19 disparities among adolescents and young adults.
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Affiliation(s)
- Ayaat Dahleh
- The Graduate College, Rush University, Chicago, IL 60612, USA
| | - Andrew J Bean
- The Graduate College, Rush University, Chicago, IL 60612, USA
| | - Tricia J Johnson
- Department of Health Systems Management, Rush University College of Health Sciences, Chicago, IL 60612, USA
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13
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Zhou S, Feng X, Hu Y, Yang J, Chen Y, Bastow J, Zheng ZJ, Xu M. Factors associated with the utilization of diagnostic tools among countries with different income levels during the COVID-19 pandemic. Glob Health Res Policy 2023; 8:45. [PMID: 37885008 PMCID: PMC10605783 DOI: 10.1186/s41256-023-00330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Disparities in the utilization of essential medical products are a key factor contributing to inequality in health outcomes. We aimed to analyze the trends and influencing factors in using Coronavirus disease 2019 (COVID-19) diagnostic tools and disparities in countries with different income levels. METHODS We conducted a cross-sectional study using open and publicly available data sources. Data were mainly collected from the Foundation for Innovative New Diagnostics, "Our World in Data," and the Global Burden of Disease databases. Negative binomial regression model and generalized linear mixed model were employed to investigate into five sets of factors associated with the usage of diagnostics: severity of COVID-19, socioeconomic status, health status, medical service capacity, and rigidity of response. Dominance analysis was utilized to compare the relative importance of these factors. The Blinder-Oaxaca decomposition was used to decompose the difference in the usage of diagnostics between countries. RESULTS The total COVID-19 testing rate ranged from 5.13 to 22,386.63 per 1000 people from March 2020 to October 2022 and the monthly testing rate declined dramatically from January 2022 to October 2022 (52.37/1000 vs 5.91/1000).. The total testing rate was primarily associated with socioeconomic status (37.84%), with every 1 standard deviation (SD) increase in Gross Domestic Product per capita and the proportion of people aged ≥ 70, the total testing rate increased by 88% and 31%. And so is the medical service capacity (33.66%), with every 1 SD increase in health workforce density, the number increased by 38%. The monthly testing rate was primarily associated with socioeconomic status (34.72%) and medical service capacity (28.67%), and the severity of COVID-19 (21.09%). The average difference in the total testing rates between high-income and low-income countries was 2726.59 per 1000 people, and 2493.43 (91.45%) of the differences could be explained through the five sets of factors. CONCLUSIONS Redoubling the efforts, such as local manufacturing, regulatory reliance, and strengthening the community health workforce and laboratory capacity in low- and middle-income countries (LMICs) cannot be more significant for ensuring sustainable and equitable access to diagnostic tools during pandemic.
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Affiliation(s)
- Shuduo Zhou
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xiangning Feng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yunxuan Hu
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jian Yang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Ying Chen
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jon Bastow
- Independent Diagnostics and Health Systems Expert, Geneva, Switzerland
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Ming Xu
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
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14
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Neupane SN, Ruel E. Association between Racial Residential Segregation and COVID-19 Mortality. J Urban Health 2023; 100:937-949. [PMID: 37715049 PMCID: PMC10618147 DOI: 10.1007/s11524-023-00780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/17/2023]
Abstract
This study investigates the impact of racial residential segregation on COVID-19 mortality during the first year of the US epidemic. Data comes from the Center for Disease Control and Prevention (CDC), and the Robert Wood Johnson Foundation's and the University of Wisconsin's joint county health rankings project. The observation includes a record of 8,670,781 individuals in 1488 counties. We regressed COVID-19 deaths, using hierarchical logistic regression models, on individual and county-level predictors. We found that as racial residential segregation increased, mortality rates increased. Controlling for segregation, Blacks and Asians had a greater risk of mortality, while Hispanics and other racial groups had a lower risk of mortality, compared to Whites. The impact of racial residential segregation on COVID-19 mortality did not vary by racial group.
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Affiliation(s)
- Suresh Nath Neupane
- Urban Studies Institute, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA.
| | - Erin Ruel
- Department of Sociology, Georgia State University, Atlanta, GA, USA
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15
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Dolbier CL, Vanacore SM, Conder L, Guiler W. A mixed-methods investigation of COVID-19 pandemic-specific stress in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-13. [PMID: 37722868 DOI: 10.1080/07448481.2023.2253929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To identify pandemic-specific stressors among college students and compare patterns of stressors in samples obtained during early and chronic phases of the pandemic. METHOD Different undergraduate student samples from a Southeastern university completed an online survey in Spring 2020 (early pandemic; N = 673) and Fall 2020 (chronic pandemic; N = 439). This repeated cross-sectional survey study used a mixed methods triangulation design to validate and expand on quantitative findings using qualitative data. RESULTS Quantitative and qualitative analyses revealed 13 pandemic stressor domains, with academics and lifestyle adjustment among the most stressful in both samples, and more stressful in the chronic pandemic sample. Non-freshmen, female, and first-generation college students were at greater risk for pandemic stress. CONCLUSIONS As college students continue to experience stressors related to COVID-19 and encounter future crises, colleges and universities must adapt to meet their unique needs specific to the context.
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Affiliation(s)
- Christyn L Dolbier
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Sarah M Vanacore
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Lauren Conder
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - William Guiler
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
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16
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Bristow J, Hamilton J, Weinshel J, Rovig R, Wallace R, Olney C, Lindquist KJ. Interplay of demographics, geography and COVID-19 pandemic responses in the Puget Sound region: The Vashon, Washington Medical Reserve Corps experience. PLoS One 2023; 18:e0274345. [PMID: 37585489 PMCID: PMC10431654 DOI: 10.1371/journal.pone.0274345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/11/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Rural U.S. communities are at risk from COVID-19 due to advanced age and limited access to acute care. Recognizing this, the Vashon Medical Reserve Corps (VMRC) in King County, Washington, implemented an all-volunteer, community-based COVID-19 response program. This program integrated public engagement, SARS-CoV-2 testing, contact tracing, vaccination, and material community support, and was associated with the lowest cumulative COVID-19 case rate in King County. This study aimed to investigate the contributions of demographics, geography and public health interventions to Vashon's low COVID-19 rates. METHODS This observational cross-sectional study compares cumulative COVID-19 rates and success of public health interventions from February 2020 through November 2021 for Vashon Island with King County (including metropolitan Seattle) and Whidbey Island, located ~50 km north of Vashon. To evaluate the role of demography, we developed multiple linear regression models of COVID-19 rates using metrics of age, race/ethnicity, wealth and educational attainment across 77 King County zip codes. To investigate the role of remote geography we expanded the regression models to include North, Central and South Whidbey, similarly remote island communities with varying demographic features. To evaluate the effectiveness of VMRC's community-based public health measures, we directly compared Vashon's success of vaccination and contact tracing with that of King County and South Whidbey, the Whidbey community most similar to Vashon. RESULTS Vashon's cumulative COVID-19 case rate was 29% that of King County overall (22.2 vs 76.8 cases/K). A multiple linear regression model based on King County demographics found educational attainment to be a major correlate of COVID-19 rates, and Vashon's cumulative case rate was just 38% of predicted (p < .05), so demographics alone do not explain Vashon's low COVID-19 case rate. Inclusion of Whidbey communities in the model identified a major effect of remote geography (-49 cases/K, p < .001), such that observed COVID-19 rates for all remote communities fell within the model's 95% prediction interval. VMRC's vaccination effort was highly effective, reaching a vaccination rate of 1500 doses/K four months before South Whidbey and King County and maintaining a cumulative vaccination rate 200 doses/K higher throughout the latter half of 2021 (p < .001). Including vaccination rates in the model reduced the effect of remote geography to -41 cases/K (p < .001). VMRC case investigation was also highly effective, interviewing 96% of referred cases in an average of 1.7 days compared with 69% in 3.7 days for Washington Department of Health investigating South Whidbey cases and 80% in 3.4 days for Public Health-Seattle & King County (both p<0.001). VMRC's public health interventions were associated with a 30% lower case rate (p<0.001) and 55% lower hospitalization rate (p = 0.056) than South Whidbey. CONCLUSIONS While the overall magnitude of the pre-Omicron COVID-19 pandemic in rural and urban U.S. communities was similar, we show that island communities in the Puget Sound region were substantially protected from COVID-19 by their geography. We further show that a volunteer community-based COVID-19 response program was highly effective in the Vashon community, augmenting the protective effect of geography. We suggest that Medical Reserve Corps should be an important element of future pandemic planning.
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Affiliation(s)
- James Bristow
- Vashon Medical Reserve Corps, Vashon, Washington, United States of America
| | - Jamie Hamilton
- Island County Public Health Department, Coupeville, Washington, United States of America
| | - John Weinshel
- Vashon Medical Reserve Corps, Vashon, Washington, United States of America
- VashonBePrepared, Vashon, Washington, United States of America
| | - Robert Rovig
- Atlas Genomics, Seattle, Washington, United States of America
| | - Rick Wallace
- VashonBePrepared, Vashon, Washington, United States of America
| | - Clayton Olney
- Vashon Medical Reserve Corps, Vashon, Washington, United States of America
- Madigan Army Medical Center, Joint Base Lewis McChord, Washington, United States of America
| | | | - Karla J. Lindquist
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
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Xin Y, Li H, Zhou Y, Yang Q, Mu W, Xiao H, Zhuo Z, Liu H, Wang H, Qu X, Wang C, Liu H, Yu K. The accuracy of artificial intelligence in predicting COVID-19 patient mortality: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2023; 23:155. [PMID: 37559062 PMCID: PMC10410953 DOI: 10.1186/s12911-023-02256-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The purpose of this paper was to systematically evaluate the application value of artificial intelligence in predicting mortality among COVID-19 patients. METHODS The PubMed, Embase, Web of Science, CNKI, Wanfang, China Biomedical Literature, and VIP databases were systematically searched from inception to October 2022 to identify studies that evaluated the predictive effects of artificial intelligence on mortality among COVID-19 patients. The retrieved literature was screened according to the inclusion and exclusion criteria. The quality of the included studies was assessed using the QUADAS-2 tools. Statistical analysis of the included studies was performed using Review Manager 5.3, Stata 16.0, and Meta-DiSc 1.4 statistical software. This meta-analysis was registered in PROSPERO (CRD42022315158). FINDINGS Of 2193 studies, 23 studies involving a total of 25 AI models met the inclusion criteria. Among them, 18 studies explicitly mentioned training and test sets, and 5 studies did not explicitly mention grouping. In the training set, the pooled sensitivity was 0.93 [0.87, 0.96], the pooled specificity was 0.94 [0.87, 0.97], and the area under the ROC curve was 0.98 [0.96, 0.99]. In the validation set, the pooled sensitivity was 0.84 [0.78, 0.88], the pooled specificity was 0.89 [0.85, 0.92], and the area under the ROC curve was 0.93 [1.00, 0.00]. In the subgroup analysis, the areas under the summary receiver operating characteristic (SROC) curves of the artificial intelligence models KNN, SVM, ANN, RF and XGBoost were 0.98, 0.98, 0.94, 0.92, and 0.91, respectively. The Deeks funnel plot indicated that there was no significant publication bias in this study (P > 0.05). INTERPRETATION Artificial intelligence models have high accuracy in predicting mortality among COVID-19 patients and have high prognostic value. Among them, the KNN, SVM, ANN, RF, XGBoost, and other models have the highest levels of accuracy.
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Affiliation(s)
- Yu Xin
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, China
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Hongxu Li
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, China
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Yuxin Zhou
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, China
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Qing Yang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Wenjing Mu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Han Xiao
- Departments of Pharmacy and Cardiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Zipeng Zhuo
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Hongyu Liu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Hongying Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Xutong Qu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China
| | - Changsong Wang
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, China.
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China.
| | - Haitao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd, Nangang District, Harbin, 150081, China.
| | - Kaijiang Yu
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, China.
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Thompson J, Wang Y, Dreischulte T, Barreiro O, Gonzalez RJ, Hanč P, Matysiak C, Neely HR, Rottenkolber M, Haskell T, Endres S, von Andrian UH. Association between bisphosphonate use and COVID-19 related outcomes. eLife 2023; 12:e79548. [PMID: 37534876 PMCID: PMC10691801 DOI: 10.7554/elife.79548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Background Although there are several efficacious vaccines against COVID-19, vaccination rates in many regions around the world remain insufficient to prevent continued high disease burden and emergence of viral variants. Repurposing of existing therapeutics that prevent or mitigate severe COVID-19 could help to address these challenges. The objective of this study was to determine whether prior use of bisphosphonates is associated with reduced incidence and/or severity of COVID-19. Methods A retrospective cohort study utilizing payer-complete health insurance claims data from 8,239,790 patients with continuous medical and prescription insurance January 1, 2019 to June 30, 2020 was performed. The primary exposure of interest was use of any bisphosphonate from January 1, 2019 to February 29, 2020. Bisphosphonate users were identified as patients having at least one bisphosphonate claim during this period, who were then 1:1 propensity score-matched to bisphosphonate non-users by age, gender, insurance type, primary-care-provider visit in 2019, and comorbidity burden. Main outcomes of interest included: (a) any testing for SARS-CoV-2 infection; (b) COVID-19 diagnosis; and (c) hospitalization with a COVID-19 diagnosis between March 1, 2020 and June 30, 2020. Multiple sensitivity analyses were also performed to assess core study outcomes amongst more restrictive matches between BP users/non-users, as well as assessing the relationship between BP-use and other respiratory infections (pneumonia, acute bronchitis) both during the same study period as well as before the COVID outbreak. Results A total of 7,906,603 patients for whom continuous medical and prescription insurance information was available were selected. A total of 450,366 bisphosphonate users were identified and 1:1 propensity score-matched to bisphosphonate non-users. Bisphosphonate users had lower odds ratios (OR) of testing for SARS-CoV-2 infection (OR = 0.22; 95%CI:0.21-0.23; p<0.001), COVID-19 diagnosis (OR = 0.23; 95%CI:0.22-0.24; p<0.001), and COVID-19-related hospitalization (OR = 0.26; 95%CI:0.24-0.29; p<0.001). Sensitivity analyses yielded results consistent with the primary analysis. Bisphosphonate-use was also associated with decreased odds of acute bronchitis (OR = 0.23; 95%CI:0.22-0.23; p<0.001) or pneumonia (OR = 0.32; 95%CI:0.31-0.34; p<0.001) in 2019, suggesting that bisphosphonates may protect against respiratory infections by a variety of pathogens, including but not limited to SARS-CoV-2. Conclusions Prior bisphosphonate-use was associated with dramatically reduced odds of SARS-CoV-2 testing, COVID-19 diagnosis, and COVID-19-related hospitalizations. Prospective clinical trials will be required to establish a causal role for bisphosphonate-use in COVID-19-related outcomes. Funding This study was supported by NIH grants, AR068383 and AI155865, a grant from MassCPR (to UHvA) and a CRI Irvington postdoctoral fellowship, CRI2453 (to PH).
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Affiliation(s)
| | - Yidi Wang
- Dept. of Immunology, Harvard Medical SchoolBostonUnited States
| | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital of Ludwig Maximilians-University MunichMunichGermany
| | - Olga Barreiro
- Dept. of Immunology, Harvard Medical SchoolBostonUnited States
| | | | - Pavel Hanč
- Dept. of Immunology, Harvard Medical SchoolBostonUnited States
| | | | - Harold R Neely
- Dept. of Immunology, Harvard Medical SchoolBostonUnited States
| | - Marietta Rottenkolber
- Institute of General Practice and Family Medicine, University Hospital of Ludwig Maximilians-University MunichMunichGermany
| | | | - Stefan Endres
- Center of Integrated Protein Science Munich and Division of Clinical Pharmacology, University Hospital, LMU Munich, GermanyMunichGermany
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Zerbo O, Ray GT, Fireman B, Layefsky E, Goddard K, Ross P, Greenberg M, Klein NP. Individual and neighborhood factors associated with being unvaccinated against COVID-19 among pregnant persons. Hum Vaccin Immunother 2023; 19:2256042. [PMID: 37697942 PMCID: PMC10498815 DOI: 10.1080/21645515.2023.2256042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/04/2023] [Accepted: 09/02/2023] [Indexed: 09/13/2023] Open
Abstract
We investigated whether unvaccinated pregnant persons cluster geographically and determined factors associated with being unvaccinated using spatial and multivariate logistic regression analyses. Pregnant persons with deliveries from December 15, 2020, through September 30, 2022, at Kaiser Permanente Northern California were included. Of the 85,852 pregnant persons in the study, 46.6% were unvaccinated before and during pregnancy. Spatial analysis identified 5 clusters with high prevalence of unvaccinated pregnant persons. Within these clusters, the proportion of unvaccinated varied from 53% to 62% versus 39% outside the clusters. In covariate-adjusted analyses, residence in a cluster increased the odds of being unvaccinated by 1.64 (95% confidence interval (CI): 1.59,1.69). The odds of being unvaccinated increased among those aged 16-24 years (odds ratio [OR] = 2.69, CI: 2.55, 2.83), aged 25-34 years (OR = 1.59, CI: 1.54, 1.64) compared with age ≥ 35 years, black race (OR = 1.45, CI:1.37, 1.54), and subsidized insurance (OR = 1.32, CI: 1.26, 1.38). The odds of being unvaccinated also increased for pregnant persons living in neighborhoods where the proportion of adults with high school education or less was greater than 20%. Geographic clustering of unvaccinated pregnant persons suggests a need for population-specific-interventions to increase vaccine coverage.
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Affiliation(s)
- Ousseny Zerbo
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - G. Thomas Ray
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Bruce Fireman
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Evan Layefsky
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kristin Goddard
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Pat Ross
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mara Greenberg
- Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, CA, USA
- Regional Perinatal Service Center, Kaiser Permanente Northern California, Santa Clara, CA, USA
| | - Nicola P. Klein
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
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20
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Okumura K, Jyothula S, Kaleekal T, Dhand A. 1-Year Outcomes of Lung Transplantation for Coronavirus Disease 2019-Associated End-Stage Lung Disease in the United States. Clin Infect Dis 2023; 76:2140-2147. [PMID: 36757715 DOI: 10.1093/cid/ciad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Lung transplantation can provide quality of life and survival benefits for patients with coronavirus disease 2019 (COVID-19)-associated end-stage lung disease. Characteristics and outcomes of these lung transplant recipients are limited to mostly single-center experiences or provide a short-term follow-up. METHODS Characteristics of deceased donors and adult lung transplant recipients for COVID-19-associated end-stage lung disease between August-2020 and June-2022 were analyzed using deidentified United Network for Organ Sharing database. Post-transplant patient survival of COVID-19 recipients was analyzed and compared with non-COVID-19 recipients. Secondary outcomes were length of hospitalization, post-transplant complications, and rates of organ rejection. RESULTS During the study period, 400 lung transplants for COVID-associated end-stage lung disease comprised 8.7% of all lung transplants performed in United States. In the COVID-19 group, Hispanic males received lung transplants at significantly higher rates. The COVID-19 group was younger and had greater need for intensive care unit stay, mechanical ventilation, hemodialysis, extracorporeal membrane oxygenation support, and receipt of antibiotics pre-lung transplant. They had higher lung allocation score, with a shorter wait-list time and received more double lung transplants compared with non-COVID-19 recipients. Post-transplant, the COVID-19 cohort had longer hospital stays, with similar 1-year patient survival (COVID, 86.6% vs non-COVID, 86.3%). Post-transplant, COVID-19-associated deaths were 9.2% of all deaths among lung transplant recipients. CONCLUSIONS Lung transplantation offers a effective option for carefully selected patients with end-stage lung disease from prior COVID-19, with short-term and long-term outcomes similar to those for lung transplant recipients of non-COVID-19 etiology.
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Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center/New York Medical College, New York, New York, USA
| | - Soma Jyothula
- Center for Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, UT Health Houston, Houston, Texas, USA
| | - Thomas Kaleekal
- Department of Pulmonary Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abhay Dhand
- Department of Surgery, Westchester Medical Center/New York Medical College, New York, New York, USA
- Transplant Infectious Diseases, Department of Medicine & Surgery, Westchester Medical Center/New York Medical College, New York, New York, USA
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21
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Hsieh MC, Lefante C, Straif-Bourgeois S, Yi Y, Gomez N, Shrestha P, Chen VW, Wu XC. Racial/ethnic and socioeconomic disparities in COVID-19 infections among working-age women with precancerous cervical lesion in Louisiana: analysis of more than two years of COVID-19 data. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1108452. [PMID: 38455937 PMCID: PMC10911027 DOI: 10.3389/fepid.2023.1108452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/18/2023] [Indexed: 03/09/2024]
Abstract
Background Precancerous cervical lesion (PCL) is common in working-age and minority women. In Louisiana, 98% of PCL cases were diagnosed at age 18-65 with over 90% of them being human papillomavirus (HPV)-related. PCL women represent those who may be immunocompromised from the precancerous condition and thus more vulnerable to SARS-CoV-2. Most studies evaluating racial disparities for COVID-19 infection have only used data prior to vaccine availability. This study assessed disparities by race/ethnicity and socioeconomic status (SES) in COVID-19 infections among working-age PCL women for pre- and post-COVID-19 vaccine availability. Methods Louisiana women aged 18-65 with PCL diagnosed in 2009-2021 were linked with the Louisiana statewide COVID-19 database to identify those with positive COVID-19 test. Race/ethnicity was categorized as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and others. The census tract SES quintiles were created based on American Community Survey estimates. Logistic regression was employed to assess the racial/ethnic and SES differences in COVID-19 infections. Results Of 14,669 eligible PCL women, 30% were tested COVID-19 positive. NHB had the highest percentage of COVID-19 infection (34.6%), followed by NHW (27.7%). The infection percentage was inversely proportional to SES, with 32.9% for women having the lowest SES and 26.8% for those with the highest SES. NHB women and those with lower SES had higher COVID-19 infection than their counterparts with an aOR of 1.37 (95% CI 1.25-1.49) and 1.21 (95% CI 1.07-1.37), respectively. In the pre-vaccine period, NHB and Hispanic women had higher odds of infection than NHW women. However, after the vaccine was implemented, the significant racial/ethnic and SES differences in COVID-19 infections still existed in PCL women residing in non-Greater New Orleans area. Conclusions There are substantial variations in racial/ethnic and SES disparities in COVID-19 infections among working-age women with PCL, even after vaccine implementation. It is imperative to provide public health interventions and resources to reduce this unequal burden for this vulnerable population.
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Affiliation(s)
- Mei-Chin Hsieh
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Christina Lefante
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Susanne Straif-Bourgeois
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Yong Yi
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Natalie Gomez
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Pratibha Shrestha
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Vivien W. Chen
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
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22
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Maqsood MH, Talha KM, Minhas AMK, Fudim M, Khan SS, Butler J, Khan MS. CDC-WONDER Database Analysis of COVID-19 and Cardiovascular Disease-Related Mortality. J Am Coll Cardiol 2023; 81:1743-1745. [PMID: 37100492 PMCID: PMC10124577 DOI: 10.1016/j.jacc.2023.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 04/28/2023]
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23
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Giotta M, Addabbo F, Mincuzzi A, Bartolomeo N. The Impact of the COVID-19 Pandemic and Socioeconomic Deprivation on Admissions to the Emergency Department for Psychiatric Illness: An Observational Study in a Province of Southern Italy. Life (Basel) 2023; 13:life13040943. [PMID: 37109472 PMCID: PMC10143488 DOI: 10.3390/life13040943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
The restriction measures adopted to limit population movement in order to contain the COVID-19 pandemic contributed to a global public health system crisis. This retrospective study aimed at identifying changes in psychiatric admissions to Accident and Emergency Departments (A&Es) in a province in southern Italy during the first two years of the pandemic and was characterized by two different restriction levels (phases 2 and 3) compared to the pre-pandemic period (phase 1). We also investigated the role of socioeconomic deprivation (DI) on psychiatric admissions. The total number of patients admitted to the A&Es was 291,310. The incidence of admission for a psychiatric disorder (IPd) was 4.9 per 1000 admissions, with a significant younger median age of 42 [IQR 33–56] compared to non-psychiatric patients (54 [35–73]). The type of admission and type of discharge were factors related to the psychiatric admission to A&E, and their relationship was modified by the pandemic. In the first year of the pandemic, patients with psychomotor agitation increased compared to the pre-pandemic period (72.5% vs. 62.3%). In the period preceding the spread of SARS-CoV-2, the IPd was equal to 3.33 ± 0.19; after the pandemic started, there was an increase in the IPd: 4.74 ± 0.32 for phase 2 and 3.68 ± 0.25 for phase 3. The IPd was higher for psychiatric admissions from areas with a very low DI compared to areas with a low DI; however, during phase 2, this difference was reduced. In conclusion, an increase in admissions for psychiatric disease was observed during the initial spread of SARS-CoV-2. Patients who lived in the most deprived municipalities generally came to the A&Es less than others, probably because the patients and their families had less awareness of their mental health. Therefore, public health policies to address these issues are needed to reduce the pandemic’s impact on these conditions.
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Affiliation(s)
- Massimo Giotta
- School of Medical Statistics and Biometry, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Francesco Addabbo
- School of Medical Statistics and Biometry, University of Bari Aldo Moro, Azienda Sanitaria Locale Taranto, 74121 Taranto, Italy
| | - Antonia Mincuzzi
- Unit of Statistics and Epidemiology, Azienda Sanitaria Locale Taranto, 74121 Taranto, Italy
| | - Nicola Bartolomeo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
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24
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Is the Gap Closing? Comparison of Sociodemographic Disparities in COVID-19 Hospitalizations and Outcomes Between Two Temporal Waves of Admissions. J Racial Ethn Health Disparities 2023; 10:593-602. [PMID: 35199327 PMCID: PMC8865177 DOI: 10.1007/s40615-022-01249-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has disproportionately impacted minority communities, yet little data exists regarding whether disparities have improved at a health system level. This study examined whether sociodemographic disparities in hospitalization and clinical outcomes changed between two temporal waves of hospitalized COVID-19 patients. METHODS This is a retrospective cohort study of primary care patients at Mass General Brigham (a large northeastern health system serving 1.27 million primary care patients) hospitalized in-system with COVID-19 between March 1, 2020, and March 1, 2021, categorized into two 6-month "wave" periods. We used chi-square tests to compare demographics between waves, and regression analysis to characterize the association of race/ethnicity and language with in-hospital severe outcomes (death, hospice discharge, intensive unit care need). RESULTS Hispanic/Latino, Black, and non-English-speaking patients constituted 30.3%, 12.5%, and 29.7% of COVID-19 admissions in wave 1 (N = 5844) and 22.2%, 9.0%, and 22.7% in wave 2 (N = 4007), compared to 2019 general admission proportions of 8.8%, 6.3%, and 7.7%, respectively. Admissions from highly socially vulnerable census tracts decreased between waves. Non-English speakers had significantly higher odds of severe illness during wave 1 (OR 1.35; 95% CI: 1.10, 1.66) compared to English speakers; this association was non-significant during wave 2 (OR 1.01; 95% CI: 0.76, 1.36). CONCLUSIONS Comparing two COVID-19 temporal waves, significant sociodemographic disparities in COVID-19 admissions improved between waves but continued to persist over a year, demonstrating the need for ongoing interventions to truly close equity gaps. Non-English-speaking language status independently predicted worse hospitalization outcomes in wave 1, underscoring the importance of targeted and effective in-hospital supports for non-English speakers.
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25
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Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality. J Racial Ethn Health Disparities 2023; 10:859-869. [PMID: 35290647 PMCID: PMC8922978 DOI: 10.1007/s40615-022-01274-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To examine the role of race/ethnicity and social determinants of health on COVID-19 care and outcomes for patients within a healthcare system that provided virtual hospital care. METHODS This retrospective cohort study included 12,956 adults who received care for COVID-19 within an integrated healthcare system between 3/1/2020 and 8/31/2020. Multinomial models were used to examine associations between race/ethnicity, insurance, neighborhood deprivation measured by Area Deprivation Index (ADI), and outcomes of interest. Outcomes included (1) highest level of care: virtual observation (VOU), virtual hospitalization (VACU), or inpatient hospitalization; (2) intensive care (ICU); and (3) all-cause 30-day mortality. RESULTS Patients were 41.8% White, 27.2% Black, and 31.0% Hispanic. Compared to White patients, Black patients had 1.86 higher odds of VACU admission and 1.43 higher odds of inpatient hospitalization (vs. VOU). Hispanic patients had 1.24 higher odds of inpatient hospitalization (vs. VOU). In models stratified by race/ethnicity, Hispanic and Black patients had higher odds of inpatient hospitalization (vs. VOU) if Medicaid insured compared to commercially insured. Hispanic patients living in the most deprived neighborhood had higher odds of inpatient hospitalization, compared to those in the least deprived neighborhood. Black and Hispanic patients had higher odds of ICU admission and 30-day mortality after adjustment for other social determinants. CONCLUSIONS Insurance and ADI were associated with COVID-19 outcomes; however, associations varied by race/ethnicity. Racial/ethnic disparities in outcomes are not fully explained by measured social determinants of health, highlighting the need for further investigation into systemic causes of inequities in COVID-19 outcomes.
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If you build it, will they come? Is test site availability a root cause of geographic disparities in COVID-19 testing? Public Health 2023; 216:21-26. [PMID: 36764116 PMCID: PMC9485419 DOI: 10.1016/j.puhe.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the relationship between test site availability and testing rate within the context of social determinants of health. STUDY DESIGN A retrospective ecological investigation was conducted using statewide COVID-19 testing data between March 2020 and December 2021. METHODS Ordinary least squares and geographically weighted regression were used to estimate state and ZIP code level associations between testing rate and testing sites per capita, adjusting for neighbourhood-level confounders. RESULTS The findings indicate that site availability is positively associated with the ZIP code level testing rate and that this association is amplified in communities of greater economic deprivation. In addition, economic deprivation is a key factor for consideration when examining ethnic differences in testing in medically underserved states. CONCLUSION The study findings could be used to guide the delivery of testing facilities in resource-constrained states.
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Anand S, Cao E, Kimura R, Guo W, Bassi N. Asian American Vaccination, Testing, and Other Healthcare Knowledge & Behaviors during COVID-19, A Systematic Review. Pathog Glob Health 2023; 117:120-133. [PMID: 35892162 PMCID: PMC9970223 DOI: 10.1080/20477724.2022.2106110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Novel COVID-19 variants continue to endanger global public health. Increasing COVID-19 vaccination, healthcare-related preventative behaviors, and general knowledge rates are all critical in halting COVID-19 spread. We evaluated Asian American COVID-19 healthcare-related behaviors and knowledge, due to the dearth of knowledge in this area and the unique social factor of COVID-19 related discrimination; discriminatory acts during the pandemic may play a role in COVID-19 related behavior adherence. Following PRISMA-P protocol, we conducted a systematic review. The search strategy combined synonyms of health-care behaviors and knowledge. Reviewers synthesized key themes across articles and assessed studies utilizing modified Newcastle-Ottawa criteria. Of the 2,518 articles, 32 were selected. Asian Americans reported greater COVID-19 vaccination willingness and decreased COVID-19 testing relative to other racial groups. Common COVID-19 vaccination concerns included vaccination side effects, long-term safety, and distrust of COVID-19 information sources. Asian Americans had high COVID-19 preventative behavior rates including mask-wearing, handwashing, and social isolation compared to other ethnic groups. Asian Americans, conversely, had lower COVID-19-related healthcare knowledge and telemedicine adoption levels relative to other participants. This systematic review informs public health officials and clinicians of COVID-19 related healthcare knowledge and behaviors in the Asian American population. Equipped with this knowledge, public health officials can better target messaging about vaccine safety concerns to the Asian American community and recognize the importance of tailoring COVID-19 educational materials to the heterogeneous Asian American subpopulations. This systematic review also provides insight into the unique telemedicine challenges physicians may face when engaging with Asian American patients.
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Affiliation(s)
- Sahil Anand
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Evan Cao
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Reona Kimura
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - William Guo
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Naresh Bassi
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
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Antibody responses to second doses of COVID-19 vaccination in lung cancer patients undergoing treatment. Respir Investig 2023; 61:247-253. [PMID: 36567161 PMCID: PMC9750888 DOI: 10.1016/j.resinv.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/13/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several reports have revealed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tends to have more severe outcomes in cancer patients. Although vaccination reduces the risk of severe disease, data on antibody titers achieved by vaccination is scarce in cancer patients. METHODS We collected 79 blood samples (69 lung cancer patients and 10 control individuals) and conducted an anti-SARS-CoV-2 antibody assay to compare the antibody titer achieved with current treatment. Sixty-eight patients (86%) received the BNT162 mRNA vaccine and 11 (14%) received the mRNA-1273 vaccine. They were categorized according to the current treatment: control individuals without cancer (cohort A), lung cancer patients who were treated with cytotoxic chemotherapy (cohort B), immunotherapy (cohort C), combination of cytotoxic chemotherapy and immunotherapy (cohort D), tyrosine kinase inhibitors (cohort E), and radiation therapy (cohort F). RESULTS Among 69 lung cancer patients (cohort B-F), 57 (83%) had adenocarcinoma, and 66 (96%) had advanced-stage cancer. In the anti-SARS-CoV-2 antibody assay, the antibody titer was significantly lower in lung cancer patients than in control individuals (p = 0.01). The median antibody titers were 161 AU/ml in control individuals and 59.9 AU/ml in lung cancer patients. CONCLUSIONS Antibody titers after the second vaccination were lower in cancer patients than those in healthy individuals. Our findings provide essential information for understanding the benefits and necessity of additional vaccination to prevent SARS-CoV-2 infection in lung cancer patients.
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Koebnick C, Sidell MA, Li X, Resnicow K, Kunani P, Young DR, Woolford SJ. Disparities in weight changes during the COVID-19 pandemic-related lockdown in youths. Obesity (Silver Spring) 2023; 31:789-801. [PMID: 36350042 PMCID: PMC9877933 DOI: 10.1002/oby.23645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study evaluates whether changes in weight among school-aged youth in California due to the COVID-19 lockdown vary by social constructs of race/ethnicity and associated social factors. METHODS Including 160,472 youth aged 5 to 17 years enrolled at Kaiser Permanente Southern California, mixed effects models stratified by age group were fitted to estimate changes in distance from the median BMI-for-age from March 2020 to January 2021 (lockdown) compared with the same period before the pandemic. RESULTS Excess pandemic weight gain was higher among Black and Hispanic youth aged 5 to 17 years than among White and Asian youth; this difference was most pronounced in those aged 5 to 11 years. In youth aged 5 to 11 years, the distance from the median BMI-for-age increased by 1.72 kg/m2 (95% CI: 1.61-1.84) in Hispanic and 1.70 kg/m2 (95% CI: 1.47-1.94) in Black youth during the lockdown compared with 1.16 kg/m2 (95% CI: 1.02-1.29) in non-Hispanic White youth. The excess weight gain was also higher in youth with fewer neighborhood parks and those with state-subsidized health insurance. CONCLUSIONS The COVID-19 pandemic lockdown led to a gain of excess body weight, particularly for Black and Hispanic youth; this weight gain varied by social factors associated with race and ethnicity.
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Affiliation(s)
- Corinna Koebnick
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Margo A. Sidell
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Xia Li
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Ken Resnicow
- School of Public HealthUniversity of Michigan Health Behavior and Health EducationAnn ArborMI
| | - Poornima Kunani
- Department of PediatricsKaiser Permanente Manhattan Beach Medical OfficeManhattan BeachCA
| | - Deborah R. Young
- Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Susan J. Woolford
- Child Health Evaluation and Research Center, Department of PediatricsUniversity of MichiganAnn ArborMI
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Chen S, Campbell J, Spain E, Woodruff A, Snider C. Improving the representativeness of the tribal behavioral risk factor surveillance system through data integration. BMC Public Health 2023; 23:273. [PMID: 36750936 PMCID: PMC9904248 DOI: 10.1186/s12889-023-15159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Previous literature showed significant health disparities between Native American population and other populations such as Non-Hispanic White. Most existing studies for Native American Health were based on non-probability samples which suffer with selection bias. In this paper, we are the first to evaluate the effectiveness of data integration methods, including calibration and sequential mass imputation, to improve the representativeness of the Tribal Behavioral Risk Factor Surveillance System (TBRFSS) in terms of reducing the biases of the raw estimates. METHODS We evaluated the benefits of our proposed data integration methods, including calibration and sequential mass imputation, by using the 2019 TBRFSS and the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). We combined the data from the 2018 and 2019 BRFSS by composite weighting. Demographic variables and general health variables were used as predictors for data integration. The following health-related variables were used for evaluation in terms of biases: Smoking status, Arthritis status, Cardiovascular Disease status, Chronic Obstructive Pulmonary Disease status, Asthma status, Cancer status, Stroke status, Diabetes status, and Health Coverage status. RESULTS For most health-related variables, data integration methods showed smaller biases compared with unadjusted TBRFSS estimates. After calibration, the demographic and general health variables benchmarked with those for the BRFSS. CONCLUSION Data integration procedures, including calibration and sequential mass imputation methods, hold promise for improving the representativeness of the TBRFSS.
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Affiliation(s)
- Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Janis Campbell
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Erin Spain
- Southern Plains Tribal Health Board, Oklahoma City, OK USA
| | - Alexandra Woodruff
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Cuyler Snider
- Southern Plains Tribal Health Board, Oklahoma City, OK USA
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Shortreed SM, Gray R, Akosile MA, Walker RL, Fuller S, Temposky L, Fortmann SP, Albertson-Junkans L, Floyd JS, Bayliss EA, Harrington LB, Lee MH, Dublin S. Increased COVID-19 Infection Risk Drives Racial and Ethnic Disparities in Severe COVID-19 Outcomes. J Racial Ethn Health Disparities 2023; 10:149-159. [PMID: 35072944 PMCID: PMC8785693 DOI: 10.1007/s40615-021-01205-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
COVID-19 inequities have been well-documented. We evaluated whether higher rates of severe COVID-19 in racial and ethnic minority groups were driven by higher infection rates by evaluating if disparities remained when analyses were restricted to people with infection. We conducted a retrospective cohort study of adults insured through Kaiser Permanente (Colorado, Northwest, Washington), follow-up in March-September 2020. Laboratory results and hospitalization diagnosis codes identified individuals with COVID-19. Severe COVID-19 was defined as invasive mechanical ventilation or mortality. Self-reported race and ethnicity, demographics, and medical comorbidities were extracted from health records. Modified Poisson regression estimated adjusted relative risks (aRRs) of severe COVID-19 in full cohort and among individuals with infection. Our cohort included 1,052,774 individuals, representing diverse racial and ethnic minority groups (e.g., 68,887 Asian, 41,243 Black/African American, 93,580 Hispanic or Latino/a individuals). Among 7,399 infections, 442 individuals experienced severe COVID-19. In the full cohort, severe COVID-19 aRRs for Asian, Black/African American, and Hispanic individuals were 2.09 (95% CI: 1.36, 3.21), 2.02 (1.39, 2.93), and 2.09 (1.57, 2.78), respectively, compared to non-Hispanic Whites. In analyses restricted to individuals with COVID-19, all aRRs were near 1, except among Asian Americans (aRR 1.82 [1.23, 2.68]). These results indicate increased incidence of severe COVID-19 among Black/African American and Hispanic individuals is due to higher infection rates, not increased susceptibility to progression. COVID-19 disparities most likely result from social, not biological, factors. Future work should explore reasons for increased severe COVID-19 risk among Asian Americans. Our findings highlight the importance of equity in vaccine distribution.
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Affiliation(s)
- Susan M. Shortreed
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA ,Department of Biostatistics, University of Washington, F-600, Health Sciences Building, 1705 NE Pacific Street, Seattle, WA 98195-7232 USA
| | - Regan Gray
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA
| | - Mary Abisola Akosile
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA
| | - Rod L. Walker
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA
| | - Sharon Fuller
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA
| | - Lisa Temposky
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA
| | - Stephen P. Fortmann
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227 USA
| | - Ladia Albertson-Junkans
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA
| | - James S. Floyd
- Department of Medicine, University of Washington, RR-512, Health Sciences Building, 1959 NE Pacific Street, Seattle, WA 98195 USA ,Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Elizabeth A. Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014 USA ,Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17th Ave, Box F 496, Aurora, CO 80045 USA
| | - Laura B. Harrington
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA ,Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Mi H. Lee
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227 USA
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste 1600, Seattle, WA 98101 USA ,Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
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Durojaiye C, Prausnitz S, Elkin EP, Escobar P, Finn L, Chen YFI, Lieu TA. Changes in COVID-19 Vaccine Intent Among a Diverse Population of Older Adults, June 2021-February 2022. Perm J 2022; 26:78-84. [PMID: 36530052 PMCID: PMC9761285 DOI: 10.7812/tpp/22.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction COVID-19 vaccination rates remain suboptimal in the United States. Clinicians and policymakers need to better understand how likely vaccine-hesitant individuals are to ultimately accept vaccination and what is associated with such changes. This study's aims were to 1) describe changes between vaccine intentions and actual uptake from June 2021 through February 2022, and 2) identify modifiable factors associated with vaccine uptake among those with initial hesitancy. Methods This cohort study included a stratified random sample of adults aged 65 years and older in an integrated health care system. The survey, conducted June through August 2021, elicited intent and perceptions regarding COVID-19 vaccination. Subsequent vaccine uptake through February 2022 was analyzed using electronic health records. Results Of 1195 individuals surveyed, 66% responded; 213 reported not yet having received a COVID-19 vaccine and were further analyzed. At baseline, most individuals said they would definitely not (42%) or probably not (5%) get the COVID-19 vaccine or were not sure (26%). During follow-up, 61 individuals (29%) were vaccinated, including 19% of those who initially said they would definitely not be vaccinated. Among vaccine-hesitant individuals, the rate of vaccination was highest for those who initially considered COVID-19 less dangerous than the vaccine (46%) or named short-term side effects (36%) as their most important concern. Conclusions COVID-19 vaccine intent among older adults was malleable during the pandemic's second year, even among those who initially said they would definitely not be vaccinated. Vaccine uptake could be enhanced by increasing awareness of COVID-19 risks and by addressing vaccine side effects.
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Affiliation(s)
- Cimone Durojaiye
- 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA,Cimone Durojaiye, MPH
| | - Stephanie Prausnitz
- 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Eric P Elkin
- 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA,2TPMG Consulting Services, Oakland, CA, USA
| | | | - Lucy Finn
- 2TPMG Consulting Services, Oakland, CA, USA
| | | | - Tracy A Lieu
- 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA,4The Permanente Medical Group, Oakland, CA, USA
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Priem JS, Krinner LM, Constantine ST, McCurdy L. Diversification of COVID-19 Testing Resources to Decrease Racial/Ethnic Disparities: Comparative Use of Adaptive Approaches to Community Testing Across an Integrated Healthcare System. DIALOGUES IN HEALTH 2022; 1:100017. [PMID: 36942315 PMCID: PMC9135493 DOI: 10.1016/j.dialog.2022.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/10/2022]
Abstract
Background: Access to SARS-CoV-2 testing is a crucial component of early identification and disease containment. Racial and ethnic health disparities exist related to testing utilization. To optimize testing with limited resources, Atrium Health developed free-standing and roving testing centers outside of the traditional clinical settings in hopes of meeting the needs of a diverse urban community. The objective of this study is to evaluate differences in testing site utilization based on demographic factors, particularly race/ethnicity. Methods:A cohort study of patients tested for COVID-19 between March 10 and October 26, 2020, within the Atrium Health system. Results: 128,258 persons under investigation (PUIs) were tested across our health system, including 25,434 patients at our Mobile Integrated Health (previously called Community Paramedicine) drive-thru testing sites and community roving testing units. PUIs were on average 47 years old (SD = 17.7); approximately half were female and White/Caucasian. Drive-thru testing sites were utilized proportionally more by non-Hispanic Whites and African Americans, and less by Hispanic PUIs. Roving testing units were used significantly more by younger PUIs, Hispanics, and PUIs of other races/ethnicities. Conclusions: Diversification in testing site locations optimized testing resources, allowed for significant reduction in the burden of patient volumes, and avoided alteration of workflow in our urgent care facilities and Emergency Departments. Additionally, roving testing units may help to decrease racial/ethnic disparities in access to COVID-19 testing. Our results highlight the importance of offering a variety of testing modalities to reach different populations.
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Affiliation(s)
- Jennifer S. Priem
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, Charlotte, NC, USA
| | - Lisa M. Krinner
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, Charlotte, NC, USA
| | - S. Tyler Constantine
- Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Charlotte, NC, USA
| | - Lewis McCurdy
- Department of Medicine, Division of Infectious Diseases, Atrium Health, Charlotte, NC, USA
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Ramos E, Baca-Motes K, Pandit JA, Ajayi TA. Improving participant representation in the era of digital clinical studies. Trends Mol Med 2022; 28:1019-1021. [PMID: 35995691 DOI: 10.1016/j.molmed.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 01/21/2023]
Abstract
Traditional clinical research relies on conventional strategies to invite and enroll research participants. However, these strategies often fail to reach potential participants from marginalized communities or that reflect the diversity of the nation, such as race, ethnicity, or geography. As we discuss here, the digital clinical study model sets the stage for improved and equitable participation in biomedical research.
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Affiliation(s)
- Edward Ramos
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct Plaza Level, La Jolla, CA 92037, USA; CareEvolution, 625 N Main St, Ann Arbor, MI 48104, USA.
| | - Katie Baca-Motes
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct Plaza Level, La Jolla, CA 92037, USA
| | - Jay A Pandit
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct Plaza Level, La Jolla, CA 92037, USA
| | - Toluwalase A Ajayi
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct Plaza Level, La Jolla, CA 92037, USA
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COVID-19 testing in Delaware’s underserved communities: demographic and social determinants of testing inequality. DISCOVER SOCIAL SCIENCE AND HEALTH 2022; 2:9. [PMID: 35782702 PMCID: PMC9236969 DOI: 10.1007/s44155-022-00013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022]
Abstract
Background Health experts believe that frequent COVID-19 testing is one of the most important practices for stopping the spread of the COVID-19 virus. Demographic and social factors might play a role in whether a person gets tested for COVID. This present study aimed to investigate (1) the demographic and social factors affecting a person’s likelihood of getting tested for COVID-19, and (2) the demographic and social factors related to a positive serology test (i.e., indicating likely past infection). Methods Data were extracted from a survey conducted in Delaware’s underserved communities. Participants were asked to complete a questionnaire about their COVID-19 testing history, and nurses at the study site collected a serology sample from each participant. Results Our results indicated that Black or Hispanic individuals living in underserved communities had greater odds of having been tested previously for COVID compared to being non-Hispanic White. In addition, our study found that being female, educated, feeling safe in one’s neighborhood, being vaccinated against COVID, and being an essential worker increased one’s odds of having been previously tested for COVID-19. Regarding the results of the COVID-19 antibody serology tests, our findings revealed that Hispanic respondents were more likely to have a positive serology test compared to non-Hispanic White respondents, indicating that the Hispanic individuals were more likely to contract the virus. Educated individuals were less likely to have a positive serology test compared to the less-educated. Those who expressed hesitancy about getting vaccinated for COVID-19 and identified themselves as essential workers were more likely to have a positive serology test and to have previously contracted the virus. Conclusions Identifying key factors associated with COVID-19 testing may help establish novel strategies to increase testing rates among vulnerable population. Public health and policy implications are discussed in the article.
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Pecoraro J, Bakour C, Oberne A, Mehmood A. Masking Behaviors in the Absence of Local Mandate-An Observational Study from Hillsborough County, Florida. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15982. [PMID: 36498054 PMCID: PMC9738456 DOI: 10.3390/ijerph192315982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this study was to understand the predictors of masking-especially age, race/ethnicity and gender-in Hillsborough County Florida, a region without mask mandates. Masking and social distancing behaviors of individuals were observed in Hillsborough County during one-week intervals in July 2021, August 2021 and Late September-early October 2021. Demographic and behavioral observations were recorded and logistic regression was utilized to determine the odds ratio of wearing a mask amongst various groups. Overall, masking ranged from 36.80% to 48.64%, peaking during the second observation period. Masking rates were highest amongst people of color, women and seniors. Establishments posting mask-negative language, such as "masks NOT required," saw a 46% decrease in the odds of masking compared to establishments without mask-related signage (thereby defaulting to no mandate). Understanding who engaged in masking and social distancing behaviors will provide local public health officials with a deeper understanding of the effectiveness of previously used strategies, which can be leveraged in future surges of COVID-19 and other emergencies to create maximum impact. Lessons learned regarding policy implementation and understanding patterns of uptake of health guidelines are important for the continuous improvement of public health practice.
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Luo Y, Li Q, Jeong H, Cheatham L. The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups. BMC Public Health 2022; 22:2193. [PMID: 36443734 PMCID: PMC9702892 DOI: 10.1186/s12889-022-14486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). METHODS This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates-including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19-four sets of weighted binary logistic regressions were conducted. RESULTS The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05). CONCLUSION Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.
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Affiliation(s)
- Yan Luo
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA ,grid.410445.00000 0001 2188 0957The University of Hawaiʻi at Mānoa, HI Honolulu, USA
| | - Qingyi Li
- grid.5386.8000000041936877XDepartment of Psychology, Cornell University, Ithaca, NY 14850 USA
| | - Haelim Jeong
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
| | - Leah Cheatham
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
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Jefferson C, Watson E, Certa JM, Gordon KS, Park LS, D’Souza G, Benning L, Abraham AG, Agil D, Napravnik S, Silverberg MJ, Leyden WA, Skarbinski J, Williams C, Althoff KN, Horberg MA. Differences in COVID-19 testing and adverse outcomes by race, ethnicity, sex, and health system setting in a large diverse US cohort. PLoS One 2022; 17:e0276742. [PMID: 36417366 PMCID: PMC9683575 DOI: 10.1371/journal.pone.0276742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Racial/ethnic disparities during the first six months of the COVID-19 pandemic led to differences in COVID-19 testing and adverse outcomes. We examine differences in testing and adverse outcomes by race/ethnicity and sex across a geographically diverse and system-based COVID-19 cohort collaboration. METHODS Observational study among adults (≥18 years) within six US cohorts from March 1, 2020 to August 31, 2020 using data from electronic health record and patient reporting. Race/ethnicity and sex as risk factors were primary exposures, with health system type (integrated health system, academic health system, or interval cohort) as secondary. Proportions measured SARS-CoV-2 testing and positivity; attributed hospitalization and death related to COVID-19. Relative risk ratios (RR) with 95% confidence intervals quantified associations between exposures and main outcomes. RESULTS 5,958,908 patients were included. Hispanic patients had the highest proportions of SARS-CoV-2 testing (16%) and positivity (18%), while Asian/Pacific Islander patients had the lowest portions tested (11%) and White patients had the lowest positivity rates (5%). Men had a lower likelihood of testing (RR = 0.90 [0.89-0.90]) and a higher positivity risk (RR = 1.16 [1.14-1.18]) compared to women. Black patients were more likely to have COVID-19-related hospitalizations (RR = 1.36 [1.28-1.44]) and death (RR = 1.17 [1.03-1.32]) compared with White patients. Men were more likely to be hospitalized (RR = 1.30 [1.16-1.22]) or die (RR = 1.70 [1.53-1.89]) compared to women. These racial/ethnic and sex differences were reflected in both health system types. CONCLUSIONS This study supports evidence of disparities by race/ethnicity and sex during the COVID-19 pandemic that persisted even in healthcare settings with reduced barriers to accessing care. Further research is needed to understand and prevent the drivers that resulted in higher burdens of morbidity among certain Black patients and men.
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Affiliation(s)
- Celeena Jefferson
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America
| | - Eric Watson
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America
- * E-mail:
| | - Julia M. Certa
- United Health Group, Fredrick, Maryland, United States of America
| | - Kirsha S. Gordon
- Yale School of Medicine, Department of General Internal Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Lesley S. Park
- Stanford Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alison G. Abraham
- Department of Epidemiology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States of America
| | - Deana Agil
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Wendy A. Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Carolyn Williams
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America
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Gerken J, Zapata D, Kuivinen D, Zapata I. Comorbidities, sociodemographic factors, and determinants of health on COVID-19 fatalities in the United States. Front Public Health 2022; 10:993662. [PMID: 36408029 PMCID: PMC9669977 DOI: 10.3389/fpubh.2022.993662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Previous studies have evaluated comorbidities and sociodemographic factors individually or by type but not comprehensively. This study aims to analyze the influence of a wide variety of factors in a single study to better understand the big picture of their effects on case-fatalities. This cross-sectional study used county-level comorbidities, social determinants of health such as income and race, measures of preventive healthcare, age, education level, average household size, population density, and political voting patterns were all evaluated on a national and regional basis. Analysis was performed through Generalized Additive Models and adjusted by the COVID-19 Community Vulnerability Index (CCVI). Effect estimates of COVID-19 fatality rates for risk factors such as comorbidities, sociodemographic factors and determinant of health. Factors associated with reducing COVID-19 fatality rates were mostly sociodemographic factors such as age, education and income, and preventive health measures. Obesity, minimal leisurely activity, binge drinking, and higher rates of individuals taking high blood pressure medication were associated with increased case fatality rate in a county. Political leaning influenced case case-fatality rates. Regional trends showed contrasting effects where larger household size was protective in the Midwest, yet harmful in Northeast. Notably, higher rates of respiratory comorbidities such as asthma and chronic obstructive pulmonary disease (COPD) diagnosis were associated with reduced case-fatality rates in the Northeast. Increased rates of chronic kidney disease (CKD) within counties were often the strongest predictor of increased case-fatality rates for several regions. Our findings highlight the importance of considering the full context when evaluating contributing factors to case-fatality rates. The spectrum of factors identified in this study must be analyzed in the context of one another and not in isolation.
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Honeycutt CC, Contento J, Kim J, Patil A, Balu S, Sendak M. Assessment of Practices Affecting Racial and Ethnic COVID-19 Vaccination Equity in 10 Large US Cities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E778-E788. [PMID: 36194821 PMCID: PMC9560901 DOI: 10.1097/phh.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT In the United States, COVID-19 vaccines have been unequally distributed between different racial and ethnic groups. Public reporting of race and ethnicity data for COVID-19 vaccination has the potential to help guide public health responses aimed at promoting vaccination equity. However, there is evidence that such data are not readily available. OBJECTIVES This study sought to assess gaps and discrepancies in COVID-19 vaccination reporting in 10 large US cities in July 2021. DESIGN, SETTING, AND PARTICIPANTS For the 10 cities selected, we collected COVID-19 vaccination and population data using publicly available resources, such as state health department Web sites and the US Census Bureau American Community Survey. We examined vaccination plans and news sources to identify initial proposals and evidence of implementation of COVID-19 vaccination best practices. MAIN OUTCOME MEASURE We performed quantitative assessment of associations of the number of vaccination best practices implemented with COVID-19 racial and ethnic vaccination equity. We additionally assessed gaps and discrepancies in COVID-19 vaccination reporting between states. RESULTS Our analysis did not show that COVID-19 vaccination inequity was associated with the number of vaccination best practices implemented. However, gaps and variation in reporting of racial and ethnic demographic vaccination data inhibited our ability to effectively assess whether vaccination programs were reaching minority populations. CONCLUSIONS Lack of consistent public reporting and transparency of COVID-19 vaccination data has likely hindered public health responses by impeding the ability to track the effectiveness of strategies that target vaccine equity.
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Affiliation(s)
- Christopher Cole Honeycutt
- Duke University, Durham, North Carolina (Mr Honeycutt and Mss Contento and Kim); The College of New Jersey, Ewing, New Jersey (Ms Patil); and Duke Institute for Health Innovation, Duke University School of Medicine, Durham, North Carolina (Mr Balu and Dr Sendak)
| | - Jacqueline Contento
- Duke University, Durham, North Carolina (Mr Honeycutt and Mss Contento and Kim); The College of New Jersey, Ewing, New Jersey (Ms Patil); and Duke Institute for Health Innovation, Duke University School of Medicine, Durham, North Carolina (Mr Balu and Dr Sendak)
| | - Joanne Kim
- Duke University, Durham, North Carolina (Mr Honeycutt and Mss Contento and Kim); The College of New Jersey, Ewing, New Jersey (Ms Patil); and Duke Institute for Health Innovation, Duke University School of Medicine, Durham, North Carolina (Mr Balu and Dr Sendak)
| | - Ankita Patil
- Duke University, Durham, North Carolina (Mr Honeycutt and Mss Contento and Kim); The College of New Jersey, Ewing, New Jersey (Ms Patil); and Duke Institute for Health Innovation, Duke University School of Medicine, Durham, North Carolina (Mr Balu and Dr Sendak)
| | - Suresh Balu
- Duke University, Durham, North Carolina (Mr Honeycutt and Mss Contento and Kim); The College of New Jersey, Ewing, New Jersey (Ms Patil); and Duke Institute for Health Innovation, Duke University School of Medicine, Durham, North Carolina (Mr Balu and Dr Sendak)
| | - Mark Sendak
- Duke University, Durham, North Carolina (Mr Honeycutt and Mss Contento and Kim); The College of New Jersey, Ewing, New Jersey (Ms Patil); and Duke Institute for Health Innovation, Duke University School of Medicine, Durham, North Carolina (Mr Balu and Dr Sendak)
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Robertson MM, Shamsunder MG, Brazier E, Mantravadi M, Zimba R, Rane MS, Westmoreland DA, Parcesepe AM, Maroko AR, Kulkarni SG, Grov C, Nash D. Racial/Ethnic Disparities in Exposure, Disease Susceptibility, and Clinical Outcomes during COVID-19 Pandemic in National Cohort of Adults, United States. Emerg Infect Dis 2022; 28:2171-2180. [PMID: 36191624 PMCID: PMC9622253 DOI: 10.3201/eid2811.220072] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We examined racial/ethnic disparities for COVID-19 seroconversion and hospitalization within a prospective cohort (n = 6,740) in the United States enrolled in March 2020 and followed-up through October 2021. Potential SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity. Hispanic and Black non-Hispanic participants had more exposure risk and difficulty with healthcare access than white participants. Participants with more exposure had greater odds of seroconversion. Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization. Race/ethnicity positively modified the association between susceptibility and hospitalization. Findings might help to explain the disproportionate burden of SARS-CoV-2 infections and complications among Hispanic/Latino/a and Black non-Hispanic persons. Primary and secondary prevention efforts should address disparities in exposure, vaccination, and treatment for COVID-19.
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Collie-Akers VL, Ablah E, Landry S, Honn A, Mussulman L, Ricketts M, Carter T, Wright U, Watson C, Liu B, Crawford B, Greiner KA, Ellerbeck EF. Understanding Barriers to COVID-19 Testing Among Rural and Urban Populations in Kansas. Am J Public Health 2022; 112:S874-S877. [PMID: 36265091 PMCID: PMC9707727 DOI: 10.2105/ajph.2022.306978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Vicki L Collie-Akers
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Elizabeth Ablah
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Sarah Landry
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Allison Honn
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Laura Mussulman
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Mary Ricketts
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Tony Carter
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Ullyses Wright
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Christal Watson
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Bing Liu
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Broderick Crawford
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - K Allen Greiner
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
| | - Edward F Ellerbeck
- Vicki L. Collie-Akers, Sarah Landry, and Edward F. Ellerbeck are with the Department of Population Health, University of Kansas School of Medicine, Kansas City. Elizabeth Ablah and Allison Honn are with the Department of Population Health, University of Kansas School of Medicine, Wichita. Laura Mussulman is with the Clinical Translational Science Unit, University of Kansas Medical Center, Fairway. Mary Ricketts is with Turning Point Training and Consultation, Overland Park, KS. Tony Carter is with Salem Missionary Baptist Church, Kansas City, KS. Ullyses Wright is an at-large community member, Overland Park. Christal Watson is with the Kansas City, Kansas, Schools Foundation. Bing Liu is with the Department of Biostatistics, University of Kansas School of Medicine, Kansas City. Broderick Crawford is with NBC Community Development Corp, Kansas City, KS. K. Allen Greiner is with the Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City
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Zhu YJ, Tang K, Zhao FJ, Yu BY, Liu TT, Zhang LL. Impact of Social Deprivation on Hospitalization and Intensive Care Unit Admission among COVID-19 Patients: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:2458-2471. [PMID: 36561272 PMCID: PMC9745414 DOI: 10.18502/ijph.v51i11.11163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/17/2022] [Indexed: 11/21/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged groups; however, the association between socioeconomic status and healthcare utilization among COVID-19 patients remains unclear. Therefore, a systematic review and meta-analysis was conducted to assess the association between socioeconomic status and hospitalization and intensive care unit admission among COVID-19 patients. Methods PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for relevant literature (updated to Jun 2022). Studies that investigated the association of social deprivation with hospitalization and intensive care unit admission in COVID-19 patients were included. The primary outcomes included risk of hospitalization and intensive care unit admission, measured by odds ratio. Results Eleven studies covering 2,423,095 patients were included in the meta-analysis. Socially disadvantaged patients had higher odds of hospitalization in comparison to socially advantaged patients (odds ratio 1.25, 95% confidence interval: 1.14 to 1.38; P<0.01). The odds of intensive care unit admission among more deprived patients was not significantly different from that of less deprived patients (odds ratio 1.03, 95% confidence interval: 0.78 to 1.35; P=0.85). These findings were proven robust through subgroup and sensitivity analyses. Conclusion Socially disadvantaged populations have higher odds of hospitalization if they become infected with COVID-19. More effective medical support and interventions for these vulnerable populations are required to reduce inequity in healthcare utilization and alleviate the burden on healthcare systems.
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Affiliation(s)
- Yang-Jie Zhu
- Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China
| | - Kang Tang
- Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China
| | - Fang-Jie Zhao
- Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China
| | - Bo-Yang Yu
- Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China, Department of Medical Health Service, General Hospital of Northern Theater Command of PLA, Shenyang 110016, China
| | - Tong-Tong Liu
- Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China, Department of Medical Health Service, 969th Hospital of PLA Joint Logistics Support Forces, Hohhot 010051, China
| | - Lu-Lu Zhang
- Department of Military Health Management, College of Health Service, Naval Medical University, Shanghai 200433, China,Corresponding Author:
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Bozio CH, Butterfield K, Irving SA, Vazquez-Benitez G, Ong TC, Zheng K, Ball SW, Naleway AL, Barron M, Reed C. Relative Risks of COVID-19-Associated Hospitalizations and Clinical Outcomes by Age and Race/Ethnicity-March 2020-March 2021. Open Forum Infect Dis 2022; 9:ofac376. [PMID: 36204160 PMCID: PMC9532249 DOI: 10.1093/ofid/ofac376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
Abstract
Background Limited data exist on population-based risks and risk ratios (RRs) of coronavirus disease 2019 (COVID-19)–associated hospitalizations and clinical outcomes stratified by age and race/ethnicity. Methods Using data from electronic health records and claims from 4 US health systems for the period March 2020–March 2021, we calculated risk and RR by age and race/ethnicity for COVID-19–associated hospitalizations and clinical outcomes among adults (≥18 years). COVID-19–associated hospitalizations were defined based on COVID-19 discharge codes or a positive severe acute respiratory syndrome coronavirus 2 result. Proportions of acute exacerbations of underlying conditions were estimated among hospitalized patients with select underlying conditions, stratified by age and race/ethnicity. Results Among 2.6 million adults included in the patient cohort, 6879 had COVID-19–associated hospitalizations during March 2020–March 2021 (risk: 264 per 100 000 population). Compared with younger, non-Hispanic White adults, non-Hispanic Black and Hispanic adults aged ≥65 years had the highest hospitalization risk ratios (RR, 8.6; 95% CI, 7.6–9.9; and RR, 9.3; 95% CI, 8.5–10.3, respectively). Among hospitalized adults with COVID-19 and renal disease or cardiovascular disease, the highest proportion of acute renal failure (55.5%) or congestive heart failure (43.9%) occurred in older, non-Hispanic Black patients. Among hospitalized adults with chronic lung disease or asthma, the highest proportion of respiratory failure (62.9%) or asthma exacerbation (66.7%) occurred in older, Hispanic patients. Conclusions During the first year of the US COVID-19 pandemic in this cohort, older non-Hispanic Black and Hispanic adults had the highest relative risks of COVID-19–associated hospitalization and adverse outcomes and, among those with select underlying conditions, the highest occurrences of acute exacerbations of underlying conditions.
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Affiliation(s)
- Catherine H Bozio
- Correspondence: C. Bozio, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-7, Atlanta, GA 30333 ()
| | | | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Toan C Ong
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kai Zheng
- University of California, Irvine, California, USA
| | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Michelle Barron
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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Castro AD, Mayr FB, Talisa VB, Shaikh OS, Omer SB, Yende S, Butt AA. Variation in Clinical Treatment and Outcomes by Race Among US Veterans Hospitalized With COVID-19. JAMA Netw Open 2022; 5:e2238507. [PMID: 36282499 PMCID: PMC9597393 DOI: 10.1001/jamanetworkopen.2022.38507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Patients from racially and ethnically minoritized populations, such as Black and Hispanic patients, may be less likely to receive evidence-based COVID-19 treatments than White patients, contributing to adverse clinical outcomes. OBJECTIVE To determine whether clinical treatments and outcomes among patients hospitalized with COVID-19 were associated with race. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in 130 Department of Veterans Affairs Medical Centers (VAMCs) between March 1, 2020, and February 28, 2022, with a 60-day follow-up period until May 1, 2022. Participants included veterans hospitalized with COVID-19. Data were analyzed from May 6 to June 2, 2022. EXPOSURES Self-reported race. MAIN OUTCOMES AND MEASURES Clinical care processes (eg, intensive care unit [ICU] admission; organ support measures, including invasive and noninvasive mechanical ventilation; prone position therapy, and COVID-19-specific medical treatments) were quantified. Clinical outcomes of interest included in-hospital mortality, 60-day mortality, and 30-day readmissions. Outcomes were assessed with multivariable random effects logistic regression models to estimate the association of race with outcomes not attributable to known mediators, such as socioeconomic status and age, while adjusting for potential confounding between outcomes and mediators. RESULTS A total of 43 222 veterans (12 135 Black veterans [28.1%]; 31 087 White veterans [71.9%]; 40 717 [94.2%] men) with a median (IQR) age of 71 (62-77) years who were hospitalized with SARS-CoV-2 infection were included. Controlling for site of treatment, Black patients were equally likely to be admitted to the ICU (4806 Black patients [39.6%] vs 13 427 White patients [43.2%]; within-center adjusted odds ratio [aOR], 0.95; 95% CI, 0.88-1.02; P = .17). Two-thirds of patients treated with supplemental oxygen or noninvasive or invasive mechanical ventilation also received systemic steroids, but Black veterans were less likely to receive steroids (within-center aOR, 0.88; 95% CI, 0.80-0.96; P = .004; between-center aOR, 0.67; 95% CI, 0.48-0.96; P = .03). Similarly, Black patients were less likely to receive remdesivir (within-center aOR, 0.89; 95% CI, 0.83-0.95; P < .001; between-center aOR, 0.68; 95% CI, 0.47-0.99; P = .02) or treatment with immunomodulatory drugs (within-center aOR, 0.77; 95% CI, 0.67-0.87; P < .001). After adjusting for patient demographic characteristics, chronic health conditions, severity of acute illness, and receipt of COVID-19-specific treatments, there was no association of Black race with hospital mortality (within-center aOR, 0.98; 95% CI, 0.86-1.10; P = .71) or 30-day readmission (within-center aOR, 0.95; 95% CI, 0.88-1.04; P = .28). CONCLUSIONS AND RELEVANCE These findings suggest that Black veterans hospitalized with COVID-19 were less likely to be treated with evidence-based COVID-19 treatments, including systemic steroids, remdesivir, and immunomodulatory drugs.
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Affiliation(s)
| | - Florian B. Mayr
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Victor B. Talisa
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Obaid S. Shaikh
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Saad B. Omer
- Institute for Global Health, Yale University, New Haven, Connecticut
| | - Sachin Yende
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adeel A. Butt
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Doha, Qatar
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Lane J, Palacio A, Chen LE, McCarter D, Tamariz L, Chen CJ, Ghany R. Access to Health Care Improves COVID-19 Vaccination and Mitigates Health Disparities Among Medicare Beneficiaries. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01343-1. [PMID: 36171495 PMCID: PMC9518942 DOI: 10.1007/s40615-022-01343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Abstract
Background COVID-19 disproportionately impacts the elderly, particularly racial/ethnic minorities and those with low socioeconomic status (SES). These latter groups may also have higher vaccine hesitancy. We aim to evaluate if access to care improves COVID-19 vaccination rates and improves health disparities. Methods We conducted a retrospective cohort study of Medicare patients receiving care in a high-touch capitated network across ten states. We collected type and date of COVID-19 vaccine and demographic and clinical data from the inpatient and outpatient electronic health records and socioeconomic status from the US census. Our primary outcome was completing vaccination using logistic regression. Results Our cohort included 93,224 patients enrolled in the network during the study period. Sixty nine percent of all enrolled patients completed full vaccination. Those who completed vaccination did it with Pfizer (46%), Moderna (49%), and Jannsen (4.6%) vaccines. In adjusted models, we found that the following characteristics increased the odds of being vaccinated: being male, increasing age, BMI, and comorbidities, being Black or Hispanic, having had the flu vaccine in 2020, and increasing number of office primary care visits. Living in a neighborhood with higher social deprivation and having dual Medicaid/Medicare enrollment decreased the odds of completing full vaccination. Conclusions Increasing office visit in a high-touch primary care model is associated with higher vaccination rates among elderly populations who belong to racial/ethnic minorities or have low socioeconomic status. However, lower SES and Medicaid populations continue to have difficulty in completing vaccination. Key points • High COVID-19 vaccination rates of minorities enrolled in Medicare can be achieved. • Lower socioeconomic status is associated with completing vaccination. • Increasing office visits can lead to higher vaccination rates. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01343-1.
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Affiliation(s)
- Jason Lane
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Ana Palacio
- Chen Neighborhood Medical Centers, Miller School of Medicine at the University of Miami, 1120 NW 14th St, Suite 1124, Miami, FL, 33136, USA.,The Geriatric Research and Education Center, Veterans Affairs Medical Center, Miami, FL, USA
| | - Li Ern Chen
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Daniel McCarter
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Leonardo Tamariz
- Chen Neighborhood Medical Centers, Miller School of Medicine at the University of Miami, 1120 NW 14th St, Suite 1124, Miami, FL, 33136, USA. .,The Geriatric Research and Education Center, Veterans Affairs Medical Center, Miami, FL, USA.
| | - Christopher James Chen
- Chen Neighborhood Medical Centers, Miller School of Medicine at the University of Miami, 1120 NW 14th St, Suite 1124, Miami, FL, 33136, USA
| | - Reyan Ghany
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL, USA
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Shoji K, Tsuzuki S, Akiyama T, Matsunaga N, Asai Y, Suzuki S, Iwamoto N, Funaki T, Yamada M, Ozawa N, Yamaguchi K, Miyairi I, Ohmagari N. Comparison of clinical characteristics of COVID-19 in pregnant women between the Delta and Omicron variants of concern predominant periods. J Infect Chemother 2022; 29:33-38. [PMID: 36103949 PMCID: PMC9464469 DOI: 10.1016/j.jiac.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
Background Information regarding effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant strains on clinical manifestations and outcomes of coronavirus disease 2019 (COVID-19) in pregnant women is limited. Methods A retrospective observational study was conducted using the data from the nationwide COVID-19 registry in Japan. We identified pregnant patients with symptomatic COVID-19 hospitalized during the study period. The Delta and Omicron variants of concern (VOC) predominant periods were defined as August 1 to December 31, 2021 and January 1 to May 31, 2022, respectively. Clinical characteristics were compared between the patients in the Delta and Omicron VOC periods. In addition, logistic regression analysis was performed to identify risk factors for developing moderate-to-severe COVID-19. Results During the study period, 310 symptomatic COVID-19 cases of pregnant women were identified; 111 and 199 patients were hospitalized during the Delta and Omicron VOC periods, respectively. Runny nose and sore throat were more common, and fatigue, dysgeusia, and olfactory dysfunction were less common manifestations observed in the Omicron VOC period. In the multivariable logistic regression analysis, onset during the later stage of pregnancy (OR: 2.08 [1.24–3.71]) and onset during the Delta VOC period (OR: 2.25 [1.08–4.90]) were independently associated with moderate-to-severe COVID-19, whereas two doses of SARS-CoV-2 vaccine were protective against developing moderate-to-severe COVID-19 (OR: 0.34 [0.13–0.84]). Conclusions Clinical manifestations of COVID-19 in pregnant women differed between the Delta and Omicron VOC periods. SARS-CoV-2 vaccination was still effective in preventing severe COVID-19 throughout the Delta and Omicron VOC periods.
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Affiliation(s)
- Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
| | - Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takayuki Akiyama
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Setsuko Suzuki
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Iwamoto
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takanori Funaki
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Masaki Yamada
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department for Advanced Medicine for Viral Infections, National Center for Child Health and Development, Tokyo, Japan
| | - Nobuaki Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koushi Yamaguchi
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Bartolomeo N, Giotta M, Tafuri S, Trerotoli P. Impact of Socioeconomic Deprivation on the Local Spread of COVID-19 Cases Mediated by the Effect of Seasons and Restrictive Public Health Measures: A Retrospective Observational Study in Apulia Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811410. [PMID: 36141682 PMCID: PMC9517341 DOI: 10.3390/ijerph191811410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 05/22/2023]
Abstract
The aim of this study was to investigate the spatiotemporal association between socioeconomic deprivation and the incidence of COVID-19 and how this association changes through the seasons due to the existence of restrictive public health measures. A retrospective observational study was conducted among COVID-19 cases that occurred in the Apulia region from 29 February 2020 to 31 December 2021, dividing the period into four phases with different levels of restrictions. A generalized estimating equation (GEE) model was applied to test the independent effect of deprivation on the incidence of COVID-19, taking into account age, sex, and regional incidence as possible confounding effects and covariates, such as season and levels of restrictions, as possible modifying effects. The highest incidence was in areas with a very high deprivation index (DI) in winter. During total lockdown, no rate ratio between areas with different levels of DI was significant, while during soft lockdown, areas with very high DI were more at risk than all other areas. The effects of social inequalities on the incidence of COVID-19 changed in association with the seasons and restrictions on public health. Disadvantaged areas showed a higher incidence of COVID-19 in the cold seasons and in the phases of soft lockdown.
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49
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Le Gars M, Hendriks J, Sadoff J, Ryser M, Struyf F, Douoguih M, Schuitemaker H. Immunogenicity and efficacy of Ad26.COV2.S: An adenoviral vector-based COVID-19 vaccine. Immunol Rev 2022; 310:47-60. [PMID: 35689434 PMCID: PMC9349621 DOI: 10.1111/imr.13088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/26/2022]
Abstract
Since its emergence in late 2019, the coronavirus disease 2019 (COVID-19) pandemic has caused substantial morbidity and mortality. Despite the availability of efficacious vaccines, new variants with reduced sensitivity to vaccine-induced protection are a troubling new reality. The Ad26.COV2.S vaccine is a recombinant, replication-incompetent human adenovirus type 26 vector encoding a full-length, membrane-bound severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein in a prefusion-stabilized conformation. This review discusses the immunogenicity and efficacy of Ad26.COV2.S as a single-dose primary vaccination and as a homologous or heterologous booster vaccination. Ad26.COV2.S elicits broad humoral and cellular immune responses, which are associated with protective efficacy/effectiveness against SARS-CoV-2 infection, moderate to severe/critical COVID-19, and COVID-19-related hospitalization and death, including against emerging SARS-CoV-2 variants. The humoral immune responses elicited by Ad26.COV2.S vaccination are durable, continue to increase for at least 2-3 months postvaccination, and involve a range of functional antibodies. Ad26.COV2.S given as a heterologous booster to mRNA vaccine-primed individuals markedly increases humoral and cellular immune responses. The use of Ad26.COV2.S as primary vaccination and as part of booster regimens is supporting the ongoing efforts to control and mitigate the COVID-19 pandemic.
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Affiliation(s)
| | - Jenny Hendriks
- Janssen Vaccines and Prevention, Leiden, The Netherlands
| | - Jerald Sadoff
- Janssen Vaccines and Prevention, Leiden, The Netherlands
| | - Martin Ryser
- Janssen Research and Development, Beerse, Belgium
| | - Frank Struyf
- Janssen Research and Development, Beerse, Belgium
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50
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Rapid Implementation of a Community-Academic Partnership Model to Promote COVID-19 Vaccine Equity within Racially and Ethnically Minoritized Communities. Vaccines (Basel) 2022; 10:vaccines10081364. [PMID: 36016251 PMCID: PMC9415044 DOI: 10.3390/vaccines10081364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has highlighted inequities in mortalities and associated illnesses among non-Hispanic Black and Hispanic/Latino individuals. Immunization against COVID-19 is critical to ending the pandemic, especially within racial and ethnically minoritized communities. However, vaccine hesitancy and institutional mistrust in these communities, resulting from decades of mistreatment, structural racism, and barriers to vaccination access, have translated into low vaccination uptake. Trustworthy relationships with healthcare professionals and partnerships with faith and community leaders are critical to increasing vaccination rates within these minoritized communities. Loma Linda University researchers collaborated with local faith and community organizations in San Bernardino County, CA, to rapidly implement a three-tiered approach to increase the vaccination rates within non-Hispanic Black and Hispanic/Latino communities. This community–academic partnership model provided over 1700 doses of the COVID-19 vaccine within these vaccine-hesitant, targeted minoritized communities. As over 100,000 individuals are diagnosed with COVID-19 daily and updated vaccines targeting variants of the Omicron strain are expected to rollout in the coming months, the development of sustainable programs aimed at increasing vaccine uptake within vulnerable communities are of the utmost importance.
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