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Weiss CR, Roberts M, Florell M, Wood R, Johnson-Koenke R, Amura CR, Kissler K, Barton AJ, Jones J. Best Practices for Telehealth in Nurse-Led Care Settings-A Qualitative Study. Policy Polit Nurs Pract 2024; 25:47-57. [PMID: 37750219 PMCID: PMC10841034 DOI: 10.1177/15271544231201417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The COVID-19 pandemic in the US prompted a sudden shift to telehealth in nurse-led care sites which provide services to diverse geolocations. Using a lens of intersectionality, this study characterizes provider and patient-perceived best and promising practices emerging from geographical variation. The aim of this study was to identify best practices of implementing telehealth in nurse-led care models in Colorado through patient and provider experiences of the sudden implementation of telehealth that can enhance health equity. In this exploratory/descriptive qualitative study, a purposive sample of 18 providers and 30 patients were interviewed using a guide informed by the RE-AIM implementation and evaluation framework to capture the contextual experiences related to the sudden shift to telehealth. Textual theme analysis and reflexive team strategies guided the interpretation. Four primary themes of perceived best practices were identified: using multiple modalities, tailoring triage and scheduling, cultivating safety through boundaries and expectations, and differentiating established versus new patient relationships. The findings suggest that telehealth is a flexible and powerful tool to enhance the delivery of equitable care through nurse-led care models within diverse communities such as the one represented in this study. Nurse leaders are positioned to participate in innovative research and create policies and protocols to ensure telehealth is a viable resource to deliver equitable, safe, and accessible high-quality healthcare.
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Affiliation(s)
- Charlotte R. Weiss
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Mia Roberts
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Melissa Florell
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Rachel Wood
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Rachel Johnson-Koenke
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Claudia R. Amura
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Katherine Kissler
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Amy J. Barton
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
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Worku F, Bennett F, Wheeler S, Siddiqi A, Papadakos J. Exploring the COVID-19 Knowledge, Attitudes, and Practices (KAPs) in the Black Community: a Scoping Review. J Racial Ethn Health Disparities 2024; 11:273-299. [PMID: 36757610 PMCID: PMC9910259 DOI: 10.1007/s40615-023-01518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION AND BACKGROUND Racial minorities have been the focal point of media coverage, attributing the disproportionate impact of COVID-19 to their individual actions; however, the ability to engage in preventative practices can also depend on one's social determinants of health. Individual actions can include knowledge, attitudes, and practices (KAPs). Since Black communities are among those disproportionately affected by COVID-19, this scoping review explores what is known about COVID-19 KAPs among Black populations. METHODS A comprehensive literature search was conducted in 2020 for articles written in English from the Medline, Embase, and PsycInfo databases. Reviews, experimental research, and observational studies were included if they investigated at least one of COVID-19 KAP in relation to the pandemic and Black communities in OECD peer countries including Canada, the United States, and the United Kingdom. RESULTS AND ANALYSIS Thirty-one articles were included for analysis, and all employed observational designs were from the United States. The following KAPs were examined: 6 (18.8%) knowledge, 21 (65.6%) attitudes, and 22 (68.8%) practices. Black communities demonstrated high levels of adherence to preventative measures (e.g., lockdowns) and practices (e.g., mask wearing), despite a strong proportion of participants believing they were less likely to become infected with the virus, and having lower levels of COVID-19 knowledge, than other racial groups. CONCLUSIONS AND IMPLICATIONS The findings from this review support that Black communities highly engage in COVID-19 preventative practices within their realm of control such as mask-wearing and hand washing and suggest that low knowledge does not predict low practice scores among this population.
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Affiliation(s)
- Fiqir Worku
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada.
| | - Falan Bennett
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Papadakos
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Siddiqui S, Bouhassira D, Kelly L, Hayes M, Herbst A, Ohnigian S, Hedrick L, Ayala KO, Talmor DS, Stevens JP. Examining the Role of Race in End-of-Life Care in the Intensive Care Unit: A Single-Center Observational Study. Palliat Med Rep 2023; 4:264-273. [PMID: 37732026 PMCID: PMC10507941 DOI: 10.1089/pmr.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Background Prior studies have shown variation in the intensity of end-of-life care in intensive care units (ICUs) among patients of different races. Objective We sought to identify variation in the levels of care at the end of life in the ICU and to assess for any association with race and ethnicity. Design An observational, retrospective cohort study. Settings A tertiary care center in Boston, MA. Participants All critically ill patients admitted to medical and surgical ICUs between June 2019 and December 2020. Exposure Self-identified race and ethnicity. Main Outcome and Measure The primary outcome was death. Secondary outcomes included "code status," markers of intensity of care, consultation by the Palliative care service, and consultation by the Ethics service. Results A total of 9083 ICU patient encounters were analyzed. One thousand two hundred fifty-nine patients (14%) died in the ICU; the mean age of patients was 64 years (standard deviation 16.8), and 44% of patients were women. A large number of decedents (22.7%) did not have their race identified. These patients had a high rate of interventions at death. Code status varied by race, with more White patients designated as "Comfort Measures Only" (CMO) (74%) whereas more Black patients were designated as "Do Not Resuscitate/Do Not Intubate (DNR/DNI) and DNR/ok to intubate" (12.1% and 15.7%) at the end of life; after adjustment for age and severity of illness, there were no statistical differences by race for the use of the CMO code status. Use of dialysis at the end of life varied by self-identified race. Specifically, Black and Unknown patients were more likely to receive renal replacement therapy, even after adjustment for age and severity of illness (24% and 20%, p = 0.003). Conclusions Our data describe a gap in identification of race and ethnicity, as well as differences at the end of life in the ICU, especially with respect to code status and certain markers of intensity.
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Affiliation(s)
- Shahla Siddiqui
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Bouhassira
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Kelly
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Hayes
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pulmonary Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Austin Herbst
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pulmonary Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Ohnigian
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pulmonary Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Luke Hedrick
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pulmonary Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Ona Ayala
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel S. Talmor
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer P. Stevens
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pulmonary Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Mehrotra‐Varma J, Kumthekar A, Henry S, Fleysher R, Hou W, Duong TQ. Hospitalization, Critical Illness, and Mortality Outcomes of COVID-19 in Patients With Rheumatoid Arthritis. ACR Open Rheumatol 2023; 5:465-473. [PMID: 37530460 PMCID: PMC10502846 DOI: 10.1002/acr2.11580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE To investigate the clinical outcomes of patients with rheumatoid arthritis (RA) with COVID-19. METHODS This retrospective study consisted of 361 patients with RA+ and 45,954 patients with RA- (March 2020 to August 2022) who tested positive for SARS-CoV-2 by polymerase-chain-reaction in the Montefiore Health System, which serves a large low-income, minority-predominant population in the Bronx and was an epicenter of the initial pandemic and subsequent surges. Primary outcomes were hospitalization, critical illness, and all-cause mortality associated with SARS-CoV-2 infection. Comparisons were made with and without adjustment for covariates, as well as with 1083 matched controls of patients with RA- and COVID-19. RESULTS Patients with RA+ and COVID-19 were older (62.2 ± 23.5 vs. 45.5 ± 26.3; P < 0.001), were more likely females (83.1% vs. 55.8%; P < 0.001), were Black (35.5% vs. 30.3%; P < 0.05), and had higher rates of comorbidities (P < 0.05), hospitalization (52.4% vs. 32.5%; P < 0.005), critical illness (10.5% vs. 6.9%; P < 0.05), and mortality (11.1% vs. 6.2%; P < 0.01) compared with patients with RA- and COVID-19. Patients with RA+ with COVID-19 had higher odds of critical illness (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.09-1.93; P = 0.008) but no differences in hospitalization (aOR = 1.18 [95% CI: 0.93-1.49]; P = 0.16) and mortality (aOR = 1.34 [95% CI: 0.92-1.89]; P = 0.10) after adjusting for covariates. Odds ratio analysis identified age, hospitalization status, female sex, chronic kidney disease, chronic obstructive pulmonary disease, and Black race to be significant risk factors for COVID-19-related mortality. Pre-COVID-19 steroid and biologic therapy to treat RA were not significantly associated with worse outcomes (P > 0.05). Outcomes were not different between patients with RA+ and propensity-matched RA- controls (P > 0.05). CONCLUSION Our findings suggest that risk factors for adverse COVID-19 outcomes were not attributed to RA per se but rather age and preexisting medical conditions of patients with RA.
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Affiliation(s)
- Jai Mehrotra‐Varma
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Anand Kumthekar
- Department of Medicine, Division of Rheumatology, Albert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Sonya Henry
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Roman Fleysher
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Wei Hou
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Tim Q. Duong
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
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Zitek T, Bui J, Eily A, Farcy DA. Discrepancies in Outcomes by Race and Ethnicity in COVID-19 Patients Receiving Casirivimab and Imdevimab. South Med J 2023; 116:15-19. [PMID: 36578112 PMCID: PMC9812297 DOI: 10.14423/smj.0000000000001498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The Centers for Disease Control and Prevention has reported increased rates of coronavirus disease 2019 (COVID-19)-related hospitalizations and deaths in Black and Hispanic individuals. One contributing factor to this may be a difference in access to treatment. We thus sought to compare the outcomes of Black, non-Hispanic patients and Hispanic patients with White, non-Hispanic individuals using a group of patients with COVID-19 who received casirivimab/imdevimab. METHODS This was a secondary analysis of data from a previously published retrospective chart review of patients who received casirivimab/imdevimab for COVID-19 between December 9, 2020 and August 20, 2021, when they were treated at one of three facilities within a single hospital system. We compared the baseline characteristics (including age, sex, body mass index, duration of symptoms, and vaccination status) and outcomes of Black, non-Hispanic patients and Hispanic patients with those of White, non-Hispanic patients. Our primary outcome was the odds of a return visit to the emergency department (ED) within 28 days of treatment as assessed by multivariate logistic regression. We also assessed the rates of return visits to the ED for symptoms caused by COVID-19, hospitalizations, and hospitalizations from hypoxia. RESULTS In total, 1318 patients received casirivimab/imdevimab for COVID-19 at the three study facilities. Of these, 410 (31.1%) identified themselves as White and non-Hispanic, 88 (6.7%) as Black and non-Hispanic, and 736 (55.8%) as Hispanic. Vaccination rates at the time of treatment were as follows: Black, non-Hispanic 10.2%, Hispanic 13.6%, and White, non-Hispanic 21.5%. On multivariate analysis, the odds of return visits to the ED within 28 days were higher for Black, non-Hispanic patients and Hispanic patients as compared with White, non-Hispanic patients, with odds ratios of 2.8 (95% confidence interval [CI] 1.4-5.5, P = 0.003) and of 2.3 (95% CI 1.5-3.6, P = 0.0002), respectively. For hospitalizations caused by hypoxia within 28 days of treatment, the adjusted odds ratio for Black, non-Hispanic patients was 3.4 (95% CI 1.1-10.5, P = 0.03) as compared with White, non-Hispanic patients. There were no other statistically significant differences among groups in regard to subsequent hospitalizations within 28 days. CONCLUSIONS Black, non-Hispanic patients and Hispanic patients are more likely to make a return visit to the ED within 28 days after casirivimab/imdevimab treatment for COVID-19 as compared with White, non-Hispanic patients. This holds true even when adjusting for higher vaccination rates among White, non-Hispanic individuals.
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Affiliation(s)
- Tony Zitek
- From the Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
| | - Joseph Bui
- Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Alyssa Eily
- From the Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
| | - David A. Farcy
- From the Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
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Armato J, DeFronzo RA, Chiu S, Rider D, Ruby R. Are angiotensin-converting enzyme inhibitors/angiotensin receptor blockers associated with reduced severe acute respiratory syndrome coronavirus 2 infections and improved outcomes, and does race matter? Diabetes Obes Metab 2022; 24:2465-2468. [PMID: 35971756 PMCID: PMC9539006 DOI: 10.1111/dom.14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 11/27/2022]
Affiliation(s)
- John Armato
- Providence Little Company of Mary Cardiometabolic CenterProvidence Medical InstituteTorranceCaliforniaUSA
| | - Ralph A. DeFronzo
- Diabetes DivisionUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Shih‐Ting Chiu
- Providence, Oregon and Southwest WashingtonPortlandOregonUSA
| | | | - Ronald Ruby
- Providence Little Company of Mary Cardiometabolic CenterProvidence Medical InstituteTorranceCaliforniaUSA
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Bogan E, Adams‐Bass VN, Francis LA, Gaylord‐Harden NK, Seaton EK, Scott JC, Williams JL. “Wearing a Mask Won't Protect Us from Our History”: The Impact of COVID‐19 on Black Children and Families. Social Policy Report 2022. [PMCID: PMC9350213 DOI: 10.1002/sop2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Erin Bogan
- The Collaborative for Academic Social, and Emotional Learning
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Abuelezam NN, Greenwood KL, Galea S, Al-Naser R. Differential COVID-19 testing, admissions, and mortality for Arab Americans in Southern California. PLoS One 2022; 17:e0267116. [PMID: 35421208 DOI: 10.1371/journal.pone.0267116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 04/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Understanding of COVID-19 acquisition and severity risk in minoritized groups is limited by data collection on race and ethnicity; very little is known about COVID-19 risk among Arab Americans in the United States. PURPOSE To quantify whether Arab Americans in the El Cajon region of California experienced differential levels of SARS-CoV-2 infection, severity and mortality when compared to other racial/ethnic groups. METHODS A retrospective study was conducted using Sharp Grossmont Hospital's electronic medical records. Patients were included in the study if they were: 18 years of age or older, tested for SARS-CoV-2, admitted for COVID-19 infection, or had COVID-19 listed as a cause of death between March 1, 2020 and January 31, 2021. The primary outcomes of interest were a positive COVID-19 test result, admission to the hospital due to COVID-19, and in hospital COVID-19 related mortality. Comparisons were made across racial/ethnic groups using chi-squared statistics and logistic regression models adjusted for sociodemographics, comorbidities, and time from March 2020. RESULTS Arab Americans had greater odds of testing positive for SARS-CoV-2 than non-Hispanic White (adjusted odds ratio, AOR: 3.83, 95% confidence interval, CI: 3.29, 4.46) and non-Hispanic Black (AOR: 2.34, 95% CI: 1.91, 2.88) patients but lower odds of admission (AOR: 0.47, 95% CI: 0.36, 0.63) and in-hospital mortality (AOR: 0.43, 95% CI: 0.28, 0.65) than Hispanic patients. CONCLUSIONS There were distinct patterns for COVID-19 infection, severity, and mortality for Arab Americans in Southern California. Without a dedicated ethnic identifier, COVID-19 disparities facing Arab Americans will continue to go undocumented.
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Sullivan PS, Siegler AJ, Shioda K, Hall EW, Bradley H, Sanchez T, Luisi N, Valentine-Graves M, Nelson KN, Fahimi M, Kamali A, Sailey C, Lopman BA. Severe Acute Respiratory Syndrome Coronavirus 2 Cumulative Incidence, United States, August 2020-December 2020. Clin Infect Dis 2022. [PMID: 34245245 DOI: 10.1093/cid/ciab626.pmid:34245245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Reported coronavirus disease 2019 (COVID-19) cases underestimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We conducted a national probability survey of US households to estimate cumulative incidence adjusted for antibody waning. METHODS From August-December 2020 a random sample of US addresses were mailed a survey and self-collected nasal swabs and dried blood spot cards. One adult household member completed the survey and mail specimens for viral detection and total (immunoglobulin [Ig] A, IgM, IgG) nucleocapsid antibody by a commercial, emergency use authorization-approved antigen capture assay. We estimated cumulative incidence of SARS-CoV-2 adjusted for waning antibodies and calculated reported fraction (RF) and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic, and clinical subgroups were explored. RESULTS Among 39 500 sampled households, 4654 respondents provided responses. Cumulative incidence adjusted for waning was 11.9% (95% credible interval [CrI], 10.5%-13.5%) as of 30 October 2020. We estimated 30 332 842 (CrI, 26 703 753-34 335 338) total infections in the US adult population by 30 October 2020. RF was 22.3% and IFR was 0.85% among adults. Black non-Hispanics (Prevalence ratio (PR) 2.2) and Hispanics (PR, 3.1) were more likely than White non-Hispanics to be seropositive. CONCLUSIONS One in 8 US adults had been infected with SARS-CoV-2 by October 2020; however, few had been accounted for in public health reporting. The COVID-19 pandemic is likely substantially underestimated by reported cases. Disparities in COVID-19 by race observed among reported cases cannot be attributed to differential diagnosis or reporting of infections in population subgroups.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Eric W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mariah Valentine-Graves
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Amanda Kamali
- California Department of Public Health, Sacramento, California, USA
| | | | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Abstract
Importance Social determinants of health have been shown to be key drivers of disparities in access to surgical care and surgical outcomes. Though the concept of social responsibility has received growing attention in the medical field, little has been published contextualizing social responsibility in surgery. In this narrative review, we define social responsibility as it relates to surgery, explore the duty of surgeons to society, and provide examples of social factors associated with adverse surgical outcomes and how they can be mitigated. Observations The concept of social responsibility in surgery has deep roots in medical codes of ethics and evolved alongside changing views on human rights and the role of social factors in disease. The ethical duty of surgeons to society is based on the ethical principles of benevolence and justice and is grounded within the framework of the social contract. Surgeons have a responsibility to understand how factors such as patient demographics, the social environment, clinician awareness, and the health care system are associated with inequitable patient outcomes. Through education, we can empower surgeons to advocate for their patients, address the causes and consequences of surgical disparities, and incorporate social responsibility into their daily practice. Conclusions and Relevance One of the greatest challenges in the field of surgery is ensuring that surgical care is provided in an equitable and sustainable way. Surgeons have a duty to understand the factors that lead to health care disparities and use their knowledge, skills, and privileged position to address these issues at the individual and societal level.
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Affiliation(s)
- Megan Janeway
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Spencer Wilson
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sabrina E Sanchez
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Tania K Arora
- Augusta University at the Medical College of Georgia, Augusta
| | - Tracey Dechert
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
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Abstract
The COVID-19 pandemic has highlighted socioeconomic and racial health disparities in the USA. In this study, we examined the COVID-19 pandemic as a threat multiplier for childhood health disparities by evaluating health behavior changes among urban St. Louis, MO, children (ages 6-14) during the COVID-19 pandemic. From 27 October to 10 December 2020, 122 parents/guardians reported on their children's health behaviors (Eating, Sleeping, Physical activity, Time outside, Time with friends in-person, Time with friends remotely, Time using media for educational proposes, Time using media for non-educational proposes, and Social connectedness) prior to and during the COVID-19 pandemic. We ran K-means cluster analyses to identify distinct health behavior cluster profiles. Relative risks were determined to evaluate behavioral differences between the two clusters. Two distinct cluster profiles were identified: a High Impact profile (n = 49) and a Moderate Impact profile (n = 73). Children in the High Impact cluster had a greater risk of being diagnosed with COVID-19, developed worsened eating habits (RR = 2.10; 95% CI = 1.50-2.93), spent less time sleeping, and spent less time outdoors (RR = 1.55; 95% CI = 1.03-2.43) than the Moderate Impact cluster. The High Impact cluster was more likely to include Black children and children from single-adult households than the Moderate Impact cluster (both p < 0.05). Our findings suggest that the COVID-19 pandemic may be a threat multiplier for childhood health disparities. Further research is needed to better understand the long-term effects of the COVID-19 pandemic on children's health.
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Affiliation(s)
- Nadav L Sprague
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Christine C Ekenga
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Wang Y, Liu Y. Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review. Prev Med Rep 2022; 25:101673. [PMID: 34934611 PMCID: PMC8675390 DOI: 10.1016/j.pmedr.2021.101673] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/05/2021] [Accepted: 12/12/2021] [Indexed: 01/10/2023] Open
Abstract
Vaccine hesitancy is a challenge for the success and optimal implementation of COVID-19 immunization programs in the US. The objective of this study was to summarize multilevel determinants of COVID-19 vaccination intention in the US to inform future intervention opportunities. To this end, we conducted a rapid systematic review by searching published articles via PubMed published by October 5, 2021, following the PRISMA guidelines. One hundred and six articles were included. According to nationally representative studies, the overall COVID-19 acceptance rate ranges from 53.6% to 84.4%. Individual (demographics, health history, behaviors and health beliefs), interpersonal (having a close friend/family member impacted by COVID-19), healthcare and societal level factors (healthcare provider recommendations, source/credential of COVID-19 related information, and COVID-19 related conspiracy theories) all contributed to COVID-19 vaccine hesitancy in the US. This study demonstrates that the acceptance to COVID-19 vaccines is influenced by various factors, particularly the role of healthcare providers in enhancing public intent to vaccination. Potential interventions to mitigate people's concerns over the vaccines and address vaccine-related conspiracy/misinformation from social media are also critical to encourage vaccine uptake in the US.
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Affiliation(s)
- Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, BOX 420644, Rochester, NY 14642, USA
| | - Yu Liu
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, BOX 420644, Rochester, NY 14642, USA
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14
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Seitz R, Robertson J, Moran TP, Zdradzinski MJ, Kaltiso SO, Heron S, Lall MD. Emergency Medicine Nurse Practitioner and Physician Assistant Burnout, Perceived Stress, and Utilization of Wellness Resources During 2020 in a Large Urban Medical Center. Adv Emerg Nurs J 2022; 44:63-73. [PMID: 35089284 DOI: 10.1097/TME.0000000000000392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objectives of this study were to measure perceived stress, burnout, and utilization and perceived benefit of wellness practices among emergency medicine (EM) nurse practitioners (NPs) and physician assistants (PAs). An additional aim was to evaluate attributions of stress to racism and the COVID-19 pandemic. A 28-item electronic survey of ED NPs/PAs at 3 hospitals was used to measure respondents' perceived stress (Perceived Stress Scale), stress attributed to COVID-19 and systemic racism, burnout (2-item measure), and utilization and helpfulness of wellness practices. The sample consisted of 53 ED NPs/PAs respondents (response rate 42.4%). More than one half (58.5%) reported burnout from their job, and a majority (58.5%) reported moderate to high stress. Burnout was reported by 70% of female respondents compared with 30.8% of male respondent (p = 0.002). A large majority (70%) of Black respondents reported concerns about experiencing racism at work, and 58.8% reported higher levels of stress attributed to racism. Respondents reported meals during shifts, community donated personal protective equipment, flexible work hours, and societal offerings of financial support (e.g., Internal Revenue Service stimulus check) as helpful. The COVID-19 pandemic and the impact of systemic racism are significant contributors to the stress and burnout of NPs/PAs. Female ED NPs/PAs disproportionally share the burden of burnout. Strategies to reduce burnout should be prioritized by institutional leadership. In addition, a majority of Black ED NPs/PAs are concerned about experiencing racism at work and report moderate to high stress associated with racism in general. There is an urgent need to address racism in the workplace with training on implicit bias, systemic racism, and allyship behavior.
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West R, DiMeo A, Langer A, Shah N, Molina RL. Addressing Racial/Ethnic Inequities in Maternal Health Through Community-Based Social Support Services: A Mixed Methods Study. Matern Child Health J 2022; 26:708-718. [PMID: 34982340 PMCID: PMC8724658 DOI: 10.1007/s10995-021-03363-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/24/2022]
Abstract
Introduction In the US, there are striking inequities in maternal health outcomes between racial and ethnic groups. Community-based organizations (CBOs) provide social support services that are critical in addressing the needs of clients of color during and after pregnancy. Methods We conducted a descriptive, cross-sectional mixed methods study of CBOs in Greater Boston that provide social support services to pregnant and postpartum clients. In May–August 2020, we administered an online survey about organizational characteristics, client population, and services offered. In July–August 2020, we conducted semi-structured interviews focused on services provided, gaps in services, and the impact of structural racism on clients. We used descriptive statistics to characterize CBOs and services and used thematic analysis to extract themes from the qualitative data. Results A total of 21 unique CBOs participated with 17 CBOs completing the survey and 14 participating in interviews. CBOs served between 10 and 35,000 pregnant and postpartum clients per year (median = 200), and about half (n = 8) focused their programming on pregnant and postpartum clients. The most significant gaps in social support services were housing and childcare. Respondents identified racism and lack of coordination among organizations as the two primary barriers to accessing social support. Discussion CBOs face multiple challenges to providing social support to pregnant and postpartum clients of color, and significant gaps exist in the types of services currently provided. Improved coordination among CBOs and advocacy efforts to develop community-informed solutions are needed to reduce barriers to social support.
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Affiliation(s)
- Rebecca West
- Boston University School of Public Health, Boston, MA USA
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Amanda DiMeo
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA USA
| | - Neel Shah
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Rose L. Molina
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
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16
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Starks TJ, Bosco SC, Doyle KM, Revenson TA. Partners' Consensus About Joint Effort and COVID-19 Prevention Among Sexual Minority Men. Arch Sex Behav 2022; 51:217-230. [PMID: 34155577 PMCID: PMC8216588 DOI: 10.1007/s10508-021-02063-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 05/07/2023]
Abstract
The current study examined the relevance of relationship functioning to partners' agreement or consensus about joint effort surrounding COVID-19 prevention. Interdependence theory has been widely used to understand how relationship partners influence health behavior, including how sexual minority male (SMM) couples regulate HIV risk. Couples with better relationship functioning tend to be more successful at negotiating joint (shared) goals and subsequently accomplishing them. The study recruited 134 cis-male, SARS-CoV-2 negative adults in relationships with cis-male partners from phone-based social networking applications. Participants completed an online survey assessing relationship functioning (Perceived Relationship Components Questionnaire), COVID-19 prevention behaviors, and risk perceptions. Partners' consensus around joint COVID-19 prevention effort was assessed using an adapted version of the Preferences for Sexual Health Outcomes scale. Path analyses indicated that consensus for joint prevention effort predicted social distancing (B = 0.23; p = .001) and the number of other COVID-19 prevention behaviors engaged in (B = 0.17; p = .003) above and beyond perceived risk and relationship functioning. Relationship satisfaction predicted higher levels of consensus for joint COVID-19 prevention effort (B = 0.40; p = .029). Findings suggest that the theoretical foundations of successful HIV prevention interventions that utilize joint goal formation may generalize to the prediction of COVID-19 prevention behavior and may be leveraged to mitigate the risk of SARS-CoV-2 infection among SMM in relationships. Interventions that overlook the potential for dyadic regulation of health behavior may miss opportunities to capitalize on shared coping resources and fail to address relational barriers to prevention.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, 10065, USA.
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA.
| | - Stephen C Bosco
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Kendell M Doyle
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Tracey A Revenson
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, 10065, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
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17
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Bergmann PJ, Ahlgren NA, Torres Stone RA. County-level societal predictors of COVID-19 cases and deaths changed through time in the United States: A longitudinal ecological study. PLOS Glob Public Health 2022; 2:e0001282. [PMID: 36962644 PMCID: PMC10022229 DOI: 10.1371/journal.pgph.0001282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022]
Abstract
People of different racial/ethnic backgrounds, demographics, health, and socioeconomic characteristics have experienced disproportionate rates of infection and death due to COVID-19. This study tests if and how county-level rates of infection and death have changed in relation to societal county characteristics through time as the pandemic progressed. This longitudinal study sampled monthly county-level COVID-19 case and death data per 100,000 residents from April 2020 to March 2022, and studied the relationships of these variables with racial/ethnic, demographic, health, and socioeconomic characteristics for 3125 or 97.0% of U.S. counties, accounting for 96.4% of the U.S. population. The association of all county-level characteristics with COVID-19 case and death rates changed significantly through time, and showed different patterns. For example, counties with higher population proportions of Black, Native American, foreign-born non-citizen, elderly residents, households in poverty, or higher income inequality suffered disproportionately higher COVID-19 case and death rates at the beginning of the pandemic, followed by reversed, attenuated or fluctuating patterns, depending on the variable. Patterns for counties with higher White versus Black population proportions showed somewhat inverse patterns. Counties with higher female population proportions initially had lower case rates but higher death rates, and case and death rates become more coupled and fluctuated later in the pandemic. Counties with higher population densities had fluctuating case and death rates, with peaks coinciding with new variants of COVID-19. Counties with a greater proportion of university-educated residents had lower case and death rates throughout the pandemic, although the strength of this relationship fluctuated through time. This research clearly shows that how different segments of society are affected by a pandemic changes through time. Therefore, targeted policies and interventions that change as a pandemic unfolds are necessary to mitigate its disproportionate effects on vulnerable populations, particularly during the first six months of a pandemic.
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Affiliation(s)
- Philip J Bergmann
- Department of Biology, Clark University, Worcester, MA, United States of America
| | - Nathan A Ahlgren
- Department of Biology, Clark University, Worcester, MA, United States of America
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18
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Shrestha SS, Kompaniyets L, Grosse SD, Harris AM, Baggs J, Sircar K, Gundlapalli AV. Estimation of Coronavirus Disease 2019 Hospitalization Costs From a Large Electronic Administrative Discharge Database, March 2020-July 2021. Open Forum Infect Dis 2021; 8:ofab561. [PMID: 34938822 PMCID: PMC8686820 DOI: 10.1093/ofid/ofab561] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Information on the costs of inpatient care for patients with coronavirus disease 2019 (COVID-19) is very limited. This study estimates the per-patient cost of inpatient care for adult COVID-19 patients seen at >800 US hospitals. Methods Patients aged ≥18 years with ≥1 hospitalization during March 2020–July 2021 with a COVID-19 diagnosis code in a large electronic administrative discharge database were included. We used validated costs when reported; otherwise, costs were calculated using charges multiplied by cost-to-charge ratios. We estimated costs of inpatient care per patient overall and by severity indicator, age, sex, underlying medical conditions, and acute complications of COVID-19 using a generalized linear model with log link function and gamma distribution. Results The overall cost among 654673 patients hospitalized with COVID-19 was $16.2 billion. Estimated per-patient hospitalization cost was $24 826. Among surviving patients, estimated per-patient cost was $13 090 without intensive care unit (ICU) admission or invasive mechanical ventilation (IMV), $21 222 with ICU admission alone, and $59 742 with IMV. Estimated per-patient cost among patients who died was $27 017. Adjusted cost differential was higher among patients with certain underlying conditions (eg, chronic kidney disease [$12 391], liver disease [$8878], cerebrovascular disease [$7267], and obesity [$5933]) and acute complications (eg, acute respiratory distress syndrome [$43 912], pneumothorax [$25 240], and intracranial hemorrhage [$22 280]). Conclusions The cost of inpatient care for COVID-19 patients was substantial through the first 17 months of the pandemic. These estimates can be used to inform policy makers and planners and cost-effectiveness analysis of public health interventions to alleviate the burden of COVID-19.
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Affiliation(s)
- Sundar S Shrestha
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron M Harris
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Baggs
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kanta Sircar
- Division of Environmental Health Science and Practice. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adi V Gundlapalli
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Giovanatti A, Elassar H, Karabon P, Wunderlich-Barillas T, Halalau A. Social Determinants of Health Correlating with Mechanical Ventilation of COVID-19 Patients: A Multi-Center Observational Study. Int J Gen Med 2021; 14:8521-8526. [PMID: 34848998 PMCID: PMC8612671 DOI: 10.2147/ijgm.s334593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/29/2021] [Indexed: 01/30/2023] Open
Abstract
Importance Several studies have relayed the disproportionate impact of COVID-19 on marginalized communities; however, few have specifically examined the association between social determinants of health and mechanical ventilation (MV). Objective To determine which demographics impact MV rates among COVID-19 patients. Design This observational study included COVID-19 patient data from eight hospitals’ electronic medical records (EMR) between February 25, 2020, to December 31, 2020. Associations between demographic data and MV rates were evaluated using uni- and multivariate analyses. Setting Multicenter (eight hospitals), largest health system in Southeast Michigan. Participants Inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab. Exclusion criteria were missing demographic data or non-permanent Michigan residents. Exposure Patients were divided into two groups: MV and non-MV. Main Outcome and Measures The primary outcome was MV rate per demographic. A multivariate model then predicted the odds of MV per demographic descriptor. Hypotheses were formulated prior to data collection. Results Among 11,304 COVID-19 inpatients investigated, 1621 (14.34%) were MV, and 49.96% were male with a mean age of 63.37 years (17.79). Significant social determinants for MV included Black race (40.19% MV vs 31.31% non-MV, p<0.01), poverty (14.60% vs. 13.21%, p<0.01), and disability (12.65% vs 9.14%; p<0.01). Black race (AOR 1.61 (CI 1.41–1.83; p<0.01)), median income (AOR 0.99 (CI 0.99–0.99; p<0.01)), disability (AOR 1.55 (CI 1.26, 1.90; p<0.01)), and non-English-speaking status (AOR 1.26 (CI 1.05, 1.53)) had significantly higher odds of MV. Conclusions and Relevance Black race, low socioeconomic status, disability, and non-English-speaking status were significant risk factors for MV from COVID-19. An urgent need remains for a pandemic response program that strategizes care for marginalized communities.
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Affiliation(s)
- Alexa Giovanatti
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - Heba Elassar
- Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Patrick Karabon
- Office of Research, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Alexandra Halalau
- Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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20
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Gómez LE. Anti-Latino Racism, the Racial State, and Revising Approaches to "Racial Disparities". J Public Health Manag Pract 2022; 28:S9-S14. [PMID: 34797255 DOI: 10.1097/PHH.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Magesh S, John D, Li WT, Li Y, Mattingly-app A, Jain S, Chang EY, Ongkeko WM. Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status: A Systematic-Review and Meta-analysis. JAMA Netw Open 2021; 4:e2134147. [PMID: 34762110 PMCID: PMC8586903 DOI: 10.1001/jamanetworkopen.2021.34147] [Citation(s) in RCA: 328] [Impact Index Per Article: 109.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE COVID-19 has disproportionately affected racial and ethnic minority groups, and race and ethnicity have been associated with disease severity. However, the association of socioeconomic determinants with racial disparities in COVID-19 outcomes remains unclear. OBJECTIVE To evaluate the association of race and ethnicity with COVID-19 outcomes and to examine the association between race, ethnicity, COVID-19 outcomes, and socioeconomic determinants. DATA SOURCES A systematic search of PubMed, medRxiv, bioRxiv, Embase, and the World Health Organization COVID-19 databases was performed for studies published from January 1, 2020, to January 6, 2021. STUDY SELECTION Studies that reported data on associations between race and ethnicity and COVID-19 positivity, disease severity, and socioeconomic status were included and screened by 2 independent reviewers. Studies that did not have a satisfactory quality score were excluded. Overall, less than 1% (0.47%) of initially identified studies met selection criteria. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Associations were assessed using adjusted and unadjusted risk ratios (RRs) and odds ratios (ORs), combined prevalence, and metaregression. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES The main measures were RRs, ORs, and combined prevalence values. RESULTS A total of 4 318 929 patients from 68 studies were included in this meta-analysis. Overall, 370 933 patients (8.6%) were African American, 9082 (0.2%) were American Indian or Alaska Native, 101 793 (2.4%) were Asian American, 851 392 identified as Hispanic/Latino (19.7%), 7417 (0.2%) were Pacific Islander, 1 037 996 (24.0%) were White, and 269 040 (6.2%) identified as multiracial and another race or ethnicity. In age- and sex-adjusted analyses, African American individuals (RR, 3.54; 95% CI, 1.38-9.07; P = .008) and Hispanic individuals (RR, 4.68; 95% CI, 1.28-17.20; P = .02) were the most likely to test positive for COVID-19. Asian American individuals had the highest risk of intensive care unit admission (RR, 1.93; 95% CI, 1.60-2.34, P < .001). The area deprivation index was positively correlated with mortality rates in Asian American and Hispanic individuals (P < .001). Decreased access to clinical care was positively correlated with COVID-19 positivity in Hispanic individuals (P < .001) and African American individuals (P < .001). CONCLUSIONS AND RELEVANCE In this study, members of racial and ethnic minority groups had higher risks of COVID-19 positivity and disease severity. Furthermore, socioeconomic determinants were strongly associated with COVID-19 outcomes in racial and ethnic minority populations.
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Affiliation(s)
- Shruti Magesh
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Daniel John
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Wei Tse Li
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Yuxiang Li
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Aidan Mattingly-app
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
| | - Sharad Jain
- The University of California Davis School of Medicine, Sacramento
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego
- Radiology Service, VA San Diego Healthcare System, San Diego, California
| | - Weg M. Ongkeko
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
- Research Service, VA San Diego Healthcare System, San Diego, California
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22
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Hudgins A, Uzwiak B, Pizzicato L, Viner K. Barriers to effective care: Specialty drug treatment in Philadelphia. J Subst Abuse Treat 2021; 131:108639. [PMID: 34728133 DOI: 10.1016/j.jsat.2021.108639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In Philadelphia, the poorest big city in the United States, an estimated 60,000 people misuse opioids and more than 3500 have died of overdose in the past three years. In 2019, fentanyl was detected in 76% of drug-related deaths and 94% of opioid-involved deaths. While much attention has been directed at the public face of the city's drug problem, more than 75% of drug deaths in 2017 took place in a private residence. METHOD Based on qualitative research to understand the vulnerabilities of this hidden population of drug users, we interviewed kin of 35 people who had died of opioid overdose in 2017 to learn whether their loved one had interacted with any social services or harm-reduction interventions. RESULTS In our demographically and geographically representative sample of decedents, we found that while most had received treatment at least once, many faced barriers to getting treatment when they needed it, including barriers related to stigma, structural racism, gender inequities, bureaucracy, insurance requirements, and cost. CONCLUSION We argue that these barriers place an undue burden on people with substance use disorder and their kin during particularly fraught moments of heightened vulnerability. The failure of state and federal policies, practices, and infrastructure to address these barriers, and the failure to require that evidence-based care be provided during treatment have deleterious effects on people affected by the opioid epidemic in the United States.
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Affiliation(s)
| | - Beth Uzwiak
- Ethnologica, 4732 Stenton Ave., Philadelphia, PA 19144, USA
| | - Lia Pizzicato
- Division of Substance Use Prevention and Harm Reduction, Philadelphia Department of Public Health, 123 S. Broad Street, Suite 1120, Philadelphia, PA 19109, USA
| | - Kendra Viner
- Division of Substance Use Prevention and Harm Reduction, Philadelphia Department of Public Health, 123 S. Broad Street, Suite 1120, Philadelphia, PA 19109, USA
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Grekousis G, Wang R, Liu Y. Mapping the geodemographics of racial, economic, health, and COVID-19 deaths inequalities in the conterminous US. Appl Geogr 2021; 135:102558. [PMID: 34511662 PMCID: PMC8416553 DOI: 10.1016/j.apgeog.2021.102558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 05/09/2023]
Abstract
A large number of studies have examined individual-level factors that increase COVID-19 fatalities. However, no research has focused on the geodemographic classification of the most susceptible communities to COVID-19. In this cross-sectional ecological study, we used local fuzzy geographically-weighted clustering to create the socioeconomic profile of the US counties in relation to COVID-19 death rates. We demonstrate that living in a county which has households with lower income, people with a lack of health insurance, a high African-American percentage, and lower education level, lead to 27.12% higher COVID-19 death rates than the national median, and 72.56% higher compared to the least vulnerable counties. Compared to counties with a high COVID-19 death rate, counties with a low COVID-19 death rate have 44.90% higher annual median household income and nearly double house worth (89.51% more). Results show that the effects of the COVID-19 pandemic are not universal and that the minoritised and impoverished populations suffer more. Our analysis can effectively pinpoint the most vulnerable counties and importantly allows for understanding the socioeconomic context in which tailored interventions can be applied to mitigate COVID-19 deaths.
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Affiliation(s)
- George Grekousis
- School of Geography and Planning, Sun Yat-sen University, China
- Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-sen University, China
- Guangdong Provincial Engineering Research Center for Public Security and Disaster, China
| | - Ruoyu Wang
- Institute of Geography, School of GeoSciences, University of Edinburgh, UK
| | - Ye Liu
- School of Geography and Planning, Sun Yat-sen University, China
- Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-sen University, China
- Guangdong Provincial Engineering Research Center for Public Security and Disaster, China
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24
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Olanipekun T, Abe T, Sobukonla T, Tamizharasu J, Gamo L, Kuete NT, Bakinde N, Westney G, Snyder RH. Association between race and risk of ICU mortality in mechanically ventilated COVID-19 patients at a safety net hospital. J Natl Med Assoc 2021; 114:18-25. [PMID: 34615602 PMCID: PMC8443330 DOI: 10.1016/j.jnma.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/09/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022]
Abstract
Purpose To determine racial differences in intensive care unit (ICU) mortality outcomes among mechanically ventilated patients with severe coronavirus disease 2019 (COVID-19) infection in a safety net hospital. Methods We retrospectively analyzed a cohort of patients ≥ 18 years old with confirmed severe acute respiratory syndrome-CoV-2 disease associated respiratory failure who were treated with invasive mechanical ventilation and admitted to the ICU from May 1, 2020 – July 30 -2020 at Grady Memorial Hospital, Atlanta, Georgia – a safety net hospital. We evaluated the association between mortality and demographics, co-morbidities, inpatient laboratory, and radiological parameters. Results Among 181 critically ill mechanically ventilated African American patients treated at a safety net hospital, the mortality rate was 33%. On stratified analysis by race (Table 2), mortality rates were significantly higher in African Americans (39%) and Hispanics (26.3%), compared to Whites (18.9%). On multivariate regression, African Americans were 3 times more likely to die in the ICU compared to Whites (OR 3.1 95% CI 1.6 -5.5). Likewise, the likelihood of mortality was higher in Hispanics compared to Whites (OR 1.3 95% CI 1.0 -3.9). Conclusions Our study demonstrated a high ICU mortality rate in a cohort of mechanically ventilated patients with severe COVID-19 infection treated at a safety net hospital. African Americans and Hispanics had significantly higher risks of ICU mortality compared to Whites. These study findings further elucidate the disproportionately higher burden of COVID-19 infection in African Americans and Hispanics.
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Affiliation(s)
- Titilope Olanipekun
- Department of Hospital Medicine, Covenant Health System, Knoxville, TN, United States.
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Timothy Sobukonla
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Jothika Tamizharasu
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Linda Gamo
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Nelson T Kuete
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Nicolas Bakinde
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Gloria Westney
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Richard H Snyder
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, United States
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Buikema AR, Buzinec P, Paudel ML, Andrade K, Johnson JC, Edmonds YM, Jhamb SK, Chastek B, Raja H, Cao F, Hulbert EM, Korrer S, Mazumder D, Seare J, Solow BK, Currie UM. Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database. EClinicalMedicine 2021; 39:101075. [PMID: 34493997 PMCID: PMC8413267 DOI: 10.1016/j.eclinm.2021.101075] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. METHODS This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. FINDINGS Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620-1·763; Black: 1·810, 1·743-1·880; Asian: 1·503, 1·381-1·636) and during follow-up (Hispanic: 1·700, 1·638-1·764; Black: 1·578, 1·526-1·633; Asian: 1·391, 1·288-1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809-0·959) but higher for Asian patients (1·205, 1·000-1·452). INTERPRETATION Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19-related care, further analyses of disaggregated population-level COVID-19 data are needed.
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Affiliation(s)
- Ami R. Buikema
- Optum, Eden Prairie, MN, USA
- Corresponding author at: 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA.
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Kaltiso SAO, Seitz RM, Zdradzinski MJ, Moran TP, Heron S, Robertson J, Lall MD. The impact of racism on emergency health care workers. Acad Emerg Med 2021; 28:974-981. [PMID: 34358387 DOI: 10.1111/acem.14347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Discrimination based on race is a known source of stress in individuals and is a contributor to poor health outcomes in patients. However, less is known about how the experiences of racism impact the stress levels of emergency health care workers (EHCWs). OBJECTIVES The goal of this study was to assess the impact that racism has on the stress of EHCWs. METHODS An anonymous electronic cross-sectional survey of EHCWs including attending physicians, resident physicians, advanced practice providers, nurses, and staff at three large metropolitan hospitals was administered in the summer of 2020. The survey evaluated the stress related to systemic racism and the COVID-19 pandemic in addition to the wellness measures utilized to cope with these stressors. The focus of this article is the impact of systemic racism on EHCWs. RESULTS Of the 576 eligible participants, the total number of respondents utilized for analysis was 260. Overall, 64% of participants were very concerned about the state of racism in the United States, and 30% reported moderate-high or high stress resulting from racism. When stratified by race, 46% of Black participants reported moderate-high or high stress resulting from racism, compared to 31% of other participants of color and 23% of White participants (p = 0.002). CONCLUSION Systemic racism is a significant concern and source of stress for EHCWs. Additional research about systemic racism, its impact on medical providers, and more importantly, active strategies to reduce and ultimately eliminate it in health care is needed.
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Affiliation(s)
- Sheri-Ann O Kaltiso
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Roslyn M Seitz
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Zdradzinski
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Timothy P Moran
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sheryl Heron
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer Robertson
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michelle D Lall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Gershengorn HB, Patel S, Shukla B, Warde PR, Bhatia M, Parekh D. Association of Race and Ethnicity with COVID-19 Test Positivity and Hospitalization Is Mediated by Socioeconomic Factors. Ann Am Thorac Soc 2021; 18:1326-1334. [PMID: 33724166 PMCID: PMC8513657 DOI: 10.1513/annalsats.202011-1448oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Rationale: Black race and Hispanic ethnicity are associated with increased risks for coronavirus disease (COVID-19) infection and severity. It is purported that socioeconomic factors may drive this association, but data supporting this assertion are sparse. Objectives: To evaluate whether socioeconomic factors mediate the association of race/ethnicity with COVID-19 incidence and outcomes. Methods: We conducted a retrospective cohort study of adults tested for (cohort 1) or hospitalized with (cohort 2) COVID-19 between March 1, 2020, and July 23, 2020, at the University of Miami Hospital and Clinics. Our primary exposure was race/ethnicity. We considered socioeconomic factors as potential mediators of our exposure's association with outcomes. We used standard statistics to describe our cohorts and multivariable regression modeling to identify associations of race/ethnicity with our primary outcomes, one for each cohort, of test positivity (cohort 1) and hospital mortality (cohort 2). We performed a mediation analysis to see whether household income, population density, and household size mediated the association of race/ethnicity with outcomes. Results: Our cohorts included 15,473 patients tested (29.0% non-Hispanic White, 48.1% Hispanic White, 15.0% non-Hispanic Black, 1.7% Hispanic Black, and 1.6% other) and 295 patients hospitalized (9.2% non-Hispanic White, 56.9% Hispanic White, 21.4% non-Hispanic Black, 2.4% Hispanic Black, and 10.2% other). Among those tested, 1,256 patients (8.1%) tested positive, and, of the hospitalized patients, 47 (15.9%) died. After adjustment for demographics, race/ethnicity was associated with test positivity-odds-ratio (95% confidence interval [CI]) versus non-Hispanic White for Non-Hispanic Black: 3.21 (2.60-3.96), Hispanic White: 2.72 (2.28-3.26), and Hispanic Black: 3.55 (2.33-5.28). Population density mediated this association (percentage mediated, 17%; 95% CI, 11-31%), as did median income (27%; 95% CI, 18-52%) and household size (20%; 95% CI, 12-45%). There was no association between race/ethnicity and mortality, although this analysis was underpowered. Conclusions: Black race and Hispanic ethnicity are associated with an increased odds of COVID-19 positivity. This association is substantially mediated by socioeconomic factors.
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Affiliation(s)
- Hayley B. Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York; and
| | - Samira Patel
- Care Transformation, University of Miami Hospital and Clinics, Miami, Florida
| | | | - Prem R. Warde
- Care Transformation, University of Miami Hospital and Clinics, Miami, Florida
| | | | - Dipen Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - on behalf of the UHealth-DART Research Group
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Division of Infectious Diseases, Department of Medicine
- Department of Medicine, and
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York; and
- Care Transformation, University of Miami Hospital and Clinics, Miami, Florida
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Sullivan PS, Siegler AJ, Shioda K, Hall EW, Bradley H, Sanchez T, Luisi N, Valentine-Graves M, Nelson KN, Fahimi M, Kamali A, Sailey C, Lopman BA. SARS-CoV-2 cumulative incidence, United States, August-December 2020. Clin Infect Dis 2021; 74:1141-1150. [PMID: 34245245 PMCID: PMC8406864 DOI: 10.1093/cid/ciab626] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Reported coronavirus disease 2019 (COVID-19) cases underestimate severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We conducted a
national probability survey of US households to estimate cumulative
incidence adjusted for antibody waning. Methods From August–December 2020 a random sample of US addresses were mailed a
survey and self-collected nasal swabs and dried blood spot cards. One adult
household member completed the survey and mail specimens for viral detection
and total (immunoglobulin [Ig] A, IgM, IgG) nucleocapsid antibody by a
commercial, emergency use authorization–approved antigen capture
assay. We estimated cumulative incidence of SARS-CoV-2 adjusted for waning
antibodies and calculated reported fraction (RF) and infection fatality
ratio (IFR). Differences in seropositivity among demographic, geographic,
and clinical subgroups were explored. Results Among 39 500 sampled households, 4654 respondents provided responses.
Cumulative incidence adjusted for waning was 11.9% (95% credible interval
[CrI], 10.5%–13.5%) as of 30 October 2020. We estimated 30 332 842
(CrI, 26 703 753–34 335 338) total infections in the US adult
population by 30 October 2020. RF was 22.3% and IFR was 0.85% among adults.
Black non-Hispanics (Prevalence ratio (PR) 2.2) and Hispanics (PR, 3.1) were
more likely than White non-Hispanics to be seropositive. Conclusions One in 8 US adults had been infected with SARS-CoV-2 by October 2020;
however, few had been accounted for in public health reporting. The COVID-19
pandemic is likely substantially underestimated by reported cases.
Disparities in COVID-19 by race observed among reported cases cannot be
attributed to differential diagnosis or reporting of infections in
population subgroups.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Eric W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mariah Valentine-Graves
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Amanda Kamali
- California Department of Public Health, Sacramento, California, USA (Kamali)
| | - Charles Sailey
- Molecular Testing Labs, Vancouver, Washington, USA (Sailey)
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Metra B, Summer R, Brooks SE, George G, Sundaram B. Racial disparities in COVID-19 associated pulmonary embolism: A multicenter cohort study. Thromb Res 2021; 205:84-91. [PMID: 34274560 PMCID: PMC8254383 DOI: 10.1016/j.thromres.2021.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/25/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Background Thromboembolism is a recognized component of severe coronavirus disease 2019 (COVID-19) disease. However, research into racial disparities in COVID-19-related pulmonary embolism is limited. Materials and methods In this retrospective cohort study, we examined adults diagnosed with COVID-19 between January 20 and September 30, 2020, using a multicenter electronic health record dataset of over 73 million patients (TriNetX), mostly in the USA. The main study outcomes were development of pulmonary embolism or mortality within 30 days of COVID-19 diagnosis. Secondary outcome analysis included hospitalization, mechanical ventilation, and ICU admission within 30 days of diagnosis, as well as lab values within 0–1 days of diagnosis. Sociodemographic and clinical variables were used to create balanced cohorts via propensity matching. Results 346,953 patients were identified, with 56.0% non-Hispanic white and 14.7% non-Hispanic black; the mean age was 47.6 years. 3879 patients developed PE, with 2036 (1.30% of 157,049) white and 1088 (2.16% of 50,376) black patients. After propensity matching, black race was associated with higher mortality (risk ratio 1.890 [95% CI 1.727–2.067]) and PE (RR 1.537 [1.380–1.711]; p < 0.0001). Both races had higher mortality with COVID-associated PE than COVID or PE alone (RR 1.575–1.627 and 3.000–5.389 respectively; p < 0.0001). Black patients with COVID-19 and PE had a higher rate of mortality compared to white patients (RR 1.397 [1.059–1.844]; p = 0.0174). Interpretation Black race was associated with higher risk of pulmonary embolism and mortality after COVID-19. Additionally, black patients with COVID-19 and PE had a higher mortality compared to white patients.
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Affiliation(s)
- Brandon Metra
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Ross Summer
- Department of Internal Medicine, Thomas Jefferson University Hospitals, Philadelphia, United States of America; The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Sandra Elaine Brooks
- Obstetrics and Gynecology, Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Gautam George
- Department of Internal Medicine, Thomas Jefferson University Hospitals, Philadelphia, United States of America; The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University Hospitals, Philadelphia, United States of America
| | - Baskaran Sundaram
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, United States of America.
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Antonio-Villa NE, Fernandez-Chirino L, Pisanty-Alatorre J, Mancilla-Galindo J, Kammar-García A, Vargas-Vázquez A, González-Díaz A, Fermín-Martínez CA, Márquez-Salinas A, Guerra EC, Bahena-López JP, Villanueva-Reza M, Márquez-Sánchez J, Jaramillo-Molina ME, Gutiérrez-Robledo LM, Bello-Chavolla OY. Comprehensive evaluation of the impact of sociodemographic inequalities on adverse outcomes and excess mortality during the COVID-19 pandemic in Mexico City. Clin Infect Dis 2021; 74:785-792. [PMID: 34159351 DOI: 10.1093/cid/ciab577] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The impact of the COVID-19 pandemic in Mexico City has been sharp, as several social inequalities at all levels coexist. Here, we conducted an in-depth evaluation of the impact of individual and municipal-level social inequalities on the COVID-19 pandemic in Mexico City. METHODS We analyzed suspected SARS-CoV-2 cases, from the Mexico City Epidemiological Surveillance System from February 24th, 2020, to March 31 st, 2021. COVID-19 outcomes included rates of hospitalization, severe COVID-19, invasive mechanical ventilation, and mortality. We evaluated socioeconomic occupation as an individual risk, and social lag, which captures municipal-level social vulnerability, and urban population density as proxies of structural risk factors. Impact of reductions in vehicular mobility on COVID-19 rates and the influence of risk factors were also assessed. Finally, we assessed discrepancies in COVID-19 and non-COVID-19 excess mortality using death certificates from the General Civil Registry. RESULTS We detected vulnerable groups who belonged to economically unfavored sectors and experienced increased risk of COVID-19 outcomes. Cases living in marginalized municipalities with high population density experienced greater for COVID-19 outcomes. Additionally, policies to reduce vehicular mobility had differential impacts modified by social lag and urban population density. Finally, we report an under-registry of COVID-19 deaths along with an excess mortality closely related to marginalized and densely populated communities in an ambulatory setting. This could be attributable to a negative impact of modified hospital admission criteria during the pandemic. CONCLUSION Socioeconomic occupation and municipality-wide factors played a significant role in shaping the course of the COVID-19 pandemic in Mexico City.
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Affiliation(s)
- Neftali Eduardo Antonio-Villa
- Division de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Luisa Fernandez-Chirino
- Division de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico.,Faculty of Chemistry, National Autonomous University of Mexico, Mexico City, Mexico
| | - Julio Pisanty-Alatorre
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Javier Mancilla-Galindo
- Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Ashuin Kammar-García
- Departamento de Atención Institucional Continua y Urgencias, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Armando González-Díaz
- Facultad de Ciencias Politicas Sociales y Sociales, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | - Enrique C Guerra
- Division de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
| | | | - Marco Villanueva-Reza
- Departamento de Infectologia. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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31
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Xian Z, Saxena A, Javed Z, Jordan JE, Alkarawi S, Khan SU, Shah K, Vahidy FS, Nasir K, Dubey P. COVID-19-related state-wise racial and ethnic disparities across the USA: an observational study based on publicly available data from The COVID Tracking Project. BMJ Open 2021; 11:e048006. [PMID: 34155078 PMCID: PMC8219486 DOI: 10.1136/bmjopen-2020-048006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA. METHODS Publicly available data from The COVID Tracking Project at The Atlantic were accessed between 9 September 2020 and 14 September 2020. For each state and the District of Columbia, % infection, % death, and % population proportion for subgroups of race (African American/black (AA/black), Asian, American Indian or Alaska Native (AI/AN), and white) and ethnicity (Hispanic/Latino, non-Hispanic) were recorded. Crude and normalised disparity estimates were generated for COVID-19 infection (CDI and NDI) and mortality (CDM and NDM), computed as absolute and relative difference between % infection or % mortality and % population proportion per state. Choropleth map display was created as thematic representation proportionate to CDI, NDI, CDM and NDM. RESULTS The Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median 158%, IQR 100%-200%). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median 50%, IQR 25%-100%). The AA population had the most disproportionate mortality, with a median of 46% higher mortality than the % population proportion (median 46%, IQR 18%-66%). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian populations, with 100% excess infections than the % population proportion seen in nine states for AI/AN and seven states for Asian populations. There was no disproportionate impact in the white population in any state. CONCLUSIONS There are racial/ethnic disparities in COVID-19 infection/mortality, with distinct state-wise patterns across the USA based on racial/ethnic composition. There were missing and inconsistently reported racial/ethnic data in many states. This underscores the need for standardised reporting, attention to specific regional patterns, adequate resource allocation and addressing the underlying social determinants of health adversely affecting chronically marginalised groups.
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Affiliation(s)
| | - Anshul Saxena
- Baptist Health South Florida, Coral Gables, Florida, USA
| | | | - John E Jordan
- Radiology, Providence Little Company of Mary Medical Center Torrance, Torrance, California, USA
- Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Safa Alkarawi
- Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Safi U Khan
- Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Karan Shah
- Strake Jesuit College Preparatory School, Houston, Texas, USA
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32
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Siegel M, Critchfield-Jain I, Boykin M, Owens A. Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism. J Racial Ethn Health Disparities 2021; 9:886-898. [PMID: 33905110 PMCID: PMC8077854 DOI: 10.1007/s40615-021-01028-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022]
Abstract
Introduction While the increased burden of COVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account. In this paper, we determine the Black–White disparity in COVID-19 mortality rates across 35 states using direct age standardization. We then explore the relationship between structural racism and differences in the magnitude of this disparity across states. Methods Using data from the Centers for Disease Control and Prevention, we calculated both crude and age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each state. We explored the relationship between a state-level structural racism index and the observed differences in the racial disparities in COVID-19 mortality across states. We explored the potential mediating effects of disparities in exposure based on occupation, underlying medical conditions, and health care access. Results Relying upon crude death rate ratios resulted in a substantial underestimation of the true magnitude of the Black–White disparity in COVID-19 mortality rates. The structural racism index was a robust predictor of the observed racial disparities. Each standard deviation increase in the racism index was associated with an increase of 0.26 in the ratio of COVID-19 mortality rates among the Black compared to the White population. Conclusions Structural racism should be considered a root cause of the Black–White disparity in COVID-19 mortality. Dismantling the long-standing systems of racial oppression is critical to adequately address both the downstream and upstream causes of racial inequities in the disease burden of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01028-1.
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Affiliation(s)
- Michael Siegel
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Isabella Critchfield-Jain
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Matthew Boykin
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Alicia Owens
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
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Qeadan F, VanSant-Webb E, Tingey B, Rogers TN, Brooks E, Mensah NA, Winkfield KM, Saeed AI, English K, Rogers CR. Racial disparities in COVID-19 outcomes exist despite comparable Elixhauser comorbidity indices between Blacks, Hispanics, Native Americans, and Whites. Sci Rep 2021; 11:8738. [PMID: 33888833 PMCID: PMC8062526 DOI: 10.1038/s41598-021-88308-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/12/2021] [Indexed: 02/08/2023] Open
Abstract
Factors contributing to racial inequities in outcomes from coronavirus disease 2019 (COVID-19) remain poorly understood. We compared by race the risk of 4 COVID-19 health outcomes--maximum length of hospital stay (LOS), invasive ventilation, hospitalization exceeding 24 h, and death--stratified by Elixhauser comorbidity index (ECI) ranking. Outcomes and ECI scores were constructed from retrospective data obtained from the Cerner COVID-19 De-Identified Data cohort. We hypothesized that racial disparities in COVID-19 outcomes would exist despite comparable ECI scores among non-Hispanic (NH) Blacks, Hispanics, American Indians/Alaska Natives (AI/ANs), and NH Whites. Compared with NH Whites, NH Blacks had longer hospital LOS, higher rates of ventilator dependence, and a higher mortality rate; AI/ANs, higher odds of hospitalization for ECI = 0 but lower for ECI ≥ 5, longer LOS for ECI = 0, a higher risk of death across all ECI categories except ECI ≥ 5, and higher odds of ventilator dependence; Hispanics, a lower risk of death across all ECI categories except ECI = 0, lower odds of hospitalization, shorter LOS for ECI ≥ 5, and higher odds of ventilator dependence for ECI = 0 but lower for ECI = 1-4. Our findings contest arguments that higher comorbidity levels explain elevated COVID-19 death rates among NH Blacks and AI/ANs compared with Hispanics and NH Whites.
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Affiliation(s)
- Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
| | - Elizabeth VanSant-Webb
- Sorenson Impact Center, University of Utah-David Eccles School of Business, Salt Lake City, UT, USA
| | - Benjamin Tingey
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Tiana N Rogers
- Sorenson Impact Center, University of Utah-David Eccles School of Business, Salt Lake City, UT, USA
| | - Ellen Brooks
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Nana A Mensah
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, USA
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Ali I Saeed
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | - Charles R Rogers
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
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Secolin R, de Araujo TK, Gonsales MC, Rocha CS, Naslavsky M, Marco LD, Bicalho MAC, Vazquez VL, Zatz M, Silva WA, Lopes-Cendes I. Genetic variability in COVID-19-related genes in the Brazilian population. Hum Genome Var 2021; 8:15. [PMID: 33824725 PMCID: PMC8017521 DOI: 10.1038/s41439-021-00146-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022] Open
Abstract
SARS-CoV-2 utilizes the angiotensin-converting enzyme 2 (ACE2) receptor and transmembrane serine protease (TMPRSS2) to infect human lung cells. Previous studies have suggested that different host ACE2 and TMPRSS2 genetic backgrounds might contribute to differences in the rate of SARS-CoV-2 infection or COVID-19 severity. Recent studies have also shown that variants in 15 genes related to type I interferon immunity to influenza virus might predispose patients toward life-threatening COVID-19 pneumonia. Other genes (SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6, XCR1, IL6, CTSL, ABO, and FURIN) and HLA alleles have also been implicated in the response to infection with SARS-CoV-2. Currently, Brazil has recorded the third-highest number of COVID-19 cases worldwide. We aimed to investigate the genetic variation present in COVID-19-related genes in the Brazilian population. We analyzed 27 candidate genes and HLA alleles in 954 admixed Brazilian exomes. We used the information available in two public databases (http://www.bipmed.org and http://abraom.ib.usp.br/) and additional exomes from individuals born in southeast Brazil, the region of the country with the highest number of COVID-19 patients. Variant allele frequencies were compared with the 1000 Genomes Project phase 3 (1KGP) and gnomAD databases. We detected 395 nonsynonymous variants; of these, 325 were also found in the 1KGP and/or gnomAD. Six of these variants were previously reported to influence the rate of infection or clinical prognosis of COVID-19. The remaining 70 variants were identified exclusively in the Brazilian sample, with a mean allele frequency of 0.0025. In silico analysis revealed that seven of these variants are predicted to affect protein function. Furthermore, we identified HLA alleles previously associated with the COVID-19 response at loci DQB1 and DRB1. Our results showed genetic variability common to other populations and rare and ultrarare variants exclusively found in the Brazilian population. These findings might lead to differences in the rate of infection or response to infection by SARS-CoV-2 and should be further investigated in patients with this disease. Genetic variants in the Brazilian population do not appear to explain the relatively high overall rates of COVID-19 cases compared to other countries, but could be relevant for risk assessment at the individual level. Iscia Lopes-Cendes of the University of Campinas and colleagues in Brazil examined gene sequences for variations in 27 genes reported to influence COVID-19 infection in Brazilians of mixed heritage and of people born in the southeast where case numbers are high. These studies included the ACE2 gene that codes for a receptor allowing SARS-CoV-2 to enter host cells. Genetic variants were also identified in two international genome databases. Seventy variants were unique to Brazilians, but computer modeling predicted only seven variants that could affect protein function. The team also looked for and found variants that could affect individual immunity to COVID-19. Similar genetic studies could help identify at-risk individuals and therapeutic targets.
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Affiliation(s)
- Rodrigo Secolin
- Department of Translational Medicine, University of Campinas (UNICAMP), and The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP Brazil
| | - Tânia K de Araujo
- Department of Translational Medicine, University of Campinas (UNICAMP), and The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP Brazil
| | - Marina C Gonsales
- Department of Translational Medicine, University of Campinas (UNICAMP), and The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP Brazil
| | - Cristiane S Rocha
- Department of Translational Medicine, University of Campinas (UNICAMP), and The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP Brazil
| | - Michel Naslavsky
- Departament of Genetics and Evolutive Biology, Institute of Bioscience, University of São Paulo, (USP) and The Human Genome and Stem Cell Research Center, São Paulo, SP Brazil
| | - Luiz De Marco
- Department of Surgery, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Maria A C Bicalho
- Department of Clinical Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Vinicius L Vazquez
- Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos, SP Brazil
| | - Mayana Zatz
- Departament of Genetics and Evolutive Biology, Institute of Bioscience, University of São Paulo, (USP) and The Human Genome and Stem Cell Research Center, São Paulo, SP Brazil
| | - Wilson A Silva
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo at Ribeirão Preto (USP), Ribeirão Preto, SP Brazil
| | - Iscia Lopes-Cendes
- Department of Translational Medicine, University of Campinas (UNICAMP), and The Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP Brazil
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Liang C, Bencurova E, Psota E, Neurgaonkar P, Prelog M, Scheller C, Dandekar T. Population-Predicted MHC Class II Epitope Presentation of SARS-CoV-2 Structural Proteins Correlates to the Case Fatality Rates of COVID-19 in Different Countries. Int J Mol Sci 2021; 22:2630. [PMID: 33807854 PMCID: PMC7961590 DOI: 10.3390/ijms22052630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 12/22/2022] Open
Abstract
We observed substantial differences in predicted Major Histocompatibility Complex II (MHCII) epitope presentation of SARS-CoV-2 proteins for different populations but only minor differences in predicted MHCI epitope presentation. A comparison of this predicted epitope MHC-coverage revealed for the early phase of infection spread (till day 15 after reaching 128 observed infection cases) highly significant negative correlations with the case fatality rate. Specifically, this was observed in different populations for MHC class II presentation of the viral spike protein (p-value: 0.0733 for linear regression), the envelope protein (p-value: 0.023), and the membrane protein (p-value: 0.00053), indicating that the high case fatality rates of COVID-19 observed in some countries seem to be related with poor MHC class II presentation and hence weak adaptive immune response against these viral envelope proteins. Our results highlight the general importance of the SARS-CoV-2 structural proteins in immunological control in early infection spread looking at a global census in various countries and taking case fatality rate into account. Other factors such as health system and control measures become more important after the early spread. Our study should encourage further studies on MHCII alleles as potential risk factors in COVID-19 including assessment of local populations and specific allele distributions.
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Affiliation(s)
- Chunguang Liang
- Department of Bioinformatics, Biocenter, Am Hubland, University of Würzburg, 97074 Würzburg, Germany; (C.L.); (E.B.); (P.N.)
| | - Elena Bencurova
- Department of Bioinformatics, Biocenter, Am Hubland, University of Würzburg, 97074 Würzburg, Germany; (C.L.); (E.B.); (P.N.)
| | - Eric Psota
- Department of Pediatrics, Rheumatology and Special Immunology, University Hospital Würzburg, Pediatric Rheumatology/Special Immunology, Josef-Schneider-Str. 2, 97080 Würzburg, Germany; (E.P.); (M.P.)
| | - Priya Neurgaonkar
- Department of Bioinformatics, Biocenter, Am Hubland, University of Würzburg, 97074 Würzburg, Germany; (C.L.); (E.B.); (P.N.)
| | - Martina Prelog
- Department of Pediatrics, Rheumatology and Special Immunology, University Hospital Würzburg, Pediatric Rheumatology/Special Immunology, Josef-Schneider-Str. 2, 97080 Würzburg, Germany; (E.P.); (M.P.)
| | - Carsten Scheller
- Institute of Virology and Immunobiology, University of Würzburg, Versbacher Str. 7, 97078 Würzburg, Germany
| | - Thomas Dandekar
- Department of Bioinformatics, Biocenter, Am Hubland, University of Würzburg, 97074 Würzburg, Germany; (C.L.); (E.B.); (P.N.)
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Garcia E, Eckel SP, Chen Z, Li K, Gilliland FD. COVID-19 Mortality in California Based on Death Certificates: Disproportionate Impacts Across Racial/Ethnic Groups and Nativity. medRxiv 2021:2021.03.01.21252678. [PMID: 33688674 PMCID: PMC7941651 DOI: 10.1101/2021.03.01.21252678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To examine characteristics of coronavirus disease 2019 (COVID-19) decedents in California (CA) and evaluate for disproportionate mortality across race/ethnicity and ethnicity/nativity. METHODS COVID-19 deaths were identified from death certificates. Age-adjusted mortality rate ratios (MRR) were compared across race/ethnicity. Proportionate mortality rates (PMR) were compared across race/ethnicity and by ethnicity/nativity. RESULTS We identified 10,200 COVID-19 deaths in CA occurring February 1 through July 31, 2020. Decedents tended to be older, male, Hispanic, foreign-born, and have lower educational attainment. MRR indicated elevated COVID-19 morality rates among Asian/Pacific Islander, Black, and Hispanic groups compared with the White group, with Black and Hispanic groups having the highest MRR at 2.75 (95%CI:2.54-2.97) and 4.18 (95%CI: 3.99-4.37), respectively. Disparities were larger at younger ages. Similar results were observed with PMR, which remained in analyses stratified by education. Elevated PMR were observed in all ethnicity/nativity groups, especially foreign-born Hispanic individuals, relative to U.S.-born non-Hispanic individuals, were generally larger at younger ages, and persisted after stratifying by education. CONCLUSIONS Differential COVID-19 mortality was observed in California across racial/ethnic groups and by ethnicity/nativity groups with evidence of greater disparities among younger age groups. Identifying COVID-19 disparities is an initial step towards mitigating disease impacts in vulnerable communities.
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Gershengorn HB, Holt GE, Rezk A, Delgado S, Shah N, Arora A, Colucci LB, Mora B, Iyengar RS, Lopez A, Martinez BM, West J, Goodman KW, Kett DH, Brosco JP. Assessment of Disparities Associated With a Crisis Standards of Care Resource Allocation Algorithm for Patients in 2 US Hospitals During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e214149. [PMID: 33739434 PMCID: PMC7980099 DOI: 10.1001/jamanetworkopen.2021.4149] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Significant concern has been raised that crisis standards of care policies aimed at guiding resource allocation may be biased against people based on race/ethnicity. OBJECTIVE To evaluate whether unanticipated disparities by race or ethnicity arise from a single institution's resource allocation policy. DESIGN, SETTING, AND PARTICIPANTS This cohort study included adults (aged ≥18 years) who were cared for on a coronavirus disease 2019 (COVID-19) ward or in a monitored unit requiring invasive or noninvasive ventilation or high-flow nasal cannula between May 26 and July 14, 2020, at 2 academic hospitals in Miami, Florida. EXPOSURES Race (ie, White, Black, Asian, multiracial) and ethnicity (ie, non-Hispanic, Hispanic). MAIN OUTCOMES AND MEASURES The primary outcome was based on a resource allocation priority score (range, 1-8, with 1 indicating highest and 8 indicating lowest priority) that was assigned daily based on both estimated short-term (using Sequential Organ Failure Assessment score) and longer-term (using comorbidities) mortality. There were 2 coprimary outcomes: maximum and minimum score for each patient over all eligible patient-days. Standard summary statistics were used to describe the cohort, and multivariable Poisson regression was used to identify associations of race and ethnicity with each outcome. RESULTS The cohort consisted of 5613 patient-days of data from 1127 patients (median [interquartile range {IQR}] age, 62.7 [51.7-73.7]; 607 [53.9%] men). Of these, 711 (63.1%) were White patients, 323 (28.7%) were Black patients, 8 (0.7%) were Asian patients, and 31 (2.8%) were multiracial patients; 480 (42.6%) were non-Hispanic patients, and 611 (54.2%) were Hispanic patients. The median (IQR) maximum priority score for the cohort was 3 (1-4); the median (IQR) minimum score was 2 (1-3). After adjustment, there was no association of race with maximum priority score using White patients as the reference group (Black patients: incidence rate ratio [IRR], 1.00; 95% CI, 0.89-1.12; Asian patients: IRR, 0.95; 95% CI. 0.62-1.45; multiracial patients: IRR, 0.93; 95% CI, 0.72-1.19) or of ethnicity using non-Hispanic patients as the reference group (Hispanic patients: IRR, 0.98; 95% CI, 0.88-1.10); similarly, no association was found with minimum score for race, again with White patients as the reference group (Black patients: IRR, 1.01; 95% CI, 0.90-1.14; Asian patients: IRR, 0.96; 95% CI, 0.62-1.49; multiracial patients: IRR, 0.81; 95% CI, 0.61-1.07) or ethnicity, again with non-Hispanic patients as the reference group (Hispanic patients: IRR, 1.00; 95% CI, 0.89-1.13). CONCLUSIONS AND RELEVANCE In this cohort study of adult patients admitted to a COVID-19 unit at 2 US hospitals, there was no association of race or ethnicity with the priority score underpinning the resource allocation policy. Despite this finding, any policy to guide altered standards of care during a crisis should be monitored to ensure equitable distribution of resources.
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Affiliation(s)
- Hayley B. Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Gregory E. Holt
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Andrew Rezk
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Nayna Shah
- University of Miami Miller School of Medicine, Miami, Florida
| | - Arshia Arora
- University of Miami Miller School of Medicine, Miami, Florida
| | - Leah B. Colucci
- University of Miami Miller School of Medicine, Miami, Florida
| | - Belen Mora
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Andy Lopez
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Joseph West
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Kenneth W. Goodman
- Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel H. Kett
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey P. Brosco
- Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
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Nyante SJ, Benefield TS, Kuzmiak CM, Earnhardt K, Pritchard M, Henderson LM. Population-level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures. Cancer 2021; 127:2111-2121. [PMID: 33635541 PMCID: PMC8013451 DOI: 10.1002/cncr.33460] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To understand how health care delays may affect breast cancer detection, the authors quantified changes in breast‐related preventive and diagnostic care during the coronavirus disease 2019 (COVID‐19) pandemic. METHODS Eligible women (N = 39,444) were aged ≥18 years and received a screening mammogram, diagnostic mammogram, or breast biopsy between January 1, 2019 and September 30, 2020, at 7 academic and community breast imaging facilities in North Carolina. Changes in the number of mammography or breast biopsy examinations after March 3, 2020 (the first COVID‐19 diagnosis in North Carolina) were evaluated and compared with the expected numbers based on trends between January 1, 2019 and March 2, 2020. Changes in the predicted mean monthly number of examinations were estimated using interrupted time series models. Differences in patient characteristics were tested using least squares means regression. RESULTS Fewer examinations than expected were received after the pandemic's onset. Maximum reductions occurred in March 2020 for screening mammography (−85.1%; 95% CI, −100.0%, −70.0%) and diagnostic mammography (−48.9%; 95% CI, −71.7%, −26.2%) and in May 2020 for biopsies (−40.9%; 95% CI, −57.6%, −24.3%). The deficit decreased gradually, with no significant difference between observed and expected numbers by July 2020 (diagnostic mammography) and August 2020 (screening mammography and biopsy). Several months after the pandemic's onset, women who were receiving care had higher predicted breast cancer risk (screening mammography, P < .001) and more commonly lacked insurance (diagnostic mammography, P < .001; biopsy, P < .001) compared with the prepandemic population. CONCLUSIONS Pandemic‐associated deficits in the number of breast examinations decreased over time. Utilization differed by breast cancer risk and insurance status, but not by age or race/ethnicity. Long‐term studies are needed to clarify the contribution of these trends to breast cancer disparities. In this observational study, the use of screening mammography, diagnostic mammography, and breast biopsy is significantly lower than expected after the onset of the COVID‐19 pandemic in North Carolina, but the deficits decrease over time. Health insurance status and predicted breast cancer risk are identified as predictors of mammography and biopsy receipt during the pandemic.
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Affiliation(s)
- Sarah J Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thad S Benefield
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cherie M Kuzmiak
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn Earnhardt
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Pritchard
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Barrett ES, Horton DB, Roy J, Gennaro ML, Brooks A, Tischfield J, Greenberg P, Andrews T, Jagpal S, Reilly N, Carson JL, Blaser MJ, Panettieri RA. Prevalence of SARS-CoV-2 infection in previously undiagnosed health care workers in New Jersey, at the onset of the U.S. COVID-19 pandemic. BMC Infect Dis 2020; 20:853. [PMID: 33198725 PMCID: PMC7668027 DOI: 10.1186/s12879-020-05587-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/04/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Healthcare workers (HCW) are presumed to be at increased risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection due to occupational exposure to infected patients. However, there has been little epidemiological research to assess these risks. METHODS We conducted a prospective cohort study of HCW (n = 546) and non-healthcare workers (NHCW; n = 283) with no known prior SARS-CoV-2 infection who were recruited from a large U.S. university and two affiliated university hospitals. In this cross-sectional analysis of data collected at baseline, we examined SARS-CoV-2 infection status (as determined by presence of SARS-CoV-2 RNA in oropharyngeal swabs) by healthcare worker status and role. RESULTS At baseline, 41 (5.0%) of the participants tested positive for SARS-CoV-2 infection, of whom 14 (34.2%) reported symptoms. The prevalence of SARS-CoV-2 infection was higher among HCW (7.3%) than in NHCW (0.4%), representing a 7.0% greater absolute risk (95% confidence interval for risk difference 4.7, 9.3%). The majority of infected HCW (62.5%) were nurses. Positive tests increased across the two weeks of cohort recruitment in line with rising confirmed cases in the hospitals and surrounding counties. CONCLUSIONS Overall, our results demonstrate that HCW had a higher prevalence of SARS-CoV-2 infection than NHCW. Continued follow-up of this cohort will enable us to monitor infection rates and examine risk factors for transmission.
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Affiliation(s)
- Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.,Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Daniel B Horton
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Center for Pharmacoepidemiology and Treatment Science, Health Care Policy and Aging Research, Institute for Health, New Brunswick, NJ, USA
| | - Jason Roy
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Maria Laura Gennaro
- Department of Medicine, Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Andrew Brooks
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA.,RUCDR Infinite Biologics and Human Genetics Institute of NJ and Department of Genetics, Rutgers University, Piscataway, NJ, USA
| | - Jay Tischfield
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,RUCDR Infinite Biologics and Human Genetics Institute of NJ and Department of Genetics, Rutgers University, Piscataway, NJ, USA
| | - Patricia Greenberg
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Tracy Andrews
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Sugeet Jagpal
- Department of Medicine, Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08901, USA
| | - Nancy Reilly
- Rutgers Institute for Translational Medicine & Science, New Brunswick, NJ, USA
| | - Jeffrey L Carson
- Department of Medicine, Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08901, USA.
| | - Martin J Blaser
- Department of Medicine, Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08901, USA.,Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ, USA
| | - Reynold A Panettieri
- Department of Medicine, Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08901, USA.,Rutgers Institute for Translational Medicine & Science, New Brunswick, NJ, USA
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Barrett ES, Horton DB, Roy J, Xia W, Greenberg P, Andrews T, Gennaro ML, Parmar V, Russell WD, Reilly N, Uprety P, Gantner JJ, Stockman L, Trooskin SZ, Blaser MJ, Carson JL, Panettieri RA. Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Hospital Workers: Results From a Screening Study in New Jersey, United States in Spring 2020. Open Forum Infect Dis 2020; 7:ofaa534. [PMID: 33403219 PMCID: PMC7665723 DOI: 10.1093/ofid/ofaa534] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a critical concern among healthcare workers (HCWs). Other studies have assessed SARS-CoV-2 virus and antibodies in HCWs, with disparate findings regarding risk based on role and demographics. Methods We screened 3904 employees and clinicians for SARS-CoV-2 virus positivity and serum immunoglobulin (Ig)G at a major New Jersey hospital from April 28 to June 30, 2020. We assessed positive tests in relation to demographic and occupational characteristics and prior coronavirus disease 2019 symptoms using multivariable logistic regression models. Results Thirteen participants (0.3%) tested positive for virus and 374 (9.6%) tested positive for IgG (total positive: 381 [9.8%]). Compared with participants with no patient care duties, the odds of positive testing (virus or antibodies) were higher for those with direct patient contact: below-median patient contact, adjusted odds ratio (aOR) = 1.71 and 95% confidence interval [CI] = 1.18-2.48; above-median patient contact, aOR = 1.98 and 95% CI = 1.35-2.91. The proportion of participants testing positive was highest for phlebotomists (23.9%), maintenance/housekeeping (17.3%), dining/food services (16.9%), and interpersonal/support roles (13.7%) despite lower levels of direct patient care duties. Positivity rates were lower among doctors (7.2%) and nurses (9.1%), roles with fewer underrepresented minorities. After adjusting for job role and patient care responsibilities and other factors, Black and Latinx workers had 2-fold increased odds of a positive test compared with white workers. Loss of smell, taste, and fever were associated with positive testing. Conclusions The HCW categories at highest risk for SARS-CoV-2 infection include support staff and underrepresented minorities with and without patient care responsibilities. Future work is needed to examine potential sources of community and nosocomial exposure among these understudied HCWs.
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Affiliation(s)
- Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA
| | - Daniel B Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Jason Roy
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Weiyi Xia
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Patricia Greenberg
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Tracy Andrews
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Maria Laura Gennaro
- Public Health Research Institute; Department of Medicine, New Jersey Medical School; Rutgers University, Newark, New Jersey, USA
| | - Veenat Parmar
- Center for Advanced Biotechnology and Medicine, Rutgers University; Rutgers University Microbiome Program, Piscataway, New Jersey, USA
| | - William D Russell
- Rutgers Institute for Translational Medicine and Science, New Brunswick, New Jersey, USA
| | - Nancy Reilly
- Rutgers Institute for Translational Medicine and Science, New Brunswick, New Jersey, USA
| | - Priyanka Uprety
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School; Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - John J Gantner
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Lydia Stockman
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Stanley Z Trooskin
- Department of Surgery, Rutgers Robert Wood Johnson Medical School; Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Martin J Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Jeffrey L Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Akanbi MO, Rivera AS, Akanbi FO, Shoyinka A. An Ecologic Study of Disparities in COVID-19 Incidence and Case Fatality in Oakland County, MI, USA, During a State-Mandated Shutdown. J Racial Ethn Health Disparities 2020. [PMID: 33124003 DOI: 10.1007/s40615-020-00909-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Introduction Data from the USA reveal disparities in hospitalization and mortality from coronavirus disease 2019 (COVID-19). Social determinants of health (SDoH) could account for disparities in disease incidence and outcomes. We investigated the association between zip code racial composition and COVID-19 incidence and case fatality in Oakland County, MI. Methods We conducted an ecological study using publicly available data on COVID-19 in 70 zip codes in Oakland County, MI. We obtained demographic surrogate markers of SDoH by zip code from the US Census Bureau website. Using negative binomial regression models, we investigated the association between the percentage of Blacks in each zip code and COVID-19 incidence and case fatality, including markers of SDoH as potential confounders. Results Reported COVID-19 cases ranged from 13.2 to 255.2 per 10,000 population. Each percentage increase in Blacks within a zip code was associated with a 3% increase in COVID-19 cases (95% CI: 1.02 to 1.04, p ≤ 0.0001), and this remained significant after adjusting for income or poverty level, number of persons per household, mode of transportation, age, and level of education (incidence rate ratio: 1.02, 95% CI: 1.01 to 1.03, p ≤ 0.0001). Zip codes with a higher percentage of Blacks also experienced a faster increase in COVID-19 rates from April 3 to May 16. However, the proportion of Blacks in a zip code was not associated with case fatality. Conclusion Zip codes with larger Black populations were disproportionately affected by COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-020-00909-1.
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Poulson M, Neufeld M, Geary A, Kenzik K, Sanchez SE, Dechert T, Kimball S. Intersectional Disparities Among Hispanic Groups in COVID-19 Outcomes. J Immigr Minor Health 2020; 23:4-10. [PMID: 33090300 PMCID: PMC7579850 DOI: 10.1007/s10903-020-01111-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 01/03/2023]
Abstract
Previous geographically limited studies have shown differential impact of COVID-19 on Hispanic individuals. Data were obtained from the Centers for Disease Control and Prevention. We performed multivariate Poisson regression assessing risk of hospitalization and death in Hispanic White (HW), Hispanic Black (HB), and Hispanic Multiracial/Other (HM) groups compared to non-Hispanic Whites (NHW). The relative risk of hospitalization was 1.35, 1.58, and 1.50 (p < 0.001) for HW, HB, and HM individuals respectively when compared to NHW. Relative risk of death was 1.36, 1.72, 1.68 (p < 0.001) times higher in HW, HB, and HM compared to NHW. HW, HB, and HM individuals also had significantly increased risk of requiring mechanical ventilation and ICU admission when compared to NHW. Hispanic individuals are more likely to be hospitalized and die from COVID-19 infection than White, which underscores the need for more precise data and policies aimed at unique Hispanic groups to decrease disparities.
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Affiliation(s)
- Michael Poulson
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Miriam Neufeld
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, USA.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Sarah Kimball
- Boston University School of Medicine, Boston, USA. .,Immigrant and Refugee Health Center, Boston Medical Center, 801 Massachusetts Ave, 6th Floor, Boston, MA, 02119, USA.
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