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Barceló MA, Perafita X, Saez M. Spatiotemporal variability in socioeconomic inequalities in COVID-19 vaccination in Catalonia, Spain. Public Health 2024; 227:9-15. [PMID: 38101317 DOI: 10.1016/j.puhe.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Socioeconomic inequalities have played a significant role in the unequal coverage of the COVID-19 vaccine. The objectives of this study were to (1) assess the socioeconomic inequalities in COVID-19 vaccination coverage in Catalonia, Spain; (2) analyse the spatial variation over time of these inequalities; and (3) assess variations in time and space in the effect of vaccination on inequalities in COVID-19 outcomes. STUDY DESIGN A mixed longitudinal ecological study design was used. METHODS Catalonia is divided in to 373 Basic Health Areas. Weekly data from these Basic Health Areas were obtained from the last week of December 2020 until the first week of March of 2022. A joint spatio-temporal model was used with the dependent variables of vaccination and COVID-19 outcomes, which were estimated using a Bayesian approach. The study controlled for observed confounders, unobserved heterogeneity, and spatial and temporal dependencies. The study allowed the effect of the explanatory variables on the dependent variables to vary in space and in time. RESULTS Areas with lower socioeconomic level were those with the lowest vaccination rates and the highest risk of COVID-19 outcomes. In general, individuals in areas that were located in the upper two quartiles of average net income per person and in the lower two quartiles of unemployment rate (i.e., the least economically disadvantaged) had a higher propensity to be vaccinated than those in the most economically disadvantaged areas. In the same sense, the greater the percentage of the population aged ≥65 years, the higher the propensity to be vaccinated, while areas located in the two upper quartiles of population density and areas with a high percentage of poor housing had a lower propensity to be vaccinated. Higher vaccination rates reduced the risk of COVID-19 outcomes, while COVID-19 outcomes did not influence the propensity to be vaccinated. The effects of the explanatory variables were not the same in all areas or between the different waves of the pandemic, and clusters of excess risk of low vaccination in the most disadvantaged areas were detected. CONCLUSIONS COVID-19 vaccination inequalities in the most disadvantaged areas could be a result of structural barriers, such as the lack of access to information about the vaccination process, and/or logistical challenges, such as the lack of transportation, limited Internet access or difficulty in scheduling appointments. Public health strategies should be developed to mitigate these barriers and reduce vaccination inequalities.
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Affiliation(s)
- M A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - X Perafita
- Observatori-Organisme Autònom de Salut Pública de la Diputació de Girona (Dipsalut), Girona, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain
| | - M Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain. http://www.udg.edu/grecs.htm
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Spadea A, Oleiro Hidalgo M, Quevedo S, Begue C, L'Arco G, Pérez A, Cueto G, Konfino J. La equidad en la campaña de vacunación COVID de la Provincia de Buenos Aires (Argentina): un análisis del Municipio de Quilmes. Glob Health Promot 2024:17579759231219493. [PMID: 38293782 DOI: 10.1177/17579759231219493] [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] [Indexed: 02/01/2024]
Abstract
INTRODUCCIÓN la pandemia de la COVID-19 ha acentuado las desigualdades sociales, económicas y relacionadas con la salud, afectando desproporcionadamente a las personas en situación de vulnerabilidad y perpetuando la inequidad en salud. En Argentina se implementó una campaña nacional gratuita de vacunación contra la COVID-19 con una perspectiva de equidad. OBJETIVO identificar desigualdades territoriales en el acceso a la vacunación contra la COVID-19 en Quilmes. MÉTODOS se analizó la información referida a la vacunación contra la COVID-19 de personas residentes en el Municipio. Se efectuó la georreferenciación de cada vacunatorio y de cada persona a partir del domicilio declarado en el momento de la vacunación. Para caracterizar el grado de vulnerabilidad de las personas vacunadas, a cada una se le asignó el índice de carencias múltiples (ICM) correspondiente al radio censal de residencia. RESULTADOS al menos el 82 % de la población completó el esquema primario de vacunación (dosis 1 y dosis 2), porcentaje que alcanzó el 97 % en los mayores de 65 años. Analizando la media de dosis aplicadas se observa algo similar con un gradiente hacia los quintiles más altos pero con una mínima diferencia entre sí, situación que también se corrobora en todos los grupos etarios. DISCUSIÓN no se observaron brechas significativas entre los diferentes niveles socioeconómicos. Si bien se observó un mínimo gradiente en el promedio de dosis recibidas, el tiempo de acceso a las diferentes vacunas y el porcentaje de esquemas primarios completos recibidos, las mismas tienen escasa relevancia clínica y sanitaria.
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Affiliation(s)
- Agostina Spadea
- Secretaría de Salud de Quilmes, Quilmes, Buenos Aires, Argentina
| | | | - Sofía Quevedo
- Secretaría de Salud de Quilmes, Buenos Aires, Argentina
| | - Carolina Begue
- Secretaría de Salud de Quilmes, Quilmes, Buenos Aires, Argentina
| | - Gabriela L'Arco
- Secretaría de Salud de Quilmes, Quilmes, Buenos Aires, Argentina
| | - Adriana Pérez
- Grupo de Bioestadística Aplicada. Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gerardo Cueto
- Grupo de Bioestadística Aplicada. Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jonatan Konfino
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
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Yuan J, Xu Y, Wong IOL, Lam WWT, Ni MY, Cowling BJ, Liao Q. Dynamic predictors of COVID-19 vaccination uptake and their interconnections over two years in Hong Kong. Nat Commun 2024; 15:290. [PMID: 38177142 PMCID: PMC10767005 DOI: 10.1038/s41467-023-44650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
The global rollout of COVID-19 vaccines faces a significant barrier in the form of vaccine hesitancy. This study adopts a dynamic and network perspective to explore the determinants of COVID-19 vaccine uptake in Hong Kong, focusing on multi-level determinants and their interconnections. Following the framework proposed by the Strategic Advisory Group of Experts (SAGE), the study used repeated cross-sectional surveys to map these determinants at multiple levels and investigates their interconnections simultaneously in a sample of 15,179 over two years. The results highlight the dynamic nature of COVID-19 vaccine hesitancy in an evolving pandemic. The findings suggest that vaccine confidence attitudes play crucial roles in vaccination uptake, with their importance shifting over time. The initial emphasis on vaccine safety gradually transitioned to heightened consideration of vaccine effectiveness at a later stage. The study also highlights the impact of chronic condition, age, COVID-19 case numbers, and non-pharmaceutical preventive behaviours on vaccine uptake. Higher educational attainment and being married were associated with primary and booster vaccine uptake and it may be possible to leverage these groups as early innovation adopters. Trust in government acts as a crucial bridging factor linking various variables in the networks with vaccine confidence attitudes, which subsequently closely linked to vaccine uptake. This study provides insights for designing future effective vaccination programmes for changing circumstances.
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Affiliation(s)
- Jiehu Yuan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yucan Xu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Irene Oi Ling Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wendy Wing Tak Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Li Ka Shing Faculty of Medicine, Jocky Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, China
| | - Michael Y Ni
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
- Urban Systems Institute, The University of Hong Kong, Hong Kong, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong, China.
| | - Qiuyan Liao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Black KC, Snyder NA, Zhou M, Zhu Z, Uptegraft C, Chintalapani A, Orwoll B. An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies. Appl Clin Inform 2024; 15:192-198. [PMID: 38253337 PMCID: PMC10917607 DOI: 10.1055/a-2250-6305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Despite mortality benefits, only 19.9% of U.S. adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates. OBJECTIVE Our objective was to evaluate whether an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine. METHODS This was a quasiexperimental pre-post-interventional design study at an academic and community hospital in the western United States between 1 January, 2021 and 31 October, 2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation. RESULTS Vaccine ordering rates increased from 4.0 to 13.0% at the academic hospital (odds ratio [OR]: 4.01, 95% confidence interval [CI]: 3.39-4.74, p < 0.001) and from 7.4 to 11.6% at the community hospital (OR: 1.62, 95% CI: 1.23-2.13, p < 0.001) after alert implementation. Administration increased postalert from 3.6 to 12.7% at the academic hospital (OR: 3.21, 95% CI: 2.70-3.82, p < 0.001) but was unchanged at the community hospital, 6.7 to 6.7% (OR: 0.99, 95% CI: 0.73-1.37, p = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital. CONCLUSION Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides a rationale for subsequent qualitative workflow analysis with alert implementation.
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Affiliation(s)
| | | | - Mengyu Zhou
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Zhen Zhu
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Colby Uptegraft
- Health Informatics Directorate, Defense Health Agency, Falls Church, Virginia
| | - Ani Chintalapani
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | - Benjamin Orwoll
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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Yuan J, Dong M, Wong IOL, Cowing BJ, Lam WWT, Ni MY, Liao Q. Can psychological distress account for the associations between COVID-19 vaccination acceptance and socio-economic vulnerability? Appl Psychol Health Well Being 2023; 15:1583-1602. [PMID: 37142547 DOI: 10.1111/aphw.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
Socially disadvantaged individuals and communities consistently showed lower COVID-19 vaccination acceptance. We aimed to examine the psychological mechanisms that could explain such vaccination disparities. This study used data from serial population-based surveys conducted since the COVID-19 vaccination programme being launched in Hong Kong (N = 28,734). We first assessed the correlations of community-level and individual-level social vulnerability with COVID-19 vaccination acceptance. Structural equation modelling (SEM) was then conducted to test whether psychological distress measured by PHQ-4 can account for the associations between participants' socio-economic vulnerability and COVID-19 vaccination acceptance. The third part analysis examined whether perceived negativity of vaccine-related news and affect towards COVID-19 vaccines accounted for the association between psychological distress and COVID-19 vaccination. Communities with higher social vulnerability scores and participants who had more vulnerable socio-economic status showed lower COVID-19 vaccination acceptance. Individuals with more vulnerable socio-economic status reported higher psychological distress, which lowered COVID-19 vaccination acceptance. Furthermore, higher psychological distress was associated with lower vaccination acceptance through its psychological mechanisms of processing vaccine-related information. We proposed a renewed focus on tackling psychological distress rather than merely increasing vaccine accessibility in more socio-economic-disadvantaged groups for promoting COVID-19 vaccination acceptance.
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Affiliation(s)
- Jiehu Yuan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Meihong Dong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Irene Oi Ling Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- World Health Organization Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Benjamin J Cowing
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- World Health Organization Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong, China
| | - Wendy Wing Tak Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Li Ka Shing Faculty of Medicine, Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, China
| | - Michael Y Ni
- World Health Organization Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong, China
| | - Qiuyan Liao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Perner MS, Trotta A, Bilal U, Acharya B, Quick H, Pacífico N, Berazategui R, Alazraqui M, Diez Roux AV. Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina. Int J Equity Health 2023; 22:198. [PMID: 37770868 PMCID: PMC10537962 DOI: 10.1186/s12939-023-02019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions. AIM To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods. METHODS We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators. RESULTS Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96). CONCLUSION We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.
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Affiliation(s)
- Mónica Serena Perner
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina.
- CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina.
| | - Andrés Trotta
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Binod Acharya
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Harrison Quick
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Natalia Pacífico
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | | | - Marcio Alazraqui
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Caixeta DC, Paranhos LR, Blumenberg C, Garcia-Júnior MA, Guevara-Vega M, Taveira EB, Nunes MAC, Cunha TM, Jardim ACG, Flores-Mir C, Sabino-Silva R. Salivary SARS-CoV-2 RNA for diagnosis of COVID-19 patients: a systematic revisew and meta-analysis of diagnostic accuracy. Jpn Dent Sci Rev 2023:S1882-7616(23)00016-9. [PMID: 37360001 PMCID: PMC10284464 DOI: 10.1016/j.jdsr.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/22/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Accurate, self-collected, and non-invasive diagnostics are critical to perform mass-screening diagnostic tests for COVID-19. This systematic review with meta-analysis evaluated the accuracy, sensitivity, and specificity of salivary diagnostics for COVID-19 based on SARS-CoV-2 RNA compared with the current reference tests using a nasopharyngeal swab (NPS) and/or oropharyngeal swab (OPS). An electronic search was performed in seven databases to find COVID-19 diagnostic studies simultaneously using saliva and NPS/OPS tests to detect SARS-CoV-2 by RT-PCR. The search resulted in 10,902 records, of which 44 studies were considered eligible. The total sample consisted of 14,043 participants from 21 countries. The accuracy, specificity, and sensitivity for saliva compared with the NPS/OPS was 94.3% (95%CI= 92.1;95.9), 96.4% (95%CI= 96.1;96.7), and 89.2% (95%CI= 85.5;92.0), respectively. Besides, the sensitivity of NPS/OPS was 90.3% (95%CI= 86.4;93.2) and saliva was 86.4% (95%CI= 82.1;89.8) compared to the combination of saliva and NPS/OPS as the gold standard. These findings suggest a similarity in SARS-CoV-2 RNA detection between NPS/OPS swabs and saliva, and the association of both testing approaches as a reference standard can increase by 3.6% the SARS-CoV-2 detection compared with NPS/OPS alone. This study supports saliva as an attractive alternative for diagnostic platforms to provide a non-invasive detection of SARS-CoV-2.
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Affiliation(s)
- Douglas Carvalho Caixeta
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Luiz Renato Paranhos
- School of Dentistry, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Cauane Blumenberg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Marcelo Augusto Garcia-Júnior
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Marco Guevara-Vega
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Elisa Borges Taveira
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Marjorie Adriane Costa Nunes
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- School of Dentistry, CEUMA University, Sao Luiz, MA, Brazil
| | - Thúlio Marquez Cunha
- Department of Pulmonology, School of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Ana Carolina Gomes Jardim
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Carlos Flores-Mir
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Robinson Sabino-Silva
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
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Fontán-Vela M, Gullón P, Bilal U, Franco M. Social and ideological determinants of COVID-19 vaccination status in Spain. Public Health 2023; 219:139-145. [PMID: 37178560 PMCID: PMC10080268 DOI: 10.1016/j.puhe.2023.04.007] [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: 11/15/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES This study analysed the association between social and ideological determinants with COVID-19 vaccine accessibility and hesitancy in the Spanish adult population. STUDY DESIGN This was a repeated cross-sectional study. METHODS The data analysed are based on monthly surveys conducted by the Centre for Sociological Research between May 2021 and February 2022. Individuals were classified according to their COVID-19 vaccination status into (1) vaccinated (reference group); (2) willing to vaccinate but not vaccinated, proxy of lack of vaccine accessibility; and (3) hesitant, proxy of vaccine hesitancy. Independent variables included social (educational attainment, gender) and ideological determinants (voting in the last elections, importance attached to the health vs the economic impact of the pandemic, and political self-placement). We estimated odds ratio (OR) and 95% confidence interval (CI) conducting one age-adjusted multinomial logistic regression model for each determinant and then stratified them by gender. RESULTS Both social and ideological determinants had a weak association with the lack of vaccine accessibility. Individuals with medium educational attainment had higher odds of vaccine hesitancy (OR = 1.44, CI 1.08-1.93) compared with those with high educational attainment. People self-identified as conservative (OR = 2.90; CI 2.02-4.15) and those who prioritised the economic impact (OR = 3.80; CI 2.62-5.49) and voted for parties opposed to the Government (OR = 2.00; CI 1.54-2.60) showed higher vaccine hesitancy. The stratified analysis showed a similar pattern for both men and women. CONCLUSIONS Considering the determinants of vaccine uptake and hesitancy could help to design strategies that increase immunisation at the population level and minimise health inequities.
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Affiliation(s)
- M Fontán-Vela
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Instituto de Lengua, Literatura y Antropología, Centro Superior de Investigaciones Sociológicas, Ministerio de Ciencia e Innovación, Spain
| | - P Gullón
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - U Bilal
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - M Franco
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2217, USA
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Pierri F, DeVerna MR, Yang KC, Axelrod D, Bryden J, Menczer F. One Year of COVID-19 Vaccine Misinformation on Twitter: Longitudinal Study. J Med Internet Res 2023; 25:e42227. [PMID: 36735835 PMCID: PMC9970010 DOI: 10.2196/42227] [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: 09/04/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vaccinations play a critical role in mitigating the impact of COVID-19 and other diseases. Past research has linked misinformation to increased hesitancy and lower vaccination rates. Gaps remain in our knowledge about the main drivers of vaccine misinformation on social media and effective ways to intervene. OBJECTIVE Our longitudinal study had two primary objectives: (1) to investigate the patterns of prevalence and contagion of COVID-19 vaccine misinformation on Twitter in 2021, and (2) to identify the main spreaders of vaccine misinformation. Given our initial results, we further considered the likely drivers of misinformation and its spread, providing insights for potential interventions. METHODS We collected almost 300 million English-language tweets related to COVID-19 vaccines using a list of over 80 relevant keywords over a period of 12 months. We then extracted and labeled news articles at the source level based on third-party lists of low-credibility and mainstream news sources, and measured the prevalence of different kinds of information. We also considered suspicious YouTube videos shared on Twitter. We focused our analysis of vaccine misinformation spreaders on verified and automated Twitter accounts. RESULTS Our findings showed a relatively low prevalence of low-credibility information compared to the entirety of mainstream news. However, the most popular low-credibility sources had reshare volumes comparable to those of many mainstream sources, and had larger volumes than those of authoritative sources such as the US Centers for Disease Control and Prevention and the World Health Organization. Throughout the year, we observed an increasing trend in the prevalence of low-credibility news about vaccines. We also observed a considerable amount of suspicious YouTube videos shared on Twitter. Tweets by a small group of approximately 800 "superspreaders" verified by Twitter accounted for approximately 35% of all reshares of misinformation on an average day, with the top superspreader (@RobertKennedyJr) responsible for over 13% of retweets. Finally, low-credibility news and suspicious YouTube videos were more likely to be shared by automated accounts. CONCLUSIONS The wide spread of misinformation around COVID-19 vaccines on Twitter during 2021 shows that there was an audience for this type of content. Our findings are also consistent with the hypothesis that superspreaders are driven by financial incentives that allow them to profit from health misinformation. Despite high-profile cases of deplatformed misinformation superspreaders, our results show that in 2021, a few individuals still played an outsized role in the spread of low-credibility vaccine content. As a result, social media moderation efforts would be better served by focusing on reducing the online visibility of repeat spreaders of harmful content, especially during public health crises.
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Affiliation(s)
- Francesco Pierri
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
- Observatory on Social Media, Indiana University, Bloomington, IN, United States
| | - Matthew R DeVerna
- Observatory on Social Media, Indiana University, Bloomington, IN, United States
| | - Kai-Cheng Yang
- Observatory on Social Media, Indiana University, Bloomington, IN, United States
| | - David Axelrod
- Observatory on Social Media, Indiana University, Bloomington, IN, United States
| | - John Bryden
- Observatory on Social Media, Indiana University, Bloomington, IN, United States
| | - Filippo Menczer
- Observatory on Social Media, Indiana University, Bloomington, IN, United States
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10
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Schnake-Mahl AS, O'Leary G, Mullachery PH, Skinner A, Kolker J, Diez Roux AV, Raifman JR, Bilal U. Higher COVID-19 Vaccination And Narrower Disparities In US Cities With Paid Sick Leave Compared To Those Without. Health Aff (Millwood) 2022; 41:1565-1574. [PMID: 36343316 PMCID: PMC9913883 DOI: 10.1377/hlthaff.2022.00779] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Paid sick leave provides workers with paid time off to receive COVID-19 vaccines and to recover from potential vaccine adverse effects. We hypothesized that US cities with paid sick leave would have higher COVID-19 vaccination coverage and narrower coverage disparities than those without such policies. Using county-level vaccination data and paid sick leave data from thirty-seven large US cities in 2021, we estimated the association between city-level paid sick leave policies and vaccination coverage in the working-age population and repeated the analysis using coverage in the population ages sixty-five and older as a negative control. We also examined associations by neighborhood social vulnerability. Cities with a paid sick leave policy had 17 percent higher vaccination coverage than cities without such a policy. We found stronger associations between paid sick leave and vaccination in the most socially vulnerable neighborhoods compared with the least socially vulnerable ones, and no association in the population ages sixty-five and older. Paid sick leave policies are associated with higher COVID-19 vaccination coverage and narrower coverage disparities. Increasing access to these policies may help increase vaccination and reduce inequities in coverage.
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Affiliation(s)
| | | | - Pricila H Mullachery
- Pricila H. Mullachery, Drexel University and Temple University, Philadelphia, Pennsylvania
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11
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Beerman JT, Beaumont GG, Giabbanelli PJ. A Scoping Review of Three Dimensions for Long-Term COVID-19 Vaccination Models: Hybrid Immunity, Individual Drivers of Vaccinal Choice, and Human Errors. Vaccines (Basel) 2022; 10:vaccines10101716. [PMID: 36298581 PMCID: PMC9607873 DOI: 10.3390/vaccines10101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
The virus that causes COVID-19 changes over time, occasionally leading to Variants of Interest (VOIs) and Variants of Concern (VOCs) that can behave differently with respect to detection kits, treatments, or vaccines. For instance, two vaccination doses were 61% effective against the BA.1 predominant variant, but only 24% effective when BA.2 became predominant. While doses still confer protection against severe disease outcomes, the BA.5 variant demonstrates the possibility that individuals who have received a few doses built for previous variants can still be infected with newer variants. As previous vaccines become less effective, new ones will be released to target specific variants and the whole process of vaccinating the population will restart. While previous models have detailed logistical aspects and disease progression, there are three additional key elements to model COVID-19 vaccination coverage in the long term. First, the willingness of the population to participate in regular vaccination campaigns is essential for long-term effective COVID-19 vaccination coverage. Previous research has shown that several categories of variables drive vaccination status: sociodemographic, health-related, psychological, and information-related constructs. However, the inclusion of these categories in future models raises questions about the identification of specific factors (e.g., which sociodemographic aspects?) and their operationalization (e.g., how to initialize agents with a plausible combination of factors?). While previous models separately accounted for natural- and vaccine-induced immunity, the reality is that a significant fraction of individuals will be both vaccinated and infected over the coming years. Modeling the decay in immunity with respect to new VOCs will thus need to account for hybrid immunity. Finally, models rarely assume that individuals make mistakes, even though this over-reliance on perfectly rational individuals can miss essential dynamics. Using the U.S. as a guiding example, our scoping review summarizes these aspects (vaccinal choice, immunity, and errors) through ten recommendations to support the modeling community in developing long-term COVID-19 vaccination models.
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Affiliation(s)
- Jack T. Beerman
- Department of Computer Science & Software Engineering, Miami University, Oxford, OH 45056, USA
| | - Gwendal G. Beaumont
- Department of Computer Science & Software Engineering, Miami University, Oxford, OH 45056, USA
- IMT Mines Ales, 6 Av. de Clavieres, 30100 Ales, France
| | - Philippe J. Giabbanelli
- Department of Computer Science & Software Engineering, Miami University, Oxford, OH 45056, USA
- Correspondence:
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12
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Mullachery PH, Li R, Melly S, Kolker J, Barber S, Diez Roux AV, Bilal U. Inequities in spatial accessibility to COVID-19 testing in 30 large US cities. Soc Sci Med 2022; 310:115307. [PMID: 36049353 PMCID: PMC9420026 DOI: 10.1016/j.socscimed.2022.115307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Testing for SARS-CoV-2 infection has been a key strategy to mitigate and control the COVID-19 pandemic. Wide spatial and racial/ethnic disparities in COVID-19 outcomes have emerged in US cities. Previous research has highlighted the role of unequal access to testing as a potential driver of these disparities. We described inequities in spatial accessibility to COVID-19 testing locations in 30 large US cities. We used location data from Castlight Health Inc corresponding to October 2021. We created an accessibility metric at the level of the census block group (CBG) based on the number of sites per population in a 15-minute walkshed around the centroid of each CBG. We also calculated spatial accessibility using only testing sites without restrictions, i.e., no requirement for an appointment or a physician order prior to testing. We measured the association between the social vulnerability index (SVI) and spatial accessibility using a multilevel negative binomial model with random city intercepts and random SVI slopes. Among the 27,195 CBG analyzed, 53% had at least one testing site within a 15-minute walkshed, and 36% had at least one site without restrictions. On average, a 1-decile increase in the SVI was associated with a 3% (95% Confidence Interval: 2% - 4%) lower accessibility. Spatial inequities were similar across various components of the SVI and for sites with no restrictions. Despite this general pattern, several cities had inverted inequity, i.e., better accessibility in more vulnerable areas, which indicates that some cities may be on the right track when it comes to promoting equity in COVID-19 testing. Testing is a key component of the strategy to mitigate transmission of SARS-CoV-2 and efforts should be made to improve accessibility to testing, particularly as new and more contagious variants become dominant.
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Affiliation(s)
- Pricila H. Mullachery
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Health Services Administration and Policy, Temple University College of Public Health, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA,Corresponding author. 1301 Cecil B. Moore Ave., 539, Philadelphia, PA, 19122, United States
| | - Ran Li
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Steven Melly
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Jennifer Kolker
- Department of Health Management and Policy, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Sharrelle Barber
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA,Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA,Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
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13
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Moran KM, Mullachery PH, Lankenau S, Bilal U. Changes in Racial/Ethnic Disparities in Opioid-Related Outcomes in Urban Areas during the COVID-19 Pandemic: A Rapid Review of the Literature. IJERPH 2022; 19:ijerph19159283. [PMID: 35954640 PMCID: PMC9368442 DOI: 10.3390/ijerph19159283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
Opioid use disorders (OUDs) are increasingly common among minoritized populations, who have historically experienced limited access to healthcare, a situation that may have worsened during the COVID-19 pandemic. Using a structured keyword search in Pubmed, we reviewed the literature to synthesize the evidence on changes in racial/ethnic disparities in OUD-related outcomes in urban areas during the COVID-19 pandemic in the US. Nine articles were included in the final analysis. Six found increases in OUD-related outcomes during the pandemic, with four showing a widening of disparities. Results also point to the worsening of opioid outcomes among Black and Latinx individuals related to shelter-in-place or stay-at-home orders. Studies examining the use of telehealth and access to OUD treatment showed that minoritized groups have benefited from telehealth programs. The limited number of studies in a small number of jurisdictions indicate a gap in research examining the intersection between COVID-19 and OUD-related outcomes with a focus on disparities. More research is needed to understand the impact of the COVID-19 pandemic and related policies on OUD outcomes among racial/ethnic minoritized groups, including examining the impact of service disruptions on vulnerable groups with OUD.
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Affiliation(s)
- Kara M. Moran
- College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102, USA;
| | - Pricila H. Mullachery
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA;
- Correspondence:
| | - Stephen Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA;
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, Philadelphia, PA 19104, USA;
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA
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14
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Rich JA, Miech EJ, Bilal U, Corbin TJ. How education and racial segregation intersect in neighborhoods with persistently low COVID-19 vaccination rates in Philadelphia. BMC Public Health 2022; 22:1044. [PMID: 35614426 PMCID: PMC9130689 DOI: 10.1186/s12889-022-13414-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND COVID-19 infection has disproportionately affected socially disadvantaged neighborhoods. Despite this disproportionate burden of infection, these neighborhoods have also lagged in COVID-19 vaccinations. To date, we have little understanding of the ways that various types of social conditions intersect to explain the complex causes of lower COVID-19 vaccination rates in neighborhoods. METHODS We used configurational comparative methods (CCMs) to study COVID-19 vaccination rates in Philadelphia by neighborhood (proxied by zip code tabulation areas). Specifically, we identified neighborhoods where COVID-19 vaccination rates (per 10,000) were persistently low from March 2021 - May 2021. We then assessed how different combinations of social conditions (pathways) uniquely distinguished neighborhoods with persistently low vaccination rates from the other neighborhoods in the city. Social conditions included measures of economic inequities, racial segregation, education, overcrowding, service employment, public transit use, health insurance and limited English proficiency. RESULTS Two factors consistently distinguished neighborhoods with persistently low COVID-19 vaccination rates from the others: college education and concentrated racial privilege. Two factor values together - low college education AND low/medium concentrated racial privilege - identified persistently low COVID-19 vaccination rates in neighborhoods, with high consistency (0.92) and high coverage (0.86). Different values for education and concentrated racial privilege - medium/high college education OR high concentrated racial privilege - were each sufficient by themselves to explain neighborhoods where COVID-19 vaccination rates were not persistently low, likewise with high consistency (0.93) and high coverage (0.97). CONCLUSIONS Pairing CCMs with geospatial mapping can help identify complex relationships between social conditions linked to low COVID-19 vaccination rates. Understanding how neighborhood conditions combine to create inequities in communities could inform the design of interventions tailored to address COVID-19 vaccination disparities.
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Affiliation(s)
- John A Rich
- Department of Health Management and Policy, Center for Nonviolence and Social Justice, Dornsife School of Public Health, Drexel University, 1505 Race Street, MS 1047, 6th floor, Philadelphia, PA, 19102, USA.
| | - Edward J Miech
- Regenstrief Institute, Center for Health Services Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA
| | - Usama Bilal
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. Suite 730, Philadelphia, PA, 19104, USA
| | - Theodore J Corbin
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Suite 108 Kellogg, Chicago, IL, 60612, USA
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15
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Bilal U, Jemmott JB, Schnake-Mahl A, Murphy K, Momplaisir F. Racial/ethnic and neighbourhood social vulnerability disparities in COVID-19 testing positivity, hospitalization, and in-hospital mortality in a large hospital system in Pennsylvania: A prospective study of electronic health records. Lancet Reg Health Am 2022; 10:100220. [PMID: 35262038 PMCID: PMC8891851 DOI: 10.1016/j.lana.2022.100220] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Disparities in COVID-19 mortality by race/ethnicity or neighborhood have been documented using surveillance data. We aimed to describe disparities by race/ethnicity and neighbourhood social vulnerability in COVID-19 positivity, hospitalization, and mortality. Methods We obtained data from the electronic health records of all individuals who tested positive for COVID-19 in the University of Pennsylvania Health System (UPHS) or were hospitalized with confirmed COVID-19 infection in five UPHS hospitals from March 1, 2020, to March 31, 2021. The main predictors were race/ethnicity and neighbourhood-level social vulnerability. The main outcomes were COVID-19 test positivity, hospitalization with COVID-19, and 30-day in-hospital mortality following hospitalization with COVID-19. Findings A total of 225,129 unique individuals received COVID-19 testing and 18,995 had a positive test result. A total of 5,794 unique patients were hospitalized with COVID-19 and 511 died in-hospital within 30 days. Racial/ethnic minority groups and residents of higher social vulnerability neighbourhoods had higher test positivity and risk of hospitalization. We did not see in-hospital mortality disparities during the first wave but observed 75% and 68% higher odds of death among Hispanic and Asians compared to Whites during subsequent waves. Interpretation We observed significant racial/ethnic and neighbourhood disparities in COVID-19 outcomes, especially test positivity and odds of hospitalization, highlighting the importance of equitably improving access to preventive measures to reduce SARS-CoV-2 infection, including reducing exposure to the virus and ensuring equity in vaccination. Funding National Institutes of Health.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology and Biostatistics and Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Room 730, Philadelphia, PA 19104, USA,Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA,Corresponding author at: Department of Epidemiology and Biostatistics and Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, Room 730, Philadelphia, PA 19104, USA.
| | - John B. Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA,University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, PA, USA
| | - Alina Schnake-Mahl
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Kathleen Murphy
- University of Pennsylvania Perelman School of Medicine, Division of Infectious Diseases, PA, USA
| | - Florence Momplaisir
- University of Pennsylvania Perelman School of Medicine, Division of Infectious Diseases, PA, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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