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Miles S, Renedo A, Kühlbrandt C, McGowan C, Stuart R, Grenfell P, Marston C. Health risks at work mean risks at home: Spatial aspects of COVID-19 among migrant workers in precarious jobs in England. Sociol Health Illn 2024; 46:381-398. [PMID: 37728181 DOI: 10.1111/1467-9566.13711] [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] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/11/2023] [Indexed: 09/21/2023]
Abstract
During COVID-19 lockdowns in England, 'key workers' including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers' experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers' families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers' lives beyond the workplace.
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Affiliation(s)
- Sam Miles
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte Kühlbrandt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine McGowan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Stuart
- College of Business, Arts and Social Sciences, Brunel University London, London, UK
| | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Bose S, McDermott KM, Keegan A, Black JH, Drudi LM, Lum YW, Zarkowsky DS, Hicks CW. Socioeconomic status fails to account for worse outcomes in non-Hispanic black patients undergoing carotid revascularization. J Vasc Surg 2023; 78:1248-1259.e1. [PMID: 37419427 PMCID: PMC10615195 DOI: 10.1016/j.jvs.2023.06.103] [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: 03/30/2023] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Previous studies have reported an association of Black race with worse carotid revascularization outcomes, but rarely include socioeconomic status as a confounding covariate. We aimed to assess the association of race and ethnicity with in-hospital and long-term outcomes following carotid revascularization before and after accounting for socioeconomic status. METHODS We identified non-Hispanic Black and non-Hispanic white patients who underwent carotid endarterectomy, transfemoral carotid stenting, or transcarotid artery revascularization between 2003 and 2022 in the Vascular Quality Initiative. Primary outcomes were in-hospital stroke/death and long-term stroke/death. Multivariable logistic regression and Cox proportional hazards models were used to assess the association of race with perioperative and long-term outcomes after adjusting for baseline characteristics using a sequential model approach without and with consideration of Area Deprivation Index (ADI), a validated composite marker of socioeconomic status. RESULTS Of 201,395 patients, 5.1% (n = 10,195) were non-Hispanic Black, and 94.9% (n = 191,200) were non-Hispanic white. Mean follow-up time was 3.4±0.01 years. A disproportionately high percentage of Black patients were living in more socioeconomically deprived neighborhoods relative to their white counterparts (67.5% vs 54.2%; P < .001). After adjusting for demographic, comorbidity, and disease characteristics, Black race was associated with greater odds of in-hospital (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.10-1.40) and long-term stroke/death (adjusted hazard ratio [aHR], 1.13; 95% CI, 1.04-1.23). These associations did not substantially change after additionally adjusting for ADI; Black race was persistently associated with greater odds of in-hospital (aOR, 1.23; 95% CI, 1.09-1.39) and long-term stroke/death (aHR, 1.12; 95% CI, 1.03-1.21). Patients living in the most deprived neighborhoods were at greater risk of long-term stroke/death compared with patients living in the least deprived neighborhoods (aHR, 1.19; 95% CI, 1.05-1.35). CONCLUSIONS Non-Hispanic Black race is associated with worse in-hospital and long-term outcomes following carotid revascularization despite accounting for neighborhood socioeconomic deprivation. There appears to be unrecognized gaps in care that prevent Black patients from experiencing equitable outcomes following carotid artery revascularization.
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Affiliation(s)
- Sanuja Bose
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Alana Keegan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD
| | - James H. Black
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura M. Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Ying-Wei Lum
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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van der Feltz S, Schlünssen V, Basinas I, Begtrup LM, Burdorf A, Bonde JPE, Flachs EM, Peters S, Pronk A, Stokholm ZA, van Tongeren M, van Veldhoven K, Oude Hengel KM, Kolstad HA. Associations between an international COVID-19 job exposure matrix and SARS-CoV-2 infection among 2 million workers in Denmark. Scand J Work Environ Health 2023; 49:375-385. [PMID: 37167299 PMCID: PMC10790132 DOI: 10.5271/sjweh.4099] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES This study investigates the associations between the Danish version of a job exposure matrix for COVID-19 (COVID-19-JEM) and Danish register-based SARS-CoV-2 infection information across three waves of the pandemic. The COVID-19-JEM consists of four dimensions on transmission: two on mitigation measures, and two on precarious work characteristics. METHODS The study comprised 2 021 309 persons from the Danish working population between 26 February 2020 and 15 December 2021. Logistic regression models were applied to assess the associations between the JEM dimensions and overall score and SARS-CoV-2 infection across three infection waves, with peaks in March-April 2020, December-January 2021, and February-March 2022. Sex, age, household income, country of birth, wave, residential region and during wave 3 vaccination status were accounted for. RESULTS Higher risk scores within the transmission and mitigation dimensions and the overall JEM score resulted in higher odds ratios (OR) of a SARS-CoV-2 infection. OR attenuated across the three waves with ranges of 1.08-5.09 in wave 1, 1.06-1.60 in wave 2, and 1.05-1.45 in those not (fully) vaccinated in wave 3. In wave 3, no associations were found for those fully vaccinated. In all waves, the two precarious work dimensions showed weaker or inversed associations. CONCLUSIONS The COVID-19-JEM is a promising tool for assessing occupational exposure to SARS-CoV-2 and other airborne infectious agents that mainly spread between people who are in close contact with each other. However, its usefulness depends on applied restrictions and the vaccination status in the population of interest.
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Affiliation(s)
- Sophie van der Feltz
- Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark.
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Pizzamiglio C, Pitceathly RDS, Lunn MP, Brady S, De Marchi F, Galan L, Heckmann JM, Horga A, Molnar MJ, Oliveira ASB, Pinto WBVR, Primiano G, Santos E, Schoser B, Servidei S, Sgobbi Souza P, Venugopalan V, Hanna MG, Dimachkie M, Machado PM. Factors associated with the severity of COVID-19 outcomes in people with neuromuscular diseases: Data from the International Neuromuscular COVID-19 Registry. Eur J Neurol 2023; 30:399-412. [PMID: 36303290 PMCID: PMC9874570 DOI: 10.1111/ene.15613] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/09/2022] [Accepted: 10/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Clinical outcome information on patients with neuromuscular diseases (NMDs) who have been infected with SARS-CoV-2 is limited. The aim of this study was to determine factors associated with the severity of COVID-19 outcomes in people with NMDs. METHODS Cases of NMD, of any age, and confirmed/presumptive COVID-19, submitted to the International Neuromuscular COVID-19 Registry up to 31 December 2021, were included. A mutually exclusive ordinal COVID-19 severity scale was defined as follows: (1) no hospitalization; (2) hospitalization without oxygenation; (3) hospitalization with ventilation/oxygenation; and (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs) for severe outcome, adjusting for age, sex, race/ethnicity, NMD, comorbidities, baseline functional status (modified Rankin scale [mRS]), use of immunosuppressive/immunomodulatory medication, and pandemic calendar period. RESULTS Of 315 patients from 13 countries (mean age 50.3 [±17.7] years, 154 [48.9%] female), 175 (55.5%) were not hospitalized, 27 (8.6%) were hospitalized without supplemental oxygen, 91 (28.9%) were hospitalized with ventilation/supplemental oxygen, and 22 (7%) died. Higher odds of severe COVID-19 outcomes were observed for: age ≥50 years (50-64 years: OR 2.4, 95% confidence interval [CI] 1.33-4.31; >64 years: OR 4.16, 95% CI 2.12-8.15; both vs. <50 years); non-White race/ethnicity (OR 1.81, 95% CI 1.07-3.06; vs. White); mRS moderately severe/severe disability (OR 3.02, 95% CI 1.6-5.69; vs. no/slight/moderate disability); history of respiratory dysfunction (OR 3.16, 95% CI 1.79-5.58); obesity (OR 2.24, 95% CI 1.18-4.25); ≥3 comorbidities (OR 3.2, 95% CI 1.76-5.83; vs. ≤2; if comorbidity count used instead of specific comorbidities); glucocorticoid treatment (OR 2.33, 95% CI 1.14-4.78); and Guillain-Barré syndrome (OR 3.1, 95% CI 1.35-7.13; vs. mitochondrial disease). CONCLUSIONS Among people with NMDs, there is a differential risk of COVID-19 outcomes according to demographic and clinical characteristics. These findings could be used to develop tailored management strategies and evidence-based recommendations for NMD patients.
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Affiliation(s)
- Chiara Pizzamiglio
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular DiseasesThe National Hospital for Neurology and NeurosurgeryLondonUK
| | - Robert D. S. Pitceathly
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular DiseasesThe National Hospital for Neurology and NeurosurgeryLondonUK
| | - Michael P. Lunn
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUK
| | - Stefen Brady
- Department of NeurologyJohn Radcliffe HospitalOxfordUK
| | - Fabiola De Marchi
- Department of Neurology and ALS Centre, Translational MedicineUniversity of Piemonte Orientale, Maggiore Della Carità HospitalNovaraItaly
| | - Lucia Galan
- Neuromuscular Diseases Unit, Department of NeurologyHospital Clínico San Carlos and Instituto de Investigación Sanitaria San Carlos (IdISSC)MadridSpain
| | - Jeannine M. Heckmann
- Division of Neurology, Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Alejandro Horga
- Neuromuscular Diseases Unit, Department of NeurologyHospital Clínico San Carlos and Instituto de Investigación Sanitaria San Carlos (IdISSC)MadridSpain
| | - Maria J. Molnar
- Institute of Genomic Medicine and Rare DisordersSemmelweis UniversityBudapestHungary
| | - Acary S. B. Oliveira
- Division of Neuromuscular Diseases, Department of Neurology and NeurosurgeryFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Wladimir B. V. R. Pinto
- Division of Neuromuscular Diseases, Department of Neurology and NeurosurgeryFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Guido Primiano
- Neurophysiopathology UnitFondazione Policlinico Universitario A. Gemelli, IRCCSRomeItaly
- Department of NeuroscienceUniversità Cattolica del Sacro CuoreRomeItaly
| | - Ernestina Santos
- Department of NeurologyCentro Hospitalar Universitario do Porto, Hospital de Santo AntonioOportoPortugal
| | - Benedikt Schoser
- Department of Neurology, LMU KlinikumFriedrich‐Baur‐Institute, Ludwig‐Maximilians‐University MunichMunichGermany
| | - Serenella Servidei
- Neurophysiopathology UnitFondazione Policlinico Universitario A. Gemelli, IRCCSRomeItaly
- Department of NeuroscienceUniversità Cattolica del Sacro CuoreRomeItaly
| | - Paulo V. Sgobbi Souza
- Division of Neuromuscular Diseases, Department of Neurology and NeurosurgeryFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Vishnu Venugopalan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Michael G. Hanna
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular DiseasesThe National Hospital for Neurology and NeurosurgeryLondonUK
| | - Mazen M. Dimachkie
- Department of NeurologyUniversity of Kansas Medical CentreKansas CityKansasUSA
| | - Pedro M. Machado
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUK
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Tien M, Saddic LA, Neelankavil JP, Shemin RJ, Williams TM. The Impact of COVID-19 on Racial and Ethnic Disparities in Cardiac Procedural Care. J Cardiothorac Vasc Anesth 2023; 37:732-747. [PMID: 36863983 PMCID: PMC9827732 DOI: 10.1053/j.jvca.2023.01.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The primary objective of this study was to evaluate whether the COVID-19 pandemic altered the racial and ethnic composition of patients receiving cardiac procedural care. DESIGN This was a retrospective observational study. SETTING This study was conducted at a single tertiary-care university hospital. PARTICIPANTS A total of 1,704 adult patients undergoing transcatheter aortic valve replacement (TAVR) (n = 413), coronary artery bypass grafting (CABG) (n = 506), or atrial fibrillation (AF) ablation (n = 785) from March 2019 through March 2022 were included in this study. INTERVENTIONS No interventions were performed as this was a retrospective observational study. MEASUREMENTS AND MAIN RESULTS Patients were grouped based on the date of their procedure: pre-COVID (March 2019 to February 2020), COVID Year 1 (March 2020 to February 2021), and COVID Year 2 (March 2021 to March 2022). Population-adjusted procedural incidence rates during each period were examined and stratified based on race and ethnicity. The procedural incidence rate was higher for White patients versus Black, and non-Hispanic patients versus Hispanic patients for every procedure and every period. For TAVR, the difference in procedural rates between White patients versus Black patients decreased between the pre-COVID and COVID Year 1 (12.05-6.34 per 1,000,000 persons). For CABG, the difference in procedural rates between White patients versus Black, and non-Hispanic patients versus Hispanic patients did not change significantly. For AF ablations, the difference in procedural rates between White patients versus Black patients increased over time (13.06 to 21.55 to 29.64 per 1,000,000 persons in the pre-COVID, COVID Year 1, and COVID Year 2, respectively). CONCLUSION Racial and ethnic disparities in access to cardiac procedural care were present throughout all study time periods at the authors' institution. Their findings reinforce the continuing need for initiatives to reduce racial and ethnic disparities in healthcare. Further studies are needed to fully elucidate the effects of the COVID-19 pandemic on healthcare access and delivery.
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Affiliation(s)
- Michael Tien
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA
| | - Louis A. Saddic
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA
| | - Jacques P. Neelankavil
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA
| | - Richard J. Shemin
- Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, CA
| | - Tiffany M. Williams
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA,Address correspondence to Tiffany M. Williams, MD, PhD, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, 757 Westwood Plaza, Suite 3304, Los Angeles, CA 90095
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Ross W, Reidhead M, Jansen R, Boyd C, Geng E. IMPACT OF THE COVID-19 PANDEMIC ON PUBLIC HOSPITALS IN THE UNITED STATES. Trans Am Clin Climatol Assoc 2023; 133:11-23. [PMID: 37701611 PMCID: PMC10493752] [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] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The country's public hospitals, guided by the principles established by the first such hospital in 1736 and codified through the policies of the Surgeon General in 1936, have played an outsized role as safety net institutions for disadvantaged populations. Public hospitals are predominantly located in urban, under-resourced neighborhoods and treat a larger percentage of low-income individuals who are uninsured or enrolled in Medicaid. In assessing the status of public hospitals and urban communities in the twenty-first century, the impact of the COVID-19 pandemic was evaluated at two high-performing public hospitals, Grady Memorial Hospital and Rush University Medical Center, and a network of safety hospitals affiliated with the Missouri Hospital Association. COVID-19 infections and death rates stratified by race and ethnicity were examined. The results suggest a trend toward lower mortality in African American patients in the first year of the pandemic and possible adverse outcomes in a subset of rural hospitals in Missouri. This study highlights the need to expand funding and support for the nation's essential hospitals.
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