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Noppert GA, Clarke P, Hoover A, Kubale J, Melendez R, Duchowny K, Hegde ST. State variation in neighborhood COVID-19 burden across the United States. Commun Med (Lond) 2024; 4:36. [PMID: 38429552 PMCID: PMC10907669 DOI: 10.1038/s43856-024-00459-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND A lack of fine, spatially-resolute case data for the U.S. has prevented the examination of how COVID-19 infection burden has been distributed across neighborhoods, a key determinant of both risk and resilience. Without more spatially resolute data, efforts to identify and mitigate the long-term fallout from COVID-19 in vulnerable communities will remain difficult to quantify and intervene on. METHODS We leveraged spatially-referenced data from 21 states collated through the COVID Neighborhood Project to examine the distribution of COVID-19 cases across neighborhoods and states in the U.S. We also linked the COVID-19 case data with data on the neighborhood social environment from the National Neighborhood Data Archive. We then estimated correlations between neighborhood COVID-19 burden and features of the neighborhood social environment. RESULTS We find that the distribution of COVID-19 at the neighborhood-level varies within and between states. The median case count per neighborhood (coefficient of variation (CV)) in Wisconsin is 3078.52 (0.17) per 10,000 population, indicating a more homogenous distribution of COVID-19 burden, whereas in Vermont the median case count per neighborhood (CV) is 810.98 (0.84) per 10,000 population. We also find that correlations between features of the neighborhood social environment and burden vary in magnitude and direction by state. CONCLUSIONS Our findings underscore the importance that local contexts may play when addressing the long-term social and economic fallout communities will face from COVID-19.
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Affiliation(s)
- Grace A Noppert
- Institute for Social Research, University of Michigan, Ann Arbor, USA.
| | - Philippa Clarke
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Andrew Hoover
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - John Kubale
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Robert Melendez
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Kate Duchowny
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Sonia T Hegde
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
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Razdan S, Hedli LC, Sigurdson K, Profit J, Morton CH. Disparity drivers, potential solutions, and the role of a health equity dashboard in the neonatal intensive care unit: a qualitative study. J Perinatol 2023:10.1038/s41372-023-01856-5. [PMID: 38155228 DOI: 10.1038/s41372-023-01856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/02/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Racial/ethnic disparities are well-described in the neonatal intensive care unit (NICU). We explored expert opinion on their etiology, potential solutions, and the ability of health equity dashboards to meaningfully capture NICU disparities. STUDY DESIGN We conducted 12 qualitative semi-structured interviews, purposively selecting a diverse group of neonatal experts. We used grounded theory to develop codes, shape interviews, and conduct analysis. RESULT We identified three sources of disparity: interpersonal bias, care process and institutional barriers, and social determinants of health, particularly as they affect parental engagement in the NICU. Proposed solutions included racial/cultural concordance, bolstering hospital-based resources, and policy interventions. Health equity dashboards were viewed as useful but limited, because clinical metrics do not account for many of the aforementioned sources of disparities. CONCLUSION Equity dashboards serve as a motivational starting point for quality improvement; future iterations may require novel, qualitative data sources to identify underlying etiologies of NICU disparities.
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Affiliation(s)
- Sheila Razdan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura C Hedli
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Krista Sigurdson
- School of Journalism, Writing, and Media, University of British Columbia, Kelowna, BC, Canada
| | - Jochen Profit
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine H Morton
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Hill D, Dunham C, Larsen DA, Collins M. Operationalizing an open-source dashboard for communicating results of wastewater-based surveillance. MethodsX 2023; 11:102299. [PMID: 37554289 PMCID: PMC10404718 DOI: 10.1016/j.mex.2023.102299] [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] [Received: 05/31/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
COVID-19 saw the expansion of public health tools to manage the pandemic. One tool that saw extensive use was the public health dashboard, web-based visualization tools that communicate information to users in easy-to-read graphics. Dashboards were widely used prior to the pandemic, but COVID-19 saw expanded use and development. To date, dashboards have become an important part of public health surveillance programs around the world helping decisionmakers use data to evaluate different public health metrics including caseloads, hospitalizations, and environmental surveillance results from testing wastewater. Wastewater surveillance provides community-based, spatially relevant data on disease trends within communities to assess the scale of infection in a region, which makes it an excellent candidate for dashboard development to improve public health. We developed a dashboard for New York State's wastewater surveillance program using open-source, reproducible web programming. The dashboard we developed has been used for the COVID-19 response in New York, and our methods can be adapted to other programs and pathogens. We provide:•descriptions of how the dashboard was developed and maintained•specific guidance for reproducing our dashboard in other areas and for other pathogens•fully reproducible code with step-by-step instructions for researchers and professionals to make their own data dashboards.
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Affiliation(s)
- Dustin Hill
- Department of Public Health, Syracuse University, Syracuse, NY, USA
| | | | - David A. Larsen
- Department of Public Health, Syracuse University, Syracuse, NY, USA
| | - Mary Collins
- School of Marine and Atmospheric Sciences, Sustainability Studies Division, Stony Brook University, Stony Brook, NY, USA
- Institute for Advanced Computational Science, Stony Brook University, Stony Brook, NY, USA
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Silva A, Saiyed NS, Canty E, Benjamins MR. Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study. BMC Public Health 2023; 23:2310. [PMID: 37993811 PMCID: PMC10664538 DOI: 10.1186/s12889-023-17214-1] [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: 05/04/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Racial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover. METHODS Using National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019). RESULTS In 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities. CONCLUSION Urban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.
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Affiliation(s)
- Abigail Silva
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA.
| | | | - Emma Canty
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
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Gallifant J, Kistler EA, Nakayama LF, Zera C, Kripalani S, Ntatin A, Fernandez L, Bates D, Dankwa-Mullan I, Celi LA. Disparity dashboards: an evaluation of the literature and framework for health equity improvement. Lancet Digit Health 2023; 5:e831-e839. [PMID: 37890905 PMCID: PMC10639125 DOI: 10.1016/s2589-7500(23)00150-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/25/2023] [Accepted: 07/26/2023] [Indexed: 10/29/2023]
Abstract
The growing recognition of differences in health outcomes across populations has led to a slow but increasing shift towards transparent reporting of patient outcomes. In addition, pay-for-equity initiatives, such as those proposed by the Centers for Medicare and Medicaid, will require the reporting of health outcomes across subgroups over time. Dashboards offer one means of visualising data in the health-care context that can highlight essential disparities in clinical outcomes, guide targeted quality-improvement efforts, and ultimately improve health equity. In this Viewpoint, we evaluate all studies that have reported the successful development of a disparity dashboard and share the data collected and unintended consequences reported. We propose a framework for systematic equality improvement through incentivisation of the collecting and reporting of health data and through implementation of reward systems to reduce health disparities.
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Affiliation(s)
- Jack Gallifant
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Emmett Alexander Kistler
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Luis Filipe Nakayama
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Ophthalmology, São Paulo Federal University, São Paulo, Brazil
| | - Chloe Zera
- Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adelline Ntatin
- Department of Health Equity, Beth Israel Lahey Health, Boston, MA, USA
| | - Leonor Fernandez
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Irene Dankwa-Mullan
- Merative & Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, MA, USA; Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
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Castaneda Y, Jacobs J, Margellos-Anast H, De Maio FG, Nunez-Montelongo L, Mettetal E, Benjamins MR. Developing and Implementing Racial Health Equity Plans in Four Large US Cities: A Qualitative Study. J Public Health Manag Pract 2023; 29:780-790. [PMID: 37290120 DOI: 10.1097/phh.0000000000001756] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT Local health departments (LHDs) and their partners are critical components of the fight for racial health equity, particularly given the variation in levels of, and pathways to, inequities at the local level. OBJECTIVE To inform continued progress in this area, we qualitatively examined the development and implementation of equity-related plans and initiatives of LHDs within 4 large US cities: Baltimore, Boston, Chicago, and Philadelphia. DESIGN AND MEASURES We conducted 15 semistructured interviews with 21 members of LHDs, academic institutions, health systems, and community-based organizations involved with health equity strategies or activities in their respective cities. Outcomes included perceptions of the effectiveness of the local health equity plan, participation in other equity-related initiatives, stakeholder engagement, and best practices. RESULTS We contacted 49 individuals, of whom 2 declined and 21 accepted our interview invitation. Recruitment was stopped after we reached saturation. Thematic analysis identified 5 themes across interviews: (1) organizations were flexible in reallocating resources to address racial and health equity; (2) multidisciplinary teams are necessary for effective development and implementation of health equity plans; (3) community collaboration is required for meaningful and sustainable change; (4) there is a direct relationship between racism, structural inequities, and health outcomes; and (5) health departments have prioritized health equity plan development, but further work is required to address root causes. CONCLUSIONS In the United States, health departments have begun to develop and implement strategic health plans focused on equity. However, the extent to which these plans result in actual initiatives (both internal and external) varied across cities. The current study increases our understanding of how different partners are working to implement structural changes, programs, and policies to reach equity-related goals in our largest urban areas, providing valuable insight for urban health advocates across the country.
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Affiliation(s)
- Yvette Castaneda
- Sinai Urban Health Institute, Chicago, Illinois (Drs Castaneda and Benjamins and Mss Jacobs and Nunez-Montelongo); American Medical Association, Chicago, Illinois (Dr De Maio); DePaul University, Chicago, Illinois (Dr De Maio); and Rosalind Franklin University, North Chicago, Illinois (Mr Mettetal)
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Razdan S, Hedli L, Sigurdson K, Profit J, Morton C. Disparities and Equity Dashboards in the Neonatal Intensive Care Unit: A Qualitative Study of Expert Perspectives. Res Sq 2023:rs.3.rs-3002217. [PMID: 37461712 PMCID: PMC10350244 DOI: 10.21203/rs.3.rs-3002217/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Objective Racial/ethnic disparities are well-described in the neonatal intensive care unit (NICU). We explore expert opinion on their root causes, potential solutions, and the ability of health equity dashboards to meaningfully address NICU disparities. Study Design We conducted 12 qualitative semi-structured interviews, purposively selecting a diverse group of neonatal experts. We used grounded theory to develop codes, shape interviews, and conduct analysis. Result Participants identified three sources of disparity: interpersonal bias, care process barriers, and social determinants of health, particularly as they affect parental engagement in the NICU. Proposed solutions included racial/cultural concordance, bolstering hospital-based resources, and policy interventions. Health equity dashboards were viewed as useful but limited because clinical metrics do not account for many of the aforementioned sources of disparities. Conclusion Equity dashboards serve as a motivational starting point for quality improvement; future iterations may require novel, qualitative data sources to identify underlying etiologies of NICU disparities.
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Bilal U, Mullachery PH, Schnake-Mahl A, Rollins H, McCulley E, Kolker J, Barber S, Diez Roux AV. Heterogeneity in Spatial Inequities in COVID-19 Vaccination Across 16 Large US Cities. Am J Epidemiol 2022; 191:1546-1556. [PMID: 35452081 PMCID: PMC9047229 DOI: 10.1093/aje/kwac076] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 10/04/2021] [Revised: 03/02/2022] [Accepted: 04/14/2022] [Indexed: 01/29/2023] Open
Abstract
Differences in vaccination coverage can perpetuate coronavirus disease 2019 (COVID-19) disparities. We explored the association between neighborhood-level social vulnerability and COVID-19 vaccination coverage in 16 large US cities from the beginning of the vaccination campaign in December 2020 through September 2021. We calculated the proportion of fully vaccinated adults in 866 zip code tabulation areas (ZCTAs) of 16 large US cities: Long Beach, Los Angeles, Oakland, San Diego, San Francisco, and San Jose, all in California; Chicago, Illinois; Indianapolis, Indiana; Minneapolis, Minnesota; New York, New York; Philadelphia, Pennsylvania; and Austin, Dallas, Fort Worth, Houston, and San Antonio, all in Texas. We computed absolute and relative total and Social Vulnerability Index-related inequities by city. COVID-19 vaccination coverage was 0.75 times (95% confidence interval: 0.69, 0.81) or 16 percentage points (95% confidence interval: 12.1, 20.3) lower in neighborhoods with the highest social vulnerability as compared with those with the lowest. These inequities were heterogeneous, with cities in the West generally displaying narrower inequities in both the absolute and relative scales. The Social Vulnerability Index domains of socioeconomic status and of household composition and disability showed the strongest associations with vaccination coverage. Inequities in COVID-19 vaccinations hamper efforts to achieve health equity, as they mirror and could lead to even wider inequities in other COVID-19 outcomes.
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Affiliation(s)
- Usama Bilal
- Correspondence to Dr. Usama Bilal, 3600 Market Street, Suite 730, Philadelphia, PA, 19104 (e-mail: )
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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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