1913. Baltimore City Health Department COVID-19 Community-based Testing Results

Background

The Baltimore City Health Department (BCHD) began community-based COVID-19 testing in response to the pandemic on April 21, 2020. The purpose was to provide access to COVID-19 testing to underserved communities. BCHD designed the program to accommodate transportation limitations, limited-access to internet and phones, and non-English speakers. BCHD has continued hosting up to five community-based testing sites per week. This analysis examines the test results of BCHD’s COVID-19 community-based testing program to date.

Methods

Patients completed an intake form, which included demographic information, at the testing event, prior to providing their specimen for COVID-19 testing. For this analysis, patient demographics and test results were analyzed using REDCap software.

Results

Total test volume for year 2020 (4/21/2020 -12/30/2020) was 15,839, year 2021 (1/5/2021- 12/30/2021) was 13,087, and year 2022 (1/4/2022 - 4/1/2022) was 2,261. Average percent positivity for year 2020 was 9%, year 2021 was 7%, and year 2022 to date was 6%. Patient ethnicity was Non-Hispanic 85.5%, Hispanic 13.5%, and Did not respond/Don’t know 1.0%. Race was Black or African America 61.1%, White 25.0%, Asian 2.8%, American Indian/Alaska Native 0.1%, Native Hawaiian or Other Pacific Islander 0.1%, and Unknown 10.7%. Total positive COVID-19 results among Black/African Americans in 2020, 2021, and 2022 respectively were 1567 (12.8%), 1177 (15.1%), and 218 (22.1%). Total positive COVID-19 results among White in 2020, 2021, and 2022 respectively were 541 (10.1%), 441 (12.1%), and 60 (15.1%) respectively. Total positive COVID-19 results among Asians in 2020, 2021, and 2022 were 63 (20.9%), 47 (11.0%), and 4 (25.5%) respectively. Total positive COVID-19 results among Native Hawaiian or Other Pacific Islander in 2020, 2021, and 2022 respectively were 4 (16.7%), 4 (20.0%), and 2 (0.0%) respectively. Total positive COVID-19 results among American Indian/Alaskan in 2020, 2021, and 2022 were 3 (13.6%), 1 (7.1%), and 2 (66.7%) respectively.

Conclusion

BCHD’s community-based testing program has completed over 31,000 tests to date. COVID-19 percent positivity among patients showed a decline across the three years. This analysis demonstrates how a local health department can provide testing to the communities.

Disclosures

All Authors: No reported disclosures.

A Web-Based Tool for Quantification of Potential Gains in Life Expectancy by Preventing Cause-Specific Mortality

Introduction: Local health departments are currently limited in their ability to use life expectancy (LE) as a benchmark for improving community health. In collaboration with the Baltimore City Health Department, our aim was to develop a web-based tool to estimate the potential lives saved and gains in LE in specific neighborhoods following interventions targeting achievable reductions in preventable deaths. Methods: The PROLONGER (ImPROved LONGEvity through Reductions in Cause-Specific Deaths) tool utilizes a novel Lives Saved Simulation model to estimate neighborhood-level potential change in LE after specified reduction in cause-specific mortality. This analysis uses 2012-2016 deaths in Baltimore City residents; a 20% reduction in heart disease mortality is shown as a case study. Results: According to PROLONGER, if heart disease deaths could be reduced by 20% in a given neighborhood in Baltimore City, there could be up to a 2.3-year increase in neighborhood LE. The neighborhoods with highest expected LE increase are not the same as those with highest heart disease mortality burden or lowest overall life expectancies. Discussion: PROLONGER is a practical resource for local health officials in prioritizing scarce resources to improve health outcomes. Focusing programs based on potential LE impact at the neighborhood level could lend new information for targeting of place-based public health interventions.

Evaluating Neighborhood Correlates and Geospatial Distribution of Breast, Cervical, and Colorectal Cancer Incidence

Introduction: Though cancer research has traditionally centered on individual-level exposures, there is growing interest in the geography of both cancer and its risk factors. This geographic and epidemiological research has consistently shown that cancer outcomes and their known causal exposures exhibit geographic variation that coincide with area-level socioeconomic status and the composition of neighborhoods. A retrospective study was conducted to evaluate geospatial variation for female breast, cervical, and colorectal cancer incidence in Baltimore City.

Materials and Methods: Using a Maryland Cancer Registry dataset of incident breast, cervical, and colorectal cancers (N = 4,966) among Baltimore City female residents diagnosed from 2000 to 2010, spatial and epidemiological analyses were conducted through choropleth maps, spatial cluster identification, and local Moran's I. Ordinary least squares regression models identified characteristics associated with the geospatial clusters.

Results: Each cancer type exhibited geographic variation across Baltimore City with the neighborhoods showing high incidence differing by cancer type. Specifically, breast cancer had significant low incidence in downtown Baltimore while cervical cancer had high incidence. The neighborhood covariates associated with the geographic variation also differed by cancer type while local Moran's I identified discordant clusters.

Discussion: Cancer incidence varied geographically by cancer type within a single city (county). Small area estimates are needed to detect local patterns of disease when developing health and preventative programs. Given the observed variability of community-level characteristics associated with each cancer type incidence, local information is essential for developing place-, social-, and outcome-specific interventions.

Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: A Randomized Controlled Trial

BACKGROUND

There is growing evidence that patient navigation improves breast cancer screening rates; however, there are limited efficacy studies of its effect among African American older adult women.

OBJECTIVE

To evaluate the effect of patient navigation on screening mammography among African American female Medicare beneficiaries in Baltimore, MD.

DESIGN

The Cancer Prevention and Treatment Demonstration (CPTD), a multi-site study, was a randomized controlled trial conducted from April 2006 through December 2010.

SETTING

Community-based and clinical setting.

PARTICIPANTS

The CPTD Screening Trial enrolled 1905 community-dwelling African American female Medicare beneficiaries who were ≥65 years of age and resided in Baltimore, MD. Participants were recruited from health clinics, community centers, health fairs, mailings using Medicare rosters, and phone calls.

INTERVENTIONS

Participants were randomized to either: printed educational materials on cancer screening (control group) or printed educational materials + patient navigation services designed to help participants overcome barriers to cancer screening (intervention group).

MAIN MEASURE

Self-reported receipt of mammography screening within 2 years of the end of the study.

KEY RESULTS

The median follow-up period for participants in this analysis was 17.8 months. In weighted multivariable logistic regression analyses, women in the intervention group had significantly higher odds of being up to date on mammography screening at the end of the follow-up period compared to women in the control group (odds ratio [OR] 2.26, 95 % confidence interval [CI]1.59-3.22). The effect of the intervention was stronger among women who were not up to date with mammography screening at enrollment (OR 3.63, 95 % CI 2.09-6.38).

CONCLUSION

Patient navigation among urban African American Medicare beneficiaries increased self-reported mammography utilization. The results suggest that patient navigation for mammography screening should focus on women who are not up to date on their screening.