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Rowley KM, Ky A, Matthews ND. Diversity, Equity, Inclusion, and Antiracism Research in Physical Therapy Over the Last 25 Years: A Scoping Review. Phys Ther 2024; 104:pzae072. [PMID: 38769877 DOI: 10.1093/ptj/pzae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/30/2024] [Accepted: 03/21/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Discussions of the root causes of health disparities and educational inequities often neglect to identify racism as a primary factor. Researchers must take a systems perspective to identify the effects of racism and other forms of systemic oppression on health. It is unclear to what extent this perspective exists in the physical therapy research literature. We conducted a scoping review to quantify and describe the volume of research in physical therapy pertaining to diversity, equity, and inclusion specifically examining race and/or ethnicity and references racism or antiracism. METHODS A systematic search of PubMed and Scopus databases for articles published between 1997 and 2021 was conducted. Articles were screened to ensure they were focused exclusively or primarily on physical therapy and used diversity, equity, and inclusion terms in the context of personal identity factors. This resulted in 158 relevant articles. Each was tagged with an article type and personal identity factor focus. RESULTS A majority of the included articles were descriptive/observational in nature. The included articles explored various personal identity factors, with race and ethnicity being the most common focus followed by culture, disability, and socioeconomic status. A small proportion of articles explicitly discussed racism or antiracism. CONCLUSION These findings highlight the need in physical therapy research for greater attention to racism as a fundamental cause of health disparities and educational inequities. Addressing this gap is crucial for promoting diversity, equity, and inclusion within the field and ultimately achieving optimal health outcomes for marginalized populations. IMPACT Including consideration of racism and other forms of systemic oppression in the motivation, design, and interpretation of research in physical therapy will help to make more visible the root causes of inequity and improve our ability to develop effective, multi-level interventions.
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Affiliation(s)
- K Michael Rowley
- Department of Kinesiology, California State University East Bay, Hayward, California, USA
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - An Ky
- Department of Kinesiology, California State University East Bay, Hayward, California, USA
| | - Ndidiamaka D Matthews
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
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Knight S, Yang XQ, Jarvis GE. "Dem sey mi mad": a scoping review of the attitudes and beliefs of English-speaking Afro-Caribbeans about psychosis. Front Psychiatry 2024; 15:1385525. [PMID: 39224480 PMCID: PMC11366823 DOI: 10.3389/fpsyt.2024.1385525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction The mental health disparities suffered by the English-speaking Afro-Caribbean diaspora living with psychosis in North America and the United Kingdom have been well described for decades, but the root causes of these disparities remain poorly understood. Part of the problem may be that the attitudes and beliefs of Caribbean communities regarding psychosis have never been systematically assessed. Such an inquiry could lay the foundation for changes to how psychiatric services for psychosis are implemented with migrant Caribbean communities. The ideal would be a re-design of services, or cultural adaptation of care, based on input from community members, patients, and their families, with the hope that disparities of care would be reduced or eliminated as clinicians co-create interventions that are more appropriate and acceptable to Caribbean people. To lay the groundwork of such an important endeavor, we investigated the shared attitudes, beliefs, experiences, practices, and traditions of English-speaking Afro-Caribbean people in relation to psychosis and psychiatric care. Methods We conducted a scoping review by searching Medline, PsychINFO and Scopus, reviewing 764 articles, and selecting 220 for thematic content analysis. Results We highlighted the heterogeneity in the Caribbean diaspora living in North America and the UK. Five principal themes emerged: (1) The enduring effects of colonialism on the psychiatric care of Afro-Caribbean migrants; (2) The effects of adaptation to migration on the experience of psychosis; (3) Pervasive cultural mistrust of psychiatry and mental health institutions; (4) A collective approach to life; and (5) The role of religion and spirituality in the understanding of psychosis. Conclusion Historical, sociocultural, and geopolitical themes characterize the English Afro-Caribbean experience of psychosis and inform culturally adapted clinical interventions for patients with psychosis and their families. Careful attention to these adaptations will reduce clinical bias and misdiagnosis, optimize adherence to treatment, engage patients and families in recovery, and ultimately, reduce treatment disparities while empowering Afro-Caribbean people and their communities. By bringing forward the themes in this chapter, individual clinicians will be given tools to change how they work with Caribbean people with psychosis in addition to laying the foundation for higher order changes in the mental health professions and society as a whole.
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Affiliation(s)
- Sommer Knight
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Xin Qiang Yang
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - G. Eric Jarvis
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
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Williams C, Paulson N, Sweat J, Rutledge R, Paulson MR, Maniaci M, Burger CD. Individual- and Community-Level Predictors of Hospital-at-Home Outcomes. Popul Health Manag 2024; 27:168-173. [PMID: 38546504 DOI: 10.1089/pop.2023.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study using patient data from July 2020 to December 2022. The study includes 3 Mayo Clinic centers and community-level data from the Agency for Healthcare Research and Quality. The authors conducted binary logistic regression analyses to examine the relationship among the independent variables (patient- and community-level characteristics) and dependent variables (30-day readmission, mortality, and escalation of care back to the brick-and-mortar hospital). The study examined 1433 patients; 53% were men, 90.58% were White, and 68.2% were married. The mortality rate was 2.8%, 30-day readmission was 11.4%, and escalation back to brick-and-mortar hospitals was 8.7%. At the patient level, older age and male gender were significant predictors of 30-day mortality (P-value <0.05), older age was a significant predictor of 30-day readmission (P-value <0.05), and severity of illness was a significant predictor for readmission, mortality, and escalation back to the brick-and-mortar hospital (P-value <0.01). Patients with COVID-19 were less likely to experience readmission, mortality, or escalations (P-value <0.05). At the community level, the Gini Index and internet access were significant predictors of mortality (P-value <0.05). Race and ethnicity did not significantly predict adverse outcomes (P-value >0.05). This study showed promise in equitable treatment of diverse patient populations. The authors discuss and address health equity issues to approximate the vision of inclusive HaH delivery.
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Affiliation(s)
- Cynthia Williams
- School of Global Health Management and Informatics, University of Central Florida, Orlando, Florida, USA
| | - Nels Paulson
- Social Science Department, University of Wisconsin-Stout, Menomonie, Wisconsin, USA
| | - Jeffrey Sweat
- Social Science Department, University of Wisconsin-Stout, Menomonie, Wisconsin, USA
| | - Rachel Rutledge
- Administrative Operations, Mayo Clinic, Jacksonville, Florida, USA
| | - Margaret R Paulson
- Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Michael Maniaci
- Division of Hospital Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Charles D Burger
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Zhang M, Payton C, Gurung A, Anglewicz P, Subedi P, Ali A, Ibrahim A, Haider M, Hamidi N, Atem J, Thang J, Wang S, Kim C, Kimball SL, Karaki F, Nazhat N, Abouagila M, Yun K. COVID-19 Infection and Contact Tracing Among Refugees in the United States, 2020-2021. J Immigr Minor Health 2023; 25:1239-1245. [PMID: 36586088 PMCID: PMC9803886 DOI: 10.1007/s10903-022-01441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
Refugees in the United States are believed to be at high risk of COVID-19. A cross-sectional study design was utilized to collect anonymous, online surveys from refugee communities in the United States during December 2020 to January 2021. We invited bilingual community leaders to share the survey link with other refugees aged ≥18 years. We identified factors associated with COVID-19 infection and measured the distribution of contact tracing among those who tested positive. Of 435 refugees who completed the survey, 26.4% reported testing positive for COVID-19. COVID-19 infection was associated with having an infected family member and knowing people in one's immediate social environment who were infected. Among respondents who tested positive, 84.4% reported that they had been contacted for contact tracing. To prepare for future pandemics, public health authorities should continue partner with refugee community leaders and organizations to ensure efficient programs are inclusive of refugee communities.
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Affiliation(s)
- Mengxi Zhang
- Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA, 24073, USA.
| | - Colleen Payton
- School of Nursing and Public Health, Moravian University, Bethlehem, PA, USA
| | - Ashok Gurung
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parangkush Subedi
- Office of Refugee Resettlement, Administration for Children and Families, US Department of Health and Human Services, Washington DC, USA
| | - Ahmed Ali
- Somali Health Board, Seattle, WA, USA
| | - Anisa Ibrahim
- Pediatric Clinic, Harborview Medical Center, Seattle, WA, USA
| | - Mahri Haider
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
- International Medicine Clinic, Harborview Medical Center, Seattle, WA, USA
| | | | - Jacob Atem
- Southern Sudan Healthcare Organization, Okemos, MI, USA
| | - Jenni Thang
- Department of Consulting Psychology, Purdue University, West Lafayette, IN, USA
| | - Siqin Wang
- School of Earth and Environmental Sciences, University of Queensland, Brisbane, QLD, Australia
- Graduate School of Interdisciplinary Information Studies, University of Tokyo, Tokyo, Hongo, Japan
| | - Curi Kim
- Office of Refugee Resettlement, Administration for Children and Families, US Department of Health and Human Services, Washington DC, USA
| | - Sarah L Kimball
- Boston University School of Medicine, 72 E Concord St, Boston, MA, USA
- Immigrant and Refugee Health Center, Boston Medical Center, 725 Albany St, Suite 5B, Boston, MA, USA
| | - Fatima Karaki
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Mouammar Abouagila
- Refugee Resettlement and Placement Services, Lutheran Community Services Northwest, SeaTac, WA, USA
| | - Katherine Yun
- Division of General Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine Philadelphia, 3401 Civic Center Blvd. , Philadelphia, PA, USA.
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Lennon-Dearing R, Morris K, Hirschi M, Rajabiun S. The Impact of the COVID-19 Pandemic on Community Health Workers from HIV Care Organizations in the Mid-South. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2023; 22:1-15. [PMID: 39104556 PMCID: PMC11299863 DOI: 10.1080/15381501.2023.2258821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/07/2023] [Indexed: 08/07/2024]
Affiliation(s)
| | | | - Melissa Hirschi
- The University of Memphis, 120 McCord Hall, Memphis, TN, 38152
| | - Serena Rajabiun
- University of Massachusetts, Lowell, 3 Solomont Way, Lowell, MA, 01854
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Zhai W, Fu X, Liu M, Peng ZR. The impact of ethnic segregation on neighbourhood-level social distancing in the United States amid the early outbreak of COVID-19. URBAN STUDIES (EDINBURGH, SCOTLAND) 2023; 60:1403-1426. [PMID: 37273498 PMCID: PMC10230299 DOI: 10.1177/00420980211050183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The COVID-19 pandemic has been argued to be the 'great equaliser', but, in fact, ethnically and racially segregated communities are bearing a disproportionate burden from the disease. Although more people have been infected and died from the disease among these minority communities, still fewer people in these communities are complying with the suggested public health measures like social distancing. The factors contributing to these ramifications remain a long-lasting debate, in part due to the contested theories between ethnic stratification and ethnic community. To offer empirical evidence to this theoretical debate, we tracked public social-distancing behaviours from mobile phone devices across urban census tracts in the United States and employed a difference-in-difference model to examine the impact of racial/ethnic segregation on these behaviours. Specifically, we focussed on non-Hispanic Black and Hispanic communities at the neighbourhood level from three principal dimensions of ethnic segregation, namely, evenness, exposure, and concentration. Our results suggest that (1) the high ethnic diversity index can decrease social-distancing behaviours and (2) the high dissimilarity between ethnic minorities and non-Hispanic Whites can increase social-distancing behavior; (3) the high interaction index can decrease social-distancing behaviours; and (4) the high concentration of ethnic minorities can increase travel distance and non-home time but decrease work behaviours. The findings of this study shed new light on public health behaviours among minority communities and offer empirical knowledge for policymakers to better inform just and evidence-based public health orders.
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Affiliation(s)
- Wei Zhai
- Hong Kong Baptist University, China
| | - Xinyu Fu
- University of Waikato, New Zealand
| | - Mengyang Liu
- Huazhong University of Science and Technology, China
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Liu TL, Chou SH, Murphy S, Kowalkowski M, Taylor YJ, Hole C, Sitammagari K, Priem JS, McWilliams A. Evaluating Racial/Ethnic Differences in Care Escalation Among COVID-19 Patients in a Home-Based Hospital. J Racial Ethn Health Disparities 2023; 10:817-825. [PMID: 35257312 PMCID: PMC8900643 DOI: 10.1007/s40615-022-01270-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 11/25/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) has infected over 414 million people worldwide with 5.8 million deaths, as of February 2022. Telemedicine-based interventions to expand healthcare systems' capacity and reduce infection risk have rapidly increased during the pandemic, despite concerns regarding equitable access. Atrium Health Hospital at Home (AH-HaH) is a home-based program that provides advanced, hospital-level medical care and monitoring for patients who would otherwise be hospitalized in a traditional setting. Our retrospective cohort study of positive COVID-19 patients who were admitted to AH-HaH aims to investigate whether the rate of care escalation from AH-HaH to traditional hospitalization differed based on patients' racial/ethnic backgrounds. Logistic regression was used to examine the association between care escalation within 14 days from index AH-HaH admission and race/ethnicity. We found approximately one in five patients receiving care for COVID-19 in AH-HaH required care escalation within 14 days. Odds of care escalation were not significantly different for Hispanic or non-Hispanic Blacks compared to non-Hispanic Whites. However, secondary analyses showed that both Hispanic and non-Hispanic Black patients were younger and with fewer comorbidities than non-Hispanic Whites. The study highlights the need for new care models to vigilantly monitor for disparities, so that timely and tailored adaptations can be implemented for vulnerable populations.
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Affiliation(s)
- Tsai-Ling Liu
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA.
| | - Shih-Hsiung Chou
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA
| | - Stephanie Murphy
- Division of Hospital Medicine, Department of Internal Medicine, Atrium Health, Charlotte, NC, USA
| | - Marc Kowalkowski
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA
| | - Yhenneko J Taylor
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA
| | - Colleen Hole
- Population Health, Atrium Health, Charlotte, NC, USA
| | - Kranthi Sitammagari
- Division of Hospital Medicine, Department of Internal Medicine, Atrium Health, Charlotte, NC, USA
| | - Jennifer S Priem
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA
| | - Andrew McWilliams
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA.,Division of Hospital Medicine, Department of Internal Medicine, Atrium Health, Charlotte, NC, USA
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Pond K, Samuels K, Meinhardt G, Jacobs C. Examining Health Disparities in Orthopedic Care During COVID-19. Am Surg 2023:31348231153551. [PMID: 36717093 PMCID: PMC9895312 DOI: 10.1177/00031348231153551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Demographics and socioeconomic status affect the delivery of medical care resulting in healthcare disparities. The purpose of this study was to investigate the impact of COVID-19 on existing healthcare disparities, including access to healthcare in the outpatient orthopedic surgery clinic. METHODS The medical records of 3006 patients treated at the University of Kentucky Orthopedic Surgery Department prior to COVID-19 (April 2018, 2019), and during the COVID-19 pandemic (2020) were retrospectively reviewed for demographic data, distance to clinic, and type of visit. We then compared the total number of patient visits, new patient visits, telehealth visits, and the patient's insurance provider (public or private) between the time period prior to and during the pandemic. RESULTS During the COVID-19 pandemic, there were significant declines in the number of patients seen, new patient presentations, and publicly insured patients. Thirty-three percent of visits were telemedicine visits in 2020 compared to 0% pre-COVID (P < .0001). There was a lower proportion of initial visits in 2020 (P < .0001). The majority of patients paid via private/commercial insurance (1798, 59.8%), with a greater proportion paying via private/commercial insurance in 2020 (P < .001). The median average household income was increased in 2020 (P < .001). DISCUSSION While COVID-19 resulted in a significant decline in overall access to care, there were negative ramifications particularly on patients with new complaints and those of lower socioeconomic status. Future endeavors should be focused on correcting the obstacles to accessing care, exacerbated by the pandemic, that these vulnerable populations face.
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Affiliation(s)
- Kristina Pond
- College of Medicine, University of Kentucky, Lexington, KY, USA,Kristina Pond, BS, Orthopaedic Surgery
& Sports Medicine, University of Kentucky College of Medicine 800 Rose
Street Lexington, KY 40506, USA.
| | - Kaitlyn Samuels
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Gerek Meinhardt
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Cale Jacobs
- Massachusetts General Brigham
Sports Medicine, Brigham and Women's
Hospital, Foxborough, MA, USA
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Luo Y, Li Q, Jeong H, Cheatham L. The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups. BMC Public Health 2022; 22:2193. [PMID: 36443734 PMCID: PMC9702892 DOI: 10.1186/s12889-022-14486-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). METHODS This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates-including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19-four sets of weighted binary logistic regressions were conducted. RESULTS The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05). CONCLUSION Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.
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Affiliation(s)
- Yan Luo
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA ,grid.410445.00000 0001 2188 0957The University of Hawaiʻi at Mānoa, HI Honolulu, USA
| | - Qingyi Li
- grid.5386.8000000041936877XDepartment of Psychology, Cornell University, Ithaca, NY 14850 USA
| | - Haelim Jeong
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
| | - Leah Cheatham
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
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Assessing Unique Risk Factors for COVID-19 Complications Among Cancer Patients: A Multi-ethnic Cohort Study. J Immigr Minor Health 2022; 25:624-633. [PMID: 36344859 PMCID: PMC9640901 DOI: 10.1007/s10903-022-01413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
A myriad of organ-specific complications have been observed with COVID-19. While racial/ethnic minorities have been disproportionately burdened by this disease, our understanding of the unique risk factors for complications among a diverse population of cancer patients remains limited. This is a multi-institutional, multi-ethnic cohort study evaluating COVID-19 complications among cancer patients. Patients with an invasive cancer diagnosis and confirmed SARS-CoV-2 infection were identified from March to November 2020. Demographic and clinical data were obtained and a multivariate logistic regression was employed to evaluate the impact of demographic and clinical factors on COVID-19 complications. The study endpoints were evaluated independently and included any complication, sepsis, pulmonary complications and cardiac complications. A total of 303 patients were evaluated, of whom 48% were male, 79% had solid tumors, and 42% were Hispanic/Latinx (Hispanic). Malignant hematologic cancers were associated with a higher risk of sepsis (OR 3.93 (95% CI 1.58–9.81)). Male patients had a higher risk of sepsis (OR 4.42 (95% CI 1.63–11.96)) and cardiac complications (OR 2.02 (95% CI 1.05–3.89)). Hispanic patients had a higher odds of any complication (OR 2.31 (95% CI 1.18–4.51)) and other race was associated with a higher odds of cardiac complications (OR 2.41 (95% CI 1.01–5.73)). Clinically, fever, cough, and ≥2 co-morbidities were independently significantly associated with any complication. This analysis evaluated covariates that can significantly predict a myriad of complications among a multi-ethnic cohort of cancer patients. The conclusions drawn from this analysis elucidate a mechanistic understanding of differential illness severity from COVID-19.
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Becoming an anti-racist interprofessional healthcare organization: Our journey. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2022; 27:100509. [PMID: 35284657 PMCID: PMC8898662 DOI: 10.1016/j.xjep.2022.100509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/17/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic amplified the egregious disproportionate burden of disease based on race, ethnicity, and failure of organizations to address structural racism. This paper describes a journey by members of the National Academies of Practice (NAP) who came together to address diversity, equity, and inclusion (DEI). Through collaborative efforts, a virtual, interactive workshop was designed and delivered at NAP's 2021 Virtual Forum to facilitate discussions about DEI priorities across professions and to initiate a sustainable action plan toward achieving inclusive excellence. Resulting discoveries and reflections led us to the essential question: can we truly become an anti-racist interprofessional healthcare organization?
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12
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Confronting Racism in Pain Research: A Call to Action. THE JOURNAL OF PAIN 2022; 23:878-892. [PMID: 35292201 PMCID: PMC9472374 DOI: 10.1016/j.jpain.2022.01.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
Racism is an established health determinant across the world. In this 3-part series, we argue that a disregard of how racism manifests in pain research practices perpetuates pain inequities and slows the progression of the field. Our goal in part-1 is to provide a historical and theoretical background of racism as a foundation for understanding how an antiracism pain research framework - which focuses on the impact of racism, rather than "race," on pain outcomes - can be incorporated across the continuum of pain research. We also describe cultural humility as a lifelong self-awareness process critical to ending generalizations and successfully applying antiracism research practices through the pain research continuum. In part-2 of the series, we describe research designs that perpetuate racism and provide reframes. Finally, in part-3, we emphasize the implications of an antiracism framework for research dissemination, community-engagement practices and diversity in research teams. Through this series, we invite the pain research community to share our commitment to the active process of antiracism, which involves both self-examination and re-evaluation of research practices shifting our collective work towards eliminating racialized injustices in our approach to pain research. PERSPECTIVE: We call on the pain community to dismantle racism in our research practices. As the first paper of the 3-part series, we introduce dimensions of racism and its effect on pain inequities. We also describe the imperative role of cultural humility in adopting antiracism pain research practices.
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Zhong X, Zhou Z, Li G, Kwizera MH, Muennig P, Chen Q. Neighborhood disparities in COVID-19 outcomes in New York city over the first two waves of the outbreak. Ann Epidemiol 2022; 70:45-52. [PMID: 35487451 PMCID: PMC9042413 DOI: 10.1016/j.annepidem.2022.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/25/2022] [Accepted: 04/18/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess the association of neighborhood demographic and socioeconomic characteristics with COVID-19 incidence and mortality in New York City (NYC) over the first two waves of outbreak. METHODS This retrospective study used neighborhood-level data from 177 modified ZIP code tabulation areas in NYC between March 01, 2020 and April 30, 2021. RESULTS Neighborhoods that were most severely impacted in wave 1 were also more affected in wave 2. Neighborhoods with a higher percentage of seniors (≥75 years), males, Black and Hispanic population, and large-size households had higher incidence rates of COVID-19 in wave 1 but not in wave 2. Neighborhoods with higher percentage of Black and Hispanic population and lower insurance coverage had higher death rate per capita and case fatality ratio in wave 1, and neighborhoods with higher percentage of Black and Asian population had elevated case fatality ratio in wave 2. Median household income was negatively associated with incidence rate and death rate per capita but not associated with case fatality ratio in both waves. Neighborhoods with more seniors had higher death rate and case fatality ratio in both waves. CONCLUSIONS Neighborhood disparities in COVID-19 incidence and mortality across NYC neighborhoods were dynamic during the first two waves of outbreak.
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Affiliation(s)
- Xiaobo Zhong
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ziqi Zhou
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Guohua Li
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Muhire H Kwizera
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
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14
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Osuji VC, Galante EM, Mischoulon D, Slaven JE, Maupome G. COVID-19 vaccine: A 2021 analysis of perceptions on vaccine safety and promise in a U.S. sample. PLoS One 2022; 17:e0268784. [PMID: 35587947 PMCID: PMC9119541 DOI: 10.1371/journal.pone.0268784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite reliable evidence-based research supporting the COVID-19 vaccines, population-wide confidence and trust remain limited. We sought to expand prior knowledge about COVID-19 vaccine perceptions, while determining which population groups are at greatest risk for not getting a vaccine. METHODS Study participants in the U.S. (79% female, median age group 46-60 years) were recruited through an online Qualtrics survey distributed as a Facebook advertisement from 3/19/21-4/30/21. We assumed that every participant is at risk of COVID-19 infection and should be able to get the vaccine with proper access. Bivariate and multivariable models were performed. Collinearity between variables was assessed. RESULTS A total of 2,626 responses were generated and 2,259 were included in data analysis. According to our multivariate model analysis, vaccines were perceived as safe by those who had or planned to obtain full vaccination (adjusted odds ratio (aOR) (95% confidence interval) = 40.0 (19.0, 84.2); p< 0.0001) and those who indicated trust in science (aOR = 10.5 (5.1, 21.8); p< 0.0001); vaccines were perceived as not safe by those who self-identified as Republicans vs. self-identified Democrats (aOR = 0.2 (0.1, 0.5); p = 0.0020) and those with high school or lower education (aOR = 0.2 (0.1, 0.4); p = 0.0007). Similarly, according to our multivariate model analysis, the following groups were most likely to reject vaccination based on belief in vaccinations: those with lower income (aOR = 0.8 (0.6, 0.9); p = 0.0106), those who do not know anyone who had been vaccinated (aOR = 0.1 (0.1, 0.4); p< 0.0001), those who are unwilling to get vaccinated even if family and friends had done so (aOR = 0.1 (<0.1, 0.2); p< 0.0001), those who did not trust science (aOR < 0.1 (<0.1, 0.1); p< 0.0001), those who believe that vaccination was unnecessary if others had already been vaccinated (aOR = 2.8 (1.5, 5.1); p = 0.0007), and those who indicate refusal to vaccinate to help others (aOR = 0.1 (0.1, 0.2); p< 0.0001). An alpha of p<0.05 was used for all tests. CONCLUSION Level of education and partisanship, but not race/ethnicity, were the most likely factors associated with vaccine hesitancy or likelihood to vaccinate. Also, low vaccination rates among underrepresented minorities may be due to distrust for healthcare industries. Population sub-groups less likely to be vaccinated and/or receptive to vaccines should be targeted for vaccine education and incentives.
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Affiliation(s)
- Vitalis C. Osuji
- Department of Global Health, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Eric M. Galante
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - David Mischoulon
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - James E. Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Gerardo Maupome
- Department of Global Health, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America
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15
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Differential COVID-19 testing, admissions, and mortality for Arab Americans in Southern California. PLoS One 2022; 17:e0267116. [PMID: 35421208 PMCID: PMC9009685 DOI: 10.1371/journal.pone.0267116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 04/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Understanding of COVID-19 acquisition and severity risk in minoritized groups is limited by data collection on race and ethnicity; very little is known about COVID-19 risk among Arab Americans in the United States. PURPOSE To quantify whether Arab Americans in the El Cajon region of California experienced differential levels of SARS-CoV-2 infection, severity and mortality when compared to other racial/ethnic groups. METHODS A retrospective study was conducted using Sharp Grossmont Hospital's electronic medical records. Patients were included in the study if they were: 18 years of age or older, tested for SARS-CoV-2, admitted for COVID-19 infection, or had COVID-19 listed as a cause of death between March 1, 2020 and January 31, 2021. The primary outcomes of interest were a positive COVID-19 test result, admission to the hospital due to COVID-19, and in hospital COVID-19 related mortality. Comparisons were made across racial/ethnic groups using chi-squared statistics and logistic regression models adjusted for sociodemographics, comorbidities, and time from March 2020. RESULTS Arab Americans had greater odds of testing positive for SARS-CoV-2 than non-Hispanic White (adjusted odds ratio, AOR: 3.83, 95% confidence interval, CI: 3.29, 4.46) and non-Hispanic Black (AOR: 2.34, 95% CI: 1.91, 2.88) patients but lower odds of admission (AOR: 0.47, 95% CI: 0.36, 0.63) and in-hospital mortality (AOR: 0.43, 95% CI: 0.28, 0.65) than Hispanic patients. CONCLUSIONS There were distinct patterns for COVID-19 infection, severity, and mortality for Arab Americans in Southern California. Without a dedicated ethnic identifier, COVID-19 disparities facing Arab Americans will continue to go undocumented.
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16
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Mercier CM, Abbott DM, Ternes MS. Coping Matters: An Examination of Coping among Black Americans During COVID-19. COUNSELING PSYCHOLOGIST 2022. [DOI: 10.1177/00110000211069598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Using a critical race theory framework and a convergent mixed-method design, this study examined the relationship between coping with stress and psychological distress among Black U.S. Americans ( N = 155) during the COVID-19 pandemic in the context of race-based stressors (e.g., anti-Black racism). Path analysis revealed mixed support for hypotheses; avoidant coping was positively related to all measured facets of psychological distress, whereas socially supported coping was associated with none. Self-sufficient coping was negatively associated with only depressive symptoms. Qualitative analysis revealed four salient themes: (a) Race and the COVID-19 Pandemic, (b) Complex Pandemic Related Changes to Life, (c) Emotional Responses to the Pandemic, and (d) Coping with the COVID Pandemic. These themes suggested the pandemic disrupted participants’ ability to engage in, or effectively use, typically adaptive coping strategies and distress was exacerbated by fears for the safety of other Black U.S. Americans. Implications for training, practice, research, and advocacy are discussed.
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Affiliation(s)
- Caitlin M. Mercier
- Department of Psychology and Behavioral Sciences, Louisiana Tech University, Ruston, LA, USA
| | - Dena M. Abbott
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Michael S. Ternes
- Department of Psychology and Behavioral Sciences, Louisiana Tech University, Ruston, LA, USA
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17
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Bowleg L, Malekzadeh AN, Mbaba M, Boone CA. Ending the HIV epidemic for all, not just some: structural racism as a fundamental but overlooked social-structural determinant of the US HIV epidemic. Curr Opin HIV AIDS 2022; 17:40-45. [PMID: 35102051 PMCID: PMC9109814 DOI: 10.1097/coh.0000000000000724] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW We review the recent theoretical and empirical literature on structural racism, social determinants of health frameworks within the context of HIV prevention and treatment, and criticism of the national responses to the US epidemic. RECENT FINDINGS In line with growing mainstream attention to the role of structural racism and health inequities, recent editorials and studies cite ending structural racism as an essential step to ending the US HIV epidemic. Recent studies demonstrate that barriers rooted in structural racism such as incarceration, housing instability, police discrimination, neighborhood disadvantage, health service utilization and community violence, and poor or no access to social services, transportation, and childcare, are barriers to HIV prevention. Recent articles also criticize national responses to HIV such as the ending the HIV epidemic (EHE) and National HIV/AIDS Strategy plans for failing to address structural racism and prioritize community engagement in EHE efforts. SUMMARY Collectively, the articles in this review highlight a growing consensus that the US has no real chance of EHE for all, absent a meaningful and measurable commitment to addressing structural racism and intersectional discrimination as core determinants of HIV, and without more equitable engagement with community-based organizations and communities disproportionately affected by HIV.
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Affiliation(s)
- Lisa Bowleg
- The George Washington University, Washington, DC, USA
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18
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Mickey EL, Misra J, Clark D. The persistence of neoliberal logics in faculty evaluations amidst Covid-19: Recalibrating toward equity. GENDER WORK AND ORGANIZATION 2022; 30:GWAO12817. [PMID: 35600799 PMCID: PMC9111687 DOI: 10.1111/gwao.12817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/05/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
In this paper, we theorize the intersectional gendered impacts of COVID-19 on faculty labor, with a particular focus on how institutions of higher education in the United States evaluate faculty labor amidst the COVID-19 transition and beyond. The pandemic has disrupted faculty research, teaching, and service in differential ways, having larger impacts on women faculty, faculty of color, and caregiving faculty in ways that further reflect the intersections of these groups. Universities have had to reconsider how evaluation occurs, given the impact of these disruptions on faculty careers. Through a case study of university pandemic responses in the United States, we summarize key components of how colleges and universities shifted evaluations of faculty labor in response to COVID-19, including suspending teaching evaluations, implementing tenure delays, and allowing for impact statements in faculty reviews. While most institutional responses recenter neoliberal principles of the ideal academic worker that is both gendered and racialized, a few universities have taken more innovative approaches to better attend to equity concerns. We conclude by suggesting a recalibration of the faculty evaluation system - one that maintains systematic faculty reviews and allows for academic freedom, but requires universities to take a more contextualized approach to evaluation in ways that center equity and inclusion for women faculty and faculty of color for the long term.
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Affiliation(s)
- Ethel L. Mickey
- University of Massachusetts AmherstADVANCE ProgramAmherstMassachusettsUSA
| | - Joya Misra
- Departments of Sociology and Public PolicyUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Dessie Clark
- University of Massachusetts AmherstADVANCE ProgramAmherstMassachusettsUSA
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19
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Yuan H, Reynolds C, Ng S, Yang W. Factors affecting the transmission of SARS-CoV-2 in school settings. Influenza Other Respir Viruses 2022; 16:643-652. [PMID: 35146922 PMCID: PMC9111692 DOI: 10.1111/irv.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background Several studies have reported SARS‐CoV‐2 outbreaks in schools, with a wide range of secondary attack rate (SAR; range: 0–100%). We aimed to examine key risk factors to better understand SARS‐CoV‐2 transmission in schools. Methods We collected records of 35 SARS‐CoV‐2 school outbreaks globally published from January 2020 to July 2021 and compiled information on hypothesized risk factors. We utilized the directed acyclic graph (DAG) to conceptualize risk mechanisms, used logistic regression to examine each risk‐factor group, and further built multirisk models. Results The best‐fit model showed that the intensity of community transmission (adjusted odds ratio [aOR]: 1.11, 95% CI: 1.06–1.16, for each increase of 1 case per 10 000 persons per week) and individualism (aOR: 2.72, 95% CI: 1.50–4.95, above vs. below the mean) was associated higher risk, whereas preventive measures (aOR: 0.25, 95% CI: 0.19–0.32, distancing and masking vs. none) and higher population immunity (aOR: 0.57, 95% CI: 0.46–0.71) were associated with lower risk of SARS‐CoV‐2 transmission in schools. Compared with students in high schools, the aOR was 0.47 (95% CI: 0.23–0.95) for students in preschools and 0.90 (95% CI: 0.76–1.08) for students in primary schools. Conclusions Preventive measures in schools (e.g., social distancing and mask wearing) and communal efforts to lower transmission and increase vaccination uptake (i.e., vaccine‐induced population immunity) in the community should be taken to collectively reduce transmission and protect children in schools.
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Affiliation(s)
- Haokun Yuan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Connor Reynolds
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sydney Ng
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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20
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Anderson-Carpenter KD, Neal ZP. Racial Disparities in COVID-19 Impacts in Michigan, USA. J Racial Ethn Health Disparities 2022; 9:156-164. [PMID: 33620712 PMCID: PMC7901513 DOI: 10.1007/s40615-020-00939-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
Racial disparities have been observed in the impacts of COVID-19 in the USA. In the present paper, we used a representative sample of adults in Michigan to examine differences in COVID-19 impacts on Blacks and Whites in four domains: direct, perceived, political, and behavioral. We found that in the initial wave of the outbreak in May 2020, Blacks experienced more severe direct impacts: they were more likely to be diagnosed or know someone who was diagnosed, and more likely to lose their job compared to Whites. In addition, Blacks differed significantly from Whites in their assessment of COVID-19's threat to public health and the economy, the adequacy of government responses to COVID-19, and the appropriateness of behavioral changes to mitigate COVID-19's spread. Although in many cases these views of COVID-19 were also associated with political ideology, this association was significantly stronger for Whites than Blacks. Continued investigation of racial disparities in COVID-19's impact is necessary; however, these preliminary findings of a race-by-ideology interaction are important because they suggest some racial disparities are restricted to conservatives, while more liberal Whites and Blacks exhibit few differences.
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21
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Cheng P, Casement MD, Cuellar R, Johnson DA, Kalmbach D, Cuamatzi Castelan A, Drake CL. Sleepless in COVID-19: racial disparities during the pandemic as a consequence of structural inequity. Sleep 2022; 45:zsab242. [PMID: 34788453 PMCID: PMC8689929 DOI: 10.1093/sleep/zsab242] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES Insomnia has been on the rise during the 2019 coronavirus disease (COVID-19) pandemic, which may disproportionately affect racial minorities. This study characterized racial disparities in insomnia during the pandemic and evaluated mechanisms for such disparities. METHODS Participants included 196 adults (48 Black) from a 2016-2017 clinical trial of insomnia treatment who were reevaluated in April 2020. Race was evaluated as a predictor of change in insomnia, impact of COVID-19, and COVID-19 stress. Mediation models using the PRODCLIN method evaluated the extent to which: (1) COVID-19 impact accounted for Black-White disparities in change in insomnia, and (2) COVID-19 stress accounted for associations between discrimination and change in insomnia. RESULTS Increases in insomnia symptoms during COVID-19 were greater in Black compared to White participants, with 4.3 times the odds of severe insomnia (Insomnia Severity Index ≥ 22). Symptom severity was associated with pre-pandemic experiences of discrimination. Black participants were also disproportionately impacted by COVID-19, with twice the odds of irreparable loss of income/employment and four times the rate of COVID-19 diagnoses in their sociofamilial network compared to White participants. The disproportionate impact of COVID-19 accounted for 69.2% of the relationship between race and change in insomnia severity, and COVID-19 related stress accounted for 66.5% of the relationship between prior history of racial discrimination and change in insomnia severity. CONCLUSIONS Black-White disparities in insomnia severity during COVID-19 may be driven by structural inequities resulting in the disproportionate impact of COVID-19 on Black Americans. Results lend support for the minority stress model in the context of sleep health. CLINICAL TRIAL REGISTRATION Sleep to Prevent Evolving Affecting Disorders (SPREAD). NCT number: NCT02988375. https://clinicaltrials.gov/ct2/show/NCT02988375.
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Affiliation(s)
- Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Ruby Cuellar
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
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22
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Tortolero GA, Otto MDO, Ramphul R, Yamal JM, Rector A, Brown M, Peskin MF, Mofleh D, Boerwinkle E. Examining Social Vulnerability and the Association With COVID-19 Incidence in Harris County, Texas. Front Public Health 2022; 9:798085. [PMID: 35071172 PMCID: PMC8767157 DOI: 10.3389/fpubh.2021.798085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Studies have investigated the association between social vulnerability and SARS-CoV-2 incidence. However, few studies have examined small geographic units such as census tracts, examined geographic regions with large numbers of Hispanic and Black populations, controlled for testing rates, and incorporated stay-at-home measures into their analyses. Understanding the relationship between social vulnerability and SARS-CoV-2 incidence is critical to understanding the interplay between social determinants and implementing risk mitigation guidelines to curtail the spread of infectious diseases. The objective of this study was to examine the relationship between CDC's Social Vulnerability Index (SVI) and SARS-CoV-2 incidence while controlling for testing rates and the proportion of those who stayed completely at home among 783 Harris County, Texas census tracts. SARS-CoV-2 incidence data were collected between May 15 and October 1, 2020. The SVI and its themes were the primary exposures. Median percent time at home was used as a covariate to measure the effect of staying at home on the association between social vulnerability and SARS-CoV-2 incidence. Data were analyzed using Kruskal Wallis and negative binomial regressions (NBR) controlling for testing rates and staying at home. Results showed that a unit increase in the SVI score and the SVI themes were associated with significant increases in SARS-CoV-2 incidence. The incidence risk ratio (IRR) was 1.090 (95% CI, 1.082, 1.098) for the overall SVI; 1.107 (95% CI, 1.098, 1.115) for minority status/language; 1.090 (95% CI, 1.083, 1.098) for socioeconomic; 1.060 (95% CI, 1.050, 1.071) for household composition/disability, and 1.057 (95% CI, 1.047, 1.066) for housing type/transportation. When controlling for stay-at-home, the association between SVI themes and SARS-CoV-2 incidence remained significant. In the NBR model that included all four SVI themes, only the socioeconomic and minority status/language themes remained significantly associated with SARS-CoV-2 incidence. Community-level infections were not explained by a communities' inability to stay at home. These findings suggest that community-level social vulnerability, such as socioeconomic status, language barriers, use of public transportation, and housing density may play a role in the risk of SARS-CoV-2 infection regardless of the ability of some communities to stay at home because of the need to work or other reasons.
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Affiliation(s)
- Guillermo A. Tortolero
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marcia de Oliveira Otto
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ryan Ramphul
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Alison Rector
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Michael Brown
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Melissa F. Peskin
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dania Mofleh
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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23
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Cohen SM, Howard JJ, Jin MC, Qian J, Capasso R. Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea. OTO Open 2022; 6:2473974X221088870. [PMID: 35321423 PMCID: PMC8935572 DOI: 10.1177/2473974x221088870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Determine risk factors for failure to receive surgical treatment among patients with obstructive sleep apnea. Study Design Population-based observational longitudinal cohort study. Setting Population-based database. Methods Multivariate analysis of 500,792 individuals with obstructive sleep apnea from Optum's deidentified Clinformatics Data Mart database (2004-2018). Results Black race, increased age, diabetes, atrial fibrillation, obesity, and congestive heart failure were independently associated with a decreased rate of surgery for obstructive sleep apnea. Asian race, hypertension, arrhythmias other than atrial fibrillation, pulmonary disease, and liver disease were independently associated with an increased rate of surgery for obstructive sleep apnea. Conclusion Racial disparities in health outcomes related to health care access and in economic resources have an enormous impact on public health and social equity. We found differences in rates of surgery for obstructive sleep apnea based on race. These data are consistent with others demonstrating disparities in medical treatment of sleep apnea with positive pressure and underline a need for a change in awareness and treatment in these populations.
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Affiliation(s)
- Samuel M. Cohen
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Javier J.M. Howard
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Michael C. Jin
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Jason Qian
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Robson Capasso
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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24
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Borno HT, Kim MO, Hong JC, Yousefi S, Lin A, Tolstykh I, Zhang S, McKay RR, Harismendy O, Cinar P, Rugo H, Koshkin VS, Rabow M, Wang C, Bailey A, Small EJ. OUP accepted manuscript. Oncologist 2022; 27:398-406. [PMID: 35348771 PMCID: PMC9074994 DOI: 10.1093/oncolo/oyac038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background The risks associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated illness, coronavirus disease 2019 (COVID-19), among patients with a cancer diagnosis have not been fully characterized. This study leverages data from a multi-institutional cohort study, the University of California Cancer COVID Consortium, to evaluate outcomes associated with SARS-CoV-2 infection among patients with cancer. Methods Clinical data were collected from March to November 2020 and included patient demographics, cancer history and treatment, SARS-CoV-2 exposure and testing, and COVID-19 clinical management and outcomes. Multivariate ordinal logistic regression permitting unequal slopes was used to evaluate the impact of demographic, disease, and treatment factors on SARS-CoV-2 related hospitalization, intensive care unit (ICU) admission, and mortality. Findings Among all evaluated patients (n = 303), 147 (48%) were male, 118 (29%) were older adults (≥65 years old), and 104 (34%) were non-Hispanic white. A subset (n = 63, 21%) had hematologic malignancies and the remaining had solid tumors. Patients were hospitalized for acute care (n = 79, 26%), ICU-level care (n = 28, 9%), or died (n = 21, 7%) due to COVID-19. Patients with ≥2 comorbidities were more likely to require acute care (odds ratio [OR] 2.09 [95% confidence interval (CI), 1.23-3.55]). Cough was identified as a significant predictor of ICU hospitalization (OR 2.16 [95% CI, 1.03-4.57]). Importantly, mortality was associated with an active cancer diagnosis (OR 3.64 [95% CI, 1.40-9.5]) or advanced age (OR 3.86 [95% CI, 1.2-12.44]). Interpretation This study observed that patients with active cancer or advanced age are at an increased risk of death from COVID-19. These study observations can inform risk counseling related to COVID-19 for patients with a cancer diagnosis.
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Affiliation(s)
- Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Corresponding author: Hala T. Borno, MD 550 16th Street, 6th Floor, Box 3211 San Francisco, CA 94158.
| | - Mi-Ok Kim
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Julian C Hong
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Sasha Yousefi
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Amy Lin
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Irina Tolstykh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Sylvia Zhang
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Rana R McKay
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Olivier Harismendy
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
- Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Pelin Cinar
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Hope Rugo
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Maya Rabow
- College of Science, Northeastern University, Boston, MA, USA
| | | | - Adina Bailey
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Eric J Small
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Burgess H, Gutierrez-Mock L, Ho YX, Moghadassi M, Lesh N, Krueger E, Reid M. Implementing a digital system for contact tracing and case investigation during COVID-19 pandemic in San Francisco: a qualitative study. JAMIA Open 2021; 4:ooab093. [PMID: 34888491 PMCID: PMC8653624 DOI: 10.1093/jamiaopen/ooab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
Abstract
During the COVID-19 pandemic, many health jurisdictions deployed digital informatics systems to support "manual" case investigation and contact tracing (CICT). This case study evaluates the implementation and use of a digital information system through the experiences of CICT workers in the City and County of San Francisco (CCSF). We conducted semi-structured, 90-min interviews with a sample of the CCSF CICT workforce (n = 37). Participants also completed standardized assessments of the digital system using the System Usability Scale (SUS). Qualitative analyses highlighted (1) the importance of digital tools to ensure rapid onboarding and effective data capture in a public health emergency; (2) the use of digital systems to support culturally sensitive care; and (3) the role of digitals tools in building supportive work environments. The mean SUS score was 70/100 (SD = 17), indicating relative ease of use. In summary, the analysis highlights the importance of digital tools to support manual CICT in the COVID-19 response.
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Affiliation(s)
| | | | | | | | - Neal Lesh
- Dimagi, Inc., Cambridge, Massachusetts, USA
| | - Elizabeth Krueger
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Michael Reid
- University of California, San Francisco, San Francisco, California, USA
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Athavale P, Kumar V, Clark J, Mondal S, Sur S. Differential Impact of COVID-19 Risk Factors on Ethnicities in the United States. Front Public Health 2021; 9:743003. [PMID: 34938701 PMCID: PMC8687082 DOI: 10.3389/fpubh.2021.743003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/10/2021] [Indexed: 01/22/2023] Open
Abstract
The coronavirus disease (COVID-19) has revealed existing health inequalities in racial and ethnic minority groups in the US. This work investigates and quantifies the non-uniform effects of geographical location and other known risk factors on various ethnic groups during the COVID-19 pandemic at a national level. To quantify the geographical impact on various ethnic groups, we grouped all the states of the US. into four different regions (Northeast, Midwest, South, and West) and considered Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Non-Hispanic Asian (NHA) as ethnic groups of our interest. Our analysis showed that infection and mortality among NHB and Hispanics are considerably higher than NHW. In particular, the COVID-19 infection rate in the Hispanic community was significantly higher than their population share, a phenomenon we observed across all regions in the US but is most prominent in the West. To gauge the differential impact of comorbidities on different ethnicities, we performed cross-sectional regression analyses of statewide data for COVID-19 infection and mortality for each ethnic group using advanced age, poverty, obesity, hypertension, cardiovascular disease, and diabetes as risk factors. After removing the risk factors causing multicollinearity, poverty emerged as one of the independent risk factors in explaining mortality rates in NHW, NHB, and Hispanic communities. Moreover, for NHW and NHB groups, we found that obesity encapsulated the effect of several other comorbidities such as advanced age, hypertension, and cardiovascular disease. At the same time, advanced age was the most robust predictor of mortality in the Hispanic group. Our study quantifies the unique impact of various risk factors on different ethnic groups, explaining the ethnicity-specific differences observed in the COVID-19 pandemic. The findings could provide insight into focused public health strategies and interventions.
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Affiliation(s)
- Prashant Athavale
- Department of Mathematics, Clarkson University, Potsdam, NY, United States
| | - Vijay Kumar
- Department of Mathematics, Clarkson University, Potsdam, NY, United States
| | - Jeremy Clark
- Department of Mathematics, Clarkson University, Potsdam, NY, United States
| | - Sumona Mondal
- Department of Mathematics, Clarkson University, Potsdam, NY, United States
| | - Shantanu Sur
- Department of Biology, Clarkson University, Potsdam, NY, United States
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Wang J, Sato T, Sakuraba A. Worldwide association of lifestyle-related factors and COVID-19 mortality. Ann Med 2021; 53:1528-1533. [PMID: 34435518 PMCID: PMC8405104 DOI: 10.1080/07853890.2021.1968029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several lifestyle-related factors, such as obesity and diabetes, have been identified as risk factors for Coronavirus disease 2019 (COVID-19) mortality. The objective of this study was to examine the global association between lifestyle-related factors and COVID-19 mortality using data from each individual country. METHODS The association between prevalence of seven lifestyle-related factors (overweight, insufficient physical activity, smoking, type-2 diabetes, hypertension, hyperlipidaemia, and age over 65) and COVID-19 mortality was assessed by linear and multivariable regression among 186 countries. The cumulative effect of lifestyle-related factors on COVID-19 mortality was assessed by dividing countries into four categories according to the number of lifestyle-related factors in the upper half range and comparing the mean mortality between groups. RESULTS In linear regression, COVID-19 mortality was significantly associated with overweight, insufficient physical activity, hyperlipidaemia, and age ≥65. In multivariable regression, overweight and age ≥65 demonstrated significant association with COVID-19 mortality (p = .0039, .0094). Countries with more risk factors demonstrated greater COVID-19 mortality (P for trend <.001). CONCLUSION Lifestyle-related factors, especially overweight and elderly population, were associated with increased COVID-19 mortality on a global scale. Global effort to reduce burden of lifestyle-related factors along with protection and vaccination of these susceptible groups may help reduce COVID-19 mortality.
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Affiliation(s)
- Jingzhou Wang
- Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
- Coronavirus Task Force, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL, USA
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Stamatis CA, Broos HC, Hudiburgh SE, Dale SK, Timpano KR. A longitudinal investigation of COVID-19 pandemic experiences and mental health among university students. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:385-404. [PMID: 34850405 DOI: 10.1111/bjc.12351] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Previous studies have established a link between the COVID-19 pandemic and poor mental health. They further suggest that young adults may be especially vulnerable to worsened mental health during the pandemic, but few studies have investigated which specific aspects of the COVID-19 experience affect psychological well-being over time. To better understand concrete predictors of poor mental health outcomes in this population, we identified several pandemic-related experiences and evaluated their effects on mental health symptoms (depression, anxiety, stress, alcohol, and substance use) in a sample of U.S. college students (N = 176). METHODS Both mental health symptoms and pandemic-related experiences were evaluated at the start of quarantine (March/April 2020, Time 1) and the end of the Spring 2020 semester (May 2020, Time 2). Given the limited literature on specific predictors of mental health during a pandemic, we used elastic net regression, a novel analytic method that helps with variable selection when theoretical background is limited, to narrow our field of possible predictors. RESULTS While mental health symptoms were elevated at both timepoints, there were no clinically significant changes from Time 1 to Time 2 and few differences between sociodemographic groups. Both disruption due to the pandemic (β = .25, p = .021) and limited confidence in the federal government's response (β = -.14, p = .038) were significant predictors of depression symptoms at the end of the semester, even when controlling for baseline depression. Further, predictions that the pandemic would continue to impact daily life further into the future were linked with pandemic stress response symptoms (β = .15, p = .032) at Time 2, beyond the effects of baseline symptoms. Alcohol (β = -.22, p = .024) and substance use (β = -.26, p = .01) were associated with reduced adherence to COVID-19 guidelines. CONCLUSIONS Our findings indicate that specific aspects of the pandemic experience may be influencing internalizing symptoms and alcohol/substance use in college students, pointing to potential avenues for targeted support and intervention. PRACTITIONER POINTS A range of factors may influence university student mental health during the COVID-19 pandemic. Students who expect the pandemic will continue to impact daily life further into the future maybe more likely to report stress symptoms. Disruption due to the pandemic and limited confidence in the federal government's response may be associated with depression symptoms. Alcohol and substance use are associated with lower COVID-19 guideline adherence in university students.
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Affiliation(s)
- Caitlin A Stamatis
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.,Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hannah C Broos
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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Ingraham NE, Purcell LN, Karam BS, Dudley RA, Usher MG, Warlick CA, Allen ML, Melton GB, Charles A, Tignanelli CJ. Racial and Ethnic Disparities in Hospital Admissions from COVID-19: Determining the Impact of Neighborhood Deprivation and Primary Language. J Gen Intern Med 2021; 36:3462-3470. [PMID: 34003427 PMCID: PMC8130213 DOI: 10.1007/s11606-021-06790-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/01/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite past and ongoing efforts to achieve health equity in the USA, racial and ethnic disparities persist and appear to be exacerbated by COVID-19. OBJECTIVE Evaluate neighborhood-level deprivation and English language proficiency effect on disproportionate outcomes seen in racial and ethnic minorities diagnosed with COVID-19. DESIGN Retrospective cohort study SETTING: Health records of 12 Midwest hospitals and 60 clinics in Minnesota between March 4, 2020, and August 19, 2020 PATIENTS: Polymerase chain reaction-positive COVID-19 patients EXPOSURES: Area Deprivation Index (ADI) and primary language MAIN MEASURES: The primary outcome was COVID-19 severity, using hospitalization within 45 days of diagnosis as a marker of severity. Logistic and competing-risk regression models assessed the effects of neighborhood-level deprivation (using the ADI) and primary language. Within race, effects of ADI and primary language were measured using logistic regression. RESULTS A total of 5577 individuals infected with SARS-CoV-2 were included; 866 (n = 15.5%) were hospitalized within 45 days of diagnosis. Hospitalized patients were older (60.9 vs. 40.4 years, p < 0.001) and more likely to be male (n = 425 [49.1%] vs. 2049 [43.5%], p = 0.002). Of those requiring hospitalization, 43.9% (n = 381), 19.9% (n = 172), 18.6% (n = 161), and 11.8% (n = 102) were White, Black, Asian, and Hispanic, respectively. Independent of ADI, minority race/ethnicity was associated with COVID-19 severity: Hispanic patients (OR 3.8, 95% CI 2.72-5.30), Asians (OR 2.39, 95% CI 1.74-3.29), and Blacks (OR 1.50, 95% CI 1.15-1.94). ADI was not associated with hospitalization. Non-English-speaking (OR 1.91, 95% CI 1.51-2.43) significantly increased odds of hospital admission across and within minority groups. CONCLUSIONS Minority populations have increased odds of severe COVID-19 independent of neighborhood deprivation, a commonly suspected driver of disparate outcomes. Non-English-speaking accounts for differences across and within minority populations. These results support the ongoing need to determine the mechanisms that contribute to disparities during COVID-19 while also highlighting the underappreciated role primary language plays in COVID-19 severity among minority groups.
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Affiliation(s)
- Nicholas E. Ingraham
- Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN USA
| | - Laura N. Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, NC USA
| | - Basil S. Karam
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI USA
| | - R. Adams Dudley
- Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN USA
| | - Michael G. Usher
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN USA
| | | | - Michele L. Allen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN USA
| | - Genevieve B. Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, University of Minnesota, Minneapolis, MN USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, NC USA
- School of Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Christopher J. Tignanelli
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Surgery, North Memorial Health Hospital, Robbinsdale, MN USA
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Bunch PM, Loevner LA, Bhala R, Hepp MB, Hirsch JA, Johnson MH, Lyp KL, Quigley EP, Salamon N, Jordan JE, Schwartz ES. The American Society of Neuroradiology: Cultivating a Diverse and Inclusive Culture to Build a Stronger Organization. AJNR Am J Neuroradiol 2021; 42:2127-2129. [PMID: 34593384 DOI: 10.3174/ajnr.a7310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Yuan H, Reynolds C, Ng S, Yang W. Factors affecting the transmission of SARS-CoV-2 in school settings. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.06.18.21259156. [PMID: 34189533 PMCID: PMC8240688 DOI: 10.1101/2021.06.18.21259156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Several studies have reported SARS-CoV-2 outbreaks in schools, with a wide range of secondary attack rate (SAR; range: 0-100%). We aimed to examine key risk factors to better understand SARS-CoV-2 transmission in schools. METHODS We collected records of 39 SARS-CoV-2 school outbreaks globally published through July 2021 and compiled information on hypothesized risk factors. We utilized the directed acyclic graph (DAG) to conceptualize risk mechanisms, used logistic regression to examine each risk-factor group, and further built multi-risk models. RESULTS The best-fit model showed that the intensity of concurrent community transmission (adjusted odds ratio [aOR]: 1.2, 95% CI: 1.17 - 1.24, for each increase of 1 case per 10,000 persons per week), individualism (aOR: 1.72, 95% CI: 1.19 - 2.5, above vs. below the median) were associated higher risk, whereas preventive measures (aOR: 0.22, 95% CI: 0.17 - 0.29, distancing and masking vs. none) and higher population immunity (aOR: 0.28, 95% CI: 0.22 - 0.35) were associated with lower risk of SARS-CoV-2 transmission in schools. Compared to students in pre-schools, the aOR was 0.35 (95% CI: 0.23 - 0.54) for students in primary schools and 1.3 (95% CI: 0.9 - 1.88) for students in high schools. CONCLUSIONS Preventive measures in schools (e.g. social distancing and mask-wearing) and communal efforts to lower transmission and increase vaccination uptake (i.e. vaccine-induced population immunity) in the community should be taken to collectively reduce transmission and protect children in schools. Flexible reopening policies may be considered for different levels of schools given their risk differences.
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Roy S, Showstark M, Tolchin B, Kashyap N, Bonito J, Salazar MC, Herbst JL, Nash KA, Nguemeni Tiako MJ, Jubanyik K, Kim N, Galusha D, Wang KH, Oladele C. The potential impact of triage protocols on racial disparities in clinical outcomes among COVID-positive patients in a large academic healthcare system. PLoS One 2021; 16:e0256763. [PMID: 34529684 PMCID: PMC8445412 DOI: 10.1371/journal.pone.0256763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a devastating impact in the United States, particularly for Black populations, and has heavily burdened the healthcare system. Hospitals have created protocols to allocate limited resources, but there is concern that these protocols will exacerbate disparities. The sequential organ failure assessment (SOFA) score is a tool often used in triage protocols. In these protocols, patients with higher SOFA scores are denied resources based on the assumption that they have worse clinical outcomes. The purpose of this study was to assess whether using SOFA score as a triage tool among COVID-positive patients would exacerbate racial disparities in clinical outcomes. METHODS We analyzed data from a retrospective cohort of hospitalized COVID-positive patients in the Yale-New Haven Health System. We examined associations between race/ethnicity and peak overall/24-hour SOFA score, in-hospital mortality, and ICU admission. Other predictors of interest were age, sex, primary language, and insurance status. We used one-way ANOVA and chi-square tests to assess differences in SOFA score across racial/ethnic groups and linear and logistic regression to assess differences in clinical outcomes by sociodemographic characteristics. RESULTS Our final sample included 2,554 patients. Black patients had higher SOFA scores compared to patients of other races. However, Black patients did not have significantly greater in-hospital mortality or ICU admission compared to patients of other races. CONCLUSION While Black patients in this sample of hospitalized COVID-positive patients had higher SOFA scores compared to patients of other races, this did not translate to higher in-hospital mortality or ICU admission. Results demonstrate that if SOFA score had been used to allocate care, Black COVID patients would have been denied care despite having similar clinical outcomes to white patients. Therefore, using SOFA score to allocate resources has the potential to exacerbate racial inequities by disproportionately denying care to Black patients and should not be used to determine access to care. Healthcare systems must develop and use COVID-19 triage protocols that prioritize equity.
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Affiliation(s)
- Shireen Roy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Mary Showstark
- Yale School of Medicine Physician Assistant Online Program, Yale Institute of Global Health, National Disaster Medical System, New Haven, CT, United States of America
| | - Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, Epilepsy Center of Excellence, VA Connecticut Healthcare System, Yale New Haven Health, New Haven, CT, United States of America
| | - Nitu Kashyap
- Yale New Haven Health, New Haven, CT, United States of America
| | - Jennifer Bonito
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Michelle C. Salazar
- Department of Surgery, Yale School of Medicine, National Clinician Scholars Program, New Haven, CT, United States of America
| | - Jennifer L. Herbst
- Quinnipiac University School of Law, Frank H. Netter, MD, School of Medicine at Quinnipiac University, North Haven, CT, United States of America
| | - Katherine A. Nash
- Department of Pediatrics, Yale School of Medicine, National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Karen Jubanyik
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Nancy Kim
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States of America
| | - Deron Galusha
- Yale School of Medicine, New Haven, CT, United States of America
| | - Karen H. Wang
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States of America
| | - Carol Oladele
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States of America
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Buikema AR, Buzinec P, Paudel ML, Andrade K, Johnson JC, Edmonds YM, Jhamb SK, Chastek B, Raja H, Cao F, Hulbert EM, Korrer S, Mazumder D, Seare J, Solow BK, Currie UM. Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database. EClinicalMedicine 2021; 39:101075. [PMID: 34493997 PMCID: PMC8413267 DOI: 10.1016/j.eclinm.2021.101075] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. METHODS This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. FINDINGS Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620-1·763; Black: 1·810, 1·743-1·880; Asian: 1·503, 1·381-1·636) and during follow-up (Hispanic: 1·700, 1·638-1·764; Black: 1·578, 1·526-1·633; Asian: 1·391, 1·288-1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809-0·959) but higher for Asian patients (1·205, 1·000-1·452). INTERPRETATION Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19-related care, further analyses of disaggregated population-level COVID-19 data are needed.
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Affiliation(s)
- Ami R. Buikema
- Optum, Eden Prairie, MN, USA
- Corresponding author at: 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA.
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Cheng P, Johnson DA. Moving beyond the "model minority" myth to understand sleep health disparities in Asian American and Pacific Islander communities. J Clin Sleep Med 2021; 17:1969-1970. [PMID: 34170239 DOI: 10.5664/jcsm.9500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Chang HY, Tang W, Hatef E, Kitchen C, Weiner JP, Kharrazi H. Differential impact of mitigation policies and socioeconomic status on COVID-19 prevalence and social distancing in the United States. BMC Public Health 2021; 21:1140. [PMID: 34126964 PMCID: PMC8201431 DOI: 10.1186/s12889-021-11149-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/26/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The spread of COVID-19 has highlighted the long-standing health inequalities across the U.S. as neighborhoods with fewer resources were associated with higher rates of COVID-19 transmission. Although the stay-at-home order was one of the most effective methods to contain its spread, residents in lower-income neighborhoods faced barriers to practicing social distancing. We aimed to quantify the differential impact of stay-at-home policy on COVID-19 transmission and residents' mobility across neighborhoods of different levels of socioeconomic disadvantage. METHODS This was a comparative interrupted time-series analysis at the county level. We included 2087 counties from 38 states which both implemented and lifted the state-wide stay-at-home order. Every county was assigned to one of four equally-sized groups based on its levels of disadvantage, represented by the Area Deprivation Index. Prevalence of COVID-19 was calculated by dividing the daily number of cumulative confirmed COVID-19 cases by the number of residents from the 2010 Census. We used the Social Distancing Index (SDI), derived from the COVID-19 Impact Analysis Platform, to measure the mobility. For the evaluation of implementation, the observation started from Mar 1st 2020 to 1 day before lifting; and, for lifting, it ranged from 1 day after implementation to Jul 5th 2020. We calculated a comparative change of daily trends in COVID-19 prevalence and Social Distancing Index between counties with three highest disadvantage levels and those with the least level before and after the implementation and lifting of the stay-at-home order, separately. RESULTS On both stay-at-home implementation and lifting dates, COVID-19 prevalence was much higher among counties with the highest or lowest disadvantage level, while mobility decreased as the disadvantage level increased. Mobility of the most disadvantaged counties was least impacted by stay-at-home implementation and relaxation compared to counties with the most resources; however, disadvantaged counties experienced the largest relative increase in COVID-19 infection after both stay-at-home implementation and relaxation. CONCLUSIONS Neighborhoods with varying levels of socioeconomic disadvantage reacted differently to the implementation and relaxation of COVID-19 mitigation policies. Policymakers should consider investing more resources in disadvantaged counties as the pandemic may not stop until most neighborhoods have it under control.
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Affiliation(s)
- Hsien-Yen Chang
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, Maryland USA
- Center for Population Health Information Technology, Johns Hopkins University, Baltimore, Maryland USA
| | - Wenze Tang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts USA
| | - Elham Hatef
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
- Center for Population Health Information Technology, Johns Hopkins University, Baltimore, Maryland USA
| | - Christopher Kitchen
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
- Center for Population Health Information Technology, Johns Hopkins University, Baltimore, Maryland USA
| | - Jonathan P. Weiner
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
- Center for Population Health Information Technology, Johns Hopkins University, Baltimore, Maryland USA
| | - Hadi Kharrazi
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
- Center for Population Health Information Technology, Johns Hopkins University, Baltimore, Maryland USA
- Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland USA
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Byrd-Williams C, Ewing M, Rosenthal EL, St. John JA, Menking P, Redondo F, Sieswerda S. Training Needs of Community Health Workers Facing the COVID-19 Pandemic in Texas: A Cross-Sectional Study. Front Public Health 2021; 9:689946. [PMID: 34195172 PMCID: PMC8236534 DOI: 10.3389/fpubh.2021.689946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has required the professional healthcare workforce not only to adjust methods of delivering care safely but also act as a trusted sources of information during a time of uncertainty and rapid research and discovery. The Community Health Worker COVID-19 Impact Survey is a cross-sectional study developed to better understand the impact of COVID-19 on this sector of the healthcare workforce, including training needs of those working through the pandemic. The survey was distributed in Texas, New Mexico, and Arizona. This study focuses on Texas, and the data presented (n = 693) is a sub-set of qualitative data from the larger survey. Results of the content analysis described in this paper are intended to inform current COVID-19-related CHW training curriculum, in addition to future infectious disease prevention and preparedness response trainings.
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Affiliation(s)
- Courtney Byrd-Williams
- Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| | - Mollie Ewing
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
| | - E. Lee Rosenthal
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, United States
| | - Julie Ann St. John
- Julia Jones Matthews Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Abilene, TX, United States
| | - Paige Menking
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | | | - Stephanie Sieswerda
- Michael & Susan Dell Center for Healthy Living at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, United States
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GREER ML, SAMPLE S, JENSEN HK, MCBAIN S, LIPSCHITZ R, SEXTON KW. COVID-19 Is Connected with Lower Health Literacy in Rural Areas. Stud Health Technol Inform 2021; 281:804-808. [PMID: 34042689 PMCID: PMC8290347 DOI: 10.3233/shti210286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The relationship between social determinants of health (SDoH) and health outcomes is established and extends to a higher risk of contracting COVID-19. Given the factors included in SDoH, such as education level, race, rurality, and socioeconomic status are interconnected, it is unclear how individual SDoH factors may uniquely impact risk. Lower socioeconomic status often occurs in concert with lower educational attainment, for example. Because literacy provides access to information needed to avoid infection and content can be made more accessible, it is essential to determine to what extent health literacy contributes to successful containment of a pandemic. By incorporating this information into clinical data, we have isolated literacy and geographic location as SDoH factors uniquely related to the risk of COVID-19 infection. For patients with comorbidities linked to higher illness severity, residents of rural areas associated with lower health literacy at the zip code level had a greater likelihood of positive COVID-19 results unrelated to their economic status.
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Affiliation(s)
- Melody L. GREER
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences
| | | | - Hanna K. JENSEN
- COM Surgery Trauma Surgery, University of Arkansas for Medical Sciences
| | - Sacha MCBAIN
- COM Surgery Trauma Surgery, University of Arkansas for Medical Sciences,,Psychiatric Research Institute, University of Arkansas for Medical Sciences
| | | | - Kevin W. SEXTON
- COM Surgery Trauma Surgery, University of Arkansas for Medical Sciences
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Introduction on Coronavirus Disease (COVID-19) Pandemic: The Global Challenge. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:1-22. [PMID: 33973169 DOI: 10.1007/978-3-030-63761-3_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
By driving the ongoing pandemic of coronavirus disease 2019 (COVID-19), coronaviruses have become a significant change in twenty-first-century medicine, healthcare systems, education, and the global economy. This chapter rapidly reviews the origin, immunopathogenesis, epidemiology, diagnosis, clinical manifestations, and potential therapeutics of COVID-19. It would also explore the effects of the introduction of a single virus, the so-called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on the public health preparedness planning.
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Siegel M, Critchfield-Jain I, Boykin M, Owens A. Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 35 US States and Their Association with Structural Racism. J Racial Ethn Health Disparities 2021; 9:886-898. [PMID: 33905110 PMCID: PMC8077854 DOI: 10.1007/s40615-021-01028-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022]
Abstract
Introduction While the increased burden of COVID-19 among the Black population has been recognized, most attempts to quantify the extent of this racial disparity have not taken the age distribution of the population into account. In this paper, we determine the Black–White disparity in COVID-19 mortality rates across 35 states using direct age standardization. We then explore the relationship between structural racism and differences in the magnitude of this disparity across states. Methods Using data from the Centers for Disease Control and Prevention, we calculated both crude and age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each state. We explored the relationship between a state-level structural racism index and the observed differences in the racial disparities in COVID-19 mortality across states. We explored the potential mediating effects of disparities in exposure based on occupation, underlying medical conditions, and health care access. Results Relying upon crude death rate ratios resulted in a substantial underestimation of the true magnitude of the Black–White disparity in COVID-19 mortality rates. The structural racism index was a robust predictor of the observed racial disparities. Each standard deviation increase in the racism index was associated with an increase of 0.26 in the ratio of COVID-19 mortality rates among the Black compared to the White population. Conclusions Structural racism should be considered a root cause of the Black–White disparity in COVID-19 mortality. Dismantling the long-standing systems of racial oppression is critical to adequately address both the downstream and upstream causes of racial inequities in the disease burden of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01028-1.
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Affiliation(s)
- Michael Siegel
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Isabella Critchfield-Jain
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Matthew Boykin
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Alicia Owens
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
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Sakuraba A, Sato T. COVID-19 mortality and gross domestic product loss: A wake-up call for government leaders. World J Clin Infect Dis 2021; 11:35-37. [DOI: 10.5495/wjcid.v11.i2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Government leaders have struggled to reduce the infection and deaths due to coronavirus disease 2019 (COVID-19) as well as to keep the economy and businesses open. There is a large variation of mortality and damage to economy among countries. One possible cause leading to the large variation is the manner in which countries have delt with COVID-19. Some countries or regions such as China, New Zealand, and Taiwan, acted quickly and aggressively by implementing border closures, lockdown, school closures, mass testing, etc. On the other hand, many European countries, United States, and Brazil delayed their decisions to implement these restrictions and measures. No study has assessed the correlation between gross domestic product (GDP) and COVID-19 mortality. In the present study, there was a negative correlation between GDP and COVID-19 mortality suggesting that countries that failed to control the virus (larger COVID-19 mortality) would see a larger decline in GDP. Governmental leaders should act fast and aggressively when making decisions because data shows that countries who have run after two hares have caught neither. Furthermore, citizens of each country need to do their own part by following guidelines and practicing social distancing and mask wearing, which are considered the most effective, easiest, and cheapest measures that can be taken, so that repeated lockdowns can be avoided.
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Affiliation(s)
- Atsushi Sakuraba
- Department of Medicine, University of Chicago, Chicago, IL 60637, United States
| | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo 108-8345, Japan
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Mackey K, Ayers CK, Kondo KK, Saha S, Advani SM, Young S, Spencer H, Rusek M, Anderson J, Veazie S, Smith M, Kansagara D. Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths : A Systematic Review. Ann Intern Med 2021; 174:362-373. [PMID: 33253040 PMCID: PMC7772883 DOI: 10.7326/m20-6306] [Citation(s) in RCA: 770] [Impact Index Per Article: 192.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Data suggest that the effects of coronavirus disease 2019 (COVID-19) differ among U.S. racial/ethnic groups. PURPOSE To evaluate racial/ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and COVID-19 outcomes, factors contributing to disparities, and interventions to reduce them. DATA SOURCES English-language articles in MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, searched from inception through 31 August 2020. Gray literature sources were searched through 2 November 2020. STUDY SELECTION Observational studies examining SARS-CoV-2 infections, hospitalizations, or deaths by race/ethnicity in U.S. settings. DATA EXTRACTION Single-reviewer abstraction confirmed by a second reviewer; independent dual-reviewer assessment of quality and strength of evidence. DATA SYNTHESIS 37 mostly fair-quality cohort and cross-sectional studies, 15 mostly good-quality ecological studies, and data from the Centers for Disease Control and Prevention and APM Research Lab were included. African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection, hospitalization, and COVID-19-related mortality compared with non-Hispanic White populations, but not higher case-fatality rates (mostly reported as in-hospital mortality) (moderate- to high-strength evidence). Asian populations experience similar outcomes to non-Hispanic White populations (low-strength evidence). Outcomes for other racial/ethnic groups have been insufficiently studied. Health care access and exposure factors may underlie the observed disparities more than susceptibility due to comorbid conditions (low-strength evidence). LIMITATIONS Selection bias, missing race/ethnicity data, and incomplete outcome assessments in cohort and cross-sectional studies must be considered. In addition, adjustment for key demographic covariates was lacking in ecological studies. CONCLUSION African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection and COVID-19-related mortality but similar rates of case fatality. Differences in health care access and exposure risk may be driving higher infection and mortality rates. PRIMARY FUNDING SOURCE Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development. (PROSPERO: CRD42020187078).
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Affiliation(s)
- Katherine Mackey
- VA Evidence Synthesis Program, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (K.M., K.K.K., S.S., D.K.)
| | - Chelsea K Ayers
- VA Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon (C.K.A., S.Y., J.A., S.V.)
| | - Karli K Kondo
- VA Evidence Synthesis Program, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (K.M., K.K.K., S.S., D.K.)
| | - Somnath Saha
- VA Evidence Synthesis Program, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (K.M., K.K.K., S.S., D.K.)
| | - Shailesh M Advani
- Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland (S.M.A.)
| | - Sarah Young
- VA Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon (C.K.A., S.Y., J.A., S.V.)
| | - Hunter Spencer
- Oregon Health & Science University, Portland, Oregon (H.S., M.R.)
| | - Max Rusek
- Oregon Health & Science University, Portland, Oregon (H.S., M.R.)
| | - Johanna Anderson
- VA Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon (C.K.A., S.Y., J.A., S.V.)
| | - Stephanie Veazie
- VA Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon (C.K.A., S.Y., J.A., S.V.)
| | - Mia Smith
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon (M.S.)
| | - Devan Kansagara
- VA Evidence Synthesis Program, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (K.M., K.K.K., S.S., D.K.)
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Dabone C, Mbagwu I, Muray M, Ubangha L, Kohoun B, Etowa E, Nare H, Kiros G, Etowa J. Global Food Insecurity and African, Caribbean, and Black (ACB) Populations During the COVID-19 Pandemic: a Rapid Review. J Racial Ethn Health Disparities 2021. [DOI: 10.1007/s40615-021-00973-1 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dabone C, Mbagwu I, Muray M, Ubangha L, Kohoun B, Etowa E, Nare H, Kiros G, Etowa J. Global Food Insecurity and African, Caribbean, and Black (ACB) Populations During the COVID-19 Pandemic: a Rapid Review. J Racial Ethn Health Disparities 2021; 9:420-435. [PMID: 33559109 PMCID: PMC7870023 DOI: 10.1007/s40615-021-00973-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/15/2022]
Abstract
Background The global food insecurity reinforces the ongoing impact of COVID-19 on human health and mortality. Although literature remained sparse, reports indicated that food insecurity is disproportionately high among African, Caribbean, and Black (ACB) population since the outset of COVID-19. Hence, we assessed the food insecurity conditions of ACB populations globally during the COVID-19 pandemic. Methods Comprehensive searches in CINAHL, Medline (Ovid), PubMed (Medline), Food Science and Technology Abstracts, SCOPUS, EMBASE, AMED, CAB Abstracts, Cochrane Library (OVID), and PsycINFO were carried out. Title/abstract and full-text screening, quality appraisal (modified JBI QARI), and data extraction were carried out by double reviewers. Results The initial search yielded 354 articles. After removal of duplicates and irrelevant articles, a full-text review and critical appraisal, 9 papers were included in the study. After data extraction and synthesis, six major themes emerged from the analysis: increased food insecurity, adverse health outcomes of food insecurity, exacerbation of existing disparities, systemic inequities and adverse policies, racism, and sociocultural response and solutions. Conclusion/implications The study showed that COVID-19 had exacerbated food insecurity and other health disparities within racialized populations including ACB people, due to systemic anti-Black racism; inadequate representation in decision-making; and issues of cultural appropriateness and competency of health services. While sociocultural response by ACB people through the expansion of their social capital is imperative, specific policies easing access to food, medicine, and shelter for racialized communities will ensure equity while reducing global food insecurity and health crises during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-00973-1.
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Affiliation(s)
- Charles Dabone
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada. .,Canadians of African Descent Health Organization (CADHO), Ottawa, Canada.
| | - Ikenna Mbagwu
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada. .,Canadians of African Descent Health Organization (CADHO), Ottawa, Canada.
| | - Mwali Muray
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Canadians of African Descent Health Organization (CADHO), Ottawa, Canada
| | - Lovelyn Ubangha
- Canadians of African Descent Health Organization (CADHO), Ottawa, Canada
| | - Bagnini Kohoun
- Canadians of African Descent Health Organization (CADHO), Ottawa, Canada.,Immigration, Refugees and Citizenship Canada, Ottawa, Canada
| | - Egbe Etowa
- Canadians of African Descent Health Organization (CADHO), Ottawa, Canada.,Department of Sociology, Anthropology & Criminology, Faculty of Arts, Humanities & Social Sciences, University of Windsor, Windsor, Canada
| | - Hilary Nare
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Canadians of African Descent Health Organization (CADHO), Ottawa, Canada
| | - Getachew Kiros
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Canadians of African Descent Health Organization (CADHO), Ottawa, Canada
| | - Josephine Etowa
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Canadians of African Descent Health Organization (CADHO), Ottawa, Canada
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Cerdeña JP. Race-Conscious Bioethics: The Call to Reject Contemporary Scientific Racism. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:48-53. [PMID: 33534686 DOI: 10.1080/15265161.2020.1861383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Collin LJ, Gaglioti AH, Beyer KM, Zhou Y, Moore MA, Nash R, Switchenko JM, Miller-Kleinhenz JM, Ward KC, McCullough LE. Neighborhood-Level Redlining and Lending Bias Are Associated with Breast Cancer Mortality in a Large and Diverse Metropolitan Area. Cancer Epidemiol Biomarkers Prev 2021; 30:53-60. [PMID: 33008873 PMCID: PMC7855192 DOI: 10.1158/1055-9965.epi-20-1038] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/29/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Structural inequities have important implications for the health of marginalized groups. Neighborhood-level redlining and lending bias represent state-sponsored systems of segregation, potential drivers of adverse health outcomes. We sought to estimate the effect of redlining and lending bias on breast cancer mortality and explore differences by race. METHODS Using Georgia Cancer Registry data, we included 4,943 non-Hispanic White (NHW) and 3,580 non-Hispanic Black (NHB) women with a first primary invasive breast cancer diagnosis in metro-Atlanta (2010-2014). Redlining and lending bias were derived for census tracts using the Home Mortgage Disclosure Act database. We calculated hazard ratios and 95% confidence intervals (CI) for the associations of redlining, lending bias on breast cancer mortality and estimated race-stratified associations. RESULTS Overall, 20% of NHW and 80% of NHB women lived in redlined census tracts, and 60% of NHW and 26% of NHB women lived in census tracts with pronounced lending bias. Living in redlined census tracts was associated with a nearly 1.60-fold increase in breast cancer mortality (hazard ratio = 1.58; 95% CI, 1.37-1.82) while residing in areas with substantial lending bias reduced the hazard of breast cancer mortality (hazard ratio = 0.86; 95% CI, 0.75-0.99). Among NHB women living in redlined census tracts, we observed a slight increase in breast cancer mortality (hazard ratio = 1.13; 95% CI, 0.90-1.42); among NHW women the association was more pronounced (hazard ratio = 1.39; 95% CI, 1.09-1.78). CONCLUSIONS These findings underscore the role of ecologic measures of structural racism on cancer outcomes. IMPACT Place-based measures are important contributors to health outcomes, an important unexplored area that offers potential interventions to address disparities.
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Affiliation(s)
- Lindsay J Collin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Anne H Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Kristen M Beyer
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Miranda A Moore
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Hu T, Yue H, Wang C, She B, Ye X, Liu R, Zhu X, Guan WW, Bao S. Racial Segregation, Testing Site Access, and COVID-19 Incidence Rate in Massachusetts, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9528. [PMID: 33352650 PMCID: PMC7766428 DOI: 10.3390/ijerph17249528] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022]
Abstract
The U.S. has merely 4% of the world population, but contains 25% of the world's COVID-19 cases. Since the COVID-19 outbreak in the U.S., Massachusetts has been leading other states in the total number of COVID-19 cases. Racial residential segregation is a fundamental cause of racial disparities in health. Moreover, disparities of access to health care have a large impact on COVID-19 cases. Thus, this study estimates racial segregation and disparities in testing site access and employs economic, demographic, and transportation variables at the city/town level in Massachusetts. Spatial regression models are applied to evaluate the relationships between COVID-19 incidence rate and related variables. This is the first study to apply spatial analysis methods across neighborhoods in the U.S. to examine the COVID-19 incidence rate. The findings are: (1) Residential segregations of Hispanic and Non-Hispanic Black/African Americans have a significantly positive association with COVID-19 incidence rate, indicating the higher susceptibility of COVID-19 infections among minority groups. (2) Non-Hispanic Black/African Americans have the shortest drive time to testing sites, followed by Hispanic, Non-Hispanic Asians, and Non-Hispanic Whites. The drive time to testing sites is significantly negatively associated with the COVID-19 incidence rate, implying the importance of the accessibility of testing sites by all populations. (3) Poverty rate and road density are significant explanatory variables. Importantly, overcrowding represented by more than one person per room is a significant variable found to be positively associated with COVID-19 incidence rate, suggesting the effectiveness of social distancing for reducing infection. (4) Different from the findings of previous studies, the elderly population rate is not statistically significantly correlated with the incidence rate because the elderly population in Massachusetts is less distributed in the hotspot regions of COVID-19 infections. The findings in this study provide useful insights for policymakers to propose new strategies to contain the COVID-19 transmissions in Massachusetts.
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Affiliation(s)
- Tao Hu
- Center for Geographic Analysis, Harvard University, Cambridge, MA 02138, USA; (T.H.); (W.W.G.)
- Geocomputation Center for Social Science, Wuhan University, Wuhan 430079, China
| | - Han Yue
- Center of GeoInformatics for Public Security, School of Geography and Remote Sensing, Guangzhou University, Guangzhou 510006, China
| | - Changzhen Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA 70803, USA;
| | - Bing She
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48106, USA;
| | - Xinyue Ye
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77840, USA;
| | - Regina Liu
- Department of Biology, Mercer University, Macon, GA 31207, USA;
| | - Xinyan Zhu
- State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan 430079, China;
- Collaborative Innovation Center of Geospatial Technology, Wuhan University, Wuhan 430079, China
| | - Weihe Wendy Guan
- Center for Geographic Analysis, Harvard University, Cambridge, MA 02138, USA; (T.H.); (W.W.G.)
| | - Shuming Bao
- China Data Institute, Ann Arbor, MI 48108, USA;
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Sakuraba A, Haider H, Sato T. Population Difference in Allele Frequency of HLA-C*05 and Its Correlation with COVID-19 Mortality. Viruses 2020; 12:E1333. [PMID: 33233780 PMCID: PMC7699862 DOI: 10.3390/v12111333] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND coronavirus disease 2019 (COVID-19) causes severe illness including cytokine storms, but mortality among countries differs largely. In the present study, we investigated the association between human leukocyte antigen (HLA) class I, which plays a major role in susceptibility to viral infections, and the mortality of COVID-19. METHODS data of allele frequencies of HLA-A, -B and -C and COVID-19 mortality were obtained for 74 countries from the Allele Frequency Net Database and worldometer.info. Association between allele frequency of each HLA and mortality was assessed by linear regression followed by multivariable regression. Subsequently, association of HLA-C*05 to its receptor KIR2DS4fl, expressed on natural killer (NK) cells, and differential mortality to historic pandemics were analyzed. RESULTS HLA-A*01, -B*07, -B*08, -B*44 and -C*05 were significantly associated with the risk of deaths (adjusted p = 0.040, 0.00081, 0.047, 0.0022, 0.00032, respectively), but only HLA-C*05 remained statistically significant (p = 0.000027) after multivariable regression. A 1% increase in the allele frequency of HLA-C*05 was associated with an increase of 44 deaths/million. Countries with different mortality could be categorized by the distribution of HLA-C*05 and its receptor KIR2DS4fl, which in combination cause NK cell-induced hyperactive immune response. Countries with similar ethnic and/or geographic background responded in a similar pattern to each pandemic. CONCLUSIONS we demonstrated that allele frequency of HLA-C*05 and the distribution pattern with its receptor KIR2DS4fl strongly correlated with COVID-19 mortality. Host genetic variance of innate immunity may contribute to the difference in mortality among various countries and further investigation using patient samples is warranted.
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Affiliation(s)
- Atsushi Sakuraba
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Haider Haider
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan;
- Corona Virus Task Force, Keio University School of Medicine, Tokyo 160-8582, Japan
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Abstract
INTRODUCTION Proton pump inhibitors (PPIs) increase the risk for enteric infections that is likely related to PPI-induced hypochlorhydria. Although the impact of acid suppression on severe acute respiratory syndrome coronavirus 2 is unknown thus far, previous data revealed that pH ≤3 impairs the infectivity of the similar severe acute respiratory syndrome coronavirus 1. Thus, we aimed to determine whether use of PPIs increases the odds for acquiring coronavirus disease 2019 (COVID-19) among community-dwelling Americans. METHODS From May 3 to June 24, 2020, we performed an online survey described to participating adults as a "national health survey." A multivariable logistic regression was performed on reporting a positive COVID-19 test to adjust for a wide range of confounding factors and to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS Of 53,130 participants, 3,386 (6.4%) reported a positive COVID-19 test. In regression analysis, individuals using PPIs up to once daily (aOR 2.15; 95% CI, 1.90-2.44) or twice daily (aOR 3.67; 95% CI, 2.93-4.60) had significantly increased odds for reporting a positive COVID-19 test when compared with those not taking PPIs. Individuals taking histamine-2 receptor antagonists were not at elevated risk. DISCUSSION We found evidence of an independent, dose-response relationship between the use of antisecretory medications and COVID-19 positivity; individuals taking PPIs twice daily have higher odds for reporting a positive test when compared with those using lower-dose PPIs up to once daily, and those taking the less potent histamine-2 receptor antagonists are not at increased risk. These findings emphasize good clinical practice that PPIs should only be used when indicated at the lowest effective dose, such as the approved once-daily label dosage of over-the-counter and prescription PPIs. Further studies examining the association between PPIs and COVID-19 are needed.
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Affiliation(s)
- Christopher V. Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - William D. Chey
- Department of Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brennan M.R. Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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50
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Baughman AW, Hirschberg RE, Lucas LJ, Suarez ED, Stockmann D, Hutton Johnson S, Hutter MM, Murphy DJ, Marsh RH, Thompson RW, Boland GW, Ives Erickson J, Palamara K. Pandemic Care Through Collaboration: Lessons From a COVID-19 Field Hospital. J Am Med Dir Assoc 2020; 21:1563-1567. [PMID: 33138938 PMCID: PMC7832230 DOI: 10.1016/j.jamda.2020.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 12/04/2022]
Abstract
During the surge of Coronavirus Disease 2019 (COVID-19) infections in March and April 2020, many skilled-nursing facilities in the Boston area closed to COVID-19 post-acute admissions because of infection control concerns and staffing shortages. Local government and health care leaders collaborated to establish a 1000-bed field hospital for patients with COVID-19, with 500 respite beds for the undomiciled and 500 post-acute care (PAC) beds within 9 days. The PAC hospital provided care for 394 patients over 7 weeks, from April 10 to June 2, 2020. In this report, we describe our implementation strategy, including organization structure, admissions criteria, and clinical services. Partnership with government, military, and local health care organizations was essential for logistical and medical support. In addition, dynamic workflows necessitated clear communication pathways, clinical operations expertise, and highly adaptable staff.
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Affiliation(s)
- Amy W Baughman
- Boston Hope Field Hospital, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA.
| | - Ronald E Hirschberg
- Boston Hope Field Hospital, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Larissa J Lucas
- Boston Hope Field Hospital, Boston, MA, USA; North Shore Physicians Group, Boston, MA, USA
| | - Elliot D Suarez
- Boston Hope Field Hospital, Boston, MA, USA; Atrius Health, Newton, MA, USA
| | - Deanna Stockmann
- Boston Hope Field Hospital, Boston, MA, USA; Atrius Health, Newton, MA, USA
| | | | - Matthew M Hutter
- Boston Hope Field Hospital, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
| | - Deborah J Murphy
- Boston Hope Field Hospital, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Regan H Marsh
- Boston Hope Field Hospital, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | | | - Giles W Boland
- Boston Hope Field Hospital, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Jeanette Ives Erickson
- Boston Hope Field Hospital, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
| | - Kerri Palamara
- Boston Hope Field Hospital, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
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