Disparities in COVID-19 Hospitalization at the Intersection of Race and Ethnicity and Income.

BACKGROUND: Existing studies have elucidated racial and ethnic disparities in COVID-19 hospitalizations, but few have examined disparities at the intersection of race and ethnicity and income. METHODS: We used a population-based probability survey of non-institutionalized adults in Michigan with a polymerase chain reaction-positive SARS-CoV-2 test before November 16, 2020. We categorized respondents by race and ethnicity and annual household income: low-income (< $50,000) Non-Hispanic (NH) Black, high-income (≥ $50,000) NH Black, low-income Hispanic, high-income Hispanic, low-income NH White, and high-income NH White. We used modified Poisson regression models, adjusting for sex, age group, survey mode, and sample wave, to estimate COVID-19 hospitalization prevalence ratios by race and ethnicity and income. RESULTS: Over half of the analytic sample (n = 1593) was female (54.9%) and age 45 or older (52.5%), with 14.5% hospitalized for COVID-19. Hospitalization was most prevalent among low-income (32.9%) and high-income (31.2%) Non-Hispanic (NH) Black adults, followed by low-income NH White (15.3%), low-income Hispanic (12.9%), high-income NH White (9.6%), and high-income Hispanic adults (8.8%). In adjusted models, NH Black adults, regardless of income (low-income prevalence ratio [PR]: 1.86, 95% CI: 1.36-2.54; high-income PR: 1.57, 95% CI: 1.07-2.31), and low-income NH White adults (PR: 1.52, 95% CI: 1.12-2.07), had higher prevalence of hospitalization compared to high-income NH White adults. We observed no significant difference in the prevalence of hospitalization among Hispanic adults relative to high-income NH White adults. CONCLUSIONS: We observed disparities in COVID-19 hospitalization at the intersection of race and ethnicity and income for NH Black adults and low-income NH White adults relative to high-income NH White adults, but not for Hispanic adults.

Patterns and predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan.

PURPOSE: The COVID-19 pandemic has had wide-ranging impacts on mental health, however, less is known about predictors of mental health outcomes among adults who have experienced a COVID-19 diagnosis. We examined the intersection of demographic, economic, and illness-related predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in the U.S. state of Michigan early in the pandemic. METHODS: Data were from a population-based survey of Michigan adults who experienced a COVID-19 diagnosis prior to August 1, 2020 (N = 1087). We used weighted prevalence estimates and multinomial logistic regression to examine associations between mental health outcomes (depressive symptoms, anxiety symptoms, and comorbid depressive/anxiety symptoms) and demographic characteristics, pandemic-associated changes in accessing basic needs (accessing food/clean water and paying important bills), self-reported COVID-19 symptom severity, and symptom duration. RESULTS: Relative risks for experiencing poor mental health outcomes varied by sex, age, race/ethnicity, and income. In adjusted models, experiencing a change in accessing basic needs associated with the pandemic was associated with higher relative risks for anxiety and comorbid anxiety/depressive symptoms. Worse COVID-19 symptom severity was associated with a higher burden of comorbid depressive/anxiety symptoms. "Long COVID" (symptom duration greater than 60 days) was associated with all outcomes. CONCLUSION: Adults diagnosed with COVID-19 may face overlapping risk factors for poor mental health outcomes, including pandemic-associated disruptions to household and economic wellbeing, as well as factors related to COVID-19 symptom severity and duration. An integrated approach to treating depressive/anxiety symptoms among COVID-19 survivors is warranted.

Lack of access to personal protective equipment is associated with severe COVID-19 symptoms among in-person workers.

The use of personal protective equipment (PPE) at work can greatly reduce risk of SARS-CoV-2 transmission. However, it is unclear whether adequate PPE reduces disease severity if transmission occurs. This study investigated associations between workplace access to adequate PPE and self-reported COVID-19 symptom severity among in-person workers. We used data from the Michigan COVID-19 Recovery Surveillance Study (MI CReSS), a population-based survey of Michigan adults with a PCR-confirmed positive SARS-CoV-2 test. The sample was restricted to employed, in-person respondents with COVID-19 onset on or before November 15, 2020 (n = 893). Access to adequate PPE at work was categorized as often/always, sometimes, or rarely/never. Self-reported symptom severity was dichotomized as severe (severe or very severe) or not severe (mild, moderate, or asymptomatic). We used modified Poisson regression to estimate prevalence ratios for the relationship between adequate PPE at work and severe COVID-19 symptoms. We examined effect modification of the relationship by occupation by including a multiplicative interaction term for healthcare worker versus other occupations. After adjusting for sociodemographic and clinical covariates, respondents who rarely/never had access to PPE at work had a 24.7 % higher prevalence of self-reported severe COVID-19 symptoms (PR: 1.25, 95 % CI 1.03-1.51, p-value = 0.024) compared to respondents who often/always had access to PPE at work. Healthcare worker status did not modify the association between access to PPE and symptom severity. The findings from this study suggest an added benefit of PPE in reducing prevalence of severe COVID-19 among all in-person workers.

COVID-19 in the workplace: Self-reported source of exposure and availability of personal protective equipment by industry and occupation in Michigan.

OBJECTIVES: Fragmented industry and occupation surveillance data throughout the COVID-19 pandemic has left public health practitioners and organizations with an insufficient understanding of high-risk worker groups and the role of work in SARS-CoV-2 transmission. METHODS: We drew sequential probability samples of noninstitutionalized adults (18+) in the Michigan Disease Surveillance System with COVID-19 onset before November 16, 2020 (N = 237,468). Among the 6000 selected, 1839 completed a survey between June 23, 2020, and April 23, 2021. We compared in-person work status, source of self-reported SARS-CoV-2 exposure, and availability of adequate personal protective equipment (PPE) by industry and occupation using weighted descriptive statistics and Rao-Scott χ2 tests. We identified industries with a disproportionate share of COVID-19 infections by comparing our sample with the total share of employment by industry in Michigan using 2020 data from the US Bureau of Labor Statistics. RESULTS: Employed respondents (n = 1244) were predominantly female (53.1%), aged 44 and under (54.4%), and non-Hispanic White (64.0%). 30.4% of all employed respondents reported work as the source of their SARS-CoV-2 exposure and 78.8% were in-person workers. Work-related exposure was prevalent in Nursing and Residential Care Facilities (65.2%); Justice, Public Order, and Safety Activities (63.3%); and Food Manufacturing (57.5%). By occupation, work-related exposure was highest among Protective Services (57.9%), Healthcare Support (56.5%), and Healthcare Practitioners (51.9%). Food Manufacturing; Nursing and Residential Care; and Justice, Public Order, and Safety Activities were most likely to report having adequate PPE "never" or "rarely" (36.4%, 27.9%, and 26.7%, respectively). CONCLUSIONS: Workplaces were a key source of self-reported SARS-CoV-2 exposure among employed Michigan residents during the first year of the pandemic. To prevent transmission, there is an urgent need in public health surveillance for the collection of industry and occupation data of people infected with COVID-19, as well as for future airborne infectious diseases for which we have little understanding of risk factors.

Population-Based Estimates of Post-acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection (PASC) Prevalence and Characteristics.

BACKGROUND: Emerging evidence suggests many people have persistent symptoms after acute coronavirus disease 2019 (COVID-19) illness. Our objective was to estimate the prevalence and correlates of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC). METHODS: We used a population-based probability survey of adults with COVID-19 in Michigan. Living noninstitutionalized adults aged ≥18 in the Michigan Disease Surveillance System with COVID-19 onset through mid-April 2020 were eligible for selection (N = 28 000). Among 2000 selected, 629 completed the survey between June-December 2020. We estimated PASC prevalence, defined as persistent symptoms ≥30 (30-day COVID-19) or ≥60 (60-day COVID-19) days post-COVID-19 onset, overall and by sociodemographic and clinical factors. We used modified Poisson regression to produce adjusted prevalence ratios (aPRs) for potential risk factors. RESULTS: The analytic sample (n = 593) was predominantly female (56.1%), aged ≥45 years (68.2%), and non-Hispanic White (46.3%) or Black (34.8%). Thirty- and 60-day COVID-19 were highly prevalent (52.5% and 35.0%), even among nonhospitalized respondents (43.7% and 26.9%) and respondents reporting mild symptoms (29.2% and 24.5%). Respondents reporting very severe (vs mild) symptoms had 2.25 times higher prevalence of 30-day COVID-19 (aPR, 2.25; 95% CI, 1.46-3.46) and 1.71 times higher prevalence of 60-day COVID-19 (aPR, 1.71; 95% CI: 1.02-2.88). Hospitalized (vs nonhospitalized) respondents had ~40% higher prevalence of both 30-day (aPR, 1.37; 95% CI: 1.12-1.69) and 60-day (aPR, 1.40; 95% CI: 1.02-1.93) COVID-19. CONCLUSIONS: PASC is highly prevalent among cases reporting severe initial symptoms and, to a lesser extent, cases reporting mild and moderate symptoms.