Socioeconomic predictors of COVID-19-related health disparities among United States workers: A structural equation modeling study

The COVID-19 pandemic has disproportionately impacted the physical and mental health, and the economic stability, of specific population subgroups in different ways, deepening existing disparities. Essential workers have faced the greatest risk of exposure to COVID-19;women have been burdened by caretaking responsibilities;and rural residents have experienced healthcare access barriers. Each of these factors did not occur on their own. While most research has so far focused on individual factors related to COVID-19 disparities, few have explored the complex relationships between the multiple components of COVID-19 vulnerabilities. Using structural equation modeling on a sample of United States (U.S.) workers (N = 2800), we aimed to 1) identify factor clusters that make up specific COVID-19 vulnerabilities, and 2) explore how these vulnerabilities affected specific subgroups, specifically essential workers, women and rural residents. We identified 3 COVID-19 vulnerabilities: financial, mental health, and healthcare access;9 out of 10 respondents experienced one;15% reported all three. Essential workers [standardized coefficient (β) = 0.23;unstandardized coefficient (B) = 0.21, 95% CI = 0.17, 0.24] and rural residents (β = 0.13;B = 0.12, 95% CI = 0.09, 0.16) experienced more financial vulnerability than non-essential workers and non-rural residents, respectively. Women (β = 0.22;B = 0.65, 95% CI = 0.65, 0.74) experienced worse mental health than men;whereas essential workers reported better mental health (β = -0.08;B = -0.25, 95% CI = -0.38, -0.13) than other workers. Rural residents (β = 0.09;B = 0.15, 95% CI = 0.07, 0.24) experienced more healthcare access barriers than non-rural residents. Findings highlight how interrelated financial, mental health, and healthcare access vulnerabilities contribute to the disproportionate COVID-19-related burden among U.S. workers. Policies to secure employment conditions, including fixed income and paid sick leave, are urgently needed to mitigate pandemic-associated disparities.

Two Case Reports of Chronic Inflammatory Demyelinating Polyneuropathy After COVID-19 Vaccination.

The occurrence of chronic inflammatory demyelinating polyneuropathy (CIDP) related to coronavirus disease 2019 (COVID-19) has rarely been reported. We describe two patients who were diagnosed with CIDP after COVID-19 vaccination. A 72-year-old man presented with a progressive tingling sensation and weakness below both knees for two weeks. He had been vaccinated against COVID-19 (mRNA-1273 vaccine) a month before the appearance of symptoms. Demyelinating polyneuropathy was observed in the nerve conduction studies (NCS). Intravenous immunoglobulin (IVIg) was administered under the diagnosis of Guillain-Barré syndrome (GBS), and his symptoms were improved. However, his symptoms relapsed at 10 weeks from the onset. Oral prednisolone, azathioprine, and IVIg were administered as treatment. The second case was a 50-year-old man who complained of a bilateral leg tingling sensation and gait disturbance lasting four weeks. He had received the Ad26.COV2.S vaccine against COVID-19 five weeks prior. Demyelinating polyneuropathy was observed in the NCS. He was treated with oral prednisolone, azathioprine, and IVIg for CIDP because his symptoms had lasted for more than 12 weeks from the onset. A causal relationship has not been established between COVID-19 vaccination and CIDP; however, CIDP may follow COVID-19 vaccination. As CIDP treatment is different from that for GBS, clinicians should closely monitor patients diagnosed with GBS associated with COVID-19 whether they deteriorate after initial treatment.

Factors affecting the intention of COVID-19 vaccination in Korean patients with myasthenia gravis: A survey-based study.

Objective: To investigate the intention of coronavirus disease 2019 (COVID-19) vaccination in Korean patients with myasthenia gravis (MG) and to determine the factors that influence their attitude toward COVID-19 vaccination. Materials and methods: We conducted a questionnaire survey of 160 Korean patients with MG. The questionnaire consisted of five categories, including vaccination status, willingness to get vaccinated, general concerns over vaccination, impact of MG diagnosis on vaccination decision, and MG-specific concerns over vaccination. The responses were rated from 1 (no intention or influence) to 5 (significant intention or influence). We compared the clinical factors between patients willing to get vaccinated (willing group) and those who were neutral or unwilling (hesitant group). Results: The average score of willingness to get vaccinated was 4.1 ± 1.2 (Likert score, 1-5). The hesitant group demonstrated higher proportions of women, patients with MG Foundation of America (MGFA) classification ≥III at nadir, and those who had experienced myasthenic crisis than the willing group (women, p = 0.027; MGFA classification≥III, p = 0.018; myasthenic crisis, p = 0.027). Scores for the willingness to get vaccinated (Likert score, 1-5) were negatively correlated with the MGFA classification at nadir (r = -0.235, p = 0.003), degree of general concern about vaccination (r = -0.362, p < 0.001), and impact of MG diagnosis on vaccination decision (r = -0.365, p < 0.001). In the path analysis, the MGFA classification at nadir was negatively associated with the willingness to get vaccinated by increasing the impact of MG diagnosis on vaccination decision. Conclusion: MG diagnosis, maximum disease severity, and general concerns about vaccination influenced the intention to get vaccinated.

What predicts people's belief in COVID-19 misinformation? A retrospective study using a nationwide online survey among adults residing in the United States.

BACKGROUND: Tackling infodemics with flooding misinformation is key to managing the COVID-19 pandemic. Yet only a few studies have attempted to understand the characteristics of the people who believe in misinformation. METHODS: Data was used from an online survey that was administered in April 2020 to 6518 English-speaking adult participants in the United States. We created binary variables to represent four misinformation categories related to COVID-19: general COVID-19-related, vaccine/anti-vaccine, COVID-19 as an act of bioterrorism, and mode of transmission. Using binary logistic regression and the LASSO regularization, we then identified the important predictors of belief in each type of misinformation. Nested vector bootstrapping approach was used to estimate the standard error of the LASSO coefficients. RESULTS: About 30% of our sample reported believing in at least one type of COVID-19-related misinformation. Belief in one type of misinformation was not strongly associated with belief in other types. We also identified 58 demographic and socioeconomic factors that predicted people's susceptibility to at least one type of COVID-19 misinformation. Different groups, characterized by distinct sets of predictors, were susceptible to different types of misinformation. There were 25 predictors for general COVID-19 misinformation, 42 for COVID-19 vaccine, 36 for COVID-19 as an act of bioterrorism, and 27 for mode of COVID-transmission. CONCLUSION: Our findings confirm the existence of groups with unique characteristics that believe in different types of COVID-19 misinformation. Findings are readily applicable by policymakers to inform careful targeting of misinformation mitigation strategies.

Factors affecting the intention of COVID-19 vaccination in Korean patients with myasthenia gravis: A survey-based study

Objective To investigate the intention of coronavirus disease 2019 (COVID-19) vaccination in Korean patients with myasthenia gravis (MG) and to determine the factors that influence their attitude toward COVID-19 vaccination. Materials and methods We conducted a questionnaire survey of 160 Korean patients with MG. The questionnaire consisted of five categories, including vaccination status, willingness to get vaccinated, general concerns over vaccination, impact of MG diagnosis on vaccination decision, and MG-specific concerns over vaccination. The responses were rated from 1 (no intention or influence) to 5 (significant intention or influence). We compared the clinical factors between patients willing to get vaccinated (willing group) and those who were neutral or unwilling (hesitant group). Results The average score of willingness to get vaccinated was 4.1 ± 1.2 (Likert score, 1–5). The hesitant group demonstrated higher proportions of women, patients with MG Foundation of America (MGFA) classification ≥III at nadir, and those who had experienced myasthenic crisis than the willing group (women, p = 0.027;MGFA classification≥III, p = 0.018;myasthenic crisis, p = 0.027). Scores for the willingness to get vaccinated (Likert score, 1–5) were negatively correlated with the MGFA classification at nadir (r = −0.235, p = 0.003), degree of general concern about vaccination (r = −0.362, p < 0.001), and impact of MG diagnosis on vaccination decision (r = −0.365, p < 0.001). In the path analysis, the MGFA classification at nadir was negatively associated with the willingness to get vaccinated by increasing the impact of MG diagnosis on vaccination decision. Conclusion MG diagnosis, maximum disease severity, and general concerns about vaccination influenced the intention to get vaccinated.

Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries.

BACKGROUND: Several studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC's peacetime impact, limiting our understanding of UHC's potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries' progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage. METHODS AND FINDINGS: Using a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a "high UHC index" group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries' income group per the World Bank classification, countries' geographical region as defined by WHO, and countries' preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI <50 (n = 60). The study's primary limitation was scarce data availability, which restricted our ability to account for confounders and to test our hypothesis for other relevant outcomes. CONCLUSIONS: We observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.

Employment conditions as barriers to the adoption of COVID-19 mitigation measures: how the COVID-19 pandemic may be deepening health disparities among low-income earners and essential workers in the United States.

BACKGROUND: The COVID-19 pandemic has disproportionately impacted economically-disadvantaged populations in the United States (US). Precarious employment conditions may contribute to these disparities by impeding workers in such conditions from adopting COVID-19 mitigation measures to reduce infection risk. This study investigated the relationship between employment and economic conditions and the adoption of COVID-19 protective behaviors among US workers during the initial phase of the COVID-19 pandemic. METHODS: Employing a social media advertisement campaign, an online, self-administered survey was used to collect data from 2,845 working adults in April 2020. Hierarchical generalized linear models were performed to assess the differences in engagement with recommended protective behaviors based on employment and economic conditions, while controlling for knowledge and perceived threat of COVID-19, as would be predicted by the Health Belief Model (HBM). RESULTS: Essential workers had more precarious employment and economic conditions than non-essential workers: 67% had variable income; 30% did not have paid sick leave; 42% had lost income due to COVID-19, and 15% were food insecure. The adoption of protective behaviors was high in the sample: 77% of participants avoided leaving home, and 93% increased hand hygiene. Consistent with the HBM, COVID-19 knowledge scores and perceived threat were positively associated with engaging in all protective behaviors. However, after controlling for these, essential workers were 60% and 70% less likely than non-essential workers, who by the nature of their jobs cannot stay at home, to stay at home and increase hand hygiene, respectively. Similarly, participants who could not afford to quarantine were 50% less likely to avoid leaving home (AOR: 0.5; 95% CI: 0.4, 0.6) than those who could, whereas there were no significant differences concerning hand hygiene. CONCLUSIONS: Our findings are consistent with the accumulating evidence that the employment conditions of essential workers and other low-income earners are precarious, that they have experienced disproportionately higher rates of income loss during the initial phase of the COVID-19 pandemic and face significant barriers to adopting protective measures. Our findings underscore the importance and need of policy responses focusing on expanding social protection and benefits to prevent the further deepening of existing health disparities in the US.

Socioeconomic predictors of COVID-19-related health disparities among United States workers: A structural equation modeling study.

The COVID-19 pandemic has disproportionately impacted the physical and mental health, and the economic stability, of specific population subgroups in different ways, deepening existing disparities. Essential workers have faced the greatest risk of exposure to COVID-19; women have been burdened by caretaking responsibilities; and rural residents have experienced healthcare access barriers. Each of these factors did not occur on their own. While most research has so far focused on individual factors related to COVID-19 disparities, few have explored the complex relationships between the multiple components of COVID-19 vulnerabilities. Using structural equation modeling on a sample of United States (U.S.) workers (N = 2800), we aimed to 1) identify factor clusters that make up specific COVID-19 vulnerabilities, and 2) explore how these vulnerabilities affected specific subgroups, specifically essential workers, women and rural residents. We identified 3 COVID-19 vulnerabilities: financial, mental health, and healthcare access; 9 out of 10 respondents experienced one; 15% reported all three. Essential workers [standardized coefficient (ß) = 0.23; unstandardized coefficient (B) = 0.21, 95% CI = 0.17, 0.24] and rural residents (ß = 0.13; B = 0.12, 95% CI = 0.09, 0.16) experienced more financial vulnerability than non-essential workers and non-rural residents, respectively. Women (ß = 0.22; B = 0.65, 95% CI = 0.65, 0.74) experienced worse mental health than men; whereas essential workers reported better mental health (ß = -0.08; B = -0.25, 95% CI = -0.38, -0.13) than other workers. Rural residents (ß = 0.09; B = 0.15, 95% CI = 0.07, 0.24) experienced more healthcare access barriers than non-rural residents. Findings highlight how interrelated financial, mental health, and healthcare access vulnerabilities contribute to the disproportionate COVID-19-related burden among U.S. workers. Policies to secure employment conditions, including fixed income and paid sick leave, are urgently needed to mitigate pandemic-associated disparities.

Comparison of ACCEL ELISA COVID-19 with Elecsys Anti-SARS-CoV-2 for Screening of COVID-19.

OBJECTIVE: Although real-time reverse transcription-PCR (RT-PCR) is the gold standard for diagnosing coronavirus disease 2019 (COVID-19), simpler and faster antibody detection tests can be complementary for diagnosis of COVID-19. To manage the COVID-19 pandemic, the need for serologic testing has increased. In this report, the newly developed antibody detection assays ACCEL ELISA COVID-19 (ACCEL) and Elecsys anti-SARS-CoV-2 (Elecsys) were evaluated. METHODS: Serum samples submitted for routine laboratory testing were analyzed (66 and 161 PCR-positive and PCR-negative samples). After the samples were aliquoted, antibody detection tests were performed using ACCEL and Elecsys assays. RESULTS: When detection of viral RNA using RT-PCR was set as the reference method for diagnosis of COVID-19, the sensitivity was 83.3% and 75.8, and the specificity was 96.9 and 99.4% in ACCEL and Elecsys, respectively. The true positivity rates of ACCEL and Elecsys assays were 57.1%/42.9%, 57.1%/28.6%, 77.8%/66.7%, and 97.1%/97.1% among the specimens collected ≤3, 4-7, 8-14, and >14 days after symptom onset, respectively. CONCLUSIONS: The ACCEL assay showed high sensitivity in samples collected within 7 days after symptom onset. Because many patients are asymptomatic in the early stage of SARS-CoV-2 infection, the ACCEL assay could be a good screening tool due to high sensitivity in the early stage of SARS-CoV-2 infection.

What predicts people’s adherence to COVID-19 misinformation? A retrospective study using a nationwide online survey among adults residing in the United States (preprint)

Background: Tackling infodemics with flooding misinformation is key to managing the COVID-19 pandemic. Yet only a few studies have attempted to understand the characteristics of the people who believe in and adhere to misinformation. Methods: : Data was used from an online survey that was administered in April 2020 to 6,518 English-speaking adult participants in the United States. We created binary variables to represent four misinformation categories related to COVID-19: general COVID-19-related, vaccine/anti-vaccine, COVID-19 as an act of bioterrorism, and mode of transmission. Using binary logistic regression and the LASSO regularization, we then identified the important predictors of adherence to each type of misinformation. Nested vector bootstrapping approach was used to estimate the standard error of the LASSO coefficients. Results: : About 30% of our sample reported adhering to at least one type of COVID-19-related misinformation. Adherence to one type of misinformation was not strongly associated with adherence to other types. We also identified 58 demographic and socioeconomic factors that predicted people’s susceptibility to at least one type of COVID-19 misinformation. Different groups, characterized by distinct sets of predictors, were susceptible to different types of misinformation. There were 25 predictors for general COVID-19 misinformation, 42 for COVID-19 vaccine, 36 for COVID-19 as an act of bioterrorism, and 27 for mode of COVID-transmission. Conclusion: Our findings confirm the existence of groups with unique characteristics that adheres to different types of COVID-19 misinformation. Findings are readily applicable by policymakers to inform careful targeting of misinformation mitigation strategies.

Depression before and during-COVID-19 by Gender in the Korean Population.

This study explored the association between Coronavirus disease (COVID-19) and depression by comparing Patient Health Questionnaire-9 (PHQ-9) results pre-pandemic (2019) and after the start of the pandemic (2020). Data of 444,051 participants (200,206 male (45.1%); 243,845 female (54.9%)) were obtained from the Korean Community Health Survey conducted from 2019 to 2020. The independent variable of interest in this study was the year, divided into binary categories, 2019 and 2020. The dependent variable was depression, measured by the PHQ-9 scale. This dependent variable was also binary, dividing those who are considered depressed or not by a cut-off score of 10. A logistic regression model was employed to examine the association. Our results reveal that compared to participants in 2019, patients from the study sample of 2020 were marginally more likely to be depressed, especially female patients (male OR: 1.092, 95% CI [0.998 to 1.195], female OR: 1.066, 95% CI [1.002 to 1.134]). Moreover, using the participants from the year 2019 as a reference group, those who appeared anxious in response to the COVID-19-related questions in the survey showed more tendency to have a PHQ-9 score of 10 or more. Compared to participants from the 2019 group, those from 2020 more likely to be depressed were those with no-one to contact in case of emergency due to COVID-19 (male OR: 1.45, 95% CI [1.26 to 1.66], female OR: 1.46, 95% CI [1.33 to 1.60]), and individuals with concerns regarding economic loss (male OR: 1.18, 95% CI [1.07 to 1.30], female OR: 1.11, 95% CI [1.04 to 1.18]) and infection of a vulnerable family member at home due to COVID-19 (male OR: 1.16, 95% CI [1.05 to 1.28], female OR: 1.09, 95% CI [ 1.02 to 1.16]).

Impact of COVID-19-related knowledge on protective behaviors: The moderating role of primary sources of information.

This study assessed the modifying role of primary source of COVID-19 information in the association between knowledge and protective behaviors related to COVID-19 among adults living in the United States (US). Data was collected from 6,518 US adults through an online cross-sectional self-administered survey via social media platforms in April 2020. Linear regression was performed on COVID-19 knowledge and behavior scores, adjusted for sociodemographic factors. An interaction term between knowledge score and primary information source was included to observe effect modification by primary information source. Higher levels of knowledge were associated with increased self-reported engagement with protective behaviors against COVID-19. The primary information source significantly moderated the association between knowledge and behavior, and analyses of simple slopes revealed significant differences by primary information source. This study shows the important role of COVID-19 information sources in affecting people's engagement in recommended protective behaviors. Governments and health agencies should monitor the use of various information sources to effectively engage the public and translate knowledge into behavior change during an evolving public health crisis like COVID-19.