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.

Public Health Workforce Development During and Beyond the COVID-19 Pandemic: Findings From a Qualitative Training Needs Assessment.

CONTEXT: The Region V Public Health Training Center (RVPHTC) serves the public health workforce in Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. An important tool in priority-setting workforce development is the training needs assessment (TNA), which is vital to identifying and addressing the capacity-building needs of the public health workforce. PROGRAM: In 2021, we conducted semistructured qualitative interviews with key partners in the local, state, and tribal health workforce. IMPLEMENTATION: Findings reflect the results of 23 interviews administered from March to May 2021. Questions solicited in-depth input related to key training gaps identified in our 2020 quantitative TNA; the impact of COVID-19 on the public health workforce; general needs, including preferred training modalities; needs by audience type; and the current capacity for public health agencies to support student development. EVALUATION: Key training needs of the public health workforce identified by the 2021 TNA include the strategic skills domains of (1) resource management; (2) change management; (3) justice, equity, diversity, and inclusion; and (4) effective communication. The first 3 domains were also noted as having the greatest training need in our 2020 quantitative TNA of local health department leadership. DISCUSSION: The COVID-19 pandemic highlighted the need for training in effective communication in new ways and the continued need for training support in the skill domains prioritized in the 2020 assessment. Findings demonstrate the need for capacity building around crosscutting skills and the intersection of strategic skill domains if the field is to be prepared for future threats to public health.

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.