County-Level COVID-19 Vaccination Rates, Non-Communicable Diseases, and Socioeconomic Inequities: Applying Syndemic Theory to Vaccines.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected certain high-risk populations, including those with underlying chronic illnesses and those who are socioeconomically disadvantaged. METHODS: Our study evaluated county-level rates of fully vaccinated populations after classifying counties based on rates of non-communicable diseases (NCDs) and socioeconomic inequities below the 25th percentile of overall distribution of counties for each measure as low, counties above the 75th percentile as high, and all other counties as medium. RESULTS: Counties with higher rates of non-communicable diseases and socioeconomic disparities had lower COVID-19 vaccination coverage than did counties with lower rates of non-communicable diseases and socioeconomic disparities. Co-occurrence of high NCD and high socioeconomic vulnerability among counties in the lower half of vaccination coverage was also found for some counties. CONCLUSION: These findings demonstrate the co-occurrence of low rates of vaccine coverage, high rates of NCDs, and high rates of socioeconomic disparities as a syndemic.

COVID-19 pandemic and telemental health policy reforms.

Many patients with mental disorders lack access to care mainly due to provider shortages. Coronavirus disease 2019 (COVID-19) pandemic significantly raised the prevalence of anxiety, depression, substance use disorder and suicidal thoughts among people. Mandated social distancing, and higher incidence of mental disorders increased the demand for Telemental Health (TMH). TMH expands access to care and can be an effective alternative to the costly conventional mental health care. However, there are barriers to the adoption of TMH such as reimbursement challenges, and licensure restrictions. During the COVID-19 pandemic, some policies and regulations changed to address the increase in TMH demand. The federal government increased funding for the new telehealth initiatives and more states legalized the interstate practice for psychologists. Medicare waived telehealth co-payments, reimbursed audio-only visits, and required payment parities between virtual and in-person visits. Nevertheless, Medicare maintained in-person visit prerequisite within the six months prior to the first time only for mental health treatments which can act as a hindrance. Additionally, four more states required telehealth coverage, 33 states required Medicaid plans, and 21 states required private insurers to cover TMH services. Ten states mandated payment parity for private insurers, and four states eliminated cost-sharing for telehealth services. Currently, 21 states are implementing payment parity on a permanent basis. During the pandemic, 78% of Mental health providers integrated TMH services into their practice. Despite the decline in use of telehealth for other health conditions after the pandemic peak, TMH use has remained strong representing 36% of outpatient visits. TMH is beneficial to patients in terms of cost and time saving; thus, the beneficiary regulatory changes should be sustained. Further well-designed studies are needed on the cost-effectiveness of telehealth interventions, and policymakers need to collect more data to decide whether and how to keep these changes permanently for TMH.