The Most Vulnerable Hispanic Immigrants in New York City: Structural Racism and Gendered Differences in COVID-19 Deaths.

This paper explores the structural and group-specific factors explaining the excess death rates experienced by the Hispanic population in New York City during the peak years of the coronavirus pandemic. Neighborhood-level analysis of Census data allows an exploration of the relation between Hispanic COVID-19 deaths and spatial concentration, conceived in this study as a proxy for structural racism. This analysis also provides a more detailed exploration of the role of gender in understanding the effects of spatial segregation among different Hispanic subgroups, as gender has emerged as a significant variable in explaining the structural and social effects of COVID-19. Our results show a positive correlation between COVID-19 death rates and the share of Hispanic neighborhood residents. However, for men, this correlation cannot be explained by the characteristics of the neighborhood, as it is for women. In sum, we find: (a) differences in mortality risks between Hispanic men and women; (b) that weathering effects increase mortality risks the longer Hispanic immigrant groups reside in the U.S.; (c) that Hispanic males experience greater contagion and mortality risks associated with the workplace; and (d) we find evidence corroborating the importance of access to health insurance and citizenship status in reducing mortality risks. The findings propose revisiting the Hispanic health paradox with the use of structural racism and gendered frameworks.

Creating a Dedicated Palliative Care Team for ICU Spanish Speaking Patients in Response to COVID-19.

CONTEXT: The Latinx population faced higher rates of infection and severe illness during the COVID-19 pandemic, resulting in an increased need for palliative care services. OBJECTIVES: We describe the creation and impact of a formal palliative care initiative developed for seriously ill, Spanish-speaking patients during the COVID-19 pandemic at a tertiary care academic medical center. METHODS: Patients were enrolled in the Spanish Palliative Care Initiative during a two-month period starting in April 2020. Selected patients were longitudinally followed by a rotating team of Spanish-speaking palliative care clinicians. Following the intervention, a retrospective chart review was conducted to evaluate the impact of the program. RESULTS: We enrolled 22 patients. The most frequent palliative care task completed during the initial visit was information giving (77%) and during follow-up visits were goals of care discussion (59%) and coping support (59%). Fifteen patients (68%) had a change in code status and 4 patients (18%) were discharged to hospice. CONCLUSION: The creation of a focused clinical program targeting a historically marginalized population offered opportunity for early palliative care intervention in clinical care for Spanish-speaking patients. This underscores the need for Spanish-language concordant palliative care to improve serious illness care, and end-of-life care, by providing continuity of care, spiritual care, and ICU team support.

ICU Admission Risk Factors for Latinx COVID-19 Patients at a U.S.-Mexico Border Hospital.

OBJECTIVE: Few studies have examined the impact of coronavirus disease 2019 (COVID-19) on the primarily Latinx community along the U.S.-Mexico border. This study explores the socioeconomic impacts which contribute to strong predictors of severe COVID-19 complications such as intensive care unit (ICU) hospitalization in a primarily Latinx/Hispanic U.S.-Mexico border hospital. METHODS: A retrospective, observational study of 156 patients (≥ 18 years) Latinx/Hispanic patients who were admitted for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at a U.S.-Mexico border hospital from April 10, 2020, to May 30, 2020. Descriptive statistics of sex, age, body mass index (BMI), and comorbidities (coronary artery disease, hypertension, diabetes, cancer/lymphoma, current use of immunosuppressive drug therapy, chronic kidney disease/dialysis, or chronic respiratory disease). Multivariate regression models were produced from the most significant variables and factors for ICU admission. RESULTS: Of the 156 hospitalized Latinx patients, 63.5% were male, 84.6% had respiratory failure, and 45% were admitted to the ICU. The average age was 67.2 (± 12.2). Those with body mass index (BMI) ≥ 25 had a higher frequency of ICU admission. Males had a 4.4 (95% CI 1.58, 12.308) odds of ICU admission (p = 0.0047). Those who developed acute kidney injury (AKI) and BMI 25-29.9 were strong predictors of ICU admission (p < 0.001 and p = 0.0020, respectively). Those with at least one reported comorbidity had 1.98 increased odds (95% CI 1.313, 2.99) of an ICU admission. CONCLUSION: Findings show that age, AKI, and male sex were the strongest predictors of COVID-19 ICU admissions in the primarily Latinx population at the U.S.-Mexico border. These predictors are also likely driven by socioeconomic inequalities which are most apparent in border hospitals.

Factors Contributing to SARS-CoV-2 Vaccine Hesitancy of Hispanic Population in Rio Grande Valley.

Hispanic communities have been disproportionately affected by economic disparities. These inequalities have put Hispanics at an increased risk for preventable health conditions. In addition, the CDC reports Hispanics to have 1.5× COVID-19 infection rates and low vaccination rates. This study aims to identify the driving factors for COVID-19 vaccine hesitancy of Hispanic survey participants in the Rio Grande Valley. Our analysis used machine learning methods to identify significant associations between medical, economic, and social factors impacting the uptake and willingness to receive the COVID-19 vaccine. A combination of three classification methods (i.e., logistic regression, decision trees, and support vector machines) was used to classify observations based on the value of the targeted responses received and extract a robust subset of factors. Our analysis revealed different medical, economic, and social associations that correlate to other target population groups (i.e., males and females). According to the analysis performed on males, the Matthews correlation coefficient (MCC) value was 0.972. An MCC score of 0.805 was achieved by analyzing females, while the analysis of males and females achieved 0.797. Specifically, several medical, economic factors, and sociodemographic characteristics are more prevalent in vaccine-hesitant groups, such as asthma, hypertension, mental health problems, financial strain due to COVID-19, gender, lack of health insurance plans, and limited test availability.