Racial-ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: the role of experienced discrimination and perceived racial bias.

BACKGROUND: Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis. METHODS: Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one's racial-ethnic group. Weighted linear regressions and mediation analyses were performed. RESULTS: Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics' poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias. CONCLUSIONS: Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.

Assessing Unique Risk Factors for COVID-19 Complications Among Cancer Patients: A Multi-ethnic Cohort Study.

A myriad of organ-specific complications have been observed with COVID-19. While racial/ethnic minorities have been disproportionately burdened by this disease, our understanding of the unique risk factors for complications among a diverse population of cancer patients remains limited. This is a multi-institutional, multi-ethnic cohort study evaluating COVID-19 complications among cancer patients. Patients with an invasive cancer diagnosis and confirmed SARS-CoV-2 infection were identified from March to November 2020. Demographic and clinical data were obtained and a multivariate logistic regression was employed to evaluate the impact of demographic and clinical factors on COVID-19 complications. The study endpoints were evaluated independently and included any complication, sepsis, pulmonary complications and cardiac complications. A total of 303 patients were evaluated, of whom 48% were male, 79% had solid tumors, and 42% were Hispanic/Latinx (Hispanic). Malignant hematologic cancers were associated with a higher risk of sepsis (OR 3.93 (95% CI 1.58-9.81)). Male patients had a higher risk of sepsis (OR 4.42 (95% CI 1.63-11.96)) and cardiac complications (OR 2.02 (95% CI 1.05-3.89)). Hispanic patients had a higher odds of any complication (OR 2.31 (95% CI 1.18-4.51)) and other race was associated with a higher odds of cardiac complications (OR 2.41 (95% CI 1.01-5.73)). Clinically, fever, cough, and ≥2 co-morbidities were independently significantly associated with any complication. This analysis evaluated covariates that can significantly predict a myriad of complications among a multi-ethnic cohort of cancer patients. The conclusions drawn from this analysis elucidate a mechanistic understanding of differential illness severity from COVID-19.

Burnout and Moral Injury Among Black Psychiatrists and Other Black Mental Health Professionals.

This column discusses burnout and moral injury among Black psychiatrists and other Black mental health professionals and highlights the contribution of racism to these outcomes. In the United States, the COVID-19 pandemic and racial turmoil have revealed stark inequities in health care and social justice, and demand for mental health services has increased. To meet the mental health needs of communities, racism must be recognized as a factor in burnout and moral injury. The authors offer preventive strategies to support the mental health, well-being, and longevity of Black mental health professionals.

Changes in familial discussions among East Asian American families during the COVID-19 pandemic

Objective: We examined the degrees of change in familial discussions about racial issues (i.e., race, ethnicity, racism, and discrimination) due to the surge of anti-Asian discrimination during the COVID-19 pandemic.Background: Asian American family racial-ethnic socialization that teaches the values, information, and perspectives about racial-ethnic group membership and race relations carry great implications for youth development. However, little is known about how anti-Asian sentiments may have contributed to the degrees of change in racial issues.Method: The participants included 143 second-generation East Asian American youth (e.g., Chinese, Korean, Japanese, and Taiwanese) ages 11-18 years (M = 14.96, SD = 1.98). Youth were attending middle (38%) or high (62%) schools in the United States.Results: Latent profile analysis identified four profiles of degrees of change in familial discussions: (a) moderate change in racial discussions about other ethnicities, (b) much change in racial discussions, (c) moderate change in racial discussions about own ethnicities, and (d) little change in racial discussions.Conclusion: Our findings provide a snapshot of the ways East Asian American families' racial discussions are changing, which in turn shape youth's experiences in navigating their social contexts.Implications: The findings provide valuable directions for research and interventions to promote important racial discussion among East Asian American families.

Racial and ethnic differences in pharmacotherapy to prevent coronary artery disease and thrombotic events.

Awareness of racial/ethnic disparities represents a key challenge for healthcare systems that attempt to provide effective healthcare and to reduce existing inequalities in the use of and adherence to guideline-recommended cardiovascular drugs to improve clinical outcomes for cardiovascular disease (CVD). In this review, we describe important racial/ethnic differences between and within ethnic groups in the prevalence, risk factors, haemostatic factors, anti-inflammatory and endothelial markers, recurrence, and outcomes of CVD. We discuss important differences in the selection, doses, and response [efficacy and adverse drug reactions (ADRs)] in ethnically diverse patients treated with antithrombotics or lipid-lowering drugs. Differences in drug response are mainly related to racial/ethnic differences in the frequency of polymorphisms in genes encoding drug-metabolizing enzymes (DMEs) and drug transporters. These polymorphisms markedly influence the pharmacokinetics, dose requirements, and safety of warfarin, clopidogrel, and statins. This review aims to support a better understanding of the genetic differences between and among populations to identify patients who may experience an ADR or a lack of drug response, thus optimizing therapy and improving outcomes. The greater the understanding of the differences in the genetic variants of DMEs and transporters that determine the differences in the exposure, efficacy, and safety of cardiovascular drugs between races/ethnicities, the greater the probability that personalized medicine will become a reality.

Suffering, the Safety Net, and Disparities During COVID-19

The economic and public health crisis caused by COVID-19 was devastating and disproportionately hurt Blacks and Hispanics and some other groups. Unemployment rates and other measures of material hardship were higher and increased more during the crisis among Blacks and Hispanics than among non-Hispanic Whites. Congress authorized a historic policy response, incorporating both targeted and universal supports, and expanding both the level and duration of benefits. This response yielded the remarkable result of an estimated decline in the Supplemental Poverty Measure between 2019 and 2020. We study administrative data to investigate the impact of the Supplemental Nutrition Assistance Program (SNAP) during the crisis. We find that participation in SNAP increased more in counties that experienced a larger employment shock. By contrast, the increase in total SNAP benefits was inversely related to the employment shock. The SNAP benefit increases were less generous to Black and Hispanic SNAP participants than to White.

COVID-19 stressors for Hispanic/Latino patients living with type 2 diabetes: a qualitative study.

Background and aim: During the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions. Methods and participants: Participants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes. We conducted a thematic analysis using patient notes collected from two research nurses between March 2020 and March 2021. Two authors read through the transcripts independently to identify overarching themes. Once the themes had been identified, both authors convened to compare themes and ensure that similar themes were identified within the transcripts. Any discrepancies were discussed by the larger study team until a consensus was reached. Results: Six themes emerged, each of which can be categorized as either a source or an outcome of stress. Sources of stress associated with the COVID-19 pandemic were (1) fear of contracting COVID-19, (2) disruptions from lockdowns, and (3) financial stressors (e.g., loss of income). Outcomes of COVID-19 stressors were (1) reduced diabetes management (e.g., reduced diabetes monitoring and physical activity), (2) suboptimal mental health outcomes (e.g., anxiety and depression), and (3) outcomes of financial stressors. Conclusion: The findings indicated that underserved Hispanic/Latino patients with type 2 diabetes encountered a number of stressors that led to the deterioration of diabetes self-management behaviors during the pandemic.

The Impact of Language on Hospital Outcomes for COVID-19 Patients: A Study of Non-English Speaking Hispanic Patients.

BACKGROUND: The COVID-19 pandemic has highlighted and exacerbated health inequities, as demonstrated by the disproportionate rates of infection, hospitalization, and death in marginalized racial and ethnic communities. Although non-English speaking (NES) patients have substantially higher rates of COVID-19 positivity than other groups, research has not yet examined primary language, as determined by the use of interpreter services, and hospital outcomes for patients with COVID-19. METHODS: Data were collected from 1,770 patients with COVID-19 admitted to an urban academic health medical center in the Chicago, Illinois area from March 2020 to April 2021. Patients were categorized as non-Hispanic White, non-Hispanic Black, NES Hispanic, and English-speaking (ES) Hispanic using NES as a proxy for English language proficiency. Multivariable logistic regression was used to compare the predicted probability for each outcome (i.e., ICU admission, intubation, and in-hospital death) by race/ethnicity. RESULTS: After adjusting for possible confounders, NES Hispanic patients had the highest predicted probability of ICU admission (p-value < 0.05). Regarding intubation and in-hospital death, NES Hispanic patients had the highest probability, although statistical significance was inconclusive, compared to White, Black, and ES Hispanic patients. CONCLUSIONS: Race and ethnicity, socioeconomic status, and language have demonstrated disparities in health outcomes. This study provides evidence for heterogeneity within the Hispanic population based on language proficiency that may potentially further contribute to disparities in COVID-19-related health outcomes within marginalized communities.

Correlates of and Disparities in Cancellations or Delays of Prenatal Visits During the Covid-19 Pandemic: Emphasis on Racial/Ethnic Minorities and Persons with Low Socioeconomic Status.

OBJECTIVES: To investigate barriers and disparities in prenatal visits across population subgroups. METHODS: This pooled cross-sectional study was conducted using Pregnancy Risk Assessment Monitoring System for 2020 through 2021. Women who reported their experiences of cancellation or delay in prenatal visits were included. A multivariable regression analysis estimated adjusted prevalence ratios (aPR) for cancellations or delays in prenatal care. RESULTS: Of a total of 11,427, one-third had cancelled or delayed care. Hispanics, compared to their white counterparts, were 22% likelier to have cancelled or delayed care. Women covered by Medicaid and those with depression had 17% and 34% greater likelihoods of cancellation or delay, respectively. Cancellations or delays were comparable for the years 2020 and 2021 across reasons, except for facility closures, which were more common in 2020 than in 2021. Hispanics tended to cancel or delay prenatal visits more often than whites for reasons, such as facility closures, COVID-19-related reasons, a lack of transportation, and loss of insurance, while transportation and insurance issues were greater barriers for blacks. Women with less than a high school diploma were more likely to report cancellations or delays due to transportation issues (aPR 2.86, 95%CI 1.47-5.57; p = 0.002) and loss of insurance (aPR 4.82, 95%CI 1.64-14.23; P = 0.004). CONCLUSIONS: While a large proportion of women experienced disruptions in prenatal care, subsets of the population, including racial/ethnic minorities and the low socioeconomically disadvantaged, faced disproportionate challenges. The current findings provide practical implications for a tailored approach to reducing barriers and disparities in prenatal care.

Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity. DATA SOURCES: Administrative data from the Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN: We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. DATA COLLECTION: We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analyses if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and stratified by race-ethnicity. PRINCIPAL FINDINGS: Overall, Veterans' mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%-24%), while Native American Veterans had the highest increase (40%, 95% CI 17%-73%). Black Veterans (32%, 95% CI 27%-39%) and Hispanic Veterans (26%, 95% CI 17%-36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. CONCLUSIONS: Minoritized Veterans experienced higher rates excess of mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities.

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States.

OBJECTIVE: Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample. METHODS: Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents. RESULTS: About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use. CONCLUSION: Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

The social development of immigrant children: A focus on Asian and Latinx children in the United States

The number of international migrants has continued to grow globally between 2000 and 2020, with the United States having the largest number of immigrants. Two in three children are projected to be of a race other than White by 2060, suggesting that the United States will be more racially and ethnically diverse. Asians and Latinx are the largest and the fastest-growing United States racial-ethnic immigrant groups. This chapter defines Asian and Latinx immigrant children in the United States and discusses the family structure and cultural values of these two groups as may be pertinent to these children's social and emotional development, and highlights some unique challenges for their social development. It provides an overview of the extant literature on several key areas of socioemotional and behavioral development and their contributors among Asian and Latinx immigrant families with young children. It also considers specific social development challenges faced by Asian and Latinx immigrant during the Covid-19 pandemic as a way to highlight the major gaps in the current literature. The chapter ends with some directions for future studies towards understanding and supporting the diverse experiences and social development of Asian and Latinx immigrant children in the United States. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities.

PURPOSE: Although telehealth access and utilization have increased during the pandemic, rural and low-income disparities persist. We sought to assess whether access or willingness to use telehealth differed between rural and non-rural and low-income and non-low-income adults and measure the prevalence of perceived barriers. METHODS: We conducted a cross-sectional study using COVID-19's Unequal Racial Burden (CURB) online survey (December 17, 2020-February 17, 2021), which included 2 nationally representative cohorts of rural and low-income Black/African American, Latino, and White adults. Non-rural and non-low-income participants from the main, nationally representative sample were matched for rural versus non-rural and low-income versus non-low-income comparisons. We measured perceived telehealth access, willingness to use telehealth, and perceived telehealth barriers. FINDINGS: Rural (38.6% vs 44.9%) and low-income adults (42.0% vs 47.4%) were less likely to report telehealth access, compared to non-rural and non-low-income counterparts. After adjustment, rural adults were still less likely to report telehealth access (adjusted prevalence ratio [aPR] = 0.89, 95% CI = 0.79-0.99); no differences were seen between low-income and non-low-income adults (aPR = 1.02, 95% CI = 0.88-1.17). The majority of adults reported willingness to use telehealth (rural = 78.4%; low-income = 79.0%), with no differences between rural and non-rural (aPR = 0.99, 95% CI = 0.92-1.08) or low-income versus non-low-income (aPR = 1.01, 95% CI = 0.91-1.13). No racial/ethnic differences were observed in willingness to use telehealth. The prevalence of perceived telehealth barriers was low, with the majority reporting no barriers (rural = 57.4%; low-income = 56.9%). CONCLUSIONS: Lack of access (and awareness of access) is likely a primary driver of disparities in rural telehealth use. Race/ethnicity was not associated with telehealth willingness, suggesting that equal utilization is possible once granted access.

Social Risks, Social Needs, and Attitudes Toward Social Health Screening 1 Year Into the COVID-19 Pandemic: Survey of Adults in an Integrated Health Care Delivery System.

Introduction Information about demographic differences in social risks, needs, and attitudes toward social health screening in non-highly vulnerable adult populations is lacking. Methods The authors analyzed data for 2869 Kaiser Permanente Northern California non-Medicaid-covered members aged 35 to 85 who responded to a 2021 English-only mailed/online survey. The survey covered 7 social risk and 11 social needs domains and attitudes toward social health screening. The authors used data weighted to the Kaiser Permanente Northern California membership to estimate prevalence of risks, needs, and screening receptivity in the overall population, by race/ethnicity (White, Black, Latinx, Asian American/Pacific Islander) and age (35-65 years old, 66-85 years old). Multivariable regression was used to evaluate differences between groups. Results Overall, 26% of adults were financially strained, 12% food insecure, 12% housing insecure, and 5% transportation insecure. Additionally, 7%, 8%, and 17% had difficulty paying for utilities, medical expenses, and dental care, respectively. Over 40% of adults wanted help with ≥ 1 social need. Dental care, vision/hearing care, paying for medical expenses and utilities, and managing debt/credit card repayment surpassed food, housing, and transportation needs. Prevalence of social risks and needs was generally higher among middle-aged versus older and Black and Latinx versus White adults. Among the 70% of adults receptive to screening, 85% were willing to complete a questionnaire and 40% were willing to have staff ask questions; 18% did not want to be screened. Conclusion When implementing social health screening in diverse patient populations, the prevalence of social risks and needs, as well as the acceptability of social health screening and screening modalities, will vary among demographic subgroups.

Local TV News Coverage of Racial Disparities in COVID-19 During the First Wave of the Pandemic, March-June 2020.

The COVID-19 pandemic has disproportionately impacted health and social outcomes for people of color in the United States. This study examined how local TV news stories attributed causes and solutions for COVID-19-related racial health and social disparities, and whether coverage of such disparities changed after George Floyd's murder, during the first wave of the COVID-19 pandemic. We systematically validated keywords to extract relevant news content and conducted a content analysis of 169 discrete local TV news stories aired between March and June 2020 from 80 broadcast networks within 22 purposefully selected media markets. We found that social determinants of COVID-19 related racial disparities have been part of the discussion in local TV news, but racism as a public health crisis was rarely mentioned. Coverage of racial disparities focused far more attention on physical health outcomes than broader social impacts. Stories cited more structural factors than individual factors, as causes of these disparities. After the murder of George Floyd, stories were more likely to mention Black and Latinx people than other populations impacted by COVID-19. Only 9% of local news stories referenced racism, and stories referenced politicians more frequently than public health experts.

Coronavirus disease (COVID-19) related discrimination and mental health in five U.S. Southern cities

Evidence is mounting that stigma and discrimination related to coronavirus disease (COVID-19) disproportionately impact racial/ethnic minority groups, and that these experiences can worsen mental health. The present study sought to examine multiple types of COVID-related discrimination and their associations with mental health outcomes among racial/ethnic groups in the U.S. South, a region characterized by high levels of racial polarization and increasingly large numbers of undocumented immigrants. We used the cross-sectional, population-based COVID-19 Southern Cities Study (5/26/20-6/6/20) of n = 1,688 adults in Atlanta-GA, Austin-TX, Dallas-TX, Houston-TX, and New Orleans-LA. Three adapted scales (Everyday Discrimination, Major Discrimination, Heightened Vigilance) assessed self-reported COVID-related discrimination. Mental health outcomes included psychological distress, sleep troubles, physical reactions, and self-rated worsened mental health. Bivariable comparisons and adjusted logistic regression models were conducted. The study found that major discrimination was more common (p < .001) among Hispanic and non-Hispanic Black than non-Hispanic Asian and non-Hispanic White respondents. All racial/ethnic minority groups experienced more everyday discrimination (p = .004) and heightened vigilance due to anticipated discrimination (p < .001) than non-Hispanic White respondents. All discrimination types were associated with all mental health outcomes (Odds Ratio;OR range: 1.63-2.61) except everyday and major discrimination with sleep troubles. Results showing greater COVID-related discrimination for racial/ethnic minority groups confirm that these discrimination experiences are not solely about the infectious disease itself, but also entrenched with persistent racism. Responses to COVID-related discrimination should also consider long-lasting impacts on mental health for racial/ethnic minority groups even after the immediate pandemic ends. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Racial/Ethnic Differences in Risk Factors Associated With Severe COVID-19 Among Older Adults With ADRD.

OBJECTIVE: To examine racial/ethnic differences in risk factors, and their associations with COVID-19-related outcomes among older adults with Alzheimer's disease and related dementias (ADRD). DESIGN: Observational study. SETTING AND PARTICIPANTS: National Medicare claims data and the Minimum Data Set 3.0 from April 1, 2020, to December 31, 2020, were linked in this study. We included community-dwelling fee-for-service Medicare beneficiaries with ADRD, diagnosed with COVID-19 between April 1, 2020, and December 1, 2020 (N = 138,533). METHODS: Two outcome variables were defined: hospitalization within 14 days and death within 30 days of COVID-19 diagnosis. We obtained information on individual sociodemographic characteristics, chronic conditions, and prior health care utilization based on the Medicare claims and the Minimum Dataset. Machine learning methods, including lasso regression and discriminative pattern mining, were used to identify risk factors in racial/ethnic subgroups (ie, White, Black, and Hispanic individuals). The associations between identified risk factors and outcomes were evaluated using logistic regression and compared across racial/ethnic subgroups using the coefficient comparison approach. RESULTS: We found higher risks of COVID-19-related outcomes among Black and Hispanic individuals. The areas under the curve of the models with identified risk factors were 0.65 to 0.68 for mortality and 0.61 to 0.62 for hospitalization across racial/ethnic subgroups. Although some identified risk factors (eg, age, gender) for COVID-19-related outcomes were common among all racial/ethnic subgroups, other risk factors (eg, hypertension, obesity) varied by racial/ethnic subgroups. Furthermore, the associations between some common risk factors and COVID-19-related outcomes also varied by race/ethnicity. Being male was related to 138.2% (95% CI: 1.996-2.841), 64.7% (95% CI: 1.546-1.755), and 37.1% (95% CI: 1.192-1.578) increased odds of death among Hispanic, White, and Black individuals, respectively. In addition, the racial/ethnic disparity in COVID-19-related outcomes could not be completely explained by the identified risk factors. CONCLUSIONS AND IMPLICATIONS: Racial/ethnic differences were detected in the likelihood of having COVID-19-related outcomes, specific risk factors, and relationships between specific risk factors and COVID-19-related outcomes. Future research is needed to elucidate the reasons for these differences.

Sub-Saharan African communities' experiences and engagement with COVID-19 and the related control strategies in Antwerp, Belgium.

BACKGROUND: Pre-existing racial/ethnic disparities in health, sustained by intersecting socio-economic and structural inequities, have widened due to the COVID-19 pandemic. Yet, little attention has been paid to the lived experiences of people in ethnic/racialised minority communities, and to the causes and effects underlying the COVID-19-related burden. This hinders tailored responses. This study explores Sub-Saharan African (SSA) communities' needs, perceptions, and experiences of the COVID-19 pandemic and its control measures in Antwerp (Belgium) in 2020. METHODS: This qualitative study using an interpretative ethnographical approach adopted an iterative and participatory methodology: a community advisory board advised on all stages of the research process. Interviews and a group discussion were conducted online, through telephone, and face-to-face. We analysed the data inductively using a thematic analytical approach. RESULTS: Our respondents, who mostly used social media for information, struggled with misinformation about the new virus and prevention measures. They reported to be vulnerable to misinformation about the origin of the pandemic, risk of infection with SARS-CoV-2, and the prevention measures. Not only did the epidemic affect SSA communities, but to a larger extent, the control strategies did-especially the lockdown. Respondents perceived the interaction of social factors (i.e. being migrants, being undocumented, having experienced racism and discrimination) and economic factors (i.e. working in temporary and precarious jobs, not being able to apply for unemployment benefit, crowded housing conditions) as increasing the burden of COVID-19 control measures. In turn, these experiences influenced people's perceptions and attitudes, and may have partially impaired them to follow some public health COVID-19 prevention guidelines. Despite these challenges, communities developed bottom-up initiatives to react quickly to the epidemic, including translation of prevention messages, food distribution, and online spiritual support. CONCLUSION: Pre-existing disparities influenced the perceptions of and attitudes towards COVID-19 and its control strategies among SSA communities. To better design support and control strategies targeted to specific groups, we need to not only involve communities and address their specific needs and concerns, but also build on their strengths and resilience. This will remain important in the context of widening disparities and future epidemics.

Health Behavior and Attitudes During the COVID-19 Pandemic Among Vulnerable and Underserved Latinx in the Southwest USA.

The COVID-19 pandemic highlighted deep-rooted health disparities, particularly among Latinx immigrants living on the Mexico-US border. This article investigates differences between populations and adherence to COVID-19 preventive measures. This study investigated whether there are differences between Latinx recent immigrants, non-Latinx Whites, and English-speaking Latinx in their attitudes and adherence to COVID-19 preventive measures. Data came from 302 participants who received a free COVID-19 test at one of the project sites between March and July 2021. Participants lived in communities with poorer access to COVID-19 testing. Choosing to complete the baseline survey in Spanish was a proxy for being a recent immigrant. Survey measures included the PhenX Toolkit, COVID-19 mitigating behaviors, attitudes toward COVID-19 risk behaviors and mask wearing, and economic challenges during the COVID-19 pandemic. With multiple imputation, ordinary least squares (OLS) regression was used to analyze between-group differences in mitigating attitudes and behaviors toward COVID-19 risk. Adjusted OLS regression analyses showed that Latinx surveyed in Spanish perceived COVID-19 risk behaviors as more unsafe (b = 0.38, p = .001) and had stronger positive attitudes toward mask wearing (b = 0.58, p = .016), as compared to non-Latinx Whites. No significant differences emerged between Latinx surveyed in English and non-Latinx Whites (p > .05). Despite facing major structural, economic, and systemic disadvantages, recent Latinx immigrants showed more positive attitudes toward public health COVID-19 mitigating measures than other groups. The findings have implications for future prevention research about community resilience, practice, and policy.

Disparities in COVID-19 Monoclonal Antibody Delivery: a Retrospective Cohort Study.

BACKGROUND: Disparities in access to anti-SARS-CoV-2 monoclonal antibodies have not been well characterized. OBJECTIVE: We sought to explore the impact of race/ethnicity as a social construct on monoclonal antibody delivery. DESIGN/PATIENTS: Following implementation of a centralized infusion program at a large academic healthcare system, we reviewed a random sample of high-risk ambulatory adult patients with COVID-19 referred for monoclonal antibody therapy. MAIN MEASURES: We examined the relationship between treatment delivery, race/ethnicity, and other demographics using descriptive statistics, binary logistic regression, and spatial analysis. KEY RESULTS: There was no significant difference in racial composition between patients who did (n = 25) and patients who did not (n = 378) decline treatment (p = 0.638). Of patients who did not decline treatment, 64.8% identified as White, 14.8% as Hispanic/Latinx, and 11.1% as Black. Only 44.6% of Hispanic/Latinx and 31.0% of Black patients received treatment compared to 64.1% of White patients (OR 0.45, 95% CI 0.25-0.81, p = 0.008, and OR 0.25, 95% CI 0.12-0.50, p < 0.001, respectively). In multivariable analysis including age, race, insurance status, non-English primary language, county Social Vulnerability Index, illness severity, and total number of comorbidities, associations between receiving treatment and Hispanic/Latinx or Black race were no longer statistically significant (AOR 1.32, 95% CI 0.69-2.53, p = 0.400, and AOR 1.34, 95% CI 0.64-2.80, p = 0.439, respectively). However, patients who were uninsured or whose primary language was not English were less likely to receive treatment (AOR 0.16, 95% CI 0.03-0.88, p = 0.035, and AOR 0.37, 95% CI 0.15-0.90, p = 0.028, respectively). Spatial analysis suggested decreased monoclonal antibody delivery to Cook County patients residing in socially vulnerable communities. CONCLUSIONS: High-risk ambulatory patients with COVID-19 who identified as Hispanic/Latinx or Black were less likely to receive monoclonal antibody therapy in univariate analysis, a finding not explained by patient refusal. Multivariable and spatial analyses suggested insurance status, language, and social vulnerability contributed to racial disparities.