Socioeconomic and Demographic Factors Contributing to COVID-19-Related Delays and Reductions in Primary Retinal Detachment Repair in a US Hot Spot.

Purpose: This work evaluates demographic and socioeconomic predictors of delayed care for rhegmatogenous retinal detachments (RRDs) during the spring 2020 COVID-19 shutdown in a US hot spot. Methods: This multicenter, retrospective, case-control study took place in 3 academic vitreoretinal practices in metropolitan Boston. Consecutive patients treated for RRD during the COVID-19 state of emergency were compared with patients treated during the same period in 2018 and 2019. The primary outcome was macula status for RRD. Secondary outcomes included visual acuity, symptom duration, proportion with proliferative vitreoretinopathy, time to procedure, method of repair, and patient demographics. Results: The total number of acute RRD decreased by 13.7% from 2018 to 2020 and 17.2% from 2019 to 2020. Symptom duration was significantly longer in 2020 than 2018 and 2019 (median, 7 vs 4 days) with a higher proportion of macula-off detachments (80 of 125 [64%] in 2020 vs 75 of 145 [51.7%] in 2018 and 78 of 151 [51.6%] in 2019). The 2020 cohort included significantly fewer patients in the racial and/or ethnic minority group than in 2019 (P = .02), and use of low-income, government-sponsored health insurance was a predictor of macula-off status during the pandemic (P = .04). Conclusions: RRDs during the spring 2020 COVID-19 lockdown were more likely to be macula-off at presentation. Because sociodemographic factors including race, ethnicity, and income level were associated with deferral of care, ophthalmologists should consider measures targeting vulnerable populations to avoid preventable vision loss as the pandemic continues or in future health care emergencies.

COVID-19 Progression: A County-Level Analysis of Vaccination and Case Fatality in Mississippi, USA.

The COVID-19 pandemic has created a severe upheaval in the U.S., with a particular burden on the state of Mississippi, which already has an exhausted healthcare burden. The main objectives of this study are: (1) to analyze the county-level COVID-19 cases, deaths, and vaccine distribution and (2) to determine the correlation between various social determinants of health (SDOH) and COVID-19 vaccination coverage. We analyzed COVID-19-associated data and county-level SDOH factors in 82 counties of Mississippi. The cumulative COVID-19 and socio-demographic data variables were grouped into feature and target variables. The statistical and exploratory data analysis (EDA) was conducted using Python 3.8.5. The correlation between the target and feature variables was performed by Pearson Correlation analysis. The heat Map Correlation Matrix was visually presented to illustrate the correlation between each pair of features and each target variable. Results indicated that people of Asian descent had the highest vaccination coverage of 77% fully vaccinated compared to 52%, 46%, 42% and 25% for African Americans, Whites, Hispanics, and American Indians/Alaska Natives, respectively. The county-level vaccination rate was significantly higher among the minority populations than the White population. It was observed that COVID-19 cases and deaths were positively correlated with per capita income and negatively correlated with the percentage of persons without a high school diploma (age 25+). This study strongly demonstrates that different SDOH factors influence the outcome of the COVID-19 vaccination rate, which also affects the total number of COVID-19 cases and deaths. Vaccine promotion should be given to all populations regardless of race and ethnicity to achieve uniform acceptance. Therefore, statewide policy recommendations focusing on specific community needs should help achieve health equity in COVID-19 vaccination management.

Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021.

Individuals with substance use disorders (SUDs) are at increased risk for COVID-19 infection and for adverse outcomes of the infection. Though vaccines are highly effective against COVID-19, their effectiveness in individuals with SUDs might be curtailed by compromised immune status and a greater likelihood of exposures, added to the waning vaccine immunity and the new SARS-CoV-2 variants. In a population-based cohort study, we assessed the risk, time trends, outcomes and disparities of COVID-19 breakthrough infection in fully vaccinated SUD patients starting 14 days after completion of vaccination. The study included 579,372 individuals (30,183 with a diagnosis of SUD and 549,189 without such a diagnosis) who were fully vaccinated between December 2020 and August 2021, and had not contracted COVID-19 infection prior to vaccination. We used the TriNetX Analytics network platform to access de-identified electronic health records from 63 health care organizations in the US. Among SUD patients, the risk for breakthrough infection ranged from 6.8% for tobacco use disorder to 7.8% for cannabis use disorder, all significantly higher than the 3.6% in non-SUD population (p<0.001). Breakthrough infection risk remained significantly higher after controlling for demographics (age, gender, ethnicity) and vaccine types for all SUD subtypes, except for tobacco use disorder, and was highest for cocaine and cannabis use disorders (hazard ratio, HR=2.06, 95% CI: 1.30-3.25 for cocaine; HR=1.92, 95% CI: 1.39-2.66 for cannabis). When we matched SUD and non-SUD individuals for lifetime comorbidities and adverse socioeconomic determinants of health, the risk for breakthrough infection no longer differed between these populations, except for patients with cannabis use disorder, who remained at increased risk (HR=1.55, 95% CI: 1.22-1.99). The risk for breakthrough infection was higher in SUD patients who received the Pfizer than the Moderna vaccine (HR=1.49, 95% CI: 1.31-1.69). In the vaccinated SUD population, the risk for hospitalization was 22.5% for the breakthrough cohort and 1.6% for the non-breakthrough cohort (risk ratio, RR=14.4, 95% CI: 10.19-20.42), while the risk for death was 1.7% and 0.5% respectively (RR=3.5, 95% CI: 1.74-7.05). No significant age, gender and ethnic disparities for breakthrough infection were observed in vaccinated SUD patients. These data suggest that fully vaccinated SUD individuals are at higher risk for breakthrough COVID-19 infection, and this is largely due to their higher prevalence of comorbidities and adverse socioeconomic determinants of health compared with non-SUD individuals. The high frequency of comorbidities in SUD patients is also likely to contribute to their high rates of hospitalization and death following breakthrough infection.

A County-Level Analysis of Socioeconomic and Clinical Predictors of COVID-19 Incidence and Case-Fatality Rates in Georgia, March-September 2020.

OBJECTIVES: The global COVID-19 pandemic has affected various populations differently. We investigated the relationship between socioeconomic determinants of health obtained from the Robert Wood Johnson Foundation County Health Rankings and COVID-19 incidence and mortality at the county level in Georgia. METHODS: We analyzed data on COVID-19 incidence and case-fatality rates (CFRs) from the Georgia Department of Public Health from March 1 through August 31, 2020. We used repeated measures generalized linear mixed models to determine differences over time in Georgia counties among quartile health rankings of health outcomes, health behaviors, clinical care, social and economic factors, and physical environment. RESULTS: COVID-19 incidence per 100 000 population increased across all quartile county groups for all health rankings (range, 23.1-51.6 in May to 688.4-1062.0 in August). COVID-19 CFRs per 100 000 population peaked in April and May (range, 3312-6835) for all health rankings, declined in June and July (range, 827-5202), and increased again in August (range, 1877-3310). Peak CFRs occurred later in counties with low health rankings for health behavior and clinical care and in counties with high health rankings for social and economic factors and physical environment. All interactions between the health ranking quartile variables and month were significant (P < .001). County-level Gini indices were associated with significantly higher rates of COVID-19 incidence (P < .001) but not CFRs. CONCLUSIONS: From March through August 2020, COVID-19 incidence rose in Georgia's counties independent of health rankings categorization. Differences in time to peak CFRs differed at the county level based upon key health rankings. Public health interventions should incorporate unique strategies to improve COVID-19-related patient outcomes in these environments.

Standing Tall: Leadership Reflections from the Community Health Center Frontlines.

Community health centers have withstood adversity for several decades. As health-care systems seek to reverse health inequities experienced by Black, Indigenous, and People of Color (BIPOC), learnings from community health centers demonstrate tangible ways to improve access and health for all. During the COVID-19 pandemic many community health centers have engaged in innovations in services to build on trust and to reach community members with testing and other needed services. Lessons around leading these efforts could support systemic change in the health-care system.

Incarceration And Its Disseminations: COVID-19 Pandemic Lessons From Chicago's Cook County Jail.

Jails and prisons are major sites of novel coronavirus (SARS-CoV-2) infection. Many jurisdictions in the United States have therefore accelerated the release of low-risk offenders. Early release, however, does not address how arrest and pretrial detention practices may be contributing to disease spread. Using data from Cook County Jail-one of the largest known nodes of SARS-CoV-2 spread in the United States-in Chicago, Illinois, we analyzed the relationship between jailing practices and community infections at the ZIP code level. We found that jail-community cycling was a significant predictor of cases of coronavirus disease 2019 (COVID-19), accounting for 55 percent of the variance in case rates across ZIP codes in Chicago and 37 percent of the variance in all of Illinois. Jail-community cycling far exceeds race, poverty, public transit use, and population density as a predictor of variance. The data suggest that cycling people through Cook County Jail alone is associated with 15.7 percent of all documented COVID-19 cases in Illinois and 15.9 percent of all documented cases in Chicago as of April 19, 2020. Our findings support arguments for reduced reliance on incarceration and for related justice reforms both as emergency measures during the present pandemic and as sustained structural changes vital for future pandemic preparedness and public health.