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Objectives: Post-COVID conditions (PCC) are increasingly reported in people who had COVID. Certain racial or socioeconomic groups may be at greater risk for PCC and less likely to seek care. We examined the uptake of the new ICD-10-CM diagnosis code for PCC in routine clinical practice in the United States and how it varied by race and payer group. Method(s): Using the Optum de-identified Electronic Health Record (EHR) dataset, we identified patients with an ICD-10-CM code for PCC (U09.9) between October 1, 2021, through March 31, 2022, with 6 months of prior EHR activity. The earliest diagnosis defined the index date. All concurrent diagnoses were measured on the index date. Prior COVID diagnosis was assessed using all available data before the index date. Result(s): There were 23,647 patients: 9.9% were African American, 12.1% had Medicaid, and 2.4% were uninsured. There was an overrepresentation of white patients among those with PCC (78.6% compared with 69.6% of the overall EHR in 2021). More African American (24.1%), Medicaid (23.1%), and uninsured (27.5%) patients were diagnosed in the inpatient setting or emergency department than whites (14.0%) and commercially insured patients (10.0%). Among racial groups, African Americans had the highest percentage of documented prior COVID diagnosis at 63.6%. Of concurrent diagnoses, shortness of breath and acute respiratory failure with hypoxia were higher among African Americans (13.9% and 6.1%, respectively) than whites (11.5% and 4.3%, respectively). The same pattern was seen when comparing Medicaid and uninsured to commercial payors. Conclusion(s): The PCC code was used differently across racial groups and payor types and captures varying manifestations of PCC. The differences in diagnosis locations underscore the importance of using data capturing all care settings when conducting studies using this code. Subgroup analyses are important for future studies using U09.9 due to variability in code application.Copyright © 2023
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Purpose: It is unknown whether certain populations of athletes benefit more from returning to sport following COVID-19 restrictions than others. The purpose of this study was to determine whether socioeconomic status (SES), race, or gender moderate the benefits of returning to sports during COVID-19. Method(s): Adolescents who participated in sports before COVID-19 reported sport participation, anxiety (GAD-7), and depression (PHQ-9) inMay 2021. The interactions of return to sport (yes [PLY], no [DNP]) and (1) sex, (2) race (white, nonwhite), and (3) SES (low vs high county household income) to predict anxiety and depression were evaluated, adjusted for age, school instruction, and concern about COVID-19. Result(s): Four thousand eight hundred seventy-four participants were included (16.1 +/- 1.3 years;52% female;PLY = 4456;DNP = 418). DNP had greater symptoms of anxiety (7.8 60.6 v 5.6+/-0.5, P<0.001) and depression (8.8+/-0.6 v 5.76 0.6, P < 0.001) and had significantly more non-white athletes (36% v 19%, P < 0.001), but no significant differences were identified with respect to gender, instructional delivery method, median county household income, or age. Compared with white athletes, adolescent athletes from racial minority groups who returned to sports had relatively greater decreases in anxiety (interaction estimate (b) = -1.18 +/- 0.6, P = 0.036) and depression (b=-1.19+/-0.6, P=0.045). Similarly, athletes from counties with lower household incomes who returned to sports had relatively greater decreases in anxiety (b= -1.23 +/-0.5, P = 0.017) and depression (b=-1.21+/-0.6, P=0.032). The benefits of returning to sports for female athletes were similar to male athletes with respect to anxiety (b = -0.16 +/-0.5, P = 0.76) and depression (beta = 0.49 +/- 0.6, P = 0.37). Conclusion(s): In this nationwide sample of adolescent athletes, returning to sport during COVID-19 was associated with significant mental health benefits for adolescent athletes. However, the greatest benefits were seen among athletes from racial minority groups and areas of lower household income. No differences in the mental health benefits of returning to sports were identified between male and female athletes. Significance: Restriction from sports may disproportionately impact the mental health of certain groups of adolescent athletes. Expanding access to sports for traditionally underserved groups can potentially provide significant mental health benefits.
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New Jersey's COVID-19 Temporary Emergency Reciprocity Licensure Program provided temporary licenses to more than 31000 out-of-state healthcare practitioners, over a quarter of whom were mental health providers. As the need for mental health care accelerated during the pandemic, especially among health disparity populations, expanding mental health provider pools may be a critical tool to increase access to care. In January 2021, we surveyed New Jersey's temporary licensees. We analyzed over 4500 mental health provider responses to examine the impact of the temporary licensure program on access to mental health care overall and on enhancing a diverse mental health workforce. Over 3700 respondents used their temporary license to provide mental health care to New Jersey patients. About 7% of respondents self-identified as Hispanic, 12% Black, 6% Asian, 1% American Indian or Alaska Native, and 0% (more than 5) Native Hawaiian or other Pacific Islander. They treated about 30100 New Jersey patients, 40% of whom were new to the provider, and 81% delivered care exclusively using telehealth. Respondents conversed with patients in at least 13 languages. About 53% served at least one patient from an underserved racial/ethnic minority group. Our findings suggest that temporary out-of-state mental health providers helped enhance mental health care continuity and access. Copyright 2023 Federation of State Medical Boards. All Rights Reserved.
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Background. Viruses are thought to play a role in triggering juvenile idiopathic inflammatory myopathies (JIIM), which include juvenile dermatomyositis (JDM), juvenile polymyositis (JPM), and overlap myositis. There is growing evidence that infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can trigger autoimmune diseases in genetically susceptible individuals, including idiopathic inflammatory myopathies (IIM). Studies have shown similarities between SARS-CoV-2 infection and anti-melanoma differentiation-associated gene 5 (MDA5) antibody-related dermatomyositis, suggesting possible shared underlying autoimmune and/or inflammatory mechanisms. To date, there are few studies describing individual cases of JIIM following SARS-CoV-2 infection, and, to our knowledge, none have explored the effects of SARS-CoV-2 on the clinical presentation of JIIM. In this study, we aim to investigate the impact of SARS-CoV-2 on JIIM by comparing the onset of new JIIM cases, as well as clinical and laboratory characteristics at disease onset, in patients diagnosed before and after onset of the Coronavirus Disease 2019 pandemic (COVID 19). Methods. Patients diagnosed with JIIM prior to age 19 at The Children's Hospital at Montefiore were eligible for study inclusion. Demographic, clinical, and laboratory data, as well as evidence of exposure to SARS-CoV-2, were collected retrospectively by manual chart review. Patients were grouped into pre-COVID 19 (defined as prior to January 1, 2020) and post-COVID 19 (defined as January 1, 2020, or later). Descriptive statistics were used to summarize each variable. Given the small sample size, non-parametric testing was performed using Fischer's exact test and Wilcoxon rank sum test. Results. Forty-four patients were included in the analysis (Table I). Thirty-four patients (77.3%) were diagnosed pre-COVID 19 and ten patients (22.7%) were diagnosed post-COVID 19. Of the ten patients diagnosed post-COVID 19, five (50%) had known exposure to or infection with SARS-CoV-2. Patients diagnosed with JIIM post-COVID 19 were more likely to be of non-Hispanic Black or Asian descent (p=0.041), develop disease at an older age (p=0.009), and present with non-classic cutaneous manifestations (as opposed to classic findings of Gottron's papules/sign or Heliotrope rash) (p=0.031), despite similar frequencies of JDM versus overlap myositis. While presence of muscle weakness did not differ between the groups, patients diagnosed post-COVID 19 tended to have more severe weakness, though results were not statistically significant. Interestingly, despite delays to diagnosis reported during the pandemic, there was no difference between time from symptom onset to diagnosis. Conclusion. This is the first study to explore the effects of SARS-CoV-2 on the clinical presentation of JIIM. In our center, we found that patients diagnosed with JIIM after COVID-19 were more likely to be racial minorities, older at onset, and present with non-classic cutaneous manifestations. While there were no significant differences in myositis specific or associated antibodies, patients diagnosed post-COVID 19 did not have complete autoantibody investigation performed at the time of this study. Clinicians should consider JIIM even in the absence of classic cutaneous manifestations, particularly in the post-COVID 19 era. Patients should be followed longitudinally to explore long-term impacts of SARS-CoV-2 on JIIM. Further investigation is warranted to identify the mechanisms by which SARS-CoV-2 impacts JIIM and how these differ from the effects of other viruses.
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Summary What is this summary about? This is a summary of the results of 2 global clinical studies of the Janssen Ad26.COV2.S vaccine against COVID-19. The ENSEMBLE study looked at the effectiveness of a single injection of the vaccine. The separate ENSEMBLE2 study looked at the effectiveness of a booster dose of the vaccine given 2 months after the first dose. In both studies, people received either the vaccine or a placebo. Vaccine effectiveness was evaluated 14 and 28 days after vaccination to allow sufficient time for generation of an immune response. What were the results? In ENSEMBLE, compared to the placebo, a single dose of the vaccine prevented: 56% of moderate to severe-critical COVID-19 cases occurring at least 14 days after vaccination 53% of moderate to severe-critical COVID-19 cases occurring at least 28 days after vaccination 75% of severe-critical COVID-19 cases occurring at least 28 days after vaccination 76% of people with COVID-19 from needing to be hospitalized for treatment 83% of COVID-19-related deaths The vaccine continued to work well for at least 6 months after a single vaccine injection. In ENSEMBLE2, compared to the placebo, a single dose of the vaccine followed by a booster dose 2 months later prevented: 75% of moderate to severe-critical COVID-19 cases occurring at least 14 days after booster vaccination 100% of severe-critical COVID-19 cases occurring at least 14 days after booster vaccination In ENSEMBLE2, there were too few cases of COVID-19 to estimate vaccine effectiveness for preventing COVID-19-related deaths or hospitalization. ENSEMBLE2 was done during early 2021, when several COVID-19 vaccines became available by emergency use authorization. For ethical reasons, people could check whether they had received vaccine or placebo and decide whether they could be vaccinated outside of the study. This meant that the researchers could not look at the long-term effectiveness of the vaccine. In both studies, after receiving the vaccine, some people experienced pain at the injection site, headache, tiredness, muscle pain, and nausea. In most cases, these were mild and went away within a few days. Serious side effects were very rare. In ENSEMBLE, blood clots, seizures, hives, and ringing in the ears were more common in the people who got the vaccine than in those who got the placebo. These side effects were very rare. In ENSEMBLE2, bleeding, hives, and ringing in the ears were slightly more common in people who got the vaccine than those who got the placebo. In ENSEMBLE2, blood clots were more common in people who got the placebo. At the time of the study, it was not clear if these side effects were caused by the vaccine. What do the results of the study mean? The vaccine was effective at protecting against moderate to severe-critical COVID-19 at 14 days after a single injection. Effectiveness was increased by a booster injection given 2 months after the first injection. You can find more detailed information and references in the original articles. Links to these articles can be found at the end of this summary. Clinical Trial Registration: NCT04505722 and NCT04614948 (ClinicalTrials.gov) </sec.Copyright © 2022 The Authors.
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Background: The Native Hawaiian and Pacific Islander (NHPI) population experiences disproportionately higher rates of food insecurity, which is a risk factor for cardiometabolic diseases such as cardiovascular disease, type 2 diabetes, obesity, and hypertension, when compared to white individuals. Novel and effective approaches that address food insecurity are needed for the NHPI population, particularly in areas of the continental United States, which is a popular migration area for many NHPI families. Social media may serve as an opportune setting to reduce food insecurity and thus the risk factors for cardiometabolic diseases among NHPI people; however, it is unclear if and how food insecurity is discussed in online communities targeting NHPI individuals. Objective: The objective of this study was to characterize the quantity, nature, and audience engagement of messages related to food insecurity posted online in community groups and organizations that target NHPI audiences. Methods: Publicly accessible Facebook pages and groups focused on serving NHPI community members living in the states of Washington or Oregon served as the data source. Facebook posts between March and June 2019 (before the COVID-19 pandemic) and from March to June 2020 (during the COVID-19 pandemic) that were related to food security were identified using a set of 36 related keywords. Data on the post and any user engagement (ie, comments, shares, or digital reactions) were extracted for all relevant posts. A content analytical approach was used to identify and quantify the nature of the identified posts and any related comments. The codes resulting from the content analysis were described and compared by year, page type, and engagement. Results: Of the 1314 nonduplicated posts in the 7 relevant Facebook groups and pages, 88 were related to food security (8 in 2019 and 80 in 2020). The nature of posts was broadly classified into literature-based codes, food assistance (the most common), perspectives of food insecurity, community gratitude and support, and macrolevel contexts. Among the 88 posts, 74% (n=65) had some form of engagement, and posts reflecting community gratitude and support or culture had more engagement than others (mean 19.9, 95% CI 11.2-28.5 vs mean 6.1, 95% CI 1.7-10.4; and mean 26.8, 95% CI 12.7-40.9 vs mean 5.3, 95% CI 3.0-7.7, respectively). Conclusions: Food security-related posts in publicly accessible Facebook groups targeting NHPI individuals living in Washington and Oregon largely focused on food assistance, although cultural values of gratitude, maintaining NHPI culture, and supporting children were also reflected. Future work should capitalize on social media as a potential avenue to reach a unique cultural group in the United States experiencing inequitably high rates of food insecurity and risk of cardiometabolic diseases.
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Aim: As a brief psychotherapy for individuals facing mortal threat, Dignity Therapy (DT) effects on spiritual outcomes are unknown, especially as an intervention to support cancer health equity for racial minority patients. Our study aim was to compare usual outpatient palliative care and such care along with nurse-led or chaplain-led DT groups for main effects on dignity impact and the interaction of DT with race. Method(s): We conducted the 4-step, stepped-wedge randomized control trial at 4 NCI designated cancer centers and 2 academic cancer centers across the United States. Half of the sites were randomized to chaplain-led DT and half to nurse-led DT. Of the 645 recruited cancer patients (age >= 55 years) receiving outpatient palliative care, 579 (59% female, mean age 66.4+/-7.4 years, 78% White, 77% Christian religion, 62% stage 4 cancer) provided data for intent-totreat analysis. Over 6 weeks, patients completed pretest/posttest measures including the Dignity Impact Scale (DIS, primary outcome) ranging from low impact of 7 to highest impact of 35. In step 1-3, study procedures were completed in person. In step 4 (during the COVID-19 pandemic), when all sites were providing the intervention, study procedures were completed via Zoom. We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and study step. Result(s): Of the 579 patients, 317 were in the DT group and 262 in the usual care group. The vast majority of the sample was White (n=448) along with 103 Blacks, 5 Asians, 2 Pacific Islanders, 1 Native American, 13 other races (all minorities were combined as Other Race), and 7 were missing race data. At pretest, the mean DIS score was 24.3+/-4.3 in the DT group and 25.9+/-4.3 in the usual care group. Adjusting for pretest DIS scores, study site, and study step, the chaplain-led (beta=1.7, p=.02) and nurse-led (beta=2.1, p=.005) groups reported significantly higher posttest DIS scores than the usual care groups. Adjusting for age, gender, race, education, and income, the effect on DIS scores remained significant for both DT groups. We then examined the interaction between race and DT with the entire sample and observed that the interaction was not significant (p=.73) and the sizes of DT effects were similar for White (beta=1.9, p=.005) and the Other Race (beta=1.6, p=.055) patients. Conclusion(s): Whether led by chaplains or nurses, DT was effective in improving dignity impact for older adult outpatient palliative care patients with cancer. DT, a patient-centered approach, has promise as an intervention to improve health equity in support of dignity for racial minorities. This rigorous trial of DT is a landmark step in gero-oncology palliative care and spiritual health services research focused on cancer health equity.
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Background: Following George Floyd's murder in May 2020, conversations about equity and bias became part of our daily national conversation. Simultaneously the COVID-19 outbreak disproportionately affected people of color which further illuminated existing disparities in outcomes. Bias training was introduced in many sectors as a strategy to address inequity. Inclusivity in healthcare is essential to develop evidence-based therapies and treatment plans. Previous studies have demonstrated the consequences when racial and ethnic minorities are excluded from research. (Hamel et al, 2016). Racial and ethnic minorities disproportionately bear adverse outcomes from cancer. Cancer clinical trials would benefit from solutions to promote inclusivity. (Khan et al. 2021) Research Purpose: The purpose of our study was to assess whether Implicit Bias Training can increase minority participation in cancer clinical trials. Methodology: The Office of Diversity, Equity, and Inclusion offered Implicit Bias Training to all clinical oncologists at the Yale Cancer Center (YCC) between May and July 2021. While 109 physicians were eligible to participate, 57 physicians were required by the department to complete this training, and 84% of these physicians completed this opportunity. We analyzed YCC clinical trial enrollment data between two time periods defined as pre-intervention and post-intervention. We selected these periods to investigate not only the efficacy of bias training but specifically bias training as an adjunct to the national conversation during the time of our study. We selected the preintervention period as January 1, 2021, to June 30, 2021. The intervention was designed to be completed by July 1, 2021 therefore the post-intervention period is defined as July 1, 2021 to December 31, 2021. Results/Summary: Our analysis showed an increase of 2.5% in the participation of Black/African American patients. There was a slight (1.5%) decrease in Hispanic patient enrollment during this time. Conclusion(s): Our analysis suggested that implicit bias training delivered once had only a very modest, if any, improvement in racial minority participation in cancer clinical trials. Our project focused on participation by Black/African American patients. The impediment to Hispanic participation is quite nuanced. Hispanic patients, many of whom are non-English speaking with immigration/insurance issues face additional structural barriers. We think that a different strategy is needed to better serve this patient population. While we had hoped for metrics to demonstrate greater impact from bias training, our next investigation will look at if the intervention is best delivered repeatedly. Future Work: We have not abandoned the strategy of bias training to build trust and increase Black/AA participation. After the intervention, we are interested in whether greater impact is seen over time. We have designed a survey to look at the effects of the intervention after a year. Our next step is to examine whether repeated delivery of this intervention will amplify our results.
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Background: The recent COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify patient demographics and social determinants of health (SDOH) which might limit access to remote telehealth services. Method(s): First, a retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center over the COVID-19 pandemic (3/2020-4/2022). Second, a prospective, crosssectional study was conducted of patients with known or suspected malignancy presenting to the same center over six-months (11/2021-5/2022). Participants were asked a standard set of survey questions regarding telehealth accessibility during an in-person clinic visit. Demographics and SDOH were ed from the electronic health record (EHR). Result(s): Although Black patients comprised 43% (n=9,021) of all patient visits (n=20,953), the proportion of telehealth visits conducted among Black patients (29%;n=889) was significantly lower compared to White patients (71%, n=2,142, p<0.0001). Within the cross-sectional study cohort (n=149), 51% (n=76) were Black, 39% (n=58) resided in a rural county, and 8.7% (n=13) were uninsured or Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% vs. 90.4%, p<0.01) and were less likely to report having access to or actively using a patient portal in the EHR compared to White patients (47.4% and 79.5%, respectively;p<0.001). Rates of self-reported access to videocapable devices (82.9% vs. 90.4%) and confidence in conducting video visits without assistance (59.2% vs. 68.5%) were similar among Black and White patients (p>0.05). The most common selfidentified challenge to telehealth usage among both races was limited digital literacy. Conclusion(s): Black patients disproportionally under-participated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal to the EHR compared to White patients. Ensuring equal internet access and digital literacy will be critical to reduce further disparities in cancer care among racial minorities.
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INTRODUCTION: Several state-based and single center studies have demonstrated evidence of higher COVID-19 exposure rates, infection rates, and worse morbidity and mortality outcomes among minorities. Furthermore, challenges with vaccine access, hesitancy, distrust of the medical system further influenced who was protected from COVID-19.This study combines databases to conduct a multisite study across diverse states during the pandemic. METHOD(S): We conducted an ancillary study using the VIRUS (Viral Infection and Respiratory illness Universal Study) registry data supplemented by electronic medical record data from Mayo Clinic enterprise to assess demographics and outcomes among hospitalized patients with severe COVID-19. We included hospitalized adult patients admitted in five participating sites between April 2020 and January 2022 including academic hospitals in MN, AZ, and FL and two community hospitals in MN and WI. Selfidentified race and ethnicity data was categorized as White, Black, Asian, and Other;Hispanic and non-Hispanic. Other baseline characteristics, disease severity, and vaccination status were included in the analyses. The primary outcome was hospital mortality, the secondary outcomes were length of stay and healthcare utilization. Multivariable regression models were developed to analyze the interactions of relevant variables to predict outcomes. RESULT(S): 6904 patients were included. 3398 (57.8%) were male and 86.9% White,3.6% Black,3.3% Asian,6.2% Other. The mean age of Whites was 64.9 years v.53.8, 58, 52.8 respectively (p< 0.0005). Whites had higher Charlson comorbidity scores-5.2 v.4.0,3.6,3.0 respectively (p< 0.005). Vaccination rates were low in cohort, but higher among Whites 11.2% v.5.4%,4.6%,5.0% respectively (p< 0.0005). Mortality outcomes between different racial groups did not differ (p=0.41). Non-Hispanics were older than Hispanics- mean age 64.5 years v.53 (p< 0.005) and had higher Charlson comorbidity scores-5.2 v.3.4 (p< 0.005) Vaccination rates among non-Hispanics were 10.7 v 3.4% (p< 0.005)). Mortality outcomes between ethnic groups did not differ(p=0.86). Mortality outcomes between vaccinated and unvaccinated patients did not differ (p=0.9). CONCLUSION(S): Despite differences in risk factors between demographic groups, outcomes did not differ significantly in this cohort.
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Background. The Baltimore City Health Department (BCHD) began community-based COVID-19 testing in response to the pandemic on April 21, 2020. The purpose was to provide access to COVID-19 testing to underserved communities. BCHD designed the program to accommodate transportation limitations, limited-access to internet and phones, and non-English speakers. BCHD has continued hosting up to five community-based testing sites per week. This analysis examines the test results of BCHD's COVID-19 community-based testing program to date. Methods. Patients completed an intake form, which included demographic information, at the testing event, prior to providing their specimen for COVID-19 testing. For this analysis, patient demographics and test results were analyzed using REDCap software. Results. Total test volume for year 2020 (4/21/2020 -12/30/2020) was 15,839, year 2021 (1/5/2021- 12/30/2021) was 13,087, and year 2022 (1/4/2022 - 4/1/2022) was 2,261. Average percent positivity for year 2020 was 9%, year 2021 was 7%, and year 2022 to date was 6%. Patient ethnicity was Non-Hispanic 85.5%, Hispanic 13.5%, and Did not respond/Don't know 1.0%. Race was Black or African America 61.1%, White 25.0%, Asian 2.8%, American Indian/Alaska Native 0.1%, Native Hawaiian or Other Pacific Islander 0.1%, and Unknown 10.7%. Total positive COVID-19 results among Black/African Americans in 2020, 2021, and 2022 respectively were 1567 (12.8%), 1177 (15.1%), and 218 (22.1%). Total positive COVID-19 results among White in 2020, 2021, and 2022 respectively were 541 (10.1%), 441 (12.1%), and 60 (15.1%) respectively. Total positive COVID-19 results among Asians in 2020, 2021, and 2022 were 63 (20.9%), 47 (11.0%), and 4 (25.5%) respectively. Total positive COVID-19 results among Native Hawaiian or Other Pacific Islander in 2020, 2021, and 2022 respectively were 4 (16.7%), 4 (20.0%), and 2 (0.0%) respectively. Total positive COVID-19 results among American Indian/Alaskan in 2020, 2021, and 2022 were 3 (13.6%), 1 (7.1%), and 2 (66.7%) respectively. Conclusion. BCHD's community-based testing program has completed over 31,000 tests to date. COVID-19 percent positivity among patients showed a decline across the three years. This analysis demonstrates how a local health department can provide testing to the communities.
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Background. Anti-SARS-CoV-2 monoclonal antibodies are administered to patients with mild-moderate COVID-19 who are at high risk of progression to severe disease. It has been shown that in addition to medical comorbidities, race or ethnicity may also place patients at high risk for progression to severe COVID-19 infection due to social disparities including limited access to care. The purpose of this study is to increase the accessibility of monoclonal antibody infusion to patients at high risk for severe outcomes of COVID-19, irrespective of race and ethnicity, by expanding outreach resources when availability of oral antiviral therapies was limited. Methods. We performed a single-center retrospective analysis of patients with mild-moderate COVID-19 infection receiving sotrovimab, amonoclonal antibody, between December 2021 and January 2022. A total of 93 SARS-CoV-2-positive patients meeting EUA criteria for eligibility were infused with sotrovimab in different settings such as emergency department, outpatient setting including infusion clinics and cancer centers, home health as well as patients hospitalized due to reasons other than COVID-19 at RUSH medical center, Chicago. For context, during omicron surge, initially home health was set up followed by introduction to infusion clinics. Primary care provider could refer patients to the infusions clinics or home health. Results. Out of 93 patients, 8 patients received mAb infusion in emergency department, 25 patients each in cancer center and infusion clinic, 17 patients in home health setting and 18 patients who were hospitalized due to reasons other than COVID-19. The median age of participants was 57 years and 61.2% were females. Overall, Hispanic patients received mAb less often than did non-Hispanic patients (33% vs 62%). Black, Asian and other racial groups received mAb 18.2%, 3.23%, 3.23% less often, respectively, than did White patients. Interestingly, in home health setting, Hispanic patients received infusion more often than non-Hispanic patients (12.9% vs 5.3%). Conclusion. Implementation of programs centered around needs of community such as increase accessibility to COVID-19 medications through home health or infusion clinics may help mitigate the racial and ethnic disparities in COVID-19 and thus, promote health equity.
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Background. Scarcity of therapeutics to treat Coronavirus Disease 2019 (COVID-19) during the surge in cases caused by the Omicron variant raised concerns that structural inequities would decrease access to these medications for racial minorities and patients with lower socioeconomic status. We hypothesized that screening plus outreach would increase identification of eligible patients in these vulnerable patient populations when compared to referrals alone. Methods. A retrospective cohort study of COVID medication allocation was performed at a quaternary pediatric medical care facility between 1/1/22-2/15/22. The two cohorts were patients referred for COVID therapy and patients identified via screening followed by outreach. Screening plus outreach included daily review of laboratory reports for new positive cases of SARS-CoV-2, followed by chart review for high-risk conditions, and communication with providers or directly with eligible patients to offer therapy. Demographic characteristics, chronic medical conditions, socioeconomic parameters, and medication receipt were compared between the two groups. Results. Overall, 51 and 94 patients were identified via referral and screening plus outreach, respectively. Thirty-two patients received medication of which eight (25%) were identified by screening plus outreach alone. Compared to referred patients, patients in the screen plus outreach group were more likely to have moderate, low, or very low childhood opportunity index (COI) scores (74.5% vs 52.9%%, p = 0.009);public health insurance (69.1% vs 37.5%, p < 0.001);asthma/obesity (63.8% vs 21.6%, p < 0.001), and race/ethnicity other than White, Non-Hispanic (79.8% vs 54.9%, p = 0.002). Patients in the referral group were more likely to receive medication (47.1% vs. 8.5%, p < 0.001). Conclusion. Compared to referral, screening plus outreach for COVID medications can increase identification of patients who are racial minorities, have asthma/ obesity, and have lower socioeconomic status. Future studies should investigate communication strategies to improve uptake of these medications after outreach. (Figure Presented).
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SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Some co-morbidities and racial/ethnic groups are associated with worse COVID-19 outcomes. Is there a statistically significant difference in baseline characteristics and co-morbidities among racial and ethnic groups? This question was explored in a descriptive study among patients admitted to Hartford HealthCare. METHODS: A retrospective review of 7049 patients admitted with COVID-19 within the Hartford HealthCare (HHC) System from Feb 23, 2020 to July 15, 2021 was performed via the COVID-19 Research Registry at HHC (an IRB approved registry of patients who tested positive for COVID-19 within HHC). Racial and ethnic categories were compared using chi-square test and multiple column proportions were compared using Bonferroni method. RESULTS: The cohort was comprised of 52% males with an average age of 65 years (SD=17). 20% were non-survivors. Race was reported as 61% White, 22% Other, 13% African American (AA), 2% Asian, 2% Grouped Races (including American Indian, Pacific Islander, refused or unknown). 23% of the cohort reported their ethnicity as Hispanic. The “Other” racial group is comprised of 87% Hispanic ethnicity. A significantly higher proportion of White was >80 years old (30%) as compared to AA (13%), Asian (11%) and Other (13%) categories. No difference in gender distribution was noted. White had increased proportions of CAD (23%) as compared to Grouped and Other groups (10-20%) and COPD (15%) and atrial fibrillation (19%) as compared to all groups (4-10%). A higher proportion of AA had obesity (15%) as compared to Asian and White groups (4-13%) and hypertension (59%) and heart failure (21%) as compared to Asian, Grouped and Other groups (39-52%, 6-14% respectively). AA also had a higher proportion of CKD (42%) as compared to all groups (18-35%). Those in the Other category (87% Hispanic) had increased proportion of diabetes mellitus (41%) as compared to all groups (23-29%) except AA and asthma (16%) compared to all groups (6-12%). A significantly higher proportion of Asian was on private insurance (42%) as compared to all groups (19-23%) except Grouped Races and had lower proportions or no statistically significant difference in co-morbidities. Highest proportion of Other was on Medicare/Medicaid (80%), followed by White (77%), AA (76%), Grouped Races (66%) then Asian (57%). CONCLUSIONS: This descriptive study found statistically significant differences in age, co-morbidites and insurance status among racial/ethnic groups admitted with COVID-19 at HHC. CLINICAL IMPLICATIONS: Studies have shown disproportionate impact of COVID-19 on minorities. Review of our hospitalized cohort shows that perhaps it is not race itself, but rather a complex interaction between patient factors and social determinants of health that likely plays a an essential role. A more complete study looking at the social determinants of health and its impact on COVID-19 mortality would be helpful to direct community interventions. DISCLOSURES: No relevant relationships by Jyoti Chhabra No relevant relationships by Jeffrey Mather No relevant relationships by Hnin Hnin Oo No relevant relationships by Oscar Serrano No relevant relationships by Joseph Tortora
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Introduction: The enhanced recovery after surgery (ERAS) pathway comprises a series of evidence-based interventions accelerating recovery after surgery. COVID-19 disrupted perioperative processes, and vulnerable populations were at exceptionally high risk. Objective: To facilitate and improve adherence to preoperative ERAS pathways, preoperative chlorhexidine (CHG) and prenutritional drinks were mailed directly to patients (ERAS kit). We hypothesized that shipping kits direct to women undergoing gynecological surgery would increase adherence and provide more equitable care. Methods: This study is a retrospective cohort study of all adult cis-gender female patients undergoing gynecological surgery at a large tertiary hospital from October to November of 2021. Adherence and access to the pathway at the time of surgery were compared between White patients and other racial minority groups in October and November 2019, 2020, and 2021 (before COVID-19, during COVID-19, and intervention period). Patient demographics were described using frequency and percent for categorical variables and mean and standard deviation for continuous variables. SPC 3-sigma p-charts were used to evaluate changes in the utilization of pre-surgical ERAS interventions. Results: Compared to White patients, women from racial minority groups undergoing hysterectomy were less likely to adhere to ERAS pre-surgical interventions such as pre-surgery carbohydrate hydration (20.9 vs. 42.9%, P = 0.005) or use the preoperative CHG soap (60.4% vs. 77.6%, P = 0185). From October 1st to November 30th of 2021, a total of 127 patients that had a hysterectomy received an ERAS pre-surgery kit at home. White patients had a 91.9% adherence to pre-surgical nutrition, while other racial minority groups had 96.4% adherence (P = 0.713). During the study period, White patients had 98.0% adherence to the CHG portion of the pathway, and other racial minorities groups had 96.3% (P = 0.188). Conclusions: t baseline, non-White patients undergoing hysterectomy were less likely to adhere to ERAS pre-surgical interventions such as pre-surgery carbohydrate hydration and CHG use. Delivering ERAS pre-surgical kits directly to the patients' homes is associated with large increases in utilization of the ERAS pathway among both White patients and patients of color.
ABSTRACT
Background Since being declared a pandemic, Coronavirus Disease 19 (COVID-19) has spread worldwide and causes various manifestations, including hair symptoms. Infection with COVID-19 produces inflammation and stress, which results in dermatological symptoms affecting the skin and hair. The most common hair loss-related finding in COVID-19 instances is Telogen Effluvium (TE), which is characterized by widespread non-scarring hair loss. The hair shedding that occurs usually happens two to three months after infection. In this article, we review and summarize how hair loss was induced in COVID-19 infections, how TE and COVID-19 severity is associated, as well as the duration and onset of TE following COVID-19 infections. Methods A literature search through PubMed was performed and nine studies were found. Studies included case reports and case series published from 2020 to 2021. Results From the nine studies reviewed, we found more than 50% of females suffered from post-COVID TE, with an age range of 20-76 years old and a mean age of 42.89 years old. The average number of days to TE onset was ±63 days after COVID-19 infection. TE was discovered in patients with mild to moderate COVID-19. Several studies have found that Caucasians are more likely to suffer from TE compared to other racial groups. The comorbidities in most of the patients included vitamin D deficiency, anemia, hypothyroidism, and type 2 diabetes mellitus. Conclusion Various factors influence post-COVID TE, including age, time of onset, gender, severity of COVID-19 infection, and pre-existing comorbidities (vitamin D deficiency, anemia, hypothyroidism, and type 2 diabetes mellitus).
ABSTRACT
Background: Despite vaccines being attributed to the eradication of smallpox and prevention of many possibly fatal diseases, public confidence in vaccines has been on the decline, and the COVID-19 pandemic has further increased the vaccination gap across the world. A study done by the Michigan Care Improvement Registry compared age-recommended vaccination rates for patients from the years of 2016-2019 and the year 2020. The study showed that in the 16-month age cohort, children obtaining measles vaccine coverage declined from 76.1% in May 2019 to 70.9% in May 2020. An analysis by Scientific American showed only 44.7% of the number of vaccines administered in March 2019 were administered in March 2020 in the state of Texas. Methods: The Quality Improvement sector of the Health Technology department at the UT Health Science Center approved the project and collected data across UT Health primary pediatric care clinics in Harris County. The data points included all the pediatric appointments of patients who were eligible for the MMR 1 and 2 vaccines in 2019 and 2020. The data displayed which eligible patients for the MMR 1 and 2 vaccines received the vaccine at their appointment. The data was analyzed for overall trends of Harris County, and then subdivided by patient racial groups. Results: From 2019 to 2020, the MMR1 vaccination rate decreased from 52.15% to 43.55%, and the MMR2 vaccination rate decreased from 55.70% to 45.57%. Combining years 2019 and 2020, the percentage of eligible patients who did not receive the MMR1 vaccine consisted of 28.04% Caucasian, 22.05% African American, 17.11% Hispanic, Latino, or Latin American, 1.34% Asian or Pacific Islander, and 31.46% Other. The percentage of eligible patients in 2019 and 2020 who did not receive the MMR2 vaccine consisted of 28.05% Caucasian, 16.25% African American, 21.76% Hispanic, Latino, or Latin American, 1.75% Asian or Pacific Islander, and 32.18% Other. The demographic labeled “other” consisted of not answered and not specified patients. Conclusion: Overall, there was a clear decline in the rate of MMR vaccinations to eligible patients from 2019 to 2020. This indicates that the COVID-19 pandemic is potentially playing an even greater role in public health than previously thought due to increasing the possibility of a measles epidemic occurring in Harris County. Stratifying the data by race demonstrated which demographics were more prone to vaccination gaps. Patients who selected not answered/not specified and Caucasian patients were the most likely to experience a gap in vaccine administration leading to an increased chance of measles outbreaks in these groups of patients. This is valuable knowledge for providers to be aware of which groups are more predisposed to vaccine gaps, so the healthcare team can help close the gap through a targeted approach of care.