Ethnic, racial and migrant inequalities in respiratory health

Disparities in the incidence, prevalence, and morbidity and mortality rates of many respiratory diseases are evident among ethnic groups. Biological, cultural and environmental factors related to ethnicity can all contribute to the differences in respiratory health observed among ethnic minority groups, but the inequalities observed are most commonly due to lower socioeconomic position. People who migrate within a country or across an international border may experience an improvement in respiratory health associated with improvements in socioeconomic position. However, migrants may also experience worse health outcomes in destination countries, as they are faced by barriers in language and culture, discrimination, exclusion and limited access to health services. While some high-quality studies investigating ethnicity and respiratory health are available, further research into ethnic differences is needed. Improving the recording of ethnicity in health records, addressing barriers to accessing respiratory healthcare and improving cultural literacy more generally are some of the ways that inequalities can be tackled.Copyright © ERS 2023.

Diversity in medical publications: a cross-sectional evaluation of COVID- 19 vaccine research

Objective: Representing diverse perspectives in medical publications is of great importance. We assessed diversity among investigators, study participants, authors and tweeters of recent publications on COVID-19 vaccine trials, a topic likely to have significant global implications. Research design and methods: Primary publications reporting on COVID vaccine randomized controlled trials (RCTs) were identified via PubMed (n=302 hits, 23 September 2022). The 100 articles with the greatest impact (Altmetric score) were selected for evaluation. National affiliation of authors and investigators, and demographics of participants were collected. Geographic locations of Tweets mentioning the publications were collected via Altmetric. Result(s): In our preliminary analysis, as expected, selected publications most frequently appeared in top-tier journals, e.g. New England Journal of Medicine (n=24) and Lancet (n=19), and had high Altmetric scores (median 886, range 30-29,153). Articles included authors from mean 2.2 countries, most frequently the USA (n=43 articles), the UK (n=31) and China (n=23). Investigators' locations were often not reported, but most frequent were the UK (n=2711 investigators), USA (n=1029) and South Africa (n=269). There was a gender balance among participants across the studies (mean 49.4% female). The most frequent ethnic groups were white, Hispanic and Asian. Tweets mentioning the publications most commonly came from the USA (8.1%), the UK (3.1%) and Japan (2.9%). Conclusion(s): Despite COVID-19 being a global health emergency, most authors, investigators and readers of high impact COVID-19 vaccine RCT publications were from a small group of countries, with some notable exceptions. Numerous studies did not report the geographic location of investigators or participant ethnicity. Consistent and transparent reporting would support the drive towards greater diversity and representation in medical research.

Telemedicine and the Utilization of Outpatient Mental Health Services By Patients with Incident Major Depressive Disorder during the COVID-19 Pandemic

Objectives: To examine the role of telemedicine in providing access to outpatient psychotherapy for children and young adults with incident major depressive disorder (MDD) before and during the COVID-19 pandemic, overall and by race and ethnicity. Method(s): Medical claims from a large, national insurer were retrospectively analyzed to identify two cohorts of individuals aged 10-26 years old, based on incident diagnosis ("index") date of MDD (pre-COVID: March-December 2018, COVID: March-December 2020). We tracked health care utilization, utilization by site of care, modality of care, and psychotherapy Results: The majority of patients in the two cohorts (pre-COVID: N=7,758, COVID: N=8,517) were White (78.9% and 78.8%, respectively), followed by Hispanic (11.5% and 10.9%), Black (6.6% and 7.1%), and Asian (3.0% and 3.2%). While pre-index utilization was similar between cohorts, the COVID cohort had 919 psychotherapy visits per 1,000 patients compared to 735 for the pre-COVID cohort in the month post-index. The increase in visits is largely attributable to an increase in telemedicine visits for the COVID cohort. Similarly, psychotherapy visits increased for all racial and ethnic groups in the COVID cohort compared to the pre-COVID cohort in the month post-index: 22.3% for Whites (931 visits per 1,000 patients in COVID cohort vs. 759 in pre-COVID cohort), 45.0% for Asians (951 vs. 656), 20.5% for Blacks (792 vs. 657) and 46.5% for Hispanics (860 vs. 587). Conclusion(s): Telemedicine increased access to mental health services during the pandemic across races and ethnicities, but racial and ethnic disparities persisted. Health systems should capitalize on the telehealth infrastructure developed during the pandemic to sustain this increased access to care while continuing work to reduce disparities.Copyright © 2023

Community outreach and engagement to increase colorectal cancer screening in ethnic minority communities

PURPOSE: Colorectal cancer (CRC) is preventable with screening, yet remains the second leading cause of cancer deaths in the U.S. Nationally, CRC screening substantially declined during the COVID-19 pandemic and is underutilized by ethnic minorities and in safety-net systems. Therefore, City of Hope partnered with Federally Qualified Health Centers (FQHCs) and community and faithbased organizations to improve CRC screening among medically underserved communities. METHOD(S): Between October 2020 and October 2022, we implemented a multi-component intervention that included community outreach and education (a multi-ethnic multimedia campaign and community training adapted from the NCI Screen2Save (S2S) program) and clinic-based interventions (provider/staff training and patient education). Intervention reach and training participant surveys were assessed. Within our four FQHC sites, we also compared clinic-level CRC screening rates among age-eligible patients before (June 2021) and after implementation of the clinic-based intervention (June 2022). RESULT(S): Our reach assessment showed that our multi-ethnic multimedia campaign reached 35.4 million impressions, our S2S education training reached 300 diverse community members, and our provider/staff training reached 150 medical providers. Among the 100 providers surveyed, >80% felt confident they could get their patients to complete their CRC screening test and follow-up care. For the clinic-based intervention component, our baseline sample included 11,259 age-eligible patients across the four FQHC sites. Overall CRC screening rates increased from 45% to 52% before vs. after the intervention implementation period. The site with the highest CRC screening rate (>62%) maintained steady rates over the observation period, whereas three sites with lower baseline rates showed greater pre-post improvements (average 15 percentage-point increase). CONCLUSION(S): An overall increase in CRC screening rates was achieved across FQHCs, despite clinic staffing challenges during the COVID-19 pandemic. Intervention implementation is ongoing with attempts to document individual, clinic improvements by race/ethnicity.

Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes (1) our screening and case identification process, (2) variation among adolescents versus young adults, and (3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12-24 years with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk indicators: 97% past-year suicidal ideation, 83% past suicidal behavior;and 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported more past-year suicide attempts (47% vs. 21%, p <.001) and NSSI (past 6 months, 64% vs. 39%, p <.001);less depression, anxiety, posttraumatic stress, and substance use;and greater social connectedness. Pandemic onset was associated with lower participation of racial-ethnic minority youths (18% vs. 33%, p <.015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.Copyright © 2023 Society of Clinical Child and Adolescent Psychology.

COVID-19 vaccination rates in people living with HIV in north east England

Background: People living with HIV (PLWH) are at increased risk of severe COVID-19. The UK recommends vaccination against COVID-19 for PLWH with two primary doses, a booster dose, then seasonal boosters (i.e. four doses by Autumn 2022). Vaccination uptake in the UK has been lower among non-white minority ethnic groups than in the white British population, despite these groups having a higher risk of severe COVID-19. Method(s): We evaluated vaccine uptake by PLWH attending treatment services at two NHS Trusts in North East England. To ensure representation of minorities, alternating PLWH from white and ethnic minorities (excluding white minorities) were purposively selected for review from the HIV and AIDS Reporting System;vaccination data were obtained from regional integrated care records. Result(s): 200 PLWH were included. 103 (51.5%) were from ethnic minority groups, of whom 78 (75.7%) were of black African ethnicity. Vaccination rates in the total population and among ethnic groups are shown in the table below. Similar proportions of white and minority ethnic background PLWH had received up to two vaccinations. These proportions among white PLWH were similar to those reported in the general English population, while fewer Black African PLWH were unvaccinated than in the general population (14.1% vs. 26%, data not shown). Vaccine uptake among PLWH diverged beyond 3 doses, with white people being almost three times as likely to have received four doses (OR 2.92;95% CI 1.63 to 5.19;pvalue for difference in distribution across all doses=0.005). Conclusion(s): Although ethnic minority PLWH were less likely to be fully vaccinated than white ethnicity PLWH, the proportion of unvaccinated black African PLWH was lower than that reported from the general population. This could infer that regular contact with healthcare professionals coupled with consistent promotion of vaccination by HIV clinicians can improve uptake. (Table Presented).

Increasing Access to a Diverse Mental Health Workforce through Emergency Reciprocity Licensure

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.

Residential Segregation as a Barrier to Covid-19 Booster Coverage in Deep South

Background: Coronavirus disease 2019 (COVID-19) had been a stronger hit in Deep South compared with other developed regions in the United States, and vaccination remains a top priority for all eligible individuals. However, there are limited data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age group, which is of critical importance for future vaccine planning. Racial/ethnic disparities were found in the COVID-19 vaccination, but the vast majority of evidence was generated from studies at the individual level. There is an urgent need for evidence at the population level to reveal and evaluate the booster coverage in racial/ethnic minority communities, which could identify vulnerable communities and inform future healthcare policymaking and resource allocation. We evaluated county-level COVID-19 booster coverage by age group in the Deep South and examined its relationship with residential segregation. Method(s): We conducted an ecological study at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of five Deep South states from December 15, 2021 to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster coverage by age group (e.g., 12 to 17 years old, 18 to 64 years old, and at least 65 years old) by the end of the study period. We examined the longitudinal relationships between residential segregation, interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson mixed model. Result(s): As of October 19, 2022, among the 418 counties, the median percentage of booster coverage was 40% (interquartile range [IQR]: 37.8-43.0%). Compared with elders, youth and adults had lower percentages of booster uptake. There was geospatial heterogeneity in the COVID-19 booster coverage. Results of the Poisson mixed model found that as time increased, higher segregated counties had lower percentages of booster coverage. Such relationships were consistent across the age groups. Conclusion(s): The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccine planning should focus on youth and adults. Healthcare facilities and resources are needed in racial/ethnic minority communities. Residential segregation and COVID-19 booster coverage by age group in the 418 counties across the five Deep South states from December 15, 2021 to October 19, 2022.

Increase in traumatic injury burden amidst COVID-19 was disproportionately shouldered by racial and ethnic minority patients: An urban case study

Background: When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method(s): We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015-2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015-Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Result(s): For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury;increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusion(s): The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.Copyright © The Author(s) 2023.

Access to Sickle Cell Disease Treatment in the Indigenous Tharu Population of Nepal

Purpose of Study: Sickle cell disease (SCD) is a hemoglobinopathy that disproportionately affects the indigenous Tharu population of Nepal, a marginalized ethnic group concentrated in the Dang district. There are significant global disparities in the prognosis of SCD;in low-income countries, which lack screening and management infrastructure, up to 80% of those born with SCD are undiagnosed and less than half survive beyond 5 years of age. Since 2015, University of British Columbia medical student teams have collaborated with a local community partner, Creating Possibilities (CP), to improve SCD awareness, screening, diagnosis, and management for the Tharu population in and around Dang. Community members with SCD have previously expressed numerous challenges in obtaining treatment once diagnosed. This study aims to better understand difficulties in accessing SCD care for this community. Methods Used: The Access to SCD Care Questionnaire was developed from items in existing scales, deductive and inductive item generation, and feedback from expert local partners to ensure it is culturally appropriate, needs-specific, and easily understandable. The questionnaire includes closed-ended questions using a Likert scale and open-ended interview prompts. It centers around five core themes: personal beliefs, community attitudes, finances, transportation, and medical infrastructure. Interviews were conducted in Tharu (local dialect) by CP staff members in January to March 2022. Themes and sub-themes were qualitatively analyzed. Summary of Results: Participants aged from 14 to 42 with an equal sex ratio, a total of 12 interviews were conducted before study saturation was reached. All participants reported at least one minor or major problem with access to SCD care in each of the five core themes of the questionnaire. Inadequate healthcare infrastructure was the most frequently reported barrier, with participants reporting lack of local medication accessibility and low supplies at further district hospitals. Additionally, despite government funding for treatment coverage, participants reported difficulties obtaining the necessary legal documents to prove eligibility. The second largest perceived barrier to care was transportation, which was reported to be costly, time-consuming, and not readily available. Regardless of sub-theme, participants reported that system-wide effects from COVID-19 perpetuated these issues. Conclusion(s): Results from the Access to SCD Care Questionnaire demonstrate that availability and accessibility to medications and transportation services are the primary challenges to receiving SCD care in this indigenous community. Therefore, future interventions for this community should focus on these findings. In contrast with previous literature, community stigma and personal beliefs were not often reported as hindering SCD treatment. This may be attributed to successful education campaigns within this specific community or due to participation bias.

Nirmatrelvir/Ritonavir Uptake among Adults with Covid-19, December 2021-October 2022

Background: COVID-19 vaccine booster uptake remains low and preventable COVID-19 deaths continue to occur, making access to oral antivirals for those most at risk of severe COVID-19 outcomes essential. Method(s): We estimated age and gender adjusted prevalence ratios of oral nirmatrelvir-ritonavir (NMV/r) uptake by sociodemographics, clinical characteristics, and prescription eligibility (based on age, underlying medical conditions, body mass index, physical inactivity, pregnancy, or smokers), among participants in a large U.S. national prospective cohort who were infected with SARS-CoV-2 between December 2021 and October 2022. Among participants who reported NMV/r uptake, we also described the proportion who reported (1) taking NMV/r as directed and (2) NMV/r was helpful for reducing COVID-19 symptoms. Result(s): Among 1,594 participants with a SARS-CoV-2 infection as of October 2022, 1,356 were eligible for NMV/r prescription;of whom 209 (15.4% [95%CI:13.5-17.3]) reported receiving NMV/r. NMV/r uptake increased from 2.2% (95%CI:1.0-3.4) between December 2021 and March 2022 to 16.5% (95% CI:13.0-20.0) between April and July 2022 and 28.6% (95%CI:24.4-32.8) between August and October 2022, respectively. Participants >=65 years of age reported the highest uptake of NMV/r (30.2% [95%CI:22.2-38.2]). Black non-Hispanic participants (7.2% [95%CI:2.4-12.0]) and those in the lowest income group (10.6% [95%CI:7.3-13.8]) had lower uptake than white non-Hispanic (15.8% [95%CI:13.6-18.0]) and high-income individuals (18.4% [95%CI:15.2-21.7]), respectively. Participants with type 2 diabetes had greater uptake (28.8% [95%CI:20.4-37.3]), compared to those without it (12.4% [95%CI:4.8-20.0]). Among a subset of 278 participants who had a prior SARSCoV-2 infection, those who had a history of long COVID reported greater uptake (22.0% [95%CI:13.9-30.1]) for a subsequent SARS-CoV-2 infection than those without a history of long COVID (7.9% [95%CI:3.9-11.8]). Among all participants who were prescribed NMV/r (N=216), 89% (95%CI:85-93) reported that they took NMV/r as directed and 63% (95%CI:57-70) stated NMV/r was helpful for reducing COVID-19 symptoms. Conclusion(s): Uptake of NMV/r increased over time coinciding with national efforts to increase awareness and access. However, most individuals who were eligible for NMV/r did not receive it. Lower NMV/r uptake among racial/ethnic minorities and individuals with lower household income suggests a need to improve awareness and address barriers to uptake in these populations.

Racial and Ethnic Disparities in the Use of Live Video Telemedicine

Purpose of Study As a result of the coronavirus disease 2019 (COVID-19) pandemic and physical distancing, telehealth has been scaled up as a key strategy to address the need for virtual access to medical services. Previous studies have examined use of web-portals for accessing health information, but data on the use of live video telemedicine for disease management across different ethnicities is limited. The objective of this study is to determine if disparities exist among different ethnic groups in accessing live video telemedicine services. Methods Used A literature review was conducted using databases such as PubMed and Google Scholar. Key search terms included: telehealth, telemedicine, ethnicity, and disparities. Studies were included if a) they were conducted in the United States, b) patients used a live video telehealth service with a provider, c) focused on telemedicine use across different racial and ethnic groups, and d) investigated completed access to live video telemedicine at the individual level, and not potential access at the aggregate level. Summary of Results Of 25 articles found, 5 met our inclusion criteria. Overall, white patients had higher rates of telehealth visit completion and video telehealth use than non-white patients. Studies that used telehealth visits for diabetes education and glycemic control showed that self-care improved in all ethnic groups, but despite tailored intervention, minority groups never achieved the same level of self-care as whites. Conclusions Our review suggests that overall white patients have better access to live video telemedicine, and use the services at higher rates compared to non-white patients. However, since this trend was not seen in every study, it is likely that other factors beyond race and ethnicity play a role in access to telemedicine. Effective strategies are needed to mitigate disparities to ensure equitable telemedicine access.

Ethnic and gender trends at the annual British Association of Urological Surgeons (BAUS) meeting: A review of BAUS programmes over a 13-year period (2009-2021)

Objective: In this paper, we wanted to review the annual British Association of Urological Surgeons (BAUS) programme to analyse the female and ethnic minority (EM) representation and find out whether there is ethnic and gender disparity, and if it does reflect the reality of the workforce. Method(s): To investigate gender and EM representation, we requested data for BAUS annual meetings over a 13-year period (2009-2021). All speakers and chairpersons for all four sub-sections including Endourology, Oncology, Andrology and Female, Neurological and Urodynamic urology (FNUU) were collated. We also looked at the geographic distribution of the speakers (London area, rest of England, Scotland, Northern Ireland and Wales). Data were analysed separately before and after the COVID-19 pandemic (cut-off March 2020), as in the latter 2 years, the meeting was held virtually. Result(s): A total of 2569 speakers (range: 135-323 speakers/year) were included in our analysis and 2187 (85%) speakers were from the United Kingdom. Of the UK speakers, more than three-quarters (76.6%, n = 1676) were males and females of White ethnicity and (23.4%, n = 511) were EM. The vast majority of speakers throughout the years were males (86%, n = 1891) with only 14% (n = 296) females regardless of their origin and ethnicity. The presence of EM females was only 1.9% (n = 43). The percentage of female representation rose consistently over time from 6.7% (n = 8) in 2009 to 21.1% (n = 44) in 2020, suggesting an upward trend. Regional distribution showed 31%, 63%, 3.6%, 1.6% and 0.2% from London, Rest of England, Scotland, Wales and Northern Ireland, respectively. Both gender and EM representation doubled in the last 2 years during the pandemic (p < 0.001). Conclusion(s): Annual BAUS meetings have seen a higher proportion of ethnic and gender representation in recent years. However, considering the workforce within urology, more needs to be done to address this historical disparity. Hopefully, the BAUS 10-point programme will provide a framework for addressing Equality, Diversity and Inclusion issues related to this bias. Level of Evidence: Not applicable.Copyright © British Association of Urological Surgeons 2022.

Geodemographic factors associated with COVID-19 mortality in indigenous population in Colombia

Introduction: Since 2019 there have been over 80,000 confirmed COVID-19 cases in the indigenous ethnic groups in Colombia. Age, sex, and region of residency might be factors that contribute to COVID-19 mortality in these ethnic populations. The objective of this research is to describe COVID-19 whether these are associated with COVID-19 mortality in this population. According to the 2018 national population census, there are 1.905.617 persons who identified themselves as indigenous, 50.1% of whom are women, younger than 64 years old and live in rural areas [1]. Method(s): This is a retrospective cohort study, using data collected through the national retrospective cohort of confirmed COVID-19 cases. The study population were the confirmed COVID-19 cases in the indigenous population in Colombia since 03/2019 until 10/2022. A Cox Regression Model was used to estimate the HR by age, sex, and geographical location. Result(s): There were 83,436 confirmed COVID-19 cases in the indigenous population in this period. The association between age and COVID-19 mortality shows that older individuals and males have higher mortality risk. The geographical location was explored as a risk factor for COVID-19 mortality. Results are shown in Table 1. Most of the regions have HR very close to 1.0, and none reached statistical significance. Conclusion(s): Age and sex remain significant factors associated with COVID-19 mortality, as they are in other population studies [2]. The region of residency is not a factor significantly associated with COVID-19 mortality in this study, as this characteristic does not seem to reflect socioeconomic inequalities that have been proven to impact COVID-19 mortality in Colombia [2].

The Racial and Socioeconomic Characteristics of a Cohort of Men Using at-Home Fertility Tests in the United States

INTRODUCTION AND OBJECTIVE: Infertility is a global health concern that affects couples worldwide. Economic, racial, and geographic disparities in reproductive medicine have long affected access to fertility care. These inequalities further worsened during the COVID-19 pandemic as fertility care services were systematically paused and treatments were delayed. At-home fertility tests emerged as a seemingly convenient, affordable and accessible option for all men seeking initial semen analysis testing and screening. We aim to study the racial and socioeconomic characteristics of a cohort of men utilizing at-home sperm testing kits in the United States over 3 years. METHOD(S): We retrospectively reviewed the records of 5,822 men who requested semen analysis at Give Legacy, Inc. (Legacy) facilities from 2019 to 2021. The demographic characteristics of these men were collected including their age, race/ethnicity, and place of residence. Further, the weighted median household income of Legacy customers was calculated using their personal ZIP codes and corresponding median income data from the U.S. census bureau. RESULT(S): The mean age (SD) of this cohort was 34.9+/-7.3 years. Among these 5,822 men, there were 3,936 (67.6%) normozoospermic men and 1,886 (32.3%) oligozoospermic men. The group consisted of predominantly white men (64.9%) with only 5.2% Black, 5.4% Latino, 8.9% Asian, 3.1% Arab, 2% Native Hawaiian, 2.4% Indian American, and 8.2% other groups. The geographic distribution of participants showed a majority of men from the Northeast (31.6%) and Pacific (23.4%) regions. The median household income of a Legacy customer is $108,858;significantly higher than the U.S. median household income of $70,784 (P<.01). CONCLUSION(S): Despite the fact that at-home, mail-in kits provide a better and more affordable access to initial fertility care, ethnic minorities and lower socioeconomic classes are still underrepresented in the population of men seeking fertility testing in this cohort. Further research is needed to understand the racial and socioeconomic drivers of the existing disparities in fertility care.

Perspectives of a Predominantly Marginalized Population on Telemedicine

Purpose of Study: Telemedicine has become a common option for healthcare delivery in the post-COVID-19 era. There are advantages, but the barriers to care for children with medical complexity (CMC) and marginalized populations have not been well-described. This study assessed parental perception of telemedicine in the care of their children. Methods Used: A REDcap survey was distributed to parents of hospitalized patients close to discharge to examine their attitudes regarding outpatient telemedicine with a focus on the post-discharge follow-up visit. Summary of Results: A total of 78 parents responded to our survey. A majority (58%) identified themselves as an ethnic minority. About 47% of parents completed college or postgraduate education;the rest had a high school diploma or some college education. Half (50%) of the parents reported a family income of <$100,000. Of the 78, 50% had used telemedicine previously, and a majority (76%) preferred in-person visits. Of those who belonged to a minority population, 80% preferred in-person visits after hospital discharge. Fifty-seven of the parents answered further questions about telemedicine and their child's medical complexity. Of these 57, 53% had a CMC, requiring specialized care and only 20% agreed or strongly agreed that it was difficult to take their child to in-person visits. Fifty-three out of the 78 parents provided a free text response about their thoughts on telemedicine visits. Common themes about advantages of in-person visits were a) preference for a physician's physical exam b) in-person visits were more personal and facilitated clearer communication and c) in-person visits provided more accurate? care compared to telemedicine (See Figure). Internet or computer access as a barrier was only mentioned by 3 parents. The main advantage of telemedicine mentioned was convenience. Conclusion(s): Our study shows that most parents prefer in-person visits, especially after hospital discharge. Our results may not apply to other populations as most of our patients were medically complex and belonged to a minority population. To increase parental support of telemedicine, techniques to improve family confidence in visual assessment and communication are required. Larger studies are needed to identify the needs of patients and families with a focus on the child's medical needs.

CASE REPORT: Immigrants and evolving food allergies

Case report Background: We present a case of coconut allergy as a rare evolving food allergy among immigrants. Case presentation: A 3-year-old girl, on treatment for asthma, was referred to the allergy clinic due to possible reactions to salmon and coconut. Due to COVID restrictions, the initial consultation was conducted by telephone. Reportedly, she developed hives and wheeze after eating salmon and coconut products. During the face-to-face review, it was noted that the child's paternal side of the family was of ethnic minorities. The patient had cradle cap as a baby, and coconut oil was applied for treatment as advised by family back home. During a hospital-based coconut challenge, she developed puffy eyes, and on subsequent consumption of coconut macaroon, she developed hives. The child was diagnosed with coconut allergy. Face-to-face assessment and food cultural awareness are essential for clinical diagnosis. Discussion(s): Allergy is a multifactorial illness affected by epigenetic, environmental factors, eczema during infancy and food culture. Studies suggest that the risk of allergy can be highest in immigrants to culturally stable food, particularly with delayed early taste during weaning. The dual allergen hypothesis proposes that early cutaneous exposure to food protein through damaged skin barrier can lead to sensitisation and allergy and that early oral exposure to food induces tolerance. Conclusion(s): Further research on understanding the interaction between epigenetics of the allergic disease and the environment is needed as is an understanding of how the movement of populations and different culture habits can affect the incidence of food allergy. In the meantime, is promoting healthy skin barrier and early food introduction enough to prevent food allergies.

Status-Based Asymmetries in Relative Deprivation During the COVID-19 Pandemic

The COVID-19 pandemic has amplified existing inequalities by disproportionately affecting marginalized groups, which should differentially affect perceptions of, and responses to, inequality. Accordingly, the present study examines the effects of the pandemic on feelings of individual- and group-based relative deprivation (IRD and GRD, respectively), as well as whether these effects differ by ethnicity. By comparing matched samples of participants assessed before and during the first 6 months of the pandemic (Ntotal = 21,131), our results demonstrate the unique impacts of the pandemic on IRD and GRD among ethnic minorities and majorities. Moreover, our results reveal the status-based indirect effects of the pandemic on support for both collective action and income redistribution via IRD and GRD. As the pandemic rages on, these results foreshadow long-term, status-specific consequences for political mobilization and support for social change. © The Author(s) 2023.

Ethnic Differences in Cancer Deaths at Home before and during Pandemic

Introduction Place of death is a metric used for planning and monitoring palliative care (PC). The COVID-19 pandemic has seen a significant increase in cancer deaths at home. Aims To determine whether pandemic increases in the percentage of cancer deaths at home differ by ethnic group Methods Data source: death registrations in England, 2018 to 2021 with underlying cause of death cancer (ICD-10 C00-C97). Ethnic group derived from linked hospital episode data. The age and deprivation distribution across ethnic groups varies and each has a strong independent effect on place of death. so, calculated percentage deaths at home were standardised by these factors to make them comparable. Analysis concentrated on the largest ethnic groups: White, Asian/Asian British (Asian), and Black/African/ Caribbean/Black British (Black). Comparisons were made between time periods by analysis of the ratio of percentages 2020-2021 (COVID-19 Pandemic) vs 2018-2019 (Baseline). Results For each ethnic group the age-standardised percentage of cancer deaths at home significantly increased (P < 0.05) from 2018-2019 to 2020-2021 . Asian: 33.5%, 47.5% . Black: 28.8%, 39.0% . White: 30.7%, 41.2% The ratio of standardised percentage of deaths at home (95% CI) was . Asian: 1.42 (1.36,1.48 ) . Black: 1.35 (1.27, 1.44) . White 1.34 (1.33, 1.35) Conclusions Cancer deaths at home increased by > 10 percentage points during the pandemic for Asians, Blacks and Whites. Significant differences between ethnic groups before the pandemic (2018-19) persisted with Asians more likely than Whites, and Blacks less likely than Whites to die at home. The largest increase was for Asians, the group with the highest pre-pandemic home deaths. Impact These ethnic differences merit investigation regarding cultural preferences, access issues and quality of PC experience. Community health and PC teams need additional resources and training in culturally sensitive care to support the increased number of ethnically diverse cancer patients dying at home.

Comparison of the impact of ethnicity on clinical outcomes of COVID-19 patients in the United Kingdom across two waves of the pandemic

Objective: To evaluate an association between severity of COVID19 infection in hospitalized patients belonging to different ethnic backgrounds with various demographic data across two waves of the pandemic. Method(s):728 COVID19 patients admitted between April 2020 and March 2021 were retrospectively analysed. Result(s):295 patients(40.5%)were from ethnic minority groups(EMG). Severe COVID19 based on chest Xray scores were not significantly different among EMGs and whites. Intensive therapy unit(ITU)admissions was required in 12% of white patients compared to 20% of EMGs(p=0.001). Continuous positive airway pressure(CPAP)was required in 22% vs 24%(p=0.12)and mechanical ventilation in 5% vs 10%(p=0.013)of whites and EMG patients,respectively. Mortality was significantly higher in White as compared to EMG(11% vs 6%;p=0.001). When the outcomes were compared between two waves(April-August 2020 and September 2020-March 2021)of COVID19,a significantly higher number of EMGs required CPAP support during first wave(5.3%vs2.6%;p=0.008)compared to second wave,where the difference was not significant(11.6%vs15.5%;p=0.465). Mortality was higher in whites as compared to EMGs during second wave(5.7%vs1.7%:p=0.03). Conclusion(s): Although mechanical ventilation and ITU admission was higher among EMGs,the overall mortality was more in whites.