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In this paper, I focus on the UK government's Covid-19 pandemic response to schooling in England with regards to the impact on race inequality, an area which has received comparatively little attention. I review the existing research, drawing on work by academics, think tanks, lobbying organisations and media reports, conducted between spring 2020 and autumn 2021, and argue that this evidence suggests that the UK government's pandemic response firstly has increased existing racial disadvantage for Black, Asian and Minority Ethnic (BAME) pupils in education, and secondly, it has potentially increased the exposure of BAME households to illness and death. I further argue that not only can education policy in response to Covid be considered to be an example of white supremacy, but it is an example of necropolitics, defined as ‘the power and the capacity [of the state] to dictate who may live and who must die' (Mbembe 2013, 161). I conclude by making some recommendations for wide-reaching social and educational change. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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OBJECTIVES: The precise number of actively practicing vascular surgeons who self-identify as Black and the historical race composition trends within the overall profession of vascular surgery are unknown. Limited demographic data has been collected and maintained at the societal or national board level. Vascular Surgery Societal reports suggest that less than 2% of vascular surgeons identify as Black. Blacks make up 13.4% of the American population yet for disorders such as peripheral arterial disease and end stage renal disease, Black communities are disproportionately impacted, and the prevalence of disease is greater on an age adjusted basis. Significant body of research showed that clinical outcomes like medication adherence, shared decision making, and research trial participation are positively impacted by racial concordance especially for communities in whom distrust is high as a consequence of historic experiences. This survey aims to characterize practice and career variables within a network of Black vascular surgeons. METHODS: A cross sectional survey was conducted via a questionnaire sent to all participants of a Society of Black Vascular Surgeons (SBVS) that began to convene monthly during the COVID-19 pandemic and experienced subsequent organic growth. The survey included 20 questions with variables quantified including the surgeon's demographics, clinical experience, practice setting, patient demographics and professional society engagement. RESULTS: Fifty-nine percent of the SBVS members completed the survey. Males compromised 81% of the responding vascular surgeons. The majority (62%) of respondents are involved in academic practice. Less than 25% percent of the total medical staff was Black in 77% of the respondents' current work practice. The patient racial composition within their respective practice settings: White (47%), Black (34%), Hispanic (13%), Asian (3%), Middle Eastern or North African (2%) and American Indian and Alaskan Natives (0.4%). Forty three percent of respondents have a current active membership in the Society of Vascular Surgery and 24% have regional society membership. Fifty-eight percent of respondents reported that they experienced workplace event that they felt were racially or ethically driven in the 12 months prior to the survey. CONCLUSION: This survey describes an underrepresented in medicine (URM) vascular surgeon subgroup that has not heretofore been characterized. Racial and ethnic demographic data are essential to better understand the current demographic makeup of our specialty, and to develop benchmark goals of race composition that mirrors our society at large. In this group of Black vascular surgeons, their patients were more likely to represent a racial minority. Efforts to increase race diversity in vascular surgery have the potential benefit of enhancing care of patients with vascular disease.
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Background: Both cancer and COVID-19 have been reported to be associated with an increased risk of VTE. Severe disease needing hospitalization is also associated with an increased risk of VTE. There is a paucity of data evaluating the effects of race on this risk, with the limited available data suggesting that such a correlation exists. Given the increased prevalence of comorbidities and risk factors for VTE in African Americans (AA), we sought to evaluate if there are racial disparities in the incidence of VTE in the hospitalized subset of COVID-19 patients with cancer. Method(s): This was a retrospective chart review of unvaccinated cancer patients hospitalized with COVID-19 at a major tertiary health facility. Only cancer patients who were on active systemic chemotherapy were included. The primary study outcomes were development of DVT or PE (VTE) within 30 days of COVID-19 diagnosis. Secondary outcomes included mortality, hospital length of stay, mechanical ventilation, ICU admission, and need for vasopressors. Mean and standard deviation were reported for continuous variables;proportions were reported for categorical variables. To compare between races, the Chi-square test was used for categorical variables and the t-test was used for continuous variables. Multivariable logistic regression was then conducted to assess the relationship between race and selected factors. All statistical tests were 2-sided with an alpha (significance) level of 0.05. Result(s): A total of 73 patients were included in our analysis. The median age of the cohort was 70 years (interquartile range [IQR] 64-79). Gender breakdown: 58.9% males, 41.1 females. 31.5% were Caucasian, 64.4% African American, 1.4% Hispanic, and 2.7% other races/ethnicities. There were 8 DVT/PE patients in the cohort. Of 23 Caucasians in our cohort, 3 (13.0%) had VTE. Of 47 African Americans, 5 (10.6%) had DVT/PE. There was no significant difference between the incidence of VTE and race (p > 0.05). Multivariable logistic regression did not show a significant relationship between race and VTE, controlling for age, ICU stay, intubation, vasopressor use, serum ferritin and serum IL-6 levels. Notably, all patients included in this study were on enoxaparin prophylaxis for VTE. The only variable associated with DVT/PE was age and the presence of hemoglobinopathy. Incidence of VTE was significantly associated with increasing age (p < 0.03) and the presence of hemoglobinopathy (p < 0.01). Hemoglobinopathy was only seen in AA cancer patients with VTE (n = 4), and none in Caucasian patients. Conclusion(s): Contrary to what has been reported in the literature, we did not detect racial disparity in the incidence of VTE in hospitalized cancer patients with COVID 19. Prophylactic anticoagulation likely had a protective effect. However, racial disparity was observed in AA cancer patients with hemoglobinopathy with increased VTE risk despite prophylactic anticoagulation. This warrants further evaluation in future studies.
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The COVID-19 pandemic altered healthcare delivery in the United States. This study examined the effect of the COVID-19 pandemic on the epidemiological trends and outcomes of gastrointestinal bleeding. We compared the admission rate, in-hospital mortality rate, and mean length of hospital stay between 2019 and 2020 to estimate the pandemic effect. The study highlighted disparities in outcomes of gastrointestinal bleeding hospitalizations stratified by sex and race. We noted a 9.5% reduction in the total number of hospitalizations in 2020. We also observed a 13% increase in overall mortality during the pandemic (P < 0.001). There was a 15.8% increase in mortality among men (P = 0.007), compared to a 4.7% increase among women (P = 0.059). There was a significant increase in mortality among Whites in 2020 compared to Black and Hispanic populations. On multivariable logistic regression, admission during the COVID-19 pandemic was associated with increased length of stay when adjusted for age, sex, and race. Despite the direct COVID-19-related morbidity and mortality, the so-called indirect effect of the pandemic cannot be overlooked. For the remainder of the pandemic and future health emergencies, it is critical to balance mitigation of the spread of the contagion with clear public health messages to not neglect other life-threatening emergencies.
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This literature critical analysis reflects on the social, political and historical background responsible for racial discrepancies in hospital mortality by COVID-19 among the Brazilian population. During the pandemic, the COVID-19 mortality among the Black population gained notoriety. Rather than an isolated fact, this finding has historical roots dating back to Brazil's foundation and draws on structural racism, which reveals degrading living and health conditions experienced by the Black population before the pandemic. This situation of vulnerability affecting the Black population is a recurring scenario that is treated with the neglect inherent to structural racism. COVID-19 mortality portrays one way in which racism impacts and reproduces itself in the life and death of Black people. Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.
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We examined the all-cause and COVID-19-specific mortality among World Trade Center Health Registry (WTCHR) enrollees. We also examined the socioeconomic factors associated with COVID-19-specific death. Mortality data from the NYC Bureau of Vital Statistics between 2015-2020 were linked to the WTCHR. COVID-19-specific death was defined as having positive COVID-19 tests that match to a death certificate or COVID-19 mentioned on the death certificate via text searching. We conducted step change and pulse regression to assess excess deaths. Limiting to those who died in 2019 (n = 210) and 2020 (n = 286), we examined factors associated with COVID-19-specific deaths using multinomial logistic regression. Death rate among WTCHR enrollees increased during the pandemic (RR: 1.70, 95% CL: 1.25-2.32), driven by the pulse in March-April 2020 (RR: 3.38, 95% CL: 2.62-4.30). No significantly increased death rate was observed during May-December 2020. Being non-Hispanic Black and having at least one co-morbidity had a higher likelihood of COVID-19-associated mortality than being non-Hispanic White and not having any co-morbidity (AOR: 2.43, 95% CL: 1.23-4.77; AOR: 2.86, 95% CL: 1.19-6.88, respectively). The racial disparity in COVID-19-specific deaths attenuated after including neighborhood proportion of essential workers in the model (AOR:1.98, 95% CL: 0.98-4.01). Racial disparities continue to impact mortality by differential occupational exposure and structural inequality in neighborhood representation. The WTC-exposed population are no exception. Continued efforts to reduce transmission risk in communities of color is crucial for addressing health inequities.
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COVID-19 , September 11 Terrorist Attacks , Humans , New York City/epidemiology , Registries , PandemicsABSTRACT
SESSION TITLE: Racial Disparities in Pulmonary Embolism Risk Factors and Mortality in the SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 1:30 pm - 2:30 pm PURPOSE: Racial disparities in pulmonary embolism (PE) related mortality rates have been reported for decades in the United States (US). The risk factors contributing to the observed disparity remain unclear. Our objective is to examine recent PE-related mortality trends and PE risk factors by race. We hypothesize racial disparity gap in PE-related mortality and risk factors has persisted and might have widened with the COVID 19 pandemic. METHODS: The Centers for Disease Control and Prevention (CDC) wide-ranging online data for epidemiologic research for both underlying cause of death (UCOD) and multiple causes of death (MCOD) in the US between the years 1999-2020 was used for this study. Non-Hispanic black (NHB) and non-Hispanic white (NHW) decedents aged 25 years and older with an ICD-10 code for PE (I26) were included. Age-adjusted mortality rates (AAMR) with 95% Confidence Intervals (CIs) were computed by race for age groups, year, Health & Human Services (HHS) regions, and urbanization and PE risk factors. Risk factors examined were trauma, cancer, cardiovascular diseases, obesity, sepsis, chronic lower respiratory diseases, and COVD-19 among PE decedents. RESULTS: Between the years 1999-2020, PE was the UCOD in 168,540 decedents, with 137,128 (81.4%) NHWs and 31,412 (18.6%) NHBs. The overall age-adjusted mortality rate (AAMR) decreased from 1999(5.3;95% CI, 5.2 - 5.4) to 2009(3.6;95% CI, 3.5 - 3.7), and then increased from 2010(3.8;95% (3.7 - 3.8) to 2020(4.2;95% CI, 4.1 - 4.3).There was a steep rise in the overall AAMR for 2020 (4.2;95% CI, 4.1 - 4.3) compared to the year prior 2019 (3.9;95% CI, 3.8 - 4.0) with highest annual % change among NHBs when compared to NHWs (NHB men (13%), NHB women (15%), NHW men (8.3%), NHW women (6%).) NHB men (AAMR 7.2;95% CI, 7.1-7.4) and NHB women (AAMR 6.6;95% CI, 6.5-6.7) had 2-fold higher AAMR compared to NHW men (AAMR 3.8;95% CI, 3.8-3-9) and NHW women (AAMR 3.7;95% CI, 3.7-3.7). Similar trends were also noted in geographical regions. The highest AAMRs were in HHS regions 3, 4, 5,6, 7, and 8. Within these HHS regions, NHBs and NHWs who resided in small metro and non-metropolitan areas had the highest AAMRs. However, NHB-NHW disparity in AAMR was seen in all 10 HHS regions and Urbanization. When risk factors such as trauma, cancer, obesity, cardiovascular diseases, sepsis, and chronic lower respiratory diseases were each mentioned as MCOD with PE decedents, rates varied by risk factor but NHBs had consistently higher AAMR than NHWs. CONCLUSIONS: We showed that PE-related mortality has increased over the past decade and racial disparities persisted and varied by gender, region, urbanization, and risk factors. The decades-long disparity observed in PE-related mortality may be narrowed by allocating resources to the management of common comorbidities. CLINICAL IMPLICATIONS: Racial disparity in PE-related mortality is related to comorbidities listed in MCOD data. DISCLOSURES: No relevant relationships by Isaac Ikwu No relevant relationships by Alem Mehari No relevant relationships by Lamiaa Rougui
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This research aims to quantify racial disparities associated with COVID-19 cases and deaths in Georgia and Mississippi. It investigates ethnic disparities at the county level, based on socioeconomic factors. The factors used include the county population, median income, percentage of the county population per ethnic group, and county presidential election party major. In addition, COVID-19 cases and death rates by ethnicity were provided. The combined data was used for K-means clustering analysis and Analysis of Variances, to investigate the differences due to ethnicity per county and the differences due to aggregated cases and death rates per county. The results showed a significant difference in the ethnic group's COVID-19 cases and deaths as well as the socioeconomic factors that might have affected these rates. Specifically, counties with the Republican party as the presidential political party majority had significantly more cases and deaths for American Indian and Alaskan Native (AIAN), Black, and White ethnic groups in Mississippi and Georgia. There was no significant statistical difference between the Asian and Latinx groups. This research concluded that there is a significant difference in the COVID-19 deaths and cases based on the ethnic groups due to socioeconomic factors and the political party majority of the counties. In addition, counties with significant cases and death rates consist of large proportions of people of color than their population representation percentage based on the 2020 Census. © 2022 IISE Annual Conference and Expo 2022. All rights reserved.
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Background: In the 1990s, it was demonstrated that Black patients were less likely to receive timely treatment for Stage 3 lung cancer than White patients. While contemporary work has found racial disparities in accessing insurance, diagnostics, and treatments, we wished to explore whether patients faced disparities once in treatment. To do this, we examined whether racial disparities were observable in a 2019 cohort of Medicare Advantage beneficiaries receiving treatment for lung cancer. Methods: This retrospective, observational study used health plan claims data to identify Black and White patients aged 18 to 89 years with a Medicare Advantage health plan in calendar year 2019 who received diagnostic imaging (computed tomography or positron emission tomography) followed by lung cancer treatment (radiation therapy [RT] or surgery claims mentioning a diagnosis of lung cancer) within 90 days. Only patients treated in 2019 were considered so that the findings would reflect the state of care immediately preceding the COVID-19 pandemic. Patients were excluded if they had a history of RT or lung surgery in the year prior to the diagnostic imaging date. Other databases were used to determine cancer stage, patient demographics, comorbidities, the urbanicity and median income of patients' home ZIP code, and whether treatment was ordered by a hospital-based physician. A multivariate logistic model was used to examine the association between race and surgery, and a multivariate negative binomial model was used to examine the association between race and days to treatment (surgery or RT). Results: We identified 823 patients, 83.8% White (690), and 16.2% (133) Black. Surgery was received by 3.1% [4/133] of Black patients and 9.7% [61/690]) of White patients. Black patients received treatment on average 36.9 days after diagnosis, versus 35.1 days for White patients. Adjusted analysis did not find a significant association between race and receipt of surgery (P = 0.07) or race and days to treatment (P = 0.77). No covariate was significantly associated with receipt of surgery. Residence in a state with a higher obesity rate was associated with fewer days to treatment (P = 0.02). Conclusions: In a uniformly insured population that successfully received treatment, adjusted analysis found no evidence of a Black / White racial disparity in use of lung surgery for Stage 3 lung cancer or in timeliness of treatment. Given the directionality of the findings, they could potentially have been significant if the sample size had been increased by extending the enrollment period. The implication of these findings is that it may be most fruitful to address racial disparities at the frontend of the care process;working to ensure that patients have access to insurance, diagnostics, and treatments, as disparities were not observed in a population that had accessed treatment. Further research is needed to assess whether racial disparities in lung cancer treatment have dissipated over time.
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Background: Mammography screening significantly reduces breast-cancer related mortality;however, many women fail to undergo screening as recommended by national guidelines. No-shows are responsible for a significant proportion of delayed or missed cancer screening exams. Further, no-shows disproportionately affect underserved and minority populations. We previously identified a high no-show rate for screening mammograms among patients seeking care our institution. African American (AA) women were almost three times more likely to no-show than non-Hispanic white women. The racial disparity in no-shows persisted after adjustment for socioeconomic factors. The objective of this survey study was to identify reasons for missed mammogram screening appointments among AA women. Methods: We conducted a survey (via mail or telephone) of AA women who missed their screening mammogram appointment in summer 2021. Using a structured survey instrument, we collected information on patient-specific and health service barriers. Patient-specific barriers included procedure-related concerns (e.g., concern about discomfort), cognitive-emotional factors (e.g., fear of finding cancer), and changes in health status. Health service barriers included logistical factors (e.g., transportation), cost (e.g., lack of insurance) and scheduling problems (e.g., forgot about appointment or scheduled at an inconvenient time). Here we describe the most common reasons for missed appointments and compared women who reported patient-specific versus health service barriers. Results: 255 women who no-showed for their appointment were contacted and 91 participated in the study survey (35.6% response rate). Most respondents (90%) attributed their no-show to at least one of the listed barriers. Nineteen (7.5%) attributed their no-show to COVID-19, but only 1 person reported this as their only barrier. Scheduling issues were the most commonly reported barriers (57.8%), followed by transportation (38.9%). Three-quarters of respondents reported health service barriers, while only 40.7% reported patient-related barriers. The most common patient-related barriers were cognitiveemotional (25%), changes in health status (20.9%) and procedure-related concerns (15.6%). The majority of respondents (82.6%) were interested in rescheduling their mammogram. Conclusions: Most appointment no-shows among surveyed AA women resulted from potentially preventable scheduling and transportation issues. Relatively few respondents reported cognitive-emotional or procedure-related concerns. Further, the majority of respondents were interested in rescheduling their mammogram;which suggests that these women remain motivated to undergo breast cancer screening. Programs which address preventable health-service related issues may help these women keep their appointments.
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Background: With the murder of George Floyd and health disparities laid bare by the COVID pandemic, the US is reckoning with racial injustice. Across medicine and oncology, institutions are grappling with how to address systemic racism and improve care for patients of color. At the University of North Carolina (UNC), trainees developed an educational curriculum to raise awareness of implicit bias and introduce methods to address racial inequities. We present our findings on feasibility and acceptability of a fellow-led course on racism in medicine at a major academic medical center. Methods: UNC oncology fellows adapted a curriculum on implicit bias and racism in medicine in spring 2021. Our aims were 1) to improve knowledge and awareness about implicit bias and systemic racism and 2) introduce methods to address racial inequities. We used lived experiences and collated materials from scientific literature and lay media to illustrate key points. Sessions were: 1) Introduction and Implicit Bias, 2) Implicit Bias in Action: A Case Study, 3) Race-Based Metrics: Journal Club, 4) Career Perspective on Equity in Oncology. Videos, journal articles, and group discussion were employed to appeal to many learning styles. Results: Four sessions were held virtually for the Divisions of Oncology and Hematology. Attendance ranged from 28 to 35 per session. A post curriculum survey assessed perception of racial inequality in medicine and the series' effects using a Likert scale. Twenty-nine participants completed the survey, 12 of whom were fellows. Of all participants, 71% reported that the course improved knowledge or awareness of racial inequities “some” or “a great deal” and 61% reported that it improved their comfort level addressing racial inequities “some” or “a great deal.” All participants endorsed at least “some” racial inequity in medicine. Notably, over 75% of participants indicated interest in further sessions. Conclusions: Formulation of an educational curriculum by fellows and delivered in a division wide setting was feasible and well received by participants with robust discussion and interest in further work. Fundamental to this series' effectiveness was creating a space for discussion and reflection among colleagues. The goals of improving knowledge and introducing methods to address racial inequities were met. Importantly, our course was integrated alongside institutional efforts on DEI. We were limited by a lack of pre-course survey results due to a technical error. Given the current groundswell of interest and focus in improving racial equity in our society, we encourage other institutions to take similar steps to highlight issues of systemic racism and continue to move our field in the right direction.
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BACKGROUND: The spatial mismatch hypothesis (SMH) postulates that the discrepancy between where Black workers live and where they have access to jobs can lead to higher unemployment and worse economic outcomes. This gap exists due to structural factors such as redlining and hiring discrimination. As one of the most salient structural factors preventing economic mobility, the SMH provides a novel lens for examining racial disparities during the COVID19 pandemic. This study explores whether there is an association between measures of spatial mismatch and COVID-19 positivity rates by neighborhood racial composition. METHODS: We conducted a retrospective cohort study of patients tested for COVID-19 at an academic medical center and five community-based testing sites in Chicago (March 12-June 25, 2020). Analyses were limited to patients living in Black or White majority neighborhoods, and those with missing data were removed. Each patient's residential address was geocoded to the census block group level and paired with neighborhood race/ethnicity data (majority Black or White) from the 2018 American Community Survey. The dependent variable was COVID-19 positivity, defined by a PCR-positive sample and extracted from the electronic health record. The primary independent variables were neighborhood racial composition and three different measures of SMH at the block group level-commute time, public transportation usage, and neighborhood low-wage job rate. Mixed effects logistic regression models were used to assess COVID-19 positivity as an independent function of block group racial composition and SMH variables, adjusting for patient sociodemographic factors and insurance type. RESULTS: Among 21,285 patients tested for COVID-19, data on 14,488 patients from 1,752 block groups were analyzed. Patients were predominantly non-Hispanic Black (69.2%), female (60.9%), and ages 50-64 (23.8%). There were significant differences in the patterns of neighborhood racial composition and SMH measures. For example, <10% of patients living in a White majority neighborhood (n=347) also lived in a neighborhood with high travel time (>75th percentile) to work. Patients living in a Black majority neighborhood had 2.06 times higher adjusted odds (95% CI, 1.76-2.42) of COVID-19 positivity relative to those in a White majority neighborhood. High travel time (AOR=1.35;95% CI, 1.12-1.64), high public transportation usage (AOR=1.24, 95% CI, 1.01-1.51), and low neighborhood low-wage job rate (AOR=1.32;95% CI, 1.05-1.65) were associated with higher COVID-19 positivity. In a cumulative model, spatial mismatch accounted for 12.6% of the disparity in COVID positivity. CONCLUSIONS: The SMH accounted for a small but significant proportion of the racial disparity in COVID-19 positivity among patients at an academic medical center in Chicago. The impact of spatial mismatch should be explored for other health outcomes, particularly chronic disease, to quantify its contribution to health disparities and better target interventions.
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BACKGROUND: Food insecurity is an important social determinant of health that links to various health conditions and exacerbated by the COVID- 19 pandemic. Our previous (unpublished) study showed a progress on the food scarcity prevalence among US adults after December 2020 when US economy started recovering quickly. We developed a hypothesis that the rapid US economic recovery has had a greater impact on the food scarcity in the vulnerable groups (Hispanic/Black). METHODS: We conducted a secondary data analysis of nationwide US adults using Household Pulse Survey (HPS) from the US Census Bureau. HPS asks about impacts of COVID-19 pandemic on daily lives among US adults. Bi- weekly data tables summarize national estimates of food security and racial differences in their responses. Food scarcity is defined as those reporting “sometimes” or “often” not enough to eat in the last 7 days. We performed multi group interrupted time series analysis to compare the effect of US economic recovery that began in December 2020 on the racial disparity in food scarcity. We chose the vulnerable group (Black/Hispanic) as the treatment group and White as the control group. RESULTS: Among nearly 250,000,000 US adults per 2 weeks, 63% was White, followed by 17% Hispanic, and 5% Black. The food scarcity rate in the control group was incremental by 0.3% per 2 weeks in the pre-intervention period (b = 0.003, p < 0.001) but it started decreasing by 0.4% per 2 weeks in the post-intervention period (b = -0.004, p < 0.001). Figure shows the effect of economic recovery on the food scarcity rate between races. Black/Hispanic group had 0.10- point higher rate of food scarcity at the beginning (b = 0.10, p < 0.001) but showed an additional 0.5%-point decrement per 2 weeks in food scarcity rate on top of the baseline effect of 0.4% decrement (b = -0.005, p = 0.019) in the post- intervention. CONCLUSIONS: The gap in food scarcity between White and Hispanic/ Black groups decreased after US economy started recovering in December 2020. Our results indicate that the economic recovery provided the vulnerable group with additional benefits to reduce food scarcity.
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BACKGROUND: Food insecurity is a part of social determinants of health associated with various health conditions. Increase in households with food insecurity has been reported in the COVID-19 pandemic, but the racial disparity and trend of food insecurity during the pandemic remains unclear. METHODS: We conducted an exploratory data analysis of Household Pulse Survey (HPS) from the US Census Bureau. HPS is a biweekly survey of nationally representative samples of adults in the households. US Census Bureau defines “food scarcity” as respondents who reported “sometimes” or “often” not enough to eat in the last 7 days. We created time series plots of the following national estimates over 34 weeks from June 2020 to September 2021: proportion of (1) food scarcity, (2) at-risk of food scarcity, (3) food sufficient groups stratified by race as well as (4) sources of money to buy food (5) experienced/expected unemployment in 4 weeks. RESULTS: Of an estimated average of 249,546,185 US adults per survey, 62.5% were White, 17.1% Hispanic, 11.4% Black, 5.2% Asian, and 3.8% Other. Age between 25-54 was the most common (51.6%) while 22% were 65 and older. Female comprised 51.6%. On average, 12.1% of Hispanic, 14.0% of Black, and 11.3% of Other adults were classified as having food scarcity as compared to 5.3% of White and 3.1% of Asian adults. Time series plots (Figure) suggested that the proportion of food scarcity was incremental from June to December 2020 and began decreasing after December 2020. This trend was seen across all racial groups, but the gaps in food scarcity rates narrowed between Black/Hispanic and White races. CONCLUSIONS: US adults/households suffered from food scarcity amid COVID-19 pandemic but there have been improvements in food scarcity after December 2020. We hypothesize that the observed improvement was not because of food assistance but because US economy started recovering and they started gaining regular income sources. Racial disparity, however, remains to be the concern especially for Black and Hispanic populations.
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BACKGROUND: The COVID-19 pandemic led to a large increase in virtual care. Traditionally, E-visits (asynchronous provider evaluation via an online portal) and video visits (synchronous evaluation using real-time audio/video) have been utilized. However, there are racial, financial, and age-related disparities in home broadband access (Pew). During the pandemic, payers reimbursed telephone evaluation and management visits, increasing access to virtual care. However, barriers remained for patients without broadband access or video-enabled devices. We aim to assess racial disparity between black and white patients and whether age or socioeconomic status are associated with use of virtual visits. METHODS: A retrospective review was conducted of first-time visits with primary care providers from 3/1/20 to 6/30/20 at a large health system. Data was collected on type of visit, race, age, and area deprivation index (ADI).ADI ranks neighborhoods by socioeconomic status (SES) using census block groups based on income, house quality, employment, and education. Higher ADI is a marker of lower socioeconomic status (ADI of 10 is lowest SES, ADI of 1 is highest SES). RESULTS: 72153 unique patients were identified of whom 31037 (43%) received virtual care;13871 (19.2%) video, 14697 (20.3%) telephone (audio only), and 2469 (3.4%) E-visits. The mean age was 55.6 years, 32760 (45.4%) individuals identified as black, and 44784 (62.1%) were female. The average ADI was 5.23 (±3.17). Black patients had lower SES compared to white patients (6.96±2.93 vs 3.8±2.6). There was no difference in overall virtual care use rate between black and white patients (45.6% vs 45.2%, p=0.240). However, black patients were less likely to use E-visits (4.7% vs 6.4%, p=0.001), with no difference between telephone (26.5% vs 26.2%, p=0.298) or video visits (25.2% vs 25.3%, p=0.823). In multivariable logistic regression (Table 1), although black race was not significantly associated with virtual care use for primary care, age and SES did predict access to virtual care suggesting ages 18-29 and >65 and higher SES were less likely to utilize virtual care. CONCLUSIONS: During the first wave of the COVID-19 pandemic, black and white patients used virtual care at equal rates. However, there is a complex relationship between race, age and virtual care use. Further research is needed to examine the causal mechanisms.
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Background. Research has reported that African American (AA) cancer patients with COVID-19 had a higher hospitalization rate than their white counterparts. Because the severity of COVID-19 is partly related to existing chronic diseases, one of the speculations is that racial differences in COVID-19 severity are attributable to AA cancer patients having a higher prevalence of chronic illnesses. Our study aimed to assess the impact of existing chronic diseases on the racial differences in hospitalization and length of hospitalization in COVID-19 cancer patients in Louisiana. Methods. We linked cancer cases diagnosed in 2015-2019 from the Louisiana Tumor Registry (LTR) with the statewide COVID-19 data to identify COVID-19 patients who had been previously diagnosed with cancer. We also identified chronic illnesses (i.e., heart disease, peripheral vascular and cerebrovascular diseases, pulmonary disease, renal disease, liver disease, diabetes, and others) from 2012-2020 hospital discharge data and LTR data. Age and census tract level poverty were at the time of COVID-19 diagnosis. Bivariate and multivariable logistic regressions were used to exam the association of race with hospitalization after adjusting for socio-demographic and chronic illnesses. The multivariable Poisson model was used to assess the racial disparity in length (in days) of hospitalization. Results. Of 6,518 COVID-19 cancer patients, there were 30.8% AA, 68.4% whites, and 0.8% other races. AA, male, older, residing in high poverty, and patients with chronic illnesses were more likely (P<0.05) to be hospitalized. The odds of hospitalization was 87.2% higher among AA patients than white patients in bivariate analysis. After adjusting for age, gender, poverty, obesity, smoking status, and chronic illnesses, the odds of hospitalization was still higher for AA than white patients (OR=1.81;95% CI: 1.55-2.09). The length of hospital stay for AA was more (P<0.05) than whites After adjusting for the same covariates. Conclusion. Sociodemographic factors and chronic illnesses are associated with the severity of COVID-19 among cancer patients. However, AA COVID-19 cancer patients have significantly higher odds of hospitalization and longer hospital stays even when controlling these factors. More research is warranted to determine underlying factors of the observed racial disparities.
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High COVID-19 mortality among Black communities heightened the pandemic's devastation. In the state of Louisiana, the racial disparity associated with COVID-19 mortality was significant; Black Americans accounted for 50% of known COVID-19-related deaths while representing only 32% of the state's population. In this paper, we argue that structural racism resulted in a synergistic framework of cumulatively negative determinants of health that ultimately affected COVID-19 deaths in Louisiana Black communities. We identify the spatial distribution of social, environmental, and economic stressors across Louisiana parishes using hot spot analysis to develop aggregate stressors. Further, we examine the correlation between stressors, cumulative health risks, COVID-19 mortality, and the size of Black populations throughout Louisiana. We hypothesized that parishes with larger Black populations (percentages) would have larger stressor values and higher cumulative health risks as well as increased COVID-19 mortality rates. Our results suggest two categories of parishes. The first group has moderate levels of aggregate stress, high population densities, predominately Black populations, and high COVID-19 mortality. The second group of parishes has high aggregate stress, lower population densities, predominantly Black populations, and initially low COVID-19 mortality that increased over time. Our results suggest that structural racism and inequities led to severe disparities in initial COVID-19 effects among highly populated Black Louisiana communities and that as the virus moved into less densely populated Black communities, similar trends emerged.
Subject(s)
COVID-19 , Health Equity , Healthcare Disparities , COVID-19/mortality , Healthcare Disparities/ethnology , Humans , Louisiana/epidemiology , Population Density , Race FactorsABSTRACT
Background: Studies have shown that COVID-19 has had a disproportionate effect on minority groups in both the clinical and social settings in America. We conducted a follow up study on patients previously diagnosed with COVID-19 one year ago in an urban community in New Jersey. The purpose of the study was to evaluate the socioeconomic impact of COVID-19 as well as assess for receptiveness towards COVID-19 vaccination amongst various ethnic groups. Methods: This was a prospective cohort study consisting of patients who had recovered from COVID-19 one year prior. The patients included in the study had a confirmed COVID-19 diagnosis in the months of March and April of 2020. This was a single institutional study conducted at St. Joseph's University Medical Center in Paterson, NJ from the months of March to April of 2021. Patients included in the study were either male or female aged 18 years or older. Patients who met criteria for inclusion were contacted by telephone to participate in a telephone survey. After informed consent was obtained, the patients completed a survey which obtained sociodemographic information pertaining to their diagnosis with COVID-19. Statistical analysis was performed using chi-square testing and multivariable logistic regression analysis. Results: Of the 170 patients enrolled in the study, the most common ethnicity was Hispanic (79/170 [46.47%]), followed by African American (46/170 [27.05%]). The gender distribution was 83 male (83/170 [48.82%]) and 87 female (87/170 [51.18%]) with a mean age of 51.5. Caucasians were the most willing to receive a COVID-19 vaccine (28/30 [93.3%]), followed by Asians (13/14 [92.8%]), Hispanics (63/78 [80.7%]) and African Americans (29/46 [63.0%]). Hispanics had the highest rate of job loss (31/79 [39.24%]), followed by of African Americans (16/46 [34.7%]). Hispanics were found to be in the most financial distress (31/79 [39.2%]), followed by African Americans (17/46 [36.9%]). Chi square analysis revealed Hispanics and African Americans were more likely to lose their jobs after being diagnosed with COVID-19 (p: 0.04). Hispanics and African Americans were also more likely to refuse vaccination with any of the available COVID-19 vaccines (p: 0.02). Multivariable Logistic regression analysis was then performed comparing both Hispanics and African Americans to Caucasians. Hispanics were more likely to lose their jobs compared to Caucasians (odds ratio, 4.456; 95% CI, 1.387 to 14.312; p: 0.0121). African Americans were also more likely to lose their jobs when compared to Caucasians (odds ratio, 4.465; 95% CI, 1.266 to 15.747; p: 0.0200). Discussion: Overall Hispanics reported the highest rates of financial distress after their diagnosis with COVID-19. Nearly 40% of the Hispanic lost their jobs following their diagnosis with COVID-19 which was the highest in our study group. African Americans were similarly affected with about 37% of all patients experiencing job loss and financial distress following diagnosis with COVID-19. Hispanics and african americans were the two ethnic groups who were least willing to receive COVID-19 vaccination. Only 63% of African Americans were willing to receive the vaccine, with 80.7% of Hispanics willing to become vaccinated. The most common reason for not receiving any of the COVID-19 vaccines was due to lack of trust in the vaccine. Both Hispanics and African Americans were more statistically likely to lose their jobs as well as refuse COVID-19 vaccination following diagnosis with COVID-19.