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1.
PLoS One ; 16(8): e0256074, 2021.
Article in English | MEDLINE | ID: covidwho-1817376

ABSTRACT

BACKGROUND: Asian-Americans are one of the most understudied racial/ethnic minority populations. To increase representation of Asian subgroups, researchers have traditionally relied on data collection at community venues and events. However, the COVID-19 pandemic has created serious challenges for in-person data collection. In this case study, we describe multi-modal strategies for online recruitment of U.S. Vietnamese parents, compare response rates and participant characteristics among strategies, and discuss lessons learned. METHODS: We recruited 408 participants from community-based organizations (CBOs) (n = 68), Facebook groups (n = 97), listservs (n = 4), personal network (n = 42), and snowball sampling (n = 197). Using chi-square tests and one-way analyses of variance, we compared participants recruited through different strategies regarding sociodemographic characteristics, acculturation-related characteristics, and mobile health usage. RESULTS: The overall response rate was 71.8% (range: 51.5% for Vietnamese CBOs to 86.6% for Facebook groups). Significant differences exist for all sociodemographic and almost all acculturation-related characteristics among recruitment strategies. Notably, CBO-recruited participants were the oldest, had lived in the U.S. for the longest duration, and had the lowest Vietnamese language ability. We found some similarities between Facebook-recruited participants and those referred by Facebook-recruited participants. Mobile health usage was high and did not vary based on recruitment strategies. Challenges included encountering fraudulent responses (e.g., non-Vietnamese). Perceived benefits and trust appeared to facilitate recruitment. CONCLUSIONS: Facebook and snowball sampling may be feasible strategies to recruit U.S. Vietnamese. Findings suggest the potential for mobile-based research implementation. Perceived benefits and trust could encourage participation and may be related to cultural ties. Attention should be paid to recruitment with CBOs and handling fraudulent responses.


Subject(s)
Asian Americans/statistics & numerical data , Internet , Patient Selection , Adult , Asian Americans/psychology , Cultural Characteristics , Female , Humans , Male , Middle Aged , Selection Bias , Socioeconomic Factors
2.
Public Health Rep ; 137(2): 317-325, 2022.
Article in English | MEDLINE | ID: covidwho-1582749

ABSTRACT

OBJECTIVES: Data on the health burden of COVID-19 among Asian American people of various ethnic subgroups remain limited. We examined COVID-19 outcomes of people of various Asian ethnic subgroups and other racial and ethnic groups in an urban safety net hospital system. METHODS: We conducted a retrospective analysis of 85 328 adults aged ≥18 tested for COVID-19 at New York City's public hospital system from March 1 through May 31, 2020. We examined COVID-19 positivity, hospitalization, and mortality, as well as demographic characteristics and comorbidities known to worsen COVID-19 outcomes. We conducted adjusted multivariable regression analyses examining racial and ethnic disparities in mortality. RESULTS: Of 9971 Asian patients (11.7% of patients overall), 48.2% were South Asian, 22.2% were Chinese, and 29.6% were in other Asian ethnic groups. South Asian patients had the highest rates of COVID-19 positivity (30.8%) and hospitalization (51.6%) among Asian patients, second overall only to Hispanic (32.1% and 45.8%, respectively) and non-Hispanic Black (27.5% and 57.5%, respectively) patients. Chinese patients had a mortality rate of 35.7%, highest of all racial and ethnic groups. After adjusting for demographic characteristics and comorbidities, only Chinese patients had significantly higher odds of mortality than non-Hispanic White patients (odds ratio = 1.44; 95% CI, 1.04-2.01). CONCLUSIONS: Asian American people, particularly those of South Asian and Chinese descent, bear a substantial and disproportionate health burden of COVID-19. These findings underscore the need for improved data collection and reporting and public health efforts to mitigate disparities in COVID-19 morbidity and mortality among these groups.


Subject(s)
Asian Americans/statistics & numerical data , COVID-19/ethnology , Health Status Disparities , Social Determinants of Health/ethnology , Adult , Aged , Female , Hospitalization , Hospitals, Public , Humans , Male , Middle Aged , New York City , Retrospective Studies , SARS-CoV-2 , Safety-net Providers , Young Adult
3.
J Am Coll Surg ; 232(5): 682-689.e5, 2021 05.
Article in English | MEDLINE | ID: covidwho-1454247

ABSTRACT

BACKGROUND: If Asian American and Pacific Islanders (AAPIs) are not recognized within patients in health services research, we miss an opportunity to ensure health equity in patient outcomes. However, it is unknown what the rates are of AAPIs inclusion in surgical outcomes research. STUDY DESIGN: Through a scoping review, we used Covidence to search MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, and CINAHL for studies published in 2008-2018 using NSQIP data. NSQIP was chosen because of its national scope, widespread use in research, and coding inclusive of AAPI patients. We examined the proportion of studies representing AAPI patients in the demographic characteristics and Methods, Results, or Discussion section. We then performed multivariable logistic regression to examine associations between study characteristics and AAPI inclusion. RESULTS: In 1,264 studies included for review, 62% included race. Overall, only 22% (n = 278) of studies included AAPI patients. Of studies that included race, 35% represented AAPI patients in some component of the study. We found no association between sample size or publication year and inclusion. Studies were significantly more likely to represent AAPI patients when there was a higher AAPI population in the region of the first author's institution (lowest vs highest tercile; p < 0.001). Studies with a focus on disparities were more likely to include AAPI patients (p = 0.001). CONCLUSIONS: Our study is the first to examine AAPI representation in surgical outcomes research. We found < 75% of studies examine race, despite availability within NSQIP. Little more than one-third of studies including race reported on AAPI patients as a separate group. To provide the best care, we must include AAPI patients in our research.


Subject(s)
Asian Americans/statistics & numerical data , Health Services Research/statistics & numerical data , Patient Selection , Specialties, Surgical/statistics & numerical data , Health Services Research/standards , Healthcare Disparities/statistics & numerical data , Humans , Patient Acceptance of Health Care/statistics & numerical data , Specialties, Surgical/organization & administration , Specialties, Surgical/standards , Treatment Outcome
5.
Am Psychol ; 76(4): 643-657, 2021.
Article in English | MEDLINE | ID: covidwho-1364572

ABSTRACT

This study examines adjustment patterns among a group neglected in developmental science-Asian American students in high-achieving schools. National reports have declared such schools to connote risk for elevated problems among teens. Asian American students are commonly referred to as model minorities, but little is known about adjustment issues within academically competitive settings, specifically. Guided by past research on culturally salient issues, multiple U.S. high schools were examined to (a) determine areas of relative strength versus weakness in adjustment of Asian Americans compared with Whites, and (b) more importantly, to illuminate salient within-group processes related to Asian Americans' well-being. Risk modifiers examined were perceptions of ethnic discrimination, parent perfectionism, internalized achievement pressure, authenticity in self-presentation, and closeness to school adults. Outcome variables included depression, anxiety, and isolation at school. Results demonstrated that Asian Americans fared better than Whites on anxiety and school isolation, but with low effect sizes. By contrast, they fared more poorly on almost all risk modifiers, with a large effect size on discrimination. Regression results showed that among Asian Americans the most consistent associations, across cohorts and outcomes, were for discrimination and authenticity. Findings underscore the need for greater recognition that discrimination could be inimical for students not typically thought of as vulnerable-Asian Americans in high-achieving schools; these issues are especially pressing in light of increased racism following coronavirus disease 2019 (COVID-19). Results also suggest that feelings of inauthenticity could be a marker of generalized vulnerability to internalizing symptoms. Implications for future theory and interventions are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Asian Americans , COVID-19 , Racism , Resilience, Psychological , Self Concept , Adolescent , Asian Americans/psychology , Asian Americans/statistics & numerical data , COVID-19/epidemiology , Humans , Racism/psychology , Risk , Schools , Students/psychology , Students/statistics & numerical data , United States/epidemiology
6.
Urology ; 156: 110-116, 2021 10.
Article in English | MEDLINE | ID: covidwho-1331280

ABSTRACT

OBJECTIVE: To examine differences between telephone and video-televisits and identify whether visit modality is associated with satisfaction in an urban, academic general urology practice. METHODS: A cross sectional analysis of patients who completed a televisit at our urology practice (summer 2020) was performed. A Likert-based satisfaction telephone survey was offered to patients within 7 days of their televisit. Patient demographics, televisit modality (telephone vs video), and outcomes of the visit (eg follow-up visit scheduled, orders placed) were retrospectively abstracted from each chart and compared between the telephone and video cohorts. Multivariate regression analysis was used to evaluate variables associated with satisfaction while controlling for potential confounders. RESULTS: A total of 269 patients were analyzed. 73% (196/269) completed a telephone televisit. Compared to the video cohort, the telephone cohort was slightly older (mean 58.8 years vs. 54.2 years, P = .03). There were no significant differences in the frequency of orders placed for medication changes, labs, imaging, or for in-person follow-up visits within 30 days between cohorts. Survey results showed overall 84.7% patients were satisfied, and there was no significant difference between the telephone and video cohorts. Visit type was not associated with satisfaction on multivariable analyses, while use of an interpreter [OR:8.13 (1.00-65.94); P = .05], labs ordered [OR:2.74 (1.12-6.70); P = .03] and female patient gender [OR:2.28 (1.03-5.03); P = .04] were significantly associated with satisfaction. CONCLUSION: Overall, most patients were satisfied with their televisit. Additionally, telephone- and video-televisits were similar regarding patient opinions, patient characteristics, and visit outcome. Efforts to increase access and coverage of telehealth, particularly telephone-televisits, should continue past the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Patient Satisfaction/statistics & numerical data , Telemedicine/methods , Telephone , Urology/statistics & numerical data , Videoconferencing , Adolescent , Adult , African Americans/statistics & numerical data , Aged , Asian Americans/statistics & numerical data , Clinical Laboratory Techniques , Communication Barriers , Cross-Sectional Studies , Female , Humans , Institutional Practice/statistics & numerical data , Language , Male , Middle Aged , Patient Satisfaction/ethnology , Retrospective Studies , SARS-CoV-2 , Sex Factors , Smoking , Surveys and Questionnaires , Transportation , Urban Population/statistics & numerical data , Young Adult
7.
Sleep Health ; 7(4): 459-467, 2021 08.
Article in English | MEDLINE | ID: covidwho-1313434

ABSTRACT

OBJECTIVES: This study investigates race-related disparities in sleep duration and quality among diverse young adults during the coronavirus 2019 (COVID-19) pandemic. DESIGN & SETTING: Online cross-sectional study of young adults in the United States in April 2020. PARTICIPANTS: About 547 American Indian/Alaskan Native (AIAN), Asian, Black, Latinx, and White young adults ages 18-25 years. MEASUREMENTS: Participants completed measures of sleep duration and quality, coronavirus victimization distress, depression, age, sex/gender, employment status, essential worker status, student status, residential region, socioeconomic status, concerns about contracting coronavirus and CDC health risks. RESULTS: Black young adults reported the largest disparity in sleep duration and quality. For sleep duration, AIAN, Asian, White, and Latinx young adults reported approximately one additional hour of sleep compared to Black respondents. Mediation analyses suggest that disparities in sleep duration between Asian and Black young adults may be explained by the higher likelihood of Black respondents being essential workers. For sleep quality, Latinx, White, AIAN, and Asian young adults reported higher levels than Black respondents. Including coronavirus victimization distress as an intervening pathway decreased the effect for Asian and White respondents on sleep quality, suggesting that coronavirus victimization distress partially explains Black and Asian, as well as Black and White differences in sleep quality. CONCLUSIONS: Black young adults reported the shortest sleep duration and lowest levels of sleep quality relative to AIAN, Asian, Latinx and White peers. Interpersonal experiences of coronavirus victimization and structural inequities may partially explain disparities during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Pandemics , Sleep , Adolescent , Adult , African Americans/statistics & numerical data , Alaskan Natives/statistics & numerical data , Asian Americans/statistics & numerical data , Female , Humans , Male , Time Factors , Young Adult
8.
Circulation ; 143(24): 2346-2354, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1304328

ABSTRACT

BACKGROUND: Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether diverse racial/ethnic populations have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths. METHODS: We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March to August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust SEs to compare change in deaths by race/ethnicity for each condition in 2020 versus 2019. RESULTS: There were a total of 339 076 heart disease and 76 767 cerebrovascular disease deaths from March through August 2020, compared with 321 218 and 72 190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 versus 1208.7; risk ratio for death [RR], 1.02 [95% CI, 1.02-1.03]), non-Hispanic Black (1783.7 versus 1503.8; RR, 1.19 [95% CI, 1.17-1.20]), non-Hispanic Asian (685.7 versus 577.4; RR, 1.19 [95% CI, 1.15-1.22]), and Hispanic (968.5 versus 820.4; RR, 1.18 [95% CI, 1.16-1.20]) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 versus 258.2; RR, 1.04 [95% CI, 1.03-1.05]), non-Hispanic Black (430.7 versus 379.7; RR, 1.13 [95% CI, 1.10-1.17]), non-Hispanic Asian (236.5 versus 207.4; RR, 1.15 [95% CI, 1.09-1.21]), and Hispanic (264.4 versus 235.9; RR, 1.12 [95% CI, 1.08-1.16]) populations. For both heart disease and cerebrovascular disease deaths, Black, Asian, and Hispanic populations experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, P<0.001). CONCLUSIONS: During the COVID-19 pandemic in the United States, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths caused by heart disease and cerebrovascular disease, suggesting that these groups have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of diverse populations.


Subject(s)
COVID-19/pathology , Cerebrovascular Disorders/mortality , Health Status Disparities , Heart Diseases/mortality , Adult , African Americans/statistics & numerical data , Aged , Asian Americans/statistics & numerical data , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/ethnology , Cerebrovascular Disorders/pathology , Female , Heart Diseases/complications , Heart Diseases/ethnology , Hospital Mortality/ethnology , Humans , Male , Middle Aged , Pandemics , Risk , SARS-CoV-2/isolation & purification , United States/epidemiology , /statistics & numerical data
9.
Cancer Epidemiol Biomarkers Prev ; 30(8): 1455-1458, 2021 08.
Article in English | MEDLINE | ID: covidwho-1301742

ABSTRACT

Since the start of the COVID-19 pandemic, Asian Americans have been subjected to rising overt discrimination and violent hate crimes, highlighting the health implications of racism toward Asian Americans. As Asian Americans are the only group for whom cancer is the leading cause of death, these manifestations of anti-Asian racism provoke the question of the impact of racism across the cancer continuum for Asian Americans. In this Commentary, we describe how the myth of the "model minority" overlooks the diversity of Asian Americans. Ignoring such diversity in sociocultural trends, immigration patterns, socioeconomic status, health behaviors, and barriers to care masks disparities in cancer risk, access to care, and outcomes across Asian American populations. We recommend cancer epidemiologists, population science researchers, and oncology providers direct attention toward: (i) studying the impacts of structural and personally mediated racism on cancer risk and outcomes; (ii) ensuring studies reflect the uniqueness of individual ethnic groups, including intersectionality, and uncover underlying disparities; and (iii) applying a critical race theory approach that considers the unique lived experiences of each group. A more nuanced understanding of cancer health disparities, and how drivers of these disparities are associated with race and differ across Asian American ethnicities, may elucidate means through which these disparities can be alleviated.


Subject(s)
Asian Americans/statistics & numerical data , Ethics, Research/education , Healthcare Disparities , Neoplasms/therapy , Racism/prevention & control , Asian Americans/psychology , Health Behavior , Humans , Racism/ethnology , Racism/psychology , Social Class
10.
JMIR Public Health Surveill ; 7(6): e23976, 2021 06 11.
Article in English | MEDLINE | ID: covidwho-1266619

ABSTRACT

BACKGROUND: The diverse Asian American population has been impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities experienced by this population are hidden. OBJECTIVE: This study aims to describe the Asian American community's experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center's (FQHC) health care services and response to challenges faced by the community. METHODS: We conducted a cross-sectional survey between May 20 and June 23, 2020, using a multipronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey question topics included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges. RESULTS: Among 1297 Asian American respondents, only 3.1% (39/1273) had previously been tested for COVID-19, and 46.6% (392/841) stated that they could not find a place to get tested. In addition, about two-thirds of respondents (477/707) reported feeling stressed, and 22.6% (160/707) reported feeling depressed. Furthermore, 5.6% (72/1275) of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32.2% (246/763) had lost their regular jobs and 22.5% (172/763) had reduced hours or reduced income. Additionally, 70.1% (890/1269) of respondents shared that they avoid leaving their home to go to public places (eg, grocery stores, church, and school). CONCLUSIONS: We found that Asian Americans had lower levels of COVID-19 testing and limited access to testing, a high prevalence of mental health issues and economic impacts, and a high prevalence of risk-avoidant behaviors (eg, not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the impact of the COVID-19 pandemic on Asian American communities served by an FQHC and underscore the longstanding need for culturally and linguistically appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multilingual and multicultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccination programs.


Subject(s)
Asian Americans/psychology , COVID-19 Testing/statistics & numerical data , COVID-19/ethnology , Healthcare Disparities/ethnology , Mental Disorders/ethnology , Pandemics , Risk Reduction Behavior , Adolescent , Adult , Aged , Asian Americans/statistics & numerical data , COVID-19/prevention & control , Child , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , San Francisco/epidemiology , Socioeconomic Factors , Surveys and Questionnaires , Young Adult
12.
J Prev Med Public Health ; 54(3): 161-165, 2021 May.
Article in English | MEDLINE | ID: covidwho-1259659

ABSTRACT

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood. METHODS: We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code. RESULTS: We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income

Subject(s)
COVID-19/ethnology , Poverty/statistics & numerical data , Adolescent , Adult , Aged , Asian Americans/statistics & numerical data , COVID-19/epidemiology , COVID-19 Testing/statistics & numerical data , Cross-Sectional Studies , Employment/statistics & numerical data , Female , Humans , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , Los Angeles/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Young Adult
13.
Circulation ; 143(24): 2346-2354, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1232383

ABSTRACT

BACKGROUND: Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether diverse racial/ethnic populations have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths. METHODS: We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March to August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust SEs to compare change in deaths by race/ethnicity for each condition in 2020 versus 2019. RESULTS: There were a total of 339 076 heart disease and 76 767 cerebrovascular disease deaths from March through August 2020, compared with 321 218 and 72 190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 versus 1208.7; risk ratio for death [RR], 1.02 [95% CI, 1.02-1.03]), non-Hispanic Black (1783.7 versus 1503.8; RR, 1.19 [95% CI, 1.17-1.20]), non-Hispanic Asian (685.7 versus 577.4; RR, 1.19 [95% CI, 1.15-1.22]), and Hispanic (968.5 versus 820.4; RR, 1.18 [95% CI, 1.16-1.20]) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 versus 258.2; RR, 1.04 [95% CI, 1.03-1.05]), non-Hispanic Black (430.7 versus 379.7; RR, 1.13 [95% CI, 1.10-1.17]), non-Hispanic Asian (236.5 versus 207.4; RR, 1.15 [95% CI, 1.09-1.21]), and Hispanic (264.4 versus 235.9; RR, 1.12 [95% CI, 1.08-1.16]) populations. For both heart disease and cerebrovascular disease deaths, Black, Asian, and Hispanic populations experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, P<0.001). CONCLUSIONS: During the COVID-19 pandemic in the United States, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths caused by heart disease and cerebrovascular disease, suggesting that these groups have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of diverse populations.


Subject(s)
COVID-19/pathology , Cerebrovascular Disorders/mortality , Health Status Disparities , Heart Diseases/mortality , Adult , African Americans/statistics & numerical data , Aged , Asian Americans/statistics & numerical data , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/ethnology , Cerebrovascular Disorders/pathology , Female , Heart Diseases/complications , Heart Diseases/ethnology , Hospital Mortality/ethnology , Humans , Male , Middle Aged , Pandemics , Risk , SARS-CoV-2/isolation & purification , United States/epidemiology , /statistics & numerical data
14.
Gynecol Oncol ; 162(1): 4-11, 2021 07.
Article in English | MEDLINE | ID: covidwho-1225432

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has quickly transformed healthcare systems with expansion of telemedicine. The past year has highlighted risks to immunosuppressed cancer patients and shown the need for health equity among vulnerable groups. In this study, we describe the utilization of virtual visits by patients with gynecologic malignancies and assess their social vulnerability. METHODS: Virtual visit data of 270 gynecology oncology patients at a single institution from March 1, 2020 to August 31, 2020 was obtained by querying a cohort discovery tool. Through geocoding, the CDC Social Vulnerability Index (SVI) was utilized to assign social vulnerability indices to each patient and the results were analyzed for trends and statistical significance. RESULTS: African American patients were the most vulnerable with a median SVI of 0.71, Asian 0.60, Hispanic 0.41, and Caucasian 0.21. Eighty-seven percent of patients in this study were Caucasian, 8.9% African American, 3.3% Hispanic, and 1.1% Asian, which is comparable to the baseline institutional gynecologic cancer population. The mean census tract SVI variable when comparing patients to all census tracts in the United States was 0.31 (range 0.00 least vulnerable to 0.98 most vulnerable). CONCLUSIONS: Virtual visits were utilized by patients of all ages and gynecologic cancer types. African Americans were the most socially vulnerable patients of the cohort. Telemedicine is a useful platform for cancer care across the social vulnerability spectrum during the pandemic and beyond. To ensure continued access, further research and outreach efforts are needed.


Subject(s)
COVID-19/prevention & control , Genital Neoplasms, Female/therapy , Patient Acceptance of Health Care/statistics & numerical data , Telemedicine/statistics & numerical data , Vulnerable Populations/statistics & numerical data , African Americans/statistics & numerical data , Aged , Asian Americans/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Cohort Studies , Communicable Disease Control/standards , Female , Genital Neoplasms, Female/diagnosis , Gynecology/organization & administration , Gynecology/standards , Gynecology/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Medical Oncology/organization & administration , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Middle Aged , Pandemics/prevention & control , Socioeconomic Factors , Telemedicine/organization & administration , Telemedicine/standards , United States/epidemiology , /statistics & numerical data
15.
Ann Intern Med ; 174(3): 362-373, 2021 03.
Article in English | MEDLINE | ID: covidwho-1190609

ABSTRACT

BACKGROUND: Data suggest that the effects of coronavirus disease 2019 (COVID-19) differ among U.S. racial/ethnic groups. PURPOSE: To evaluate racial/ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and COVID-19 outcomes, factors contributing to disparities, and interventions to reduce them. DATA SOURCES: English-language articles in MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, searched from inception through 31 August 2020. Gray literature sources were searched through 2 November 2020. STUDY SELECTION: Observational studies examining SARS-CoV-2 infections, hospitalizations, or deaths by race/ethnicity in U.S. settings. DATA EXTRACTION: Single-reviewer abstraction confirmed by a second reviewer; independent dual-reviewer assessment of quality and strength of evidence. DATA SYNTHESIS: 37 mostly fair-quality cohort and cross-sectional studies, 15 mostly good-quality ecological studies, and data from the Centers for Disease Control and Prevention and APM Research Lab were included. African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection, hospitalization, and COVID-19-related mortality compared with non-Hispanic White populations, but not higher case-fatality rates (mostly reported as in-hospital mortality) (moderate- to high-strength evidence). Asian populations experience similar outcomes to non-Hispanic White populations (low-strength evidence). Outcomes for other racial/ethnic groups have been insufficiently studied. Health care access and exposure factors may underlie the observed disparities more than susceptibility due to comorbid conditions (low-strength evidence). LIMITATIONS: Selection bias, missing race/ethnicity data, and incomplete outcome assessments in cohort and cross-sectional studies must be considered. In addition, adjustment for key demographic covariates was lacking in ecological studies. CONCLUSION: African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection and COVID-19-related mortality but similar rates of case fatality. Differences in health care access and exposure risk may be driving higher infection and mortality rates. PRIMARY FUNDING SOURCE: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development. (PROSPERO: CRD42020187078).


Subject(s)
COVID-19/ethnology , COVID-19/mortality , Health Services Accessibility , Health Status Disparities , Hospitalization/statistics & numerical data , African Americans/statistics & numerical data , Asian Americans/statistics & numerical data , COVID-19/therapy , Humans , Pandemics , Risk Factors , SARS-CoV-2 , /statistics & numerical data
16.
Transl Behav Med ; 11(3): 785-792, 2021 04 07.
Article in English | MEDLINE | ID: covidwho-1153242

ABSTRACT

Widespread uptake of the COVID-19 vaccine is critical to halt the pandemic. At present, little is known about factors that will affect vaccine uptake, especially among diverse racial/ethnic communities that have experienced the highest burden of COVID. We administered an online survey to a Qualtrics respondent panel of women ages 27-45 years (N = 396) to assess vaccine intentions and attitudes, and trusted vaccine information sources. 56.8% intended to be vaccinated and 25.5% were unsure. In bivariate analyses, a greater percentage of non-Latina White (NLW) and Chinese women reported that they would be vaccinated, compared with Latina and non-Latina Black (NLB) women (p < 0.001). Those who were uninsured, unemployed and those with lower incomes were less likely to say that they would be vaccinated. In analyses stratified by race/ethnicity, NLB women remained significantly less likely to report that they would be vaccinated compared with NLW women (adjusted odds ratio: 0.47; 95% confidence interval: 0.23, 0.94), controlling for age, marital status, income, education, employment, and insurance status. When analyses were additionally controlled for beliefs in vaccine safety and efficacy, racial/ethnic differences were no longer significant (adjusted odds ratio: 0.64; 95% confidence interval: 0.31, 1.34). Given that NLB women were less likely to report the intention to be vaccinated, targeted efforts will be needed to promote vaccine uptake. It will be critical to emphasize that the vaccine is safe and effective; this message may be best delivered by trusted community members.


Subject(s)
African Americans/ethnology , Asian Americans/statistics & numerical data , COVID-19 Vaccines , Health Knowledge, Attitudes, Practice/ethnology , Mass Vaccination/ethnology , /ethnology , Adult , Female , Humans , Intention , Middle Aged , United States/ethnology , Women
19.
Health Aff (Millwood) ; 39(6): 1087-1091, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1007111
20.
Ann Intern Med ; 174(3): 362-373, 2021 03.
Article in English | MEDLINE | ID: covidwho-1005048

ABSTRACT

BACKGROUND: Data suggest that the effects of coronavirus disease 2019 (COVID-19) differ among U.S. racial/ethnic groups. PURPOSE: To evaluate racial/ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and COVID-19 outcomes, factors contributing to disparities, and interventions to reduce them. DATA SOURCES: English-language articles in MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, searched from inception through 31 August 2020. Gray literature sources were searched through 2 November 2020. STUDY SELECTION: Observational studies examining SARS-CoV-2 infections, hospitalizations, or deaths by race/ethnicity in U.S. settings. DATA EXTRACTION: Single-reviewer abstraction confirmed by a second reviewer; independent dual-reviewer assessment of quality and strength of evidence. DATA SYNTHESIS: 37 mostly fair-quality cohort and cross-sectional studies, 15 mostly good-quality ecological studies, and data from the Centers for Disease Control and Prevention and APM Research Lab were included. African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection, hospitalization, and COVID-19-related mortality compared with non-Hispanic White populations, but not higher case-fatality rates (mostly reported as in-hospital mortality) (moderate- to high-strength evidence). Asian populations experience similar outcomes to non-Hispanic White populations (low-strength evidence). Outcomes for other racial/ethnic groups have been insufficiently studied. Health care access and exposure factors may underlie the observed disparities more than susceptibility due to comorbid conditions (low-strength evidence). LIMITATIONS: Selection bias, missing race/ethnicity data, and incomplete outcome assessments in cohort and cross-sectional studies must be considered. In addition, adjustment for key demographic covariates was lacking in ecological studies. CONCLUSION: African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection and COVID-19-related mortality but similar rates of case fatality. Differences in health care access and exposure risk may be driving higher infection and mortality rates. PRIMARY FUNDING SOURCE: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development. (PROSPERO: CRD42020187078).


Subject(s)
COVID-19/ethnology , COVID-19/mortality , Health Services Accessibility , Health Status Disparities , Hospitalization/statistics & numerical data , African Americans/statistics & numerical data , Asian Americans/statistics & numerical data , COVID-19/therapy , Humans , Pandemics , Risk Factors , SARS-CoV-2 , /statistics & numerical data
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