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1.
JMIR Public Health Surveill ; 7(6): e23976, 2021 06 11.
Article in English | MEDLINE | ID: covidwho-2197875

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
3.
JAMA ; 327(6): 588-589, 2022 02 08.
Article in English | MEDLINE | ID: covidwho-2172107
5.
Int J Environ Res Public Health ; 19(12)2022 06 10.
Article in English | MEDLINE | ID: covidwho-2142774

ABSTRACT

Much of the differences in health care outcomes can be attributed to the differential rates of primary health care utilization and resource allocation across population subgroups [...].


Subject(s)
Patient Acceptance of Health Care , Rural Population , Healthcare Disparities , Humans , Primary Health Care , Urban Population
6.
Am J Public Health ; 112(10): 1412-1415, 2022 10.
Article in English | MEDLINE | ID: covidwho-2141106
8.
Front Health Serv Manage ; 39(2): 27-31, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2135664

ABSTRACT

For too long, healthcare disparities have negatively affected underrepresented groups in urban areas throughout the United States. Disparities in care and outcomes related to social determinants were known, and efforts were made to address them. Effective change for all moved up to top priority in the wake of COVID-19's arrival, police brutality, social unrest, and the murders of Black Americans, including George Floyd. Henry Ford Health (HFH), working with leading local community organizations, immediately pledged to address social and racial injustices. Unfortunately, many neighborhoods still suffer disproportionately from maternal and infant mortality, food insecurity, and other social vulnerabilities. HFH's commitment to equity includes creatively meeting the needs of the underserved. HFH has developed innovative ways to address the social, economic, and educational challenges to the health of Metro Detroit. Through thoughtful consideration and passionate leadership, HFH is strategically creating authentic and scalable social change to address racism and discrimination in healthcare.


Subject(s)
COVID-19 , Healthcare Disparities , Infant , Humans , United States , COVID-19/therapy , Infant Mortality
9.
Int J Environ Res Public Health ; 19(21)2022 Oct 27.
Article in English | MEDLINE | ID: covidwho-2123596

ABSTRACT

COVID-19 has disproportionally impacted Latinx and Black communities in the US. Our study aimed to extend the understanding of ethnic disparities in COVID-19 case rates by using a unique dataset of municipal case rates across New Jersey (NJ) during the first 17 months of the pandemic. We examined the extent to which there were municipal-level ethnic disparities in COVID-19 infection rates during three distinct spikes in case rates over this period. Furthermore, we used the Blinder-Oaxaca decomposition analysis to identify municipal-level exposure and vulnerability factors that contributed to ethnic disparities and how the contributions of these factors changed across the three initial waves of infection. Two clear results emerged. First, in NJ, the COVID-19 infection risk disproportionally affected Latinx communities across all three waves during the first 17 months of the pandemic. Second, the exposure and vulnerability factors that most strongly contributed to higher rates of infection in Latinx and Black communities changed over time as the virus, alongside medical and societal responses to it, also changed. These findings suggest that understanding and addressing ethnicity-based COVID-19 disparities will require sustained attention to the systemic and structural factors that disproportionately place historically marginalized ethnic communities at greater risk of contracting COVID-19.


Subject(s)
COVID-19 , Ethnicity , Humans , United States , COVID-19/epidemiology , Healthcare Disparities , New Jersey/epidemiology , Pandemics
10.
Parkinsonism Relat Disord ; 93: 97-102, 2021 12.
Article in English | MEDLINE | ID: covidwho-2119837

ABSTRACT

Inequalities in mental healthcare and lack of social support during the COVID-19 pandemic have lowered quality of life and increased overall burden of disease in people with Parkinson's (PWP). Although the pandemic has brought attention to these inequalities, they are long standing and will persist unless addressed. Lack of awareness of mental health issues is a major barrier and even when recognized disparities based on race, gender, and socioeconomic factors limit access to already scarce resources. Stigma regarding mental illness is highly prevalent and is a major barrier even when adequate care exists. Limited access to mental healthcare during the pandemic and in general increases the burden on caregivers and families. Historically, initiatives to improve mental healthcare for PWP focused on interventions designed for specialty and academic centers generally located in large metropolitan areas, which has created unintended geographic disparities in access. In order to address these issues this point of view suggests a community-based wellness model to extend the reach of mental healthcare resources for PWP.


Subject(s)
Healthcare Disparities/trends , Mental Disorders/therapy , Mental Health/trends , Parkinson Disease/therapy , Social Support/trends , Health Resources/trends , Humans , Mental Disorders/epidemiology , Mental Disorders/psychology , Parkinson Disease/epidemiology , Parkinson Disease/psychology , Social Support/psychology
13.
Acad Radiol ; 29(12): 1861-1862, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2116670
14.
Otolaryngol Head Neck Surg ; 166(6): 1013-1021, 2022 06.
Article in English | MEDLINE | ID: covidwho-2115872

ABSTRACT

The coronavirus pandemic has illuminated long-standing inequities in America's health care system and societal structure. While numerous studies have identified health care disparities within our specialty, few have progressed beyond detection. Otolaryngologists have the opportunity and the responsibility to act. Within this article, leaders from otolaryngology share their experience and perspective on health care disparities, including (1) a discussion of disparities in otolaryngology, (2) a summary of health care system design and incentives, (3) an overview of implicit bias, and (4) practical recommendations for providers to advance their awareness of health care disparities and the actions to mitigate them. While the path forward can be daunting, it should not be a deterrent. Throughout the course of this article, numerous resources are provided to support these efforts. To move ahead, our specialty needs to advance our level of understanding and develop, implement, and disseminate successful interventions toward the goal of eliminating health care disparities.


Subject(s)
Coronavirus Infections , Otolaryngology , Healthcare Disparities , Humans , Otolaryngologists , Pandemics/prevention & control
15.
BMC Health Serv Res ; 22(1): 1364, 2022 Nov 17.
Article in English | MEDLINE | ID: covidwho-2115847

ABSTRACT

OBJECTIVE: Primary health care (PHC) is widely perceived to be the backbone of health care systems. Since the outbreak of COVID-19, PHC has not only provided primary medical services, but also served as a grassroots network for public health. Our research explored the accessibility, availability, and affordability of primary health care from a spatial perspective, to understand the social determinants affecting access to it in Hong Kong. METHOD: This constitutes a descriptive study from the perspective of spatial analysis. The nearest neighbor method was used to measure the geographic accessibility of PHC based on the road network. The 2SFCA method was used to measure spatial availability and affordability to primary health care, while the SARAR model, Spatial Error model, and Spatial Lag model were then constructed to explain potential factors influencing accessibility and availability of PHC. RESULTS: In terms of accessibility, 95% of residents in Hong Kong can reach a PHC institution within 15 minutes; in terms of availability, 83% of residents can receive PHC service within a month; while in terms of affordability, only 32% of residents can afford PHC services with the support of medical insurance and medical voucher. In Hong Kong, education status and household income show a significant impact on accessibility and availability of PHC. Regions with higher concentrations of residents with post-secondary education receive more PHC resources, while regions with higher concentrations of high-income households show poorer accessibility and poorer availability to PHC. CONCLUSION: The good accessibility and availability of primary health care reflects that the network layout of existing PHC systems in Hong Kong is reasonable and can meet the needs of most residents. No serious gap between social groups further shows equality in resource allocation of PHC in Hong Kong. However, affordability of PHC is not ideal. Indeed, narrowing the gap between availability and affordability is key to fully utilizing the capacity of the PHC system in Hong Kong. The private sector plays an important role in this, but the low coverage of medical insurance in outpatient services exacerbates the crowding of public PHC and underutilization of private PHC. We suggest diverting patients from public to private institutions through medical insurance, medical vouchers, or other ways, to relieve the pressure on the public health system and make full use of existing primary health care in Hong Kong.


Subject(s)
COVID-19 , Primary Health Care , Social Determinants of Health , Humans , Costs and Cost Analysis , COVID-19/epidemiology , Hong Kong/epidemiology , Spatial Analysis , Health Services Accessibility , Healthcare Disparities
16.
Health Aff (Millwood) ; 41(11): 1598-1606, 2022 11.
Article in English | MEDLINE | ID: covidwho-2109345

ABSTRACT

Research demonstrates that receiving unemployment insurance decreases mental health problems. But researchers have also found racial and ethnic disparities in unemployment insurance receipt resulting from differences in work history and location. We examined a population disproportionately affected by job loss and unemployment insurance exclusions, using a survey of service workers from a single city who were parents of young children and who overwhelmingly had eligible work histories. During the COVID-19 pandemic, workers not identifying as White non-Hispanic in our sample were more likely to get laid off than White workers. Among those who were laid off, these workers and White workers experienced similar increases in material and mental health difficulties and similar gains when they received unemployment insurance. However, these workers were less likely than White workers to receive unemployment insurance at all. These results indicate that unemployment insurance has unrealized potential to reduce material and health disparities. Policies should be implemented to make this coverage more effective and equitable through increased access.


Subject(s)
COVID-19 , Pandemics , Child , Humans , United States , Child, Preschool , Healthcare Disparities , Unemployment , Insurance, Health
17.
J Health Care Poor Underserved ; 33(4): 1965-1984, 2022.
Article in English | MEDLINE | ID: covidwho-2109266

ABSTRACT

Delayed medical care is a negative consequence of the COVID-19 pandemic for families with young children. Our study used data from the Accessing California Communities' Experiences with Safety net Supports (ACCESS) survey, a cross-sectional study that assessed experiences with safety-net programs among working families with low incomes (n=491). From August 2020 to May 2021, we conducted interviewer-administered surveys of low-income families with young children (ages zero to eight) in California and asked questions about whether participants had delayed medical care for their children or themselves. We found that delaying care for children was associated with lack of childcare and with the child having pre-existing conditions. Delaying parental medical care was associated with lack of childcare, experiences of racism, government mistrust, and perceptions of welfare stigma. These results suggest that health care access may be improved through a focus on supporting childcare systems and addressing structural racism.


Subject(s)
COVID-19 , Delivery of Health Care , Health Services Accessibility , Child , Child, Preschool , Humans , California/epidemiology , COVID-19/epidemiology , Cross-Sectional Studies , Economic Factors , Pandemics , Healthcare Disparities
18.
Lancet Respir Med ; 10(11): 1009, 2022 11.
Article in English | MEDLINE | ID: covidwho-2106216
19.
JAMA Netw Open ; 5(11): e2241144, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2103438

ABSTRACT

This cross-sectional study explores geographic disparities in antiviral access by quantifying the accessibility of COVID-19 Test to Treat sites for subpopulations by race, ethnicity, age, and rurality.


Subject(s)
COVID-19 , Ethnicity , Humans , Rural Population , Healthcare Disparities
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