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1.
Bioethics ; 36(7): 816-817, 2022 09.
Article in English | MEDLINE | ID: covidwho-2078347
2.
PLoS Comput Biol ; 18(10): e1010516, 2022 10.
Article in English | MEDLINE | ID: covidwho-2065097

ABSTRACT

In 2020, the combination of police killings of unarmed Black people, including George Floyd, Breonna Taylor, and Ahmaud Arbery, and the Coronavirus Disease 2019 (COVID-19) pandemic brought about public outrage over long-standing inequalities in society. The events of 2020 ignited global attention to systemic racism and racial inequalities, including the lack of diversity, equity, and inclusion in the academy and especially in science, technology, engineering, mathematics, and medicine (STEMM) fields. Racial and ethnic diversity in graduate programs in particular warrants special attention as graduate students of color report experiencing alarming rates of racism, discrimination, microaggressions, and other exclusionary behaviors. As part of the Graduate Dean's Advisory Council on Diversity (GDACD) at the University of California Merced, the authors of this manuscript held a year-long discussion on these issues and ways to take meaningful action to address these persistent issues of injustices. We have outlined 10 rules to help graduate programs develop antiracist practices to promote racial and ethnic justice, equity, diversity, and inclusion (JEDI) in the academy. We focus on efforts to address systemic causes of the underrepresentation and attrition of students from minoritized communities. The 10 rules are developed to allow graduate groups to formulate and implement rules and policies to address root causes of underrepresentation of minoritized students in graduate education.


Subject(s)
COVID-19 , Racism , COVID-19/epidemiology , COVID-19/prevention & control , Ethnicity , Humans , Pandemics/prevention & control , Racial Groups
3.
JAMA ; 328(9): 861-871, 2022 09 06.
Article in English | MEDLINE | ID: covidwho-2058978

ABSTRACT

Importance: Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney disease progression. The equitability of these agents' prescription across racial and ethnic groups has not been well-evaluated. Objective: To investigate differences in the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with type 2 diabetes by racial and ethnic groups. Design, Setting, and Participants: Cross-sectional analysis of data from the US Veterans Health Administration's Corporate Data Warehouse. The sample included adult patients with type 2 diabetes and at least 2 primary care clinic visits from January 1, 2019, to December 31, 2020. Exposures: Self-identified race and self-identified ethnicity. Main Outcomes and Measures: The primary outcomes were prevalent SGLT2i or GLP-1 RA prescription, defined as any active prescription during the study period. Results: Among 1 197 914 patients (mean age, 68 years; 96% men; 1% American Indian or Alaska Native, 2% Asian, Native Hawaiian, or Other Pacific Islander, 20% Black or African American, 71% White, and 7% of Hispanic or Latino ethnicity), 10.7% and 7.7% were prescribed an SGLT2i or a GLP-1 RA, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 8.4% among American Indian or Alaska Native patients; 11.8% and 8% among Asian, Native Hawaiian, or Other Pacific Islander patients; 8.8% and 6.1% among Black or African American patients; and 11.3% and 8.2% among White patients, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 7.1% among Hispanic or Latino patients and 10.7% and 7.8% among non-Hispanic or Latino patients. After accounting for patient- and system-level factors, all racial groups had significantly lower odds of SGLT2i and GLP-1 RA prescription compared with White patients. Black patients had the lowest odds of prescription compared with White patients (adjusted odds ratio, 0.72 [95% CI, 0.71-0.74] for SGLT2i and 0.64 [95% CI, 0.63-0.66] for GLP-1 RA). Patients of Hispanic or Latino ethnicity had significantly lower odds of prescription (0.90 [95% CI, 0.88-0.93] for SGLT2i and 0.88 [95% CI, 0.85-0.91] for GLP-1 RA) compared with non-Hispanic or Latino patients. Conclusions and Relevance: Among patients with type 2 diabetes in the Veterans Health Administration system during 2019 and 2020, prescription rates of SGLT2i and GLP-1 RA medications were low, and individuals of several different racial groups and those of Hispanic ethnicity had statistically significantly lower odds of receiving prescriptions for these medications compared with individuals of White race and non-Hispanic ethnicity. Further research is needed to understand the mechanisms underlying these differences in rates of prescribing and the potential relationship with differences in clinical outcomes.


Subject(s)
Diabetes Mellitus, Type 2 , Glucagon-Like Peptide-1 Receptor , Healthcare Disparities , Prescriptions , Sodium-Glucose Transporter 2 Inhibitors , Veterans Health , Adult , Aged , Cross-Sectional Studies , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/ethnology , Ethnicity/statistics & numerical data , Female , Glucagon-Like Peptide-1 Receptor/agonists , Health Equity/statistics & numerical data , Healthcare Disparities/ethnology , Healthcare Disparities/statistics & numerical data , Humans , Hypoglycemic Agents/therapeutic use , Male , Practice Patterns, Physicians'/statistics & numerical data , Prescriptions/statistics & numerical data , Professional Practice/statistics & numerical data , Racial Groups/statistics & numerical data , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , United States/epidemiology , Veterans Health/ethnology , Veterans Health/statistics & numerical data
4.
J Correct Health Care ; 28(5): 296-300, 2022 10.
Article in English | MEDLINE | ID: covidwho-2051224

ABSTRACT

COVID-19 has disproportionately impacted Americans in carceral settings and secure facilities. A disproportionate number of persons who are confined to carceral settings and secure facilities are members of racial, ethnic, and socioeconomic groups who experience a significant burden of COVID-19 morbidity and mortality. The pandemic-related disparities experienced by minoritized and detained adult populations have received national attention, but the burden of COVID-19 risk among justice-involved youth has been largely absent from these national conversations. With more than 40,000 youth in carceral settings, their COVID-19 risks and prevention needs warrant specific consideration, especially as vaccine distribution programs expand. Youth have been assigned a lower priority status in most state vaccine allocation plans, but youth in carceral settings are at increased risk compared with their peers, raising important questions about how to ethically allocate and administer vaccines to them. In this article we examine ethical issues that arise in the health care of minors in carceral settings and identify an ethical model that could be used to reconsider the allocation of COVID-19 vaccines.


Subject(s)
COVID-19 , Vaccines , Adult , United States , Adolescent , Humans , COVID-19/prevention & control , COVID-19 Vaccines , Racial Groups , Ethnicity
5.
J Behav Med ; 45(5): 760-770, 2022 10.
Article in English | MEDLINE | ID: covidwho-2048387

ABSTRACT

Medical avoidance is common among U.S. adults, and may be emphasized among members of marginalized communities due to discrimination concerns. In the current study, we investigated whether this disparity in avoidance was maintained or exacerbated during the onset of the COVID-19 pandemic. We assessed the likelihood of avoiding medical care due to general-, discrimination-, and COVID-19-related concerns in an online sample (N = 471). As hypothesized, marginalized groups (i.e., non-White race, Latinx/e ethnicity, non-heterosexual sexual orientation, high BMI) endorsed more general- and discrimination-related medical avoidance than majoritized groups. However, marginalized groups were equally likely to seek COVID-19 treatment as majoritized groups. Implications for reducing medical avoidance among marginalized groups are discussed.


Subject(s)
COVID-19 , Healthcare Disparities , Pandemics , Patient Acceptance of Health Care , Social Marginalization , Vulnerable Populations , Adult , Body Mass Index , COVID-19/epidemiology , COVID-19/therapy , Ethnicity/statistics & numerical data , Female , Healthcare Disparities/statistics & numerical data , Humans , Male , Patient Acceptance of Health Care/statistics & numerical data , Racial Groups/statistics & numerical data , Sexual Behavior , Treatment Refusal/statistics & numerical data , United States/epidemiology , Vulnerable Populations/statistics & numerical data
6.
J Community Psychol ; 50(6): 2537-2541, 2022 08.
Article in English | MEDLINE | ID: covidwho-2047664

ABSTRACT

At the time of this special issue, coronavirus disease 2019 (COVID-19) is the leading cause of death in the United States and has contributed to millions of deaths worldwide. The world had no idea how the pandemic was going to impact our lives. COVID-19 exposed the inequities in our world and the individuals that were most impacted by it: vulnerable populations. Vulnerable populations may be defined as those living in poverty, living with disability, and racial, ethnic, sexual, and gender minorities. Additionally, as community psychologists we understand that the impact of inequities do not appear singlehandedly since as human beings we do not exist in a vacuum and there are multiple factors that create our level of health and well-being. Therefore, the idea of examining COVID-19 in a syndemic framework allows us to explore how a synergistic epidemic (i.e., the aggregation of two or more concurrent or sequential epidemics or disease clusters in a population with biological interactions) exacerbates the prognosis and burden of disease, which can impact vulnerable populations simultaneously. The main goal of this special issue concentrates on how COVID-19 had a synergistic impact on vulnerable populations and how these populations reacted and coped with these events.


Subject(s)
COVID-19 , Humans , Pandemics , Racial Groups , SARS-CoV-2 , United States/epidemiology , Vulnerable Populations
8.
Proc Natl Acad Sci U S A ; 119(40): e2210941119, 2022 10 04.
Article in English | MEDLINE | ID: covidwho-2037060

ABSTRACT

As research documenting disparate impacts of COVID-19 by race and ethnicity grows, little attention has been given to dynamics in mortality disparities during the pandemic and whether changes in disparities persist. We estimate age-standardized monthly all-cause mortality in the United States from January 2018 through February 2022 for seven racial/ethnic populations. Using joinpoint regression, we quantify trends in race-specific rate ratios relative to non-Hispanic White mortality to examine the magnitude of pandemic-related shifts in mortality disparities. Prepandemic disparities were stable from January 2018 through February 2020. With the start of the pandemic, relative mortality disadvantages increased for American Indian or Alaska Native (AIAN), Native Hawaiian or other Pacific Islander (NHOPI), and Black individuals, and relative mortality advantages decreased for Asian and Hispanic groups. Rate ratios generally increased during COVID-19 surges, with different patterns in the summer 2021 and winter 2021/2022 surges, when disparities approached prepandemic levels for Asian and Black individuals. However, two populations below age 65 fared worse than White individuals during these surges. For AIAN people, the observed rate ratio reached 2.25 (95% CI = 2.14, 2.37) in October 2021 vs. a prepandemic mean of 1.74 (95% CI = 1.62, 1.86), and for NHOPI people, the observed rate ratio reached 2.12 (95% CI = 1.92, 2.33) in August 2021 vs. a prepandemic mean of 1.31 (95% CI = 1.13, 1.49). Our results highlight the dynamic nature of racial/ethnic disparities in mortality and raise alarm about the exacerbation of mortality inequities for Indigenous groups due to the pandemic.


Subject(s)
COVID-19 , Health Status Disparities , Mortality , American Indians or Alaska Natives , Asians , Blacks , COVID-19/epidemiology , Ethnicity , Hispanic or Latino , Humans , Mortality/ethnology , Native Hawaiian or Other Pacific Islander , Pandemics , Racial Groups , United States/epidemiology , Whites
10.
Am J Public Health ; 112(10): 1421-1428, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2029853

ABSTRACT

Morbidity and mortality from COVID-19 have unduly affected older adults from racial and ethnic minority groups. In this article, we highlight the experiences and vulnerabilities of diverse older adults with complex health and social needs when their access to vital, but overlooked, community-based adult day service centers (ADSCs) was abruptly cut off during a pandemic. Pandemic-related ADSC closures left vulnerable older adults and their care partners without essential daily support and services, such as health monitoring and socialization. However, the magnitude of the impact of ADSC closures on well-being, particularly among members of racial/ethnic minority groups, has yet to be measured with any form of "big data" because large-scale, nationally representative data sets consisting of participant-level information and outcomes associated with ADSC participation do not yet exist. Unmet needs of older adults resulting from pandemic-related ADSC closures are underrecognized because of a lack of systematic data collection, undermining efforts to achieve health equity. We call on ADSCs to link rigorous collection of racial and ethnic data to quality measures of access to equitable "age-friendly" care as a means of better supporting diverse community-dwelling older adults beyond the COVID-19 pandemic. (Am J Public Health. 2022;112(10):1421-1428. https://doi.org/10.2105/AJPH.2022.306968).


Subject(s)
Adult Day Care Centers , COVID-19 , Health Equity , Health Services Needs and Demand , Aged , COVID-19/epidemiology , COVID-19/ethnology , Ethnicity , Humans , Minority Groups , Pandemics , Racial Groups
12.
JAMA Intern Med ; 182(8): 858, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-2003580
13.
14.
Rev Bras Enferm ; 75(6): e20210482, 2022.
Article in English, Portuguese | MEDLINE | ID: covidwho-1987211

ABSTRACT

OBJECTIVE: To analyze the mortality rate of COVID-19 among children and adolescents aged 0 to 14 years. METHODS: Ecological and exploratory study of children's mortality rate by COVID-19 in Brazil, from February to October 2020. The study used the Severe Acute Respiratory Syndrome database to collect the data and made the analysis using descriptive spatial statistics by age and race/color classification. RESULT: The mortality rate due to COVID-19 represented 1.34 deaths per one hundred thousand in the total group evaluated. The age group with the highest frequency and mortality rate was 1 to 4 years of age. There is a higher frequency of deaths in the brown and Indigenous population. CONCLUSION: The distribution of deaths due to COVID-19 is unequal in the national territory, and there is a wide variation in the mortality rate by age and race/color groups.


Subject(s)
COVID-19 , Adolescent , Brazil/epidemiology , COVID-19/epidemiology , Child , Child, Preschool , Humans , Infant , Racial Groups
15.
Popul Health Manag ; 25(4): 462-471, 2022 08.
Article in English | MEDLINE | ID: covidwho-1985014

ABSTRACT

Many studies have assessed the factors associated with overall video visit use during the COVID-19 pandemic, but little is known about who is most likely to continue to use video visits and why. The authors combined a survey with electronic health record data to identify factors affecting the continued use of video visit. In August 2020, a stratified random sample of 20,000 active patients from a large health care system were invited to complete an email survey on health care seeking preferences during the COVID. Weighted logistic regression models were applied, adjusting for sampling frame and response bias, to identify factors associated with video visit experience, and separately for preference of continued use of video visits. Actual video visit utilization was also estimated within 12 months after the survey. Three thousand three hundred fifty-one (17.2%) patients completed the survey. Of these, 1208 (36%) reported having at least 1 video visit in the past, lowest for African American (33%) and highest for Hispanic (41%). Of these, 38% would prefer a video visit in the future. The strongest predictors of future video visit use were comfort using video interactions (odds ratio [OR] = 5.30, 95% confidence interval [95% CI]: 3.57-7.85) and satisfaction with the overall quality (OR = 3.94, 95% CI: 2.66-5.86). Interestingly, despite a significantly higher satisfaction for Hispanic (40%-55%) and African American (40%-50%) compared with Asian (29%-39%), Hispanic (OR = 0.46, 95% CI: 0.12-0.88) and African American (OR = 0.54, 95% CI: 0.16-0.90) were less likely to prefer a future video visit. Disparity exists in the use of video visit. The association between patient satisfaction and continued video visit varies by race/ethnicity, which may change the future long-term video visit use among race/ethnicity groups.


Subject(s)
COVID-19 , Telemedicine , COVID-19/epidemiology , Ethnicity , Humans , Pandemics , Patient Satisfaction , Racial Groups
16.
PLoS One ; 17(8): e0267505, 2022.
Article in English | MEDLINE | ID: covidwho-1974302

ABSTRACT

OBJECTIVE: To evaluate racial and ethnic differences in mortality among patients hospitalized with coronavirus disease 2019 (COVID-19) after adjusting for baseline characteristics and comorbidities. METHODS: This retrospective cohort study at 13 acute care facilities in the New York City metropolitan area included sequentially hospitalized patients between March 1, 2020, and April 27, 2020. Last day of follow up was July 31, 2020. Patient demographic information, including race/ethnicity and comorbidities, were collected. The primary outcome was in-hospital mortality. RESULTS: A total of 10 869 patients were included in the study (median age, 65 years [interquartile range (IQR) 54-77; range, 18-107 years]; 40.5% female). In adjusted time-to-event analysis, increased age, male sex, insurance type (Medicare and Self-Pay), unknown smoking status, and a higher score on the Charlson Comorbidity Index were significantly associated with higher in-hospital mortality. Adjusted risk of hospital mortality for Black, Asian, Hispanic, multiracial/other, and unknown race/ethnicity patients were similar to risk for White patients. CONCLUSIONS: In a large diverse cohort of patients hospitalized with COVID-19, patients from racial/ethnic minorities experienced similar mortality risk as White patients.


Subject(s)
COVID-19 , Hospital Mortality , Aged , Ethnicity , Female , Hospital Mortality/ethnology , Hospitalization , Humans , Male , Medicare , Middle Aged , Racial Groups , Retrospective Studies , SARS-CoV-2 , United States , Whites
17.
Prog Community Health Partnersh ; 16(2S): 45-58, 2022.
Article in English | MEDLINE | ID: covidwho-1974212

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic and activism against structural racism heightened awareness of racial-ethnic disparities and disproportionate burden among the underserved. The opioid crisis further compounds these phenomena, increasing vulnerability for substance use disorders (SUD). Community-based participatory research can facilitate multidisciplinary collaboration, yet literature on these approaches to prevent and reduce SUD and associated stigma remains limited. OBJECTIVE: Discrimination, stigma, and multiple crises with health care and systemic barriers increasingly marginalize the underserved, specifically around SUD. The Detroit Area Mental Health Leadership Team (DAMHLT, since 2015), aims to optimize SUD prevention, enhance resiliency and advocacy to advance knowledge on SUD research and influence community-level research and practice. LESSONS LEARNED: DAMHLT's approach on bidirectionality, community level access to real-time epidemiological data, advocacy (i.e., institutional responsiveness) and dissemination may be translational to other partnerships. CONCLUSIONS: As we move through an ever-changing pandemic, DAMHLT's lessons learned can inform partnership dynamics and public health strategies such as hesitancy on public health response.


Subject(s)
COVID-19 , Substance-Related Disorders , COVID-19/prevention & control , Community-Based Participatory Research , Humans , Public Health , Racial Groups , Substance-Related Disorders/prevention & control
18.
Int J Environ Res Public Health ; 19(15)2022 07 29.
Article in English | MEDLINE | ID: covidwho-1969232

ABSTRACT

Opioid use disorders (OUDs) are increasingly common among minoritized populations, who have historically experienced limited access to healthcare, a situation that may have worsened during the COVID-19 pandemic. Using a structured keyword search in Pubmed, we reviewed the literature to synthesize the evidence on changes in racial/ethnic disparities in OUD-related outcomes in urban areas during the COVID-19 pandemic in the US. Nine articles were included in the final analysis. Six found increases in OUD-related outcomes during the pandemic, with four showing a widening of disparities. Results also point to the worsening of opioid outcomes among Black and Latinx individuals related to shelter-in-place or stay-at-home orders. Studies examining the use of telehealth and access to OUD treatment showed that minoritized groups have benefited from telehealth programs. The limited number of studies in a small number of jurisdictions indicate a gap in research examining the intersection between COVID-19 and OUD-related outcomes with a focus on disparities. More research is needed to understand the impact of the COVID-19 pandemic and related policies on OUD outcomes among racial/ethnic minoritized groups, including examining the impact of service disruptions on vulnerable groups with OUD.


Subject(s)
COVID-19 , Analgesics, Opioid , COVID-19/epidemiology , Ethnicity , Humans , Pandemics , Racial Groups
20.
Front Public Health ; 10: 866134, 2022.
Article in English | MEDLINE | ID: covidwho-1952805

ABSTRACT

Health comunication is a critical component of pandemic mitigation, but mainstream prevention messaging often lacks social, cultural and linguistic relevance to vulnerable populations. This community case study presents a novel, highly participatory pandemic prevention communication campaign that engaged individuals in remote Aboriginal communities of the Northern Territory of Australia directly in prevention messaging via crowdsourcing, and distributed videos to remote area post-codes via targeted Facebook advertising. Facebook metrics, administrative campaign data and national statistics are used to assess campaign reach and engagement. The case study discusses lessons learned from the campaign, including how seeking unscripted COVID-19 prevention video messaging can support community ownership of pandemic messaging, rapid content generation, and a high level of Facebook user engagement. It also discusses the effectiveness of targeting remote area post-codes via Facebook advertising both to reach the target audience, and to support quality improvement assessments to inform health communication decision-making in a low resource setting.


Subject(s)
COVID-19 , Crowdsourcing , COVID-19/prevention & control , Humans , Pandemics , Public Health , Racial Groups
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