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1.
J Am Soc Nephrol ; 32(3): 677-685, 2021 03.
Article in English | MEDLINE | ID: covidwho-1496676

ABSTRACT

BACKGROUND: Patients may accrue wait time for kidney transplantation when their eGFR is ≤20 ml/min. However, Black patients have faster progression of their kidney disease compared with White patients, which may lead to disparities in accruable time on the kidney transplant waitlist before dialysis initiation. METHODS: We compared differences in accruable wait time and transplant preparation by CKD-EPI estimating equations in Chronic Renal Insufficiency Cohort participants, on the basis of estimates of kidney function by creatinine (eGFRcr), cystatin C (eGFRcys), or both (eGFRcr-cys). We used Weibull accelerated failure time models to determine the association between race (non-Hispanic Black or non-Hispanic White) and time to ESKD from an eGFR of ≤20 ml/min per 1.73 m2. We then estimated how much higher the eGFR threshold for waitlisting would be required to achieve equity in accruable preemptive wait time for the two groups. RESULTS: By eGFRcr, 444 CRIC participants were eligible for waitlist registration, but the potential time between eGFR ≤20 ml/min per 1.73 m2 and ESKD was 32% shorter for Blacks versus Whites. By eGFRcys, 435 participants were eligible, and Blacks had 35% shorter potential wait time compared with Whites. By the eGFRcr-cys equation, 461 participants were eligible, and Blacks had a 31% shorter potential wait time than Whites. We estimated that registering Blacks on the waitlist as early as an eGFR of 24-25 ml/min per 1.73 m2 might improve racial equity in accruable wait time before ESKD onset. CONCLUSIONS: Policies allowing for waitlist registration at higher GFR levels for Black patients compared with White patients could theoretically attenuate disparities in accruable wait time and improve racial equity in transplant access.


Subject(s)
Glomerular Filtration Rate , Healthcare Disparities , Kidney Transplantation , Racism , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/surgery , Waiting Lists , African Americans , Aged , Cohort Studies , Disease Progression , Female , Health Policy , Healthcare Disparities/statistics & numerical data , Humans , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/surgery , Male , Middle Aged , Models, Statistical , Racism/statistics & numerical data , Time Factors , United States
6.
ANS Adv Nurs Sci ; 44(3): 183-194, 2021.
Article in English | MEDLINE | ID: covidwho-1354311

ABSTRACT

In this article, we apply Agamben's theory of biopower and other related concepts to the COVID-19 pandemic in the United States. We explore the similarities between the COVID-19 pandemic and the pandemic of racism. Concepts such as bios, zoe, homo sacer, and states of exception can be applied to understand inequities among marginalized communities in the COVID-19 pandemic. We recommend that nurses and health care workers use critical conscientization and structural competency to increase awareness and develop interventions to undo the injustices related to biopower faced by many in the COVID-19 pandemic.


Subject(s)
Attitude to Health , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Health Status Disparities , Racism/statistics & numerical data , COVID-19/psychology , Health Personnel/psychology , Humans , Public Health , Racism/psychology , Social Environment , United States
7.
Am J Epidemiol ; 190(8): 1439-1446, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1337250

ABSTRACT

Coronavirus disease 2019 (COVID-19) is disproportionately burdening racial and ethnic minority groups in the United States. Higher risks of infection and mortality among racialized minorities are a consequence of structural racism, reflected in specific policies that date back centuries and persist today. Yet our surveillance activities do not reflect what we know about how racism structures risk. When measuring racial and ethnic disparities in deaths due to COVID-19, the Centers for Disease Control and Prevention statistically accounts for the geographic distribution of deaths throughout the United States to reflect the fact that deaths are concentrated in areas with different racial and ethnic distributions from those of the larger United States. In this commentary, we argue that such an approach misses an important driver of disparities in COVID-19 mortality, namely the historical forces that determine where individuals live, work, and play, and that consequently determine their risk of dying from COVID-19. We explain why controlling for geography downplays the disproportionate burden of COVID-19 on racialized minority groups in the United States. Finally, we offer recommendations for the analysis of surveillance data to estimate racial disparities, including shifting from distribution-based to risk-based measures, to help inform a more effective and equitable public health response to the pandemic.


Subject(s)
COVID-19/ethnology , COVID-19/mortality , Health Status Disparities , Minority Groups/statistics & numerical data , /statistics & numerical data , Geography , Healthcare Disparities , Humans , Racism/statistics & numerical data , SARS-CoV-2 , United States/epidemiology
8.
Acad Med ; 96(11): 1524-1528, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1298990

ABSTRACT

The role that resistance plays in medicine and medical education is ill-defined. Although physicians and students have been involved in protests related to the COVID-19 pandemic, structural racism, police brutality, and gender inequity, resistance has not been prominent in medical education's discourses, and medical education has not supported students' role and responsibility in developing professional approaches to resistance. While learners should not pick and choose what aspects of medical education they engage with, neither should their moral agency and integrity be compromised. To that end, the authors argue for professional resistance to become a part of medical education. This article sets out a rationale for a more explicit and critical recognition of the role of resistance in medical education by exploring its conceptual basis, its place both in training and practice, and the ways in which medical education might more actively embrace and situate resistance as a core aspect of professional practice. The authors suggest different strategies that medical educators can employ to embrace resistance in medical education and propose a set of principles for resistance in medicine and medical education. Embracing resistance as part of medical education requires a shift in attention away from training physicians solely to replicate and sustain existing systems and practices and toward developing their ability and responsibility to resist situations, structures, and acts that are oppressive, harmful, or unjust.


Subject(s)
COVID-19/psychology , Education, Medical/methods , Health Personnel/education , Professional Practice/ethics , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Concept Formation/ethics , Female , Gender-Based Violence/prevention & control , Gender-Based Violence/statistics & numerical data , Humans , Male , Physicians/statistics & numerical data , Racism/prevention & control , Racism/statistics & numerical data , SARS-CoV-2/genetics , Social Responsibility , Students, Medical/statistics & numerical data
10.
Obstet Gynecol ; 137(2): 220-224, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1272975

ABSTRACT

The evidence of racial health disparities is profound. Much attention has been given to the disparity in maternal morbidity and mortality experienced by Black mothers. The disparity in Black lives lost from coronavirus disease 2019 (COVID-19) has further highlighted the disparity in health outcomes for Black people. Although COVID-19 is a new disease, the reason for the health disparity is the same as in maternal morbidity and mortality: implicit bias and structural racism. Implicit bias among health care professionals leads to disparities in how health care is delivered. Generations of structural racism perpetuated through racial residential segregation, economic suppression, and health care inequality have normalized the poorer health outcomes for Black Americans. It is easy to dismiss these issues as someone else's problem, because health care professionals often fail to acknowledge the effect of implicit bias in their own practices. We all need to be highly critical of our own practices and look introspectively for implicit bias to find the cure. Health care organizations must invest time and resources into investigating the structural racism that exists within our own walls.


Subject(s)
African Americans/statistics & numerical data , COVID-19/mortality , Healthcare Disparities/statistics & numerical data , Racism/statistics & numerical data , SARS-CoV-2 , Female , Health Personnel/statistics & numerical data , Humans , Infant , Infant Mortality/ethnology , Maternal Mortality/ethnology , Pregnancy , Pregnancy Complications, Infectious/mortality
11.
Health Secur ; 19(S1): S14-S26, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1254356

ABSTRACT

The long, fallacious history of attributing racial disparities in public health outcomes to biological inferiority or poor decision making persists in contemporary conversations about the COVID-19 pandemic. Given the disproportionate impacts of this pandemic on communities of color, it is essential for scholars, practitioners, and policymakers to focus on how structural racism drives these disparate outcomes. In May and June 2020, we conducted a 6-state online survey to examine racial/ethnic differences in exposure to COVID-19, risk mitigation behaviors, risk perceptions, and COVID-19 impacts. Results show that Black and Hispanic individuals were more likely than White respondents to experience factors associated with structural racism (eg, living in larger households, going to work in person, using public transportation) that, by their very nature, increase the likelihood of exposure to COVID-19. Controlling for other demographic and socioeconomic characteristics, non-White respondents were equally or more likely than White respondents to take protective actions against COVID-19, including keeping distance from others and wearing masks. Black and Hispanic respondents also perceived higher risks of dying of the disease and of running out of money due to the pandemic, and 40% of Black respondents reported knowing someone who had died of COVID-19 at a time when the US death toll had just surpassed 100,000 people. To manage the current pandemic and prepare to combat future health crises in an effective, equitable, and antiracist manner, it is imperative to understand the structural factors perpetuating racial inequalities in the COVID-19 experience.


Subject(s)
Attitude to Health/ethnology , COVID-19/psychology , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Racism/statistics & numerical data , Adult , African Americans/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , /statistics & numerical data , Humans , Male , Middle Aged , Social Isolation , Socioeconomic Factors , Surveys and Questionnaires , United States , Young Adult
12.
Acad Med ; 96(11): 1586-1591, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1246779

ABSTRACT

PURPOSE: Recent national events, including the COVID-19 pandemic and protests of racial inequities, have drawn attention to the role of physicians in advocating for improvements in the social, economic, and political factors that affect health. Characterizing the current state of advocacy training in U.S. medical schools may help set expectations for physician advocacy and predict future curricular needs. METHOD: Using the member school directory provided by the Association of American Medical Colleges, the authors compiled a list of 154 MD-granting medical schools in the United States in 2019-2020. They used multiple search strategies to identify online course catalogues and advocacy-related curricula using variations of the terms "advocacy," "policy," "equity," and "social determinants of health." They used an iterative process to generate a preliminary coding schema and to code all course descriptions, conducting content analysis to describe the structure of courses and topics covered. RESULTS: Of 134 medical schools with any online course catalogue available, 103 (76.9%) offered at least 1 advocacy course. Required courses were typically survey courses focused on general content in health policy, population health, or public health/epidemiology, whereas elective courses were more likely to focus specifically on advocacy skills building and to feature field experiences. Of 352 advocacy-specific courses, 93 (26.4%) concentrated on a specific population (e.g., children or persons with low socioeconomic status). Few courses (n = 8) focused on racial/ethnic minorities and racial inequities. CONCLUSIONS: Findings suggest that while most U.S. medical schools offer at least 1 advocacy course, the majority are elective rather than required, and the structure and content of advocacy-related courses vary substantially. Given the urgency to address social, economic, and political factors affecting health and health equity, this study provides an important and timely overview of the prevalence and content of advocacy curricula at U.S. medical schools.


Subject(s)
Health Equity/standards , Patient Advocacy/education , Racism/ethnology , Schools, Medical/statistics & numerical data , American Medical Association/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Child , Curriculum/statistics & numerical data , Education, Distance/organization & administration , Female , Humans , Male , Physician's Role , Politics , Prevalence , Racism/statistics & numerical data , SARS-CoV-2/genetics , Schools, Medical/organization & administration , Sexual and Gender Minorities/psychology , Social Determinants of Health/standards , Surveys and Questionnaires , United States/epidemiology
13.
Public Health Rep ; 136(4): 508-517, 2021.
Article in English | MEDLINE | ID: covidwho-1243754

ABSTRACT

OBJECTIVES: Experiences of vicarious racism-hearing about racism directed toward one's racial group or racist acts committed against other racial group members-and vigilance about racial discrimination have been salient during the COVID-19 pandemic. This study examined vicarious racism and vigilance in relation to symptoms of depression and anxiety among Asian and Black Americans. METHODS: We used data from a cross-sectional study of 604 Asian American and 844 Black American adults aged ≥18 in the United States recruited from 5 US cities from May 21 through July 15, 2020. Multivariable linear regression models examined levels of depression and anxiety by self-reported vicarious racism and vigilance. RESULTS: Controlling for sociodemographic characteristics, among both Asian and Black Americans, greater self-reported vicarious racism was associated with more symptoms of depression (Asian: ß = 1.92 [95% CI, 0.97-2.87]; Black: ß = 1.72 [95% CI, 0.95-2.49]) and anxiety (Asian: ß = 2.40 [95% CI, 1.48-3.32]; Black: ß = 1.98 [95% CI, 1.17-2.78]). Vigilance was also positively related to symptoms of depression (Asian: ß = 1.54 [95% CI, 0.58-2.50]; Black: ß = 0.90 [95% CI, 0.12-1.67]) and anxiety (Asian: ß = 1.98 [95% CI, 1.05-2.91]; Black: ß = 1.64 [95% CI, 0.82-2.45]). CONCLUSIONS: Mental health problems are a pressing concern during the COVID-19 pandemic. Results from our study suggest that heightened racist sentiment, harassment, and violence against Asian and Black Americans contribute to increased risk of depression and anxiety via vicarious racism and vigilance. Public health efforts during this period should address endemic racism as well as COVID-19.


Subject(s)
African Americans/psychology , Anxiety/ethnology , Asian Americans/psychology , COVID-19/psychology , Depression/ethnology , Racism/psychology , Adult , Anxiety/etiology , Cross-Sectional Studies , Depression/etiology , Female , Humans , Linear Models , Male , Racism/statistics & numerical data , United States/epidemiology
14.
Proc Natl Acad Sci U S A ; 118(21)2021 05 25.
Article in English | MEDLINE | ID: covidwho-1223142

ABSTRACT

Black and Hispanic communities are disproportionately affected by both incarceration and COVID-19. The epidemiological relationship between carceral facilities and community health during the COVID-19 pandemic, however, remains largely unexamined. Using data from Cook County Jail, we examine temporal patterns in the relationship between jail cycling (i.e., arrest and processing of individuals through jails before release) and community cases of COVID-19 in Chicago ZIP codes. We use multivariate regression analyses and a machine-learning tool, elastic regression, with 1,706 demographic control variables. We find that for each arrested individual cycled through Cook County Jail in March 2020, five additional cases of COVID-19 in their ZIP code of residence are independently attributable to the jail as of August. A total 86% of this additional disease burden is borne by majority-Black and/or -Hispanic ZIPs, accounting for 17% of cumulative COVID-19 cases in these ZIPs, 6% in majority-White ZIPs, and 13% across all ZIPs. Jail cycling in March alone can independently account for 21% of racial COVID-19 disparities in Chicago as of August 2020. Relative to all demographic variables in our analysis, jail cycling is the strongest predictor of COVID-19 rates, considerably exceeding poverty, race, and population density, for example. Arrest and incarceration policies appear to be increasing COVID-19 incidence in communities. Our data suggest that jails function as infectious disease multipliers and epidemiological pumps that are especially affecting marginalized communities. Given disproportionate policing and incarceration of racialized residents nationally, the criminal punishment system may explain a large proportion of racial COVID-19 disparities noted across the United States.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Jails/statistics & numerical data , Public Health/statistics & numerical data , Racism/statistics & numerical data , COVID-19/ethnology , COVID-19/prevention & control , COVID-19/transmission , Chicago/epidemiology , Humans , Incidence , Prisoners/statistics & numerical data , SARS-CoV-2 , Socioeconomic Factors
15.
J Soc Psychol ; 161(4): 419-434, 2021 Jul 04.
Article in English | MEDLINE | ID: covidwho-1219300

ABSTRACT

This research examined the effects of the onset of the COVID-19 pandemic on perceived Black-White intergroup competition and negative intergroup psychological outcomes. Two datasets (collected before [2018] and after the onset of [April, 2020] COVID-19) were combined (N = 2,131) for this research. The data provided support for the hypothesis that perceptions of Black-White intergroup competition, and subsequently perceptions of discrimination, behavioral avoidance, intergroup anxiety, and interracial mistrust would be higher after the onset of COVID-19. Three additional predictors, a perceived interracial competition manipulation, political orientation, and population density at the ZIP-code level were examined to test for main effects and moderation of COVID-19 effects. All three predictors exhibited main effects on focal outcomes, and political orientation moderated COVID-19 onset effects: effects were stronger for conservatives. Lastly, perceived intergroup competition mediated the effect of COVID-19 onset on the four focal outcomes.


Subject(s)
African Americans/psychology , COVID-19/psychology , Interpersonal Relations , Racism/psychology , /psychology , Adolescent , Adult , African Americans/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Politics , Racism/statistics & numerical data , SARS-CoV-2 , Young Adult
16.
J Public Health Manag Pract ; 27(3): 258-267, 2021.
Article in English | MEDLINE | ID: covidwho-1150044

ABSTRACT

OBJECTIVE: The primary aim of this study was to investigate whether students in minority race categories are more likely to experience race-related bias and hatred in their lifetime and since the onset of COVID-19, after controlling the effect of demographic and other variables. METHODS: This quantitative study used primary data from the survey of 1249 college students at one of the universities in Georgia during April and May 2020. We performed multinomial logistic regression, computing 2 models for the 2 ordinal dependent variables concerning students' experience of race-related bias and hatred-(a) during their lifetime and (b) since the onset of COVID-19 in March 2020-both measured as "never," "rarely," "sometimes," and "fairly often or very often." RESULTS: During their lifetime, 47.5% of students had experienced some level of bias or hatred, ranging from "rarely" to "very often." Since the onset of COVID-19 on March 2 in Georgia, in a short period of 1 to 2 months, 17.6% of students reported experiencing race-related bias or hatred. Univariate statistics revealed substantial differences in race-related bias and hatred by race, experienced during students' lifetime as well as since the onset of COVID-19. Results of multinomial logistic regression showed that the odds of having experienced bias or hatred during their lifetime were significantly higher (P < .05) for the Black students than for White students (adjusted odds ratio [AOR] = 75.8, for very often or often vs never; AOR = 42 for sometimes vs never). Compared with White students, the odds of hatred and bias were also significantly higher for students who were Asian, multiple races, or another non-White race. The odds of having experienced race-related bias and hatred since the onset of COVID-19 were also higher for Black Asian, multiple races, and other non-White students. CONCLUSIONS: This study adds critical scientific evidence about variation in the perception of bias and hatred that should draw policy attention to race-related issues experienced by college students in the United States.


Subject(s)
COVID-19/psychology , Minority Groups/psychology , Racism/psychology , Racism/statistics & numerical data , Students/psychology , Students/statistics & numerical data , Adult , African Americans/psychology , African Americans/statistics & numerical data , COVID-19/epidemiology , Female , Georgia/epidemiology , /statistics & numerical data , Humans , Male , Minority Groups/statistics & numerical data , SARS-CoV-2 , Socioeconomic Factors , Surveys and Questionnaires , Universities/statistics & numerical data , Young Adult
17.
Am J Epidemiol ; 190(8): 1439-1446, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1132423

ABSTRACT

Coronavirus disease 2019 (COVID-19) is disproportionately burdening racial and ethnic minority groups in the United States. Higher risks of infection and mortality among racialized minorities are a consequence of structural racism, reflected in specific policies that date back centuries and persist today. Yet our surveillance activities do not reflect what we know about how racism structures risk. When measuring racial and ethnic disparities in deaths due to COVID-19, the Centers for Disease Control and Prevention statistically accounts for the geographic distribution of deaths throughout the United States to reflect the fact that deaths are concentrated in areas with different racial and ethnic distributions from those of the larger United States. In this commentary, we argue that such an approach misses an important driver of disparities in COVID-19 mortality, namely the historical forces that determine where individuals live, work, and play, and that consequently determine their risk of dying from COVID-19. We explain why controlling for geography downplays the disproportionate burden of COVID-19 on racialized minority groups in the United States. Finally, we offer recommendations for the analysis of surveillance data to estimate racial disparities, including shifting from distribution-based to risk-based measures, to help inform a more effective and equitable public health response to the pandemic.


Subject(s)
COVID-19/ethnology , COVID-19/mortality , Health Status Disparities , Minority Groups/statistics & numerical data , /statistics & numerical data , Geography , Healthcare Disparities , Humans , Racism/statistics & numerical data , SARS-CoV-2 , United States/epidemiology
18.
J Diabetes Sci Technol ; 15(5): 1005-1009, 2021 09.
Article in English | MEDLINE | ID: covidwho-1085175

ABSTRACT

The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.


Subject(s)
COVID-19/therapy , Diabetes Complications/therapy , Diabetes Mellitus/therapy , Resource Allocation , COVID-19/complications , COVID-19/epidemiology , Diabetes Complications/economics , Diabetes Complications/epidemiology , Diabetes Mellitus/economics , Diabetes Mellitus/epidemiology , Health Services Accessibility/economics , Health Services Accessibility/ethics , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Health Status Disparities , Healthcare Disparities/economics , Healthcare Disparities/ethics , Healthcare Disparities/organization & administration , Healthcare Disparities/statistics & numerical data , Humans , Pandemics , Racism/ethics , Racism/statistics & numerical data , Resource Allocation/economics , Resource Allocation/ethics , Resource Allocation/organization & administration , Resource Allocation/statistics & numerical data , Triage/economics , Triage/ethics , United States/epidemiology , Ventilators, Mechanical/economics , Ventilators, Mechanical/statistics & numerical data , Ventilators, Mechanical/supply & distribution
19.
Psychiatr Serv ; 72(5): 594-596, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1072865

ABSTRACT

During the COVID-19 pandemic, frontline workers have faced unparalleled levels of distress, and hospitals have used many interventions to improve workers' mental health. However, service workers-including water, sanitation, and hygiene staff; food service workers; and countless others-are not being appropriately supported for their heroic efforts. This Open Forum describes the demographic characteristics of this neglected population, explores the role of structural racism in the lack of support interventions, examines the relationship between social determinants of health and COVID-19-related morbidity and mortality within this population, and petitions institutions to more deeply consider how they support their service workers.


Subject(s)
COVID-19 , Health Personnel/statistics & numerical data , Pandemics , Racism/statistics & numerical data , COVID-19/epidemiology , Humans , SARS-CoV-2
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