Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 48
Filter
1.
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
2.
Public Health Rep ; 137(1): 137-148, 2022.
Article in English | MEDLINE | ID: covidwho-1523161

ABSTRACT

OBJECTIVES: Nursing homes are a primary setting of COVID-19 transmission and death, but research has primarily focused only on factors within nursing homes. We investigated the relationship between US nursing home-associated COVID-19 infection rates and county-level and nursing home attributes. METHODS: We constructed panel data from the Centers for Medicare & Medicaid Services (CMS) minimum dataset, CMS nursing home data, 2010 US Census data, 5-year (2012-2016) American Community Survey estimates, and county COVID-19 infection rates. We analyzed COVID-19 data from June 1, 2020, through January 31, 2021, during 7 five-week periods. We used a maximum likelihood estimator, including an autoregressive term, to estimate effects and changes over time. We performed 3 model forms (basic, partial, and full) for analysis. RESULTS: Nursing homes with nursing (0.005) and staff (0.002) shortages had high COVID-19 infection rates, and locally owned (-0.007) or state-owned (-0.025) and nonprofit (-0.011) agencies had lower COVID-19 infection rates than privately owned agencies. County-level COVID-19 infection rates corresponded with COVID-19 infection rates in nursing homes. Racial and ethnic minority groups had high nursing home-associated COVID-19 infection rates early in the study. High median annual personal income (-0.002) at the county level correlated with lower nursing home-associated COVID-19 infection rates. CONCLUSIONS: Communities with low rates of nursing home infections had access to more resources (eg, financial resources, staffing) and likely had better mitigation efforts in place earlier in the pandemic than nursing homes that had access to few resources and poor mitigation efforts. Future research should address the social and structural determinants of health that are leaving racial and ethnic minority populations and institutions such as nursing homes vulnerable during times of crises.


Subject(s)
COVID-19/ethnology , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Social Determinants of Health/ethnology , Humans , Ownership , SARS-CoV-2 , United States/epidemiology
4.
Obstet Gynecol ; 135(4): 896-915, 2020 04.
Article in English | MEDLINE | ID: covidwho-1455362

ABSTRACT

OBJECTIVE: To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the United States and to highlight opportunities for intervention and future research. DATA SOURCES: We performed a systematic search using Ovid MEDLINE, CINAHL, Popline, Scopus, and ClinicalTrials.gov (1990-2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States. METHODS OF STUDY SELECTION: Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion. TABULATION, INTEGRATION, AND RESULTS: Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy-eight of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12), and increased incidence of maternal death and severe maternal morbidity. Only 2 of 83 studies investigated associations between these outcomes and socioeconomic, political, and cultural context (eg, public policy), and 20 of 83 studies investigated material and physical circumstances (eg, neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence. CONCLUSION: Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018102415.


Subject(s)
Healthcare Disparities , Maternal Mortality/ethnology , Social Determinants of Health/ethnology , Female , Humans , Pregnancy , United States
9.
Health Educ Behav ; 48(3): 371-375, 2021 06.
Article in English | MEDLINE | ID: covidwho-1269854

ABSTRACT

Anti-Asian racism and violence dramatically increased during the COVID-19 pandemic. As a result, recent studies and reports are showing that the health and well-being of Asian Americans are negatively affected. To address this urgent problem, the field of health education and public health must be equipped with the critical frameworks and concepts to analyze racism and White supremacy and how it affects the health and well-being of Asian Americans. We argue that using an ethnic studies lens in health education can help educators, researchers, and practitioners teach and train health educators to address racism experienced by Asian Americans during COVID-19 in relation to their health. We will discuss the elements of ethnic studies and demonstrate how to use it as a lens in understanding health disparities in the Asian American population influenced and exacerbated by the COVID-19 pandemic.


Subject(s)
Asian Americans/education , COVID-19/ethnology , Cultural Competency , Health Education/organization & administration , Racism/psychology , Health Education/standards , Humans , Pandemics , SARS-CoV-2 , Social Determinants of Health/ethnology , United States
10.
Hepatology ; 74(5): 2808-2812, 2021 11.
Article in English | MEDLINE | ID: covidwho-1248687

ABSTRACT

The COVID-19 pandemic and social justice movement have highlighted the impact of social determinants of health (SDOH) and structural racism in the United States on both access to care and patient outcomes. With the evaluation for liver transplantation being a highly subjective process, there are multiple ways for SDOH to place vulnerable patients at a disadvantage. This policy corner focuses on three different methods to reverse the deleterious effects of SDOH-identify and reduce implicit bias, expand and optimize telemedicine, and improve community outreach.


Subject(s)
COVID-19 , Health Equity/organization & administration , Liver Transplantation , Racism/prevention & control , Social Determinants of Health/ethnology , Telemedicine/methods , COVID-19/epidemiology , COVID-19/prevention & control , Health Services Accessibility/standards , Healthcare Disparities/ethnology , Humans , Liver Diseases/ethnology , Liver Diseases/surgery , Liver Transplantation/methods , Liver Transplantation/standards , Policy Making , Public Health/standards , Quality Improvement , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology
11.
Health Secur ; 19(S1): S5-S13, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1236194

ABSTRACT

Communities of color in the United States have been disproportionately impacted by the COVID-19 pandemic. Studies exploring the mental health implications of these disparities have only just begun to emerge. The purpose of this study is to better understand mental health concerns and test whether social determinants of health and COVID-19-related experiences influence these concerns. In April 2020, we launched a community-based survey for adults across the United States. A total of 341 respondents completed the survey, which included questions about demographics, depression, social isolation, work environment, and preexisting mental health conditions. We generated matched controls by adding county data from the Robert Wood Johnson Foundation to our survey. Chi square, Pearson product-moment correlation, point biserial correlation, and logistic regression were estimated. Our analysis revealed that respondents who identified as Latinx, Latin@, or Hispanic were 10 times more likely to meet the threshold score for depression. Similarly, individuals with prior mental health conditions and those who expressed feelings of social isolation due to COVID-19 were 3 times more likely to meet the threshold score for depression. These results confirm our hypothesis that communities of color will likely experience disproportionate mental health impacts of COVID-19-specifically, the mental health sequela that emerge from exposure, cumulative burden, and social isolation. We discuss the implications for expanding access and quality of health and mental health services to address current inequities.


Subject(s)
COVID-19/ethnology , COVID-19/psychology , Health Status Disparities , Mental Health/statistics & numerical data , Social Determinants of Health/ethnology , Adaptation, Psychological , Adult , Humans , Male , Middle Aged , United States
12.
J Am Heart Assoc ; 10(11): e020997, 2021 06.
Article in English | MEDLINE | ID: covidwho-1234323

ABSTRACT

The COVID-19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID-19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID-19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID-19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID-19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence-based pharmacotherapy are essential. There is a need to improve the implementation of community-based interventions and blood pressure self-monitoring, which can help build patient trust and increase healthcare engagement.


Subject(s)
Blood Pressure Monitoring, Ambulatory , COVID-19/epidemiology , Health Services Accessibility , Healthcare Disparities/standards , Hypertension , Racism/prevention & control , Social Determinants of Health/ethnology , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Status Disparities , Humans , Hypertension/ethnology , Hypertension/therapy , Needs Assessment , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology
13.
Acad Med ; 96(11): 1518-1523, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1207326

ABSTRACT

Public health crises palpably demonstrate how social determinants of health have led to disparate health outcomes. The staggering mortality rates among African Americans, Native Americans, and Latinx Americans during the COVID-19 pandemic have revealed how recalcitrant structural inequities can exacerbate disparities and render not just individuals but whole communities acutely vulnerable. While medical curricula that educate students about disparities are vital in rousing awareness, it is experience that is most likely to instill passion for change. The authors first consider the roots of health care disparities in relation to the current pandemic. Then, they examine the importance of salient learning experiences that may inspire a commitment to championing social justice. Experiences in diverse communities can imbue medical students with a desire for lifelong learning and advocacy. The authors introduce a 3-pillar framework that consists of trust building, structural competency, and cultural humility. They discuss how these pillars should underpin educational efforts to improve social determinants of health. Effecting systemic change requires passion and resolve; therefore, perseverance in such efforts is predicated on learners caring about the structural inequities in housing, education, economic stability, and neighborhoods-all of which influence the health of individuals and communities.


Subject(s)
COVID-19/psychology , Education, Medical/ethics , Racism/ethnology , African Americans , Awareness , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Education, Medical/statistics & numerical data , Female , Healthcare Disparities/ethnology , Humans , Male , Minority Groups , Problem-Based Learning/statistics & numerical data , Public Health/ethics , Public Health/statistics & numerical data , SARS-CoV-2/genetics , Social Determinants of Health/ethnology , Social Determinants of Health/statistics & numerical data , Social Justice/ethics , Stakeholder Participation , Students, Medical/statistics & numerical data , United States/epidemiology
15.
Prev Chronic Dis ; 18: E33, 2021 04 08.
Article in English | MEDLINE | ID: covidwho-1173046

ABSTRACT

The Centers for Disease Control and Prevention (CDC) define chronic diseases as conditions that last 1 year or more and that require ongoing medical attention or limit activities of daily living, or both (1). Chronic diseases may be influenced by a combination of genetics, lifestyle and social behaviors, health care system factors, community influences, and environmental determinants of health (2). These risk factors often coexist and interact with each other. Therefore, a better understanding of determinants of chronic diseases such as tobacco use, unhealthy eating, and physical inactivity stands to benefit from effective strategies for improving primary, secondary, and tertiary disease prevention and management in diverse global settings (3). Strategies to prevent and manage chronic disease outcomes such as diabetes and cardiovascular diseases (CVDs) have global commonalities (4-7). The impact of chronic diseases is disproportionately evident in Black and Brown communities (8,9). Chronic disease prevention and management typically focus on behavioral interventions such as healthy eating, increased physical activity, and cessation of unhealthy practices such as tobacco and alcohol use (10-15). In 2020, the COVID-19 pandemic added to the fact that chronic diseases disproportionately affect low-resource communities, where many Black and Brown populations live (16,17). COVID-19 demonstrated that chronic disease disparities actually present as preexisting conditions in Black and Brown communities, who are disproportionately affected by COVID-19 outcomes. Although most of the articles in this Preventing Chronic Disease (PCD) collection were published before the pandemic, the insights they present, combined with the racial and ethnic data on the burden of COVID-19 thus far, support this reality. Many researchers and public health practitioners often consider the need to sufficiently address the relationships between chronic diseases and social, behavioral, and community factors (18). Global lessons in the prevention and management of chronic diseases, therefore, can help researchers and practitioners benefit from the shared lessons and experience derived from research and interventions conducted in different parts of the world. There are more than 7 billion people worldwide, who speak diverse languages and who have different nationalities, identities, and health systems. Yet, if we share challenges and opportunities for chronic disease prevention and management, many of the global adversities to improving health and well-being can be ameliorated, which is the purpose of this collection. The authors in this collection share lessons that represent experiences in diverse contexts across countries and regions of the world.


Subject(s)
COVID-19/epidemiology , Chronic Disease , Global Health , Public Health , Social Determinants of Health , Causality , Chronic Disease/epidemiology , Chronic Disease/prevention & control , Chronic Disease/therapy , Health Services Accessibility , Healthcare Disparities , Humans , Information Dissemination , Life Style , Psychology , Public Health/standards , Public Health/trends , SARS-CoV-2 , Social Determinants of Health/ethnology , Social Determinants of Health/statistics & numerical data
16.
Public Health Rep ; 136(4): 483-492, 2021.
Article in English | MEDLINE | ID: covidwho-1171653

ABSTRACT

OBJECTIVE: COVID-19 disproportionately affects racial/ethnic minority groups in the United States. We evaluated characteristics associated with obtaining a COVID-19 test from the Veterans Health Administration (VHA) and receiving a positive test result for COVID-19. METHODS: We conducted a retrospective cohort analysis of 6 292 800 veterans in VHA care at 130 VHA medical facilities. We assessed the number of tests for SARS-CoV-2 administered by the VHA (n = 822 934) and the number of positive test results (n = 82 094) from February 8 through December 28, 2020. We evaluated associations of COVID-19 testing and test positivity with demographic characteristics of veterans, adjusting for facility characteristics, comorbidities, and county-level area-based socioeconomic measures using nested generalized linear models. RESULTS: In fully adjusted models, veterans who were female, Black/African American, Hispanic/Latino, urban, and low income and had a disability had an increased likelihood of obtaining a COVID-19 test, and veterans who were Asian had a decreased likelihood of obtaining a COVID-19 test. Compared with veterans who were White, veterans who were Black/African American (risk ratio [RR] = 1.23; 95% CI, 1.19-1.27) and Native Hawaiian/Other Pacific Islander (RR = 1.13; 95% CI, 1.05-1.21) had an increased likelihood of receiving a positive test result. Hispanic/Latino veterans had a 43% higher likelihood of receiving a positive test result than non-Hispanic/Latino veterans did. CONCLUSIONS: Although veterans have access to subsidized health care at the VHA, the increased risk of receiving a positive test result for COVID-19 among Black and Hispanic/Latino veterans, despite receiving more tests than White and non-Hispanic/Latino veterans, suggests that other factors (eg, social inequities) are driving disparities in COVID-19 prevalence.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/ethnology , SARS-CoV-2/isolation & purification , Veterans , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Female , Humans , Male , Middle Aged , Odds Ratio , Retrospective Studies , Social Determinants of Health/ethnology , Socioeconomic Factors , United States/epidemiology , Young Adult
18.
J Natl Black Nurses Assoc ; 31(2): 15-24, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1092202

ABSTRACT

The purpose of this article is to discern and examine causative factors that are likely to influence the higher consequences of health disparities experienced by pregnant and postpartum African-American women with COVID-19. Although understudied, pregnancy in the presence of COVID-19 increases the risk for illness severity. Data suggest that pregnant women with COVID-19 are more likely to be hospitalized, to be admitted to the intensive care unit, and to require life support. Similarly, COVID-19 poses significant challenges to maternal and obstetric care during the postpartum recovery period. African- American women bear a disproportionately higher morbidity and mortality burden for diseases such as diabetes, obesity, and hypertension. Pre-existing chronic health conditions may place pregnant and postpartum women at a higher risk for developing severe health consequences from COVID-19 before, during, and after delivery. In addition, social determinants of health are hypothesized to modulate the deleterious impact of COVID-19 among pregnant and postpartum African-American women.


Subject(s)
African Americans , COVID-19 , African Americans/psychology , African Americans/statistics & numerical data , COVID-19/ethnology , Female , Health Status Disparities , Humans , Maternal Health Services/organization & administration , Postpartum Period , Pregnancy , Pregnancy Complications, Infectious/ethnology , Pregnancy Complications, Infectious/virology , Severity of Illness Index , Social Determinants of Health/ethnology
20.
Int J Environ Res Public Health ; 18(2)2021 01 14.
Article in English | MEDLINE | ID: covidwho-1067718

ABSTRACT

In addition to the direct health impacts of COVID-19, the pandemic disrupted economic, educational, healthcare, and social systems in the US. This cross-sectional study examined the primary and secondary impacts of the COVID-19 pandemic among low-income and minority groups in New York State using the social determinants of health framework. New Yorkers were recruited to complete a web-based survey through Qualtrics. The survey took place in May and June 2020 and asked respondents about COVID-19 health impacts, risk factors, and concerns. Chi-square analysis examined the health effects experienced by race and ethnicity, and significant results were analyzed in a series of logistic regression models. Results showed disparities in the primary and secondary impacts of COVID-19. The majority of differences were reported between Hispanic and white respondents. The largest differences, in terms of magnitude, were reported between other or multiracial respondents and white respondents. Given the disproportionate burden of COVID-19 on minority populations, improved policies and programs to address impacts on lower-paying essential jobs and service positions could reduce exposure risks and improve safety for minority populations. Future research can identify the long-term health consequences of the pandemic on the social determinants of health among populations most at risk.


Subject(s)
COVID-19/ethnology , Health Status , Minority Groups , Social Determinants of Health/ethnology , Cross-Sectional Studies , Humans , New York/epidemiology , Pandemics , Risk Factors , Surveys and Questionnaires
SELECTION OF CITATIONS
SEARCH DETAIL