Association of Human Mobility Restrictions and Race/Ethnicity-Based, Sex-Based, and Income-Based Factors With Inequities in Well-being During the COVID-19 Pandemic in the United States.
JAMA Netw Open
; 4(4): e217373, 2021 04 01.
Article
in English
| MEDLINE | ID: covidwho-1171508
ABSTRACT
Importance An accurate understanding of the distributional implications of public health policies is critical for ensuring equitable responses to the COVID-19 pandemic and future public health threats. Objective:
To identify and quantify the association of race/ethnicity-based, sex-based, and income-based inequities of state-specific lockdowns with 6 well-being dimensions in the United States. Design, Setting, andParticipants:
This pooled, repeated cross-sectional study used data from 14â¯187â¯762 households who participated in phase 1 of the population-representative US 2020 Household Pulse Survey (HPS). Households were invited to participate by email, text message, and/or telephone as many as 3 times. Data were collected via an online questionnaire from April 23 to July 21, 2020, and participants lived in all 50 US states and the District of Columbia. Exposures Indicators of race/ethnicity, sex, and income and their intersections. Main Outcomes andMeasures:
Unemployment; food insufficiency; mental health problems; no medical care received for health problems; default on last month's rent or mortgage; and class cancellations with no distance learning. Race/ethnicity, sex, income, and their intersections were used to measure distributional implications across historically marginalized populations; state-specific, time-varying population mobility was used to measure lockdown intensity. Logistic regression models with pooled repeated cross-sections were used to estimate risk of dichotomous outcomes by social group, adjusted for confounding variables.Results:
The 1â¯088â¯314 respondents (561â¯570 [51.6%; 95% CI, 51.4%-51.9%] women) were aged 18 to 88 years (mean [SD], 51.55 [15.74] years), and 826â¯039 (62.8%; 95% CI, 62.5%-63.1%) were non-Hispanic White individuals; 86â¯958 (12.5%; 95% CI, 12.4%-12.7%), African American individuals; 86â¯062 (15.2%; 95% CI, 15.0%-15.4%), Hispanic individuals; and 50â¯227 (5.6%; 95% CI, 5.5%-5.7%), Asian individuals. On average, every 10% reduction in mobility was associated with higher odds of unemployment (odds ratio [OR], 1.3; 95% CI, 1.2-1.4), food insufficiency (OR, 1.1; 95% CI, 1.1-1.2), mental health problems (OR, 1.04; 95% CI, 1.0-1.1), and class cancellations (OR, 1.1; 95% CI, 1.1-1.2). Across most dimensions compared with White men with high income, African American individuals with low income experienced the highest risks (eg, food insufficiency, men OR, 3.3; 95% CI, 2.8-3.7; mental health problems, women OR, 1.9; 95% CI, 1.8-2.1; medical care inaccessibility, women OR, 1.7; 95% CI, 1.6-1.9; unemployment, men OR, 2.8; 95% CI, 2.5-3.2; rent/mortgage defaults, men OR, 5.7; 95% CI, 4.7-7.1). Other high-risk groups were Hispanic individuals (eg, unemployment, Hispanic men with low income OR, 2.9; 95% CI, 2.5-3.4) and women with low income across all races/ethnicities (eg, medical care inaccessibility, non-Hispanic White women OR, 1.8; 95% CI, 1.7-2.0). Conclusions and Relevance In this cross-sectional study, African American and Hispanic individuals, women, and households with low income had higher odds of experiencing adverse outcomes associated with the COVID-19 pandemic and stay-at-home orders. Blanket public health policies ignoring existing distributions of risk to well-being may be associated with increased race/ethnicity-based, sex-based, and income-based inequities.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Ethnicity
/
Sex Factors
/
Communicable Disease Control
/
Racial Groups
/
COVID-19
/
Income
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Variants
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
/
Young adult
Country/Region as subject:
North America
Language:
English
Journal:
JAMA Netw Open
Year:
2021
Document Type:
Article
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