Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19.

BACKGROUND: Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths. OBJECTIVE: To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors. DESIGN, SETTING, PARTICIPANTS: Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020. EXPOSURES: Self-reported ethnicity and primary language. MAIN OUTCOMES AND MEASURES: Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes. RESULTS: 32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10- 1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001). CONCLUSION: The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.

Lessons learned while implementing a legislated school policy: body mass index assessments among Arkansas's public school students.

BACKGROUND: To comprehensively address the childhood and adolescent obesity epidemic, Arkansas enacted Act 1220 of 2003. Among a series of community- and school-based interventions, the Act requires each public school student to have his/her body mass index (BMI) assessed and reported annually to parents. The process of implementing this policy on a statewide level and lessons learned are described in this article. METHODS: A confidential, standardized protocol to measure student BMIs and report results to parents was developed. Affordable, reliable, and durable equipment was selected and school personnel who conducted BMI assessments were trained to ensure standardization. To enhance the efficiency and ease of the measurement and reporting process and promote long-term and locally based sustainability, during the first 3 years of implementation, a transition from a paper-based system to a Web-based system was made. Confidential, individualized Child Health Reports have provided students' parents with information about the health of their children. RESULTS: Participation by schools and students has been high as a result of collaboration between the health and education communities and the students and their families. Childhood obesity has not increased since Act 1220 was passed into law. CONCLUSIONS: Parents, schools, school districts, and the state are able to better understand the obesity epidemic and track progress using detailed annual data. Providing a standardized measurement protocol, equipment, and efficient data entry and report generation options has enabled Arkansas to institutionalize the BMI assessment process in public schools.