More Like this

1. COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022

   https://doi.org/10.1001/jamanetworkopen.2023.11098  

   Lundberg, Dielle J.; Wrigley-Field, Elizabeth; Cho, Ahyoung; Raquib, Rafeya; Nsoesie, Elaine O.; Paglino, Eugenio; Chen, Ruijia; Kiang, Mathew V.; Riley, Alicia R.; Chen, Yea-Hung; et al (May 2023, JAMA Network Open)

   Importance Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. Objective To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic’s changing geography. Design, Setting, and Participants This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Exposures Metropolitan vs nonmetropolitan areas and race and ethnicity. Main Outcomes and Measures Age-standardized death rates. Results There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. Conclusions and Relevance This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response. 

   more » « less
2. Effect of Race and Ethnicity on In-Hospital Mortality in Patients with COVID-2019

   https://doi.org/10.18865/ed.31.3.389  

   Qureshi, Adnan I.; Baskett, William I.; Huang, Wei; Shyu, Daniel; Myers, Danny; Lobanova, Iryna; Naqvi, S. Hasan; Thompson, Vetta S.; Shyu, Chi-Ren (July 2021, Ethnicity & Disease)

   null (Ed.)

   Objective: To identify differences in short-term outcomes of patients with coronavirus disease 2019 (COVID-19) according to various racial/ethnic groups.Design: Analysis of Cerner de-identified COVID-19 dataset.Setting: A total of 62 health care facilities.Participants: The cohort included 49,277 adult COVID-19 patients who were hospitalized from December 1, 2019 to November 13, 2020.Methods: We compared patients’ age, gender, individual components of Charl­son and Elixhauser comorbidities, medical complications, use of do-not-resuscitate, use of palliative care, and socioeconomic status between various racial and/or ethnic groups. We further compared the rates of in-hos­pital mortality and non-routine discharges between various racial and/or ethnic groups.Main Outcome Measures: The primary outcome of interest was in-hospital mortali­ty. The secondary outcome was non-routine discharge (discharge to destinations other than home, such as short-term hospitals or other facilities including intermediate care and skilled nursing homes).Results: Compared with White patients, in-hospital mortality was significantly higher among African American (OR 1.5; 95%CI:1.3-1.6, P<.001), Hispanic (OR1.4; 95%CI:1.3-1.6, P<.001), and Asian or Pacific Islander (OR 1.5; 95%CI: 1.1-1.9, P=.002) patients after adjustment for age and gender, Elixhauser comorbidities, do-not-resuscitate status, palliative care use, and socioeconomic status.Conclusions: Our study found that, among hospitalized patients with COVID-2019, African American, Hispanic, and Asian or Pacific Islander patients had increased mortality compared with White patients after adjusting for sociodemographic factors, comorbidities, and do-not-resuscitate/pallia­tive care status. Our findings add additional perspective to other recent studies. Ethn Dis. 2021;31(3):389-398; doi:10.18865/ed.31.3.389 

   more » « less
3. Disparities in Hemoglobin A _1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

   https://doi.org/10.1001/jamanetworkopen.2023.8881  

   Addala, Ananta; Ding, Victoria; Zaharieva, Dessi P.; Bishop, Franziska K.; Adams, Alyce S.; King, Abby C.; Johari, Ramesh; Scheinker, David; Hood, Korey K.; Desai, Manisha; et al (April 2023, JAMA Network Open)

   Importance Continuous glucose monitoring (CGM) is associated with improvements in hemoglobin A 1c (HbA 1c ) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes. Objective To determine whether HbA 1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM. Design, Setting, and Participants This cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children’s Hospital, a single-site, freestanding children’s hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022. Exposures All eligible participants were offered CGM within 1 month of diabetes diagnosis. Main Outcomes and Measures To assess HbA 1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016. Results The Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants’ race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA 1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, −0.26% [95% CI, −1.05% to 0.43%], −0.60% [−1.46% to 0.21%], and −0.15% [−1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, −0.27% [95% CI, −0.62% to 0.10%], −0.50% [−0.81% to −0.11%], and −0.47% [−0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA 1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, −0.52% [95% CI, −1.22% to 0.15%], −0.38% [−1.26% to 0.33%], and −0.57% [−2.08% to 0.74%]) and privately insured individuals (estimated difference, −0.34% [95% CI, −0.67% to 0.03%], −0.57% [−0.85% to −0.26%], and −0.43% [−0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA 1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, −0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, −0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [−0.09% to 2.13%]). Conclusions and Relevance The findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA 1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA 1c for all youths but is unlikely to eliminate disparities entirely. Trial Registration ClinicalTrials.gov Identifier: NCT04336969 

   more » « less
4. Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI

   https://doi.org/10.3390/vaccines10010036  

   Wagner, Abram L.; Wileden, Lydia; Shanks, Trina R.; Goold, Susan Door; Morenoff, Jeffrey D.; Sheinfeld Gorin, Sherri N. (January 2022, Vaccines)

   Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises. 

   more » « less
5. Education Racial and Gender Disparities in COVID-19 Worry, Stress, and Food Insecurities across Undergraduate Biology Students at a Southeastern University

   https://doi.org/10.1128/jmbe.00224-21  

   Correia, Kelly M.; Bierma, Shannon R.; Houston, Sophia D.; Nelson, Madison T.; Pannu, Khushwant S.; Tirman, Chase M.; Cannon, Randi L.; Clance, Lauren R.; Canterbury, Dawn N.; Google, Angela N.; et al (April 2022, Journal of Microbiology & Biology Education)

   Goller, Carlos C. (Ed.)

   ABSTRACT The global spread of the novel coronavirus first reported in December 2019 led to drastic changes in the social and economic dynamics of everyday life. Nationwide, racial, gender, and geographic disparities in symptom severity, mortality, and access to health care evolved, which impacted stress and anxiety surrounding COVID-19. On university campuses, drastic shifts in learning environments occurred as universities shifted to remote instruction, which further impacted student mental health and anxiety. Our study aimed to understand how students from diverse backgrounds differ in their worry and stress surrounding COVID-19 upon return to hybrid or in-person classes during the Fall of 2020. Specifically, we addressed the differences in COVID-19 worry, stress response, and COVID-19-related food insecurity related to race/ethnicity (Indigenous American, Asian/Asian American, black/African American, Latinx/Hispanic, white, or multiple races), gender (male, female, and gender expressive), and geographic origin (ranging from rural to large metropolitan areas) of undergraduate students attending a regional-serving R2 university, in the southeastern U.S. Overall, we found significance in worry, food insecurity, and stress responses with females and gender expressive individuals, along with Hispanic/Latinx, Asian/Asian American, and black/African American students. Additionally, students from large urban areas were more worried about contracting the virus compared to students from rural locations. However, we found fewer differences in self-reported COVID-related stress responses within these students. Our findings can highlight the disparities among students’ worry based on gender, racial differences, and geographic origins, with potential implications for mental health of university students from diverse backgrounds. Our results support the inclusion of diverse voices in university decisioning making around the transition through the COVID-19 pandemic. 

   more » « less