Variations in Presentation and Management of COVID-19 Inpatients by Race and Ethnicity in a Large Texas Metroplex

ABSTRACT Objective: To assess variations in presentation and outcomes of COVID-19 across race/ethnicity at a large Texas metroplex hospital. Methods: Retrospective cohort study. Results: Although COVID-19 patients demonstrated significant socioeconomic disparities, race/ethnicity was not a significant predictor of ICU admission (p=0.067) or case fatality (p=0.078). Hospital admission varied by month, with incidence among Black/African-American and Hispanic/Latino patients peaking earlier in the pandemic timeline (p<0.001). Patients reporting Spanish as their primary language were significantly more likely to be admitted to the ICU (OR: 1.75, p=0.007). Conclusions: COVID-19 patients do not demonstrate significant racial/ethnic disparities in case fatality, suggesting that state-wide disparities in mortality rate are rooted in infection risk rather than hospital course. Variations in admission rates by race/ethnicity across the timeline and increased ICU admission among Spanish-speaking patients demonstrate the need to pursue tailored interventions on both a community and structural level to mitigate further health disparities throughout the pandemic and after.

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Measuring the missing: greater racial and ethnic disparities in COVID-19 burden after accounting for missing race/ethnicity data

10.1101/2020.09.30.20203315 ◽

2020 ◽

Author(s):

Katie Labgold ◽

Sarah Hamid ◽

Sarita Shah ◽

Neel R. Gandhi ◽

Allison Chamberlain ◽

...

Keyword(s):

Ethnic Disparities ◽

Case Fatality ◽

The United States ◽

Infection Rates ◽

Bias Adjustment ◽

Social Inequities ◽

Increased Risk ◽

Race Ethnicity ◽

The Difference ◽

Racial Ethnic

AbstractBlack, Hispanic, and Indigenous persons in the United States have an increased risk of SARS-CoV-2 infection and death from COVID-19, due to persistent social inequities. The magnitude of the disparity is unclear, however, because race/ethnicity information is often missing in surveillance data. In this study, we quantified the burden of SARS-CoV-2 infection, hospitalization, and case fatality rates in an urban county by racial/ethnic group using combined race/ethnicity imputation and quantitative bias-adjustment for misclassification. After bias-adjustment, the magnitude of the absolute racial/ethnic disparity, measured as the difference in infection rates between classified Black and Hispanic persons compared to classified White persons, increased 1.3-fold and 1.6-fold respectively. These results highlight that complete case analyses may underestimate absolute disparities in infection rates. Collecting race/ethnicity information at time of testing is optimal. However, when data are missing, combined imputation and bias-adjustment improves estimates of the racial/ethnic disparities in the COVID-19 burden.

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How Administrative Data Collection and Analysis Can Better Reflect Racial and Ethnic Identities

Review of Research in Education ◽

10.3102/0091732x20903321 ◽

2020 ◽

Vol 44 (1) ◽

pp. 301-331

Author(s):

Samantha Viano ◽

Dominique J. Baker

Keyword(s):

Data Collection ◽

Administrative Data ◽

Race And Ethnicity ◽

Ethnic Disparities ◽

Ethnic Identities ◽

Birth Certificates ◽

Data Sets ◽

Race Ethnicity ◽

Equivalent Sources ◽

Racial Ethnic

Measuring race and ethnicity for administrative data sets and then analyzing these data to understand racial/ethnic disparities present many logistical and theoretical challenges. In this chapter, we conduct a synthetic review of studies on how to effectively measure race/ethnicity for administrative data purposes and then utilize these measures in analyses. Recommendations based on this synthesis include combining the measure of Hispanic ethnicity with the broader racial/ethnic measure and allowing individuals to select more than one race/ethnicity. Data collection should rely on self-reports but could be supplemented using birth certificates or equivalent sources. Collecting data over time, especially for young people, will help identify multiracial and American Indian populations. For those with more complex racial/ethnic identities, including measures of country of origin, language, and recency of immigration can be helpful in addition to asking individuals which racial/ethnic identity they most identify with. Administrative data collection could also begin to incorporate phenotype measures to facilitate the calculation of disparities within race/ethnicity by skin tone. Those analyzing racial/ethnic disparities should understand how these measures are created and attempt to develop fieldwide terminology to describe racial/ethnic identities.

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Race and ethnicity on MS presentation and disease course

Multiple Sclerosis Journal ◽

10.1177/1352458519887328 ◽

2020 ◽

Vol 26 (5) ◽

pp. 561-567

Author(s):

Lilyana Amezcua ◽

Jacob L McCauley

Keyword(s):

African Americans ◽

Race And Ethnicity ◽

Ethnic Disparities ◽

European Ancestry ◽

Mortality Trends ◽

Ethnic Populations ◽

Specific Mortality ◽

Future Challenges ◽

Race Ethnicity ◽

Racial Ethnic

Multiple sclerosis (MS) has a strong racial and ethnic component and disproportionately affects whites of European background. Recent incidence reports suggest an increasing rate of MS among African Americans compared with whites. Despite this recent increase in MS in African Americans, Hispanics and Asians are significantly less likely to develop MS than whites of European ancestry. MS-specific mortality trends demonstrate distinctive disparities by race/ethnicity and age, suggesting that there is an unequal burden of disease. Inequalities in health along with differences in clinical characteristics that may be genetic, environmental, and social in origin may be contributing to disease variability and be suggestive of endophenotypes. The overarching goal of this review was to summarize the current understanding on the variability of disease that we observe in selected racial and ethnic populations: Hispanics and African Americans. Future challenges will be to unravel the genetic, environmental, and social determinants of the observed racial/ethnic disparities.

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Racial-ethnic disparities in case fatality ratio narrowed after age standardization: A call for race-ethnicity-specific age distributions in State COVID-19 data

10.1101/2020.10.01.20205377 ◽

2020 ◽

Author(s):

Ishaan Pathak ◽

Yoonjoung Choi ◽

Dazhi Jiao ◽

Diana Yeung ◽

Li Liu

Keyword(s):

Racial Disparities ◽

Ethnic Disparities ◽

Case Fatality ◽

Asian Population ◽

Data Availability ◽

White Population ◽

Key Points ◽

Race Ethnicity ◽

Racial Ethnic ◽

Death Data

AbstractImportanceCOVID-19 racial disparities have gained significant attention yet little is known about how age distributions obscure racial-ethnic disparities in COVID-19 case fatality ratios (CFR).ObjectiveWe filled this gap by assessing relevant data availability and quality across states, and in states with available data, investigating how racial-ethnic disparities in CFR changed after age adjustment.Design/Setting/Participants/ExposureWe conducted a landscape analysis as of July 1st, 2020 and developed a grading system to assess COVID-19 case and death data by age and race in 50 states and DC. In states where age- and race-specific data were available, we applied direct age standardization to compare CFR across race-ethnicities. We developed an online dashboard to automatically and continuously update our results.Main Outcome and MeasureOur main outcome was CFR (deaths per 100 confirmed cases). We examined CFR by age and race-ethnicities.ResultsWe found substantial variations in disaggregating and reporting case and death data across states. Only three states, California, Illinois and Ohio, had sufficient age- and race-ethnicity-disaggregation to allow the investigation of racial-ethnic disparities in CFR while controlling for age. In total, we analyzed 391,991confirmed cases and 17,612 confirmed deaths. The crude CFRs varied from, e.g. 7.35% among Non-Hispanic (NH) White population to 1.39% among Hispanic population in Ohio. After age standardization, racial-ethnic differences in CFR narrowed, e.g. from 5.28% among NH White population to 3.79% among NH Asian population in Ohio, or an over one-fold difference. In addition, the ranking of race-ethnic-specific CFRs changed after age standardization. NH White population had the leading crude CFRs whereas NH Black and NH Asian population had the leading and second leading age-adjusted CFRs respectively in two of the three states. Hispanic population’s age-adjusted CFR were substantially higher than the crude. Sensitivity analysis did not change these results qualitatively.Conclusions and RelevanceThe availability and quality of age- and race-ethnic-specific COVID-19 case and death data varied greatly across states. Age distributions in confirmed cases obscured racial-ethnic disparities in COVID-19 CFR. Age standardization narrows racial-ethnic disparities and changes ranking. Public COVID-19 data availability, quality, and harmonization need improvement to address racial disparities in this pandemic.Key PointsQuestionWhat are the racial-ethnic disparities in COVID-19 case fatality ratios (CFR) across states after adjusting for age?FindingsWe conducted direct standardization among 391,991 COVID-19 cases and 17,612 deaths from California, Illinois and Ohio to compare age-adjusted CFR across race-ethnicities. The racial-ethnic disparities in CFR narrowed and the ranking changed after age standardization.MeaningAge distributions in confirmed cases obscured racial-ethnic disparities in COVID-19 CFR.

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Racial/Ethnic Disparities in Intensive Care Admissions in a Pregnant and Postpartum Population, Hawai‘i, 2012-2017

Public Health Reports ◽

10.1177/00333549211021146 ◽

2021 ◽

pp. 003335492110211

Author(s):

Pamela Estrada ◽

Hyeong Jun Ahn ◽

Scott A. Harvey

Keyword(s):

Maternal Morbidity ◽

Clinical Characteristics ◽

White Women ◽

Ethnic Disparities ◽

Severe Maternal Morbidity ◽

Obstetric Outcomes ◽

Icu Admission ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

Objective Maternal morbidity and mortality is a global concern despite advances in medical care and technology and improved economic resources of nations worldwide. The primary objective of our study was to describe racial/ethnic disparities in severe maternal morbidity by using admission to an intensive care unit (ICU) as a marker. The secondary objective was to evaluate associations between patient characteristics, including obstetric outcomes, and severe maternal morbidity. Methods This retrospective cohort study used a large inpatient database to identify pregnancy and postpartum hospitalizations in Hawai‘i from January 2012 through September 2017. We evaluated associations between sociodemographic and clinical characteristics and race/ethnicity by using χ2 tests. We used multivariable logistic regression to assess associations between race/ethnicity and ICU admission. We used a post hoc analysis to assess associations between ICU admission and obstetric outcomes by race/ethnicity. Results After adjustment, we found a significantly higher ICU admission rate among Asian (adjusted odds ratio [aOR] = 1.30; 95% CI, 1.04-1.62; P = .02), Filipino (aOR = 1.45; 95% CI, 1.17-1.79; P < .001), and Native Hawaiian/Other Pacific Islander (aOR = 1.39; 95% CI, 1.15-1.68; P < .001) women compared with non-Hispanic White women. Multiple clinical characteristics and outcomes were associated with ICU admission, such as preexisting chronic conditions and pregnancy-induced hypertensive disorders. Conclusion We found that severe maternal morbidity represented by ICU admission is higher among Asian, Filipino, and Native Hawaiian/Other Pacific Islander women than among non-Hispanic White women in Hawai’i. Our findings reemphasize the need for health care providers to be vigilant in caring for members of racial/ethnic minority groups and managing their comorbidities.

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Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062921 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2921

Author(s):

Jay J. Xu ◽

Jarvis T. Chen ◽

Thomas R. Belin ◽

Ronald S. Brookmeyer ◽

Marc A. Suchard ◽

...

Keyword(s):

United States ◽

District Of Columbia ◽

Ethnic Disparities ◽

The United States ◽

Attributable Mortality ◽

Race Ethnicity ◽

Using Data ◽

Rate Ratios ◽

Degree Of Association ◽

Racial Ethnic

The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

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Reductions in US life expectancy from COVID-19 by Race and Ethnicity: Is 2021 a repetition of 2020?

10.1101/2021.10.17.21265117 ◽

2021 ◽

Author(s):

Theresa Andrasfay ◽

Noreen Goldman

Keyword(s):

Life Expectancy ◽

Race And Ethnicity ◽

Ethnic Disparities ◽

White Population ◽

Widespread Distribution ◽

Life Expectancy At Birth ◽

The Us ◽

The Impact ◽

Racial Ethnic ◽

Black And Latino

COVID-19 had a huge mortality impact in the US in 2020 and accounted for the majority of the 1.5-year reduction in 2020 life expectancy at birth. There were also substantial racial/ethnic disparities in the mortality impact of COVID-19 in 2020, with the Black and Latino populations experiencing reductions in life expectancy at birth over twice the reduction experienced by the White population. Despite continued vulnerability of the Black and Latino populations, the hope was that widespread distribution of effective vaccines would mitigate the overall impact and reduce racial/ethnic disparities in 2021. In this study, we use cause-deleted life table methods to estimate the impact of COVID-19 mortality on 2021 US period life expectancy. Our partial-year estimates, based on provisional COVID-19 deaths for January-early October 2021 suggest that racial/ethnic disparities have persisted and that life expectancy at birth in 2021 has already declined by 1.2 years from pre-pandemic levels. Our projected full-year estimates, based on projections of COVID-19 deaths through the end of 2021 from the Institute for Health Metrics and Evaluation, suggest a 1.8-year reduction in US life expectancy at birth from pre-pandemic levels, a steeper decline than the estimates produced for 2020. The reductions in life expectancy at birth estimated for the Black and Latino populations are 1.6-2.4 times the impact for the White population.

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Racial/Ethnic Disparities in Influenza Vaccination Coverage Among US Adolescents, 2010-2016

Public Health Reports ◽

10.1177/0033354918805720 ◽

2018 ◽

Vol 133 (6) ◽

pp. 667-676 ◽

Cited By ~ 5

Author(s):

Noah S. Webb ◽

Benjamin Dowd-Arrow ◽

Miles G. Taylor ◽

Amy M. Burdette

Keyword(s):

Influenza Vaccination ◽

Vaccination Coverage ◽

Black Adolescents ◽

Ethnic Disparities ◽

White Adolescents ◽

Hispanic Adolescents ◽

Vaccination Rates ◽

Targeted Interventions ◽

Race Ethnicity ◽

Racial Ethnic

Objective: Although research suggests racial/ethnic disparities in influenza vaccination and mortality rates, few studies have examined racial/ethnic trends among US adolescents. We used national cross-sectional data to determine (1) trends in influenza vaccination rates among non-Hispanic white (hereinafter, white), non-Hispanic black (hereinafter, black), and Hispanic adolescents over time and (2) whether influenza vaccination rates among adolescents varied by race/ethnicity. Methods: We analyzed provider-reported vaccination histories for 2010-2016 from the National Immunization Survey–Teen. We used binary logistic regression models to determine trends in influenza vaccination rates by race/ethnicity for 117 273 adolescents, adjusted for sex, age, health insurance, physician visit in the previous 12 months, vaccination facility type, poverty status, maternal education level, children in the household, maternal marital status, maternal age, and census region of residence. We calculated adjusted probabilities for influenza vaccination for each racial/ethnic group, adjusted for the same demographic characteristics. Results: Compared with white adolescents, Hispanic adolescents had higher odds (adjusted odds ratio [aOR] = 1.11; 95% confidence interval [CI], 1.06-1.16) and black adolescents had lower odds (aOR = 0.95; 95% CI, 0.90-1.00) of vaccination. Compared with white adolescents, Hispanic adolescents had significantly higher adjusted probabilities of vaccination for 2011-2013 (2011: 0.22, P < .001; 2012: 0.23, P < .001; 2013: 0.26, P < .001). Compared with white adolescents, black adolescents had significantly lower probabilities of vaccination for 2016 (2016: 0.21, P < .001). Conclusions: Targeted interventions are needed to improve adolescent influenza vaccination rates and reduce racial/ethnic disparities in adolescent vaccination coverage.

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A Systematic Review of Parenting Scales Measurement Invariance/Equivalence of by Race and Ethnicity: Recommendations for Inclusive Parenting Research

Assessment ◽

10.1177/10731911211038630 ◽

2021 ◽

pp. 107319112110386

Author(s):

Violeta J. Rodriguez ◽

Dominique L. La Barrie ◽

Miriam C. Zegarac ◽

Anne Shaffer

Keyword(s):

Systematic Review ◽

Measurement Invariance ◽

Ethnic Minorities ◽

Race And Ethnicity ◽

Parenting Practices ◽

The United States ◽

Weak Evidence ◽

Race Ethnicity ◽

Development And Validation ◽

Racial Ethnic

The limited inclusion of racial/ethnic minorities in the development and validation of parenting measures limits our understanding of whether parenting constructs are valid in racial and ethnic minorities. Tests of measurement invariance/equivalence (MI/E) of parenting measures can help evaluate the validity of parenting constructs among racial/ethnic minorities. This systematic review summarized studies on MI/E of parenting constructs by race/ethnicity and evaluated the strength of the evidence. A literature search was conducted using various databases and references to retrieve studies from the United States. Indeed, 10 studies were identified that tested for MI/E of eight parenting scales by race/ethnicity. Only one scale showed moderate evidence of MI/E, five showed weak evidence of MI/E, and two showed no evidence of MI/E. Most studies (80%) used factor analytic methods to test for MI/E, but only two studies (20%) examined all levels of invariance. These findings show that differences exist in how racial/ethnic minorities perceive parenting constructs. Further research is needed to develop more inclusive parenting measures, to protect against the ways in which biased measures may pathologize or misrepresent parenting practices among racial/ethnic minorities.

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Abstract TP188: Location of Intracerebral Hemorrhage in a Tri-ethnic Cohort: The ERICH Study

Stroke ◽

10.1161/str.44.suppl_1.atp188 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Lee Birnbaum ◽

Anne Leonard ◽

Julio Andino ◽

Charles J Moomaw ◽

Carl Langfeld ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Univariate Analysis ◽

Case Fatality ◽

Final Model ◽

Location Data ◽

History Of ◽

Race Ethnicity ◽

Pairwise Testing ◽

Racial Ethnic ◽

Control Study

Background: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) is an ongoing case-control study of spontaneous ICH among non-hispanic whites, non-hispanic blacks, and Hispanics. Prior studies have identified hypertension as a greater risk for non-lobar (NL) ICH as compared with lobar (L) ICH. Given the greater reported prevalence of hypertension among black and Hispanic populations, we hypothesized that the location of ICH may differ by race/ethnicity. Methods: At the time of this analysis, we had ICH location data, lobar vs. non-lobar, on 648 subjects. We performed univariate analysis on known and potential predictors of ICH location: age, sex, race/ethnicity, hypertension, diabetes, BMI, creatinine, cholesterol, aspirin use, smoking, alcohol use, caffeine use, and INR. INR was dichotomized at >1.1. After forcing in age, sex, race, history of diabetes, aspirin use and INR, we added significant and near-significant (p<0.2) variables in a stepwise fashion to complete our final logistic regression model. Our outcome measure was lobar ICH. Conditional pairwise testing was performed for race/ethnicity. Results: Of the 648 subjects (mean age 61.12 ± 14.51 years; 39.8% female; 35.0% Hispanic, 26.5% white, 38.4% black), 181 (27.9%) presented with lobar ICH. Hypertension was present in 525 subjects (75.1% L, 83.3% NL; p=.018), diabetes in 152 (26.0% L, 22.5% NL; p=.348), high cholesterol in 244 (45.9% L, 34.5% NL; p=.008), aspirin use in 200 (37.0% L, 28.5% NL; p=.035), and INR >1.1 (24.1% L, 21.8% NL; p=.535) In our final model, race/ethnicity (p<.024) was associated with location of ICH. Furthermore, white race/ethnicity was associated with L ICH, compared with black (b=.57, p=.016) or Hispanic (b=.56, p=.018). Hypertension (b=-0.63, p=.009) was associated with NL ICH, and smoking (b=0.51, p=.007) was associated with L ICH. Discussion: Our results suggest that there are significant racial/ethnic differences in the distribution of lobar and non-lobar ICH. The conditional pairwise testing for race/ethnicity showed a significantly higher rate of lobar ICH in whites, compared with blacks or Hispanics. These findings are intriguing given the differences in case-fatality rates and age at ICH onset.

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