Disparities in Telemedicine Access: A Cross-Sectional Study of a Newly Established Infrastructure during the COVID-19 Pandemic

2021 ◽  
Vol 12 (03) ◽  
pp. 445-458
Author(s):  
Vivian Hsiao ◽  
Thevaa Chandereng ◽  
Robin L. Lankton ◽  
Jeffrey A. Huebner ◽  
Jeffrey J. Baltus ◽  
...  
Keyword(s):  
African American ◽  
Health Care Access ◽  
Digital Literacy ◽  
Geographic Region ◽  
Secondary Outcome ◽  
Primary Study ◽  
Patient Portal ◽  
Cross Sectional ◽  
Black African ◽  
African American Race

Abstract Background The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a “digital divide” of disparate access may prevent certain populations from realizing the benefits of telemedicine. Objectives The study aimed to understand telemedicine utilization patterns after a widespread deployment to identify potential disparities exacerbated by expanded telemedicine usage. Methods We performed a cross-sectional retrospective analysis of adults who scheduled outpatient visits between June 1, 2020 and August 31, 2020 at a single-integrated academic health system encompassing a broad range of subspecialties and a large geographic region in the Upper Midwest, during a period of time after the initial surge of COVID-19 when most standard clinical services had resumed. At the beginning of this study period, approximately 72% of provider visits were telemedicine visits. The primary study outcome was whether a patient had one or more video-based visits, compared with audio-only (telephone) visits or in-person visits only. The secondary outcome was whether a patient had any telemedicine visits (video-based or audio-only), compared with in-person visits only. Results A total of 197,076 individuals were eligible (average age = 46 years, 56% females). Increasing age, rural status, Asian or Black/African American race, Hispanic ethnicity, and self-pay/uninsured status were significantly negatively associated with having a video visit. Digital literacy, measured by patient portal activation status, was significantly positively associated with having a video visit, as were Medicaid or Medicare as payer and American Indian/Alaskan Native race. Conclusion Our findings reinforce previous evidence that older age, rural status, lower socioeconomic status, Asian race, Black/African American race, and Hispanic/Latino ethnicity are associated with lower rates of video-based telemedicine use. Health systems and policies should seek to mitigate such barriers to telemedicine when possible, with efforts such as digital literacy outreach and equitable distribution of telemedicine infrastructure.

scholarly journals Self-Rated Health and Health Care Access Associated With African American Men’s Health Self-Efficacy

2015 ◽  
Vol 11 (5) ◽  
pp. 1385-1387 ◽  
Author(s):  
Terry Thompson ◽  
Jamie A. Mitchell ◽  
Vicki Johnson-Lawrence ◽  
Daphne C. Watkins ◽  
Charles S. Modlin
Keyword(s):  
Health Care ◽  
African American ◽  
Health Insurance ◽  
Health Care Access ◽  
Self Efficacy ◽  
African American Men ◽  
Good Care ◽  
Cross Sectional ◽  
Self Rated Health ◽  
Care Access

Health self-efficacy, a measure of one’s self-assurance in taking care of their own health, is known to contribute to a range of health outcomes that has been under examined among African American men. The purpose of this investigation was to identify and contextualize predictors of general health self-efficacy in this population. A cross-sectional sample of surveys from 558 African American was examined. These men were older than 18 years, could read and write English, and attended a hospital-based community health fair targeting minority men in 2011. The outcome of interest was health self-efficacy, which was assessed by asking, “Overall, how confident are you in your ability to take good care of your health?” Responses ranged from 1 ( not confident at all) to 5 ( completely confident). Covariates included age, self-rated health, health insurance status, having a regular physician, and being a smoker. The mean age of participants was 54.4 years, and 61.3% of participants indicated confidence in their ability to take good care of their health. Older age and being a smoker were inversely associated with the outcome. Good self-rated health, having health insurance, and having a regular doctor were positively associated with reports of health self-efficacy. Findings suggest that multiple points of connection to the health care system increase the likelihood of health self-efficacy for this sample and interventions to support older African American men who may evaluate their own health status as poor and who may face barriers to health care access are implicated.

scholarly journals The Association Between Racial Microaggressions and Depressive Symptoms: A Cross-Sectional Analysis

2021 ◽  
Vol 26 (2) ◽  
pp. 208-220
Author(s):  
Marisol Aquino ◽  
Mia Budescu
Keyword(s):  
College Students ◽  
High School ◽  
African American ◽  
High School Students ◽  
Depressive Symptoms ◽  
Racial Microaggressions ◽  
Cross Sectional Study ◽  
School Students ◽  
Cross Sectional ◽  
Black African

The present study investigated whether racial microaggressions, specifically assumptions of inferiority, assumptions of criminality/second class citizenship, and microinvalidations had a relationship with depressive symptoms, and whether this relationship varied by age group (adults vs. adolescents) and race (Black and Latinx). This cross-sectional study compared 194 undergraduate college students who were all over the age of 18 to 168 high school juniors and seniors. All participants identified as either African American/Black or Latinx/Hispanic. The results indicated that respondents identifying as Black/African American, regardless of age, experience higher levels of assumptions of criminality/second class citizenship compared to Latinx respondents, F(2, 350) = 0.82, p = .442, ηp2 = .004. Results also indicated that, among Black/African American college students, but not high school students nor Latinx participants, higher levels of assumptions of inferiority were associated with depressive symptoms (b = .34, SE = 0.07, p < .001). Assumptions of criminality/second class citizenship, on the other hand, were not related with depressive symptoms (b = .06, SE = 0.08, p = .433). Lastly, regardless of race, high school students experienced more microinvalidations than college students, F(2, 350) = 3.97, p = .047, ηp2 =.013. These results underscore developmental changes in how students of color experience race and racism as they transition from adolescence into adulthood.

Abstract 15047: Effects of Blood Pressure Percentile, Body Mass Index, and Race on Left Ventricular Mass in Children

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michelle L Udine ◽  
Jonathan Kaltman ◽  
Qianxi Li ◽  
Jin Liu ◽  
Deyu Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass Index ◽  
African American ◽  
Body Mass ◽  
Left Ventricular ◽  
Left Ventricle Mass ◽  
Cross Sectional ◽  
Populations At Risk ◽  
African American Race

Introduction: Childhood hypertension, obesity, and left ventricular hypertrophy (LVH) are risk factors for premature cardiovascular events in adulthood, particularly among minorities. In children, race and body mass index (BMI) have been shown to be independently associated with LVH, with conflicting data on the association of systolic blood pressure (SBP) level with risk of LVH and utility of ECG in assessing LVH. This study looks at the association of SBP percentile, race, and BMI with LVH on electrocardiogram (ECG) and echocardiogram (echo) to define populations at risk. Methods: This is a retrospective cross-sectional study design utilizing a data analytics tool (Tableau) combining ECG and echo databases from 2003-2020. Customized queries identified patients ages 2-18 years old who had an outpatient ECG and echo on the same date with available SBP and body measurements. Cases with congenital heart disease, cardiomyopathy, or arrhythmia diagnoses were excluded. Echos with left ventricle mass (indexed to height 2.7 ) were included. The main outcome was LVH on echo defined as LV mass index greater than the 95 th percentile for age. Results: In a cohort of 13,926 patients, 6.9% of studies had LVH on echo. SBP percentile > 90% has a sensitivity of 36% and specificity of 82% for LVH on echo. LVH on ECG was a poor predictor of LVH on echo (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.11, 1.55, p=.001), SBP percentile > 95% (OR=1.64, 95% CI = 1.37, 1.95, p <.001), and higher body mass index (OR= 7.43, 95% CI = 6.44, 8.55, p <.001) were independently associated with LVH on echo. Figure 1 shows the prevalence of LVH by African American race, obesity, and SBP. Conclusions: African American race, obesity, and hypertension are independent risk factors for LVH in children. Outpatient ECG has low utility in screening for LVH.

Factors Associated With Psychosocial Illness Impact Among Black/African American and Hispanic Older Women Living With HIV

2021 ◽  
pp. 107839032110587
Author(s):  
Evelyn Iriarte ◽  
Rosina Cianelli ◽  
Natalia Villegas ◽  
Giovanna De Oliveira ◽  
Christine Toledo ◽  
...  
Keyword(s):  
African American ◽  
Older Women ◽  
Secondary Data ◽  
The United States ◽  
Cross Sectional ◽  
Black African ◽  
Factors Associated ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Perception Of Health

Background: In 2018, one in six newly diagnosed individuals with HIV in the United States were adults aged 50 years and older, 24% were women, and 60% were Black/African American and Hispanic (42% and 18%, respectively). Objectives: This study aims to examine the factors associated with HIV psychosocial illness impact among Black/African American and Hispanic older women living with HIV. Method: Guided by the socioecological model, a secondary data analysis design with cross-sectional data that included 138 Black/African American and Hispanic women aged 50 years and older was conducted. Results: Higher levels of avoidant coping, depressive symptoms, negative self-perception of health, and decreased social support were significant factors associated with HIV psychosocial illness impact among this sample. Conclusions: Findings from this study can contribute to identifying solutions to prevent and decrease these negative factors associated with HIV psychosocial illness impact among Black/African American and Hispanic older women.

scholarly journals 0359 The Moderating Role of Race in the Association of Adolescent Sleep Duration and Marijuana Use

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A137-A137
Author(s):  
J C Levenson ◽  
B Atuahene ◽  
T Bear ◽  
K Hacker ◽  
E Ricci ◽  
...  
Keyword(s):  
African American ◽  
Racial Differences ◽  
Sleep Duration ◽  
African American Youth ◽  
Marijuana Use ◽  
White Youth ◽  
Cross Sectional ◽  
Insufficient Sleep ◽  
Black African ◽  
Adolescent Sleep

Abstract Introduction Insufficient sleep and marijuana use during adolescence vary by race and are associated with poor outcomes in various domains. Sleep difficulties predict drug-related problems, but not all adolescents with insufficient sleep go on to use substances. We examined whether race/ethnicity moderates the association of sleep duration and marijuana use among Black/African-American and White adolescents using a countywide probability-based survey of adolescents. Methods Using cross-sectional data (n=1447), logistic regression examined whether race moderated the association of adolescent sleep duration and recent marijuana use alone and after controlling for covariates in both weighted and unweighted models. Results Hours of sleep was significantly negatively associated with recent marijuana use. Black/African-American youth in our sample had up to a 60% increased odds of marijuana use in the past 30 days compared to White youth, and they reported significantly shorter sleep duration than their White peers. In weighted models, Black/African-American youth had an increased probability of marijuana use with fewer hours of sleep as compared to White youth, even after accounting for covariates. Conclusion In our countywide survey of adolescents, we found racial differences in the association of sleep duration and marijuana use. Future work should replicate our analyses with a longitudinal sample of adolescents to better evaluate the direction of these effects. Future efforts should also focus on identifying contextual factors that may explain racial differences in the sleep duration—substance use relationship, as well as developing strategies to reduce disparities in this relationship. Support The Heinz Foundation, the Hillman Foundation, the Grable Foundation, and the FISA Foundation. Dr. Levenson’s effort was supported by NICHD.

scholarly journals Serological surveys to estimate cumulative incidence of SARS-CoV-2 infection in adults (Sero-MAss study), Massachusetts, July–August 2020: a mail-based cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e051157
Author(s):  
Teah Snyder ◽  
Johanna Ravenhurst ◽  
Estee Y Cramer ◽  
Nicholas G Reich ◽  
Laura Balzer ◽  
...  
Keyword(s):  
Undergraduate Students ◽  
Febrile Illness ◽  
Cross Sectional Study ◽  
Asymptomatic Infection ◽  
Geographic Region ◽  
Secondary Outcome ◽  
Igg Antibodies ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Primary Sample

ObjectivesTo estimate the seroprevalence of anti-SARS-CoV-2 IgG and IgM among Massachusetts residents and to better understand asymptomatic SARS-CoV-2 transmission during the summer of 2020.DesignMail-based cross-sectional survey.SettingMassachusetts, USA.ParticipantsPrimary sampling group: sample of undergraduate students at the University of Massachusetts, Amherst (n=548) and a member of their household (n=231).Secondary sampling group: sample of graduate students, faculty, librarians and staff (n=214) and one member of their household (n=78). All participants were residents of Massachusetts without prior COVID-19 diagnosis.Primary and secondary outcome measuresPrevalence of SARS-CoV-2 seropositivity. Association of seroprevalence with variables including age, gender, race, geographic region, occupation and symptoms.ResultsApproximately 27 000 persons were invited via email to assess eligibility. 1001 households were mailed dried blood spot sample kits, 762 returned blood samples for analysis. In the primary sample group, 36 individuals (4.6%) had IgG antibodies detected for an estimated weighted prevalence in this population of 5.3% (95% CI: 3.5 to 8.0). In the secondary sampling group, 10 participants (3.4%) had IgG antibodies detected for an estimated adjusted prevalence of 4.0% (95% CI: 2.2 to 7.4). No samples were IgM positive. No association was found in either group between seropositivity and self-reported work duties or customer-facing hours. In the primary sampling group, self-reported febrile illness since February 2020, male sex and minority race (Black or American Indian/Alaskan Native) were associated with seropositivity. No factors except geographic regions within the state were associated with evidence of prior SARS-CoV-2 infection in the secondary sampling group.ConclusionsThis study fills a critical gap in estimating the levels of subclinical and asymptomatic infection. Estimates can be used to calibrate models estimating levels of population immunity over time, and these data are critical for informing public health interventions and policy.

scholarly journals Cross-sectional study of correlates and prevalence of functional and high-risk multimorbidity in an academic HIV practice in New York City

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047199
Author(s):  
Eugenia Siegler ◽  
Jerad Moxley ◽  
Elizabeth Mauer ◽  
Marshall Glesby
Keyword(s):  
New York ◽  
New York City ◽  
African American ◽  
High Risk ◽  
York City ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Hiv Diagnosis ◽  
Cross Sectional

ObjectivesPeople with HIV have high levels of multimorbidity, but studies often focus on high-risk comorbidities such as hypertension or coronary artery disease. We examined both high-risk and functional comorbidities in an ethnically diverse clinic population to compare the prevalence of comorbidities and different patterns of multimorbidity.DesignRetrospective cross-sectional study.SettingUniversity-based primary care HIV clinic with two locations in New York City.ParticipantsPatients who had been seen by a physician at least once between 1 June 2016 and 31 May 2017.Primary and secondary outcome measuresData regarding demographics, diagnoses and lab values were downloaded in a one-time data import from the electronic medical record. Comorbidities were classified as high-risk (with major impact on mortality) or functional (with major impact on function), and multimorbidity was determined for both classes in the total sample of 2751. Factors associated with high-risk and functional multimorbidity were determined first through bivariate analysis and then through multivariable median regression in 2013 patients with complete data.ResultsMedian age was 52 years (IQR 43–59). Cisgendered women comprised 24.6% of the sample, and 31.7% were African-American. Both functional and high-risk comorbidities were common and risk increased with age. Among those 75 and older, median number of both functional and high-risk comorbidities was 3 (IQR 2–4). High-risk comorbidities were associated with age (p<0.001), more years with an HIV diagnosis (p<0.001) and being an African-American (p<0.001). Associated with a higher number of functional comorbidities were age (p<0.001), being a cisgender female (p<0.001), being Hispanic (p=0.01) and more years with an HIV diagnosis (p<0.001).ConclusionsComorbidities with functional impact increase with age in parallel to those with a more direct impact on mortality and should be assessed and monitored, especially as the population with HIV ages.

Youth Perceptions of Law Enforcement and Worry About Crime from 1976 to 2016

2020 ◽  
Vol 47 (5) ◽  
pp. 564-581 ◽  
Author(s):  
Adam D. Fine ◽  
Sachiko Donley ◽  
Caitlin Cavanagh ◽  
Elizabeth Cauffman
Keyword(s):  
African American ◽  
Law Enforcement ◽  
African American Youth ◽  
Youth Of Color ◽  
White Youth ◽  
Cross Sectional ◽  
Black African ◽  
American Law ◽  
Youth Perceptions ◽  
Racial Ethnic

Recent unjust interactions between law enforcement and youth of color may have provoked a “crisis” in American law enforcement. Utilizing Monitoring the Future’s data on distinct, cross-sectional cohorts of 12th graders from each year spanning 1976–2016, we examined whether youth perceptions of law enforcement have changed. We also traced youth worry about crime considering declining perceptions of law enforcement may correspond with increasing worry about crime. Across decades, White youth consistently perceived law enforcement the most positively and worried least about crime, followed by Hispanic/Latinx then Black/African American youth. During the 1990s, among all youth, perceptions of law enforcement declined while worry about crime increased. However, recently, such trends were limited to White youth; among youth of color, perceptions of law enforcement declined while worry about crime remained largely stable. Problematically, youth perceptions of law enforcement recently reached a decades-long low and racial/ethnic gaps in perceptions appear to be growing.

Socioeconomic Status and Race Outperform Concussion History and Sport Participation in Predicting Collegiate Athlete Baseline Neurocognitive Scores

2017 ◽  
Vol 24 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Zac Houck ◽  
Breton Asken ◽  
James Clugston ◽  
William Perlstein ◽  
Russell Bauer
Keyword(s):  
Socioeconomic Status ◽  
African American ◽  
Collegiate Athletes ◽  
Older Age ◽  
Football Players ◽  
Black African ◽  
Speed Performance ◽  
History Of ◽  
Concussion History ◽  
African American Race

AbstractObjectives: The purpose of this study was to assess the contribution of socioeconomic status (SES) and other multivariate predictors to baseline neurocognitive functioning in collegiate athletes. Methods: Data were obtained from the Concussion Assessment, Research and Education (CARE) Consortium. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baseline assessments for 403 University of Florida student-athletes (202 males; age range: 18–23) from the 2014–2015 and 2015–2016 seasons were analyzed. ImPACT composite scores were consolidated into one memory and one speed composite score. Hierarchical linear regressions were used for analyses. Results: In the overall sample, history of learning disability (β=−0.164; p=.001) and attention deficit–hyperactivity disorder (β=−0.102; p=.038) significantly predicted worse memory and speed performance, respectively. Older age predicted better speed performance (β=.176; p<.001). Black/African American race predicted worse memory (β=−0.113; p=.026) and speed performance (β=−.242; p<.001). In football players, higher maternal SES predicted better memory performance (β=0.308; p=.007); older age predicted better speed performance (β=0.346; p=.001); while Black/African American race predicted worse speed performance (β=−0.397; p<.001). Conclusions: Baseline memory and speed scores are significantly influenced by history of neurodevelopmental disorder, age, and race. In football players, specifically, maternal SES independently predicted baseline memory scores, but concussion history and years exposed to sport were not predictive. SES, race, and medical history beyond exposure to brain injury or subclinical brain trauma are important factors when interpreting variability in cognitive scores among collegiate athletes. Additionally, sport-specific differences in the proportional representation of various demographic variables (e.g., SES and race) may also be an important consideration within the broader biopsychosocial attributional model. (JINS, 2018, 24, 1–10)

scholarly journals Who’s Vaccinated? A Closer Look at Healthcare Workers’ COVID-19 Vaccine Hesitancy and Demographics

2021 ◽  
pp. 1-7
Author(s):  
Mary Fossen ◽  
Margaret Bethany ◽  
Sanjay Modak ◽  
Sally Parris ◽  
Rohit Modak
Keyword(s):  
African American ◽  
Odds Ratio ◽  
Vaccination Rate ◽  
Vaccine Hesitancy ◽  
Black African ◽  
Demographic Groups ◽  
Vaccination Rates ◽  
Hospital Employees ◽  
American Employees ◽  
African American Race

Abstract Objective: To compare COVID-19 vaccine hesitancy among hospital employees by demographics. Methods: Our institution has offered an mRNA COVID-19 vaccine to all employees since January 2021. We collected data on vaccination rates among hospital employees and looked for differences in demographic groups to determine in which groups vaccine hesitancy is the highest. Those who received at least one dose of vaccine were considered “vaccinated” for this study. Results: There was a 71% vaccination rate among all hospital employees as of March 10, 2021. Age over 50 (odds ratio 1.85, 95% CI 1.53 to 2.24, p<0.01), working in a clinical department (odds ratio 1.19, 95% CI 1.01 to 1.42, p = 0.02), and white race compared to black/African American race (odds ratio 4.55, 95% CI 3.74 to 5.52, p<0.01) were all significant factors for receiving vaccination. Gender (odds ratio 1.12, 95% CI 0.94 to 1.35, p=0.10) was not significant. Conclusions: In a population with equal access to the COVID-19 vaccine, there were significant differences in vaccination rates among different demographic groups. Employees under 50 years of age, non-clinical employees, and black/African American employees were less likely to be vaccinated. This suggests that attitudes towards vaccination, and not simply access to the vaccine, are factors in vaccination rates.

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