The disproportionate rise in COVID-19 cases among Hispanic/Latinx in disadvantaged communities of Orange County, California: A socioeconomic case-series

AbstractBackgroundRecent epidemiological evidence has demonstrated a higher rate of COVID-19 hospitalizations and deaths among minorities. This pattern of race-ethnic disparities emerging throughout the United States raises the question of what social factors may influence spread of a highly transmissible novel coronavirus. The purpose of this study is to describe race-ethnic and socioeconomic disparities associated with COVID-19 in patients in our community in Orange County, California and understand the role of individual-level factors, neighborhood-level factors, and access to care on outcomes.MethodsThis is a case-series of COVID-19 patients from the University of California, Irvine (UCI) across six-weeks between 3/12/2020 and 4/22/2020. Note, California’s shelter-in-place order began on 3/19/2020. Individual-level factors included race-ethnicity status were recorded. Neighborhood-level factors from census tracts included median household income, mean household size, proportion without a college degree, proportion working from home, and proportion without health insurance were also recorded.ResultsA total of 210-patients tested were COVID-19 positive, of which 73.3% (154/210) resided in Orange County. Hispanic/Latinx patients residing in census tracts below the median income demonstrated exponential growth (rate = 55.9%, R2 = 0.9742) during the study period. In addition, there was a significant difference for both race-ethnic (p < 0.001) and income bracket (p = 0.001) distributions prior to and after California’s shelter-in-place. In addition, the percentage of individuals residing in neighborhoods with denser households (p = 0.046), lower levels of college graduation (p < 0.001), health insurance coverage (p = 0.01), and ability to work from home (p < 0.001) significantly increased over the same timeframe.Conclusions and RelevanceOur study examines the race-ethnic disparities in Orange County, CA, and highlights vulnerable populations that are at increased risk for contracting COVID-19. Our descriptive case series illustrates that we also need to consider socioeconomic factors, which ultimately set the stage for biological and social disparities.

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Abstract P447: Index of Concentration at the Extremes and Diabetes Prevalence: The Reasons for Geographic and Racial Differences in Stroke (regards) Study

Circulation ◽

10.1161/circ.141.suppl_1.p447 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Gargya Malla ◽

D. Leann Long ◽

Nyesha C Black ◽

Sha Zhu ◽

Jalal Uddin ◽

...

Keyword(s):

Racial Differences ◽

Community Level ◽

Diabetes Prevalence ◽

Median Income ◽

Census Tracts ◽

Individual Level ◽

Black And White ◽

The Us ◽

Regards Study ◽

Increase Diabetes Risk

Background: Stark regional and racial disparities in diabetes prevalence exist in the US. Community-level factors (e.g., median income) have been associated with higher diabetes prevalence. However, few studies have investigated how community-level spatial polarization, specifically in race and income, may relate to diabetes burden. Objective: To investigate the association between the Index of Concentration at the Extremes (ICE), a measure that reflects polarization in race and income at the community-level, and individual-level diabetes prevalence. Methods: This analysis included 24,752 Black and White adults age ≥ 45 years at baseline (2003-2007) from the REGARDS Study. The ICE measure quantifies the concentration of community affluence and poverty in a census tract using both income and race jointly, with values ranging from -1 (most deprived) to +1 (most privileged). Diabetes was defined as fasting glucose ≥ 126 mg/dL or random glucose ≥ 200 mg/dL or use of diabetes medication. Modified Poisson regression was used to obtain prevalence ratios and 95% CI for the association of ICE quartiles with prevalent diabetes. Results: The overall prevalence of diabetes was 21% and was highest for adults living in the most deprived census tracts (28.3%) and lowest for those living in the most privileged census tracts (12.5%). The association between ICE and prevalent diabetes was graded in crude analyses but attenuated after adjustment for individual-level sociodemographic, lifestyle and clinical factors (Table). Conclusion: Communities with greater polarization in race and income had a higher burden of diabetes. This association was mostly explained by individual-level socioeconomic and lifestyle factors. Further investigation of community-level attributes and how they relate to individual-level factors that increase diabetes risk is needed.

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Medicare and Medicaid Services Online

Public Affairs and Administration ◽

10.4018/978-1-4666-8358-7.ch032 ◽

2015 ◽

pp. 696-710

Author(s):

Mary Schmeida ◽

Ramona McNeal

Keyword(s):

Health Insurance ◽

Multivariate Regression Analysis ◽

The United States ◽

Vulnerable Groups ◽

Government Programs ◽

Life Project ◽

Demographic Groups ◽

Individual Level ◽

Level Data ◽

Access To Health

Government initiatives in the United States have been passed in an effort to increase citizen usage of e-government programs. One such service is the availability of online health insurance information. However, not all demographic groups have been equally able to access these services, primarily the poor and rural American. As more legislation is passed, including the advancement of broadband services to remote areas, infrastructure barriers are being removed, opening access to Medicare and Medicaid websites for these vulnerable groups. The purpose of this chapter is to analyze factors predicting the impact of recent government actions on citizen access to health insurance information online. This topic is explored using multivariate regression analysis and individual level data from the Internet and American Life Project. The findings suggest that healthcare needs and quality of Internet access may be playing a more important role in health insurance information services than other factors.

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Racial/ethnic disparities in childhood cancer survival in the United States: Mediation effects of health insurance coverage and area-level social deprivation.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.143 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 143-143

Author(s):

Jingxuan Zhao ◽

Xuesong Han ◽

Zhiyuan Zheng ◽

Leticia Maciel Nogueira ◽

Paul C. Nathan ◽

...

Keyword(s):

United States ◽

Health Insurance ◽

Childhood Cancer ◽

Cancer Survival ◽

Social Deprivation ◽

Insurance Coverage ◽

Ethnic Disparities ◽

The United States ◽

Childhood Cancer Survival ◽

Racial Ethnic

143 Background: Childhood cancer survival varies by race/ethnicity in the United States. This study evaluated the impact of potentially modifiable characteristics - health insurance and area-level social deprivation - on racial/ethnic disparities in childhood cancer survival nationwide. Methods: We identified 65,113 childhood cancer patients aged < 18 years newly diagnosed with any of 10 common cancer types (e.g. central nervous system (CNS) neoplasms, acute lymphoblastic leukemia (ALL), Hodgkin lymphoma) from the 2004-2014 National Cancer Database. Cox proportional hazard models were used to compare survival probabilities by race and ethnicity (non-Hispanic white (NHW) vs non-Hispanic black (NHB), Hispanic, and non-Hispanic other (NH other)) for each cancer type. We conducted mediation analyses by the mma R package to evaluate the racial/ethnic survival disparities mediated by health insurance (private, Medicaid, and uninsured) and social deprivation index (SDI) quartile. SDI is a composite measure of deprivation based on seven characteristics (e.g. income, education, employment). Results: Compared to NHW, worse survival were observed for NHB (HR (hazard ratio): 1.4, 95% CI: 1.3-1.5), Hispanic (HR: 1.2, 95% CI: 1.1-1.2), and NH other (HR: 1.2, 95% CI: 1.1-1.3) for all cancer sites combined after adjusting for sociodemographic characteristics other than health insurance and SDI. Health insurance explained 20% of the survival disparities and SDI explained 19% of the disparity between NHB vs NHW; health insurance explained 48% of the survival disparities and SDI explained 45% of the disparity between Hispanic vs NHW. For ALL, health insurance significantly explained 15% and 18% of the survival disparities between NHB and Hispanic vs NHW, respectively. SDI significantly explained 19% and 31% of the disparities, respectively. Conclusions: Health insurance and SDI mediated racial/ethnic survival disparities for several childhood cancers. Expanding insurance coverage and improving healthcare access in disadvantaged areas may effectively reduce disparities for these cancer sites.

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Young Adult's Perspectives on Being Uninsured and Implications for Health Reform

The Qualitative Report ◽

10.46743/2160-3715/2014.1281 ◽

2014 ◽

Author(s):

Kim Dauner ◽

Jack Thompson

Keyword(s):

Young Adults ◽

Health Insurance ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

The United States ◽

State Health ◽

Individual Level ◽

State Health Insurance ◽

Federal Statute ◽

Insurance Exchanges

Young adults between the ages of 18-34 are most likely to lack health insurance in the United States. The Affordable Care Act (ACA), a federal statute signed into law in 2010, contains provisions specific to increasing access to health insurance for young adults including the provision that persons under 26 can stay on their parents’ insurance. While the reasons for uninsurance among young adults have been documented, how they operate and are perceived on an individual level have not been explored in great detail. Further, it is poorly understood how the ACA policies and the state health insurance exchanges can serve young adults. Thus, we interviewed uninsured young adults aged 18-35 in northeastern Minnesota and northwestern Wisconsin and used inductive thematic analysis to explore these issues. Findings suggest that young adults don’t feel at risk for health problems and therefore have low levels of health insurance literacy and place little value on health insurance. Multiple barriers to health insurance coverage, including the provision about staying on a parent’s policy, persist despite the ACA. Our findings also suggest valuable lessons for state health insurance exchanges on how to better serve this population.

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Clinical Features and Outcomes of Isolated Myeloid Sarcoma in the United States: Analysis Using a National Dataset

Blood ◽

10.1182/blood.v128.22.1618.1618 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1618-1618

Author(s):

Gaurav Goyal ◽

Adam C Bartley ◽

Aref Al-Kali ◽

William J Hogan ◽

Mark Litzow ◽

...

Keyword(s):

United States ◽

Overall Survival ◽

Research Funding ◽

Median Overall Survival ◽

Case Series ◽

The United States ◽

Myeloid Sarcoma ◽

Anatomical Distribution ◽

Mediastinal Disease ◽

Significant Difference

Abstract Introduction Isolated myeloid sarcoma is a rare form (<1%) of acute myeloid leukemia presenting as extramedullary tumor. Contemporary clinical data are mostly limited to institutional case series. Using the National Cancer Database, the largest public cancer registry covering >70% of all newly diagnosed cancers in the United States, we determined the patterns of anatomical presentation and clinical outcome of myeloid sarcoma. Methods We identified patients with a histologically confirmed diagnosis of isolated myeloid sarcoma from 2004-2013 using International Classification of Diseases for Oncology version 3 (ICD-O-3) code: 9930. To allow at least 1 year of follow-up, only patients diagnosed from 2004-2012 were included in the survival analysis using Kaplan-Meier estimates. Results A total of 746 patients were included in the study. The median age of patients was 59 years (range, 41 to 73) and 56% were males. The anatomical distribution and median overall survival of patients are depicted in the Table. The top 3 most common sites of presentation were connective/soft tissues (31.3%), skin/breast (12.3%), and digestive system (10.3%). Compared to other races, Blacks were more likely to have presentation in bones/joints (11.8% vs 6.3% in others), lymph nodes/spleen (22.1% vs. 9%), and less likely in skin/breast (4.4% vs. 13.8%). Asians were more likely to present with cardiopulmonary/mediastinal disease as compared to other races (13.6% vs. 4.2%). According to outcomes, we can categorize the patients into 3 groups: good (median overall survival >30 months: reproductive and digestive systems), intermediate (median overall survival 15-30 months: head/neck and kidney/bladder/retroperitoneum/adrenal), and poor (median overall survival <15 months: nervous system, connective/soft tissue, and bones/joints). There was no significant difference in overall survival between males and females (P =0.06). Among the races, Blacks had the worst overall survival (P =0.02; Figure). Conclusions This is the largest registry-based study on isolated myeloid sarcoma in the United States. Isolated myeloid sarcoma has a diverse anatomic clinical presentation and the overall survival varied significantly according to sites of presentation and racial subgroups. The results of our study may aid the prognostication of patients for treatment decision making and in the understanding of the biological differences by anatomic sites of presentation. Table Anatomical distribution and median overall survival of isolated myeloid sarcoma Table. Anatomical distribution and median overall survival of isolated myeloid sarcoma Figure Overall survival by sex and race in isolated myeloid sarcoma Figure. Overall survival by sex and race in isolated myeloid sarcoma Disclosures Al-Kali: Onconova Therapeutics, Inc.: Research Funding; Celgene: Research Funding.

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Demographic Disparities in Proximity to Certified Stroke Care in the United States

Stroke ◽

10.1161/strokeaha.121.034493 ◽

2021 ◽

Author(s):

Cathy Y. Yu ◽

Timothy Blaine ◽

Peter D. Panagos ◽

Akash P. Kansagra

Keyword(s):

United States ◽

American Indian ◽

Census Tract ◽

Urban Areas ◽

Stroke Care ◽

The United States ◽

Median Income ◽

Census Tracts ◽

Median Distance ◽

Stroke Center

Background and Purpose: Demographic disparities in proximity to stroke care influence time to treatment and clinical outcome but remain understudied at the national level. This study quantifies the relationship between distance to the nearest certified stroke hospital and census-derived demographics. Methods: This cross-sectional study included population data by census tract from the United States Census Bureau’s 2014–2018 American Community Survey, stroke hospitals certified by a state or national body and providing intravenous thrombolysis, and geographic data from a public mapping service. Data were retrieved from March to November 2020. Quantile regression analysis was used to compare relationships between road distance to the nearest stroke center for each census tract and tract-level demographics of age, race, ethnicity, medical insurance status, median annual income, and population density. Results: Two thousand three hundred eighty-eight stroke centers and 71 929 census tracts including 316 995 649 individuals were included. Forty-nine thousand nine hundred eighteen (69%) tracts were urban. Demographic disparities in proximity to certified stroke care were greater in nonurban areas than urban areas. Higher representation of individuals with age ≥65 years was associated with increased median distance to a certified stroke center in nonurban areas (0.51 km per 1% increase [99.9% CI, 0.42–0.59]) but not in urban areas (0.00 km [−0.01 to 0.01]). In urban and nonurban tracts, median distance was greater with higher representation of American Indian (urban: 0.10 km per 1% increase [0.06–0.14]; nonurban: 1.06 km [0.98–1.13]) or uninsured populations (0.02 km [0.00–0.03]; 0.27 km [0.15–0.38]). Each $10 000 increase in median income was associated with a decrease in median distance of 5.04 km [4.31–5.78] in nonurban tracts, and an increase of 0.17 km [0.10–0.23] in urban tracts. Conclusions: Disparities were greater in nonurban areas than in urban areas. Nonurban census tracts with greater representation of elderly, American Indian, or uninsured people, or low median income were substantially more distant from certified stroke care.

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Association between Chronic Kidney Disease and the Most Common Corneal Ectasia Disease (Keratoconus): a Nationwide Cohort Study

10.21203/rs.3.rs-38727/v3 ◽

2020 ◽

Author(s):

Ren-Long Jan ◽

Shih-Feng Weng ◽

Jhi-Joung Wang ◽

Yuh-Shin Chang

Keyword(s):

Chronic Kidney Disease ◽

Health Insurance ◽

Kidney Disease ◽

Incidence Rate ◽

Case Series ◽

Control Group ◽

Study Cohort ◽

Research Database ◽

Increased Risk ◽

Significant Difference

Abstract Background: Both keratoconus (KCN) and chronic kidney disease (CKD) are multifactorial conditions with multiple aetiologies and share several common pathophysiologies. However, the few studies that have described the relationship between KCN and CKD are limited to case reports and small case series. This study aimed to evaluate the association between KCN and CKD.Methods: The study cohort included 4,609 new-onset keratoconus patients ≥ 12 years identified by the International Classification of Diseases, Ninth Revision, Clinical Modification, code 371.6 and recruited between 2004 and 2011 from the Taiwan National Health Insurance Research Database. The age- , sex- , and comorbidity-matched control group included 27,654 non-KCN patients, selected from the Taiwan Longitudinal Health Insurance Database, 2000. Information for each patient was collected and tracked from the index date until December 2013. The incidence and risk of CKD were compared between the two groups. The adjusted hazard ratios (HRs) for CKD were calculated with Cox proportional hazard regression analysis. Kaplan–Meier analysis was used to calculate the cumulative CKD incidence rate. Results: The incidence rate of CKD was 1.36 times higher in KCN patients than in controls without statistically significant difference (95% confidence interval [CI] = 0.99–1.86, p = 0.06). In total, 29 male KCN patients and 90 male controls developed CKD during the follow-up period. The incidence rate of CKD was 1.92 times (95% [CI] = 1.26–2.91; p = 0.002) higher in male KCN patients than in controls. After adjusting for potential confounders, including age, hypertension, hyperlipidaemia, and diabetes mellitus, male KCN patients were 1.75 times (adjusted HR = 1.75, 95% [CI] = 1.14–2.68, p < 0.05) more likely to develop CKD. Conclusions: We found that male KCN patients have an increased risk of CKD. Therefore, it is recommended that male KCN patients should be aware of CKD.

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Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC)

10.2337/figshare.15174003.v1 ◽

2021 ◽

Author(s):

Fida Bacha ◽

Peiyao Cheng ◽

Robin L. Gal ◽

Lindsey C. Beaulieu ◽

Craig Kollman ◽

...

Keyword(s):

Type 2 Diabetes ◽

Ethnic Disparities ◽

The United States ◽

Self Report ◽

Alcoholic Fatty Liver ◽

Pediatric Diabetes ◽

Significant Difference ◽

Racial Ethnic ◽

Hispanic White

Background: Type 2 diabetes in the United States is more prevalent in youth of minority racial-ethnic background but disparities in health outcomes have not be examined in this population. Methods: We examined racial-ethnic differences in the initial presentation and subsequent comorbidities in youth with type 2 diabetes (N=1217, 63% females) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report. Results: Overall, the mean age at presentation was 13.4 ± 2.4 years, BMI was 35.0 (9.4) kg/m2. HbA1c was higher and C-peptide was lower in Non-Hispanic Black (NHB) and Hispanic (H) youth compared to Non-Hispanic White (NHW) youth. NHB were 3 times as likely to present in DKA (19%) vs. NHW (6.3%) and H (7.5%) and both NHB and H had a worse HbA1c trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34% and dyslipidemia in 42% of Registry participants with no significant difference among racial-ethnic groups. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively vs. 2% in NHB. Conclusion: NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1c trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.

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Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC)

10.2337/figshare.15174003 ◽

2021 ◽

Author(s):

Fida Bacha ◽

Peiyao Cheng ◽

Robin L. Gal ◽

Lindsey C. Beaulieu ◽

Craig Kollman ◽

...

Keyword(s):

Type 2 Diabetes ◽

Ethnic Disparities ◽

The United States ◽

Self Report ◽

Alcoholic Fatty Liver ◽

Pediatric Diabetes ◽

Significant Difference ◽

Racial Ethnic ◽

Hispanic White

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Early implementation of stereoelectroencephalography in children: a multiinstitutional case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.5.peds20923 ◽

2021 ◽

pp. 1-8

Author(s):

Jacob R. Lepard ◽

Irene Kim ◽

Anastasia Arynchyna ◽

Sean M. Lew ◽

Robert J. Bollo ◽

...

Keyword(s):

Case Series ◽

The United States ◽

Postoperative Hemorrhage ◽

Pediatric Epilepsy ◽

Continuous Variables ◽

Early Implementation ◽

Significant Difference ◽

Normative Practice ◽

The Mean

OBJECTIVE Pediatric stereoelectroencephalography (SEEG) has been increasingly performed in the United States, with published literature being limited primarily to large single-center case series. The purpose of this study was to evaluate the experience of pediatric epilepsy centers, where the technique has been adopted in the last several years, via a multicenter case series studying patient demographics, outcomes, and complications. METHODS A retrospective cohort methodology was used based on the STROBE criteria. ANOVA was used to evaluate for significant differences between the means of continuous variables among centers. Dichotomous outcomes were assessed between centers using a univariate and multivariate logistic regression. RESULTS A total of 170 SEEG insertion procedures were included in the study from 6 different level 4 pediatric epilepsy centers. The mean patient age at time of SEEG insertion was 12.3 ± 4.7 years. There was no significant difference between the mean age at the time of SEEG insertion between centers (p = 0.3). The mean number of SEEG trajectories per patient was 11.3 ± 3.6, with significant variation between centers (p < 0.001). Epileptogenic loci were identified in 84.7% of cases (144/170). Patients in 140 cases (140/170, 82.4%) underwent a follow-up surgical intervention, with 47.1% (66/140) being seizure free at a mean follow-up of 30.6 months. An overall postoperative hemorrhage rate of 5.3% (9/170) was noted, with patients in 4 of these cases (4/170, 2.4%) experiencing a symptomatic hemorrhage and patients in 3 of these cases (3/170, 1.8%) requiring operative evacuation of the hemorrhage. There were no mortalities or long-term complications. CONCLUSIONS As the first multicenter case series in pediatric SEEG, this study has aided in establishing normative practice patterns in the application of a novel surgical technique, provided a framework for anticipated outcomes that is generalizable and useful for patient selection, and allowed for discussion of what is an acceptable complication rate relative to the experiences of multiple institutions.

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