Comprehensive Testing Highlights Racial, Ethnic, and Age Disparities in the COVID-19 Outbreak: Epidemiological and Clinical Characteristic of Cases in Utah

2020 ◽  
Author(s):  
Sharia M Ahmed ◽  
Rashmee U. Shah ◽  
Margaret Bale ◽  
Jordan B. Peacock ◽  
Ben Berger ◽  
...  
Keyword(s):  
Salt Lake ◽  
Severe Disease ◽  
Vital Signs ◽  
Ethnic Disparities ◽  
Population Level ◽  
The United States ◽  
Duration Of Symptoms ◽  
University Of Utah ◽  
Increased Risk ◽  
Exposure Risks

AbstractThe United States (US), which is currently the epicenter for the COVID-19 pandemic, is a country whose demographic composition differs from that of other highly-impacted countries. US-based descriptions of SARS-CoV-2 infections have, for the most part, focused on patient populations with severe disease, captured in areas with limited testing capacity. The objective of this study is to compare characteristics of positive and negative SARS-CoV-2 patients, in a population primarily comprised of mild and moderate infections, identified from comprehensive population-level testing. Here, we extracted demographics, comorbidities, and vital signs from 20,088 patients who were tested for SARS-CoV-2 at University of Utah Health clinics, in Salt Lake County, Utah; and for a subset of tested patients, we performed manual chart review to examine symptoms and exposure risks. To determine risk factors for testing positive, we used logistic regression to calculate the odds of testing positive, adjusting for symptoms and prior exposure. Of the 20,088 individuals, 1,229 (6.1%) tested positive for SARS-CoV-2. We found that Non-White persons were more likely to test positive compared to non-Hispanic Whites (adjOR=1.1, 95% CI: 0.8, 1.6), and that this increased risk is more pronounced among Hispanic or Latino persons (adjOR=2.0, 95%CI: 1.3, 3.1). However, we did not find differences in the duration of symptoms nor type of symptom presentation between non-Hispanic White and non-White individuals. We found that risk of hospitalization increases with age (adjOR=6.9 95% CI: 2.1, 22.5 for age 60+ compared to 0-19), and additionally show that younger individuals (aged 019), were underrepresented both in overall rates of testing as well as rates of testing positive. We did not find major race/ethnic differences in hospitalization rates. In this analysis of predominantly non-hospitalized individuals tested for SARS-CoV-2, enabled by expansive testing capacity, we found disparities in both testing and SARS-CoV-2 infection status by race/ethnicity and by age. Further work on addressing racial and ethnic disparities, particularly among Hispanic/Latino communities (where SARS-CoV-2 may be spreading more rapidly due to increased exposure and comparatively reduced testing), will be needed to effectively combat COVID-19 in the US.

scholarly journals Robust Testing in Outpatient Settings to Explore COVID-19 Epidemiology: Disparities in Race/Ethnicity and Age, Salt Lake County, Utah, 2020

2021 ◽  
pp. 003335492098861
Author(s):  
Sharia M. Ahmed ◽  
Rashmee U. Shah ◽  
Valerie Fernandez ◽  
Sara Grineski ◽  
Benjamin Brintz ◽  
...  
Keyword(s):  
Salt Lake ◽  
Severe Disease ◽  
The United States ◽  
Demographic Characteristics ◽  
Positive Test ◽  
Positive Test Result ◽  
Lake County ◽  
University Of Utah ◽  
Race Ethnicity ◽  
Test Result

Objective US-based descriptions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have focused on patients with severe disease. Our objective was to describe characteristics of a predominantly outpatient population tested for SARS-CoV-2 in an area receiving comprehensive testing. Methods We extracted data on demographic characteristics and clinical data for all patients (91% outpatient) tested for SARS-CoV-2 at University of Utah Health clinics in Salt Lake County, Utah, from March 10 through April 24, 2020. We manually extracted data on symptoms and exposures from a subset of patients, and we calculated the adjusted odds of receiving a positive test result by demographic characteristics and clinical risk factors. Results Of 17 662 people tested, 1006 (5.7%) received a positive test result for SARS-CoV-2. Hispanic/Latinx people were twice as likely as non-Hispanic White people to receive a positive test result (adjusted odds ratio [aOR] = 2.0; 95% CI, 1.3-3.1), although the severity at presentation did not explain this discrepancy. Young people aged 0-19 years had the lowest rates of receiving a positive test result for SARS-CoV-2 (<4 cases per 10 000 population), and adults aged 70-79 and 40-49 had the highest rates of hospitalization per 100 000 population among people who received a positive test result (16 and 11, respectively). Conclusions We found disparities by race/ethnicity and age in access to testing and in receiving a positive test result among outpatients tested for SARS-CoV-2. Further research and public health outreach on addressing racial/ethnic and age disparities will be needed to effectively combat the coronavirus disease 2019 pandemic in the United States.

Personalized stratification of back to work risk amidst COVID-19: A machine learning approach (Preprint)

2020 ◽  
Author(s):  
Carson Lam ◽  
Jacob Calvert ◽  
Gina Barnes ◽  
Emily Pellegrini ◽  
Anna Lynn-Palevsky ◽  
...  
Keyword(s):  
Machine Learning ◽  
High Risk ◽  
Learning Algorithm ◽  
Severe Disease ◽  
High Specificity ◽  
Population Level ◽  
The United States ◽  
Health Condition ◽  
Available P ◽  
Severe Illness

BACKGROUND In the wake of COVID-19, the United States has developed a three stage plan to outline the parameters to determine when states may reopen businesses and ease travel restrictions. The guidelines also identify subpopulations of Americans that should continue to stay at home due to being at high risk for severe disease should they contract COVID-19. These guidelines were based on population level demographics, rather than individual-level risk factors. As such, they may misidentify individuals at high risk for severe illness and who should therefore not return to work until vaccination or widespread serological testing is available. OBJECTIVE This study evaluated a machine learning algorithm for the prediction of serious illness due to COVID-19 using inpatient data collected from electronic health records. METHODS The algorithm was trained to identify patients for whom a diagnosis of COVID-19 was likely to result in hospitalization, and compared against four U.S policy-based criteria: age over 65, having a serious underlying health condition, age over 65 or having a serious underlying health condition, and age over 65 and having a serious underlying health condition. RESULTS This algorithm identified 80% of patients at risk for hospitalization due to COVID-19, versus at most 62% that are identified by government guidelines. The algorithm also achieved a high specificity of 95%, outperforming government guidelines. CONCLUSIONS This algorithm may help to enable a broad reopening of the American economy while ensuring that patients at high risk for serious disease remain home until vaccination and testing become available.

scholarly journals Ethnic disparities in COVID-19: increased risk of infection or severe disease?

The Lancet ◽  
2021 ◽  
Vol 398 (10298) ◽  
pp. 389-390
Author(s):  
Daniel Pan ◽  
Christopher A Martin ◽  
Joshua Nazareth ◽  
Clareece R Nevill ◽  
Jatinder S Minhas ◽  
...  
Keyword(s):  
Severe Disease ◽  
Ethnic Disparities ◽  
Risk Of Infection ◽  
Increased Risk

scholarly journals Ethnic disparities in COVID-19: increased risk of infection or severe disease? – Authors' reply

The Lancet ◽  
2021 ◽  
Vol 398 (10298) ◽  
pp. 390
Author(s):  
Rohini Mathur ◽  
Christopher T Rentsch ◽  
Caroline E Morton ◽  
Rosalind M Eggo ◽  
Krishnan Bhaskaran ◽  
...  
Keyword(s):  
Severe Disease ◽  
Ethnic Disparities ◽  
Risk Of Infection ◽  
Increased Risk

Anxiety and depression among racial/ethnic minorities and impoverished women testing positive for BRCA1/2 mutations in the United States

2021 ◽  
Author(s):  
Kate E Dibble ◽  
Avonne E Connor
Keyword(s):  
United States ◽  
Depressive Symptoms ◽  
Hispanic Women ◽  
Ethnic Disparities ◽  
The United States ◽  
Medically Underserved ◽  
Increased Risk ◽  
Poverty Status ◽  
Race Ethnicity ◽  
Severe Anxiety

Abstract PurposeTo outline the association between race/ethnicity and poverty status and perceived anxiety and depressive symptomologies among BRCA1/2-positive United States (US) women to identify high-risk groups of mutation carriers from medically underserved backgrounds.Methods211 BRCA1/2-positive women from medically underserved backgrounds were recruited through national Facebook support groups and completed an online survey. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for associations between race/ethnicity, poverty status, and self-reported moderate-to-severe anxiety and depressive symptoms.ResultsWomen ranged in age (18–75, M = 39.5, SD = 10.6). Most women were non-Hispanic white (NHW) (67.2%) and were not impoverished (76.7%). Hispanic women with BRCA1/2 mutations were 6.11 times more likely to report moderate-to-severe anxiety (95% CI, 2.16–17.2, p = 0.001) and 4.28 times more likely to report moderate-to-severe depressive symptoms (95% CI, 1.98–9.60, p = < 0.001) than NHW women with BRCA1/2. Associations were not statistically significant among other minority women. Women living in poverty were significantly less likely to report moderate-to-severe depressive symptoms than women not in poverty (aOR, 0.42, 95% CI, 0.18–0.95, p = 0.04).ConclusionHispanic women with BRCA1/2 mutations from medically underserved backgrounds are an important population at increased risk for worse anxiety and depressive symptomology. Our findings among Hispanic women with BRCA1/2 mutations add to the growing body of literature focused on ethnic disparities experienced across the cancer control continuum.

Trends in Childhood Obesity Research: A Brief Analysis of NIH-Supported Efforts

2007 ◽  
Vol 35 (1) ◽  
pp. 148-153 ◽  
Author(s):  
Terry T-K Huang ◽  
Mary N. Horlick
Keyword(s):  
Childhood Obesity ◽  
Behavioral Change ◽  
Population Level ◽  
Well Being ◽  
The United States ◽  
Obesity Epidemic ◽  
Obesity Research ◽  
Increased Risk ◽  
Economic Well Being

Childhood obesity continues to rise in the United States, with now over 17% of children and adolescents considered overweight. Childhood obesity predisposes an entire generation to increased risk of chronic diseases and disabilities and is a severe threat to the economic well-being of the nation. At first thought, the solution to the obesity epidemic may seem simple: encourage people to eat less and exercise more. However, the reality is that behavioral change is difficult to achieve without also considering the interplay of genetics, biological processes, and social and environmental mechanisms. As such, investment in obesity research has been considered an important tool to combat obesity and obesity-related diseases. Childhood obesity research, in particular, has drawn considerable attention, given the lower cost of prevention relative to treatment and the high potential for long-term benefits at a population level.

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

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.

Development of a Training Program for Law Enforcement K9 Handlers to Administer Naloxone

2020 ◽  
Vol 56 (4) ◽  
pp. 197-205
Author(s):  
Ashley Mitek ◽  
Maureen McMichael ◽  
Brad Weir ◽  
Michael Smith ◽  
Danielle Schneider ◽  
...  
Keyword(s):  
Law Enforcement ◽  
Training Program ◽  
Training Session ◽  
Vital Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
Comfort Level ◽  
Opioid Overdose ◽  
Increased Risk ◽  
Level Monitoring

ABSTRACT As the opioid epidemic continues across the United States, law enforcement K9s (LEK9s) are at increased risk of accidental exposure and overdose. This study evaluated a novel training program teaching handlers to administer naloxone to their LEK9 in the event of an overdose. Seventy-five LEK9 handlers from a governmental agency attended a naloxone training session. A presurvey given to the handlers evaluated their knowledge of opioid overdose in LEK9s and their confidence administering naloxone. Officers were educated via a PowerPoint presentation about naloxone and how to administer it to their LEK9. A postsurvey evaluated changes in their knowledge and confidence as a result of the presentation. Sixty-two presurveys and 47 postsurveys were completed. Nearly all handlers had never given their LEK9 an intramuscular or intranasal injection. Most handlers were not comfortable monitoring their LEK9’s vital signs for an opioid overdose. After the training, handlers demonstrated a mild increase in comfort level administering intramuscular and intranasal naloxone (15 and 14% increase, respectively). Comfort level monitoring vital signs and symptoms of an opioid overdose increased 38 and 32%, respectively. Handlers may not be fully prepared to assess and treat their LEK9 and may benefit from a targeted training program teaching them to administer naloxone.

scholarly journals COVID-19 Severity among Women of Reproductive Age with Symptomatic Laboratory-Confirmed SARS-CoV-2 by Pregnancy Status – United States, Jan 1, 2020 – Sep 30, 2021

2021 ◽  
Author(s):  
Penelope Strid ◽  
Lauren B. Zapata ◽  
Van T. Tong ◽  
Laura D. Zambrano ◽  
Kate R. Woodworth ◽  
...  
Keyword(s):  
United States ◽  
Severe Disease ◽  
The United States ◽  
Reproductive Age ◽  
Invasive Ventilation ◽  
Women Of Reproductive Age ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Pregnancy Status ◽  
Risk Ratios

Abstract Importance: Pregnant people are at increased risk for severe COVID-19 compared with nonpregnant people. Limited information is available on the severity of COVID-19 attributable to the Delta variant, the predominant variant in the United States as of late June 2021, among pregnant persons.Objective: To assess risk for severe COVID-19 by pregnancy status and time period relative to Delta variant predominance. Design: Using a cross-sectional design, we describe characteristics of symptomatic women of reproductive age (WRA) with COVID-19 and calculate adjusted risk ratios for severe disease comparing pregnant with nonpregnant WRA during the pre-Delta period (January 1, 2020 – June 26, 2021) and the Delta period (June 27, 2021 – September 30, 2021). Additionally, we calculate adjusted risk ratios for severe disease comparing the Delta period with the pre-Delta period for pregnant and nonpregnant WRA.Setting: Reports of COVID-19 in the United States occurring from January 1, 2020 ─ September 30, 2021, submitted to the CDC.Participants: Pregnant and nonpregnant women aged 15-44 years.Exposure(s): Laboratory-confirmed, symptomatic SARS-CoV-2 infection.Main Outcome(s): Severe disease: (intensive care unit [ICU] admission, receipt of invasive ventilation or extracorporeal membrane oxygenation [ECMO], and death).Results: Among 1,856,428 cases of symptomatic COVID-19 in WRA, the risk for severe disease was increased among pregnant compared with nonpregnant WRA during the pre-Delta and Delta periods. Compared with the pre-Delta period, the risk of ICU admission during the Delta period was 66% higher (adjusted risk ratio [aRR] 1.66, 95% CI: 1.34-2.06) for pregnant WRA and 23% higher (aRR 1.23, 95% CI: 1.12-1.35) for nonpregnant WRA. The risk of invasive ventilation or ECMO was higher for pregnant and nonpregnant WRA in the Delta period. During the Delta period, the risk of death was 3.40 (95% CI: 2.36-4.91) times the risk in the pre-Delta period among pregnant WRA and 1.96 (95% CI: 1.75-2.18) among nonpregnant WRA. Conclusions and Relevance: The overall risk for severe COVID-19 among WRA remains low; however, symptomatic pregnant WRA remain at increased risk for severe outcomes compared with symptomatic nonpregnant WRA during Delta variant predominance. Compared with the pre-Delta period, pregnant and nonpregnant WRA are at increased risk for severe COVID-19 in the Delta period.

Investigation of an ethnic predisposition to developing brain metastases (BM) in Asian patients with colorectal cancer (CRC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15023-e15023
Author(s):  
Kerri McGovern ◽  
Teresa Rodriguez ◽  
Melissa H Smith ◽  
Antonia Maloney ◽  
Wasif M. Saif
Keyword(s):  
Overall Survival ◽  
Molecular Markers ◽  
Ethnic Disparities ◽  
The United States ◽  
Treatment Modalities ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Race Ethnicity ◽  
The Impact ◽  
Hispanic White

e15023 Background: CRC, the third most common cancer in the United States, carries racial/ethnic disparities in both incidence and mortality. With availability of effective systemic therapies, the life of CRC patients can be prolonged which thereby increases the risk of metastases at uncommon sites, such as the brain. We report our investigation into the impact of race/ethnicity on the incidence of BM in CRC patients using retrospective data (2010 – 2018) at a single institution. Methods: We retrospectively reviewed patients diagnosed with CRC and collected data on age, race/ethnicity, stage, treatment modalities, metastatic sites, and survival. Race and ethnicity were defined in accordance with federal standards set by the U.S. Census. Following this, race/ethnicity was self-declared and/or based on the primary language declared and categorized as non-Hispanic White, Hispanic White, non–Hispanic Black, Asian, or Unknown/Other. CRC location was classified as right-sided, left-sided or rectal. Results: We identified 264 CRC patients (median age: 61; range: 38 - 99). Among them 123 identified as non-Hispanic white, 28 non-Hispanic black, 26 Hispanic white, and 9 declared Other. There were 76 (29%) who identified as Asian. Of those 76 patients, 5 (7%) developed BM. All 5 patients were male and stage IV at initial diagnosis. BM was a late stage phenomenon with rectal primary and lung metastases seemly associated with an increased risk in the specific cohort. Molecular markers such as KRAS were available in 3 patients without clear association. Median time to development of BM was 29 months (range: 26 - 33). Median overall survival after BM diagnosis was 5.5 months (range: 4 - 11). Overall survival was longest for the patient who had both radiation and surgery. Conclusions: Our study showed an incidence of BM of 7% in the Asian sub-population compared to the historical control of 0.6 – 3.2% in the overall population. These results at the least warrant further investigation in a larger patient population of BM in CRC patients with emphasis on molecular markers. Recognition of BM in CRC patients is clinically relevant secondary to multiple lines of therapy as mentioned earlier and its grave impact on outcome.

Sign in / Sign up

Export Citation Format

Share Document