Disproportionate Impact of COVID-19 Pandemic on Racial and Ethnic Minorities

Background Health disparities are prevalent in many areas of medicine. We aimed to investigate the impact of the COVID-19 pandemic on racial/ethnic groups in the United States (US) and to assess the effects of social distancing, social vulnerability metrics, and medical disparities. Methods A cross-sectional study was conducted utilizing data from the COVID-19 Tracking Project and the Centers for Disease Control and Prevention (CDC). Demographic data were obtained from the US Census Bureau, social vulnerability data were obtained from the CDC, social distancing data were obtained from Unacast, and medical disparities data from the Center for Medicare and Medicaid Services. A comparison of proportions by Fisher’s exact test was used to evaluate differences between death rates stratified by age. Negative binomial regression analysis was used to predict COVID-19 deaths based on social distancing scores, social vulnerability metrics, and medical disparities. Results COVID-19 cumulative infection and death rates were higher among minority racial/ethnic groups than whites across many states. Older age was also associated with increased cumulative death rates across all racial/ethnic groups on a national level, and many minority racial/ethnic groups experienced significantly greater cumulative death rates than whites within age groups ≥ 35 years. All studied racial/ethnic groups experienced higher hospitalization rates than whites. Older persons (≥ 65 years) also experienced more COVID-19 deaths associated with comorbidities than younger individuals. Social distancing factors, several measures of social vulnerability, and select medical disparities were identified as being predictive of county-level COVID-19 deaths. Conclusion COVID-19 has disproportionately impacted many racial/ethnic minority communities across the country, warranting further research and intervention.

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Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

PLoS ONE ◽

10.1371/journal.pone.0248702 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248702

Author(s):

Brian Neelon ◽

Fedelis Mutiso ◽

Noel T. Mueller ◽

John L. Pearce ◽

Sara E. Benjamin-Neelon

Keyword(s):

Social Vulnerability ◽

Primary Care Physicians ◽

Negative Binomial ◽

Temporal Trends ◽

The United States ◽

Social Vulnerability Index ◽

Crossover Effect ◽

Death Rates ◽

The Impact ◽

Over Time

Background Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. Methods We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. Results At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. Conclusions The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.

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Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

10.1101/2020.09.09.20191643 ◽

2020 ◽

Author(s):

Brian Neelon ◽

Fedelis Mutiso ◽

Noel T Mueller ◽

John L Pearce ◽

Sara E Benjamin-Neelon

Keyword(s):

United States ◽

Social Vulnerability ◽

Negative Binomial ◽

Temporal Trends ◽

The United States ◽

Systems Science ◽

Crossover Effect ◽

Death Rates ◽

The Impact ◽

Over Time

Background: Emerging evidence suggests that socially vulnerable communities are at higher risk for coronavirus disease 2019 (COVID-19) outbreaks in the United States. However, no prior studies have examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. The purpose of this study was to examine temporal trends among counties with high and low social vulnerability and to quantify disparities in these trends over time. We hypothesized that highly vulnerable counties would have higher incidence and death rates compared to less vulnerable counties and that this disparity would widen as the pandemic progressed. Methods: We conducted a retrospective longitudinal analysis examining COVID-19 incidence and death rates from March 1 to August 31, 2020 for each county in the US. We obtained daily COVID-19 incident case and death data from USAFacts and the Johns Hopkins Center for Systems Science and Engineering. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention in which higher scores represent more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles. We adjusted for percentage of the county designated as rural, percentage in poor or fair health, percentage of adult smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, and the proportion tested for COVID-19 in the state. Results: In unadjusted analyses, we found that for most of March 2020, counties in the upper SVI quartile had significantly fewer cases per 100,000 than lower SVI quartile counties. However, on March 30, we observed a crossover effect in which the RR became significantly greater than 1.00 (RR = 1.10, 95% PI: 1.03, 1.18), indicating that the most vulnerable counties had, on average, higher COVID-19 incidence rates compared to least vulnerable counties. Upper SVI quartile counties had higher death rates on average starting on March 30 (RR = 1.17, 95% PI: 1.01,1.36). The death rate RR achieved a maximum value on July 29 (RR = 3.22, 95% PI: 2.91, 3.58), indicating that most vulnerable counties had, on average, 3.22 times more deaths per million than the least vulnerable counties. However, by late August, the lower quartile started to catch up to the upper quartile. In adjusted models, the RRs were attenuated for both incidence cases and deaths, indicating that the adjustment variables partially explained the associations. We also found positive associations between COVID-19 cases and deaths and percentage of the county designated as rural, percentage of resident in fair or poor health, and average daily PM2.5. Conclusions: Results indicate that the impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties over time. This highlights the importance of protecting vulnerable populations as the pandemic unfolds.

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Culturally Congruent Health Care of COVID-19 in Minorities in the United States: A Clinical Practice Paper From the National Coalition of Ethnic Minority Nurse Associations

Journal of Transcultural Nursing ◽

10.1177/1043659620941578 ◽

2020 ◽

Vol 31 (5) ◽

pp. 434-443

Author(s):

Norma G. Cuellar ◽

Elizabeth Aquino ◽

Martha A. Dawson ◽

Mary Joy Garcia-Dia ◽

Eun-Ok Im ◽

...

Keyword(s):

Health Care ◽

Ethnic Minority ◽

Ethnic Groups ◽

Epidemiological Data ◽

The United States ◽

Clinical Paper ◽

Culturally Congruent ◽

National Coalition ◽

The Impact ◽

Racial Ethnic

Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial–ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method: NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial–ethnic groups. Results: Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion: This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country.

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Impact of Ethnicity On Incidence and Survival Among Adults with Acute Lymphoblastic Leukemia in the United States; Insights From 2005 SEER Data.

Blood ◽

10.1182/blood.v114.22.3069.3069 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3069-3069

Author(s):

Casey L O'Connell ◽

Pedram Razavi ◽

Roberta McKean-Cowdin ◽

Malcolm C. Pike

Keyword(s):

T Cell ◽

B Cell ◽

Ethnic Groups ◽

Lymphoblastic Leukemia ◽

The United States ◽

Incidence Rates ◽

The Us ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic

Abstract Abstract 3069 Poster Board III-6 Background Acute lymphoblastic leukemia (ALL) is an aggressive malignancy whose incidence declines through adolescence and then increases steadily with age. Prognosis appears to be inversely related to age among adults. We sought to explore the impact of race/ethnicity on incidence and survival among adults with ALL in the United States (US). Methods We examined trends in incidence and survival among adults with ALL in the US using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program which includes data from 17 SEER registries. We calculated the incidence rates for the most recent time period (2001-2005) because the classification for ALL subtypes was more complete during this time. For the survival analysis we used the data collected between 1975 and 2005. We categorized race/ethnicity into 5 mutually exclusive categories: non-Hispanic whites (NHW), Hispanic whites (HW), African Americans (AA), Asian/Pacific Islanders (API) and American Indians/Native Alaskans (AI/NA). Hispanic ethnicity was defined using SEER's Hispanic-origin variable which is based on the NAACCR Hispanic Identification Algorithm (NHIA); 11 patients dually coded as black and Hispanic were included in the AA group for our analyses. Few ALL cases were identified among AI/NA, so that group is not represented in the final analyses. We included ALL cases coded in the SEER registry using the International Classification of Disease for Oncology (ICD-0-3) as 9827-9829 and 9835-9837. We excluded cases of Burkitt's leukemia (n=228), cases that were not confirmed by microscopic or cytologic tests (n=132), cases that were reported only based on autopsy data (n=3) and cases whose race/ethnicity were unknown (n=20). The average annual incidence rates per 100,000 for 2001-2005, age-adjusted to the 2000 US standard population were calculated using SEER*Stat Version 6.4.4 statistical software. We used multivariate Cox hazard models stratified by SEER registry and age category to estimate the hazard ratios (HR) and 95% confidence intervals (95% CI) for relative survival of adult ALL cases across race/ethnicity, sex and cell of origin (B- or T-cell). All models were adjusted for the diagnosis era, and use of non-CNS radiation. The model also included an interaction term for age and diagnosis era. We performed a separate stratified analysis of the impact of race/ethnicity on survival within age subgroups (20-29, 30-39, 40-59, 60-69, 70+). Results The highest incidence rate (IR) of ALL was observed for HW (IR: 1.60; 95% CI: 1.43-1.79). HW had a significantly higher IR across all age categories as compared to the other racial/ethnic groups, while AA had the lowest IR. In particular, the observed rate of B-cell ALL among HW (IR 0.77; 95% CI 0.69-0.87) was more than twice that of NHW (IR: 0.29; 95% CI: 0.27-0.32) and more than three times the rate observed among AA (IR: 0.20; 95% CI: 0.15-0.26). In contrast, we did not observe statistically significant variability in the rates of T-cell ALL across race/ethnic groups (overall IR: 0.12; 95% CI: 0.11-0.14). Survival was significantly poorer among AA (HR: 1.26; 95% CI: 1.09-1.46), HW (HR: 1.21; 95% CI: 1.09-1.46), and API (HR: 1.18; 95% CI: 1.06-1.32) compared to NHW with all subtypes of ALL. Among adults younger than 40 with B-cell ALL, survival was significantly poorer among AA (HR: 1.60; 95% CI:1.021-2.429) and HW (HR: 1.53; 95% CI:1.204-1.943) with a non-signficant trend among API (HR: 1.22; 95% 0.834-1.755) compared to NHW. Survival differences between the different racial/ethnic groups were no longer statistically significant among adults with B-cell ALL over the age of 40. For T-cell ALL, survival was significantly poorer among AA (HR: 1.61; 95% CI: 1.22-2.10), HW (HR: 1.49; 95% CI: 1.14-1.93) and API (HR: 1.57; 95% CI: 1.13-2.13), as compared to NHW. A similar survival pattern by age (adults above and below age 40 years) was observed for T-cell as described for B-cell, with AA under 40 having a particularly dismal prognosis (HR: 2.89; 95% CI 1.96-4.17) compared to NHW. Conclusions The incidence rate of B-cell ALL among adults in the US is higher among HW than other ethnic groups. Survival is significantly poorer among AA and HW than among NHW under the age of 40 with B-cell ALL. Survival is also significantly poorer among AA, HW and API than among NHW with T-cell ALL in adults under 40. Survival trends appear to converge after the age of 40 among all racial/ethnic groups. Disclosures No relevant conflicts of interest to declare.

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Trends in Mortality From Parkinson Disease in the United States, 1999–2019

Neurology ◽

10.1212/wnl.0000000000012826 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012826

Author(s):

Shuang Rong ◽

Guifeng Xu ◽

Buyun Liu ◽

Yangbo Sun ◽

Linda G Snetselaar ◽

...

Keyword(s):

United States ◽

Ethnic Groups ◽

Geographic Location ◽

The United States ◽

Death Rates ◽

Urban Rural ◽

Long Term Trends ◽

Race Ethnicity ◽

Racial Ethnic

Background and Objectives:The mortality from Parkinson's disease (PD) and its long-term trends in the United States remains unknow. This study aimed to describe the trends in PD mortality in the United States from 1999 to 2019.Methods:We used data from the National Vital Statistics System, a nationwide, population-based, death registry, to determine national trends in PD mortality, in overall and by age, sex, race/ethnicity, urban-rural classification and geographic location. Analyses focused on the data from 479,059 deaths due to PD from 1999 to 2019. Joinpoint regression was performed to examine temporal trends in age-standardized death rates.Results:The age-adjusted mortality from PD increased from 5.4 (95% CI, 5.3-5.5) per 100,000 population in 1999 to 8.8 (95% CI, 8.7-8.9) per 100,000 population in 2019, with an average annual percent change of 2.4% (95% CI, 1.8%-3.0%). From 1999 to 2019, PD mortality increased significantly across all age groups, both sexes, various racial/ethnic groups and different urban-rural classifications. The US states and District of Columbia with reported death rates experienced an increase in PD mortality. Significant differences by sex and race/ethnicity were noted. Age-adjusted PD mortality rates were twice as high in men as in women, and were greater in Whites than other racial/ethnic groups.Discussion:From 1999 to 2019, the mortality from PD in the United States has increased significantly. The increase was regardless of age, sex, race/ethnicity, urban-rural classification and geographic location. A comprehensive evaluation of long-term trends in PD mortality is important for health care priority setting.

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Measuring Segregation in a Multiracial Era: The Impact of Federal Racial Reporting Changes on Estimates of Public School Segregation

Teachers College Record ◽

10.1177/016146812012200508 ◽

2020 ◽

Vol 122 (5) ◽

pp. 1-42

Author(s):

Meredith P. Richards ◽

Kori J. Stroub

Keyword(s):

Public School ◽

Ethnic Groups ◽

Fixed Effects ◽

The United States ◽

Reporting Scheme ◽

Study Objective ◽

Multiracial Students ◽

The Impact ◽

Analytical Approaches ◽

Racial Ethnic

Background Despite accounting for 3% of the student population, multiracial students are the fastest growing racial/ethnic group in the United States. Aligning with new federal guidelines, in 2008, the National Center for Education Statistics (NCES) revised its single-race reporting scheme for the Common Core of Data (CCD), permitting students to identify as two or more races (i.e., multiracial). Study Objective The addition of a multiracial reporting category to the NCES CCD permits students to more accurately represent their racial identity. By creating categories that are not strictly comparable to their historical counterparts, however, it may problematize longitudinal analysis of trends in the racial composition and segregation of schools, which are of perennial scholarly and public interest. In this study, we examine the extent to which the reporting change affects estimates of segregation over time. Research Design We compute annual values of racial/ethnic segregation (i.e., isolation and dissimilarity) among elementary schools for 5,357 public school districts using data from the NCES CCD Public Elementary/Secondary School Universe Survey from 2000–01 to 2013–14. Before 2008, we compute segregation for the five monoracial groups tracked by the CCD. After 2008, we compute segregation using the two analytical approaches to the treatment of multiracial students that have been employed by scholars of segregation. We estimate the effect of the racial/ethnic reporting change on estimates of segregation via a series of multilevel longitudinal fixed-effects models. Results We found that the NCES CCD's addition of a multiracial reporting category has problematized longitudinal analyses of segregation, particularly racial/ethnic isolation. Models revealed abrupt changes in most dimensions of segregation in the year immediately following the reporting change. Moreover, the reporting change has complicated interpretation of segregation trends since 2008, because seemingly minor analytical decisions may lead to contradictory conclusions: When multiracial students are excluded from calculations, isolation appears to be increasing for all racial/ethnic groups; however, when multiracial students are included in calculations, isolation appears to be decreasing for all racial/ethnic groups. The reporting change has a weaker, but still significant, effect on certain dimensions of racial/ethnic dissimilarity. Conclusions In this study, we found that the NCES CCD's recent addition of a multiracial reporting category has resulted in estimates of segregation that are not longitudinally comparable and may vary in magnitude and direction depending on relatively minor analytical decisions. We urge scholars to take particular care in calculating and interpreting segregation trends and offer recommendations for educational research and practice.

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Improved measurement of racial/ethnic disparities in COVID-19 mortality in the United States

10.1101/2020.05.21.20109116 ◽

2020 ◽

Cited By ~ 8

Author(s):

Joshua R. Goldstein ◽

Serge Atherwood

Keyword(s):

United States ◽

New York ◽

National Level ◽

Ethnic Disparities ◽

State Level ◽

The United States ◽

Estimation Methods ◽

Death Rates ◽

Population Distributions ◽

Racial Ethnic

AbstractDifferent estimation methods produce diverging accounts of racial/ethnic disparities in COVID-19 mortality in the United States. The CDC’s decision to present the racial/ethnic distribution of COVID-19 deaths at the state level alongside re-weighted racial/ethnic population distributions—in effect, a geographic adjustment—makes it seem that Whites have the highest death rates. Age adjustment procedures used by others, including the New York City Department of Health and Mental Hygiene, lead to the opposite conclusion that Blacks and Hispanics are dying from COVID-19 at higher rates than Whites. In this paper, we use indirect standardization methods to adjust per-capita death rates for both age and geography simultaneously, avoiding the one-sided adjustment procedures currently in use. Using CDC data, we find age-and-place-adjusted COVID-19 death rates are 80% higher for Blacks and more than 50% higher for Hispanics, relative to Whites, on a national level, while there is almost no disparity for Asians. State-specific estimates show wide variation in mortality disparities. Comparison with non-epidemic mortality reveals potential roles for pre-existing health disparities and differential rates of infection and care.

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Mining Google and Apple mobility data: temporal anatomy for COVID-19 social distancing

Scientific Reports ◽

10.1038/s41598-021-83441-4 ◽

2021 ◽

Vol 11 (1) ◽

Cited By ~ 2

Author(s):

Corentin Cot ◽

Giacomo Cacciapaglia ◽

Francesco Sannino

Keyword(s):

Infection Rate ◽

The United States ◽

Strong Decrease ◽

Social Distancing ◽

Mobility Data ◽

Actual Measure ◽

The Us ◽

The Impact ◽

Political Decisions ◽

Mobility Reduction

AbstractWe employ the Google and Apple mobility data to identify, quantify and classify different degrees of social distancing and characterise their imprint on the first wave of the COVID-19 pandemic in Europe and in the United States. We identify the period of enacted social distancing via Google and Apple data, independently from the political decisions. Our analysis allows us to classify different shades of social distancing measures for the first wave of the pandemic. We observe a strong decrease in the infection rate occurring two to five weeks after the onset of mobility reduction. A universal time scale emerges, after which social distancing shows its impact. We further provide an actual measure of the impact of social distancing for each region, showing that the effect amounts to a reduction by 20–40% in the infection rate in Europe and 30–70% in the US.

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Shooting from the ‘Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting

Vaccines ◽

10.3390/vaccines9050444 ◽

2021 ◽

Vol 9 (5) ◽

pp. 444

Author(s):

Charles Stoecker

Keyword(s):

Positive Impact ◽

National Level ◽

State Level ◽

The United States ◽

Scope Of Practice ◽

Patient Specific ◽

Behavioral Risk ◽

Influenza Immunization ◽

Immunization Rates ◽

The Impact

In the past two decades, most states in the United States have added authorization for pharmacists to administer some vaccinations. Expansions of this authority have also come with prescription requirements or other regulatory burdens. The objective of this study was to evaluate the impact of these expansions on influenza immunization rates in adults age 65 and over. A panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level was used on a combination of a dataset of state-level statute and regulatory changes and influenza immunization data from the Behavioral Risk Factor Surveillance System. Giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of 1.4 percentage points for adults age 65 and over. This effect was diminished by the presence of laws requiring pharmacists to obtain patient-specific prescriptions. There was no evidence that allowing pharmacists to administer vaccinations led patients to have fewer annual check-ups with physicians or not have a usual source of health care. Expanding pharmacists’ scope of practice laws to include administering the influenza vaccine had a positive impact on influenza shot uptake. This may have implications for relaxing restrictions on other forms of care that could be provided by pharmacists.

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Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz022 ◽

2019 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Priya Bhagwat ◽

Shashi N Kapadia ◽

Heather J Ribaudo ◽

Roy M Gulick ◽

Judith S Currier

Keyword(s):

Antiretroviral Therapy ◽

Adverse Events ◽

Socioeconomic Factors ◽

Ethnic Groups ◽

Virologic Failure ◽

Virologic Suppression ◽

Factors Associated ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic

Abstract Background Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. In a study of initial regimens, we found viral suppression varied by race/ethnicity. In this exploratory analysis, we use clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups. Methods Data were from AIDS Clinical Trial Group A5257, a randomized trial of initial regimens with either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (each combined with tenofovir DF and emtricitabine). We grouped participants by race/ethnicity and then used Cox-proportional hazards regression to examine the impact of demographic, clinical, and socioeconomic factors on the time to virologic suppression and time to adverse event reporting within each racial/ethnic group. Results We analyzed data from 1762 participants: 757 self-reported as non-Hispanic black (NHB), 615 as non-Hispanic white (NHW), and 390 as Hispanic. The proportion with virologic failure was higher for NHB (22%) and Hispanic (17%) participants compared with NHWs (9%). Factors associated with virologic failure were poor adherence and higher baseline HIV RNA level. Prior clinical AIDS diagnosis was associated with virologic failure for NHBs only, and unstable housing and illicit drug use for NHWs only. Factors associated with adverse events were female sex in all groups and concurrent use of medications for comorbidities in NHB and Hispanic participants only. Conclusions Clinical and socioeconomic factors that are associated with virologic failure and tolerability of antiretroviral therapy vary between and within racial and ethnic groups. Further research may shed light into mechanisms leading to disparities and targeted strategies to eliminate those disparities.

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