scholarly journals Major disparities in COVID-19 test positivity for patients with non-English preferred language even after accounting for race and social factors in the United States in 2020

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Cohen-Cline ◽  
Hsin-Fang Li ◽  
Monique Gill ◽  
Fatima Rodriguez ◽  
Tina Hernandez-Boussard ◽  
...  
Keyword(s):  
Low Income ◽  
Social Factors ◽  
The United States ◽  
Healthcare Systems ◽  
English Speakers ◽  
Health Records ◽  
Communities Of Color ◽  
Multi Level ◽  
Race Ethnicity ◽  
Barriers To Health

Abstract Background The COVID-19 pandemic has further exposed inequities in our society, demonstrated by disproportionate COVID-19 infection rate and mortality in communities of color and low-income communities. One key area of inequity that has yet to be explored is disparities based on preferred language. Methods We conducted a retrospective cohort study of 164,368 adults tested for COVID-19 in a large healthcare system across Washington, Oregon, and California from March – July 2020. Using electronic health records, we constructed multi-level models that estimated the odds of testing positive for COVID-19 by preferred language, adjusting for age, race/ethnicity, and social factors. We further investigated interaction between preferred language and both race/ethnicity and state. Analysis was performed from October–December 2020. Results Those whose preferred language was not English had higher odds of having a COVID-19 positive test (OR 3.07, p < 0.001); this association remained significant after adjusting for age, race/ethnicity, and social factors. We found significant interaction between language and race/ethnicity and language and state, but the odds of COVID-19 test positivity remained greater for those whose preferred language was not English compared to those whose preferred language was English within each race/ethnicity and state. Conclusions People whose preferred language is not English are at greater risk of testing positive for COVID-19 regardless of age, race/ethnicity, geography, or social factors – demonstrating a significant inequity. Research demonstrates that our public health and healthcare systems are centered on English speakers, creating structural and systemic barriers to health. Addressing these barriers are long overdue and urgent for COVID-19 prevention.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

State-Level Sexism and Women’s Health Care Access in the United States: Differences by Race/Ethnicity, 2014–2019

2021 ◽  
pp. e1-e10
Author(s):  
Kristen Schorpp Rapp ◽  
Vanessa V. Volpe ◽  
Hannah Neukrug
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Hispanic Women ◽  
State Level ◽  
The United States ◽  
Barriers To Health Care ◽  
Care Access ◽  
Race Ethnicity ◽  
The Relationship ◽  
Barriers To Health

Objectives. To quantify racial/ethnic differences in the relationship between state-level sexism and barriers to health care access among non-Hispanic White, non-Hispanic Black, and Hispanic women in the United States. Methods. We merged a multidimensional state-level sexism index compiled from administrative data with the national Consumer Survey of Health Care Access (2014–2019; n = 10 898) to test associations between exposure to state-level sexism and barriers to access, availability, and affordability of health care. Results. Greater exposure to state-level sexism was associated with more barriers to health care access among non-Hispanic Black and Hispanic women, but not non-Hispanic White women. Affordability barriers (cost of medical bills, health insurance, prescriptions, and tests) appeared to drive these associations. More frequent need for care exacerbated the relationship between state-level sexism and barriers to care for Hispanic women. Conclusions. The relationship between state-level sexism and women’s barriers to health care access differs by race/ethnicity and frequency of needing care. Public Health Implications. State-level policies may be used strategically to promote health care equity at the intersection of gender and race/ethnicity. (Am J Public Health. Published online ahead of print September 2, 2021: e1–e10. https://doi.org/10.2105/AJPH.2021.306455 )

scholarly journals Who has nature during the pandemic? COVID-19 cases track widespread inequity in nature access across the United States

2021 ◽  
Author(s):  
Erica Spotswood ◽  
Matthew Benjamin ◽  
Lauren Stoneburner ◽  
Megan Wheeler ◽  
Erin Beller ◽  
...  
Keyword(s):  
Low Income ◽  
Vegetation Index ◽  
Normalized Difference Vegetation Index ◽  
The United States ◽  
Incidence Rates ◽  
Demographic Variables ◽  
Urban Nature ◽  
Communities Of Color ◽  
The Us ◽  
Block Groups

Abstract Urban nature can alleviate distress and provide space for safe recreation during the COVID-19 pandemic. However, nature is often less available in low-income and communities of color—the same communities hardest hit by COVID-19. We quantified nature inequality across all urbanized areas in the US and linked nature access to COVID-19 case rates for ZIP Codes in 17 states. Areas with majority persons of color had both higher case rates and less greenness. Furthermore, when controlling for socio-demographic variables, an increase of 0.1 in Normalized Difference Vegetation Index (NDVI) was associated with a 4.1% decrease in COVID-19 incidence rates (95% confidence interval: 0.9-6.8%). Across the US, block groups with lower-income and majority persons of color are less green and have fewer parks. Thus, communities most impacted by COVID-19 also have the least nature nearby. Given urban nature is associated with both human health and biodiversity, these results have far-reaching implications both during and beyond the pandemic.

East LA Interchange: A Documentary Exploration of Boyle Heights

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Betsy Kalin
Keyword(s):  
United States ◽  
Low Income ◽  
Political Representation ◽  
The United States ◽  
Community Action ◽  
Multicultural Society ◽  
Immigrant Rights ◽  
Communities Of Color ◽  
Boyle Heights ◽  
The Impact

The documentary East LA Interchange (2015) has extraordinary potential to be used to increase awareness about our diverse, multicultural society and the specific challenges facing low-income communities of color. These communities’ residents are especially vulnerable to gentrification and displacement, and across the United States, we are currently seeing the impact of gentrification on our neighborhoods. One of the most important aspects of a documentary is what happens after the film is completed. We are in the process of creating a multiplatform strategic outreach campaign designed to engage youth and mobilize advocates around the issues addressed in the film. Our outreach and engagement goals are varied yet complementary to the themes in East LA Interchange. We believe that East LA Interchange’s message of empowerment through community action is one that can greatly benefit youth and adults in rapidly changing communities. Because Boyle Heights is one of the United States’ great places of diversity, inclusion, and tolerance, we would like the film to create momentum around social justice issues depicted in the film such as acceptance and appreciation of diversity, immigrant rights, environmental and transportation justice, urban development, and effective political representation.

scholarly journals Evaluating for Differences by Race/Ethnicity in the Association Between Income and Gambling Disorder

2020 ◽  
Vol 36 (4) ◽  
pp. 1093-1105
Author(s):  
Brendan Day ◽  
Geoffrey Rosenthal ◽  
Fiyinfolu Adetunji ◽  
Andrea Monaghan ◽  
Christina Scheele ◽  
...  
Keyword(s):  
Low Income ◽  
Household Income ◽  
Gambling Disorder ◽  
The United States ◽  
Multivariable Logistic Regression Analysis ◽  
Annual Household Income ◽  
Interview Schedule ◽  
Veteran Status ◽  
Race Ethnicity ◽  
Racial Ethnic

AbstractMultiple studies show an increased prevalence of gambling disorder among African Americans compared to whites. However, few studies take an analytic approach to understanding differences in risk factors by race/ethnicity. Income is inversely associated with gambling disorder; we hypothesized that this association would vary by race/ethnicity. The main objective was to evaluate whether the association between income and gambling disorder varies by race/ethnicity. With data from the baseline visit of a prospective cohort study, Prevention and Etiology of Gambling Addiction Study in the United States, we used multivariable logistic regression analysis to determine whether the association between income and gambling disorder varies by race/ethnicity. 1164 participants were included in the final analyses. Measures included: demographics (age, sex, race/ethnicity, education, employment, annual household income), veteran status, marital status, homelessness, smoking, substance abuse, alcohol abuse, marijuana use, and lifetime gambling disorder diagnosis as derived from Alcohol Use Disorder and Associated Disabilities Interview Schedule. There was no evidence of effect modification by race/ethnicity in the association between income and gambling disorder (global p value = 0.17). Income was associated with increased odds of gambling disorder, but only for those with low income (< $15,000; OR 2.27, 95% CI 1.46, 3.53). There was no evidence that the effect of income on gambling disorder varies by race/ethnicity. For all race/ethnicities combined, low income was associated with significantly increased odds of gambling disorder (OR 2.27, 95% CI 1.46, 3.53). Further research is needed to better understand racial/ethnic differences in gambling disorder.

scholarly journals The Convergence of Racial and Income Disparities in Health Insurance Coverage in the United States

2020 ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract ObjectiveThis study applies the vulnerability framework and examines the combined effect of race and income on health insurance coverage in the US. Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage.Data sourcesThe household component of the US Medical Expenditure Panel Survey (MEPS-HC) in 2017 was used for the study.Study designLogistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or partially insured, partially insured only, and uninsured only, respectively.Data collection/extraction methodsWe constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findingsWhile income was a significant predictor of health insurance coverage (a difference of 6.1%-7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 66% less odds of being insured instead of uninsured or partially insured than high-income Whites with good health.ConclusionsPolicymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and are racial/ethnic minorities.

scholarly journals Poverty, Racism, and the Public Health Crisis in America

2021 ◽  
Vol 9 ◽  
Author(s):  
Bettina M. Beech ◽  
Chandra Ford ◽  
Roland J. Thorpe ◽  
Marino A. Bruce ◽  
Keith C. Norris
Keyword(s):  
Public Health ◽  
Low Income ◽  
Ethnic Disparities ◽  
Well Being ◽  
The United States ◽  
Health Improvement ◽  
Structural Racism ◽  
Health Crisis ◽  
Communities Of Color ◽  
Use Of Social Media

The purpose of this article is to discuss poverty as a multidimensional factor influencing health. We will also explicate how racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. Poverty is one of the most significant challenges for our society in this millennium. Over 40% of the world lives in poverty. The U.S. has one of the highest rates of poverty in the developed world, despite its collective wealth, and the burden falls disproportionately on communities of color. A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe. Importantly, poverty is much more than just a low-income household. It reflects economic well-being, the ability to negotiate society relative to education of an individual, socioeconomic or health status, as well as social exclusion based on institutional policies, practices, and behaviors. Until structural racism and economic injustice can be resolved, the use of evidence-based prevention and early intervention initiatives to mitigate untoward effects of socioeconomic deprivation in communities of color such as the use of social media/culturally concordant health education, social support, such as social networks, primary intervention strategies, and more will be critical to address the persistent racial/ethnic disparities in chronic diseases.

scholarly journals Without Environmental Justice, the Renewable Energy Transition Will Leave Low-Income and BIPOC Communities Behind

2021 ◽  
Vol 18 (03) ◽  
Author(s):  
Carolyn Ramírez
Keyword(s):  
Renewable Energy ◽  
Low Income ◽  
Energy Transition ◽  
The United States ◽  
Power Grids ◽  
Extreme Weather Events ◽  
Energy Technologies ◽  
Communities Of Color ◽  
Weather Events ◽  
The Cost

As extreme weather events become more common in the United States due to the worsening effects of climate change, access to utilities like electricity and water will be continually strained. Blackouts and intermittent utility interruptions impact low-income and communities of color most negatively. While renewable energy technologies promise alleviation of emissions and pollution, high cost and a lack of equitable energy infrastructure make it harder for low-income and communities of color to access renewable energy benefits. I propose a series of policies to address the cost barriers of renewable energy, improve reliability and access to power grids, and standardize household weatherization for people from all communities.

scholarly journals Social factors shaping the adoption of lead-filtering point-of-use systems: an observational study of an MTurk sample

2020 ◽  
Vol 18 (4) ◽  
pp. 505-521
Author(s):  
Noelle Chesley ◽  
Helen Meier ◽  
Jake Luo ◽  
Immaculate Apchemengich ◽  
W. Hobart Davies
Keyword(s):  
Lead Exposure ◽  
Low Income ◽  
Social Factors ◽  
Mechanical Turk ◽  
Health Policies ◽  
Service Line ◽  
Lower Odds ◽  
Point Of Use ◽  
Race Ethnicity ◽  
Drinking Frequency

Abstract Some municipalities are promoting lead-filtering point-of-use (POU) systems to minimize the risk of lead exposure through drinking water, often targeting use at racial minorities and low-income households. However, links among social inequality markers and adoption of these systems are not well understood. Survey data on adoption and use of POU systems were collected from a U.S. Mechanical Turk (MTurk) sample (N = 2,867) in March 2018. We use logistic regression to assess the association of race/ethnicity, socioeconomic status (SES), and lead-filtering POU adoption. We also examined key health behaviors related to POU systems. We found that race and SES are indirectly predictive of lead-filtering POU adoption through the propensity of some respondents to report a residence with a lead service line and levels of concern and knowledge about lead exposure. In addition, individuals with similar levels of concern about lead in water have lower odds of adopting a POU system if they have lower, rather than higher, incomes. Among POU adopters, while confidence in correct use of these devices was relatively high, the frequency of filtered water use for cooking was lower than drinking frequency. Overall, these findings inform health policies aimed at mitigating risk of lead exposure through water.

Barriers to Health Care Among Adults With Minoritized Identities in the United States, 2013–2017

2020 ◽  
Vol 110 (6) ◽  
pp. 857-862
Author(s):  
Stephanie M. Hernandez ◽  
P. Johnelle Sparks
Keyword(s):  
United States ◽  
Health Care ◽  
Access To Health Care ◽  
The United States ◽  
Barriers To Health Care ◽  
Access To Health ◽  
Interview Survey ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Barriers To Health

Objectives. To examine the relationship between minoritized identity and barriers to health care in the United States. Methods. Nationally representative data collected from the 2013 to 2017 waves of the National Health Interview Survey were used to conduct descriptive and logistic regression analyses. Men and women were placed in 1 of 4 categories: no minoritized identities, minoritized identities of race/ethnicity (MIoRE), minoritized identities of sexuality (MIoS), or minoritized identities of both race/ethnicity and sexuality (MIoRES). Five barriers to health care were considered. Results. Relative to heterosexual White adults and after controlling for socioeconomic status, adults with MIoRE were less likely to report barriers, adults with MIoS were more likely to report barriers, and adults with MIoRES were more likely to report barriers across 2 of the study measures. Conclusions. Barriers to care varied according to gender, minoritized identity, and the measure of access to health care itself. Public Health Implications. Approaching health disparities research using an intersectional lens moves the discussion from examining individual differences to examining the role of social structures such as the health care system in maintaining and reproducing inequality.

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