SARS-CoV-2 Vaccine Acceptability in Patients on Hemodialysis: A Nationwide Survey

BackgroundPatients on dialysis are at increased risk for COVID-19–related complications. However, a substantial fraction of patients on dialysis belong to groups more likely to be hesitant about vaccination.MethodsWith the goal of identifying strategies to increase COVID-19 vaccine uptake among patients on hemodialysis, we conducted a nationwide vaccine acceptability survey, partnering with a dialysis network to distribute an anonymized English and Spanish language online survey in 150 randomly selected facilities in the United States. We used logistic regression to evaluate characteristics of vaccine-hesitant persons.ResultsA total of 1515 (14% of eligible) patients responded; 20% of all responders, 29% of patients aged 18–44 years, and 29% of Black responders reported being hesitant to seek the COVID-19 vaccine, even if the vaccine was considered safe for the general population. Odds of vaccine hesitancy were higher among patients aged 18–44 years versus those 45–64 years (odds ratio [OR], 1.5; 95% confidence interval [95% CI], 1.0 to 2.3), Black patients versus non-Hispanic White patients (OR, 1.9; 95% CI, 1.3 to 2.7), Native Americans or Pacific Islanders versus non-Hispanic White patients (OR, 2.0; 95% CI, 1.1 to 3.7), and women versus men (OR, 1.6; 95% CI, 1.2 to 2.0). About half (53%) of patients who were vaccine hesitant expressed concerns about side effects. Responders’ main information sources about COVID-19 vaccines were television news and dialysis staff (68% and 38%, respectively).ConclusionsA substantial proportion of patients receiving in-center hemodialysis in the United States are hesitant about seeking COVID-19 vaccination. Facilitating uptake requires outreach to younger patients, women, and Black, Native American, or Pacific Islander patients, and addressing concerns about side effects.

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Disparities in access to surgery for glioblastoma multiforme at high-volume Commission on Cancer–accredited hospitals in the United States

Journal of Neurosurgery ◽

10.3171/2021.7.jns211307 ◽

2021 ◽

pp. 1-10

Author(s):

Anshit Goyal ◽

Jad Zreik ◽

Desmond A. Brown ◽

Panagiotis Kerezoudis ◽

Elizabeth B. Habermann ◽

...

Keyword(s):

United States ◽

Surgical Intervention ◽

Residential Location ◽

High Volume ◽

The United States ◽

National Cancer Database ◽

Subgroup Analyses ◽

Access To Surgery ◽

Hispanic White ◽

White Patients

OBJECTIVE Although it has been shown that surgery for glioblastoma (GBM) at high-volume facilities (HVFs) may be associated with better postoperative outcomes, the use of such hospitals may not be equally distributed. The authors aimed to evaluate racial and socioeconomic differences in access to surgery for GBM at high-volume Commission on Cancer (CoC)–accredited hospitals. METHODS The National Cancer Database was queried for patients with GBM that was newly diagnosed between 2004 and 2015. Patients who received no surgical intervention or those who received surgical intervention at a site other than the reporting facility were excluded. Annual surgical case volume was calculated for each hospital, with volume ≥ 90th percentile defined as an HVF. Multivariable logistic regression was performed to identify patient-level predictors for undergoing surgery at an HVF. Furthermore, multiple subgroup analyses were performed to determine the adjusted odds ratio of the likelihood of undergoing surgery at an HVF in 2016 as compared to 2004 for each patient subpopulation (by age, race, sex, educational group, etc.). RESULTS A total of 51,859 patients were included, with 10.7% (n = 5562) undergoing surgery at an HVF. On multivariable analysis, Hispanic White patients (OR 0.58, 95% CI 0.49–0.69, p < 0.001) were found to have significantly lower odds of undergoing surgery at an HVF (reference = non-Hispanic White). In addition, patients from a rural residential location (OR 0.55, 95% CI 0.41–0.72, p < 0.001; reference = metropolitan); patients with nonprivate insurance status (Medicare [OR 0.78, 95% CI 0.71–0.86, p < 0.001], Medicaid [OR 0.68, 95% CI 0.60–0.78, p < 0001], other government insurance [OR 0.68, 95% CI 0.52–0.86, p = 0.002], or who were uninsured [OR 0.61, 95% CI 0.51–0.72, p < 0.001]); and lower-income patients ($50,354–$63,332 [OR 0.68, 95% CI 0.63–0.74, p < 0.001], $40,227–$50,353 [OR 0.84, 95% CI 0.76–0.92, p < 0.001]; reference = ≥ $63,333) were also found to be significantly associated with a lower likelihood of surgery at an HVF. Subgroup analyses revealed that elderly patients (age ≥ 65 years), both male and female patients and non-Hispanic White patients, and those with private insurance, Medicare, metropolitan residential location, median zip code–level household income in the first and second quartiles, and educational attainment in the first and third quartiles had increased odds of undergoing surgery at an HVF in 2016 compared to 2004 (all p ≤ 0.05). On the other hand, patients with other governmental insurance, patients with a rural residence, and those from a non-White racial category did not show a significant difference in odds of surgery at an HVF over time (all p > 0.05). CONCLUSIONS The present analysis from the National Cancer Database revealed significant disparities in access to surgery at an HVF for GBM within the United States. Furthermore, there was evidence that these racial and socioeconomic disparities may have widened between 2004 and 2016. The findings should assist health policy makers in the development of strategies for improving access to HVFs for racially and socioeconomically disadvantaged populations.

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Immunization Stress-Related Responses: Mitigating Patient Fears and Associated Side Effects Amidst a Global Vaccination Effort

Patient Safety ◽

10.33940/med/2022.1.4 ◽

2022 ◽

pp. 36-41

Author(s):

Michael Mast ◽

Yihan Li

Keyword(s):

United States ◽

Side Effects ◽

Adverse Events ◽

The United States ◽

Mass Vaccination ◽

Vaccine Hesitancy ◽

Substantial Role

The event of receiving a vaccine can lead to feelings of stress and anxiety for many patients and may present as adverse events. With coronavirus disease 2019 (COVID-19) mass vaccination efforts, adverse events following immunization, including immunization stress-related reactions (ISRR), have subsequently increased. Traditionally rare, but increasingly common, cluster events have also become a concern. Demonstrated in recent publications by Hause et al. concerning Janssen (Johnson & Johnson) COVID-19 vaccine clinics, these adverse events can lead to personal apprehension towards receiving vaccines, as well as public distrust towards the immunization process. To combat ISRRs, mass vaccination clinics across the United States must create administration protocols to mitigate these responses. Anticipation and swift management can play a substantial role in minimizing frequency and severity of these reactions and prevent future vaccine hesitancy.

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Lung Adenocarcinoma Biomarker Incidence in Hispanic Versus Non-Hispanic White Patients

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2013-0225-oa ◽

2013 ◽

Vol 138 (3) ◽

pp. 390-394 ◽

Cited By ~ 5

Author(s):

Elizabeth McQuitty ◽

Wei Zhang ◽

Heather Hendrickson ◽

Fermin O. Tio ◽

Jaishree Jagirdar ◽

...

Keyword(s):

United States ◽

Lung Adenocarcinoma ◽

The United States ◽

Smoking History ◽

Genetic Changes ◽

Mutational Frequency ◽

Hispanic Patients ◽

Biomarker Testing ◽

Hispanic White ◽

White Patients

Context.—Lung cancer is the leading cause of cancer deaths in the United States and worldwide. Biomarker testing is critical to personalized therapy in lung adenocarcinoma and has been extensively investigated in non-Hispanic whites, Asians, and African Americans. However, little information addresses the underlying genetic changes in lung adenocarcinoma among Hispanic patients in the United States. Objective.—To identify targetable biomarkers other than EGFR and EML4-ALK in Hispanic patients with lung adenocarcinoma. Design.—We tested DNA extracted from 85 lung adenocarcinoma specimens collected from 40 Hispanic and 43 non-Hispanic white patients for previously reported mutations in KRAS, MET, BRAF, mTOR, STAT3, JAK2, PIK3CA, AKT1 through AKT3, and PTEN with a custom Sequenom massARRAY assay (Sequenom, San Diego, California). Results.—Mutations in KRAS were identified in 11 cases (13%; 6 Hispanic [7%], 5 non-Hispanic white [6%]) and had no correlation with sex, age, or smoking history. Mutations in PIK3CA were identified in 2 of the 40 Hispanic patients (5%), including one patient (2.5%) with a concurrent KRAS mutation. The tumors were wild type for all other genes tested. Conclusions.—Targetable biomarkers other than EGFR and EML4-ALK were identified in 7 of the 40 Hispanic patients (18%) and 5 of the 43 non-Hispanic white patients (12%), suggesting a similar mutational frequency. Our highly multiplexed genotyping assay detected actionable mutations in 14% (12 of 83) more patients than would have been identified by EGFR and EML4-ALK testing alone.

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Acral melanocytic lesions in the United States: Prevalence, awareness, and dermoscopic patterns in skin-of-color and non-Hispanic white patients

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2015.11.035 ◽

2016 ◽

Vol 74 (4) ◽

pp. 724-730.e1 ◽

Cited By ~ 9

Author(s):

Reshmi Madankumar ◽

Priyanka V. Gumaste ◽

Kathryn Martires ◽

Panta R. Schaffer ◽

Sonal Choudhary ◽

...

Keyword(s):

United States ◽

The United States ◽

Melanocytic Lesions ◽

Hispanic White ◽

White Patients

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Trusted Sources of COVID-19 Vaccine Information among Hesitant Adopters in the United States

Vaccines ◽

10.3390/vaccines9121418 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1418

Author(s):

Rachel S. Purvis ◽

Emily Hallgren ◽

Ramey A. Moore ◽

Don E. Willis ◽

Spencer Hall ◽

...

Keyword(s):

United States ◽

Health Care ◽

Information Sources ◽

The United States ◽

Vaccine Uptake ◽

World Health ◽

Health Concern ◽

Vaccine Hesitancy ◽

Care Providers ◽

Vaccine Information

The World Health Organization has identified vaccine hesitancy as a top health concern. Emerging research shows that those who are hesitant may still get vaccinated; however, little is known about those who say they are hesitant but still get vaccinated. Most people have high trust in several sources of COVID-19 information, and trust in certain information sources such as the Centers for Disease Control and Prevention and health care providers was associated with being vaccinated. This study explored trusted information sources among hesitant adopters in the United States with a survey respondents completed while waiting after receiving a COVID-19 vaccine dose. The study included (n = 867) respondents. The majority of respondents were female (60.21%); were between the ages of 18 and 44 years old (71.97%); and were diverse, with most identifying as White (44.54%) or Hispanic/Latinx (32.55%). Hesitant adopters reported multiple trusted sources of COVID-19 vaccine information, which can be grouped into four emergent subthemes: (1) Health care/Medical science, (2) Personal relationships, (3) News and social media, and (4) Individual/Myself. Some respondents expressed a distrust of all sources of COVID-19 vaccine information, despite receiving the vaccine, describing a lack of trust in traditional sources of information such as the mainstream media or government. This study contributes to the literature by documenting trusted sources of COVID-19 vaccine information among hesitant adopters in the United States. Findings provide important insights about respondents’ trusted sources of COVID-19 vaccine information that can inform future public health messaging campaigns intended to increase vaccine uptake among hesitant adopters.

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COVID-19 Vaccine Concerns about Safety, Effectiveness, and Policies in the United States, Canada, Sweden, and Italy among Unvaccinated Individuals

Vaccines ◽

10.3390/vaccines9101138 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1138

Author(s):

Rachael Piltch-Loeb ◽

Nigel Walsh Harriman ◽

Julia Healey ◽

Marco Bonetti ◽

Veronica Toffolutti ◽

...

Keyword(s):

United States ◽

Population Control ◽

Vaccine Safety ◽

The United States ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Government Control ◽

Thematic Area ◽

Safety Effectiveness

Despite the effectiveness of the COVID-19 vaccine, global vaccination distribution efforts have thus far had varying levels of success. Vaccine hesitancy remains a threat to vaccine uptake. This study has four objectives: (1) describe and compare vaccine hesitancy proportions by country; (2) categorize vaccine-related concerns; (3) rank vaccine-related concerns; and (4) compare vaccine-related concerns by country and hesitancy status in four countries—the United States, Canada, Sweden, and Italy. Using the Pollfish survey platform, we sampled 1000 respondents in Canada, Sweden, and Italy and 750 respondents in the United States between 21–28 May 2021. Results showed vaccine-related concerns varied across three topical areas—vaccine safety and government control, vaccine effectiveness and population control, and freedom. For each thematic area, the top concern was statistically significantly different in each country and among the hesitant and non-hesitant subsamples within each county. Concerns related to freedom were the most universal. Understanding the specific concerns among individuals when it comes to the COVID-19 vaccine can help to inform public communications and identify which, if any, salient narratives are global.

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Risk Factors for the Development of Bacteremia in Previously Healthy Children with Non-typhoidal Salmonella Gastroenteritis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.889 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S365-S365

Author(s):

Bethany Burdick ◽

Ankhi Dutta ◽

Lauren Hess ◽

Charles Minard

Keyword(s):

United States ◽

Risk Factors ◽

Laboratory Data ◽

The United States ◽

Healthy Children ◽

Exclusion Criteria ◽

Increased Risk ◽

Pediatric Study ◽

Age Of Diagnosis ◽

Hispanic White

Abstract Background Non-typhoidal Salmonella (NTS) causes approximately 1.2 million illnesses per year in the United States. There are very few pediatric studies which has investigated the risk factors for NTS bacteremia in healthy children with NTS gastroenteritis (NTS-AGE). Methods This was a retrospective study of children admitted to Texas Children’s Hospital, Houston, TX, with NTS-AGE from 2007–2016. Exclusion criteria included: patients aged ≤3 m or > 18 years, immunodeficiencies, hemoglobinopathies, extraintestinal manifestations or those in whom blood cultures were not obtained. Demographics, clinical and laboratory data were collected from electronic medical records. Patients with NTS bacteremia (NTS-B) were compared with patients who were non-bacteremic (NTS-NB). Results Of 350 patients reviewed, 83 patients met inclusion criteria: 53 with NTS-B and 30 NTS-NB. The median age of diagnosis was 1.58 years (range 3.5 months-18 years). Thirty-nine patients (47.0%) were female and 44 (53.0%) were male. Majority of patients were non-Hispanic White (n = 70; 84.3%). The most common serotype was Salmonella Group C (n = 41(49.4%). There was no difference in risk factors between NTS-B vs. NTS-NB in terms of age, duration of diarrhea prior to admission, travel or pet exposure, prior antibiotic exposure or white blood cell count at presentation. Duration of fever prior to admission was statistically significant with median duration for NTS-B being 6.11 days compared with NTS-NB at 1.97 days (P =  0.0000006). There was an increased trend for bacteremia in males and Salmonella Group C bacteremia (P = 0.07 and P = 0.08 respectively). Conclusion To our knowledge this is first pediatric study in the United States to evaluate risk factors for NTS bacteremia in healthy children with NTS-AGE. Duration of fever prior to admission was associated with increased risk of NTS-B along with increased trend with males and infection with Group C Salmonella. These risk factors should prompt clinicians to monitor patients with NTS-AGE closely and help in deciding whether antimicrobials are warranted or not. Disclosures All authors: No reported disclosures.

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COVID-19 Vaccine Concerns about Safety, Effectiveness and Policies in the United States, Canada, Sweden, and Italy among Unvaccinated Individuals

10.1101/2021.09.09.21263328 ◽

2021 ◽

Author(s):

Rachael Piltch-Loeb ◽

Nigel Harriman ◽

Julia Healey ◽

Marco Bonetti ◽

Veronica Toffolutti ◽

...

Keyword(s):

United States ◽

Population Control ◽

Vaccine Safety ◽

The United States ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Government Control ◽

Thematic Area ◽

Safety Effectiveness

AbstractDespite the effectiveness of the COVID-19 vaccine, global vaccination distribution efforts have thus far had varying levels of success. Vaccine hesitancy remains a threat to vaccine uptake. This study has four objectives: 1) describe and compare vaccine hesitancy proportions by country; 2) categorize vaccine-related concerns; 3) rank vaccine-related concerns; and 4) compare vaccine-related concerns by country and hesitancy status in four countries- the United States, Canada, Sweden, and Italy. Using the Pollfish survey platform, we sampled 1000 respondents in Canada, Sweden, and Italy and 750 respondents in the United States between May 21-28, 2021. Results showed vaccine related concerns varied across three topical areas- vaccine safety and government control, vaccine effectiveness and population control, and freedom. For each thematic area, the top concern was statistically significantly different in each country and among the hesitant and non-hesitant subsamples within each county. Understanding the specific concerns among individuals when it comes to the COVID-19 vaccine can help to inform public communications and identify which, if any, salient narratives, are global.

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COVID-19 Vaccination Uptake and Hesitancy Among Current Tobacco Users

Tobacco Use Insights ◽

10.1177/1179173x211068027 ◽

2021 ◽

Vol 14 ◽

pp. 1179173X2110680

Author(s):

Nicolle M Krebs ◽

Gail D’Souza ◽

Candace Bordner ◽

Sophia I Allen ◽

Andrea L Hobkirk ◽

...

Keyword(s):

Adult Population ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

P Value ◽

Current Cigarette Smoking ◽

Chi Square ◽

Convenience Sample ◽

Increased Risk ◽

Current Tobacco

Novel mRNA vaccines have been developed and were first distributed to high-risk individuals (including smokers) in the United States starting in December 2020 to combat the coronavirus (COVID-19) pandemic. Over one-half of the U.S. adult population has received at least 1 dose of a COVID-19 vaccine, but many others have reported hesitation about becoming vaccinated. We examined COVID-19 vaccine uptake and hesitancy from a convenience sample of Pennsylvanian adult smokers in April 2021, approximately 3 months after tobacco users were eligible to receive vaccination in the state. Participants (n = 231) were 23.4% male, 90.5% white, and had a mean age of 48.1 (SD = 11.9) years. All participants were current tobacco users, with the majority reporting current cigarette smoking (90.9%) with an average of 16 (SD = 8.1) cigarettes smoked per day. Nearly 60% (n = 137) reported receiving at least 1 dose of the vaccine and of those who did not (n = 94), 84% (n = 79) said they were somewhat or very unlikely to get a vaccine. Those who were unvaccinated were more likely to not consume news about COVID-19 (chi-square P-value < .01) and less likely to believe government news sources as reliable information for COVID-19 (chi-square P-value < .01). Qualitative responses among those who were vaccine hesitant expressed concerns about the lack of research on the vaccine, distrust of the safety of the vaccine, and fears about side effects. Understanding vaccine hesitancy among tobacco users can help develop targeted communication strategies and directly address concerns to promote vaccination among this population who may be at an increased risk of severe complications from COVID-19.

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The impact of race and ethnicity on outcomes in 19,584 adults hospitalized with COVID-19

PLoS ONE ◽

10.1371/journal.pone.0254809 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254809

Author(s):

Ann M. Navar ◽

Stacey N. Purinton ◽

Qingjiang Hou ◽

Robert J. Taylor ◽

Eric D. Peterson

Keyword(s):

United States ◽

Race And Ethnicity ◽

The United States ◽

Lower Mortality ◽

Real World Data ◽

Black Adults ◽

Increased Risk ◽

Hispanic Patients ◽

The Impact ◽

White Patients

Introduction At the population level, Black and Hispanic adults in the United States have increased risk of dying from COVID-19, yet whether race and ethnicity impact on risk of mortality among those hospitalized for COVID-19 is unclear. Methods Retrospective cohort study using data on adults hospitalized with COVID-19 from the electronic health record from 52 health systems across the United States contributing data to Cerner Real World DataTM. In-hospital mortality was evaluated by race first in unadjusted analysis then sequentially adjusting for demographics and clinical characteristics using logistic regression. Results Through August 2020, 19,584 patients with median age 52 years were hospitalized with COVID-19, including n = 4,215 (21.5%) Black and n = 5,761 (29.4%) Hispanic patients. Relative to white patients, crude mortality was slightly higher in Black adults [22.7% vs 20.8%, unadjusted OR 1.12 (95% CI 1.02–1.22)]. Mortality remained higher among Black adults after adjusting for demographic factors including age, sex, date, region, and insurance status (OR 1.13, 95% CI 1.01–1.27), but not after including comorbidities and body mass index (OR 1.07, 95% CI 0.93–1.23). Compared with non-Hispanic patients, Hispanic patients had lower mortality both in unadjusted and adjusted models [mortality 12.7 vs 25.0%, unadjusted OR 0.44(95% CI 0.40–0.48), fully adjusted OR 0.71 (95% CI 0.59–0.86)]. Discussion In this large, multicenter, EHR-based analysis, Black adults hospitalized with COVID-19 had higher observed mortality than white patients due to a higher burden of comorbidities in Black adults. In contrast, Hispanic ethnicity was associated with lower mortality, even in fully adjusted models.

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