Analysis of COVID-19 Case Demographics in Gary, Indiana

Background and Hypothesis It has been reported in several recent studies that health disparities associated with COVID-19 infection r are prevalent in Black and impoverished populations. The contribution of multiple causes to these disparities is still not completely elucidated. Gary, Indiana has a large Black population (80%), high number of residents living below the poverty line (34%), and high unemployment rate (20%). We hypothesized that Black individuals in Gary have a higher rate of positive cases, hospitalizations, and deaths than non-Black individuals. Also, we hypothesized that (median household income measured by the zip code) is negatively correlated with COVID-19 positive cases, hospitalizations, and deaths. Methods In collaboration with the Gary Health Department, we analyzed data on all positive cases in the city from 06/16/2020 through 06/07/2021(totally 5149 cases). We compared this data to the data from 03/16/2020 through 06/16/2020 (totally 724 cases) that we analyzed previously. Data was de-identified and included age, race, ethnicity, and zip code. The data was analyzed using Pearson's chi-square test and regression analysis. Results When compared to the non-Black population in Gary age and population-adjusted rates of hospitalizations and deaths in the Black population are 3-fold (p<9.385E-11) and 2-fold (p<0.0171) higher, respectively. Surprisingly, the non-Black population had a higher infection rate than the Black population (p<2.69E-09). Median household income of a zip code is negatively correlated with COVID-19 hospitalizations in that zip code (R2=0.6345, p=0.03), but is does not affect the .rates of infections and deaths. Conclusion Our data show that in Gary, there is a clear health disparity of both income and race, specifically in the context of COVID-19. IUSMNW and Gary health officials can collaborate and utilize this data to reallocate resources to the highly populated, low income, and predominantly Black neighborhoods.

Trends in COVID-19 Health Disparities in North Carolina: Preparing the Field for Long-Haul Patients

Long-term coronavirus disease 2019 (long-COVID) refers to persistent symptoms of SARS-CoV-2 (COVID-19) lingering beyond four weeks of initial infection. Approximately 30% of COVID-19 survivors develop prolonged symptoms. Communities of color are disproportionately affected by comorbidities, increasing the risk of severe COVID-19 and potentially leading to long-COVID. This study aims to identify trends in health disparities related to COVID-19 cases, which can help unveil potential populations at risk for long-COVID. All North Carolina (NC) counties (n = 100) were selected as a case study. Cases and vaccinations per 1000 population were calculated based on the NC Department of Health and Human Services COVID-19 dashboard with reports current as of 8 October 2021, which were stratified by age groups and race/ethnicity. Then, NC COVID-19 cases were correlated to median household income, poverty, population density, and social vulnerability index themes. We observed a negative correlation between cases (p < 0.05) and deaths (p < 0.01) with both income and vaccination status. Moreover, there was a significant positive association between vaccination status and median household income (p < 0.01). Our results highlight the prevailing trend between exacerbated COVID-19 infection and low-income/under-resourced communities. Consequently, efforts and resources should be channeled to these communities to effectively monitor, diagnose, and treat against COVID-19 and potentially prevent an overwhelming number of long-COVID cases.

National U.S. Patient and Transplant Data for Krabbe Disease

Krabbe disease (KD) is a leukodystrophy caused by mutations in the galactosylceramidase gene. Presymptomatic hematopoietic stem cell transplantation (HSCT) is associated with improved outcomes, but most data are from single-center studies. Our objective was to characterize national patterns of HSCT for KD including whether there were disparities in HSCT utilization and outcomes. We conducted a retrospective study of KD patients ≤ age 18 years from November 1, 2015, through December 31, 2019, using the U.S. Children's Hospital Association's Pediatric Health Information System database. We evaluated outcomes for HSCT, intensive care unit days, and mortality, comparing age, sex, race/ethnicity, rural/urban location, and median household income. We identified 91 KD patients. HSCT, performed in 32% of patients, was associated with reduced mortality, 31 vs. 68% without HSCT (p &lt; 0.003). Trends included the fact that more males than females had HSCT (39 vs. 23%); more Asian and White patients had HSCT compared to Black or Hispanic patients (75, 33, 25, and 17%, respectively); and patients from households with the lowest-income quartile (&lt; $25,000) had more HSCT compared to higher-income quartiles (44 vs. 33, 30, and 0%). Overall, receiving HSCT was associated with reduced mortality. We noted trends in patient groups who received HSCT. Our findings suggest that disparities in receiving HSCT could affect outcomes for KD patients.

Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women: Protocol for a Pilot Study

Background Innovative analyses of cardiovascular (CV) risk markers and health behaviors linked to neighborhood stressors are essential to further elucidate the mechanisms by which adverse neighborhood social conditions lead to poor CV outcomes. We propose to objectively measure physical activity (PA), sedentary behavior, and neighborhood stress using accelerometers, GPS, and real-time perceived ecological momentary assessment via smartphone apps and to link these to biological measures in a sample of White and African American women in Washington, DC, neighborhoods. Objective The primary aim of this study is to test the hypothesis that living in adverse neighborhood social conditions is associated with higher stress-related neural activity among 60 healthy women living in high or low socioeconomic status neighborhoods in Washington, DC. Sub-aim 1 of this study is to test the hypothesis that the association is moderated by objectively measured PA using an accelerometer. A secondary objective is to test the hypothesis that residing in adverse neighborhood social environment conditions is related to differences in vascular function. Sub-aim 2 of this study is to test the hypothesis that the association is moderated by objectively measured PA. The third aim of this study is to test the hypothesis that adverse neighborhood social environment conditions are related to differences in immune system activation. Methods The proposed study will be cross-sectional, with a sample of at least 60 women (30 healthy White women and 30 healthy Black women) from Wards 3 and 5 in Washington, DC. A sample of the women (n=30) will be recruited from high-income areas in Ward 3 from census tracts within a 15% of Ward 3’s range for median household income. The other participants (n=30) will be recruited from low-income areas in Wards 5 from census tracts within a 15% of Ward 5’s range for median household income. Finally, participants from Wards 3 and 5 will be matched based on age, race, and BMI. Participants will wear a GPS unit and accelerometer and report their stress and mood in real time using a smartphone. We will then examine the associations between GPS-derived neighborhood variables, stress-related neural activity measures, and adverse biological markers. Results The National Institutes of Health Institutional Review Board has approved this study. Recruitment will begin in the summer of 2021. Conclusions Findings from this research could inform the development of multilevel behavioral interventions and policies to better manage environmental factors that promote immune system activation or psychosocial stress while concurrently working to increase PA, thereby influencing CV health. International Registered Report Identifier (IRRID) PRR1-10.2196/29191

Clinical Implications of Nonbiological Factors With Colorectal Cancer Patients Younger Than 45 Years

BackgroundTo evaluate the clinical implications of non-biological factors (NBFs) with colorectal cancer (CRC) patients younger than 45 years.MethodsIn the present study, we have conducted Cox proportional hazard regression analyses to evaluate the prognosis of different prognostic factors, the hazard ratios (HRs) were shown with 95% confidence intervals (CIs). Kaplan–Meier method was utilized to compare the prognostic value of different factors with the log-rank test. NBF score was established according to the result of multivariate Cox analyses.ResultsIn total, 15129 patients before 45 years with known NBFs were identified from the SEER database. Only county-level median household income, marital status and insurance status were NBFs that significantly corelated with the cause specifical survival in CRC patients aged less than 45 years old (P &lt; 0.05). Stage NBF 1 showed 50.5% increased risk of CRC-specific mortality (HR = 1.505, 95% CI = 1.411-1.606, P &lt; 0.001). Stage NBF 0 patients were associated with significantly increased CRC-specific survival (CCSS) when compared with the stage NBF 1 patients in different AJCC TNM stages.ConclusionsNBF stage (defined by county-level median household income, marital status and insurance status) was strongly related to the prognosis of CRC patients. NBFs should arouse enough attention of us in clinical practice of patients younger than 45 years.

Therapy Utilization among Children with Vitiligo at an Urban Tertiary Care Center

Vitiligo is a skin disorder characterized by depigmentation, and 25% of children develop symptoms by age 10. Children with vitiligo have suffered from social isolation and bullying, and thus many seek treatment for re-pigmentation. However, there is limited data on the use of therapies in pediatric vitiligo patients. To address this knowledge gap, we performed a retrospective chart review of 360 patients who were diagnosed with vitiligo under the age of 18 at The Children’s Hospital of Philadelphia. The average age was 10.8 years; average age at diagnosis was 6.21 years. The median household income by zip code was $78,660. Majority were insured by private insurance (53.9%); 44.2% had Medicaid and 1.9% had no information on insurance coverage. Most subjects used topical steroids (55.6%) and/or topical pimecrolimus (58.9%); only a small proportion (17.2%) received light therapy in clinic or at home. Although vitiligo has been shown to affect patients of color more negatively, of those using Home-Based Phototherapy (HBPT) (13), 8 were self-described Caucasian. Twelve out of the 13 had private insurance and the median household income was $105,080 for those using HBPT. Our results indicate that certain groups of patients, such as children of color, those without private insurance, and those from lower-income areas, may not have equal access to the most cost-effective vitiligo therapies. These findings support the need for creation of educational resources and strategies to ensure access to cost-effective vitiligo treatments for patients from all backgrounds.

Disparities in outpatient and telehealth visits during the COVID-19 pandemic in a large integrated health care organization (Preprint)

BACKGROUND Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patients’ demographics and socioeconomic status. OBJECTIVE To assess the impact of the pandemic on outpatient and telehealth visits by demographic characteristics and household income in a diverse population. METHODS We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) during January 5, 2020-October 31, 2020, and the corresponding period in 2019. We estimated the change in visit rates during the early pandemic period (March 22-April 25, 2020) and the late pandemic period (October 4-October 31, 2020) from the pre-pandemic period (January 5-March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% confidence intervals. RESULTS Among 4.56 million KPSC members enrolled in January 2020, about 15% were aged ≥65 years, 52% were female, 39% were Hispanic, and 8% lived in an area of median household income less than $40,000. Increases in telehealth visits during the pandemic varied across subgroups, while decreases in outpatient visits were similar except for age. Among age groups, the 65 years and older population had the least increase in telehealth visits (236.6%; 95% confidence interval [CI], 228.8% to 244.5%): 4.9 per one person-year during the early pandemic period versus 1.5 per one person-year during the pre-pandemic period. During the same periods, across racial/ethnic groups, Hispanic individuals had the largest increase in telehealth visits (295.5%; 95% CI, 275.5% to 316.5%); across income levels, telehealth visits in the low-income group increased the most (313.5%; 95% CI, 294.8 to 333.1%). The rate of combined outpatient and telehealth visits in the Hispanic, Non-Hispanic Black, and low-income group returned to pre-pandemic levels by October 2020. CONCLUSIONS The Hispanic group and the low-income group had the largest increase in telehealth utilization in responding to the COVID-19 pandemic. The use of virtual care potentially mitigated the impact of the pandemic on health care utilization in these vulnerable populations.

Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women: Protocol for a Pilot Study (Preprint)

BACKGROUND Innovative analyses of cardiovascular (CV) risk markers and health behaviors linked to neighborhood stressors are essential to further elucidate the mechanisms by which adverse neighborhood social conditions lead to poor CV outcomes. We propose to objectively measure physical activity (PA), sedentary behavior, and neighborhood stress using accelerometers, GPS, and real-time perceived ecological momentary assessment via smartphone apps and to link these to biological measures in a sample of White and African American women in Washington, DC, neighborhoods. OBJECTIVE The primary aim of this study is to test the hypothesis that living in adverse neighborhood social conditions is associated with higher stress-related neural activity among 60 healthy women living in high or low socioeconomic status neighborhoods in Washington, DC. Sub-aim 1 of this study is to test the hypothesis that the association is moderated by objectively measured PA using an accelerometer. A secondary objective is to test the hypothesis that residing in adverse neighborhood social environment conditions is related to differences in vascular function. Sub-aim 2 of this study is to test the hypothesis that the association is moderated by objectively measured PA. The third aim of this study is to test the hypothesis that adverse neighborhood social environment conditions are related to differences in immune system activation. METHODS The proposed study will be cross-sectional, with a sample of at least 60 women (30 healthy White women and 30 healthy Black women) from Wards 3 and 5 in Washington, DC. A sample of the women (n=30) will be recruited from high-income areas in Ward 3 from census tracts within a 15% of Ward 3’s range for median household income. The other participants (n=30) will be recruited from low-income areas in Wards 5 from census tracts within a 15% of Ward 5’s range for median household income. Finally, participants from Wards 3 and 5 will be matched based on age, race, and BMI. Participants will wear a GPS unit and accelerometer and report their stress and mood in real time using a smartphone. We will then examine the associations between GPS-derived neighborhood variables, stress-related neural activity measures, and adverse biological markers. RESULTS The National Institutes of Health Institutional Review Board has approved this study. Recruitment will begin in the summer of 2021. CONCLUSIONS Findings from this research could inform the development of multilevel behavioral interventions and policies to better manage environmental factors that promote immune system activation or psychosocial stress while concurrently working to increase PA, thereby influencing CV health. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT PRR1-10.2196/29191

Abstract 20: Patterns of Stroke Center Certification and the Impact on Stroke Mortality in Counties of New York State

Introduction: To establish a statewide stroke system in March 2019, New York State (NYS) created the Stroke Designation Program. Stroke centers (SCs) must be certified by a state-approved certifying organization (CO), which is tasked with initial designation and ongoing re-certification. Previous research has found an association at the national level between socioeconomic status and access to higher levels of acute stroke care. Objective: This study characterizes the relationship between socioeconomic status of NYS populations and stroke care level access by comparing median household income and wealth in counties with and without certified SCs. Methods: Population and median household income from the U.S. Census (2010), stroke epidemiological data from the Center for Disease Control, and Area Deprivation Index (ADI) data (ranked within NYS) from the Neighborhood Atlas, a project that quantifies disadvantage by census tract, were collected and averaged for each county. Income has been used to assess local wealth and ADI to analyze community health risks. Certification data were mined from quality check databases for The Joint Commission and Det Norske Veritas, the most commonly used COs. Student’s t-tests compared income and ADI in counties with at least one certified SC to those without. Linear regression characterized the relationship between income and ADI with number of certified SCs, stroke incidence and stroke mortality. Results: All 62 counties in NYS were investigated to yield 40 certified SCs. Counties with at least one certified SC had a significantly higher income ($68,183.63 vs. $57,155.12; p=0.03) and lower ADI (5.90 vs. 7.37; p=0.004) compared to counties with no certified SC. Higher income (p<0.001) and lower ADI (p<0.001) were also associated with more certified SCs. Counties with fewer certified SCs had significantly higher stroke mortality (p<0.001) despite having similar stroke incidence. Conclusion: Socioeconomic heterogeneity in NYS counties is correlated to differential access to certified SCs and quality stroke care, as fewer centers are found in lower-income and disadvantaged communities. Although populations with less access experience stroke at similar rates, this study finds higher death rates in these counties.

Abstract P142: The Impact of Regional Socioeconomic Status on Stroke Center Certification in the Northeastern United States

Introduction: The northeastern United States has been a national leader in stroke healthcare delivery. The current roster of designated comprehensive, primary, thrombectomy-capable and acute stroke ready centers is the result of respective state initiatives. Access to certified stroke centers (SCs) varies by county as states have widely varied certification processes and typically rely on certifying organizations (COs) to identify stroke centers. Previous research has found an association at the national level between likelihood of stroke certification and local socioeconomic status. Objective: This study describes the relationship between socioeconomic status of patient populations in the Northeast U.S. and their access to quality stroke care by comparing median household income and wealth in counties with and without certified SCs. Methods: Population and median household income for 218 counties in Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont were collected from the U.S. Census (2010), stroke epidemiological data were collected from the Center for Disease Control, and Area Deprivation Index (ADI) data (ranked within the U.S.) were collected from the Neighborhood Atlas, a project that quantifies disadvantage. Median household income has been used to quantify local population wealth and ADI to analyze community health risks. Certification data were mined from quality check databases for The Joint Commission and Det Norske Veritas, the most commonly used COs, and yielded 259 certified centers. Linear regression characterized the relationship between income and ADI with number of certified SCs, stroke incidence and stroke mortality. Results: Higher income (p<0.001) and lower ADI (p<0.001) were associated with having more certified SCs (p<0.001). Counties with a higher stroke incidence had significantly more certified SCs (p=0.01). Conclusions: Throughout the counties of the Northeastern U.S., access to quality stroke care depends on local wealth and resources. At the same time, the current analysis indicates that SC certification distribution does appear to correlate to those counties where stroke incidence is highest.