Retrospective Analysis of COVID-19 Pandemic Impact on Breast Cancer Screening Rates in Northwest Indiana

Background: Few changes to healthcare delivery during the COVID-19 pandemic altered pre-pandemic diagnostic testing as much as those made to cancer screening. Several studies show that screening volumes decreased by as much as 80% across multiple modalities and cancer types in the spring of 2020. These studies examined large hospital systems in the American East and West, but communities with predominantly Black populations like Gary, Indiana, have been absent from this research. Methods: Our study captures how the COVID-19 pandemic affected access to diagnostic screening for cancerous and precancerous breast lesions through mammography using patient-level data. “Hospital A” provided data from 17,973 mammography encounters that occurred between March 2019 and June 2021. Screening volumes from the eight-week period from March 23rd and May 17th in 2020, the period elective procedures were suspended, was compared to three other distinct periods: the previous 8-week period, the next 8-week period, and the same 8-week period from 2019. Results: From the 17,973 encounters, the average patient age was 61.7 (SD 11.4) years, 61.0% of patients paid with Medicare or Medicaid, and 66.0% of patients identified as Black. Despite performing a weekly average of 190 (12.3) mammograms during the 2019 baseline period and 158 (16.1) mammograms in the eight weeks preceding the COVID-19 pandemic, the weekly average fell to 13 (22.4) mammograms during the study period with zero occurring in a four-week stretch. Fortunately, volume returned sharply to near pre-pandemic levels in the eight weeks following the study period with 139 (18.9) average weekly mammograms. Conclusion: Despite a 93% year-over-year decrease in mammography during the height of the pandemic, volume returned in the summer of 2020. Concerning, however, is that average monthly volume (582 (88.5) mammograms) in the first six months of 2021 remains 22.1% lower than 2019 numbers (747 (66.7) mammograms).

Race-Specific Genetic Profiles of Homologous Recombination Deficiency in Multiple Cancers

Homologous recombination deficiency (HRD) has been used to predict both cancer prognosis and the response to DNA-damaging therapies in many cancer types. HRD has diverse manifestations in different cancers and even in different populations. Many screening strategies have been designed for detecting the sensitivity of a patient’s HRD status to targeted therapies. However, these approaches suffer from low sensitivity, and are not specific to each cancer type and population group. Therefore, identifying race-specific and targetable HRD-related genes is of clinical importance. Here, we conducted analyses using genomic sequencing data that was generated by the Pan-Cancer Atlas. Collapsing non-synonymous variants with functional damage to HRD-related genes, we analyzed the association between these genes and race within cancer types using the optimal sequencing kernel association test (SKAT-O). We have identified race-specific mutational patterns of curated HRD-related genes across cancers. Overall, more significant mutation sites were found in ATM, BRCA2, POLE, and TOP2B in both the ‘White’ and ‘Asian’ populations, whereas PTEN, EGFG, and RIF1 mutations were observed in both the ‘White’ and ‘African American/Black’ populations. Furthermore, supported by pathogenic tendency databases and previous reports, in the ‘African American/Black’ population, several associations, including BLM with breast invasive carcinoma, ERCC5 with ovarian serous cystadenocarcinoma, as well as PTEN with stomach adenocarcinoma, were newly described here. Although several HRD-related genes are common across cancers, many of them were found to be specific to race. Further studies, using a larger cohort of diverse populations, are necessary to identify HRD-related genes that are specific to race, for guiding gene testing methods.

Racial Disparities in Use of Memory Care and Prevalence of Duals in Assisted Living

Assisted living (AL) communities with memory care licenses are disproportionately located in affluent and predominantly White communities and Black older adults are underrepresented in AL. But little is known about characteristics of AL that care for Black residents. We estimated the association of facility-level characteristics as proxy measures for AL resources, such as memory care designations and percentage of dual-eligible residents, across low (0-5%), medium (5-10%) and high (>10%) percentages of Black residents. We found broad differences among communities in the three levels of Black-resident prevalence. High percentage of Black residents was associated with large differences in the percentage of Medicaid-enrolled residents (high 54% duals [s.d.=34], med 28% [31], low=13% [22], p<0.001). ALs with high Black populations were less likely to have a memory-care designation than ALs with medium and low percentages of Black residents (high 4.7% memory care, med 11%, low 17%).

Systematic review of pathways to care in the U.S. for Black individuals with early psychosis

The pathway to receiving specialty care for first episode psychosis (FEP) among Black youth in the US has received little attention despite documented challenges that negatively impact engagement in care and clinical outcomes. We conducted a systematic review of US-based research, reporting findings related to the pathway experiences of Black individuals with FEP and their family members. A systematic search of PubMed, PsycInfo, and Embase/Medline was performed with no date restrictions up to April 2021. Included studies had samples with at least 75% Black individuals and/or their family members or explicitly examined racial differences. Of the 80 abstracts screened, 28 peer-reviewed articles met the inclusion criteria. Studies were categorized into three categories: premordid and prodromal phase, help-seeking experiences, and the duration of untreated psychosis (DUP). Compounding factors such as trauma, substance use, and structural barriers that occur during the premorbid and prodromal contribute to delays in treatment initiation and highlight the limited use of services for traumatic childhood experiences (e.g., sexual abuse). Studies focused on help-seeking experiences demonstrated the limited use of mental health services and the potentially traumatic entry to services (e.g., law enforcement), which is associated with a longer DUP. Although the majority of studies focused on help-seeking experiences and predictors of DUP, findings suggests that for Black populations, there is a link between trauma and substance use in the pathway to care that impacts the severity of symptoms, initiation of treatment, and DUP. The present review also identifies the need for more representative studies of Black individuals with FEP.

Prevalence and contributing factors to recurrent binge eating and obesity among black adults with food insufficiency: findings from a cross-sectional study from a nationally-representative sample

Background Living in a food-insecure or food insufficient household may increase risk for binge eating and obesity. Because racial disparities in food access, obesity, and access to treatment for disordered eating exist, it is important to examine these relationships in Black populations. Methods We conducted a secondary analysis of data from the National Survey of American Life (N = 4553), a nationally-representative sample of Black Americans, including African Americans and Afro-Caribbeans. Logistic regression was used to explore the association of food insufficiency with obesity and binge eating. Results In the total sample of Black Americans, the prevalence of food insufficiency was 10.9% (95% CI 10.0–11.8%). Food insufficiency was not significantly associated with obesity in Black Americans, but when associations were explored in analyses stratified by ethnicity and sex, food insufficiency significantly predicted an increased odds of obesity in Afro-Caribbeans (odds ratio [OR] = 1.47, 95% CI 1.01, 2.13). Individuals experiencing food insufficiency were more likely to report recurrent binge eating in the last 12 months (3% v 2%, P = 0.02) and a lifetime history of binge eating (6% v 3%, P = 0.004) compared to those who were food sufficient. After adjusting for socio-demographic factors, food insufficiency was not significantly associated with recurrent binge eating in Black Americans or in sex- and ethnicity-stratified analyses. Conclusion The present study reveals a more complex relation between food insufficiency and binge eating than previously thought—although an association existed, it was attenuated by an array of sociodemographic factors. Our results also underscore the importance of considering ethnicity as different patterns emerged between African American and Afro-Caribbean participants.

“All Blacks Are Angry”

This chapter examines the continuing disparities between Whites and Blacks through extensive social science data and studies of the impacts of systemic racism. It first utilizes what demographers call the dissimilarity index to measure housing segregation in major metropolitan areas; cities with heavily Black populations, such as Detroit, have become “hyper-segregated” with almost total “social isolation” of Blacks. The chapter then examines the long-standing academic and political debates over the causes of systemic racism, beginning in 1965 with a government report, The Negro Family: The Case for National Action, by a young Labor Department aide, Daniel Patrick “Pat” Moynihan. He found the main cause of Black poverty and increasing single Black motherhood in the “pathology” of a “matriarchal” Black family structure in which males are neither needed nor welcome. Moynihan’s report spurred an angry rebuttal in a book by psychology professor William Ryan, Blaming the Victim, which found the main cause of Black poverty in the systemic racism of White society and culture. The chapter then looks at social science studies by William Julius Wilson (explaining the “racial invariance” of White and Black crime); psychologist John Dollard (explaining the prevalence of Black-on-Black crime with the “frustration-aggression-displacement” theory); and Black psychiatrists William Grier and Price Cobbs (explaining “Black rage” as rooted in White control of institutions that exclude or discriminate against Blacks). The chapter concludes with a look at the War on Drugs of the 1980s and 1990s and the resulting mass incarceration of Black men.

An Unhealthy Country

This chapter analyzes the health divides in the United States, which unfold along economic, racial, and ethnic lines. These health divides reflect a core paradox of modernity—a world that is simultaneously far healthier than it has ever been and far less healthy than it could be. By bringing health inequalities to the surface, COVID-19 complicates the narrative of progress. Again and again in the US, one sees people sicken and die not just from the disease, but from a status quo which significantly increased their chance of catching the contagion or developing a more serious case of it. Indeed, it soon became clear that Black populations were significantly likelier to suffer from the virus than whites. Being owned as property, then being subject to generations of Jim Crow laws and the denial of full social and political rights, created for the Black community a level of disadvantage constituting a foundational flaw in the overall health of the country. If any good came from COVID-19, it was that the pandemic shattered the idea that the poor health faced by marginalized communities is merely the problem of those communities and that it is not fundamentally a product of the health inequities.

Time varying association between deprivation, ethnicity and SARS-CoV-2 infections in England: a space-time study

Background: Ethnically diverse and socio-economically deprived communities have been differentially affected by the COVID-19 pandemic in the UK. Method: Using a multilevel regression model we assess the time-varying association between SARS-CoV-2 infections and areal level deprivation and ethnicity. We separately consider weekly test positivity rate and estimated unbiased prevalence at the Lower Tier Local Authority (LTLA) level, adjusting for confounders and spatio-temporal correlation structure. Findings: Comparing the least deprived and predominantly White areas with most deprived and predominantly non-White areas over the whole study period, the weekly positivity rate increases by 13% from 2.97% to 3.35%. Similarly, prevalence increases by 10% from 0.37% to 0.41%. Deprivation has a stronger effect until October 2020, while the effect of ethnicity becomes more pronounced at the peak of the second wave and then again in May-June 2021. In the second wave of the pandemic, LTLAs with large South Asian populations were the most affected, whereas areas with large Black populations did not show increased values for either outcome during the entire period under analysis. Interpretation: IMD and BAME% are both associated with an increased COVID-19 burden in terms of disease spread and monitoring, and the strength of association varies over the course of the pandemic. The consistency of results across the two outcomes suggests that deprivation and ethnicity have a differential impact on disease exposure or susceptibility rather than testing access and habits.

The Pandemic Policy U-Turn: Partisanship, Public Health, and Race in Decisions to Ease COVID-19 Social Distancing Policies in the United States

We explore the US states’ evolving policy responses to the COVID-19 pandemic by examining governors’ decisions to begin easing five types of social distancing policies after the initial case surge in March–April 2020. Applying event history models to original data on state COVID-19 policies, we test the relative influence of health, economic, and political considerations on their decisions. We find no evidence that differences in state economic conditions influenced when governors began easing. Governors of states with larger recent declines in COVID-19 deaths per capita and improving trends in new confirmed cases and test positivity were quicker to ease. However, politics played as powerful a role as epidemiological conditions, driven primarily by governors’ party affiliation. Republican governors made the policy U-turn from imposing social distancing measures toward easing those measures a week earlier than Democratic governors, all else equal. Most troubling of all, we find that states with larger Black populations eased their social distancing policies more quickly, despite Black Americans’ higher exposure to infection from SARS-CoV-2 and subsequent death from COVID-19.