American Individuals Research Articles

Experiences of racist encounters among Asian Americans: analysis of #thisis2016

ABSTRACT Asian Americans have a history of discrimination and othering in the US. In October 2016, journalist Michael Luo put out a call for Asian Americans to tweet racist encounters using the hashtag, #thisis2016. The aim of this study was to examine the encounters shared by Asian Americans. Tweets between October 2016 and December 2017 were obtained via Twitter. The tweets were scoped down to 3,156 tweets to include those that appeared to answer the original call. A phenomenological approach was the overall framework with thematic content analysis applied to analyze the data. Tweets were categorized by type of racist encounter. The racist encounters included: microaggressions, denial of intra-ethnic differences, seen as other, verbal harassment, validation of anti-Asian racism, prejudice, verbal violence/attack, and model minority. Understanding the unique experiences of Asian American individuals, families, and communities helps to target policies, social services, and programming that takes these factors into account.

The Relationship Between Racial Prejudice and Cardiovascular Disease Mortality Risk at the State and County Level.

Robust evidence shows that perceived discrimination among stigmatized groups is associated with negative health outcomes. However, little work has examined whether holding prejudiced attitudes toward others is associated with health risks for prejudiced individuals. The study is a test of the hypothesis that holding prejudicial attitudes has negative health implications for both the holders and targets of prejudicial attitudes. The project connected data (2003-2015) at the state and county levels on average explicit and implicit prejudice held by White, Black, and Native American respondents from Project Implicit with data on cardiovascular disease (CVD) mortality for White, Black, and Native American individuals from the CDC Wonder database. Separate analyses regressed implicit and explicit prejudice on CVD mortality risk for White, Black, and Native American individuals, respectively. At the state level, among White individuals, explicit prejudice toward Blacks (β = .431, p =.037) and implicit prejudice toward Native Americans (β = .283, p = .045) were positively associated with greater CVD mortality for Whites. At the county level, White individuals' implicit prejudice toward Blacks (β =.081, p = .015) and Black individuals' implicit prejudice toward Whites (β = -.066, p = .018) were associated with greater CVD mortality for Whites. Also, at the county-level, among Black individuals, higher implicit (β = -.133, p < .001) and explicit (β = -.176, p < .001) prejudice toward Whites predicted CVD mortality for Blacks. Moreover, explicit prejudice held by White individuals was positively associated with Blacks' county-level CVD deaths (β = .074, p = .036). This evidence suggests that across racial groups, holding racial prejudice is associated with CVD mortality risk for both the prejudiced and the stigmatized groups. Future research should verify the reliability of this potential public health effect with additional work explicating moderators and mediators to inform surveillance and interventions.

Big Five Development From Young Adulthood to Midlife: Findings From a Longitudinal Study of Mexican-Origin Adults

Forms of dietary restriction like intermittent fasting (IF) and caloric restriction (CR) promote health and longevity through changes in gene expression. While the transcriptional changes that occur in response to DR have been well described across several species, the role of translational regulation has lagged. Using polysome profiling and mRNA-seq, we quantified changes in actively translated mRNAs that occur in C. elegans under CR compared to well-fed conditions. The analysis revealed hundreds of transcripts regulated on the translational level that would have been missed using conventual transcriptomics. Among the translationally down-regulated genes that where pro-longevity when knocked down were regulators of the cell-cycle: fbxb-24, sdz-33, kbp-1, and cdk-2. In search of the mechanisms regulating selective translation under CR we investigated a role for ribosomal protein 6 (RPS-6) as its phosphorylation status is thought to regulate cell cycle and selective translation of mRNA transcripts. Using RPS-6 phospho-null and phospho-mimetic mutants, we show that phosphorylation and de-phosphorylation of RPS-6 is necessary for the pro-longevity effects of CR and IF. Furthermore, we show that IF is more beneficial for retaining locomotion with age than CR and that endogenously tagged RPS-6 ::mCherry accumulates in body wall muscle under fasting. However, the benefit of IF on locomotion is lost in RPS-6 phospho-mimetic mutants. Together, results suggest that protein translation is enhanced in the muscle under IF to prevent sarcopenia in a way dependent on RPS-6. Translatome analysis of the phospho-mutant suggested a role for RPS-6 in selective translation of p38 mitogen-activated protein kinases.

Keep Your Hopes Up: An Examination of Racial Differences in the Association Between Hope and Pain

Hope has been associated with increased pain tolerance (Snyder et al., 2005) and has been incorporated in interventions targeting chronic pain (Howell et al., 2015; Katsimigos et al., 2020). Research suggests that African Americans with osteoarthritis (OA) pain experience greater pain severity and disability compared to non-Hispanic White individuals (Vaughn et al., 2019). Although the literature is limited, there is some evidence to suggest racial/ethnic differences in hope (Chang & Banks, 2007). The current study examined race as a moderator of the association between hope and pain in a sample of older adults. Experience sampling (ESM) data was used from a multi-site study examining non-Hispanic White and African American individuals with knee osteoarthritis (OA). Participants completed the Adult Hope Scale (Snyder et al., 1991) during baseline interviews and self-reported momentary pain during 28 ESM calls. Multilevel models revealed a significant interaction between hope and race (p = .04). Specifically, greater hope was associated with decreased momentary pain, and this association was stronger for African American compared to non-Hispanic White individuals. Results suggest that high levels of hope may be particularly protective for African American chronic pain patients. These findings can help inform existing and future interventions focused on enhancing hope in chronic pain populations. (Supported by AG041655, P. Parmelee and D. Smith, Co-PIs)

Wpływ teorii pestalozziańskich na teorię i praktyki filozofii edukacji Josiah Warrena – geneza systemu

The Influence of Pestalozzian Theories on the Theory and Practice of Josiah Warren's Philosophy of Education – The Genesis of the System Josiah Warren is portrayed as the father of American individualist anarchism and the first American anarchist. This paper investigates his contribution to the development of educational theories and his educational practices, since for Warren, as many anarchists, education is the main path to create a new society. Warren’s educational theories and experiments originated mainly from his stay in New Harmony between 1825 and 1827, where he encountered innovative method of teaching that nurtured children’s independence, invented by Johann Heinrich Pestalozzi. Therefore, the aim of this text is to trace how Warren’s philosophy of education was shaped to become an essential element of his theory of stateless political and legal order and how Warren combined concepts of extreme individualism with his economic theories, such as equitable commerce and cost the limit of price. The knowledge of Warren’s New Harmony experience where he encountered William Maclure and Pestalozzian social reformers will enable the reader to better understand the framework of his own concept of education that he practiced at the Spring Hill School in Ohio.

Alzheimer disease in African American individuals: increased incidence or not enough data?

Research on racial differences in Alzheimer disease (AD) dementia has increased in recent years. Older African American individuals bear a disproportionate burden of AD and cognitive impairment compared with non-Latino white individuals. Tremendous progress has been made over the past two decades in our understanding of the neurobiological substrates of AD. However, owing to well-documented challenges of study participant recruitment and a persistent lack of biological data in the African American population, knowledge of the drivers of these racial disparities has lagged behind. Therapeutic targets and effective interventions for AD are increasingly sought, but without a better understanding of the disease in African American individuals, any identified treatments and/or cures will evade this rapidly growing at-risk population. In this Perspective, I introduce three key obstacles to progress in understanding racial differences in AD: uncertainty about diagnostic criteria, disparate cross-sectional and longitudinal findings; and a dearth of neuropathological data. I also highlight evidence-informed strategies to move the field forward.

Invisible Spread and Perceived Stress Amidst COVID-19.

IntroductionThere are limited reports on the mental health toll associated with the fear of spreading coronavirus disease 2019 (COVID-19) and the associated stay-at-home orders. The goal of the present study was to characterize the self-reported stress of participants from the Kansas City Metropolitan Area (KCMA) and to examine the relation between potential for asymptomatic spread and perceived stress.MethodsThis prospective convenience sample study enrolled 461 participants from May 4 to May 22, 2020. Participants were consented and surveyed prior to free SARS-CoV-2 testing. Measures employed included the Perceived Stress Scale-10 and a comprehensive COVID-19 questionnaire. During the study period, testing resources were limited. In the community, only symptomatic individuals or close contacts of known positives could be tested. Our program aimed to reach those who were unable to access testing resources due to their asymptomatic status or other barriers to care.ResultsWorry about asymptomatic spread was associated significantly with greater perceived stress (p < 0.001). Higher stress was reported among women (p < 0.001), Hispanic/Latinx (p = 0.001), non-Black/ African American individuals (p < 0.001), and those reporting the presence of COVID-19 symptoms (p = 0.001).ConclusionsThe COVID-19 pandemic has caused significant economic, social, and health disruptions around the world. Distress is significantly related to concern over unintentionally contributing to the spread of SARS-CoV-2 through asymptomatic transmission. In addition to examining outcomes like distress, future research should characterize the modifiable psychotherapeutic processes that might be targeted through intervention among those experiencing distress.

Comparing Social Media and In-Person Recruitment: Lessons Learned From Recruiting Substance-Using, Sexual and Gender Minority Adolescents and Young Adults for a Randomized Control Trial.

BackgroundRecruiting large samples of diverse sexual and gender minority adolescent and young adults (AYAs) into HIV intervention research is critical to the development and later dissemination of interventions that address the risk factors for HIV transmission among substance-using, sexual and gender minority AYAs.ObjectiveThis paper aimed to describe the characteristics of the samples recruited via social media and in-person methods and makes recommendations for strategies to recruit substance-using, sexual and gender minority AYAs, a hardly reached population that is a priority for HIV prevention research.MethodsUsing data from a randomized control trial of an HIV and substance use intervention with sexual and gender minority AYAs, aged 15 to 29 years in southeastern Michigan (n=414), we examined demographic and behavioral characteristics associated with successful recruitment from a range of virtual and physical venues.ResultsWe found that paid advertisements on Facebook, Instagram, and Grindr offered the largest quantity of eligible participants willing to enroll in the trial. Instagram offered the largest proportion of transgender masculine participants, and Grindr offered the largest proportion of Black/African American individuals. Although we attempted venue-based recruitment at clubs, bars, community centers, and AIDS service organizations, we found it to be unsuccessful for this specific hardly reached population. Social media and geobased dating applications offered the largest pool of eligible participants.ConclusionsUnderstanding factors associated with successful recruitment has the potential to inform effective and efficient strategies for HIV prevention research with substance-using, sexual and gender AYAs.Trial RegistrationClinicalTrials.gov NCT02945436; https://clinicaltrials.gov/ct2/show/NCT02945436International Registered Report Identifier (IRRID)RR2-10.2196/resprot.9414

A multiethnic bidirectional Mendelian randomization study negates causal effects of C-reactive protein concentrations on lung cancer.

BackgroundSignificantly rising plasma circulating C-reaction protein (CRP) concentrations are pervasive in lung cancer (LC) development, demonstrating a bidirectional relation. However, it remains uncertain whether the causation between them exists, and the degree to which the effect varies across different ethnic ancestries remains unknown. Therefore, we attempted to investigate the causal relationship between these two phenotypes.MethodsWith summary statistics of CRP-related single nucleotide polymorphisms (SNPs) identified by several large-scale genome-wide association studies (GWAS) datasets based on five ethnic ancestries coverage worldwide, we implemented bidirectional two-sample Mendelian randomization (MR) analyses. Genetic summary data of 11,348 LC cases and 15,861 controls from the International Lung Cancer Consortium (ILCCO) were applied. The inverse-variance weighted (IVW) approach was utilized as the principal analysis, supplemented by various complementary methods.ResultsMR study did not reveal the causal relationship shared across genetically predisposed CRP blood concentrations and LC risk (OR =1.022, 95% CI: 0.965–1.083, P=0.455) including pathological subtypes (OR =1.026, 95% CI: 0.947–1.112, P=0.534 for lung adenocarcinoma; OR =1.060, 95% CI: 0.970–1.158, P=0.201 for squamous cell lung cancer). Further analyses among East Asian, Hispanic/Latin American, European, African American/Afro-Caribbean, and South Asian populations revealed consistent null causation. Additionally, the causal effects of LC on CRP concentrations were not statically significant (OR =0.999, 95% CI: 0.977–1.021, P=0.923).ConclusionsWe did not observe a bidirectional causal association between CRP blood concentrations on LC among East Asian, Hispanic/Latin American, European, African American/Afro-Caribbean, and South Asian ancestry individuals.

African locus reduces the effect of ApoE ε4 allele in Alzheimer's disease.

Strong associations between ApoE ε4 and Alzheimer disease (AD) risk have been confirmed worldwide, but there is variability in the effect size across populations. African (AF)-descent populations have a lower risk from ApoE ε4 compared to other populations. Studies in admixed populations showed that the AF ancestral background surrounding the ApoE gene reduces the ε4 risk allele effect. Our aim in this study is to identify genetic loci that show a protective effect in AF ancestral background. Primary analyses included imputed data from 6,417 African American (AA) individuals (Kunkle et al. 2020). We estimated global ancestry using a PC-AiR approach that is robust to known and cryptic relatedness. To identify any protective factors interacting with ApoE in the AF local ancestry region, we performed association analyses using a logistic regression model with ApoE ε4 allele as an interaction term and adjusted for genome-wide ancestry, age, and sex. We performed replication analysis using Whole Genome Sequence (WGS) data on 837 African LA ancestry individuals from Ibadan/Nigeria. We identified a locus (rs10423769) that lies within a large cluster of pregnancy specific beta-1 glycoproteins on chromosome 19, ∼ 2 mB from ApoE, with a significant interaction with the ApoE ε4 allele (β=-0.53; SE=0.12;p-value=1.2x10-5 ; FDR adjusted p-value<0.05) in the logistic regression model in the imputed AA samples. We replicated the association in the Nigerian population (β=-1.35; SE=0.52;p-value=9.6x10-3 ). The epistatic interaction reduced the ApoE ε4 allele risk in AD individuals. This study identifies a new locus that reduces the risk effect of ApoE ε4 in AD in AF. rs10423769 is a common allele in AF-descent populations (minor allele frequency (MAF) = 0.12), rare in Europeans (MAF = 0.003) and monomorphic in East Asians. Our results confirm that the AF ancestral background surrounding the ApoE gene harbors protective factors that help mitigate the effect of the detrimental ε4 allele.

Metabolomic Analysis of Coronary Heart Disease in an African American Cohort From the Jackson Heart Study

African American individuals have disproportionate rates of coronary heart disease (CHD) but lower levels of coronary artery calcium (CAC), a marker of subclinical CHD, than non-Hispanic White individuals. African American individuals may have distinct metabolite profiles associated with incident CHD risk compared with non-Hispanic White individuals, and examination of these differences could highlight important processes that differ between them. To identify novel biomarkers of incident CHD and CAC among African American individuals and to replicate incident CHD findings in a multiethnic cohort. This analysis targeted plasma metabolomic profiling of 2346 participants in the Jackson Heart Study (JHS), a prospective population-based cohort study that included 5306 African American participants who were examined at baseline (2000-2004) and 2 follow-up visits. Replication of CHD-associated metabolites was sought among 1588 multiethnic participants from the Women's Health Initiative (WHI), a prospective population-based multiethnic cohort study of 161 808 postmenopausal women who were examined at baseline (1991-1995) and ongoing follow-up visits. Regression analyses were performed for each metabolite to examine the associations with incident CHD and CAC scores. Data were collected from the WHI between 1994 and 2009 and from the JHS between 2000 and 2015. All data were analyzed from November 2020 to August 2021. Plasma metabolites. Incident CHD was defined as definite or probable myocardial infarction or definite fatal CHD in both the JHS and WHI cohorts. In the JHS cohort, silent myocardial infarction between examinations (as determined by electrocardiography) and coronary revascularization were included in the incident CHD analysis. Coronary artery calcium was measured using a 16-channel computed tomographic system and reported as an Agatston score. Among 2346 African American individuals in the JHS cohort, the mean (SD) age was 56 (13) years, and 1468 individuals (62.6%) were female. Among 1588 postmenopausal women in the WHI cohort, the mean (SD) age was 67 (7) years; 217 individuals (13.7%) self-identified as African American, 1219 (76.8%) as non-Hispanic White, and 152 (9.6%) as other races or ethnicities. In the fully adjusted model including 1876 individuals, 46 of 303 targeted metabolites were associated with incident CHD (false discovery rate q <0.100). Data for 32 of the 46 metabolites were available in the WHI cohort, and 13 incident CHD-associated metabolites from the JHS cohort were replicated in the WHI cohort. A total of 1439 participants from the JHS cohort with available CAC scores received metabolomic profiling. Nine metabolites were associated with CAC scores. Minimal overlap was found between the results from the incident CHD and CAC analyses, with only 3 metabolites shared between the 2 analyses. This cohort study identified metabolites that were associated with incident CHD among African American individuals, including 13 incident CHD-associated metabolites that were replicated in a multiethnic population and 9 novel metabolites that included N-acylamides, leucine, and lipid species. These findings may help to elucidate common and distinct metabolic processes that may be associated with CHD among individuals with different self-identified race.

Genomic medicine year in review: 2021

Genomic medicine year in review: 2021

Does Protest Against Police Violence Matter? Evidence from U.S. Cities, 1990 through 2019

An underlying premise of democratic politics is that protest can be an effective form of civic engagement that shapes policy changes desired by marginalized groups. But it is not certain that this premise holds up under scrutiny. This article presents a three-part argument that protest (1) signals the salience of a movement’s focal issue and expands awareness that an issue is a social problem requiring a solution, (2) empowers residents in disadvantaged communities and raises a sense of community cohesion, which together (3) raise costs and exert pressure on elites to make concessions. The empirical analysis examines the likelihood that a city will establish a civilian review board (CRB). It then compares the effects of protest and CRB presence on counts of officer-involved fatalities by race and ethnicity. Two main hypotheses about the effect of protest are supported: cities with more protest against police brutality are significantly more likely to establish a CRB, and protest against police brutality reduces officer-involved fatalities for African American and Latino (but not for White) individuals. However, the establishment of CRBs does not reduce fatalities, as some have hoped. Nonetheless, mobilizing against police brutality matters, even in the absence of civilian review boards.

The effect of online reputation systems on intergroup inequality

Recent studies state that online reputation systems may decrease or even eliminate intergroup inequality. These studies base their conclusion on the finding that the presence of reputation information may decrease platform users’ reliance on demographic information. However, these findings tell only part of the story of the relation between reputation systems and intergroup inequality: they overlook the problem that reputation systems help those who obtained at least one review but may negatively affect those individuals who have not participated in interactions before. This study is the first to take the endogeneity of the reputation building process into account by providing a direct test of differences in inequality between individuals of different nationality between a situation with and without a reputation system. Using a preregistered online experiment, I show that inequality between American and Indian individuals is not lower when there is a reputation system than when there is no reputation system. Moreover, emergent inequality in initial rounds affects inequality in later rounds. This implies that platforms that wish to create equal opportunities for users with different backgrounds should not only try to make their reputation system more effective, but also to reduce initial differences between individuals with different backgrounds.

Growing budget deficit and national debt: estimates, problems, risks

The article analyzes the structure of the US federal budget, the main sources of revenues, expenditures (annually revised discretionary spendings, mandatory financing of the main social and a number of critical areas of government activity, interest debt payments), factors affecting their dynamics. A special place is occupied by the analysis of the national (sovereign) debt of the United States, which includes two types of debt: the government’s debt to buyers of its securities (American individuals and legal entities, the Federal Reserve System, international investors, foreign governments) and the so-called intragovernmental debt. The article raises the question of where the "red line" is when the growing debt becomes dangerous for the United States. However, the article lists factors that mitigate the sovereign debt problem for the United States. Much attention is paid to the challenges that the administration of J. Biden and the Congress of the current and future convocations will have to face. In particular, in the short term, this is the need to reduce the budget deficit, to extend a number of social programs that are about to expire, but above all to resolve the debt ceiling issues. The paradoxes of decision-making in the budget process concerning the debt ceiling are considered. The points of view of experts are presented, arguing the need for refusal and preservation of the legislative codification of the debt ceiling. In the long term, the United States will face challenges such as a growing debt burden, the need to reform the budgetary decision-making process. The Congress will have to worry about how to defuse the time bomb laid down in a number of mandatory budget programs.

Ask a Political Scientist: A Conversation with Efrén Pérez about Political Psychology and the Study of Race and Ethnic Politics

Ask a Political Scientist: A Conversation with Efrén Pérez about Political Psychology and the Study of Race and Ethnic Politics

Abstract 13194: Regional Disparities in Clinical and Socioeconomic Characteristics of African-American Patients With Cardiac Amyloidosis Served by Two Inner City Hospitals

Introduction: The highest prevalence of cardiac amyloidosis (CA) in the United States (US) is reported among African American (AA) individuals, with a significant regional variation in this prevalence. We aimed to study the clinical, demographic and socioeconomic differences among AA patients diagnosed with CA from inner city hospital located in different regions of the US. Methods: Demographic, clinical and socioeconomic data on patients diagnosed with CA was collected from Buffalo General Medical Center, Buffalo, NY (Northeast region; Erie County) and Cook County Health, Chicago, NY (Midwest region; Cook County). CA was diagnosed based on a combination of pyrophosphate scintigraphy and assessment of paraproteinemia. Socio-economic data from zip code of patient’s residence was obtained from publicly available 2010 census summary data. Results: Overall, 80 patients were tested for CA in Erie County and 150 patients in Cook County, of which 58 (72.5%) and 128 (85.3%) were AA, respectively. Among AA patients, 16 (28%) from Erie County and 29 (23%) from Cook County were diagnosed with CA (Table). Despite younger age, and a lower prevalence of male gender, CAD, hypertension and aortic stenosis, Cook County patients had more severe cardiomyopathy, given a significantly lower ejection fraction at presentation. Additionally, patients from Cook County had lower socioeconomic status as evident by a lower average income, fewer social security beneficiaries, greater unemployment and a greater prevalence of uninsured population. Conclusions: Despite similar racial background, there are significant demographic, clinical and socioeconomic differences among AA patients with CA from two different regions in the US. Within race disparities, that could be influenced by regional socioeconomic differences, may drive clinical outcomes of AA patients with CA.

An Examination of Rural and Female-Led Firms: A Resource Approach

Previous studies in entrepreneurship research indicate that external funding is critical for entrepreneurial success and that spatial funding inequities between nascent rural and non-rural firms are ever-present. Moreover, women entrepreneurs, rural or otherwise, receive fewer external resources than their male counterparts. To our knowledge there has been no research leveraging the Panel Study of Entrepreneurial Dynamics (PSED), a representative dataset of American individuals trying to create new firms, to better understand differences between rural, non-rural and female-led firms in terms of their ability to stay engaged in the entrepreneurial process and to earn a profit. Using the resource-based theory of the firm, this research will begin to examine some of the critical factors driving rural firm success and rural female-led firm success. We utilize Cox and logistic regression models to analyze the time to quit, time to profit, and the likelihood of firm survival and profit generation for these firms. Results reveal that externally monitored funds are a significant variable for rural firm success in comparison to non-rural firms and appear to be especially important for women-led nascent firms early in the firm gestation process. Future research would benefit from further exploration of funding bias, entrepreneurial motivation and personal characteristics of rural, female-rural and their non-rural counterparts. This research adds to the literature on rural entrepreneurship by using the resource based theory of the firm in conjunction with the PSED database to study the nature of firm success and firm profit for rural and female led rural firms.

Trends in COVID-19 vaccination intent and factors associated with deliberation and reluctance among adult homeless shelter residents and staff, 1 November 2020 to 28 February 2021 – King County, Washington

IntroductionLittle is known about COVID-19 vaccination intent among people experiencing homelessness. This study assesses surveyed COVID-19 vaccination intent among adult homeless shelter residents and staff and identifies factors associated with vaccine deliberation (responded “undecided”) and reluctance (responded “no”), including time trends. MethodsFrom 11/1/2020–2/28/21, we conducted repeated cross-sectional surveys at nine shelters in King County, WA as part of ongoing community-based SARS-CoV-2 surveillance. We used a multinomial model to identify characteristics associated with vaccine deliberation and reluctance. ResultsA total of 969 unique staff (n = 297) and residents (n = 672) participated and provided 3966 survey responses. Among residents, 53.7% (n = 361) were vaccine accepting, 28.1% reluctant, 17.6% deliberative, and 0.6% already vaccinated, whereas among staff 56.2% were vaccine accepting, 14.1% were reluctant, 16.5% were deliberative, and 13.1% already vaccinated at their last survey. We observed higher odds of vaccine deliberation or reluctance among Black/African American individuals, those who did not receive a seasonal influenza vaccine, and those with lower educational attainment. There was no significant trend towards vaccine acceptance. ConclusionsStrong disparities in vaccine intent based on race, education, and prior vaccine history were observed. Increased vaccine intent over the study period was not detected. An intersectional, person-centered approach to addressing health inequities by public health authorities planning vaccination campaigns in shelters is recommended.Clinical Trial Registry Number: NCT04141917.

Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status

COVID-19 has disproportionately affected racial and ethnic minority groups, and race and ethnicity have been associated with disease severity. However, the association of socioeconomic determinants with racial disparities in COVID-19 outcomes remains unclear. To evaluate the association of race and ethnicity with COVID-19 outcomes and to examine the association between race, ethnicity, COVID-19 outcomes, and socioeconomic determinants. A systematic search of PubMed, medRxiv, bioRxiv, Embase, and the World Health Organization COVID-19 databases was performed for studies published from January 1, 2020, to January 6, 2021. Studies that reported data on associations between race and ethnicity and COVID-19 positivity, disease severity, and socioeconomic status were included and screened by 2 independent reviewers. Studies that did not have a satisfactory quality score were excluded. Overall, less than 1% (0.47%) of initially identified studies met selection criteria. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Associations were assessed using adjusted and unadjusted risk ratios (RRs) and odds ratios (ORs), combined prevalence, and metaregression. Data were pooled using a random-effects model. The main measures were RRs, ORs, and combined prevalence values. A total of 4 318 929 patients from 68 studies were included in this meta-analysis. Overall, 370 933 patients (8.6%) were African American, 9082 (0.2%) were American Indian or Alaska Native, 101 793 (2.4%) were Asian American, 851 392 identified as Hispanic/Latino (19.7%), 7417 (0.2%) were Pacific Islander, 1 037 996 (24.0%) were White, and 269 040 (6.2%) identified as multiracial and another race or ethnicity. In age- and sex-adjusted analyses, African American individuals (RR, 3.54; 95% CI, 1.38-9.07; P = .008) and Hispanic individuals (RR, 4.68; 95% CI, 1.28-17.20; P = .02) were the most likely to test positive for COVID-19. Asian American individuals had the highest risk of intensive care unit admission (RR, 1.93; 95% CI, 1.60-2.34, P < .001). The area deprivation index was positively correlated with mortality rates in Asian American and Hispanic individuals (P < .001). Decreased access to clinical care was positively correlated with COVID-19 positivity in Hispanic individuals (P < .001) and African American individuals (P < .001). In this study, members of racial and ethnic minority groups had higher risks of COVID-19 positivity and disease severity. Furthermore, socioeconomic determinants were strongly associated with COVID-19 outcomes in racial and ethnic minority populations.