Chicago Residents Research Articles

Long-term exposure to ambient air pollution and measures of central hemodynamics and arterial stiffness among multiethnic Chicago residents

ObjectivesTo examine whether long-term air pollution exposure is associated with central hemodynamic and brachial artery stiffness parameters.MethodsWe assessed central hemodynamic parameters including central blood pressure, cardiac parameters, systemic vascular compliance and resistance, and brachial artery stiffness measures [including brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR)] using waveform analysis of the arterial pressure signals obtained from a standard cuff sphygmomanometer (DynaPulse2000A, San Diego, CA). The long-term exposures to particles with an aerodynamic diameter < 2.5 μm (PM2.5) and nitrogen dioxide (NO2) for the 3-year periods prior to enrollment were estimated at residential addresses using fine-scale intra-urban spatiotemporal models. Linear mixed models adjusted for potential confounders were used to examine associations between air pollution exposures and health outcomes.ResultsThe cross-sectional study included 2,387 Chicago residents (76% African Americans) enrolled in the ChicagO Multiethnic Prevention And Surveillance Study (COMPASS) during 2013–2018 with validated address information, PM2.5 or NO2, key covariates, and hemodynamics measurements. We observed long-term concentrations of PM2.5 and NO2 to be positively associated with central systolic, pulse pressure and BAR, and negatively associated with BAD, and BAC after adjusting for relevant covariates. A 1-µg/m3 increment in preceding 3-year exposures to PM2.5 was associated with 1.8 mmHg higher central systolic (95% CI: 0.98, 4.16), 1.0 mmHg higher central pulse pressure (95% CI: 0.42, 2.87), a 0.56%mmHg lower BAD (95% CI: -0.81, -0.30), and a 0.009 mL/mmHg lower BAC (95% CI: -0.01, -0.01).ConclusionThis population-based study provides evidence that long-term exposures to PM2.5 and NO2 is related to central BP and arterial stiffness parameters, especially among African Americans.

Assessing life expectancy disparities in Chicago with a deep dive into green space

BackgroundFew studies have examined the association between green space and life expectancy, and only one study has looked at that data for small areas in the United States. These studies have found a positive association between green space and life expectancy. This study investigates the association between green space and small-area life expectancy in Chicago, a city in the United States with distinct environmental and socioeconomic characteristics and the largest U.S. life expectancy gap between neighborhoods. MethodsWe conducted a spatial analysis using the green space metrics of normalized difference vegetation index (NDVI), park access, and tree canopy. Additionally, we included 18 lifestyle, environmental, and social covariates. Diagnostic analytics included multiple linear regression, Moran I test for spatial dependence, and principal component analysis with CAR Gaussian model. We performed a simulation to predict life expectancy gain if NDVI was brought to median levels. ResultsOur study revealed that after adjusting for covariates and spatial dependence (Moran I test p = 0.012) with a CAR Gaussian model, NDVI (credible interval = 0.292-0.894) demonstrated significance at a 5 % level, while tree canopy (credible interval = -0.404-0.109) and park access (credible interval = -0.258-0.161) did not. Excluding non-significant variables (tree canopy and park access) from the CAR Gaussian model, the median effect of NDVI on life expectancy was 0.491 (95 % credible interval: 0.24–0.718). Projecting this effect to tracts below the median NDVI predicted a gain of 476,000 years of life expectancy for Chicago residents. ConclusionThis study provides evidence that green space and LE are positively correlated, suggesting the potential to increase green space to address current LE gaps. Future research should investigate the mechanisms by which green space correlates to lifespan.

A Tale of Two Divvys: The Bicycle Sharing System of Chicago

How did Chicago develop one of the largest and most successful Bicycle Sharing Systems in a very short time, what benefits does this system afford to the city and its residents, and what developments threaten this success? Urban areas benefit significantly and in a variety of ways from micromobility, which contributes to an urgently needed sustainability transformation. In this qualitative, exploratory case study, we examine the foundations of the success and types of benefits of the second largest bicycle sharing system in North America, the City of Chicago’s Divvy. We juxtapose our data, which consists of participant and non-participant observations, fieldwork, interviews, documents, and social media posts, with a typology gleaned from the academic literature on bicycle sharing systems to explore Divvy’s wide-ranging positive impact. This typology includes economic, environmental, health and safety, and quality of life benefits. In addition, we identify two further benefits from our data: modularity and zoetic capacity. Despite this impact, we show how the consequences of changes in the ownership structure since 2018 are threatening the success and benefits. The emerging service model is no longer based on the initial pillars of its success: the city’s policy and vision for Divvy, the funding and ownership structure, and the strategic deployment of bicycle stations to balance demand potential with locational equity. Based on our study, we conclude that it is unlikely that the new micromobility system, refocused on more profitable e-bike and e-scooter rentals in privileged neighborhoods, is viable in the long term because it is abandoning the core values that embedded Divvy into the fabric of the city. Worse, the emergent model may actually contribute to a systematic exclusion of poorer neighborhoods and less privileged residents of Chicago.

Equity in Cancer and Chronic Disease Prevention through a Multi-Pronged Network Intervention: Works-in-Progress.

The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified health centers) to reduce the risks of cancer, chronic disease, and other conditions. In this study, we tested whether improving personal health literacy (i.e., confidence in seeking information) and enabling successful information transfer (i.e., intention to share the specific information learned through the program) among community residents could contribute to greater diffusion intention (i.e., number of network members with whom residents plan to share information and resources). The current study used post-intervention surveys, which were administered to Chicago residents who were 18 years or older and had participated in the program. Among the 1499 diverse Chicago residents, improved personal health literacy was associated with greater diffusion intention (ORs = 2.00-2.68, 95% CI [1.27-4.39], p ≤ 0.003). Successful information transfer was associated with greater diffusion, especially for cancer and other chronic disease risk reductions (ORs = 3.43-3.73, 95% CI [1.95-6.68], p < 0.001). The findings highlight the potential gains for health equity through sustainable, scalable, multi-sectoral partnerships.

COVID-19 Vaccine Policy Implementation and Differential Vaccine Uptake Trajectories in Chicago Communities.

Since the onset of the COVID-19 pandemic, multiple public health interventions have been implemented to respond to the rapidly evolving pandemic and community needs. This article describes the scope, timing, and impact of coordinated strategies for COVID-19 vaccine uptake in Chicago for the first year of vaccine distribution. Using a series of interviews with public health officials and leaders of community-based organizations (CBOs) who participated in the implementation of the citywide COVID-19 vaccine outreach initiatives, we constructed a timeline of vaccine outreach initiatives. The timeline was matched to the vaccine uptake rates to explore the impact of the vaccine outreach initiatives by community area. Finally, we discussed the nature of policy initiatives and the level of vaccine uptake in relation to community characteristics. The Chicago Department of Public Health (CDPH) implemented myriad vaccine outreach strategies, including mass vaccination sites, improved access, and community-level vaccine campaigns. Protect Chicago+ was the primary vaccine outreach effort initiated by the CDPH, which identified 15 highly vulnerable community areas. More than 2.7 million (67%) Chicagoans completed the vaccine regimen by December 2021. Black (51.3%) Chicagoans were considerably less likely to be vaccinated than Asian (77.6%), White (69.8%), and Hispanic (63.6%) Chicago residents. In addition, there were significant spatial differences in the rate of COVID-19 vaccine completion: predominantly White and Hispanic communities, compared with Black communities, had higher rates of vaccine completion. The community outreach efforts to improve COVID-19 vaccine uptake in Chicago have shown the importance of community-engaged approaches in pandemic responses. Despite citywide efforts to build community infrastructure, Black communities had relatively lower levels of vaccine uptake than other communities. Broader social restructuring to mitigate disinvestment and residential segregation and to ameliorate medical mistrust will be needed to prepare for future pandemics and disasters.

Breakthrough SARS-CoV-2 infections among recipients of tixagevimab-cilgavimab prophylaxis: A citywide real-world effectiveness study.

There are limited real-world data on the effectiveness of tixagevimab-cilgavimab as pre-exposure prophylaxis of COVID-19. We describe lessons learned when coordinating data collection and identifying breakthrough SARS-CoV-2 infections among patients across indications and institutions in a major US city. The Chicago Department of Public Health requested patient-level tixagevimab-cilgavimab administration data from all prescribing providers in Chicago, for treatments December 8, 2021 through June 30, 2022. Records were matched to COVID-19 vaccinations and laboratory-confirmed SARS-CoV-2 infections through December 31, 2022. Due to difficulty collecting data from all providers, targeted follow-up was conducted to improve completeness on key variables (demographics, vaccination status, clinical indication for prophylaxis). Over half of reported tixagevimab-cilgavimab administrations were to patients residing outside Chicago. Five hundred forty-four Chicago residents who received at least one dose of tixagevimab-cilgavimab were included in this analysis. Most were age 50 years or older (72%), Black non-Latinx (33%) or White non-Latinx (29%), and fully vaccinated (80%). Seventy-five patients (14%) had laboratory-confirmed COVID-19. Patients with and without breakthrough infections were demographically similar. Clinical indication was missing for >95% of cases, improved to 64% after follow-up; the most frequently specified was hematologic malignancy (10%). Severe outcomes were uncommon: 16% had documented COVID-19-related hospitalizations, one death was identified. Tixagevimab-cilgavimab recipients in Chicago had a lower rate of severe SARS-CoV-2 infection than reported among other untreated high-risk patients, including during predominance of non-neutralizing variants. Improving stakeholder collaboration is essential for generation of real-world effectiveness data, informing pandemic preparedness and optimizing use of medical countermeasures.

Experiences of Policing in Gentrifying Neighborhoods: Evidence From Chicago

Do patterns of unequal policing persist or transform within gentrifying neighborhoods? Using an original survey of Chicago residents, we assess whether gentrifiers and longtime residents experience policing differently. Building on macro-level studies which rely on aggregate population data and micro-level studies which rely on ethnographies and interviews, we conduct a meso-level study that compares the experiences and views of differently positioned residents. We find that the phenomenon of being “over-policed and under-protected” that characterizes race-class subjugated neighborhoods is replicated within gentrifying neighborhoods for longtime residents. Meanwhile, gentrifiers express less concern about crime and report fewer interactions with police. While the average gentrifier has low levels of police contact, we find some evidence that a subset of gentrifiers are more likely to call the police about quality-of-life issues compared to neighbors. Our methodological approach provides a blueprint for how survey research can provide insights on individual-level experiences and attitudes in gentrifying neighborhoods.

SARS-CoV-2 Reinfection Risk in Persons with HIV, Chicago, Illinois, USA, 2020-2022.

Understanding if persons with HIV (PWH) have a higher risk for SARS-CoV-2 reinfection may help tailor future COVID-19 public health guidance. To determine whether HIV infection was associated with increased risk for SARS-CoV-2 reinfection, we followed adult residents of Chicago, Illinois, USA, with SARS-CoV-2 longitudinally from their first reported infection through May 31, 2022. We matched SARS-CoV-2 laboratory data and COVID-19 vaccine administration data to Chicago's Enhanced HIV/AIDS Reporting System. Among 453,587 Chicago residents with SARS-CoV-2, a total of 5% experienced a SARS-CoV-2 reinfection, including 192/2,886 (7%) PWH and 23,642/450,701 (5%) persons without HIV. We observed higher SARS-CoV-2 reinfection incidence rates among PWH (66 [95% CI 57-77] cases/1,000 person-years) than PWOH (50 [95% CI 49-51] cases/1,000 person-years). PWH had a higher adjusted rate of SARS-CoV-2 reinfection (1.46, 95% CI 1.27-1.68) than those without HIV. PWH should follow the recommended COVID-19 vaccine schedule, including booster doses.

The Role of Health Insurance Type and Clinic Visit on Hypertension Status Among Multiethnic Chicago Residents.

To investigate the joint relationship of health insurance and clinic visit with hypertension among underserved populations. Population-based cohort study. Data from 1092 participants from the Chicago Multiethnic Prevention and Surveillance Study (COMPASS) between 2013 and 2020 were analyzed. Five health insurance types were included: uninsured, Medicaid, Medicare, private, and other. Clinic visit over past 12months were retrieved from medical records and categorized into 4 groups: no clinic visit, 1-3 visits, 4-7 visits, >7 visits. Inverse-probability weighted logistic regression was used to estimate odds ratios (OR) and 95% confidence interval (CI) for hypertension status according to health insurance and clinic visit. Models were adjusted for individual socio-demographic variables and medical history. The study population was predominantly Black (>85%) of low socioeconomic status. Health insurance was not associated with more clinic visit. Measured hypertension was more frequently found in private insurance (OR = 6.48, 95% CI: 1.92-21.85) compared to the uninsured group, while 1-3 clinic visits were associated with less prevalence (OR = .59, 95% CI: .35-1.00) compared to no clinic visit. These associations remained unchanged when health insurance and clinic visit were adjusted for each other. In this study population, private insurance was associated with higher measured hypertension prevalence compared to no insurance. The associations of health insurance and clinic visit were independent of each other.

Financial, Social, and Health Impacts from the COVID-19 Pandemic: Findings from the Healthy Chicago Survey.

This study examines self-reported impacts of the COVID-19 pandemic among Chicago residents and disparities of these impacts across demographic characteristics. Six logistic regression models were developed to identify demographic and socioeconomic factors associated with each COVID-19 impact. The study used de-identified and weighted data from the 2020 Healthy Chicago Survey (HCS). HCS is an annual survey using an address-based random sampling method administered by the Chicago Department of Public Health (CDPH) across the city of Chicago on adults aged 18 or older living between July 17 and November 11, 2020, and received 4517 responses. Chicago residents with lower socioeconomic status had a higher likelihood of food and housing insecurity. Non-Hispanic (NH) Black residents were more likely to report being unable to obtain food (OR: 2.996; 95% CI: 2.268-2.324); being unable to pay for rent, mortgage, or bills (OR: 2.352; 95% CI: 2.325-2.380); and grief from a loss of someone to COVID-19 (OR: 2.037; 95% CI: 2.013-2.061) compared to NH White residents. NH White residents were more likely than other racial/ethnic groups to report loss of social connections, worsened mental health, and canceling or postponing medical care. The analysis showed higher odds of social contact loss and worsened mental health from COVID-19 in NH White and higher education populations. By implementing strategies to address specific challenges faced by different racial groups, Chicago may effectively mitigate pandemic's adverse effects. These strategies can promote a more inclusive approach to distributing COVID investments for programs and policies.

Examining the Relationship between Anti-Black Racism, Community and Police Violence, and COVID-19 Vaccination

In 2020, the COVID-19 pandemic emerged against a backdrop of long-standing racial inequities that contributed to significant disparities in COVID-19 mortality, morbidity, and eventually, vaccination rates. COVID-19 also converged with two social crises: anti-Black racism and community and police violence. The goal of this study was to examine the associations between community violence, police violence, anti-Black racism, and COVID-19 vaccination. Survey data were collected from a sample of 538 Black residents of Chicago between September 2021 and March 2022. Structural equation modeling was used to test associations between neighborhood violence, police violence, racism, medical mistrust, trust in COVID-related information, depressive symptoms, and having received a COVID-19 vaccination. In line with predictions, neighborhood violence had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor. Additionally, racism had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor, as well as via medical mistrust and trust in COVID-related information from a personal doctor. These findings add to the growing body of literature demonstrating the importance of medical mistrust when examining COVID-19 vaccination disparities. Furthermore, this study highlights the importance of considering how social and structural factors such as violence and racism can influence medical mistrust.

The Influence of Racism in Healthcare: COVID-19 Vaccine Hesitancy Among Black Mothers in Chicago.

Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.

Nature's path to thinking about others and the surrounding environment

Research has shown differences in pro-social and pro-environmental attitudes after exposure to different physical environments. It is unclear whether these perspective shifts are associated with changes in conscious thoughts and feelings about other people and the environment. In Study 1, we used a within-subject experiment to measure social and environmental thought content throughout 1-h environmental explorations of a nature conservatory and an indoor mall. At three survey time points, participants (N = 86, undergraduates and community members) reported whom they were thinking about and how connected they felt to the physical and social environment. Using Bayesian multi-level models, we found that while visiting the conservatory, participants were less likely to think about themselves, felt closer to people nearby and around the world, and felt higher connectedness to their social and physical environment. In Study 2, we used a correlational design to investigate the association between perceived naturalness of city parks and feelings of connection to nearby others and the physical environment while visiting. Participants (N = 303, Chicago residents) reported feeling higher levels of connection to nearby people and the physical environment when they were visiting city parks rated as more natural. These studies further our understanding of the ways in which natural environments influence conscious thoughts and feelings about the social and physical environment.

The Gradual and Immediate Violence of an Engineered Conflict: School Closings, Public Housing, Law Enforcement, and the Future of Black Life in Chicago

Background/Context: This article considers violence, both structurally and interpersonally, in Chicago, a city that moves to isolate and contain many of its Black working-class/low-income/no-income residents. Violence (particularly death by gun violence) should never be understood as a singular social problem that requires unilateral decisions on how to address the issue. Instead, it is critical to understand that homicides and other forms of violence are often the outcomes of conflict exacerbated by planned scarcity and abandonment (engineered conflict). In short, we should consider these conflicts as largely engineered by the state, declaring some Chicago residents to be of value along the lines of race, class, gender, age, (dis)ability, and sexual orientation, while others are deemed disposable. Purpose/Objective/Research Question/Focus of Study: Instead of the deficit narrative of crazed, pathological criminals roaming the streets, another conversation pushes us to understand violence beyond the acts that result in bodily harm or death, and begin to consider the structural conditions that increase the chances of a violent act taking place. For these reasons, this article contemplates the following questions: What pushes people to be in conflict with each other while remaining reluctant to strike back at the system that has largely engineered the conditions of marginalization, isolation, and containment? More important, for those who have decided to resist, what are they doing to address the situation while building new realities for themselves and the people they care about? Research Design: The design of the study is qualitative, utilizing archival and current data on school closings, the destruction of public housing, and law enforcement. Utilizing conceptual design, the study positions engineered conflict as a material and ideological process with the goal of rendering certain Black communities in Chicago disposable. Conclusions/Recommendations: Instead of ending with the adage that “there’s nothing we can do about it,” we should understand that people who find state-sanctioned violence to be unacceptable are operating in ways that are proactive and compelling. Local organizations throughout the city have created their own unique processes in developing strategies to address affordable housing, quality education, and public safety. Their consideration of fugitive possibilities (strategies that are not based in commonplace policy solutions offered by the state) and actions is critical in a city that attempts to enforce a logic of disposability on their humanity.

COVID-Related Stressors and Psychological Distress Among Chicago Residents: the Moderating Role of Race.

Racial and ethnic minorities have been disproportionately affected by the COVID-19 pandemic and have experienced greater financial loss, housing instability, and food insecurity due to COVID-related restrictions. As a result, Black and Hispanic communities may be at greater risk of experiencing psychological distress (PD). Using data collected between October 2020 and January 2021from 906 Black (39%), White (50%), and Hispanic (11%) adults, we assessed racial/ethnic differences in the effect of three COVID-related stressors-employment stress, housing instability, and food insecurity-on PD using ordinary least square regression. Black adults reported lower PD levels compared to White adults (β = - 0.23, P < 0.001), but Hispanic adults did not differ significantly from White adults. COVID-related housing instability (β = 0.46, P < 0.001), food insecurity (β =0.27, P < 0.001), and employment stress (β = 0.29, P < 0.001) were associated with higher PD. Employment stress was the only stressor to differentially affect PD by race/ethnicity. Among those that reported employment stress, Black adults had lower levels of distress compared to Whites (β = - 0.54, P < 0.001) and Hispanics (β = - 0.04, P = 0.85). Despite relatively high exposure to COVID-related stressors, Black respondents had lower levels of PD compared to Whites and Hispanics which may reflect differences in race-specific coping mechanisms. Future research is needed to elucidate the nuances of these relationships and identify policies and interventions that prevent and minimize the impact of employment, food, and housing-related stressors and support coping mechanisms that promote mental health among minority populations, such as policies that support easier access to mental health and financial and housing assistance.

Trends in assault-related hospitalizations during the SARS-CoV-2 pandemic

IntroductionViolence remains a priority issue in the United States (US) requiring public health input to discern the magnitude and impact of violence on the health system. Concerns over violence and the injuries resulting from violence have increased following the SARS-CoV-2 pandemic which exacerbated an array of individual and economic stressors related to violence including increased unemployment, alcohol intake, social isolation, anxiety and panic and decreased access to health services. The aim of this study was to analyze the trends in violence-related injuries in the state of Illinois during the SARS-CoV-2 lockdown periods and post-lockdown in order to inform future public health policy. Material and methodsOutpatient and inpatient assault related injuries treated in Illinois hospitals from 2016 through March 2022 were analyzed. Segmented regression models evaluating change in time trends were adjusted for seasonality, serial correlation, overall trend and economic variables. ResultsThe annual rate of assault related hospitalizations per one million Illinois residents decreased from 3857.8 pre-pandemic to 3458.7 pandemic period. However, during the pandemic there was an increase in deaths and in the proportion of injuries involving open wounds, internal injuries, and fractures, while there was a reduction in less serious injuries. Segmented regression time series models demonstrated significant increase in firearm violence in all four pandemic periods examined. Firearm violence increased particularly in subgroups including African-American victims, 15–34-year-olds, and Chicago residents. ConclusionDuring SARS-CoV-2, we saw an overall reduction in assault related hospitalization, however, findings demonstrated an increase in serious injuries which may be associated with social and economic stressors of the pandemic, increased gun-violence while decrease in less serious injuries may be linked to hospital avoidance for non-lethal injuries during the peak waves of the pandemic. Our findings have implications for ongoing surveillance, service planning and management of the increased gunshot and penetrating assault cases and further demonstrate the need for public health input into the violence epidemic in the US.

The COVID-19, racism, and violence syndemic: Evidence from a qualitative study with Black residents of Chicago

The COVID-19 pandemic emerged in the United States in the shadows of a vast history of structural racism and community and police violence that disproportionately affect Black communities. Collectively, they have created a syndemic, wherein COVID-19, racism, and violence are mutually reinforcing to produce adverse health outcomes. The purpose of this study was to understand the COVID-19, racism, and violence syndemic and examine how structural racism and violence contributed to the disproportionate impact of COVID-19 on Black communities. In early 2021, we conducted phenomenological qualitative interviews with 50 Black residents of Chicago. Interview transcripts were coded and analyzed using thematic analysis. We identified four primary themes in our analyses: 1) the intersection of racism and violence in Chicago; 2) longstanding inequities were laid bare by COVID-19; 3) the pervasiveness of racism and violence contributes to poor mental health; 4) and COVID-19, racism and violence emerged as a syndemic. Our findings underscore the importance of addressing social and structural factors in remediating the health and social consequences brought about by COVID-19.

248. Change in Incidence of Multisystem Inflammatory Syndrome in Children Across the COVID-19 Pandemic in Chicago — March 2020 – March 2022

Abstract Background Peak counts of multisystem inflammatory syndrome in children (MIS-C) have followed each COVID-19 peak by 2–5 weeks. Fewer cases of MIS-C occurred after the Delta-predominant period compared to early waves of the pandemic. The Chicago Department of Public Health analyzed the ratio of MIS-C to pediatric COVID-19 hospitalization by period of variant predominance from March 2020 – mid-March 2022 to evaluate differences by variant. Methods MIS-C in Chicago residents was reported using the standard CDC MIS-C case report form. Four periods of COVID-19 infection were identified with dates defined by variant predominance (≥50%); date ranges for corresponding MIS-C periods were defined as starting 21 days after the COVID-19 period (Table 1). MIS-C cases were compared to hospitalizations as a measure of COVID-19 disease activity in children (rather than case counts which are more subject biases inherent in disease testing) among confirmed and probable COVID-19 cases in children ≤21 years reported to CDPH. Ratios of MIS-C cases per 100 corresponding pediatric hospitalizations for each variant period were calculated. Proportions of MIS-C hospitalizations with intensive care unit (ICU) admission, mechanical ventilation (MV), and receipt of vasopressors (VP) were calculated as markers of disease severity in MIS-C for each wave. Results 90 cases of MIS-C and 1,597 pediatric COVID-19 hospitalizations were reported (Table 2). The overall ratio was 5.6 MIS-C cases/100 pediatric COVID-19 hospitalizations. The first period with predominance of the original lineage had a ratio of 10.2; subsequent periods with variant predominance all had lower ratios. The Delta period had the second highest ratio which was 68% of the first period. Across waves, 74% of MIS-C patients were admitted to ICU (range, 67–82%); 11% underwent MV (range, 0–14%); and 52% received VP (range, 45–71%). Conclusion The ratio of MIS-C to pediatric COVID-19 hospitalizations varied by period of SARS-CoV-2 variant predominance. The ratio was highest in the early pandemic. There was no consistent change in MIS-C severity. Further study is needed to determine if the change in ratio is due to increased immunologic exposure (vaccination or previous infection) or if it is variant dependent. Disclosures All Authors: No reported disclosures.

Vanilla Nightmares and Urban Legends: The Racial Politics of Candyman (1992)

Candyman (dir. Bernard Rose, 1992) is considered one of the best horror-noire films of the 1990s. Certainly it’s one of the smartest. Adapted from Clive Barker’s short story “The Forbidden,” Candyman traces two intertwining plotlines. One has to do with miscegenation and a haunting, haunted love affair. A nineteenth-century white woman fell in love with the black artist hired to paint her portrait; when she became pregnant her family exacted a horrific revenge—against the artist, of course. His ghost haunts the present. The other story has to do with urban “renewal,” the creation of Cabrini-Green, urban drug violence, and the difficulties confronting contemporary black residents of Chicago. The way these two stories come together, intermingle, and ultimately re-segregate is part of what I want to explore in this essay. I am interested in the irreducible and unresolvable conflict between the film’s two diegetic strands and the different knowledges they represent. I’m also interested in what they have to tell us about the racist history that haunts this country, that will not be laid to rest until some kind of justice is exacted, and that continually calls into question everything we think we know.

Association of Zip Code Vaccination Rate With COVID-19 Mortality in Chicago, Illinois

There has been large geographic inequity in vaccination coverage across Chicago, Illinois, with higher vaccination rates in zip codes with residents who predominantly have high incomes and are White. To determine the association between inequitable zip code-level vaccination coverage and COVID-19 mortality in Chicago. This retrospective cohort study used Chicago Department of Public Health vaccination and mortality data and Cook County Medical Examiner mortality data from March 1, 2020, through November 6, 2021, to assess the association of COVID-19 mortality with zip code-level vaccination rates. Data were analyzed from June 1, 2021, to April 13, 2022. Zip code-level first-dose vaccination rates before the Alpha and Delta waves of COVID-19. The primary outcome was deaths from COVID-19 during the Alpha and Delta waves. The association of a marginal increase in zip code-level vaccination rate with weekly mortality rates was estimated with a mixed-effects Poisson regression model, and the total number of preventable deaths in the least vaccinated quartile of zip codes was estimated with a linear difference-in-difference design. The study population was 2 686 355 Chicago residents in 52 zip codes (median [IQR] age 34 [32-38] years; 1 378 658 [51%] women; 773 938 Hispanic residents [29%]; 783 916 non-Hispanic Black residents [29%]; 894 555 non-Hispanic White residents [33%]). Among residents in the least vaccinated quartile, 80% were non-Hispanic Black, compared with 8% of residents identifying as non-Hispanic Black in the most vaccinated quartile (P < .001). After controlling for age distribution and recovery from COVID-19, a 10-percentage point increase in zip code-level vaccination 6 weeks before the peak of the Alpha wave was associated with a 39% lower relative risk of death from COVID-19 (incidence rate ratio [IRR], 0.61 [95% CI, 0.52-0.72]). A 10-percentage point increase in zip code vaccination rate 6 weeks before the peak of the Delta wave was associated with a 24% lower relative risk of death (IRR, 0.76 [95% CI, 0.66-0.87]). The difference-in-difference estimate was that 119 Alpha wave deaths (72% [95% CI, 63%-81%]) and 108 Delta wave deaths (75% [95% CI, 66%-84%]) might have been prevented in the least vaccinated quartile of zip codes if it had had the vaccination coverage of the most vaccinated quartile. These findings suggest that low zip code-level vaccination rates in Chicago were associated with more deaths during the Alpha and Delta waves of COVID-19 and that inequitable vaccination coverage exacerbated existing racial and ethnic disparities in COVID-19 deaths.