Disparities In COVID-19 Outcomes Research Articles

Prior COVID-19 Diagnosis, Severe Outcomes, and Long COVID among U.S. Adults, 2022.

Given the increase in COVID-19 emergency department visits and hospitalizations during the winter of 2023-2024, identifying groups that have a high prevalence of COVID-19 cases, severity, and long-term symptoms can help increase efforts toward reducing disparities and prevent severe COVID-19 outcomes. Using data from the 2022 National Health Interview Survey (n = 27,651), we assessed the prevalence of COVID-19 outcomes (prior diagnosis, moderate/severe COVID-19, and long COVID) by sociodemographic characteristics and factors associated with each COVID-19 outcome. Approximately one third of adults reported a prior COVID-19 diagnosis (30.7%), while one half (51.6%) who had COVID-19 reported moderate or severe symptoms, and one fifth (19.7%) who had COVID-19 symptoms reported long COVID. The following were associated with higher odds of moderate/severe COVID-19 and long COVID: havinga high-risk condition (aOR = 1.20, OR = 1.52); having anxiety or depression (OR = 1.46, OR = 1.49); having a disability (OR = 1.41, OR = 1.60); and having a food insecurity (OR = 1.37, OR = 1.50) compared to a lack of these conditions. Having two or more COVID-19 vaccinations was associated with lower odds of a COVID-19 diagnosis (OR = 0.75), moderate/severe COVID-19 (OR = 0.86), and long COVID (OR = 0.82). Improving vaccination coverage and reducing disparities in COVID-19 outcomes could advance health equities and protect against future resurgence of disease.

1364-P: Racial and Ethnic Disparities in COVID-19 Outcomes among Dialysis Patients with Diabetes

1364-P: Racial and Ethnic Disparities in COVID-19 Outcomes among Dialysis Patients with Diabetes

COVID-19 Diagnosis, Severity, and Long COVID Among U.S. Adolescents, National Health Interview Survey, 2022.

Understanding disparities in COVID-19 outcomes, overall and stratified by vaccination status, is important for developing targeted strategies to increase vaccination coverage and protect adolescents from COVID-19. The 2022 National Health Interview Survey (NHIS) is a cross-sectional nationally representative household survey of U.S. adults. A probability sample of households in the U.S. One child aged 12-17years is randomly selected from each family in the household. A knowledgeable adult (eg, parent or guardian), responds on behalf of the child through an in-person interview (response rate = 49.9%). Input measures-sociodemographic characteristics and COVID-19 vaccination status; output measures-ever had COVID-19, moderate/severe COVID-19, long COVID. Prevalence of COVID-19 outcomes was assessed for adolescents aged 12-17years. Factors associated with each COVID-19 outcome were assessed with multivariable logistic regression analyses. Among 2758 adolescents aged 12-17years in 2022, 60.5% had received ≥1 dose of COVID-19 vaccine, 30.2% had ever been diagnosed by a doctor that they had COVID-19, 29.5% had moderate/severe COVID-19, and 6.2% had long COVID. Adolescents who were vaccinated with ≥1 dose were less likely to be diagnosed with COVID-19 (aOR = .79) and less likely to have long COVID (aOR = .30). Targeted messaging to highlight the importance of early treatment, the harms of long COVID-19, and the benefits of vaccination in protecting against long-term effects may be necessary to ensure that all adolescents and their families are adequately protected.

Sex-specific disparities in COVID-19 outcomes.

Sex-specific disparities in morbidity and mortality of COVID-19 illness are not well understood. Neutralizing antibodies (Ab) may protect against severe COVID-19 illness. We investigated the association of sex with disease progression and SARS-CoV-2 Ab response. In this exploratory analysis of the phase 3, multicenter, randomized, placebo-controlled Convalescent Plasma in Outpatients (C3PO) trial, we examined whether sex was associated with progression to severe illness, defined as a composite of all-cause hospitalization, emergency/urgent care visit, or death within 15 days from study enrollment. Patients had a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test, symptom onset within 7 days, stable condition for emergency department discharge, and were either ≥50 years old or had at least one high-risk feature for disease progression. Patients received blinded convalescent plasma or placebo in a 1:1 fashion and were evaluated on days 15 and 30 after infusion. Blood samples were collected on day 0 (pre-/post-infusion), 15, and 30 to measure Ab levels with the Broad Institute using the Plaque Reduction Neutralization Test assay. Of 511 patients enrolled (median age 54 [Iinterquartile range 41-62] years, 46% male, 66% white, 20% black, 3.5% Asian), disease progression occurred in 36.7% of males and 25.9% of females (unadjusted risk difference 10.8%, 95% confidence interval [CI], 2.8-18.8%). Sex-disparities did not persist when adjusted for treatment group, age, viremic status, symptom onset, and tobacco use (adjusted risk difference 5.6%, 95% confidence interval [CI], -2.2% to 13.4%), but were present in the subgroup presenting 3 or more days after symptom onset (adjusted risk difference 12.6%, 95% CI, 3.4% to 21.9%). Mean baseline Ab levels (log scale) available for 367 patients were similar between sexes (difference 0.19 log units, 95% CI, -0.08 to 0.46). The log-scale mean increase from baseline to day 15 after adjusting for treatment assignment and baseline levels was larger in males than females (3.26vs. 2.67). A similar difference was noted when the groups were subdivided by outcome. Progression of COVID-19 was similar in males and females when adjusted for age, tobacco use, and viremia status in this study. However, in the cohort presenting 3 or more days after symptom onset, COVID-19 outcomes were worse in males than females. Neutralizing Ab levels increased more in males but did not correlate with sex differences in outcomes.

The Association Between Black vs. White Race and 30-Day Hospitalization Among People Diagnosed with COVID-19 Within an Integrated Care Setting: a Cohort Study.

Black Americans are more likely to experience hospitalization from COVID-19 compared with White Americans. Whether this excess risk differs by age, sex, obesity, or diabetes, key risk factors for COVID hospitalization, among an integrated population with uniform healthcare access, are less clear. We identified all adult members (≥ 18years) of Kaiser Permanente Georgia (KPGA) diagnosed with COVID-19 between January 1, 2020, and September 30, 2021 (N = 24,564). We restricted the analysis to members of Black or White race identified from electronic medical records. Our primary outcome was first hospitalization within 30days of COVID-19 diagnosis. To assess the association between race and 30-day hospitalization, we performed multivariable logistic regression adjusting for several member and neighborhood-level characteristics, and tested for interactions of race with age, sex, diabetes, and obesity. A regression-based decomposition method was then used to estimate how much of the observed race disparity in 30-day hospitalization could be explained by member and neighborhood-level factors. Overall, 11.27% of Black KPGA members were hospitalized within 30days of a COVID diagnosis, as compared with 9.44% of White KPGA members. Black (vs. White) KPGA members had a 34% (aOR: 1.32 [95% CI: 1.19-1.47]) higher odds of 30-day hospitalization following COVID-19 after accounting for clinical differences. The odds of 30-day hospitalization in Black vs. White KPGA members did not differ significantly by sex (men: 1.46 [1.25-1.70]; women: 1.24 [1.07-1.43]), by age (18-29years: 1.33 [0. 841-2.10]; 30-49years: 1.26 [1.02-1.56]; ≥ 50years: 1.24 [1.10-1.41]); by diabetes status (with diabetes: 1.38 [1.16-1.66]; without diabetes: 1.26 [1.11-1.44]), or by obesity (with obesity: 1.31 [1.15-1.50]; without obesity: 1.28 [1.06-1.53]). Factors that, if Black and White KPGA members had the same level of exposure, would be most likely to reduce the Black-White disparity in 30-day hospitalization from COVID-19 were obesity, history of flu vaccine, and neighborhood-level income and social vulnerability. Early in the pandemic, Black (vs. White) members of an integrated health system had higher odds of being hospitalized within 30days of COVID-19 diagnosis and this excess risk was similar by sex, age, and comorbidities. Factors that explained the largest proportions of race-based disparities were obesity, receipt of flu vaccine, and neighborhood-level social determinants of health. These findings suggest that social determinants of health, or other unmeasured factors, may be drivers of racial disparities in COVID-19 outcomes.

SCD and COVID-19 Vaccines: What Do Pediatric Patients Want to Know?

Introduction: Recent polls reported that only 49% of adults plan to receive a COVID-19 vaccine, while 31% reported being uncertain and 20% reporting they would not receive a vaccine citing safety as a major concern. There are disparities related to intention to receive a vaccine with 56% of whites, 25% of Blacks, and 37% of Hispanics citing they would receive a vaccine. Individuals living with sickle cell disease (SCD) were noted to be an at-risk population for higher morbidity and mortality with COVID-19 infection. Health disparities in COVID-19 outcomes could become exacerbated if racial and ethnic minorities like those with sickle cell disease (SCD) are less likely to receive a vaccine. While polls provide insight into the public's intention to receive COVID-19 vaccines, most of them include only adults. Further, there are limited empirical data on what influences people's intent to get vaccinated. Thus, there is a need to examine educational needs and preferences with respect to COVID-19 vaccines among adolescents and young adults with SCD and caregivers of children with SCD. This research is significant because it is essential to developing targeted educational interventions to promote COVID-19 vaccine uptake in pediatric patients with SCD. Methods: We conducted N=17 qualitative interviews with parents/caregivers (N=6), young adults 18 years and older (n=8), and adolescents ages 12-17 years (n=3) receiving care at one of two sickle cell centers in the US. After achieving thematic saturation, a directed content analysis approach was used to code interview data into themes related to four categories: a) COVID-19 vaccine concerns; b) key influencers for decision-making about COVID-19 vaccines; c) sources of trustworthy COVID-19 vaccine information; and d) preferred methods of receiving COVID-19 vaccine information. Two authors independently coded all the transcripts (AL, CM), and a third author served as a reliability coder. To promote rigor, interrater reliability was assessed (>90%) and themes were reviewed with clinical staff and patients (member checking). Results: Participants' top COVID-19 vaccine concerns were side effects and that they are understudied in sickle cell disease. Key influences for getting the vaccine included healthcare provider recommendation, a desire to increase protection and decrease worry, and the ability to return to normal activities. Sources of trustworthy information included the healthcare team, reputable websites (e.g., CDC) and personal recommendations. Preferred methods were talking directly with and asking follow-up questions to their hematology team and vaccine experts. Least preferred methods included the media and conducting one's own research which some found overwhelming. Using an iterative design process, themes were then converted into educational interventions which will be featured in this poster (e.g., patient vaccine question cards, expert videos, and provider scripts). Conclusions: Study results support that educational efforts about COVID-19 vaccines for pediatric patients with SCD should involve the hematology team who is viewed as a trustworthy source of information. Given vaccine concerns, teams may benefit from tools that help them foster conversations about vaccine protection and specific data about SCD and the vaccines. Results further indicate that clear and concise information about COVID-19 vaccines presented in a variety of formats (e.g., expert videos, websites) may be beneficial.

COVID-19, Housing, and Environmental Injustice

In the United States, there has been a long history of environmental injustice that disproportionately affects racial and ethnic minorities and low-income communities due to racially targeted policies and widespread discrimination. Environmental racism can be revealed in housing discrimination that perpetuates inequities in exposure to environmental pollutants. Biased credit and mortgaging practices such as redlining have led to housing segregation of racial and ethnic minorities in the USA, permitting policymakers to diminish and disinvest in these communities. The COVID-19 pandemic has amplified housing instability for families of color, including Black and Hispanic/Latinx communities, putting them at increased risk for COVID-19 exposure. There is a need to investigate how environmental injustice intensifies the COVID-19 pandemic, illuminates racial and ethnic inequities in exposure to environmental contaminants, and fuels disparities in COVID-19 outcomes. The aims of this paper are to analyze and discuss environmental injustice and racial and ethnic disparities related to COVID-19 and housing. We also propose recommendations to address this pervasive issue.

Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic.

Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs). To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout. A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022. Frontline HCWs at an urban tertiary care hospital in New York City. Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout. Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001). Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.

Quantifying association and disparities between diabetes complications and COVID-19 outcomes: A retrospective study using electronic health records.

Despite established relationships between diabetic status and an increased risk for COVID-19 severe outcomes, there is a limited number of studies examining the relationships between diabetes complications and COVID-19-related risks. We use the Adapted Diabetes Complications Severity Index to define seven diabetes complications. We aim to understand the risk for COVID-19 infection, hospitalization, mortality, and longer length of stay of diabetes patients with complications. We perform a retrospective case-control study using Electronic Health Records (EHRs) to measure differences in the risks for COVID-19 severe outcomes amongst those with diabetes complications. Using multiple logistic regression, we calculate adjusted odds ratios (OR) for COVID-19 infection, hospitalization, and in-hospital mortality of the case group (patients with diabetes complications) compared to a control group (patients without diabetes). We also calculate adjusted mean difference in length of stay between the case and control groups using multiple linear regression. Adjusting demographics and comorbidities, diabetes patients with renal complications have the highest odds for COVID-19 infection (OR = 1.85, 95% CI = [1.71, 1.99]) while those with metabolic complications have the highest odds for COVID-19 hospitalization (OR = 5.58, 95% CI = [3.54, 8.77]) and in-hospital mortality (OR = 2.41, 95% CI = [1.35, 4.31]). The adjusted mean difference (MD) of hospital length-of-stay for diabetes patients, especially those with cardiovascular (MD = 0.94, 95% CI = [0.17, 1.71]) or peripheral vascular (MD = 1.72, 95% CI = [0.84, 2.60]) complications, is significantly higher than non-diabetes patients. African American patients have higher odds for COVID-19 infection (OR = 1.79, 95% CI = [1.66, 1.92]) and hospitalization (OR = 1.62, 95% CI = [1.39, 1.90]) than White patients in the general diabetes population. However, White diabetes patients have higher odds for COVID-19 in-hospital mortality. Hispanic patients have higher odds for COVID-19 infection (OR = 2.86, 95% CI = [2.42, 3.38]) and shorter mean length of hospital stay than non-Hispanic patients in the general diabetes population. Although there is no significant difference in the odds for COVID-19 hospitalization and in-hospital mortality between Hispanic and non-Hispanic patients in the general diabetes population, Hispanic patients have higher odds for COVID-19 hospitalization (OR = 1.83, 95% CI = [1.16, 2.89]) and in-hospital mortality (OR = 3.69, 95% CI = [1.18, 11.50]) in the diabetes population with no complications. The presence of diabetes complications increases the risks of COVID-19 infection, hospitalization, and worse health outcomes with respect to in-hospital mortality and longer hospital length of stay. We show the presence of health disparities in COVID-19 outcomes across demographic groups in our diabetes population. One such disparity is that African American and Hispanic diabetes patients have higher odds of COVID-19 infection than White and Non-Hispanic diabetes patients, respectively. Furthermore, Hispanic patients might have less access to the hospital care compared to non-Hispanic patients when longer hospitalizations are needed due to their diabetes complications. Finally, diabetes complications, which are generally associated with worse COVID-19 outcomes, might be predominantly determining the COVID-19 severity in those infected patients resulting in less demographic differences in COVID-19 hospitalization and in-hospital mortality.

Ethnic disparities in COVID-19 outcomes: a multinational cohort study of 20 million individuals from England and Canada

BackgroundHeterogeneous studies have demonstrated ethnic inequalities in the risk of SARS-CoV-2 infection and adverse COVID-19 outcomes. This study evaluates the association between ethnicity and COVID-19 outcomes in two large population-based cohorts from England and Canada and investigates potential explanatory factors for ethnic patterning of severe outcomes.MethodsWe identified adults aged 18 to 99 years in the QResearch primary care (England) and Ontario (Canada) healthcare administrative population-based datasets (start of follow-up: 24th and 25th Jan 2020 in England and Canada, respectively; end of follow-up: 31st Oct and 30th Sept 2020, respectively). We harmonised the definitions and the design of two cohorts to investigate associations between ethnicity and COVID-19-related death, hospitalisation, and intensive care (ICU) admission, adjusted for confounders, and combined the estimates obtained from survival analyses. We calculated the ‘percentage of excess risk mediated’ by these risk factors in the QResearch cohort.ResultsThere were 9.83 million adults in the QResearch cohort (11,597 deaths; 21,917 hospitalisations; 2932 ICU admissions) and 10.27 million adults in the Ontario cohort (951 deaths; 5132 hospitalisations; 1191 ICU admissions). Compared to the general population, pooled random-effects estimates showed that South Asian ethnicity was associated with an increased risk of COVID-19 death (hazard ratio: 1.63, 95% CI: 1.09-2.44), hospitalisation (1.53; 1.32-1.76), and ICU admission (1.67; 1.23-2.28). Associations with ethnic groups were consistent across levels of deprivation. In QResearch, sociodemographic, lifestyle, and clinical factors accounted for 42.9% (South Asian) and 39.4% (Black) of the excess risk of COVID-19 death.ConclusionInternational population-level analyses demonstrate clear ethnic inequalities in COVID-19 risks. Policymakers should be cognisant of the increased risks in some ethnic populations and design equitable health policy as the pandemic continues.

A Community-Engaged Social Marketing Campaign to Promote Equitable Access to COVID-19 Services Among Latino Immigrants.

To address disparities in COVID-19 outcomes among Latinos with limited English proficiency in Maryland, our team developed a culturally congruent intervention that coupled a statewide social marketing campaign with community-based COVID-19 services. In the first year, we reached 305 122 people through social media advertisements and had 9607 visitors to the Web site. Social marketing campaigns represent an opportunity to promote COVID-19 testing and vaccine uptake among Latino populations, especially when they are paired with community services that simultaneously address structural barriers to care. (Am J Public Health. 2023;113(3):263-266. https://doi.org/10.2105/10.2105/AJPH.2022.307191).

Spatial-temporal differences of COVID-19 vaccinations in the U.S.

Although the disparities in COVID-19 outcomes have been proved, they have not been explicitly associated with COVID-19 full vaccinations. This paper examines the spatial and temporal patterns of the county-level COVID-19 case rates, fatality rates, and full vaccination rates in the United States from December 24, 2020 through September 30, 2021. Statistical and geospatial analyses show clear temporal and spatial patterns of the progression of COVID-19 outcomes and vaccinations. In the relationship between two time series, the fatality rates series was positively related to past lags of the case rates series. At the same time, case rates series and fatality rates series were negatively related to past lags of the full vaccination rates series. The lag level varies across urban and rural areas. The results of partial correlation, ordinary least squares (OLS) and Geographically Weighted Regression (GWR) also confirmed that the existing COVID-19 infections and different sets of socioeconomic, healthcare access, health conditions, and environmental characteristics were independently associated with COVID-19 vaccinations over time and space. These results empirically identify the geographic health disparities with COVID-19 vaccinations and outcomes and provide the evidentiary basis for targeting pandemic recovery and public health mitigation actions.

Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample.

COVID-19 has brought the disparities in health outcomes for patients to the forefront. Racial and gender identity are associated with prevalent healthcare disparities. In this study, we examine the health disparities in COVID-19 hospitalization outcome from the intersectional lens of racial and gender identity. The Agency for Healthcare Research and Quality (AHRQ) 2020 NIS dataset for hospitalizations from 1 January 2020 to 31 December 2020 was analyzed for primary outcome of in-patient mortality and secondary outcomes of intubation, acute kidney injury (AKI), AKI requiring hemodialysis (HD), cardiac arrest, stroke, and vasopressor use. A multivariate regression model was used to identify associations. A p value of &lt;0.05 was considered significant. Men had higher rates of adverse outcomes. Native American men had the highest risk of in-hospital mortality (aOR 2.0, CI 1.7-2.4) and intubation (aOR 1.8, CI 1.5-2.1), Black men had highest risk of AKI (aOR 2.0, CI 1.9-2.0). Stroke risk was highest in Asian/Pacific Islander women (aOR 1.5, p = 0.001). We note that the intersection of gender and racial identities has a significant impact on outcomes of patients hospitalized for COVID-19 in the United States with Black, Indigenous, and people of color (BIPOC) men have higher risks of adverse outcomes.

An Equity Response to COVID-19 in Allegheny County, Pennsylvania: The Development and Work of the Black Equity Coalition.

From the onset of the pandemic in the United States, racial disparities in COVID-19 outcomes have been evident. In April 2020, several events prompted a concerned group of colleagues to form the Black Equity Coalition (BEC), a Black-led coalition in Allegheny County, Pennsylvania, which brings together professionals from multiple sectors who aim to ensure an equitable response to the COVID-19 pandemic. Several significant milestones have been achieved, and this article describes the development, functioning, and outcomes of the Coalition in the first 15 months of operation (April 2020-June 2021). COVID-19 was the reason for such an unprecedented effort, but this BEC infrastructure will be needed long after COVID-19 is controlled. In addition to short-term activities and reactive measures to prevent and mitigate COVID-19 in Black populations, the BEC is serving as a crucial link between government, health care stakeholders, and communities to produce long-term systemic change.

The influence of COVID-19 messaging on immunization and other outcomes

The CDC reported COVID-19 disparities in outcomes between rural and urban areas. These may be related to differences in perceived severity of disease subsequent to discrepant public messaging. This study assessed the impact of different COVID-19 messaging in Georgia rural and urban counties on immunization, cases, and death rates. The research design was longitudinal retrospective using mixed methods with secondary data from Georgia public databases (January 2020–July 2022) and COVID-19 messaging information from public agencies’ websites. The sample included 120 urban and 39 rural counties. Outcome variables included COVID-19 cases, mortality, and vaccination rates, and predictor variables included type of information related to COVID-19 and geographical location (rural/urban). Quantitative data were analyzed with IBM SPSS27 and qualitative data with NVivo 12 Plus. Preliminary findings indicate no significant rural/urban differences in cases (M rural = 24,152.9, SD = 6080.2, and M urban = 25,137.1, SD = 2885.5 per 100,000), however significantly higher rural deaths (mean difference = 177.9, SE = 30.6, 95% CI [117.4–238.3], P < .001). Urban vaccination rates were significantly higher (mean difference = 5.18, SE = 1.54, CI [2.15, 8.22], P < .001). Preliminary qualitative analysis found fewer rural sources of information about severity of disease, testing options, and vaccination compared to urban areas. Rural/urban disparities in COVID-19 outcomes and vaccination were statistically significant in death rates and vaccination rates, despite similar number of cases recorded over the study period. Limited access to information about COVID-19 in rural counties explain some of the variability.

Racial and ethnic variation in COVID-19 care, treatment, and outcomes: A retrospective cohort study from the MiCOVID-19 registry.

Racial and ethnic disparities in COVID-19 outcomes exist, but whether in-hospital care explains this difference is not known. We sought to determine racial and ethnic differences in demographics, comorbidities, in-hospital treatments, and in-hospital outcomes of patients hospitalized with COVID-19. This was a cohort study using MiCOVID-19, a multi-center, retrospective, collaborative quality improvement registry, which included data on patients hospitalized with COVID-19 across 38 hospitals in the State of Michigan. 2,639 adult patients with COVID-19 hospitalized at a site participating in the MiCOVID-19 Registry were randomly selected. Outcomes included in-hospital mortality, age at death, intensive care unit admission, and need for invasive mechanical ventilation by race and ethnicity. Baseline comorbidities differed by race and ethnicity. In addition, Black patients had higher lactate dehydrogenase, erythrocyte sedimentation rate, C-reactive protein, creatine phosphokinase, and ferritin levels. Black patients were less likely to receive dexamethasone and remdesivir compared with White patients (4.2% vs 14.3% and 2.2% vs. 11.8%, p < 0.001 for each). Black (18.7%) and White (19.6%) patients experienced greater mortality compared with Asian (13.0%) and Latino (5.9%) patients (p < 0.01). The mean age at death was significantly lower by 8 years for Black patients (69.4 ± 13.3 years) compared with White (77.9 ± 12.6), Asian (77.6 ± 6.6), and Latino patients (77.4 ± 15.5) (p < 0.001). COVID-19 mortality appears to be driven by both pre-hospitalization clinical and social factors and potentially in-hospital care. Policies aimed at population health and equitable application of evidence-based medical therapy are needed to alleviate the burden of COVID-19.

How Cumulative Statistics Can Mislead: The Temporal Dynamism of Sex Disparities in COVID-19 Mortality in New York State.

Overall, men have died from COVID-19 at slightly higher rates than women. But cumulative estimates of mortality by sex may be misleading. We analyze New York State COVID-19 mortality by sex between March 2020 and August 2021, demonstrating that 72.7% of the total difference in the number of COVID-19 deaths between women and men was accrued in the first seven weeks of the pandemic. Thus, while the initial surge in COVID-19 mortality was characterized by stark sex disparities, this article shows that disparities were greatly attenuated in subsequent phases of the pandemic. Investigating changes over time could help illuminate how contextual factors contributed to the development of apparent sex disparities in COVID-19 outcomes.

County-Level Segregation and Racial Disparities in COVID-19 Outcomes.

Segregation has been linked to unequal life chances. Individuals from marginalized communities experience more crime, higher levels of poverty, poorer health, and less civic engagement. In addition, segregated metropolitan regions have been found to display inequality in access to basic services. This article builds on these findings by linking segregation to infection and deaths from COVID-19. Using census data matched to COVID infection and death statistics at the county level, this article offers a theoretical basis for the researchers' choice of segregation measures and predictions for different racial groups. It analyzes the relationship between two dimensions of segregation-racial isolation and racial unevenness-and COVID outcomes for different racial and ethnic groups. In counties where Black and Latino residents lived in more racially isolated neighborhoods, they were much more likely to contract COVID-19. This pattern was exacerbated in counties with a high proportion of frontline workers. In addition, racial segregation increased COVID-19 death rates for Black, Latino, and white residents. These findings suggest that devastating outcomes of the coronavirus pandemic were linked to a long history of racial marginalization and entrenched discrimination produced by structural inequalities embedded in our geographies. This knowledge should be used to inform public health planning.

Race-ethnicity disparities in COVID-19 outcomes may be worsened by shorter- and long-term aerosol pollutants exposure

BACKGROUND AND AIM: The importance of ultrafine particles (UFP or PM₀.₁) exposure to respiratory disease has been identified. However, its effect (and that of PM₂.₅) on COVID-19 outcomes remain unknown. This study aims to identify and quantify shorter- and long-term aerosol impacts on COVID-19 in context of disparate outcomes observed for minority race-ethnicity groups in New York State (NYS). METHODS: COVID-19 outcomes included infections, hospitalizations, ICU admissions, and deaths reported by the CDC COVID-19 Case Surveillance Restricted Access Detailed Data, 2020–2022. UFP and PM₂.₅ data were simulated by a global three-dimensional model of chemical transport with state-of-the-science aerosol microphysical processes extensively validated with observations. For shorter-term (0–30 lag days) UFP and PM₂.₅ exposure, Distributed Lag Non-linear Model (DLNM) were used to examine the association at county-level, adjusting for meteorological factors. Long-term (average level of 2013–2020) associations with COVID-19 were assessed by Negative Binomial Mixed Models adjusting for county-level confounders. County-level confounders from the Census Bureau, Behavioral Survey, and Homeland Infrastructure Data were used. RESULTS: Compared to White, Hispanic/Black subgroups had greater excess risk of COVID-19 infection (+25%), hospitalization (+31%), ICU admission (+60%), and death (+5.5%). Excess risk per IQR increase for long-term UFP (PM₂.₅) exposure was significant for COVID-19 hospitalization: +40%; 95%-CI=20.5–63.6% (+22%;18.8–25.5%), ICU admission: +44%;39.1–49.2% (+24%;18.6–30.5%), and death: +40%;38.0–42.4% (+19%;8.2–30.7%). For short-term exposures, risks for all COVID-19 outcomes were elevated (RRs range from 1.0–4.6, all p &amp;#x3c; 0.05) when UFP &amp;#x3e; 2000 #·cm−3 and PM₂.₅ &amp;#x3e; 6.3 µg·m−3. CONCLUSIONS: Both shorter- and long-term exposure to aerosols increased the risk of COVID-19 infection and subsequent outcomes, with ultrafine particles (UFP) exerting larger effects than PM₂.₅, and with greater likelihood. The UFP and PM₂.₅-associated risks were disproportionately higher for race-ethnicity minorities (particularly Hispanic and Black) and for their economically vulnerable subgroups. KEYWORDS: COVID-19, ultrafine aerosol, particulate matter, environmental justice, socioeconomic status

Inequities in spatial accessibility to COVID-19 testing in 30 large US cities

Testing for SARS-CoV-2 infection has been a key strategy to mitigate and control the COVID-19 pandemic. Wide spatial and racial/ethnic disparities in COVID-19 outcomes have emerged in US cities. Previous research has highlighted the role of unequal access to testing as a potential driver of these disparities. We described inequities in spatial accessibility to COVID-19 testing locations in 30 large US cities. We used location data from Castlight Health Inc corresponding to October 2021. We created an accessibility metric at the level of the census block group (CBG) based on the number of sites per population in a 15-minute walkshed around the centroid of each CBG. We also calculated spatial accessibility using only testing sites without restrictions, i.e., no requirement for an appointment or a physician order prior to testing. We measured the association between the social vulnerability index (SVI) and spatial accessibility using a multilevel negative binomial model with random city intercepts and random SVI slopes. Among the 27,195 CBG analyzed, 53% had at least one testing site within a 15-minute walkshed, and 36% had at least one site without restrictions. On average, a 1-decile increase in the SVI was associated with a 3% (95% Confidence Interval: 2% - 4%) lower accessibility. Spatial inequities were similar across various components of the SVI and for sites with no restrictions. Despite this general pattern, several cities had inverted inequity, i.e., better accessibility in more vulnerable areas, which indicates that some cities may be on the right track when it comes to promoting equity in COVID-19 testing. Testing is a key component of the strategy to mitigate transmission of SARS-CoV-2 and efforts should be made to improve accessibility to testing, particularly as new and more contagious variants become dominant.