Disproportionate Impact Of COVID-19 Research Articles

LB18. Healthcare Utilization for Acute Respiratory Illness by Race/Ethnicity across Ambulatory, Emergency, and Hospital Settings

BackgroundGiven the disproportionate impact of COVID-19 among racial/ethnic minority groups across the United States on emergency visits, hospitalizations, and deaths, we examined healthcare utilization more broadly for acute respiratory illness (ARI across healthcare settings by racial/ethnic group.MethodsUsing data on 33,992,254 unique nonpharmacy healthcare encounters from the IBM Explorys Electronic Health Record database from January 1, 2020–May 1, 2021, across healthcare settings (ambulatory care or telehealth, emergency department, and hospitalizations) with nonmissing bridged racial/ethnic data. Encounters were classified as ARI based on ICD-10 and SNOMED codes and aggregated by month and US Census region. We estimated the population denominator as the total number of persons by bridged racial/ethnic group with encounters recorded during 2019. We both estimated the rate of ARI visits per 100,000 persons across healthcare settings and the rate ratio of ARI visits to non-ARI visits. We performed comparisons of these values by race/ethnicity, taking White persons as referent, using Poisson generalized estimating equations clustered within geographic regions.ResultsA total of 244,137 (6.5% of 3,745,135) hospitalizations, 237,873 (18% of 1,305,474) emergency visits, and 1,636,383 (5.7% of 28,941,645) ambulatory visits were associated with ARIs. We observed similar rates of ARI visits across race/ethnicity groups in all settings combined and in ambulatory settings, but higher rates of ARI hospitalization among Hispanic persons (IRR [95% CI]: 2.5 [1.7–3.7]) and higher rates of ARI emergency department visits among Black persons (2.5 [1.9–3.2]) (Figure). We also observed differences in the relative proportion of care received for ARI vs. other visits types by setting, for example with Black persons utilizing higher rates of hospital visits for ARI vs non-ARI care (2.2 [1.7–2.7]) but lower rates of ambulatory care for ARI (0.9 [0.7–0.96]).ARI Visits Per 100k Persons ConclusionPopulation rates of ARI visits and relative proportions of ARI vs. non ARI visits differed between racial/ethnic groups by setting. Understanding how utilization of care varies for ARI across settings can inform future monitoring efforts for health equity.Disclosures All Authors: No reported disclosures

COVID-19 risk factors and mortality among Native Americans

Background: Academic research on the disproportionate impact of COVID-19 among Native Americans has largely been restricted to particular indigenous groups or reservations.

Infectious Diseases-Related Emergency Department Visits Among Non-Elderly Adults with Intellectual and Developmental Disabilities in the United States: Results from the National Emergency Department Sample, 2016.

Emerging evidence on the disproportionate impact of COVID-19 on people with intellectual and developmental disabilities (IDD) points to the underlying risk and burden of infectious diseases (IDs) in this population. The objective of this study was to examine the risk of ID-related emergency department (ED) visits, subsequent hospitalizations, and hospital-based mortality during ID-related visits among adults with IDD compared to those without IDD. The authors conducted a retrospective study using data from the 2016 Nationwide Emergency Department Sample. The sample included 94,928 adults with IDD identified using ICD-10-CM codes, and age- and sex-matched 284,763 non-IDD adults in a 1:3 case-control ratio. A Poisson regression model was used to compare the risk of ID-related ED visits, subsequent hospitalizations, and hospital-based mortality during ID-related visits between adults with and without IDD. Covariates included sociodemographic and hospital characteristics. Results showed that adults with IDD are at a higher risk for ID-related ED visits, subsequent hospitalization, and mortality during ID-related ED visits compared to non-IDD adults. Adults with IDD continued to experience higher risks even after accounting for sociodemographic, hospital, and clinical characteristics. Septicemia and respiratory tract infections are the leading causes of ED visits, hospitalization, and mortality. This study found substantial disparities in ID-related ED visits, subsequent hospitalization, and mortality among the burdens for adults with IDD. These observations underscore the importance of integrated strategies to reduce ID-related morbidity among adults with IDD.

Advancing Diversity, Equity, and Inclusion in Scientific Publishing

Advancing Diversity, Equity, and Inclusion in Scientific Publishing

Disproportionate Impact of COVID-19 on Racial and Ethnic Minority Groups in the United States: a 2021 Update.

The COVID-19 pandemic’s disproportionate impact on people from some racial and ethnic groups in the U.S. persisted throughout 2021. Black, Latinx, and American Indian persons have been hospitalized and died at a higher rate than White persons consistently from the start of the pandemic. Early data show that hospitalization and mortality rates for Black, Latinx, and American Indian children are higher than White children in a worrying trend. The pandemic has likely worsened the gaps in wealth, employment, housing, and access to health care: the social determinants of health that caused the disparities in the first place. School closures will have a long-lasting impact on the widening achievement gaps between Black and Latinx students and White students. In the earlier vaccination phase, Black and Latinx persons were being vaccinated at a lower rate than their proportion of cases due to vaccine hesitancy, misinformation, and barriers to access. Vaccine hesitancy rates among these groups have since decreased and are now comparable to White persons. Aggregated data make it challenging to paint a picture of the actual impact of COVID-19 on Asian Americans as they are a diverse group with significant disparities. All of this highlights that we have much work to do in dismantling systemic racism, engaging communities we serve, and advancing health equity to prepare us for future pandemics and a more just healthcare system.

Measuring the exposure of Black, Asian and other ethnic groups to COVID-infected neighbourhoods in English towns and cities

Drawing on the work of The Doreen Lawrence Review—a report on the disproportionate impact of COVID-19 on Black, Asian and minority ethnic communities in the UK—this paper develops an index of exposure, measuring which ethnic groups have been most exposed to COVID-19 infected residential neighbourhoods during the first and second waves of the pandemic in England. The index is based on a Bayesian Poisson model with a random intercept in the linear predictor, allowing for extra-Poisson variation at neighbourhood and town/city scales. This permits within-city differences to be decoupled from broader regional trends in the disease. The research finds that members of ethnic minority groups can be living in areas with higher infection rates but also that the risk of exposure is distributed unevenly across these groups. Initially, in the first wave, the disease disproportionately affected Black residents but, as the pandemic has progressed, especially the Pakistani but also the Bangladeshi and Indian groups have had the highest exposure. This higher exposure of the Pakistani group is not straightforwardly a function of neighbourhood deprivation because it is present across a range of average house prices. We find evidence to support the view, expressed in The Doreen Lawrence Review, that it is linked to occupational and environmental exposure, particularly residential density but, having allowed for these factors, differences between the towns and cities remain.

The Disproportionate Impact of COVID-19 on Residents of Long-Term Care Homes

The Disproportionate Impact of COVID-19 on Residents of Long-Term Care Homes

Structural racism and the experience of “tightness” during the COVID-19 pandemic

ABSTRACT Research has established the disproportionate impact of COVID-19 on communities of colour. Drawing on three waves of in-depth interviews with 36 college students (for a total of 94 interviews), we extend the conceptual metaphor of “tightness” (derived from the sociology of punishment) to understand the experiential dimensions of structural racism in America, especially during periods of crisis. We argue that tightness intensified for Black and Latinx participants as they struggled to cope with the loss of loved ones, fears surrounding their own health, financial challenges, and concerns about police surveillance. We also find that the demonstrations following the killing of George Floyd represented a brief release from the suffocating tightness that Black participants experienced during the pandemic. Using the tightness metaphor to capture the compounding hardships endured by vulnerable populations, we build on existing research that has largely focused on isolated measures of harms associated with the pandemic.

The Case for Health Reparations.

The disproportionate impact of COVID-19 on racially marginalized communities has again raised the issue of what justice in healthcare looks like. Indeed, it is impossible to analyze the meaning of the word justice in the medical context without first discussing the central role of racism in the American scientific and healthcare systems. In summary, we argue that physicians and scientists were the architects and imagination of the racial taxonomy and oppressive machinations upon which this country was founded. This oppressive racial taxonomy reinforced and outlined the myth of biological superiority, which laid the foundation for the political, economic, and systemic power of Whiteness. Therefore, in order to achieve universal racial justice, the nation must first address science and medicine's historical role in scaffolding the structure of racism we bear witness of today. To achieve this objective, one of the first steps, we believe, is for there to be health reparations. More specifically, health reparations should be a central part of establishing racial justice in the United States and not relegated to a secondary status. While other scholars have focused on ways to alleviate healthcare inequities, few have addressed the need for health reparations and the forms they might take. This piece offers the ethical grounds for health reparations and various justice-focused solutions.

Why We Must Learn The Lessons Now: A call for a truly independent public inquiry by the UK Government

The BAPIO Think-tank recommends that the Independent Inquiry establishes;
 
 If the scientists did get the advice right (best practice at the time on protection, prevention of spread, detection of new cases, restriction of movement internal/external), and timely.
 Whether the government adhered to its own mantra of ‘following the science’ of acting on scientific evidence
 If the policy effectively assessed the risk to and protected key workers, how should this be conducted in the future?
 If the government had formed ‘a protective ring’ for Care Homes and if the early policy of encouraging NHS Trusts to discharge patients without repeat testing, compromised the care of other residents and care, home workers,
 If the disproportionate impact of COVID-19 on ethnic minorities and deprived communities was recognised in policy actions, so those at enhanced risk were appropriately prioritised if there was active engagement and co-designed provision of culturally appropriate timely information; if disinformation was tackled, and if there was an enhanced drive to vaccinate those at higher risk.
 If there was recognition by the government of public health expert advice that a blanket national policy is ineffective. More local intelligence, engagement, and leadership should tackle the outbreaks seen in different regions.
 If there was transparency and efficiency in the financial investment in tackling the pandemic - potential wastage and duplication from unusable PPE and the Nightingale hospitals), and the cost of private firms supplying testing, tracing and other equipment.
 Urgently, the health–social care priorities for recovery; whether segregation of facilities, protected allocation of resources in dealing with non-Covid conditions, how the NHS might continue to function optimally in the event of a third or subsequent waves
 If there is action on pressures on the NHS workforce, the impact on their morale, wellbeing and actions that are required to manage these in the future.

Addressing Racial and Ethnic Disparities in COVID-19 Among School-Aged Children: Are We Doing Enough?

The disproportionate impact of COVID-19 and associated disparities among Hispanic, non-Hispanic Black, and non-Hispanic American Indian/Alaska Native children and teenagers has been documented. Reducing these disparities along with overcoming unintended negative consequences of the pandemic, such as the disruption of in-person schooling, calls for broad community-based collaborations and nuanced approaches. Based on national survey data, children from some racial and ethnic minority groups have a higher prevalence of obesity, asthma, type 2 diabetes, and hypertension; were diagnosed more frequently with COVID-19; and had more severe outcomes compared with their non-Hispanic White (NHW) counterparts. Furthermore, a higher proportion of children from some racial and ethnic minority groups lived in families with incomes less than 200% of the federal poverty level or in households lacking secure employment compared with NHW children. Children from some racial and ethnic minority groups were also more likely to attend school via online learning compared with NHW counterparts. Because the root causes of these disparities are complex and multifactorial, an organized community-based approach is needed to achieve greater proactive and sustained collaborations between local health departments, local school systems, and other public and private organizations to pursue health equity. This article provides a summary of potential community-based health promotion strategies to address racial and ethnic disparities in COVID-19 outcomes and educational inequities among children and teens, specifically in the implementation of strategic partnerships, including initial collective work, outcomes-based activities, and communication. These collaborations can facilitate policy, systems, and environmental changes in school systems that support emergency preparedness, recovery, and resilience when faced with public health crises.

Underreporting of race/ethnicity in COVID-19 research

ObjectivesAlthough racial/ethnic disparities in healthcare have long been recognized, recent discourse around structural racism will hopefully lead to improved transparency surrounding these issues. Despite the disproportionate impact of COVID-19 on racial/ethnic minorities, the extent and reliability of race reporting in COVID research is unclear. MethodsCOVID-19 research published in three top medical journals during the first wave of the COVID-19 pandemic was reviewed and assessed for race reporting and proportional representation. ResultsOf the 95 manuscripts that were identified, 56 reporting on 252,262 patients met eligibility. Thirty-five (62.5%) did not report race distribution and 15 (26.7%) did not report ethnicity. There was no difference based on journal (P = 0.87), study sponsor (P = 0.41), whether the study was retrospective or prospective (P = 0.33), or observational vs interventional (P = 0.11). Studies with ≥250 patients were more likely to report on race (OR 4.01, 95% CI: 1.12–14.37, P = 0.027), and North American (USA and Canada) studies were more likely than European studies (OR 7.88, 95% CI: 1.73–37.68, P = 0.006) to report on race. COVID-19 research mirrored USA COVID-19 racial incidence; however, both showed higher distribution of COVID-19 infection among Blacks and a smaller proportion of Whites compared to the USA population. This suggests that research is broadly representing infection rates and that social determinants of health are impacting racial distribution of infection. ConclusionsDespite increasing awareness of racial disparities and inequity, COVID-19 research during the first wave of the pandemic lacked appropriate racial/ethnicity reporting. However, research mirrored COVID-19 incidence in the USA, with an increased burden of infection among Black individuals.

COVID-19-related state-wise racial and ethnic disparities across the USA: an observational study based on publicly available data from The COVID Tracking Project

ObjectiveTo evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA.MethodsPublicly available data from The COVID Tracking Project at The Atlantic were...

How do employment conditions and psychosocial workplace exposures impact the mental health of young workers? A systematic review.

PurposeTo assess the quality of the research about how employment conditions and psychosocial workplace exposures impact the mental health of young workers, and to summarize the available evidence.MethodsWe undertook a systematic search of three databases using a tiered search strategy. Studies were included if they: (a) assessed employment conditions such as working hours, precarious employment, contract type, insecurity, and flexible work, or psychosocial workplace exposures such as violence, harassment and bullying, social support, job demand and control, effort-reward imbalance, and organizational justice; (b) included a validated mental health measure; and (c) presented results specific to young people aged ≤ 30 years or were stratified by age group to provide an estimate for young people aged ≤ 30 years. The quality of included studies was assessed using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool.ResultsNine studies were included in the review. Four were related to employment conditions, capturing contract type and working hours. Five studies captured concepts relevant to psychosocial workplace exposures including workplace sexual harassment, psychosocial job quality, work stressors, and job control. The quality of the included studies was generally low, with six of the nine at serious risk of bias. Three studies at moderate risk of bias were included in the qualitative synthesis, and results of these showed contemporaneous exposure to sexual harassment and poor psychosocial job quality was associated with poorer mental health outcomes among young workers. Longitudinal evidence showed that exposure to low job control was associated with incident depression diagnosis among young workers.ConclusionsThe findings of this review illustrate that even better studies are at moderate risk of bias. Addressing issues related to confounding, selection of participants, measurement of exposures and outcomes, and missing data will improve the quality of future research in this area and lead to a clearer understanding of how employment conditions and psychosocial workplace exposures impact the mental health of young people. Generating high-quality evidence is particularly critical given the disproportionate impact of COVID-19 on young people’s employment. In preparing for a post-pandemic world where poor-quality employment conditions and exposure to psychosocial workplace exposures may become more prevalent, rigorous research must exist to inform policy to protect the mental health of young workers.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00127-021-02077-x.

The Economic Gains from Equity

How much is inequity costing us? Using a simple growth accounting framework we apply standard shift-share techniques to data from the Current Population Survey (1990-2019) to compute the aggregate economic costs of persistent educational and labor market disparities by gender and race. We find significant economic losses associated with these gaps. Building on this finding, we consider which disparities generate the largest costs, paying specific attention to differences in employment, hours worked, educational attainment, educational utilization, and occupational allocation. We also examine gaps in the returns on these variables. Our findings suggest that differences in employment opportunities and educational attainment make the largest contributions by race; differences in returns on these variables also contribute materially to the total costs. Differences by gender are primarily driven by gaps in employment and hours. Given the disproportionate impact of COVID-19 on the labor market outcomes of women and people of color, as well as the fact that the U.S. population is increasingly racially diverse, these costs will only increase in the future.

Ethnopolitical challenges of the COVID-19 pandemic: international and national contexts

The article considers the current ethno-political challenges caused by the spread of the COVID-19 pandemic and the measures of the state to counter the spread of coronavirus infection. The analysis of humanitarian threats is carried out posed by the spread of the pandemic in the ethno-political sphere at the international and national levels. Attention is drawn to the growing vulnerability of certain ethnic and racial groups as a result of the pandemic, both from the coronavirus itself and from the socio-economic consequences of national governments' response to the pandemic. The aim of the article is to analyze the main ethno-political challenges of the COVID-19 pandemic at the international and national levels, as well as the priority goals of the policy to opposition the negative consequences of the spread of coronavirus in Ukraine.The article emphasizes the need for a comprehensive approach to the analysis of the disproportionate impact of COVID-19 on "vulnerable" groups from minority communities, in particular – socio-economic factors that cause the spread of coronavirus infection in multicultural communities and reduce the effectiveness of government pandemic policies. Among the main challenges of the COVID-19 pandemic are the ethno-political consequences of the pandemic, which are the growing inequality of certain minority groups, discrimination and the conflict-generating potential of interethnic/racial relations within multicultural societies. The article emphasizes the need for a comprehensive approach to the analysis of the disproportionate impact of COVID-19 on "vulnerable" groups from minority communities and the growing conflict potential of interethnic / racial relations within multicultural societies.The ethno-political factors of influence of the COVID-19 pandemic on the Ukrainian society, actual questions of formation and realization of the state policy in the ethnonational sphere concerning protection of vulnerable groups and counteraction to displays of interethnic intolerance are considered. The most vulnerable groups that have suffered the most from the socio-economic consequences of the pandemic and the forms of interethnic intolerance in Ukrainian society during this period have been identified. The article concludes that the effectiveness of the implemented anti-epidemic measures of national governments depends on the state policy in the ethno-political sphere. Also, the importance of further analysis and prevention of ethno-political challenges caused by the COVID-19 pandemic to preserve the domestic political stability of the state and develop an effective policy of preserving interethnic harmony in Ukraine is stated.

Addressing the Disproportionate Impact of COVID-19 on Communities of Color

With Black and Hispanic communities across the USA experiencing more detrimental negative effects from the COVID-19 pandemic as compared with other demographic groups, the virus has exposed the racial and ethnic disparities in treatment and care that public health experts have been grappling with for years. This paper explains how the systematic collection of racial and ethnic data gleaned from COVID-19 testing in underserved communities can be used to better understand this pandemic and inform measures within our control to prevent the spread of disease in the future.

Engineering Solutions to COVID-19 and Racial and Ethnic Health Disparities

The role of engineers in response to the COVID-19 pandemic and in the elimination of health disparities, while not always visible, has important implications for the attainment of impactful solutions. The design skills, systems approach, and innovative mindset that engineers bring all have the potential to combat crises in novel and impactful ways. When a disparities lens is applied, a lens that views gaps in access, resources, and care, the engineering solutions are bound to be more robust and equitable. The disproportionate impact of COVID-19 on the Black community and other communities of color is linked to inequities in health rooted in a centuries long structural racism. Engineers working collaboratively with physicians and healthcare providers are poised to close equity gaps and strengthen the collective response to COVID-19 and future pandemics.

COVID-19 and Black, Asian, and Minority Ethnic Communities: A Complex Relationship Without Just Cause

Emerging evidence has indicated a negative and disproportionate impact of COVID-19 on Black, Asian, and minority ethnic (BAME) communities. Previous studies have already reported that biological and social risk factors increase disease susceptibility, particularly in BAME communities. Despite frontline workers in ethnic minority communities in the United Kingdom’s National Health Service attempting to quell the pandemic, disproportionate numbers of BAME physicians and other health care workers have died of COVID-19. This unprecedented situation highlights ethical and moral implications, which could further augment the impact of the pandemic on their mental health. While the government attempts to mitigate the rate of virus transmission, certain key factors inadvertently augment the negative impact of the pandemic on the mental health and general well-being of BAME communities. This study examined the available literature to explore the association between, and the wider impact of, COVID-19 on BAME communities. Furthermore, this study aims to raise awareness and provide a deeper insight into current scientific discussions.

A Proposed Framework on Integrating Health Equity and Racial Justice into the Artificial Intelligence Development Lifecycle

The COVID-19 pandemic has created multiple opportunities to deploy artificial intelligence (AI)-driven tools and applied interventions to understand, mitigate, and manage the pandemic and its consequences. The disproportionate impact of COVID-19 on racial/ethnic minority and socially disadvantaged populations underscores the need to anticipate and address social inequalities and health disparities in AI development and application. Before the pandemic, there was growing optimism about AI's role in addressing inequities and enhancing personalized care. Unfortunately, ethical and social issues that are encountered in scaling, developing, and applying advanced technologies in health care settings have intensified during the rapidly evolving public health crisis. Critical voices concerned with the disruptive potentials and risk for engineered inequities have called for reexamining ethical guidelines in the development and application of AI. This paper proposes a framework to incorporate ethical AI principles into the development process in ways that intentionally promote racial health equity and social justice. Without centering on equity, justice, and ethical AI, these tools may exacerbate structural inequities that can lead to disparate health outcomes.