Health Insurance Rates Research Articles

Preliminary Observations from The FILLED Project (FILipino Lived Experiences during COVID-19).

Health outcomes for Asian American subgroups are often aggregated, masking unique experiences and disparities exacerbated by the COVID-19 pandemic, specifically among Filipino Americans (FilAms). The FILLED (Filipino Lived Experiences during COVID-19) Project launched a cross-sectional online survey between April-August 2021 among FilAm adults in Southern California to document community issues and outcomes during the pandemic. Among 223 participants, 47.5% were immigrants, 50.9% identified as essential workers, and 40.6% had a pre-existing health condition before the pandemic. Despite high rates of health insurance (93.3%), 24.4% of the sample did not have a regular health care provider. During the pandemic, 32.7% needed mental health help but did not get it and 44.2% did not know where to get such services. Most respondents felt that the COVID-19 vaccination was a personal responsibility to others (76.9%) and the majority had received at least one dose of a COVID-19 vaccine (82.4%). Regarding COVID-19 impact, participants reported moderate-severe changes in their daily routines (73.5%), access to extended social support (38.9%), housing issues (15.4%), and access to medical care (11.6%). To our knowledge, this study is the first community-driven effort highlighting FilAm community experiences in Southern California, where the highest proportion of FilAms in the United States reside, specifically after the COVID-19 vaccine was made widely available. The observational findings may help community leaders, policy makers, and public health researchers in the design, development, and implementation of post-pandemic intervention strategies used by community-partnered projects that address FilAm and sub-Asian group health disparities at grassroots to societal levels.

Contributory Factors Influencing Interdisciplinary Pediatric Weight Management Program Attendance for Racially Minoritized Youth.

Childhood obesity is a complex medical condition associated with biopsychosocial complications that requires a multifaceted treatment approach. Historically weight management treatment has been challenging to access for racially minoritized youth. This study evaluated factors influencing treatment attendance for racially minoritized youth in a pediatric weight management program between 2018 and 2021. Medical information from 228 participants was collected, including demographics, insurance type, use of telehealth visits, measures of health-related quality of life (HRQOL), distance from the weight management program, and medical history. Although participants entering the weight management program came from across the state, racially minoritized participants from the Indianapolis area were more likely to attend the program. Racially minoritized participants farther from the program were comparatively underrepresented. Relative to families from majority backgrounds, racially minoritized families had the highest public health insurance rates. Specific physical and mental health comorbidities may further increase risk. Results have important implications for pediatric weight management programs to improve access and treatment opportunities for racially minoritized and underserved populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10880-022-09899-0.

Rapid COVID-19 Testing and On-site Case Investigation and Contact Tracing in an Underresourced Area of Salt Lake City, Utah, December 2020-April 2021.

This case study describes how we paired free SARS-CoV-2 rapid antigen testing with on-site case investigation and contact tracing at a drive-through site in an underresourced area of Salt Lake City. Residents of this area had lower rates of employment and health insurance and higher rates of poverty than in the Utah general population. People were given an option to remain on-site and wait until their test results were ready. If a vehicle occupant received a positive test result, the case investigation occurred on-site; contact tracing with the other vehicle occupants was also initiated. People were provided resources to support isolation and quarantine. Bilingual staff who spoke Spanish were incorporated into the workflow. From December 2020 through April 2021, public health staff administered 39 587 rapid tests; 4094 people received a positive test result and 1133 stayed for on-site case investigation. More than half (60.5%) of people with a positive test result who agreed to stay for on-site case investigation were Hispanic or self-reported belonging to a non-Hispanic racial minority group (American Indian/Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, or other racial identities). Pairing rapid antigen testing with on-site case investigation and contact tracing is feasible and improved the timeliness of case investigation by ≥1 day. On-site vaccination services were later integrated. Future emergency responses might consider assisting underresourced communities with on-site services that provide convenient and accessible public health interventions. By providing dependable and reliable services, we were able to achieve buy-in and become a consistent resource for those in the community.

Are patients with alcohol-related cancers (ARCs) more likely to quit drinking than the general population? Results of a national population-based survey.

e18716 Background: Alcohol is a known carcinogen, predisposing to a variety of cancers. While abstinence may reduce the risk of recurrence of these tumors, it is unclear whether patients diagnosed with an alcohol related cancer (ARC) are more likely to quit than the general population. Methods: We utilized the National Health Interview Survey (NHIS) dataset to compare the rate of quitting drinking between those with ARCs (mouth, pharynx, larynx, esophagus, liver, stomach, colon/rectum, breast, and pancreas) versus the general population. Results: In 2020, the NHIS surveyed 31,512 people, representing 251,697,992 in the population. Of these, 2.56% reported having been diagnosed with an ARC in the past. The proportion of people who had consumed alcohol at least once in their lives was similar between those with ARC and the general population (87.57% vs. 86.86%, p = 0.625); however, among those who had ever drunk, those with ARC were more likely to state they had not consumed any alcohol in the past 12 months (33.92% vs. 19.85%, p < 0.001). Patients diagnosed with an ARC were more likely to be white (75.43% vs. 63.34%), older than 65 (58.72% vs. 19.30%), with annual household income < $35,000 (32.56% vs. 22.92%) and a lower rate of private health insurance (48.12% vs. 62.08%), all p < 0.001. Controlling for these sociodemographic factors, among ever-drinkers, those with an ARC were still more likely to report having quit drinking (OR: 1.20; 95% CI: 1.00-1.44, p = 0.046). Of note, however, 5.95% of people with ARCs remained current heavy drinkers (similar to those without ARCs 5.98%, p = 0.977). Among people with ARCs, those who were older than 65 (69.31% vs. 59.10%, p < 0.001), with less than a high school education (20.63% vs. 6.02%, p = 0.001), public insurance (49.27% vs. 32.65%, p = 0.001), and annual household income < $35,000 (44.40% vs. 23.34%, p < 0.001) were less likely to continue to drink. On multivariate analysis, age (p < 0.001), education (p = 0.019) and income (p < 0.001) remained independent predictors of continuing to drink among ARC survivors. Conclusions: While patients with ARCs are more likely to have quit drinking than the general population, nearly two thirds of patients diagnosed with ARCs continue to consume alcohol, with nearly 6% being heavy drinkers. ARC survivors who continue to drink tend to be well-educated, affluent and well-insured; it may therefore behoove clinicians not to neglect educating this population on the merits of abstaining from alcohol after an ARC.

State-level changes in health insurance coverage and parental substance use-associated foster care entry

For many families whose children are placed in foster care, initial contact with the child welfare system occurs due to interactions with the healthcare system, particularly in the context of the opioid epidemic and increased attention to prenatal drug exposure. In the last decade, many previously uninsured families have gained Medicaid health coverage, which has implications for their access to healthcare services and visibility to mandatory reporters. Using administrative foster care case data from the Adoption and Foster Care Analysis and Reporting System Foster Care Files and health insurance data from the American Community Survey, this study analyzes the associations between state-level health insurance coverage and rates of foster care entry due to parental substance use between 2009 and 2019. State-level fixed effects models revealed that public, but not private, health insurance rates were positively associated with rates of foster care entry due to parental substance use. These results support the hypothesis that health insurance coverage may promote greater contact with mandatory reporters among low-income parents with substance use disorders. Furthermore, this study illustrates how healthcare policy may have unintended consequences for the child welfare system.

The Public Policy Dynamics of Increasing Health Insurance Rates in a Developing Country

Health insurance plays an important role in the COVID-19 pandemic. As a part of public policy, examining increasing health insurance contributions in developing countries is important to understand the dynamics, formulation processes, pros and cons, and implications for public participation. This study considered the increasing contributions of Indonesia Health Insurance (BPJS) and the findings indicated that the government faces a dilemma. On one side, the income of citizens is relatively diminished due to the restrictions on mobility as a result of the pandemic. On the other side, during the pandemic, health services need to perform well. Considering that health insurance is part of a national social security system, which is a common feature in developing countries, public health costs should be the responsibility of the State. Therefore, the increase in the BPJS Kesehatan rate needs to consider the ability of the citizen, and also ensure a positive impact on improving health services for the citizen.
 Keywords: public policy dynamics, public participation, positive impact

Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study

BackgroundBefore widespread vaccination, the United States was disproportionately affected by COVID-19 with a mortality rate several times that of other affluent societies. Comparing regions with different rates of health insurance, we assess how much of this excess mortality may be due to the relatively large population without health insurance.MethodsWe use daily surveillance data from the US Centers for Disease Control and Prevention (CDC) stratified by region, age group, gender, and race in regression analysis of daily COVID-19 cases, hospitalization, and mortality. COVID-19 data have been matched with structural characteristics of the region including average proportion with health insurance. As checks, we have estimated regressions for different time periods, different groups of states, and by comparing adjacent counties between states with and without Medicaid expansion.FindingsGroups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization. Early in the pandemic, they were also less likely to be tested for COVID-19. Applying our regression estimates, we estimate that had there been full health insurance coverage of the population, there would have been 60,000 fewer deaths, 26% of the total death toll in the period of this analysis.InterpretationOur study demonstrates that a significant share of COVID-19 mortality in the United States, and much of the excess mortality in the United States compared with other countries, is due to our reliance on a system of market-driven healthcare. Providing universal insurance coverage should be part of our campaign to reduce COVID-19 mortality. It also suggests that these concerns should not be restricted to COVID-19 but apply across all diseases, contributing to many unnecessary deaths in the United States each year even apart from the COVID-19 pandemic.FundingThis study was supported by grants from the NSF (Expeditions grant 1918784), and the NIH (1R01AI151176-01 and 5K01AI141576).

Care for Chiari malformation type I: the role of socioeconomic disadvantage and race.

There is little research on the effect of social determinants of health on Chiari malformation type I (CM-I). The authors analyzed data on all children evaluated for CM-I at a single institution to assess how socioeconomic factors and race affect the surgical treatment of this population. Medical records of patients treated for CM-I at the authors' institution between 1992 and 2017 were reviewed. Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes for each patient were used to measure neighborhood disadvantage. Non-Hispanic White patients were compared to non-White patients and Hispanic patients of any race (grouped together as non-White in this study) in terms of insurance status, ADI, and RUCA. Patients with initially benign CM-I, defined as not having undergone surgery within 9 months of their initial visit, were then stratified by having delayed symptom presentation or not, and compared on these same measures. The sample included 665 patients with CM-I: 82% non-Hispanic White and 18% non-White. The non-White patients were more likely to reside in disadvantaged (OR 3.4, p < 0.001) and urban (OR 4.66, p < 0.001) neighborhoods and to have public health insurance (OR 3.11, p < 0.001). More than one-quarter (29%) of patients underwent surgery. The non-White and non-Hispanic White patients had similar surgery rates (29.5% vs 28.9%, p = 0.895) at similar ages (8.8 vs 9.7 years, p = 0.406). There were no differences by race/ethnicity for symptoms at presentation. Surgical and nonsurgical patients had similar ADI scores (3.9 vs 4.2, p = 0.194), RUCA scores (2.1 vs 2.3, p = 0.252), and private health insurance rates (73.6% vs 74.2%, p = 0.878). A total of 153 patients underwent surgery within 9 months of their initial visit. The remaining 512 were deemed to have benign CM-I. Of these, 40 (7.8%) underwent decompression surgery for delayed symptom presentation. Patients with delayed symptom presentation were from less disadvantaged (ADI 3.2 vs 4.2; p = 0.025) and less rural (RUCA 1.8 vs 2.3; p = 0.023) areas than those who never underwent surgery. Although non-White patients were more likely to be socioeconomically disadvantaged, race and socioeconomic disadvantage were not associated with undergoing surgical treatment. However, among patients with benign CM-I, those undergoing decompression for delayed symptom presentation resided in more affluent and urban areas.

Healthcare coverage and service access for low-income adults with substance use disorders

IntroductionAlthough health coverage facilitates service access to adults in the general population, uncertainty exists over the extent to which this relationship extends to low-income adults with substance use disorders. MethodsThe health status and service use patterns of low-income adults with substance use disorders who had continuous, discontinuous, and no past year health coverage were compared using data from the 2015–2019 National Survey on Drug Use and Health (NSDUH). The NSDUH is a nationally representative survey of the civilian non-institutionalized population. ResultsIn the weighted sample (unweighted n = 9243), approximately 65.66% of low-income adults with substance use disorders had continuous coverage, 17.03% had discontinuous coverage, and 17.31% had no insurance coverage during the past year. Although few group differences were observed in self-reported health status, the uninsured group compared to the discontinously and continuously covered groups, respectively, was less likely to report a past year substance use treatment visit (11.03% vs. 14.83% vs. 15.61%), an outpatient care visit (53.39% vs. 71.27% vs. 79.04%), an emergency department visit (33.33% vs. 45.76% vs. 45.57%), or an inpatient admission (9.24% vs. 15.11% vs. 15.58%). ConclusionsAlthough the cross sectional design limits causal inferences, the correlations between lacking health insurance and low rates of substance use treatment and healthcare use raise the possibility that increasing healthcare coverage might increase access to substance use treatment and other needed healthcare services for low-income adults with substance use disorders.

Asian-Americans in COVID-19: A Literature Review of Mental Health Status and Service Use

Objectives: Reports of racial discrimination against Asian Americans has surged during the Covid-19 pandemic. The goal of this paper is to provide an overview of Asian Americans' mental health status during Covid-19 and an assessment of the barriers and disparities within Asian Americans mental health service delivery. Methods: Four databases and the publisher The Lancet were chosen to search journal articles regarding Asian Americans' mental health status and service use. The increasing racial discrimination was examined as a critical parameter to assess Asian Americans' mental health status. The accessibility of mental health services and the responsiveness of Asian Americans appropriate needs were studied by gender, subgroups and other moderating factors. Results: A total of 49 studies met the review criteria. Asian Americans encountered increasing coronavirus-related discrimination and presented a deteriorated mental health state during Covid-19. A high rate of informal/non-professional mental health service use and an overall low rate of professional service use were found in Asian Americans. Inaccurate self-reporting and diagnosis, language barriers, financial difficulty, and the lack of health insurance and education are contributing factors of the unmet needs of Asian Americans when seeking mental health services. Conclusions: Possible reasons that explain Asian Americans mental health issues reside in socio-economic factors such as cultural differences, limited English proficiency, and low prevalence rates of health insurance and education. Evidence-based policies against racism, inter-ethnic connections, and cultural identity understanding are needed on national and community levels to address Asian hate crimes and discrimination. Virtual mental health services, culture-specific forms of intervention and treatment responses and appropriate education about Asian American mental health issues can help improve Asian Americans' mental health conditions.

Migration and Health: Freedom of Movement and Social Benefits for Chinese Migrant Workers

Nearly 30% of China’s workforce consists of China’s rural-to-urban migrant workers, accounting for nearly 300 million of China’s population. Even though they have gained freedom of movement since the 1980s, they still have no access to healthcare in urban areas where they work. This study utilizes a mixed method of a survey with a sample of migrant workers from three Chinese emigration provinces (n=817) in 2018 and follow-up interviews with 30 migrant workers in 2020 to examine factors of migration experience affecting migrant worker’s health and healthcare. Using binary logistic regression, we found that migrant workers’ longer work experience is correlated with poorer self-rated health, their better financial status and level of hopefulness towards the future are positively correlated to self-rated health. Qualitative findings shed light on the cumulative effect of the length of work experience and fear of medical cost on migrant workers’ declining health. The lack of portability in health insurance and different reimbursement rates in health care access are structural barriers in health-seeking behaviors among migrant workers. Policy implications are presented in the global context of social rights and freedom of movement.

State Medicaid Expansion and the Self-Employed

This paper examines effects of state Medicaid Expansion via the Affordable Care Act on the self-employed. We first examine impacts on the probability of self-employment and find small and not significant estimated effects of Medicaid expansion on the likelihood of being self-employed. We then examine effects of Medicaid expansion on the probability of having health insurance for persons who are self-employed. State Medicaid expansion increased overall health insurance coverage rates, with especially large impacts for the unincorporated self-employed. Impacts on health insurance rates of the self-employed also strengthened over time. The results indicate that Medicaid expansion does not affect entry into self-employment but it does provide significant health insurance benefits for many small business owners with low incomes who otherwise would face considerable difficulty obtaining health insurance.

Migration and Health—Freedom of Movement and Social Benefits for Chinese Migrant Workers

This study utilized the concept of social right to understand factors affecting migrant workers’ health and healthcare in China. Using mixed methods, this study integrated findings from a survey of 817 migrant workers and a follow-up study of 30 intensive interviews to present an in-depth understanding of cumulative disadvantage of health and healthcare of rural-to-urban migrant workers. Our quantitative results indicated that migrant workers with no more than 5 years of working experience and having a good relationship with employers were 65% and 72.8% more likely to report good self-rated health as compared to their counterparts; those with work-related injury experience and low income were 41.6% and 53.6% less likely to report good self-rated health. Qualitative findings revealed the social contexts of the cumulative effect of the length of work experience and fear of medical cost on migrant workers’ declining health. Even though the participation rate for health insurance in China is reported to be over 99%, the lack of portability in health insurance and different reimbursement rates in health care access are structural barriers in health-seeking behaviors among Chinese migrant workers and in establishing sustainability in China’s healthcare system. This study adds to the literature by delineating the process of the unequal access to social rights in general, healthcare in particular as the major explanation for migrant workers’ poor health beyond the surface of China’s universal healthcare.

Socio-ecological and pharmacy-level factors associated with buprenorphine stocking at pharmacies in New York City.

Research is lacking on community and pharmacy-level factors that are associated with stocking buprenorphine. To address these gaps, this study applied a socio-ecological framework to estimate the association between community- and pharmacy-level factors and buprenorphine stocking among a sample of pharmacies in New York City. A telephone survey recruitment strategy was used to administer surveys to 662 pharmacies on the New York City Naloxone Standing Order Pharmacy list in 2018. The survey assessed pharmacy-level factors of private spaces to consult with pharmacists, type of pharmacy (chain/independent), size of pharmacy, having buprenorphine in stock and being open on nights and weekends. Socio-ecological variables drawn from census tract and public health data consisted of racial and ethnic composition, rates of poverty, rates of people without insurance, and rates of overdose. Mixed effects logistic regression estimated odds ratios (OR) of carrying buprenorphine in stock after adjusting for socio-ecological and pharmacy-level factors. Fewer than half of the pharmacies reported having buprenorphine in stock (43.81% n=290). Logistic regression analyses indicate that several pharmacy-level factors - the number of private spaces (aOR=1.67 95% CI=1.20, 2.32 p=.002), large size of the pharmacy (aOR=1.52 95% CI=1.04, 2.22, p=.032), having naloxone in stock (aOR=1.54, 95%CI=1.03, 2.32 p=.037), as well as neighborhood-level factors of higher rates of poverty (aOR=2.07 95%CI=1.07, 4.02 p<.001) and higher rates of uninsured residents were associated with carrying buprenorphine (aOR=0.23 95%CI=0.14,.38). Using a socio-ecological framework, this study identified inequities in pharmacy stocking of buprenorphine by neighborhood rates of health insurance. At the pharmacy level, increasing private spaces for consultation and encouraging co-stocking of naloxone with buprenorphine stocking may reduce inequalities in buprenorphine availability.

Individual and Community Social Determinants of Health and Recovery from Alcohol Use Disorder Three Years following Treatment

ABSTRACT Prior research on recovery from alcohol use disorder (AUD) has often focused on individual-level factors that promote recovery. Given systemic health inequities, it is also important to study community-level social determinants of health (SDOH) that may promote recovery from AUD. This study extended prior work examining individual profiles of recovery from AUD to assess how individual and community SDOH at the time of treatment entry were associated with recovery from AUD three years after treatment. Data were utilized from the COMBINE study (n = 664), a multisite randomized clinical trial evaluating pharmacological and behavioral treatments for AUD. Public community data sources associated with participants’ study sites were used to measure community SDOH. Multilevel latent profile analyses with individual- and community-level variables as predictors of recovery profiles were estimated. Four profiles were identified based on participants’ alcohol consumption and functioning. Individual SDOH variables, such as fewer years of education and lower income, and community SDOH, including lower rates of health insurance, lower income, and greater income inequality, were each associated with lower functioning profiles. The findings highlight the importance of community SDOH in AUD recovery and the value of including both individual and community SDOH variables in research on long-term recovery.

Undocumented Older Latino Immigrants in the United States: Population Projections and Share of Older Undocumented Latinos by Health Insurance Coverage and Chronic Health Conditions, 2018-2038.

This article focuses on the older Latino undocumented population and anticipates how their current demographic characteristics and health insurance coverage might affect future population size and health insurance trends. We use the 2013-2018 American Community Survey as a baseline to project growth in the Latino 55 and older undocumented population over the next 20 years. We use the cohort component method to estimate population size across different migration scenarios and distinguish between aging in place and new immigration. We also examine contemporary health insurance coverage and chronic health conditions among 55 and older undocumented Latinos from the 2003-2014 California Health Interview Survey. We then project health insurance rates in 2038 among Latino immigrants under different migration and policy scenarios. If current mortality, migration, and policy trends continue, projections estimate that 40% of undocumented Latino immigrants will be 55 years or older by 2038-nearly all of whom will have aged in place. Currently, 40% of older Latino undocumented immigrants do not have insurance. Without policies that increase access to insurance, projections estimate that the share who are uninsured among all older Latinos immigrants will rise from 15% to 21%, and the share who is both uninsured and living with a chronic health condition will rise from 5% to 9%. Without access to health care, older undocumented immigrants may experience delayed care and more severe morbidity. Our projections highlight the need to develop and enact policies that can address impending health access concerns for an increasingly older undocumented Latino population.

Factors Associated with Influenza Vaccination Uptake among U.S. Adults: Focus on Nativity and Race/Ethnicity.

To support implementation strategies for upcoming influenza (flu) vaccinations for foreign-born and racial/ethnic minority groups, we analyzed the 2018 National Health Interview Survey (NHIS) database and performed logistic regression to examine the factors associated with, and the interaction between nativity and race/ethnicity in directing flu vaccination rates during the past 12 months (n = 25,045). As a result, we found nativity and race/ethnicity were associated with flu vaccination rates; foreign-born and non-Hispanic black respondents were less likely to take the vaccine than U.S.-born and non-Hispanic white respondents. The odds ratios were largest for the elderly, those working in the healthcare industry, those with health insurance, and those with a usual source of care (ORs = 3.058, 2.871, 2.317, and 2.342, respectively), suggesting that access to healthcare resources is critical for the uptake of the flu vaccine. There was a significant interaction effect between nativity and race/ethnicity. For improving flu vaccination rates, more support is necessary for foreign-born people and racial/ethnic minorities who have lower health insurance rates and usual sources of care than U.S.-born people and non-Hispanic whites, and thus are less able to adequately access healthcare resources in a timely manner.

Health Insurance Coverage before and after the Affordable Care Act in the USA

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA, but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. Government in deciding the fate of the ACA.

Association of Lower Socioeconomic Status and SARS-CoV-2 Positivity in Los Angeles, California.

ObjectivesSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood.MethodsWe evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code.ResultsWe analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income <US$65 000 (adjusted odds ratio [aOR], 1.77; 95% confidence interval [CI], 1.72 to 1.82), as well as from zip codes with <85% of individuals with health insurance (aOR, 1.29; 95% CI, 1.25 to 1.33), and <60% of individuals employed (aOR, 1.42; 95% CI, 1.41 to 1.44).ConclusionsResidence in zip codes with lower average annual household income, lower rates of employment, or lower rates of health insurance was associated with SARS-CoV-2 positivity. Further research is needed into how those factors increase the spread of SARS-CoV-2 infection among populations of lower socioeconomic status in order to develop targeted public health interventions.

Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors.

Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.