Racial disparities in patients hospitalized for COVID-19

BackgroundThe COVID-19 pandemic has demonstrated the significance of health disparities across populations with older adults and minoritized groups being disproportionately affected. Data during the COVID-19 pandemic demonstrated higher infection rates, hospitalization rates, morbidity, and potentially greater mortality in Black, Hispanic, and Native Americans compared to Whites.MethodsThis is a retrospective cohort study of de-identified patient data from 178 hospitals across the United States. Outcome variables were the length of stay, in-hospital mortality, disease severity, and discharge disposition. Outcomes were stratified by sex and racial groups.ResultsOf 45,360 patients, 22% were Black, 35% were Hispanic, 37% were White, and 6% were Other. The overall mortality rate was 15% across all groups but was 17% for White patients, 10% for Black patients, 14% for Hispanic patients, and 15% for patients categorized as Other. However, White patients have higher median age on admission (71 years) compared to Blacks (60 years), Hispanics (57 years), and Other (61 years). Race remained statistically significant in a multivariable model that included age, sex, and race. 6484 patients required ICU admission, intubation, and hemodynamic support. This burden was disproportionate across racial groups, with 15.6% of Blacks and 13.9% of non-Blacks having such critical disease (p < 0.0001, z-test for proportions).ConclusionsIn this national study of admitted patients with COVID-19, White patients admitted were older on average compared to other racial/ethnic groups and had a higher mortality rate compared to non-Whites hospitalized for COVID-19. Black patients were significantly more likely to require admission to the ICU, mechanical ventilation, and hemodynamic support. These COVID-19 health disparities highlight the importance of addressing social and structural determinants of health.     

Racial and ethnic disparities in renal transplantation

Racial and ethnic disparities exist in renal transplantation. The causes are multifactorial and include but are not limited to racism, socioeconomic status and class, unfavorable geographical location, lack of organ donation by minority groups, and differences in social networks, health beliefs culture and HLA typing. These disparities affect blacks, Hispanic Americans, Native Americans, Alaskan natiives and Asians. Elimination of these disparities is difficult, since many of the causes are intertwined, and it is difficult todiscern attributable disparity risk associated with the various factors. The possible solutions and recommendations are numerous. Since it is difficult to identify which may be successsful, thorough evaluation is required to determine which should be implemented. Some recommendations may not be easily implemented. Those selected for implementation must be continuously monitored for the expected results and effects.     

Racial and ethnic disparities in cancers of the uterine corpus

Survival after diagnosis of cancer of the uterine corpus is significantly worse in black women as compared with white women. The etiology of the racial and ethnic disparities that exist in endometrial cancer incidence and outcome is multifactorial and complex. Potential explanations include cancer biology, differences in access to care, sociodemographic characteristics, response to treatment and comorbid factors. In this article, a review was performed to assess the magnitude and reasons for the observed disparity in endometrial cancer mortality. Strategies and recommendations to reduce or eliminate differences in endometrial cancer outcome are explored. These include advocacy for more research to clarify the underlying causes of cancer disparities at all levels, including the molecular basis of disparate outcomes, improving access to quality healthcare services, establishing culturally competent models of healthcare delivery, and developing novel cost-effective screening and early prevention methods.     

Racial and ethnic disparities in HIV diagnoses for women in the United States

BACKGROUND: An estimated 361,000 persons in the United States are currently living with HIV (not AIDS), and approximately 29% are women. METHODS: Data on all HIV cases diagnosed from 1999 through 2004 for adult and adolescent women at least 13 years old and reported to the Centers for Disease Control and Prevention from 33 states with confidential name-based reporting systems were used. HIV diagnoses and rates per 100,000 women (95% confidence intervals) were analyzed by age group, race and/or ethnicity, transmission category, diagnosis year, and geographic region. RESULTS: The annual estimated rate of HIV diagnosis for black women decreased significantly, from 82.7 in 2001 to 67.0 in 2004, but remained 21 times that of white women. Rates also decreased significantly for women in all age groups except those aged 50 years and older. In 2004, rates were highest in the Mid Atlantic (23.2 per 100,000) and South Atlantic (20.8 per 100,000) regions, where rates also significantly decreased. CONCLUSIONS: Rates of HIV diagnoses remain disproportionately high for Hispanic women and especially for black women.     

Racial and ethnic disparities in childhood asthma diagnosis: the role of clinical findings

OBJECTIVES: To establish rates of childhood asthma symptoms, diagnosis, and hospitalization by race, ethnicity, and income, and to ascertain if elevated reported prevalence of asthma diagnosis among African-American children could be explained by differences in clinical findings. METHODS: Estimates of each indicator were calculated based on data from the third National Health and Nutrition and Examination Survey (NHANES III). Bivariate and multivariate logistic regression models were estimated to predict parent or guardian report of current asthma diagnosis. RESULTS: African-American children aged 1 to 5 have a 2-fold higher probability of both asthma diagnosis and hospitalization during the previous year but no significant difference in wheeze prevalence compared to Mexican-American and European-American children. These differences are not explained by household income or clinical information. Children aged 6 to 16 had similar rates of diagnosis and hospitalization for all racial/ethnic groups, although African-American children reported wheeze symptoms one-third less often. CONCLUSIONS: Although younger African-American children have higher morbidity from asthma than their Mexican-American and European-American peers, clinical findings were similar and did not explain increased rates of diagnosis. Interpersonal dynamics within families and communication between families and clinicians are believed to influence both symptom reporting and diagnosis generation.     

Racial disparities in HIV incidence among young men who have sex with men: the Baltimore Young Men's Survey

Recent reports have demonstrated racial disparities in the prevalence of HIV infection among men who have sex with men (MSM). The objectives of this study are to investigate whether racial disparities exist in HIV incidence among young MSM in Baltimore, MD and to examine potential explanations for differences. Data were collected by the Baltimore Young Men's Survey, a cross-sectional venue-based survey (1996 to 2000) enrolling MSM aged 15 to 29 years. HIV incidence was ascertained using the serologic testing algorithm for recent HIV seroconversion. HIV incidence was 4.2% per year (95% confidence interval [CI]: 1.2 to 10.5) among 843 participants. There were substantial racial differences in HIV incidence, ranging from 0 among Hispanics to 11.0% per year (95% CI: 5.5 to 19.7) among non-Hispanic blacks. In multivariate analysis, among MSM at risk for HIV acquisition, race was not associated with unprotected anal intercourse. Independent risks included having more than 4 recent male sexual partners (adjusted odds ratio [AOR] = 1.6, 95% CI: 1.0 to 2.4) and being under the influence of drugs while having sex (AOR = 1.6, 95% CI: 1.1 to 2.3). Non-Hispanic blacks were no more likely than non-Hispanic whites to report these risk behaviors. Possible alternative explanations for the observed racial disparities in HIV incidence and implications for prevention are explored.     

Racial and ethnic disparities in cardiac catheterization for acute myocardial infarction in the United States, 1995--2001

OBJECTIVE: To examine recent trends in racial and ethnic disparities in cardiac catheterization for acute myocardial infarction (AMI) to determine whether disparities documented from the 1980s through mid-1990s persist, and evaluate whether patient and hospital characteristics are associated with any observed disparities METHODS: Cross-sectional analyses of 585,710 white, 51,369 black and 31,923 Hispanic discharges from hospitals in the Nationwide Inpatient Sample (which includes data on all discharges from 951 representative hospitals in 23 states) that had performed cardiac catheterization from 1995--2001 with a primary diagnosis of AMI. Adjusted procedure rates and prevalence ratios (PR) were computed to compare catheterization rates by race and ethnicity. MEASUREMENTS AND MAIN RESULTS: Catheterization rates were higher for whites than blacks for all years examined; rates among Hispanics increased during this period and approached the rate among whites. After adjustment for age, demographics, comorbidity, year and hospital characteristics, rates (per 100 discharges) were 58.4 for whites, 50.1 for blacks (PR 0.87; 95% CI 0.84-0.91) and 55.2 for Hispanics (PR 0.95; 95% CI 0.90-0.99). CONCLUSIONS: These nationwide data suggest blacks remain less likely than whites and Hispanics to undergo catheterization during a hospitalization for AMI. Whether this disparity stems from patient or provider factors remains to be determined.     

The Devastating Cost of Racial and Ethnic Health Inequity in the COVID-19 Pandemic

The COVID-19 pandemic has laid bare the devastating truth about pervasive health inequity in the United States. As the virus swept through the country, underserved racial and ethnic minority populations disproportionately bore the brunt of the hospitalizations, severe illness, and fatalities. The devastation among these groups far outstripped their privileged counterparts due to convergence of disadvantages that created a perfect storm of exposures. We used empirical evidence incorporated into a theoretical framework analyzing vulnerabilities that have long plagued these communities. These exposures were further exacerbated by the rapid transmission of this virus and impaired the capability of these communities to escape illness and death due to a lack of adequate public health and medical responses. Will the aftermath of this coronavirus prove to be a reckoning for how American society addresses the conditions of most vulnerable populations or another ignored data-point? We suggest some policy steps to address the problem.     

Public perceptions and disparities in access to telehealth orthopaedic services in the COVID-19 era

BackgroundWe used online crowdsourcing to explore public perceptions and attitudes towards virtual orthopaedic care, and to identify factors associated with perceived difficulty navigating telehealth services during the COVID-19 pandemic.MethodsA modified version of the validated Telemedicine Satisfaction and Usefulness Questionnaire was completed by 816 individuals using crowd-sourcing methods. Multivariable logistic regression modelling was used to determine population characteristics associated with perceived difficulty using telehealth technology.ResultsMost respondents (85%) believed that telehealth visits would be a convenient form of healthcare delivery, and 64% would prefer them over in-person office visits. The majority (92%) agreed that telehealth would save them time, but 81% had concerns regarding the lack of physical contact during a musculoskeletal examination. More respondents would feel comfortable using telehealth for routine follow-up care (81%) compared to initial assessment visits (59%) and first postoperative appointments (60%). Roughly 1 in 15 (7%) expressed difficulty with using telehealth; these respondents were more often unmarried, lower-income, and more medically infirm, and reported greater symptoms of depression. After multivariable adjustment, lower income and poor health were retained as predictors of difficulty with navigating telehealth technology (p = 0.027,p = 0.036, respectively).ConclusionThe majority of the public appears receptive to telehealth for orthopaedic care for both new patient visits and follow-up appointments. The finding that people with multiple chronic conditions and psychosocial needs struggle to engage with telehealth suggests that those who arguably stand to benefit the most from continued care are the ones being unintentionally left out of this digitization boom.     

Socioeconomic disparities and COVID-19 vaccination acceptance: a nationwide ecologic study

ObjectiveTo analyse the correlation between COVID-19 vaccination percentage and socioeconomic status (SES).MethodsA nationwide ecologic study based on open-sourced, anonymized, aggregated data provided by the Israel Ministry of Health. The correlations between municipal SES, vaccination percentage and active COVID-19 cases during the vaccination campaign were analysed by using weighted Pearson correlations. To assess the adequacy of first dose vaccination rollout relative to the municipality COVID-19 disease burden, a metric termed the vaccination need ratio was devised by dividing the total number of active cases (per 10 000 people) by the vaccination percentage of the population over 60 in each municipality, and its correlation with the SES was examined.Results23 days after initiation of the vaccination campaign, 760 916 (56.8%) individuals over the age of 60 were vaccinated in Israel with the first dose of the BNT162b2 COVID-19 vaccine. A negative correlation was found between the COVID-19 active case burden and the vaccination percentage of the study population in each municipality (r = –0.47, 95% CI –0.59 to –0.30). The vaccination percentage significantly correlated with the municipal SES (r = 0.83, 95% CI 0.79 to 0.87). This finding persisted but was attenuated over a 5-week period. A negative correlation between the vaccination need ratio and municipal SES (r = –0.80, 95% CI –0.88 to –0.66) was found.DiscussionLower COVID-19 vaccination percentage was associated with lower SES and high active disease burden. Vaccination efforts should focus on areas with lower SES and high disease burden to assure equality of vaccine allocation and potentially provide a more diligent disease mitigation.     

Racial and ethnic disparities in perinatal mortality: applying the perinatal periods of risk model to identify areas for intervention

OBJECTIVES: To determine the feto-infant mortality rate for New York City, assess racial/ethnic variations and identify areas for intervention using the Perinatal Periods of Risk (PPOR) approach. METHODS: The PPOR model examines fetal and infant deaths by age at death (fetal, neonatal, postneonatal) and birthweight (500-1499, > or =1500 g). It groups age at death and birthweight into four categories to identify problems hypothesized to lead to the death: factors related to Maternal Health and Prematurity, Maternal Care, Newborn Care and Infant Health. The model was applied to fetal and infant deaths occurring in New York City using Vital Records data from 1996-2000. Analysis was completed for the entire city and by race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, Asians/Pacific Islander). RESULTS: The overall feto-infant mortality rate was 11.5/1,000 live births plus fetal deaths. This rate varied by race/ethnicity; black non-Hispanics had a higher rate than other racial/ethnic groups. Conditions related to maternal health and prematurity were the largest contributing factors to feto-infant mortality (5.9/1000) in New York City. Among blacks and Hispanics, problems related to maternal health and prematurity contributed a larger share than among whites and Asians/Pacific Islanders. CONCLUSION: The use of the PPOR approach shows that the racial/ethnic disparities in feto-infant mortality that exist in New York City are largely related to maternal health and prematurity. Interventions to reduce the feto-infant mortality rate should include preconception care and improvements in women's health.     

Racial and ethnic disparities in communication study enrollment for young people with cancer: A descriptive analysis of the literature

ObjectiveWe aimed to evaluate the racial and ethnic diversity of study participants in recent pediatric cancer communication literature.MethodsWe systematically searched for communication studies in pediatric oncology published between January 2018 and September 2020, limiting analysis to US studies. We considered race and ethnicity as separate categories in our analysis. Two authors screened studies and abstracted characteristics of race and ethnicity reporting and enrollment.ResultsOf 98 articles included in this analysis, many studies failed to report participants’ race (21/98) and ethnicity (40/98). Most studies ascertained race and ethnicity by self-report (51/98); 25 studies did not describe how they ascertained race and ethnicity. White participants were overrepresented in studies relative to the US population (median 80% in studies vs 72% in 2020 US census). Racial and ethnic minorities were underrepresented (Black: 7% vs 14%; Asian: 4% vs 7%; Pacific Islander: 0% vs 0.5%; Native American: 0.5% vs 3%; Hispanic 8% vs 19%).ConclusionCommunication literature in pediatric oncology underrepresents all racial and ethnic minority populations and is inconsistent in the reporting of race and ethnicity.Practice implicationsFuture work should follow best practices to ensure this literature adequately represents the experiences of all families in pediatric oncology.