The Association Between Neighborhood Social Vulnerability and COVID-19 Testing,Positivity, and Incidence in Alabama and Louisiana

Racial/ethnic and socioeconomic disparities in COVID-19 burden have been widely reported. Using data from the state health departments of Alabama and Louisiana aggregated to residential Census tracts, we assessed the relationship between social vulnerability and COVID-19 testing rates, test positivity, and incidence. Data were cumulative for the period of February 27, 2020 to October 7, 2020. We estimated the association of the 2018 Social Vulnerability Index (SVI) overall score and theme scores with COVID-19 tests, test positivity, and cases using multivariable negative binomial regressions. We adjusted for rurality with 2010 Rural–Urban Commuting Area codes. Regional effects were modeled as fixed effects of counties/parishes and state health department regions. The analytical sample included 1160 Alabama and 1105 Louisiana Census tracts. In both states, overall social vulnerability and vulnerability themes were significantly associated with increased COVID-19 case rates (RR 1.57, 95% CI 1.45–1.70 for Alabama; RR 1.36, 95% CI 1.26–1.46 for Louisiana). There was increased COVID-19 testing with higher overall vulnerability in Louisiana (RR 1.26, 95% CI 1.14–1.38), but not in Alabama (RR 0.95, 95% CI 0.89–1.02). Consequently, test positivity in Alabama was significantly associated with social vulnerability (RR 1.66, 95% CI 1.57–1.75), whereas no such relationship was observed in Louisiana (RR 1.05, 95% CI 0.98–1.12). Social vulnerability is a risk factor for COVID-19 infection, particularly among racial/ethnic minorities and those in disadvantaged housing conditions without transportation. Increased testing targeted to vulnerable communities may contribute to reduction in test positivity and overall COVID-19 disparities.

     

Assessing the quality of project data by means of a data sufficiency categorization scheme

Improving the quality of gathered or abstracted data is often an important part of a quality improvement project's early stages. This is especially so if indicators will be compared across providers or if various data elements will be used for severity adjustment. One common data problem is missing data. This paper describes a flowchart-based approach for assessing the magnitude of missing data problems. The approach is demonstrated by means of two indicators currently used in multihospital cooperative improvement projects. The approach results in assigning each observation (e.g., patient record) in a sample into one of five data categories. These categories follow standard definitions advanced by the Joint Commission on Accreditation of Healthcare Organizations. Two of the categories tally observations with missing data problems. Assessment of missing data can be viewed as one component of reliability assessment, and its relationship to other forms of reliability assessment is discussed, with emphasis on the relationship to interrater agreement.     

Racial Disparities in End-of-Life Care Between Black and White Adults With Metastatic Cancer

ContextThe comfort of patients with cancer near the end of life (EOL) is often undermined by unnecessary and burdensome treatments. There is a need for more research examining racial disparities in EOL care, especially in regions with a history of racial discrimination.ObjectivesTo examine whether black adults received more burdensome EOL care than white adults in a population-based data set of cancer decedents in Louisiana, a state with a history of slavery and long-standing racial disparities.MethodsThis was a retrospective analysis of EOL care from the Research Action for Health Network (REACHnet), a regional Patient-Centered Outcomes Research Institute-funded database. The sample consisted of 875 white and 415 black patients with metastatic cancer who died in Louisiana from 2011 to 2017. We used logistic regression to examine whether race was associated with five indicators of burdensome care in the last 30 days of life: chemotherapy use, inpatient hospitalization, intensive care unit admission, emergency department (ED) admission, and mechanical ventilation.ResultsMost patients (85.0%) received at least one indicator of burdensome care: hospitalization (76.5%), intensive care unit admission (44.1%), chemotherapy (29.1%), mechanical ventilation (23.0%), and ED admission (18.3%). Odds ratios (ORs) indicated that black individuals were more likely than white individuals to be hospitalized (OR = 1.66; 95% CI = 1.21–2.28; P = 0.002) or admitted to the ED (OR = 1.57; 95% CI = 1.16–2.13; P = 0.004) during their last month of life.ConclusionFindings have implications for informing health care decision making near the EOL for patients, families, and clinicians, especially in regions with a history of racial discrimination and disparities.     

Sex differences in the risk of stroke and HbA1c among diabetic patients

Aims/hypothesis

Sex differences in macrovascular disease, especially in stroke, are observed across studies of epidemiology. We studied a large sample of patients with type 2 diabetes to better understand the relationship between glycaemic control and stroke risk.

Methods

We prospectively investigated the sex-specific association between different levels of HbA_1c and incident stroke risk among 10,876 male and 19,278 female patients with type 2 diabetes.

Results

During a mean follow-up of 6.7 years, 2,949 incident cases of stroke were identified. The multivariable-adjusted HRs of stroke associated with different levels of HbA_1c at baseline (HbA_1c <6.0% [<42 mmol/mol], 6.0–6.9% [42–52 mmol/mol] [reference group], 7.0–7.9% [53–63 mmol/mol], 8.0–8.9% [64–74 mmol/mol], 9.0–9.9% [75–85 mmol/mol] and ≥10.0% [≥86 mmol/mol]) were 0.96 (95% CI 0.80, 1.14), 1.00, 1.04 (0.85, 1.28), 1.11 (0.89, 1.39), 1.10 (0.86, 1.41) and 1.22 (0.92, 1.35) (p for trend?=?0.66) for men, and 1.03 (0.90, 1.18), 1.00, 1.09 (0.94, 1.26), 1.19 (1.00, 1.42), 1.32 (1.09, 1.59) and 1.42 (1.23, 1.65) (p for trend <0.001) for women, respectively. The graded association between HbA_1c during follow-up and stroke risk was observed among women (p for trend?=?0.066). When stratified by race, whether with or without glucose-lowering agents, this graded association of HbA_1c with stroke was still present among women. When stratified by age, the adjusted HRs were significantly higher in women older than 55 years compared with younger women.

Conclusions/interpretation

The current study suggests a graded association between HbA_1c and the risk of stroke among women with type 2 diabetes. Poor control of blood sugar has a stronger effect in diabetic women older than 55 years.     

Increasing prevalence of hypertension in low income residents within Louisiana State University Health Care Services Division Hospital System

BackgroundHypertension risk in local areas may vary from national estimates; however, the data on the prevalence of hypertension in some local areas are limited. We investigate the trend in the prevalence of hypertension in Louisiana from 2000 to 2009.MethodsWe conducted a retrospective study among the subjects aged ≥ 20 years who received medical care from the Louisiana State University Health Care Services Division (LSUHCSD) hospital system during 2000–2009. Hypertensive cases were identified by using ICD-9 codes. The annual hypertension prevalence was calculated as the number of unique hypertensive individuals during the year divided by the number of unique individuals visiting the LSUHCSD hospital during the year.ResultsThe age-standardized prevalence of hypertension in LSUHCSD hospital patients aged ≥ 20 years increased by 49.4% during 2000–2009, from 24.1% in 2000 to 36.0% in 2009. The rise in age-standardized prevalence of hypertension from 2000 to 2009 occurred in both men (from 20.1% to 32.8%) and women (from 26.8 % to 38.3%), and in White (from 20.1% to 33.0%), African (from 27.4% to 37.6%) and other race Americans (from 14.9% to 22.3%). The age-standardized prevalence of hypertension was higher in women than in men, and higher in African Americans than in White and other race Americans.ConclusionThe annual prevalence of hypertension has dramatically increased from 2000 to 2009 in both men and women and in all races of the population served by the LSUHCSD hospitals.     

A quantitative determination of lipid bilayer deposition efficiency using AFM

The efficacy of a number of different methods for depositing a dimyristoylphosphatidylcholine (DMPC) lipid bilayer or DMPC–cholesterol (3 : 1) mixed bilayer onto a silicon substrate has been investigated in a quantitative manner using atomic force microscopy (AFM) image analysis to extract surface coverage. Complementary AFM-IR measurements were used to confirm the presence of the lipids. For the Langmuir–Blodgett/Schaefer deposition method at temperatures below the chain-melting transition temperature (T_m), a large number of bilayer defects resulted when DMPC was deposited from a water subphase. Addition of calcium ions to the trough led to smaller, more frequent defects, whereas addition of cholesterol to the lipid mixture led to a vast improvement in bilayer coverage. Poor coverage was achieved for deposition at temperatures above T_m. Formation of the deposited bilayer from vesicle fusion proved a more reliable method for all systems, with formation of near-complete bilayers within 60 seconds at temperatures above T_m, although this method led to a higher probability of multilayer formation and rougher bilayer surfaces.

The efficacy of different methods for depositing a DMPC or mixed DMPC–cholesterol (3 : 1) lipid bilayer onto a silicon substrate has been investigated in a quantitative manner using atomic force microscopy image analysis to extract surface coverage.     

Maxillonasal dysplasia (Binder's syndrome): a critical review and case study

Binder's syndrome (maxillonasal dysplasia) is a disorder of unknown etiology characterized by nasomaxillary hypoplasia and a 40-50% association of an underdeveloped frontal sinus and cervicospinal abnormalities. The midfacial retrusion is similar to that in chondrodysplasia punctata, resulting in confusion regarding diagnosis. This paper outlines the distinguishing features of Binder's syndrome, the treatment considerations, and presents 24 patients seen and treated. The facial and skeletal characteristics and developmental findings are emphasized to affirm the diagnosis of Binder's syndrome. A familial finding of Binder's features in five patients raises the possibility of a genetic mechanism, a previously undisclosed finding.     

Factors influencing acceptance of influenza vaccination given in an ED

Factors correlating with successful administration of flu vaccine in an emergency department (ED) were examined. Patients 18 years and older were screened for indications for flu immunization. Vaccine was offered to those with indications. Of 3425 patients screened, 1311 had indications, 705 of 1311 agreed to immunization, and 513 of 705 were immunized. Factors related to immunization agreement were comorbidity, interviewer, and being 50 to 64 years old with prior immunization. Immunization factors were month, comorbidity, and not being pregnant. Factors associated with suboptimal acceptance and receipt should be addressed in future efforts.