Variation in Reporting of the Race and Ethnicity of COVID-19 Cases and Deaths Across US States: April 12, 2020, and November 9, 2020.

Despite growing evidence that COVID-19 is disproportionately affecting communities of color, state-reported racial/ethnic data are insufficient to measure the true impact.We found that between April 12, 2020, and November 9, 2020, the number of US states reporting COVID-19 confirmed cases by race and ethnicity increased from 25 to 50 and 15 to 46, respectively. However, the percentage of confirmed cases reported with missing race remained high at both time points (29% on April 12; 23% on November 9). Our analysis demonstrates improvements in reporting race/ethnicity related to COVID-19 cases and deaths and highlights significant problems with the quality and contextualization of the data being reported.We discuss challenges for improving race/ethnicity data collection and reporting, along with opportunities to advance health equity through more robust data collection and contextualization. To mitigate the impact of COVID-19 on racial/ethnic minorities, accurate and high-quality demographic data are needed and should be analyzed in the context of the social and political determinants of health.

Population-Level Disparities in COVID-19: Measuring the Independent Association of the Proportion of Black Population on COVID-19 Cases and Deaths in US Counties.

CONTEXT: There is a need to understand population race and ethnicity disparities in the context of sociodemographic risk factors in the US experience of the COVID-19 pandemic. OBJECTIVE: Determine the association between county-level proportion of non-Hispanic Black (NHB) on county COVID-19 case and death rates and observe how this association was influenced by county sociodemographic and health care infrastructure characteristics. DESIGN AND SETTING: This was an ecologic analysis of US counties as of September 20, 2020, that employed stepwise construction of linear and negative binomial regression models. The primary independent variable was the proportion of NHB population in the county. Covariates included county demographic composition, proportion uninsured, proportion living in crowded households, proportion living in poverty, population density, state testing rate, Primary Care Health Professional Shortage Area status, and hospital beds per 1000 population. MAIN OUTCOME MEASURES: Outcomes were exponentiated COVID-19 cases per 100 000 population and COVID-19 deaths per 100 000 population. We produced county-level maps of the measures of interest. RESULTS: In total, 3044 of 3142 US counties were included. Bivariate relationships between the proportion of NHB in a county and county COVID-19 case (Exp ß = 1.026; 95% confidence interval [CI], 1.024-1.028; P < .001) and death rates (rate ratio [RR] = 1.032; 95% CI, 1.029-1.035; P < .001) were not attenuated in fully adjusted models. The adjusted association between the proportion of NHB population in a county and county COVID-19 case was Exp ß = 1.025 (95% CI, 1.023-1.027; P < .001) and the association with county death rates was RR = 1.034 (95% CI, 1.031-1.038; P < .001). CONCLUSIONS: The proportion of NHB people in a county was positively associated with county COVID-19 case and death rates and did not change in models that accounted for other socioecologic and health care infrastructure characteristics that have been hypothesized to account for the disproportionate impact of COVID-19 on racial and ethnic minority populations. Results can inform efforts to mitigate the impact of structural racism of COVID-19.

A High Level of Patient Activation Is Observed But Unrelated to Glycemic Control Among Adults With Type 2 Diabetes.

OBJECTIVE: To measure patient activation and its relationship to glycemic control among adults with type 2 diabetes who had not participated in a formal diabetes self-management education program as a baseline assessment for tailoring diabetes education in a primary care setting. RESEARCH DESIGN AND METHODS: Patient activation was assessed in a stratified, cross-sectional study of adults with controlled (n = 21) and uncontrolled (n = 27) type 2 diabetes, who were receiving primary care at a unique family practice center of Baylor Health Care System in Dallas, Tex. RESULTS: The mean patient activation was 66.0 (95% confidence interval [CI] 60.8-71.2) among patients with uncontrolled diabetes and 63.7 (55.9-71.5) among those with controlled diabetes (P = 0.607). A significant association was observed between the self-management behavior score and activation among patients whose glycemia was under control (ρ = 0.73, P = 0.01) as well as among patients with uncontrolled glycemia (ρ = 0.48, P < 0.001). CONCLUSIONS: Although activation is correlated with self-management and may be important in tailored patient-centered approaches to improving diabetes care outcomes, the highest stage of activation may be necessary to achieve glycemic control. These findings reinforce the importance of conducting prerequisite needs assessments so diabetes educators are able to tailor their educational interventions to individual patients' needs and readiness to take action.

Explaining Poor Medication Adherence among Adults with Type 2 Diabetes in an Urban Community Health Center.

Nonadherence to diabetes medication is a common and costly problem, significantly precluding the evidence-based benefits of diabetes care. Nonadherence is also a poorly understood multifactorial behavior, particularly among African Americans with type 2 diabetes receiving care in under-resourced primary care settings. We investigated several known or suspected individual-level factors influencing diabetes medication adherence among a predominantly African American group of adults with diabetes at a local community health center. Overall diabetes medication adherence was observed to be surprisingly low at 23% (95% confidence interval (CI) = 19%-26%) and did not differ by medication type (p=.435). Common sociodemographic factors were poor predictors of adherence. However, self-perceived health and presence of comorbid conditions were significant. The strongest independent predictors of diabetes medication adherence in this population were a heart attack and having maintained a desired level of glycemic control, indicating the importance of specific comorbidities and motivation for self-care in tailoring interventions to improve adherence.

Total antihypertensive therapeutic intensity score and its relationship to blood pressure reduction.

Predicting blood pressure (BP) response to antihypertensive therapy is challenging. The therapeutic intensity score (TIS) is a summary measure that accounts for the number of medications and the relative doses a patient received, but its relationship to BP change and its utility as a method to project dosing equivalence has not been reported. We conducted a prospective, single center, randomized controlled trial to compare the effects of Joint National Committee (JNC) 7 compliant treatment with more intensive (<120/80 mm Hg) BP goals on left ventricular structure and function in hypertensive patients with echocardiographically determined subclinical heart disease who were treated over a 12-month period. For this preplanned subanalysis, we sought to compare changes in BP over time with changes in TIS. Antihypertensive therapy was open label. TIS and BP were determined at 3-month intervals with titration of medication doses as needed to achieve targeted BP. Mixed linear models defined antihypertensive medication TIS as an independent variable and change in systolic BP as an outcome measure, while controlling for gender, age, baseline BP, and treatment group. A total of 123 patients (mean age 49.4 ± 8.2 years; 66% female; 95.1% African-American) were enrolled and 88 completed the protocol. For each single point increase in total antihypertensive TIS, a 14.5 (95% confidence interval: 11.5, 17.4) mm Hg decrease in systolic BP was noted (15.5 [95% confidence interval: 13.0, 18.0] mm Hg for those who completed the trial). Total TIS is a viable indicator of the anticipated BP-lowering effect associated with antihypertensive therapy.