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Black and Hispanic children have a higher likelihood of experiencing neighborhood poverty than white children. This study uses data from the Baby's First Years (BFY) randomized trial to examine whether an unconditional cash transfer causes families to make opportunity moves to better quality neighborhoods. We use Intent to Treat linear regression models to test whether the BFY treatment, of receiving $333/month (vs. $20/month) for three years, leads to moves to neighborhoods of greater childhood opportunity. Overall, we find no relation between the BFY treatment and neighborhood opportunity across time. However, we find effect modification by maternal baseline health. High-cash receipt among mothers with poor health at baseline corresponds with moves to neighborhoods of greater childhood opportunity.
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Recent work finds that upward neighborhood mobility-defined as reductions in neighborhood socioeconomic disadvantage due to moving-may improve birth outcomes. Less work, however, explores whether changes in socioeconomic context differentially impact birth outcomes by maternal race and ethnicity. In the US, mothers of minoritized racial and ethnic identity often experience worse neighborhood conditions and pregnancy outcomes than White mothers. Using a sibling-linked dataset, we examined whether neighborhood mobility corresponds with changes in preterm birth risk among Asian (N = 130,079), Black (N = 50,149), Hispanic (N = 429,938), and White (N = 233,428) mothers who delivered multiple live births in California between 2005 and 2015. We linked residential addresses at each birth to census-derived indices of neighborhood disadvantage and defined levels of neighborhood mobility as moving-induced changes in disadvantage between pregnancies. We mapped neighborhood mobility patterns and fit conditional logistic regression models estimating the odds of preterm birth in the sibling delivered after moving, controlling for the risk of preterm birth in the sibling delivered before moving, by maternal race and ethnicity. Dot density maps highlight racialized patterns of neighborhood mobility and segregation between Black and White mothers. Regression results show that Black and, in some cases, Asian and Hispanic mothers who experienced upward mobility (moves away from neighborhood disadvantage) exhibited reduced odds of preterm birth in the second delivery. Upward mobility did not reduce the odds of preterm birth among White mothers. Findings suggest that policies and programs that enable opportunities for neighborhood mobility may reduce persistent racial and ethnic disparities in adverse birth outcomes.
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On November 4, 2008, Barack Obama was elected the first Black President of the United States. His campaign and electoral win served as a symbol of hope for a more just future, fostering an "Obama effect" that appears associated with improved well-being among non-Hispanic (NH) Black communities. Situating the Obama election within the symbolic empowerment framework, we consider the potentially protective role of the Obama election on NH Black fetal death, an important but understudied measure of perinatal health that has stark racial disparities. Using restricted-use natality files from the National Center for Health Statistics, we proxy fetal death using the male twin rate (number of twins per 1000 male live births). Male twins have a relatively high risk of in utero selection that is sensitive to maternal and environmental stressors, making the twin rate an important marker of fetal death. We then estimate interrupted time-series models to assess the relation between the Obama election and male twin rates among NH Black births across monthly conception cohorts (February 2003-October 2008). Greater-than-expected male twin rates signal less susceptibility to fetal loss. Results indicate a 4.5% higher male twin rate among all NH Black cohorts exposed in utero to the Obama election, after accounting for historical and NH white trends (p < 0.005). The greater-than-expected rates concentrated among births conceived in the months preceding Obama's nomination at the Democratic National Convention and Obama's presidential win. These results suggest a salutary perinatal response to election events that likely reduced NH Black fetal loss. They also indicate the possibility that sociopolitical shifts can mitigate persisting NH Black-NH white disparities in perinatal health.
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BACKGROUND: Mental, neurological, and substance abuse (MNS) disorders describe a range of conditions that affect the brain and cause distress or functional impairment. In the Middle East and North Africa (MENA), MNS disorders make up 10.88 percent of the burden of disease as measured in disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) is one of the main providers of mental health services and one of the largest contributors to mental health research in the region. Within the past decade, mental health resources and services has increased. METHODS: We employ a needs-based workforce estimate as a planning exercise to arrive at the total number of psychiatrists, nurses, and psychosocial care providers needed to meet the epidemiological need of mental health conditions of the population of KSA. Estimates for a potential mental health workforce gap were calculated using five steps: Step 1-Quantify target population for priority mental health conditions. Step 2-Identify number of expected cases per year. Step 3-Set target service coverage for each condition. Step 4-Estimate cost-effective health care service resource utilization for each condition. Step 5-Estimate service resources needed for each condition. RESULTS: The planning exercise indicates an epidemiologic need for a total of 17,100 full-time-equivalent (FTE) health care providers to treat priority MNS disorders. KSA appears to have a need-based shortage of 10,400 health workers to treat mental disorders. A total of 100 psychiatrists, 5700 nurses, and 4500 psychosocial care providers would be additionally needed (that is, above and beyond current levels) to address the priority mental health conditions. The shortfall is particularly severe for nurses and psychosocial workers who make up 98.9 percent of the shortfall. This shortage is substantial when compared to other high-income countries. Overall, the workforce needed to treat MNS conditions translates to 49.2 health workers per 100,000 population. CONCLUSION: Challenges to addressing the shortfall are Saudi specific which includes awareness of cultural customs and norms in the medical setting. These challenges are compounded by the lack of Saudi nationals in the mental health workforce. Saudi nationals make up 29.5 percent of the physician workforce and 38.8 percent of the nursing workforce. Policymakers and planners supplement this shortfall with non-Saudi providers, who must be mindful of Saudi-specific cultural considerations. Potential solutions to reducing the shortfall of mental health care workers includes nurse task shifting and training of general practitioners to screen for, and treat, a subset of MNS disorders.
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Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde , Transtornos Mentais , Serviços de Saúde Mental , Humanos , Arábia Saudita , Transtornos Mentais/terapia , Psiquiatria , Enfermeiras e Enfermeiros/provisão & distribuição , Análise Custo-Benefício , Recursos Humanos , Recursos em Saúde/provisão & distribuição , Pessoal de Saúde/psicologiaRESUMO
Epidemiologists have long argued that side effects of the stress response include preterm birth. Research reports that fear of lethal infection stressed pregnant persons at the outset of the COVID-19 pandemic and that "shutdowns" and "social distancing" impeded access to social support and prenatal care. The decline in preterm births in high-income countries, including the United States (US), during the early months of the pandemic therefore poses a paradox for science. Explanations of this "pandemic preterm paradox" remain untested. We apply time-series modeling to data describing 80 monthly conception cohorts begun in the US from July 2013 through February 2020 to determine which of 3 explanations most parsimoniously explains the paradox. We infer that "prior loss," or the argument that an increase in spontaneous abortions and stillbirths depleted the population of fetuses at risk of preterm birth, best explains data currently available. We describe the implications of these results for public health practice.
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BACKGROUND: Structurally racist systems, ideologies and processes generate and reinforce inequities among minoritised racial/ethnic groups. Prior cross-sectional literature finds that place-based structural racism, such as the Index of Concentration at the Extremes (ICE), correlates with higher infant morbidity and mortality. We move beyond cross-sectional approaches and examine whether a decline in place-based structural racism over time coincides with a reduced risk of preterm birth across the USA. METHODS: We used as the outcome count of preterm births overall and among non-Hispanic (NH) black and NH white populations across three epochs (1998-2002, 2006-2010, 2014-2018) in 1160 US counties. For our measure of structural racism, we used ICE race/income county measures from the US Census Bureau. County-level fixed effects Poisson models include a population offset (number of live births) and adjust for epoch indicators, per cent poverty and mean maternal age within counties. RESULTS: An SD increase in ICE (0.11) over time corresponds with a 0.6% reduced risk of preterm birth overall (incidence rate ratio (IRR): 0.994, 95% CI 0.990, 0.998), a 0.6% decrease in preterm risk among NH black births (IRR: 0.994, 95% CI 0.989, 0.999) and a 0.4% decrease among NH white births (IRR: 0.996, 95% CI 0.992, 0.999). CONCLUSIONS: Movement away from county-level concentrated NH black poverty preceded reductions in preterm risk, especially among NH black populations. Our longitudinal design strengthens inference that place-based reductions in structural racism may improve perinatal health. These improvements, however, do not appear sufficient to redress large disparities.
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Nascimento Prematuro , Humanos , Nascimento Prematuro/etnologia , Nascimento Prematuro/epidemiologia , Feminino , Estados Unidos/epidemiologia , Gravidez , Negro ou Afro-Americano/estatística & dados numéricos , População Branca/estatística & dados numéricos , Recém-Nascido , Adulto , Estudos Transversais , Racismo , Racismo Sistêmico , Disparidades nos Níveis de SaúdeRESUMO
BACKGROUND: In the US, non-Hispanic (NH) Black birthing persons show a two-fold greater risk of fetal death relative to NH white birthing persons. Since males more than females show a greater risk of fetal death, such loss in utero may affect the sex composition of live births born preterm (PTB; <37 weeks gestational age). We examine US birth data from 1995 to 2019 to determine whether the ratio of male to female preterm (i.e., PTB sex ratios) among NH Black births falls below that of NH whites and Hispanics. METHODS: We acquired data on all live births in the US from January 1995 to December 2019. We arrayed 63 million live births into 293 "conception cohort" months of which 2,475,928 NH Black, 5,746,953 NH white, and 2,511,450 Hispanic infants were PTB. We used linear regression methods to identify trend and seasonal patterns in PTB sex ratios. We also examined subgroup differences in PTB sex ratios (e.g., advanced maternal ages, twin gestations, and narrower gestational age ranges). RESULTS: The mean PTB sex ratio for NH Black births over the entire test period (1.06, 95% Confidence Interval [CI]: 1.05, 1.07) is much lower than that for NH white births (1.18, 95% CI: 1.17, 1.19). NH Black PTB sex ratios are especially low for twins and for births to mothers 35 years or older. Only NH white PTB sex ratios show a trend over the test period. CONCLUSIONS: Analysis of over 10 million PTBs reveals a persistently low male PTB frequency among NH Black conception cohorts relative to NH white cohorts. Low PTB sex ratios among NH Black births concentrate among subgroups that show an elevated risk of fetal death. PTB sex ratios may serve as an indicator of racial/ethnic and subgroup differences in fetal death, especially among male gestations.
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Nascimento Prematuro , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , População Negra , Etnicidade , Morte Fetal , Hispânico ou Latino , Nascimento Prematuro/epidemiologia , Negro ou Afro-Americano , Estados Unidos , Brancos , Gravidez , AdultoRESUMO
BACKGROUND: Societies under duress may selectively increase the reporting of disordered persons from vulnerable communities to law enforcement. Mentally ill African American males reportedly are perceived as more threatening relative to females and other race/ethnicities. We examine whether law enforcement/court order-requested involuntary psychiatric hospitalizations increased among African American males shortly after ambient economic decline-a widely characterized population stressor. METHODS: We identified psychiatric inpatient admissions requested by law enforcement/court orders from 2006 to 2011 across four US states (Arizona, California, New York, North Carolina). Our analytic sample comprises 13.1 million psychiatric inpatient admissions across 95 counties over 72 months. We operationalized exposure to economic downturns as percent change in monthly employment in a metropolitan statistical area (MSA). We used zero inflated negative binomial and linear fixed effects regression analyses to examine psychiatric inpatient admissions requested by law enforcement/court orders following regional employment decline over a time period that includes the Great Recession of 2008. FINDINGS: Declines in monthly employment precede by one month a 6% increase in psychiatric hospitalizations requested by law enforcement/court order among African American males (p < 0.05), but not among other race/sex groups. Estimates amount to an excess of 2554 involuntary admissions among African American males statistically attributable to aggregate-level employment decline. CONCLUSIONS: Economic downturns may increase involuntary psychiatric commitments among African American males. Our findings underscore the unique vulnerability of racial/ethnic minorities during economic contractions.
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Much literature in the US documents an intergenerational transmission of birthing person and perinatal morbidity in socioeconomically disadvantaged groups. A separate line of work indicates that family cash transfers may improve life chances of low-income families well into adulthood. By exploiting a quasi-random natural experiment of a large family cash transfer among a southeastern American Indian (AI) tribe in rural North Carolina, we examine whether a "perturbation" in socioeconomic status during childhood improves birthing person/perinatal outcomes when they become parents themselves. We acquired birth records on 6805 AI and non-AI infants born from 1995 to 2018. Regression methods to examine effect modification tested whether the birthing person's American Indian (AI) status and exposure to the family cash transfer during their childhood years corresponds with improvements in birthing person and perinatal outcomes. Findings show an increase in age at childbearing (coef: 0.15 years, 95% confidence interval [CI]: 0.05, 0.25) and a decrease in pre-pregnancy body mass index (BMI; coef: -0.42, 95% CI: -0.76, -0.09) with increased duration of cash transfer exposure during childhood. The odds of large-for-gestational age at delivery, as well as mean infant birthweight, is also reduced among AI births whose birthing person had relatively longer duration of exposure to the cash transfer. We, however, observe no relation with other birthing person/perinatal outcomes (e.g., tobacco use during pregnancy, preterm birth). In this rural AI population, cash transfers in one generation correspond with improved birthing person and infant health in the next generation.
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PURPOSE: A recent meta-analysis finds reduced risk of preterm birth (PTB; <37 weeks gestational age) during the initial stage of COVID-19 in which infection rates remained relatively low but many societies imposed restrictions on movement. None of this work, however, examines sex-specific responses despite much literature on other ambient "shocks" which would predict male sensitivity. We use a conception cohort approach to explore potential sex-specific PTB responses in France, a country which imposed a lockdown in Spring 2020. METHODS: We applied interrupted time series methods using national data in France for 207 weeks among 1403,284 males and 1341,359 females conceived from 19 Jan 2016 to 6 Jan 2020. RESULTS: For males in utero, the 1st COVID-19 societal lockdown corresponds with a - 0.60 per 100 conception reduction in PTB cases per week, for 12 consecutive weeks (95% confidence interval [CI]: -.36, -.84). For females in utero, the PTB reduction is smaller (-0.40 reduction per 100 conceptions, for 10 consecutive weeks, 95% CI: -.15, -.61). A formal test of sex differences in the PTB response indicates a stronger reduction in male (vs. female) PTB during the lockdown (p = .001). CONCLUSIONS: Explanations for the counterintuitive reduction in PTB during COVID-19 among cohorts in utero during Spring 2020 should consider mechanisms that disproportionately affect males.
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COVID-19 , Nascimento Prematuro , Recém-Nascido , Feminino , Masculino , Humanos , Nascimento Prematuro/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Idade Gestacional , França/epidemiologiaRESUMO
Prior research based on Swedish data suggests that collective optimism, as measured by monthly incidence of suicides, correlates inversely with selection in utero against male twins in a population. We test this finding in the US, which reports the highest suicide rate of all high-income countries, and examine whether monthly changes in overall suicides precede changes in the ratio of male twin to male singleton live births. Consistent with prior work, we also examine as a key independent variable, suicides among women aged 15-49 years. We retrieved monthly data on suicides and the ratio of male twin to singleton live births from CDC WONDER, 2003 to 2019, and applied Box-Jenkins iterative time-series routines to detect and remove autocorrelation from both series. Results indicate that a 1% increase in monthly change in overall suicides precedes a 0.005 unit decline in male twin live births ratio 6 months later (coefficient = -.005, p value = .004). Results remain robust to use of suicides among reproductive-aged women as the independent variable (coefficient = -.0012, p value = .014). Our study lends external validity to prior research and supports the notion that a decline in collective optimism corresponds with greater selection in utero.
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Introduction: The 2019 outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) is believed to have been caused by vitamin E acetate, an additive used in some cannabis vaporizer products. Previous studies have primarily focused on changes in sales of electronic nicotine delivery systems following the initial advisory issued by the Centers for Disease Control (CDC) on August 17, 2019. The present study is intended to examine variation by age groups in sales of regulated cannabis vape products in the state of California before, during, and after the outbreak. Methods: Weekly sales revenue of cannabis vape products (from January 1, 2018, to December 31, 2020) was obtained from a sample of recreational cannabis retailers licensed in California. An interrupted time series analysis, using AutoRegressive, Integrated, Moving Average methods, was employed to estimate changes in the sales and market share of cannabis vape products in the weeks following the CDC advisory. Results: The total volume of regulated cannabis vape product sales increased substantially over the 3-year study period (2018-2020). Sales and market share of cannabis vape products, however, declined in both young and older adults immediately following the advisory, rebounding to pre-EVALI levels only for the young adults. For sales, the potential EVALI effect following the CDC's advisory equates to an 8.0% and 2.2% decline below expected levels in the older and young adults, respectively. Conclusions: The differential age effect on sales may reflect concerns regarding health effects of cannabis vaping products and greater awareness of the outbreak among older adults. Findings highlight the importance of informing consumers about health risks associated with using cannabis vape products acquired from regulated versus illicit sources.
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BACKGROUND: Globally, HIV, TB and malaria account for an estimated three million deaths annually. The Global Fund partnered with the World Health Organization to assist countries with health workforce planning in these areas through the development of an integrated health workforce investment impact tool. Our study illustrates the development of a user-friendly tool (with two MS Excel calculator subcomponents) that computes associations between human resources for health (HRH) investment inputs and reduced morbidity and mortality from HIV, TB, and malaria via increased coverage of effective treatment services. METHODS: We retrieved from the peer-reviewed literature quantitative estimates of the relation among HRH inputs and HRH employment and productivity. We converted these values to additional full-time-equivalent doctors, nurses and midwives (DNMs). We used log-linear regression to estimate the relation between DNMs and treatment service coverage outcomes for HIV, TB, and malaria. We then retrieved treatment effectiveness parameters from the literature to calculate lives saved due to expanded treatment coverage for HIV, TB, and malaria. After integrating these estimates into the tool, we piloted it in four countries. RESULTS: In most countries with a considerable burden of HIV, TB, and malaria, the health workforce investments include a mix of pre-service education, full remuneration of new hires, various forms of incentives and in-service training. These investments were associated with elevated HIV, TB and malaria treatment service coverage and additional lives saved. The country case studies we developed in addition, indicate the feasibility and utility of the tool for a variety of international and local actors interested in HRH planning. CONCLUSIONS: The modelled estimates developed for illustrative purposes and tested through country case studies suggest that HRH investments result in lives saved across HIV, TB, and malaria. Furthermore, findings show that attainment of high targets of specific treatment coverage indicators would require a substantially greater health workforce than what is currently available in most LMICs. The open access tool can assist with future HRH planning efforts, particularly in LMICs.
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Infecções por HIV , Malária , Humanos , Mão de Obra em Saúde , Recursos Humanos , Malária/terapia , Avaliação de Resultados em Cuidados de Saúde , Infecções por HIV/terapiaRESUMO
Primary care providers (PCPs) are increasingly called upon to screen for and treat depression. However, PCPs often lack the training to diagnose and treat depression. We designed an innovative 12-month evidence and mentorship-based primary care psychiatric training program entitled the University of California, Irvine (UCI) School of Medicine Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship and examined whether this training impacted clinician prescription rates for antidepressants. We retrieved information on 18,844 patients and 192 PCPs from a publicly insured health program in Southern California receiving care between 2017 and 2021. Of the 192 PCPs, 42 received TNT training and 150 did not. We considered a patient as exposed to the provider's TNT treatment if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of antidepressant prescriptions per patient, per quarter-year as the dependent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification. After PCPs completed TNT training, "exposed" patients received 0.154 more antidepressant prescriptions per quarter-year relative to expected levels (p < 0.01). Clustering of standard errors by provider characteristics reduced precision of the estimate (p < 0.10) but the direction and magnitude of the results were unchanged. Early results from the UCI TNT PCP Fellowship demonstrate enhanced antidepressant prescription behavior in PCPs who have undergone TNT training. A novel, and relatively low-cost, clinician training program holds the potential to empower PCPs to optimally deliver depression treatment.
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Atenção Primária à Saúde , Psiquiatria , Humanos , Antidepressivos/uso terapêutico , Prescrições , Análise por ConglomeradosRESUMO
Importance: Infants and pregnant people in the US fare worse on almost all health measures compared with those in peer nations. Families in the US are more likely to live in poverty and have a less generous social safety net, which has generated debate over the contribution of economic conditions to this disparity. Objective: To assess the association between temporary increases in income during pregnancy through the 2021 expanded Child Tax Credit (CTC) and birth outcomes. Design, Setting, and Participants: This cross-sectional study applied a comparison-population, interrupted time series design to data from US birth certificates (January 1, 2014, through December 31, 2021) to test whether the log odds of low birth weight (LBW) among monthly cohorts of births exposed to the CTC would coincide with a decreased incidence of LBW. All singleton live births to US residents aged 15 to 49 years with available data were included. Exposure: Monthly birth cohorts exposed to the CTC were defined as those born to parous people during the CTC advance payment period from July through December 2021. Main Outcomes and Measures: The main outcome was the natural logarithm of the odds of LBW (<2500 g) among monthly birth cohorts. Results: Among included births (n = 28â¯866â¯466), 61.2% were to parous people, the majority were to people aged 20 to 39 years (91.7%), and 6.5% were born LBW. The odds of LBW increased above expected values in 5 of the 6 months of the CTC payments (range of increases, 3.3%-5.4% across the 5 months). The outlier-adjusted odds of LBW increased, on average, by 4.2% (95% CI, 2.7%-5.7%) among the monthly birth cohorts exposed to the CTC. Conclusions and Relevance: This study found that the odds of LBW among birth cohorts exposed to the CTC increased above expected values in 5 of the 6 months of the CTC advance payments. Additional research is needed to evaluate rival explanations for this increase in LBW among births exposed to the CTC payments.
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Recém-Nascido de Baixo Peso , Nascido Vivo , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Transversais , Renda , Pobreza , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-IdadeRESUMO
Background and objectives: Selection in utero predicts that population stressors raise the standard for how quickly fetuses must grow to avoid spontaneous abortion. Tests of this prediction must use indirect indicators of fetal loss in birth cohorts because vital statistics systems typically register fetal deaths at the 20th week of gestation or later, well after most have occurred. We argue that tests of selection in utero would make greater progress if researchers adopted an indicator of selection against slow-growing fetuses that followed from theory, allowed sex-specific tests and used readily available data. We propose such an indicator and assess its validity as a dependent variable by comparing its values among monthly birth cohorts before, and during, the first 10 months of the COVID-19 pandemic in Sweden. Methodology: We apply Box-Jenkins methods to 50 pre-pandemic birth cohorts (i.e., December 2016 through January 2020) and use the resulting transfer functions to predict counterfactual values in our suggested indicator for selection for ten subsequent birth cohorts beginning in February 2020. We then plot all 60 residual values as well as their 95% detection interval. If birth cohorts in gestation at the onset of the pandemic lost more slow-growing fetuses than expected from history, more than one of the last 10 (i.e. pandemic-exposed) residuals would fall below the detection interval. Results: Four of the last 10 residuals of our indicator for males and for females fell below the 95% detection interval. Conclusions and implications: Consistent with selection in utero, Swedish birth cohorts in gestation at the outset of the COVID-19 pandemic included fewer than expected infants who grew slowly in utero.
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On January 6, 2021, rioters stormed the US Capitol to overturn the Congressional certification of Joseph Biden as the 46th president of the United States. In previous work, the symbolic dis/empowerment framework, as a result of sociopolitical context, has influenced health outcomes in certain sub-populations. We examine whether the Capitol Riot corresponds with an increase in mental health symptoms and explore whether this relation differs by individual political party affiliation and/or state electoral college victory. We utilize the Understanding America Study, a nationally representative panel of adults, between March 10, 2020-July 11, 2021. Using fixed effects linear regression, we find a modest increase above expected levels in mental health symptoms immediately following the Capitol Riot. This result holds for Democrats overall, Democrats in Biden states, and when restricting analyses to only states that voted for Biden (or separately, for Trump). Democrats show the greatest increase of mental health symptoms following the Capital Riot, supporting the symbolic dis/empowerment framework as well as notions of political polarization and allegiance. Social and political events of national importance may adversely affect mental health of specific subpopulations.
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Transtornos Mentais , Saúde Mental , Adulto , Humanos , Estados Unidos/epidemiologia , Política , UniversidadesRESUMO
Emergency department (ED) visits for conditions unrelated to the Coronavirus Disease 2019 (COVID-19) pandemic decreased during the early pandemic, raising concerns about critically ill patients forgoing care and increasing their risk of adverse outcomes. It is unclear if Hispanic and Black adults, who have a high prevalence of chronic conditions, sought medical assistance for acute emergencies during this time. This study used 2018-2020 ED visit data from the largest safety net hospital in Los Angeles County to estimate ED visit differences for cardiac emergencies, diabetic complications, and strokes, during the first societal lockdown among Black and Hispanic patients using time series analyses. Emergency department visits were lower than the expected levels during the first societal lockdown. However, after the lockdown ended, Black patients experienced a rebound in ED visits while visits for Hispanics remained depressed. Future research could identify barriers Hispanics experienced that contributed to prolonged ED avoidance.
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COVID-19 , Etnicidade , Adulto , Humanos , Pandemias , Emergências , Controle de Doenças Transmissíveis , Serviço Hospitalar de EmergênciaRESUMO
PUBLIC HEALTH IMPLICATIONS: Under global warming scenarios, heat waves of this magnitude will become much more common. Adaptation and planning efforts are needed to protect residents of the historically temperate Pacific Northwest for a range of health outcomes. (Am J Public Health. 2023;113(6):657-660. https://doi.org/10.2105/AJPH.2023.307269).