Disparities in Incidence of COVID-19 Among Underrepresented Racial/Ethnic Groups in Counties Identified as Hotspots During June 5-18, 2020 - 22 States, February-June 2020.

During January 1, 2020-August 10, 2020, an estimated 5 million cases of coronavirus disease 2019 (COVID-19) were reported in the United States.* Published state and national data indicate that persons of color might be more likely to become infected with SARS-CoV-2, the virus that causes COVID-19, experience more severe COVID-19-associated illness, including that requiring hospitalization, and have higher risk for death from COVID-19 (1-5). CDC examined county-level disparities in COVID-19 cases among underrepresented racial/ethnic groups in counties identified as hotspots, which are defined using algorithmic thresholds related to the number of new cases and the changes in incidence.† Disparities were defined as difference of ≥5% between the proportion of cases and the proportion of the population or a ratio ≥1.5 for the proportion of cases to the proportion of the population for underrepresented racial/ethnic groups in each county. During June 5-18, 205 counties in 33 states were identified as hotspots; among these counties, race was reported for ≥50% of cumulative cases in 79 (38.5%) counties in 22 states; 96.2% of these counties had disparities in COVID-19 cases in one or more underrepresented racial/ethnic groups. Hispanic/Latino (Hispanic) persons were the largest group by population size (3.5 million persons) living in hotspot counties where a disproportionate number of cases among that group was identified, followed by black/African American (black) persons (2 million), American Indian/Alaska Native (AI/AN) persons (61,000), Asian persons (36,000), and Native Hawaiian/other Pacific Islander (NHPI) persons (31,000). Examining county-level data disaggregated by race/ethnicity can help identify health disparities in COVID-19 cases and inform strategies for preventing and slowing SARS-CoV-2 transmission. More complete race/ethnicity data are needed to fully inform public health decision-making. Addressing the pandemic's disproportionate incidence of COVID-19 in communities of color can reduce the community-wide impact of COVID-19 and improve health outcomes.

Trends in Number and Distribution of COVID-19 Hotspot Counties - United States, March 8-July 15, 2020.

The geographic areas in the United States most affected by the coronavirus disease 2019 (COVID-19) pandemic have changed over time. On May 7, 2020, CDC, with other federal agencies, began identifying counties with increasing COVID-19 incidence (hotspots) to better understand transmission dynamics and offer targeted support to health departments in affected communities. Data for January 22-July 15, 2020, were analyzed retrospectively (January 22-May 6) and prospectively (May 7-July 15) to detect hotspot counties. No counties met hotspot criteria during January 22-March 7, 2020. During March 8-July 15, 2020, 818 counties met hotspot criteria for ≥1 day; these counties included 80% of the U.S. population. The daily number of counties meeting hotspot criteria peaked in early April, decreased and stabilized during mid-April-early June, then increased again during late June-early July. The percentage of counties in the South and West Census regions* meeting hotspot criteria increased from 10% and 13%, respectively, during March-April to 28% and 22%, respectively, during June-July. Identification of community transmission as a contributing factor increased over time, whereas identification of outbreaks in long-term care facilities, food processing facilities, correctional facilities, or other workplaces as contributing factors decreased. Identification of hotspot counties and understanding how they change over time can help prioritize and target implementation of U.S. public health response activities.

Surveying Strategies for Hard-to-Survey Populations: Lessons From the Native Hawaiian and Pacific Islander National Health Interview Survey.

Calls for remedies for the persistent scarcity of accurate, reliable, national, disaggregated health statistics on hard-to-survey populations are common, but solutions are rare. Survey strategies used in community and clinical studies of hard-to-survey populations often cannot be, and generally are not, implemented at the national level.This essay presents a set of approaches, for use in combination with traditional survey methods in large-scale surveys of these populations, to overcome challenges in 2 domains: sampling and motivating respondents to participate. The first approach consists of using the American Community Survey as a frame, and the second consists of implementing a multifaceted community engagement effort.We offer lessons learned from implementing these strategies in a national survey, some of which are relevant to all survey planners. We then present evidence of the quality of the resulting data set. If these approaches were used more widely, hard-to-survey populations could become more visible and accurately represented to those responsible for setting national priorities for health research and services.

Mental Health Treatment Among Adults: United States, 2020.

In 2019, 19.2% of adults had received any mental health treatment in the past 12 months, including 15.8% who had taken prescription medication for their mental health and 9.5% who received counseling or therapy from a mental health professional (1). A recent study showed that symptoms of anxiety and depression among adults increased during 2020 (2). This report describes the percentage of U.S. adults who have taken prescription medication for their mental health or have received counseling or therapy from a mental health professional in the past 12 months by select characteristics, based on data from the 2020 National Health Interview Survey (NHIS). Estimates are also presented for any mental health treatment, defined as having taken medication for mental health, received counseling or therapy, or both in the past 12 months.

Health of American Indian and Alaska Native Adults, by Urbanization Level: United States, 2014-2018.

Historically, the American Indian and Alaska Native (AIAN) population in the United States has faced health disparities including greater prevalence of physical and mental health problems and high uninsured rates when compared with the non-AIAN population (1). Almost 80% of the AIAN population resides outside of reservations or land trusts and about 40% reside in rural areas (2). Rural Americans are more likely to die from preventable or selfmanageable conditions (3), and risk factors and health conditions may vary by urbanization level (4). This report examines differences in the percentage of selected health status and conditions by urbanization level between AIAN adults and all U.S. adults.

Regional Variation in Private Dental Coverage and Care Among Dentate Adults Aged 18-64 in the United States, 2014-2017.

Routine dental care can promote oral health (1,2), and those with private dental insurance are more likely to visit a dentist than those with other types of dental coverage or no coverage (3,4). Geographical variation in dental coverage and care among adults under age 65 exists (5,6), as does the availability of dental health professionals (7). This report examines regional variation in dental coverage among dentate adults (i.e., adults who have not lost all permanent teeth) aged 18-64 who had private health insurance in the past year, their utilization of dental care, and unmet dental needs due to cost in the past year.

Vaccination Coverage Among Adults Aged 65 and Over: United States, 2015.

KEY FINDINGS: Data from the National Health Interview Survey ? Among adults aged 65 and over, more than two-thirds had an influenza vaccine in the past 12 months (69.0%). ? More than one in two adults aged 65 and over had a tetanus vaccine in the past 10 years (56.9%). ? More than 6 of 10 adults aged 65 and over had ever had a pneumococcal vaccine (63.6%), while a little more than one-third had ever had a shingles vaccine (34.2%). ? Among adults aged 65 and over, vaccination coverage was highest for non-Hispanic white adults compared with non- Hispanic black and Hispanic adults. ? Vaccination coverage was lowest among poor adults aged 65 and over.

Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care.

BACKGROUND: Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States. This is the first Sustain registry report detailing longitudinal data on CLABSI among HPN patients. OBJECTIVE: To describe CLABSI rates for HPN patients followed in the Sustain registry from 2011-2014. METHODS: Descriptive, χ2, and t tests were used to analyze data from the Sustain registry. RESULTS: Of the 1,046 HPN patients from 29 sites across the United States, 112 (10.7%) experienced 194 CLABSI events during 223,493 days of HPN exposure, for an overall CLABSI rate of 0.87 episodes/1,000 parenteral nutrition-days. Although the majority of patients were female (59%), adult (87%), white (75%), and with private insurance or Medicare (69%), CLABSI episodes per 1,000 parenteral nutrition-days were higher for men (0.69 vs 0.38), children (1.17 vs 0.35), blacks (0.91 vs 0.41), and Medicaid recipients (1.0 vs 0.38 or 0.39). Patients with implanted ports or double-lumen catheters also had more CLABSIs than those with peripherally inserted or central catheters or single-lumen catheters. Staphylococci were the most commonly reported pathogens. These data support findings of smaller studies about CLABSI risk for children and by catheter type and identify new potential risk factors, including gender, race, and insurance type. CONCLUSIONS: Additional studies are needed to determine effective interventions that will reduce HPN-associated CLABSI.