Place, Race, and Case: Examining Racialized Economic Segregation and COVID-19 in Louisiana.

Early COVID-19 pandemic data suggested racial/ethnic minority and low-income earning people bore the greatest burden of infection. Structural racism, the reinforcement of racial and ethnic discrimination via policy, provides a framework for understanding disparities in health outcomes like COVID-19 infection. Residential racial and economic segregation is one indicator of structural racism. Little attention has been paid to the relationship of infection to relative overall concentrations of risk (i.e., segregation of the most privileged from the most disadvantaged). We used ordinary least squares and geographically weighted regression models to evaluate the relationship between racial and economic segregation, measured by the Index of Concentration at the Extremes, and COVID-19 cases in Louisiana. We found a significant global association between racial segregation and cumulative COVID-19 case rate in Louisiana and variation across the state during the study period. The northwest and central regions exhibited a strong negative relationship indicating greater risk in areas with high concentrations of Black residents. On the other hand, the southeastern part of the state exhibited more neutral or positive relationships indicating greater risk in areas with high concentrations of White residents. Our findings that the relationship between racial segregation and COVID-19 cases varied within a state further support evidence that social and political determinants, not biological, drive racial disparities. Small area measures and measures of polarization provide localized information better suited to tailoring public health policy according to the dynamics of communities at the census tract level, which may lead to better health outcomes.

The COVID-19 pandemic and associated increases in experiences of assault violence among black men with low socioeconomic status living in Louisiana.

Background: The COVID-19 pandemic has had mental health, social, and economic implications among communities with high levels of social disadvantage; this may have impacted community violence rates. The objective of this study was to characterize overall trends in assault and social disadvantage of patients experiencing assault before and during the COVID-19 pandemic. Methods: All trauma activations at a level one trauma center serving the entire southeast Louisiana region were included during March-August pre-COVID (2018-2019) and during COVID (2020). ICD-10 E-codes were used to identify trauma intent (assault vs. other). Assaults in this context are defined as physical injuries caused by an act of violence wherein the perpetrator was suspected or confirmed to have intended harm, injury, or death to the victim. Social disadvantage was assessed using the Area Deprivation Index (ADI). Change in the monthly rate of assault-trauma activations was assessed using negative binomial regression with adjustment for race, gender, and injury intent. The study was reviewed and approved by the Louisiana State University Health Sciences Institutional Review Board. Results: A total of 4,233 trauma activations were included. The majority of activations occurred among men. Assaults increased from 27.5% of all activations pre-Covid to 35.6% during the pandemic. Penetrating trauma similarly increased from 29.5% to 35.7% of all activations. Negative binomial regression demonstrated that in addition to this increase in proportion of assaults relative to all activations, the monthly assault rate also increased by 20% during the pandemic. These increases were driven primarily by increased assaults among Black men. ADI rank did not change between study periods. Conclusions: Health disparities in violence worsened during the pandemic: increased cases of assault occurred disproportionately among Black men, and assaults persisted in occurring primarily among low-ADI communities where burden had been high pre-pandemic. There is a critical need for resources and support to Black men, to mitigate violence and improve racial heath equity.

National health disparities in incisional hernia repair outcomes: An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2012-2014.

BACKGROUND: Incisional hernias represent an acquired defect from failed healing of an abdominal facial incision and are therefore distinct from primary hernias. While literature regarding incisional hernia incidence, risk factors, and treatment are abundant, no study has examined national health disparities specific to incisional hernia repair. The objective of this study was to analyze national health disparities unique to surgical incisional hernia repair procedures. METHODS: Patient data queried from the Healthcare Cost and Utilization Project National Inpatient Sample from 2012 to 2014 using International Classification of Diseases 9th revision procedure codes for incisional hernia repair were used to generate univariate and multivariate models including demographics, socioeconomic factors, admission status, and hospital characteristics. Primary outcomes were nonelective admission status, in-hospital mortality, surgical complications, and extended duration of stay. RESULTS: We estimated that 89,258 incisional hernia repair procedures occurred annually from 2012 to 2014, incurring $6.3 billion in hospital charges. By multivariate analysis, multiple risk factors contribute to significantly increased odds of nonelective repair. These include age over 65, female sex, non-White race, nonprivate insurance, obesity, and increased Charlson comorbidity index. Nonelective incisional hernia repair was strongly correlated with worse outcomes including in-hospital mortality (odds ratio [95% confidence interval] 3.01 [2.51, 3.61]), postoperative complications (odds ratio 1.2 [1.14, 1.25]), and extended duration of stay (odds ratio 2.96 [2.81, 3.12]). After controlling for admission status, other disparities persisted including extended duration of stay for Black individuals (odds ratio 1.21 (1.12, 1.31]). CONCLUSION: Providers should be aware of these significant health disparities in incisional hernia repair status and outcomes especially for elderly, non-White, nonprivate insurance, and obese/comorbid patients. Management strategies that increase access to elective repair and that prevent incisional hernia should be expanded to address these disparities.

Structural racism in the built environment: Segregation and the overconcentration of alcohol outlets.

Structural racism, evidenced in practices like residential racial segregation, has been linked to health inequities. We examined the relationship between an adverse environmental factor (alcohol outlet overconcentration), segregated neighborhoods, and county alcohol policy in Louisiana and Alabama to investigate this link. Multilevel analysis revealed high outlet density associated with segregated counties and predominantly black census tracts in counties with restrictive alcohol policy. This inverse association between policies designed to limit alcohol availability and overconcentration of outlets in black neighborhoods warrants consideration by policymakers given links between outlet density and health inequities. Consideration of these findings in historical context suggests these policies may function as a contemporary actualization of the historical use of alcohol policy to subjugate black people in the South, now over-concentrating instead of prohibiting access.

Health Disparities in Incisional Hernia Presentation : An Analysis of HCUP-NIS Years 2012-2014.

INTRODUCTION: Incisional hernias (IH) are iatrogenically created in 400 000 new patients annually. Without repair, IH-associated complications can result in major illness and death. The health disparities literature suggests that under-represented patients present more frequently with surgical emergencies. The health disparities associated with IH remain relatively unstudied. METHODS: Inpatient admission data were obtained from the Healthcare Cost and Utilization Project National Inpatient Sample for 2012-2014. Patients with IH International Classification of Diseases ninth revision were included. Analyses were completed using survey specific procedures (SAS v.9.4). Type of admission within groups was compared via Rao-Scott chi-square tests. The probability of an elective admission was modeled via SurveyLogistic Procedure. RESULTS: Of 39 296 cases, 38.5% IH admissions were urgent or emergent (nonelective). The proportion of nonelective admission was statistically higher (P < .0001) in patients >65 (40.9%) and females (40.3%). Among insurance types, self-paying patients had the highest proportion of nonelective admissions (64.3%). Racial disparities remained significant after adjusting for age, sex, and insurance. Compared with white patients, the odds of an admission being nonelective were significantly higher for black (odds ratio [OR] [95% CI]: 1.65 [1.53-1.77]], Hispanic (OR [95% CI]: 1.39 [1.28-1.51]), and other (OR [95% CI]: 1.2 [1.06-1.37]) patients. DISCUSSION: These data show that multiple at-risk patient populations are significantly more likely to require urgent admission for IH-related complications. These include older, female, non-white, and uninsured patients. Systematic efforts to ameliorate these disparities should be developed.

Neighborhood disadvantage and racial disparities in colorectal cancer incidence: a population-based study in Louisiana.

PURPOSE: Colorectal cancer (CRC) continues to demonstrate racial disparities in incidence and survival in the United States. This study investigates the role of neighborhood concentrated disadvantage in racial disparities in CRC incidence in Louisiana. METHODS: Louisiana Tumor Registry and U.S. Census data were used to assess the incidence of CRC diagnosed in individuals 35 years and older between 2008 and 2012. Neighborhood concentrated disadvantage index (CDI) was calculated based on the PhenX Toolkit protocol. The incidence of CRC was modeled using multilevel binomial regression with individuals nested within neighborhoods. RESULTS: Our study included 10,198 cases of CRC. Adjusting for age and sex, CRC risk was 28% higher for blacks than whites (risk ratio [RR] = 1.28; 95% confidence interval [CI] = 1.22-1.33). One SD increase in CDI was associated with 14% increase in risk for whites (RR = 1.14; 95% CI = 1.10-1.18) and 5% increase for blacks (RR = 1.05; 95% CI = 1.02-1.09). After controlling for differential effects of CDI by race, racial disparities were not observed in disadvantaged areas. CONCLUSION: CRC incidence increased with neighborhood disadvantage and racial disparities diminished with mounting disadvantage. Our results suggest additional dimensions to racial disparities in CRC outside of neighborhood disadvantage that warrants further research.