Disparities in COVID-19 vaccine hesitancy among a diverse community-based sample in Connecticut, United States.

Though vaccination is among our strongest tools to prevent COVID-19 infections, its delivery has proven challenging. At a time when COVID-19 cases were rapidly increasing in the Northeast, we examined the role of sociodemographic factors, social determinants of health (SDOH), and health-related beliefs, including conspiracy theories, in influencing COVID-19 vaccine hesitancy among a diverse sample of Connecticut (United States) residents. Between August and December 2020, utilizing community partners and advertisements via social media, we surveyed communities known to be most impacted by COVID-19. We used descriptive analysis and multivariable logistic regression to examine vaccine hesitancy. Among 252 participants, most were female (69.8%) and under the age of 55 (62.7%). Approximately one-third reported household incomes less than $30,000 per year and 23.5% were non-Hispanic Black and 17.5% were Hispanic/Latinx. While 38.9% of participants were vaccine hesitant, non-Hispanic Black and Hispanic/Latinx participants were more vaccine hesitant (adjusted odds ratio [AOR] = 3.62; 95% CI 1.77, 7.40) compared to non-Hispanic Whites/Others. Additional factors associated with vaccine hesitancy after adjustment for socioeconomic status and barriers related to SDOH included low perceived risk of COVID-19 and not receiving COVID-19 information from medical institutions and community health workers (p < 0.05). Race/ethnicity, perceived risk, sources of health information, and conspiracy beliefs played a significant role in vaccine hesitancy among this diverse sample. Interventions to promote vaccination should include trusted messengers and sources of information, while long term efforts should focus on addressing the social conditions that deter confidence in scientific data, vaccine efficacy, and the healthcare system.

Knowledge of, and beliefs about, access to screening facilities and cervical cancer screening behaviors among low-income women in New Jersey.

Racial/ethnic disparities in cancer outcomes have been well documented. Access to Pap testing may account for some of the variation in the racial and socioeconomic differences in cervical cancer outcomes. Literature exploring perceived access to care as it relates to women of color and low-income women is lacking. The goal of the study was to evaluate and characterize the relationship between what respondents believe about access to free/low-cost screening facilities and screening behaviors among low-income women in New Jersey. We used multivariate logistic regression to investigate belief about access to affordable screening on cancer screening behaviors using data from a cross-sectional study of low-income women in New Jersey (n = 430). Having had a Pap test in the past 3 years was inversely associated with age (OR 0.94, 95% CI 0.92-0.97) and was positively associated with having had insurance in the previous 2 years (OR 32.48. 95% CI 1.04-5.91), higher perceived risk of cervical cancer (OR 2.59, 95% CI 1.29-5.66), and knowing where to go to get a check-up that includes a cancer test (OR 1.97, 95% CI 1.11-3.49). These results suggest that insurance status continues to be a predictor of screening behavior but also that perceived risk awareness of where to go to get cancer screenings in general may influence the likelihood of utilizing screening, which can be important in developing targeted prevention strategies.

Serious adverse events in African-American cancer patients with sickle cell trait and inherited haemoglobinopathies in a SEER-Medicare claims cohort.

African-American (AA) cancer patients have long-experienced worse outcomes compared to non-Hispanic whites (NHW). No studies to date have evaluated the prognostic impact of sickle cell trait (SCT) and other inherited haemoglobinopathies, of which several are disproportionately high in the AA population. In a cohort analysis of treated patients diagnosed with breast or prostate cancer in the linked SEER-Medicare database, the relative risk (RR) for ≥1 serious adverse events (AEs), defined as hospitalisations or emergency department visits, was estimated for 371 AA patients with a haemoglobinopathy (AA+) compared to patients without haemoglobinopathies (17,303 AA-; 144,863 NHW-). AA+ patients had significantly increased risk for ≥1 AEs compared to AA- (RR = 1.19; 95% CI 1.11-1.27) and NHW- (RR = 1.23; 95% CI 1.15-1.31) patients. The magnitude of effect was similar by cancer type, and in analyses of AA+ with SCT only. Our findings suggest a novel hypothesis for disparities in cancer outcomes.

Quality Of Breast Cancer Care In The US Territories: Insights From Medicare.

The quality of breast cancer care among Medicare beneficiaries in the US territories-where federal spending for health care is lower than in the continental US-is unknown. We compared female Medicare beneficiaries who were residents of the US territories and had surgical treatment for breast cancer in 2008-14 to those in the continental US in terms of receipt of recommended breast cancer care (diagnostic needle biopsy and adjuvant radiation therapy [RT] following breast-conserving surgery) and the timeliness (time from needle biopsy to surgery and from surgery to adjuvant RT) of that care. Residents of the US territories were less likely to receive recommended care (24 percent lower odds of receiving diagnostic needle biopsy and 34 percent lower odds of receiving adjuvant RT) and to receive timely care (45 percent lower odds of receiving surgery and 82 percent lower odds of receiving adjuvant RT, both within three months). Further research is needed to identify barriers to the provision of adequate and timely breast cancer care in this unique population.

Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004-2009.

OBJECTIVES: Significant effort has been expended over the past decade to reduce racial disparities in breast cancer care. Whether disparities in receipt of appropriate radiotherapy care for breast cancer persisted despite these efforts is unknown, as is the impact of being eligible for Medicare. We therefore investigated trends in racial differences by age in postbreast lumpectomy radiation therapy (PLRT) from 2004 to 2009. MATERIALS AND METHODS: We analyzed the Surveillance, Epidemiology and End Results registry database for women aged 40 to 85 years who underwent lumpectomy for stage I breast cancer and were eligible for PLRT. We examined variables potentially associated with the receipt of PLRT, including year of diagnosis, race, and examined women separately by age group. RESULTS: Among 67,124 women aged 40 to 85 years undergoing lumpectomy, receipt of PLRT decreased from 80.7% in 2004 to 76.8% by 2009 (P<0.001). There remained a persistent disparity in PLRT among African American women (in 2004, 80.6% white vs. 78.9% African American and in 2009, 77.5% white vs. 72.0% African American). In multivariable logistic regression, African American race (odds ratio [OR], 0.82; 95% confidence interval [CI]. 0.76-0.89) and being diagnosed more recently were associated with lower odds of PLRT (OR for 2009 vs. 2004: 0.74; 95% CI, 0.69-0.79), whereas older women typically covered by public health insurance (aged 65 to 69 y) were more likely to receive PLRT (OR, 1.09; 95% CI, 1.02-1.15). CONCLUSIONS: PLRT decreased by a significant percentage of 3.9% among all women in recent years, and racial disparities in PLRT receipt have persisted. Medicare eligibility increased the likelihood of PLRT receipt.

Socially-assigned race, healthcare discrimination and preventive healthcare services.

BACKGROUND: Race and ethnicity, typically defined as how individuals self-identify, are complex social constructs. Self-identified racial/ethnic minorities are less likely to receive preventive care and more likely to report healthcare discrimination than self-identified non-Hispanic whites. However, beyond self-identification, these outcomes may vary depending on whether racial/ethnic minorities are perceived by others as being minority or white; this perception is referred to as socially-assigned race. PURPOSE: To examine the associations between socially-assigned race and healthcare discrimination and receipt of selected preventive services. METHODS: Cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance System "Reactions to Race" module. Respondents from seven states and the District of Columbia were categorized into 3 groups, defined by a composite of self-identified race/socially-assigned race: Minority/Minority (M/M, n = 6,837), Minority/White (M/W, n = 929), and White/White (W/W, n = 25,913). Respondents were 18 years or older, with 61.7% under age 60; 51.8% of respondents were female. Measures included reported healthcare discrimination and receipt of vaccinations and cancer screenings. RESULTS: Racial/ethnic minorities who reported being socially-assigned as minority (M/M) were more likely to report healthcare discrimination compared with those who reported being socially-assigned as white (M/W) (8.9% vs. 5.0%, p = 0.002). Those reporting being socially-assigned as white (M/W and W/W) had similar rates for past-year influenza (73.1% vs. 74.3%) and pneumococcal (69.3% vs. 58.6%) vaccinations; however, rates were significantly lower among M/M respondents (56.2% and 47.6%, respectively, p-values<0.05). There were no significant differences between the M/M and M/W groups in the receipt of cancer screenings. CONCLUSIONS: Racial/ethnic minorities who reported being socially-assigned as white are more likely to receive preventive vaccinations and less likely to report healthcare discrimination compared with those who are socially-assigned as minority. Socially-assigned race/ethnicity is emerging as an important area for further research in understanding how race/ethnicity influences health outcomes.

Needs assessment of cancer survivors in Connecticut.

INTRODUCTION: There are knowledge gaps regarding the needs of cancer survivors in Connecticut and their utilization of supportive services. METHODS: A convenience sample of cancer survivors residing in Connecticut were invited to complete a self-administered (print or online) needs assessment (English or Spanish). Participants identified commonly occurring problems and completed a modified version of the Supportive Care Needs Survey Short Form (SNCS-SF34) assessing needs across five domains (psychosocial, health systems/information, physical/daily living, patient care /support, and sexuality). RESULTS: The majority of the 1,516 cancer survivors (76.4%) were women, 47.5% had completed high school or some college, 66.1% were diagnosed ≤5 years ago, and 87.7% were non-Hispanic white. The breast was the most common site (47.6%), followed by the prostate, colorectal, lung, and melanoma. With multivariate adjustment, need on the SCNS-SF34 was greatest among women, younger survivors, those diagnosed within the past year, those not free of cancer, and Hispanics/Latinos. We also observed some differences by insurance and education status. In addition, we assessed the prevalence of individual problems, with the most common being weight gain/loss, memory changes, paying for care, communication, and not being told about services. CONCLUSIONS: Overall and domain specific needs in this population of cancer survivors were relatively low, although participants reported a wide range of problems. Greater need was identified among cancer survivors who were female, younger, Hispanic/Latino, and recently diagnosed. IMPLICATIONS FOR CANCER SURVIVORS: These findings can be utilized to target interventions and promote access to available resources for Connecticut cancer survivors.

Area-level socioeconomic position and repeat mammography screening use: results from the 2005 National Health Interview Survey.

BACKGROUND: Despite a considerable number of studies describing the relationship between area-level socioeconomic conditions and mammography screening, definitive conclusions have yet to be drawn. The aim of this study was to examine the relationship between area-level socioeconomic position (SEP) and repeat mammography screening, using nationwide U.S. census SEP data linked to a nationally representative sample of women who participated in the 2005 National Health Interview Survey (NHIS). METHODS: An area-level SEP index using 2000 U.S. census tract data was constructed and categorized into quartiles, including information on unemployment, poverty, housing values, annual family income, education, and occupation. Repeat mammography utilization (dichotomous variable) was defined as having three mammograms over the course of 6 years (24-month interval), which must have included a recent mammogram (in past 2 years). Results were obtained by ordinary multivariable logistic regression for survey data. Women ages 46 to 79 years (n = 7,352) were included in the analysis. RESULTS: In a model adjusted for sociodemographics, health care factors, and known correlates of mammography screening, women living in more disadvantaged areas had lower odds of engaging in repeat mammography than women living in the most advantaged areas [OR comparing quartile 4 (most disadvantaged) to quartile 1 (most advantaged) = 0.63; 95% confidence interval, 0.50-0.80]. CONCLUSION: The results of this nationwide study support the hypothesis that area-level SEP is independently associated with mammography utilization. IMPACT: These findings underscore the importance of addressing area-level social inequalities, if uptake of mammography screening guidelines is to be realized across all social strata.

Neighborhood- and individual-level socioeconomic variation in perceptions of racial discrimination.

OBJECTIVE: In approaching the study of racial discrimination and health, the neighborhood- and individual-level antecedents of perceived discrimination need further exploration. We investigated the relationship between neighborhood- and individual-level socioeconomic position (SEP), neighborhood racial composition, and perceived racial discrimination in a cohort of African-American and White women age 40-79 from Connecticut, USA. DESIGN: The logistic regression analysis included 1249 women (39% African-American and 61% White). Neighborhood-level SEP and racial composition were determined using 1990 census tract information. Individual-level SEP indicators included income, education, and occupation. Perceived racial discrimination was measured as lifetime experience in seven situations. RESULTS: For African-American women, living in the most disadvantaged neighborhoods was associated with fewer reports of racial discrimination (odds ratio (OR) 0.44; 95% confidence interval (CI) 0.26, 0.75), with results attenuated after adjustment for individual-level SEP (OR 0.54, CI: 0.29, 1.03), and additional adjustment for neighborhood racial composition (OR 0.70, CI: 0.30, 1.63). African-American women with 12 years of education or less were less likely to report racial discrimination, compared with women with more than 12 years of education (OR 0.57, CI: 0.33, 0.98 (12 years); OR 0.51, CI: 0.26, 0.99 (less than 12 years)) in the fully adjusted model. For White women, neither neighborhood-level SEP nor individual-level SEP was associated with perceived racial discrimination. CONCLUSION: Individual- and neighborhood-level SEP may be important in understanding how racial discrimination is perceived, reported, processed, and how it may influence health. In order to fully assess the role of racism in future studies, inclusion of additional dimensions of discrimination may be warranted.

Neighborhood-level socioeconomic predictors of nonadherence to mammography screening guidelines.

As neighborhood context is increasingly recognized as an important predictor of health outcomes and health behaviors, this analysis sought to determine the relationship between neighborhood-level socioeconomic status (SES) and regular mammography screening behavior. One thousand four hundred fifty-one women ages 40 to 79 years who obtained an "index" screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998 were enrolled in this prospective study. The logistic regression analysis includes the 1,229 women [484 African-American (39%) and 745 White (61%)] who completed telephone interviews at baseline and follow-up (average 29.4 months later) and for whom the study outcome, nonadherence to age-specific mammography screening guidelines, was ascertained. Neighborhood-level SES was determined using 1990 census tract information. Neighborhood-level SES variables (quartiles) were associated with nonadherence for African-American women [neighborhood-level education and composite socioeconomic position index (SEP Index)] and White women (neighborhood-level crowding and neighborhood-level assets). Using race-specific categorizations reflective of individual-level SES distributions, the SEP Index and neighborhood-level education were associated with nonadherence to mammography screening guidelines for African-American women (marginally significant for White women), independent of individual-level SES and other known predictors of mammography screening use [African-American women: SEP Index odds ratio (OR), 3.55; 95% confidence interval (95% CI), 1.33-9.51; neighborhood-level education OR, 3.21; 95% CI, 1.25-8.26; White women: SEP Index OR, 2.13; 95% CI, 0.97-4.67; neighborhood-level education OR, 2.31; 95% CI, 0.93-5.76]. The results of this analysis underscore the importance of examining neighborhood social context as well as individual factors in the study of mammography screening behavior.

Perceived racial discrimination and nonadherence to screening mammography guidelines: results from the race differences in the screening mammography process study.

The study objective was to determine whether perceived racial discrimination influenced nonadherence to screening mammography guidelines. Enrolled in this prospective study were 1,451 women aged 40-79 years who obtained an "index" screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998. This logistic regression analysis included 1,229 women (484 African American (39%), 745 White (61%)) who completed telephone interviews at baseline and follow-up (on average 29 months later). Perceived racial discrimination was measured as lifetime experience in seven possible situations. Approximately 42% of African-American women and 10% of White women reported lifetime racial discrimination. Perceived racial discrimination was not associated with nonadherence to age-specific mammography screening guidelines in unadjusted or multivariate-adjusted analyses. Although these negative findings may reflect the well-recognized problems associated with measurement of perceived discrimination, it is possible that women who recognize and report racial discrimination develop compensatory characteristics that enable positive health prevention behavior, in spite of their past experiences.