Justice and the racial dimensions of health inequalities: A view from COVID-19.

In this paper, we take up the call to further examine structural injustice in health, and racial inequalities in particular. We examine the many facets of racism: structural, interpersonal and institutional as they appeared in the COVID-19 pandemic in the UK, and emphasize the relevance of their systemic character. We suggest that such inequalities were entirely foreseeable, for their causal mechanisms are deeply ingrained in our social structures. It is by recognizing the conventional, un-extraordinary nature of racism within social systems that we can begin to address socially mediated health inequalities.

COVID-19 diagnosis, vaccination during pregnancy, and adverse pregnancy outcomes of 865,654 women in England and Wales: a population-based cohort study.

Background: The extent to which COVID-19 diagnosis and vaccination during pregnancy are associated with risks of common and rare adverse pregnancy outcomes remains uncertain. We compared the incidence of adverse pregnancy outcomes in women with and without COVID-19 diagnosis and vaccination during pregnancy. Methods: We studied population-scale linked electronic health records for women with singleton pregnancies in England and Wales from 1 August 2019 to 31 December 2021. This time period was divided at 8th December 2020 into pre-vaccination and vaccination roll-out eras. We calculated adjusted hazard ratios (HRs) for common and rare pregnancy outcomes according to the time since COVID-19 diagnosis and vaccination and by pregnancy trimester and COVID-19 variant. Findings: Amongst 865,654 pregnant women, we recorded 60,134 (7%) COVID-19 diagnoses and 182,120 (21%) adverse pregnancy outcomes. COVID-19 diagnosis was associated with a higher risk of gestational diabetes (adjusted HR 1.22, 95% CI 1.18-1.26), gestational hypertension (1.16, 1.10-1.22), pre-eclampsia (1.20, 1.12-1.28), preterm birth (1.63, 1.57-1.69, and 1.68, 1.61-1.75 for spontaneous preterm), very preterm birth (2.04, 1.86-2.23), small for gestational age (1.12, 1.07-1.18), thrombotic venous events (1.85, 1.56-2.20) and stillbirth (only within 14-days since COVID-19 diagnosis, 3.39, 2.23-5.15). HRs were more pronounced in the pre-vaccination era, within 14-days since COVID-19 diagnosis, when COVID-19 diagnosis occurred in the 3rd trimester, and in the original variant era. There was no evidence to suggest COVID-19 vaccination during pregnancy was associated with a higher risk of adverse pregnancy outcomes. Instead, dose 1 of COVID-19 vaccine was associated with lower risks of preterm birth (0.90, 0.86-0.95), very preterm birth (0.84, 0.76-0.94), small for gestational age (0.93, 0.88-0.99), and stillbirth (0.67, 0.49-0.92). Interpretation: Pregnant women with a COVID-19 diagnosis have higher risks of adverse pregnancy outcomes. These findings support recommendations towards high-priority vaccination against COVID-19 in pregnant women. Funding: BHF, ESRC, Forte, HDR-UK, MRC, NIHR and VR.

Firearm injury-a preventable public health issue.

Firearm-related injury is a leading cause of death disproportionately affecting adolescents and young adults across the world, especially in the Americas. Little progress has been made over the past four decades, as inaction and the adoption of ineffective or unevidenced interventions have become commonplace. The COVID-19 pandemic reconfigured health systems towards prevention and harm reduction, sharpened public attention to the burden of preventable deaths, and inspired a fresh ambition of eliminating avertable deaths. In this Viewpoint, we argue that preventing firearm injury should garner bolder action in post-pandemic public health and we present a case for reducing the global burden of firearm injury supported by evidence and international examples. Crucially, we aim to guide policy making in directions that end the cycle of grief, anger, activism, deflection, and inaction and create more peaceful and fairer societies.

Could high heat cooking and food processing promoting neo-formed contaminants partially explain the high prevalence of chronic kidney disease in South Asian populations? A hypothesis.

BACKGROUND AND AIMS: The occurrence of chronic heart and kidney diseases among the South Asian populations has been rising exponentially over the years. Research has been carried out in the past to explain the increased susceptibility with no resultant strong evidence. Various possible causes have been suggested with a previous hypothesis suggestive of high heat cooking techniques being responsible for increased production of neo-formed contaminants such as advanced glycation end products (AGEs) and trans-fatty acids (TFAs) leading to increased chronic heart diseases among the South Asian diaspora (India, Pakistan, Bangladesh, Sri Lanka in South Asia and overseas). The aim of this study proposes the high-heating cooking techniques and subsequent NFCs also to be responsible for the development of chronic kidney ailments among the South Asians. METHODS: Review of the literature was conducted to ascertain the burden of accumulation and actions of AGEs and TFAs on kidney structure and functions. The varied high-heat cooking techniques including reheating of oils, food processing and kinds of food sources and their association with increased NFCs production and kidney damage were explored. RESULTS: Higher NFCs content of AGEs/TFAs in reheated oils at elevated temperatures and TFAs among processed and fast foods of South Asians was associated with elevated diabetic complications and CKDs progression in few animal and human studies but the research on the actual burden of NFCs in the renal tissues of South Asians was lacking. CONCLUSION: We hypothesize the high heat cooked foods generating increased levels of NFCs to be responsible for the preponderance of higher risk of CKDs among South Asians. Scientific exploration of the hypothesis to obtain quantifiable evidence of NFCs is suggested.

Exploring ethnic minority women's experiences of maternity care during the SARS-CoV-2 pandemic: a qualitative study.

OBJECTIVE: To explore the experiences of pregnancy, childbirth, antenatal and postnatal care in women belonging to ethnic minorities and to identify any specific challenges that these women faced during the SARS-CoV-2 pandemic. DESIGN: This was a qualitative study using semistructured interviews of pregnant women or those who were 6 weeks postnatal from Black, Asian and minority ethnic backgrounds. The study included 16 women in a predominantly urban Scottish health board area. RESULTS: The finding are presented in four themes: 'communication', 'interactions with healthcare professionals', 'racism' and 'the pandemic effect'. Each theme had relevant subthemes. 'Communication' encompassed respect, accent bias, language barrier and cultural dissonance; 'interactions with healthcare professionals': continuity of care, empathy, informed decision making and dissonance with other healthcare systems; 'racism' was deemed to be institutional, interpersonal or internalised; and 'the pandemic effect' consisted of isolation, psychological impact and barriers to access of care. CONCLUSIONS: This study provides insight into the specific challenges faced by ethnic minority women in pregnancy, which intersect with the unique problems posed by the ongoing SARS-CoV-2 pandemic to potentially widen existing ethnic disparities in maternal outcomes and experiences of maternity care.

Population perspective comparing COVID-19 to all and common causes of death during the first wave of the pandemic in seven European countries.

OBJECTIVES: Mortality statistics on the COVID-19 pandemic have led to widespread concern and fear. To contextualise these data, we compared mortality related to COVID-19 during the first wave of the pandemic across seven countries in Europe with all and common causes of death, stratifying by age and sex. We also calculated deaths as a proportion of the population by age and sex. STUDY DESIGN: Analysis of population mortality data. METHODS: COVID-19 related mortality and population statistics from seven European countries were extracted: England and Wales, Italy, Germany, Spain, France, Portugal and Netherlands. Available data spanned 14-16 weeks since the first recorded deaths in each country, except Spain, where only comparable stratified data over an 8-week time period was available. The Global Burden of Disease database provided data on all deaths and those from pneumonia, cardiovascular disease combining ischaemic heart disease and stroke, chronic obstructive pulmonary disease, cancer, road traffic accidents and dementia in 2017. RESULTS: Deaths related to COVID-19, while modest overall, varied considerably by age. Deaths as a percentage of all cause deaths during the time period under study ranged from <0.01% in children in Germany, Portugal and Netherlands, to as high as 41.65% for men aged over 80 years in England and Wales. The percentage of the population who died from COVID-19 was less than 0.2% in every age group under the age of 80. In each country, over the age of 80, these proportions were: England and Wales 1.27% males, 0.87% females; Italy 0.6% males, 0.38% females; Germany 0.13% males, 0.09% females; France 0.39% males, 0.2% females; Portugal 0.2% males, 0.15% females; and Netherlands 0.6% males, 0.4% females. CONCLUSIONS: Mortality rates from COVID-19 during the first wave of the pandemic were low including when compared to other common causes of death and are likely to decline further while control measures are maintained, treatments improve and vaccination is instituted. These data may help people to contextualise their risk and for decision-making by policymakers.

The Impact of Educational Attainment on Black Women's Obesity Rate in the United States.

Over the last two decades, Black women have been disproportionately impacted by the obesity epidemic in the USA. According to the Centers for Disease Control and Prevention (CDC), 56.6% of Black women are overweight or obese compared with 44.4% Hispanic and 32.8% of white women. Social scientists and public health researchers have argued that increasing educational attainment would lead to overall improvements in health outcomes. Using the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey, Cycles 1999-2010, I examined how educational attainment impacts Black women's rate of obesity and C-reactive protein levels (N = 2685). Multiple linear regression was used to analyze the association between body mass index (BMI) and educational attainment. C-reactive protein, inflammation response, was used to measure the body's reaction to being exposed to stress. The results demonstrated that educational attainment among Black women does not decrease their risk of being obese or levels of C-reactive protein. This article provides evidence to support a need to increase awareness of health disparities that disproportionately impact Black women.