ABSTRACT
Using COVID-19 Case Surveillance Public Use Data by the Centers for Disease Control and Prevention, we estimate monthly age-adjusted case fatality rates (CFR) for four major groups: non-Hispanic (NH) whites, NH Blacks, NH Asians, and Hispanics. Available data show that CFRs across race/ethnic groups have become more equal over time. Nevertheless, racial and ethnic disparities persist. NH whites consistently experience lower CFRs; NH Blacks generally experience higher case fatality among younger patients; and NH Asians generally experience higher case fatality among older patients. Age-adjusted CFRs reveal dramatically different racial and ethnic disparities that are hidden by crude CFRs. Such adjustment is imperative for understanding COVID-19s toll.
ABSTRACT
ImportanceCOVID-19 racial disparities have gained significant attention yet little is known about how age distributions obscure racial-ethnic disparities in COVID-19 case fatality ratios (CFR). ObjectiveWe filled this gap by assessing relevant data availability and quality across states, and in states with available data, investigating how racial-ethnic disparities in CFR changed after age adjustment. Design/Setting/Participants/ExposureWe conducted a landscape analysis as of July 1st, 2020 and developed a grading system to assess COVID-19 case and death data by age and race in 50 states and DC. In states where age- and race-specific data were available, we applied direct age standardization to compare CFR across race-ethnicities. We developed an online dashboard to automatically and continuously update our results. Main Outcome and MeasureOur main outcome was CFR (deaths per 100 confirmed cases). We examined CFR by age and race-ethnicities. ResultsWe found substantial variations in disaggregating and reporting case and death data across states. Only three states, California, Illinois and Ohio, had sufficient age- and race-ethnicity-disaggregation to allow the investigation of racial-ethnic disparities in CFR while controlling for age. In total, we analyzed 391,991confirmed cases and 17,612 confirmed deaths. The crude CFRs varied from, e.g. 7.35% among Non-Hispanic (NH) White population to 1.39% among Hispanic population in Ohio. After age standardization, racial-ethnic differences in CFR narrowed, e.g. from 5.28% among NH White population to 3.79% among NH Asian population in Ohio, or an over one-fold difference. In addition, the ranking of race-ethnic-specific CFRs changed after age standardization. NH White population had the leading crude CFRs whereas NH Black and NH Asian population had the leading and second leading age-adjusted CFRs respectively in two of the three states. Hispanic populations age-adjusted CFR were substantially higher than the crude. Sensitivity analysis did not change these results qualitatively. Conclusions and RelevanceThe availability and quality of age- and race-ethnic-specific COVID-19 case and death data varied greatly across states. Age distributions in confirmed cases obscured racial-ethnic disparities in COVID-19 CFR. Age standardization narrows racial-ethnic disparities and changes ranking. Public COVID-19 data availability, quality, and harmonization need improvement to address racial disparities in this pandemic. Key PointsO_ST_ABSQuestionC_ST_ABSWhat are the racial-ethnic disparities in COVID-19 case fatality ratios (CFR) across states after adjusting for age? FindingsWe conducted direct standardization among 391,991 COVID-19 cases and 17,612 deaths from California, Illinois and Ohio to compare age-adjusted CFR across race-ethnicities. The racial-ethnic disparities in CFR narrowed and the ranking changed after age standardization. MeaningAge distributions in confirmed cases obscured racial-ethnic disparities in COVID-19 CFR.
ABSTRACT
The subcutaneous (SC) injectable, widely known by its commercial name Sayana Press, has potential to improve access to contraceptive methods. In Burkina Faso, SC-injectables were first piloted in select regions in 2014 and introduced nationally in 2016. PMA2020 is the first national survey to track programmatic progress of SC-injectable introduction at both population and health facility levels in the country across 2 rounds of data collection: March-May 2016 and November 2016-January 2017. Over this 6-month period, SC-injectable availability at public service delivery points increased from 50% to 85%, largely driven by increases in availability among the non-pilot regions. In terms of use, while the modern contraceptive prevalence rate among all women remained constant at about 23%, SC-injectable prevalence nearly doubled from 1.1% to 2.0%, making up approximately 9% of all modern method users in Burkina Faso by late 2016, though the difference was not statistically significant. Increases were comparable between pilot and non-pilot regions. While the difference was not statistically significant, more rural women were using the method compared with their urban counterparts in the pilot regions, an interesting finding considering the opposite pattern is generally true for contraceptive prevalence nationally. In summary, following national scale-up, data show substantially improved availability of SC-injectables at service delivery points and potential for changes in the method mix in Burkina Faso. In order to further improve contraceptive access and choice, scale-up of community-based distribution of SC-injectables should be considered, especially among rural populations with higher unmet need for family planning.