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2.
Ann Epidemiol ; 53: 56-62.e2, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32927056

RESUMEN

PURPOSE: To evaluate associations between counties' COVID-19 cases and racial-ethnic and nativity composition, considering heterogeneity across Latin American-origin subgroups and regions of the United States. METHODS: Using county-level data and multilevel negative binomial models, we evaluate associations between COVID-19 cases and percentages of residents that are foreign-born, Latinx, Black, or Asian, presenting estimates for all counties combined and stratifying across regions. Given varying risk factors among Latinx, we also evaluate associations for percentages of residents from specific Latin American-origin groups. RESULTS: Percentage of foreign-born residents is positively associated with COVID-19 case rate (IRR = 1.106; 95% CI: 1.074-1.139). Adjusted associations for percentage Latinx are nonsignificant for all counties combined, but this obscures heterogeneity. Counties with more Central Americans have higher case rates (IRR = 1.130; 95% CI: 1.067-1.197). And, in the Northeast and Midwest, counties with more Puerto Ricans have higher case rates. Associations with percentage Asians are nonsignificant after adjusting for percentage foreign-born. With the confirmation of prior evidence, the percentage of Black residents is positively and robustly associated with COVID-19 case rate (IRR = 1.031; 95% CI: 1.025-1.036). CONCLUSIONS: Counties with more immigrants, as well as more Central American or Black residents, have more COVID-19 cases. In the Northeast and Midwest, counties with more Puerto Rican residents also have more COVID-19 cases.


Asunto(s)
/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Gobierno Local , Masculino , Persona de Mediana Edad , Pandemias , Clase Social , Estados Unidos/epidemiología , Adulto Joven
3.
J Stroke Cerebrovasc Dis ; 30(1): 105418, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33152594

RESUMEN

INTRODUCTION: Differences in access to stroke care and compliance with standard of care stroke management among patients of varying racial and ethnic backgrounds and sex are well-characterized. However, little is known on the impact of telestroke in addressing disparities in acute ischemic stroke care. METHODS: We conducted a retrospective review of acute ischemic stroke patients evaluated over our 17-hospital telestroke network in Texas from 2015-2018. Patients were described as Non-Hispanic White (NHW) male or female, Non-Hispanic Black (NHB) male or female, or Hispanic (HIS) male or female. We compared frequency of tPA and mechanical thrombectomy (MT) utilization, door-to-consultation times, door-to-tPA times, and time-to-transfer for patients who went on to MT evaluation at the hub after having been screened for suspected large vessel occlusion at the spoke. RESULTS: Among 3873 patients (including 1146 NHW male (30%) and 1134 NHW female (29%), 405 NHB male (10%) and 491 NHB female (13%), and 358 HIS male (9%) and 339 HIS female (9%) patients), we did not find any differences in door-to consultation time, door-to-tPA time, time-to-transfer, frequency of tPA administration, or incidence of MT utilization. CONCLUSION: We did not find racial, ethnic, and sex disparities in ischemic stroke care metrics within our telestroke network. In order to fully understand how telestroke alleviates disparities in stroke care, collaboration among networks is needed to formulate a multicenter telestroke database similar to the Get-With-The Guidelines.


Asunto(s)
Afroamericanos , Prestación Integrada de Atención de Salud , Grupo de Ascendencia Continental Europea , Disparidades en Atención de Salud/etnología , Hispanoamericanos , Telemedicina , Anciano , Femenino , Humanos , /etnología , Masculino , Persona de Mediana Edad , Transferencia de Pacientes , Factores Raciales , Sistema de Registros , Estudios Retrospectivos , Factores Sexuales , Texas/epidemiología , Trombectomía , Terapia Trombolítica , Tiempo de Tratamiento
4.
J Surg Res ; 257: 486-492, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32916501

RESUMEN

BACKGROUND: There are well-documented disparities in outcomes for injured Black and Hispanic patients in the United States. However, patient level characteristics cannot fully explain the differences in outcomes and system-level factors, including the trauma center designation of the hospital to which a patient presents, may contribute to their worse outcomes. We aim to determine if Black and Hispanic patients are more likely to be undertriaged, compared with white patients. METHODS: This is a retrospective, cross-sectional, population-based study that uses data from the 2014 Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project State Inpatient Databases. We included data from all states with available State Inpatient Databases data that included both race and hospital characteristics needed for analysis (n = 18). Logistic regression was used to identify predictors of severely injured (Injury Severity Score ≥16) patients being brought to a trauma center. RESULTS: We identified 70,970 severely injured trauma patients with complete data. Non-Hispanic White represented 74.1% of the study population, 9.8% were non-Hispanic Black, and 9.7% were Hispanic. After adjustment for other demographic and injury characteristics, Non-Hispanic Black and Hispanic patients were more likely to be undertriaged, compared with white patients (odds ratio, 1.20; 95% confidence interval, 1.12-1.29 and odds ratio, 1.39; 95% confidence interval, 1.29-1.48, respectively). Male sex and older age were associated with higher odds of undertriage, whereas urban residence, high injury severity, and penetrating injury were associated with lower odds of undertriage. CONCLUSIONS: Severely injured Black and Hispanic trauma patients are more likely to be undertriaged than otherwise similar white patients. The factors that contribute to racial and ethnic disparities in receiving trauma center care need to be identified and addressed to provide equitable trauma care.


Asunto(s)
Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Hispanoamericanos/estadística & datos numéricos , Triaje/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto Joven
5.
Adv Chronic Kidney Dis ; 27(5): 427-433, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-33308509

RESUMEN

Racial, ethnic, socioeconomic, age, and sex-related health disparities in kidney disease are prominent in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately affected marginalized populations. Older adults, people experiencing unstable housing, racial and ethnic minorities, and immigrants are potentially at increased risk for infection and severe complications from COVID-19. The direct and societal effects of the pandemic may increase risk of incident kidney disease and lead to worse outcomes for those with kidney disease. The rapid transition to telemedicine potentially limits access to care for older adults, immigrants, and people experiencing unstable housing. The economic impact of the pandemic has had a disproportionate effect on women, minorities, and immigrants, which may limit their ability to manage kidney disease and lead to complications or kidney disease progression. We describe the impact of COVID-19 on marginalized populations and highlight how the pandemic may exacerbate existing disparities in kidney disease.


Asunto(s)
/epidemiología , Estatus Económico/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Personas sin Hogar/estadística & datos numéricos , Enfermedades Renales/epidemiología , Factores de Edad , Equidad en Salud , Disparidades en Atención de Salud/etnología , Humanos , Enfermedades Renales/etnología , Refugiados/estadística & datos numéricos , Factores Sexuales , Clase Social , Inmigrantes Indocumentados/estadística & datos numéricos , Estados Unidos/epidemiología
6.
Artículo en Inglés | MEDLINE | ID: mdl-33171864

RESUMEN

Racial and ethnic minority subpopulations experience a disproportionate burden of asthma and adverse childhood experiences (ACEs). These disparities result from systematic differences in risk exposure, opportunity access, and return on resources, but we know little about how accumulated differentials in ACEs may be associated with adult asthma by racial/ethnic groups. We used Behavioral Risk Factor Surveillance System data (N = 114,015) from 2009 through 2012 and logistic regression to examine the relationship between ACEs and adult asthma using an intersectional lens, investigating potential differences for women and men aged 18 and older across seven racial/ethnic groups. ACEs were significantly related to asthma, adjusting for race/ethnicity and other covariates. Compared to the reference group (Asians), asthma risk was significantly greater for Black/African American, American Indian and Alaska Native (AIAN), White, and multiracial respondents. In sex-stratified interactional models, ACEs were significantly related to asthma among women. The relationship between ACEs and asthma was significantly weaker for Black/African American and AIAN women compared to the reference group (Asian women). The findings merit attention for the prevention and early detection of ACEs to mitigate long-term health disparities, supporting standardized screening and referrals in clinical settings, evidence-based prevention in communities, and the exploration of strategies to buffer the influence of adversities in health.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Experiencias Adversas de la Infancia/etnología , Asma/epidemiología , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Asma/etnología , Sistema de Vigilancia de Factor de Riesgo Conductual , Niño , Grupos de Población Continentales/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud/etnología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Distribución por Sexo , Clase Social , Determinantes Sociales de la Salud , Adulto Joven
7.
Health Educ Behav ; 47(6): 845-849, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33148042

RESUMEN

The COVID-19 pandemic has exposed, and intensified, health inequities faced by Latinx in the United States. Washington was one of the first U.S. states to report cases of COVID-19. Public health surveillance shows that 31% of Washington cases are Latinx, despite being only 13% of the state population. Unjust policies related to immigration, labor, housing, transportation, and education have contributed to both past and existing inequities. Approximately 20% of Latinx are uninsured, leading to delays in testing and medical care for COVID-19, and early reports indicated critical shortages in professional interpreters and multilingual telehealth options. Washington State is taking action to address some of these inequities. Applying a health equity framework, we describe key factors contributing to COVID-19-related health inequities among Latinx populations, and how Washington State has aimed to address these inequities. We draw on these experiences to make recommendations for other Latinx communities experiencing COVID-19 disparities.


Asunto(s)
Infecciones por Coronavirus/etnología , Disparidades en Atención de Salud/etnología , Hispanoamericanos/estadística & datos numéricos , Neumonía Viral/etnología , Betacoronavirus , Barreras de Comunicación , Política de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Vivienda/normas , Humanos , Pandemias , Traducción , Estados Unidos/epidemiología , Washingtón/epidemiología , Trabajo/estadística & datos numéricos
8.
Epidemiol Psychiatr Sci ; 29: e188, 2020 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-33239117

RESUMEN

AIMS: People living with serious mental ill-health experience adverse cardiovascular outcomes causing some of the greatest health inequality gaps in England, UK. We describe uptake of the NHS Health Check programme in people with mental ill-health, and rates of new diagnoses and management of cardiovascular risk factors in those who attend NHS Health Checks in comparison to those people without mental ill-health. METHODS: We used a large nationally representative database of people registered with general practitioners in England (QResearch). Between 2013 and 2017, we analysed attendance at NHS Health Checks and outcomes in the succeeding 12 months, in people with serious mental illness (SMI) including psychoses and in people prescribed long-term antidepressant medications (LTAD), with comparison to attendees who did not have these conditions. Hazard ratios (HR) were used to describe the association between outcomes and SMI and LTAD adjusting for sociodemographic variables. RESULTS: In those eligible for the NHS Health Check programme, we found a higher percentage of people with SMI attended an NHS Health Check (65 490, 19.8%) than those without SMI (524 728, 16.6%); adjusted HR 1.05 [95% confidence interval 1.02-1.08]. We also observed a higher percentage of attendance in people on LTAD (46 437, 20.1%) compared to people who were not prescribed LTAD (543 781, 16.7%); adjusted HR 1.10 (1.08-1.13). People with SMI were more likely to be identified with chronic kidney disease (CKD, HR 1.23, 1.12-1.34) and type 2 diabetes (HR 1.14, 1.03-1.25) within the 12 months following their NHS Health Check compared with those without SMI. People on LTAD were more likely to be identified with CKD (HR 1.55, 1.42-1.70) and type 2 diabetes (HR 1.45, 1.31-1.60) and also hypertension, cardiovascular disease, non-diabetic hyperglycaemia, familial hypercholesterolemia and dementia within the 12 months following their NHS Health Check. Statins were more likely to be prescribed to NHS Health Check attendees with SMI and those on LTAD than those without these conditions; HR 1.31 (1.25-1.38) and 1.91 (1.82-2.01), respectively. Antihypertensives were more likely to be prescribed to those on LTAD; HR 1.21 (1.14-1.29). CONCLUSIONS: We found evidence that people with SMI or on LTAD treatment were 5-10% more likely to access NHS Health Checks than people without these conditions. People with SMI or on LTAD treatment who attended NHS Health Checks had higher rates of diagnosis of CKD, type 2 diabetes and some other relevant co-morbidities and increased treatment with statins and also anti-hypertensive medication in people on LTAD. This is likely to contribute to equitable reduction in adverse cardiovascular events for people with mental ill-health.


Asunto(s)
Antidepresivos/uso terapéutico , Enfermedades Cardiovasculares/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Promoción de la Salud/métodos , Disparidades en Atención de Salud/estadística & datos numéricos , Trastornos Mentales/tratamiento farmacológico , Servicios Preventivos de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Trastornos Psicóticos/tratamiento farmacológico , Medicina Estatal/estadística & datos numéricos , Adulto , Anciano , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Comorbilidad , Inglaterra/epidemiología , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Salud Mental , Persona de Mediana Edad , Servicios Preventivos de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Factores Socioeconómicos , Medicina Estatal/organización & administración
11.
Nat Commun ; 11(1): 5131, 2020 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-33046699

RESUMEN

As artificial intelligence (AI) is increasingly applied to biomedical research and clinical decisions, developing unbiased AI models that work equally well for all ethnic groups is of crucial importance to health disparity prevention and reduction. However, the biomedical data inequality between different ethnic groups is set to generate new health care disparities through data-driven, algorithm-based biomedical research and clinical decisions. Using an extensive set of machine learning experiments on cancer omics data, we find that current prevalent schemes of multiethnic machine learning are prone to generating significant model performance disparities between ethnic groups. We show that these performance disparities are caused by data inequality and data distribution discrepancies between ethnic groups. We also find that transfer learning can improve machine learning model performance for data-disadvantaged ethnic groups, and thus provides an effective approach to reduce health care disparities arising from data inequality among ethnic groups.


Asunto(s)
Disparidades en Atención de Salud/etnología , Aprendizaje Automático , Algoritmos , Inteligencia Artificial , Investigación Biomédica , Grupos Étnicos , Humanos , Neoplasias/etnología
12.
J Gen Intern Med ; 35(12): 3685-3688, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33009656

RESUMEN

Coronavirus disease 2019 (COVID-19) is a global pandemic. In the USA, the burden of mortality and morbidity has fallen on minority populations. The understanding of the impact of this pandemic has been limited in Asian-Americans and Pacific Islanders (AAPIs), though disaggregated data suggest disproportionately high mortality rates. AAPIs are at high risk for COVID-19 transmission, in part due to their over-representation in the essential workforce, but also due to cultural factors, such as intergenerational residency, and other social determinants of health, including poverty and lack of health insurance. Some AAPI subgroups also report a high comorbidity burden, which may increase their susceptibility to more severe COVID-19 infection. Furthermore, AAPIs have encountered rising xenophobia and racism across the country, and we fear such discrimination only serves to exacerbate these rapidly emerging disparities in this community. We recommend interventions including disaggregation of mortality and morbidity data, investment in community-based healthcare, advocacy against discrimination and the use of non-inflammatory language, and a continued emphasis on underlying comorbidities, to ensure the protection of vulnerable communities and the navigation of this current crisis.


Asunto(s)
/etnología , Disparidades en Atención de Salud/etnología , Americanos Asiáticos , Comorbilidad , Estudios Epidemiológicos , Personal de Salud/estadística & datos numéricos , Humanos , Grupo de Ascendencia Oceánica , Pandemias , Racismo , Estados Unidos/epidemiología
13.
Prev Med ; 141: 106282, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33035550

RESUMEN

Black and Hispanic communities in the U.S. have endured a disproportionate burden of COVID-19-related morbidity and mortality. Racial and ethnic health disparities such as these are frequently aggravated by inequitable access to healthcare resources in disadvantaged communities. Yet, no known studies have investigated disadvantaged communities' access to COVID-19-related healthcare resources. The current study accordingly examined racial and ethnic differences in (1) April 2020 COVID-19 total and positive viral test rates across 177 New York City (NYC) ZIP Code Tabulation Areas (ZCTA); and (2) November 2019-April 2020 licensed and intensive care unit (ICU) hospital bed access across 194 NYC ZCTAs. Pairwise analyses indicated higher COVID-19 total and positive test rates per 1000 persons in majority Black and Hispanic vs. majority White ZCTAs (CI [0.117, 4.55]; CI [2.53, 5.14]). Multiple linear regression analyses indicated that higher percentage of Black and Hispanic residents predicted more total COVID-19 tests per 1000 persons (p < 0.05). In contrast, majority Black and Hispanic ZCTAs had fewer licensed and ICU beds (CI [6.50, 124.25]; CI [0.69, 7.16]), with social disadvantage predicting lower licensed and ICU bed access per 1000 persons (p < 0.01). While news reports of inequitable access to COVID-19-related healthcare resources in ethnocultural minority communities have emerged, this is the first study to reveal that social disadvantage may be a major driver of hospital resource inequities in Black and Hispanic communities. Thus, it will be imperative to enact policies that ensure equitable allocation of healthcare resources to socially disadvantaged communities to address current and future public health crises.


Asunto(s)
/tratamiento farmacológico , Grupos Étnicos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Factores Raciales , Factores Socioeconómicos
16.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33000953

RESUMEN

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Asunto(s)
Toma de Decisiones Conjunta , Detección Precoz del Cáncer/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Neoplasias Pulmonares/diagnóstico , Fumar/etnología , Determinación de la Elegibilidad , Grupos Étnicos/estadística & datos numéricos , Costos de la Atención en Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Ciencia de la Implementación , Cobertura del Seguro , Comercialización de los Servicios de Salud/métodos , Medicaid , Pacientes no Asegurados/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Derivación y Consulta/estadística & datos numéricos , Factores Sexuales , Fumar/epidemiología , Fumar/terapia , Cese del Hábito de Fumar/estadística & datos numéricos , Clase Social , Estados Unidos
17.
MMWR Morb Mortal Wkly Rep ; 69(39): 1391-1397, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33001873

RESUMEN

Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy (1). ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27-36 (2,3). Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal with racial/ethnic disparities persisting (4-6). To assess influenza and Tdap vaccination coverage among women pregnant during the 2019-20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018-19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018-19 season (4). Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%). Compared with the 2018-19 season, increases in influenza vaccination coverage were observed during the 2019-20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018-19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019-20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Disparidades en Atención de Salud/etnología , Vacunas contra la Influenza/administración & dosificación , Mujeres Embarazadas/etnología , Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Adulto , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Estados Unidos , Adulto Joven
18.
JAMA Netw Open ; 3(9): e2015470, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32876682

RESUMEN

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Design, Setting, and Participants: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Exposures: Hospital referral to home health care. Main Outcomes and Measures: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Results: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Conclusions and Relevance: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.


Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud/etnología , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Derivación y Consulta , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Planes de Aranceles por Servicios , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Medicaid/estadística & datos numéricos , Medicare , Medicare Part C , Alta del Paciente , Pobreza/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Desempleo/estadística & datos numéricos , Estados Unidos
19.
J Am Geriatr Soc ; 68(11): 2454-2461, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32955105

RESUMEN

BACKGROUND/OBJECTIVES: To determine racial/ethnic disparities in weekly counts of new COVID-19 cases and deaths among nursing home residents or staff. DESIGN: Cross-sectional analysis of national nursing home COVID-19 reports linked to other data. Multivariable two-part models modeled disparities in count of cases or deaths, and logistic regressions modeled disparities in self-reported shortages in staff and personal protective equipment (PPE), across nursing home groups with varying proportions of racial/ethnic minority residents, defined as low-, medium-, medium-high-, and high-proportion groups. SETTING: A total of 12,576 nursing homes nationally. PARTICIPANTS: None. INTERVENTION: None. MEASUREMENTS: Numbers of incident COVID-19 confirmed cases among residents and staff, and incident COVID-19 related deaths among residents (primary outcomes); and nursing home reported shortages in staff and PPE (secondary outcomes). All outcomes were reported for the week of May 25, 2020. RESULTS: The number of weekly new COVID-19 confirmed cases among residents ranged from an average of 0.4 cases per facility (standard deviation (SD) = 2.5) for the low-proportion group (93.0% had zero new cases) to 1.5 cases per facility (SD = 6.3) for the high-proportion group (78.9% had zero new cases). Multivariable regression estimated that compared with the low-proportion group, the likelihood of having at least one new resident case was 76% higher (odds ratio = 1.76; 95% confidence interval = 1.38-2.25; P = .000) for the high-proportion group. Similar across-facility disparities were found for the weekly count of new COVID-19 deaths among residents (ranging from 0.1 deaths per facility (SD = 1.1) for the low-proportion group to 0.4 deaths (SD = 2.0) for the high-proportion group) and in the weekly count of new COVID-19 confirmed cases among staff (ranging from 0.3 cases (SD = 1.4] to 1.3 cases (SD = 4.4) per facility). No substantial disparities in self-reported shortages of staff or PPE were found. CONCLUSION: Nursing homes caring for disproportionately more racial/ethnic minority residents reported more weekly new COVID-19 confirmed cases and/or deaths. Immediate actions are needed to address these system-level disparities.


Asunto(s)
/mortalidad , Grupos Étnicos/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Grupos Minoritarios/estadística & datos numéricos , Casas de Salud , Estudios Transversales , Humanos , Estados Unidos/epidemiología
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