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1.
Rev Bras Epidemiol ; 23: e200095, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33027434

RESUMEN

OBJECTIVE: To assess, through space-time analyses, whether the income inequality of the Federative Units (FUs) in Brazil can be associated with the risk of infection and death by COVID-19. METHODS: This was an ecological study, based on secondary data on incidence and mortality rates for COVID-19. Data were analyzed at the state level, having the Gini coefficient as the main independent variable. Records of twelve days were used, spaced one week each, between April 21th and June 7th, 2020. The weekly variation in the rates was calculated through Prais-Winsten regression, aiming at measuring the evolution of the pandemic in each FU. Spearman's correlation test was used to assess correlation between the rates and their weekly evolution and the independent variables. Lastly, a spatial dependence diagnosis was conducted, and a Spatial Regression lag model was used when applicable. RESULTS: Incidence and mortality rates of COVID-19 increased in all Brazilian FUs, being more pronounced among those with greater economic inequality. Association between Gini coefficient and COVID-19 incidence and mortality rates remained even when demographic and spatial aspects were taken into account. CONCLUSION: Income inequality can play an important role in the impact of COVID-19 on the Brazilian territory, through absolute and contextual effects. Structural policies to reduce inequality are essential to face this and future health crises in Brazil.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Disparidades en el Estado de Salud , Pandemias , Neumonía Viral/epidemiología , Brasil/epidemiología , Infecciones por Coronavirus/mortalidad , Humanos , Neumonía Viral/mortalidad , Medición de Riesgo , Factores Socioeconómicos
2.
Int J Equity Health ; 19(1): 170, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33004064

RESUMEN

With the threat of coronavirus disease 2019 (Covid-19) enduring in the United States, effectively and equitably implementing testing, tracing, and self-isolation as key prevention and detection strategies remain critical to safely re-opening communities. As testing and tracing capacities increase, frameworks are needed to inform design and delivery to ensure their effective implementation and equitable distribution, and to strengthen community engagement in slowing and eventually stopping Covid-19 transmission. In this commentary, we highlight opportunities for integrating implementation research into planned and employed strategies in the United States to accelerate reach and effectiveness of interventions to more safely relax social distancing policies and open economies, schools, and other institutions. Implementation strategies, such as adapting evidence-based interventions based on contextual factors, promoting community engagement, and providing data audit and feedback on implementation outcomes, can support the translation of policies on testing, tracing, social distancing, and public mask use into reality. These data can demonstrate how interventions are put into practice and where adaptation in policy or practice is needed to respond to the needs of specific communities and socially vulnerable populations. Incorporating implementation research into Covid-19 policy design and translation into practice is urgently needed to mitigate the worsening health inequities in the pandemic toll and response. Applying rigorous implementation research frameworks and evaluation systems to the implementation of evidence-based interventions which are adapted to contextual factors can promote effective and equitable pandemic response and accelerate learning both among local stakeholders as well as between states to further inform their varied experiences and responses to the pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Disparidades en el Estado de Salud , Ciencia de la Implementación , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Humanos , Política Pública , Estados Unidos/epidemiología
4.
Rev Panam Salud Publica ; 44, sept. 2020
Artículo en Español | PAHO-IRIS | ID: phr-52680

RESUMEN

Objetivo. Determinar si existen disparidades asociadas a la estratificación socioeconómica, la etnicidad, los servicios médicos y la región geográfica en la progresión de la enfermedad por coronavirus (COVID-19) en adultos mexicanos infectados por SARS-CoV-2. Método. Se analizaron los datos registrados por la Dirección General de Epidemiología de la Secretaría de Salud del Gobierno Federal de México respecto de los casos confirmados de infección por SARS-CoV-2. El análisis se limitó a los datos de adultos de 20 años o más registrados hasta el 10 de julio del 2020 (n=234 870). Los indicadores de severidad de la COVID-19 fueron hospitalización, desarrollo de neumonía, requerimiento de intubación o ingreso a la unidad de cuidados intensivos, y muerte. Se estimaron diferencias de acuerdo con el nivel de marginación municipal, la pertenencia a un grupo indígena, la región geográfica y el sector de los servicios. A partir de modelos de regresión multinivel se estimaron razones de prevalencias (RP). Resultados. Las personas que residían en municipios con mayor marginación tuvieron mayor riesgo de presentar los cuatro indicadores de formas severas de COVID-19 (RP=1,05 o 1,06). Las personas indígenas tuvieron mayor riesgo de neumonía (RP=1,22), hospitalización (RP=1,14) y muerte (RP=1,23). Entre los casos atendidos en servicios privados fue menor el riesgo de muerte (RP=0,40), pero mayor el uso de intubación o ingreso a la unidad de cuidados intensivos (RP=4,45). Conclusiones. Las tendencias observadas indican que los efectos de la COVID-19 no solo se deben a las características biológicas del SARS-CoV-2, sino también a los recursos (o falta de ellos) para enfrentarlo, los cuales están distribuidos por procesos sociales.


Objective. To determine if there are disparities associated with socioeconomic stratification, ethnicity, medical services, and geographic region in the progression of coronavirus disease (COVID-19) in Mexican adults infected with SARS-CoV-2. Method. We analyzed data registered by the General Direction of Epidemiology of the Ministry of Health of the Federal Government of Mexico regarding the confirmed cases of SARS-CoV-2 infection. The analysis was limited to data from adults 20 years and older recorded up to July 10, 2020 (n=234 870). Indicators of severity of COVID-19 were hospitalization, development of pneumonia, requirement for intubation or admission to the intensive care unit, and death. Differences were estimated according to the level of municipal marginalization, belonging to an indigenous group, geographic region, and service sector. Prevalence ratios (PR) were estimated using multilevel regression models. Results. People who lived in municipalities with greater marginalization were at greater risk of presenting the four indicators of severe forms of COVID-19 (PR=1.05 or 1.06). Indigenous people were at greater risk of pneumonia (PR=1.22), hospitalization (PR=1.14) and death (PR=1.23). Among the cases treated in the private health sector, the risk of death was lower (PR=0.40), but the use of intubation or admission to the intensive care unit was higher (PR=4.45). Conclusions. The trends observed indicate that the effects of COVID-19 are not only related to the biological characteristics of SARS-CoV-2, but also to the resources (or lack thereof) to deal with it, which are distributed by social processes.


Asunto(s)
Inequidad Social , Infecciones por Coronavirus , Factores Socioeconómicos , Disparidades en el Estado de Salud , Grupos Étnicos , Infecciones por Coronavirus , Inequidad Social , Infecciones por Coronavirus , Factores Socioeconómicos , Disparidades en el Estado de Salud , Grupos Étnicos , México
5.
Rev Panam Salud Publica ; 44, sept. 2020
Artículo en Español | PAHO-IRIS | ID: phr-52321

RESUMEN

[RESUMEN]. Objetivo. Medir desigualdades sociales en la resistencia antimicrobiana de la Neisseria gonorrhoeae en Colombia. Métodos. Estudio ecológico utilizando un multipanel de datos desagregado a nivel subnacional de los aislamientos en la N. gonorrhoeae como proxy de resistencia antimicrobiana (RAM) entre 2009 y 2018. Se llevó a cabo una caracterización sociodemográfica, un análisis de la sensibilidad antimicrobiana de aislamientos de N. gonorrhoeae, y una medición de desigualdades en la RAM para la N. gonorrhoeae mediante el índice de desigualdad de la pendiente, el índice de desigualdad relativo y el índice de concentración. Resultados. Los hallazgos indican resistencia antimicrobiana de aislamientos de N. gonorrhoeae a penicilina (50,7%) y tetraciclina (67,3%); y la existencia de desigualdades absolutas y relativas durante el período analizado. Las barreras de acceso a servicios de salud, no haber recibido información de prevención de las infecciones de transmisión sexual, necesidades básicas insatisfechas y analfabetismo explicaron las desigualdades en la RAM de la N. gonorrhoeae. Conclusiones. Seis recomendaciones emergen para contener en gran medida la RAM en la N. gonorrhoeae: i) aumentar conciencia sobre la salud sexual y reproductiva segura; ii) repensar cómo entregar mensajes claves con enfoque de equidad; iii) mejorar los sistemas de información, prescripción y cadena de medicamentos; iv) crear coaliciones para mejorar la respuesta y compartir objetivos con el sector privado; v) mejorar la disponibilidad y desagregación de los datos; y vi) apoyar investigaciones en desigualdades en RAM.


[ABSTRACT]. Objective. Measure social inequalities in antimicrobial resistance in Neisseria gonorrhoeae in Colombia. Methods. Ecological study using a multi-panel of data, disaggregated at the subnational level, and using isolations of N. gonorrhoeae as a proxy for antimicrobial resistance (AMR) between 2009 and 2018. A sociodemographic characterization, an analysis of the antimicrobial sensitivity of isolations of N. gonorrhoeae, and a measurement of inequalities in AMR in N. gonorrhoeae were conducted using the slope index of inequality, the relative inequality index, and the concentration index. Results. The findings indicate antimicrobial resistance to penicillin (50.7%) and tetracycline (67.3%) in isolations of N. gonorrhoeae, and the existence of absolute and relative inequalities during the study period. Access barriers to health services, not having received information on the prevention of sexually transmitted infections, basic unmet needs, and illiteracy explained the inequalities in AMR in N. gonorrhoeae. Conclusions. Six recommendations emerged with a view to largely containing AMR in N. gonorrhoeae: i) increase awareness of safe sexual and reproductive health; ii) rethink how to deliver key messages with an equity approach; iii) improve information, prescription, and drug chain systems; iv) form coalitions to improve response and share objectives with the private sector; v) improve the availability and disaggregation of data; and vi) support research on inequalities in AMR.


[RESUMO]. Objetivo. Medir as desigualdades sociais na resistência antimicrobiana de Neisseria gonorrhoeae na Colômbia. Métodos. Estudo ecológico que utilizou um painel múltiplo de dados desagregados ao nível subnacional de isolados de N. gonorrhoeae como substituto para a resistência antimicrobiana (RAM) entre 2009 e 2018. Realizamos uma caracterização sociodemográfica, uma análise da sensibilidade antimicrobiana dos isolados de N. gonorrhoeae e uma medição das desigualdades na RAM para N. gonorrhoeae utilizando o índice absoluto de desigualdade, o índice relativo de desigualdade e o índice de concentração. Resultados. Os resultados indicam a existência de resistência antimicrobiana nos isolados de N. gonorrhoeae à penicilina (50,7%) e à tetraciclina (67,3%), bem como desigualdades absolutas e relativas durante o período analisado. Os obstáculos no acesso aos serviços de saúde, a falta de informações sobre a prevenção de infecções sexualmente transmissíveis, a existência de necessidades básicas não satisfeitas e o analfabetismo explicam as desigualdades na RAM de N. gonorrhoeae. Conclusões. Podem ser feitas seis recomendações para conter em grande medida a RAM de N. gonorrhoeae: i) aumentar a conscientização sobre a saúde sexual e reprodutiva segura, ii) repensar a forma de transmitir as mensagens principais, com foco na equidade, iii) melhorar os sistemas de informação, prescrição e a cadeia de medicamentos, iv) criar coalisões para melhorar a capacidade de resposta e compartilhar objetivos com o setor privado, v) melhorar a disponibilidade e a desagregação de dados e vi) apoiar a pesquisa sobre as desigualdades na RAM.


Asunto(s)
Farmacorresistencia Microbiana , Neisseria gonorrhoeae , Disparidades en el Estado de Salud , Salud Sexual y Reproductiva , Sistemas de Salud , Colombia , Farmacorresistencia Microbiana , Disparidades en el Estado de Salud , Salud Sexual y Reproductiva , Sistemas de Salud , Farmacorresistencia Microbiana , Disparidades en el Estado de Salud , Salud Sexual y Reproductiva , Sistemas de Salud , Colombia
6.
MMWR Morb Mortal Wkly Rep ; 69(37): 1277-1282, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32941410

RESUMEN

The spontaneous death or loss of a fetus during pregnancy is termed a fetal death. In the United States, national data on fetal deaths are available for losses at ≥20 weeks' gestation.* Deaths occurring during this period of pregnancy are commonly known as stillbirths. In 2017, approximately 23,000 fetal deaths were reported in the United States (1). Racial/ethnic disparities exist in the fetal mortality rate; however, much of the known disparity in fetal deaths is unexplained (2). CDC analyzed 2015-2017 U.S. fetal death report data and found that non-Hispanic Black (Black) women had more than twice the fetal mortality rate compared with non-Hispanic White (White) women and Hispanic women. Fetal mortality rates also varied by maternal state of residence. Cause of death analyses were conducted for jurisdictions where >50% of reports had a cause of death specified. Still, even in these jurisdictions, approximately 31% of fetal deaths had no cause of death reported on a fetal death report. There were differences by race and Hispanic origin in causes of death, with Black women having three times the rate of fetal deaths because of maternal complications compared with White women. The disparities suggest opportunities for prevention to reduce the U.S. fetal mortality rate. Improved documentation of cause of death on fetal death reports might help identify preventable causes and guide prevention efforts.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Mortalidad Fetal/etnología , Disparidades en el Estado de Salud , Adulto , Femenino , Humanos , Embarazo , Estados Unidos/epidemiología , Estadísticas Vitales , Adulto Joven
7.
West J Emerg Med ; 21(5): 1048-1053, 2020 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-32970553

RESUMEN

INTRODUCTION: The unfolding COVID-19 pandemic has predictably followed the familiar contours of well established socioeconomic health inequities, exposing and often amplifying preexisting disparities. People living in homeless shelters are at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population. The purpose of this study was to identify shelter characteristics that may be associated with higher transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We conducted a cross-sectional assessment of five congregate shelters in Rhode Island. Shelter residents 18 years old and older were tested for SARS-CoV-2 from April 19-April 24, 2020. At time of testing, we collected participant characteristics, symptomatology, and vital signs. Shelter characteristics and infection control strategies were collected through a structured phone questionnaire with shelter administrators. RESULTS: A total of 299 shelter residents (99%, 299/302) participated. Thirty-five (11.7%) tested positive for SARS-CoV-2. Shelter-level prevalence ranged from zero to 35%. Symptom prevalence did not vary by test result. Shelters with positive cases of SARS-CoV-2 were in more densely populated areas, had more transient resident populations, and instituted fewer physical distancing practices compared to shelters with no cases. CONCLUSION: SARS-CoV-2 prevalence varies with shelter characteristics but not individual symptoms. Policies that promote resident stability and physical distancing may help reduce SARS-CoV-2 transmission. Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission. Frequent universal testing and congregate housing alternatives that promote stability may help reduce spread of infection.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Disparidades en el Estado de Salud , Personas sin Hogar/estadística & datos numéricos , Vivienda/estadística & datos numéricos , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Estudios Transversales , Femenino , Política de Salud , Encuestas Epidemiológicas , Humanos , Control de Infecciones/métodos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Prevalencia , Rhode Island/epidemiología , Adulto Joven
8.
BMC Public Health ; 20(1): 1442, 2020 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-32967642

RESUMEN

BACKGROUND: There has been an increase in older rural-to-urban migrant workers (aged 50 and above) in mainland China, little known about their depressive symptoms. The aim of this study was to identify depressive symptoms among older rural-to-urban migrant workers, as well as explored the factors leading to differences in depressive symptoms between older rural-to-urban migrant workers and their rural counterparts (older rural dwellers) and urban counterparts (older urban residents) in mainland China. The results provided a comprehensive understanding of the depressive symptoms of older rural-to-urban migrant workers, and had great significance for improving the depressive symptoms for this vulnerable group. METHODS: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015, and coarsened exact matching (CEM) method was employed to control confounding factors. This study employed a Chinese version 10-item short form of the Center for Epidemiologic Studies-Depression Scale (CES-D 10) to measure depressive symptoms, and used the Social-Ecological Model as a framework to explore influential factors related to depressive symptoms. Specifically, the approach of Fairlie's decomposition was used to parse out differences into observed and unobserved components. RESULTS: After matching, our findings indicated that the prevalence of depressive symptoms in older rural-to-urban migrant workers was lower than older rural dwellers; and the prevalence of depressive symptoms in older rural-to-urban migrant workers was higher than older urban residents. Fairlie's decomposition analysis indicated that type of in-house shower, sleeping time at night and ill in the last month were proved to be major contributors to the differences in depressive symptoms between older rural-to-urban migrant workers and older rural dwellers; self-reported health and sleeping time at night were proved to be major contributors to the differences in depressive symptoms between older rural-to-urban migrant workers and older urban residents. CONCLUSIONS: Differences in depressive symptoms between older rural-to-urban migrant workers and their rural and urban counterparts did exist. Our findings contributed to a more reliable understanding in depressive symptoms among older rural-to-urban migrant workers. Our findings would be of referential significance for improving older rural-to-urban migrant workers' depressive symptoms.


Asunto(s)
Depresión/epidemiología , Disparidades en el Estado de Salud , Población Rural/estadística & datos numéricos , Migrantes/psicología , Población Urbana/estadística & datos numéricos , Anciano , China/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Migrantes/estadística & datos numéricos
10.
JAMA Netw Open ; 3(9): e2021892, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32975575

RESUMEN

Importance: Initial public health data show that Black race may be a risk factor for worse outcomes of coronavirus disease 2019 (COVID-19). Objective: To characterize the association of race with incidence and outcomes of COVID-19, while controlling for age, sex, socioeconomic status, and comorbidities. Design, Setting, and Participants: This cross-sectional study included 2595 consecutive adults tested for COVID-19 from March 12 to March 31, 2020, at Froedtert Health and Medical College of Wisconsin (Milwaukee), the largest academic system in Wisconsin, with 879 inpatient beds (of which 128 are intensive care unit beds). Exposures: Race (Black vs White, Native Hawaiian or Pacific Islander, Native American or Alaska Native, Asian, or unknown). Main Outcomes and Measures: Main outcomes included COVID-19 positivity, hospitalization, intensive care unit admission, mechanical ventilation, and death. Additional independent variables measured and tested included socioeconomic status, sex, and comorbidities. Reverse transcription polymerase chain reaction assay was used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: A total of 2595 patients were included. The mean (SD) age was 53.8 (17.5) years, 978 (37.7%) were men, and 785 (30.2%) were African American patients. Of the 369 patients (14.2%) who tested positive for COVID-19, 170 (46.1%) were men, 148 (40.1%) were aged 60 years or older, and 218 (59.1%) were African American individuals. Positive tests were associated with Black race (odds ratio [OR], 5.37; 95% CI, 3.94-7.29; P = .001), male sex (OR, 1.55; 95% CI, 1.21-2.00; P = .001), and age 60 years or older (OR, 2.04; 95% CI, 1.53-2.73; P = .001). Zip code of residence explained 79% of the overall variance in COVID-19 positivity in the cohort (ρ = 0.79; 95% CI, 0.58-0.91). Adjusting for zip code of residence, Black race (OR, 1.85; 95% CI, 1.00-3.65; P = .04) and poverty (OR, 3.84; 95% CI, 1.20-12.30; P = .02) were associated with hospitalization. Poverty (OR, 3.58; 95% CI, 1.08-11.80; P = .04) but not Black race (OR, 1.52; 95% CI, 0.75-3.07; P = .24) was associated with intensive care unit admission. Overall, 20 (17.2%) deaths associated with COVID-19 were reported. Shortness of breath at presentation (OR, 10.67; 95% CI, 1.52-25.54; P = .02), higher body mass index (OR per unit of body mass index, 1.19; 95% CI, 1.05-1.35; P = .006), and age 60 years or older (OR, 22.79; 95% CI, 3.38-53.81; P = .001) were associated with an increased likelihood of death. Conclusions and Relevance: In this cross-sectional study of adults tested for COVID-19 in a large midwestern academic health system, COVID-19 positivity was associated with Black race. Among patients with COVID-19, both race and poverty were associated with higher risk of hospitalization, but only poverty was associated with higher risk of intensive care unit admission. These findings can be helpful in targeting mitigation strategies for racial disparities in the incidence and outcomes of COVID-19.


Asunto(s)
Afroamericanos , Infecciones por Coronavirus/etnología , Disparidades en el Estado de Salud , Hospitalización , Unidades de Cuidados Intensivos , Neumonía Viral/etnología , Adulto , Anciano , Betacoronavirus , Índice de Masa Corporal , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Estudios Transversales , Disnea/epidemiología , Disnea/etiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Grupos Minoritarios , Oportunidad Relativa , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Neumonía Viral/virología , Pobreza , Respiración Artificial , Wisconsin/epidemiología
11.
J Am Board Fam Med ; 33(5): 645-649, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32989057

RESUMEN

The COVID-19 outbreak is a stark reminder of the ongoing challenge of emerging and reemerging disease, the human cost of pandemics and the need for robust research.1 For primary care, the advent of COVID-19 has forced an unprecedented wave of practice change. In turn, Practice-Based Research Networks (PBRNs) must rapidly pivot to address the changing environment and the critical challenges faced by primary care. The pandemic has also impacted the ability of PBRNs to deploy traditional research methods such as face-to-face patient and provider interactions, practice facilitation, and stakeholder engagement. Providers need more relevant, patient-centered evidence and the skills to effect change. These skills will become more important than ever as primary care practices evolve in response to the current COVID-19 pandemic and the disparities in health outcomes highlighted by COVID-19 and the global Black Lives Matter social movement for justice. Throughout this issue, authors detail the work conducted by PBRNs that demonstrate many of these evolving concepts. Articles explore how PBRNs can evaluate COVID-19 in primary care, the role of PBRNs in quality improvement, stakeholder engagement, prevention and chronic care management, and patient safety in primary care.


Asunto(s)
Betacoronavirus , Redes Comunitarias/tendencias , Infecciones por Coronavirus , Investigación sobre Servicios de Salud/tendencias , Pandemias , Neumonía Viral , Atención Primaria de Salud/tendencias , Redes Comunitarias/organización & administración , Investigación sobre Servicios de Salud/métodos , Investigación sobre Servicios de Salud/organización & administración , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Proyectos de Investigación , Participación de los Interesados , Estados Unidos
12.
N Z Med J ; 133(1521): 28-39, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994635

RESUMEN

AIMS: There is limited evidence as to how clinical outcomes of COVID-19 including fatality rates may vary by ethnicity. We aim to estimate inequities in infection fatality rates (IFR) in New Zealand by ethnicity. METHODS: We combine existing demographic and health data for ethnic groups in New Zealand with international data on COVID-19 IFR for different age groups. We adjust age-specific IFRs for differences in unmet healthcare need, and comorbidities by ethnicity. We also adjust for life expectancy reflecting evidence that COVID-19 amplifies the existing mortality risk of different groups. RESULTS: The IFR for Maori is estimated to be 50% higher than that of non-Maori, and could be even higher depending on the relative contributions of age and underlying health conditions to mortality risk. CONCLUSIONS: There are likely to be significant inequities in the health burden from COVID-19 in New Zealand by ethnicity. These will be exacerbated by racism within the healthcare system and other inequities not reflected in official data. Highest risk communities include those with elderly populations, and Maori and Pacific communities. These factors should be included in future disease incidence and impact modelling.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/etnología , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Esperanza de Vida/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Neumonía Viral/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Zelanda , Pandemias , Neumonía Viral/mortalidad , Tasa de Supervivencia , Adulto Joven
14.
Nat Commun ; 11(1): 4674, 2020 09 16.
Artículo en Inglés | MEDLINE | ID: mdl-32938924

RESUMEN

SARS-CoV-2-related mortality and hospitalizations differ substantially between New York City neighborhoods. Mitigation efforts require knowing the extent to which these disparities reflect differences in prevalence and understanding the associated drivers. Here, we report the prevalence of SARS-CoV-2 in New York City boroughs inferred using tests administered to 1,746 pregnant women hospitalized for delivery between March 22nd and May 3rd, 2020. We also assess the relationship between prevalence and commuting-style movements into and out of each borough. Prevalence ranged from 11.3% (95% credible interval [8.9%, 13.9%]) in Manhattan to 26.0% (15.3%, 38.9%) in South Queens, with an estimated city-wide prevalence of 15.6% (13.9%, 17.4%). Prevalence was lowest in boroughs with the greatest reductions in morning movements out of and evening movements into the borough (Pearson R = -0.88 [-0.52, -0.99]). Widespread testing is needed to further specify disparities in prevalence and assess the risk of future outbreaks.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Características de la Residencia/estadística & datos numéricos , Transportes/estadística & datos numéricos , Adolescente , Adulto , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Femenino , Disparidades en el Estado de Salud , Humanos , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Mujeres Embarazadas , Prevalencia , Adulto Joven
15.
J Rural Health ; 36(4): 602-608, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32894612

RESUMEN

PURPOSE: This study compared the average daily increase in COVID-19 mortality rates by county racial/ethnic composition (percent non-Hispanic Black and percent Hispanic) among US rural counties. METHODS: COVID-19 daily death counts for 1,976 US nonmetropolitan counties for the period March 2-July 26, 2020, were extracted from USAFacts and merged with county-level American Community Survey and Area Health Resource File data. Covariates included county percent poverty, age composition, adjacency to a metropolitan county, health care supply, and state fixed effects. Mixed-effects negative binomial regression with random intercepts to account for repeated observations within counties were used to predict differences in the average daily increase in the COVID-19 mortality rate across quartiles of percent Black and percent Hispanic. FINDINGS: Since early March, the average daily increase in the COVID-19 mortality rate has been significantly higher in rural counties with the highest percent Black and percent Hispanic populations. Compared to counties in the bottom quartile, counties in the top quartile of percent Black have an average daily increase that is 70% higher (IRR = 1.70, CI: 1.48-1.95, P < .001), and counties in the top quartile of percent Hispanic have an average daily increase that is 50% higher (IRR = 1.50, CI: 1.33-1.69, P < .001), net of covariates. CONCLUSION: COVID-19 mortality risk is not distributed equally across the rural United States, and the COVID-19 race penalty is not restricted to cities. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest shares of Black and Hispanic residents.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Betacoronavirus , Infecciones por Coronavirus/mortalidad , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Neumonía Viral/mortalidad , Infecciones por Coronavirus/terapia , Femenino , Disparidades en el Estado de Salud , Humanos , Pandemias , Neumonía Viral/terapia , Pobreza/estadística & datos numéricos , Factores de Riesgo , Población Rural/estadística & datos numéricos , Estados Unidos
17.
Soins ; 65(845): 25-26, 2020 May.
Artículo en Francés | MEDLINE | ID: mdl-32862960

RESUMEN

In terms of health, women and men are not on equal footing. Not only due to biological factors, but also in the social, cultural and economic realms. Gender bias influences medical practice, research, teaching and behaviour of both caregivers and patients. This bias results in situations of inequality as well as gender discrimination in access to health and medical care. Taking gender into account in matters of health is a major bioethical issue.


Asunto(s)
Disparidades en el Estado de Salud , Sexismo , Cuidadores/psicología , Femenino , Disparidades en Atención de Salud , Humanos , Masculino , Factores Sexuales , Factores Socioeconómicos
18.
Soins ; 65(845): 27-29, 2020 May.
Artículo en Francés | MEDLINE | ID: mdl-32862961

RESUMEN

From the 1980s, the dissociation of sexuality and reproduction has led to questioning on the "evidence" of the female-male categories. The United States were the first to take governmental initiatives to offset the under-representation of women, particularly in the field of research. They were followed, twenty years later, by the European Community. However, inequalities between women and men persist today. It seems obvious that only proactive measures can help to improve this situation.


Asunto(s)
Disparidades en el Estado de Salud , Investigación/historia , Femenino , Historia del Siglo XX , Humanos , Masculino , Factores Sexuales , Estados Unidos
19.
Cien Saude Colet ; 25(9): 3557-3562, 2020 Sep.
Artículo en Español | MEDLINE | ID: mdl-32876262

RESUMEN

Thinking about the SARS-CoV-2 pandemic implies the study of general and unique dimensions for the historical evolution of Latin America and the Caribbean. From the individual to the collective, from biomedical sciences to social sciences and collective health, from risk groups to exclusive societies and the inequities constituting the colonial, patriarchal, modern capitalist heritage in the State and societies. The objective of this article is to review what are called the three intersections for Latin American critical health thinking. Seeking to analyze and reflect on the assumptions and logic present in the responses to the health emergency with reference to: 1. Critical health theory and its intersections with Latin American critical thinking; 2. The decolonial implications of problematizing the State and public health systems; and 3. The geopolitics of global health security as a roadmap for the global North. They outline approaches on the risks of capitalism's acceleration of the post-pandemic disaster and the alternative ways of addressing creative tensions in the reconstruction of emancipatory processes for regional health sovereignty and Health from the South.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Salud Pública , Capitalismo , Región del Caribe/epidemiología , Composición Familiar , Salud Global , Disparidades en el Estado de Salud , Humanos , América Latina/epidemiología , Pandemias , Pensamiento
20.
Cien Saude Colet ; 25(9): 3555-3556, 2020 Sep.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32876280

RESUMEN

We live in a global pandemic unprecedented in our generation. These are challenging times for healthcare workers. We are all in the same storm and join the same collective effort against COVID-19. However, we are not in the same boat. Inequality determines how each category of the health workforce is affected by the new coronavirus in Brazil. Exposed to the disease on the frontlines, nursing technicians and assistants suffer disproportionately the dire effects of the pandemic. More than 1.3 million technicians and almost 420 thousand nursing assistants provide essential care in health units and do not have the assistance and financial backing to mitigate the effects of COVID-19 on themselves and their families. Eight in every ten of these professionals are women, who are providers and also assume, in most cases, the role of primary caregivers for children, older adults, and the sick in their families. Low wages make hinder access to safer transportation and care alternatives for dependents, which is the reality of most professionals who keep the health system running throughout the pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Personal de Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Neumonía Viral/epidemiología , Brasil/epidemiología , Cuidadores/estadística & datos numéricos , Infecciones por Coronavirus/terapia , Prestación de Atención de Salud/organización & administración , Femenino , Personal de Salud/organización & administración , Humanos , Masculino , Pandemias , Neumonía Viral/terapia
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