An Exploratory Analysis of Sociodemographic Factors Associated With Physical Functional Impairment in ICU Survivors.

IMPORTANCE: Physical functional impairment is one of three components of postintensive care syndrome (PICS) that affects up to 60% of ICU survivors. OBJECTIVES: To explore the prevalence of objective physical functional impairment among a diverse cohort of ICU survivors, both at discharge and longitudinally, and to highlight sociodemographic factors that might be associated with the presence of objective physical functional impairment. DESIGN, SETTING, AND PARTICIPANTS: This was a secondary analysis of 37 patients admitted to the ICU in New Orleans, Louisiana, and Denver, Colorado between 2016 and 2019 who survived with longitudinal follow-up data. MAIN OUTCOMES AND MEASURES: Our primary outcome of physical functional impairment was defined by handgrip strength and the short physical performance battery. We explored associations between functional impairment and sociodemographic factors that included race/ethnicity, sex, primary language, education status, and medical comorbidities. RESULTS: More than 75% of ICU survivors were affected by physical functional impairment at discharge and longitudinally at 3- to 6-month follow-up. We did not see a significant difference in the proportion of patients with physical functional impairment by race/ethnicity, primary language, or education status. Impairment was relatively higher in the follow-up period among women, compared with men, and those with comorbidities. Among 18 patients with scores at both time points, White patients demonstrated greater change in handgrip strength than non-White patients. Four non-White patients demonstrated diminished handgrip strength between discharge and follow-up. CONCLUSIONS AND RELEVANCE: In this exploratory analysis, we saw that the prevalence of objective physical functional impairment among ICU survivors was high and persisted after hospital discharge. Our findings suggest a possible relationship between race/ethnicity and physical functional impairment. These exploratory findings may inform future investigations to evaluate the impact of sociodemographic factors on functional recovery.

High prevalence of hepatitis C virus infection among incarcerated persons: Results from the Louisiana Hepatitis C Elimination Plan's opt-out testing program in prisons.

In the United States, modelling studies suggest a high prevalence of hepatitis C virus (HCV) infection in incarcerated populations. However, limited HCV testing has been conducted in prisons. Through the Louisiana Hepatitis C Elimination Plan, persons incarcerated in the eight state prisons were offered HCV testing from 20 September 2019 to 14 July 2022, and facility entry/exit HCV testing was introduced. Multivariable logistic regression was used to evaluate associations with HCV antibody (anti-HCV) positivity and viremia. Of 17,231 persons in the eight state prisons screened for anti-HCV, 95.1% were male, 66.7% were 30-57 years old, 3% were living with HIV, 68.2% were Black and 2904 (16.9%) were anti-HCV positive. HCV RNA was detected in 69.3% of anti-HCV positive individuals tested. In the multivariable model, anti-HCV positivity was associated with older age including those 30-57 (odds ratio [OR] 3.53, 95% confidence interval [CI] 2.96-4.20) and those ≥58 (OR 10.43, 95% CI 8.66-12.55) as compared to those ≤29 years of age, living with HIV (OR 1.68, 95% CI 1.36-2.07), hepatitis B (OR 1.83, 95% CI 1.25-2.69) and syphilis (OR 1.51, 95% CI 1.23-1.86). HCV viremia was associated with male sex (OR 1.89, 95% CI 1.36-2.63) and Black race (OR 1.42, 95% CI 1.20-1.68). HCV prevalence was high in the state prisons in Louisiana compared to community estimates. To the extent that Louisiana is representative, to eliminate HCV in the United States, it will be important for incarcerated persons to have access to HCV testing and treatment.

Measuring Spatial Access of Vulnerable Population to HIV Testing Facilities in the Baton Rouge Metropolitan Statistical Area, Louisiana.

Ensuring adequate and equitable access to affordable HIV testing is a crucial step toward ending the HIV epidemic (EHE). Using the high-burden Baton Rouge Metropolitan Statistical Area (MSA) as an example, we measure spatial access to HIV testing facilities for vulnerable populations and assess whether their access would improve if eliminating a considerable barrier-costs. Locations and status (free, low-cost, and full cost) of HIV testing facilities are searched on the Internet and confirmed through a field survey. Vulnerable populations include the uninsured and people living with HIV (PLWH), disaggregated from county-level HIV prevalence data. Spatial access is computed by a normalized urban-rural two-step floating catchment area (NUR2SFCA) method. Our survey confirms that only 11% and 37% of the 103 Internet-searched HIV testing facilities are indeed free and low-cost. Making more facilities cheaper or free increases the average access of PLWH, the uninsured, and the entire population but their geographic patterns vary. Free testing facilities, clustered in Baton Rouge city, are highly accessible to 82.6%, 69.4%, and 70.2% of three population groups living in East and West Baton Rouge Parish. In comparison, making all low-cost facilities free increases access in most outlying parishes but at the cost of reducing access in East Baton Rouge Parish, leaving west Livingston, north Iberville, and east Pointe Coupee Parish with the poorest access. Making all full-cost facilities cheaper or free exhibits a similar pattern. The study has important policy implications for where and how to improve access to HIV testing for vulnerable populations.

RESUMEN: Medimos el acceso espacial a las instalaciones de pruebas de VIH para poblaciones vulnerables y evaluamos si su acceso mejoraría si se eliminaran las barreras de costos, utilizando como ejemplo el área estadística metropolitana de Baton Rouge, que tiene una alta carga. Nuestra encuesta confirma que el 11% y el 37% de los 103 centros de pruebas de VIH buscados en Internet son efectivamente gratuitos y de bajo costo. Hacer que más instalaciones sean más baratas o gratuitas aumenta el acceso promedio de las PLWH, las personas sin seguro y toda la población, pero sus patrones geográficos varían. Las instalaciones de pruebas gratuitas, agrupadas en la ciudad de Baton Rouge, son muy accesibles para el 82,6%, el 69,4% y el 70,2% de los tres grupos de población del este y oeste de Baton Rouge. En comparación, hacer que las instalaciones de bajo costo sean gratuitas aumenta el acceso en las parroquias periféricas, pero a costa de reducir el acceso en East Baton Rouge. Hacer que las instalaciones de costo total sean más baratas o gratuitas muestra un patrón similar. El estudio tiene importantes implicaciones políticas para mejorar el acceso a las pruebas del VIH para las poblaciones vulnerables.

In-field detection and characterization of B/Victoria lineage deletion variant viruses causing early influenza activity and an outbreak in Louisiana, 2019.

Background: In 2019, the Louisiana Department of Health reported an early influenza B/Victoria (B/VIC) virus outbreak. Method: As it was an atypically large outbreak, we deployed to Louisiana to investigate it using genomics and a triplex real-time RT-PCR assay to detect three antigenically distinct B/VIC lineage variant viruses. Results: The investigation indicated that B/VIC V1A.3 subclade, containing a three amino acid deletion in the hemagglutinin and known to be antigenically distinct to the B/Colorado/06/2017 vaccine virus, was the most prevalent circulating virus within the specimens evaluated (86/88 in real-time RT-PCR). Conclusion: This work underscores the value of portable platforms for rapid, onsite pathogen characterization.

Hepatitis C Virus Elimination Programs in Louisiana and Washington: Importance of Screening and Surveillance Systems.

The US government has established a national goal of hepatitis C virus (HCV) elimination by 2030. To date, most HCV elimination planning and activity have been at the state level. Fifteen states presently have publicly available HCV elimination plans. In 2019, Louisiana and Washington were the first states to initiate 5-year funded HCV elimination programs. These states differ on motivation for pursuing HCV elimination and ranking on several indicators. Simultaneously, however, they have emphasized several similar elimination components including HCV screening promotion through public awareness, screening expansion, surveillance enhancement (including electronic reporting and task force development), and harm reduction. The 13 other states with published elimination plans have proposed the majority of the elements identified by Louisiana and Washington, but several have notable gaps. Louisiana's and Washington's comprehensive plans, funding approaches, and programs provide a useful framework that can move states and the nation toward HCV elimination.

Trends in Gestational Weight Gain in Louisiana, March 2019 to March 2022.

Importance: Average gestational weight gain (GWG) increased during the COVID-19 pandemic, but it is not known whether this trend has continued. Objective: To examine patterns of GWG during the COVID-19 pandemic by delivery and conception timing through the second year of the pandemic. Design, Setting, and Participants: This cohort study is a retrospective review of birth certificate and delivery records from 2019 to 2022. Electronic health records were from the largest delivery hospital in Louisiana. Participants included all individuals giving birth from March 2019 to March 2022. Data analysis was performed from October 2022 to July 2023. Exposure: Delivery date (cross-sectionally) and conception before the pandemic (March 2019 to March 2020) and during the peak pandemic (March 2020 to March 2021) and late pandemic (March 2021 to March 2022). Main Outcomes and Measures: The primary outcome was GWG (total GWG and adherence to the 2009 Institute of Medicine recommendations) analyzed using linear and log-linear regression with control for covariates. Results: Among 23 012 total deliveries (8763 Black individuals [38.1%]; 11 774 White individuals [51.2%]; mean [SD] maternal age, 28.9 [5.6] years), 3182 individuals (42.0%) exceeded the recommended weight gain in the year proceeding the pandemic, 3400 (45.4%) exceeded recommendations during the peak pandemic, and 3273 (44.0%) exceeded recommendations in the late pandemic. Compared with those who delivered before the pandemic (reference), participants had higher total GWG if they delivered peak or late pandemic (adjusted ß [SE], 0.38 [0.12] kg vs 0.19 [0.12] kg; P = .007). When cohorts were defined by conception date, participants who conceived before the pandemic but delivered after the pandemic started had higher GWG compared with those whose entire pregnancy occurred before the pandemic (adjusted ß [SE], 0.51 [0.16] kg). GWG was lower in the pregnancies conceived after the pandemic started and the late pandemic (adjusted ß [SE], 0.29 [0.12] kg vs 0.003 [0.14] kg; P = .003) but these participants began pregnancy at a slightly higher weight. Examining mean GWG month by month suggested a small decrease for March 2020, followed by increased mean GWG for the following year. Individuals with 2 pregnancies (1289 individuals) were less likely to gain weight above the recommended guidelines compared with their prepandemic pregnancy, but this association was attenuated after adjustment. Conclusions and Relevance: In this cohort, individuals with critical time points of their pregnancy during the COVID-19 pandemic gained more weight compared with the previous year. The increased GWG leveled off as the pandemic progressed but individuals were slightly heavier beginning pregnancy.

Characteristics of Mpox Infections in Louisiana in the 2022 Outbreak.

The 2022 outbreak of mpox in Louisiana was limited to just >300 cases, perhaps an unexpected outcome given the state's high rates of HIV and other sexually transmitted infections (STIs). We aimed to describe the local outbreak within two health centers in the New Orleans region, partnering with the Louisiana Department of Health to offer additional statewide data. We reviewed charts of persons testing positive for mpox in New Orleans from July to November 2022 at two local health centers that together accounted for half of local cases. We abstracted data on HIV status, immune function [CD4 count, viral load (VL)], antiretroviral therapy regimen, symptoms and severity of infection, vaccination status, and whether tecovirimat was administered. We present local data relative to statewide data (July 2022-January 2023). Of 103 individuals in our network for whom charts were reviewed, 96 (93%) identified as male, 52 (50%) were Black, and 69 (67%) had HIV, including 12 (17%) with uncontrolled HIV (CD4 < 200 cells/mm3 or VL >200 copies/mL). The most common presenting symptoms were rash (n = 71, 69%), fever (n = 36, 35%), and rectal pain (n = 33, 32%). Of six (6%) patients hospitalized, four (67%) were persons with HIV (PWH). Two were hospitalized for severe mpox infection with >100 lesions at presentation; both were PWH, and one had uncontrolled infection. Across the state, 307 cases have been identified and 24 have been hospitalized. Of those hospitalized, 18 (75%) were PWH, including 9 (50%) with uncontrolled HIV. The demographic data from Louisiana, a state with high prevalence of STIs and HIV/AIDS, are consistent with prior reports describing the 2022 mpox outbreak. Our results contribute to accumulating data on the severity of infection in individuals with HIV-related immunocompromise.

Trends and disparities in telehealth use among Louisiana Medicaid beneficiaries with type 2 diabetes.

AIM: To examine trends in telehealth use among Medicaid beneficiaries with type 2 diabetes (T2D) before and during the coronavirus disease 2019 (COVID-19) pandemic and identify factors related to telehealth use. METHODS: We compared monthly proportions of outpatient visits delivered by telehealth by race/ethnicity, geography and age among Louisiana Medicaid beneficiaries with T2D using claims data from January 2018 to August 2021. We also examined the changes in provider types delivering telehealth. Multivariable logistic regression was conducted to identify individual level and zip code-level factors associated with telehealth use during the COVID-19 pandemic. RESULTS: The monthly proportion of outpatient visits delivered by telehealth was low (< 1%) before the pandemic, spiked in April 2020 (> 15%), then remained at approximately 5%. Telehealth use varied across different racial/ethnic groups, geography and age groups over years. Older beneficiaries were less probable to use telehealth during the pandemic (adjusted odds ratio [AOR] = 0.874, 95% confidence interval [CI]: 0.831-0.919). Females used more telehealth than males (AOR = 1.359, 95% CI: 1.298-1.423). Black beneficiaries used more telehealth than White beneficiaries (AOR = 1.067, 95% CI: 1.000-1.139). More telehealth services were used by Medicaid beneficiaries who were living in urban areas, with more primary care utilization, and with more chronic conditions at baseline. CONCLUSIONS: We found disparities in the uptake of telehealth during the COVID-19 pandemic, but they might have been narrowed for some groups (Hispanic and rural) among Louisiana Medicaid beneficiaries with T2D. Future studies should explore strategies to improve access to telehealth services and reduce related disparities for the low-income population.

Self-assessed health status and obesity vulnerability in rural Louisiana: A cross-sectional analysis.

Rural communities are resource-constrained and at higher risk of obesity and obesity-related conditions. Thus, studying self-assessed health status and underlying vulnerabilities is critical to provide insights to the program planners for effective and efficient planning of obesity prevention programs. This study aims to investigate the correlates of self-assessed health status and subsequently determine the obesity vulnerability level of residents in rural communities. Randomly sampled data were obtained from in-person community surveys in three rural Louisiana counties-East Carroll, Saint Helena, and Tensas-in June 2021. The association of social-demographic factors, grocery store choice, and exercise frequency with self-assessed health was investigated using the ordered logit model. An obesity vulnerability index was constructed using the weights obtained from the principal component analysis. The results show that gender, race, education, possession of children, exercise frequency, and grocery store choice significantly influence self-assessed health status. Around 20% of respondents fall into the most-vulnerable segment and 65% of respondents are vulnerable to obesity. The obesity vulnerability index ranged from -4.036 to 4.565, indicating a wide heterogeneity in the vulnerability level of rural residents. The findings show that the self-assessed health status of rural residents is not promising along with a high level of vulnerability to obesity. The findings from this study could serve as a reference in the policy discussion regarding an effective and efficient suite of interventions in rural communities to address obesity and promote well-being.

Fatal drug use in the COVID-19 pandemic response: Changing trends in drug-involved deaths before and after stay-at-home orders in Louisiana.

The effect of disaster events on increasing drug-involved deaths has been clearly shown in previous literature. As the COVID-19 pandemic led to stay-at-home orders throughout the United States, there was a simultaneous spike in drug-involved deaths around the country. The landscape of a preexisting epidemic of drug-involved deaths in the United States is one which is not geographically homogenous. Given this unequal distribution of mortality, state-specific analysis of changing trends in drug use and drug-involved deaths is vital to inform both care for people who use drugs and local policy. An analysis of public health surveillance data from the state of Louisiana, both before and after the initial stay-at-home order of the COVID-19 pandemic, was used to determine the effect the pandemic may have had on the drug-involved deaths within this state. Using the linear regression analysis of total drug-involved deaths, as well as drug-specific subgroups, trends were measured based on quarterly (Qly) deaths. With the initial stay-at-home order as the change point, trends measured through quarter 1 (Q1) of 2020 were compared to trends measured from quarter 2 (Q2) of 2020 through quarter 3 (Q3) of 2021. The significantly increased rate of change in Qly drug-involved deaths, synthetic opioid-involved deaths, stimulant-involved deaths, and psychostimulant-involved deaths indicates a long-term change following the initial response to the COVID-19 pandemic. Changes in the delivery of mental health services, harm reduction services, medication for opioid use disorder (MOUD), treatment services, withdrawal management services, addiction counseling, shelters, housing, and food supplies further limited drug-involved prevention support, all of which were exacerbated by the new stress of living in a pandemic and economic uncertainty.

Telemedicine Use by Age in Louisiana Medicaid During COVID-19: Claims-Based Longitudinal Analysis.

BACKGROUND: Limited availability of in-person health care services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, long-standing inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities. OBJECTIVE: The aim of this study is to examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana. METHODS: Interrupted time series models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1000 Medicaid beneficiaries between January 2018 and December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection leveling off period (December 2020). Four mutually exclusive age categories (0 to 17, 18 to 34, 35 to 49, and 50 to 64 years) were used to compare the differences. RESULTS: Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1% of total office visit claim volume across the age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients, with those aged 50 to 64 years seeing increases of 184.09 telemedicine claims per 1000 Medicaid beneficiaries in April 2020 (95% CI 172.19 to 195.99) and 120.81 in July 2020 (95% CI 101.32 to 140.31) compared with those aged 18 to 34 years, seeing increases of 84.47 (95% CI 78.64 to 90.31) and 57.00 (95% CI 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95% CI 112.79 to 134.51) for those aged 50 to 64 years compared with 59.07 (95% CI 53.89 to 64.24) for those aged 18 to 34 years. CONCLUSIONS: Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared with younger beneficiaries.

Associations of COVID-19 Hospitalizations, ICU Admissions, and Mortality with Black and White Race and Their Mediation by Air Pollution and Other Risk Factors in the Louisiana Industrial Corridor, March 2020-August 2021.

Louisiana ranks among the bottom five states for air pollution and mortality. Our objective was to investigate associations between race and Coronavirus Disease 2019 (COVID-19) hospitalizations, intensive care unit (ICU) admissions, and mortality over time and determine which air pollutants and other characteristics may mediate COVID-19-associated outcomes. In our cross-sectional study, we analyzed hospitalizations, ICU admissions, and mortality among positive SARS-CoV-2 cases within a healthcare system around the Louisiana Industrial Corridor over four waves of the pandemic from 1 March 2020 to 31 August 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race-outcome relationships after adjusting for all available confounders. Race was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed, these rates became greater in White patients. However, Black patients were disproportionately represented in these measures. Our findings imply that air pollution might contribute to the disproportionate share of COVID-19 hospitalizations and mortality among Black residents in Louisiana.

Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic led to an increased reliance on telemedicine. Whether this exacerbated existing disparities within vulnerable populations is not yet known. OBJECTIVES: Characterize changes in outpatient telemedicine evaluation and management (E&M) services for Louisiana Medicaid beneficiaries by race, ethnicity, and rurality during the COVID-19 pandemic. RESEARCH DESIGN: Interrupted time series regression models estimated pre-COVID-19 trends and changes in E&M service use at the April and July 2020 peaks in COVID-19 infections in Louisiana and in December 2020 after those peaks had subsided. SUBJECTS: Louisiana Medicaid beneficiaries continuously enrolled between January 2018 and December 2020 who were not also enrolled in Medicare. MEASURES: Monthly outpatient E&M claims per 1000 beneficiaries. RESULTS: Prepandemic differences in service use between non-Hispanic White and non-Hispanic Black beneficiaries narrowed by 34% through December 2020 (95% CI: 17.6%-50.6%), while differences between non-Hispanic White and Hispanic beneficiaries increased by 10.5% (95% CI: 0.1%-20.7%). Non-Hispanic White beneficiaries used telemedicine at higher rates than non-Hispanic Black (difference=24.9 claims per 1000 beneficiaries, 95% CI: 22.3-27.4) and Hispanic beneficiaries (difference=42.3 claims per 1000 beneficiaries, 95% CI: 39.1-45.5) during the first wave of COVID-19 infections in Louisiana. Telemedicine use increased slightly for rural beneficiaries compared with urban beneficiaries (difference=5.3 claims per 1000 beneficiaries, 95% CI: 4.0-6.6). CONCLUSIONS: The COVID-19 pandemic narrowed gaps in outpatient E&M service use between non-Hispanic White and non-Hispanic Black Louisiana Medicaid beneficiaries, though gaps in telemedicine use emerged. Hispanic beneficiaries experienced large reductions in service use and relatively small increases in telemedicine use.

Telehealth and Medicare Type 2 Diabetes Care Outcomes: Evidence From Louisiana.

BACKGROUND: At the onset of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services broadened access to telehealth. This provided an opportunity to test whether diabetes, a risk factor for COVID-19 severity, can be managed with telehealth services. OBJECTIVE: The objective of this study was to examine the impacts of telehealth on diabetes control. RESEARCH DESIGN: A doubly robust estimator combined a propensity score-weighting strategy with regression controls for baseline characteristics using electronic medical records data to compare outcomes in patients with and without telehealth care. Matching on preperiod trajectories in outpatient visits and weighting by odds were used to ensure comparability between comparators. SUBJECTS: Medicare patients with type 2 diabetes in Louisiana between March 2018 and February 2021 (9530 patients with a COVID-19 era telehealth visit and 20,666 patients without one). MEASURES: Primary outcomes were glycemic levels and control [ie, hemoglobin A1c (HbA1c) under 7%]. Secondary outcomes included alternative HbA1c measures, emergency department visits, and inpatient admissions. RESULTS: Telehealth was associated with lower pandemic era mean A1c values [estimate=-0.080%, 95% confidence interval (CI): -0.111% to -0.048%], which translated to an increased likelihood of having HbA1c in control (estimate=0.013; 95% CI: 0.002-0.024; P<0.023). Hispanic telehealth users had relatively higher COVID-19 era HbA1c levels (estimate=0.125; 95% CI: 0.044-0.205; P<0.003). Telehealth was not associated with differences in the likelihood of having an emergency department visits (estimate=-0.003; 95% CI: -0.011 to 0.004; P<0.351) but was associated with more the likelihood of having an inpatient admission (estimate=0.024; 95% CI: 0.018-0.031; P<0.001). CONCLUSION: Telehealth use among Medicare patients with type 2 diabetes in Louisiana stemming from the COVID-19 pandemic was associated with relatively improved glycemic control.

Deepwater Horizon Oil Spill Exposures and Long-term Self-rated Health Effects Among Parents in Coastal Louisiana.

PURPOSE: To assess whether exposure to the 2010 Deepwater Horizon oil spill (DHOS) was related to parents' self-rated health over time. DESIGN: 3 waves of panel data were drawn from the Gulf Coast Population Impact study (2014) and Resilient Children, Youth, and Communities study (2016, 2018). SETTING: Coastal Louisiana communities in high-impact DHOS areas. PARTICIPANTS: Respondents were parents or guardians aged 18 - 84, culled from a probability sample of households with a child aged 4 to 18 (N = 526) at the time of the 2010 DHOS. MEASURES: Self-rated health was measured at each wave. Self-reported physical exposure to the DHOS, economic exposure to the DHOS, and control variables were measured in 2014. ANALYSIS: We used econometric random effects regression for panel data to assess relationships between DHOS exposures and self-rated health over time, controlling for potentially confounding covariates. RESULTS: Both physical exposure (b = -0.39; P < 0.001) and economic exposure (b = -0.34; P < 0.001) to the DHOS had negative associations with self-rated health over the study period. Physical exposure had a larger effect size. CONCLUSION: Parents' physical contact with, and economic disruption from, the 2010 DHOS were tied to long-term diminished health.

Disparities in the use of screening breast magnetic resonance imaging persist in Louisiana after the Affordable Care Act: A question of access, policy, institutional support, or something else?

BACKGROUND: Louisiana continues to have one of the highest breast cancer mortality rates in the nation, and Black women are disproportionally affected. Louisiana has made advances in improving access to breast cancer screening through the expansion of Medicaid. There remains, however, broad underuse of advanced imaging technology such as screening breast magnetic resonance imaging (MRI), particularly for Black women. METHODS: Breast MRI has been proven to be very sensitive for the early detection of breast cancer in women at high risk. MRI is more sensitive than mammography for aggressive, invasive breast cancer types, which disproportionally affect Black women. Here the authors identify potential barriers to breast MRI screening in Black women, propose strategies to address disparities in access, and advocate for specific recommendations for change. RESULTS: Cost was identified as one of the greatest barriers to screening breast MRI. The authors propose implementation of cost-saving, abbreviated protocols to address cost along with lobbying for further expansion of the Affordable Care Act (ACA) to include coverage for screening breast MRI. In addition, addressing gaps in communication and knowledge and facilitating providers' ability to readily identify women who might benefit from MRI could be particularly impactful for high-risk Black women in Louisiana communities. CONCLUSIONS: Since the adoption of the ACA in Louisiana, Black women have continued to have disproportionally high breast cancer mortality rates. This persistent disparity provides evidence that additional change is needed. This change should include exploring innovative ways to make advanced imaging technology such as breast MRI more accessible and expanding research to specifically address community and culturally specific barriers.

Extragenital Sexually Transmitted Infection Testing Among Louisiana Parish Health Units, 2016-2019.

BACKGROUND: The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) get tested annually for urethral and rectal chlamydia (CT) and gonorrhea (NG), and pharyngeal NG. There are no national recommendations to screen women and heterosexual men at extragenital sites. We assessed extragenital CT/NG screening among men and women at Louisiana's Parish Health Units (PHU). METHODS: The Louisiana STD/HIV/Hepatitis Program piloted extragenital screening at 4 PHUs in February 2016 and expanded to 11 PHUs in 2017. Sexual histories were used to identify gender of sex partners and exposed sites. Because of billing restrictions, up to 2 anatomical sites were tested for CT/NG. RESULTS: From February 2016 to June 2019, 70,895 urogenital and extragenital specimens (56,086 urogenital, 13,797 pharyngeal, and 1,012 rectal) were collected from 56,086 patients. Pharyngeal CT positivity was 160 of 7,868 (2.0%) among women, 54 of 4,838 (1.1%) among men who have sex with women (MSW) and 33 of 1,091 (3.0%) among MSM. Rectal CT positivity was 51 of 439 (11.6%) among women and 95 of 573 (16.6%) among MSM. Pharyngeal NG positivity was 299 of 7,868 (3.8%) among women, 222 of 4,838 (4.6%) among MSW, and 97 of 1,091 (8.9%) among MSM. Rectal NG positivity was 20 of 439 (4.6%) among women and 134 of 573 (23.4%) among MSM.Urogenital-only screening would have missed: among women, 173 of 3,923 (4.4%) CT and 227 of 1,480 (15.3%) NG infections; among MSW, 26 of 2,667 (1%) CT and 149 of 1,709 (8.7%) NG infections; and among MSM, 116 of 336 (34.5%) CT and 127 of 413 (42.1%) NG infections. CONCLUSIONS: Many CT/NG infections would have been missed with urogenital-only screening. Men who have sex with men had much higher extragenital infection rates than women and MSW.

American Indian/Alaska Native Birth and Maternal Health Outcomes in Louisiana: Investigating Regional Disparities.

OBJECTIVES: To report regional maternal and infant health characteristics in the Louisiana American Indian/Alaska Native (AIAN) population. METHODS: This was a cross-sectional descriptive analysis using 2016-2019 Louisiana birth certificate data (N = 242,359; 3205 AIAN births). Prevalence of health characteristics and disparities from population averages were calculated. Health characteristics included low birth weight, preterm birth, very low birth weight, very preterm birth, high birth weight, NICU admission, breastfeeding at discharge, rurality, cesarean section, inadequate prenatal care, and maternal smoking. RESULTS: Low birth weight prevalence ranged from 5.7% in central Louisiana to 20.7% in northeast Louisiana. Most other infant outcomes followed a similar pattern. Disparities from regional averages also varied. AIAN infants had 8% higher risk of LBW than the northeast Louisiana average and 4% lower risk in central Louisiana. Maternal smoking was most prevalent in northern and western Louisiana. Across Louisiana, maternal smoking was as or more prevalent in mothers of AIAN infants compared to regional averages. CONCLUSIONS FOR PRACTICE: There is substantial regional variability in maternal and infant health characteristics in Louisiana AIAN populations, motivating emphasis on locally focused epidemiology to better serve Indigenous communities.

Place, Race, and Case: Examining Racialized Economic Segregation and COVID-19 in Louisiana.

Early COVID-19 pandemic data suggested racial/ethnic minority and low-income earning people bore the greatest burden of infection. Structural racism, the reinforcement of racial and ethnic discrimination via policy, provides a framework for understanding disparities in health outcomes like COVID-19 infection. Residential racial and economic segregation is one indicator of structural racism. Little attention has been paid to the relationship of infection to relative overall concentrations of risk (i.e., segregation of the most privileged from the most disadvantaged). We used ordinary least squares and geographically weighted regression models to evaluate the relationship between racial and economic segregation, measured by the Index of Concentration at the Extremes, and COVID-19 cases in Louisiana. We found a significant global association between racial segregation and cumulative COVID-19 case rate in Louisiana and variation across the state during the study period. The northwest and central regions exhibited a strong negative relationship indicating greater risk in areas with high concentrations of Black residents. On the other hand, the southeastern part of the state exhibited more neutral or positive relationships indicating greater risk in areas with high concentrations of White residents. Our findings that the relationship between racial segregation and COVID-19 cases varied within a state further support evidence that social and political determinants, not biological, drive racial disparities. Small area measures and measures of polarization provide localized information better suited to tailoring public health policy according to the dynamics of communities at the census tract level, which may lead to better health outcomes.

Disparities in Underlying Health Conditions and COVID-19 Infection and Mortality in Louisiana, USA.

BACKGROUND: Louisiana is ranked among the top 10 states with the highest COVID-19 death rate in the USA, and African Americans (AA) that account 32.2% (1.5 million) of the state's population have been impacted differentially with higher rates of chronic health conditions such as hypertension, obesity, and diabetes. These conditions can compromise immune systems and increase susceptibility to COVID-19. Prior health disparity and COVID-19 studies in Louisiana are limited to comprehensively evaluate the risk of underlying health conditions on COVID-19 incidence and death in minority communities and thus the study aims to address this research gap. METHODS: Negative binomial regression analyses were used to correlate risk factors with COVID-19 incidence and death rates using SAS software. Spatial distribution and burden of COVID-19 incidence and mortality rates were mapped using ArcGIS Pro. RESULTS: We found that AA COVID-19 death was three times higher than other races, and mortality rate was ten times higher in counties with more than 40% AA. Highest AA case and death counts were found in Orleans County; mortality rate in Bienville; and incidence rate in East Feliciana. Hypertension, diabetes, and obesity were significantly correlated with both COVID-19 incidence and mortality rates in AA. Greater odds of incidence and death rates also found in counties with higher AA population density with higher burden of underlying health conditions. Furthermore, living in poverty, being 65 years and older significantly influenced COVID-19 cases and deaths in the state. CONCLUSIONS: The study highlights the need to reduce the burden of health disparities in underserved communities, and help to inform the public, scientific communities, and policy makers to plan effective responses to reduce the risks of COVID-19 infection, death, and other potential infectious diseases at the state.