Joint Effects of Socioeconomic Position, Race/Ethnicity, and Gender on COVID-19 Mortality among Working-Age Adults in the United States.

Substantial racial/ethnic and gender disparities in COVID-19 mortality have been previously documented. However, few studies have investigated the impact of individual socioeconomic position (SEP) on these disparities. Objectives: To determine the joint effects of SEP, race/ethnicity, and gender on the burden of COVID-19 mortality. A secondary objective was to determine whether differences in opportunities for remote work were correlated with COVID-19 death rates for sociodemographic groups. Design: Annual mortality study which used a special government tabulation of 2020 COVID-19-related deaths stratified by decedents' SEP (measured by educational attainment), gender, and race/ethnicity. Setting: United States in 2020. Participants: COVID-19 decedents aged 25 to 64 years old (n = 69,001). Exposures: Socioeconomic position (low, intermediate, and high), race/ethnicity (Hispanic, Black, Asian, Indigenous, multiracial, and non-Hispanic white), and gender (women and men). Detailed census data on occupations held by adults in 2020 in each of the 36 sociodemographic groups studied were used to quantify the possibility of remote work for each group. Main Outcomes and Measures: Age-adjusted COVID-19 death rates for 36 sociodemographic groups. Disparities were quantified by relative risks and 95% confidence intervals. High-SEP adults were the (low-risk) referent group for all relative risk calculations. Results: A higher proportion of Hispanics, Blacks, and Indigenous people were in a low SEP in 2020, compared with whites. COVID-19 mortality was five times higher for low vs. high-SEP adults (72.2 vs. 14.6 deaths per 100,000, RR = 4.94, 95% CI 4.82-5.05). The joint detriments of low SEP, Hispanic ethnicity, and male gender resulted in a COVID-19 death rate which was over 27 times higher (178.0 vs. 6.5 deaths/100,000, RR = 27.4, 95% CI 25.9-28.9) for low-SEP Hispanic men vs. high-SEP white women. In regression modeling, percent of the labor force in never remote jobs explained 72% of the variance in COVID-19 death rates. Conclusions and Relevance: SARS-CoV-2 infection control efforts should prioritize low-SEP adults (i.e., the working class), particularly the majority with "never remote" jobs characterized by inflexible and unsafe working conditions (i.e., blue collar, service, and retail sales workers).

Out-of-Hospital COVID-19 Deaths: Consequences for Quality of Medical Care and Accuracy of Cause of Death Coding.

Objectives. To examine age and temporal trends in the proportion of COVID-19 deaths occurring out of hospital or in the emergency department and the proportion of all noninjury deaths assigned ill-defined causes in 2020. Methods. We analyzed newly released (March 2021) provisional COVID-19 death tabulations for the entire United States. Results. Children (younger than 18 years) were most likely (30.5%) and elders aged 64 to 74 years were least likely (10.4%) to die out of hospital or in the emergency department. In parallel, among all noninjury deaths, younger people had the highest proportions coded to symptoms, signs, and ill-defined conditions, and percentage symptoms, signs, and ill-defined conditions increased from 2019 to 2020 in all age-race/ethnicity groups. The majority of young COVID-19 decedents were racial/ethnic minorities. Conclusions. The high proportions of all noninjury deaths among children, adolescents, and young adults that were coded to ill-defined causes in 2020 suggest that some COVID-19 deaths were missed because of systemic failures in timely access to medical care for vulnerable young people. Public Health Implications. Increasing both availability of and access to the best hospital care for young people severely ill with COVID-19 will save lives and improve case fatality rates.

Creating community-academic partnerships for cancer disparities research and health promotion.

To effectively attenuate cancer disparities in multiethnic, medically underserved populations, interventions must be developed collaboratively through solid community-academic partnerships and driven by community-based participatory research (CBPR). The Tampa Bay Community Cancer Network (TBCCN) has been created to identify and implement interventions to address local cancer disparities in partnership with community-based nonprofit organizations, faith-based groups, community health centers, local media, and adult literacy and education organizations. TBCCN activities and research efforts are geared toward addressing critical information and access issues related to cancer control and prevention in diverse communities in the Tampa Bay area. Such efforts include cross-cultural health promotion, screening, and awareness activities in addition to applied research projects that are rooted in communities and guided by CBPR methods. This article describes these activities as examples of partnership building to positively affect cancer disparities, promote community health, and set the stage for community-based research partnerships.

Strategies for assessing community challenges and strengths for cancer disparities participatory research and outreach.

Interventions involving community-academic partnerships must be driven by a participatory approach that is informed by a comprehensive understanding of the perspectives of communities or focus populations. Often research agendas of academics are different from perceived priority needs of community members. Successful and sustainable interventions are made possible with initial open dialogue among all collaborators so that roles are clearly defined and concerns are addressed. This article describes approaches used in the development of a participatory assessment of health and social issues as defined by community and academic partners, current findings, and lessons learned. The assessment is one initial activity of the Tampa Bay Community Cancer Network (TBCCN) to guide network directions through 2010. The TBCCN is one of 25 programs nationwide addressing cancer disparities through sustainable community-based participatory research, outreach, and screening activities.