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1.
Sci Rep ; 11(1): 18443, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531435

RESUMO

Prior research has well established the association of ethno-racial and economic inequality with COVID-19 incidence and mortality rates across counties in the US. In this ecological study, a similar association was found between ethno-racial and economic inequality and COVID-19 full vaccination rates across the 102 counties in the American state of Illinois in the early months of vaccination. Among the counties with income inequality below the median, a county's poverty rate had a negative association with the proportion of population fully vaccinated. However, among the counties with income inequality above the median, a higher percentage of Black or Hispanic population was persistently associated with a lower proportion of fully vaccinated population over the two-month period from early February to early April of 2021.


Assuntos
Afro-Americanos/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Hispano-Americanos/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , Feminino , Disparidades nos Níveis de Saúde , Humanos , Illinois/etnologia , Incidência , Masculino , Vacinação em Massa/estatística & dados numéricos , Mortalidade/etnologia , Fatores Socioeconômicos
2.
Proc Natl Acad Sci U S A ; 118(40)2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34583990

RESUMO

Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990 and 2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in high- and low-income US areas and with reference to six European countries. Inequalities in life expectancy are starker in the United States than in Europe. In 1990, White Americans and Europeans in high-income areas had similar overall life expectancy, while life expectancy for White Americans in low-income areas was lower. However, since then, even high-income White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%. Black American life expectancy increased more than White American life expectancy in all US areas, but improvements in lower-income areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black Americans' mortality reductions included cancer, homicide, HIV, and causes originating in the fetal or infant period. Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both high-income and low-income areas.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Expectativa de Vida/etnologia , Mortalidade/etnologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Europa (Continente) , Humanos , Lactente , Expectativa de Vida/tendências , Pessoa de Meia-Idade , Mortalidade/tendências , Estados Unidos , Adulto Jovem
3.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205293

RESUMO

We examined the associations of dietary cholesterol and egg intakes with cardiometabolic and all-cause mortality among Chinese and low-income Black and White Americans. Included were 47,789 Blacks, 20,360 Whites, and 134,280 Chinese aged 40-79 years at enrollment. Multivariable Cox models with restricted cubic splines were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes using intakes of 150 mg cholesterol/day and 1 egg/week as the references. Cholesterol intake showed a nonlinear association with increased all-cause mortality and a linear association with increased cardiometabolic mortality among Black Americans: HRs (95% CIs) associated with 300 and 600 mg/day vs. 150 mg/day were 1.07 (1.03-1.11) and 1.13 (1.05-1.21) for all-cause mortality (P-linearity = 0.04, P-nonlinearity = 0.002, and P-overall < 0.001) and 1.10 (1.03-1.16) and 1.21 (1.08-1.36) for cardiometabolic mortality (P-linearity = 0.007, P-nonlinearity = 0.07, and P-overall = 0.005). Null associations with all-cause or cardiometabolic mortality were noted for White Americans (P-linearity ≥ 0.13, P-nonlinearity ≥ 0.06, and P-overall ≥ 0.05 for both). Nonlinear inverse associations were observed among Chinese: HR (95% CI) for 300 vs. 150 mg/day was 0.94 (0.92-0.97) for all-cause mortality and 0.91 (0.87-0.95) for cardiometabolic mortality, but the inverse associations disappeared with cholesterol intake > 500 mg/day (P-linearity ≥ 0.12; P-nonlinearity ≤ 0.001; P-overall < 0.001 for both). Similarly, we observed a positive association of egg intake with all-cause mortality in Black Americans, but a null association in White Americans and a nonlinear inverse association in Chinese. In conclusion, the associations of cholesterol and egg intakes with cardiometabolic and all-cause mortality may differ across ethnicities who have different dietary patterns and cardiometabolic risk profiles. However, residual confounding remains possible.


Assuntos
Colesterol na Dieta/administração & dosagem , Dieta/estatística & dados numéricos , Ovos , Síndrome Metabólica/mortalidade , Mortalidade/etnologia , Pobreza/estatística & dados numéricos , Adulto , Afro-Americanos , Idoso , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Saúde do Homem , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Estudos Prospectivos , Estados Unidos/epidemiologia , Saúde da Mulher
4.
Am J Public Health ; 111(S2): S133-S140, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34314200

RESUMO

Since its founding, the US government has sorted people into racial/ethnic categories for the purpose of allowing or disallowing their access to social services and protections. The current Office of Management and Budget racial/ethnic categories originated in a dominant racial narrative that assumed a binary biological difference between Whites and non-Whites, with a hard-edged separation between them. There is debate about their continued use in researching group differences in mortality profiles and health outcomes: should we use them with modifications, cease using them entirely, or develop a new epistemology of human similarities and differences? This essay offers a research framework for including in these debates the daily lived experiences of the 110 million racialized non-White Americans whose lived experiences are the legacy of historically limited access to society's services and protections. The experience of Latinos in California is used to illustrate the major elements of this framework that may have an effect on mortality and health outcomes: a subaltern fuzzy-edged multivalent racial narrative, agency, voice, and community and cultural resilience.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Mortalidade/etnologia , Fatores Raciais/estatística & dados numéricos , Classe Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
5.
J Glob Health ; 11: 05015, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34221360

RESUMO

Background: People from racial minority groups in western countries experience disproportionate socioeconomic and structural determinants of health disadvantages. These disadvantages have led to inequalities and inequities in health care access and poorer health outcomes. We report disproportionate disparities in prevalence, hospitalisation, and deaths from COVID-19 by racial minority populations. Methods: We conducted a systematic literature search of relevant databases to identify studies reporting on prevalence, hospitalisations, and deaths from COVID-19 by race groups between 01 January 2020 - 15 April 2021. We grouped race categories into Blacks, Hispanics, Whites and Others. Random effects model using the method of DerSimonian and Laird were fitted, and forest plot with respective ratio estimates and 95% confidence interval (CI) for each race category, and subgroup meta-regression analyses and the overall pooled ratio estimates for prevalence, hospitalisation and mortality rate were presented. Results: Blacks experienced significantly higher burden of COVID-19: prevalence ratio 1.79 (95% confidence interval (CI) = 1.59-1.99), hospitalisation ratio 1.87 (95% CI = 1.69-2.04), mortality ratio 1.68 (95% CI = 1.52-1.83), compared to Whites: prevalence ratio 0.70 (95% CI = 0.0.64-0.77), hospitalisation ratio 0.74 (95% CI = 0.65-0.82), mortality ratio 0.82 (95% CI = 0.78-0.87). Also, Hispanics experienced a higher burden: prevalence ratio 1.78 (95% CI = 1.63-1.94), hospitalisation ratio 1.32 (95% CI = 1.08-1.55), mortality ratio 0.94 (95% CI = 0.84-1.04) compared to Whites. A higher burden was also observed for Other race groups: prevalence ratio 1.43 (95% CI = 1.19-1.67), hospitalisation ratio 1.12 (95% CI = 0.89-1.35), mortality ratio 1.06 (95% CI = 0.89-1.23) compared to Whites. The disproportionate burden among Blacks and Hispanics remained following correction for publication bias. Conclusions: Blacks and Hispanics have been disproportionately affected by COVID-19. This is deeply concerning and highlights the systemically entrenched disadvantages (social, economic, and political) experienced by racial minorities in western countries; and this study underscores the need to address inequities in these communities to improve overall health outcomes.


Assuntos
COVID-19/etnologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Mortalidade/etnologia , COVID-19/diagnóstico , Hospitalização , Humanos , Pandemias , Prevalência , SARS-CoV-2
7.
Natl Vital Stat Rep ; 70(3): 1-31, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34029180

RESUMO

Objectives-This report presents findings on the effects of fully implementing the Office of Management and Budget's 1997 standards for collecting, tabulating, and reporting race and ethnicity in the National Vital Statistics System mortality data across all vital statistics reporting areas. It compares bridgedrace death counts and rates based on the 1977 standards with single-race death counts and rates based on the 1997 standards, overall and by age (categories), sex, and state. Methods-Mortality statistics in this report are based on information from all death certificates filed in the United States and the District of Columbia in 2018. Crude and age-adjusted death rates are calculated with bridged-race and single-race death counts and population estimates then compared using rate ratios. Results-In 2018, single-race death counts were lower than bridged-race counts for all major racial and ethnic groups, overall and by age and sex. This is expected because in bridged-race data, multiple-race decedents are reassigned to single-race categories. The single-race age-adjusted death rate was higher than the bridged-race rate by 0.4% for the non-Hispanic white population (748.7 per 100,000 U.S. standard population versus 745.7) and by 1.5% for the non-Hispanic black population (892.6 versus 879.5). State-specific differences between bridged-race and single-race age-adjusted death rates were significant only for the non-Hispanic Asian or Pacific Islander (API) population in Hawaii, for whom the single-race rate (488.9) was 10.3% lower than the bridged-race rate (545.3). Generally, at the national level, the transition to single-race mortality data seems to have minimal impacts for all major racial and ethnic groups on age-adjusted death rates; however, impacts vary by state.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Mortalidade/etnologia , Projetos de Pesquisa/normas , Estatísticas Vitais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
9.
MMWR Morb Mortal Wkly Rep ; 70(14): 519-522, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33830988

RESUMO

CDC's National Vital Statistics System (NVSS) collects and reports annual mortality statistics using data from U.S. death certificates. Because of the time needed to investigate certain causes of death and to process and review data, final annual mortality data for a given year are typically released 11 months after the end of the calendar year. Daily totals reported by CDC COVID-19 case surveillance are timely but can underestimate numbers of deaths because of incomplete or delayed reporting. As a result of improvements in timeliness and the pressing need for updated, quality data during the global COVID-19 pandemic, NVSS expanded provisional data releases to produce near real-time U.S. mortality data.* This report presents an overview of provisional U.S. mortality data for 2020, including the first ranking of leading causes of death. In 2020, approximately 3,358,814 deaths† occurred in the United States. From 2019 to 2020, the estimated age-adjusted death rate increased by 15.9%, from 715.2 to 828.7 deaths per 100,000 population. COVID-19 was reported as the underlying cause of death or a contributing cause of death for an estimated 377,883 (11.3%) of those deaths (91.5 deaths per 100,000). The highest age-adjusted death rates by age, race/ethnicity, and sex occurred among adults aged ≥85 years, non-Hispanic Black or African American (Black) and non-Hispanic American Indian or Alaska Native (AI/AN) persons, and males. COVID-19 death rates were highest among adults aged ≥85 years, AI/AN and Hispanic persons, and males. COVID-19 was the third leading cause of death in 2020, after heart disease and cancer. Provisional death estimates provide an early indication of shifts in mortality trends and can guide public health policies and interventions aimed at reducing numbers of deaths that are directly or indirectly associated with the COVID-19 pandemic.


Assuntos
COVID-19/mortalidade , Mortalidade/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/etnologia , Causas de Morte/tendências , Criança , Pré-Escolar , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Estados Unidos/epidemiologia , Estatísticas Vitais , Adulto Jovem
10.
J Am Soc Nephrol ; 32(6): 1444-1453, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33833076

RESUMO

BACKGROUND: Reports from around the world have indicated a fatality rate of patients with coronavirus disease 2019 (COVID-19) in the range of 20%-30% among patients with ESKD. Population-level effects of COVID-19 on patients with ESKD in the United States are uncertain. METHODS: We identified patients with ESKD from Centers for Medicare and Medicaid Services data during epidemiologic weeks 3-27 of 2017-2020 and corresponding weeks of 2017-2019, stratifying them by kidney replacement therapy. Outcomes comprised hospitalization for COVID-19, all-cause death, and hospitalization for reasons other than COVID-19. We estimated adjusted relative rates (ARRs) of death and non-COVID-19 hospitalization during epidemiologic weeks 13-27 of 2020 (March 22 to July 4) versus corresponding weeks in 2017-2019. RESULTS: Among patients on dialysis, the rate of COVID-19 hospitalization peaked between March 22 and April 25 2020. Non-Hispanic Black race and Hispanic ethnicity associated with higher rates of COVID-19 hospitalization, whereas peritoneal dialysis was associated with lower rates. During weeks 13-27, ARRs of death in 2020 versus 2017-2019 were 1.17 (95% confidence interval [95% CI], 1.16 to 1.19) and 1.30 (95% CI, 1.24 to 1.36) among patients undergoing dialysis or with a functioning transplant, respectively. Excess mortality was higher among non-Hispanic Black, Hispanic, and Asian patients. Among patients on dialysis, the rate of non-COVID-19 hospitalization during weeks 13-27 in 2020 was 17% lower versus hospitalization rates for corresponding weeks in 2017-2019. CONCLUSIONS: During the first half of 2020, the clinical outcomes of patients with ESKD were greatly affected by COVID-19, and racial and ethnic disparities were apparent. These findings should be considered in prioritizing administration of COVID-19 vaccination.


Assuntos
COVID-19/complicações , Falência Renal Crônica/complicações , SARS-CoV-2 , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/etnologia , COVID-19/mortalidade , COVID-19/prevenção & controle , Vacinas contra COVID-19/provisão & distribuição , Causas de Morte , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/etnologia , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Transplante de Rim , Masculino , Medicaid , Medicare , Pessoa de Meia-Idade , Mortalidade/etnologia , Diálise Renal , Estudos Retrospectivos , Análise de Sobrevida , Triagem , Estados Unidos/epidemiologia , Adulto Jovem
11.
Natl Vital Stat Rep ; 70(1): 1-18, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33814036

RESUMO

Objectives-This report presents complete period life tables for each of the 50 states and the District of Columbia by sex based on age-specific death rates in 2018. Methods-Data used to prepare the 2018 state-specific life tables include 2018 final mortality statistics; July 1, 2018 population estimates based on the 2010 decennial census; and 2018 Medicare data for persons aged 66-99. The methodology used to estimate the state-specific life tables is the same as that used to estimate the 2018 national life tables, with some modifications. Results-Among the 50 states and the District of Columbia, Hawaii had the highest life expectancy at birth, 81.0 years in 2018, and West Virginia had the lowest, 74.4 years. Life expectancy at age 65 ranged from 17.5 years in Kentucky to 21.1 years in Hawaii. Life expectancy at birth was higher for females in all states and the District of Columbia. The difference in life expectancy between females and males ranged from 3.8 years in Utah to 6.2 years in New Mexico.


Assuntos
Expectativa de Vida/tendências , Tábuas de Vida , Mortalidade/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Grupos Étnicos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Expectativa de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto Jovem
12.
MMWR Morb Mortal Wkly Rep ; 70(14): 510-513, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33830986

RESUMO

Geographic differences in infectious disease mortality rates have been observed among American Indian or Alaska Native (AI/AN) persons in the United States (1), and aggregate analyses of data from selected U.S. states indicate that COVID-19 incidence and mortality are higher among AI/AN persons than they are among White persons (2,3). State-level data could be used to identify disparities and guide local efforts to reduce COVID-19-associated incidence and mortality; however, such data are limited. Reports of laboratory-confirmed COVID-19 cases and COVID-19-associated deaths reported to the Montana Department of Public Health and Human Services (MDPHHS) were analyzed to describe COVID-19 incidence, mortality, and case-fatality rates among AI/AN persons compared with those among White persons. During March-November 2020 in Montana, the estimated cumulative COVID-19 incidence among AI/AN persons (9,064 cases per 100,000) was 2.2 times that among White persons (4,033 cases per 100,000).* During the same period, the cumulative COVID-19 mortality rate among AI/AN persons (267 deaths per 100,000) was 3.8 times that among White persons (71 deaths per 100,000). The AI/AN COVID-19 case-fatality rate (29.4 deaths per 1,000 COVID-19 cases) was 1.7 times the rate in White persons (17.0 deaths per 1,000). State-level surveillance findings can help in developing state and tribal COVID-19 vaccine allocation strategies and assist in local implementation of culturally appropriate public health measures that might help reduce COVID-19 incidence and mortality in AI/AN communities.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Nativos Estadunidenses/estatística & dados numéricos , COVID-19/etnologia , COVID-19/mortalidade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Montana/epidemiologia , Mortalidade/etnologia , Adulto Jovem
13.
J Racial Ethn Health Disparities ; 8(3): 783-789, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33751484

RESUMO

IMPORTANCE: Blacks and Latinx are disproportionately affected by Coronavirus disease 2019 (Covid-19) and experience higher mortality rates than Whites and Asians in the USA. Such racial disparities, in Covid-19 testing, cases, and mortality are visible in Connecticut too. Recently, excess deaths have become an important consideration in news reports and academic research. However, data on racial differences in excess death is limited. OBJECTIVE: This study examines racial/ethnic differences in excess deaths in the state of Connecticut during the Covid-19 pandemic. DESIGN: This is a cross-sectional epidemiological study to estimate excess deaths by racial/ethnic status utilizing mortality data during the peak months of Covid-19 infections from March 1 to June 30, 2020, in Connecticut. The following assumption is applied: expected non-Covid-19 deaths from March 1 to June 30, 2020, are equal to the number of deaths occurring during the period of March 1 to June 30, 2019. Race/ethnicity are defined as Non-Hispanic White, Non-Hispanic Black, and Latinx. Descriptive statistics and rates with 95% confidence intervals are presented. Chi-square analyses are performed where applicable. SETTING: Connecticut PARTICIPANTS: All deaths in Connecticut from March 1 to June 30, 2020. EXPOSURE: Covid-19 and race/ethnicity RESULTS: From March 1 to June 30, 2020, a total of 14,226 all-cause deaths occurred including 1514 Blacks (10.6%), 1095 Latinx (7.7%), and 11,617 Whites (81.7%). This represented a 74% increase in mortality for Blacks; 63% for Latinx, and 30% for Whites. In addition, 42.70% of the deaths in Blacks were attributed to Covid-19; 38.5% for Latinx, and 23.0% for Whites (p<0.001). Covid-19 deaths accounted for over 90% of the excess deaths in Blacks and Hispanics. In contrast, in Whites, Covid-19 deaths exceeded the number of excess deaths by 353 cases (113.2%), indicating that some Whites may have died from other underlined health conditions with a positive Covid-19 diagnosis. Furthermore, there was an increase in undetermined deaths in 2020, which accounted for 10.8% of deaths in Blacks, 13% in Latinx, and 6.2% of deaths in Whites. CONCLUSIONS AND RELEVANCE: Excess deaths in Blacks and Latinx were found above the numbers of deaths determined to have occurred due to Covid-19. The fact that a large number of undetermined deaths were found for Blacks and Latinx individuals, and testing rates for Blacks and Latinx individuals (as determined by positivity rates) were lacking during this period strongly suggests, these excess deaths were Covid-19-related deaths. The study findings indicate that Black and Latinx COVID-19-related deaths may be underreported in this pandemic. We advocate for targeted strategies that increase testing capacity, treatment, and vaccine availability in Black and Latinx communities.


Assuntos
Afro-Americanos/estatística & dados numéricos , COVID-19/etnologia , COVID-19/mortalidade , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Connecticut/epidemiologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Humanos , Mortalidade/etnologia
14.
PLoS One ; 16(3): e0246813, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33657143

RESUMO

BACKGROUND: Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates. METHODS AND FINDINGS: We queried CDC WONDER to identify HF deaths between 2011-2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35-64 and 65-84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011-2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011-2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 [95% CI: 72.2-74.2] vs. 57.2 [56.8-57.6] in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 [123.3-138.9] in 2018) with greatest increases in HF-related mortality in those 35-64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 [1.04-1.16]) and older adults (1.04 [1.02-1.07]) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates (<20). CONCLUSIONS: Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.


Assuntos
Insuficiência Cardíaca/mortalidade , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Insuficiência Cardíaca/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Mortalidade/tendências , Estados Unidos/epidemiologia
15.
JAMA Netw Open ; 4(3): e214149, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739434

RESUMO

Importance: Significant concern has been raised that crisis standards of care policies aimed at guiding resource allocation may be biased against people based on race/ethnicity. Objective: To evaluate whether unanticipated disparities by race or ethnicity arise from a single institution's resource allocation policy. Design, Setting, and Participants: This cohort study included adults (aged ≥18 years) who were cared for on a coronavirus disease 2019 (COVID-19) ward or in a monitored unit requiring invasive or noninvasive ventilation or high-flow nasal cannula between May 26 and July 14, 2020, at 2 academic hospitals in Miami, Florida. Exposures: Race (ie, White, Black, Asian, multiracial) and ethnicity (ie, non-Hispanic, Hispanic). Main Outcomes and Measures: The primary outcome was based on a resource allocation priority score (range, 1-8, with 1 indicating highest and 8 indicating lowest priority) that was assigned daily based on both estimated short-term (using Sequential Organ Failure Assessment score) and longer-term (using comorbidities) mortality. There were 2 coprimary outcomes: maximum and minimum score for each patient over all eligible patient-days. Standard summary statistics were used to describe the cohort, and multivariable Poisson regression was used to identify associations of race and ethnicity with each outcome. Results: The cohort consisted of 5613 patient-days of data from 1127 patients (median [interquartile range {IQR}] age, 62.7 [51.7-73.7]; 607 [53.9%] men). Of these, 711 (63.1%) were White patients, 323 (28.7%) were Black patients, 8 (0.7%) were Asian patients, and 31 (2.8%) were multiracial patients; 480 (42.6%) were non-Hispanic patients, and 611 (54.2%) were Hispanic patients. The median (IQR) maximum priority score for the cohort was 3 (1-4); the median (IQR) minimum score was 2 (1-3). After adjustment, there was no association of race with maximum priority score using White patients as the reference group (Black patients: incidence rate ratio [IRR], 1.00; 95% CI, 0.89-1.12; Asian patients: IRR, 0.95; 95% CI. 0.62-1.45; multiracial patients: IRR, 0.93; 95% CI, 0.72-1.19) or of ethnicity using non-Hispanic patients as the reference group (Hispanic patients: IRR, 0.98; 95% CI, 0.88-1.10); similarly, no association was found with minimum score for race, again with White patients as the reference group (Black patients: IRR, 1.01; 95% CI, 0.90-1.14; Asian patients: IRR, 0.96; 95% CI, 0.62-1.49; multiracial patients: IRR, 0.81; 95% CI, 0.61-1.07) or ethnicity, again with non-Hispanic patients as the reference group (Hispanic patients: IRR, 1.00; 95% CI, 0.89-1.13). Conclusions and Relevance: In this cohort study of adult patients admitted to a COVID-19 unit at 2 US hospitals, there was no association of race or ethnicity with the priority score underpinning the resource allocation policy. Despite this finding, any policy to guide altered standards of care during a crisis should be monitored to ensure equitable distribution of resources.


Assuntos
COVID-19 , Alocação de Recursos para a Atenção à Saúde , Disparidades em Assistência à Saúde/etnologia , Hospitalização/estatística & dados numéricos , Alocação de Recursos , Padrão de Cuidado/estatística & dados numéricos , COVID-19/etnologia , COVID-19/terapia , Estudos de Coortes , Grupos Étnicos , Feminino , Florida/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Alocação de Recursos/métodos , Alocação de Recursos/organização & administração
16.
J R Soc Med ; 114(4): 182-211, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33759630

RESUMO

OBJECTIVE: To estimate the proportion of ethnic inequalities explained by living in a multi-generational household. DESIGN: Causal mediation analysis. SETTING: Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020). PARTICIPANTS: Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568). MAIN OUTCOME MEASURES: Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health. RESULTS: Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06-1.30) and 1.21 (95% CI 1.06-1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01-1.13) for elderly men and 1.17 (95% CI 1.07-1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups. CONCLUSION: Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.


Assuntos
COVID-19 , Características da Família/etnologia , Habitação , Mortalidade/etnologia , Características de Residência/estatística & dados numéricos , Fatores Etários , Idoso , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , COVID-19/mortalidade , COVID-19/prevenção & controle , Criança , Inglaterra/epidemiologia , Família , Feminino , Disparidades nos Níveis de Saúde , Habitação/normas , Habitação/estatística & dados numéricos , Humanos , Masculino , Medição de Risco , SARS-CoV-2 , Fatores Sexuais , Fatores Socioeconômicos
17.
MMWR Morb Mortal Wkly Rep ; 70(7): 236-239, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33600382

RESUMO

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with manifestations that vary widely in severity. Although minority populations are at higher risk for SLE and have more severe outcomes (1), population-based estimates of mortality by race and ethnicity are often lacking, particularly for Asian and Hispanic/Latino persons. Among 812 patients in the California Lupus Surveillance Project (CLSP) during 2007-2009 (2,3), who were matched to the 2007-2017 National Death Index (NDI), 16.6% had died by 2017. This proportion included persons of White (14.4%), Black (25%), Asian (15.3%), and Hispanic/Latino (15.5%) race/ethnicity. Standardized mortality ratios (SMRs) of observed-to-expected deaths among persons with SLE within each racial/ethnic group were 2.3, 2.0, 3.8, and 3.9, respectively. These findings provide the first population-based estimates of mortality among Asian and Hispanic/Latino persons with SLE. Coordination of robust care models between primary care providers and rheumatologists could ensure that persons with SLE receive a timely diagnosis and appropriate treatments that might help address SLE-associated mortality.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/etnologia , Lúpus Eritematoso Sistêmico/mortalidade , Grupos Minoritários/estatística & dados numéricos , Adolescente , Adulto , Idoso , California/epidemiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Adulto Jovem
18.
Int J STD AIDS ; 32(3): 257-265, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33525959

RESUMO

The growing trend of HIV/AIDS is a major concern in the Middle East and North Africa (MENA) regions, as its incidence in the region has increased by 31% in the last decade. The study population in the countries of the MENA region included 21 countries with a population of approximately 400 million. The Global Burden of Disease database was used to calculate the number of HIV/AIDS cases. Modeling for each country is based on the availability and quality of data. The highest incidence rates of HIV/AIDS were in Sudan, United Arab Emirates (UAE), Tunisia, and Iran, respectively, and the highest mortality rates were in Sudan, UAE, Oman, and Morocco, respectively. The incidence, prevalence and mortality rates, as well as the disability adjusted life years (DALYs) rate declined in 2017 compared to 1990. The highest percentage of changes in DALY rates was reported for Turkey, the United Arab Emirates (UAE), and Sudan, respectively, and the lowest for Qatar, Kuwait, and Bahrain. In general, unsafe sex had the highest impact on the DALY index in all countries in the region except Iran and Bahrain. Policymakers should therefore be encouraged to develop harm reduction programs for people living with HIV, and invest globally in reducing HIV prevalence rates in commercial sex workers, people who inject drugs, and men who have sex with men in the region, as well as eliminating mother-to-child HIV transmission.


Assuntos
Infecções por HIV/etnologia , Mortalidade/etnologia , África do Norte/epidemiologia , Feminino , Infecções por HIV/mortalidade , Humanos , Incidência , Masculino , Oriente Médio/epidemiologia , Prevalência
20.
Health Aff (Millwood) ; 40(2): 307-316, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33523748

RESUMO

The impact of the coronavirus disease 2019 (COVID-19) pandemic has been starkly unequal across race and ethnicity. We examined the geographic variation in excess all-cause mortality by race and ethnicity to better understand the impact of the pandemic. We used individual-level administrative data on the US population between January 2011 and April 2020 to estimate the geographic variation in excess all-cause mortality by race and Hispanic origin. All-cause mortality allows a better understanding of the overall impact of the pandemic than mortality attributable to COVID-19 directly. Nationwide, adjusted excess all-cause mortality during that period was 6.8 per 10,000 for Black people, 4.3 for Hispanic people, 2.7 for Asian people, and 1.5 for White people. Nationwide averages mask substantial geographic variation. For example, despite similar excess White mortality, Michigan and Louisiana had markedly different excess Black mortality, as did Pennsylvania compared with Rhode Island. Wisconsin experienced no significant White excess mortality but had significant Black excess mortality. Further work understanding the causes of geographic variation in racial and ethnic disparities-the relevant roles of social and environmental factors relative to comorbidities and of the direct and indirect health effects of the pandemic-is crucial for effective policy making.


Assuntos
COVID-19/epidemiologia , Grupos de Populações Continentais , Geografia , Disparidades nos Níveis de Saúde , Mortalidade/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Mortalidade/tendências , Estados Unidos
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