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Artikel ; Online: Racial and ethnic health disparities in healthcare settings.

Gardiner, Tom / Abraham, Sonya / Clymer, Olivia / Rao, Mala / Gnani, Shamini

2021 Band 372, Seite(n) n605

Mesh-Begriff(e)	COVID-19/epidemiology ; COVID-19/ethnology ; COVID-19/prevention & control ; COVID-19 Vaccines/administration & dosage ; Clinical Trials as Topic/statistics & numerical data ; Community Participation/statistics & numerical data ; Continental Population Groups/statistics & numerical data ; Culturally Competent Care/organization & administration ; Culturally Competent Care/statistics & numerical data ; Ethnic Groups/statistics & numerical data ; Health Services Research/organization & administration ; Health Services Research/statistics & numerical data ; Health Status Disparities ; Healthcare Disparities/ethnology ; Humans ; Minority Groups/statistics & numerical data ; Patient Selection ; United Kingdom/epidemiology
Chemische Substanzen	COVID-19 Vaccines
Sprache	Englisch
Erscheinungsdatum	2021-03-08
Erscheinungsland	England
Dokumenttyp	Editorial
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.n605
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Racial and Ethnic Disparities in Cervical Cancer Screening From Three U.S. Healthcare Settings.

Spencer, Jennifer C / Kim, Jane J / Tiro, Jasmin A / Feldman, Sarah J / Kobrin, Sarah C / Skinner, Celette Sugg / Wang, Lei / McCarthy, Anne Marie / Atlas, Steve J / Pruitt, Sandi L / Silver, Michelle I / Haas, Jennifer S

American journal of preventive medicine

2023 Band 65, Heft 4, Seite(n) 667–677

Abstract: Introduction: This study sought to characterize racial and ethnic disparities in cervical cancer ... screening and follow-up of abnormal findings across 3 U.S. healthcare settings.: Methods: Data were ... S., a northwestern mixed-model system, and a northeastern integrated healthcare system. Screening ...

Abstract	Introduction: This study sought to characterize racial and ethnic disparities in cervical cancer screening and follow-up of abnormal findings across 3 U.S. healthcare settings. Methods: Data were from 2016 to 2019 and were analyzed in 2022, reflecting sites within the Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations Research Center, part of the Population-based Research to Optimize the Screening Process consortium, including a safety-net system in the southwestern U.S., a northwestern mixed-model system, and a northeastern integrated healthcare system. Screening uptake was evaluated among average-risk patients (i.e., no previous abnormalities) by race and ethnicity as captured in the electronic health record, using chi-square tests. Among patients with abnormal findings requiring follow-up, the proportion receiving colposcopy or biopsy within 6 months was reported. Multivariable regression was conducted to assess how clinical, socioeconomic, and structural characteristics mediate observed differences. Results: Among 188,415 eligible patients, 62.8% received cervical cancer screening during the 3-year study period. Screening use was lower among non-Hispanic Black patients (53.2%) and higher among Hispanic (65.4%,) and Asian/Pacific Islander (66.5%) than among non-Hispanic White patients (63.5%, all p<0.001). Most differences were explained by the distribution of patients across sites and differences in insurance. Hispanic patients remained more likely to screen after controlling for a variety of clinical and sociodemographic factors (risk ratio=1.14, CI=1.12, 1.16). Among those receiving any screening test, Black and Hispanic patients were more likely to receive Pap-only testing (versus receiving co-testing). Follow-up from abnormal results was low for all groups (72.5%) but highest among Hispanic participants (78.8%, p<0.001). Conclusions: In a large cohort receiving care across 3 diverse healthcare settings, cervical cancer screening and follow-up were below 80% coverage targets. Lower screening for Black patients was attenuated by controlling for insurance and site of care, underscoring the role of systemic inequity. In addition, it is crucial to improve follow-up after abnormalities are identified, which was low for all populations.
Mesh-Begriff(e)	Female ; Humans ; Delivery of Health Care ; Early Detection of Cancer ; Ethnicity ; Hispanic or Latino ; Uterine Cervical Neoplasms/diagnosis ; White ; Black or African American ; Pacific Island People ; Asian ; Healthcare Disparities
Sprache	Englisch
Erscheinungsdatum	2023-05-03
Erscheinungsland	Netherlands
Dokumenttyp	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2023.04.016
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Locking the Revolving Door: Racial Disparities in Cardiovascular Disease.

Velarde, Gladys / Bravo-Jaimes, Katia / Brandt, Eric J / Wang, Daniel / Douglass, Paul / Castellanos, Luis R / Rodriguez, Fatima / Palaniappan, Latha / Ibebuogu, Uzoma / Bond, Rachel / Ferdinand, Keith / Lundberg, Gina / Thamman, Ritu / Vijayaraghavan, Krishnaswami / Watson, Karol

Journal of the American Heart Association

2023 Band 12, Heft 8, Seite(n) e025271

Abstract: ... differences in care and outcomes of racial and ethnic minority groups in both of these settings ... determinants are a primary cause of health disparities, and these include factors such as structural and overt ... Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social ...

Abstract	Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strategies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.
Mesh-Begriff(e)	Humans ; United States/epidemiology ; Ethnicity ; Minority Groups ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/therapy ; Healthcare Disparities ; Racial Groups
Sprache	Englisch
Erscheinungsdatum	2023-03-21
Erscheinungsland	England
Dokumenttyp	Journal Article ; Review
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.122.025271
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Examining racial/ethnic inequities in treatment participation among perinatal individuals with depression.

Boama-Nyarko, Esther / Flahive, Julie / Zimmermann, Martha / Allison, Jeroan J / Person, Sharina / Moore Simas, Tiffany A / Byatt, Nancy

General hospital psychiatry

2024 Band 88, Seite(n) 23–29

Abstract: ... by race/ethnicity.: Conclusions: Perinatal mental healthcare inequities are associated with disparities ... in treatment referrals. Interventions focusing on referral disparities across race and ethnicity are needed. ... attended ≥1 mental health visit or reported prescribed antidepressant medication), and 3) sustainment (i.e ...

Abstract	Objective: A cluster randomized controlled trial (RCT) of two interventions for addressing perinatal depression treatment in obstetric settings was conducted. This secondary analysis compared treatment referral and participation among Minoritized perinatal individuals compared to their non-Hispanic white counterparts. Methods: Among perinatal individuals with depression symptoms, we examined rates of treatment 1) referral (i.e., offered medications or referred to mental health clinician), 2) initiation (i.e., attended ≥1 mental health visit or reported prescribed antidepressant medication), and 3) sustainment (i.e., attended >1 mental health visit per study month or prescribed antidepressant medication at time of study interviews). We compared non-Hispanic white (NHW) (n = 149) vs. Minoritized perinatal individuals (Black, Asian, Hispanic/Latina, Pacific Islander, Native American, Multiracial, and white Hispanic/Latina n = 157). We calculated adjusted odds ratios (aOR) for each outcome. Results: Minoritized perinatal individuals across both interventions had significantly lower odds of treatment referral (aOR = 0.48;95% CI = 0.27-0.88) than their NHW counterparts. There were no statistically significant differences in the odds of treatment initiation (aOR = 0.64 95% CI:0.36-1.2) or sustainment (aOR = 0.54;95% CI = 0.28-1.1) by race/ethnicity. Conclusions: Perinatal mental healthcare inequities are associated with disparities in treatment referrals. Interventions focusing on referral disparities across race and ethnicity are needed.
Mesh-Begriff(e)	Female ; Humans ; Pregnancy ; Antidepressive Agents/therapeutic use ; Depression ; Ethnicity ; Racial Groups ; Health Inequities ; Healthcare Disparities
Chemische Substanzen	Antidepressive Agents
Sprache	Englisch
Erscheinungsdatum	2024-02-15
Erscheinungsland	United States
Dokumenttyp	Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	392299-6
ISSN	1873-7714 ; 0163-8343
ISSN (online)	1873-7714
ISSN	0163-8343
DOI	10.1016/j.genhosppsych.2024.02.006
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Racial and Ethnic Disparities in Short-Stay Total Knee Arthroplasty.

MacMahon, Aoife S / Mekkawy, Kevin L / Barry, Kawsu / Khanuja, Harpal S

The Journal of arthroplasty

2023 Band 38, Heft 7, Seite(n) 1217–1223

Abstract: Background: The purpose of this study was to understand racial and ethnic disparities in hospital ... between racial/ethnic groups and 2) trends in outpatient TKA volume, based on race/ethnicity.: Methods ... of outpatient TKA are impacted by risk factors that reflect underlying disparities in healthcare. As joint ...

Abstract	Background: The purpose of this study was to understand racial and ethnic disparities in hospital-based, Medicare-defined outpatient total knee arthroplasty (TKA). We aimed to determine the following: 1) whether there are differences in preoperative characteristics or postoperative outcomes in outpatient TKA between racial/ethnic groups and 2) trends in outpatient TKA volume, based on race/ethnicity. Methods: This was a retrospective cohort study of a large national database. Outpatient TKAs performed between 2012 and 2018 were identified. Patient demographics, comorbidities, and 30-day postoperative outcomes were compared between White, Black, Asian, and Hispanic patients. Results: Of 54,183 outpatient patients, 85.6% were White, 7.4% Black, 2.6% Asian, and 4.1% Hispanic. Black patients had the highest body mass index, and there were higher rates of diabetes among all minority groups (P < .001). All minority groups were more likely to be discharged to a rehabilitation or a skilled care facility compared to White patients (P < .001). Annual percentage increases in outpatient TKA were most pronounced for Asians and Hispanics and least pronounced among Blacks, when compared to White patients. Conclusion: The outcomes of outpatient TKA are impacted by risk factors that reflect underlying disparities in healthcare. As joint arthroplasties have come off the inpatient-only list and procedures move to ambulatory settings, these disparities will likely magnify and impact outcomes, costs, and access points. Extensive preoperative optimization and interventions that target medical and social factors may help to reduce these disparities in TKA and increase access among minority patients. Level of evidence: III, retrospective cohort study.
Mesh-Begriff(e)	Aged ; Humans ; Arthroplasty, Replacement, Knee ; Ethnicity ; Healthcare Disparities ; Hispanic or Latino ; Medicare ; Retrospective Studies ; United States ; White ; Black or African American ; Asian
Sprache	Englisch
Erscheinungsdatum	2023-01-06
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2022.12.044
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients.

Yakusheva, Olga / Lee, Kathryn A / Keller, Abiola / Weiss, Marianne E

Medical care

2023 Band 62, Heft 1, Seite(n) 21–29

Abstract: ... from racial and ethnic minority groups are less likely to receive HHC visits.: Objective: To examine how ... at the time of hospital discharge differs by race and ethnic minority group.: Research design: Secondary ... needed to address systemic structural injustice in health care settings. ...

Abstract	Background: Home health care (HHC) services following hospital discharge provide essential continuity of care to mitigate risks of posthospitalization adverse outcomes and readmissions, yet patients from racial and ethnic minority groups are less likely to receive HHC visits. Objective: To examine how the association of nurse assessments of patients' readiness for discharge with referral to HHC services at the time of hospital discharge differs by race and ethnic minority group. Research design: Secondary data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals (READI Randomized Clinical Trial: 09/15/2014-03/31/2017), using linear and logistic models adjusted for patient demographic/clinical characteristics and hospital fixed effects. Subjects: All Medicare patients in the study's intervention arm (n=14,684). Measures: Patient's race/ethnicity and discharge disposition code for referral to HHC (vs. home) from electronic health records. Patient's Readiness for Hospital Discharge Scale (RHDS) score (0-10 scale) assessed by the discharging nurse on the day of discharge. Results: Adjusted RHDS scores were similar for non-Hispanic White (8.21; 95% CI: 8.18-8.24), non-Hispanic Black (8.20; 95% CI: 8.12-8.28), Hispanic (7.92; 95% CI: 7.81-8.02), and other race/ethnicity patients (8.09; 95% CI: 8.01-8.17). Non-Hispanic Black patients with low RHDS scores (6 or less) were less likely than non-Hispanic White patients to be discharged with an HHC referral (Black: 26.8%, 95% CI: 23.3-30.3; White: 32.6%, 95% CI: 31.1-34.1). Conclusions: Despite similar RHDS scores, Black patients were less likely to be discharged with HHC. A better understanding of root causes is needed to address systemic structural injustice in health care settings.
Mesh-Begriff(e)	Adult ; Aged ; Humans ; Ethnicity ; Healthcare Disparities ; Medicare ; Minority Groups ; Racial Groups ; Referral and Consultation ; Retrospective Studies ; United States
Sprache	Englisch
Erscheinungsdatum	2023-12-07
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	411646-x
ISSN	1537-1948 ; 0025-7079
ISSN (online)	1537-1948
ISSN	0025-7079
DOI	10.1097/MLR.0000000000001945
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Racial, Ethnic, and Socioeconomic Disparities in Prehospital Encounters for Children with Asthma.

Owusu-Ansah, Sylvia / Crowe, Remle P / Ramgopal, Sriram

Prehospital emergency care

2023 Band 27, Heft 8, Seite(n) 1107–1114

Abstract: ... by emergency medical services (EMS). While care disparities for children with asthma have been observed in other healthcare ... confidence intervals (95%CI) for prehospital bronchodilator use or steroid use by race and ethnicity, adjusting for age ... corticosteroid administration did not differ significantly by race and ethnicity.: Conclusion: Black non ...

Abstract	Objective: Asthma represents one of the most common medical conditions among children encountered by emergency medical services (EMS). While care disparities for children with asthma have been observed in other healthcare settings, limited data exist characterizing disparities in prehospital care. We sought to characterize differences in prehospital treatment and transport of children with suspected asthma exacerbations by race and ethnicity, within the context of community socioeconomic status. Methods: We conducted a multi-agency retrospective study of EMS encounters in 2019 for children (2-17 years) with asthma and wheezing using a national prehospital database. Our primary outcomes included EMS transport and prehospital bronchodilator or systemic corticosteroid administration. Scene socioeconomic status was evaluated using the social vulnerability index. We used generalized estimating equations to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for prehospital bronchodilator use or steroid use by race and ethnicity, adjusting for age, presence of abnormal vital signs, community size, bronchodilator use prior to EMS arrival, and transport disposition. Results: We analyzed 5,266 EMS encounters (median age 8 years). Approximately half (53%) were Black non-Hispanic and 34% were White non-Hispanic. Overall, 77% were transported by EMS. In an adjusted model, Black non-Hispanic children were 25% less likely to be transported compared to White non-Hispanic children (aOR: 0.75, 95%CI: 0.58-0.96). EMS administered at least one bronchodilator to 81% of Black non-Hispanic patients, 73% of Hispanic patients, and 68% of White, non-Hispanic patients. Relative to White non-Hispanic children, EMS bronchodilator administration was greater for Black non-Hispanic children, (aOR: 1.55, 95%CI: 1.25-1.93), after controlling for scene socioeconomic status and potential confounding variables. Systemic corticosteroids were administered in 3% of all encounters. Odds of prehospital systemic corticosteroid administration did not differ significantly by race and ethnicity. Conclusion: Black non-Hispanic children comprised a larger proportion of EMS encounters for asthma and were more likely to receive a bronchodilator in adjusted analyses accounting for community socioeconomic status. However, these children were less likely to be transported by EMS. These findings may reflect disease severity not manifested by abnormal vital signs, management, and other social factors that warrant further investigation.
Mesh-Begriff(e)	Humans ; Child ; Retrospective Studies ; Emergency Medical Services ; Socioeconomic Disparities in Health ; Bronchodilator Agents ; Asthma/drug therapy ; Asthma/epidemiology ; Adrenal Cortex Hormones ; Healthcare Disparities
Chemische Substanzen	Bronchodilator Agents ; Adrenal Cortex Hormones
Sprache	Englisch
Erscheinungsdatum	2023-11-01
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2023.2260471
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Racial and ethnic inequities in psychiatric inpatient building and unit assignment.

Michaels, Timothy I / Thomas, Elsa / Flaxer, Joseph M / Singal, Sonali / Hanna, Lauren / Van Meter, Anna / Tang, Sunny X / Kane, John M / Saito, Ema

Psychiatry research

2023 Band 330, Seite(n) 115560

Abstract: Racism is a social determinant of mental health which has a disproportionally negative impact ... on the experiences of psychiatric inpatients of color. Distinct differences in the physical space and clinical ... of patients to specific buildings and units. Archival electronic medical record data were analyzed from over ...

Abstract	Racism is a social determinant of mental health which has a disproportionally negative impact on the experiences of psychiatric inpatients of color. Distinct differences in the physical space and clinical settings of two inpatient buildings at a hospital system in the tristate (New York, New Jersey, Connecticut) area of the United States led to the present investigation of racial inequities in the assignment of patients to specific buildings and units. Archival electronic medical record data were analyzed from over 18,000 unique patients over a period of six years. Hierarchical logistic regression analyses were conducted with assigned building (old vs. new building) as the binary outcome variable. Non-Hispanic White patients were set as the reference group. Black, Hispanic/Latinx, and Asian patients were significantly less likely to be assigned to better resourced units in the new building. When limiting the analysis to only general adult units, Black and Hispanic/Latinx patients were significantly less likely to be assigned to units in the new building. These results suggest ethnoracial inequities in patient assignment to buildings which differed in clinical and physical conditions. The findings serve as a call to action for hospital systems to examine the ways in which structural racism impact clinical care.
Mesh-Begriff(e)	Adult ; Humans ; Black People ; Hispanic or Latino ; Inpatients/psychology ; Inpatients/statistics & numerical data ; Racial Groups/ethnology ; Racial Groups/psychology ; Racial Groups/statistics & numerical data ; Racism/ethnology ; Racism/statistics & numerical data ; United States ; Hospitals, Psychiatric/statistics & numerical data ; Social Determinants of Health/ethnology ; Social Determinants of Health/statistics & numerical data ; White ; Asian ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data
Sprache	Englisch
Erscheinungsdatum	2023-11-02
Erscheinungsland	Ireland
Dokumenttyp	Journal Article
ZDB-ID	445361-x
ISSN	1872-7123 ; 1872-7506 ; 0925-4927 ; 0165-1781
ISSN (online)	1872-7123 ; 1872-7506
ISSN	0925-4927 ; 0165-1781
DOI	10.1016/j.psychres.2023.115560
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Racial discrimination in healthcare settings and mental health among a population-based sample of racial and ethnic minoritized adults with COVID-19 in Michigan.

Ryu, Soomin / Hirschtick, Jana L / Allgood, Kristi L / Orellana, Robert / Fleischer, Nancy L

Preventive medicine reports

2023 Band 36, Seite(n) 102529

Abstract: The COVID-19 pandemic has worsened existing racial health disparities and racial ... to mental health during the pandemic. Using a population-based probability sample of racial and ethnic minoritized ... measures of perceived racial discrimination in (1) seeking healthcare for COVID-19 (n = 1,210) and (2 ...

Abstract	The COVID-19 pandemic has worsened existing racial health disparities and racial discrimination in healthcare; however, little is known about how racial discrimination in healthcare settings is related to mental health during the pandemic. Using a population-based probability sample of racial and ethnic minoritized adults with a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection in Michigan, we examined how measures of perceived racial discrimination in (1) seeking healthcare for COVID-19 (n = 1,210) and (2) receiving testing/treatment for COVID-19 (n = 1,364) were associated with binary variables of depressive and anxiety symptoms. We conducted a modified Poisson regression analysis with robust standard errors to estimate associations between each measure of racial discrimination and each mental health outcome separately, adjusting for demographic and socio-economic variables, health insurance, and pre-existing physical and psychiatric conditions. 7.3 % and 8.7 % of adults reported racial discrimination in seeking healthcare for COVID-19 and in getting testing/treatment for COVID-19, respectively. Although the overall prevalence of racial discrimination in healthcare settings was low, experiences of racial discrimination were associated with depressive symptoms. Adults who experienced racial discrimination in seeking healthcare had 1.74 times higher prevalence of reporting depressive symptoms (95 % CI:1.21-2.52) than those who did not. Moreover, adults who experienced racial discrimination in getting testing/treatment had 1.86 times higher prevalence of reporting depressive symptoms (95 % CI:1.36-2.53) than those who did not. Neither measure of racial discrimination was associated with anxiety symptoms in the adjusted models. There is a need for promoting anti-racial discrimination policies, educational programs, and awareness efforts in healthcare settings.
Sprache	Englisch
Erscheinungsdatum	2023-11-29
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2785569-7
ISSN	2211-3355
ISSN	2211-3355
DOI	10.1016/j.pmedr.2023.102529
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Racial, Ethnic, and Rural Disparities in US Veteran COVID-19 Vaccine Rates.

Bernstein, Ethan / DeRycke, Eric C / Han, Ling / Farmer, Melissa M / Bastian, Lori A / Bean-Mayberry, Bevanne / Bade, Brett / Brandt, Cynthia / Crothers, Kristina / Skanderson, Melissa / Ruser, Christopher / Spelman, Juliette / Bazan, Isabel S / Justice, Amy C / Rentsch, Christopher T / Akgün, Kathleen M

AJPM focus

2023 , Seite(n) 100094

Abstract: Background: Race, ethnicity, and rurality-related disparities in coronavirus disease 2019 (COVID ... whether these disparities existed among patients at the Department of Veterans Affairs (VA), the largest healthcare ... with urban White patients. A better understanding of disparities and rural outreach will inform equitable ...

Abstract	Background: Race, ethnicity, and rurality-related disparities in coronavirus disease 2019 (COVID-19) vaccine uptake have been documented in the United States (US). Objective: We determined whether these disparities existed among patients at the Department of Veterans Affairs (VA), the largest healthcare system in the US. Design settings participants measurements: Using VA Corporate Data Warehouse data, we included 5,871,438 patients (9.4% women) with at least one primary care visit in 2019 in a retrospective cohort study. Each patient was assigned a single race/ethnicity, which were mutually exclusive, self-reported categories. Rurality was based on 2019 home address at the zip code level. Our primary outcome was time-to-first COVID-19 vaccination between December 15, 2020-June 15, 2021. Additional covariates included age (in years), sex, geographic region (North Atlantic, Midwest, Southeast, Pacific, Continental), smoking status (current, former, never), Charlson Comorbidity Index (based on ≥1 inpatient or two outpatient ICD codes), service connection (any/none, using standardized VA-cutoffs for disability compensation), and influenza vaccination in 2019-2020 (yes/no). Results: Compared with unvaccinated patients, those vaccinated (n=3,238,532; 55.2%) were older (mean age in years vaccinated=66.3, (standard deviation=14.4) vs. unvaccinated=57.7, (18.0), p<.0001)). They were more likely to identify as Black (18.2% vs. 16.1%, p<.0001), Hispanic (7.0% vs. 6.6% p<.0001), or Asian American/Pacific Islander (AA/PI) (2.0% vs. 1.7%, P<.0001). In addition, they were more likely to reside in urban settings (68.0% vs. 62.8, p<.0001). Relative to non-Hispanic White urban Veterans, the reference group for race/ethnicity-urban/rural hazard ratios reported, all urban race/ethnicity groups were associated with increased likelihood for vaccination except American Indian/Alaskan Native (AI/AN) groups. Urban Black groups were 12% more likely (Hazard Ratio (HR)=1.12 [CI 1.12-1.13]) and rural Black groups were 6% more likely to receive a first vaccination (HR=1.06 [1.05-1.06]) relative to white urban groups. Urban Hispanic, AA/PI and Mixed groups were more likely to receive vaccination while rural members of these groups were less likely (Hispanic: Urban HR=1.17 [1.16-1.18], Rural HR=0.98 [0.97-0.99]; AA/PI: Urban HR=1.22 [1.21-1.23], Rural HR=0.86 [0.84-0.88]). Rural White Veterans were 21% less likely to receive an initial vaccine compared with urban White Veterans (HR=0.79 [0.78-0.79]). AI/AN groups were less likely to receive vaccination regardless of rurality: Urban HR=0.93 [0.91-0.95]; AI/AN-Rural HR=0.76 [0.74-0.78]. Conclusions: Urban Black, Hispanic, and AA/PI Veterans were more likely than their urban White counterparts to receive a first vaccination; all rural race/ethnicity groups except Black patients had lower likelihood for vaccination compared with urban White patients. A better understanding of disparities and rural outreach will inform equitable vaccine distribution.
Sprache	Englisch
Erscheinungsdatum	2023-03-24
Erscheinungsland	United States
Dokumenttyp	Journal Article
ISSN	2773-0654
ISSN (online)	2773-0654
DOI	10.1016/j.focus.2023.100094
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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