Health care experiences during the COVID-19 pandemic by race and social determinants of health among adults age ≥ 58 years in the REGARDS study

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Abstract

Background

Understanding health care experiences during the COVID-19 pandemic may provide insights into patient needs and inform policy. The objective of this study was to describe health care experiences by race and social determinants of health.

Methods

We conducted a telephone survey (July 6, 2020-September 4, 2021) among 9492 Black and White participants in the longitudinal REasons for Geographic And Racial Differences in Stroke cohort study, age 58–105 years, from the continental United States. Among participants with symptoms of COVID-19, outcomes were: 1. Sought care or advice for the illness; 2. Received a SARS-CoV-2 test for the illness; and 3. Tested positive. Among participants without symptoms of COVID-19, outcomes were: 1. Wanted a test; 2. Wanted and received a test; 3. Did not want but received a test; and 4. Tested positive. We examined these outcomes overall and in subgroups defined by race, household income, marital status, education, area-level poverty, rural residence, Medicaid expansion, public health infrastructure ranking, and residential segregation.

Results

The average age of participants was 76.8 years, 36% were Black, and 57% were female. Among participants with COVID-19 symptoms ( n = 697), 74% sought care or advice for the illness, 50% received a SARS-CoV-2 test, and 25% had a positive test (50% of those tested). Among participants without potential COVID-19 symptoms ( n = 8795), 29% wanted a SARS-CoV-2 test, 22% wanted and received a test, 8% did not want but received a test, and 1% tested positive; a greater percentage of participants who were Black compared to White wanted (38% vs 23%, p < 0.001) and received tests (30% vs 18%, p < 0.001) and tested positive (1.4% vs 0.8%, p = 0.005).

Conclusions

In this national study of older US adults, many participants with potential COVID-19 symptoms and asymptomatic participants who desired testing did not receive COVID-19 testing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12273-8.

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Most cited references 33

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Hospitalization and Mortality among Black Patients and White Patients with Covid-19

Eboni Price-Haywood, Jeffrey Burton, Daniel Fort … (2020)

Abstract Background Many reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19. Methods In this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death. Results A total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19–positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19–positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17). Conclusions In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.

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The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States

Don Bambino Geno Tai, Aditya Shah, Chyke Doubeni … (2020)

Abstract The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. While the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.

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Levels of racism: a theoretic framework and a gardener's tale.

Walton Jones (2000)

The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized. This framework is useful for raising new hypotheses about the basis of race-associated differences in health outcomes, as well as for designing effective interventions to eliminate those differences. She then presents an allegory about a gardener with 2 flower boxes, rich and poor soil, and red and pink flowers. This allegory illustrates the relationship between the 3 levels of racism and may guide our thinking about how to intervene to mitigate the impacts of racism on health. It may also serve as a tool for starting a national conversation on racism.

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Author and article information

Contributors

Emily B. Levitan:

ORCID: http://orcid.org/0000-0002-5429-3852

elevitan@uab.edu

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 11 December 2021

Publication date PMC-release: 11 December 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 2255

Affiliations

[1 ]GRID grid.265892.2, ISNI 0000000106344187, School of Public Health, , University of Alabama at Birmingham, ; Birmingham, AL 35294-0022 USA

[2 ]GRID grid.59062.38, ISNI 0000 0004 1936 7689, Department of Medicine, , Larner College of Medicine at the University of Vermont, ; Burlington, VT USA

[3 ]GRID grid.261331.4, ISNI 0000 0001 2285 7943, Department of Emergency Medicine, , The Ohio State University, ; Columbus, OH USA

[4 ]GRID grid.5288.7, ISNI 0000 0000 9758 5690, Oregon Health and Science University, ; Portland, OR USA

[5 ]GRID grid.239395.7, ISNI 0000 0000 9011 8547, Beth Israel Deaconess Medical Center, ; Boston, MA USA

[6 ]GRID grid.5386.8, ISNI 000000041936877X, Weill Cornell Medicine, ; New York, NY USA

Author information

Emily B. Levitan http://orcid.org/0000-0002-5429-3852

Article

Publisher ID: 12273

DOI: 10.1186/s12889-021-12273-8

PMC ID: 8665704

PubMed ID: 34895192

SO-VID: f7ac8ad2-4273-41e4-954c-da2b863f63a8

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 26 May 2021

Date accepted : 19 November 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000065, National Institute of Neurological Disorders and Stroke;

Award ID: U01 NS041588

Award Recipient : Suzanne E. Judd

Funded by: FundRef http://dx.doi.org/10.13039/100000049, National Institute on Aging;

Award ID: U01 NS041588

Award Recipient : Suzanne E. Judd

Funded by: FundRef http://dx.doi.org/10.13039/100000050, National Heart, Lung, and Blood Institute;

Award ID: OT2 HL158276

Funded by: FundRef http://dx.doi.org/10.13039/100000057, National Institute of General Medical Sciences;

Award ID: P20 GM135007

Custom metadata

ScienceOpen disciplines: Public health

Keywords: covid-19,social determinants of health,health care access

Data availability:

ScienceOpen disciplines: Public health

Keywords: covid-19, social determinants of health, health care access

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Health care experiences during the COVID-19 pandemic by race and social determinants of health among adults age ≥ 58 years in the REGARDS study

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Abstract

Background

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Results

Conclusions

Supplementary Information

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 33

Hospitalization and Mortality among Black Patients and White Patients with Covid-19

The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States

Levels of racism: a theoretic framework and a gardener's tale.

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