Background The burden and presentation of post-acute sequela of SARS-CoV-2 infection (PASC) are a developing major public health concern. Objectives To characterize the burden of PASC in community-dwelling individuals and understand the experiences of people living with PASC. Methods This mixed-methods study of COVID-19 positive community-dwelling persons involved surveys and in-depth interviews. Main outcome was self-report of possible PASC symptoms 3 weeks or longer after positive COVID-19 test. In-depth interviews were guided by a semi-structured interview guide with open-ended questions and probes based on emerging literature on PASC and the impact of COVID-19. Results With a survey response rate of 70%, 442 participants were included in this analysis, mean (SD) age 45.4 (16.2) years, 71% female, 12% Black/African American. Compared to those with no PASC symptoms, persons who reported PASC symptoms were more likely to be older (mean age: 46.5 vs. 42; p = 0.013), female (74.3% vs. 61.2%; p = 0.010), to have pre-existing conditions (49.6% vs. 34%; p = 0.005), and to have been hospitalized for COVID-19 (14.2% vs. 2.9%; p = 0.002). About 30% of the participants experienced severe fatigue; the proportion of persons reporting severe fatigue was 7-fold greater in those with PASC symptoms (Adjusted Prevalence Ratio [aPR] 6.73, 95%CI: 2.80–16.18). Persons with PASC symptoms were more likely to report poor quality of life (16% vs. 5%, p<0.001) and worse mental health functioning (Mean difference: -1.87 95%CI: -2.38, -1.37, p<0.001). Themes from in-depth interviews revealed PASC was experienced as debilitating. Conclusions In this study, the prevalence of PASC among community-dwelling adults was substantial. Participants reported considerable coping difficulties, restrictions in everyday activities, invisibility of symptoms and experiences, and impediments to getting and receiving PASC care.

Introduction: Recent literature has documented a high prevalence of cardiovascular disease (CVD) risk factors among Middle Eastern (ME) population. Yet, literature is sparse regarding the association of social determinants of health (SDoH) and CVD risk factors among ME immigrants. The objective of this study was to examine the associations between SDoH and hypertension and diabetes among ME immigrants in the U.S. Methods: A cross-sectional analysis was conducted using data from the 2010-2018 National Health Interview Survey (NHIS). SDoH were defined as income, education, employment, and health insurance. Hypertension and diabetes diagnoses were self-reported. Generalized linear models using Poisson distribution were fitted to examine the associations between the SDoH and hypertension and diabetes, separately. Results: We included 3,271 ME immigrants, 45% female, with mean age 46 years, 85.3% were insured, 44% had at least a college education, and 21% lived below poverty level. Almost 3% had diabetes and 8% had hypertension. Participants with higher income had lower odds (Adjusted Odds Ratio(aOR): 0.35, 95% CI): 0.18-0.69), while those who had health insurance had higher odds (aOR: 5.77, 95% CI: 1.37–24.32) of diabetes diagnosis. There were no significant associations between SDoH and hypertension diagnosis. Conclusion: Our analysis yielded significant associations of SDoH and diabetes among ME immigrants. Future investigations should focus on addressing health inequities to establish SDoH-informed care targeting CVD risk factors.

Introduction: Despite advances in diabetes care, racial disparities in diabetes care and outcomes remain. Moreover, better access to and utilization of healthcare is associated with optimal diabetes control. Yet, little is known about race and ethnicity disparities in diabetes care utilization in the US. Objective: To estimate racial/ethnic differences in access and utilization of health services among adults diagnosed with diabetes in the US population. Methods: In this cross-sectional analyses, we identified and analysed data of 3,563 adults diagnosed with diabetes from the National Health and Nutrition Examination Survey, 2011-2018. The sample (Whites N=1,100, Black N=1,002, Asian N=438, Hispanic N=1,023) included adults ≥18 years who had self-reported diagnosed diabetes. The exposure variable was race/ethnicity groups. Healthcare care access was defined as having a routine place of healthcare, health insurance, and provider for diabetes care; and utilization measures were defined as having checked HbA1c and received diabetes care ≥4 times in the past year. We fitted generalized linear models with Poisson distribution to examine disparities in healthcare access and utilization by race/ethnicity among adults with diabetes. Results: Participants had a mean age of 59 (SE .32) years old, 49% female. In the fully adjusted models, compared to White adults, Hispanic adults were less likely to have health insurance (adjusted Odds Ratio [aOR]: 0.96; 95% CI 0.91-0.99) and less likely to have their HbA1c checked in the past year (aOR: 0.92; 95% CI: 0.86-0.98) ( Table ). There were no significant differences in having a routine place for healthcare, provider for diabetes care, and diabetes care received (≥4 times) in the past year in the fully adjusted analyses. Conclusion: Racial differences exist with lower access and utilization of diabetes care particularly among Hispanic adults. Targeted health interventions to address access to diabetes care are needed.

Introduction: Latino individuals account for almost 20% of the U.S. population and are disproportionately affected by cardiovascular disease (CVD) risk factors, such as hypertension and overweight/obesity. They are not monolithic, but diverse in culture, lifestyle, and health exposures that impact their cardiovascular health. Further examination of heterogeneity in CVD risk factors among US-born and foreign-born Latino subgroups is needed to deepen our understanding of the burden of CVD risk in this population. Hypothesis: We hypothesized that there would be significant heterogeneity in the prevalence of hypertension and overweight/obesity among foreign-born Latino individuals as compared to their US-born counterparts. Methods: We examined the prevalence of CVD risk factors using a cross-sectional design, among Latino adults in the 2010-2018 National Health Interview Surveys. Generalized linear models using Poisson distribution were fitted to obtain adjusted odds ratio and risk of self-reported hypertension and overweight/obesity among US-born and foreign-born Latino subgroups. Results: We included 175,761 participants with mean(±sd) age 41 (0.2) years, 50.1% female, 32.4% with less than high school education, 84.5% with ≥10 years of length of US residence, and 72% with health insurance. We observed a statistically significant lower prevalence of hypertension among foreign-born Mexicans (adjusted odds ratio [AOR]: 0.98, 95% confidence interval or [CI]: 0.80 - 0.99) and Puerto Ricans (AOR: 0.75; 95% CI: 0.65 - 0.86) compared to their US-born counterparts. ( Table ) Conclusion: We observed heterogeneity in the prevalence of hypertension when foreign-born and US-born Mexicans and Puerto Ricans are compared. No differences were found for overweight/obesity. Our results highlight the need to evaluate CVD risk differences by nativity status.

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