In-Hospital Mortality Disparities Among American Indian and Alaska Native, Black, and White Patients With COVID-19

Musshafen, Leslie A.; El-sadek, Lamees; Lirette, Seth T.; Summers, Richard L.; Compretta, Caroline; Dobbs, Thomas

doi:10.1001/jamanetworkopen.2022.4822

Cited by 29 publications

(19 citation statements)

References 16 publications

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“…Another study also evaluated the impact of race on COVID-19 and observed a higher burden of the pandemic on Black and Hispanic individuals, with enhanced mortality, infection rate, and hospitalization [ 49 ]. Other studies tried to evaluate the impact of COVID-19 on the Indigenous peoples, in which enhanced death was observed in American Indians, Alaska Natives, and Indigenous individuals from Australia [ 50 , 51 ]. Finally, only a few studies evaluated individuals with multiracial backgrounds, and higher mortality and admission to ICU has observed [ 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

Characterization of demographic data, clinical signs, comorbidities, and outcomes according to the race in hospitalized individuals with COVID-19 in Brazil: An observational study

et al. 2022

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Background Brazil is a multiracial country with five major official races: White, Black, individuals with multiracial backgrounds, Asian, and Indigenous. Brazil is also one of the epicentres of the Coronavirus Disease (COVID)-19 pandemic. Thus, we evaluated how the races of the Brazilian population contribute to the outcomes in hospitalized individuals with COVID-19, and we also described the clinical profile of the five official Brazilian races. Methods We performed an epidemiological analysis for the first 67 epidemiological weeks of the COVID-19 pandemic in Brazil (from February 22, 2020, to April 04, 2021) using the data available at OpenDataSUS of the Brazilian Ministry of Health, a data set containing data from Brazilian hospitalized individuals. We evaluated more than 30 characteristics, including demographic data, clinical symptoms, comorbidities, need for intensive care unit and mechanical ventilation, and outcomes. Results In our data, 585 655 hospitalized individuals with a positive result in SARS-CoV-2 real-time chain reaction (RT-PCR) were included. Of these total, 309 646 (52.9%) identified as White, 31 872 (5.4%) identified as Black, 7108 (1.2%) identified as Asian, 235 108 (40.1%) identified as individuals with multiracial background, and 1921 (0.3%) identified as Indigenous. The multivariate analysis demonstrated that race was significative to predict the death being that Black (OR = 1.43; 95% CI = 1.39-1.48), individuals with multiracial background (OR = 1.36; 95% CI = 1.34-1.38), and Indigenous (OR = 1.91; 95% CI = 1.70-2.15) races were more prone to die compared to the White race. The Asian individuals did not have a higher chance of dying due to SARS-CoV-2 infection compared to White individuals (OR = 0.99; 95% CI = 0.94-1.06). In addition, other characteristics contributed as such as being male (OR = 1.17; 95% CI = 1.16-1.19), age (mainly, +85 years old – OR = 23.02; 95% CI = 20.05-26.42) compared to 1-year-old individuals, living in rural areas (OR = 1.22; 95% CI = 1.18-1.26) or in peri-urban places (OR = 1.25; 95% CI = 1.11-1.40), and the presence of nosocomial infection (OR = 1.91; 95% CI = 1.82-2.01). Among the clinical symptoms, the main predictors were dyspnoea (OR = 1.25; 95% CI = 1.23-1.28), respiratory discomfort (OR = 1.30; 95% CI = 1.28-1.32), oxygen saturation <95% (OR = 1.40; 95% CI = 1.38-1.43). Also, among the comorbidities, the main predictors were the presence of immunosuppressive disorder (OR = 1.44; 95% CI = 1.39-1.49), neurological disorder (OR = 1.21; 95% CI = 1.17-1.25), hepatic disorder (OR = 1.41; 95% CI = 1.34-1.50), diabetes mellitus (OR = 1.40; 95% CI = 1.37-1.42), cardiopathy (OR = 1.13; 95%CI = 1.11-1.14), hematologic disorder (OR = 1.34; 95% CI = 1.24-1.43), Down syndrome (OR = 1.61; 95% CI = 1.43-1.81), renal disease (OR = 1.15; 95% CI = 1.11-1.18), and obesity (OR = 1.18; 95% CI = 1.15-1.21). Individuals on intensive care unit (OR = 2.25; 95% CI = 2.22-2.29) and on invasive (OR = 10.9...

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Section: Discussionmentioning

confidence: 99%

Characterization of demographic data, clinical signs, comorbidities, and outcomes according to the race in hospitalized individuals with COVID-19 in Brazil: An observational study

et al. 2022

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“…This is one of the two levels where participants had the most barriers to discuss. The barriers discussed broadly centered on three interrelated issues that acted in synergy to affect the delivery of services: (1) limited health insurance policy, (2) severely inadequate human resources, and [58] (3) limited health infrastructure tailored to CLWCP. All participants were frustrated with Ghana's health insurance policies and inadequacies of the health systems infrastructures like patient assessment rooms, health information systems, and pharmaceutical products for CP care.…”

Section: Structural Barriersmentioning

confidence: 99%

Barriers to providing healthcare to children living with cerebral palsy in Ghana: A qualitative study of healthcare provider perspectives

Oguntade

Nishath

Owusu

et al. 2022

PLOS Glob Public Health

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Children with neurodevelopmental disabilities in low- and middle-income countries (LMICs) experience profound health and social inequities. While challenges faced by children living with disabilities and their caregivers have been widely documented, little is known about barriers faced by healthcare providers (HCPs) who serve these children. This study seeks to understand the barriers to testing, diagnosing, referral, and treatment of children living with cerebral palsy (CLWCP) from the perspectives of HCPs in Ghana. This qualitative study was conducted in the Greater Accra region of Ghana. A snowball sampling strategy was used to recruit HCPs from major hospitals, education centers, and health facilities. Data were collected through 11 semi-structured in-depth interviews (IDIs) with HCPs. Using an adapted version of the Sweat & Denison socio-ecological framework (SDSF), barriers to providing healthcare to CLWCPs were organized into superstructural, structural, environmental, relational, individual, and technological levels. We found that barriers to providing healthcare to CLWCPs exist at all levels of the adapted framework. The most salient barriers were identified at the superstructural, structural, and environmental levels. All HCPs expressed frustration with Ghana’s health insurance policies and inadequacies of the health systems infrastructures, such as patient assessment rooms, health information systems, and pharmaceutical products for CP care. HCPs also reported that disability-related stigma often discourages providers in training from specializing in the area of developmental disabilities. HCPs emphasized critical challenges related to local perceptions of disability, gender norms and ideologies, and health system policies and infrastructure. Findings highlight the importance of identifying multi-level factors that can influence testing, diagnosing, referral, treatment, and provision of care for CLWCPs in Ghana. Addressing identified challenges from each level of influence may improve CLWCP’s experiences throughout the care continuum.

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“…Contributing factors that have been posited include a self-perpetuating system of income inequality, disproportionate burden of underlying comorbidities, population dense neighborhoods, family dense households, greater likelihood to work in public-facing occupations, less ability to stop working or to accept a furlough from work, and fewer healthcare resources in the neighborhoods of these communities. 8 , 9 , 10 , 11 , 12 , 13…”

Section: Introductionmentioning

confidence: 99%

Coronavirus Disease-2019 Pneumonia

Sharifi

Hsu

2023

Clinics in Chest Medicine

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In-Hospital Mortality Disparities Among American Indian and Alaska Native, Black, and White Patients With COVID-19

Cited by 29 publications

References 16 publications

Characterization of demographic data, clinical signs, comorbidities, and outcomes according to the race in hospitalized individuals with COVID-19 in Brazil: An observational study

Characterization of demographic data, clinical signs, comorbidities, and outcomes according to the race in hospitalized individuals with COVID-19 in Brazil: An observational study

Barriers to providing healthcare to children living with cerebral palsy in Ghana: A qualitative study of healthcare provider perspectives

Coronavirus Disease-2019 Pneumonia

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