Income Disparities In Access To Critical Care Services

Kanter, Genevieve P.; Segal, Andrea G.; Groeneveld, Peter W.

doi:10.1377/hlthaff.2020.00581

Cited by 43 publications

(38 citation statements)

References 7 publications

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“…A recent study showed extreme disparities in access to critical care services, with 49% of the lowest-income communities having no available intensive care unit beds-compared with only 3% of the highest-income communities. 23 Such areas are acutely vulnerable to COVID-19. Lower-income communities also have a greater burden of comorbidities that predispose to severe disease.…”

Section: Discussionmentioning

confidence: 99%

County-Level Socioeconomic and Political Predictors of Distancing for COVID-19

Kavanagh

Goel

Venkataramani

2021

American Journal of Preventive Medicine

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Introduction In response to the coronavirus disease 2019 (COVID-19) pandemic, governments have implemented social distancing measures to slow viral transmission. This work aims to determine the extent to which socioeconomic and political conditions have shaped community-level distancing behaviors during the COVID-19 pandemic, especially how these dynamics have evolved over time. Methods This study used daily data on physical distancing based on 15‒17 million cell phone users in 3,037 U.S. counties. County-level changes in the average distance traveled per person were estimated relative to pre-pandemic weeks as a proxy for physical distancing. Pooled ordinary least squares regressions estimated the association between physical distancing and a variety of county-level demographic, socioeconomic, and political characteristics by week from March 9, 2020 through January 17, 2021. Data were collected until January 2021, at which point the analyses were finalized. Results Lower per capita income and greater Republican orientation were associated with significantly reduced physical distancing throughout nearly all of the study period. These associations persisted after adjusting for a variety of county-level demographic and socioeconomic characteristics. Other county-level characteristics, such as the share of Black and Hispanic residents, were associated with reduced distancing at various points during the study period. Conclusions These results highlight the importance of dynamic socioeconomic and political gradients in preventive behavior and imply the need for nimble policy responses.

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Section: Discussionmentioning

confidence: 99%

County-Level Socioeconomic and Political Predictors of Distancing for COVID-19

Kavanagh

Goel

Venkataramani

2021

American Journal of Preventive Medicine

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“…16 With hospital closures forcing remaining hospitals to care for larger populations, our finding of rural hospitals with higher odds of reaching critical ICU capacity highlights the need to support rural hospitals. Similar disparities in access to ICU capacity exist in low-income areas with high rates of uninsurance 17 . Lack of insurance may be causing greater surges in these communities either directly, because people delay seeking care, or as a proxy for broader social challenges that lead to more multi-generational homes, jobs that are hard to do socially-distanced, and as a result, more spread of the disease in those communities.…”

Section: Discussionmentioning

confidence: 80%

Effect of COVID-19 on Critical ICU Capacity in US Acute Care Hospitals

Tsai

Jacobson

Jha

2020

Preprint

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ImportanceThe current wave of COVID-19 infections has led to media reports of ICUs across the country reaching critical capacity. But the degree to which this has happened and community and institutional characteristics of hospitals where capacity limits have been reached is largely unknown.ObjectiveTo determine changes in intensive care capacity in US acute care hospitals between September and early December, 2020 and to identify whether hospitals serving more vulnerable populations were more likely to exceed critical-levels of ICU occupancy.Design, Setting, and ParticipantsRetrospective observational cohort of US acute care hospitals reporting to the US Department of Health and Human Services (HHS) from September 4, 2020 to December 3, 2020. Hospitals in this cohort were compared to all US acute care hospitals. Multivariate logistic regression was used to assess the relationship between community socioeconomic factors and hospital-structural features with a hospital reaching critical ICU capacity.ExposureCommunity-level socioeconomic status and hospital-structural featuresMain Outcomes and MeasuresOur primary outcome was reaching critical ICU capacity (>90%) for at least two weeks since September 4. Secondary outcomes included the weekly capacity and occupancy tabulated by state and by hospital referral region.Results1,791 hospitals had unsuppressed ICU capacity data in the HHS Protect dataset, with 45% of hospitals reaching critical ICU capacity for at least two weeks during the study period. Hospitals in the South (OR = 2.79, p<0.001), Midwest (OR = 1.76, p=0.01) and West (OR = 1.85, p<0.01) were more likely to reach critical capacity than those in the Northeast. For-profit hospitals (OR = 2.15, p<0.001), rural hospitals (OR = 1.40, p<0.05) and hospitals in areas of high uninsurance (OR = 1.94, p<0.001) were more likely to reach critical ICU capacity, while hospitals with more intensivists (OR = 0.92, p=0.044 and higher nurse-bed ratios (OR = 0.95, p=0.013) were less likely to reach critical capacity.Conclusions and RelevanceNearly half of U.S. hospitals reporting data to HHS Protect have reached critical capacity at some point since September. Those that are better resourced with staff were less likely to do so while for for-profit hospitals and those in poorer communities were more likely to reach capacity. Continued non-pharmacologic interventions are clearly needed to spread of the disease to ensure ICUs remain open for all patients needing critical care.Key PointsQuestionWith an increasing number of SARS-CoV2 infections, how has the burden on ICU capacity changed over the past three months and what community and institutional factors are associated with hospitals reaching critical capacity?Finding45% of US acute care hospitals have reached critical ICU capacity at some point over the past three months. Hospital located in areas with fewer insured people were more likely to reach critical ICU capacity. At an institutional level, for-profit hospitals, rural hospitals, and those that have less baseline staffing of intensivists and nurses were more likely to reach critical ICU capacity.MeaningThe COVID-19 pandemic appears to be disproportionately straining ICUs with fewer resources and staff, setting up a substantial risk to widen disparities in access to care for already underserved populations.

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“…Rural communities suffered from shortages in clinical personnel, protective gear, and even intensive care unit beds. 20 Also in the early Summer months, the leading COVID-19 vaccine manufacturers began the recruitment for Phase 3 clinical trials, 21 with the United States federal government securing advance purchase agreements with large vaccine manufacturers if their vaccines proved efficacious and were approved by regulatory agencies. 22 The study protocol and survey instruments were approved by the Institutional Review Board at Johns Hopkins Bloomberg School of Public Health (IRB00012413).…”

Section: Methodsmentioning

confidence: 99%

COVID-19 Vaccine Acceptability and Inequity in the United States: Results from a nationally representative survey

Gibson

Agarwal

Meghani

et al. 2021

Preprint

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BackgroundAt the time of this survey, September 1st, there were roughly 6 million COVID-19 cases and 176,771 deaths in the United States and no federally approved vaccine. The objective of this study was to explore the willingness to accept a COVID-19 vaccine in the United States and describe variability in this acceptability by key racial, ethnic and socio-demographic characteristics.MethodsThis was a cross-sectional digital survey that sampled participants from a nationally-representative panel maintained by a third party, Dynata. Dynata randomly sampled their database and emailed web-based surveys to United States residents ensuring the sample was matched to US Census estimates for age, race, gender, income, and Census region. Participants were asked how willing or unwilling they would be to: 1) receive a COVID-19 vaccine as soon as it was made publicly available, and 2) receive the influenza vaccine for the upcoming influenza season. Participants could respond with extremely willing, willing, unwilling, or extremely unwilling. For those who reported being unwilling to receive a COVID-19 vaccine, reasons for this hesitancy were captured. All participants were asked about where they obtain vaccine-related information, and which sources they trust most. Univariable and multivariable logistic regressions were conducted to examine the association of all demographic characteristics with willingness to receive COVID-19 vaccine.FindingsFrom September 1st to September 7, 2020, 1592 respondents completed the online survey. Overall, weighted analyses found that only 58.9% of the sample population were either willing or extremely willing to receive a COVID-19 vaccine as soon as it was made publicly available. In comparison, 67.7% of the respondents were willing or extremely willing to take the influenza vaccine. By gender, 66.1% of males and 51.5% of females were willing to receive a COVID-19 vaccine. Males were significantly more willing to receive a COVID-19 vaccine (adjusted odds ratio (OR)=1.98, 95% CI: 1.56, 2.53; p<0.001) than females. Blacks were the least willing racial/ethnic group (48.8%) Blacks, (aOR=0.59, 95%CI: 0.43, 0.80; p<0.001) were significantly less willing, than whites, to receive a COVID-19 vaccine. There were numerous reasons provided for being unwilling to receive a COVID-19 vaccine. The most common reason was concern about the vaccine’s safety (36.9%), followed by concerns over its efficacy (19.1%).InterpretationIn conclusion, we found that a substantial proportion (41%) of United States residents are unwilling to receive a COVID-19 vaccine as soon as one is made publicly available. We found that vaccine acceptance differs by sub-populations. In addition to sub-group differences in willingness to receive the vaccine, respondents provided a variety of reasons for being unwilling to receive the vaccine, driven by various sources of vaccine information (and misinformation). This compounds the challenge of delivering a safe and efficacious COVID-19 vaccine at a population level to achieve herd immunity. A multi-pronged and targeted communications and outreach effort is likely needed to achieve a high level of immunization coverage.

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Income Disparities In Access To Critical Care Services

Cited by 43 publications

References 7 publications

County-Level Socioeconomic and Political Predictors of Distancing for COVID-19

County-Level Socioeconomic and Political Predictors of Distancing for COVID-19

Effect of COVID-19 on Critical ICU Capacity in US Acute Care Hospitals

COVID-19 Vaccine Acceptability and Inequity in the United States: Results from a nationally representative survey

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