The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans

Wong, Michelle S.; Upchurch, Dawn M.; Steers, W. Neil; Haderlein, Taona P.; Yuan, Anita T; Washington, Donna L.

doi:10.1007/s40615-021-01123-3

Cited by 10 publications

(13 citation statements)

References 38 publications

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“…The neighborhood context has contributed to racial and ethnic health disparities for numerous health conditions, including COVID-19. 1 , 2 , 3 , 4 Racial and ethnic residential segregation (hereinafter referred to as segregation ) is a well-characterized determinant of racial and ethnic health disparities. 5 While racially and ethnically segregated neighborhoods are often socioeconomically deprived, segregation also negatively affects health through other pathways.…”

Section: Introductionmentioning

confidence: 99%

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Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users

2023

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ImportanceDespite complexities of racial and ethnic residential segregation (hereinafter referred to as segregation) and neighborhood socioeconomic deprivation, public health studies, including those on COVID-19 racial and ethnic disparities, often rely on composite neighborhood indices that do not account for residential segregation.ObjectiveTo examine the associations by race and ethnicity among California’s Healthy Places Index (HPI), Black and Hispanic segregation, Social Vulnerability Index (SVI), and COVID-19–related hospitalization.Design, Setting, and ParticipantsThis cohort study included veterans with positive test results for COVID-19 living in California who used Veterans Health Administration services between March 1, 2020, and October 31, 2021.Main Outcomes and MeasuresRates of COVID-19–related hospitalization among veterans with COVID-19.ResultsThe sample available for analysis included 19 495 veterans with COVID-19 (mean [SD] age, 57.21 [17.68] years), of whom 91.0% were men, 27.7% were Hispanic, 16.1% were non-Hispanic Black, and 45.0% were non-Hispanic White. For Black veterans, living in lower-HPI (ie, less healthy) neighborhoods was associated with higher rates of hospitalization (odds ratio [OR], 1.07 [95% CI, 1.03-1.12]), even after accounting for Black segregation (OR, 1.06 [95% CI, 1.02-1.11]). Among Hispanic veterans, living in lower-HPI neighborhoods was not associated with hospitalization with (OR, 1.04 [95% CI, 0.99-1.09]) and without (OR, 1.03 [95% CI, 1.00-1.08]) Hispanic segregation adjustment. For non-Hispanic White veterans, lower HPI was associated with more frequent hospitalization (OR, 1.03 [95% CI, 1.00-1.06]). The HPI was no longer associated with hospitalization after accounting for Black (OR, 1.02 [95% CI, 0.99-1.05]) or Hispanic (OR, 0.98 [95% CI, 0.95-1.02]) segregation. Hospitalization was higher for White (OR, 4.42 [95% CI, 1.62-12.08]) and Hispanic (OR, 2.90 [95% CI, 1.02-8.23]) veterans living in neighborhoods with greater Black segregation and for White veterans in more Hispanic-segregated neighborhoods (OR, 2.81 [95% CI, 1.96-4.03]), adjusting for HPI. Living in higher SVI (ie, more vulnerable) neighborhoods was associated with greater hospitalization for Black (OR, 1.06 [95% CI, 1.02-1.10]) and non-Hispanic White (OR, 1.04 [95% CI, 1.01-1.06]) veterans.Conclusions and RelevanceIn this cohort study of US veterans with COVID-19, HPI captured neighborhood-level risk for COVID-19–related hospitalization for Black, Hispanic, and White veterans comparably with SVI. These findings have implications for the use of HPI and other composite neighborhood deprivation indices that do not explicitly account for segregation. Understanding associations between place and health requires ensuring composite measures accurately account for multiple aspects of neighborhood deprivation and, importantly, variation by race and ethnicity.

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Section: Introductionmentioning

confidence: 99%

“…The neighborhood context has contributed to racial and ethnic health disparities for numerous health conditions, including COVID-19 . Racial and ethnic residential segregation (hereinafter referred to as segregation ) is a well-characterized determinant of racial and ethnic health disparities .…”

Section: Introductionmentioning

confidence: 99%

Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users

2023

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“…11,12 Social determinants of health have been linked to adverse health outcomes among healthcare users in these settings. 13,14 While healthcare access is fundamental to health systems operations, it is an inherently challenging concept to define and has garnered various interpretations over time. 7,15 One recently developed, comprehensive, and increasingly used framework through which to conceptualize access is the conceptual model for access to health developed by Jean-Frederic Levesque et al 7,16 (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…Though financial obstacles constitute major access barriers to healthcare use in many settings, even users of healthcare settings with minimal financial barriers to care, such as the Veterans Health Administration (VA), experience access barriers related to other social determinants of health 11,12 . Social determinants of health have been linked to adverse health outcomes among healthcare users in these settings 13,14 …”

Section: Introductionmentioning

confidence: 99%

Investigation of the role of perceived access to primary care in mediating and moderating racial and ethnic disparities in chronic disease control in the veterans health administration

Shannon,

Steers,

Washington

2023

Health Services Research

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ObjectiveTo examine the role of patient‐perceived access to primary care in mediating and moderating racial and ethnic disparities in hypertension control and diabetes control among Veterans Health Administration (VA) users.Data Source and Study SettingWe performed a secondary analysis of national VA user administrative data for fiscal years 2016–2019.Study DesignOur primary exposure was race or ethnicity and primary outcomes were binary indicators of hypertension control (<140/90 mmHg) and diabetes control (HgbA1c < 9%) among patients with known disease. We used the inverse odds‐weighting method to test for mediation and logistic regression with race and ethnicity‐by‐perceived access interaction product terms to test moderation. All models were adjusted for age, sex, socioeconomic status, rurality, education, self‐rated physical and mental health, and comorbidities.Data Collection/Extraction MethodsWe included VA users with hypertension and diabetes control data from the External Peer Review Program who had contemporaneously completed the Survey of Healthcare Experience of Patients‐Patient‐Centered Medical Home. Hypertension (34,233 patients) and diabetes (23,039 patients) samples were analyzed separately.Principal FindingsAfter adjustment, Black patients had significantly lower rates of hypertension control than White patients (75.5% vs. 78.8%, p < 0.01); both Black (81.8%) and Hispanic (80.4%) patients had significantly lower rates of diabetes control than White patients (85.9%, p < 0.01 for both differences). Perceived access was lower among Black, Multi‐Race and Native Hawaiian and Other Pacific Islanders compared to White patients in both samples. There was no evidence that perceived access mediated or moderated associations between Black race, Hispanic ethnicity, and hypertension or diabetes control.ConclusionsWe observed disparities in hypertension and diabetes control among minoritized patients. There was no evidence that patients' perception of access to primary care mediated or moderated these disparities. Reducing racial and ethnic disparities within VA in hypertension and diabetes control may require interventions beyond those focused on improving patient access.

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“…4,5 The risks of COVID-19 and death are higher among nursing home minority residents, 6 suggesting unequal access to resources and greater exposure to infection. Neighborhood socioeconomic status, including racial/composition of a community, 8,9 per-capita income, 10 housing conditions, 11,12 and the general neighborhood deprivation [13][14][15] are also potential risk factors.…”

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confidence: 99%

Coronavirus disease 2019 (COVID-19) in assisted living communities: Neighborhood deprivation and state social distancing policies matter

Guo

Temkin‐Greener

2022

Infect. Control Hosp. Epidemiol.

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BACKGROUND: Residents of long-term care facilities face significantly greater risk of contracting or dying from COVID-19. However, little is known about COVID-19 in assisted living communities (ALCs) and the potential determinants of its spread. We examined the association between COVID-19 cases in ALCs and the proportion of Medicare-Medicaid (dual) eligible minority residents, neighborhood area deprivation, and state COVID-19 policy stringency. METHODS: We conducted longitudinal analyses employing data on confirmed COVID-19 cases in ALCs within 5 states. Outcome was weekly cumulative number of COVID-19 cases in ALCs. Covariates were ALC characteristics, area deprivation index, and state COVID-19 policy stringency. Multivariate two-part models were used to determine the associations between independent variables and the likelihood of an outbreak and the overall count of cases. RESULTS: In our study sample, 201 ALCs (7.04%) reported 1 or more COVID-19 cases as of August 17th, 2020. A higher percentage of minority residents was associated with an increased likelihood of ALC reporting at least one COVID-19 case (OR=1.06, P=0.032). Conditional on having at least one case, ALCs in states with stricter social distancing policies had lower case count (IRR=0.98, P<0.001). Greater neighborhood deprivation was associated with higher case count (IRR=1.36, P=0.049). CONCLUSION: ALCs with higher proportions of dual-eligible minority residents were more likely to have COVID-19 outbreaks within their communities. ALCs located in more socioeconomically deprived neighborhoods, and in states with less stringent state social distancing policies tended to have more COVID-19 cases.

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The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans

Cited by 10 publications

References 38 publications

Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users

Inclusion of Race and Ethnicity With Neighborhood Socioeconomic Deprivation When Assessing COVID-19 Hospitalization Risk Among California Veterans Health Administration Users

Investigation of the role of perceived access to primary care in mediating and moderating racial and ethnic disparities in chronic disease control in the veterans health administration

Coronavirus disease 2019 (COVID-19) in assisted living communities: Neighborhood deprivation and state social distancing policies matter

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