Dataset Information

Regional variation in COVID-19 disparities: Connections with immigrant and Latinx communities in US counties.

ABSTRACT: PURPOSE:To evaluate associations between counties' COVID-19 cases and racial-ethnic and nativity composition, considering heterogeneity across Latin American-origin subgroups and regions of the U.S. METHODS:Using county-level data and multi-level negative binomial models, we evaluate associations between COVID-19 cases and percentages of residents that are foreign-born, Latinx, Black, or Asian, presenting estimates for all counties combined and stratifying across regions. Given varying risk factors among Latinx, we also evaluate associations for percentages of residents from specific Latin American-origin groups. RESULTS:Percentage of foreign-born residents is positively associated with COVID-19 case rate (IRR=1.106; 95%CI: 1.074-1.139). Adjusted associations for percentage Latinx are non-significant for all counties combined, but this obscures heterogeneity. Counties with more Central Americans have higher case rates (IRR=1.130; 95%CI: 1.067-1.197). And, in the Northeast and Midwest, counties with more Puerto Ricans have higher case rates. Associations with percentage Asians are non-significant after adjusting for percentage foreign-born. Confirming prior evidence, percentage of Black residents is positively and robustly associated with COVID-19 case rate (IRR=1.031; 95%CI: 1.025-1.036). CONCLUSIONS:Counties with more immigrants, as well as more Central American or Black residents have more COVID-19 cases. In the Northeast and Midwest, counties with more Puerto Rican residents also have more COVID-19 cases.

SUBMITTER: Strully K

PROVIDER: S-EPMC7485497 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Regional variation in COVID-19 disparities: connections with immigrant and Latinx communities in U.S. counties.

Strully Kate K Yang Tse-Chuan TC Liu Han H

Annals of epidemiology 20200911

<h4>Purpose</h4>To evaluate associations between counties' COVID-19 cases and racial-ethnic and nativity composition, considering heterogeneity across Latin American-origin subgroups and regions of the United States.<h4>Methods</h4>Using county-level data and multilevel negative binomial models, we evaluate associations between COVID-19 cases and percentages of residents that are foreign-born, Latinx, Black, or Asian, presenting estimates for all counties combined and stratifying across regions. ...[more]

PMID: 32927056

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Project description:ImportanceLatinx individuals have been disproportionately affected during the COVID-19 pandemic caused by the spread of SARS-CoV-2. It is imperative to evaluate newly developed preventive interventions to assess their effect on COVID-19 health disparities.ObjectiveTo examine the effectiveness of a culturally tailored outreach intervention designed to increase SARS-CoV-2 testing rates among Latinx populations.Design, setting, and participantsIn this cluster randomized trial performed from February 1 to August 31, 2021, in community settings in 9 Oregon counties, 38 sites were randomized a priori (19 to the community health promoters intervention and 19 to outreach as usual wait-listed controls). Thirty-three sites were activated. A total of 394 SARS-CoV-2 testing events were held and 1851 diagnostic samples collected, of which 919 were from Latinx persons.InterventionsA culturally informed outreach program was developed that made use of promotores de salud (community health promoters) to increase Latinx SARS-CoV-2 testing. Strategies addressed barriers by disseminating information on testing events in English and Spanish, mitigating misinformation, and increasing trust.Main outcomes and measuresThe primary outcomes were the count of sample tests from Latinx persons and the sampled proportion of the Latinx populace. Site-level covariates included census tract Latinx populace, nativity (number of US-born individuals per 100 population), median age, and income inequality. Time-varying covariates included number of new weekly SARS-CoV-2-positive cases and percentage of vaccine coverage at the county level.ResultsA total of 15 clusters (sites) were randomized to the control group and 18 to the community health promoters group. A total of 1851 test samples were collected, of which 995 (53.8%) were from female participants and 919 (49.6%) were from Latinx individuals. The intervention tested 3.84 (95% CI, 2.47-5.97) times more Latinx individuals per event than controls (incident rate ratio, 0.79; 95% CI, 0.46-1.34; Cohen d = 0.74; P < .001). The intervention was associated with a 0.28 increase in the proportion of Latinx populace being tested compared with control sites for the dependent variable scaled as the proportion of the Latinx populace ×100, or a 0.003 proportion of the raw populace count. The use of a standardized scaling of the proportion of Latinx individuals showed that the relative percentage increase was 0.53 (95% CI, 0.21-0.86) in the intervention sites compared with controls, representing a medium effect size.Conclusions and relevanceTo our knowledge, this was the first randomized evaluation of an outreach intervention designed to increase SARS-CoV-2 testing among Latinx populations. Findings could be used to implement strategies to reduce other health disparities experienced by these groups.Trial registrationClinicalTrials.gov Identifier: NCT04793464.

Project description:BackgroundThe US Centers for Disease Control and Prevention has repeatedly called for Coronavirus Disease 2019 (COVID-19) vaccine equity. The objective our study was to measure equity in the early distribution of COVID-19 vaccines to healthcare facilities across the US. Specifically, we tested whether the likelihood of a healthcare facility administering COVID-19 vaccines in May 2021 differed by county-level racial composition and degree of urbanicity.Methods and findingsThe outcome was whether an eligible vaccination facility actually administered COVID-19 vaccines as of May 2021, and was defined by spatially matching locations of eligible and actual COVID-19 vaccine administration locations. The outcome was regressed against county-level measures for racial/ethnic composition, urbanicity, income, social vulnerability index, COVID-19 mortality, 2020 election results, and availability of nontraditional vaccination locations using generalized estimating equations. Across the US, 61.4% of eligible healthcare facilities and 76.0% of eligible pharmacies provided COVID-19 vaccinations as of May 2021. Facilities in counties with >42.2% non-Hispanic Black population (i.e., > 95th county percentile of Black race composition) were less likely to serve as COVID-19 vaccine administration locations compared to facilities in counties with <12.5% non-Hispanic Black population (i.e., lower than US average), with OR 0.83; 95% CI, 0.70 to 0.98, p = 0.030. Location of a facility in a rural county (OR 0.82; 95% CI, 0.75 to 0.90, p < 0.001, versus metropolitan county) or in a county in the top quintile of COVID-19 mortality (OR 0.83; 95% CI, 0.75 to 0.93, p = 0.001, versus bottom 4 quintiles) was associated with decreased odds of serving as a COVID-19 vaccine administration location. There was a significant interaction of urbanicity and racial/ethnic composition: In metropolitan counties, facilities in counties with >42.2% non-Hispanic Black population (i.e., >95th county percentile of Black race composition) had 32% (95% CI 14% to 47%, p = 0.001) lower odds of serving as COVID administration facility compared to facilities in counties with below US average Black population. This association between Black composition and odds of a facility serving as vaccine administration facility was not observed in rural or suburban counties. In rural counties, facilities in counties with above US average Hispanic population had 26% (95% CI 11% to 38%, p = 0.002) lower odds of serving as vaccine administration facility compared to facilities in counties with below US average Hispanic population. This association between Hispanic ethnicity and odds of a facility serving as vaccine administration facility was not observed in metropolitan or suburban counties. Our analyses did not include nontraditional vaccination sites and are based on data as of May 2021, thus they represent the early distribution of COVID-19 vaccines. Our results based on this cross-sectional analysis may not be generalizable to later phases of the COVID-19 vaccine distribution process.ConclusionsHealthcare facilities in counties with higher Black composition, in rural areas, and in hardest-hit communities were less likely to serve as COVID-19 vaccine administration locations in May 2021. The lower uptake of COVID-19 vaccinations among minority populations and rural areas has been attributed to vaccine hesitancy; however, decreased access to vaccination sites may be an additional overlooked barrier.

Dataset Information

Regional variation in COVID-19 disparities: Connections with immigrant and Latinx communities in US counties.

Publications

Regional variation in COVID-19 disparities: connections with immigrant and Latinx communities in U.S. counties.

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