Geographically targeted COVID-19 vaccination is more equitable and averts more deaths than age-based thresholds alone.
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ABSTRACT:
SUBMITTER: Wrigley-Field E
PROVIDER: S-EPMC8480919 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:COVID-19 mortality increases dramatically with age and is also substantially higher among Black, Indigenous, and People of Color (BIPOC) populations in the United States. These two facts can have conflicting implications because BIPOC populations are younger than white populations. In analyses of California and Minnesota--demographically divergent states--we show that COVID vaccination schedules based solely on age benefit the older white populations at the expense of younger BIPOC populations with higher risk of death from COVID-19. We find that strategies that prioritize high-risk geographic areas for vaccination at all ages better target mortality risk than age-based strategies alone, although they do not always perform as well as direct prioritization of high-risk racial/ethnic groups. Vaccination schemas directly implicate equitability of access, both domestically and globally.
| S-EPMC8010750 | biostudies-literature
Project description:BackgroundCOVID-19 vaccination in many countries, including England, has been prioritised primarily by age. However, people of the same age can have very different health statuses. Frailty is a commonly used metric of health and has been found to be more strongly associated with mortality than age among COVID-19 inpatients.MethodsWe compared the number of first vaccine doses administered across the 135 NHS Clinical Commissioning Groups (CCGs) of England to both the over 50 population and the estimated frail population in each area. Area-based frailty estimates were generated using the English Longitudinal Survey of Ageing (ELSA), a national survey of older people. We also compared the number of doses to the number of people with other risk factors associated with COVID-19: atrial fibrillation, chronic kidney disease, diabetes, learning disabilities, obesity and smoking status.ResultsWe estimate that after 79 days of the vaccine program, across all Clinical Commissioning Group areas, the number of people who received a first vaccine per frail person ranged from 4.4 (95% CI 4.0-4.8) and 20.1 (95% CI 18.3-21.9). The prevalences of other risk factors were also poorly associated with the prevalence of vaccination across England.ConclusionsVaccination with age-based priority created area-based inequities in the number of doses administered relative to the number of people who are frail or have other risk factors associated with COVID-19. As frailty has previously been found to be more strongly associated with mortality than age for COVID-19 inpatients, an age-based priority system may increase the risk of mortality in some areas during the vaccine roll-out period. Authorities planning COVID-19 vaccination programmes should consider the disadvantages of an age-based priority system.
| S-EPMC8592495 | biostudies-literature
Project description:Many factors have been proposed to explain the attrition of women in science, technology, engineering and math fields, among them the lower performance of women in introductory courses resulting from deficits in incoming preparation. We focus on the impact of mixed methods of assessment, which minimizes the impact of high-stakes exams and rewards other methods of assessment such as group participation, low-stakes quizzes and assignments, and in-class activities. We hypothesized that these mixed methods would benefit individuals who otherwise underperform on high-stakes tests. Here, we analyze gender-based performance trends in nine large (N > 1000 students) introductory biology courses in fall 2016. Females underperformed on exams compared to their male counterparts, a difference that does not exist with other methods of assessment that compose course grade. Further, we analyzed three case studies of courses that transitioned their grading schemes to either de-emphasize or emphasize exams as a proportion of total course grade. We demonstrate that the shift away from an exam emphasis consequently benefits female students, thereby closing gaps in overall performance. Further, the exam performance gap itself is reduced when the exams contribute less to overall course grade. We discuss testable predictions that follow from our hypothesis, and advocate for the use of mixed methods of assessments (possibly as part of an overall shift to active learning techniques). We conclude by challenging the student deficit model, and suggest a course deficit model as explanatory of these performance gaps, whereby the microclimate of the classroom can either raise or lower barriers to success for underrepresented groups in STEM.
| S-EPMC5744948 | biostudies-literature
Project description: Not available
| S-EPMC8080160 | biostudies-literature
Project description:The Paralympic Movement explicitly sets out to create a more equitable society and promote participation for all and fairness in disability sport. This is primarily achieved through the use of a range of interventions with less attention given to how economic factors may hinder access and achievement in Paralympic sport. We investigated how country-level economic variables influence the level of participation and achievement in the 2015 International Paralympic Committee (IPC) Athletics Championships held in Doha. We used multiple regression analysis to show how levels of participation and achievement in the Championships were significantly determined by economic factors independent of population size. Our data show that in spite of the ideals of inclusion and fairness within the Paralympic Movement and the considerable effort expended on the use of technologies to achieve this, economic factors continue to exert a statistically significant influence on both the level of participation and achievement of Paralympic athletes. LMICs participate at lower levels and achieve fewer medals when compared to HICs. These differences are particularly marked in events that have a high cost of participation. Our findings raise questions regarding the use of current technologies and the level to which they are able to truly disrupt the politics of global inequality in sport.
| S-EPMC5152818 | biostudies-other
Project description:ImportanceThe United States is currently facing an epidemic of deaths related to substance use disorder (SUD), with totals exceeding those due to motor vehicle crashes and gun violence. The epidemic has led to decreased life expectancy in some populations. In recent years, Medicaid eligibility has expanded in some states, and the association of this expansion with SUD-related deaths is yet to be examined.ObjectiveTo examine the association between eligibility thresholds for state Medicaid coverage and SUD-related deaths.Design, setting, and participantsEconomic evaluation study using a retrospective analysis of state-level data between 2002 and 2015 to determine the association between the Medicaid eligibility threshold and SUD-related deaths, controlling for other relevant policies, state socioeconomic characteristics, fixed effects, and a time trend. Policy variables were lagged by 1 year to allow time for associations to materialize. Data were collected and analyzed from 2016 to 2017.ExposuresThe policy of interest was the state Medicaid eligibility threshold, ie, the highest allowed income that qualifies a person for Medicaid, expressed as a percentage of the federal poverty level. State policies related to mental health, overdose treatment, and law enforcement of drug crimes were included as controls.Main outcomes and measuresThe primary outcome was number of SUD-related deaths, obtained from data provided by the Centers for Disease Control and Prevention.ResultsAcross 700 state-year observations, the mean (SD) number of SUD-related deaths was 21.15 (6.05) per 100 000 population. Between 2002 and 2015, the national SUD-related death rate increased from 16.0 to 27.5 per 100 000, while the average Medicaid eligibility threshold increased from 87.2% to 97.1% of the federal poverty level. Over this period, every 100-percentage point increase in the Medicaid eligibility threshold (eg, from 50% to 150% of the federal poverty level) was associated with 1.373 (95% CI, -2.732 to -0.014) fewer SUD-related deaths per 100 000 residents, a reduction of 6.50%. In the 22 states with net contractions in eligibility thresholds between 2005 and 2015, an estimated increase of 570 SUD-related deaths (95% CI, -143 to 1283) occurred. In the 28 states that increased eligibility thresholds, an estimated 1045 SUD-related deaths (95% CI, -209 to 2299) may have been prevented.Conclusions and relevanceThese findings suggest that the overall increase in SUD-related deaths between 2002 and 2015 may have been greater had the average eligibility threshold for Medicaid not increased over this period. Broader eligibility for Medicaid coverage may be one tool to help reduce SUD-related deaths.
| S-EPMC6487569 | biostudies-literature
Project description:Background: Worsening socioeconomic conditions in rural America have been fueling increases in chronic disease and poor health. The goal of this study was to identify cost-effective methods of deploying geographically targeted health surveys in rural areas, which often have limited resources. These health surveys were administered in New York's rural Sullivan County, which has some of the poorest health outcomes in the entire state.Methods: Comparisons were made for response rates, estimated costs, respondent demographics, and prevalence estimates of a brief health survey delivered by mail and phone using address-based sampling, and in-person using convenience sampling at a sub-county level in New York's rural Sullivan County during 2017.Results: Overall response rates were 27.0% by mail, 8.2% by phone, and 71.4% for convenience in-person surveys. Costs to perform phone surveys were substantially higher than mailed or convenience in-person surveys. All modalities had lower proportions of Hispanic respondents compared to Census estimates. Unadjusted and age-adjusted prevalence estimates were similar between mailed and in-person surveys, but not for phone surveys.Conclusions: These findings are consistent with declining response rates of phone surveys, which obtained an inadequate sample of rural residents. Though in-person surveys had higher response rates, convenience sampling failed to obtain a geographically distributed sample of rural residents. Of modalities tested, mailed surveys provided the best opportunity to perform geographically targeted rural health surveillance.
| S-EPMC7686693 | biostudies-literature
Project description:Focusing screening and treatment to those most likely to benefit is the promise of precision medicine but inequitable distribution of precision medicine innovations may exacerbate health disparities. We investigated whether complex genomic concepts can be successfully communicated to diverse populations. Incorporating principles of Community-based Participatory Research, we created a precision medicine curriculum tailored to the needs of our predominantly Hispanic community. We administered the curriculum over 26 months, assessed pre- and post-test comprehension of 8 genetics-related terms, and compared comprehension differences based on demography and health literacy. In total, 438 individuals completed pre-/post-test assessments. At pre-test, 45.6% scored ≥75% across eight major constructs; 66.7% at post-test. Comprehension increased for 7/8 terms with greatest pre/post-test increases for 'mutation' (55% to 78%) and 'sporadic' (34% to 59%). Mean pre-test comprehension scores (≥75%) were lower for Spanish versus. English speakers; mean post-test scores were equivalent. No heterogeneity by demographics or health literacy was observed. We demonstrate that a brief community educational program can improve knowledge of complex genomic concepts. Interventions to increase understanding of genomic concepts underlying precision medicine are key to patients making informed treatment and prevention decisions and may lead to more equitable uptake of precision medicine initiatives.
| S-EPMC7138137 | biostudies-literature
Project description:In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ? 65 during the months May-October for years 2000-2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90-97 °F; 32.2-36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide.
| S-EPMC3987036 | biostudies-literature
Project description:To provide data that can guide community-targeted practices, policies, and interventions in urban metropolitan areas, we used geospatial analysis to examine the community-level opioid overdose death determinants and their spatial variation across a study area. We obtained spatial datasets containing multiple, high-quality measures of socioeconomic conditions, public health status, and demographics for analysis and visualization in geographic information systems. We employed a multiscale modeling approach (multiscale geographically weighted regression; MGWR) to provide a comprehensive and robust analysis of opioid overdose death determinants, explain how geospatial patterns vary across scales across Milwaukee County in 2019, and examine the differential influence of factors locally, regionally, and globally. We subsequently examined how associations varied with the racial/ethnic composition of communities by dividing Milwaukee County into White-majority, Black-majority, and Hispanic-majority regions according to census data and conducting separate, independent modeling processes. Overall, the multiscale model explained 83% of opioid overdose death variability across neighborhoods in Milwaukee County using 12 selected variables. Statistical analysis and geovisualization of patterns, trends, and clusters using MGWR unveiled dramatic racialized health disparities in Milwaukee, showing how factors that influenced opioid overdose deaths varied across diverse communities in Milwaukee. The observed geographic variation in relationships included the impact of naloxone availability and incarceration rates on overdose deaths with pronounced differences between White communities and communities of color. Understanding, community-level factors that contribute to overdose risk should guide targeted community-level solutions. Overall, our findings demonstrate the value of precision epidemiology using MGWR analysis for defining and guiding responses to public health challenges.
| S-EPMC8260014 | biostudies-literature