Journal of Racial and Ethnic Health Disparities

Latine people differ markedly in our lived experiences in ways that are underappreciated. Meanwhile, variations in social experiences are known to be associated with differential health outcomes. We test whether immigration history is associated with health differences among U.S.-based Cuban refugees. Cubans from the circum-1980 Mariel Boatlift migration wave reported significantly higher instance and severity of disability on average than Early Cuban Exiles (1959-1962), Freedom Flight refugees (1965-1973), and Special Period (1990-2002) refugees. In contrast, disability among immigrants from Mexico to the U.S. across time-matched periods followed a different pattern. To help identify potential factors underlying the Cuban refugee pattern, we interviewed Miami-based Cubans. Participants described heightened discrimination in 1980s Cuba and U.S., which we hypothesize contributed to higher instances of disability refugees of that era. Our results suggest that understanding the history of Latine immigration relative to country of origin, and the differential experiences of individuals both across and among ethnic groups, is imperative. A more nuanced understanding of the social determinants of immigrant health is important to help combat adverse factors in future generations. Significance StatementEven within a Latine community from a single country of origin, we find that differential social experiences of immigrating to the U.S. are associated with variation in health outcomes. Understanding the social determinants of health within marginalized populations can help scientists, policymakers, and community-based organizers contextualize the conditions in which adverse health outcomes are arising and organize to combat these factors in future generations of refugees and immigrants coming to the United States.

Provisional U.S. national COVID-19 mortality data for the year 2020 analyzed by the CDC in March 2021 indicated that non-Hispanic Asians fared markedly better overall than other racial/ethnic minority groups-and marginally better than non-Hispanic Whites-in terms of age-adjusted mortality rates. However, Asians in the United States are composed of diverse array of origin subgroups with highly varying social, economic, and environmental experiences, which influence health outcomes. As such, lumping all Asians together into a single category can mask meaningful health disparities among more vulnerable Asian subgroups. To date, there has not been a national-level analysis of COVID-19 mortality outcomes between Asian subgroups. Utilizing final multiple cause of death data for 2020 and population projections from the U.S. Census Bureaus Current Population Survey Annual Social and Economic Supplement for 2020, crude and age-adjusted national COVID-19 mortality rates, both overall and stratified by sex, were calculated for the six major single-race Asian origin subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and a catch-all seventh category that comprises the remaining Asian subgroups (Other Asians), contrasting them to the corresponding mortality rates of other racial/ethnic groups. A substantially more nuanced picture emerges when disaggregating Asians into its diverse origin subgroups and stratifying by sex, with Filipino males and Asian males outside of the six major Asian subgroups in particular experiencing markedly higher age-adjusted mortality rates than their White male counterparts, whether comparisons were restricted to their non-Hispanic subsets or not. During the COVID-19 pandemic and in the post-pandemic recovery, it is imperative not to overlook the health needs of vulnerable Asian populations. Public health strategies to mitigate the effects of COVID-19 must avoid viewing Asians as a monolithic entity and recognize the heterogeneous risk profiles within the U.S. Asian population.

Background: Little is known about risk factors for COVID-19 outcomes, particularly across diverse racial and ethnic populations in the United States. Methods: In this prospective cohort study, we followed 3,086 COVID-19 patients hospitalized on or before April 13, 2020 within an academic health system in New York (The Mount Sinai Health System) until June 2, 2020. Multivariable logistic regression was used to evaluate demographic, clinical, and laboratory factors as independent predictors of in-hospital mortality. The analysis was stratified by self-reported race and ethnicity. Findings: A total of 3,086 COVID-19 patients were hospitalized, of whom 680 were excluded (78 due to missing race or ethnicity data, 144 were Asian, and 458 were of other unspecified race/ethnicity). Of the 2,406 patients included, 892 (37.1%) were Hispanic, 825 (34.3%) were black, and 689 (28.6%) were white. Black and Hispanic patients were younger than White patients (median age 67 and 63 vs. 73, p<0.001 for both), and they had different comorbidity profiles. Older age and baseline hypoxia were associated with increased mortality across all races. There were suggestive but non-significant interactions between Black race and diabetes (p=0.09), and obesity (p=0.10). Among inflammatory markers associated with COVID-19 mortality, there was a significant interaction between Black race and interleukin-1-beta (p=0.04), and a suggestive interactions between Hispanic ethnicity and procalcitonin (p=0.07) and interleukin-8 (p=0.09). Interpretation: In this large, racially and ethnically diverse cohort of COVID-19 patients in New York City, we identified similarities and important differences across racial and ethnic groups in risk factors for in-hospital mortality.

ObjectivesLoneliness and social isolation pose significant risks for an individuals physical, mental, and social health including higher incidence of cardiovascular disease (CVD), poorer patient reported outcomes, and earlier mortality compared to those not experiencing loneliness or social isolation. The objective of this study was to assess loneliness and social and emotional support among adults aged 18 years and older who have CVD in the US. DesignUsing the 2023 Behavioral Risk Factor Surveillance Systems social determinants and health equity module, we examined the distribution of US adults with CVD, compared the prevalence of CVD by Hispanic ethnicity, and conducted multivariable logistic regressions assessing the relationship of independent variables with loneliness and social and emotional support. ResultsThe proportion of adults with CVD who felt lonely sometimes, usually, and always was 44.6%. Hispanic adults who felt lonely (56.3% vs. 43.0%; P<0.0001) and did not receive needed social and emotional support (13.7% vs. 9.8%; P=0.0162) experienced a higher prevalence of CVD than their non-Hispanic adult counterparts who felt lonely and did not receive needed social and emotional support. Adults with CVD who reported rarely or never receiving needed social and emotional support (odds ratio [OR]: 1.42; confidence interval [CI]: 1.14-1.77) had 42% higher odds of feeling lonely, compared to adults who indicated receiving social and emotional support sometimes, usually, or always. Among Hispanic adults with CVD, widowed/divorced/separated adults (OR: 2.30; CI: 1.46-3.61), urban residents (OR: 2.14; CI: 1.05-4.36), and unemployed adults (OR: 3.26; CI: 1.93-5.51) had higher odds of feeling lonely compared to married, rural, and employed adults. ConclusionThis study demonstrates significant disparities in loneliness and social and emotional support in CVD among US adults, with Hispanics experiencing a disadvantage in both outcomes. Future studies should examine strategies to improve social connection for those experiencing disparities.

Participation and inclusion in biomedical research remain disproportionate across sociodemographics limiting discoveries in genomic studies and contributing to systemic disparities in healthcare. To alleviate such inequities, the National Institute of Health initiated the All of Us Research Program (AoU), a prospective, population-based cohort to identify the root causes and consequences of health outcomes across diverse demographics. We quantify representation of key racial groups in the accruing AoU cohort of US adults aged [&ge;]18 years and compare to their actual representation in the US. Of the 358,705 AoU participants to date, Hispanic or Latino participants were underrepresented by 0.85-fold, non-Hispanic Asian by 0.58-fold, non-Hispanic White by 0.98-fold, and Other by 0.43-fold. Meanwhile, individuals identifying as non-Hispanic Black or African American were overrepresented by 1.88-fold. While AoU representation better mirrors the US demographics compared to other cohorts, recruitment trends for the ongoing AoU underscore the need to further tailor participation initiatives for diverse populations.

ObjectiveIn type 1 diabetes, results for hemoglobin A1c (HbA1c) sex-based differences are mixed with limited data in later ages. The study objective was to determine if female sex is independently associated with higher HbA1c in the United States older adult population. Research Design and MethodsA cross-sectional analysis was performed on real world Premier Healthcare data from January 2020-December 2022 examining adults with type 1 diabetes, ages 55-75. Multivariate linear and logistic regression models were used to determine demographic variables independently associated with HbA1c. Predictor variables included age, sex, race, ethnicity, insurance payor, testing location, marital status, atherosclerotic cardiovascular disease. ResultsOf 12,088 individuals with HbA1c data (52.4% women, mean age 64.7 {+/-} 5.8 years), HbA1c was 0.13% (95% CI: [0.08, 0.18], P<0.001) higher on average in females and 0.81-0.97% higher in Black patients adjusting for all other variables. Female sex (unadjusted odds ratio 1.13, 95% CI: [1.05, 1.21], P<0.001, adjusted odds ratio [aOR] 1.16, 95% CI: [1.07, 1.26], P<0.001), Black compared to White race (aOR 1.78, 95% CI: [1.49, 2.12], P<0.001), and Medicaid compared to Managed Care payor (aOR 1.63, 95% CI: [1.28, 2.07], P<0.001) were independently associated with increased odds of HbA1c above target, [&ge;]7% for ages 55-64 and [&ge;]8.5% for ages [&ge;] 65. ConclusionsIn this cohort with type 1 diabetes, females experienced slightly higher HbA1c and higher odds of HbA1c above recommendations. Individuals with Black race and Medicaid insurance payor experienced clinically significantly higher HbA1c levels. Further interventions to address HbA1c disparities are needed. Twitter summaryHemoglobin A1c was slightly higher for women, ages 55 to 75, with type 1 diabetes in a real world healthcare database. Major racial and insurance based hemoglobin A1c disparities were observed. Article HighlightsO_LIWhy did we undertake this study? O_LILimited, mixed data exists examining hemoglobin A1c (HbA1c) sex-differences in people with type 1 diabetes in later ages. C_LI C_LIO_LIWhat is the specific question(s) we wanted to answer? O_LIIn older age groups, do women have higher HbA1c levels, adjusting for demographic characteristics which influence HbA1c? C_LI C_LIO_LIWhat did we find? O_LIHbA1c was 0.13% higher in women compared to men adjusting for other variables. Women had higher odds of HbA1c above age-based targets. C_LIO_LIBlack race was associated with a 0.81% and 0.97% higher HbA1c compared to White and Asian races respectively. C_LI C_LIO_LIWhat are the implications of our findings? O_LIMechanistic study is needed to understand higher HbA1c in women at these age groups, and further intervention is needed to reduce health disparities. C_LI C_LI

This study examines longitudinal and geographic trends in perceived racial discrimination among U.S. adolescents using data from the Adolescent Brain Cognitive Development (ABCD) Study. A diverse sample of 11,868 children aged 9-10 at baseline from 22 sites across the U.S. was analyzed, assessing perceived discrimination at ages 10-11, 11-12, and 13-14 using items adapted from the Perceived Discrimination Scale. Binomial logistic regression models were used to evaluate longitudinal trends and geographic variation, adjusting for demographic factors such as race/ethnicity, parental education, and income. Results show that perceived racial discrimination increased significantly from ages 10-11 to 13-14, particularly among Black and Asian adolescents. By age 13-14, nearly half of Black adolescents and over a quarter of Asian adolescents reported discrimination. Geographic analysis revealed that Black adolescents in the Western U.S. and predominantly White affluent neighborhoods had the highest odds of perceived discrimination. Higher state-level anti-Black bias was associated with lower discrimination rates among Black adolescents but higher rates for Asian adolescents. These findings highlight the evolving nature of racial discrimination during adolescence and underscore the need for targeted interventions that address racisms mental health impacts on adolescents, particularly in high-risk geographic and socio-economic contexts.

Many Asian American (AA) subgroups experience disproportionate rates of cardiometabolic (CMB) conditions, yet the contextual drivers of these disparities remain unclear. Little is known about the role of Asian residential segregation, often conceptualized as Asian enclaves, with limited prior work largely ignoring region of origin and nativity. Using six years of population-based survey data from New York City (N>6,000 AAs) linked with multiple sources of community data, we examine how residence in ethnicity-specific enclaves relates to CMB risks (obesity, hypertension, and diabetes), whether these associations differ by nativity, and the extent to which neighborhood socioeconomic conditions, the built environment, social cohesion, and institutional support account for observed associations. Our combined concentration-based and spatial clustering analysis identified five East Asian enclaves and six South Asian enclaves, with no geographic overlap between the two. Logistic regression analyses show that residence in an East Asian enclave was associated with lower odds of obesity (OR=0.63), while residence in a South Asian enclave was linked to higher odds of diabetes (OR=1.42) and hypertension (OR=1.46). These associations were present only among foreign-born individuals. After adjusting for neighborhood characteristics, the lower obesity risk in East Asian enclaves persisted, while elevated risks in South Asian enclaves were partly reduced. Both suggest a role for unmeasured enclave factors, including cultural and food environments. Our findings challenge the view that Asian enclaves are monolithically health-promoting and redirects scholarly attention toward disaggregated approaches to investigating AA health disparities.

High-income countries like Canada have the highest self-reported levels of life satisfaction in the world, although little is known regarding the experiences of racialized people and immigrants to these countries. This study investigates the factors that influence subjective well-being among a large national cohort study of 8,063 adults from the Canadian Alliance of Healthy Hearts and Minds cohort study recruited between 2014 and 2018, including a subset of 2,142 immigrants. Measures of demographic, socioeconomic, health, healthcare access, and self-reported ethnicity, from which racialized status was derived, were investigated in relation to self-reported life satisfaction as measured by the validated Cantril ladder score. Among 8,063 adults average age of 58 years, approximately half were women, 18.6% were racialized, and 26.6% were immigrants. Racialized immigrants had significantly lower life satisfaction compared to non-racialized immigrants and Canadian-born persons, whether racialized or not. Multivariable analysis showed that factors associated with higher life satisfaction included older age, male sex, having trusted neighbours, and having a language-concordant family doctor. Factors associated with lower life satisfaction included being racialized, having a higher social disadvantage, poorer cardiovascular health, and being unable to afford prescription medications. Amongst immigrants, those racialized were more likely to report experiencing discrimination based on skin colour and reported lower life satisfaction. Although high income countries like Canada have amongst the highest life satisfaction scores in the world, racialized people, especially immigrants, have lower life satisfaction compared to non-racialized people. Key MessagesO_LIThis study examines associations of demographic, socioeconomic, health, healthcare access that influence self-reported life satisfaction among adults in Canada, particularly among racialized individuals and immigrants. C_LIO_LIUsing data from the Canadian Alliance of Healthy Hearts and Minds cohort study, we found racialized immigrants report significantly lower life satisfaction compared to non-racialized immigrants and Canadian-born individuals. C_LIO_LIDespite Canadas high average life satisfaction, the data suggests there is still a need for equity-focused and culturally tailored healthcare to improve well-being among structurally marginalized groups. C_LI

Objectives. To investigate self-reported discrimination and concern for physical assault due to the COVID-19 pandemic among disaggregated Asian subgroups in the US. Methods. We conducted a nationwide survey to assess self-reported discrimination and concern for physical assault due to COVID-19 across racial/ethnic groups, including diverse subgroups of Asians. Results. Chinese respondents experienced the largest change (15% increase) in proportion of respondents reporting discrimination from 2019 to 2020 (P<.01). Chinese, Korean, Japanese, Vietnamese, and Other API showed up to 3.9 times increased odds of self-reported racial/ethnic discrimination due to COVID-19 and, with the addition of Filipino, experienced up to 5.4 times increased odds of concern for physical assault due to COVID-19 compared to Whites. Conclusions. Our study is the first to examine self-reported discrimination and concern for physical assault due to COVID-19 in subgroups of Asian Americans, finding that East (Chinese, Korean, Japanese) and Southeast (Vietnamese, Filipino) Asian Americans have been disproportionately affected. Future studies should disaggregate Asian subgroups to fully understand experiences of discrimination in diverse populations in the US.

Cardiovascular disease (CVD) remains a leading cause of premature mortality in the Caribbean, with particularly high rates from stroke and hypertensive heart disease. While global outcomes have improved, CVD-related mortality in the Caribbean remains elevated. This study examined sex-specific CVD mortality, risk factors, and health policy indicators across non-Latin Caribbean nations, using data from the 2019 PAHO Enlace Portal and comparing results to North America (United States and Canada). Despite North Americans exhibiting more overall risky CVD behaviors, CVD mortality was higher in the Non-Latin Caribbean compared to North America (196.7 vs. 122.6 deaths per 100,000). Total-to-HDL cholesterol ratios were significantly higher in the Caribbean, both in men (4.01 vs. 3.63; p < 0.0001) and women (3.82 vs. 3.01; p < 0.0001), indicating reduced cardioprotective effects of HDL. Hypertensive heart disease mortality was significantly higher in Caribbean women compared to North American women (p < .01), with a similar but non-significant trend in men. Caribbean men also had significantly higher rates of undiagnosed hypertension compared to North American men (47.6% vs. 20.8%; p < .001). NCD policy implementation across the Caribbean was inconsistent, with major gaps in CVD drug therapy access, alcohol advertising restrictions, NCD planning, and surveillance systems. These findings underscore the urgent need for regional investment in prevention, policy enforcement, and culturally relevant strategies to reduce CVD disparities and improve health outcomes in the Caribbean.

IntroductionHomelessness poses unique barriers to diabetes management. Population-level data on the risks of diabetes outcomes among people experiencing homelessness are needed to inform resource investment. The aim of this study was to create a population cohort of people with diabetes with a history of homelessness to understand their unique demographic and clinical characteristics and improve long-term health outcomes. MethodsOntario residents with diabetes were identified in administrative hospital databases between 2006 and 2020. A history of homelessness was identified using a validated algorithm. Demographic and clinical characteristics were compared between people with and without a history of homelessness. Propensity score matching was used to create a cohort of people with diabetes experiencing homelessness matched to comparable non-homeless controls. ResultsOf the 1,455,567 patients with diabetes who used hospital services, 0.7% (n=8,599) had a history of homelessness. Patients with a history of homelessness were younger (mean: 54 vs 66 years), more likely to be male (66% vs 51%) and more likely to live in a large urban centre (25% vs 7%). Notably, they were also more likely to be diagnosed with mental illness (49% vs 2%) and be admitted to a designated inpatient mental health bed (37% versus 1%). A suitable match was found for 5219 (75%) people with documented homelessness. The derived matched cohort was balanced on important demographic and clinical characteristics. ConclusionPeople with diabetes experiencing homelessness have unique characteristics that may require additional supports. Population-level comparisons can inform the delivery of tailored diabetes care and self-management resources.

BackgroundThe COVID-19 pandemic disrupted healthcare services, potentially affecting diabetes management and complications. ObjectiveTo investigate the impact of the pandemic on lower extremity amputation (LEA) rates among individuals with type 1 and type 2 diabetes mellitus, focusing on social determinants of health. MethodsA retrospective observational cohort study using de-identified claims data from a large U.S. health plan. LEA rates were compared before and after the onset of the COVID-19 pandemic using interrupted time series analysis. ResultsIndividuals with type 2 diabetes experienced an initial decline in LEA rates followed by a significant increase (p=0.022) as delayed care needs were addressed. Individuals with type 1 diabetes showed no significant fluctuations in amputation rates. Social determinants were significantly associated with changes in LEA rates among individuals with type 2 diabetes. Lower-income ([&le;]$40,000/year) and less educated individuals experienced significant increases in amputation rates (p=0.027 and p=0.043, respectively). Individuals aged 45-64 years showed a significant increase in LEA rates (p=0.013), while those aged 18-44 experienced a decrease (p=0.017). Metropolitan residents saw significant increases in LEA rates (p=0.021). ConclusionsThe COVID-19 pandemic significantly disrupted healthcare access for individuals with type 2 diabetes, leading to increased LEA rates. Social determinants of health exacerbated existing disparities in diabetes outcomes. These findings underscore the need for targeted interventions to address healthcare disparities, especially during public health crises.

ImportanceCOVID-19 has affected millions of people worldwide. Furthermore, with its increasing incidence, more has been learned about the risk factors that can make certain groups more at risk of contracting the disease or have worse outcomes. We aim to identify any discrepancy in the hospitalization rate by race/ethnicity of patients who tested positive for COVID-19, and through this, analyze the risks of these groups in an effort to call out for attention to the circumstances that make them more vulnerable and susceptible to disease. ObservationsAnalysis indicates that patients identified as non-Hispanic White and Asian/Pacific Islander in hospital admission data are underrepresented in COVID-19 admissions. Patients identified as non-Hispanic Black, Hispanic/Latino, and American Indian have a disproportionate burden of hospital admissions, suggesting an increased risk of more severe disease. Conclusions and RelevanceThere is a disproportionate rate of COVID-19 hospitalizations found among non-Hispanic Blacks. Further investigation is imperative to identify and remediate the reason(s) for increased vulnerability to COVID-19 infections requiring hospital admission. These efforts would likely reduce the COVID-19 morbidity and mortality in the non-Hispanic Black population.

ObjectiveThe goal of this study was to investigate the association of perceived discrimination with health outcomes and disparities. Materials and MethodsThe study cohort consists of 60,180 participants from the four largest SIRE groups in the All of Us Research Program participant body: Asian (1,291), Black (4,726), Hispanic (5,336), and White (48,827). A perceived discrimination index (PDI) was derived from participant responses to the "Social Determinants of Health" survey, and the All of Us Researcher Workbench was used to analyze associations and mediation effects of PDI and self-identified race and ethnicity (SIRE) with 1,755 diseases. ResultsThe Black SIRE group has the greatest median PDI, followed by the Asian, Hispanic, and White groups. The Black SIRE group shows the greatest number of diseases with elevated risk relative to the White reference group, followed by the Hispanic and Asian groups. PDI was found to be positively and significantly associated with 489 out of 1,755 (27.86%) diseases. Mental Disorders is the disease category with the greatest proportion of diseases positively and significantly associated with PDI: 59 out of 72 (81.94%) diseases. Mediation analysis showed that PDI mediates 69 out of 351 (19.66%) Black-White disease disparities. DiscussionPerceived discrimination is significantly associated with risk for numerous diseases and mediates Black-White disease disparities in the All of Us participant cohort. ConclusionThis work highlights the role of discrimination as an important social determinant of health and provides a means by which it can be quantified and modeled on the All of Us platform.

The United States (US), which is currently the epicenter for the COVID-19 pandemic, is a country whose demographic composition differs from that of other highly-impacted countries. US-based descriptions of SARS-CoV-2 infections have, for the most part, focused on patient populations with severe disease, captured in areas with limited testing capacity. The objective of this study is to compare characteristics of positive and negative SARS-CoV-2 patients, in a population primarily comprised of mild and moderate infections, identified from comprehensive population-level testing. Here, we extracted demographics, comorbidities, and vital signs from 20,088 patients who were tested for SARS-CoV-2 at University of Utah Health clinics, in Salt Lake County, Utah; and for a subset of tested patients, we performed manual chart review to examine symptoms and exposure risks. To determine risk factors for testing positive, we used logistic regression to calculate the odds of testing positive, adjusting for symptoms and prior exposure. Of the 20,088 individuals, 1,229 (6.1%) tested positive for SARS-CoV-2. We found that Non-White persons were more likely to test positive compared to non-Hispanic Whites (adjOR=1.1, 95% CI: 0.8, 1.6), and that this increased risk is more pronounced among Hispanic or Latino persons (adjOR=2.0, 95%CI: 1.3, 3.1). However, we did not find differences in the duration of symptoms nor type of symptom presentation between non-Hispanic White and non-White individuals. We found that risk of hospitalization increases with age (adjOR=6.9 95% CI: 2.1, 22.5 for age 60+ compared to 0-19), and additionally show that younger individuals (aged 019), were underrepresented both in overall rates of testing as well as rates of testing positive. We did not find major race/ethnic differences in hospitalization rates. In this analysis of predominantly non-hospitalized individuals tested for SARS-CoV-2, enabled by expansive testing capacity, we found disparities in both testing and SARS-CoV-2 infection status by race/ethnicity and by age. Further work on addressing racial and ethnic disparities, particularly among Hispanic/Latino communities (where SARS-CoV-2 may be spreading more rapidly due to increased exposure and comparatively reduced testing), will be needed to effectively combat COVID-19 in the US.

Asian Americans are a diverse and significant group within the United States and encompass a wide range of social demographics. Research on social determinants of hypertension within this population is limited, despite a notable burden of illness. Asian American attendees at health fairs held in Monterey Park and Rosemead, California in Los Angeles County were surveyed on various social demographics and screened for presence of hypertension outcomes. Logistic regression modeling was employed to determine major demographic contributors to the prevalence of prehypertensive or higher outcomes, ultimately finding that health fair location was a significant predictor (OR: 3.41; 95% CI: 1.54, 7.58; P-Value: 0.003). Further analysis of only attendees exhibiting prehypertensive or higher outcomes showed a significant distribution in the conditional distribution of education levels between Monterey Park and Rosemead attendees. Study findings uncover further areas for research into both Asian American and Chinese American populations and contribute to an overall gap in research within these demographic groups.

BackgroundAfrican Americans have been severely affected by COVID-19 noted with the rising mortality rates within the African American community. Health disparities, health inequities and issues with systemic health access are some of the pre-existing issues African Americans were subjected to within the southern states in the United States. Second, social distancing is a critical non-pharmacological intervention to reduce the spread of COVID-19. However, social distancing was not practical and presented a challenge within the African American community, specifically, in the southern states. ObjectiveThis article assesses the effect of COVID-19 on African Americans in the southern states. MethodologyThis short communication queried the publicly available Department of Health statistics on COVID-19 related mortality and underlying health conditions in four southern states (Alabama [AL], Georgia [GA], Louisiana [LA] and Mississippi [MS]) with a high proportion of African American residents. Second, the unacast COVID-19 toolkit was used to derive a social distancing (SD) grade for any given state, based on three different metrics: (i) percent change in average distance travelled (ii) percent change in non-essential visits and (iii) decrease in human encounters (compared to national baseline). ResultsAcross the four states, on average, as many as 54% of COVID-19 related deaths are in the African American community, although this minority group comprises only 32% of the population cumulatively. This article finds that all four southern states received a social distancing grade of F. COVID-19 have demonstrated that adverse outcomes are higher in individuals with underlying health conditions such as diabetes, cardiovascular diseases, or pre-existing pulmonary compromise. ConclusionThe COVID-19 pandemic has exposed racial disparities in our healthcare system that disproportionately impacts African Americans within the four states of the southern United States. In addition, the lack of diversity in the healthcare system likely impacts this disproportionate impact on African American communities because it is not able to address its primary obligations within minority communities. Recognizing that there is a great need for African American representation or diversity in the health workforce would be able to better address the health disparities.

AimsTo: 1) compare characteristics of those who report knowing their hemoglobin A1C (A1C) value versus those who do not; 2) determine the correlation and concordance between self-reported and lab-measured A1C; and 3) examine factors associated with a lab-measured A1C of [&le;] 7%. MethodsThis was a cross-sectional secondary data analyses of the National Health and Nutrition Examination Survey from 2013-2020. Participants [&ge;] 20 years old who reported receiving a diabetes diagnosis were included. ResultsAfter proper sample weighting, twenty-two percent of participants reported not knowing their A1C value. Not knowing ones A1C value was associated with identifying as a racial or ethnic group other than White, having a lower income, and having less formal education (P values < 0.5). Self-reported A1C was moderately correlated with lab-measured A1C (r = 0.62, P < 0.001). Higher self-reported A1C and identifying as Black or Mexican American were associated with lower odds of good glycemic control. ConclusionsMany patients with diabetes did not know their A1C, and among those that did, the value was often inaccurate. Even when patients knew their A1C, the correlation between self-reported and lab-measured A1C was only moderate. Clinicians should evaluate and, if needed, enhance patient knowledge of A1C.

BackgroundRecent epidemiological evidence has demonstrated a higher rate of COVID-19 hospitalizations and deaths among minorities. This pattern of race-ethnic disparities emerging throughout the United States raises the question of what social factors may influence spread of a highly transmissible novel coronavirus. The purpose of this study is to describe race-ethnic and socioeconomic disparities associated with COVID-19 in patients in our community in Orange County, California and understand the role of individual-level factors, neighborhood-level factors, and access to care on outcomes. MethodsThis is a case-series of COVID-19 patients from the University of California, Irvine (UCI) across six-weeks between 3/12/2020 and 4/22/2020. Note, Californias shelter-in-place order began on 3/19/2020. Individual-level factors included race-ethnicity status were recorded. Neighborhood-level factors from census tracts included median household income, mean household size, proportion without a college degree, proportion working from home, and proportion without health insurance were also recorded. ResultsA total of 210-patients tested were COVID-19 positive, of which 73.3% (154/210) resided in Orange County. Hispanic/Latinx patients residing in census tracts below the median income demonstrated exponential growth (rate = 55.9%, R2 = 0.9742) during the study period. In addition, there was a significant difference for both race-ethnic (p < 0.001) and income bracket (p = 0.001) distributions prior to and after Californias shelter-in-place. In addition, the percentage of individuals residing in neighborhoods with denser households (p = 0.046), lower levels of college graduation (p < 0.001), health insurance coverage (p = 0.01), and ability to work from home (p < 0.001) significantly increased over the same timeframe. Conclusions and RelevanceOur study examines the race-ethnic disparities in Orange County, CA, and highlights vulnerable populations that are at increased risk for contracting COVID-19. Our descriptive case series illustrates that we also need to consider socioeconomic factors, which ultimately set the stage for biological and social disparities.