Marked Inequalities in COVID-19 Vaccination by Racial/Ethnic, Socioeconomic, Geographic, and Health Characteristics, United States, January 6 – February 15, 2021

Background: The COVID-19 pandemic has had a substantial adverse impact on the health and wellbeing of populations in the United States (US) and globally. Since the availability of COVID-19 vaccines in December 2020, efforts have been underway to vaccinate priority populations who are at increased risks of COVID-19 infections, morbidity, and mortality, but rigorous and analytical national data on vaccination rates are lacking. Using the latest nationally representative data, we examine disparities in COVID-19 vaccination among US adults aged 18 years and older by a wide range of social determinants. Methods: Using three consecutive rounds of the US Census Bureau’s Household Pulse Survey from January 6 to February 15, 2021 (N=224,458), disparities in vaccination rates by race/ethnicity, socioeconomic status, health insurance, health status, and metropolitan area were modeled by multivariate logistic regression. Results: An estimated 33.6 million or 13.6% of US adults received COVID-19 vaccination. Vaccination rates varied 5-fold across the age range, from a low of 5.8% for adults aged 18-24 to 19.1% for those aged 65-74, and 29.0% for those aged ≥75 years. Males, non-Hispanic Blacks, Hispanics, divorced/separated and single individuals, those with lower education and household income levels, renters, not-employed individuals, the uninsured, and individuals with higher depression levels reported significantly lower rates of vaccination. Controlling for covariates, non-Hispanic Blacks had 11% lower odds and Asians had 50% higher odds of receiving vaccination than non-Hispanic Whites. Adults with less than a high school education had 64% lower adjusted odds of receiving vaccination than those with a Master’s degree. Adults with an annual income of <$25,000 had 33% lower adjusted odds of vaccination than those with a ≥$200,000. Vaccination rates ranged from 10.7% in Riverside-San Bernardino, California to 16.1% in Houston, Texas. Conclusion and Implications for Translation: Ethnic minorities, socioeconomically-disadvantaged individuals, uninsured adults, and those with serious depression reported significantly lower vaccination rates. Equitable vaccination coverage is critical to reducing inequities in COVID-19 health outcomes. Copyright © 2021 Singh. et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Diet-Related Chronic Diseases Among a Multi-Ethnic Group of Uninsured Adults

Objectives The prevalence of diet-related chronic diseases, such as obesity, hypertension and type 2 diabetes, among adults in the U.S. is of increasing import during the COVID-19 pandemic. These conditions are among the top risk factors associated with severe COVID-19 morbidity and mortality. The aim of this study was to assess the of diet-related diseases among a multi-racial/ethnic uninsured group in South Florida. Methods Electronic heath records of adult patients (N = 272) from a free clinic in South Florida, a 4-week pre COVID-19 pandemic de-identified dataset was analyzed. Presence of diet-related conditions for each patient was quantified. Numerical and categorical data were compared using independent t-test and Chi-Squared test, respectively. Spearman`s correlation, multi-linear regression, and binary regression models were used to assess the relationship between the variables. Results The sample included females (65%) and males (35%). The mean age was 49.08 ± 14.56 years. There were 26.5% Whites, 33.8% Blacks, 35.6% Asians/Asian-Indians, and 1.1% American Indians. About 24% were Hispanic/Latino. The mean BMI was 29.45 ± 6.76 kg/m² (n = 250). Overall, 87% of patients had at least one diet-related condition with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). The inter-racial analysis revealed that BMI is a significant predictor of prevalence of hypertension among Whites (P = 0.008) and Blacks (P = 0.002), but not Asians/Asian-Indians (P = 0.536). BMI was a significant predictor of prevalence of dyslipidemia (P = 0.027) and type 2 diabetes (P = 0.006) among Hispanics/Latinos. Bivariate analysis showed a 70.8% co-incidence of hypertension and a 64.4% co-incidence of dyslipidemia among adults with type 2 diabetes. Co-incidence of hypertension among adults with dyslipidemia was at 73%. Conclusions High rate of diet-related chronic diseases was found among the multi-ethnic group of uninsured adults in this study. This supports the need for increased patient-education regarding nutrition in free clinic settings. Nutrition programs tailored for low economic resources and culturally appropriate dietary recommendations could assist uninsured patients with management of their diet-related chronic diseases. Funding Sources This research was supported by an NIH sub-award.

Addressing treatment capacity of uninsured adults with co-occurring disorders

Purpose The purpose of this paper is to report on the success of an initiative involving the transformation of a group of small substance use treatment only or mental health treatment only provider agencies serving uninsured adults into providers of co-occurring disorder treatment. Design/methodology/approach The paper uses a case study narrative to describe the initiative and the transformation of the participant agencies from being providers of mental health or substance use treatment to providers of co-occurring disorders. Findings Six agencies serving uninsured adults expanded their scope of patient treatment services to include the capacity to treat adults with co-occurring disorders. This was achieved with modest support funding from a local foundation. The initiative has been ongoing for five years. Practical implications The outcome of this initiative demonstrates the financial and practical feasibility of improving and expanding treatment services to low-resourced patient populations. The participating agencies were able to improve their capacity to treat patients with substance use or mental health issues that previously they were not prepared to treat and thus increased their ability to provide integrated care. Originality/value The initiative described here shows that the treatment of concomitant substance use and mental health disorders is within the range of many small-scale treatment providers, if provided the leadership and support. Delivery of effective treatments to populations experiencing co-occurring disorders that are underserved and undertreated are achievable in community-based clinical practices. This has implications for developing treatment capacity outside of hospital settings to enable treatment of co-occurring disorders to become more accessible.