Question

In: Nursing

Covid19 among African American Method Briefly introduce the next capstone section. Research Method and Design Appropriateness...

Covid19 among African American Method Briefly introduce the next capstone section.

Research Method and Design Appropriateness Elaborate on the differences among various research methodologies. What are the differences between qualitative research and quantitative research? Which was more appropriate for the study covid19 African American ? Why? More than likely, this will be a descriptive research project, focusing more on the literature surrounding the topic, rather than conducting actual quantitative or qualitative research. Population Discuss covid 19 study population. The study population is the larger picture of the research. Sampling Frame Elaborate on covid19 sampling frame here Data Collection Discuss the collection of covid19 data. Was it quantitative or qualitative? How collect the data? How to protect the integrity of the data? Data Analysis Discuss the process where analyzed data. How to analyze it? If quantitative, what statistical tool use? If qualitative, how to interpret the information? REferences Please

Solutions

Expert Solution

Much has been published in leading medical journals about the phenomenon of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The resulting condition, coronavirus disease 2019 (COVID-19), has had a societal effect comparable only to the Spanish flu epidemic of 1918. As the flow of clinical science has better informed the contemporary narratives, more is being learned about which individuals and groups experience the most dire complications. Researchers have emphasized older age, male sex, hypertension, diabetes, obesity, concomitant cardiovascular diseases (including coronary artery disease and heart failure), and myocardial injury as important risk factors associated with worse outcomes; specifically, case-fatality rates vary over 100%.1-3 These data sourced from China and Europe have not been replicated in the US, but the US experience may nevertheless represent similarly distressing outcomes in these highest-risk phenotypes.

The concerns about these observations are appropriate and the published data are indeed actionable; those who fit the highest-risk phenotypes can be advised to assiduously adhere to safe practices including hand hygiene, use of masks in public spaces, and social distancing/physical isolation.These measures not only are flattening the curve but are no doubt saving lives. However, a new concern has arisen: evidence of potentially egregious health care disparities is now apparent. Persons who are African American or black are contracting SARS-CoV-2 at higher rates and are more like

What is currently known about these differences in disease risk and fatality rates? In Chicago, more than 50% of COVID-19 cases and nearly 70% of COVID-19 deaths involve black individuals, although blacks make up only 30% of the population. Moreover, these deaths are concentrated mostly in just 5 neighborhoods on the city’s South Side.6 In Louisiana, 70.5% of deaths have occurred among black persons, who represent 32.2% of the state’s population.7 In Michigan, 33% of COVID-19 cases and 40% of deaths have occurred among black individuals, who represent 14% of the population.5 If New York City has become the epicenter, this disproportionate burden is validated again in underrepresented minorities, especially blacks and now Hispanics, who have accounted for 28% and 34% of deaths, respectively (population representation: 22% and 29%, respectively).8

The Johns Hopkins University and American Community Survey indicate that to date, of 131 predominantly black counties in the US, the infection rate is 137.5/100 000 and the death rate is 6.3/100 000.5 This infection rate is more than 3-fold higher than that in predominantly white counties. Moreover, this death rate for predominantly black counties is 6-fold higher than in predominantly white counties. Even though these data are preliminary and further study is warranted, the pattern is irrefutable: underrepresented minorities are developing COVID-19 infection more frequently and dying disproportionately. Do these observations qualify as evident health care disparities?

Yes. The definition of a health care disparity is not simply a difference in health outcomes by race or ethnicity, but a disproportionate difference attributable to variables other than access to care.9 Given the known risk factors for COVID-19 complications, the confluence of hypertension, diabetes, obesity, and the higher prevalence of cardiovascular disease among black persons may be driving these early signals. Data fully adjusted for comorbidities have not been reported but it is likely that some, if not most, of these differences in disease rates and outcomes will be explained by concomitant comorbidities.

But concerns go beyond these comorbidities. Where and how black individuals live matters. If race per se enters this discussion, it is because in so many communities, race determines home. Once adverse outcomes attributable to known risks for COVID-19 complications are disaggregated from total morbidity and mortality burden due to COVID-19, the pernicious influence of adverse social determinants of health is likely to become apparent.10 The communities where many black people reside are in poor areas characterized by high housing density, high crime rates, and poor access to healthy foods. Low socioeconomic status alone is a risk factor for total mortality independent of any other risk factors. These social determinants of health must be considered in a complex equation, including known cardiovascular risk factors, which puts underrepresented minorities who live in at-risk communities at greater risk for disease, not just for cardiovascular diseases but now for COVID-19 mortality.

The most effective strategy known to reduce COVID-19 infection is social distancing, but herein lies a vexing challenge. Being able to maintain social distancing while working from home, telecommuting, and accepting a furlough from work but indulging in the plethora of virtual social events are issues of privilege. In certain communities these privileges are simply not accessible. Thus, consider the aggregate of a higher burden of at-risk comorbidities, the pernicious effects of adverse social determinants of health, and the absence of privilege that does not allow a reprieve from work without dire consequences for a person’s sustenance, does not allow safe practices, and does not even allow for 6-foot distancing. The consequent infection and death rates due to COVID-19 complications are no longer surprising; they should have been expected. These observations are rooted in the recalcitrant reality of the deeply entrenched history of health care disparities and may settle as the most painful example yet of the regressive tax of poor health. COVID-19 has become the herald event that now fully exposes the deep and chronic social wounds in US communities.

What makes this particularly egregious is that unlike the known risk factors for which physicians and others can stridently offer clear advice regarding prevention, these concerns—the burden of ill health, limited access to healthy food, housing density, the need to work or else, the inability to practice social distancing—cannot be well-articulated as clear, pithy, and easily actionable items.

What is the action plan? It is less an action plan and more of a commitment. A 6-fold increase in the rate of death for African Americans due to a now ubiquitous virus should be deemed unconscionable. This is a moment of ethical reckoning. The scourge of COVID-19 will end, but health care disparities will persist. Does the US chronicle these poor outcomes due to COVID-19 complications with the higher burden of cardiovascular disease, poorer outcomes for breast cancer, higher amputation rates for peripheral vascular disease, lower kidney transplant rates, and worse rates for maternal mortality, then safely park everything in the health care disparity domain and go back to “normal”? Or will the nation finally hear this familiar refrain, think differently, and as has been done in response to other major diseases, declare that a civil society will no longer accept disproportionate suffering?

Public health is complicated and social reengineering is complex, but change of this magnitude does not happen without a new resolve. The US has needed a trigger to fully address health care disparities; COVID-19 may be that bellwether event. Certainly, within the broad and powerful economic and legislative engines of the US, there is room to definitively address a scourge even worse than COVID-19: health care disparities. It only takes will. It is time to end the refrain.Annals of Epidemiology

Available online 14 May 2020

In Press, Journal Pre-proofWhat are Journal Pre-proof articles?

Original article

Assessing Differential Impacts of COVID-19 on Black Communities

Author links open overlay panelGregorio A.MillettMPH1PatrickSullivanDVM, PhD3

https://doi.org/10.1016/j.annepidem.2020.05.003

Get rights and content

Under a Creative Commons licenseopen access

Abstract

Purpose

Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants.

Methods

Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (>13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated.

Results

Nearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with >13% black residents.

Conclusions

Nearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.

MeSH heading key words

BlackAfrican-AmericanCOVID-19disparityrace

Introduction

As of April 30, 2020, more than one million cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been diagnosed in the United States, and deaths exceed 63,000.1 Emerging evidence suggests that black Americans are at increased risk for COVID-19 morbidity and mortality. Although it may be counter-intuitive that a newly identified virus that can infect anyone would rapidly manifest pronounced racial disparities, a consistent pattern has been reported across multiple states, showing that black Americans comprise a disproportionately greater number of reported COVID-19 cases and deaths compared to other Americans2, 3, 4 For instance, in New York City, the current epicenter of the US epidemic, COVID-19 deaths disproportionately affect black Americans (22% of population and 28% of deaths) and in the rest of the state (9% of the population and 18% of deaths).5 Such disparities are also evident within individual counties, such as in Milwaukee County, Wisconsin where black residents comprise 26% of the population yet account for 73% of COVID-19 deaths;6 and in Dougherty County, GA (69% black) where 81% of 38 deaths were black.7

Although the CDC reports cumulative COVID-19 data reported by state health departments, 78% of those data were missing race/ethnicity disaggregations as of April 15, 2020.8 Incomplete reporting of race remains common. One state’s department of health reported 20.5% of COVID-19 cases among blacks, 15.3% among whites, 1.5% other, yet nearly two-thirds (62.7%) were racial/ethnic category unknown.9 Another disaggregated their data, but reported that three quarters (74%) of the cases were of unknown race or ethnicity.10

A more thorough understanding of the impact of COVID-19 by race/ethnicity will remain unavailable until more states report disaggregated data and until additional work is conducted to strengthen the completeness of race/ethnicity data. In the meantime, it is possible to use ecological analyses with data at the county level to assess determinants of risk among black Americans to inform immediate policy actions. However, this approach risks confounding of the relationship between proportion of black Americans and disease and death rates in a county and other social determinants of health potentially associated with risk for COVID-19 infection and death, such as sociodemographic, comorbidities, and socioeconomic determinants.

We analyzed county-level data comparing counties with higher and lower proportions of black people to document whether COVID-19 diagnoses and deaths were higher in counties with higher proportions of black Americans. In addition, we used multivariable modeling to assess whether observed disproportionate impacts of COVID-19 disease and death in disproportionately black counties were explained by confounding with comorbidities, social, and environmental factors? Finally, we calculated the population attributable fraction of COVID-19 diagnoses and deaths in disproportionately black counties that was associated with demographics (unemployment, uninsurance), comorbidities, social or environmental factors.

Materials and Methods

U.S. counties were stratified by the population of black Americans nationally, as previously described.11 We assessed differences between in the characteristics of counties with a greater share of black residents than the US average (>13% black population; hereafter disproportionately black counties) versus all other counties (<13% black population). We subsequently examined associations between the proportion of black residents and COVID-19 cases and deaths. All data used in these analyses are from publicly available datasets.

Demographic data: County-level data from the US Census Bureau American Community Survey 5-Year12 were collected for select demographics (i.e. county population, percent black American, percent of the population over the age of 65, percent of the under 65 population without health insurance, occupants per room). Annual average county unemployment rates were obtained from the Bureau of Labor Statistics.13

COVID-19 data and co-morbidities: COVID-19 cases and deaths at the county-level were downloaded from USAFacts through April 13th.14 Rates of diagnosed diabetes among adults aged 20+ were downloaded from CDC Diabetes Atlas (2016).15 Heart disease per 100,000 were accessed from CDC’s Interactive Atlas of Heart Disease and Stroke (2014-16)16, and the combined rate of cerebrovascular and hypertension deaths per 100,000 were sourced from CDC WONDER (2018).17 Estimates of people living with diagnosed HIV per 100,000 among adults and adolescents 13 and older were derived from CDC ATLAS (2017).18 For counties with missing HIV data in Kentucky and Alaska, archived HIV data from AIDSVu.org 19

from 2015 were used given that state data sharing agreements for these two states restrict CDC from releasing comparable data.

Social/Environmental data: Following Wu, we use county-level estimates of fine particulate matter (PM2.5) to assess air quality.20 Social distancing grades were drawn from Unacast’s county measures on April 13 and were coded as A+/- = 1; B+/- = 2; C+/-=3; D+/-=4; F+/-=5.21 Thus, higher scores are associated with poorer social distancing. The CDC’s National Center for Health Statistics Urban-Rural Classification Scheme was used to assess urbanicity (index from 1-6, with 1 being the most urban).22

Statistical Analyses

We compared characteristics of counties based on the proportion of the population who are black (< or ≥13%) using medians and interquartile ranges. We plotted the county proportion of black residents by the county rate of COVID-19 diagnoses, adjusted for days since first infection in the county. To assess whether observed associations between proportion of black residents and COVID-19 cases and deaths were confounded by other factors, we used Bayesian hierarchical models. A zero-inflated negative binomial model with a logarithmic link function was fit separately to COVID-19 cases and deaths using integrated nested Laplace approximations.23 The model included county population as an offset term, adjusted for all county-level characteristics (see Table 1 for characteristics), and included a spatially structured state-level random effect.24 We also included a variable representing days since the first case of COVID-19 was reported in each county in order to control for potential confounding by temporality of the outbreak. Diffuse priors were included for all components of the model. Exponentiated regression coefficients are presented along with 95% confidence intervals, representing rate ratios of COVID-19 cases and deaths. The primary question was whether the rate ratios COVID-19 cases and deaths for disproportionately black counties remained significant after controlling for sociodemographics, comorbidities, and socioeconomic determinants. In reporting results for the covariates, county-level characteristics are scaled to represent a comparison of two counties similar in all other respects, but for one county having the variable of interest equal to the observed third quartile of that characteristic, the other equal to the observed first quartile. Thus, rate ratios greater than one mean that higher levels of a given characteristic are associated with higher rates of COVID-19 cases or deaths. For “modifiable” risk factors (e.g., insurance, population density), we computed population attributable fractions by computing the multiplicative reduction in predicted number of cases/deaths under the observed data versus when all counties in the upper three quartiles of a risk factor were reduced to the first quartile.

PLEASE DO LIKE??


Related Solutions

Litterature about Why Covid19 death among  African American is higher than other race? This section is the...
Litterature about Why Covid19 death among  African American is higher than other race? This section is the literature review. need a minimum of three concepts to elaborate on relative to the research topic. Within this section "Literature Review" are required to include one paragraph which gives a brief overview of what a literature review is and what concepts plan to discuss. Briefly introduce the next research section. While this may seem redundant at each section, it is important to remind the...
Is the life expectancy among African-American females and males and Caucasian females and males different. What...
Is the life expectancy among African-American females and males and Caucasian females and males different. What factors may account for these differences?
Hello I am doing a research paper on microaggression in the workplace focusing on African American...
Hello I am doing a research paper on microaggression in the workplace focusing on African American individuals. I need a thesis statement that focuses on microaggression toward people of color in the workplace and the impact and effect it has on them. Also, what is Microaggression? an explanation of microaggression in 3 sentences thank you
Briefly introduce the concept of Crime Prevention through Environmental Design (CPTED) by summarizing two or three...
Briefly introduce the concept of Crime Prevention through Environmental Design (CPTED) by summarizing two or three examples of CPTED principles that offer alternatives to active surveillance.
What are the three aspects of research design? Use one research paper as example to briefly...
What are the three aspects of research design? Use one research paper as example to briefly explain the three aspects of research design in this research paper.
What are different types of sampling in bussiness research method? Briefly
What are different types of sampling in bussiness research method? Briefly
Briefly outline the key issues in section 3 in the research report by Drury and El-Shishini...
Briefly outline the key issues in section 3 in the research report by Drury and El-Shishini (2005) -- link: https://www.cimaglobal.com/Documents/Thought_leadership_docs/2009-12-16-tech_resrep_divisional_performance_measurement.pdf Focus on the following questions: •What is the difference between economic performance and managerial performance? •What are the limitations of financial metrics in general? State two ways in which the limitations maybe addressed? •Under what conditions may the use of ROI, in particular, lead to ‘under-investment’? •How does the use of residual income avoid the ‘under-investment’ problem? •Why is ROI...
Theoretical question: What is the Research Purpose, Objective, and Design? Also: What is the sampling method...
Theoretical question: What is the Research Purpose, Objective, and Design? Also: What is the sampling method & size, data collection method as well as data analysis & Presentation? The American Conservatory theater, a major repertory theater located in San Francisco, was completing its tenth season. The management team at ACT decided to conduct a major research study, intended to help their planning effort. A questionnaire was deceloped and mailed to their approximately 9,000 season subscribers. A return rate of 40%...
Identify and briefly discuss the two main factors in the Strength Limit State Design Method which...
Identify and briefly discuss the two main factors in the Strength Limit State Design Method which are used for safety purposes. Briefly discuss the significance of both these factors in the context of a real-world structural steel design example of your own choosing.
Using the scientific method, design your own simple psychological research study and describe it. In your...
Using the scientific method, design your own simple psychological research study and describe it. In your description, please identify: 1. What is your theory? What is your hypothesis?  Make sure your theory/hypothesis relates to psychology and involves human participants. 2. What kind of sample will you use? Why? How will you recruit them? 3. Which research design you’ll be using to test your hypothesis (experimental or correlational)? Why did you choose this design? 4. How you will split your participants into...
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT