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National polls have shown that COVID-19 has been highly stressful, negatively affecting well-being and life satisfaction overall, but few studies have focused on individuals with sexual and gender diverse identities. Pandemic-related stress may increase engagement in adverse or negative health-related coping behaviors and decrease engagement in positive coping strategies, potentially exacerbating existing LGBTQ+ health disparities. Relying on a nationally representative population-based sample, we examine disparities in rates of negative and positive COVID-19 coping behaviors by sexual and gender identities. Using Poisson regression models adjusted for key sociodemographic and pandemic related factors, we found higher rates of negative and positive coping behaviors among certain sexual and gender diverse groups compared to their heterosexual and cisgender counterparts. Specifically, we find that lesbian and gay respondents reported more positive and negative coping strategies compared to heterosexual persons. We also found higher rates of negative coping behaviors among plurisexual (bisexual, pansexual, omnisexual) and noncisgender adults (transgender or other nonbinary gender identity) compared to heterosexual and cisgender adults, respectively. We contribute to prior studies by focusing on both negative and positive pandemic related coping among sexually and gender diverse populations. These responses to the pandemic may have long-term implications for the health and well-being of sexual and gender diverse individuals.

Introduction: The lingering burden of the COVID-19 pandemic on primary care clinicians and practices poses a public health emergency for the United States. This study uses clinician-reported data to examine changes in primary care demand and capacity., Methods: From March 2020 to March 2022, 36 electronic surveys were fielded among primary care clinicians responding to survey invitations as posted on listservs and identified through social media and crowd sourcing. Quantitative and qualitative analyses were performed on both closed- and open-ended survey questions., Results: An average of 937 respondents per survey represented family medicine, pediatrics, internal medicine, geriatrics, and other specialties. Responses reported increases in patient health burden, including worsening chronic care management and increasing volume and complexity. A higher frequency of dental- and eyesight-related issues was noted by respondents, as was a substantial increase in mental or emotional health needs. Respondents also noted increased demand, "record high" wait times, and struggles to keep up with patient needs and the higher volume of patient questions. Frequent qualitative statements highlighted the mismatch of patient needs with practice capacity. Staffing shortages and the inability to fill open clinical positions impaired clinicians' ability to meet patient needs and a substantial proportion of respondents indicated an intention to leave the profession or knew someone who had., Conclusion: These data signal an urgent need to take action to support the ability of primary care to meet ongoing patient and population health care needs., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The articles in this special issue of AIDS and Behavior focus on the collision between HIV/AIDS and COVID-19 as intersecting pandemics that profoundly impacted communities globally. This editorial highlights the complex interplay between these two public health crises. The pandemic disrupted access to HIV prevention, testing, and treatment services, potentially jeopardizing decades of progress. Mental health challenges and social vulnerability among people living with HIV (PWH) were exacerbated, with preexisting health disparities amplified, disproportionately affecting marginalized populations. However, despite these challenges, the pandemic also spurred innovation and adaptation in HIV prevention and care, with increased use of telehealth and other modalities. The enduring and actionable lessons learned from the collision of HIV and COVID-19 pandemics can prepare us for the next public health challenge with two calls for action. First, we call for integrated and equitable responses that address the multifaceted challenges faced by individuals and communities affected by HIV in the post-COVID-19 era. Second, we call for a strengthened commitment to building resilient health systems and community-engaged interventions that can withstand future challenges., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The Sars coronavirus 2019 (COVID-19) pandemic has resulted in increased morbidity and mortality; however, there is limited understanding of how excess mortality is distributed among different racial and ethnic subgroups and vascular diseases., Methods: We conducted a retrospective, cross-sectional study design using data from the United States (US) Center for Disease Control (CDC) Wide Ranging Online Data for Epidemiologic Research (Wonder) database. The database contains death certificate information for all US residents by cause of death as ascertained by the treating physician. We examined the trends of excess death by vascular disease specific mortality among different racial and ethnicity subgroups. Excess deaths were defined as the difference between observed numbers of deaths in specific time periods and the expected numbers of deaths in the same time periods. We compared mortality rates during the reference period of 2018-2019 (pre-pandemic) with the study period of 2020-2021 (pandemic years). We also compared excess mortality rates among racial and ethnic subgroups (Non-Hispanic white, Non-Hispanic Black, and Hispanic individuals). Vascular disease was categorized by administrative diagnostic codes (ICD10): Vascular disease (I26, I82, I70-73, I74) and its subtypes Arterial thrombosis (I74), venous thromboembolism (I26, I82) and atherosclerotic disease (I70-73)., Results: Compared to 2018-2019, there was a 1.3 % excess mortality associated with vascular disease, a 12.2 % excess mortality due to arterial thrombosis mortality, and an 8.0 % excess mortality due to thromboembolism in 2020-2021. Black individuals demonstrated higher excess vascular mortality (6.9 %) compared to white individuals (-0.3 %) P < .001, higher excess venous thromboembolism mortality (14.1 % vs 5.1 % P = 0.002) and higher atherosclerosis mortality (2.1 % vs -2.6 % P = 0.002). Hispanics compared to white individuals had higher excess vascular mortality (5.1 % vs -0.3 % P = 0.03) and excess venous thromboembolism mortality (24.2 % vs 5.1 % P < 0.001)., Conclusion: The COVID-19 pandemic has led to a significant and persistent increase in vascular mortality. Excess mortality has disproportionately affected Black and Hispanic individuals compared to white individuals, highlighting the need for further studies to address and eliminate these health care disparities., Competing Interests: Declaration of competing interest The authors have no disclosures pertinent to this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To determine if SARS-CoV-2 disproportionately impacted infants born to racial and ethnic minorities and if virus exposure led to decreased access to care., Methods: This study was an observational case-control study, between March 2020 and March 2022 in Portland, Maine. Forty-seven cases and 47 controls were enrolled. Cases were infants born to mothers diagnosed with SARS-CoV-2 at delivery, and controls were infants matched by date of birth, born to SARS-CoV-2 negative women. Demographic data, maternal clinical data, infant outcomes, and infant discharge plans were compared using Chi squared or Fisher Exact tests. Logistic regression was used to examine the impact of race on neonatal SARS-CoV-2 exposure., Results: Infants exposed to SARS-CoV-2 were more likely Black or Hispanic than White and Non-Hispanic early in the pandemic, with reversal during the second year. SARS-CoV-2-exposed infants experienced delays in routine newborn outpatient care, although delay improved over the pandemic., Conclusion: Infants exposed to SARS-CoV-2 were initially more likely to be infants of color. During this time, infants exposed to SARS-CoV-2 were also experiencing significant delays in newborn care., (© 2023. W. Montague Cobb-NMA Health Institute.)

Objectives: To examine disparities by sex, age group, and race and ethnicity in COVID-19 confirmed cases, hospitalizations, and deaths among incarcerated people and staff in correctional facilities., Methods: Six U.S. jurisdictions reported data on COVID-19 confirmed cases, hospitalizations, and deaths stratified by sex, age group, and race and ethnicity for incarcerated people and staff in correctional facilities during March 1- July 31, 2020. We calculated incidence rates and rate ratios (RR) and absolute rate differences (RD) by sex, age group, and race and ethnicity, and made comparisons to the U.S. general population., Results: Compared with the U.S. general population, incarcerated people and staff had higher COVID-19 case incidence (RR = 14.1, 95% CI = 13.9-14.3; RD = 6,692.2, CI = 6,598.8-6,785.5; RR = 6.0, CI = 5.7-6.3; RD = 2523.0, CI = 2368.1-2677.9, respectively); incarcerated people also had higher rates of COVID-19-related deaths (RR = 1.6, CI = 1.4-1.9; RD = 23.6, CI = 14.9-32.2). Rates of COVID-19 cases, hospitalizations, and deaths among incarcerated people and corrections staff differed by sex, age group, and race and ethnicity. The COVID-19 hospitalization (RR = 0.9, CI = 0.8-1.0; RD = -48.0, CI = -79.1- -16.8) and death rates (RR = 0.8, CI = 0.6-1.0; RD = -11.8, CI = -23.5- -0.1) for Black incarcerated people were lower than those for Black people in the general population. COVID-19 case incidence, hospitalizations, and deaths were higher among older incarcerated people, but not among staff., Conclusions: With a few exceptions, living or working in a correctional setting was associated with higher risk of COVID-19 infection and resulted in worse health outcomes compared with the general population; however, Black incarcerated people fared better than their U.S. general population counterparts., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Data from Asian Americans (AsA) are commonly aggregated in research studies and reporting, obscuring the significant differences across AsA subgroups. We investigated the differential experience of AsA subgroups in COVID-19 testing, vaccination, engagement in risky and protective behaviors and mental health status against this infectious disease. We surveyed a representative sample of the Los Angeles County population (N = 5500) in April 2021 as part of the Los Angeles Pandemic Surveillance Cohort Study and focused on participants who self-identified as AsA (N = 756). There were significant differences across the AsA subgroups, with Koreans, Asian Indians, and Other Asians living in areas with higher COVID-19 mortality rates, and Asian Indians demonstrating the lowest proportion of COVID-19 vaccination. Vietnamese and Koreans had a higher proportion of becoming unemployed during the pandemic. Although the AsA sample on average demonstrated better outcomes than other racial and ethnic groups, the apparent advantages were heterogenous and due to specific subgroups of AsAs rather than AsAs as a whole. The observed differences in COVID-19 measures across AsA subgroups underscore the need to disaggregate AsA data to identify and reduce existing disparities., (© 2023. The Author(s).)

Background: Evidence is limited about healthcare cost disparities associated with homelessness, particularly in recent years after major policy and resource changes affecting people experiencing homelessness occurred after the onset of the COVID-19 pandemic. We estimated 1-year healthcare expenditures, overall and by type of service, among a representative sample of people experiencing homelessness in Toronto, Canada, in 2021 and 2022, and compared these to costs among matched housed and low-income housed individuals., Methods: Data from individuals experiencing homelessness participating in the Ku-gaa-gii pimitizi-win cohort study were linked with Ontario health administrative databases. Participants (n = 640) were matched 1:5 by age, sex-assigned-at-birth and index month to presumed housed individuals (n = 3,200) and to low-income presumed housed individuals (n = 3,200). Groups were followed over 1 year to ascertain healthcare expenditures, overall and by healthcare type. Generalized linear models were used to assess unadjusted and adjusted mean cost ratios between groups., Results: Average 1-year costs were $12,209 (95% CI $9,762-$14,656) among participants experiencing homelessness compared to $1,769 ($1,453-$2,085) and $1,912 ($1,510-$2,314) among housed and low-income housed individuals. Participants experiencing homelessness had nearly seven times (6.90 [95% confidence interval [CI] 5.98-7.97]) the unadjusted mean ratio (MR) of costs as compared to housed persons. After adjustment for number of comorbidities and history of healthcare for mental health and substance use disorders, participants experiencing homelessness had nearly six times (adjusted MR 5.79 [95% CI 4.13-8.12]) the expected healthcare costs of housed individuals. The two housed groups had similar costs., Conclusions: Homelessness is associated with substantial excess healthcare costs. Programs to quickly resolve and prevent cases of homelessness are likely to better meet the health and healthcare needs of this population while being a more efficient use of public resources., (© 2024. The Author(s).)

Background: This study explored whether opinions about the government's role in addressing the COVID-19 pandemic vary based on demographic characteristics and racial beliefs. We hypothesized that opinions about the United States (U.S.) government's response to COVID-19 would differ based on an individual's characteristics such as age, race, and racial beliefs., Methods: We utilized an Inter-University Consortium for Political and Social Research dataset to examine differences in opinion regarding the government's pandemic response, considering personal characteristics and racial beliefs. Descriptive statistics depicted respondents' characteristics, and a Chi-square test for independence assessed whether differences emerged based on racial attitude, self-reported racial identity, sex, income, education, and age. Logistic regression analyses were conducted to independently determine which characteristics were associated with differences in evaluating the government's pandemic response., Results: The sample consisted of 1028 respondents: 47.5% male and 52.5% female. Overall, the group viewed the government unfavorably, with only 40% reporting that the government responded correctly and 54% believing the government is almost always wasteful and inefficient. Hispanics or Latinos were more likely to view the government as wasteful or inefficient, while more Whites rated the government's pandemic response as appropriate. Individuals who believed that racial discrimination is the main reason why many Black people cannot get ahead generally regarded the government's pandemic response more favorably. Only 5% deemed the government's response excessive. Being Black, younger, and female was associated with the view that racial discrimination is the main reason why many Black people cannot get ahead. Individuals who felt this way viewed the government unfavorably by almost a 2:1 ratio., Conclusions: A majority of U.S. residents do not believe the government responded correctly to the pandemic and more than half viewed the government as wasteful and inefficient. Differences emerged by ethnicity and racial attitudes, with individuals of color holding more negative views of the government's response. Understanding this perspective can help develop messaging and strategies that resonate with communities where racial and minority groups live.

Context: The COVID-19 pandemic disproportionately impacted non-Hispanic Black and Hispanic patients. However, little is known about the quality of serious illness communication in these communities during this time., Objective: We aimed to determine whether racial and ethnic disparities manifested in serious illness conversations during the pandemic., Methods: This was a retrospective, observational, cohort study of adult patients with a documented serious illness conversation from March 2020 to April 2021. Serious illness conversation documentation quality was assessed by counting the median number (IQR) of conversation domains and their elements included in the documentation. Domains included (1) values and goals, (2) prognosis and illness understanding, (3) end-of-life care planning, and (4) life-sustaining treatment preferences. A multivariable ordinal logistic regression analysis was conducted to assess associations between differences in serious illness documentation quality with patient race and ethnicity., Results: Among 291 patients, 149 (51.2%) were non-Hispanic White; 81 (27.8%) were non-Hispanic Black; and 61 (21.0%) were Hispanic patients. Non-Hispanic Black patients were associated with fewer domains (OR 0.46 [95% CI 0.25, 0.84]; P=.01) included in their serious illness conversation documentation compared to non-Hispanic White patients. Both non-Hispanic Black (OR 0.35 [95% CI 0.20, 0.62]; P<.001) and Hispanic patients (OR 0.29 [95% CI 0.14, 0.58]; P<.001) were associated with fewer elements in the values and goals domain compared to non-Hispanic White patients in their serious illness documentation., Conclusion: During the COVID-19 pandemic, serious illness conversation documentation among non-Hispanic Black and Hispanic patients was less comprehensive compared to non-Hispanic White patients., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic., Objective: This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points., Methods: Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age., Results: For millennials, being female, attaining some college or a college degree, and reporting an annual income of US $50,000-$74,999 or >US $75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2020 (OR 1.56, 95% CI 1.15-2.12) and 2022 (OR 4.04, 95% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2022 (OR 5.76, 95% CI 3.05-10.89) were associated with the use of eHealth for information seeking., Conclusions: Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women., (©Christian Elias Vazquez, Rebecca L Mauldin, Denise N Mitchell, Faheem Ohri. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.08.2024.)

Background: The COVID-19 pandemic brought greater focus to the rural mortality penalty in the U.S., which describes the greater mortality rate in rural compared to urban areas. Although it is widely thought that issues such as access to care, age structure of the population, and differences in behavior are likely drivers of the rural mortality penalty, few studies have attempted to tie delayed access to care in rural populations to healthcare outcomes quantitatively. Therefore, it is critical to try and understand these factors to enable more effective public health policy., Methods: We performed a cross-sectional analysis of a population of patients with COVID-19 who were admitted to hospitals in the United States between 3/1/2020 and 2/26/2023 to better understand factors leading to outcome disparities amongst groups that all had some level of access to hospital care. Nevertheless, it is widely thought that rural populations often experience delayed access to care, due to transportation and other constraints. Therefore, we hypothesized that deteriorated patient condition at admission likely explained some of the observed difference in mortality between rural and urban populations., Results: Our results supported our hypothesis, showing that the rural mortality penalty persists in this population and that by multiple measures, rural patients were likely to be admitted in worse condition, had worse overall health, and were older., Conclusions: Although the pandemic threw the rural mortality penalty into sharp relief, it is important to remember that it existed prior to the pandemic and will continue to exist until effective interventions are implemented. This study demonstrates the critical need to address the underlying factors that resulted in rural-dwelling patients being admitted to the hospital in worse condition than their urban-dwelling counterparts during the COVID-19 pandemic, which likely affected other healthcare outcomes as well., (© 2024. The Author(s).)

Introduction: The adoption of remote healthcare methods has been accelerated by the COVID-19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID-19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups., Methods: This was a mixed-methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis., Findings: Survey responses were received from 292 staff and 1069 patients and carers. Twenty-three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p < 0.001) and had more difficulty in understanding information (p = 0.005). Health status (p = 0.004), ethnicity (p < 0.001), gender (p < 0.001) and employment (p = 0.007) were associated with differential engagement with monitoring, and minority ethnic groups reported more difficulty understanding service information (p = 0.001). Qualitative data found illness severity to be an important factor in the support required, and patients' living situation and social network affected whether they found the service reassuring., Conclusion: Addressing health disparities must be a key focus in the design and delivery of remote care. Services should be tailored to match the needs of their local population, encourage access through collaboration and referral pathways with other services and monitor their inclusiveness. Involving patients and staff in service design can illuminate the diversity of patients' needs and experiences of care., Patient or Public Contribution: The study team met with service user and public members of the BRACE PPI group and patient representatives from RSET in a series of workshops. Workshops informed study design, data collection tools, data interpretation and dissemination activities. Study documents (such as consent forms, topic guides, surveys and information sheets) were reviewed by PPI members; patient surveys and interview guides were piloted, and members also commented on the manuscript., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Background: Previous studies examined the impact of the COVID-19 pandemic on mental health, but few studies looked at associations between the pandemic and state-funded behavioral health service utilization. We aimed to examine behavioral health service utilization during the early phase of COVID-19 among individuals with psychiatric disorders (PD), substance use disorders (SUD), and co-occurring disorders (COD)., Methods: Using the last Adult Needs and Strengths Assessment (ANSA) completed in 2019 and 2020 in a Midwestern state, a column proportion test and Poisson regression model examined the associations of the pandemic year, age, gender, race/ethnicity, diagnostic type, and behavioral health needs., Results: Between 2019 and 2020, the number of adults newly involved in behavioral health services increased from 11,882 to 17,385. The number of total actionable items (TAI) differed by gender and age group. Adults who were Black or American Indian were more likely to have a significantly higher number of needs that interfered with functioning (β = 0.08; CI [0.06, 0.09]), (β = 0.16; CI [0.08, 0.23]), respectively, than White peers. Individuals with COD showed the highest number of needs (β = 0.27; CI [0.26, 0.28]) when compared to the needs of individuals with psychiatric disorders, after controlling for year, age, gender, and race/ethnicity., Conclusions: Additional research is needed to better understand the intersections of age, gender identity, race/ethnicity, the complexity of needs, and useful strengths. The involvement of practitioners, service organizations, researchers, and policymakers will be required to provide accessible, effective behavioral health services with cultural and developmental adaptations to support recovery., (© 2023. International Society of Behavioral Medicine.)

Background: During the pandemic, a notable increase in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), conditions that warrant emergent management, was reported. We aimed to investigate the trend of DKA- and HHS-related mortality and excess deaths during the pandemic., Methods: Annual age-standardized mortality rates related to DKA and HHS between 2006 and 2021 were estimated using a nationwide database. Forecast analyses based on prepandemic data were conducted to predict the mortality rates during the pandemic. Excess mortality rates were calculated by comparing the observed versus predicted mortality rates. Subgroup analyses of demographic factors were performed., Results: There were 71 575 DKA-related deaths and 8618 HHS-related deaths documented during 2006-2021. DKA, which showed a steady increase before the pandemic, demonstrated a pronounced excess mortality during the pandemic (36.91% in 2020 and 46.58% in 2021) with an annual percentage change (APC) of 29.4% (95% CI: 16.0%-44.0%). Although HHS incurred a downward trend during 2006-2019, the excess deaths in 2020 (40.60%) and 2021 (56.64%) were profound. Pediatric decedents exhibited the highest excess mortality. More than half of the excess deaths due to DKA were coronavirus disease 2019 (COVID-19) related (51.3% in 2020 and 63.4% in 2021), whereas only less than a quarter of excess deaths due to HHS were COVID-19 related. A widened racial/ethnic disparity was observed, and females exhibited higher excess mortality than males., Conclusions: The DKA- and HHS-related excess mortality during the pandemic and relevant disparities emphasize the urgent need for targeted strategies to mitigate the escalated risk in these populations during public health crises., (© 2024 The Author(s). Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Objective: To measure the impact of the COVID-19 pandemic on racial and ethnic disparities in attendance to well-child visit recommendations., Methods: We used the nationally representative Medical Expenditure Panel Survey (MEPS) to compare pre-pandemic (2018-2019) and pandemic (2020 and 2021) ratios of well-child visits to age-based recommendations, presenting both unadjusted and adjusted attendance disparities over time. We also used the 1996-2021 MEPS to place the pandemic changes in an historical context., Results: Average attendance decreased from 66.6% in 2018-2019 (95% confidence interval [CI]: 64.1, 69.1) to 58.6% in 2020 (95% CI: 55.5, 61.6), rebounding to 65.1% in 2021 (95% CI: 61.5, 68.7). The unadjusted disparity in attendance between White non-Hispanic and Black non-Hispanic children widened from 9.6 percentage points in 2018-2019 (95% CI: 2.8, 16.4) to 24.8 percentage points in 2020 (95% CI: 17.5, 32.2) and 21.4 percentage points in 2021 (95% CI: 11.2, 31.5). The unadjusted disparity in attendance between White non-Hispanic and Hispanic children widened from 14.8 percentage points in 2018-2019 (95% CI: 9.7, 19.8) to 26.3 percentage points in 2020 (95% CI: 19.9, 32.7) and 24.9 percentage points in 2021 (95% CI: 17.5, 32.3). Changes in disparities were large even when we controlled for health status, demographic and socioeconomic characteristics, health insurance, and state of residence. Magnitudes of the racial and ethnic attendance disparities during the pandemic's first two years were unprecedented since 1996., Conclusions: Widening attendance disparities during the pandemic highlight the need to build a more equitable health care system for all children., Competing Interests: Declaration of Competing Interest Salam Abdus – none. Thomas M. Selden – none., (Published by Elsevier Inc.)

Background: People with disabilities are at increased risk for severe COVID-19 health outcomes and face barriers accessing COVID-19 vaccines. The aim of this study is to examine receipt of ≥ 1 dose of the COVID-19 vaccine, intention to vaccinate in the future, and reasons for not vaccinating among people with disabilities and functional limitations using a large, nationally representative dataset of adults in the United States., Methods: Data were analyzed from the Census Bureau's Household Pulse Survey (14-26 April 2021, n  = 68,913). Separate logistic regression models were conducted to examine the association between each disability (vision, hearing, cognition and mobility), overall disability status, and functional status on ≥1 dose COVID-19 vaccination receipt and intention to vaccinate. Furthermore, reasons for not getting vaccinated were examined among those with disabilities or functional limitations., Results: Approximately 13% of adults reported having a disability, and almost 60% reported having some or a lot of functional limitations. Over 65% of adults with disabilities had received ≥1 dose of COVID-19 vaccines, compared to 73% among adults without disabilities (adjusted prevalence ratio = 0.94). Among adults with disabilities, those who were younger, had lower educational attainment and income, did not have insurance and had a prior history of COVID-19 were less likely to get vaccinated or intend to get vaccinated than their respective counterparts. The main reasons for not getting vaccinated were concerns about possible side effects (52.1%), lack of trust in COVID-19 vaccines (45.4%) and lack of trust in the government (38.6%)., Discussion and Conclusion: Efforts to ensure high and equitable vaccination coverage include working with communities to strengthen the message that the vaccine is safe and effective, educating health professionals about the need to recommend and promote vaccines, and making vaccination sites more accessible for people who need additional accommodations.

People surviving cancer represent a particularly vulnerable population who are at a higher risk for food insecurity (FI) due to the adverse short- and long-term effects of cancer treatment. This analysis examines the influence of the COVID-19 pandemic on the prevalence of FI among cancer survivors across New York State (NYS). Data from the 2019 and 2021 NYS Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate the prevalence of FI. Multivariable logistic regression was used to explore socioeconomic determinants of FI. Among cancer survivors, FI varied geographically with a higher prevalence in New York City compared to the rest of the state (ROS) prior to (25.3% vs. 13.8%; p = .0025) and during the pandemic (27.35% vs. 18.52%; p = 0.0206). In the adjusted logistic regression model, pre-pandemic FI was associated with non-White race (OR 2.30 [CI 1.16-4.56]), household income <$15,000 (OR 22.67 [CI 6.39-80.43]) or $15,000 to less than <$25,000 (OR 22.99 [CI 6.85-77.12]), and more co-morbidities (OR 1.39 [CI 1.09-1.77]). During the pandemic, the association of FI with non-White race (OR 1.76 [CI 0.98-3.16]) was attenuated but remained significant for low household income and more co-morbidities. FI was newly associated with being out of work for less than one year (OR 6.36 [CI 1.80-22.54] and having one (OR 4.42 [CI 1.77-11.07]) or two or more children in the household (OR 4.54 [CI 1.78-11.63]). Our findings highlight geographic inequities and key determinants of FI among cancer survivors that are amendable to correction by public health and social policies, for which several were momentarily implemented during the pandemic., (© 2024. The Author(s).)

Introduction: Understanding changes in vaccine hesitancy, overall and by sociodemographic characteristics, may highlight sub-populations for whom more intensive efforts are needed to increase vaccine uptake and confidence., Methods: We analyzed data using the CDC's Research and Development Survey (RANDS), a nationally representative survey of U.S. adults ≥18 years, collected from 17 May 2021-30 June 2021 ( n  = 5,458) and 3 November 2022-12 December 2022 ( n  = 6,821). We assessed changes in vaccine hesitancy, changes in vaccine attitudes and attitudes, and factors associated with hesitancy toward both vaccines in general and COVID-19 vaccines among a nationally representative sample of U.S. adults., Results: Although COVID-19 vaccination (≥1 dose) increased from 67.2% (2021) to 74.7% (2022), COVID-19 vaccine hesitancy increased from 40.7% to 44.6% during the same period. During the same period, hesitancy toward both COVID-19 vaccines and vaccines in general increased among those who were aged ≥65 years and who were non-Hispanic White. However, COVID-19 vaccine hesitancy decreased among non-Hispanic Black adults. Current or former smokers were more hesitant toward vaccines in general (aPR = 1.13, 95%CI: 1.03-1.24) and toward COVID-19 vaccines (aPR = 1.08, 95%CI: 1.01-1.16) compared to never smokers. Among adults who did not receive any COVID-19 vaccines, COVID-19 vaccine hesitancy increased from 86.6% in 2021 to 92.4% in 2022. Furthermore, belief in the overall social benefit of the COVID-19 vaccine decreased from 47.5% to 25.1%., Conclusion: This study highlights concerning trends in vaccine hesitancy and uptake of the COVID-19 and other recommended vaccines. We found that some high-risk groups (e.g. smokers) and population subgroups have become more vaccine hesitant, suggesting the need for improved and intensified strategies to increase vaccine confidence and uptake. Future research may focus on qualitative inquiry to understand specific concerns and determinants contributing to increased hesitancy among these groups to help inform interventions and communication campaigns to support vaccination.

This study examined negative life changes due to coronavirus disease of 2019 (COVID-19) and its correlates in a sample of community-dwelling older adults from a low-income urban city in Korea, focusing on gendered differences. Negative life changes due to COVID-19 were categorized into four domains: behavioral/physical, psychosocial, goal-seeking, and control/freedom. Being female, not receiving basic livelihood security, and dissatisfaction with housing situation were significantly associated with negative life changes during the pandemic. Gender-stratified analyses revealed that most within-gender social disparities associated with changes due to COVID-19 occurred in older women. The odds of experiencing negative changes were higher among working women and those receiving security income aid. In low-income urban communities, those who were previously socially and economically active perceived more negative changes owing to the pandemic. The contribution of gender to negative life changes should be considered to effectively alleviate concerns among older adults during pandemics., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Vaccination plays an important role in preventing COVID-19 infection and reducing the severity of the disease. There are usually differences in vaccination rates between urban and rural areas. Measuring these differences can aid in developing more coordinated and sustainable solutions. This information also serves as a reference for the prevention and control of emerging infectious diseases in the future., Objective: This study aims to assess the current coverage rate and influencing factors of COVID-19 (second booster) vaccination among Chinese residents, as well as the disparities between urban and rural areas in China., Methods: This cross-sectional study used a stratified random sampling approach to select representative samples from 11 communities and 10 villages in eastern (Changzhou), central (Zhengzhou), western (Xining), and northeast (Mudanjiang) Mainland China from February 1 to February 18, 2023. The questionnaires were developed by experienced epidemiologists and contained the following: sociodemographic information, health conditions, vaccine-related information, information related to the Protective Motivation Theory (PMT), and the level of trust in the health care system. Vaccination rates among the participants were evaluated based on self-reported information provided. Binary logistic regression models were performed to explore influencing factors of vaccination among urban and rural participants. Urban-rural disparities in the vaccination rate were assessed using propensity score matching (PSM)., Results: A total of 5780 participants were included, with 53.04% (3066/5780) being female. The vaccination rate was 12.18% (704/5780; 95% CI 11.34-13.02) in the total sample, 13.76% (341/2478; 95% CI 12.40-15.12) among the rural participants, and 10.99% (363/3302; 95% CI 9.93-12.06) among the urban participants. For rural participants, self-reported health condition, self-efficacy, educational level, vaccine knowledge, susceptibility, benefits, and trust in the health care system were independent factors associated with vaccination (all P＜.05). For urban participants, chronic conditions, COVID-19 infection, subjective community level, vaccine knowledge, self-efficacy, and trust in the health care system were independent factors associated with vaccination (all P＜.05). PSM analysis uncovered a 3.42% difference in vaccination rates between urban and rural participants., Conclusions: The fourth COVID-19 vaccination coverage rate (second booster) among the Chinese population was extremely low, significantly lower than the previous vaccine coverage rate. Given that COVID-19 infection is still prevalent at low levels, efforts should focus on enhancing self-efficacy to expand the vaccine coverage rate among the Chinese population. For rural residents, building awareness of the vaccine's benefits and improving their overall health status should be prioritized. In urban areas, a larger proportion of people with COVID-19 and patients with chronic illness should be vaccinated., (©Wenyong Dong, Yudong Miao, Zhanlei Shen, Wanliang Zhang, Junwen Bai, Dongfang Zhu, Ruizhe Ren, Jingbao Zhang, Jian Wu, Clifford Silver Tarimo, Theodora Ojangba, Yi Li. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 19.07.2024.)

In September 2020, the National Institutes of Health acted in response to the COVID-19 pandemic, recognizing the critical need to combat misinformation, particularly in communities disproportionately affected by the crisis. The Community Engagement Alliance (CEAL) emerged as an initiative dedicated to fostering reliable, science-based information, diversity, and inclusion; aiming to implement effective strategies to mitigate the spread of COVID-19 nationwide. One of the teams participating in this initiative is Puerto Rico-CEAL (PR-CEAL). Our whose goal was to raise awareness about the coronavirus disease and advance research, mainly focusing on vulnerable and underserved populations. This concept paper seeks to outline PR-CEAL's infrastructure during its initial two cycles, providing insights into the research and community engagement activities designed to enhance prevention, counter misinformation, and foster awareness and uptake of COVID-19 vaccines. Ultimately, our objective is to reflect on the strengths and challenges encountered thus far as we endeavor to sustain this robust infrastructure, addressing ongoing public health issues with a forward-looking approach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pons-Calvo, Pérez, Canales-Birriel, Tamarit-Quevedo, Solís-Torres, López-Cepero, García-Rivera, Larriuz, Acosta-Pérez, Colón, Román, Ortiz, Rivera-Gastón and Colón-López.)

Background: There is limited information on the extent and patterns of disparities in COVID-19 mortality throughout the pandemic. We aimed to examine trends in disparities by demographics over variants in the pre- and post-vaccine availability period among Californian workers using a social determinants of health lens., Methods: Using death certificates, we identified all COVID-19 deaths that occurred between January 2020 and May 2022 among workers aged 18-64 years in California (CA). We derived estimates for at-risk worker populations using the Current Population Survey. The waves of COVID-19 mortality in the pre-vaccine availability period were March 2020-June 2020 (wave 1), and July 2020-November 2020 (wave 2), and in the post-vaccine availability period: December 2020-May 2021 (wave 3), June 2021-January 2022 (wave 4), and February 2022-May 2022 (wave 5). Poisson regression models with robust standard errors were used to determine wave-specific mortality rate ratios (MRRs). We examined the change in MRR across waves by including an interaction term between each demographic characteristic and wave period in different models. The role of potential misclassification of Race/ethnicity on death certificates was examined using probabilistic quantitative bias analysis as sensitivity analysis., Results: Among the 24.1 million working age CA population included in the study, there were 26,068 COVID-19 deaths in the period between January 2020 and May 2022. Compared with their respective reference groups, workers who were 50-64 years old, male, Native Hawaiian, Latino, or African American, foreign-born; individuals who had lower education; and unmarried were disproportionately affected by COVID-19 mortality. While disparities by sex, race/ethnicity and foreign-born status narrowed in later waves (post-vaccine availability), disparities by age, education level and marital status did not change substantially across waves., Conclusion: Demographic disparities in COVID-19 mortality narrowed in the post-vaccine availability waves. However, the existence of disparities across all waves of the pandemic, even in an era of widespread vaccine coverage, could indicate remaining gaps in prevention and differential vulnerability. Addressing the underlying social, structural, and occupational factors that contribute to these disparities is critical for achieving health equity., (© 2024. The Author(s).)

Introduction: Equity-oriented efforts to mitigate and prevent COVID-related disparities are hindered due to methodological limitations of the categorization of racial and ethnic groups, including Arabs and Middle Eastern and North African (MENA) communities, which remain invisible in national data collection efforts. This study highlights the disparities in COVID-related outcomes in Toronto, Canada and supports ongoing calls to collect public health data among MENA communities in the United States., Methods: Data on racial/ethnic identity and hospitalizations were collected by the Toronto Public Health (TPH) of the Ontario Ministry of Public Health Case between May 20, 2020, and September 30, 2021 from people with a confirmed or probable case of COVID-19., Results: The reported COVID-19 infection rate for Arab, Middle Eastern, West Asians (i.e., categories used to self-identify as MENA in Canada) relative to Whites in Toronto was 3.51. The age-standardized hospitalization rate ratio between Arab, Middle Eastern, West Asians and Whites was 4.59., Discussion: Data from Toronto highlight that Arab, Middle Eastern, and West Asians have higher rates of COVID-19 infections and hospitalizations than their White counterparts. Comparable studies are currently not possible in the United States due to lack of data that can disaggregate MENA individuals. This study underscores the critical need to collect data among MENA communities in the United States to advance our field's goal of promoting and advancing equity.

Objectives: Lack of access to timely, accurate, and linguistically appropriate COVID-19 information has complicated the dissemination of evidence-based information and contributed to vaccine hesitancy among racial and ethnic minority groups in the United States. We developed community events that provided outreach, education, and access to COVID-19 vaccination to overcome vaccine hesitancy in these communities., Methods: Using spatial analysis techniques, we identified 3 communities with low vaccine uptake in Houston, Texas, in fall 2021; engaged 20 stakeholders from these communities via 4 focus groups to understand barriers to vaccination; and developed and implemented 3 COVID-19 vaccine education and outreach events tailored to the needs of these communities in January-March 2022. We used program evaluation surveys to assess attendee characteristics and satisfaction with the events. Vaccinated attendees also completed surveys on what motivated them to get vaccinated., Results: Two communities were predominantly Hispanic, and the third had an equal number of Black and Hispanic residents. Based on community stakeholder input, the study team organized 2 health fairs and 1 community festival featuring dialogue-based COVID-19 vaccine engagement in January and March 2022. Across the 3 events, a total of 865 attendees received COVID-19 education and 205 (24.0%) attendees received a COVID-19 vaccine or booster. Of 90 attendees who completed program evaluation surveys, 81 (90%) rated the outreach event as good or excellent. Of 145 attendees who completed postvaccination surveys, 132 (91%) endorsed ≥1 key program feature as motivating them to either get vaccinated or vaccinate their child that day., Conclusion: Community outreach events are important strategies for disseminating information, building trust, and facilitating COVID-19 vaccine uptake., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Poorer leadership communication during COVID-19 may have contributed to the moral distress of nurses in hospitals where Black patients predominantly access their care (BSH)., Purpose: To compare nurse moral distress and leadership communication during the COVID-19 pandemic in hospitals that serve disproportionately many or few patients of Black race., Methods: In a national hospital sample (n = 90), nurse survey data were collected (March 2021). Nurse moral distress was analyzed in linear regression models. The key covariates were BSH category (Medicare Black patient percentage) and leadership communication., Discussion: Nurses in high-BSH had significantly greater moral distress and more difficulty accessing personal protective equipment than nurses in low-BSH. The percentage of nurses in high-BSHs with high moral distress was double that of nurses in low-BSHs. Poorer leadership communication in BSHs accounted for the nurses' greater moral distress., Conclusion: Policies should improve leadership communication, mitigate distress, and support nurses in under-resourced settings., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Mental health disparities were prevalent among racially and ethnically minoritized youth prior to the COVID-19 pandemic. As complete datasets from 2022 become available, we can estimate the extent to which the pandemic further magnified existing inequities. Our objective was to quantify disparities in trajectories of depression, anxiety, and suicide risk-related diagnoses in youth before and after the start of the COVID-19 pandemic, using an intersectional lens of race, ethnicity and gender., Methods: Using electronic medical record data from one mid-Atlantic health care system (2015-2022), we evaluated changes in annual rates of depression, anxiety and suicide risk-related diagnoses in 29,117 youths, aged 8-20 years, using graphical analysis, comparison of adjusted mean differences (AMD) and adjusted mixed multilevel logistic regression., Results: Almost all racial and gender subgroups had significantly higher rates of depression and anxiety after the start of COVID-19 compared to the years prior, with the greatest changes observed in Hispanic and Asian females. Suicide risk-related diagnoses significantly increased among all female subgroups, with the largest increase among Asian females (AMD 4.8, 95% CI 0.2-9.3) and Black females (AMD 4.6, 95% CI 2.2-6.9)., Conclusions: Rates of depression, anxiety, and suicidal thoughts and/or behaviors in young people continued to increase in the post-pandemic period. Many pre-existing disparities between subgroups, especially females, significantly widened, highlighting the importance of using an intersectional lens. Urgent action is warranted, including universal screening of pediatric patients for suicide risk, broadening effective treatment and support options in minoritized patients, and increasing support services to patients and families., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors have received support from the following for the production of this manuscript: Grants and Contracts: NIH BIRCWH (K12 award) (Dr. Prichett), NIDA (K23 award) (Dr. Young), Intramural JHU award (Dr. Young) Stanley Medical Research Institute (Dr. Yolken, Dr. Severance). Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Only to non-profit academic institutions. Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Helping Give Away Psychological Science (503b) (Dr. Young) (Board member)., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

The COVID-19 pandemic has been associated with increases in pediatric obesity and widening pre-existing disparities. To better understand the pandemic's long-term impacts, we evaluated trends in obesity across different demographic groups during the pandemic through December 2022. Using a retrospective cohort design, we analyzed electronic health record data from a large pediatric primary care network. Logistic regression models fit using generalized estimating equations estimated odds ratios (ORs) for changes in the level and trajectory of obesity across 2-year month-matched periods: prepandemic (June 2017 to December 2019) and pandemic (June 2020 to December 2022). Among a cohort of 153,667 patients with visits in each period, there was a significant increase in the level of obesity at the pandemic onset [OR: 1.229, 95% confidence interval (CI): 1.211-1.247] followed by a significant decrease in the trend for obesity (OR: 0.993, 95% CI: 0.992-0.993). By December 2022, obesity had returned to prepandemic levels. However, persistent sociodemographic disparities remain.

The COVID-19 pandemic caused major disruptions to healthcare services in 2020, delaying cancer diagnosis and treatment. While early-stage thyroid cancer often progresses slowly, it is crucial to determine whether treatment delays associated with the pandemic have impacted the clinical presentation and management of advanced-stage thyroid cancer. The purpose of our study was to determine the impact of the early COVID-19 pandemic on thyroid cancer presentation and treatment times. Utilizing the National Cancer Database, chi-squared tests and regression analyses were performed to compare patient demographic and clinical characteristics over time for 56,011 patients diagnosed with primary thyroid cancer who were treated at the Commission on Cancer-accredited sites in 2019 and 2020. We found that thyroid cancer diagnoses decreased between 2019 and 2020, with the biggest drop among patients with cT1 disease relative to other T stages. We also found that patients diagnosed with thyroid cancer in 2020 had similar treatment times to patients diagnosed in 2019, as measured by both the time between diagnosis and start of treatment and the time between surgery and start of radioactive iodine therapy. Overall, our study suggests that resources during the pandemic were allocated to patients with advanced thyroid disease, despite a decrease in diagnoses.

Purpose: To examine changes in addiction medicine treatment utilization during the COVID-19 pandemic among adolescents (aged 13-17 years) and differences by race/ethnicity., Methods: We compared treatment initiation (overall and telehealth), engagement, and 12-week retention between insured adolescents with substance use problems during pre-COVID-19 (March to December 2019, n = 1,770) and COVID-19 (March to December 2020, n = 1,177) using electronic health record data from Kaiser Permanente Northern California., Results: Compared to pre-COVID-19, odds of treatment initiation, overall (adjusted odds ratio [95% confidence interval] = 1.42 [1.21-1.67]), and telehealth (5.98 [4.59-7.80]) were higher during COVID-19, but odds of engagement and retention did not significantly change. Depending on the outcome, Asian/Pacific Islander, Black, and Latino/Hispanic (vs. White) adolescents had lower treatment utilization across both periods. Changes in utilization over time did not differ by race/ethnicity., Discussion: Addiction medicine treatment initiation increased among insured adolescents during the pandemic, especially via telehealth. Although racial/ethnic disparities in treatment utilization persisted, they did not worsen., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Israel is regarded as a country with a developed economy and a moderate income inequality index. In this population-based study, we aimed to measure the inequalities in colorectal cancer screening within Clalit Health, an organization with universal insurance, before and during the coronavirus disease 2019 pandemic., Setting: Retrospective analysis within Clalit Health Services, Israel., Methods: We evaluated the rate of being up to date with screening (having a colonoscopy within 10 years or a fecal occult blood test within 1 year) and the colonoscopy completion rate (having a colonoscopy within 6 months of a positive fecal occult blood test) among subjects aged 50-75 in 2019-2021., Results: In 2019, out of 918,135 subjects, 61.3% were up to date with screening; high socioeconomic status: 65.9% (referent), medium-socioeconomic status: 60.1% (odds ratio 0.81, 95% confidence interval 0.80-0.82), low-socioeconomic status: 59.0% (odds ratio 0.75, 95% confidence interval 0.74-0.75); Jews: 61.9% (referent), Arabs: 59.7% (odds ratio 0.91, 95% confidence interval 0.90-0.92), Ultraorthodox-Jews: 51.7% (odds ratio 0.77, 95% confidence interval 0.75-0.78). Out of 21,308 with a positive fecal occult blood test, the colonoscopy completion rate was 51.8%; high-socioeconomic status: 59.8% (referent), medium-socioeconomic status: 54.1% (odds ratio 0.79, 95% confidence interval 0.73-0.86), low-socioeconomic status: 45.5% (odds ratio 0.60, 95% confidence interval 0.56-0.65); Jews: 54.7% (referent), Ultraorthodox-Jews: 51.4% (odds ratio 0.91, 95% confidence interval 0.90-0.92), Arabs: 44.7% (odds ratio 0.77, 95% confidence interval 0.75-0.78). In 2020-2021, there was a slight drop in the rate of being up to date with screening, while most of the discrepancies were kept or slightly increased with time., Conclusions: We report significant inequalities in colorectal cancer screening before and during the coronavirus disease 2019 pandemic in Israel, despite a declared policy of equality and universal insurance., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Telehealth was adopted to maintain HIV care continuity during the COVID-19 pandemic; however, its use was unequally distributed. This study examined variation in HIV care visit patterns and whether telehealth use was associated with viral suppression. Methods: Electronic health record (EHR) data from a large HIV clinic in South Carolina was analyzed using multivariable logistic regression to characterize variation in telehealth use, having a viral load (VL) test, and viral suppression in 2022. Results: EHR data from 2,375 people living with HIV (PWH) between March 2021 and March 2023 showed telehealth use among 4.8% of PWH. PWH who are 50+ years and non-Hispanic Black had lower odds of telehealth use (odds ratio [OR] 0.59, 95% confidence interval [CI 0.40-0.86]; OR 0.58, 95% CI [0.37-0.92] respectively). Telehealth use was not associated with viral suppression and VL testing. Conclusion: Telehealth disparities in HIV care affected older and non-Hispanic Black PWH, requiring tailored strategies to promote telehealth among them.

Background: Challenges with SARS-CoV-2 vaccine prioritization, access, and hesitancy have influenced vaccination uptake., Research Question: Was the impact of SARS-CoV-2 vaccine rollout on COVID-19 monthly admission and mortality trends different between Hispanic and non-Hispanic populations?, Study Design and Methods: We used interrupted time series analysis to conduct an ancillary study of the Viral Infection and Respiratory Illness Universal Study registry supplemented by electronic health record data from five participating Mayo Clinic sites in Florida, Arizona, Minnesota, and Wisconsin. We included hospitalized patients with COVID-19 admitted between April 2020 and December 2021. Our primary outcome was the impact of vaccine rollout on admission trends. Our secondary outcome was the impact of vaccine rollout on mortality trends., Results: This interrupted time series analysis includes 6,442 patients. Vaccine rollout was associated with improved monthly hospital admission trends among both Hispanic and non-Hispanic patients. Among Hispanic patients, pre-vaccine rollout, monthly admissions increased by 12.9% (95% CI, 8.1%-17.9%). Immediately after vaccine rollout, patient admissions declined by -66.3% (95% CI, -75.6% to -53.9%). Post-vaccine rollout, monthly admissions increased by 3.7% (95% CI, 0.2%-7.3%). Among non-Hispanic patients, pre-vaccine rollout, monthly admissions increased by 35.8% (95% CI, 33.4%-38.1%). Immediately after vaccine rollout, patient admissions declined by -75.2% (95% CI, -77.6% to -72.7%). Post-vaccine rollout, monthly admissions increased by 5.6% (95% CI, 4.5%-6.7%). These pre-vaccine rollout admission trends were significantly different (P < .001). Post-vaccine rollout, the change in admission trend was significantly different (P < .001). The associated beneficial impact from vaccine rollout on monthly hospital admission trends among Hispanic patients was significantly lower. The trend in monthly mortality rate was fourfold greater (worse) among Hispanic patients (8.3%; 95% CI, 3.6%-13.4%) vs non-Hispanic patients (2.2%; 95% CI, 0.6%-3.8%), but this was not shown to be related to vaccine rollout., Interpretation: SARS-CoV-2 vaccine rollout was associated with improved COVID-19 admission trends among non-Hispanic vs Hispanic patients. Vaccine rollout was not shown to influence mortality trends in either group, which were four times higher among Hispanic patients. Improved vaccine rollout may have reduced disparities in admission trends for Hispanic patients, but other factors influenced their mortality trends., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare in the United States., Aim: To investigate COVID-19-related and non-COVID-19-related death and characteristics associated with excess death among inflammatory bowel disease (IBD) decedents., Methods: We performed a register-based study using data from the National Vital Statistics System, which reports death data from over 99% of the United States population, from January 1, 2006 through December 31, 2021. IBD-related deaths among adults 25 years and older were stratified by age, sex, race/ethnicity, place of death, and primary cause of death. Predicted and actual age-standardized mortality rates (ASMRs) per 100000 persons were compared., Results: 49782 IBD-related deaths occurred during the study period. Non-COVID-19-related deaths increased by 13.14% in 2020 and 18.12% in 2021 [2020 ASMR: 1.55 actual vs 1.37 predicted, 95% confidence interval (CI): 1.26-1.49; 2021 ASMR: 1.63 actual vs 1.38 predicted, 95%CI: 1.26-1.49]. In 2020, non-COVID-19-related mortality increased by 17.65% in ulcerative colitis (UC) patients between the ages of 25 and 65 and 36.36% in non-Hispanic black (NHB) Crohn's disease (CD) patients. During the pandemic, deaths at home or on arrival and at medical facilities as well as deaths due to neoplasms also increased., Conclusion: IBD patients suffered excess non-COVID-19-related death during the pandemic. Excess death was associated with younger age among UC patients, and with NHB race among CD patients. Increased death at home or on arrival and due to neoplasms suggests that delayed presentation and difficulty accessing healthcare may have led to increased IBD mortality., Competing Interests: Conflict-of-interest statement: Melmed GY discloses position as consultant/advisor to: Abbvie, Arena Pharmaceuticals, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech, Gilead, Ferring, Fresenius Kabi, Janssen, Oshi, Pfizer, Prometheus Labs, Samsung Bioepis, Takeda, Techlab. Ji FP discloses position as consultant/advisor to: Gilead Sciences, MSD, and speaker to: Gilead Sciences, MSD and Ascletis. All other authors have no conflicts of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: This study explored the increased quantity and frequency of alcohol use in the American Indian (AI) population during the COVID-19 pandemic. Objectives: The aims of this study were to explore possible associations between covariables and both binge drinking and alcohol consumption during COVID-19. Methods: This cross-sectional survey study analyzed data from a sample of AI individuals (63% female) residing in California ( n  = 411) and Oklahoma ( n  = 657) between October 2020-January 2021. Analysis included summary statistics and multivariable logistic regression, including a variety of socio-economic, COVID-19 concern, and tobacco and marijuana use variables. Results: One or more alcohol binge episodes were reported between October 2020-January 2021 in 19.3% of participants and elevated overall alcohol consumption was reported by 21.6% of participants. Higher odds of elevated alcohol consumption occurred in women and those following more social distancing measures. The odds of binge drinking or elevated alcohol consumption in those using both marijuana and tobacco (aOR/ adjusted odds ratio:18.9, 95% CI = 8.5, 42.2, and aOR:3.9, 95% CI = 1.7, 8.6, respectively) were higher compared to those using neither. Similarly, the odds of binge drinking or elevated alcohol consumption in those using tobacco only (aOR:4.7, 95% CI = 2.9, 7.7 and aOR: 2.0, 95% CI = 1.1, 3.5, respectively) were higher compared to those using neither. Conclusions: This study found high rates of alcohol use and bingeing during the COVID-19 pandemic. Offering collaborative, culturally sensitive, and affordable support services are important components of intervention and preparation for future stressful events on local, as well as global levels.

Purpose: Understanding disparities in COVID-19 outcomes, overall and stratified by vaccination status, is important for developing targeted strategies to increase vaccination coverage and protect adolescents from COVID-19., Design: The 2022 National Health Interview Survey (NHIS) is a cross-sectional nationally representative household survey of U.S. adults., Setting: A probability sample of households in the U.S., Sample: One child aged 12-17 years is randomly selected from each family in the household. A knowledgeable adult (eg, parent or guardian), responds on behalf of the child through an in-person interview (response rate = 49.9%)., Measures: Input measures-sociodemographic characteristics and COVID-19 vaccination status; output measures-ever had COVID-19, moderate/severe COVID-19, long COVID., Analysis: Prevalence of COVID-19 outcomes was assessed for adolescents aged 12-17 years. Factors associated with each COVID-19 outcome were assessed with multivariable logistic regression analyses., Results: Among 2758 adolescents aged 12-17 years in 2022, 60.5% had received ≥1 dose of COVID-19 vaccine, 30.2% had ever been diagnosed by a doctor that they had COVID-19, 29.5% had moderate/severe COVID-19, and 6.2% had long COVID. Adolescents who were vaccinated with ≥1 dose were less likely to be diagnosed with COVID-19 (aOR = .79) and less likely to have long COVID (aOR = .30)., Conclusion: Targeted messaging to highlight the importance of early treatment, the harms of long COVID-19, and the benefits of vaccination in protecting against long-term effects may be necessary to ensure that all adolescents and their families are adequately protected., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To better understand impacts of the COVID-19 pandemic and resulting economic and social disruptions on families, we analyzed qualitative data capturing perspectives from parents of young children., Methods: This study analyzes interviews of parents of children aged 1-3.5 years at enrollment, recruited from four primary care systems serving mainly lower-income Hispanic families in Los Angeles, California. Interviews were conducted over 15 months beginning September 2020. Analyses focused on the open-ended question: Please describe in your own words how the COVID-19 pandemic has affected you and your family. We used iterative, multi-step processes to identify emergent qualitative themes., Results: A total of 460 parent responses were collected and coded. Key themes and subthemes were tested for interrater reliability, with Kappa ranging from 0.74 to 0.91. Thematic analysis revealed two groups of responses, one emphasizing stress and one emphasizing "silver linings." Parents cited a range of stressors, from fear of COVID-19 to social isolation. Those emphasizing "silver linings" also referenced formal or informal supports - especially government/community assistance programs and childcare access - that enabled stronger family ties and positive lifestyle modifications., Conclusions for Practice: Experiences of families with young children during COVID-19 were not uniform. Economic stability and reliable childcare may be critical mediators of family stress. Results affirm that the pandemic's impacts were distributed through channels largely built on, and possibly exacerbating, existing disparities. For lower-income families with young children, funding for public and private programs that target economic stability and childcare assistance may merit prioritization in future socio-economic disruptions., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: The COVID-19 pandemic brought unprecedented change to the health care industry, including a large and rapid shift to providing care through telehealth technologies. Although the expansion of telehealth services was successful in continuing to provide patients with care while preventing the spread of disease, it is less clear how patient sociodemographic characteristics influenced telehealth use during this time. This study aims to systematically review the published literature on demographic differences in telehealth access, utilization, and health outcomes among a variety of adult patient types in the United States. Methods: Litcovid, PubMed, Web of Science, and MEDLINE databases were searched, resulting in a final sample of n = 32 studies. Results: Results found that studies could be categorized as addressing at least one of eight different areas of inquiry: sociodemographic differences in telehealth use (1) during and (2) before the pandemic, telehealth use versus nonuse (3) during and (4) before the pandemic, (5) telehealth modality, (6) satisfaction with telehealth, (7) outcomes associated with telehealth use, and (8) perceived or actual access to telehealth services. Discussion: Findings are robust across included studies with respect to racial, age, and socioeconomic differences in telehealth utilization and health outcomes, reflecting sociodemographic differences in health care access, utilization, and outcomes more broadly that persist despite this expansion of telehealth services owing to COVID-19. Additional findings across studies are summarized and areas for future research are discussed.

Objective: To examine potential health disparities due to a broad reliance on telehealth during the COVID-19 pandemic, the authors studied the impact of video-enabled tablets provided by the U.S. Department of Veterans Affairs (VA) on psychotherapy usage among rural versus urban, Black versus White, and female versus male veterans., Methods: Psychotherapy usage trends before and after onset of the COVID-19 pandemic were examined among veterans with at least one mental health visit in 2019 (63,764 tablet recipients and 1,414,636 nonrecipients). Adjusted difference-in-differences and event study analyses were conducted to compare psychotherapy usage among tablet recipients and nonrecipients (March 15, 2020-December 31, 2021) 10 months before and after tablet issuance. Analyses were stratified by rurality, sex, and race., Results: Adjusted analyses demonstrated that tablet receipt was associated with increases in psychotherapy visit frequency in every patient group studied (rural, 27.4%; urban, 24.6%; women, 30.5%; men, 24.4%; Black, 20.8%; White, 28.1%), compared with visits before tablet receipt. Compared with men, women had statistically significant tablet-associated psychotherapy visit increases (video visits, 1.2 per year; all modalities, 1.0 per year)., Conclusions: VA-issued tablets led to increased psychotherapy usage for all groups examined, with similar increases found for rural versus urban and Black versus White veterans and higher increases for women versus men. Eliminating barriers to Internet access or device ownership may improve mental health care access among underserved or historically disadvantaged populations. VA's tablet program offers insights to inform policy makers' and health systems' efforts to bridge the digital divide., Competing Interests: The authors report no financial relationships with commercial interests.

Background: To study the impact of the COVID-19 pandemic on traumatic brain injury (TBI) patient demographic, clinical and trauma related characteristics, and outcomes., Methods: Retrospective chart review was conducted on pediatric TBI patients admitted to a Level I Pediatric Trauma Center between January 2015 and June 2022. The pre-COVID era was defined as January 1, 2015, through March 12, 2020. The COVID-19 era was defined as March 13, 2020, through June 30, 2022. Bivariate analysis and logistic regression were performed., Results: Four hundred-thirty patients were treated for pediatric TBI in the pre-COVID-19 period, and 166 patients during COVID-19. In bivariate analyses, the racial/ethnic makeup, age, and sex varied significantly across the two time periods (p < 0.05). Unwitnessed TBI events increased during the COVID-19 era. Logistic regression analyses also demonstrated significantly increased odds of death, severe disability, or vegetative state during COVID-19 (AOR 7.23; 95 % CI 1.43, 36.41)., Conclusion: During the COVID-19 pandemic, patients admitted with pediatric TBI had significantly different demographics with regards to age, sex, and race/ethnicity when compared to patients prior to the pandemic. There was an increase in unwitnessed events. In the COVID period, patients had a higher odds ratio of severe morbidity and mortality despite adjustment for confounding factors., Level of Evidence and Study Type: Level II, Prognosis., Competing Interests: Conflicts of interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The COVID-19 pandemic led to a dramatic increase in Medicare reimbursed telehealth utilization in the United States, but significant racial disparities persist. Methods: This research analyzed trends and disparities in Medicare reimbursed telehealth usage and claims from 2020 through 2022 using data from the Centers for Medicare & Medicaid Services. Results: Medicare telehealth user claims were 10.1 million in 2020, 52.7 million in 2021, and 85.3 million in 2023. The adjusted odds of telehealth use were significantly lower in 2021 (adjusted odds ratios [aORs]: 0.746; 95% confidence intervals [CI]: 0.683-0.815) and 2022 (aOR: 0.529; 95% CI: 0.484-0.578) compared with 2020. Large racial differences were observed in 2020-2022, with lower telehealth usage among African Americans (aOR: 0.068; 95% CI: 0.054-0.087), Hispanics (aOR: 0.036; 95% CI: 0.027-0.047), American Indians/Alaska Natives (aOR: 0.012; 95% CI: 0.009-0.017), and Asian Pacific Americans (aOR: 0.001; 95% CI: 0.001-0.002) versus Non-Hispanic Whites. Rural residents, older adults, and beneficiaries with disabilities also had reduced telehealth utilization. However, women were more likely to use telehealth versus men (aOR: 1.689; 95% CI: 1.363-2.094). Conclusion: Despite telehealth expansion during the pandemic, significant disparities remain, highlighting the need for targeted efforts to increase access and reduce barriers among underserved populations. Addressing disparities is critical to ensuring equitable access to health care through telehealth.

Objectives: Missed infant well-child visits (WCV) result in lost opportunities for critical preventive care. Black infants consistently receive less WCV care than other racial groups. We sought to understand barriers and facilitators to timely infant WCV for Black families in the context of COVID-19., Methods: We conducted 21 semi-structured interviews with caregivers of Medicaid-insured Black children aged 15- to 24-months who attended six or fewer of eight recommended well-child visits within the first 15 months of life. Interviews focused on WCV value, barriers, and facilitators. After developing our initial coding structure through rapid qualitative analysis, we inductively derived the final codebook and themes through line-by-line content analysis., Results: Caregivers attended a mean of 3.53 of eight infant visits. Structural (e.g., transportation) and psychological (e.g., maternal depression) barriers delayed Black infant WCV. Families most frequently valued monitoring development and addressing concerns. Caregivers perceived visits as less urgent when infants seemed healthy or more recently avoided visits due to fears around COVID-19. Long waits and feeling rushed/dismissed were linked to WCV delays; positive provider relationships encouraged WCV attendance. Most caregivers reported reluctance to vaccinate. Vaccine hesitancy contributed to delayed infant WCV., Conclusions: Caregivers described several factors that impacted WCV attendance for Black infants. Persistent structural and psychological barriers are compounded by perceptions that caregiver time is not respected and by notable vaccine hesitancy. To address these barriers, well-care can meet Black families in their communities, better address caregiver wellbeing, more efficiently use caregiver and provider time, and cultivate partnerships with Black caregivers., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The COVID-19 pandemic accelerated telemedicine and mobile app use, potentially changing our historic model of maternity care. MyChart is a widely adopted mobile app used in health care settings specifically for its role in facilitating communication between health care providers and patients with its messaging function in a secure patient portal. However, previous studies analyzing portal use in obstetric populations have demonstrated significant sociodemographic disparities in portal enrollment and messaging, specifically showing that patients who have a low income and are non-Hispanic Black, Hispanic, and uninsured are less likely to use patient portals., Objective: The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic., Methods: This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system's Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended ≥3 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (≤5 messages), moderate (6-14 messages), or frequent (≥15 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse., Results: Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non-English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity., Conclusions: Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging., (© Kai Holder, Joe Feinglass, Charlotte Niznik, Lynn M Yee. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org).)

Background: Trust in the healthcare system may impact adherence to recommended healthcare practices, including willingness to test for and vaccinate against COVID-19. This study examined racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19 during the first year of the pandemic., Methods: This cross-sectional study used data from the REACH-US study, a nationally representative online survey conducted among a diverse sample of U.S. adults from January 26, 2021-March 3, 2021 (N = 5,121). Multivariable logistic regression estimated the associations between trust in the U.S. healthcare system (measured as "Always", "Most of the time", "Sometimes/Almost Never", and "Never") and willingness to test for COVID-19, and willingness to receive the COVID-19 vaccine. Racial/ethnic differences in these associations were examined using interaction terms and multigroup analyses., Results: Always trusting the U.S. healthcare system was highest among Hispanic/Latino Spanish Language Preference (24.9%) and Asian (16.7%) adults and lowest among Multiracial (8.7%) and Black/African American (10.7%) adults. Always trusting the U.S. healthcare system, compared to never, was associated with greater willingness to test for COVID-19 (AOR: 3.20, 95% CI: 2.38-4.30) and greater willingness to receive the COVID-19 vaccine (AOR: 2.68, 95% CI: 1.97-3.65)., Conclusions: Trust in the U.S. healthcare system was associated with greater willingness to test for COVID-19 and receive the COVID-19 vaccine, however, trust in the U.S. healthcare system was lower among most marginalized racial/ethnic groups. Efforts to establish a more equitable healthcare system that increases trust may encourage COVID-19 preventive behaviors., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

This short review summarizes two recent U.S.-based studies in which researchers evaluated the impact of the COVID-19 pandemic on postpartum outcomes. The first study examined the neurodevelopmental status of infants born to women infected with SARS-CoV-2, and the second examined psychological risks to maternal-infant bonding. Results indicated that pandemic-related stressors likely contributed to diminished maternal-infant health outcomes. It is imperative that nurses stay informed on the latest science exploring the impact the pandemic has had on the health and well-being of pregnant persons and infants., (Copyright © 2024 AWHONN. Published by Elsevier Inc. All rights reserved.)

Objectives: The COVID-19 pandemic changed the setting of education for many children in the U.S. Understanding COVID-19 vaccination coverage by educational setting is important for developing targeted messages, increasing parents' confidence in COVID-19 vaccines, and protecting all children from severe effects of COVID-19 infection., Study Design/methods: Using data from the Household Pulse Survey (n = 25,173) collected from December 9-19, 2022, January 4-16, 2023, and February 1-13, 2023, this study assessed factors associated with COVID-19 vaccination and reasons for non-vaccination among school-aged children 5-11 and adolescents 12-17 by educational setting., Results: Among children 5-11 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (53.7%) compared to those who were homeschooled (32.5%). Furthermore, among adolescents 12-17 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (73.5%) or virtual/online instruction (70.1%) compared to those who were homeschooled (51.0%). Children and adolescents were more likely to be vaccinated if the parental respondent had been vaccinated compared to those who had not. Among children and adolescents who were homeschooled, main reasons for non-vaccination were concern about side effects (45.4-51.6%), lack of trust in COVID-19 vaccines (45.0-50.9%), and lack of trust in the government (32.7-39.2%)., Conclusions: Children and adolescents who were home-schooled during the pandemic had lower vaccination coverage than those who attended school in person, and adolescents who were home-schooled had lower vaccination coverage than those who received virtual instruction. Based on the reasons for non-vaccination identified in this study, increasing parental confidence in vaccines, and reducing barriers to access are important for supporting COVID-19 vaccination for school-age children., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults., Objective: This study compared sexual minority and heterosexual adults' willingness to use COVID-19-related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity., Methods: We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed., Results: On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults., Conclusions: In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations., (©Wilson Vincent. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 08.03.2024.)

Background: Telemedicine use dramatically increased during the COVID-19 pandemic. However, the effects of telemedicine on pre-existing disparities in pediatric surgical access have not been well described. We describe our center's early experience with telemedicine and disparities in patients' access to outpatient surgical care. Methods: A retrospective study of outpatient visits within all surgical divisions from May to December 2020 was conducted. We assessed the rates of scheduled telemedicine visits during that period, as well as the rate of completing a visit after it has been scheduled. Descriptive and logistic regression analyses were used to test for associations between these rates and patient characteristics. Results: Over the study period, 109,601 visits were scheduled. Telemedicine accounted for 6.1% of all visits with lower cancellation rates than in-person visits (26.9% vs. 34.7%). More scheduled telemedicine encounters were observed for older patients, White, English speakers, those with private insurance, and those living in rural areas. Lower odds of telemedicine visit completion were observed among patients with public insurance (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.64-0.77), Spanish language preference (OR 0.84, 95% CI 0.72-0.97), and those living in rural areas (OR 0.73, 95% CI 0.64-0.84). In contrast, higher odds of telemedicine visit completion were associated with a higher Social Deprivation Index score (OR 1.41, 95% CI 1.27-1.58). Telemedicine visit completion was also associated with increasing community-level income and distance from the hospital. Conclusions: Telemedicine use for outpatient surgical care was generally low during the peak of the pandemic, and certain populations were less likely to utilize it. These findings call for further action to bridge gaps in telemedicine use.

This study quantifies the prevalence and trends in weekly PrEP coverage at the national, state and county-level, before and during the COVID-19 pandemic in the United States.We estimated weekly PrEP coverage using longitudinal individual-level pharmacy claims from IQVIA LRx for a cohort of PrEP users (N = 287,493) ages 16 to 85 years between December 29th, 2019 and November 8th, 2020. Weekly PrEP coverage was defined as PrEP use among individuals at high risk for HIV. We conducted an interrupted time series analysis to quantify changes in weekly PrEP coverage before (December 29th, 2019 - March 8th, 2020) and during (March 29th - November 8th, 2020) the COVID-19 pandemic at the national, state and county-level by county characteristics, specifically by EHE priority jurisdiction, racial/ethnic composition, and urbanity. Nationally, weekly PrEP coverage among individuals ages 16 to 85 at high risk for HIV declined by 11.5% (from 11.0% before to 9.5% during the pandemic; t = 8.02,p < 0.01). Weekly PrEP coverage declined in all states and most counties yet varied substantially across states and counties. Geographic disparities in weekly PrEP coverage were also observed between urban EHE priority counties with significantly lower rates in counties with ≥ 50% Black/Latinx population when compared to their counterparts (7.9% vs. 11.2%; t = 18.91,p < 0.01);these disparities were most pronounced in California and New York. Weekly PrEP coverage was much lower than the 25% annual coverage reported by the Centers for Disease Control and geographic disparities observed within states likely contribute to the persistent racial/ethnic disparities in new HIV diagnoses observed within those states., (© 2023. The Author(s).)

Estimates of excess mortality can provide insight into direct and indirect impacts of the coronavirus disease 2019 (COVID-19) pandemic beyond deaths specifically attributed to COVID-19. We analyzed death certificate data from Baltimore City, Maryland, from March 1, 2020, to March 31, 2021, and found that 1,725 individuals (95% confidence interval: 1,495, 1,954) died in excess of what was expected from all-cause mortality trends in 2016-2019; 1,050 (61%) excess deaths were attributed to COVID-19. Observed mortality was 23%-32% higher than expected among individuals aged 50 years and older. Non-White residents of Baltimore City also experienced 2 to 3 times higher rates of excess mortality than White residents (e.g., 37.4 vs. 10.7 excess deaths per 10,000 population among Black residents vs. White residents). There was little to no observed excess mortality among residents of hospice, long-term care, and nursing home facilities, despite accounting for nearly 30% (312/1,050) of recorded COVID-19 deaths. There was significant geographic variation in excess mortality within the city, largely following racial population distributions. These results demonstrate the substantial and unequal impact of the COVID-19 pandemic on Baltimore City residents and the importance of building robust, timely surveillance systems to track disparities and inform targeted strategies to remediate the impact of future epidemics., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)