IMPORTANCE Black and Hispanic populations have higher rates of coronavirus disease 2019 hospitalization and mortality than White populations but lower in-hospital case-fatality rates. The extent to which neighborhood characteristics and comorbidity explain these disparities is unclear. Outcomes in Asian American populations have not been explored. OBJECTIVETo compare COVID-19 outcomes based on race and ethnicity and assess the association of any disparities with comorbidity and neighborhood characteristics. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted within the New York University Langone Health system, which includes over 260 outpatient practices and 4 acute care hospitals. All patients within the system's integrated health record who were tested for severe acute respiratory syndrome coronavirus 2 between March 1, 2020, and April 8, 2020, were identified and followed up through May 13, 2020. Data were analyzed in June 2020. Among 11 547 patients tested, outcomes were compared by race and ethnicity and examined against differences by age, sex, body mass index, comorbidity, insurance type, and neighborhood socioeconomic status.EXPOSURES Race and ethnicity categorized using self-reported electronic health record data (ie, non-Hispanic White, non-Hispanic Black, Hispanic, Asian, and multiracial/other patients). MAIN OUTCOMES AND MEASURESThe likelihood of receiving a positive test, hospitalization, and critical illness (defined as a composite of care in the intensive care unit, use of mechanical ventilation, discharge to hospice, or death). RESULTSAmong 9722 patients (mean [SD] age, 50.7 [17.5] years; 58.8% women), 4843 (49.8%) were positive for COVID-19; 2623 (54.2%) of those were admitted for hospitalization (1047 [39.9%] White, 375 [14.3%] Black, 715 [27.3%] Hispanic, 180 [6.9%] Asian, 207 [7.9%] multiracial/other). In fully adjusted models, Black patients (odds ratio [OR], 1.3; 95% CI, 1.2-1.6) and Hispanic patients (OR, 1.5; 95% CI, 1.3-1.7) were more likely than White patients to test positive. Among those who tested positive, odds of hospitalization were similar among White, Hispanic, and Black patients, but higher among Asian (OR, 1.6, 95% CI, 1.1-2.3) and multiracial patients (OR, 1.4; 95% CI, 1.0-1.9) compared with White patients. Among those hospitalized, Black patients were less likely than White patients to have severe illness (OR, 0.6; 95% CI, 0.4-0.8) and to die or be discharged to hospice (hazard ratio, 0.7; 95% CI, 0.6-0.9). CONCLUSIONS AND RELEVANCEIn this cohort study of patients in a large health system in New York City, Black and Hispanic patients were more likely, and Asian patients less likely, than White patients to test positive; once hospitalized, Black patients were less likely than White patients to have (continued) Key Points Question Do outcomes among patients with coronavirus disease 2019 (COVID-19) differ by race/ethnicity, and are observed disparities associated with comorbidity and neighborhood characteristics? Findings This cohort study including ...

Context Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain. Objective To evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers will motivate male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control. Design, Setting, and Participants Cluster randomized trial (Barber-Assisted Reduction in Blood Pressure in Ethnic Residents [BARBER-1]) of HTN control among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006-December 2008). Intervention Black male patrons of participating barbershops underwent 10-week baseline BP screening. Study sites were then randomized to a comparison group (8 shops, 77 hypertensives/shop) that received standard BP pamphlets or an intervention group (9 shops, 75 hypertensives/shop) in which barbers continually offered BP checks with haircuts and promoted physician follow-up with gender-specific peer-based health messaging. After 10 months, follow-up data were obtained. Primary Outcome Measure Change in HTN control rate for each barbershop. Results The HTN control rate increased more in intervention-arm barbershops than in comparison-arm barbershops (absolute group difference, 8.8%; 95% confidence interval [CI], 0.8 to 16.9%; P=0.036); the intervention effect persisted after adjustment for covariates (P=0.031). A marginal intervention effect was found for systolic BP change (absolute group difference: −2.5 mmHg; 95% CI, −5.3 to 0.3 mmHg; P=0.08). Conclusion The effect of BP screening on HTN control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician referral. Further research is warranted. Trial registration clinicalTrials.gov Identifier NCT00325533

Abstract-Barbershops constitute potential sites for community health promotion programs targeting hypertension (HTN) in black men, but such programs have not been evaluated previously. Here we conducted 2 nonrandomized feasibility studies to determine whether an enhanced intervention program of continuous blood pressure (BP) monitoring and peer-based health messaging in a barbershop lowers BP more than standard screening and health education (study 1) and can be implemented by barbers rather than research personnel (study 2). In study 1, we measured changes in HTN treatment and BP in regular barbershop customers with poorly controlled HTN assigned for 8 months to either an enhanced intervention group (nϭ36) or a contemporaneous comparison group (nϭ27). Groups were similar at baseline. BP fell by 16Ϯ3/9Ϯ2 mm Hg in the enhanced intervention group but was unchanged in the comparison group (PϽ0.0001, adjusted for age and body mass index). HTN treatment and control increased from 47% to 92% (PϽ0.001) and 19% to 58% (PϽ0.001), respectively, in the enhanced intervention group, whereas both remained unchanged in the comparison group. In study 2, barbers were trained to administer the enhanced intervention continuously for 14 months to the entire adult black male clientele (nϭ321) in 1 shop. Six barbers recorded 8953 BP checks during 11 066 haircuts, thus demonstrating a high degree of intervention fidelity. Furthermore, among 107 regular customers with HTN, treatment and control increased progressively with increasing intervention exposure (PϽ0.01). Taken together, these data suggest that black-owned barbershops can be transformed into effective HTN detection, referral, and follow-up centers. Further research is warranted. Key Words: population science Ⅲ special populations Ⅲ blood pressure measurement/monitoring Ⅲ blacks Ⅲ hypertension H ypertension (HTN) is more prevalent, more severe, and causes disproportionate numbers of premature disabilities and deaths from heart attack, stroke, and end-stage renal disease in blacks than in all other racial/ethnic groups in the United States. [1][2][3] HTN is present in 40% of blacks, with blood pressure (BP) being controlled with medication to a recommended value of Ͻ140/90 mm Hg in less than one-third of these affected high-risk individuals. 2,4 In the other two-thirds, HTN either is untreated or undertreated.Among black women, HTN treatment rates are high, and most of the uncontrolled HTN occurs under the watchful eye of the healthcare system. 2,5 Black men have less frequent contact with the healthcare system and considerably lower rates of HTN detection and treatment. 2,[5][6][7][8] The black church has been a conventional site for medical outreach and HTN screening programs. 9,10 However, regular church attendance is much less common among black men than women. 6,11 To reach a larger fraction of the at-risk male population, we approached the black-owned barbershop, a cultural institution that regularly attracts large numbers of black men and provides an open forum for dis...

Blacks had poorer HTN control compared with whites and Hispanics. Significant discrepancies in BP control between hypertensive patients with and without diabetes may be related to a lack of provider adherence to JNC 7 guidelines that define BP control in this population as <130/80. Further research is needed to understand racial disparities in BP control as well as factors influencing clinician's management of BP among patients with diabetes.