Key Points Question Are population-level social factors associated with coronavirus disease 2019 (COVID-19) incidence and mortality? Findings In this cross-sectional study including 4 289 283 COVID-19 cases and 147 074 COVID-19 deaths, county-level sociodemographic risk factors as assessed by the Social Vulnerability Index were associated with greater COVID-19 incidence and mortality. Meaning These findings suggest that to address inequities in the burden of the COVID-19 pandemic, these sociodemographic risk factors and their root causes must be addressed.

Key Points Question What is the association between health insurance literacy and avoidance of health care services owing to cost? Findings In this US national survey study of 506 insured adults, 29.6% reported having delayed or foregone care because of cost. Higher health insurance literacy was associated with a lower likelihood of delayed or foregone care owing to cost for both preventive and nonpreventive care. Meaning These findings suggest that to improve appropriate use of recommended health care services, including preventive health services, clinicians and policymakers may need to adopt communication strategies that make health insurance concepts accessible to individuals regardless of health insurance literacy and improve consumers’ understanding of services exempt from out-of-pocket costs.

Patients from racial and ethnic minority populations seem to be at increased risk of complications and/or mortality following spine surgical or joint replacement procedures. There is insufficient evidence to support generalization to the entire orthopedic field. Studies specific to African American patients identify health care disparities at a significantly higher rate than those utilizing non-white cohorts.

IMPORTANCE Opioid-prescribing policies and guidelines aimed at reducing inappropriate opioid prescribing may lead physicians to stop prescribing opioids. Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids. OBJECTIVES To assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types. DESIGN, SETTING, AND PARTICIPANTS This survey study used a simulated patient call audit method. A brief telephone survey was administered to all clinics followed by a call using a patient script simulating an adult patient with chronic pain who was taking long-term opioids. The patient had Medicaid or private insurance. Calls were made between June 22 and October 30, 2018, to 667 primary care clinics that served a general adult population in Michigan. Clinics that accepted both Medicaid and private insurance, took new patient appointments, and were successfully recontacted for the simulated call were eligible for the study. MAIN OUTCOMES AND MEASURES Prevalence of clinics' acceptance of new patients receiving prescription opioids overall and by clinic characteristics and insurance type. RESULTS Of the 194 eligible clinics, 94 (48.4%) were randomized according to insurance type to receive calls from research assistants posing as children of patients with Medicaid and 100 (51.5%) to receive calls from those with private insurance. Overall, 79 (40.7%) stated that their practitioners would not prescribe opioids to the simulated patient. Thirty-three clinics (17.0%) requested more information before making a decision. Compared with single-practitioner clinics, clinics with more than 3 practitioners were more likely (odds ratio [OR], 2.99; 95% CI, 1.48-6.04) to accept new patients currently taking opioids. No difference was found in access based on insurance status (OR, 0.92; 95% CI, 0.52-1.64) or whether the clinic offered medications for opioid use disorders (OR, 1.10; 95% CI, 0.45-2.69). CONCLUSIONS AND RELEVANCE The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities.