Addressing Barriers to Primary Care Access for Latinos in the U.S.: An Agent-Based Model

Oh, Hyunsung; Trinh, Mai P.; Vang, Cindy; Becerra, David

doi:10.1086/708616

Cited by 27 publications

(19 citation statements)

References 45 publications

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“…42 Additionally, COVID-19 treatment trials were typically conducted among inpatient populations, which were likely disproportionately Hispanic or Latino owing to the relative lack of primary care services on contracting COVID-19 and the increased risk of COVID-19-associated hospitalization among Hispanic or Latino groups. 43,44 The present findings about Hispanic or Latino representation stand in contrast to prior studies for COVID-19 and other diseases, which have found low enrollment of Hispanic or Latino populations in trials owing to institutional and/or systemic racism, distrust of the health care system, lack of access to clinical trial centers, low socioeconomic status, and language and communication barriers. 11,29,[45][46][47][48][49][50] The underrepresentation of Hispanic or Latino participants indicated in some previous studies may also be related to poor reporting of Hispanic or Latino identity when using administrative records.…”

Section: Discussioncontrasting

confidence: 99%

Sex, Racial, and Ethnic Representation in COVID-19 Clinical Trials

et al. 2023

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ImportanceSince the onset of the COVID-19 pandemic, there have been calls for COVID-19 clinical trials to be fully representative of all demographic groups. However, limited evidence is available about the sex, racial, and ethnic representation among COVID-19 prevention and treatment trials.ObjectiveTo investigate whether female participants and racial and ethnic minority individuals are adequately represented in COVID-19 prevention and treatment trials in the US.Data SourcesIdentified studies were registered on ClinicalTrials.gov or published in the PubMed database from October 2019 to February 2022.Study SelectionIncluded studies must have provided the number of enrolled participants by sex, race, or ethnicity. Only interventional studies conducted in the US for the primary purpose of the diagnosis, prevention, or treatment of (or supportive care for) COVID-19 conditions were included.Data Extraction and SynthesisData on counts of enrollments by demographic variables (sex, race, and ethnicity) and location (country and state) were abstracted. Studies were broadly categorized by primary purpose as prevention (including vaccine and diagnosis studies) vs treatment (including supportive care studies). A random effects model for single proportions was used. Trial estimates were compared with corresponding estimates of representation in the US population with COVID-19.Main Outcomes and MeasuresSex, racial, and ethnic representation in COVID-19 clinical trials compared with their representation in the US population with COVID-19.ResultsOverall, 122 US-based COVID-19 clinical trials comprising 176 654 participants were analyzed. Studies were predominantly randomized trials (n = 95) for treatment of COVID-19 (n = 103). Sex, race, and ethnicity were reported in 109 (89.3%), 95 (77.9%), and 87 (71.3%) trials, respectively. Estimated representation in prevention and treatment trials vs the US population with COVID-19 was 48.9% and 44.6% vs 52.4% for female participants; 23.0% and 36.6% vs 17.7% for Hispanic or Latino participants; 7.2% and 16.5% vs 14.1% for Black participants; 3.8% and 4.6% vs 3.7% for Asian participants; 0.2% and 0.9% vs 0.2% for Native Hawaiian or Other Pacific Islander participants; and 1.3% and 1.4% vs 1.1% for American Indian or Alaska Native participants. Compared with expected rates in the COVID-19 reference population, female participants were underrepresented in treatment trials (85.1% of expected; P &lt; .001), Black participants (53.7% of expected; P = .003) and Asian participants (64.4% of expected; P = .003) were underrepresented in prevention trials, and Hispanic or Latino participants were overrepresented in treatment trials (206.8% of expected; P &lt; .001).Conclusions and RelevanceIn this systematic review and meta-analysis, aggregate differences in representation for several demographic groups in COVID-19 prevention and treatment trials in the US were found. Strategies to better ensure diverse representation in COVID-19 studies are needed, especially for prevention trials.

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Section: Discussioncontrasting

confidence: 99%

Sex, Racial, and Ethnic Representation in COVID-19 Clinical Trials

et al. 2023

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“…Past studies have demonstrated that Hispanic individuals are less likely to delay care if the primary care physician to patient ratio is improved. 93…”

Section: Discussionmentioning

confidence: 99%

Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status

et al. 2021

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IMPORTANCE COVID-19 has disproportionately affected racial and ethnic minority groups, and race and ethnicity have been associated with disease severity. However, the association of socioeconomic determinants with racial disparities in COVID-19 outcomes remains unclear.OBJECTIVE To evaluate the association of race and ethnicity with COVID-19 outcomes and to examine the association between race, ethnicity, COVID-19 outcomes, and socioeconomic determinants.

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“…Undocumented immigrants largely lacked access to COVID-19 testing and treatment, while even documented family members may have avoided seeking services to protect undocumented loved ones from deportation (9,11,115,116). Further, the hardship associated with employment loss may have intensified the already present financial barriers that many Latinos face to accessing services (117,118). Latinos may have also encountered technology-related barriers as formal and informal interactions across the country shifted to video conference formats (119,120).…”

Section: Discussionmentioning

confidence: 99%

Politics, Pandemics, and Trauma: Understanding and Addressing Latino Health Needs Through a Culturally-Informed Lens

Held

Villarreal-Otálora

McPherson

et al. 2022

Front. Public Health

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Latino communities in the United States (U.S.) have long endured trauma due to multiple intersecting social and political forces. New restrictive immigration policies since 2016 and the COVID-19 pandemic have each created novel stressors for Latino communities, while escalating the risk of mental health disorders and highlighting the communities' vulnerabilities. The effects of these stressors have been particularly pronounced in southeastern states, such as Tennessee and Georgia, due to their state-level anti-immigrant legislation. Yet, we lack sufficient data to understand how these factors present among Latinos seeking services. To focus attention on the specific experiences of Latino communities living in the U.S. Southeast, the authors analyzed the perspectives of 44 service providers working with these communities in the region using qualitative data collected in an online survey administered during the COVID-19 pandemic and while President Trump's exclusionary immigration policies were in force. Four themes were identified: (1) Latino communities' strengths; (2) impact of the Trump administration on Latino communities; (3) impact of COVID-19's on Latino communities; and (4) strategies to enhance service delivery in Latino communities. Results provide meaningful data to inform micro- and macro-level service delivery in two exclusionary policy states and beyond. Findings suggest future research should include other new immigrant destinations and explore perceptions of Latino community members.

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Addressing Barriers to Primary Care Access for Latinos in the U.S.: An Agent-Based Model

Cited by 27 publications

References 45 publications

Sex, Racial, and Ethnic Representation in COVID-19 Clinical Trials

Sex, Racial, and Ethnic Representation in COVID-19 Clinical Trials

Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status

Politics, Pandemics, and Trauma: Understanding and Addressing Latino Health Needs Through a Culturally-Informed Lens

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