Persistence of Disparities Among Racially/Ethnically Marginalized Groups in the Coronavirus Disease 2019 Pandemic Regardless of Statewide Shelter-in-Place Policies: An Analysis From Northern California

Azar, Kristen M.J.; Lockhart, Stephen H.; Shen, Zijun; Romanelli, Robert J.; Brown, Stephanie; Smits, Kelly; Pressman, Alice

doi:10.1093/aje/kwab191

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…The study was conducted at Sutter Health, a large, multispecialty healthcare delivery system in northern and central California that serves approximately 3.5 million patients across 22 counties and is representative of the underlying catchment area: 45.6% non-Hispanic white, 15.6% Hispanic, 16.5% non-Hispanic Asian, 4.7% non-Hispanic Black, and 17.4% non-Hispanic other as of 2020 [ 23 ]. Sutter Health began offering LCS-LDCT to patients in 2012, and implemented an LCS-LDCT SmartSet (a pre-programed Epic tool to help walk providers through orders and referrals of specific procedures, such as LCS-LDCT) in 2018.…”

Section: Methodsmentioning

confidence: 99%

Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study

Martinez

Stults

2022

BMC Prim. Care

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Lung cancer remains the leading cause of cancer-related deaths for both men and women in the U.S., yet uptake of preventive cancer screening for people with a heavy smoking history remains low. This qualitative interview study of patients and providers from a large ambulatory healthcare system in northern and central California reevaluated perceptions of lung cancer screening with low-dose computed tomography (LCS-LDCT) 5 years after Medicare coverage. We hypothesized that initial attitudes and barriers within the LCS-LDCT discussion and process have likely persisted with little change since Medicare coverage and we sought to understand how these attitudes continue to impact effective implementation and uptake of screening with the goal of identifying opportunities for improvement. Between 2019 and 2020, interviews were conducted with 10 primary care physicians and 30 patients using semi-structured interview guides. Providers and patients expressed that they were both aware and supportive of LCS-LDCT, a change from earlier studies, but continued to report little to no shared decision making nor use of a decision aid despite being Medicare requirements. Creation and incorporation of a single-page, graphic heavy decision aid may help address many of the persistent barriers around implementation for both providers and patients. Given recently expanded guidelines from the U.S. Preventive Services Task Force for LCS-LDCT screening and their coverage by Medicare, it is important for healthcare systems to understand provider and patient perceptions to further improve the implementation of LCS-LDCT to ultimately reduce lung cancer mortality.

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Section: Methodsmentioning

confidence: 99%

Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study

Martinez

Stults

2022

BMC Prim. Care

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“…As of 2020, Sutter patients self-identified their race/ethnicity in the electronic health record (EHR) as: 45.6% non-Hispanic White, 15.6% Hispanic, 16.5% non-Hispanic Asian, 4.7% non-Hispanic Black/African American, and 17.4% other. 13 Sutter Health’s electronic health record system (EPIC) is deployed across the enterprise in 3 settings: acute, ambulatory, and community-based practices.…”

Section: Methodsmentioning

confidence: 99%

Effects of Smoking on SARS-CoV-2 Positivity: A Study of a Large Health System in Northern and Central California

Martinez

Frosch

et al. 2022

Tob Use Insights

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Introduction COVID-19 continues to impact vulnerable populations disproportionally. Identifying modifiable risk factors could lead to targeted interventions to reduce infections. The purpose of this study is to identify risk factors for testing positive for SARS-CoV-2. Methods Using electronic health records collected from a large ambulatory care system in northern and central California, the study identified patients who had a test for SARS-CoV-2 between 2/20/2020 and 3/31/2021. The adjusted effect of active and passive smoking and other risk factors on the probability of testing positive for SARS-CoV-2 were estimated using multivariable logistic regression. Analyses were conducted in 2021. Results Of 556 690 eligible patients in our sample, 70 564 (12.7%) patients tested positive for SARS-CoV-2. Younger age, being male, racial/ethnic minorities, and having mild major comorbidities were significantly associated with a positive SARS-CoV-2 test. Current smokers (adjusted OR: 0.69, 95% CI: 0.66-0.73) and former smokers (adjusted OR: 0.92, 95% CI: 0.89-0.95) were less likely than nonsmokers to be lab-confirmed positive, but no statistically significant differences were found when comparing passive smokers with non-smokers. The patients with missing smoking status (25.7%) were more likely to be members of vulnerable populations with major comorbidities (adjusted OR ranges from severe: 2.52, 95% CI = 2.36-2.69 to mild: 3.28, 95% CI = 3.09-3.48), lower income (adjusted OR: 0.85, 95% CI: 0.85-0.86), aged 80 years or older (adjusted OR: 1.11, 95% CI: 1.07-1.16), have less access to primary care (adjusted OR: 0.07, 95% CI: 0.07-0.07), and identify as racial ethnic minorities (adjusted OR ranges from Hispanic: 1.61, 95% CI = 1.56-1.65 to Non-Hispanic Black: 2.60, 95% CI = 2.5-2.69). Conclusions Our findings suggest that the odds of testing positive for SARS-CoV-2 were significantly lower in smokers compared to nonsmokers. Other risk factors include missing data on smoking status, being under 18, being male, being a racial/ethnic minority, and having mild major comorbidities. Since those with missing data on smoking status were more likely to be members of vulnerable populations with higher smoking rates, the risk of testing positive for SARS-CoV-2 among smokers may have been underestimated due to missing data on smoking status. Future studies should investigate the risk of severe outcomes among active and passive smokers, the role that exposure to tobacco smoke constitutes among nonsmokers, the role of comorbidities in COVID-19 disease course, and health disparities experienced by disadvantaged groups.

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“…Sutter Health delivers comprehensive medical services in more than 100 ambulatory clinics and 24 acute care hospitals and serves an estimated 3.5 million people each year. As of 2020 Sutter patients self-identified their race/ethnicity in the electronic health record (EHR) as: 45.6% White, 15.6% Hispanic, 16.5% Asian, 4.7% Black/African American and 17.4% other [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system

Chhoa

Palaniappan

et al. 2023

BMC Public Health

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Background The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted nor disaggregated these disparities by Asian Americans and NH/PIs ethnic subgroups. Methods This retrospective, cross-sectional observational study aimed to assess variation of Asian Americans and NH/PIs COVID-19 testing and outcomes compared to non-Hispanic Whites (NHW). The study utilized data from the electronic health records (EHR) and the COVID-19 Universal Registry for Vital Evaluations (CURVE) from all patients tested for SARS-CoV-2 (n = 556,690) at a large, health system in Northern and Central California between February 20, 2020 and March 31, 2021. Chi-square tests were used for testing differences in the severity of COVID-19 (hospitalization, ICU admission, death) and patient demographic and clinical characteristics across the Asian Americans and NH/PIs subgroups and NHW. Unadjusted and adjusted Odds Ratios (ORs) were estimated for measuring effect of race ethnicity on severity of COVID-19 using multivariable logistic regression. Results Of the entire tested population, 70,564/556,690 (12.7%) tested positive for SARS-CoV-2. SARS-CoV-2 positivity of Asian subgroups varied from 4% in the Chinese and Korean populations, to 11.2%, 13.5%, and 12.5% for Asian Indian, Filipino, and “other Asian” populations respectively. Pacific Islanders had the greatest subgroup test positivity at 20.1%. Among Asian Americans and NH/PIs patients with COVID-19 disease, Vietnamese (OR = 2.06, 95% CI = 1.30–3.25), “Other Asian” (OR = 2.13, 95% CI = 1.79–2.54), Filipino (OR = 1.78, 95% CI = 1.34–2.23), Japanese (OR = 1.78, 95% CI = 1.10–2.88), and Chinese (OR = 1.73, 95% CI = 1.34–2.23) subgroups had almost double the odds of hospitalization compared to NHW. Pacific Islander (OR = 1.58, 95% CI = 1.19–2.10) and mixed race subgroups (OR = 1.55, 95% CI = 1.10–2.20) had more than one and a half times odds of hospitalization compared to NHW. Adjusted odds of ICU admission or death among hospitalized patients by different Asian subgroups varied but were not statistically significant. Conclusions Variation of COVID-19 testing and hospitalization by Asian subgroups was striking in our study. A focus on the Asian Americans and NH/PIs population with disaggregation of subgroups is crucial to understand nuances of health access, utilization, and outcomes among subgroups to create health equity for these underrepresented populations.

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Persistence of Disparities Among Racially/Ethnically Marginalized Groups in the Coronavirus Disease 2019 Pandemic Regardless of Statewide Shelter-in-Place Policies: An Analysis From Northern California

Cited by 7 publications

References 21 publications

Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study

Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study

Effects of Smoking on SARS-CoV-2 Positivity: A Study of a Large Health System in Northern and Central California

Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system

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