Neighborhood Ecologies, Cases, and Deaths during the Beginning of the COVID-19 Pandemic: Lessons for Current and Future Epidemics?

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected Black and Latinx communities. Ecologic analyses have shown that counties with a higher percentage of Latinx and Black people have worse COVID-19 outcome rates. Few ecologic analyses have been published at the neighborhood (census tract) level.

Population-Level Disparities in Exposure to COVID-19 Mitigation Policies, April 2020-April 2021.

Context: Studies have found that COVID-19 stay-at-home orders (SHOs) and face mask policies (FMPs) were associated with reduced COVID-19 transmission and deaths. But it is unknown whether exposure to these policies varied by sociodemographic characteristics across the US population.

Objective: The goal of this study was to quantify and characterize the sociodemographic characteristics and geographic distribution of populations exposed to evidence-based COVID-19 mitigation policies.

Influence of Mask Wearing during COVID-19 Surge and Non-Surge Time Periods in Two K-12 Public School Districts in Georgia, USA.

Background: Into the third year of the COVID-19 pandemic and the second year of in-person learning for many K-12 schools in the United States, the benefits of mitigation strategies in this setting are still unclear. We compare COVID-19 cases in school-aged children and adolescents between a school district with a mandatory mask-wearing policy to one with an optional mask-wearing policy, during and after the peak period of the Delta variant wave of infection.

Methods: COVID-19 cases during the Delta variant wave (August 2021) and post the wave (October 2021) were obtained from public health records.

Association Between Racial Segregation and COVID-19 Vaccination Rates.

Objective: To examine the association between county-level Black-White residential segregation and COVID-19 vaccination rates.

Design: Observational cross-sectional study using multivariable generalized linear models with state fixed effects to estimate the average marginal effects of segregation on vaccination rates.

Setting: National analysis of county-level vaccination rates.

Space-time trends of community-onset Staphylococcus aureus infections in children: a group-based trajectory modeling approach.

Purpose: Staphylococcus aureus (S. aureus) remains a serious cause of infections in the United States and worldwide. In the United States, methicillin-resistant S.

Interpersonal Primary Care Continuity for Chronic Conditions Is Associated with Fewer Hospitalizations and Emergency Department Visits Among Medicaid Enrollees.

Background: Interpersonal primary care continuity or chronic condition continuity (CCC) is associated with improved health outcomes. Ambulatory care-sensitive conditions (ACSC) are best managed in a primary care setting, and chronic ACSC (CACSC) require management over time. However, current measures do not measure continuity for specific conditions or the impact of continuity for chronic conditions on health outcomes.

Neighborhood characteristics and arterial stiffness among Black adults - Results from the Jackson Heart Study and Morehouse-Emory Cardiovascular Center for Health Equity.

Introduction: Poor quality neighborhood environments are independent risk factors for cardiovascular disease (CVD) but are understudied in Black adults, who face large CVD health disparities. Arterial stiffness, a marker of early vascular aging, precedes development of hypertension and adverse CVD events but the effect of neighborhood on arterial stiffness among Black adults remains unknown.

Objective: We compared the association between neighborhood environment and arterial stiffness among Black adults in Jackson, MS and Atlanta, GA.

Measuring State-Level Racial Inequity in Severe Maternal Morbidity in the Medicaid Population.

Objective: Severe maternal morbidity represents a "near miss" mortality and is an important measure of quality and safety. Racial inequity in maternal morbidity is stark and the reasons for this disparity are poorly understood. We aimed to identify states achieving racial equity in maternal morbidity in order to identify policies that may promote racial equity.

Racial and ethnic disparities in H1N1 vaccine uptake in Medicaid: Lessons learned for a COVID-19 vaccine rollout.

Background: Racial and ethnic minorities in the US have been disproportionately affected by the COVID-19 pandemic and are at risk for disparities in COVID-19 vaccinations. The H1N1 flu vaccine experience provides lessons learned to address and prevent racial and ethnic disparities in COVID-19 vaccinations. We aim to identify racial/ethnic and geographic disparities in H1N1 vaccinations among Medicaid enrollees to inform equitable COVID-19 vaccination policies and strategies.

Association of physical activity with arterial stiffness among Black adults.

Arterial stiffness is a precursor for the development of hypertension and premature cardiovascular disease (CVD). Physical activity has been associated with lower arterial stiffness among largely White populations, but the types of activity required and whether these findings apply to Black adults remain unknown. We examined whether physical activity levels were associated with arterial stiffness among Black adults in two independent cohorts.

Association Between Early Trauma and Ideal Cardiovascular Health Among Black Americans: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity.

Background: Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans.

Identifying neighbourhood and individual resilience profiles for cardiovascular health: a cross-sectional study of blacks living in the Atlanta metropolitan area.

Objective: To simultaneously examine multiple individual-level neighbourhood perceptions and psychosocial characteristics and their relationships with cardiovascular health (CVH) among blacks.

Design: Cross-sectional study.

Setting: Subjects were recruited between 2016 and 2018 via convenience sampling.

Food Access and Cardiovascular Outcomes in Metropolitan Atlanta Census Tracts With Residents at Low Risk and High Risk of Cardiovascular Disease: The Morehouse-Emory Cardiovascular Center for Health Equity Study.

Introduction: Perceived and actual access to healthy foods may differ in urban areas, particularly among Black people. We assessed the effect of objective and perceived neighborhood food access on self-reported cardiovascular disease (CVD) among Black people living in areas of high risk and low risk for the disease in Atlanta, Georgia. We hypothesized that perceived and objective food access would independently predict self-reported CVD.

Variation in Reporting of the Race and Ethnicity of COVID-19 Cases and Deaths Across US States: April 12, 2020, and November 9, 2020.

Despite growing evidence that COVID-19 is disproportionately affecting communities of color, state-reported racial/ethnic data are insufficient to measure the true impact.We found that between April 12, 2020, and November 9, 2020, the number of US states reporting COVID-19 confirmed cases by race and ethnicity increased from 25 to 50 and 15 to 46, respectively. However, the percentage of confirmed cases reported with missing race remained high at both time points (29% on April 12; 23% on November 9).

Population-Level Disparities in COVID-19: Measuring the Independent Association of the Proportion of Black Population on COVID-19 Cases and Deaths in US Counties.

Context: There is a need to understand population race and ethnicity disparities in the context of sociodemographic risk factors in the US experience of the COVID-19 pandemic.

Objective: Determine the association between county-level proportion of non-Hispanic Black (NHB) on county COVID-19 case and death rates and observe how this association was influenced by county sociodemographic and health care infrastructure characteristics.

Design And Setting: This was an ecologic analysis of US counties as of September 20, 2020, that employed stepwise construction of linear and negative binomial regression models.

Percentage of Black Population and Primary Care Shortage Areas Associated with Higher COVID-19 Case and Death Rates in Georgia Counties.

Objectives: We hypothesized that the proportion of Black individuals in a county would be associated with higher rates of coronavirus disease 2019 (COVID-19) cases and deaths, even after accounting for other high-risk socioecologic factors such as poverty, population density, and household crowding, and uninsured rates. We also expected that counties designated as primary care health professional shortage areas (PCHPSAs) would be associated with higher COVID-19 death rates, and the lack of primary care access would exacerbate racial disparities in death rates. We undertook this study to test these hypotheses and discern the independent effects of racial composition, socioecologic characteristics, and healthcare system factors on COVID-19 cases and deaths in Georgia counties.

Neighborhood characteristics and ideal cardiovascular health among Black adults: results from the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity.

Purpose: Neighborhood environment is increasingly recognized as an important determinant of cardiovascular health (CVH) among Black adults. Most research to date has focused on negative aspects of the neighborhood environment, with little attention being paid to the specific positive features, in particular the social environment, that promote cardiovascular resilience among Black adults.We examined whether better neighborhood physical and social characteristics are associated with ideal CVH among Black adults, as measured by Life's Simple 7 (LS7) scores.

Having a Usual Source of Care Is Associated with Longer Telomere Length in a National Sample of Older Adults.

Objective: To provide a potential biological, mechanistic link for the well-established association between primary care access and reduced mortality, this study sought to measure the impact of having a usual source of health care on leukocyte telomere length (LTL).

Data Sources: Our study population included 3202 participants aged 50 to 84 years from National Health and Nutrition Examination Survey 1999 to 2001.

Study Design: Cross-sectional Study.

Individual Psychosocial Resilience, Neighborhood Context, and Cardiovascular Health in Black Adults: A Multilevel Investigation From the Morehouse-Emory Cardiovascular Center for Health Equity Study.

Background: Despite well-documented cardiovascular disparities between racial groups, within-race determinants of cardiovascular health among Black adults remain understudied. Factors promoting cardiovascular resilience among Black adults in particular warrant further investigation. Our objective was to examine whether individual psychosocial resilience and neighborhood-level cardiovascular resilience were associated with better cardiovascular health in Black adults, measured utilizing Life's Simple 7 (LS7) scores.

Primary Care Comprehensiveness and Care Coordination in Robust Specialist Networks Results in Lower Emergency Department Utilization: A Network Analysis of Medicaid Physician Networks.

Care coordination is an essential and difficult to measure function of primary care. Our objective was to assess the impact of network characteristics in primary/specialty physician networks on emergency department (ED) visits for patients with chronic ambulatory care sensitive conditions (ACSCs). This cross-sectional social network analysis of primary care and specialty physicians caring for adult Medicaid beneficiaries with ACSCs was conducted using 2009 Texas Medicaid Analytic eXtract (MAX) files.

Cardiovascular Risk and Resilience Among Black Adults: Rationale and Design of the MECA Study.

Background Cardiovascular disease incidence, prevalence, morbidity, and mortality have declined in the past several decades; however, disparities persist among subsets of the population. Notably, blacks have not experienced the same improvements on the whole as whites. Furthermore, frequent reports of relatively poorer health statistics among the black population have led to a broad assumption that black race reliably predicts relatively poorer health outcomes.

Racial and Ethnic Disparities in Treatment and Treatment Type for Depression in a National Sample of Medicaid Recipients.

Objective: The purpose of this secondary data analysis was to describe racial-ethnic disparities in receipt of depression treatment and treatment modality among adult Medicaid beneficiaries with depression from a nationally representative sample-28 states and the District of Columbia-of Medicaid beneficiaries (N=599,421).

Methods: Medicaid claims data were extracted from the full 2008-2009 Medicaid Analytic Extract file. The primary outcome was type of depression treatment: medication only, therapy only, medication and therapy, and no treatment.

Individual Characteristics of Resilience are Associated With Lower-Than-Expected Neighborhood Rates of Cardiovascular Disease in Blacks: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study.

Background Factors promoting cardiovascular health in the face of high risk, ie, resilience, are unknown and may identify novel areas of intervention for reducing racial health disparities. We examined neighborhood perceptions and psychological attributes of blacks living in high and low cardiovascular-risk neighborhoods, as potential characteristics of resilience promoting cardiovascular health. Methods and Results We identified 1433 blacks residing in census tracts of Atlanta, GA , with higher-than-expected ("high" risk) or lower-than-expected ("low" risk) rates of cardiovascular mortality, hospitalizations, and emergency department visits during 2010-2014.

Identification of Resilient and At-Risk Neighborhoods for Cardiovascular Disease Among Black Residents: the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study.

Introduction: Despite the growing interest in place as a determinant of health, areas that promote rather than reduce cardiovascular disease (CVD) in blacks are understudied. We performed an ecologic analysis to identify areas with high levels of CVD resilience and risk among blacks from a large southern, US metropolitan area.

Methods: We obtained census tract-level rates of cardiovascular deaths, emergency department (ED) visits, and hospitalizations for black adults aged 35 to 64 from 2010 through 2014 for the Atlanta, Georgia, metropolitan area.

Identifying County-Level All-Cause Mortality Rate Trajectories and Their Spatial Distribution Across the United States.

Introduction: All-cause mortality in the United States declined from 1935 through 2014, with a recent uptick in 2015. This national trend is composed of disparate local trends. We identified distinct groups of all-cause mortality rate trajectories by grouping US counties with similar temporal trajectories.