Which social factors explain racial and ethnic disparities in COVID-19 access to care and outcomes remain unclear.
We hypothesized that preferred language mediates the association between race, ...ethnicity and delays to care.
Multicenter, retrospective cohort study of adults with COVID-19 consecutively admitted to the ICU in three Massachusetts hospitals in 2020.
Causal mediation analysis was performed to evaluate potential mediators including preferred language, insurance status, and neighborhood characteristics.
Non-Hispanic White (NHW) patients (157/442, 36%) were more likely to speak English as their preferred language (78% vs. 13%), were less likely to be un- or under-insured (1% vs. 28%), lived in neighborhoods with lower social vulnerability index (SVI) than patients from racial and ethnic minority groups (SVI percentile 59 28 vs. 74 21) but had more comorbidities (Charlson comorbidity index 4.6 2.5 vs. 3.0 2.5), and were older (70 13.2 vs. 58 15.1 years). From symptom onset, NHW patients were admitted 1.67 0.71-2.63 days earlier than patients from racial and ethnic minority groups (
< 0.01). Non-English preferred language was associated with delay to admission of 1.29 0.40-2.18 days (
< 0.01). Preferred language mediated 63% of the total effect (
= 0.02) between race, ethnicity and days from symptom onset to hospital admission. Insurance status, social vulnerability, and distance to the hospital were not on the causal pathway between race, ethnicity and delay to admission.
Preferred language mediates the association between race, ethnicity and delays to presentation for critically ill patients with COVID-19, although our results are limited by possible collider stratification bias. Effective COVID-19 treatments require early diagnosis, and delays are associated with increased mortality. Further research on the role preferred language plays in racial and ethnic disparities may identify effective solutions for equitable care.
Background Children with food allergies spend a large proportion of time in school but characteristics of allergic reactions in schools are not well studied. Some schools self-designate as ...peanut-free or have peanut-free areas, but the impact of policies on clinical outcomes has not been evaluated. Objective We sought to determine the effect of peanut-free policies on rates of epinephrine administration for allergic reactions in Massachusetts public schools. Methods In this retrospective study, we analyzed (1) rates of epinephrine administration in all Massachusetts public schools and (2) Massachusetts public school nurse survey reports of school peanut-free policies from 2006 to 2011 and whether schools self-designated as “peanut-free” based on policies. Rates of epinephrine administration were compared for schools with or without peanut-restrictive policies. Results The percentage of schools with peanut-restrictive policies did not change significantly in the study time frame. There was variability in policies used by schools self-designated as peanut-free. No policy was associated with complete absence of allergic reactions. Both self-designated peanut-free schools and schools banning peanuts from being served in school or brought from home reported allergic reactions to nuts. Policies restricting peanuts from home, served in schools, or having peanut-free classrooms did not affect epinephrine administration rates. Schools with peanut-free tables, compared to without, had lower rates of epinephrine administration (incidence rate per 10,000 students 0.2 and 0.6, respectively, P = .009). Conclusions These data provide a basis for evidence-based school policies for children with food allergies. Further studies are required before decisions can be made regarding peanut-free policies in schools.
Methods 23 children with asthma, aged 5 - 10 years and recruited from 3 urban schools, were analyzed to determine the relation of exposure to triclosan, an environmental phenol, and pediatric asthma ...morbidity in the context of a pilot classroom-based air cleaner intervention to reduce classroom specific exposures.
After adjusting for race and season (spirometry reference values standardized by age, height and gender), NO2 was highly associated with increased airflow obstruction such that each 10ppb rise in NO2 ...exposure was associated with a 3% decline in FEV1/FVC (β: -0.03, 95% confidence interval (CI) -0.05, -0.00, p=0.03).
Hospital visitor restriction policies prompted by Coronavirus Disease 2019 (COVID-19) may lead to a less comfortable or informed inpatient experience for oncology patients admitted for non-COVID-19 ...conditions. We surveyed oncology inpatients before (n = 47) and after (n = 65) implementation of a no-visitor policy using a validated questionnaire to measure patient experience. Results revealed no significant difference in the percentage of patients reporting “no problems” (P < .05) in all questions. Patient experience was not adversely impacted by visitor restrictions enacted in response to COVID-19 on an oncology service, as measured by a questionnaire capturing common concerns among inpatients.
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