COVID-19 impacts and inequities among underserved communities with diabetes

IF 4.2 Q1 ENDOCRINOLOGY & METABOLISM Journal of Clinical and Translational Endocrinology Pub Date : 2024-03-19 DOI:10.1016/j.jcte.2024.100337
Jennifer L. Maizel , Michael J. Haller , David M. Maahs , Ananta Addala , Rayhan A. Lal , Stephanie L. Filipp , Matthew J. Gurka , Sarah Westen , Brittney N. Dixon , Lauren Figg , Melanie Hechavarria , Keilecia G. Malden , Ashby F. Walker
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Abstract

Background

People with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for underserved communities including racial/ethnic minorities and people with lower socioeconomic status. However, limited research has examined COVID-19 outcomes specifically affecting underserved communities with diabetes.

Methods

From November 2021 to July 2022, adults with insulin-requiring diabetes at federally qualified health centers in Florida and California (n = 450) completed surveys examining COVID-19 outcomes and demographics. Surveys assessed COVID-19 severity, vaccination uptake, mask-wearing habits, income changes, and healthcare access changes. Surveys also included the full Coronavirus Anxiety Scale (CAS-19). Descriptive statistics were computed for all outcomes. Between-group comparisons for state and race/ethnicity were evaluated via Chi-Squared, Fisher’s Exact, Cochran-Mantel-Haenszel, One-Way ANOVA, and t-tests. Logistic regression determined factors associated with COVID-19 vaccination uptake. Data were self-reported and analyzed cross-sectionally.

Results

Overall, 29.7 % reported contracting COVID-19; of those, 45.3 % sought care or were hospitalized. Most (81.3 %) received ≥ 1 vaccine. Hispanics had the highest vaccination rate (91.1 %); Non-Hispanic Blacks (NHBs) had the lowest (73.9 %; p =.0281). Hispanics had 4.63x greater vaccination odds than Non-Hispanic Whites ([NHWs]; 95 % CI = [1.81, 11.89]). NHWs least often wore masks (18.8 %; p <.001). Participants reported pandemic-related healthcare changes (62 %) and higher costs of diabetes medications (41 %). Income loss was more frequent in Florida (76 %; p <.001). NHBs most frequently reported “severe” income loss (26.4 %; p =.0124). Loss of health insurance was more common among NHBs (13.3 %; p =.0416) and in Florida (9.7 %; p =.039). COVID-19 anxiety was highest among NHBs and Hispanics (IQR = [0.0, 3.0]; p =.0232) and in Florida (IQR = [0.0, 2.0]; p =.0435).

Conclusions

Underserved communities with diabetes had high COVID-19 vaccine uptake but experienced significant COVID-19-related physical, psychosocial, and financial impacts. NHBs and those in Florida had worse outcomes than other racial/ethnic groups and those in California. Further research, interventions, and policy changes are needed to promote health equity for this population.

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COVID-19 对服务不足社区糖尿病患者的影响和不公平现象
背景糖尿病患者的 COVID-19 发病率和死亡率较高。对于服务不足的社区,包括少数种族/族裔和社会经济地位较低的人群,这些风险更大。方法从 2021 年 11 月到 2022 年 7 月,佛罗里达州和加利福尼亚州联邦合格医疗中心的胰岛素需求糖尿病成人(n = 450)完成了对 COVID-19 结果和人口统计学的调查。调查评估了 COVID-19 的严重程度、疫苗接种率、戴口罩的习惯、收入变化和医疗保健服务的变化。调查还包括完整的冠状病毒焦虑量表 (CAS-19)。对所有结果都进行了描述性统计。通过Chi-Squared、Fisher's Exact、Cochran-Mantel-Haenszel、单向方差分析和t检验对州和种族/民族的组间比较进行了评估。逻辑回归确定了与 COVID-19 疫苗接种率相关的因素。数据均为自我报告,并进行了横截面分析。结果总体而言,29.7%的人报告感染了COVID-19;其中45.3%的人就医或住院。大多数人(81.3%)接种了 ≥ 1 种疫苗。西班牙裔接种率最高(91.1%);非西班牙裔黑人(NHBs)接种率最低(73.9%;P =.0281)。西班牙裔的疫苗接种率是非西班牙裔白人([NHWs];95 % CI = [1.81, 11.89])的 4.63 倍。非西班牙裔白人戴口罩的比例最低(18.8%;p <.001)。参与者报告了与大流行相关的医疗保健变化(62 %)和糖尿病药物费用的增加(41 %)。收入损失在佛罗里达州更为常见(76%;p <.001)。国家卫生局最常报告 "严重 "收入损失(26.4%;p =.0124)。失去医疗保险在非户籍人口(13.3%;p =.0416)和佛罗里达州(9.7%;p =.039)中更为常见。COVID-19焦虑在NHBs和西班牙裔(IQR = [0.0,3.0];p =.0232)以及佛罗里达州(IQR = [0.0,2.0];p =.0435)中最高。与其他种族/族裔群体和加利福尼亚州相比,非裔美国人和佛罗里达州的非裔美国人的结果更差。为促进该人群的健康公平,需要进一步的研究、干预和政策改变。
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CiteScore
6.10
自引率
0.00%
发文量
24
审稿时长
16 weeks
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