Association of Human Mobility Restrictions and Race/Ethnicity-Based, Sex-Based, and Income-Based Factors With Inequities in Well-being During the COVID-19 Pandemic in the United States.
Association of Human Mobility Restrictions and Race/Ethnicity-Based, Sex-Based, and Income-Based Factors With Inequities in Well-being During the COVID-19 Pandemic in the United States.
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DOI：
10.1001/jamanetworkopen.2021.7373
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发表时间：
2021-04-01
影响因子：
13.8
通讯作者：
Subramanian SV
中科院分区：
文献类型：
--
作者：
Chakrabarti S;Hamlet LC;Kaminsky J;Subramanian SV
在美国第一波COVID-19大流行期间，各州的特定流动限制是否与历史上因种族/民族、性别或收入而被边缘化的群体中的个人的福祉有关？在这项针对1，088，314名美国成年人的横断面研究中，低收入的非洲裔美国人、西班牙裔美国人和所有种族/民族的女性在COVID-19大流行的第一波期间经历失业、取消课程、食物不足和心理健康问题的风险更高。这些发现表明，如果公共卫生政策未能针对历史上经历过最边缘化的个人采取必要的救济措施，那么忽视现有福祉风险分布的公共卫生政策可能本质上是倒退的。这项横断面研究确定并量化了美国种族/民族，性别和收入以及州特定锁定措施与6个幸福维度的关联。准确理解公共卫生政策的分布影响对于确保公平应对COVID-19大流行和未来的公共卫生威胁至关重要。确定并量化美国各州特定封锁中基于种族/民族、基于性别和基于收入的不平等与6个幸福维度的关联。这项汇总的重复横断面研究使用了14187762个家庭的数据，这些家庭参加了美国2020年人口代表性家庭脉搏调查（HPS）的第一阶段。通过电子邮件、短信和/或电话邀请家庭参与多达3次。数据是在2020年4月23日至7月21日期间通过在线问卷收集的，参与者居住在美国所有50个州和哥伦比亚特区。种族/民族、性别和收入及其交叉点的指标。失业;食物不足;心理健康问题;健康问题得不到医疗照顾;拖欠上个月的房租或抵押贷款;取消课程，没有远程学习。种族/民族、性别、收入及其交叉点被用来衡量历史上被边缘化的人群的分布影响;各州特定的、随时间变化的人口流动性被用来衡量封锁强度。采用逻辑回归模型，合并重复横断面，以估计社会群体的二分结局风险，调整混杂变量。1 088 314名受访者（561 570例[51.6%; 95% CI，51.4%-51.9%]女性）年龄为18 - 88岁（平均值[SD]，51.55 [15.74]岁）和826 039（62.8%; 95% CI，62.5%-63.1%）为非西班牙裔白色个体; 86 958（12.5%; 95% CI，12.4%-12.7%），非裔美国人个体; 86 062（15.2%; 95% CI，15.0%-15.4%），西班牙裔个体;和50 227（5.6%; 95% CI，5.5%-5.7%），亚裔个体。平均而言，流动性每减少10%，失业率就会增加（比值比[OR]，1.3; 95% CI，1.2-1.4），食物不足（OR，1.1; 95%CI，1.1-1.2），心理健康问题（OR，1.04; 95%CI，1.0-1.1），和类取消（OR，1.1; 95%CI，1.1-1.2）。在大多数方面，与高收入的白色男性相比，低收入的非洲裔美国人经历的风险最高（例如，食物不足，男性：OR，3.3; 95% CI，2.8-3.7;心理健康问题，女性：OR，1.9; 95% CI，1.8-2.1;医疗保健不可及性，女性：OR，1.7; 95% CI，1.6-1.9;失业，男性：OR，2.8; 95% CI，2.5-3.2;房租/抵押贷款违约，男性：OR，5.7; 95% CI，4.7-7.1）。其他高风险组为西班牙裔个体（例如，失业，低收入西班牙裔男性：OR，2.9; 95% CI，2.5-3.4）和所有种族/民族的低收入女性（例如，医疗保健不可及，非西班牙裔白色女性：OR，1.8; 95% CI，1.7-2.0）。在这项横断面研究中，非洲裔美国人和西班牙裔个人、妇女和低收入家庭经历与COVID-19大流行和呆在家里命令相关的不良后果的几率更高。忽视现有福祉风险分布的一揽子公共卫生政策可能与基于种族/族裔、基于性别和基于收入的不平等增加有关。
Were state-specific mobility restrictions during the first wave of the COVID-19 pandemic in the United States associated with the well-being of individuals in groups that have historically been marginalized on the basis of race/ethnicity, sex, or income? In this cross-sectional study of 1 088 314 US adults, African American individuals with low income, Hispanic individuals, and women of all racial/ethnic groups had higher risks of experiencing unemployment, class cancellations, food insufficiency, and mental health problems during the first wave of the COVID-19 pandemic. These findings suggest that public health policies that ignore existing distributions of risks to well-being may be intrinsically regressive if they fail to target necessary relief measures to individuals who have historically experienced the most marginalization. This cross-sectional study identifies and quantifies the association of race/ethnicity, sex, and income as well as state-specific lockdown measures with 6 well-being dimensions in the United States. An accurate understanding of the distributional implications of public health policies is critical for ensuring equitable responses to the COVID-19 pandemic and future public health threats. To identify and quantify the association of race/ethnicity–based, sex-based, and income-based inequities of state-specific lockdowns with 6 well-being dimensions in the United States. This pooled, repeated cross-sectional study used data from 14 187 762 households who participated in phase 1 of the population-representative US 2020 Household Pulse Survey (HPS). Households were invited to participate by email, text message, and/or telephone as many as 3 times. Data were collected via an online questionnaire from April 23 to July 21, 2020, and participants lived in all 50 US states and the District of Columbia. Indicators of race/ethnicity, sex, and income and their intersections. Unemployment; food insufficiency; mental health problems; no medical care received for health problems; default on last month’s rent or mortgage; and class cancellations with no distance learning. Race/ethnicity, sex, income, and their intersections were used to measure distributional implications across historically marginalized populations; state-specific, time-varying population mobility was used to measure lockdown intensity. Logistic regression models with pooled repeated cross-sections were used to estimate risk of dichotomous outcomes by social group, adjusted for confounding variables. The 1 088 314 respondents (561 570 [51.6%; 95% CI, 51.4%-51.9%] women) were aged 18 to 88 years (mean [SD], 51.55 [15.74] years), and 826 039 (62.8%; 95% CI, 62.5%-63.1%) were non-Hispanic White individuals; 86 958 (12.5%; 95% CI, 12.4%-12.7%), African American individuals; 86 062 (15.2%; 95% CI, 15.0%-15.4%), Hispanic individuals; and 50 227 (5.6%; 95% CI, 5.5%-5.7%), Asian individuals. On average, every 10% reduction in mobility was associated with higher odds of unemployment (odds ratio [OR], 1.3; 95% CI, 1.2-1.4), food insufficiency (OR, 1.1; 95% CI, 1.1-1.2), mental health problems (OR, 1.04; 95% CI, 1.0-1.1), and class cancellations (OR, 1.1; 95% CI, 1.1-1.2). Across most dimensions compared with White men with high income, African American individuals with low income experienced the highest risks (eg, food insufficiency, men: OR, 3.3; 95% CI, 2.8-3.7; mental health problems, women: OR, 1.9; 95% CI, 1.8-2.1; medical care inaccessibility, women: OR, 1.7; 95% CI, 1.6-1.9; unemployment, men: OR, 2.8; 95% CI, 2.5-3.2; rent/mortgage defaults, men: OR, 5.7; 95% CI, 4.7-7.1). Other high-risk groups were Hispanic individuals (eg, unemployment, Hispanic men with low income: OR, 2.9; 95% CI, 2.5-3.4) and women with low income across all races/ethnicities (eg, medical care inaccessibility, non-Hispanic White women: OR, 1.8; 95% CI, 1.7-2.0). In this cross-sectional study, African American and Hispanic individuals, women, and households with low income had higher odds of experiencing adverse outcomes associated with the COVID-19 pandemic and stay-at-home orders. Blanket public health policies ignoring existing distributions of risk to well-being may be associated with increased race/ethnicity–based, sex-based, and income-based inequities.
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