Pandemic preparedness for underserved persons in the US: Harnessing data from the RADx-UP consortium to assess public health tools for resource allocation

项目摘要 大流行的准备工作需要加强对新出现的病毒的监测，但也需要制定一项计划， 当下一个病原体在全球范围内迅速感染人类时，卫生反应。为确保 美国弱势群体经历的不成比例的残疾和死亡不会重演 在未来的大流行中，公共卫生机构将需要验证资源分配和监测工具 在健康不平等的框架内。RADx-UP Consortium能够实现诸如评估，因为 NIH资助的130多个项目的联盟，全国参与者超过370，000人，重点是改善 测试访问，并在服务不足的人群中引发COVID 19压力和疫苗认知。使用RADx- 以UP数据为基础，我们将检验三个地区层面的脆弱性指标--社会脆弱性 指数、少数民族健康社会脆弱性指数和社区脆弱性指数-确定 在大流行期间经历粮食或住房不安全，或在获得医疗保健方面存在差距（目标1）。我们将 利用临床试验文献中的方法评估RADx-UP数据的普遍性。我们将连接到美国 进行社区调查，并对流行病压力和疫苗问题进行县标准化估计， 超过900个美国县参与了RADx-UP联盟。然后我们将评估 将这些标准化估计数与三个地区一级脆弱性指数联系起来。第二个目标 拟议的工作将是评估有前途的废水监测工具的预测性能 在服务不足的人群中。我们将把RADx-UP数据与公开的国家废水处理数据相关联， 监测系统数据，并将废水感染流行率指标与检测阳性率进行比较 在RADx-UP进行的测试，县一级的住院和死亡。我们将评估 随时间的预测性能（例如，疫苗供应之前与之后），并结合区域- 一级脆弱性指数和其他普查人口变量。最终目的是减少健康 我们的流行病学家、统计学家、肾脏病学和传染病专家团队 临床医生和卫生政策专家将评估现有的和新出现的大流行防范工具。做 因此，我们希望促进公共卫生基础设施对最易受健康影响的群体作出反应， 流行病所固有的社会动荡。

PROJECT ABSTRACT Pandemic preparedness requires strengthening surveillance for emerging viruses, but also a plan for public health response when the next pathogen rapidly infects humans on a global scale. In order to ensure that the disproportionate disability and death experienced among disadvantaged populations in the US does not repeat in a future pandemic, public health agencies will need to validate resource allocation and surveillance tools within a health disparities framework. The RADx-UP Consortium enables such as an evaluation, since this NIH-funded Consortium of over 130 projects, with over 370,000 nationwide participants, focused on improving test access, and eliciting COVID19 stress and vaccine perception among underserved persons. Using RADx- UP data as the ground truth, we will test whether three area level vulnerability indices—the Social Vulnerability Index, the Minority Health Social Vulnerability Index, and the Community Vulnerability Index—identify persons experiencing food or housing insecurity, or gaps in healthcare access during the pandemic (Aim 1). We will leverage methods from clinical trial literature to assess RADx-UP data generalizability. We will link to American Community Survey, and generate county-standardized estimates of pandemic stress and vaccine concerns for the more than 900 US counties with participants in the RADx-UP consortium. We will then assess the association of these standardized estimates with the three area level vulnerability indices. A second aim of the proposed work will be to assess the predictive performance of the promising tool of wastewater surveillance among underserved populations. We will link RADx-UP data with the publicly available National Wastewater Surveillance System data, and compare wastewater infection prevalence metrics with the test positivity rate among RADx-UP performed tests, and county-level hospitalizations and deaths. We will evaluate changes in predictive performance over time (e.g., before versus after vaccine availability), and with integration of area- level vulnerability indices and other census demographic variables. With the ultimate aim of reducing health disparities in the future pandemic, our team of epidemiologists, statisticians, nephrology and infectious disease clinicians, and health policy experts will evaluate existing and emerging pandemic preparedness tools. In doing so, we hope to promote a public health infrastructure responsive to groups most vulnerable to the health and social turbulence inherent to a pandemic.