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 大流行防备需要加强对新出现病毒的监测，但也需要为公众制定计划 当下一个病原体在全球范围内迅速感染人类时的健康反应。为了确保 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 在健康差距框架内。RADx-UP联盟实现了这样的评估，因为 由NIH资助的130多个项目组成的联盟，在全国范围内有超过37万人参与，重点是改善 测试准入，并在服务不足的人中引起COVID19压力和疫苗认知。使用RADx- 以数据为基础，我们将检验三个地区层面的脆弱性指数--社会脆弱性 少数群体健康社会脆弱性指数和社区脆弱性指数--确定人 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)。我们会 利用临床试验文献中的方法评估RADx-UP数据的概括性。我们将链接到美国航空公司 社区调查，并为大流行压力和疫苗担忧生成县标准化估计 参加RADx-UP联盟的美国900多个县。然后，我们将评估 将这些标准化估计数与三个地区一级的脆弱性指数相关联。的第二个目标 拟议的工作将是评估有前景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数据与公开可用的国家污水 监测系统数据，并将废水感染流行指标与测试阳性率进行比较 其中RADX-UP进行了检测，以及县级住院和死亡人数。我们将评估以下方面的变化 随着时间的推移(例如，在疫苗可用之前和之后)的预测性能，并结合区域- 水平脆弱性指数和其他人口普查变量。其最终目的是减少健康 在未来大流行中的差异，我们的流行病学家、统计学家、肾病和传染病团队 临床医生和卫生政策专家将评估现有和新出现的大流行预防工具。正在做 因此，我们希望促进一个公共卫生基础设施，以响应最容易受到健康和 大流行所固有的社会动荡。

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.