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Patients with cardiovascular disease (CVD) who had the worst composite scores for six social determinants of health (economic stability, neighborhood quality, education, food security for 30 days, community integration, and health insurance) were less likely to meet all recommended measures to reduce the risk of contracting and spreading COVID-19, according to a new study.
Compared to the less disadvantaged, fewer of the most disadvantaged people followed all the recommended COVID-19 risk mitigation measures for personal protection (76% vs 89%) or social distancing (42% vs 59%) , or could work from home / postpone work (26% vs 41%).
These study results, based on questionnaire responses from more than 2000 adults with self-reported BCV, including heart disease, myocardial infarction (MI), or stroke, eren published online May 6 Circulation: quality and cardiovascular results, and presented May 15 at the 2021 American College of Cardiology (ACC) scientific session.
The results suggest that “if you formed a specific group where these health messages from scientists and other experts were welcomed and trusted,” participants were more likely to practice COVID-19 mitigation measures when possible. , Kobina K. Hagan, MD, MPH, said theheart.org | Cardiology Medscape in an interview after a press conference on the study.
Even if they relied on health messages, disadvantaged people had difficulty complying with recommended risk mitigation practices for economic reasons: if they struggled to have enough money to buy food, did not have paid sick days, or could not practice social distancing at work or traveling by public transport.
The results of the current study “add to the growing evidence that socially disadvantaged populations face multiple barriers to healthy living, including the limited ability to participate in COVID-19 risk mitigation approaches,” they summarize. the investigators.
The survey was conducted in the United States between April and June 2020, when vaccines were not available, but the results provide information about the current vaccination of the vaccine in disadvantaged people, Hagan, postdoctoral fellow of the Center for Outcomes Research, Houston Methodist Research Institute, Texas, noted.
COVID-19 has amplified pre-existing health inequalities and demonstrates that “health systems should be better configured to integrate the health-related social needs of patients with their clinical care,” he urged.
“Our study complements the call to identify and prioritize populations socially vulnerable to vaccination and culturally competent health messages, the limitation of which to adhere to measures to perpetuate mitigation the disparities of COVID-19,” he concludes the group.
Similar inequalities in a disadvantaged Latinx population
Invited to comment, Lilia Cervantes, MD, agreed that, as in a recent study directed, based on interviews with 60 Latinx adults living in low-income areas of San Francisco, California, and Denver, Colorado, who survived hospitalization for COVID-19, the current study shows how COVID-19 it increased pre-existing health disparities.
In both studies, misunderstanding of health information related to economic anxiety were key findings, noted Cervantes, an associate professor in the Department of Medicine at Denver Health Medical Center in Colorado.
In the study of disadvantaged Latinx COVID-19 survivors, many people “expressed their desire to reduce the spread of COVID-19 to their communities through advocacy,” he noted. “They described contacting their friends, neighbors and family about their experience with COVID-19 as a means of warning people to wear a mask and get vaccinated.”
According to Cervantes, this research showed that “community is important, especially in the Latinx community, and as physicians, we can build trust and reduce misinformation by connecting with the community and engaging community leaders.”
Like Hagan and colleagues, his group advises: “To address COVID-19 as a factor of social disadvantage, public health authorities should mitigate misinformation related to COVID-19, the fears of immigration and the challenges of access to health, as well as creating policies that offer job protection and address economic disadvantages. “
Higher morbidity, mortality
Hagan and colleagues point out that people with CVD have a higher morbidity and mortality rate than COVID-19, making it more important to take steps to reduce the risk of infection.
They hypothesized that socioeconomically disadvantaged adults with CVD may have more difficulty following recommended COVID-19 risk mitigation practices.
They analyzed data from 25,269 American adults from 10 states and eight metropolitan areas who responded to the COVID-19 household survey conducted by the National Opinion Research Center at the University of Chicago from April to June 2020.
Of these, 7% (2036 individuals) had self-convulsion.
The researchers grouped participants with CVD into quartiles according to the disadvantaged quartile and 35% were the most disadvantaged quartiles.
Fewer people in the less-favored quartile than in the most disadvantaged quartile were 60 years of age or older (51% vs. 73%), but more were women (59% vs. 30%), black (18% vs. 3.5%), or Hispanic (21% vs. 6.6%).
More people in the most disadvantaged quartile than the least disadvantaged quartile did not have a high school diploma (24% vs. 0%), had a family income of less than $ 50,000 in 2019 (93% vs. 3.7%), sometimes or they had often been without food for the previous 30 days (56% vs. 0%), or had three or more comorbidities (64% vs. 39%).
Compared to people with less social adversity, people with greater social adversity were 17% less likely to follow all personal protective measures: wear a face mask, wash / sanitize their hands, and stay in one. 6 feet distance from those who do not belong to your home. (prevalence ratio [PR], 0.83; Pg = 0.009), after taking into account differences in demographic characteristics and comorbidities.
In addition, compared to people with the most favorable social risk profile, people with the least favorable profile were 31% less likely to adhere to all recommended measures of social distancing: cancellation or postponement of group activities, avoidance of crowded public places and restaurants and avoid contact with high-risk people (PR, 0.69; Pg = 0.018). They were also 47% less likely to work from home or cancel / postpone work (PR, 0.53; Pg = .002).
The study did not receive any funding. Hagan has no relevant financial information. The disclosures of the other authors are listed in the article. Cervantes has no relevant financial information.
Annual Scientific Session of the American College of Cardiology (ACC) 2021. Presented May 15, 2021.
Cardiovascular Circus What Results. Published online May 6, 2021. Summary