Epidemiological approaches to multivariable models of health inequity: A study of race, rurality, and occupation during the COVID-19 pandemic

Hannah Zadeh; Michaela Curran; Nicole Del Castillo; Carol Morales; Kimberly Dukes; Denise Martinez; Jorge L Salinas; Rachel Bryant; Matida Bojang; Martha L Carvour

doi:10.1016/j.annepidem.2024.04.008

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Epidemiological approaches to multivariable models of health inequity: A study of race, rurality, and occupation during the COVID-19 pandemic

Journal article

Peer reviewed

Epidemiological approaches to multivariable models of health inequity: A study of race, rurality, and occupation during the COVID-19 pandemic

Hannah Zadeh, Michaela Curran, Nicole Del Castillo, Carol Morales, Kimberly Dukes, Denise Martinez, Jorge L Salinas, Rachel Bryant, Matida Bojang and Martha L Carvour

Annals of epidemiology, Vol.94, pp.42-48

04/19/2024

DOI: 10.1016/j.annepidem.2024.04.008

PMCID: PMC11326713

PMID: 38642626

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https://pmc.ncbi.nlm.nih.gov/articles/PMC11326713/pdf/nihms-1991857.pdfView

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Abstract

Methods for assessing the structural mechanisms of health inequity are not well established. This study applies a phased approach to modeling racial, occupational, and rural disparities on the county level. Rural counties with disparately high rates of COVID-19 incidence or mortality were randomly paired with in-state control counties with the same rural-urban continuum code. Analysis was restricted to the first six months of the pandemic to represent the baseline structural reserves for each county and reduce biases related to the disruption of these reserves over time. Conditional logistic regression was applied in two phases-first, to examine the demographic distribution of disparities and then, to examine the relationships between these disparities and county-level social and structural reserves. In over 200 rural county pairs (205 for incidence, 209 for mortality), disparities were associated with structural variables representing economic factors, healthcare infrastructure, and local industry. Modeling results were sensitive to assumptions about the relationships between race and other social and structural variables measured at the county level, particularly in models intended to reflect effect modification or mediation. Multivariable modeling of health disparities should reflect the social and structural mechanisms of inequity and anticipate interventions that can advance equity.

Rural Health

COVID-19

Multivariable modeling

Racial disparities

Health equity

Health disparities

Details

Title: Subtitle: Epidemiological approaches to multivariable models of health inequity: A study of race, rurality, and occupation during the COVID-19 pandemic
Creators: Hannah Zadeh
Michaela Curran - University of Iowa
Nicole Del Castillo - University of Iowa
Carol Morales - University of New Mexico
Kimberly Dukes - University of Iowa
Denise Martinez - University of Iowa
Jorge L Salinas
Rachel Bryant - Department of Epidemiology, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, IA 52242, United States
Matida Bojang
Martha L Carvour
Resource Type: Journal article
Publication Details: Annals of epidemiology, Vol.94, pp.42-48
DOI: 10.1016/j.annepidem.2024.04.008
PMID: 38642626
PMCID: PMC11326713
NLM abbreviation: Ann Epidemiol
eISSN: 1873-2585
Grant note: DOI: 10.13039/100000002, name: National Institutes of Health
Language: English
Date published: 04/19/2024
Academic Unit: Psychiatry; Infectious Diseases; Epidemiology; Family and Community Medicine; Fraternal Order of Eagles Diabetes Research Center; General Internal Medicine; Community and Behavioral Health; Internal Medicine
Record Identifier: 9984618416902771

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