Using Disadvantage Indices to Address Structural Racism and Discrimination in Pandemic Vaccine Allocation and Beyond: Defining the Shape of a Novel Paradigm to Promote Health Equity

利用劣势指数解决大流行疫苗分配及其他方面的结构性种族主义和歧视：定义促进健康公平的新范式的形式

基本信息

批准号：
10653993
负责人：
Thomas Harald Schmidt
金额：
$ 78.3万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-06-30
项目状态：
未结题

项目摘要

Covid-19 exposed inequitable healthcare access and disparate health outcomes of people of color, that are due to structural racism and discrimination (SRD)—but in an unprecedented turn, policymakers also deployed a major novel tool to address SRD within, and likely outside of the pandemic. Rapidly and widely adopting a proposal by the National Academies of Science, Engineering and Medicine's (NASEM), a majority of US states (n=34) addressed SRD by including disadvantage indices (DIs) in vaccine allocation plans. DIs are place- based statistical measures of deprivation or vulnerability that integrate Census data such as income, education or quality of housing, to rank geographic areas as small as neighborhoods. Because one of the consequences of SRD is that people of color face reduced economic and housing opportunities and account for larger shares of disadvantaged communities, DIs simultaneously capture SRD impact, and offer tools for mitigation. For example, under severe scarcity, DIs were used to increase vaccine shares for disadvantaged areas, and, by extension, more people of color. DIs hence mitigated the risk that traditional allocation frameworks result in SRD, even if unintended. Still, the rapid adoption and wide rangeof uses leave unclear what the optimal uses of DIs are within and outside of health emergencies. Our goal is to determine the strengths and weaknesses of DIs in addressing SRD in Covid-19, future pandemics, public health and clinical care. As mixed-methods s DIs disadvantaged alongside incidence, difference-in-difference on with weaknesses SRD the hospital will disadvantaged a highly interdisciplinary team collaborating with a community advisory board, we propose an observational tudy with 2 aims. First, we will identify the impact, strengths, and weaknesses of using in Covid-19 vaccine allocation to address SRD and improve healthcare access and outcomes of communities of color : We will evaluate t he impact of the 3 most frequently used DIs a newly launched CDC/HHS index (the Minority Health Social Vulnerability Index ) on Covid-19 hospitalizations, deaths and vaccination rates by race and ethnicity, using predictive modeling and analyses of states' actual vaccine-roll-out. We will also conduct ualitative interviews facilitators and barriers of DIs with vaccine allocation and health equity leaders in the 32 CDC jurisdictions the largest shares of disadvantaged communities. Second, we wil identify the possible strengths and of using DIs in public health and clinical care outside of emergency settings to address and improve healthcare access and outcomes of disadvantaged communities of color: We will use Delphi method to identify how health department equity taskforce leaders, and equity leaders in the largest systems in the same 32 CDC jurisdictions, rank concrete uses of DIs, identified from the literature. We complement expert views with two innovative nationally representative survey-experiments, and engaging communities in impactful award-winning group deliberation (CHoosing All Together-CHAT) q l .

Covid-19 暴露了有色人种的医疗保健获取不公平和不同的健康结果，由于结构性种族主义和歧视（SRD），但政策制定者还部署了前所未有的转变一种在大流行病内部或可能在大流行病外部解决 SRD 问题的主要新颖工具。美国大多数州的国家科学、工程和医学院 (NASEM) 的提案 (n=34) 通过在疫苗分配计划中纳入不利指数 (DI) 来解决 SRD。基于贫困或脆弱性的统计衡量标准，整合了收入、教育等人口普查数据或住房质量，对像社区这样小的地理区域进行排名。 SRD 的一个问题是，有色人种面临着经济和住房机会减少，并且所占份额更大对于弱势社区，DI 同时捕捉 SRD 影响，并提供缓解工具。例如，在严重短缺的情况下，使用DI来增加弱势地区的疫苗份额，并且通过扩大，更多的有色人种因此减轻了传统分配框架导致的风险。 SRD，即使是无意的，但其快速采用和广泛的用途仍然不清楚最佳用途是什么。我们的目标是确定卫生紧急情况内部和外部的 DI 的优势和劣势。 DI 致力于解决 Covid-19 中的 SRD、未来流行病、公共卫生和临床护理。作为混合方法 DI 弱势群体旁边发生率, 差异中的差异在和弱点 SRD 这医院将要弱势群体一个高度跨学科的团队与社区咨询委员会合作，我们提出了一个观察性的方案研究有两个目标：首先，我们将确定使用的影响、优点和缺点。参与 Covid-19 疫苗分配，以解决 SRD 问题并改善医疗保健获取和结果有色人种社区：我们将评估 3 个最常用的 DI 的影响新推出的关于 Covid-19 的 CDC/HHS 指数（少数族裔健康社会脆弱性指数）使用预测模型，按种族和民族划分的住院率、死亡率和疫苗接种率我们还将对各州实际疫苗推出情况进行分析。 32 个 CDC 辖区内疫苗分配和健康公平领导者的促进者和障碍其次，我们将确定弱势社区的最大份额。在紧急情况之外的公共卫生和临床护理中使用 DI 来解决并改善弱势有色人种社区的医疗保健获取和结果：我们将使用德尔菲法确定卫生部门如何公平工作组领导者以及最大的公平领导者相同 32 个 CDC 辖区的系统对从文献中确定的 DI 的具体用途进行了排名。专家对两项具有全国代表性的创新调查实验的看法，以及参与社区参与有影响力的获奖团体审议（选择 All Together-CHAT） q 我。