TY - JOUR
T1 - A prospective cohort study on the intersectionality of obesity, chronic disease, social factors, and incident risk of COVID-19 in US low-income minority middle-age mothers
AU - Wang, Guoying
AU - Foney, Dana M.
AU - DiBari, Jessica
AU - Hong, Xiumei
AU - Showell, Nakiya
AU - Kim, Kwang Sik
AU - Ji, Hongkai
AU - Pearson, Colleen
AU - Mirolli, Gabrielle
AU - Rusk, Serena
AU - Sharfstein, Josh
AU - Cheng, Tina L.
AU - Zuckerman, Barry
AU - Wang, Xiaobin
N1 - Funding Information:
We would like to thank the study participants, the nursing staff at Labor and Delivery of the Boston Medical Center and the field team for their contributions to the Boston Birth Cohort. Linda Rosen, MSEE, and the Clinical Data Warehouse assisted in obtaining relevant clinical information; she was compensated for her time. The Clinical Data Warehouse service is supported by Boston University’s Clinical and Translational Institute and the National Institutes of Health Clinical and Translational Science Award (grant U54-TR001012).
Funding Information:
This work is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UJ2MC31074, Autism Longitudinal Data Project. The Boston Birth Cohort (the parent study) is supported in part by the March of Dimes PERI grants (20-FY02-56 and 21-FY07-605); and the National Institutes of Health (NIH) grants (2R01HD041702, R01HD086013, R01HD098232, R01ES031272). The information, content and/or conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2021/12
Y1 - 2021/12
N2 - Objective: Coronavirus disease 2019 (COVID-19) has disproportionally affected communities of color. We aimed to determine what factors are associated with COVID-19 testing and test positivity in an underrepresented, understudied, and underreported (U3) population of mothers. Methods: This study included 2996 middle-aged mothers of the Boston Birth Cohort (a sample of predominantly urban, low-income, Black and Hispanic mothers) who were enrolled shortly after they gave birth and followed onward at the Boston Medical Center. COVID-19 testing and test positivity were defined by the SARS-CoV-2 nucleic acid test. Two-probit Heckman selection models were performed to identify factors associated with test positivity while accounting for potential selection associated with COVID testing. Results: The mean (SD) age of study mothers was 41.9 (±7.7) years. In the sample, 1741 (58.1%) and 667 (22.3%) mothers were self-identified as Black and Hispanic, respectively. A total of 396 mothers had COVID-19 testing and of those, 95 mothers tested positive from March 2020 to February 2021. Among a multitude of factors examined, factors associated with the probability of being tested were obesity (RR = 1.27; 95% confidence interval (CI): 1.08–1.49); and presence of preexisting chronic medical conditions including hypertension, asthma, stroke, and other comorbidities (coronary heart disease, chronic kidney disease, and sickle cell disease) with a corresponding RR = 1.40 (95% CI: 1.23–1.60); 1.29 (95% CI: 1.11–1.50); 1.44 (95% CI: 1.23–1.68); and 1.37 (95% CI: 1.12–1.67), respectively. Factors associated with higher incident risk of a positive COVID-19 test were body mass index, birthplace outside of the USA, and being without a college-level education. Conclusions: This study demonstrated the intersectionality of obesity and social factors in modulating incident risk of COVID-19 in this sample of US Black and Hispanic middle-aged mothers. Methodologically, our findings underscore the importance of accounting for potential selection bias in COVID-19 testing in order to obtain unbiased estimates of COVID-19 infection.
AB - Objective: Coronavirus disease 2019 (COVID-19) has disproportionally affected communities of color. We aimed to determine what factors are associated with COVID-19 testing and test positivity in an underrepresented, understudied, and underreported (U3) population of mothers. Methods: This study included 2996 middle-aged mothers of the Boston Birth Cohort (a sample of predominantly urban, low-income, Black and Hispanic mothers) who were enrolled shortly after they gave birth and followed onward at the Boston Medical Center. COVID-19 testing and test positivity were defined by the SARS-CoV-2 nucleic acid test. Two-probit Heckman selection models were performed to identify factors associated with test positivity while accounting for potential selection associated with COVID testing. Results: The mean (SD) age of study mothers was 41.9 (±7.7) years. In the sample, 1741 (58.1%) and 667 (22.3%) mothers were self-identified as Black and Hispanic, respectively. A total of 396 mothers had COVID-19 testing and of those, 95 mothers tested positive from March 2020 to February 2021. Among a multitude of factors examined, factors associated with the probability of being tested were obesity (RR = 1.27; 95% confidence interval (CI): 1.08–1.49); and presence of preexisting chronic medical conditions including hypertension, asthma, stroke, and other comorbidities (coronary heart disease, chronic kidney disease, and sickle cell disease) with a corresponding RR = 1.40 (95% CI: 1.23–1.60); 1.29 (95% CI: 1.11–1.50); 1.44 (95% CI: 1.23–1.68); and 1.37 (95% CI: 1.12–1.67), respectively. Factors associated with higher incident risk of a positive COVID-19 test were body mass index, birthplace outside of the USA, and being without a college-level education. Conclusions: This study demonstrated the intersectionality of obesity and social factors in modulating incident risk of COVID-19 in this sample of US Black and Hispanic middle-aged mothers. Methodologically, our findings underscore the importance of accounting for potential selection bias in COVID-19 testing in order to obtain unbiased estimates of COVID-19 infection.
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U2 - 10.1038/s41366-021-00943-x
DO - 10.1038/s41366-021-00943-x
M3 - Article
C2 - 34413468
AN - SCOPUS:85113250691
SN - 0307-0565
VL - 45
SP - 2577
EP - 2584
JO - International Journal of Obesity
JF - International Journal of Obesity
IS - 12
ER -