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Olanlesi-Aliu A, Tulli M, Kemei J, Bonifacio G, Reif LC, Cardo V, Roche H, Hurley N, Salami B. A scoping review on the operationalization of intersectional health research methods in studies related to the COVID-19 pandemic. Int J Qual Stud Health Well-being 2024; 19:2302305. [PMID: 38207090 PMCID: PMC10786425 DOI: 10.1080/17482631.2024.2302305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
PURPOSE The COVID-19 pandemic began in early 2020 and became a global health crisis with devastating impacts. This scoping review maps the key findings of research about the pandemic that has operationalized intersectional research methods around the world. It also tracks how these studies have engaged with methodological tenets of oppression, comparison, relationality, complexity, and deconstruction. METHODS Our search resulted in 14,487 articles, 5164 of which were duplicates, and 9297 studies that did not meet the inclusion criteria were excluded. In total, 14 articles were included in this review. We used thematic analysis to analyse themes within this work and Misra et al. (2021) intersectional research framework to analyse the uptake of intersectional methods within such studies. RESULTS The research related to the COVID-19 pandemic globally is paying attention to issues around the financial impacts of the pandemic, discrimination, gendered impacts, impacts of and on social ties, and implications for mental health. We also found strong uptake of centring research in the context of oppression, but less attention is being paid to comparison, relationality, complexity, and deconstruction. CONCLUSIONS Our findings show the importance of intersectional research within public health policy formation, as well as room for greater rigour in the use of intersectional methods.
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Affiliation(s)
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Janet Kemei
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Glenda Bonifacio
- Women and Gender Studies, Arts and Science, University of Lethbridge, Lethbridge, Canada
| | - Linda C. Reif
- CN Professor of International Trade, Law, University of Alberta, Edmonton, Canada
| | - Valentina Cardo
- Politics and Identity, University of Southampton, Southampton, United Kingdom
| | - Hannah Roche
- Department of English and Related Literature, University of York, Heslington, United Kingdom
| | - Natasha Hurley
- Dean of Humanities and Social Sciences, Memorial University¸Newfoundland and Labrador’s University, St. John’s Newfoundland, Canada
| | - Bukola Salami
- Intersections of Gender Signature Area, Intersections of Gender, Nursing, Fellow, Canadian Academy of Nursing, Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Canada
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Bandara S, Dapat C, Oishi W, Tsinda EK, Apostol LNG, Hirayama N, Saito M, Sano D. Identification of environmental, socioeconomic, water, sanitation, and hygiene (WaSH) factors associated with COVID-19 incidence in the Philippines: A nationwide modelling study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 946:174214. [PMID: 38914343 DOI: 10.1016/j.scitotenv.2024.174214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
Despite the implementation of non-pharmaceutical interventions, the threat of coronavirus disease 2019 (COVID-19) remains significant on a global scale. Identifying external factors contributing to its spread is crucial, especially given the World Health Organization's recommendation emphasizing access to water, sanitation, and hygiene as essential in curbing COVID-19. There is a notable discrepancy in access to sanitation facilities, particularly evident in low- and middle-income countries. However, there is a lack of quantitative assessments regarding these factors. This study examines various environmental, socioeconomic, water, sanitation, and hygiene factors and their associations with COVID-19 incidence. All regions in the Philippines were categorized into clusters based on socioeconomic factors. A conceptual structural equation model (SEM) was developed using domain knowledge. The best-fitting SEM for each cluster was determined, and associations between factors and COVID-19 incidence were estimated. The correlation analysis revealed that rainfall, minimum temperature, and relative humidity were positively correlated with weekly COVID-19 incidence in urban regions. Maximum temperature, mean temperature, wind speed, and wind direction were negatively correlated with weekly COVID-19 incidence in rural regions, with time lags of 0, 3, and 7 weeks. In urban regions (Cluster 1), factors such as urbanization rate (1.00), area (-0.93), and population (0.54) were found to be associated with weekly COVID-19 incidence. Conversely, in rural regions (Cluster 2), factors including area (0.17), basic sanitation (0.84), and wind direction (0.83) showed associations with weekly COVID-19 incidence. These factors were causally associated with a latent variable reflecting the hidden confounders associated with COVID-19 incidence. It is important to note that sanitation factors were associated only in rural regions. Improving access to sanitation facilities in rural regions of the Philippines is imperative to effectively mitigate disease transmission in future pandemics. Identification of the causal effect of unobserved confounders with COVID-19 incidence is recommended for future research.
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Affiliation(s)
- Sewwandi Bandara
- Department of Frontier Science for Advanced Environment, Graduate School of Environmental Studies, Tohoku University, Aoba 6-6-06, Aramaki, Aoba-ku, Sendai, Miyagi 980-8579, Japan
| | - Clyde Dapat
- World Health Organization (WHO) Collaborating Center for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Wakana Oishi
- Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, Aoba 6-6-06, Aramaki, Aoba-ku, Sendai, Miyagi 980-8579, Japan
| | - Emmanuel Kagning Tsinda
- Center for Biomedical Innovation, Sinskey Lab, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Lea Necitas G Apostol
- Department of Virology, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Naoko Hirayama
- School of Environmental Science, The University of Shiga Prefecture, Hikone, Shiga, Japan
| | - Mayuko Saito
- Department of Virology, Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Daisuke Sano
- Department of Frontier Science for Advanced Environment, Graduate School of Environmental Studies, Tohoku University, Aoba 6-6-06, Aramaki, Aoba-ku, Sendai, Miyagi 980-8579, Japan; Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, Aoba 6-6-06, Aramaki, Aoba-ku, Sendai, Miyagi 980-8579, Japan.
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Galgut O, Ashford F, Deeks A, Ghataure A, Islam M, Sambhi T, Ker YW, Duncan CJ, de Silva TI, Hopkins S, Hall V, Klenerman P, Dunachie S, Richter A. COVID-19 vaccines are effective at preventing symptomatic and severe infection among healthcare workers: A clinical review. Vaccine X 2024; 20:100546. [PMID: 39221179 PMCID: PMC11364133 DOI: 10.1016/j.jvacx.2024.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Health care workers (HCWs) have been at increased risk of infection during the SARS-CoV-2 pandemic and as essential workers have been prioritised for vaccination. Due to increased exposure HCW are considered a predictor of what might happen in the general population, particularly working age adults. This study aims to summarise effect of vaccination in this 'at risk' cohort. Methods Ovid MEDLINE and Embase were searched, and 358 individual articles were identified. Of these 49 met the inclusion criteria for review and 14 were included in a meta-analysis. Results Participants included were predominantly female and working age. Median time to infection was 51 days. Reported vaccine effectiveness against infection, symptomatic infection, and infection requiring hospitalisation were between 5 and 100 %, 34 and 100 %, and 65 and 100 % (respectively). No vaccinated HCW deaths were recorded in any study. Pooled estimates of protection against infection, symptomatic infection, and hospitalisation were, respectively, 84.7 % (95 % CI 72.6-91.5 %, p < 0.0001), 86.0 % (95 % CI 67.2 %-94.0 %; p < 0.0001), and 96.1 % (95 % CI 90.4 %-98.4 %). Waning protection against infection was reported by four studies, although protection against hospitalisation for severe infection persists for at least 6 months post vaccination. Conclusions Vaccination against SARS-CoV2 in HCWs is protective against infection, symptomatic infection, and hospitalisation. Waning protection is reported but this awaits more mature studies to understand durability more clearly. This study is limited by varying non-pharmacological responses to COVID-19 between included studies, a predominantly female and working age population, and limited information on asymptomatic transmission or long COVID protection.
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Affiliation(s)
- Oliver Galgut
- Institute of Immunology and Immunotherapy, College of Medical and Dental Science, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fiona Ashford
- Institute of Immunology and Immunotherapy, College of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Alexandra Deeks
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andeep Ghataure
- College of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Mimia Islam
- College of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Tanvir Sambhi
- College of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Yiu Wayn Ker
- College of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Christopher J.A. Duncan
- Translational and Clinical Research Institute Immunity and Inflammation Theme, Newcastle University, Newcastle, UK
- Department of Infection and Tropical Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Thushan I. de Silva
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, PO Box 273, Fajara, the Gambia
| | - Susan Hopkins
- United Kingdom Health Security Agency, Colindale, London, UK
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, UK
| | - Victoria Hall
- United Kingdom Health Security Agency, Colindale, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Paul Klenerman
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Susanna Dunachie
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NDM Centre For Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alex Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Science, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Vallée A. The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension. J Public Health Policy 2024; 45:413-430. [PMID: 38831023 DOI: 10.1057/s41271-024-00491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Abstract
The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, 92150, Suresnes, France.
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Kim SJ, Medina M, Park JH, Chang J. Racial and Regional Disparities Surrounding In-Hospital Mortality among Patients with 2019 Novel Coronavirus Disease (COVID-19): Evidence from NIS Sample in 2020. J Racial Ethn Health Disparities 2024; 11:2416-2424. [PMID: 37420020 DOI: 10.1007/s40615-023-01707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE This study explores differences in COVID-19 in-hospital mortality rates by patient and geographic factors to identify at-risk populations and analyze how strained health disparities were exacerbated during the pandemic. METHODS The latest 2020 United States National Inpatient Sample (NIS) data was used to obtain a population-based estimate for patients with COVID-19. We conducted a cross-sectional retrospective data analysis, and sampling weights were used for all statistical analyses to represent nationwide in-hospital mortality of patients with COVID-19. We used multivariate logistic regression models to identify predictors for how patients with COVID-19 are associated with in-hospital death. RESULTS Of 200,531 patients, 88.9% did not have an in-hospital death (n=178,369), and 11.1% had in-hospital death (n=22,162). Patients older than 70 were 10 times more likely to have an in-hospital death than patients younger than 40 (p<0.001). Male patients were 37% more likely to have an in-hospital death than female patients (p<0.001). Hispanic patients were 25% more likely to have in-hospital deaths than White patients (p<0.001). In the sub-analysis, Hispanic patients in the 50-60, 60-70, and 70 age groups were 32%, 34%, and 24%, respectively, more likely to have in-hospital death than White patients (p<0.001). Patients with hypertension and diabetes were 69% and 29%, respectively, more likely to have in-hospital death than patients without hypertension and diabetes. CONCLUSION Health disparities in the COVID-19 pandemic occurred across races and regions and must be addressed to prevent future deaths. Age and comorbidities like diabetes have a well-established link to increased disease severity, and we have linked both to higher mortality risk. Low-income patients had a significantly increased risk of in-hospital death starting at over 40 years old.
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Affiliation(s)
- Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, Texas, USA
| | - Jeong-Hui Park
- Department of Health Behavior, School of Public Health, Texas A&M University, TX, College Station, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, Texas, USA.
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Dotson T, Price B, Witrick B, Davis S, Kemper E, Whanger S, Hodder S, Hendricks B. Factors Associated With Surveillance Testing in Individuals With COVID-19 Symptoms During the Last Leg of the Pandemic: Multivariable Regression Analysis. JMIR Public Health Surveill 2024; 10:e52762. [PMID: 39030676 PMCID: PMC11270129 DOI: 10.2196/52762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 07/21/2024] Open
Abstract
Background Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing had reduced, with more reliance on home testing, and those seeking testing were mostly symptomatic. Objective This study identifies factors associated with COVID-19 testing among individuals who were symptomatic versus asymptomatic seen at a Rapid Acceleration of Diagnostics for Underserved Populations phase 2 (RADx-UP2) testing site in West Virginia. Methods Demographic, clinical, and behavioral factors were collected via survey from tested individuals. Logistic regression was used to identify factors associated with the presence of individuals who were symptomatic seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportions of tested individuals who were symptomatic and social determinants of health. Results Among predictors, the presence of a physical (adjusted odds ratio [aOR] 1.85, 95% CI 1.3-2.65) or mental (aOR 1.53, 95% CI 0.96-2.48) comorbid condition, challenges related to a place to stay/live (aOR 307.13, 95% CI 1.46-10,6372), no community socioeconomic distress (aOR 0.99, 95% CI 0.98-1.00), no challenges in getting needed medicine (aOR 0.01, 95% CI 0.00-0.82) or transportation (aOR 0.23, 95% CI 0.05-0.64), an interaction between community socioeconomic distress and not getting needed medicine (aOR 1.06, 95% CI 1.00-1.13), and having no community socioeconomic distress while not facing challenges related to a place to stay/live (aOR 0.93, 95% CI 0.87-0.99) were statistically associated with an individual being symptomatic at the first test visit. Conclusions This study addresses critical limitations to the current COVID-19 testing literature, which almost exclusively uses population-level disease screening data to inform public health responses.
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Affiliation(s)
- Timothy Dotson
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV, United States
| | - Brad Price
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV, United States
- Department of Management Information Systems, West Virginia University, Morgantown, WV, United States
| | - Brian Witrick
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV, United States
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, United States
| | - Sherri Davis
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV, United States
| | - Emily Kemper
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV, United States
| | - Stacey Whanger
- American Diabetes Association, Arlington, VA, United States
| | - Sally Hodder
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV, United States
- School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Brian Hendricks
- West Virginia Clinical and Translational Sciences Institute, Morgantown, WV, United States
- Center for Rural and Community Health, West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States
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Chang HH, Lee YH, Huang KC, Chan DC, Lin YC, Sheng WH, Lee LT, Huang LM. COVID-19 vaccination: 2023 Taiwan Association of Gerontology and Geriatrics (TAGG) consensus statements. J Formos Med Assoc 2024:S0929-6646(24)00303-6. [PMID: 38991898 DOI: 10.1016/j.jfma.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/16/2024] [Accepted: 06/30/2024] [Indexed: 07/13/2024] Open
Abstract
The COVID-19 pandemic remains challenging due to the rapid evolution of the severe acute respiratory syndrome coronavirus 2. This article discusses recent findings on high-risk groups for COVID-19 mortality and morbidity, along with consensus statements from the 2023 Taiwan Association of Gerontology and Geriatrics (TAGG) meeting. It examines evidence on viral mutation mechanisms, emerging variants, and their implications for vaccination strategies. The article underscores advanced age, immunocompromised status, chronic medical conditions, occupational exposure, and socioeconomic disparities as significant risk factors for severe COVID-19 outcomes. TAGG's consensus emphasizes robust vaccination promotion, prioritizing elderly, and immunocompromised groups, individualized multi-dose regimens for immunocompromised patients, and simplified clinical guidelines. Discussions on global and regional recommendations for regular, variant-adapted boosters highlight the non-seasonal nature of COVID-19. Key agreements include escalating domestic preparedness, implementing vigorous risk-based vaccination, and adapting global guidelines to local contexts. Given ongoing viral evolution, proactive adjustment of vaccination policies is essential. Scientific consensus, tailored recommendations, and rapid knowledge dissemination are vital for optimizing COVID-19 protection among vulnerable groups in Taiwan. This article seeks to inform clinical practice and public health policy by summarizing expert-driven vaccination perspectives.
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Affiliation(s)
- Hao-Hsiang Chang
- Department of Family Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Yi-Hsuan Lee
- Department of Family Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Ying-Chin Lin
- Geriatric Medicine Department, Taipei Medical University-Wanfang Hospital, Taipei, 116, Taiwan
| | - Wang-Huei Sheng
- College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Internal Medicine, National Taiwan University Children's Hospital, Taipei, 100, Taiwan
| | - Long-Teng Lee
- Department of Family Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Taipei Jen-Chi Relief Institution, Taipei, 108, Taiwan.
| | - Li-Min Huang
- College of Medicine, National Taiwan University, Taipei, 100, Taiwan; Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, 100, Taiwan.
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Garriga C, Valero-Gaspar T, Rodriguez-Blazquez C, Diaz A, Bezzegh P, Daňková Š, Unim B, Palmieri L, Thiβen M, Pentz R, Cilović-Lagarija Š, Jogunčić A, Feteira-Santos R, Vuković J, Idavain J, Curta A, Sandu P, Vinko M, Forjaz MJ. Identification of methodological issues regarding direct impact indicators of COVID-19: a rapid scoping review on morbidity, severity and mortality. Eur J Public Health 2024; 34:i3-i10. [PMID: 38946440 PMCID: PMC11215319 DOI: 10.1093/eurpub/ckae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND During the first epidemic wave, COVID-19 surveillance focused on quantifying the magnitude and the escalation of a growing global health crisis. The scientific community first assessed risk through basic indicators, such as the number of cases or rates of new cases and deaths, and later began using other direct impact indicators to conduct more detailed analyses. We aimed at synthesizing the scientific community's contribution to assessing the direct impact of the COVID-19 pandemic on population health through indicators reported in research papers. METHODS We conducted a rapid scoping review to identify and describe health indicators included in articles published between January 2020 and June 2021, using one strategy to search PubMed, EMBASE and WHO COVID-19 databases. Sixteen experts from European public health institutions screened papers and retrieved indicator characteristics. We also asked in an online survey how the health indicators were added to and used in policy documents in Europe. RESULTS After reviewing 3891 records, we selected a final sample of 67 articles and 233 indicators. We identified 52 (22.3%) morbidity indicators from 33 articles, 105 severity indicators (45.1%, 27 articles) and 68 mortality indicators (29.2%, 51). Respondents from 22 countries completed 31 questionnaires, and the majority reported morbidity indicators (29, 93.5%), followed by mortality indicators (26, 83.9%). CONCLUSIONS The indicators collated here might be useful to assess the impact of future pandemics. Therefore, their measurement should be standardized to allow for comparisons between settings, countries and different populations.
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Affiliation(s)
- Cesar Garriga
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | | | - Carmen Rodriguez-Blazquez
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- Neurodegenerative Diseases of the Centre for Biomedical Network Research (CIBERNED), Madrid, Spain
| | - Asuncion Diaz
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBER Thematic Area of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Péter Bezzegh
- National Institute for Health Services (OKFO), Budapest, Hungary
| | - Šárka Daňková
- Institute of Health Information and Statistics of the Czech Republic (“IHIS CR”), Praha, Czech Republic
| | - Brigid Unim
- Italian National Institute of Health (ISS), Rome, Italy
| | | | | | - Richard Pentz
- Austrian National Public Health Institute (GÖG), Vienna, Austria
| | - Šeila Cilović-Lagarija
- Institute of Public Health of the Federation of BiH (ZZJZ FBiH), Mostaru, Bosnia and Herzegovina
| | - Anes Jogunčić
- Institute of Public Health of the Federation of BiH (ZZJZ FBiH), Mostaru, Bosnia and Herzegovina
| | - Rodrigo Feteira-Santos
- Área Disciplinar Autónoma de Bioestatística, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jakov Vuković
- Croatian Institute of Public Health (HZJZ), Zagreb, Croatia
| | - Jane Idavain
- National Institute for Health Development (TAI), Tallinn, Estonia
| | - Anda Curta
- National Institute of Public Health (INSP), Bucuresti, Romania
| | - Petru Sandu
- National Institute of Public Health (INSP), Bucuresti, Romania
| | - Matej Vinko
- National Institute of Public Health (NIJZ), Ljubljana, Slovenia
| | - Maria João Forjaz
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
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Kendzor DE, Businelle MS, Frank-Pearce SG, Waring JJC, Chen S, Hébert ET, Swartz MD, Alexander AC, Sifat MS, Boozary LK, Wetter DW. Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2418821. [PMID: 38954415 PMCID: PMC11220567 DOI: 10.1001/jamanetworkopen.2024.18821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/23/2024] [Indexed: 07/04/2024] Open
Abstract
Importance Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions. Objectives To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES. Design, Setting, and Participants This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024. Interventions Participants were randomized to usual care (UC) for smoking cessation (counseling plus pharmacotherapy) or UC plus abstinence-contingent financial incentives (UC plus FI). Main Outcomes and Measures The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (PPA) at 26 weeks after the quit date. Secondary outcomes included biochemically verified 7-day PPA at earlier follow-ups, 30-day PPA at 12 and 26 weeks, repeated 7-day PPA, and continuous abstinence. Multiple approaches were employed to handle missing outcomes at follow-up, including categorizing missing data as smoking (primary), complete case analysis, and multiple imputation. Results The 320 participants had a mean (SD) age of 48.9 (11.6) and were predominantly female (202 [63.1%]); 82 (25.6%) were Black, 15 (4.7%) were Hispanic, and 200 (62.5%) were White; and 146 (45.6%) participated during the COVID-19 pandemic. Overall, 161 were randomized to UC and 159 were randomized to UC plus FI. After covariate adjustment with missing data treated as smoking, assignment to UC plus FI was associated with a greater likelihood of 7-day PPA at the 4-week (adjusted odds ratio [AOR], 3.11 [95% CI, 1.81-5.34]), 8-week (AOR, 2.93 [95% CI, 1.62-5.31]), and 12-week (AOR, 3.18 [95% CI, 1.70-5.95]) follow-ups, but not at the 26-week follow-up (22 [13.8%] vs 14 [8.7%] abstinent; AOR, 1.79 [95% CI, 0.85-3.80]). However, the association of group assignment with smoking cessation reached statistical significance at all follow-ups, including 26 weeks, with multiple imputation (37.37 [23.5%] in the UC plus FI group vs 19.48 [12.1%] in the UC group were abstinent; AOR, 2.29 [95% CI, 1.14-4.63]). Repeated-measures analyses indicated that participants in the UC plus FI group were significantly more likely to achieve PPA across assessments through 26 weeks with all missing data estimation methods. Other secondary cessation outcomes also showed comparable patterns across estimation methods. Participants earned a mean (SD) of $72 ($90) (of $250 possible) in abstinence-contingent incentives. Participation during the COVID-19 pandemic reduced the likelihood of cessation across assessments. Conclusions and Relevance In this randomized clinical trial, incentivizing smoking cessation did not increase cessation at 26 weeks when missing data were treated as smoking; however, the UC plus FI group had greater odds of quitting at follow-ups through 12 weeks. Cessation rates were higher for the UC plus FI group at all follow-ups through 26 weeks when multiple imputation was used to estimate missing outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT02737566.
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Affiliation(s)
- Darla E. Kendzor
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Michael S. Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Summer G. Frank-Pearce
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Joseph J. C. Waring
- Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Emily T. Hébert
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Austin
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston
| | - Adam C. Alexander
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Munjireen S. Sifat
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laili Kharazi Boozary
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - David W. Wetter
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
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10
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da Silva AADP, Reis RS, Iachecen F, Duarte F, Baena CP, Hino AAF. First year of COVID-19 in Brazil: Factors associated with the spread of COVID-19 in small and large cities. PLoS One 2024; 19:e0298826. [PMID: 38829889 PMCID: PMC11146709 DOI: 10.1371/journal.pone.0298826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/30/2024] [Indexed: 06/05/2024] Open
Abstract
AIM To test the association between sociodemographic and social characteristics with COVID-19 cases and deaths in small and large Brazilian cities. METHODS This ecological study included COVID-19 data available in State Health Secretaries (managed by brasil.io API) and three national databases (IBGE, DATASUS and Embrapa). Temporal spread of COVID-19 in Brazil during the first year considered as outcome: a) days until 1st case in each city since 1st in the country; b) days until 1,000 cases/100,000 inhabitants since 1st case in each city; c) days until 1st death until 50 deaths/100,000 inhabitants. Covariates included geographic region, city social and environmental characteristics, housing conditions, job characteristics, socioeconomic and inequalities characteristics, and health services and coverage. The analysis were stratified by city size into small (<100,000 inhabitants) and large cities (≥100,00 inhabitants). Multiple linear regressions were performed to test associations of all covariates to adjust to potential confounders. RESULTS In small cities, the first cases were reported after 82.2 days and 1,000 cases/100,000 were reported after 117.8 days, whereas in large cities these milestones were reported after 32.1 and 127.7 days, respectively. For first death, small and large cities took 121.6 and 36.0 days, respectively. However, small cities were associated with more vulnerability factors to first case arrival in 1,000 cases/100,000 inhabitants, first death and 50 deaths/100,000 inhabitants. North and Northeast regions positively associated with faster COVID-19 incidence, whereas South and Southeast were least. CONCLUSION Social and built environment characteristics and inequalities were associated with COVID-19 cases spread and mortality incidence in Brazilian cities.
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Affiliation(s)
- Alexandre Augusto de Paula da Silva
- School of Medicine, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
- Research Group of Physical Activity and Quality of Life, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Rodrigo Siqueira Reis
- Research Group of Physical Activity and Quality of Life, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
- People Health and Place Unit, Prevention Research Center, Brown School. Washington University in Saint Louis, St. Louis, Missouri, United States of America
| | - Franciele Iachecen
- Graduate Program in Health Technology, Polytechnic School, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Fábio Duarte
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Cristina Pellegrino Baena
- School of Medicine, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Adriano Akira Ferreira Hino
- School of Medicine, Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
- Research Group of Physical Activity and Quality of Life, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
- Graduate Program in Health Technology, Polytechnic School, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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11
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Wu JY, Tang M, Touponse G, Theologitis M, Williamson T, Zygourakis CC. Socioeconomic disparities in lumbar fusion rates were exacerbated during the COVID-19 pandemic. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100321. [PMID: 38741936 PMCID: PMC11089397 DOI: 10.1016/j.xnsj.2024.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/16/2024]
Abstract
Background The COVID-19 pandemic disrupted healthcare access and utilization throughout the US, with variable impact on patients of different socioeconomic status (SES) and race. We characterize pre-pandemic and pandemic demographic and SES trends of lumbar fusion patients in the US. Methods Adults undergoing first-time lumbar fusion 1/1/2004-3/31/2021 were assessed in Clinformatics® Data Mart for patient age, geographical location, gender, race, education level, net worth, and Charlson Comorbidity Index (CCI). Multivariable regression models were used to evaluate the significance of trends over time, with a focus on pandemic trends 2020-2021 versus previous trends 2004-2019. Results The total 217,204 patients underwent lumbar fusions, 1/1/2004-3/31/2021. The numbers and per capita rates of lumbar fusions increased 2004-2019 and decreased in 2020 (first year of COVID-19 pandemic), with large variation in geographic distribution. There was overall a significant decrease in proportion of White patients undergoing lumbar fusion over time (OR=0.997, p<.001), though they were more likely to undergo surgery during the pandemic (OR=1.016, p<.001). From 2004-2021, patients were more likely to be educated beyond high school. Additionally, patients in the highest (>$500k) and lowest (<$25k) net worth categories had significantly more fusions over time (p<.001). During the pandemic (2020-2021), patients in higher net worth groups were more likely to undergo lumbar fusions ($150k-249k & $250k-499k: p<.001) whereas patients in the lowest net worth group had decreased rate of surgeries (p<.001). Lastly, patients' CCI increased significantly from 2004 to 2021 (coefficient=0.124, p<.001), and this trend held true during the pandemic (coefficient=0.179, p<.001). Conclusions To the best of our knowledge, our work represents the most comprehensive and recent characterization of SES variables in lumbar fusion rates. Unsurprisingly, lumbar fusions decreased overall with the onset of the COVID-19 pandemic. Importantly, disparities in fusion patients across patient race and wealth widened during the pandemic, reversing years of progress, a lesson we can learn for future public health emergencies.
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Affiliation(s)
- Janet Y. Wu
- School of Medicine, Stanford University Medical Center, 291 Campus Drive, Stanford, CA 94305, United States
| | - Megan Tang
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, United States
| | - Gavin Touponse
- School of Medicine, Stanford University Medical Center, 291 Campus Drive, Stanford, CA 94305, United States
| | - Marinos Theologitis
- School of Medicine, University of Crete, Voutes Campus, P.O. Box 2208, 71003 Heraklion, Crete, Greece
| | - Theresa Williamson
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Corinna C. Zygourakis
- Department of Neurosurgery, Stanford University Medical Center, 453 Quarry Road Palo Alto, CA 94304, United States
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12
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Jason K, Wilson M, Catoe J, Brown C, Gonzalez M. The Impact of the COVID-19 Pandemic on Black and Hispanic Americans' Work Outcomes: a Scoping Review. J Racial Ethn Health Disparities 2024; 11:1157-1172. [PMID: 37117935 PMCID: PMC10147367 DOI: 10.1007/s40615-023-01594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/30/2023]
Abstract
In early 2020, it was hypothesized that COVID-19 would lead to disproportionately negative health and work outcomes for Black and Hispanic adults, but sufficient data had yet been collected to fully support this claim. Now, we have empirical evidence, but little has been done to aggregate this information to fully understand its impact on these communities. Utilizing 44 articles from a scoping review of three databases (PubMed, Web of Science, and Business Source Complete), this study seeks to identify the primary work-related risks that help explain Black and Hispanic adults' disparate COVID-19-related work outcomes (e.g., loss of hours, job disruption, stress). Findings illuminate four primary risks faced by Black and Hispanic workers: (1) being an essential worker, (2) type of work performed, (3) workplace factors; and (4) community and geographic factors. We conclude with policy recommendations that will help inform policy and practice for economic recovery from the pandemic for other marginalized populations.
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Affiliation(s)
- Kendra Jason
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA.
| | - Miguel Wilson
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jamel Catoe
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Courtney Brown
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Mayleen Gonzalez
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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13
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Koks-Leensen MC, Menko A, Raaijmakers F, Fransen-Kuppens GA, Bevelander KE. An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis. JMIR Public Health Surveill 2024; 10:e44827. [PMID: 38607229 PMCID: PMC11176870 DOI: 10.2196/44827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/30/2024] [Accepted: 03/20/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information. OBJECTIVE This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys. METHODS A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems. RESULTS Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample's percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained. CONCLUSIONS General COVID-19-related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey's results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general.
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Affiliation(s)
- Monique Cj Koks-Leensen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
- Academic Collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, Netherlands
| | - Anouk Menko
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
- Academic Collaborative AMPHI - Integrated Health Policy, Nijmegen, Netherlands
| | - Fieke Raaijmakers
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
- Academic Collaborative AMPHI - Integrated Health Policy, Nijmegen, Netherlands
- Safety and Health Region Gelderland-Midden, Arnhem, Netherlands
| | - Gerdine Aj Fransen-Kuppens
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
- Academic Collaborative AMPHI - Integrated Health Policy, Nijmegen, Netherlands
- Municipal Health Service Gelderland Zuid, Nijmegen, Netherlands
| | - Kirsten E Bevelander
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
- Academic Collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, Netherlands
- Academic Collaborative AMPHI - Integrated Health Policy, Nijmegen, Netherlands
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14
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Alvandi M, Shaghaghi Z, Fatehi Z, Naghshtabrizi B, Mohammadi T, Nikzad S. Exploring the impact of recent COVID-19 infection on perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease. Ann Nucl Med 2024:10.1007/s12149-024-01946-0. [PMID: 38806866 DOI: 10.1007/s12149-024-01946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This study seeks to evaluate how recent COVID-19 infection affects myocardial perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease. The goal is to enhance our understanding of COVID-19's influence on the cardiovascular system. METHOD Conducted at Farshchian Heart Hospital from 2022 to 2023, this case-control study enrolled patients suspected of coronary artery disease, stratified into two groups: those with confirmed COVID-19 infection within the past 6 months (study group) and those without prior COVID-19 infection (control group). Employing a 2-day protocol, stress testing and gated SPECT MPI were performed. Statistical analysis included descriptive statistics, Chi-square test, Student's t test, and Mann-Whitney U test. RESULT Among the 86 patients included, 43 were in each group. Significantly higher summed stress core and summed difference score values were observed in the study group compared to the control group (p < 0.05). In addition, the study group exhibited significantly altered global left ventricular ejection fraction, end-diastolic volume, and end-systolic volume (p < 0.05). Non-perfusion findings, including transient ischemic dilation and transient right ventricular visualization, were more prevalent in the study group. CONCLUSION Recent COVID-19 infection is associated with impaired myocardial perfusion and altered functional parameters as detected by MPI. These findings underscore the intricate interplay between COVID-19 and cardiovascular health, emphasizing the importance of comprehensive evaluation and management strategies to address cardiac complications in affected individuals. Further research is warranted to elucidate the underlying mechanisms and optimize patient care in the context of COVID-19-associated cardiovascular manifestations.
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Affiliation(s)
- Maryam Alvandi
- Cardiovascular Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Shaghaghi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Zhino Fatehi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behshad Naghshtabrizi
- Clinical Research Development Unit of Farshchian Heart Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Tayeb Mohammadi
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Safoora Nikzad
- Department of Medical Physics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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15
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Brown RD, Pepper GV. The Uncontrollable Mortality Risk Hypothesis: Theoretical foundations and implications for public health. Evol Med Public Health 2024; 12:86-96. [PMID: 38807860 PMCID: PMC11132133 DOI: 10.1093/emph/eoae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
The 'Uncontrollable Mortality Risk Hypothesis' employs a behavioural ecological model of human health behaviours to explain the presence of social gradients in health. It states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviours. We outline the theoretical assumptions of the hypothesis and stress the importance of incorporating evolutionary perspectives into public health. We explain how measuring perceived uncontrollable mortality risk can contribute towards understanding socioeconomic disparities in preventative health behaviours. We emphasize the importance of addressing structural inequalities in risk exposure, and argue that public health interventions should consider the relationship between overall levels of mortality risk and health behaviours across domains. We suggest that measuring perceptions of uncontrollable mortality risk can capture the unanticipated health benefits of structural risk interventions, as well as help to assess the appropriateness of different intervention approaches.
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Affiliation(s)
- Richard D Brown
- Psychology Department, Northumbria University, Newcastle, UK
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16
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Akinyemi OA, Jones MD LS, Ochoa A, Nelson L, Weldeslase TA, Yousuf SJ. Socioeconomic Disparities and Emergency Department Visits for Diabetic Retinopathy in California. JOURNAL OF VITREORETINAL DISEASES 2024; 8:293-298. [PMID: 38770079 PMCID: PMC11102713 DOI: 10.1177/24741264241234132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To investigate the association between neighborhood-level socioeconomic factors, quantified by the Distressed Communities Index, and emergency department visits for diabetic retinopathy (DR). Methods: All patients who presented to the emergency department for DR in California were analyzed using the State Emergency Department Database (2018-2020). Patients were stratified by Distressed Communities Index score and DR severity. Logistic regression was applied to explore the independent correlation between Distressed Communities Index scores and proliferative DR (PDR). Results: Of 2 725 195 emergency department visits for diabetic patients, Distressed Communities Index data were available for 2 459 577 (90.3%); 39 693 were for DR, including 13 617 (34.3%) for PDR. Hispanics (44.2%) were the largest racial/ethnic group to present for PDR, followed by non-Hispanic Whites (19.6%) and non-Hispanic Blacks (19.3%). A significant association was observed between the Distressed Communities Index and emergency department visits for PDR, with distressed neighborhoods having the highest incidence (adjusted odds ratio [aOR], 1.63; 95% CI, 1.20-2.23; P = .001). Other predictors included Hispanic ethnicity (aOR, 2.21; 95% CI, 1.97-2.48; P < .001) and Black race (aOR, 1.46; 95% CI, 1.28-1.67; P < .001) compared with White race and having Medicaid (aOR, 1.37; 95% CI, 1.13-1.65; P = .001) compared with private insurance. Conclusions: The Distressed Communities Index identified patients residing in the most distressed neighborhoods as being at the highest risk for presenting to the emergency department for PDR based on 7 socioeconomic factors. Policymakers may consider the Distressed Communities Index as a tool for targeting DR prevention strategies and improving healthcare accessibility.
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Affiliation(s)
- Oluwasegun A. Akinyemi
- The Clive O. Callender, M.D., Howard-Harvard Health Sciences Outcomes Research Center, Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Leslie S. Jones MD
- Department of Ophthalmology, Howard University College of Medicine, Washington, DC, USA
| | - Alejandro Ochoa
- Department of Ophthalmology, Howard University College of Medicine, Washington, DC, USA
| | - Luke Nelson
- Howard University College of Medicine, Washington, DC, USA
| | - Terhas A. Weldeslase
- The Clive O. Callender, M.D., Howard-Harvard Health Sciences Outcomes Research Center, Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Salman J. Yousuf
- Department of Ophthalmology, Howard University College of Medicine, Washington, DC, USA
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Sun Y, Liu W, Zhang G, Shi P. The Inverted U-Shaped Relationship Between Socio-Economic Status and Infections During the COVID-19 Pandemic. GEOHEALTH 2024; 8:e2024GH001025. [PMID: 38784719 PMCID: PMC11114092 DOI: 10.1029/2024gh001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
Although the World Health Organization has declared that the COVID-19 pandemic no longer qualifies as a global public health emergency, it still needs to explore the response of society to the COVID-19 pandemic. Socio-economic status (SES) was proven to be linearly associated with the COVID-19 pandemic, although this relationship may be more complex due to regional differences. In the study, we analyzed and revealed the effects and mechanisms of SES on infections among low, lower-middle, upper-middle and high SES group (LSG, LMSG, UMSG, and HSG, respectively). The results showed that the relationship between SES and infections was inverted U-shaped, especially in the first three phases. In Phase I, UMSG had the highest number of infections, with an average of 238.31/1M people (95%CI: 135.47-341.15/1M people). In Phases II and III, infections decreased insignificantly with increasing SES (r = -0.01, p = 0.92; r = -0.11, p = 0.22) and the highest number of infections were found in the LMSG. In Phase IV, SES was positively related to the number of infections (r = 0.54, p < 0.001). Furthermore, the nonlinear impact of multiple factors related to SES on the infections explains the complex relationships between SES and infections. SES affected infections mainly through medical resources, demographics and vaccination, and differed across the SES groups. Particularly, demographics could exert an impact on population mobility, subsequently influencing infections in LMSG, with an indirect effect of 0.01 (p < 0.05) in Phase II. This study argues for greater attention to countries with middle SES and the need for future targeted measures to cope with infectious diseases.
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Affiliation(s)
- Yelin Sun
- State Key Laboratory of Earth Surface Processes and Resource EcologyBeijing Normal UniversityBeijingChina
- Faculty of Geographical ScienceBeijing Normal UniversityBeijingChina
- Academy of Disaster Reduction and Emergency ManagementMinistry of Emergency Management & Ministry of EducationBeijing Normal UniversityBeijingChina
| | - Weihang Liu
- State Key Laboratory of Earth Surface Processes and Resource EcologyBeijing Normal UniversityBeijingChina
- Faculty of Geographical ScienceBeijing Normal UniversityBeijingChina
- Academy of Disaster Reduction and Emergency ManagementMinistry of Emergency Management & Ministry of EducationBeijing Normal UniversityBeijingChina
| | - Gangfeng Zhang
- State Key Laboratory of Earth Surface Processes and Resource EcologyBeijing Normal UniversityBeijingChina
- Faculty of Geographical ScienceBeijing Normal UniversityBeijingChina
- Academy of Disaster Reduction and Emergency ManagementMinistry of Emergency Management & Ministry of EducationBeijing Normal UniversityBeijingChina
| | - Peijun Shi
- State Key Laboratory of Earth Surface Processes and Resource EcologyBeijing Normal UniversityBeijingChina
- Faculty of Geographical ScienceBeijing Normal UniversityBeijingChina
- Academy of Disaster Reduction and Emergency ManagementMinistry of Emergency Management & Ministry of EducationBeijing Normal UniversityBeijingChina
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Marsall M, Dinse H, Schröder J, Skoda EM, Teufel M, Bäuerle A. Assessing Electronic Health Literacy in Individuals With the Post-COVID-19 Condition Using the German Revised eHealth Literacy Scale: Validation Study. JMIR Form Res 2024; 8:e52189. [PMID: 38662429 PMCID: PMC11082733 DOI: 10.2196/52189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/12/2024] [Accepted: 02/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The eHealth Literacy Scale (eHEALS) is a widely used instrument for measuring eHealth literacy (eHL). However, little is known so far about whether the instrument is valid for the assessment of eHL in persons who are affected by the post-COVID-19 condition. This is particularly important as people with the post-COVID-19 condition are frequently affected by false information from the internet. OBJECTIVE The objective of our study was to evaluate the validity and reliability of the German Revised eHealth Literacy Scale (GR-eHEALS) in individuals with the post-COVID-19 condition. METHODS A cross-sectional study was conducted from January to May 2022. The self-assessment survey consisted of the GR-eHEALS, health status- and internet use-related variables, sociodemographic data, and (post)-COVID-19-related medical data. Confirmatory factor analysis (CFA), correlational analyses, and tests of measurement invariance were deployed. RESULTS In total, 330 participants were included in the statistical analyses. CFA revealed that the 2-factor model reached an excellent model fit (comparative fit index=1.00, Tucker-Lewis index=0.99, root mean square error of approximation=0.036, standardized root mean square residual=0.038). Convergent validity was confirmed by significant positive correlations between eHL and knowledge of internet-based health promotion programs, experience in using these programs, and the duration of private internet use. In addition, a significantly negative relationship of eHL with internet anxiety supported convergent validity. Further, significant relationships of eHL with mental health status and internal health locus of control confirmed the criterion validity of the instrument. However, relationships of eHL with physical health status and quality of life could not be confirmed. The 2-factor model was fully measurement invariant regarding gender. Regarding age and educational level, partial measurement invariance was confirmed. The subscales as well as the overall GR-eHEALS reached good-to-excellent reliability (Cronbach α≥.86). CONCLUSIONS The GR-eHEALS is a reliable and largely valid instrument for assessing eHL in individuals with the post-COVID-19 condition. Measurement invariance regarding gender was fully confirmed and allows the interpretation of group differences. Regarding age and educational level, group differences should be interpreted with caution. Given the high likelihood that individuals with the post-COVID-19 condition will be confronted with misinformation on the Internet, eHL is a core competency that is highly relevant in this context, in both research and clinical practice. Therefore, future research should also explore alternative instruments to capture eHL to overcome shortcomings in the validity of the GR-eHEALS.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Hannah Dinse
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Julia Schröder
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
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19
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Baymon DE, Vakkalanka JP, Krishnadasan A, Mohr NM, Talan DA, Hagen MB, Wallace K, Harland KK, Aisiku IP, Hou PC. Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers. JAMA Netw Open 2024; 7:e245697. [PMID: 38598239 PMCID: PMC11007575 DOI: 10.1001/jamanetworkopen.2024.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Access to COVID-19 testing is critical to reducing transmission and supporting early treatment decisions; when made accessible, the timeliness of testing may also be an important metric in mitigating community spread of the infection. While disparities in transmission and outcomes of COVID-19 have been well documented, the extent of timeliness of testing and the association with demographic factors is unclear. Objectives To evaluate demographic factors associated with delayed COVID-19 testing among health care personnel (HCP) during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study used data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing study, a multicenter, test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms and testing between December 2020 and April 2022. Data analysis was conducted from March 2022 to Junne 2023. Exposure Displaying COVID-19-like symptoms and polymerase chain reaction testing occurring from the first day symptoms occurred up to 14 days after symptoms occurred. Main Outcomes and Measures Variables of interest included patient demographics (sex, age, and clinical comorbidities) and COVID-19 characteristics (vaccination status and COVID-19 wave). The primary outcome was time from symptom onset to COVID-19 testing, which was defined as early testing (≤2 days) or delayed testing (≥3 days). Associations of demographic characteristics with delayed testing were measured while adjusting for clinical comorbidities, COVID-19 characteristics, and test site using multivariable modeling to estimate relative risks and 95% CIs. Results A total of 5551 HCP (4859 female [82.9%]; 1954 aged 25-34 years [35.2%]; 4233 non-Hispanic White [76.3%], 370 non-Hispanic Black [6.7%], and 324 non-Hispanic Asian [5.8%]) were included in the final analysis. Overall, 2060 participants (37.1%) reported delayed testing and 3491 (62.9%) reported early testing. Compared with non-Hispanic White HCP, delayed testing was higher among non-Hispanic Black HCP (adjusted risk ratio, 1.18; 95%CI, 1.10-1.27) and for non-Hispanic HCP of other races (adjusted risk ratio, 1.17; 95% CI, 1.03-1.33). Sex and age were not associated with delayed testing. Compared with clinical HCP with graduate degrees, all other professional and educational groups had significantly delayed testing. Conclusions and Relevance In this cross-sectional study of HCP, compared with non-Hispanic White HCP and clinical HCP with graduate degrees, non-Hispanic Black HCP, non-Hispanic HCP of other races, and HCP all other professional and education backgrounds were more likely to have delayed COVID-19 testing. These findings suggest that time to testing may serve as a valuable metric in evaluating sociodemographic disparities in the response to COVID-19 and future health mitigation strategies.
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Affiliation(s)
- DaMarcus E. Baymon
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - J. Priyanka Vakkalanka
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Anusha Krishnadasan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
| | - Nicholas M. Mohr
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
- Department of Anesthesia Critical Care, Carver College of Medicine, University of Iowa, Iowa City
| | - David A. Talan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
- David Geffen School of Medicine, University of California, Los Angeles
| | - Melissa Briggs Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Kelli Wallace
- University of Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City
| | - Karisa K. Harland
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Imoigele P. Aisiku
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter C. Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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20
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Bann D, Wright L, Hughes A, Chaturvedi N. Socioeconomic inequalities in cardiovascular disease: a causal perspective. Nat Rev Cardiol 2024; 21:238-249. [PMID: 37821646 DOI: 10.1038/s41569-023-00941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Socioeconomic inequalities in cardiovascular disease (CVD) persist in high-income countries despite marked overall declines in CVD-related morbidity and mortality. After decades of research, the field has struggled to unequivocally answer a crucial question: is the association between low socioeconomic position (SEP) and the development of CVD causal? We review relevant evidence from various study designs and disciplinary perspectives. Traditional observational, family-based and Mendelian randomization studies support the widely accepted view that low SEP causally influences CVD. However, results from quasi-experimental and experimental studies are both limited and equivocal. While more experimental and quasi-experimental studies are needed to aid causal understanding and inform policy, high-quality descriptive studies are also required to document inequalities, investigate their contextual dependence and consider SEP throughout the lifespan; no simple hierarchy of evidence exists for an exposure as complex as SEP. The COVID-19 pandemic illustrates the context-dependent nature of CVD inequalities, with the generation of potentially new causal pathways linking SEP and CVD. The linked goals of understanding the causal nature of SEP and CVD associations, their contextual dependence, and their remediation by policy interventions necessitate a detailed understanding of society, its change over time and the phenotypes of CVD. Interdisciplinary research is therefore key to advancing both causal understanding and policy translation.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK.
| | - Liam Wright
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
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21
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Wang W, Wang YH, Huang CH, Hsieh TH, Ibarburu GH, Wei JCC. Paxlovid use is associated with lower risk of cardiovascular diseases in COVID-19 patients with autoimmune rheumatic diseases: a retrospective cohort study. BMC Med 2024; 22:117. [PMID: 38481216 PMCID: PMC10938827 DOI: 10.1186/s12916-024-03331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Paxlovid has been shown to be effective in reducing mortality and hospitalization rates in patients with coronavirus disease 2019 (COVID-19). It is not known whether Paxlovid can reduce the risk of cardiovascular diseases (CVD) in COVID-19-surviving patients with autoimmune rheumatic diseases (AIRDs). METHODS TriNetX data from the US Collaborative Network were used in this study. A total of 5,671,395 patients with AIRDs were enrolled between January 1, 2010, and December 31, 2021. People diagnosed with COVID-19 were included in the cohort (n = 238,142) from January 1, 2022, to December 31, 2022. The Study population was divided into two groups based on Paxlovid use. Propensity score matching was used to generate groups with matched baseline characteristics. The hazard ratios (HRs) and 95% confidence intervals of cardiovascular outcomes, admission rate, mortality rate, and intensive care unit (ICU) admission rate were calculated between Paxlovid and non-Paxlovid groups. Subgroup analyses on sex, age, race, autoimmune diseases group, and sensitivity analyses for Paxlovid use within the first day or within 2-5 days of COVID-19 diagnosis were performed. RESULTS Paxlovid use was associated with lower risks of cerebrovascular complications (HR = 0.65 [0.47-0.88]), arrhythmia outcomes (HR = 0.81 [0.68-0.94]), ischemic heart disease, other cardiac disorders (HR = 0.51 [0.35-0.74]) naming heart failure (HR = 0.41 [0.26-0.63]) and deep vein thrombosis (HR = 0.46 [0.24-0.87]) belonging to thrombotic disorders in AIRD patients with COVID-19. Compared with the Non-Paxlovid group, risks of major adverse cardiac events (HR = 0.56 [0.44-0.70]) and any cardiovascular outcome mentioned above (HR = 0.76 [0.66-0.86]) were lower in the Paxlovid group. Moreover, the mortality (HR = 0.21 [0.11-0.40]), admission (HR = 0.68 [0.60-0.76]), and ICU admission rates (HR = 0.52 [0.33-0.80]) were significantly lower in the Paxlovid group than in the non-Paxlovid group. Paxlovid appears to be more effective in male, older, and Black patients with AIRD. The risks of cardiovascular outcomes and severe conditions were reduced significantly with Paxlovid prescribed within the first day of COVID-19 diagnosis. CONCLUSIONS Paxlovid use is associated with a lower risk of CVDs and severe conditions in COVID-19-surviving patients with AIRD.
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Affiliation(s)
- Weijie Wang
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Science, Beijing, China
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Hua Huang
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Tsung-Hsueh Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | | | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
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22
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Pucciarelli DM, Ramasubramani R, Trautmann CH. Associations Between Psychopathological Symptom Severity Amid the Pandemic and the Childhood Sociodemographic Environment. Cureus 2024; 16:e56458. [PMID: 38638738 PMCID: PMC11024765 DOI: 10.7759/cureus.56458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
It is well-documented that childhood socioeconomic status (SES) is associated with various health conditions in adulthood. Here, we examine the extent to which childhood SES is associated with COVID-19 pandemic anxiety and depression. Participants (n = 212), recruited from Amazon Mechanical Turk, were assessed for depression and anxiety in February 2022 for both the current context and retrospective self-perceived early pandemic depression and anxiety (April 2020). Participants also reported childhood SES and current demographics. Consistent with predated findings, we show a strong, positive correlation between depression and anxiety under both conditions. Paternal unemployment in childhood was associated with increased anxiety, while maternal occupation was not. High household education in childhood was generally associated with greater anxiety and depression, similar to past studies examining education levels and depression. However, the shift from high school to post-secondary degrees (trade school and associate's) was associated with decreased anxiety and depression, which may reflect "essential work" careers, therefore indicating a dualism. Growing up in crowded, de-individualized spaces was associated with lower anxiety and depression, suggesting better conditioning for the imposition of COVID-19 quarantines. Pandemic-related unemployment was associated with an increase in anxiety and depression. Strong political views, regardless of ideology, were associated with increased anxiety. Finally, participants in our cohort perceived their mental health to be worse in the early pandemic for anxiety and depression, up 6.6% and 7.9%, respectively. Our work suggests a complex relationship between SES, demographics, and anxiety and depression during the pandemic. These findings emphasize the importance of exploring the dynamics between early SES and mental health in adulthood, particularly during extended societal stressors.
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23
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Frey A, Tilstra AM, Verhagen MD. Inequalities in healthcare use during the COVID-19 pandemic. Nat Commun 2024; 15:1894. [PMID: 38424038 PMCID: PMC10904793 DOI: 10.1038/s41467-024-45720-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
The COVID-19 pandemic led to reductions in non-COVID related healthcare use, but little is known whether this burden is shared equally. This study investigates whether reductions in administered care disproportionately affected certain sociodemographic strata, in particular marginalised groups. Using detailed medical claims data from the Dutch universal health care system and rich full population registry data, we predict expected healthcare use based on pre-pandemic trends (2017 - Feb 2020) and compare these expectations with observed healthcare use in 2020 and 2021. Our findings reveal a 10% decline in the number of weekly treated patients in 2020 and a 3% decline in 2021 relative to prior years. These declines are unequally distributed and are more pronounced for individuals below the poverty line, females, older people, and individuals with a migrant background, particularly during the initial wave of COVID-19 hospitalisations and for middle and low urgency procedures. While reductions in non-COVID related healthcare decreased following the initial shock of the pandemic, inequalities persist throughout 2020 and 2021. Our results demonstrate that the pandemic has not only had an unequal toll in terms of the direct health burden of the pandemic, but has also had a differential impact on the use of non-COVID healthcare.
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Affiliation(s)
- Arun Frey
- Leverhulme Centre for Demographic Science, 42 Park End St, Oxford, OX1 1JD, UK
- Nuffield College, University of Oxford, 1 New Rd, Oxford, OX1 1NF, UK
- Amsterdam Health and Technology Institute, Paasheuvelweg 25, Amsterdam, 1105 BP, The Netherlands
- Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, USA
- Department of Sociology, University of Oxford, 42 Park End St, Oxford, OX3 7LF, UK
| | - Andrea M Tilstra
- Leverhulme Centre for Demographic Science, 42 Park End St, Oxford, OX1 1JD, UK
- Nuffield College, University of Oxford, 1 New Rd, Oxford, OX1 1NF, UK
- Department of Sociology, University of Oxford, 42 Park End St, Oxford, OX3 7LF, UK
- Nuffield Department of Population Health, University of Oxford, 42 Park End St, Oxford, OX1 1JD, UK
| | - Mark D Verhagen
- Leverhulme Centre for Demographic Science, 42 Park End St, Oxford, OX1 1JD, UK.
- Nuffield College, University of Oxford, 1 New Rd, Oxford, OX1 1NF, UK.
- Amsterdam Health and Technology Institute, Paasheuvelweg 25, Amsterdam, 1105 BP, The Netherlands.
- Department of Sociology, University of Oxford, 42 Park End St, Oxford, OX3 7LF, UK.
- Nuffield Department of Population Health, University of Oxford, 42 Park End St, Oxford, OX1 1JD, UK.
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24
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Morrow AJ, Sykes R, Saleh M, Zahra B, MacIntosh A, Kamdar A, Bagot C, Bayes HK, Blyth KG, Bulluck H, Carrick D, Church C, Corcoran D, Findlay I, Gibson VB, Gillespie L, Grieve D, Barrientos PH, Ho A, Lang NN, Lowe DJ, Lennie V, Macfarlane PW, Mayne KJ, Mark PB, McConnachie A, McGeoch R, Nordin S, Payne A, Rankin AJ, Robertson K, Ryan N, Roditi G, Sattar N, Stobo D, Allwood-Spiers S, Touyz RM, Veldtman G, Weeden S, Weir R, Watkins S, Welsh P, Mangion K, Berry C. Socioeconomic deprivation and illness trajectory in the Scottish population after COVID-19 hospitalization. COMMUNICATIONS MEDICINE 2024; 4:32. [PMID: 38418616 PMCID: PMC10901805 DOI: 10.1038/s43856-024-00455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain. METHODS A prospective, multicentre cohort study was conducted on post-COVID-19 patients, enrolled either in-hospital or shortly post-discharge. Two evaluations were carried out: an initial assessment and a follow-up at 28-60 days post-discharge. The study encompassed research blood tests, patient-reported outcome measures, and multisystem imaging (including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging). Primary and secondary outcomes were analysed in relation to socioeconomic status, using the Scottish Index of Multiple Deprivation (SIMD). The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. RESULTS Of the 252 enrolled patients (mean age 55.0 ± 12.0 years; 40% female; 23% with diabetes), deprivation status was linked with increased BMI and diabetes prevalence. 186 (74%) returned for the follow-up. Within this group, findings indicated associations between deprivation and lung abnormalities (p = 0.0085), coronary artery disease (p = 0.0128), and renal inflammation (p = 0.0421). Furthermore, patients with higher deprivation exhibited worse scores in health-related quality of life (EQ-5D-5L, p = 0.0084), illness perception (BIPQ, p = 0.0004), anxiety and depression levels (PHQ-4, p = 0.0038), and diminished physical activity (DASI, p = 0.002). At the 3-month mark, those with greater deprivation showed a higher frequency of referrals to secondary care due to ongoing COVID-19 symptoms (p = 0.0438). However, clinical outcomes were not influenced by deprivation. CONCLUSIONS In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.
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Affiliation(s)
- Andrew J Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Merna Saleh
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Baryab Zahra
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Anna Kamdar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Hannah K Bayes
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - David Carrick
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - David Corcoran
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain Findlay
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Vivienne B Gibson
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, UK
| | - Lynsey Gillespie
- Project Management Unit, Glasgow Clinical Research Facility, Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Douglas Grieve
- Department of Respiratory Medicine, Royal Alexandra Hospital, Glasgow, UK
| | | | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Vera Lennie
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Peter W Macfarlane
- Electrocardiology Core Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kaitlin J Mayne
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ross McGeoch
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Sabrina Nordin
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alexander Payne
- Department of Cardiology, University Hospital Crosshouse, Kilmarnock, UK
| | - Alastair J Rankin
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Keith Robertson
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Giles Roditi
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - David Stobo
- Department of Radiology, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | | | - Rhian M Touyz
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Service, NHS Golden Jubilee, Clydebank, UK
| | - Sarah Weeden
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Robin Weir
- Regional Heart and Lung Centre, NHS Golden Jubilee, Clydebank, UK
| | - Stuart Watkins
- Department of Cardiology, Royal Alexandra Hospital, Paisley, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK.
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25
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Williams MK, Crawford CA, Zapolski TC, Hirsh AT, Stewart JC. Longer-Term Mental Health Consequences of COVID-19 Infection: Moderation by Race and Socioeconomic Status. Int J Behav Med 2024:10.1007/s12529-024-10271-9. [PMID: 38396274 DOI: 10.1007/s12529-024-10271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE While evidence suggests that the mental health symptoms of COVID-19 can persist for several months following infection, little is known about the longer-term mental health effects and whether certain sociodemographic groups may be particularly impacted. This cross-sectional study aimed to characterize the longer-term mental health consequences of COVID-19 infection and examine whether such consequences are more pronounced in Black people and people with lower socioeconomic status. METHODS 277 Black and White adults (age ≥ 30 years) with a history of COVID-19 (tested positive ≥ 6 months prior to participation) or no history of COVID-19 infection completed a 45-minute online questionnaire battery. RESULTS People with a history of COVID-19 had greater depressive (d = 0.24), anxiety (d = 0.34), post-traumatic stress disorder (PTSD) (d = 0.32), and insomnia (d = 0.31) symptoms than those without a history of COVID-19. These differences remained for anxiety, PTSD, and insomnia symptoms after adjusting for age, sex, race, education, income, employment status, body mass index, and smoking status. No differences were detected for perceived stress and general psychopathology. People with a history of COVID-19 had more than double the odds of clinically significant symptoms of anxiety (OR = 2.22) and PTSD (OR = 2.40). Education, but not race, income, or employment status, moderated relationships of interest such that COVID-19 status was more strongly and positively associated with all the mental health outcomes for those with fewer years of education. CONCLUSION The mental health consequences of COVID-19 may be significant, widespread, and persistent for at least 6 months post-infection and may increase as years of education decreases.
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Affiliation(s)
- Michelle K Williams
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA
| | - Christopher A Crawford
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA
| | - Tamika C Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA.
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Brown R, Pepper G. The Relationship Between Perceived Uncontrollable Mortality Risk and Health Effort: Replication, Secondary Analysis, and Mini Meta-analysis. Ann Behav Med 2024; 58:192-204. [PMID: 38190133 PMCID: PMC10858306 DOI: 10.1093/abm/kaad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied. PURPOSE To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort. METHODS We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale-a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research. RESULTS PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort. CONCLUSIONS Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk.
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Affiliation(s)
- Richard Brown
- Psychology Department, Northumbria University, Newcastle, UK
| | - Gillian Pepper
- Psychology Department, Northumbria University, Newcastle, UK
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Wu JY, Touponse GC, Theologitis M, Ahmad HS, Zygourakis CC. Demographic and Socioeconomic Trends in Cervical Fusion Utilization from 2004 Through 2021 and the COVID-19 Pandemic. World Neurosurg 2024; 182:e107-e125. [PMID: 38000672 DOI: 10.1016/j.wneu.2023.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Cervical fusion rates increased in the U.S. exponentially 1990-2014, but trends leading up to/during the COVID-19 pandemic have not been fully evaluated by patient socioeconomic status (SES). Here, we provide the most recent, comprehensive characterization of demographic and SES trends in cervical fusions, including during the pandemic. METHODS We collected the following variables on adults undergoing cervical fusions, 1/1/2004-3/31/2021, in Optum's Clinformatics Data Mart: age, Charlson Comorbidity Index, provider's practicing state, gender, race, education, and net worth. We performed multivariate linear and logistic regression to evaluate associations of cervical fusion rates with SES variables. RESULTS Cervical fusion rates increased 2004-2016, then decreased 2016-2020. Proportions of Asian, Black, and Hispanic patients undergoing cervical fusions increased (OR = 1.001,1.001,1.004, P < 0.01), with a corresponding decrease in White patients (OR = 0.996, P < 0.001) over time. There were increases in cervical fusions in higher education groups (OR = 1.006, 1.002, P < 0.001) and lowest net worth group (OR = 1.012, P < 0.001). During the pandemic, proportions of White (OR = 1.015, P < 0.01) and wealthier patients (OR ≥ 1.015, P < 0.01) undergoing cervical fusions increased. CONCLUSIONS We present the first documented decrease in annual cervical surgery rates in the U.S. Our data reveal a bimodal distribution for cervical fusion patients, with racial-minority, lower-net-worth, and highly-educated patients receiving increasing proportions of surgical interventions. White and wealthier patients were more likely to undergo cervical fusions during the COVID-19 pandemic, which has been reported in other areas of medicine but not yet in spine surgery. There is still considerable work needed to improve equitable access to spine care for the entire U.S. POPULATION
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Affiliation(s)
- Janet Y Wu
- School of Medicine, Stanford University, Stanford, California, USA
| | - Gavin C Touponse
- School of Medicine, Stanford University, Stanford, California, USA
| | | | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
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Almeida A. The trade-off between health system resiliency and efficiency: evidence from COVID-19 in European regions. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:31-47. [PMID: 36729309 PMCID: PMC9893956 DOI: 10.1007/s10198-023-01567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The objective of this paper was to investigate the existence of a trade-off between health system resilience and the economic efficiency of the health system, using data for 173 regions in the European Union and the European Free Trade Association countries. Data Envelopment Analysis was used to measure the efficiency of regional health systems before the COVID-19 pandemic. Then, a spatial econometrics model was used to estimate whether this measure of efficiency, adjusted for several covariates, has a significant impact on regional health system resilience during the COVID-19 pandemic, measured by the number of COVID-19 deaths per hundred thousand inhabitants. The results show that COVID-19 death rates were significantly higher in regions with higher population density, higher share of employment in industry, and higher share of women in the population. Results also show that regions with higher values of the health system efficiency index in 2017 had significantly higher rates of COVID-19 deaths in 2020 and 2021, suggesting the existence of a trade-off between health system efficiency and health system resilience during the COVID-19 pandemic.
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Affiliation(s)
- Alvaro Almeida
- Cef.up Center for Economics and Finance at UPorto, Rua Dr. Roberto Frias, 4200-464, Porto, Portugal.
- Faculdade de Economia, Universidade do Porto, 4200-464, Porto, Portugal.
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O’Laughlin KN, Klabbers RE, Ebna Mannan I, Gentile NL, Geyer RE, Zheng Z, Yu H, Li SX, Chan KCG, Spatz ES, Wang RC, L’Hommedieu M, Weinstein RA, Plumb ID, Gottlieb M, Huebinger RM, Hagen M, Elmore JG, Hill MJ, Kelly M, McDonald S, Rising KL, Rodriguez RM, Venkatesh A, Idris AH, Santangelo M, Koo K, Saydah S, Nichol G, Stephens KA. Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection. Front Public Health 2024; 11:1324636. [PMID: 38352132 PMCID: PMC10861779 DOI: 10.3389/fpubh.2023.1324636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Data on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection. Methods Participants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point. Results Following SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36-2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06-2.02; much less, OR: 2.23; 95%CI: 1.38-3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25-2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21-2.46; much less, OR: 2.08; 95%CI: 1.18-3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13-3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60-5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10-3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02-2.51; much less, OR: 2.49; 95%CI: 1.40-4.44), and more missed work (OR: 2.25; 95%CI: 1.27-3.98). Discussion Awareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.
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Affiliation(s)
- Kelli N. O’Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Robin E. Klabbers
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Imtiaz Ebna Mannan
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Nicole L. Gentile
- Department of Family Medicine, University of Washington, Seattle, WA, United States
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
- Post-COVID Rehabilitation and Recovery Clinic, University of Washington, Seattle, WA, United States
| | - Rachel E. Geyer
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Zihan Zheng
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Kwun C. G. Chan
- Department of Biostatistics, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Erica S. Spatz
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Ralph C. Wang
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michelle L’Hommedieu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Robert A. Weinstein
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Medicine, Cook County Hospital, Chicago, IL, United States
| | - Ian D. Plumb
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Ryan M. Huebinger
- UTHealth Houston McGovern Medical School Department of Emergency Medicine, Houston, TX, United States
| | - Melissa Hagen
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Joann G. Elmore
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Mandy J. Hill
- UTHealth Houston McGovern Medical School Department of Emergency Medicine, Houston, TX, United States
| | - Morgan Kelly
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Samuel McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kristin L. Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
- Center for Connected Care, Thomas Jefferson University, Philadelphia, PA, United States
| | - Robert M. Rodriguez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Arjun Venkatesh
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Ahamed H. Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michelle Santangelo
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Katherine Koo
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Sharon Saydah
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Graham Nichol
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington, Seattle, WA, United States
- Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
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Inoue LH, Baccon WC, Pesce GB, Pereira ND, Silva IVTC, Salci MA, Vissoci JRN, Facchini LA, Carreira L. Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. Rev Esc Enferm USP 2024; 57:e20230036. [PMID: 38265117 PMCID: PMC10807406 DOI: 10.1590/1980-220x-reeusp-2023-0036en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To estimate the prevalence and to analyze the factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. METHOD Cross-sectional study conducted with secondary data from older people with a positive diagnosis of Covid-19 living in the State of Paraná, collected from March 1, 2020 to August 31, 2021. Prevalence ratios were obtained by adjusting the regression model. RESULTS A total of 16,153 deaths of older people hospitalized in the State of Paraná were analyzed. The adjusted model revealed an association between death and some factors such as: belonging to the age group of 75 to 84 years (PR = 1.28; CI95% = 1.24-1.32) and 85 years or over (PR = 1.52; CI95% = 1.45-1.59); male (PR = 1.17; CI95% = 1.13-1.21); obesity (PR = 1.23; CI95% = 1.16-1.29); other morbidities (PR = 1.25; CI95% = 1.20-1.30); and having used ventilatory support (PR = 2.60; CI95% = 2.33-2.86). Older people vaccinated against influenza had a probability of death reduced by 11% (PR = 0.89; CI95% = 0.86-0.93). CONCLUSION The association of age, sex, and diagnosis of previous comorbidities with unfavorable outcomes from Covid-19 was identified. Having received the flu vaccine provided protection to elderly people who contracted SARS-CoV-2.
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Aronoff JE, McDade TW, Adair LS, Lee NR, Carba DB, MacIsaac JL, Dever K, Atashzay P, Kobor MS, Kuzawa CW. Socioeconomic status is negatively associated with immunosenescence but positively associated with inflammation among middle-aged women in Cebu, Philippines. Brain Behav Immun 2024; 115:101-108. [PMID: 37820972 PMCID: PMC10841485 DOI: 10.1016/j.bbi.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) gradients in health are well-documented, and while biological pathways are incompletely understood, chronic inflammation and accelerated immune aging (immunosenescence) among lower SES individuals have been implicated. However, previous findings have come from samples in higher income countries, and it is unclear how generalizable they are to lower- and middle-income countries (LMIC) with different infectious exposures and where adiposity-an important contributor to chronic inflammation-might show different SES patterning. To address this gap, we explored associations between SES and inflammation and immunosenescence in a sample of women in Cebu, Philippines. METHODS Data came from the mothers of the Cebu Longitudinal Health and Nutrition Survey birth cohort (mean age: 47.7, range: 35-69 years). SES was measured as a combination of annual household income, education level, and assets. Chronic inflammation was measured using C-reactive protein (CRP) in plasma samples from 1,834 women. Immunosenescence was measured by the abundance of exhausted CD8T (CD8 + CD28-CD45RA-) and naïve CD8T and CD4T cells, estimated from DNA methylation in whole blood in a random subsample of 1,028. Possible mediators included waist circumference and a collection of proxy measures of pathogen exposure. RESULTS SES was negatively associated with the measures of immunosenescence, with slight evidence for mediation by a proxy measure for pathogen exposure from the household's drinking water source. In contrast, SES was positively associated with CRP, which was explained by the positive association with waist circumference. CONCLUSIONS Similar to higher income populations, in Cebu there is an SES-gradient in pathogen exposures and immunosenescence. However, lifestyle changes occurring more rapidly among higher SES individuals is contributing to a positive association between SES and adiposity and inflammation. Our results suggest more studies are needed to clarify the relationship between SES and inflammation and immunosenescence across LMIC.
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Affiliation(s)
- Jacob E Aronoff
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA.
| | - Thomas W McDade
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, CB #8120, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nanette R Lee
- Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | - Delia B Carba
- Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | - Julia L MacIsaac
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Edwin S.H. Leong Centre for Healthy Aging, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Molecular Medicine and Therapeutics, Vancouver, British Columbia, Canada
| | - Kristy Dever
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Edwin S.H. Leong Centre for Healthy Aging, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Molecular Medicine and Therapeutics, Vancouver, British Columbia, Canada
| | - Parmida Atashzay
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Edwin S.H. Leong Centre for Healthy Aging, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Molecular Medicine and Therapeutics, Vancouver, British Columbia, Canada
| | - Michael S Kobor
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Edwin S.H. Leong Centre for Healthy Aging, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Molecular Medicine and Therapeutics, Vancouver, British Columbia, Canada
| | - Christopher W Kuzawa
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA
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Nyunt G, McMillen J, Oplt K, Beckham V. Flourishing (or lack thereof) during COVID-19: College students'social-psychological well-being during the Fall 2020 semester. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:177-187. [PMID: 35026969 DOI: 10.1080/07448481.2021.2024548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 10/22/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Objective: This exploratory quantitative study examined college students' social-psychological well-being during the COVID-19 pandemic. Participants: The sample included 1,723 students (undergraduate and graduate) at a public research university. Methods: Paired samples t-test were utilized to compare students' social-psychological well-being pre-pandemic, at the start of the Fall 2020 semester, and toward the end of the Fall 2020 semester. Regression analyses were utilized to identify predictors of students' social-psychological well-being at the start and toward the end of the Fall 2020 semester. Results: Students experienced a significant decrease in social-psychological well-being pre-pandemic to the start of the Fall 2020 semester and most had not returned to pre-pandemic levels toward the end of the semester. While demographics, housing arrangements, and course modality impacted social-psychological well-being, they only explained a small percentage of the variance in students' well-being. Conclusion: Students continued to experience low mental well-being during the Fall 2020 semester.
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Affiliation(s)
- Gudrun Nyunt
- Counseling and Higher Education, Northern Illinois University, DeKalb, Illinois, USA
| | - Jeanine McMillen
- Counseling and Higher Education, Northern Illinois University, DeKalb, Illinois, USA
| | - Kaley Oplt
- Counseling and Higher Education, Northern Illinois University, DeKalb, Illinois, USA
| | - Vanessa Beckham
- Counseling and Higher Education, Northern Illinois University, DeKalb, Illinois, USA
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Yuan J, Zhou J, Zhang T, Ju X, Xu D. An online questionnaire survey on the sexual function of Chinese male adults in the COVID-19 pandemic with loosened controls. Prev Med Rep 2023; 36:102464. [PMID: 37854665 PMCID: PMC10580037 DOI: 10.1016/j.pmedr.2023.102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) may have a negative impact on the sexual health of male adults. An online questionnaire survey was conducted among male adults from February 04, 2023 to March 15, 2023 to analyze the impact of COVID-19 on the sexual health of male adults in China. Participants provided about their medical, social, lifestyle, and family situations information through questionnaires including the Brief Sexual Function Inventory (BSFI). Sexual function problems were defined based on predetermined cutoff values of the BSFI domain scores. A total of 1,250 male adults were included with median age as 32 years. According to the analysis of statistical results, sexual drive and erections firm enough to have sexual intercourse were reported to be present only a few days or less last month among 14.8 % and 11.1 % of COVID-19 survivors, respectively. Compared with uninfected persons, COVID-19 survivors had significantly lower scores on all BSFI domains and an increased risk of problems with sexual drive and erectile. In multivariate models of COVID-19 survivors, age ≥30 years, rural resident, lower education level, manual worker, lower income, and shorter duration from recovery to survey date were significantly associated with poorer overall sexual function. In this study, COVID-19 survivors was reported to have significantly poorer sexual function than uninfected persons. The COVID-19 may have had a significant impact on the sexual health of Chinese male adults. We need to focus on sexual dysfunction in COVID-19 survivors, and proactively provide effective interventions.
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Affiliation(s)
- Jixiang Yuan
- Urology Centre, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
- Institute of Surgery of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
| | - Jielong Zhou
- Urology Centre, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
- Institute of Surgery of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
| | - Tongtong Zhang
- Urology Centre, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
- Institute of Surgery of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
| | - Xiran Ju
- Urology Centre, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
- Institute of Surgery of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
| | - Dongliang Xu
- Urology Centre, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
- Institute of Surgery of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200000, China
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Lesnikova I, Obukhau A, Lashmanova N, Braun A, Venkatraman SMK, Vega M, Wolf MY, Arunkumar P. Report of 5146 Cases of Coronavirus Disease 2019-Related Mortality From Cook County, Illinois Causes of Death, Demographics, and Comorbidities. Am J Forensic Med Pathol 2023; 44:285-292. [PMID: 38019948 DOI: 10.1097/paf.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
ABSTRACT A cross-sectional study used 5216 laboratory-confirmed coronavirus disease 2019 (severe acute respiratory syndrome coronavirus 2)-related mortality cases in Cook County of Illinois. The data set included each case's demographic data, manner of death, and comorbidities. The age ranged from 0 to 108 years, with a median of 73.5 years. There were few mortality cases in the age group younger than 30 years, and the incidence of fatal infection increased with age. We demonstrated an increased incidence of mortality in males compared with females (P < 0.01). The urban population had a higher incidence of fatal infection than the suburban population (P < 0.01). We found a significant increase (P < 0.01) in the incidence of fatal coronavirus disease 2019 (severe acute respiratory syndrome coronavirus 2) infection in African American males compared with background frequencies. Latino population demonstrated younger ages at death compared with the non-Latino population. Obesity and hypertension significantly predict fatal outcomes in the younger age group. In comparison, dementia and hypertensive and arteriosclerotic cardiovascular disease are significant predictive factors in the older age group. In a large data set, we demonstrated that the demographical distribution of the population and comorbidities is associated with the risk of fatal complications and death.
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Affiliation(s)
- Iana Lesnikova
- From the St Johns County Medical Examiner's Office, St. Augustine, FL
| | | | | | - Ankica Braun
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | | | - Matthew Vega
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Maxim Y Wolf
- Department of Biomedical Informatics, Harvard Medical School, Boston, MS
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Is there a relationship between internet access and COVID-19 mortality? Evidence from Nigeria based on a spatial analysis. DIALOGUES IN HEALTH 2023; 2:100102. [PMID: 36685010 PMCID: PMC9846902 DOI: 10.1016/j.dialog.2023.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/24/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
With over 6.5 million deaths due to COVID-19, it has become an issue of global health concern. Early findings have identified several social determinants of deaths from COVID-19. However, very few studies have been done on the relationship between internet access and COVID-19 mortality in the context of developing countries. Using geospatial methods, this study examines the relationship between internet access and COVID-19 mortality disparity in Nigeria. In contrast to the widely reported relationship in the literature that internet access lowers the risk of COVID-19 mortality, the current study finds that geographical locations with the highest internet access are the hotspots of COVID-19 mortality in Nigeria, especially some parts of southwest Nigeria. In addition, findings show that population density and unemployment are risk factors of COVID-19 mortality. The study recommends educating the population on the use of online health information and the need to adhere strictly to non-pharmaceutical and vaccination interventions to reduce the number of deaths caused by the virus.
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Ramalho JP, Simões DG, Aguiar P. Impact of sociodemographic and economic determinants of health on COVID-19 infection: incidence variation between reference periods. Public Health 2023; 225:305-310. [PMID: 37963420 DOI: 10.1016/j.puhe.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES The COVID-19 pandemic hit Portugal in March 2020, causing widespread disruption to various aspects of society. While extensive research has been conducted on the significance of socio-economic disparities in infection risk, this study aims to enhance our understanding of their evolving relationship over time by analysing four distinct periods in 2020. STUDY DESIGN AND METHODS This retrospective observational ecological study included individuals residing in the Primary Healthcare Cluster areas of Almada-Seixal and Western Lisbon and Oeiras, who tested positive for SARS-CoV-2 through a polymerase chain reaction (PCR) test between the 2nd of March and the 8th of November of 2020. Using incidence rates for each specific neighbourhood (n = 29) and period, we explored the relationship between neighbourhood-level socio-economic variables and the risk of infection using negative-binomial regression models. RESULTS In the analysed period, a total of 8562 confirmed COVID-19 cases were identified. Overall incidence rates for each period were sequentially 2.74, 5.03, 3.99 and 14.29 COVID-19 cases per 100,000 person-days. Housing overcrowding, illiteracy rate and place of birth were associated with increased risk of infection, while age, congregate living, and employment in the secondary sector exhibited the opposite association. No association was consistent across all time periods. CONCLUSIONS Our findings support the idea that the influence of socio-economic determinants of health is not immutable throughout time. In a pandemic context where information, knowledge, beliefs, and behaviours are ever-changing and evolving, a dynamic, inclusive, and adaptable approach to disease control can lead to a more equitable distribution of improved outcomes, benefiting all strata of society.
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Affiliation(s)
- J P Ramalho
- Public Health Unit of Primary Healthcare Cluster of Western Lisbon and Oeiras, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal; National School of Public Health, NOVA University of Lisbon, Portugal.
| | - D G Simões
- National School of Public Health, NOVA University of Lisbon, Portugal; Public Health Unit of Primary Healthcare Cluster of Almada-Seixal, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal
| | - P Aguiar
- National School of Public Health, NOVA University of Lisbon, Portugal; Public Health Research Centre (CISP/PHRC), NOVA University of Lisbon, Portugal; Comprehensive Health Research Centre (CHRC), NOVA University of Lisbon, Portugal
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Nieto MA, Caballero N, Remolina CI, Moreno S, Vega D, Quintero J. Incidence and risk factors related to SARS-CoV-2 infection, reinfection, and seroconversion: Analysis of a healthcare workers cohort from a university hospital in Colombia. IJID REGIONS 2023; 9:63-71. [PMID: 37928802 PMCID: PMC10623274 DOI: 10.1016/j.ijregi.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 11/07/2023]
Abstract
Objectives To determine the incidence and factors associated with SARS-CoV-2 infection and seroconversion among healthcare workers (HCWs) during the COVID-19 pandemic in a university hospital in Colombia. Methods We analyzed the CoVIDA-Fundación Santa Fe de Bogotá (FSFB) cohort, consisting of 419 HCWs from the FSFB university hospital. The cohort was followed during active surveillance (June 25, 2020, to April 30, 2021) and passive surveillance (May 01, 2021, to March 16, 2022) periods. Incidence rates for SARS-CoV-2 infection, reinfection, and seroconversion were estimated, considering pre- and post-COVID-19 vaccination. Cox proportional-hazards models were used to identify factors related to infection and seroconversion during the active surveillance period. Results COVID-19 incidence rate ranged between 16-52 cases per 1000 person-month. SARS-CoV-2 reinfections were rare, ranging between less than one case to 13 cases per 1000 person-month. The seroconversion rates ranged between 52-55 cases per 1000 person-month. High socioeconomic level was a protective factor for SARS-CoV-2 infection, while SARS-CoV-2 infection was the main factor associated with seroconversion. Conclusion This study provides insights into the incidence and risk factors of SARS-CoV-2 infection among HCWs in a Colombian university hospital. The findings may offer valuable guidance for reducing virus spread within healthcare settings.
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Affiliation(s)
- María A Nieto
- Population Health, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
- School of Medicine, Universidad de Los Andes, Bogotá D.C., Colombia
| | - Nohemí Caballero
- Population Health, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
- School of Medicine, Universidad de Los Andes, Bogotá D.C., Colombia
| | - Camila I Remolina
- Population Health, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
- School of Medicine, Universidad de Los Andes, Bogotá D.C., Colombia
| | - Sergio Moreno
- School of Medicine, Universidad de Los Andes, Bogotá D.C., Colombia
| | - Daniela Vega
- Population Health, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
- School of Medicine, Universidad de Los Andes, Bogotá D.C., Colombia
| | - Juliana Quintero
- Population Health, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
- Department of Internal Medicine, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
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Dahleh A, Bean AJ, Johnson TJ. Racial, socioeconomic, and neighborhood characteristics in relation to COVID-19 severity of illness for adolescents and young adults. PNAS NEXUS 2023; 2:pgad396. [PMID: 38034092 PMCID: PMC10682970 DOI: 10.1093/pnasnexus/pgad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
This study tests the hypotheses that insurance status, race and ethnicity, and neighborhood characteristics are associated with hospital admission and severe health outcomes (Intensive Care Unit [ICU] admission and oxygen assistance) for youth and young adults who present to the emergency department (ED) with COVID-19 in a single, academic health system in Illinois, Rush University System for Health (RUSH). Demographic and clinical data from the electronic health record were collected for all 13- to 24-y-old patients seen at RUSH who tested positive for COVID-19 between March 2020 and 2021. Individual-level and neighborhood characteristics were analyzed to determine their association with hospital admission and severe health outcomes through generalized estimating equations. As of March 2021, 1,057 patients were seen in the ED within RUSH in which non-Hispanic White (odds ratio [OR], 2.96; 95% CI, 1.61-5.46; P = 0.001) and Hispanic (OR, 3.34; 95% CI, 1.84-6.10; P < 0.001) adolescents and youth were more likely to be admitted to the hospital compared with non-Hispanic Black/other adolescents and youth. Patients with public insurance or who were uninsured were less likely to be admitted to the ICU compared with those with private insurance (OR, 0.24; 95% CI, 0.09-0.64; P = 0.004). None of the neighborhood characteristics were significantly associated with hospital admission or severe health outcomes after adjusting for covariates. Our findings demonstrated that race and ethnicity were related to hospitalization, while insurance was associated with presentation severity due to COVID-19 for adolescents and young adults. These findings can aid public health investigators in understanding COVID-19 disparities among adolescents and young adults.
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Affiliation(s)
- Ayaat Dahleh
- The Graduate College, Rush University, Chicago, IL 60612, USA
| | - Andrew J Bean
- The Graduate College, Rush University, Chicago, IL 60612, USA
| | - Tricia J Johnson
- Department of Health Systems Management, Rush University College of Health Sciences, Chicago, IL 60612, USA
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Alam MF, Wildman J, Abdul Rahim H. Income inequality and its association with COVID-19 cases and deaths: a cross-country analysis in the Eastern Mediterranean region. BMJ Glob Health 2023; 8:e012271. [PMID: 37918870 PMCID: PMC10626889 DOI: 10.1136/bmjgh-2023-012271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION There is limited evidence on the associations between economic and social disparities in the Eastern Mediterranean region (EMR) with COVID-19 infections and deaths. This study aims to investigate the relationship between income inequalities using Gini coefficients and COVID-19 cases and deaths per million population in the EMR countries. METHODS Country-level data on monthly COVID-19 cases and deaths between March 2020 and October 2021, along with data on selected confounders, were collected from publicly available databases. Mixed-effect negative binomial and inverse hyperbolic sine transformation regressions were estimated to examine the association. RESULTS The study showed that, in the EMR, a unit increase in Gini coefficient is associated with approximately 7.2% and 3.9% increase in COVID-19 cases and deaths per million population, respectively. The magnitude and direction of the association between income inequality and COVID-19 cases and deaths per-million population still remain the same after excluding four warzone countries from the analysis. CONCLUSION This increase in COVID-19 cases and deaths is underpinned by the fact that a large number of the population in the region is living in conditions of poverty, with inadequate housing, comorbidities and limited or virtually no access to essential healthcare services. Healthcare policy-makers across countries in the region need to implement effective interventions in areas of income inequality, where it may be linked to increasing the risk of COVID-19 cases and deaths.
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Affiliation(s)
- Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - John Wildman
- Department of Economics, Newcastle University, Newcastle upon Tyne, UK
| | - Hanan Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Marc MS, Rosca D, Bratosin F, Fira-Mladinescu O, Oancea C, Pescaru CC, Velescu D, Wellmann N, Motofelea AC, Ciuca IM, Saracin K, Manolescu D. The Effect of Comorbidities and Complications on COVID-19 Mortality: A Detailed Retrospective Study in Western Romania. J Pers Med 2023; 13:1552. [PMID: 38003867 PMCID: PMC10672588 DOI: 10.3390/jpm13111552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19 continues to impact global health systems even after being declared over, with some patients exhibiting severe complications linked to pre-existing conditions. This study aimed to investigate the association between comorbidities, complications, and survival outcomes among COVID-19 survivors in Western Romania. Our hypothesis posited that comorbidities and complications significantly influence survival rates. We conducted a retrospective analysis of 1948 COVID-19 survivors admitted from January to December 2021, with 192 selected for detailed analysis based on inclusion and exclusion criteria. The severity of COVID-19 was classified according to WHO guidelines, and conditions like hypertension and obesity were defined using criteria from the European Society of Hypertension (ESH), the European Society of Cardiology (ESC), and WHO, respectively. Among the 192 patients, 33 had mild, 62 had moderate, and 97 had severe COVID-19. The median age across the severity groups was 63.2 years. Patients undergoing tracheostomy had a mortality rate of 83.3% versus 22.2% for non-tracheostomy patients (p < 0.001) and presented with significantly higher lung injury, hospitalization duration, and complications. Remarkably, tracheostomized patients were 17.50 times more likely to succumb to the disease (95% CI 4.39-116.91, p < 0.001). Furthermore, pneumothorax increased the mortality risk significantly (OR 22.11, 95% CI 5.72-146.03, p < 0.001). Intriguingly, certain conditions like grade I hypertension and grade II obesity showed a protective effect against mortality, whereas type 2 diabetes mellitus increased mortality risk (univariate OR 2.89, p = 0.001). The presence of certain comorbidities and complications significantly impacts the survival rates of COVID-19 patients in Western Romania. Notably, tracheostomy, pneumothorax, and T2DM were associated with increased mortality. This study underscores the importance of personalized patient care and provides insights for healthcare policymakers in Western Romania to improve clinical management strategies.
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Affiliation(s)
- Monica Steluta Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniela Rosca
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
| | - Felix Bratosin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
- Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Fira-Mladinescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Diana Velescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Norbert Wellmann
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
| | - Alexandru Catalin Motofelea
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Ioana Mihaiela Ciuca
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Pediatric Pulmonology Unit, Clinical County Hospital, Evliya Celebi 1-3, 300226 Timisoara, Romania
| | - Karina Saracin
- Emergency County Hospital Craiova, Strada Tabaci 1, 200642 Craiova, Romania;
| | - Diana Manolescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Radiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Nyachoti DO, Ranjit N, Ramphul R, Whigham LD, Springer AE. Association of Social Vulnerability and COVID-19 Mortality Rates in Texas between 15 March 2020, and 21 July 2022: An Ecological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6985. [PMID: 37947543 PMCID: PMC10647229 DOI: 10.3390/ijerph20216985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Despite the key role of social vulnerability such as economic disadvantage in health outcomes, research is limited on the impact of social vulnerabilities on COVID-19-related deaths, especially at the state and county level in the USA. METHODS We conducted a cross-sectional ecologic analysis of COVID-19 mortality by the county-level Minority Health Social Vulnerability Index (MH SVI) and each of its components in Texas. Negative binomial regression (NBR) analyses were used to estimate the association between the composite MH SVI (and its components) and COVID-19 mortality. RESULTS A 0.1-unit increase in the overall MH SVI (IRR, 1.27; 95% CI, 1.04-1.55; p = 0.017) was associated with a 27% increase in the COVID-19 mortality rate. Among the MH SVI component measures, only low socioeconomic status (IRR, 1.55; 95% CI, 1.28-1.89; p = 0.001) and higher household composition (e.g., proportion of older population per county) and disability scores (IRR, 1.47; 95% CI, 1.29-1.68; p < 0.001) were positively associated with COVID-19 mortality rates. CONCLUSIONS This study provides further evidence of disparities in COVID-19 mortality by social vulnerability and can inform decisions on the allocation of social resources and services as a strategy for reducing COVID-19 mortality rates and similar pandemics in the future.
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Affiliation(s)
- Dennis Ogeto Nyachoti
- Epidemiology and Surveillance Unit, Texas Department of State Health Services, 201 W Howard Ln, Austin, TX 78753, USA
- Department of Health Promotion and Behavioral Sciences, Center for Community Health Impact, The University of Texas Health Science Center at Houston School of Public Health, 5130 Gateway Boulevard East MCA 110, El Paso, TX 79905, USA;
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
| | - Ryan Ramphul
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA;
| | - Leah D. Whigham
- Department of Health Promotion and Behavioral Sciences, Center for Community Health Impact, The University of Texas Health Science Center at Houston School of Public Health, 5130 Gateway Boulevard East MCA 110, El Paso, TX 79905, USA;
| | - Andrew E. Springer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
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Vander Woude CA, King EJ, Hirschtick JL, Titus AR, Power LE, Elliott MR, Fleischer NL. Differential care-seeking behaviors during the beginning of the COVID-19 pandemic in Michigan: a population-based cross-sectional study. BMC Public Health 2023; 23:2101. [PMID: 37880623 PMCID: PMC10601223 DOI: 10.1186/s12889-023-16999-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND At the beginning of the COVID-19 pandemic in the United States in the spring of 2020, many Americans avoided the healthcare system, while those with COVID-19 symptoms were faced with decisions about seeking healthcare services for this novel virus. METHODS Using a probability sample (n = 1088) from the Michigan adult population of PCR-confirmed COVID-19 cases who were diagnosed prior to July 31, 2020, we used logistic regression to examine sociodemographic and symptom severity predictors of care-seeking behaviors. The analyses examined three different outcomes: (1) whether respondents sought care and, among those who sought care, whether they sought care from (2) a primary care provider or (3) an emergency room. Final models were adjusted for sex, age, race and ethnicity, income, education, marital status, living arrangement, health insurance, and self-reported symptom severity. RESULTS We found that participants ages 65 and older had 4.00 times higher odds of seeking care than 18-34-year-olds (95% CI: 2.21, 7.24), while adults reporting very severe symptoms had roughly 15 times higher odds of seeking care than those with mild symptoms (95% CI: 7.73, 27.01). Adults who were non-Hispanic Black or were uninsured had lower odds of seeking care from a primary care physician versus seeking care from other locations in comparison to adults who were non-Hispanic White or were privately insured, respectively (non-Hispanic Black: aOR = 0.27, 95% CI: 0.16, 0.44; Uninsured: aOR = 0.19, 95% CI: 0.09, 0.42). Conversely, adults who were older or reported more severe symptoms had higher odds of seeking care from an emergency room versus other locations in comparison to adults who were younger or reported less severe symptoms (Age 65+: aOR = 2.96, 95% CI: 1.40, 6.28; Very Severe Symptoms: aOR = 6.63, 95% CI: 3.33, 13.20). CONCLUSIONS Our results suggest differential utilization of healthcare services early in the COVID-19 pandemic. Further analyses are needed to examine the reasons for these differences.
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Affiliation(s)
| | - Elizabeth J King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jana L Hirschtick
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Andrea R Titus
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Laura E Power
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michael R Elliott
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Chien KS, Peterson CB, Young E, Chihara D, Manasanch EE, Ramdial JL, Thompson PA. Outcomes of breakthrough COVID-19 infections in patients with hematologic malignancies. Blood Adv 2023; 7:5691-5697. [PMID: 36696472 PMCID: PMC9896882 DOI: 10.1182/bloodadvances.2022008827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
Patients with hematologic malignancies have both an increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and higher morbidity/mortality. They have lower seroconversion rates after vaccination, potentially leading to inferior coronavirus disease 2019 (COVID-19) outcomes, despite vaccination. We consequently evaluated the clinical outcomes of COVID-19 infections in 243 vaccinated and 175 unvaccinated patients with hematologic malignancies. Hospitalization rates were lower in the vaccinated group when compared with the unvaccinated group (31.3% vs 52.6%). However, the rates of COVID-19-associated death were similar at 7.0% and 8.6% in vaccinated and unvaccinated patients, respectively. By univariate logistic regression, females, older patients, and individuals with higher modified Charlson Comorbidity Index scores were at a higher risk of death from COVID-19 infections. To account for the nonrandomized nature of COVID-19 vaccination status, a propensity score weighting approach was used. In the final propensity-weighted model, vaccination status was not significantly associated with the risk of death from COVID-19 infections but was associated with the risk of hospitalization. The predicted benefit of vaccination was an absolute decrease in the probability of death and hospitalization from COVID-19 infections by 2.3% and 22.9%, respectively. In conclusion, COVID-19 vaccination status in patients with hematologic malignancies was associated with a decreased risk of hospitalization but not associated with a decreased risk of death from COVID-19 infections in the pre-Omicron era. Protective strategies, in addition to immunization, are warranted in this vulnerable patient population.
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Affiliation(s)
- Kelly S. Chien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christine B. Peterson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elliana Young
- Department of Enterprise Data Engineering and Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dai Chihara
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabet E. Manasanch
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeremy L. Ramdial
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Philip A. Thompson
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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Pothisiri W, Prasitsiriphon O, Apakupakul J, Ploddi K. Gender differences in estimated excess mortality during the COVID-19 pandemic in Thailand. BMC Public Health 2023; 23:1900. [PMID: 37784059 PMCID: PMC10544589 DOI: 10.1186/s12889-023-16828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There is a limited body of research specifically examining gender inequality in excess mortality and its variations across age groups and geographical locations during the COVID-19 pandemic. This study aims to fill this gap by analyzing the patterns of gender inequality in excess all-cause mortality in Thailand during the COVID-19 pandemic. METHODS Data pertaining to all-cause deaths and population between January 1, 2010, and December 31, 2021, were obtained from Thailand's Bureau of Registration Administration. A seasonal autoregressive integrated moving average (SARIMA) technique was used to estimate excess mortality during the pandemic between January 2020 to December 2021. Gender differential excess mortality was measured as the difference in age-standardized mortality rates between men and women. RESULTS Our SARIMA-based estimate of all-cause mortality in Thailand during the COVID-19 pandemic amounted to 1,032,921 deaths, with COVID-19-related fatalities surpassing official figures by 1.64 times. The analysis revealed fluctuating patterns of excess and deficit in all-cause mortality rates across different phases of the pandemic, as well as among various age groups and regions. In 2020, the most pronounced gender disparity in excess all-cause mortality emerged in April, with 4.28 additional female deaths per 100,000, whereas in 2021, the peak gender gap transpired in August, with 7.52 more male deaths per 100,000. Individuals in the 80 + age group exhibited the largest gender gap for most of the observed period. Gender differences in excess mortality were uniform across regions and over the period observed. Bangkok showed the highest gender disparity during the peak of the fourth wave, with 24.18 more male deaths per 100,000. CONCLUSION The findings indicate an overall presence of gender inequality in excess mortality during the COVID-19 pandemic in Thailand, observed across age groups and regions. These findings highlight the need for further attention to be paid to gender disparities in mortality and call for targeted interventions to address these disparities.
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Affiliation(s)
- Wiraporn Pothisiri
- College of Population Studies, Chulalongkorn University, Bangkok, Thailand
| | | | - Jutarat Apakupakul
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nontaburi, Thailand
| | - Kritchavat Ploddi
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nontaburi, Thailand
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Castel AD, Barth S, Wilbourn BC, Horberg M, Monroe AK, Greenberg AE. Trends in COVID-19 Vaccine Hesitancy and Uptake Among Persons Living With HIV in Washington, DC. J Acquir Immune Defic Syndr 2023; 94:124-134. [PMID: 37368934 PMCID: PMC10529778 DOI: 10.1097/qai.0000000000003243] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has disproportionately affected older people, people with underlying health conditions, racial and ethnic minorities, socioeconomically disadvantaged, and people living with HIV (PWH). We sought to describe vaccine hesitancy and associated factors, reasons for vaccine hesitancy, and vaccine uptake over time in PWH in Washington, DC. METHODS We conducted a cross-sectional survey between October 2020 and December 2021 among PWH enrolled in a prospective longitudinal cohort in DC. Survey data were linked to electronic health record data and descriptively analyzed. Multivariable logistic regression was performed to identify factors associated with vaccine hesitancy. The most common reasons for vaccine hesitancy and uptake were assessed. RESULTS Among 1029 participants (66% men, 74% Black, median age 54 years), 13% were vaccine hesitant and 9% refused. Women were 2.6-3.5 times, non-Hispanic Blacks were 2.2 times, Hispanics and those of other race/ethnicities were 3.5-8.8 times, and younger PWH were significantly more likely to express hesitancy or refusal than men, non-Hispanic Whites, and older PWH, respectively. The most reported reasons for vaccine hesitancy were side effect concerns (76%), plans to use other precautions/masks (73%), and speed of vaccine development (70%). Vaccine hesitancy and refusal declined over time (33% in October 2020 vs. 4% in December 2021, P < 0.0001). CONCLUSIONS This study is one of the largest analyses of vaccine hesitancy among PWH in a US urban area highly affected by HIV and COVID-19. Multilevel culturally appropriate approaches are needed to effectively address COVID-19 vaccine concerns raised among PWH.
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Affiliation(s)
- Amanda D Castel
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Shannon Barth
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Brittany C Wilbourn
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | | | - Anne K Monroe
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
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Kalwij A. Risk preferences, preventive behaviour, and the probability of a loss: Empirical evidence from the COVID-19 pandemic. Soc Sci Med 2023; 334:116169. [PMID: 37633114 DOI: 10.1016/j.socscimed.2023.116169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 07/07/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Abstract
RATIONALE A theoretical model of optimal choice under risk, in which an individual chooses the level of prevention to avoid a loss, has the ambiguous prediction that a higher risk-taking preference increases the probability of a loss. OBJECTIVE To empirically investigate the prediction in the case of COVID-19 with individual-level survey data. DATA Survey data from the Understanding America Study (UAS). The UAS Coronavirus Tracking Survey followed 8628 respondents from March 2020 until July 2021 (29 survey waves) and data was gathered on having contracted COVID-19, vaccination, and preventive behaviour. Separate UAS modules gathered data on individuals' risk preferences; twice before and once during the COVID-19 pandemic. UAS also gathered data on pre-pandemic health and socio-economic status. Combining these data, and dropping missing observations, provided longitudinal data for 4335 respondents (96,370 observations) of whom 530 contracted COVID-19. RESULTS In support of the theoretical prediction, the empirical findings show that a one-standard deviation higher risk-taking preference is associated with about a one-third higher probability of contracting COVID-19 within two weeks. Furthermore, the findings show that individuals' risk-taking preference is negatively associated with the preventive behaviour of social distancing and not associated with getting vaccinated. There is, however, no support for preventive behaviour being associated with the probability of contracting COVID-19. The exception is for being vaccinated, which is negatively associated with the probability of contracting COVID-19. The findings, therefore, do not support that the positive association of the risk-taking preference with the probability of contracting COVID-19 is mediated through observed preventive behaviour. CONCLUSIONS The findings support the importance of individuals' risk-taking behaviour for contracting COVID-19 and, more generally, the importance of loss prevention as a risk management tool for individuals.
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Affiliation(s)
- Adriaan Kalwij
- Utrecht University School of Economics, Department of Economics, Utrecht University, Kriekenpitplein 21-22, 3584EC, Utrecht, the Netherlands.
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Forsyth J, Wang L, Thomas-Bachli A. COVID-19 case rates, spatial mobility, and neighbourhood socioeconomic characteristics in Toronto: a spatial-temporal analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:806-822. [PMID: 37526916 PMCID: PMC10486339 DOI: 10.17269/s41997-023-00791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/29/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES This study has two primary research objectives: (1) to investigate the spatial clustering pattern of mobility reductions and COVID-19 cases in Toronto and their relationships with marginalized populations, and (2) to identify the most relevant socioeconomic characteristics that relate to human mobility and COVID-19 case rates in Toronto's neighbourhoods during five distinct time periods of the pandemic. METHODS Using a spatial-quantitative approach, we combined hot spot analyses, Pearson correlation analyses, and Wilcoxon two-sample tests to analyze datasets including COVID-19 cases, a mobile device-derived indicator measuring neighbourhood-level time away from home (i.e., mobility), and socioeconomic data from 2016 census and Ontario Marginalization Index. Temporal variations among pandemic phases were examined as well. RESULTS The paper identified important spatial clustering patterns of mobility reductions and COVID-19 cases in Toronto, as well as their relationships with marginalized populations. COVID-19 hot spots were in more materially deprived neighbourhood clusters that had more essential workers and people who spent more time away from home. While the spatial pattern of clusters of COVID-19 cases and mobility shifted slightly over time, the group socioeconomic characteristics that clusters shared remained similar in all but the first time period. A series of maps and visualizations were created to highlight the dynamic spatiotemporal patterns. CONCLUSION Toronto's neighbourhoods have experienced the COVID-19 pandemic in significantly different ways, with hot spots of COVID-19 cases occurring in more materially and racially marginalized communities that are less likely to reduce their mobility. The study provides solid evidence in a Canadian context to enhance policy making and provide a deeper understanding of the social determinants of health in Toronto during the COVID-19 pandemic.
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Affiliation(s)
- Jack Forsyth
- Toronto Metropolitan University, Toronto, ON, Canada
- BlueDot, Toronto, ON, Canada
| | - Lu Wang
- Toronto Metropolitan University, Toronto, ON, Canada.
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Bingham J, Tempia S, Moultrie H, Viboud C, Jassat W, Cohen C, Pulliam JR. Estimating the time-varying reproduction number for COVID-19 in South Africa during the first four waves using multiple measures of incidence for public and private sectors across four waves. PLoS One 2023; 18:e0287026. [PMID: 37738280 PMCID: PMC10516415 DOI: 10.1371/journal.pone.0287026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/30/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES The aim of this study was to quantify transmission trends in South Africa during the first four waves of the COVID-19 pandemic using estimates of the time-varying reproduction number (R) and to compare the robustness of R estimates based on three different data sources, and using data from public and private sector service providers. METHODS R was estimated from March 2020 through April 2022, nationally and by province, based on time series of rt-PCR-confirmed cases, hospitalisations, and hospital-associated deaths, using a method that models daily incidence as a weighted sum of past incidence, as implemented in the R package EpiEstim. R was also estimated separately using public and private sector data. RESULTS Nationally, the maximum case-based R following the introduction of lockdown measures was 1.55 (CI: 1.43-1.66), 1.56 (CI: 1.47-1.64), 1.46 (CI: 1.38-1.53) and 3.33 (CI: 2.84-3.97) during the first (Wuhan-Hu), second (Beta), third (Delta), and fourth (Omicron) waves, respectively. Estimates based on the three data sources (cases, hospitalisations, deaths) were generally similar during the first three waves, but higher during the fourth wave for case-based estimates. Public and private sector R estimates were generally similar except during the initial lockdowns and in case-based estimates during the fourth wave. CONCLUSION Agreement between R estimates using different data sources during the first three waves suggests that data from any of these sources could be used in the early stages of a future pandemic. The high R estimates for Omicron relative to earlier waves are interesting given a high level of exposure pre-Omicron. The agreement between public and private sector R estimates highlights that clients of the public and private sectors did not experience two separate epidemics, except perhaps to a limited extent during the strictest lockdowns in the first wave.
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Affiliation(s)
- Jeremy Bingham
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Harry Moultrie
- Division of the National Health Laboratory Service, Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cecile Viboud
- Fogarty International Center, NIH, Bethesda, MD, United States of America
| | - Waasila Jassat
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Right to Care, Pretoria, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliet R.C. Pulliam
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
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Lindqvist Bagge AS, Lekander M, Olofsson Bagge R, Carlander A. Mental health, stress, and well-being measured before (2019) and during (2020) COVID-19: a Swedish socioeconomic population-based study. Psychol Health 2023:1-18. [PMID: 37728316 DOI: 10.1080/08870446.2023.2257747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Compare mental health, stress, and well-being in the Swedish population as measured before and during the COVID-19 pandemic. METHODS Repeated cross-sectional design using data measured before (Jan-2019; n = 2791) and during (Oct/Nov-2020; n = 2926) COVID-19 pandemic in Swedish population-representative cohorts. Following constructs were measured: anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), stress (Perceived Stress Scale-10 items), health-related quality of life (HRQOL[Functional Assessment of Cancer Therapy-General Population]) and self-rated health (SRH) was assessed with a single-item question. RESULTS When adjusting for age, sex, education, and income there were significantly higher levels of anxiety (M̂ = 9.15 vs. 8.48, p < 0.01) and depression (M̂ = 3.64 vs. 3.30, p = 0.03), lower levels of stress (M̂ = 14.06 vs. 14.91, p < 0.001), but worsened HRQOL (M̂ = 76.40 vs. 77.92, p < 0.01) and SRH (M̂ = 6.91 vs. 7.20, p < 0.001), observed in 2020 compared to 2019. For the negative effects seen in anxiety, depression, HRQOL, and SRH, higher income and education had a protective effect. The decrease in stress was also correlated with higher income. CONCLUSIONS The COVID-19 pandemic led to a small but significant worsening in mental health and well-being in the general Swedish population, where higher socioeconomic status seemed to have a protective effect.
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Affiliation(s)
- Ann-Sophie Lindqvist Bagge
- Dept of Psychology, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Mats Lekander
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
- Osher Center for Integrative Health and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Roger Olofsson Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anders Carlander
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- SOM Institute, University of Gothenburg, Gothenburg, Sweden
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Gálvez JM, Pinzón-Rondón ÁM, Chaparro-Solano HM, Tovar-Romero HV, Ramírez-Prieto J, Ortigoza-Espitia SA, Ruiz-Sternberg ÁM. Effectiveness of the Booster Dose in Protecting against COVID-19, Colombia 2022. Vaccines (Basel) 2023; 11:1461. [PMID: 37766137 PMCID: PMC10538081 DOI: 10.3390/vaccines11091461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/29/2023] Open
Abstract
Vaccination has proven to be one of the most effective strategies against the COVID-19 pandemic. Several studies have evaluated and confirmed its effectiveness in different populations, particularly in reducing severe outcomes such as hospitalization and death. Some studies have investigated the effectiveness of vaccination against the infection, identifying the need for booster doses. This study aimed to explore the effectiveness of the vaccination schedule on the probability of infection in a sample of Colombian patients during the fourth wave of the COVID-19 pandemic, which was associated with the emergence and predominance of the Omicron variant. A cross-sectional study was conducted on individuals who underwent RT-PCR testing for COVID-19 detection in a dedicated laboratory in Bogotá, Colombia, between 30 December 2021 and 7 February 2022. A total of 1468 subjects was included in the study, of whom 36.6% (n = 538) had a positive PCR test for COVID-19. The comparison between fully vaccinated individuals with a booster dose and those without the booster dose revealed a 28% reduction in the odds of infection (OR = 0.719 CI 0.531-0.971). Age (OR = 1.009 CI 1.001-1.018) and low economic status (OR = 1.812 CI 1.416-2.319) were associated with an increased risk of infection. These findings suggest the need for a booster vaccination in the general population to improve the prevention rates of SARS-CoV-2 infection and mitigate severe outcomes.
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Affiliation(s)
| | | | | | | | - Juliana Ramírez-Prieto
- Clinical Investigation Group, Universidad del Rosario, Carrera 24 #63C-69, Bogotá 111221, Colombia
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