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Mayorga NA, Garey L, Viana A, Cardoso JB, Schmidt NB, Zvolensky MJ. Psychological Distress and Physical Health Symptoms in the Latinx Population During the COVID-19 Pandemic: Exploring the Role of Anxiety Sensitivity. COGNITIVE THERAPY AND RESEARCH 2021; 46:20-30. [PMID: 34177003 PMCID: PMC8214047 DOI: 10.1007/s10608-021-10243-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 12/24/2022]
Abstract
Objective The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial physical and mental health consequences. Rates of mortality and hospitalization are highest among those of racial and ethnic minority persons, including Latinx persons. Further, Latinx persons have been experiencing elevated mental health problems in response to the pandemic compared to non-Latinx Whites. The current study examined whether individual differences in anxiety sensitivity (AS) related to more severe emotional distress associated with social distancing, financial strain, fear of COVID-19, and physical health symptoms stemming from the COVID-19 pandemic among Latinx adults. Methods Participants included 188 Latinx persons (31.4% female, Mage = 34.1 years, SD = 8.16) recruited via an online survey panel program. Results Results indicated that AS significantly contributed to increased severity of the emotional stress response associated with social distancing (ΔR2 = 0.15, p < 0.001), financial strain (ΔR2 = 0.15, p < 0.001), physical health symptoms (ΔR2 = 0.03, p = 0.006), and fear of COVID-19 (ΔR2 = 0.15, p < 0.001). These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and work and home life COVID-19-related stress. Conclusions These cross-sectional findings suggest AS may be an important individual difference factor for better understanding mental health among Latinx persons in the context of the COVID-19 pandemic.
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Affiliation(s)
- Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX USA
| | - Andres Viana
- Department of Psychology, University of Houston, Houston, TX USA
- Texas Institute of Measurement, Evaluation, and Statistics, Houston, USA
| | - Jodi Berger Cardoso
- HEALTH Institute, University of Houston, Houston, TX USA
- Graduate College of Social Work, University of Houston, Houston, TX USA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX USA
- HEALTH Institute, University of Houston, Houston, TX USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204 USA
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102
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Hou X, Gao S, Li Q, Kang Y, Chen N, Chen K, Rao J, Ellenberg JS, Patz JA. Intracounty modeling of COVID-19 infection with human mobility: Assessing spatial heterogeneity with business traffic, age, and race. Proc Natl Acad Sci U S A 2021; 118:e2020524118. [PMID: 34049993 PMCID: PMC8214685 DOI: 10.1073/pnas.2020524118] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic is a global threat presenting health, economic, and social challenges that continue to escalate. Metapopulation epidemic modeling studies in the susceptible-exposed-infectious-removed (SEIR) style have played important roles in informing public health policy making to mitigate the spread of COVID-19. These models typically rely on a key assumption on the homogeneity of the population. This assumption certainly cannot be expected to hold true in real situations; various geographic, socioeconomic, and cultural environments affect the behaviors that drive the spread of COVID-19 in different communities. What's more, variation of intracounty environments creates spatial heterogeneity of transmission in different regions. To address this issue, we develop a human mobility flow-augmented stochastic SEIR-style epidemic modeling framework with the ability to distinguish different regions and their corresponding behaviors. This modeling framework is then combined with data assimilation and machine learning techniques to reconstruct the historical growth trajectories of COVID-19 confirmed cases in two counties in Wisconsin. The associations between the spread of COVID-19 and business foot traffic, race and ethnicity, and age structure are then investigated. The results reveal that, in a college town (Dane County), the most important heterogeneity is age structure, while, in a large city area (Milwaukee County), racial and ethnic heterogeneity becomes more apparent. Scenario studies further indicate a strong response of the spread rate to various reopening policies, which suggests that policy makers may need to take these heterogeneities into account very carefully when designing policies for mitigating the ongoing spread of COVID-19 and reopening.
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Affiliation(s)
- Xiao Hou
- Department of Mathematics, University of Wisconsin-Madison, Madison, WI 53706
| | - Song Gao
- Geospatial Data Science Lab, Department of Geography, University of Wisconsin-Madison, Madison, WI 53706;
| | - Qin Li
- Department of Mathematics, University of Wisconsin-Madison, Madison, WI 53706;
| | - Yuhao Kang
- Geospatial Data Science Lab, Department of Geography, University of Wisconsin-Madison, Madison, WI 53706
| | - Nan Chen
- Department of Mathematics, University of Wisconsin-Madison, Madison, WI 53706
| | - Kaiping Chen
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, WI 53706
| | - Jinmeng Rao
- Geospatial Data Science Lab, Department of Geography, University of Wisconsin-Madison, Madison, WI 53706
| | - Jordan S Ellenberg
- Department of Mathematics, University of Wisconsin-Madison, Madison, WI 53706
| | - Jonathan A Patz
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706
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103
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Todd M, Pharis M, Gulino SP, Robbins JM, Bettigole C. Excess Mortality During the COVID-19 Pandemic in Philadelphia. Am J Public Health 2021; 111:1352-1357. [PMID: 34111937 DOI: 10.2105/ajph.2021.306285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate excess all-cause mortality in Philadelphia, Pennsylvania, during the COVID-19 pandemic and understand the distribution of excess mortality in the population. Methods. With a Poisson model trained on recent historical data from the Pennsylvania vital registration system, we estimated expected weekly mortality in 2020. We compared these estimates with observed mortality to estimate excess mortality. We further examined the distribution of excess mortality by age, sex, and race/ethnicity. Results. There were an estimated 3550 excess deaths between March 22, 2020, and January 2, 2021, a 32% increase above expectations. Only 77% of excess deaths (n = 2725) were attributed to COVID-19 on the death certificate. Excess mortality was disproportionately high among older adults and people of color. Sex differences varied by race/ethnicity. Conclusions. Excess deaths during the pandemic were not fully explained by COVID-19 mortality; official counts significantly undercount the true death toll. Far from being a great equalizer, the COVID-19 pandemic has exacerbated preexisting disparities in mortality by race/ethnicity. Public Health Implications. Mortality data must be disaggregated by age, sex, and race/ethnicity to accurately understand disparities among groups.
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Affiliation(s)
- Megan Todd
- All authors are with the Philadelphia Department of Public Health
| | - Meagan Pharis
- All authors are with the Philadelphia Department of Public Health
| | - Sam P Gulino
- All authors are with the Philadelphia Department of Public Health
| | | | - Cheryl Bettigole
- All authors are with the Philadelphia Department of Public Health
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104
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Rowell-Cunsolo TL, Bellerose M, Hart C. Access to Harm Reduction Treatment Among Formerly Incarcerated Individuals During the COVID-19 Era. Health Secur 2021; 19:S95-S101. [PMID: 34101494 PMCID: PMC8236556 DOI: 10.1089/hs.2021.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tawandra L Rowell-Cunsolo
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
| | - Meghan Bellerose
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
| | - Carl Hart
- Tawandra L. Rowell-Cunsolo, PhD, is an Assistant Professor, Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin. Meghan Bellerose, MPH, is a Graduate Student, Mailman School of Public Health; and Carl Hart, PhD, is a Professor, Department of Psychology; both at Columbia University, New York, NY
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105
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Pimentel Walker AP, Sanga N, Benson OG, Yoshihama M. Risk Communication and Institutional Racism: The Protective Health Effect of Refugee-Led Community Organizations. Health Secur 2021; 19:S89-S94. [PMID: 34096802 DOI: 10.1089/hs.2021.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ana Paula Pimentel Walker
- Ana Paula Pimentel Walker, PhD, MURP, MA, JD, is an Assistant Professor and Naganika Sanga, MSc, is a PhD Candidate, Taubman College of Architecture and Urban Planning; Odessa Gonzalez Benson, PhD, MSW, is an Assistant Professor, School of Social Work and Detroit School of Urban Studies; and Mieko Yoshihama, PhD, LMSW, ACSW, is a Professor, School of Social Work; all at the University of Michigan, Ann Arbor, MI
| | - Naganika Sanga
- Ana Paula Pimentel Walker, PhD, MURP, MA, JD, is an Assistant Professor and Naganika Sanga, MSc, is a PhD Candidate, Taubman College of Architecture and Urban Planning; Odessa Gonzalez Benson, PhD, MSW, is an Assistant Professor, School of Social Work and Detroit School of Urban Studies; and Mieko Yoshihama, PhD, LMSW, ACSW, is a Professor, School of Social Work; all at the University of Michigan, Ann Arbor, MI
| | - Odessa Gonzalez Benson
- Ana Paula Pimentel Walker, PhD, MURP, MA, JD, is an Assistant Professor and Naganika Sanga, MSc, is a PhD Candidate, Taubman College of Architecture and Urban Planning; Odessa Gonzalez Benson, PhD, MSW, is an Assistant Professor, School of Social Work and Detroit School of Urban Studies; and Mieko Yoshihama, PhD, LMSW, ACSW, is a Professor, School of Social Work; all at the University of Michigan, Ann Arbor, MI
| | - Mieko Yoshihama
- Ana Paula Pimentel Walker, PhD, MURP, MA, JD, is an Assistant Professor and Naganika Sanga, MSc, is a PhD Candidate, Taubman College of Architecture and Urban Planning; Odessa Gonzalez Benson, PhD, MSW, is an Assistant Professor, School of Social Work and Detroit School of Urban Studies; and Mieko Yoshihama, PhD, LMSW, ACSW, is a Professor, School of Social Work; all at the University of Michigan, Ann Arbor, MI
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BERGER ZACKARY, ALTIERY DE JESUS VIVIAN, ASSOUMOU SABRINAA, GREENHALGH TRISHA. Long COVID and Health Inequities: The Role of Primary Care. Milbank Q 2021; 99:519-541. [PMID: 33783907 PMCID: PMC8241274 DOI: 10.1111/1468-0009.12505] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Policy Points An estimated 700,000 people in the United States have "long COVID," that is, symptoms of COVID-19 persisting beyond three weeks. COVID-19 and its long-term sequelae are strongly influenced by social determinants such as poverty and by structural inequalities such as racism and discrimination. Primary care providers are in a unique position to provide and coordinate care for vulnerable patients with long COVID. Policy measures should include strengthening primary care, optimizing data quality, and addressing the multiple nested domains of inequity.
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Affiliation(s)
- ZACKARY BERGER
- Johns Hopkins School of Medicine
- Johns Hopkins Berman Institute of Bioethics
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107
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Gupta S, Georgiou A, Sen S, Simon K, Karaca-Mandic P. US Trends in COVID-19-Associated Hospitalization and Mortality Rates Before and After Reopening Economies. JAMA HEALTH FORUM 2021; 2:e211262. [PMID: 35977172 PMCID: PMC8796994 DOI: 10.1001/jamahealthforum.2021.1262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
Importance After abrupt closures of businesses and public gatherings in the US in late spring 2020 due to the COVID-19 pandemic, by mid-May 2020, most states reopened their economies. Owing in part to a lack of earlier data, there was little evidence on whether state reopening policies influenced important pandemic outcomes-COVID-19-related hospitalizations and mortality-to guide future decision-making in the remainder of this and future pandemics. Objective To investigate changes in COVID-19-related hospitalizations and mortality trends after reopening of US state economies. Design Setting and Participants Using an interrupted time series approach, this cross-sectional study examined trends in per-capita COVID-19-related hospitalizations and deaths before and after state reopenings between April 16 and July 31, 2020. Daily state-level data from the University of Minnesota COVID-19 Hospitalization Tracking Project on COVID-19-related hospitalizations and deaths across 47 states were used in the analysis. Exposures Dates that states reopened their economies. Main Outcomes and Measures State-day observations of COVID-19-related hospitalizations and COVID-19-related new deaths per 100 000 people. Results The study included 3686 state-day observations of hospitalizations and 3945 state-day observations of deaths. On the day of reopening, the mean number of hospitalizations per 100 000 people was 17.69 (95% CI, 12.54-22.84) and the mean number of daily new deaths per 100 000 people was 0.395 (95% CI, 0.255-0.536). Both outcomes displayed flat trends before reopening, but they started trending upward thereafter. Relative to the hospitalizations trend in the period before state reopenings, the postperiod trend was higher by 1.607 per 100 000 people (95% CI, 0.203-3.011; P = .03). This estimate implied that nationwide reopenings were associated with 5319 additional people hospitalized for COVID-19 each day. The trend in new deaths after reopening was also positive (0.0376 per 100 000 people; 95% CI, 0.0038-0.0715; P = .03), but the change in mortality trend was not significant (0.0443; 95% CI, -0.0048 to 0.0933; P = .08). Conclusions and Relevance In this cross-sectional study conducted over a 3.5-month period across 47 US states, data on the association of hospitalizations and mortality with state reopening policies may provide input to state projections of the pandemic as policy makers continue to balance public health protections with sustaining economic activity.
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Affiliation(s)
- Sumedha Gupta
- Department of Economics, Indiana University Purdue University, Indianapolis
| | | | - Soumya Sen
- Information & Decision Sciences, Carlson School of Management, Minneapolis, Minnesota
| | - Kosali Simon
- O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
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108
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Landes SD, Turk MA, Damiani MR, Proctor P, Baier S. Risk Factors Associated With COVID-19 Outcomes Among People With Intellectual and Developmental Disabilities Receiving Residential Services. JAMA Netw Open 2021; 4:e2112862. [PMID: 34100935 PMCID: PMC8188265 DOI: 10.1001/jamanetworkopen.2021.12862] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Although there is evidence of more severe COVID-19 outcomes, there is no information describing the risk factors for COVID-19 diagnosis and/or mortality among people with intellectual and developmental disabilities (IDD) receiving residential support services in the US. OBJECTIVE To identify associations between demographic characteristics, residential characteristics, and/or preexisting health conditions and COVID-19 diagnosis and mortality for people with IDD receiving residential support services. DESIGN, SETTING, AND PARTICIPANTS This cohort study tracked COVID-19 outcomes for 543 individuals with IDD. Participants were receiving support services from a single organization providing residential services in the 5 boroughs of New York City from March 1 to October 1, 2020. Statistical analysis was performed from December 2020 to February 2021. EXPOSURES Resident-level characteristics, including age, sex, race/ethnicity, disability status, residential characteristics, and preexisting medical conditions. MAIN OUTCOMES AND MEASURES COVID-19 diagnosis was confirmed by laboratory test. COVID-19 mortality indicated that the individual died from COVID-19 during the course of the study. Logistic regression models were used to evaluate associations between demographic characteristics, residential characteristics, and preexisting health conditions and COVID-19 diagnosis and mortality. RESULTS Among the 543 individuals with IDD in the study, the median (interquartile range) age was 57.0 (45-65) years; 217 (40.0%) were female, and 274 (50.5%) were Black, Asian/Pacific Islander, American Indian or Alaskan Native, or Hispanic. The case rate was 16 759 (95% CI, 13 853-20 131) per 100 000; the mortality rate was 6446 (95% CI, 4671-8832) per 100 000; and the case-fatality rate was 38.5% (95% CI, 29.1%-48.7%). Increased age (odds ratio [OR], 1.04; 95% CI, 1.02-1.06), Down syndrome (OR, 2.91; 95% CI, 1.49-5.69), an increased number of residents (OR, 1.07; 95% CI, 1.00-1.14), and chronic kidney disease (OR, 4.17; 95% CI, 1.90-9.15) were associated with COVID-19 diagnosis. Heart disease (OR, 10.60; 95% CI, 2.68-41.90) was associated with COVID-19 mortality. CONCLUSIONS AND RELEVANCE This study found that, similar to the general population, increased age and preexisting health conditions were associated with COVID-19 outcomes for people with IDD receiving residential support services in New York City. As with older adults living in nursing homes, number of residents was also associated with more severe COVID-19 outcomes. Unique to people with IDD was an increased risk of COVID-19 diagnosis for people with Down syndrome.
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Affiliation(s)
- Scott D. Landes
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York
| | - Margaret A. Turk
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, New York
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109
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Bhasin B, Veitla V, Dawson AZ, Garacci Z, Sturgill D, Ozieh MN, Regner KR. AKI in Hospitalized Patients with COVID-19 and Seasonal Influenza: A Comparative Analysis. KIDNEY360 2021; 2:619-628. [PMID: 35373047 PMCID: PMC8791326 DOI: 10.34067/kid.0007322020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/24/2021] [Indexed: 02/04/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is often compared with seasonal influenza and the two diseases have similarities, including the risk of systemic manifestations such as AKI. The aim of this study was to perform a comparative analysis of the prevalence, risk factors, and outcomes of AKI in patients who were hospitalized with COVID-19 and influenza. Methods Retrospective cohort study of patients who were hospitalized with COVID-19 (n=325) or seasonal influenza (n=433). AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Baseline characteristics and hospitalization data were collected, and multivariable analysis was performed to determine the independent predictors for AKI. Results AKI occurred in 33% of COVID-19 hospitalizations (COV-AKI) and 33% of influenza hospitalizations (FLU-AKI). After adjusting for age, sex, and comorbidity count, the risk of stage 3 AKI was significantly higher in COV-AKI (OR, 3.46; 95% CI, 1.63 to 7.37). Pre-existing CKD was associated with a six- to seven-fold increased likelihood for FLU-AKI and COV-AKI. Mechanical ventilation was associated with a higher likelihood of developing AKI in the COVID-19 cohort (OR, 5.85; 95% CI, 2.30 to 15.63). Black race, after adjustment for comorbidities, was an independent risk for COV-AKI. Conclusions Pre-existing CKD was a major risk factor for AKI in both cohorts. Black race (independent of comorbidities) and mechanical ventilation were associated with a higher risk of developing COV-AKI, which is characterized by a higher burden of stage 3 AKI and overall poorer prognosis.
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Affiliation(s)
- Bhavna Bhasin
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vineet Veitla
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aprill Z. Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhuping Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Mukoso N. Ozieh
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin R. Regner
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Romano SD, Blackstock AJ, Taylor EV, El Burai Felix S, Adjei S, Singleton CM, Fuld J, Bruce BB, Boehmer TK. Trends in Racial and Ethnic Disparities in COVID-19 Hospitalizations, by Region - United States, March-December 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:560-565. [PMID: 33857068 PMCID: PMC8344991 DOI: 10.15585/mmwr.mm7015e2] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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111
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López-Medina E, López P, Hurtado IC, Dávalos DM, Ramirez O, Martínez E, Díazgranados JA, Oñate JM, Chavarriaga H, Herrera S, Parra B, Libreros G, Jaramillo R, Avendaño AC, Toro DF, Torres M, Lesmes MC, Rios CA, Caicedo I. Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19: A Randomized Clinical Trial. JAMA 2021; 325:1426-1435. [PMID: 33662102 PMCID: PMC7934083 DOI: 10.1001/jama.2021.3071] [Citation(s) in RCA: 224] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Ivermectin is widely prescribed as a potential treatment for COVID-19 despite uncertainty about its clinical benefit. OBJECTIVE To determine whether ivermectin is an efficacious treatment for mild COVID-19. DESIGN, SETTING, AND PARTICIPANTS Double-blind, randomized trial conducted at a single site in Cali, Colombia. Potential study participants were identified by simple random sampling from the state's health department electronic database of patients with symptomatic, laboratory-confirmed COVID-19 during the study period. A total of 476 adult patients with mild disease and symptoms for 7 days or fewer (at home or hospitalized) were enrolled between July 15 and November 30, 2020, and followed up through December 21, 2020. INTERVENTION Patients were randomized to receive ivermectin, 300 μg/kg of body weight per day for 5 days (n = 200) or placebo (n = 200). MAIN OUTCOMES AND MEASURES Primary outcome was time to resolution of symptoms within a 21-day follow-up period. Solicited adverse events and serious adverse events were also collected. RESULTS Among 400 patients who were randomized in the primary analysis population (median age, 37 years [interquartile range {IQR}, 29-48]; 231 women [58%]), 398 (99.5%) completed the trial. The median time to resolution of symptoms was 10 days (IQR, 9-13) in the ivermectin group compared with 12 days (IQR, 9-13) in the placebo group (hazard ratio for resolution of symptoms, 1.07 [95% CI, 0.87 to 1.32]; P = .53 by log-rank test). By day 21, 82% in the ivermectin group and 79% in the placebo group had resolved symptoms. The most common solicited adverse event was headache, reported by 104 patients (52%) given ivermectin and 111 (56%) who received placebo. The most common serious adverse event was multiorgan failure, occurring in 4 patients (2 in each group). CONCLUSION AND RELEVANCE Among adults with mild COVID-19, a 5-day course of ivermectin, compared with placebo, did not significantly improve the time to resolution of symptoms. The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand the effects of ivermectin on other clinically relevant outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04405843.
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Affiliation(s)
- Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia
- Department of Pediatrics, Universidad del Valle, Cali, Colombia
- Clínica Imbanaco, Cali, Colombia
| | - Pío López
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia
- Department of Pediatrics, Universidad del Valle, Cali, Colombia
| | - Isabel C. Hurtado
- Department of Pediatrics, Universidad del Valle, Cali, Colombia
- State Health Department, Valle del Cauca, Colombia
| | - Diana M Dávalos
- Department of Public Health, Universidad Icesi, Cali, Colombia
| | - Oscar Ramirez
- Clínica Imbanaco, Cali, Colombia
- POHEMA (Pediatric Oncologist and Hematologist) Foundation, Cali, Colombia
- Cali’s Cancer Population-based Registry, Cali, Colombia
| | - Ernesto Martínez
- Department of Internal Medicine, Universidad del Valle, Cali, Colombia
- Christus Sinergia Salud, Cali, Colombia
| | | | - José M. Oñate
- Clínica Imbanaco, Cali, Colombia
- Department of Internal Medicine, Universidad del Valle, Cali, Colombia
- Clínica de Occidente, Cali, Colombia
| | | | - Sócrates Herrera
- Caucaseco Scientific Research Center, Malaria Vaccine and Drug Development Center, Cali, Colombia
| | - Beatriz Parra
- Department of Microbiology, Universidad del Valle, Cali, Colombia
| | - Gerardo Libreros
- Department of Microbiology, Universidad del Valle, Cali, Colombia
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Senefeld JW, Johnson PW, Kunze KL, van Helmond N, Klassen SA, Wiggins CC, Bruno KA, Golafshar MA, Petersen MM, Buras MR, Klompas AM, Sexton MA, Soto JCD, Baker SE, Shepherd JRA, Verdun NC, Marks P, van Buskirk CM, Winters JL, Stubbs JR, Rea RF, Herasevich V, Whelan ER, Clayburn AJ, Larson KF, Ripoll JG, Andersen KJ, Vogt MNP, Dennis JJ, Regimbal RJ, Bauer PR, Blair JE, Wright K, Greenshields JT, Paneth NS, Fairweather D, Wright RS, Casadevall A, Carter RE, Joyner MJ. Program and patient characteristics for the United States Expanded Access Program to COVID-19 convalescent plasma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33851175 DOI: 10.1101/2021.04.08.21255115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The United States (US) Expanded Access Program (EAP) to COVID-19 convalescent plasma was initiated in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease-2019 (COVID-19). While randomized clinical trials were in various stages of development and enrollment, there was an urgent need for widespread access to potential therapeutic agents particularly for vulnerable racial and ethnic minority populations who were disproportionately affected by the pandemic. The objective of this study is to report on the demographic, geographic, and chronological access to COVID-19 convalescent plasma in the US via the EAP. METHODS AND FINDINGS Mayo Clinic served as the central IRB for all participating facilities and any US physician could participate as local physician-principal investigator. Registration occurred through the EAP central website. Blood banks rapidly developed logistics to provide convalescent plasma to hospitalized patients with COVID-19. Demographic and clinical characteristics of all enrolled patients in the EAP were summarized. Temporal trends in access to COVID-19 convalescent plasma were investigated by comparing daily and weekly changes in EAP enrollment in response to changes in infection rate on a state level. Geographical analyses on access to convalescent plasma included assessing EAP enrollment in all national hospital referral regions as well as assessing enrollment in metropolitan and less populated areas which did not have access to COVID-19 clinical trials.From April 3 to August 23, 2020, 105,717 hospitalized patients with severe or life-threatening COVID-19 were enrolled in the EAP. A majority of patients were older than 60 years of age (57.8%), male (58.4%), and overweight or obese (83.8%). There was substantial inclusion of minorities and underserved populations, including 46.4% of patients with a race other than White, and 37.2% of patients were of Hispanic ethnicity. Severe or life-threatening COVID-19 was present in 61.8% of patients and 18.9% of patients were mechanically ventilated at time of convalescent plasma infusion. Chronologically and geographically, increases in enrollment in the EAP closely followed confirmed infections across all 50 states. Nearly all national hospital referral regions enrolled patients in the EAP, including both in metropolitan and less populated areas. CONCLUSIONS The EAP successfully provided widespread access to COVID-19 convalescent plasma in all 50 states, including for underserved racial and ethnic minority populations. The efficient study design of the EAP may serve as an example framework for future efforts when broad access to a treatment is needed in response to a dynamic disease affecting demographic groups and areas historically underrepresented in clinical studies.
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Valdes AM, Moon JC, Vijay A, Chaturvedi N, Norrish A, Ikram A, Craxford S, Cusin LM, Nightingale J, Semper A, Brooks T, McKnight A, Kurdi H, Menni C, Tighe P, Noursadeghi M, Aithal G, Treibel TA, Ollivere BJ, Manisty C. Longitudinal assessment of symptoms and risk of SARS-CoV-2 infection in healthcare workers across 5 hospitals to understand ethnic differences in infection risk. EClinicalMedicine 2021; 34:100835. [PMID: 33880438 PMCID: PMC8049191 DOI: 10.1016/j.eclinm.2021.100835] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND : Healthcare workers (HCWs) have increased rates of SARS-CoV-2 infection compared with the general population. We aimed to understand ethnic differences in SARS-CoV-2 seropositivity among hospital healthcare workers depending on their hospital role, socioeconomic status, Covid-19 symptoms and basic demographics. METHODS A prospective longitudinal observational cohort study. 1364 HCWs at five UK hospitals were studied with up to 16 weeks of symptom questionnaires and antibody testing (to both nucleocapsid and spike protein) during the first UK wave in five NHS hospitals between March 20 and July 10 2020. The main outcome measures were SARS-CoV-2 infection (seropositivity at any time-point) and symptoms. Registration number: NCT04318314. FINDINGS 272 of 1364 HCWs (mean age 40.7 years, 72% female, 74% White, ≥6 samples per participant) seroconverted, reporting predominantly mild or no symptoms. Seropositivity was lower in Intensive Therapy Unit (ITU) workers (OR=0.44 95%CI 0.24, 0.77; p=0.0035). Seropositivity was higher in Black (compared to White) participants, independent of age, sex, role and index of multiple deprivation (OR=2.61 95%CI 1.47-4.62 p=0.0009). No association was seen between White HCWs and other minority ethnic groups. INTERPRETATION In the UK first wave, Black ethnicity (but not other ethnicities) more than doubled HCWs likelihood of seropositivity, independent of age, sex, measured socio-economic factors and hospital role.
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Affiliation(s)
- Ana M. Valdes
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
- Corresponding Author: Professor Ana Valdes, University of Nottingham School of Medicine, Nottingham, United Kingdom, Tel: (+44)0115 823 1954
| | - James C. Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Amrita Vijay
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - Alan Norrish
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Adeel Ikram
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Simon Craxford
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | | | - Jessica Nightingale
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - Timothy Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Aine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hibba Kurdi
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - Patrick Tighe
- School of Life Sciences, University of Nottingham, NG7 2RB
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Guruprasad Aithal
- Nottingham Digestive Disease Centre, University of Nottingham School of Medicine, Nottingham, UK
| | - Thomas A. Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Benjamin J. Ollivere
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Charlotte Manisty
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
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Garcia E, Eckel SP, Chen Z, Li K, Gilliland FD. COVID-19 mortality in California based on death certificates: disproportionate impacts across racial/ethnic groups and nativity. Ann Epidemiol 2021; 58:69-75. [PMID: 33746033 PMCID: PMC8005258 DOI: 10.1016/j.annepidem.2021.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/22/2022]
Abstract
Purpose To examine characteristics of coronavirus disease 2019 (COVID-19) decedents in California (CA) and evaluate for disproportionate mortality across race/ethnicity and ethnicity/nativity. Methods COVID-19 deaths were identified from death certificates. Age-adjusted mortality rate ratios (MRR) were compared across race/ethnicity. Proportionate mortality rates (PMR) were compared across race/ethnicity and by ethnicity/nativity. Results We identified 10,200 COVID-19 deaths in CA occurring February 1 through July 31, 2020. The most frequently observed characteristics among decedents were age 65 years or above, male, Hispanic, foreign-born, and educational attainment of High School or below. MRR indicated elevated COVID-19 morality rates among Asian/Pacific Islander, Black, and Hispanic groups compared with the White group, with Black and Hispanic groups having the highest MRR at 2.75 (95%CI: 2.54–2.97) and 4.18 (95%CI: 3.99–4.37), respectively. Disparities were larger at younger ages. Similar results were observed with PMR, and patterns of age-racial/ethnic disparities remained in analyses stratified by education. Elevated PMR were observed in all ethnicity/nativity groups, especially foreign-born Hispanic individuals, relative to U.S.-born non-Hispanic individuals. These were generally larger at younger ages and persisted after stratifying by education. Conclusions Differential COVID-19 mortality was observed in California across racial/ethnic groups and by ethnicity/nativity groups with evidence of greater disparities among younger age groups. Identifying COVID-19 disparities is an initial step toward mitigating disease impacts in vulnerable communities.
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Affiliation(s)
- Erika Garcia
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.
| | - Sandrah P Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Zhanghua Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Kenan Li
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA
| | - Frank D Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062921. [PMID: 33809240 PMCID: PMC8000338 DOI: 10.3390/ijerph18062921] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 12/17/2022]
Abstract
The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.
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Garcia E, Eckel SP, Chen Z, Li K, Gilliland FD. COVID-19 Mortality in California Based on Death Certificates: Disproportionate Impacts Across Racial/Ethnic Groups and Nativity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.01.21252678. [PMID: 33688674 PMCID: PMC7941651 DOI: 10.1101/2021.03.01.21252678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To examine characteristics of coronavirus disease 2019 (COVID-19) decedents in California (CA) and evaluate for disproportionate mortality across race/ethnicity and ethnicity/nativity. METHODS COVID-19 deaths were identified from death certificates. Age-adjusted mortality rate ratios (MRR) were compared across race/ethnicity. Proportionate mortality rates (PMR) were compared across race/ethnicity and by ethnicity/nativity. RESULTS We identified 10,200 COVID-19 deaths in CA occurring February 1 through July 31, 2020. Decedents tended to be older, male, Hispanic, foreign-born, and have lower educational attainment. MRR indicated elevated COVID-19 morality rates among Asian/Pacific Islander, Black, and Hispanic groups compared with the White group, with Black and Hispanic groups having the highest MRR at 2.75 (95%CI:2.54-2.97) and 4.18 (95%CI: 3.99-4.37), respectively. Disparities were larger at younger ages. Similar results were observed with PMR, which remained in analyses stratified by education. Elevated PMR were observed in all ethnicity/nativity groups, especially foreign-born Hispanic individuals, relative to U.S.-born non-Hispanic individuals, were generally larger at younger ages, and persisted after stratifying by education. CONCLUSIONS Differential COVID-19 mortality was observed in California across racial/ethnic groups and by ethnicity/nativity groups with evidence of greater disparities among younger age groups. Identifying COVID-19 disparities is an initial step towards mitigating disease impacts in vulnerable communities.
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Nguyen LH, Joshi AD, Drew DA, Merino J, Ma W, Lo CH, Kwon S, Wang K, Graham MS, Polidori L, Menni C, Sudre CH, Anyane-Yeboa A, Astley CM, Warner ET, Hu CY, Selvachandran S, Davies R, Nash D, Franks PW, Wolf J, Ourselin S, Steves CJ, Spector TD, Chan AT. Racial and ethnic differences in COVID-19 vaccine hesitancy and uptake. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.02.25.21252402. [PMID: 33655271 PMCID: PMC7924296 DOI: 10.1101/2021.02.25.21252402] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Racial and ethnic minorities have been disproportionately impacted by COVID-19. In the initial phase of population-based vaccination in the United States (U.S.) and United Kingdom (U.K.), vaccine hesitancy and limited access may result in disparities in uptake. METHODS We performed a cohort study among U.S. and U.K. participants in the smartphone-based COVID Symptom Study (March 24, 2020-February 16, 2021). We used logistic regression to estimate odds ratios (ORs) of COVID-19 vaccine hesitancy (unsure/not willing) and receipt. RESULTS In the U.S. ( n =87,388), compared to White non-Hispanic participants, the multivariable ORs of vaccine hesitancy were 3.15 (95% CI: 2.86 to 3.47) for Black participants, 1.42 (1.28 to 1.58) for Hispanic participants, 1.34 (1.18 to 1.52) for Asian participants, and 2.02 (1.70 to 2.39) for participants reporting more than one race/other. In the U.K. ( n =1,254,294), racial and ethnic minorities had similarly elevated hesitancy: compared to White participants, their corresponding ORs were 2.84 (95% CI: 2.69 to 2.99) for Black participants, 1.66 (1.57 to 1.76) for South Asian participants, 1.84 (1.70 to 1.98) for Middle East/East Asian participants, and 1.48 (1.39 to 1.57) for participants reporting more than one race/other. Among U.S. participants, the OR of vaccine receipt was 0.71 (0.64 to 0.79) for Black participants, a disparity that persisted among individuals who specifically endorsed a willingness to obtain a vaccine. In contrast, disparities in uptake were not observed in the U.K. CONCLUSIONS COVID-19 vaccine hesitancy was greater among racial and ethnic minorities, and Black participants living in the U.S. were less likely to receive a vaccine than White participants. Lower uptake among Black participants in the U.S. during the initial vaccine rollout is attributable to both hesitancy and disparities in access.
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Affiliation(s)
- Long H. Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amit D. Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David A. Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jordi Merino
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard. Cambridge, MA, USA
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chun-Han Lo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sohee Kwon
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kai Wang
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark S. Graham
- School of Biomedical Engineering & Imaging Sciences, King’s College London. London, U.K
| | | | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, U.K
| | - Carole H. Sudre
- School of Biomedical Engineering & Imaging Sciences, King’s College London. London, U.K
| | - Adjoa Anyane-Yeboa
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christina M. Astley
- Broad Institute of MIT and Harvard. Cambridge, MA, USA
- Computational Epidemiology Lab and Division of Endocrinology, Boston Children’s Hospital and Harvard Medical School. Boston, MA, USA
| | - Erica T. Warner
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Paul W. Franks
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London. London, U.K
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, U.K
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, U.K
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health. Boston, MA, USA
- Massachusetts Consortium on Pathogen Readiness, Cambridge, MA, USA
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Klein H, Asseo K, Karni N, Benjamini Y, Nir-Paz R, Muszkat M, Israel S, Niv MY. Onset, duration and unresolved symptoms, including smell and taste changes, in mild COVID-19 infection: a cohort study in Israeli patients. Clin Microbiol Infect 2021; 27:S1198-743X(21)00083-5. [PMID: 33607252 PMCID: PMC7884919 DOI: 10.1016/j.cmi.2021.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To characterize longitudinal symptoms of mild coronavirus disease 2019 (COVID-19) patients for a period of 6 months, to potentially aid in disease management. METHODS Phone interviews were conducted with 103 patients with mild COVID-19 in Israel over a 6-month period (April 2020 to October 2020). Patients were recruited via social media and word to mouth and were interviewed up to 4 times, depending on reports of their unresolved symptoms. Inclusion criteria required participants to be residents of Israel aged 18 years or older, with positive COVID-19 real-time PCR results and nonsevere symptoms. The onset, duration, severity and resolution of symptoms were analysed. RESULTS A total of 44% (45/103), 41% (42/103), 39% (40/103) and 38% (39/103) of patients experienced headache, fever, muscle ache and dry cough as the first symptom respectively. Smell and taste changes were experienced at 3.9 ± 5.4 and 4.6 ± 5.7 days (mean ± standard deviation (SD)) after disease onset respectively. Among prevalent symptoms, fever had the shortest duration (5.8 ± 8.6 days), and taste and smell changes were the longest-lasting symptoms (17.2 ± 17.6 and 18.9 ± 19.7 days; durations censored at 60 days). Longer recovery of the sense of smell correlated with the extent of smell change. At the 6-month follow-up, 46% (47/103) of the patients had at least one unresolved symptom, most commonly fatigue (22%, 23/103), smell and taste changes (15%, 15/103 and 8%, 8/103 respectively) and breathing difficulties (8%, 8/103). CONCLUSIONS Long-lasting effects of mild COVID-19 manifested in almost half of the participants reporting at least one unresolved symptom after 6 months.
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Affiliation(s)
- Hadar Klein
- Institute of Biochemistry, Food and Nutrition, Hebrew University, Rehovot, Israel
| | - Kim Asseo
- Institute of Biochemistry, Food and Nutrition, Hebrew University, Rehovot, Israel
| | - Noam Karni
- Department of Medicine, Hadassah University Hospital, Mt Scopus Campus, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Benjamini
- Department of Statistics and Data Science, Hebrew University, Mt Scopus Campus, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mordechai Muszkat
- Department of Medicine, Hadassah University Hospital, Mt Scopus Campus, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah Israel
- Department of Medicine, Hadassah University Hospital, Mt Scopus Campus, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Masha Y Niv
- Institute of Biochemistry, Food and Nutrition, Hebrew University, Rehovot, Israel.
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Bolouri H, Speake C, Skibinski D, Long SA, Hocking AM, Campbell DJ, Hamerman JA, Malhotra U, Buckner JH. The COVID-19 immune landscape is dynamically and reversibly correlated with disease severity. J Clin Invest 2021; 131:143648. [PMID: 33529167 DOI: 10.1172/jci143648] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUNDDespite a rapidly growing body of literature on coronavirus disease 2019 (COVID-19), our understanding of the immune correlates of disease severity, course, and outcome remains poor.METHODSUsing mass cytometry, we assessed the immune landscape in longitudinal whole-blood specimens from 59 patients presenting with acute COVID-19 and classified based on maximal disease severity. Hospitalized patients negative for SARS-CoV-2 were used as controls.RESULTSWe found that the immune landscape in COVID-19 formed 3 dominant clusters, which correlated with disease severity. Longitudinal analysis identified a pattern of productive innate and adaptive immune responses in individuals who had a moderate disease course, whereas those with severe disease had features suggestive of a protracted and dysregulated immune response. Further, we identified coordinate immune alterations accompanying clinical improvement and decline that were also seen in patients who received IL-6 pathway blockade.CONCLUSIONThe hospitalized COVID-19 negative cohort allowed us to identify immune alterations that were shared between severe COVID-19 and other critically ill patients. Collectively, our findings indicate that selection of immune interventions should be based in part on disease presentation and early disease trajectory due to the profound differences in the immune response in those with mild to moderate disease and those with the most severe disease.FUNDINGBenaroya Family Foundation, the Leonard and Norma Klorfine Foundation, Glenn and Mary Lynn Mounger, and the National Institutes of Health.
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Affiliation(s)
- Hamid Bolouri
- Center for Systems Immunology, Benaroya Research Institute (BRI) at Virginia Mason, Seattle, Washington, USA.,Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | | | | | - Daniel J Campbell
- Center for Fundamental Immunology, Benaroya Research Institute (BRI) at Virginia Mason, Seattle, Washington, USA.,Department of Immunology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jessica A Hamerman
- Center for Fundamental Immunology, Benaroya Research Institute (BRI) at Virginia Mason, Seattle, Washington, USA.,Department of Immunology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Uma Malhotra
- Department of Infectious Disease, Virginia Mason Medical Center, Seattle, Washington, USA.,Department of Medicine, Section of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Jane H Buckner
- Center for Translational Immunology, and.,Department of Immunology, University of Washington School of Medicine, Seattle, Washington, USA
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Ajufo E, Rao S, Navar AM, Pandey A, Ayers CR, Khera A. U.S. population at increased risk of severe illness from COVID-19. Am J Prev Cardiol 2021; 6:100156. [PMID: 33615285 PMCID: PMC7880833 DOI: 10.1016/j.ajpc.2021.100156] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background The U.S. Centers for Disease Control and Prevention (CDC) recognizes that older adults and individuals with certain medical conditions are at increased risk of severe COVID-19 infection. Understanding the proportion of the population at risk of severe infection, including among those with heart disease, could assist current vaccine strategy efforts. Methods Using data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES), we estimated the weighted prevalence of any of eight of eleven increased-risk conditions (including age ≥65) in U.S. adults aged ≥18 (N = 10,581) and extrapolated these results to a population of 233.8 million U.S. adults ≥18, and subgroups from the overall population defined by race/ethnicity, education, income and history of heart disease. Results An estimated 176.1 million individuals representing 75.4% of U.S. adults had at least one increased-risk condition, 40.3% ≥2 and, 18.5% ≥3 conditions. Approximately 129 million adults aged <65 (69.2%) were also estimated to be at increased-risk. Compared to Whites, similar proportions of Blacks in the overall population (78.0 vs. 75.6%, p>0.05) and Hispanics in the younger population (70.8 vs 68.4%) were estimated to be at increased-risk. Conversely, a greater proportion of individuals with lower education and income levels were estimated to be at increased-risk both in the overall and younger population. In addition, an estimated 6.2 million individuals (14.5%) had heart disease. Among these, virtually all had at least one additional CDC risk factor (97.9%) and most had ≥2 or ≥3 risk factors (83.8% and 58.5%, respectively). Conclusions As vaccination strategies are being explored, these results demonstrate that >75% of adults in the U.S. would be considered at increased-risk for severe COVID-19 infection by CDC criteria. Risk factor prevalence alone may not adequately capture the totality of risk, particularly among Black and Hispanic racial/ethnic groups and those with heart disease.
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Affiliation(s)
- Ezimamaka Ajufo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Shreya Rao
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ann Marie Navar
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Colby R Ayers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Amit Khera
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.,Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
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Abstract
Rationale & Objective Reported coronavirus disease 2019 (COVID-19) cases underestimate the actual number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Patients receiving maintenance dialysis are at high risk for COVID-19 and higher case rates have been reported relative to the general population. To better understand infection patterns, we performed a seroprevalence study among maintenance dialysis patients at a large dialysis organization in the United States. Study Design Cross-sectional. Setting & Participants We measured immunoglobulin G antibodies in an institutional review board–approved study of remnant serum samples collected for routine laboratory screenings in a national sample of 12,932 maintenance dialysis patients (May 27 to July 1, 2020). Exposure State, sex, age, and race. Outcomes Seropositivity; ratio of seropositivity to known COVID-19 case rate. Analytic Approach Seropositivity was calculated overall and by state, sex, age, and race. The ratio of seropositivity to known COVID-19 cases was calculated overall and by state. Results 747 (5.8%) samples were seropositive. Seroprevalence varied by state and was lowest in Kentucky (1.0%) and highest in New York (23.6%). Seroprevalence was similar among men and women. Among samples from patients younger than 70 years, 6.0% to 6.5% were seropositive; whereas 5.2% and 3.9% of samples from patients aged 70 to 79 and 80 years or older, respectively, were seropositive. Samples from Black and Hispanic patients were 7.3% and 7.7% positive, respectively, compared with 2.8% of samples from White patients. After adjustment, risk differences among racial groups were lower but not eliminated. During the study period, the known COVID-19 case rate was 3.3%. The ratio of seropositivity to known COVID-19 cases was 1.7. Limitations Imperfect assay sensitivity; results represent infections occurring before July 2020; deidentification prevented comparison of antibodies to previous COVID-19 status for individual patients; may not generalize to patients dialyzing with other providers or in other countries. Conclusions Seroprevalence was 5.8% among dialysis patients as of July 1, 2020. This indicates that the actual number of infections was 1.7 times greater than reported cases. This ratio is lower than reported in the general population, suggesting that there were fewer unknown infections among maintenance dialysis patients.
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122
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Simopoulos AP. Genetic Variation, Diet, Inflammation, and the Risk for COVID-19. Lifestyle Genom 2021; 14:37-42. [PMID: 33530084 PMCID: PMC7900446 DOI: 10.1159/000513886] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/16/2020] [Indexed: 12/19/2022] Open
Abstract
COVID-19, which is caused by SARS-CoV-2, is characterized by various symptoms, ranging from mild fatigue to life-threatening pneumonia, "cytokine storm," and multiorgan failure. The manifestation of COVID-19 may lead to a cytokine storm, i.e., it facilitates viral replication that triggers a strong release of cytokines, which then modulates the immune system and results in hyperinflammation. Today's diet is high in omega-6 fatty acids and deficient in omega-3 fatty acids; this, along with a high fructose intake, leads to obesity, which is a chronic state of low-grade inflammation. Omega-6 fatty acids are proinflammatory and prothrombotic whereas omega-3 fatty acids are less proinflammatory and thrombotic. Furthermore, omega-3 fatty acids make specialized lipid mediators, namely resolvins, protectins, and maresins, that are potent anti-inflammatory agents. Throughout evolution there was a balance between omega-6 and omega-3 fatty acids with a ratio of 1-2/1 omega-6/omega-3, but today this ratio is 16-20/1 omega-6/omega-3, leading to a proinflammatory state. In addition, genetic variants in FADS1, FADS2, ELOV-2, and ELOV-5 lead to a more efficient biosynthesis of long-chain polyunsaturated fatty acids (PUFAs), e.g., of linoleic acid (LA) to arachidonic acid (ARA), and (alpha-linolenic acid) (ALA) to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), leading to higher ARA levels. Because the US diet is already high in omega-6 fatty acids, the increased biosynthesis of ARA in people with the derived FADS haplotype (haplotype D) leads to an increased production of leukotrienes, thromboxanes, C-reactive protein (CRP), and eventually elevated levels of cytokines, like interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF), which may increase susceptibility to COVID-19. About 80% of African Americans, 50% of Hispanics, and 45% of European Americans have the FADS haplotype D and are thus efficient metabolizers, which could account for the higher vulnerability of these populations to COVID-19. Therefore, another reason that African Americans and Hispanics are more susceptible to COVID-19 is that they have a higher frequency of haplotype D, which is no longer beneficial in today's environment and diet. Genetic variation must be considered in all studies of disease development and therapy because it is important to the practice of precision nutrition by physicians and other health professionals. The objective of this commentary is to emphasize the importance of genetic variation within populations and its interaction with diet in the development of disease. Differences in the frequency of genes and their interactions with nutrients in various population groups must be considered among the factors contributing to health disparities in the development of COVID-19. A balanced omega-6/omega-3 ratio is essential to health. Physicians should measure their patients' fatty acids and recommend decreasing the intake of foods rich in omega-6 fatty acids and increasing the intake of omega-3 fatty acids along with fruits and vegetables.
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Affiliation(s)
- Artemis P. Simopoulos
- *Artemis P. Simopoulos, The Center for Genetics, Nutrition and Health, 4330 Klingle Street NW, Washington, DC 20016 (USA),
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123
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Lorenzo NE, Zeytinoglu S, Morales S, Listokin J, Almas AN, Degnan KA, Henderson H, Chronis-Tuscano A, Fox NA. Transactional Associations Between Parent and Late Adolescent Internalizing Symptoms During the COVID-19 Pandemic: The Moderating Role of Avoidant Coping. J Youth Adolesc 2021; 50:459-469. [PMID: 33495969 PMCID: PMC7833445 DOI: 10.1007/s10964-020-01374-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
Extensive research has demonstrated the transactional nature of parent-child psychopathology, with limited studies examining these effects during late adolescence and none, to our knowledge, longitudinally during the COVID-19 pandemic. The current study examined the cross-lagged effects of parent and adolescent internalizing symptoms during the COVID-19 pandemic and the moderating role of avoidant coping. A sample of 291 adolescents (Agemean = 18.27; 53% female; 61% White) and their parents rated their own anxiety and depressive symptoms and coping during the first two months following stay-at-home orders during the COVID-19 pandemic. Parent internalizing symptoms at the first assessment predicted adolescent internalizing symptoms at the second assessment. Adolescent avoidant coping style moderated this effect of parent internalizing symptoms on adolescent internalizing symptoms in the subsequent month, such that parent internalizing symptoms predicted child internalizing symptoms only among adolescents with moderate to high rates of avoidant coping. Follow-up analyses indicated different patterns when examining depressive and anxiety symptoms separately. The results highlight complex family dynamics between adolescents and their parents and begin to differentiate how individual characteristics impact the response to a significant life event such as the COVID-19 pandemic.
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Affiliation(s)
- Nicole E Lorenzo
- University of Maryland, 3942 Campus Drive, College Park, MD, 20742, USA.
| | - Selin Zeytinoglu
- University of Maryland, 3942 Campus Drive, College Park, MD, 20742, USA
| | - Santiago Morales
- University of Maryland, 3942 Campus Drive, College Park, MD, 20742, USA
| | - Jamie Listokin
- University of Maryland, 3942 Campus Drive, College Park, MD, 20742, USA
| | - Alisa N Almas
- University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kathryn A Degnan
- Catholic University, 620 Michigan Ave., N.E., Washington, DC, 20064, USA
| | - Heather Henderson
- Waterloo University, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Nathan A Fox
- University of Maryland, 3942 Campus Drive, College Park, MD, 20742, USA
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124
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Salama C, Han J, Yau L, Reiss WG, Kramer B, Neidhart JD, Criner GJ, Kaplan-Lewis E, Baden R, Pandit L, Cameron ML, Garcia-Diaz J, Chávez V, Mekebeb-Reuter M, Lima de Menezes F, Shah R, González-Lara MF, Assman B, Freedman J, Mohan SV. Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia. N Engl J Med 2021; 384:20-30. [PMID: 33332779 PMCID: PMC7781101 DOI: 10.1056/nejmoa2030340] [Citation(s) in RCA: 837] [Impact Index Per Article: 279.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (Covid-19) pneumonia is often associated with hyperinflammation. Despite the disproportionate incidence of Covid-19 among underserved and racial and ethnic minority populations, the safety and efficacy of the anti-interleukin-6 receptor antibody tocilizumab in patients from these populations who are hospitalized with Covid-19 pneumonia are unclear. METHODS We randomly assigned (in a 2:1 ratio) patients hospitalized with Covid-19 pneumonia who were not receiving mechanical ventilation to receive standard care plus one or two doses of either tocilizumab (8 mg per kilogram of body weight intravenously) or placebo. Site selection was focused on the inclusion of sites enrolling high-risk and minority populations. The primary outcome was mechanical ventilation or death by day 28. RESULTS A total of 389 patients underwent randomization, and the modified intention-to-treat population included 249 patients in the tocilizumab group and 128 patients in the placebo group; 56.0% were Hispanic or Latino, 14.9% were Black, 12.7% were American Indian or Alaska Native, 12.7% were non-Hispanic White, and 3.7% were of other or unknown race or ethnic group. The cumulative percentage of patients who had received mechanical ventilation or who had died by day 28 was 12.0% (95% confidence interval [CI], 8.5 to 16.9) in the tocilizumab group and 19.3% (95% CI, 13.3 to 27.4) in the placebo group (hazard ratio for mechanical ventilation or death, 0.56; 95% CI, 0.33 to 0.97; P = 0.04 by the log-rank test). Clinical failure as assessed in a time-to-event analysis favored tocilizumab over placebo (hazard ratio, 0.55; 95% CI, 0.33 to 0.93). Death from any cause by day 28 occurred in 10.4% of the patients in the tocilizumab group and 8.6% of those in the placebo group (weighted difference, 2.0 percentage points; 95% CI, -5.2 to 7.8). In the safety population, serious adverse events occurred in 38 of 250 patients (15.2%) in the tocilizumab group and 25 of 127 patients (19.7%) in the placebo group. CONCLUSIONS In hospitalized patients with Covid-19 pneumonia who were not receiving mechanical ventilation, tocilizumab reduced the likelihood of progression to the composite outcome of mechanical ventilation or death, but it did not improve survival. No new safety signals were identified. (Funded by Genentech; EMPACTA ClinicalTrials.gov number, NCT04372186.).
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Affiliation(s)
- Carlos Salama
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Jian Han
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Linda Yau
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - William G Reiss
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Benjamin Kramer
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Jeffrey D Neidhart
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Gerard J Criner
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Emma Kaplan-Lewis
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Rachel Baden
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Lavannya Pandit
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Miriam L Cameron
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Julia Garcia-Diaz
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Victoria Chávez
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Martha Mekebeb-Reuter
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Ferdinando Lima de Menezes
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Reena Shah
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Maria F González-Lara
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Beverly Assman
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Jamie Freedman
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
| | - Shalini V Mohan
- From Elmhurst Hospital Center-Icahn School of Medicine at Mount Sinai Hospital (C.S.), and Elmhurst Hospital Center-New York City Health and Hospitals (E.K.-L.) - both in New York; Genentech, South San Francisco (J.H., L.Y., W.G.R., B.K., B.A., J.F., S.V.M.), and Highland Hospital, Oakland (R.B.) - both in California; San Juan Oncology Associates, Farmington, NM (J.D.N); Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); Michael E. DeBakey Houston VA Medical Center, Houston (L.P.); Holy Cross Health, Silver Spring, MD (M.L.C.); Ochsner Clinic Foundation, New Orleans (J.G.-D.); Central Military Hospital, Lima, Peru (V.C.); Stellenbosch University, Cape Town, South Africa (M.M.-R); BR Trials-Clinical Research, São Paulo (F.L.M.); Aga Khan University Hospital, Nairobi (R.S.); and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (M.F.G.-L.)
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125
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Strand NK. Racial Myths and Regulatory Responsibility. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:231-240. [PMID: 34924049 DOI: 10.1017/jme.2021.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Calls to abolish race as a proxy for biology or genetics in clinical care have reached a fever pitch in the latter half of 2020, including articles in the New England Journal of Medicine, and urgent letters from prominent Senators.
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126
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Brown LB, Spinelli MA, Gandhi M. The interplay between HIV and COVID-19: summary of the data and responses to date. Curr Opin HIV AIDS 2021; 16:63-73. [PMID: 33186229 PMCID: PMC7735216 DOI: 10.1097/coh.0000000000000659] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW We examine the interplay between the HIV and COVID-19 epidemics, including the impact of HIV on COVID-19 susceptibility and severe disease, the effect of the COVID-19 epidemic on HIV prevention and treatment, and the influence of the HIV epidemic on responses to COVID-19. RECENT FINDINGS Evidence to date does not suggest that people living with HIV (PLWH) have a markedly higher susceptibility to SARS-CoV-2 infection, with disparities in the social determinants of health and comorbidities likely having a greater influence. The majority of literature has not supported a higher risk for severe disease among PLWH in Europe and the United States, although a large, population-based study in South Africa reported a higher rate of death due to COVID-19. Higher rates of comorbidities associated with COVID-19 disease severity among PLWH is an urgent concern. COVID-19 is leading to decreased access to HIV prevention services and HIV testing, and worsening HIV treatment access and virologic suppression, which could lead to worsening HIV epidemic control. CONCLUSION COVID-19 is threatening gains against the HIV epidemic, including the U.S. Ending the HIV Epidemic goals. The ongoing collision of these two global pandemics will continue to need both study and interventions to mitigate the effects of COVID-19 on HIV efforts worldwide.
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Affiliation(s)
- Lillian B. Brown
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
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127
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Weiden MD, Zeig-Owens R, Singh A, Schwartz T, Liu Y, Vaeth B, Nolan A, Cleven KL, Hurwitz K, Beecher S, Prezant DJ. Pre-COVID-19 lung function and other risk factors for severe COVID-19 in first responders. ERJ Open Res 2021; 7:00610-2020. [PMID: 33527077 PMCID: PMC7607970 DOI: 10.1183/23120541.00610-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/06/2020] [Indexed: 01/09/2023] Open
Abstract
Risk factors for #COVID19 infection and severe disease (hospitalisation or death) in NYC first responders: greater pre-pandemic rate of FEV1 decline is associated with severe COVID-19, as is emergency medical service work versus firefighting https://bit.ly/3nZPuZY.
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Affiliation(s)
- Michael D. Weiden
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary, Critical Care and Sleep Medicine Division, Depts of Medicine and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Rachel Zeig-Owens
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Epidemiology, Dept of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ankura Singh
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Theresa Schwartz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yang Liu
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandon Vaeth
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anna Nolan
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary, Critical Care and Sleep Medicine Division, Depts of Medicine and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Krystal L. Cleven
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karen Hurwitz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
| | - Shenecia Beecher
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
| | - David J. Prezant
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Dept of the City of New York, Brooklyn, NY, USA
- Pulmonary Medicine Division, Dept of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- Office of Medical Affairs, Fire Dept of the City of New York, Brooklyn, NY, USA
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128
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Lucic M, Ghazzai H, Lipizzi C, Massoud Y. Integrating County-Level Socioeconomic Data for COVID-19 Forecasting in the United States. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2021; 2:235-248. [PMID: 35402976 PMCID: PMC8901003 DOI: 10.1109/ojemb.2021.3096135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022] Open
Abstract
Goal: The United States (US) is currently one of the countries hardest-hit by the novel SARS-CoV-19 virus. One key difficulty in managing the outbreak at the national level is that due to the US’ diversity, geographic spread, and economic inequality, the COVID-19 pandemic in the US acts more as a series of diverse regional outbreaks rather than a synchronized homogeneous one. Method: In order to determine how to assess regional risk related to COVID-19, a two-phase modeling approach is developed while considering demographic and economic criteria. First, an unsupervised clustering technique, specifically \documentclass[12pt]{minimal}
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}{}$k$\end{document}-means, is employed to group US counties based on demographic and economic similarities. Then, time series forecasting of each cluster of counties is developed to assess the short-run viral transmissibility risk. Results: To this end, we test ARIMA and Seasonal Trend Random Walk forecasts to determine which is more appropriate for modeling the spread and lethality of COVID-19. From our analysis, we then utilize the superior ARIMA models to forecast future COVID-19 trends in the clusters, and present the areas in the US which have the highest COVID-19 related risk heading into the winter of 2020. Conclusion: Including sub-national socioeconomic characteristics to data-driven COVID-19 infection and fatality forecasts may play a key role in assessing the risk associated with changes in infection patterns at the national level.
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Affiliation(s)
| | - Hakim Ghazzai
- Stevens Institute of Technology Hoboken NJ 07030 USA
| | - Carlo Lipizzi
- Stevens Institute of Technology Hoboken NJ 07030 USA
| | - Yehia Massoud
- Computer, Electrical and Mathematical Sciences and Engineering DivisionKing Abdullah University of Science and Technology Thuwal 23955-6900 Saudi Arabia
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129
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Hotez PJ, Huete-Perez JA, Bottazzi ME. COVID-19 in the Americas and the erosion of human rights for the poor. PLoS Negl Trop Dis 2020; 14:e0008954. [PMID: 33338042 PMCID: PMC7748132 DOI: 10.1371/journal.pntd.0008954] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Peter J. Hotez
- Texas Children’s Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- Hagler Institute for Advanced Study at Texas A&M University, College Station, Texas, United States of America
- James A Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America
- Scowcroft Institute of International Affairs, Bush School of Government and Public Service, College Station, Texas, United States of America
- * E-mail: (PJH); (JAHP); (MEB)
| | - Jorge A. Huete-Perez
- Molecular Biology Center, University of Central America, Managua, Nicaragua
- * E-mail: (PJH); (JAHP); (MEB)
| | - Maria Elena Bottazzi
- Texas Children’s Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- * E-mail: (PJH); (JAHP); (MEB)
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130
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Abstract
Considering the influence of stress on research participants during the pandemic and beyond may provide new insights and benefit the broader field of human neuroscience.
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Affiliation(s)
- Elizabeth V Goldfarb
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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131
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Millett GA. New pathogen, same disparities: why COVID-19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic. J Int AIDS Soc 2020; 23:e25639. [PMID: 33222424 PMCID: PMC7645849 DOI: 10.1002/jia2.25639] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The U.S. Ending the HIV Epidemic (EHE) Initiative was launched nationally in February 2019. With a target of ending the HIV epidemic by 2030, EHE initially scales up effective HIV prevention and care in 57 localities that comprise the greatest proportion of annual HIV diagnoses in the United States (US). However, the EHE effort has been eclipsed by another infectious disease 11 months into the Initiative's implementation. SARS-COV-2, a novel coronavirus, has infected more than eight million Americans and at least 223 000 (as of 23 October 2020) have succumbed to the disease. This commentary explores the social conditions that place communities of colour at greater risk for COVID-19 and HIV, and assesses challenges to EHE in a post-COVID-19 universe. DISCUSSION One of the many common threads between HIV and COVID-19 is the disproportionate impact of each disease among communities of colour. A recent report by the National Academy of Sciences surmised that as much as 70% of health outcomes are due to health access, socio-economic factors and environmental conditions. Social determinants of health associated with greater HIV burden in Black and Brown communities have re-emerged in epidemiological studies of disproportionate COVID-19 cases, hospitalizations and deaths in communities of colour. Using data from the scientific literature, this commentary makes direct comparisons between HIV and COVID-19 racial disparities across the social determinants of health. Furthermore, I examine three sets of challenges facing EHE: (1) Challenges that hamper both the EHE and COVID-19 response (i.e. insufficiently addressing the social determinants of health; amplification of disparities as new health technologies are introduced) (2) Challenges posed by COVID-19 (i.e. diverting HIV resources to address COVID-19 and tapering of EHE funding generally); and (3) Challenges unrelated to COVID-19 (i.e. emergence of new and related health disparities; repeal of the Affordable Care Act and long-term viability of EHE). CONCLUSIONS Racism and discrimination place communities of colour at greater risk for COVID-19 as well as HIV. Achieving and sustaining an end to the U.S. HIV epidemic will require structural change to eliminate conditions that give rise to and maintain disparities.
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132
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Zakeri R, Bendayan R, Ashworth M, Bean DM, Dodhia H, Durbaba S, O'Gallagher K, Palmer C, Curcin V, Aitken E, Bernal W, Barker RD, Norton S, Gulliford M, Teo JTH, Galloway J, Dobson RJB, Shah AM. A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19. EClinicalMedicine 2020; 28:100574. [PMID: 33052324 PMCID: PMC7545271 DOI: 10.1016/j.eclinm.2020.100574] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People of minority ethnic backgrounds may be disproportionately affected by severe COVID-19. Whether this relates to increased infection risk, more severe disease progression, or worse in-hospital survival is unknown. The contribution of comorbidities or socioeconomic deprivation to ethnic patterning of outcomes is also unclear. METHODS We conducted a case-control and a cohort study in an inner city primary and secondary care setting to examine whether ethnic background affects the risk of hospital admission with severe COVID-19 and/or in-hospital mortality. Inner city adult residents admitted to hospital with confirmed COVID-19 (n = 872 cases) were compared with 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people residing in the same region. For the cohort study, we studied 1827 adults consecutively admitted with COVID-19. The primary exposure variable was self-defined ethnicity. Analyses were adjusted for socio-demographic and clinical variables. FINDINGS The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63-3.71] and 2.97 [2.30-3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.24 [1.83-2.74] for Black, 2.70 [2.03-3.59] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (adjusted OR 1.01 [0.70-1.46]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4-16) days. Age and male sex, but not Black (adjusted HR 1.06 [0.82-1.37]) or Mixed/Other ethnicity (adjusted HR 0.72 [0.47-1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality but with a large confidence interval (adjusted HR 1.71 [1.15-2.56]). INTERPRETATION Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease, but do not affect in-hospital mortality risk. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians. FUNDING British Heart Foundation; the National Institute for Health Research; Health Data Research UK.
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Affiliation(s)
- Rosita Zakeri
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, UK
| | - Daniel M Bean
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Hiten Dodhia
- School of Population Health and Environmental Sciences, King's College London, UK
| | - Stevo Durbaba
- School of Population Health and Environmental Sciences, King's College London, UK
| | - Kevin O'Gallagher
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Claire Palmer
- King's College Hospital NHS Foundation Trust, London, UK
| | - Vasa Curcin
- School of Population Health and Environmental Sciences, King's College London, UK
| | | | - William Bernal
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Sam Norton
- Centre for Rheumatic Disease, School of Immunology and Microbial Sciences, King's College London, UK
| | - Martin Gulliford
- School of Population Health and Environmental Sciences, King's College London, UK
| | - James T H Teo
- King's College Hospital NHS Foundation Trust, London, UK
| | - James Galloway
- Centre for Rheumatic Disease, School of Immunology and Microbial Sciences, King's College London, UK
| | - Richard J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Health Data Research UK London, Institute of Health Informatics, University College London, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre, 125 Coldharbour Lane, London SE5 9NU, UK
- King's College Hospital NHS Foundation Trust, London, UK
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Cromer SJ, Lakhani CM, Wexler DJ, Burnett-Bowie SAM, Udler M, Patel CJ. Geospatial Analysis of Individual and Community-Level Socioeconomic Factors Impacting SARS-CoV-2 Prevalence and Outcomes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.09.30.20201830. [PMID: 33024982 PMCID: PMC7536884 DOI: 10.1101/2020.09.30.20201830] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The SARS-CoV-2 pandemic has disproportionately affected racial and ethnic minority communities across the United States. We sought to disentangle individual and census tract-level sociodemographic and economic factors associated with these disparities. Methods and Findings All adults tested for SARS-CoV-2 between February 1 and June 21, 2020 were geocoded to a census tract based on their address; hospital employees and individuals with invalid addresses were excluded. Individual (age, sex, race/ethnicity, preferred language, insurance) and census tract-level (demographics, insurance, income, education, employment, occupation, household crowding and occupancy, built home environment, and transportation) variables were analyzed using linear mixed models predicting infection, hospitalization, and death from SARS-CoV-2.Among 57,865 individuals, per capita testing rates, individual (older age, male sex, non-White race, non-English preferred language, and non-private insurance), and census tract-level (increased population density, higher household occupancy, and lower education) measures were associated with likelihood of infection. Among those infected, individual age, sex, race, language, and insurance, and census tract-level measures of lower education, more multi-family homes, and extreme household crowding were associated with increased likelihood of hospitalization, while higher per capita testing rates were associated with decreased likelihood. Only individual-level variables (older age, male sex, Medicare insurance) were associated with increased mortality among those hospitalized. Conclusions This study of the first wave of the SARS-CoV-2 pandemic in a major U.S. city presents the cascade of outcomes following SARS-CoV-2 infection within a large, multi-ethnic cohort. SARS-CoV-2 infection and hospitalization rates, but not death rates among those hospitalized, are related to census tract-level socioeconomic characteristics including lower educational attainment and higher household crowding and occupancy, but not neighborhood measures of race, independent of individual factors.
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Affiliation(s)
- Sara J. Cromer
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142
| | - Chirag M. Lakhani
- Harvard Medical School, Boston, MA 02115
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | | | - Miriam Udler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA 02142
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