201
|
Brayne C, Moffitt TE. The limitations of large-scale volunteer databases to address inequalities and global challenges in health and aging. NATURE AGING 2022; 2:775-783. [PMID: 37118500 PMCID: PMC10154032 DOI: 10.1038/s43587-022-00277-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2022] [Indexed: 04/30/2023]
Abstract
Large-scale volunteer databanks (LSVD) have emerged from the recognized value of cohorts, attracting substantial funding and promising great scientific value. A major focus is their size, with the implicit and sometimes explicit assumption that large size (thus power) creates generalizability. We contend that this is open to challenge. In the context of aging and age-related disease research, LSVD typically have limitations such as healthy volunteer, white ethnicity and high-education biases, and they omit early and late life stages critical for understanding aging. Their outputs are heavily focused on biomedical pathways of single chronic diseases. LSVD outputs increasingly dominate the funding and the publication landscapes. This Perspective discusses LSVD limitations and calls for more transparent reporting in LSVD research, as well as a greater reflection on the value of LSVD in relation to resources consumed. We invite funders and researchers to examine whether LSVD do actually contribute knowledge needed for our acute global health challenges including inequalities.
Collapse
Affiliation(s)
- Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK.
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Promenta Centre, University of Oslo, Oslo, Norway
| |
Collapse
|
202
|
Holt H, Talaei M, Greenig M, Zenner D, Symons J, Relton C, Young KS, Davies MR, Thompson KN, Ashman J, Rajpoot SS, Kayyale AA, El Rifai S, Lloyd PJ, Jolliffe D, Timmis O, Finer S, Iliodromiti S, Miners A, Hopkinson NS, Alam B, Lloyd-Jones G, Dietrich T, Chapple I, Pfeffer PE, McCoy D, Davies G, Lyons RA, Griffiths C, Kee F, Sheikh A, Breen G, Shaheen SO, Martineau AR. Risk factors for developing COVID-19: a population-based longitudinal study (COVIDENCE UK). Thorax 2022; 77:900-912. [PMID: 34848555 PMCID: PMC8646971 DOI: 10.1136/thoraxjnl-2021-217487] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Risk factors for severe COVID-19 include older age, male sex, obesity, black or Asian ethnicity and underlying medical conditions. Whether these factors also influence susceptibility to developing COVID-19 is uncertain. METHODS We undertook a prospective, population-based cohort study (COVIDENCE UK) from 1 May 2020 to 5 February 2021. Baseline information on potential risk factors was captured by an online questionnaire. Monthly follow-up questionnaires captured incident COVID-19. We used logistic regression models to estimate multivariable-adjusted ORs (aORs) for associations between potential risk factors and odds of COVID-19. RESULTS We recorded 446 incident cases of COVID-19 in 15 227 participants (2.9%). Increased odds of developing COVID-19 were independently associated with Asian/Asian British versus white ethnicity (aOR 2.28, 95% CI 1.33 to 3.91), household overcrowding (aOR per additional 0.5 people/bedroom 1.26, 1.11 to 1.43), any versus no visits to/from other households in previous week (aOR 1.31, 1.06 to 1.62), number of visits to indoor public places (aOR per extra visit per week 1.05, 1.02 to 1.09), frontline occupation excluding health/social care versus no frontline occupation (aOR 1.49, 1.12 to 1.98) and raised body mass index (BMI) (aOR 1.50 (1.19 to 1.89) for BMI 25.0-30.0 kg/m2 and 1.39 (1.06 to 1.84) for BMI >30.0 kg/m2 versus BMI <25.0 kg/m2). Atopic disease was independently associated with decreased odds (aOR 0.75, 0.59 to 0.97). No independent associations were seen for age, sex, other medical conditions, diet or micronutrient supplement use. CONCLUSIONS After rigorous adjustment for factors influencing exposure to SARS-CoV-2, Asian/Asian British ethnicity and raised BMI were associated with increased odds of developing COVID-19, while atopic disease was associated with decreased odds. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04330599).
Collapse
Affiliation(s)
- Hayley Holt
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mohammad Talaei
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew Greenig
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dominik Zenner
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Clare Relton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Katherine S Young
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Molly R Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katherine N Thompson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jed Ashman
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sultan Saeed Rajpoot
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ahmed Ali Kayyale
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah El Rifai
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Philippa J Lloyd
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David Jolliffe
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Olivia Timmis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Finer
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stamatina Iliodromiti
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Thomas Dietrich
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Iain Chapple
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Paul E Pfeffer
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David McCoy
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gwyneth Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Christopher Griffiths
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Frank Kee
- Centre for Public Health Research (NI), Queen's University Belfast, Belfast, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Seif O Shaheen
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
203
|
Djuric O, Ottone M, Vicentini M, Venturelli F, Pezzarossi A, Manicardi V, Greci M, Giorgi Rossi P. Diabetes and COVID-19 testing, positivity, and mortality: A population-wide study in Northern Italy. Diabetes Res Clin Pract 2022; 191:110051. [PMID: 36030900 PMCID: PMC9417741 DOI: 10.1016/j.diabres.2022.110051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 01/08/2023]
Abstract
AIMS To assess if patients with type 2 diabetes mellitus (DM2) are: a) at excess risk of undergoing testing, contracting, and dying from SARS-CoV-2 infection compared to the general population; b) whether cardiovascular diseases (CAVDs) contribute to COVID-19-related death; and c) what is the effect of DM2 duration and control on COVID-19-related death. METHODS This population-based study involved all 449,440 adult residents of the Reggio Emilia province, Italy. DM2 patients were divided in groups by COVID testing, presence of CAVDs and COVID death. Several mediation analyses were performed. RESULTS Patients with DM2 had an increased likelihood of being tested (Odds ratio, OR 1.27 95 %CI 1.23-1.30), testing positive (OR 1.21 95 %CI 1.16-1.26) and dying from COVID-19 (OR 1.75 95 %CI 1.54-2.00). COVID-19-related death was almost three times higher among obese vs non-obese patients with DM2 (OR 4.3 vs 1.6, respectively). For COVID-19 death, CAVDs mediated a) just 5.1 % of the total effect of DM2, b) 40 % of the effect of DM2 duration, and c) did not mediate the effect of glycemic control. CONCLUSIONS For COVID-19-related deaths in DM2 patients, the effect is mostly direct, obesity amplifies it, DM2 control and duration are important predictors, while CAVDs only slightly mediates it.
Collapse
Affiliation(s)
- Olivera Djuric
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy.
| | - Marta Ottone
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Francesco Venturelli
- Public Health Unit, Azienda USL - IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Annamaria Pezzarossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Valeria Manicardi
- Medical Diabetologist Association Coordinator, Diabetologist, Salus Hospital, 42122 Reggio Emilia, Italy
| | - Marina Greci
- Primary Health Care Department, Azienda USL - IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| |
Collapse
|
204
|
Abstract
Human genetics can inform the biology and epidemiology of coronavirus disease 2019 (COVID-19) by pinpointing causal mechanisms that explain why some individuals become more severely affected by the disease upon infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Large-scale genetic association studies, encompassing both rare and common genetic variants, have used different study designs and multiple disease phenotype definitions to identify several genomic regions associated with COVID-19. Along with a multitude of follow-up studies, these findings have increased our understanding of disease aetiology and provided routes for management of COVID-19. Important emergent opportunities include the clinical translatability of genetic risk prediction, the repurposing of existing drugs, exploration of variable host effects of different viral strains, study of inter-individual variability in vaccination response and understanding the long-term consequences of SARS-CoV-2 infection. Beyond the current pandemic, these transferrable opportunities are likely to affect the study of many infectious diseases.
Collapse
Affiliation(s)
- Mari E K Niemi
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Mark J Daly
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Broad Institute, Cambridge, MA, USA
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
- Broad Institute, Cambridge, MA, USA.
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
205
|
Sheridan C, Klompmaker J, Cummins S, James P, Fecht D, Roscoe C. Associations of air pollution with COVID-19 positivity, hospitalisations, and mortality: Observational evidence from UK Biobank. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 308:119686. [PMID: 35779662 PMCID: PMC9243647 DOI: 10.1016/j.envpol.2022.119686] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 05/26/2023]
Abstract
Individual-level studies with adjustment for important COVID-19 risk factors suggest positive associations of long-term air pollution exposure (particulate matter and nitrogen dioxide) with COVID-19 infection, hospitalisations and mortality. The evidence, however, remains limited and mechanisms unclear. We aimed to investigate these associations within UK Biobank, and to examine the role of underlying chronic disease as a potential mechanism. UK Biobank COVID-19 positive laboratory test results were ascertained via Public Health England and general practitioner record linkage, COVID-19 hospitalisations via Hospital Episode Statistics, and COVID-19 mortality via Office for National Statistics mortality records from March-December 2020. We used annual average outdoor air pollution modelled at 2010 residential addresses of UK Biobank participants who resided in England (n = 424,721). We obtained important COVID-19 risk factors from baseline UK Biobank questionnaire responses (2006-2010) and general practitioner record linkage. We used logistic regression models to assess associations of air pollution with COVID-19 outcomes, adjusted for relevant confounders, and conducted sensitivity analyses. We found positive associations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) with COVID-19 positive test result after adjustment for confounders and COVID-19 risk factors, with odds ratios of 1.05 (95% confidence intervals (CI) = 1.02, 1.08), and 1.05 (95% CI = 1.01, 1.08), respectively. PM 2.5 and NO 2 were positively associated with COVID-19 hospitalisations and deaths in minimally adjusted models, but not in fully adjusted models. No associations for PM10 were found. In analyses with additional adjustment for pre-existing chronic disease, effect estimates were not substantially attenuated, indicating that underlying chronic disease may not fully explain associations. We found some evidence that long-term exposure to PM2.5 and NO2 was associated with a COVID-19 positive test result in UK Biobank, though not with COVID-19 hospitalisations or deaths.
Collapse
Affiliation(s)
- Charlotte Sheridan
- London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, United Kingdom.
| | - Jochem Klompmaker
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, United States.
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St., London, United Kingdom.
| | - Peter James
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, United States; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, United States.
| | - Daniela Fecht
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Medicine, St Mary's Campus, Imperial College London, London, W2 1PG, United Kingdom.
| | - Charlotte Roscoe
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, United States; MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Medicine, St Mary's Campus, Imperial College London, London, W2 1PG, United Kingdom; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02115, United States.
| |
Collapse
|
206
|
Kedor C, Freitag H, Meyer-Arndt L, Wittke K, Hanitsch LG, Zoller T, Steinbeis F, Haffke M, Rudolf G, Heidecker B, Bobbert T, Spranger J, Volk HD, Skurk C, Konietschke F, Paul F, Behrends U, Bellmann-Strobl J, Scheibenbogen C. A prospective observational study of post-COVID-19 chronic fatigue syndrome following the first pandemic wave in Germany and biomarkers associated with symptom severity. Nat Commun 2022; 13:5104. [PMID: 36042189 PMCID: PMC9426365 DOI: 10.1038/s41467-022-32507-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/03/2022] [Indexed: 01/08/2023] Open
Abstract
A subset of patients has long-lasting symptoms after mild to moderate Coronavirus disease 2019 (COVID-19). In a prospective observational cohort study, we analyze clinical and laboratory parameters in 42 post-COVID-19 syndrome patients (29 female/13 male, median age 36.5 years) with persistent moderate to severe fatigue and exertion intolerance six months following COVID-19. Further we evaluate an age- and sex-matched postinfectious non-COVID-19 myalgic encephalomyelitis/chronic fatigue syndrome cohort comparatively. Most post-COVID-19 syndrome patients are moderately to severely impaired in daily live. 19 post-COVID-19 syndrome patients fulfill the 2003 Canadian Consensus Criteria for myalgic encephalomyelitis/chronic fatigue syndrome. Disease severity and symptom burden is similar in post-COVID-19 syndrome/myalgic encephalomyelitis/chronic fatigue syndrome and non-COVID-19/myalgic encephalomyelitis/chronic fatigue syndrome patients. Hand grip strength is diminished in most patients compared to normal values in healthy. Association of hand grip strength with hemoglobin, interleukin 8 and C-reactive protein in post-COVID-19 syndrome/non-myalgic encephalomyelitis/chronic fatigue syndrome and with hemoglobin, N-terminal prohormone of brain natriuretic peptide, bilirubin, and ferritin in post-COVID-19 syndrome/myalgic encephalomyelitis/chronic fatigue syndrome may indicate low level inflammation and hypoperfusion as potential pathomechanisms.
Collapse
Affiliation(s)
- Claudia Kedor
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany.
| | - Helma Freitag
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
| | - Lil Meyer-Arndt
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Kirsten Wittke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
| | - Leif G Hanitsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Milan Haffke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
| | - Gordon Rudolf
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
| | - Bettina Heidecker
- Department of Cardiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Thomas Bobbert
- Department of Endcrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Joachim Spranger
- Department of Endcrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Hans-Dieter Volk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
- Center for Regenerative Therapies (BCRT), Berlin Institute of Health, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Frank Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Uta Behrends
- Childrens' Hospital, School of Medicine, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Berlin, Germany
- AGV Research Unit Gene Vectors, Helmholtz Center Munich (HMGU), Munich, Germany
| | - Judith Bellmann-Strobl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Carmen Scheibenbogen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
| |
Collapse
|
207
|
Matthews AA, Danaei G, Islam N, Kurth T. Target trial emulation: applying principles of randomised trials to observational studies. BMJ 2022; 378:e071108. [PMID: 36041749 DOI: 10.1136/bmj-2022-071108] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anthony A Matthews
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Goodarz Danaei
- Department of Global Health and Population and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nazrul Islam
- Oxford Population Health, Big Data Institute, University of Oxford, Oxford, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
208
|
Beese F, Waldhauer J, Wollgast L, Pförtner TK, Wahrendorf M, Haller S, Hoebel J, Wachtler B. Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic—A Scoping Review. Int J Public Health 2022; 67:1605128. [PMID: 36105178 PMCID: PMC9464808 DOI: 10.3389/ijph.2022.1605128] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/16/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives: International evidence of socioeconomic inequalities in COVID-19 outcomes is extensive and growing, but less is known about the temporal dynamics of these inequalities over the course of the pandemic. Methods: We systematically searched the Embase and Scopus databases. Additionally, several relevant journals and the reference lists of all included articles were hand-searched. This study follows the PRISMA guidelines for scoping reviews. Results: Forty-six studies were included. Of all analyses, 91.4% showed stable or increasing socioeconomic inequalities in COVID-19 outcomes over the course of the pandemic, with socioeconomically disadvantaged populations being most affected. Furthermore, the study results showed temporal dynamics in socioeconomic inequalities in COVID-19, frequently initiated through higher COVID-19 incidence and mortality rates in better-off populations and subsequent crossover dynamics to higher rates in socioeconomically disadvantaged populations (41.9% of all analyses). Conclusion: The identified temporal dynamics of socioeconomic inequalities in COVID-19 outcomes have relevant public health implications. Socioeconomic inequalities should be monitored over time to enable the adaption of prevention and interventions according to the social particularities of specific pandemic phases.
Collapse
Affiliation(s)
- Florian Beese
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- *Correspondence: Florian Beese,
| | - Julia Waldhauer
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lina Wollgast
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine and Faculty of Human Sciences, University of Cologne, Cologne, Germany
- Research Methods Division, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society (CHS), Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany
| | - Sebastian Haller
- Division of Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Benjamin Wachtler
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
209
|
Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada. PLoS One 2022; 17:e0272648. [PMID: 36001553 PMCID: PMC9401116 DOI: 10.1371/journal.pone.0272648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/22/2022] [Indexed: 01/08/2023] Open
Abstract
Background There are limited data on outcomes of SARS-CoV-2 infection among infants (<1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions. The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2. Methods This is a national, prospective study of infants with SARS-CoV-2 from April 8th 2020 to May 31st 2021 using the infrastructure of the Canadian Paediatric Surveillance Program. Infants <1 year of age with microbiologically confirmed SARS-CoV-2 infection from both inpatients and outpatients seen in clinics and emergency departments were included. Cases were classified as either: 1) Non-hospitalized patient with SARS-CoV-2 infection; 2) COVID-19-related hospitalization; or 3) non-COVID-19-related hospitalization (e.g., incidentally detected SARS-CoV-2). Case severity was defined as asymptomatic, outpatient care, mild (inpatient care), moderate or severe disease. Multivariable logistic regression was performed to identify characteristics associated with hospitalization. Results A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions (aOR = 4.53, 2.06–9.97), and infants <1 month had higher odds of hospitalization then infants aged 1–3 months (aOR = 3.78, 1.97–7.26). In total, 20 infants (3.8%) met criteria for severe disease. Conclusions We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group was found to be uncommon. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants.
Collapse
|
210
|
Li J, Lu N, Lyu H, Lei G, Zeng C, Wei J, Wang Y, Xie D. Peptic Ulcer Disease and Risk of Hip Fracture: A General Population-based Cohort Study. J Clin Endocrinol Metab 2022; 107:e3738-e3746. [PMID: 35689555 DOI: 10.1210/clinem/dgac358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Indexed: 12/20/2022]
Abstract
AIMS Previous studies reported proton pump inhibitor (PPI) use may increase the risk of fracture; however, the findings may be susceptible to indication bias because peptic ulcer disease (PUD), 1 major indication for PPIs, may affect skeletal health. Determining whether PUD would increase hip fracture risk may help identify high-risk populations and explore risk factors. METHODS We conducted a cohort study using data from The Health Improvement Network (THIN) in the United Kingdom. THIN contains patient information such as disease diagnosis and medicine prescriptions. Up to 5 non-PUD individuals (n = 138 265) were matched to each case of incident PUD (n = 27 653) by age, sex, and body mass index. We examined the association between PUD and hip fracture by a multivariable Cox proportional hazard model. We repeated the same analysis among individuals with incident PUD and gastroesophageal reflux disease (GERD) (n = 27 160), another disease with similar indication for PPIs, as a positive control exposure. RESULTS Over a mean of 5.6 years of follow-up, hip fracture occurred in 589 individuals with PUD and 2015 individuals without PUD (3.8 vs 2.6/1000 person-years), with a multivariable-adjusted hazard ratio (HR) being 1.44 (95% confidence interval [CI], 1.31-1.58). The association persisted among subgroups stratified by sex and age. In positive control exposure analysis, the hip fracture risk was also higher in PUD than GERD (3.8 vs 2.4/1000 person-years; multivariable-adjusted HR = 1.65; 95% CI, 1.45-1.7). CONCLUSIONS This general population-based cohort study suggests, after controlling for acid-lowering medication and other potential risk factors, PUD is independently associated with an increased risk of hip fracture.
Collapse
Affiliation(s)
- Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Na Lu
- Arthritis Research Canada, Richmond, V5Y3P2, Canada
| | - Houchen Lyu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, 410008, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, 410008, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jie Wei
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, 410008, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| |
Collapse
|
211
|
Lowell W, Dickerson S, Gassman-Pines A, Gifford E, Rangel M. Racial Disparities in COVID-19 Case Positivity and Social Context: The Role of Housing, Neighborhood, and Health Insurance. HOUSING POLICY DEBATE 2022; 34:443-468. [PMID: 39296307 PMCID: PMC11407753 DOI: 10.1080/10511482.2022.2104336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 09/21/2024]
Abstract
Research on racial-ethnic COVID-19 disparities has yet to employ housing variables measured at the individual level, limiting our understanding of housing's role in determining early exposure to the virus. To address this gap, we linked data from SARS-CoV-2 polymerase chain reaction (PCR) tests within the Duke University Health System between March 12, 2020, and July 31, 2020 (N = 23,057 individuals), with housing parcel data. We then analyzed how housing, neighborhood, and health insurance explain disparities in case positivity between and within racial-ethnic groups in Durham County, North Carolina. We find that 55% of the Black-White disparity and 25% of the Hispanic-White disparity in positive cases are explained by these social-contextual variables. Neighborhood-fixed effects explained the largest portion (27%) of the Black-White disparity, whereas health insurance type explained the largest portion (14%) of the Hispanic-White disparity. We conclude that housing, neighborhood, and health insurance had a significant role in producing racial-ethnic disparities in COVID-19 case positivity.
Collapse
Affiliation(s)
- Warren Lowell
- Sanford School of Public Policy & Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Sarah Dickerson
- Sanford School of Public Policy & Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Anna Gassman-Pines
- Sanford School of Public Policy & Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Elizabeth Gifford
- Sanford School of Public Policy & Center for Child and Family Policy, Duke University, Durham, NC, USA
- Children's Health and Discovery Initiative, Duke University Health System, Durham, NC, USA
| | - Marcos Rangel
- Sanford School of Public Policy & Center for Child and Family Policy, Duke University, Durham, NC, USA
| |
Collapse
|
212
|
Lo Re V, Dutcher SK, Connolly JG, Perez-Vilar S, Carbonari DM, DeFor TA, Djibo DA, Harrington LB, Hou L, Hennessy S, Hubbard RA, Kempner ME, Kuntz JL, McMahill-Walraven CN, Mosley J, Pawloski PA, Petrone AB, Pishko AM, Driscoll MR, Steiner CA, Zhou Y, Cocoros NM. Association of COVID-19 vs Influenza With Risk of Arterial and Venous Thrombotic Events Among Hospitalized Patients. JAMA 2022; 328:637-651. [PMID: 35972486 PMCID: PMC9382447 DOI: 10.1001/jama.2022.13072] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE The incidence of arterial thromboembolism and venous thromboembolism in persons with COVID-19 remains unclear. OBJECTIVE To measure the 90-day risk of arterial thromboembolism and venous thromboembolism in patients hospitalized with COVID-19 before or during COVID-19 vaccine availability vs patients hospitalized with influenza. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 41 443 patients hospitalized with COVID-19 before vaccine availability (April-November 2020), 44 194 patients hospitalized with COVID-19 during vaccine availability (December 2020-May 2021), and 8269 patients hospitalized with influenza (October 2018-April 2019) in the US Food and Drug Administration Sentinel System (data from 2 national health insurers and 4 regional integrated health systems). EXPOSURES COVID-19 or influenza (identified by hospital diagnosis or nucleic acid test). MAIN OUTCOMES AND MEASURES Hospital diagnosis of arterial thromboembolism (acute myocardial infarction or ischemic stroke) and venous thromboembolism (deep vein thrombosis or pulmonary embolism) within 90 days. Outcomes were ascertained through July 2019 for patients with influenza and through August 2021 for patients with COVID-19. Propensity scores with fine stratification were developed to account for differences between the influenza and COVID-19 cohorts. Weighted Cox regression was used to estimate the adjusted hazard ratios (HRs) for outcomes during each COVID-19 vaccine availability period vs the influenza period. RESULTS A total of 85 637 patients with COVID-19 (mean age, 72 [SD, 13.0] years; 50.5% were male) and 8269 with influenza (mean age, 72 [SD, 13.3] years; 45.0% were male) were included. The 90-day absolute risk of arterial thromboembolism was 14.4% (95% CI, 13.6%-15.2%) in patients with influenza vs 15.8% (95% CI, 15.5%-16.2%) in patients with COVID-19 before vaccine availability (risk difference, 1.4% [95% CI, 1.0%-2.3%]) and 16.3% (95% CI, 16.0%-16.6%) in patients with COVID-19 during vaccine availability (risk difference, 1.9% [95% CI, 1.1%-2.7%]). Compared with patients with influenza, the risk of arterial thromboembolism was not significantly higher among patients with COVID-19 before vaccine availability (adjusted HR, 1.04 [95% CI, 0.97-1.11]) or during vaccine availability (adjusted HR, 1.07 [95% CI, 1.00-1.14]). The 90-day absolute risk of venous thromboembolism was 5.3% (95% CI, 4.9%-5.8%) in patients with influenza vs 9.5% (95% CI, 9.2%-9.7%) in patients with COVID-19 before vaccine availability (risk difference, 4.1% [95% CI, 3.6%-4.7%]) and 10.9% (95% CI, 10.6%-11.1%) in patients with COVID-19 during vaccine availability (risk difference, 5.5% [95% CI, 5.0%-6.1%]). Compared with patients with influenza, the risk of venous thromboembolism was significantly higher among patients with COVID-19 before vaccine availability (adjusted HR, 1.60 [95% CI, 1.43-1.79]) and during vaccine availability (adjusted HR, 1.89 [95% CI, 1.68-2.12]). CONCLUSIONS AND RELEVANCE Based on data from a US public health surveillance system, hospitalization with COVID-19 before and during vaccine availability, vs hospitalization with influenza in 2018-2019, was significantly associated with a higher risk of venous thromboembolism within 90 days, but there was no significant difference in the risk of arterial thromboembolism within 90 days.
Collapse
Affiliation(s)
- Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sarah K. Dutcher
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - John G. Connolly
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Silvia Perez-Vilar
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Dena M. Carbonari
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | | | - Laura Hou
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rebecca A. Hubbard
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Maria E. Kempner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Jennifer L. Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | - Jolene Mosley
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | | | - Andrew B. Petrone
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Allyson M. Pishko
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Meighan Rogers Driscoll
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | | | - Yunping Zhou
- Humana Healthcare Research Inc, Louisville, Kentucky
| | - Noelle M. Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| |
Collapse
|
213
|
Luo S, Liang Y, Wong THT, Schooling CM, Au Yeung SL. Identifying factors contributing to increased susceptibility to COVID-19 risk: a systematic review of Mendelian randomization studies. Int J Epidemiol 2022; 51:1088-1105. [PMID: 35445260 PMCID: PMC9047195 DOI: 10.1093/ije/dyac076] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To summarize modifiable factors for coronavirus disease 2019 (COVID-19) suggested by Mendelian randomization studies. METHODS In this systematic review, we searched PubMed, EMBASE and MEDLINE, from inception to 15 November 2021, for Mendelian randomization studies in English. We selected studies that assessed associations of genetically predicted exposures with COVID-19-related outcomes (severity, hospitalization and susceptibility). Risk of bias of the included studies was evaluated based on the consideration of the three main assumptions for instrumental variable analyses. RESULTS We identified 700 studies through systematic search, of which 50 Mendelian randomization studies were included. Included studies have explored a wide range of socio-demographic factors, lifestyle attributes, anthropometrics and biomarkers, predisposition to diseases and druggable targets in COVID-19 risk. Mendelian randomization studies suggested that increases in smoking, obesity and inflammatory factors were associated with higher risk of COVID-19. Predisposition to ischaemic stroke, combined bipolar disorder and schizophrenia, attention-deficit and hyperactivity disorder, chronic kidney disease and idiopathic pulmonary fibrosis was potentially associated with higher COVID-19 risk. Druggable targets, such as higher protein expression of histo-blood group ABO system transferase (ABO), interleukin (IL)-6 and lower protein expression of 2'-5' oligoadenylate synthetase 1 (OAS1) were associated with higher risk of COVID-19. There was no strong genetic evidence supporting the role of vitamin D, glycaemic traits and predisposition to cardiometabolic diseases in COVID-19 risk. CONCLUSION This review summarizes modifiable factors for intervention (e.g. smoking, obesity and inflammatory factors) and proteomic signatures (e.g. OAS1 and IL-6) that could help identify drugs for treating COVID-19.
Collapse
Affiliation(s)
- Shan Luo
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ying Liang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tommy Hon Ting Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Catherine Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Environmental, Occupational, and Geospatial Health Sciences, School of Public Health and Health Policy, City University of New York, New York, USA
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
214
|
Possible Bias in Supervised Deep Learning Algorithms for CT Lung Nodule Detection and Classification. Cancers (Basel) 2022; 14:cancers14163867. [PMID: 36010861 PMCID: PMC9405732 DOI: 10.3390/cancers14163867] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Artificial Intelligence (AI) algorithms can assist clinicians in their daily tasks by automatically detecting and/or classifying nodules in chest CT scans. Bias of such algorithms is one of the reasons why implementation of them in clinical practice is still not widely adopted. There is no published review on the bias that these algorithms may contain. This review aims to present different types of bias in such algorithms and present possible ways to mitigate them. Only then it would be possible to ensure that these algorithms work as intended under many different clinical settings. Abstract Artificial Intelligence (AI) algorithms for automatic lung nodule detection and classification can assist radiologists in their daily routine of chest CT evaluation. Even though many AI algorithms for these tasks have already been developed, their implementation in the clinical workflow is still largely lacking. Apart from the significant number of false-positive findings, one of the reasons for that is the bias that these algorithms may contain. In this review, different types of biases that may exist in chest CT AI nodule detection and classification algorithms are listed and discussed. Examples from the literature in which each type of bias occurs are presented, along with ways to mitigate these biases. Different types of biases can occur in chest CT AI algorithms for lung nodule detection and classification. Mitigation of them can be very difficult, if not impossible to achieve completely.
Collapse
|
215
|
van Smeden M. A Very Short List of Common Pitfalls in Research Design, Data Analysis, and Reporting. PRIMER (LEAWOOD, KAN.) 2022; 6:26. [PMID: 36119906 PMCID: PMC9477699 DOI: 10.22454/primer.2022.511416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
216
|
Jordan S, Bromley R, Damase-Michel C, Given J, Komninou S, Loane M, Marfell N, Dolk H. Breastfeeding, pregnancy, medicines, neurodevelopment, and population databases: the information desert. Int Breastfeed J 2022; 17:55. [PMID: 35915474 PMCID: PMC9343220 DOI: 10.1186/s13006-022-00494-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The pharmacoepidemiology of the long-term benefits and harms of medicines in pregnancy and breastfeeding has received little attention. The impact of maternal medicines on children is increasingly recognised as a source of avoidable harm. The focus of attention has expanded from congenital anomalies to include less visible, but equally important, outcomes, including cognition, neurodevelopmental disorders, educational performance, and childhood ill-health. Breastfeeding, whether as a source of medicine exposure, a mitigator of adverse effects or as an outcome, has been all but ignored in pharmacoepidemiology and pharmacovigilance: a significant 'blind spot'. WHOLE-POPULATION DATA ON BREASTFEEDING WHY WE NEED THEM: Optimal child development and maternal health necessitate breastfeeding, yet little information exists to guide families regarding the safety of medicine use during lactation. Breastfeeding initiation or success may be altered by medicine use, and breastfeeding may obscure the true relationship between medicine exposure during pregnancy and developmental outcomes. Absent or poorly standardised recording of breastfeeding in most population databases hampers analysis and understanding of the complex relationships between medicine, pregnancy, breastfeeding and infant and maternal health. The purpose of this paper is to present the arguments for breastfeeding to be included alongside medicine use and neurodevelopmental outcomes in whole-population database investigations of the harms and benefits of medicines during pregnancy, the puerperium and postnatal period. We review: 1) the current situation, 2) how these complexities might be accommodated in pharmacoepidemiological models, using antidepressants and antiepileptics as examples; 3) the challenges in obtaining comprehensive data. CONCLUSIONS The scarcity of whole-population data and the complexities of the inter-relationships between breastfeeding, medicines, co-exposures and infant outcomes are significant barriers to full characterisation of the benefits and harms of medicines during pregnancy and breastfeeding. This makes it difficult to answer the questions: 'is it safe to breastfeed whilst taking this medicine', and 'will this medicine interfere with breastfeeding and/ or infants' development'?
Collapse
Affiliation(s)
- Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK.
| | - Rebecca Bromley
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Christine Damase-Michel
- Faculté de Médecine, Center for Epidemiology and Research in POPulation Health (CERPOP), Université Toulouse III, CHU Toulouse INSERM, Pharmacologie Médicale, Toulouse, France
| | - Joanne Given
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
| | - Sophia Komninou
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Maria Loane
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
| | - Naomi Marfell
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Helen Dolk
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
| |
Collapse
|
217
|
Hardelid P, Favarato G, Wijlaars L, Fenton L, McMenamin J, Clemens T, Dibben C, Milojevic A, Macfarlane A, Taylor J, Cunningham S, Wood R. SARS-CoV-2 tests, confirmed infections and COVID-19-related hospital admissions in children and young people: birth cohort study. BMJ Paediatr Open 2022; 6:e001545. [PMID: 36053647 PMCID: PMC9437731 DOI: 10.1136/bmjpo-2022-001545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/05/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There have been no population-based studies of SARS-CoV-2 testing, PCR-confirmed infections and COVID-19-related hospital admissions across the full paediatric age range. We examine the epidemiology of SARS-CoV-2 in children and young people (CYP) aged <23 years. METHODS We used a birth cohort of all children born in Scotland since 1997, constructed via linkage between vital statistics, hospital records and SARS-CoV-2 surveillance data. We calculated risks of tests and PCR-confirmed infections per 1000 CYP-years between August and December 2020, and COVID-19-related hospital admissions per 100 000 CYP-years between February and December 2020. We used Poisson and Cox proportional hazards regression models to determine risk factors. RESULTS Among the 1 226 855 CYP in the cohort, there were 378 402 tests (a rate of 770.8/1000 CYP-years (95% CI 768.4 to 773.3)), 19 005 PCR-confirmed infections (179.4/1000 CYP-years (176.9 to 182.0)) and 346 admissions (29.4/100 000 CYP-years (26.3 to 32.8)). Infants had the highest COVID-19-related admission rates. The presence of chronic conditions, particularly multiple types of conditions, was strongly associated with COVID-19-related admissions across all ages. Overall, 49% of admitted CYP had at least one chronic condition recorded. CONCLUSIONS Infants and CYP with chronic conditions are at highest risk of admission with COVID-19. Half of admitted CYP had chronic conditions. Studies examining COVID-19 vaccine effectiveness among children with chronic conditions and whether maternal vaccine during pregnancy prevents COVID-19 admissions in infants are urgently needed.
Collapse
Affiliation(s)
- Pia Hardelid
- Population, Policy & Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Graziella Favarato
- Population, Policy & Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Linda Wijlaars
- Population, Policy & Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Lynda Fenton
- Clinical and Public Health Intelligence Team, Public Health Scotland, Edinburgh, UK
| | - Jim McMenamin
- Respiratory Infection Team, Public Health Scotland, Edinburgh, UK
| | - Tom Clemens
- School of Geosciences, The University of Edinburgh, Edinburgh, UK
| | - Chris Dibben
- School of Geosciences, The University of Edinburgh, Edinburgh, UK
| | - Ai Milojevic
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison Macfarlane
- Department of Midwifery and Radiography, City University of London, London, UK
| | - Jonathon Taylor
- Faculty of Built Environment, Tampere University, Tampere, Finland
| | - Steven Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- Clinical and Public Health Intelligence Team, Public Health Scotland, Edinburgh, UK
- Centre for Brain Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
218
|
Semenzato L, Botton J, Drouin J, Baricault B, Bertrand M, Jabagi MJ, Cuenot F, Vu SL, Dray-Spira R, Weill A, Zureik M. Characteristics associated with the residual risk of severe COVID-19 after a complete vaccination schedule: A cohort study of 28 million people in France. Lancet Reg Health Eur 2022; 19:100441. [PMID: 35789881 PMCID: PMC9243470 DOI: 10.1016/j.lanepe.2022.100441] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Methods Findings Interpretation Funding
Collapse
Affiliation(s)
- Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Marion Bertrand
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Marie-Joëlle Jabagi
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - François Cuenot
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Stéphane Le Vu
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
- University Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Anti-infective evasion and Pharmacoepidemiology Unit/Team, CESP, 78180, Montigny le Bretonneux, France
- Corresponding author.
| |
Collapse
|
219
|
Burn E, Duarte-Salles T, Fernandez-Bertolin S, Reyes C, Kostka K, Delmestri A, Rijnbeek P, Verhamme K, Prieto-Alhambra D. Venous or arterial thrombosis and deaths among COVID-19 cases: a European network cohort study. THE LANCET INFECTIOUS DISEASES 2022; 22:1142-1152. [PMID: 35576963 PMCID: PMC9106320 DOI: 10.1016/s1473-3099(22)00223-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/11/2022]
Abstract
Background There are few data on the incidence of thrombosis among COVID-19 cases, with most research concentrated on hospitalised patients. We aimed to estimate the incidence of venous thromboembolism, arterial thromboembolism, and death among COVID-19 cases and to assess the impact of these events on the risks of hospitalisation and death. Methods We conducted a distributed network cohort study using primary care records from the Netherlands, Italy, Spain, and the UK, and outpatient specialist records from Germany. The Spanish database was linked to hospital admissions. Participants were followed up from the date of a diagnosis of COVID-19 or positive RT-PCR test for SARS-CoV-2 (index date) for 90 days. The primary study outcomes were venous thromboembolic events, arterial thromboembolic events, and death, all over the 90 days from the index date. We estimated cumulative incidences for the study outcomes. Multistate models were used to calculate adjusted hazard ratios (HRs) for the association between venous thromboembolism or arterial thromboembolism occurrence and risks of hospitalisation or COVID-19 fatality. Findings Overall, 909 473 COVID-19 cases and 32 329 patients hospitalised with COVID-19 on or after Sept 1, 2020, were studied. The latest index dates across the databases ranged from Jan 30, 2021, to July 31, 2021. Cumulative 90-day incidence of venous thromboembolism ranged from 0·2% to 0·8% among COVID-19 cases, and up to 4·5% for those hospitalised. For arterial thromboembolism, estimates ranged from 0·1% to 0·8% among COVID-19 cases, increasing to 3·1% among those hospitalised. Case fatality ranged from 1·1% to 2·0% among patients with COVID-19, rising to 14·6% for hospitalised patients. The occurrence of venous thromboembolism in patients with COVID-19 was associated with an increased risk of death (adjusted HRs 4·42 [3·07–6·36] for those not hospitalised and 1·63 [1·39–1·90] for those hospitalised), as was the occurrence of arterial thromboembolism (3·16 [2·65–3·75] and 1·93 [1·57–2·37]). Interpretation Risks of venous thromboembolism and arterial thromboembolism were up to 1% among COVID-19 cases, and increased with age, among males, and in those who were hospitalised. Their occurrence was associated with excess mortality, underlying the importance of developing effective treatment strategies that reduce their frequency. Funding European Medicines Agency.
Collapse
Affiliation(s)
- Edward Burn
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Sergio Fernandez-Bertolin
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Carlen Reyes
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Kristin Kostka
- Real World Solutions, IQVIA, Cambridge, MA, USA; The Observational Health Data Sciences and Informatics Center at The Roux Institute, Northeastern University, Portland, ME, USA
| | - Antonella Delmestri
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands.
| |
Collapse
|
220
|
Edoka I, Fraser H, Jamieson L, Meyer-Rath G, Mdewa W. Inpatient Care Costs of COVID-19 in South Africa's Public Healthcare System. Int J Health Policy Manag 2022; 11:1354-1361. [PMID: 33949817 PMCID: PMC9808349 DOI: 10.34172/ijhpm.2021.24] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has had a devastating impact globally, with severe health and economic consequences. To prepare health systems to deal with the pandemic, epidemiological and cost projection models are required to inform budgets and efficient allocation of resources. This study estimates daily inpatient care costs of COVID-19 in South Africa, an important input into cost projection and economic evaluation models. METHODS We adopted a micro-costing approach, which involved the identification, measurement and valuation of resources used in the clinical management of COVID-19. We considered only direct medical costs for an episode of hospitalisation from the South African public health system perspective. Resource quantities and unit costs were obtained from various sources. Inpatient costs per patient day was estimated for consumables, capital equipment and human resources for three levels of inpatient care - general wards, high care wards and intensive care units (ICUs). RESULTS Average daily costs per patient increased with the level of care. The highest average daily cost was estimated for ICU admissions - 271 USD to 306 USD (financial costs) and ~800 USD to 830 USD (economic costs, excluding facility fee) depending on the need for invasive vs. non-invasive ventilation (NIV). Conversely, the lowest cost was estimated for general ward-based care - 62 USD to 79 USD (financial costs) and 119 USD to 278 USD (economic costs, excluding facility fees) depending on the need for supplemental oxygen. In high care wards, total cost was estimated at 156 USD, financial costs and 277 USD, economic costs (excluding facility fees). Probabilistic sensitivity analyses suggest our costs estimates are robust to uncertainty in cost inputs. CONCLUSION Our estimates of inpatient costs are useful for informing budgeting and planning processes and cost-effectiveness analysis in the South African context. However, these estimates can be adapted to inform policy decisions in other context.
Collapse
Affiliation(s)
- Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather Fraser
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Boston, MA, USA
| | - Winfrida Mdewa
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
221
|
Mahalingasivam V, Su G, Iwagami M, Davids MR, Wetmore JB, Nitsch D. COVID-19 and kidney disease: insights from epidemiology to inform clinical practice. Nat Rev Nephrol 2022; 18:485-498. [PMID: 35418695 PMCID: PMC9006492 DOI: 10.1038/s41581-022-00570-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/08/2023]
Abstract
Over the course of the COVID-19 pandemic, numerous studies have aimed to address the challenges faced by patients with kidney disease and their caregivers. These studies addressed areas of concern such as the high infection and mortality risk of patients on in-centre haemodialysis and transplant recipients. However, the ability to draw meaningful conclusions from these studies has in some instances been challenging, owing to barriers in aspects of usual care, data limitations and problematic methodological practices. In many settings, access to SARS-CoV-2 testing differed substantially between patient groups, whereas the incidence of SARS-CoV-2 infection varied over time and place because of differences in viral prevalence, targeted public health policies and vaccination rates. The absence of baseline kidney function data posed problems in the classification of chronic kidney disease and acute kidney injury in some studies, potentially compromising the generalizability of findings. Study findings also require attentive appraisal in terms of the effects of confounding, collider bias and chance. As this pandemic continues and in the future, the implementation of sustainable and integrated research infrastructure is needed in settings across the world to minimize infection transmission and both prevent and plan for the short-term and long-term complications of infectious diseases. Registries can support the real-world evaluation of vaccines and therapies in patients with advanced kidney disease while enabling monitoring of rare complications.
Collapse
Affiliation(s)
- Viyaasan Mahalingasivam
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Guobin Su
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Mogamat Razeen Davids
- Division of Nephrology, Stellenbosch University, Cape Town, South Africa
- South African Renal Registry, Cape Town, South Africa
- African Renal Registry, African Association of Nephrology, Durban, South Africa
| | - James B Wetmore
- Division of Nephrology, Hennepin Healthcare, Minneapolis, MN, USA
- Chronic Disease Research Group, Hennepin Healthcare, Minneapolis, USA
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
- UK Renal Registry, Bristol, UK.
| |
Collapse
|
222
|
Schumm LP, Giurcanu MC, Locey KJ, Ortega JC, Zhang Z, Grossman RL. Racial and Ethnic Disparities in the Observed COVID-19 Case Fatality Rate Among the U.S. Population. Ann Epidemiol 2022; 74:118-124. [PMID: 35940395 PMCID: PMC9352645 DOI: 10.1016/j.annepidem.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/09/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022]
Abstract
Purpose During the initial 12 months of the pandemic, racial and ethnic disparities in COVID-19 death rates received considerable attention but it has been unclear whether disparities in death rates were due to disparities in case fatality rates (CFRs), incidence rates or both. We examined differences in observed COVID-19 CFRs between U.S. White, Black/African American, and Latinx individuals during this period. Methods Using data from the COVID Tracking Project and the Centers for Disease Control and Prevention COVID-19 Case Surveillance Public Use dataset, we calculated CFR ratios comparing Black and Latinx to White individuals, both overall and separately by age group. We also used a model of monthly COVID-19 deaths to estimate CFR ratios, adjusting for age, gender, and differences across states and time. Results Overall Black and Latinx individuals had lower CFRs than their White counterparts. However, when adjusting for age, Black and Latinx had higher CFRs than White individuals among those younger than 65. CFRs varied substantially across states and time. Conclusions Disparities in COVID-19 case fatality among U.S. Black and Latinx individuals under age 65 were evident during the first year of the pandemic. Understanding racial and ethnic differences in COVID-19 CFRs is challenging due to limitations in available data.
Collapse
Affiliation(s)
- L Philip Schumm
- Department of Public Health Sciences, The University of Chicago, Chicago, IL; Pandemic Response Commons, Chicago, IL.
| | - Mihai C Giurcanu
- Department of Public Health Sciences, The University of Chicago, Chicago, IL; Pandemic Response Commons, Chicago, IL
| | - Kenneth J Locey
- Pandemic Response Commons, Chicago, IL; Center for Quality, Safety and Value Analytics, Rush University Medical Center, Chicago, IL
| | | | - Zhenyu Zhang
- Pandemic Response Commons, Chicago, IL; Center for Translational Data Science, The University of Chicago, Chicago, IL
| | - Robert L Grossman
- Pandemic Response Commons, Chicago, IL; Center for Translational Data Science, The University of Chicago, Chicago, IL; Department of Medicine, The University of Chicago, Chicago, IL
| |
Collapse
|
223
|
Income differences in COVID-19 incidence and severity in Finland among people with foreign and native background: A population-based cohort study of individuals nested within households. PLoS Med 2022; 19:e1004038. [PMID: 35947575 PMCID: PMC9365184 DOI: 10.1371/journal.pmed.1004038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although intrahousehold transmission is a key source of Coronavirus Disease 2019 (COVID-19) infections, studies to date have not analysed socioeconomic risk factors on the household level or household clustering of severe COVID-19. We quantify household income differences and household clustering of COVID-19 incidence and severity. METHODS AND FINDINGS We used register-based cohort data with individual-level linkage across various administrative registers for the total Finnish population living in working-age private households (N = 4,315,342). Incident COVID-19 cases (N = 38,467) were identified from the National Infectious Diseases Register from 1 July 2020 to 22 February 2021. Severe cases (N = 625) were defined as having at least 3 consecutive days of inpatient care with a COVID-19 diagnosis and identified from the Care Register for Health Care between 1 July 2020 and 31 December 2020. We used 2-level logistic regression with individuals nested within households to estimate COVID-19 incidence and case severity among those infected. Adjusted for age, sex, and regional characteristics, the incidence of COVID-19 was higher (odds ratio [OR] 1.67, 95% CI 1.58 to 1.77, p < 0.001, 28.4% of infections) among individuals in the lowest household income quintile than among those in the highest quintile (18.9%). The difference attenuated (OR 1.23, 1.16 to 1.30, p < 0.001) when controlling for foreign background but not when controlling for other household-level risk factors. In fact, we found a clear income gradient in incidence only among people with foreign background but none among those with native background. The odds of severe illness among those infected were also higher in the lowest income quintile (OR 1.97, 1.52 to 2.56, p < 0.001, 28.0% versus 21.6% in the highest quintile), but this difference was fully attenuated (OR 1.08, 0.77 to 1.52, p = 0.64) when controlling for other individual-level risk factors-comorbidities, occupational status, and foreign background. Both incidence and severity were strongly clustered within households: Around 77% of the variation in incidence and 20% in severity were attributable to differences between households. The main limitation of our study was that the test uptake for COVID-19 may have differed between population subgroups. CONCLUSIONS Low household income appears to be a strong risk factor for both COVID-19 incidence and case severity, but the income differences are largely driven by having foreign background. The strong household clustering of incidence and severity highlights the importance of household context in the prevention and mitigation of COVID-19 outcomes.
Collapse
|
224
|
Rimfeld K, Malanchini M, Arathimos R, Gidziela A, Pain O, McMillan A, Ogden R, Webster L, Packer AE, Shakeshaft NG, Schofield KL, Pingault JB, Allegrini AG, Stringaris A, von Stumm S, Lewis CM, Plomin R. The consequences of a year of the COVID-19 pandemic for the mental health of young adult twins in England and Wales. BJPsych Open 2022; 8:e129. [PMID: 35860899 PMCID: PMC9304950 DOI: 10.1192/bjo.2022.506] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected all our lives, not only through the infection itself but also through the measures taken to control the spread of the virus (e.g. lockdown). AIMS Here, we investigated how the COVID-19 pandemic and unprecedented lockdown affected the mental health of young adults in England and Wales. METHOD We compared the mental health symptoms of up to 4773 twins in their mid-20s in 2018 prior to the COVID-19 pandemic (T1) and during four-wave longitudinal data collection during the pandemic in April, July and October 2020, and in March 2021 (T2-T5) using phenotypic and genetic longitudinal designs. RESULTS The average changes in mental health were small to medium and mainly occurred from T1 to T2 (average Cohen d = 0.14). Despite the expectation of catastrophic effects of the pandemic on mental health, we did not observe trends in worsening mental health during the pandemic (T3-T5). Young people with pre-existing mental health problems were disproportionately affected at the beginning of the pandemic, but their increased problems largely subsided as the pandemic persisted. Twin analyses indicated that the aetiology of individual differences in mental health symptoms did not change during the lockdown (average heritability 33%); the average genetic correlation between T1 and T2-T5 was 0.95, indicating that genetic effects before the pandemic were substantially correlated with genetic effects up to a year later. CONCLUSIONS We conclude that on average the mental health of young adults in England and Wales has been remarkably resilient to the effects of the pandemic and associated lockdown.
Collapse
Affiliation(s)
- Kaili Rimfeld
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychology, Royal Holloway University of London, London, UK
| | - Margherita Malanchini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Department of Psychology, Queen Mary University of London, UK
| | - Ryan Arathimos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Agnieszka Gidziela
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Department of Psychology, Queen Mary University of London, UK
| | - Oliver Pain
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Andrew McMillan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rachel Ogden
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Louise Webster
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Amy E. Packer
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nicholas G. Shakeshaft
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Kerry L. Schofield
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jean-Baptiste Pingault
- Clinical, Educational & Health Psychology, Division of Psychology & Language Sciences, Faculty of Brain Sciences, University College London, UK
| | - Andrea G. Allegrini
- Clinical, Educational & Health Psychology, Division of Psychology & Language Sciences, Faculty of Brain Sciences, University College London, UK
| | - Argyris Stringaris
- Mood, Brain & Development Unit, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Sophie von Stumm
- Psychology in Education Research Centre, Department of Education, University of York, UK
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, and Department of Medical and Molecular Genetics, King's College London, UK
| | - Robert Plomin
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
225
|
van Oers JAH, Pouwels S, Ramnarain D, Kluiters Y, Bons JAP, de Lange DW, de Grooth HJ, Girbes ARJ. Mid-regional proadrenomedullin, C-terminal proendothelin-1 values, and disease course are not different in critically ill SARS-CoV-2 pneumonia patients with obesity. Int J Obes (Lond) 2022; 46:1801-1807. [PMID: 35840771 PMCID: PMC9283850 DOI: 10.1038/s41366-022-01184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 01/08/2023]
Abstract
Background/objectives Patients affected by obesity and Coronavirus disease 2019, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appear to have a higher risk for intensive care (ICU) admission. A state of low-grade chronic inflammation in obesity has been suggested as one of the underlying mechanisms. We investigated whether obesity is associated with differences in new inflammatory biomarkers mid-regional proadrenomedullin (MR-proADM), C-terminal proendothelin-1 (CT-proET-1), and clinical outcomes in critically ill patients with SARS-CoV-2 pneumonia. Subjects/methods A total of 105 critically ill patients with SARS-CoV-2 pneumonia were divided in patients with obesity (body mass index (BMI) ≥ 30 kg/m2, n = 42) and patients without obesity (BMI < 30 kg/m2, n = 63) and studied in a retrospective observational cohort study. MR-proADM, CT-proET-1 concentrations, and conventional markers of white blood count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were collected during the first 7 days. Results BMI was 33.5 (32–36.1) and 26.2 (24.7–27.8) kg/m2 in the group with and without obesity. There were no significant differences in concentrations MR-proADM, CT-proET-1, WBC, CRP, and PCT at baseline and the next 6 days between patients with and without obesity. Only MR-proADM changed significantly over time (p = 0.039). Also, BMI did not correlate with inflammatory biomarkers (MR-proADM rho = 0.150, p = 0.125, CT-proET-1 rho = 0.179, p = 0.067, WBC rho = −0.044, p = 0.654, CRP rho = 0.057, p = 0.564, PCT rho = 0.022, p = 0.842). Finally, no significant differences in time on a ventilator, ICU length of stay, and 28-day mortality between patients with or without obesity were observed. Conclusions In critically ill patients with confirmed SARS-CoV-2 pneumonia, obesity was not associated with differences in MR-proADM, and CT-proET-1, or impaired outcome. Trial registration Netherlands Trial Register, NL8460.
Collapse
Affiliation(s)
- Jos A H van Oers
- Department of Intensive Care Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands.
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Yvette Kluiters
- Department of Clinical Chemistry, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Judith A P Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Harm-Jan de Grooth
- Department of Intensive Care Medicine, Amsterdam UMC, Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Amsterdam UMC, Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
226
|
Morgan J, Halstead I, Northstone K, Major-Smith D. Religious/spiritual beliefs and behaviours and study participation in a prospective cohort study (ALSPAC) in Southwest England. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17975.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Longitudinal studies are key to understanding risk factors for health, well-being, and disease, yet associations may be biased if study invitation and participation are non-random. Religious/spiritual beliefs and behaviours (RSBB) are increasingly recognised as having potentially important relationships with health. However, it is unclear whether RSBB is associated with study participation. We examine whether RSBB is associated with participation in the longitudinal birth cohort ALSPAC (Avon Longitudinal Study of Parents and Children). Methods Three RSBB factors were used: religious belief (belief in God/a divine power; yes/not sure/no), religious affiliation (Christian/none/other), and religious attendance (frequency of attendance at a place of worship). Participation was measured in three ways: i) total number of questionnaires/clinics completed; ii) completion of the most recent questionnaire (in 2020); and iii) length of participation. Analyses were repeated for the ALSPAC mothers, their partners, and the study children, and were adjusted for relevant socio-demographic confounders. Results Religious attendance was positively associated with participation in all adjusted models in all three cohorts. For example, study mothers who attended a place of worship at least once a month on average completed two more questionnaires (out of a possible 50), had 50% greater odds of having completed the most recent questionnaire, and had 25% reduced risk of drop-out, relative to those who did not attend a place of worship. In the adjusted analyses, religious belief and attendance were not associated with participation. However, the majority of unadjusted models showed associations between RSBB and participation. Conclusion After adjusting for confounders, religious attendance – not religious belief or affiliation – was associated with participation in ALSPAC. These results indicate that use of RSBB variables (and religious attendance in particular) may result in selection bias and spurious associations; these potential biases should be explored and discussed in future studies using these data.
Collapse
|
227
|
Rhodes S, Wilkinson J, Pearce N, Mueller W, Cherrie M, Stocking K, Gittins M, Katikireddi SV, Tongeren MV. Occupational differences in SARS-CoV-2 infection: analysis of the UK ONS COVID-19 infection survey. J Epidemiol Community Health 2022; 76:jech-2022-219101. [PMID: 35817467 PMCID: PMC9484374 DOI: 10.1136/jech-2022-219101] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Concern remains about how occupational SARS-CoV-2 risk has evolved during the COVID-19 pandemic. We aimed to ascertain occupations with the greatest risk of SARS-CoV-2 infection and explore how relative differences varied over the pandemic. METHODS Analysis of cohort data from the UK Office of National Statistics COVID-19 Infection Survey from April 2020 to November 2021. This survey is designed to be representative of the UK population and uses regular PCR testing. Cox and multilevel logistic regression were used to compare SARS-CoV-2 infection between occupational/sector groups, overall and by four time periods with interactions, adjusted for age, sex, ethnicity, deprivation, region, household size, urban/rural neighbourhood and current health conditions. RESULTS Based on 3 910 311 observations (visits) from 312 304 working age adults, elevated risks of infection can be seen overall for social care (HR 1.14; 95% CI 1.04 to 1.24), education (HR 1.31; 95% CI 1.23 to 1.39), bus and coach drivers (1.43; 95% CI 1.03 to 1.97) and police and protective services (HR 1.45; 95% CI 1.29 to 1.62) when compared with non-essential workers. By time period, relative differences were more pronounced early in the pandemic. For healthcare elevated odds in the early waves switched to a reduction in the later stages. Education saw raises after the initial lockdown and this has persisted. Adjustment for covariates made very little difference to effect estimates. CONCLUSIONS Elevated risks among healthcare workers have diminished over time but education workers have had persistently higher risks. Long-term mitigation measures in certain workplaces may be warranted.
Collapse
Affiliation(s)
- Sarah Rhodes
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Neil Pearce
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mark Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
| | - Katie Stocking
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Matthew Gittins
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | | | - Martie Van Tongeren
- Centre for Occupation and Environmental Health, The University of Manchester, Manchester, UK
| |
Collapse
|
228
|
Fernández-Sanlés A, Smith D, Clayton GL, Northstone K, Carter AR, Millard LAC, Borges MC, Timpson NJ, Tilling K, Griffith GJ, Lawlor DA. Bias from questionnaire invitation and response in COVID-19 research: an example using ALSPAC. Wellcome Open Res 2022; 6:184. [PMID: 35919505 PMCID: PMC9294498 DOI: 10.12688/wellcomeopenres.17041.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Longitudinal studies are crucial for identifying potential risk factors for infection with, and consequences of, COVID-19, but relationships can be biased if they are associated with invitation and response to data collection. We describe factors relating to questionnaire invitation and response in COVID-19 questionnaire data collection in a multigenerational birth cohort (the Avon Longitudinal Study of Parents and Children, ALSPAC). Methods: We analysed online questionnaires completed between the beginning of the pandemic and easing of the first UK lockdown by participants with valid email addresses who had not actively disengaged from the study. We assessed associations of pre-pandemic sociodemographic, behavioural, anthropometric and health-related factors with: i) being sent a questionnaire; ii) returning a questionnaire; and iii) item response (for specific questions). Analyses were conducted in three cohorts: the index children born in the early 1990s (now young adults; 41 variables assessed), their mothers (35 variables) and the mothers' partners (27 variables). Results: Of 14,849 young adults, 41% were sent a questionnaire, of whom 57% returned one. Item response was >95%. In this cohort, 78% of factors were associated with being sent a questionnaire, 56% with returning one, and, as an example of item response, 20% with keyworker status response. For instance, children from mothers educated to degree-level had greater odds of being sent a questionnaire (OR=5.59; 95% CI=4.87-6.41), returning one (OR=1.60; 95% CI=1.31-1.95), and responding to items (e.g., keyworker status OR=1.65; 95% CI=0.88-3.04), relative to children from mothers with fewer qualifications. Invitation and response rates and associations were similar in all cohorts. Conclusions: These results highlight the importance of considering potential biases due to non-response when using longitudinal studies in COVID-19 research and interpreting results. We recommend researchers report response rates and factors associated with invitation and response in all COVID-19 observational research studies, which can inform sensitivity analyses.
Collapse
Affiliation(s)
- Alba Fernández-Sanlés
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Daniel Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Gemma L Clayton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Alice R Carter
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Louise AC Millard
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Maria Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Nicholas John Timpson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Gareth J Griffith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, Bristol, UK
| |
Collapse
|
229
|
Zheng J, Zhang Y, Zhao H, Liu Y, Baird D, Karim MA, Ghoussaini M, Schwartzentruber J, Dunham I, Elsworth B, Roberts K, Compton H, Miller-Molloy F, Liu X, Wang L, Zhang H, Smith GD, Gaunt TR. Multi-ancestry Mendelian randomization of omics traits revealing drug targets of COVID-19 severity. EBioMedicine 2022; 81:104112. [PMID: 35772218 PMCID: PMC9235320 DOI: 10.1016/j.ebiom.2022.104112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/16/2022] [Accepted: 05/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent omic studies prioritised several drug targets associated with coronavirus disease 2019 (COVID-19) severity. However, little evidence was provided to systematically estimate the effect of drug targets on COVID-19 severity in multiple ancestries. METHODS In this study, we applied Mendelian randomization (MR) and colocalization approaches to understand the putative causal effects of 16,059 transcripts and 1608 proteins on COVID-19 severity in European and effects of 610 proteins on COVID-19 severity in African ancestry. We further integrated genetics, clinical and literature evidence to prioritise drug targets. Additional sensitivity analyses including multi-trait colocalization and phenome-wide MR were conducted to test for MR assumptions. FINDINGS MR and colocalization prioritized four protein targets, FCRL3, ICAM5, ENTPD5 and OAS1 that showed effect on COVID-19 severity in European ancestry. One protein target, SERPINA1 showed a stronger effect in African ancestry but much weaker effect in European ancestry (odds ratio [OR] in Africans=0.369, 95%CI=0.203 to 0.668, P = 9.96 × 10-4; OR in Europeans=1.021, 95%CI=0.901 to 1.157, P = 0.745), which suggested that increased level of SERPINA1 will reduce COVID-19 risk in African ancestry. One protein, ICAM1 showed suggestive effect on COVID-19 severity in both ancestries (OR in Europeans=1.152, 95%CI=1.063 to 1.249, P = 5.94 × 10-4; OR in Africans=1.481, 95%CI=1.008 to 2.176; P = 0.045). The OAS1, SERPINA1 and ICAM1 effects were replicated using updated COVID-19 severity data in the two ancestries respectively, where alternative splicing events in OAS1 and ICAM1 also showed marginal effects on COVID-19 severity in Europeans. The phenome-wide MR of the prioritised targets on 622 complex traits provided information on potential beneficial effects on other diseases and suggested little evidence of adverse effects on major complications. INTERPRETATION Our study identified six proteins as showing putative causal effects on COVID-19 severity. OAS1 and SERPINA1 were targets of existing drugs in trials as potential COVID-19 treatments. ICAM1, ICAM5 and FCRL3 are related to the immune system. Across the six targets, OAS1 has no reliable instrument in African ancestry; SERPINA1, FCRL3, ICAM5 and ENTPD5 showed a different level of putative causal evidence in European and African ancestries, which highlights the importance of more powerful ancestry-specific GWAS and value of multi-ancestry MR in informing the effects of drug targets on COVID-19 across different populations. This study provides a first step towards clinical investigation of beneficial and adverse effects of COVID-19 drug targets. FUNDING No.
Collapse
Affiliation(s)
- Jie Zheng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom.
| | - Yuemiao Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Huiling Zhao
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom
| | - Yi Liu
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom
| | - Denis Baird
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom
| | - Mohd Anisul Karim
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, United Kingdom; Open Targets, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SD, United Kingdom
| | - Maya Ghoussaini
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, United Kingdom; Open Targets, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SD, United Kingdom
| | - Jeremy Schwartzentruber
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, United Kingdom; Open Targets, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SD, United Kingdom
| | - Ian Dunham
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, United Kingdom; Open Targets, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SD, United Kingdom; European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SD, United Kingdom
| | - Benjamin Elsworth
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom
| | - Katherine Roberts
- Bristol Medical School, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, United Kingdom
| | - Hannah Compton
- Bristol Medical School, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, United Kingdom
| | - Felix Miller-Molloy
- Bristol Medical School, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, United Kingdom
| | - Xingzi Liu
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Lin Wang
- Department of Microbiology and Infectious Disease Centre, School of Basic Medical Sciences, Peking University Health Science Centre, Beijing, China
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom; NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, United Kingdom
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom; NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, United Kingdom.
| |
Collapse
|
230
|
Bender Ignacio RA, Shapiro AE, Nance RM, Whitney BM, Delaney JAC, Bamford L, Wooten D, Karris MY, Mathews WC, Kim HN, Keruly J, Burkholder G, Napravnik S, Mayer KH, Jacobson J, Saag M, Moore RD, Eron JJ, Willig AL, Christopoulos KA, Martin J, Hunt PW, Crane HM, Kitahata MM, Cachay ER. Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States. AIDS 2022; 36:1095-1103. [PMID: 35796731 PMCID: PMC9273020 DOI: 10.1097/qad.0000000000003223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. DESIGN Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020. METHODS We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores. RESULTS Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity. CONCLUSION Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.
Collapse
Affiliation(s)
- Rachel A Bender Ignacio
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center
| | - Adrienne E Shapiro
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center
| | - Robin M Nance
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Bridget M Whitney
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Joseph A C Delaney
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
- College of Pharmacy, Department of Epidemiology of Manitoba, Winnipeg, Canada
| | - Laura Bamford
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| | - Darcy Wooten
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| | - Maile Y Karris
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| | - William C Mathews
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| | - Hyang Nina Kim
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jeanne Keruly
- Departments of Medicine and Epidemiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kenneth H Mayer
- Division of Infectious Diseases, Fenway Health and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Jacobson
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Michael Saag
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard D Moore
- Departments of Medicine and Epidemiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph J Eron
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda L Willig
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, Carolina, USA
| | - Jeffrey Martin
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, Carolina, USA
| | - Peter W Hunt
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, Carolina, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Mari M Kitahata
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Edward R Cachay
- Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, California
| |
Collapse
|
231
|
Sanderson E, Richardson TG, Morris TT, Tilling K, Davey Smith G. Estimation of causal effects of a time-varying exposure at multiple time points through multivariable mendelian randomization. PLoS Genet 2022; 18:e1010290. [PMID: 35849575 PMCID: PMC9348730 DOI: 10.1371/journal.pgen.1010290] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/03/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022] Open
Abstract
Mendelian Randomisation (MR) is a powerful tool in epidemiology that can be used to estimate the causal effect of an exposure on an outcome in the presence of unobserved confounding, by utilising genetic variants as instrumental variables (IVs) for the exposure. The effect estimates obtained from MR studies are often interpreted as the lifetime effect of the exposure in question. However, the causal effects of some exposures are thought to vary throughout an individual's lifetime with periods during which an exposure has a greater effect on a particular outcome. Multivariable MR (MVMR) is an extension of MR that allows for multiple, potentially highly related, exposures to be included in an MR estimation. MVMR estimates the direct effect of each exposure on the outcome conditional on all the other exposures included in the estimation. We explore the use of MVMR to estimate the direct effect of a single exposure at different time points in an individual's lifetime on an outcome. We use simulations to illustrate the interpretation of the results from such analyses and the key assumptions required. We show that causal effects at different time periods can be estimated through MVMR when the association between the genetic variants used as instruments and the exposure measured at those time periods varies. However, this estimation will not necessarily identify exact time periods over which an exposure has the most effect on the outcome. Prior knowledge regarding the biological basis of exposure trajectories can help interpretation. We illustrate the method through estimation of the causal effects of childhood and adult BMI on C-Reactive protein and smoking behaviour.
Collapse
Affiliation(s)
- Eleanor Sanderson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tom G. Richardson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Novo Nordisk Research Centre, Headington, Oxford, United Kingdom
| | - Tim T. Morris
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
232
|
Au Yeung SL, Li AM, He B, Kwok KO, Schooling CM. Association of smoking, lung function and COPD in COVID-19 risk: a two-step Mendelian randomization study. Addiction 2022; 117:2027-2036. [PMID: 35220625 PMCID: PMC9111410 DOI: 10.1111/add.15852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/02/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Smoking increases the risk of severe COVID-19, but whether lung function or chronic obstructive pulmonary disease (COPD) mediate the underlying associations is unclear. We conducted the largest Mendelian randomization study to date, to our knowledge, to address these questions. DESIGN Mendelian randomization study using summary statistics from genome-wide association studies (GWAS), FinnGen and UK Biobank. The main analysis was the inverse variance weighted method, and we included a range of sensitivity analyses to assess the robustness of the findings. SETTING GWAS which included international consortia, FinnGen and UK Biobank. PARTICIPANTS The sample size ranged from 193 638 to 2 586 691. MEASUREMENTS Genetic determinants of life-time smoking index, lung function [e.g. forced expiratory volume in 1 sec (FEV1 )], chronic obstructive pulmonary disease (COPD) and different severities of COID-19. RESULTS Smoking increased the risk of COVID-19 compared with population controls for overall COVID-19 [odds ratio (OR) = 1.19 per standard deviation (SD) of life-time smoking index, 95% confidence interval (CI) = 1.11-1.27], hospitalized COVID-19 (OR = 1.67, 95% CI = 1.42-1.97) or severe COVID-19 (OR = 1.48, 95% CI = 1.10-1.98), with directionally consistent effects from sensitivity analyses. Lung function and COPD liability did not appear to mediate these associations. CONCLUSION There is genetic evidence that smoking probably increases the risk of severe COVID-19 and possibly also milder forms of COVID-19. Decreased lung function and increased risk of chronic obstructive pulmonary disease do not seem to mediate the effect of smoking on COVID-19 risk.
Collapse
Affiliation(s)
- Shiu Lun Au Yeung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Albert Martin Li
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Baoting He
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kin On Kwok
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China
| | - C Mary Schooling
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,School of Public Health and Health Policy, City University of New York, New York, NY, USA
| |
Collapse
|
233
|
Lee CC, Ho MP, Huang AH, Tan J, Yo CH, Hsu WT. Collider Bias Rather Than a Healthy Condition Leads to the Unfavorable Outcome of Sepsis. Chest 2022; 162:e63-e64. [PMID: 35809956 DOI: 10.1016/j.chest.2022.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 10/17/2022] Open
Affiliation(s)
- Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center for Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Amy Huaishiuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center for Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan
| | - Jasmine Tan
- Department of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hung Yo
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
234
|
Thompson EJ, Williams DM, Walker AJ, Mitchell RE, Niedzwiedz CL, Yang TC, Huggins CF, Kwong ASF, Silverwood RJ, Di Gessa G, Bowyer RCE, Northstone K, Hou B, Green MJ, Dodgeon B, Doores KJ, Duncan EL, Williams FMK, Steptoe A, Porteous DJ, McEachan RRC, Tomlinson L, Goldacre B, Patalay P, Ploubidis GB, Katikireddi SV, Tilling K, Rentsch CT, Timpson NJ, Chaturvedi N, Steves CJ. Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records. Nat Commun 2022; 13:3528. [PMID: 35764621 PMCID: PMC9240035 DOI: 10.1038/s41467-022-30836-0] [Citation(s) in RCA: 217] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/19/2022] [Indexed: 12/14/2022] Open
Abstract
The frequency of, and risk factors for, long COVID are unclear among community-based individuals with a history of COVID-19. To elucidate the burden and possible causes of long COVID in the community, we coordinated analyses of survey data from 6907 individuals with self-reported COVID-19 from 10 UK longitudinal study (LS) samples and 1.1 million individuals with COVID-19 diagnostic codes in electronic healthcare records (EHR) collected by spring 2021. Proportions of presumed COVID-19 cases in LS reporting any symptoms for 12+ weeks ranged from 7.8% and 17% (with 1.2 to 4.8% reporting debilitating symptoms). Increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma were associated with prolonged symptoms in both LS and EHR data, but findings for other factors, such as cardio-metabolic parameters, were inconclusive.
Collapse
Affiliation(s)
- Ellen J Thompson
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK.
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Alex J Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxfort, UK
| | - Ruth E Mitchell
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Tiffany C Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Charlotte F Huggins
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Alex S F Kwong
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Giorgio Di Gessa
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ruth C E Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bo Hou
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Michael J Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Brian Dodgeon
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Katie J Doores
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - David J Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Laurie Tomlinson
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxfort, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | | | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Christopher T Rentsch
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK.
- Department of Ageing and Health, Guys and St Thomas's NHS Foundation Trust, London, UK.
| |
Collapse
|
235
|
Lee H, Han B. A theory-based practical solution to correct for sex-differential participation bias. Genome Biol 2022; 23:138. [PMID: 35761388 PMCID: PMC9238114 DOI: 10.1186/s13059-022-02703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
Most genomic cohorts are retrospective where the exposures and outcomes are predetermined prior to sample collection. Therefore, a spurious association between an exposure and an outcome can arise if both variables affect study participation. Such concerns were raised in previous studies questioning the representativeness of the UK Biobank. Recently, a genome-wide association study (GWAS) on biological sex found many autosomal hits and non-negligible autosomal heritability which the authors attribute to selection bias. In this study, we propose a simple and a practical method that can overcome sex-driven selection bias based on theoretical analysis and simulations.
Collapse
Affiliation(s)
- Hanbin Lee
- Department of Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Buhm Han
- Department of Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Biomedical Sciences, BK21 Plus Biomedical Science Project, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea.
| |
Collapse
|
236
|
Fox MP, Nianogo R, Rudolph JE, Howe CJ. Illustrating How to Simulate Data From Directed Acyclic Graphs to Understand Epidemiologic Concepts. Am J Epidemiol 2022; 191:1300-1306. [PMID: 35259232 DOI: 10.1093/aje/kwac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/28/2022] [Accepted: 03/01/2022] [Indexed: 01/26/2023] Open
Abstract
Simulation methods are a powerful set of tools that can allow researchers to better characterize phenomena from the real world. As such, the ability to simulate data represents a critical set of skills that epidemiologists should use to better understand epidemiologic concepts and ensure that they have the tools to continue to self-teach even when their formal instruction ends. Simulation methods are not always taught in epidemiology methods courses, whereas causal directed acyclic graphs (DAGs) often are. Therefore, this paper details an approach to building simulations from DAGs and provides examples and code for learning to perform simulations. We recommend using very simple DAGs to learn the procedures and code necessary to set up a simulation that builds on key concepts frequently of interest to epidemiologists (e.g., mediation, confounding bias, M bias). We believe that following this approach will allow epidemiologists to gain confidence with a critical skill set that may in turn have a positive impact on how they conduct future epidemiologic studies.
Collapse
|
237
|
Udell JA, Behrouzi B, Sivaswamy A, Chu A, Ferreira-Legere LE, Fang J, Goodman SG, Ezekowitz JA, Bainey KR, van Diepen S, Kaul P, McAlister FA, Bogoch II, Jackevicius CA, Abdel-Qadir H, Wijeysundera HC, Ko DT, Austin PC, Lee DS. Clinical risk, sociodemographic factors, and SARS-CoV-2 infection over time in Ontario, Canada. Sci Rep 2022; 12:10534. [PMID: 35750706 PMCID: PMC9232511 DOI: 10.1038/s41598-022-13598-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/25/2022] [Indexed: 01/08/2023] Open
Abstract
We aimed to determine whether early public health interventions in 2020 mitigated the association of sociodemographic and clinical risk factors with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a population-based cohort study of all adults in Ontario, Canada who underwent testing for SARS-CoV-2 through December 31, 2020. The outcome was laboratory-confirmed SARS-CoV-2 infection, determined by reverse transcription polymerase chain reaction testing. Adjusted odds ratios (ORs) were determined for sociodemographic and clinical risk factors before and after the first-wave peak of the pandemic to assess for changes in effect sizes. Among 3,167,753 community-dwelling individuals, 142,814 (4.5%) tested positive. The association between age and SARS-CoV-2 infection risk varied over time (P-interaction < 0.0001). Prior to the first-wave peak, SARS-CoV-2 infection increased with age whereas this association reversed thereafter. Risk factors that persisted included male sex, residing in lower income neighborhoods, residing in more racially/ethnically diverse communities, immigration to Canada, hypertension, and diabetes. While there was a reduction in infection rates after mid-April 2020, there was less impact in regions with higher racial/ethnic diversity. Immediately following the initial peak, individuals living in the most racially/ethnically diverse communities with 2, 3, or ≥ 4 risk factors had ORs of 1.89, 3.07, and 4.73-fold higher for SARS-CoV-2 infection compared to lower risk individuals in their community (all P < 0.0001). In the latter half of 2020, this disparity persisted with corresponding ORs of 1.66, 2.48, and 3.70-fold higher, respectively. In the least racially/ethnically diverse communities, there was little/no gradient in infection rates across risk strata. Further efforts are necessary to reduce the risk of SARS-CoV-2 infection among the highest risk individuals residing in the most racially/ethnically diverse communities.
Collapse
Affiliation(s)
- Jacob A Udell
- ICES, Toronto, Canada. .,Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Canada. .,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. .,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Bahar Behrouzi
- ICES, Toronto, Canada.,Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | | | | | - Shaun G Goodman
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada.,Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kevin R Bainey
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Sean van Diepen
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Finlay A McAlister
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Isaac I Bogoch
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Divisions of General Internal Medicine and Infectious Diseases, University Health Network, Toronto, Canada
| | - Cynthia A Jackevicius
- ICES, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Western University of Health Sciences, Pomona, CA, USA
| | - Husam Abdel-Qadir
- ICES, Toronto, Canada.,Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Harindra C Wijeysundera
- ICES, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dennis T Ko
- ICES, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Douglas S Lee
- ICES, Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
238
|
Pettit RW, Amos CI. Linkage Disequilibrium Score Statistic Regression for Identifying Novel Trait Associations. CURR EPIDEMIOL REP 2022. [DOI: 10.1007/s40471-022-00297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
239
|
Bouillon K, Baricault B, Semenzato L, Botton J, Bertrand M, Drouin J, Dray‐Spira R, Weill A, Zureik M. Association of Statins for Primary Prevention of Cardiovascular Diseases With Hospitalization for COVID-19: A Nationwide Matched Population-Based Cohort Study. J Am Heart Assoc 2022; 11:e023357. [PMID: 35699173 PMCID: PMC9238639 DOI: 10.1161/jaha.121.023357] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
Background There is little evidence on the relationship between statin use and the risk of hospitalization attributable to COVID-19. Methods and Results The French National Healthcare Data System database was used to conduct a matched-cohort study. For each adult aged ≥40 years receiving statins for the primary prevention of cardiovascular diseases, one nonuser was randomly selected and matched for year of birth, sex, residence area, and comorbidities. The association between statin use and hospitalization for COVID-19 was examined using conditional Cox proportional hazards models, adjusted for baseline characteristics, comorbidities, and long-term medications. Its association with in-hospital death from COVID-19 was also explored. All participants were followed up from February 15, 2020, to June 15, 2020. The matching procedure generated 2 058 249 adults in the statin group and 2 058 249 in the control group, composed of 46.6% of men with a mean age of 68.7 years. Statin users had a 16% lower risk of hospitalization for COVID-19 than nonusers (adjusted hazard ratio [HR], 0.84; 95% CI, 0.81-0.88). All types of statins were significantly associated with a lower risk of hospitalization, with the adjusted HR ranging from 0.75 for fluvastatin to 0.89 for atorvastatin. Low- and moderate-intensity statins also showed a lower risk compared with nonusers (HR, 0.78 [95% CI, 0.71-0.86] and HR, 0.84 [95% CI, 0.80-0.89], respectively), whereas high-intensity statins did not (HR, 1.01; 95% CI, 0.86-1.18). We found similar results with in-hospital death from COVID-19. Conclusions Our findings support that the use of statins for primary prevention is associated with lower risks of hospitalization for COVID-19 and of in-hospital death from COVID-19.
Collapse
Affiliation(s)
- Kim Bouillon
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Bérangère Baricault
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Laura Semenzato
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Jérémie Botton
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
- Faculty of PharmacyParis‐Saclay UniversityChâtenay‐MalabryFrance
| | - Marion Bertrand
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Jérôme Drouin
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Rosemary Dray‐Spira
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Alain Weill
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Mahmoud Zureik
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
- Paris‐Saclay UniversityUVSQCESP‐Inserm, Anti‐infective evasion and pharmacoepidemiologyMontigny le BretonneuxFrance
| |
Collapse
|
240
|
Bhaduri R, Kundu R, Purkayastha S, Kleinsasser M, Beesley LJ, Mukherjee B, Datta J. Extending the susceptible-exposed-infected-removed (SEIR) model to handle the false negative rate and symptom-based administration of COVID-19 diagnostic tests: SEIR-fansy. Stat Med 2022; 41:2317-2337. [PMID: 35224743 PMCID: PMC9035093 DOI: 10.1002/sim.9357] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 01/08/2023]
Abstract
False negative rates of severe acute respiratory coronavirus 2 diagnostic tests, together with selection bias due to prioritized testing can result in inaccurate modeling of COVID-19 transmission dynamics based on reported "case" counts. We propose an extension of the widely used Susceptible-Exposed-Infected-Removed (SEIR) model that accounts for misclassification error and selection bias, and derive an analytic expression for the basic reproduction number R 0 as a function of false negative rates of the diagnostic tests and selection probabilities for getting tested. Analyzing data from the first two waves of the pandemic in India, we show that correcting for misclassification and selection leads to more accurate prediction in a test sample. We provide estimates of undetected infections and deaths between April 1, 2020 and August 31, 2021. At the end of the first wave in India, the estimated under-reporting factor for cases was at 11.1 (95% CI: 10.7,11.5) and for deaths at 3.58 (95% CI: 3.5,3.66) as of February 1, 2021, while they change to 19.2 (95% CI: 17.9, 19.9) and 4.55 (95% CI: 4.32, 4.68) as of July 1, 2021. Equivalently, 9.0% (95% CI: 8.7%, 9.3%) and 5.2% (95% CI: 5.0%, 5.6%) of total estimated infections were reported on these two dates, while 27.9% (95% CI: 27.3%, 28.6%) and 22% (95% CI: 21.4%, 23.1%) of estimated total deaths were reported. Extensive simulation studies demonstrate the effect of misclassification and selection on estimation of R 0 and prediction of future infections. A R-package SEIRfansy is developed for broader dissemination.
Collapse
Affiliation(s)
- Ritwik Bhaduri
- Department of StatisticsHarvard UniversityCambridgeMassachusettsUSA
| | - Ritoban Kundu
- Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUnited States
| | - Soumik Purkayastha
- Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUnited States
| | - Michael Kleinsasser
- Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUnited States
| | - Lauren J. Beesley
- Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUnited States
| | - Bhramar Mukherjee
- Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUnited States
- Department of EpidemiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Jyotishka Datta
- Department of StatisticsVirginia Polytechnic Institute and State UniversityBlacksburgVirginiaUSA
| |
Collapse
|
241
|
Van Goethem N, Chung PYJ, Meurisse M, Vandromme M, De Mot L, Brondeel R, Stouten V, Klamer S, Cuypers L, Braeye T, Catteau L, Nevejan L, van Loenhout JAF, Blot K. Clinical Severity of SARS-CoV-2 Omicron Variant Compared with Delta among Hospitalized COVID-19 Patients in Belgium during Autumn and Winter Season 2021-2022. Viruses 2022; 14:1297. [PMID: 35746768 PMCID: PMC9227815 DOI: 10.3390/v14061297] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/08/2023] Open
Abstract
This retrospective multi-center matched cohort study assessed the risk for severe COVID-19 (combination of severity indicators), intensive care unit (ICU) admission, and in-hospital mortality in hospitalized patients when infected with the Omicron variant compared to when infected with the Delta variant. The study is based on a causal framework using individually-linked data from national COVID-19 registries. The study population consisted of 954 COVID-19 patients (of which, 445 were infected with Omicron) above 18 years old admitted to a Belgian hospital during the autumn and winter season 2021-2022, and with available viral genomic data. Patients were matched based on the hospital, whereas other possible confounders (demographics, comorbidities, vaccination status, socio-economic status, and ICU occupancy) were adjusted for by using a multivariable logistic regression analysis. The estimated standardized risk for severe COVID-19 and ICU admission in hospitalized patients was significantly lower (RR = 0.63; 95% CI (0.30; 0.97) and RR = 0.56; 95% CI (0.14; 0.99), respectively) when infected with the Omicron variant, whereas in-hospital mortality was not significantly different according to the SARS-CoV-2 variant (RR = 0.78, 95% CI (0.28-1.29)). This study demonstrates the added value of integrated genomic and clinical surveillance to recognize the multifactorial nature of COVID-19 pathogenesis.
Collapse
Affiliation(s)
- Nina Van Goethem
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Pui Yan Jenny Chung
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Marjan Meurisse
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Mathil Vandromme
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Laurane De Mot
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Ruben Brondeel
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Veerle Stouten
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Sofieke Klamer
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Lize Cuypers
- Clinical Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, University Hospitals Leuven, 3000 Leuven, Belgium; (L.C.); (L.N.)
| | - Toon Braeye
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Lucy Catteau
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Louis Nevejan
- Clinical Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, University Hospitals Leuven, 3000 Leuven, Belgium; (L.C.); (L.N.)
| | - Joris A. F. van Loenhout
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Koen Blot
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| |
Collapse
|
242
|
Clinical outcomes associated with SARS-CoV-2 Omicron (B.1.1.529) variant and BA.1/BA.1.1 or BA.2 subvariant infection in southern California. Nat Med 2022; 28:1933-1943. [PMID: 35675841 DOI: 10.1038/s41591-022-01887-z] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/06/2022] [Indexed: 02/06/2023]
Abstract
ABTRACT Epidemiologic surveillance has revealed decoupling of COVID-19 hospitalizations and deaths from case counts following emergence of the Omicron (B.1.1.529) SARS-CoV-2 variant globally. However, assessment of the relative severity of Omicron variant infections presents challenges because of differential acquired immune protection against Omicron and prior variants, and because longer-term changes have occurred in testing and healthcare practices. Here we show that Omicron variant infections were associated with substantially reduced risk of progression to severe clinical outcomes relative to time-matched Delta (B.1.617.2) variant infections within a large, integrated healthcare system in southern California. Adjusted hazard ratios (aHRs) for any hospital admission, symptomatic hospital admission, intensive care unit admission, mechanical ventilation, and death comparing cases with Omicron versus Delta variant infection were 0.59 (95% confidence interval: 0.51-0.69), 0.59 (0.51-0.68), 0.50 (0.29-0.87), 0.36 (0.18-0.72), and 0.21 (0.10-0.44) respectively. This reduced severity could not be explained by differential history of prior infection among cases with Omicron or Delta variant infection, and was starkest among cases not previously vaccinated against COVID-19 (aHR=0.40 [0.33-0.49] for any hospital admission and 0.14 [0.07-0.28] for death). Infections with the Omicron BA.2 subvariant were not associated with differential risk of severe outcomes in comparison to BA.1/BA.1.1 subvariant infections. Lower risk of severe clinical outcomes among cases with Omicron variant infection should inform public health response amid establishment of the Omicron variant as the dominant SARS-CoV-2 lineage globally.
Collapse
|
243
|
Arif S, MacNeil A. Predictive models aren't for causal inference. Ecol Lett 2022; 25:1741-1745. [DOI: 10.1111/ele.14033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/21/2022] [Accepted: 05/08/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Suchinta Arif
- Ocean Frontier Institute Dalhousie University, Department of Biology Halifax Nova Scotia Canada
| | - Aaron MacNeil
- Ocean Frontier Institute Dalhousie University, Department of Biology Halifax Nova Scotia Canada
| |
Collapse
|
244
|
Loader J, Taylor FC, Lampa E, Sundström J. Renin-Angiotensin Aldosterone System Inhibitors and COVID-19: A Systematic Review and Meta-Analysis Revealing Critical Bias Across a Body of Observational Research. J Am Heart Assoc 2022; 11:e025289. [PMID: 35624081 PMCID: PMC9238740 DOI: 10.1161/jaha.122.025289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/07/2022] [Indexed: 12/18/2022]
Abstract
Background Renin-angiotensin aldosterone system (RAAS) inhibitor-COVID-19 studies, observational in design, appear to use biased methods that can distort the interaction between RAAS inhibitor use and COVID-19 risk. This study assessed the extent of bias in that research and reevaluated RAAS inhibitor-COVID-19 associations in studies without critical risk of bias. Methods and Results Searches were performed in MEDLINE, EMBASE, and CINAHL databases (December 1, 2019 to October 21, 2021) identifying studies that compared the risk of infection and/or severe COVID-19 outcomes between those using or not using RAAS inhibitors (ie, angiotensin-converting enzyme inhibitors or angiotensin II type-I receptor blockers). Weighted hazard ratios (HR) and 95% CIs were extracted and pooled in fixed-effects meta-analyses, only from studies without critical risk of bias that assessed severe COVID-19 outcomes. Of 169 relevant studies, 164 had critical risks of bias and were excluded. Ultimately, only two studies presented data relevant to the meta-analysis. In 1 351 633 people with uncomplicated hypertension using a RAAS inhibitor, calcium channel blocker, or thiazide diuretic in monotherapy, the risk of hospitalization (angiotensin-converting enzyme inhibitor: HR, 0.76; 95% CI, 0.66-0.87; P<0.001; angiotensin II type-I receptor blockers: HR, 0.86; 95% CI, 0.77-0.97; P=0.015) and intubation or death (angiotensin-converting enzyme inhibitor: HR, 0.64; 95% CI, 0.48-0.85; P=0.002; angiotensin II type-I receptor blockers: HR, 0.74; 95% CI, 0.58-0.95; P=0.019) with COVID-19 was lower in those using a RAAS inhibitor. However, these protective effects are probably not clinically relevant. Conclusions This study reveals the critical risk of bias that exists across almost an entire body of COVID-19 research, raising an important question: Were research methods and/or peer-review processes temporarily weakened during the surge of COVID-19 research or is this lack of rigor a systemic problem that also exists outside pandemic-based research? Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021237859.
Collapse
Affiliation(s)
- Jordan Loader
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- Inserm U1300 – HP2CHU Grenoble AlpesGrenobleFrance
| | - Frances C. Taylor
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- Mary MacKillop Institute for Health Research, Australian Catholic UniversityMelbourneVictoriaAustralia
| | - Erik Lampa
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Johan Sundström
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| |
Collapse
|
245
|
Bastard P, Hsiao KC, Zhang Q, Choin J, Best E, Chen J, Gervais A, Bizien L, Materna M, Harmant C, Roux M, Hawley NL, Weeks DE, McGarvey ST, Sandoval K, Barberena-Jonas C, Quinto-Cortés CD, Hagelberg E, Mentzer AJ, Robson K, Coulibaly B, Seeleuthner Y, Bigio B, Li Z, Uzé G, Pellegrini S, Lorenzo L, Sbihi Z, Latour S, Besnard M, Adam de Beaumais T, Jacqz Aigrain E, Béziat V, Deka R, Esera Tulifau L, Viali S, Reupena MS, Naseri T, McNaughton P, Sarkozy V, Peake J, Blincoe A, Primhak S, Stables S, Gibson K, Woon ST, Drake KM, Hill AV, Chan CY, King R, Ameratunga R, Teiti I, Aubry M, Cao-Lormeau VM, Tangye SG, Zhang SY, Jouanguy E, Gray P, Abel L, Moreno-Estrada A, Minster RL, Quintana-Murci L, Wood AC, Casanova JL. A loss-of-function IFNAR1 allele in Polynesia underlies severe viral diseases in homozygotes. J Exp Med 2022; 219:e20220028. [PMID: 35442418 PMCID: PMC9026234 DOI: 10.1084/jem.20220028] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 12/11/2022] Open
Abstract
Globally, autosomal recessive IFNAR1 deficiency is a rare inborn error of immunity underlying susceptibility to live attenuated vaccine and wild-type viruses. We report seven children from five unrelated kindreds of western Polynesian ancestry who suffered from severe viral diseases. All the patients are homozygous for the same nonsense IFNAR1 variant (p.Glu386*). This allele encodes a truncated protein that is absent from the cell surface and is loss-of-function. The fibroblasts of the patients do not respond to type I IFNs (IFN-α2, IFN-ω, or IFN-β). Remarkably, this IFNAR1 variant has a minor allele frequency >1% in Samoa and is also observed in the Cook, Society, Marquesas, and Austral islands, as well as Fiji, whereas it is extremely rare or absent in the other populations tested, including those of the Pacific region. Inherited IFNAR1 deficiency should be considered in individuals of Polynesian ancestry with severe viral illnesses.
Collapse
Affiliation(s)
- Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
- Paris Cité University, Imagine Institute, Paris, France
- Department of Pediatrics, Necker Hospital for Sick Children, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Kuang-Chih Hsiao
- Starship Child Health, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Murdoch Children’s Research Institute, Melbourne, Australia
- Clinical Immunogenomics Research Consortium Australasia, Sydney, Australia
| | - Qian Zhang
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
- Paris Cité University, Imagine Institute, Paris, France
| | - Jeremy Choin
- Institut Pasteur, Université de Paris, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
- Chair of Human Genomics and Evolution, Collège de France, Paris, France
- Paris Cité University, Paris, France
| | - Emma Best
- Starship Child Health, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jie Chen
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
- Department of Infectious Diseases, Shanghai Sixth Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Adrian Gervais
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Lucy Bizien
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Marie Materna
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Christine Harmant
- Institut Pasteur, Université de Paris, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
| | - Maguelonne Roux
- Institut Pasteur, Université de Paris, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
- Institut Pasteur, Université de Paris, Bioinformatics and Biostatistics Hub, Paris, France
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Daniel E. Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Stephen T. McGarvey
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI
- Department of Anthropology, Brown University, Providence, RI
| | - Karla Sandoval
- National Laboratory of Genomics for Biodiversity (LANGEBIO) - UGA, CINVESTAV, Irapuato, Guanajuato, Mexico
| | - Carmina Barberena-Jonas
- National Laboratory of Genomics for Biodiversity (LANGEBIO) - UGA, CINVESTAV, Irapuato, Guanajuato, Mexico
| | - Consuelo D. Quinto-Cortés
- National Laboratory of Genomics for Biodiversity (LANGEBIO) - UGA, CINVESTAV, Irapuato, Guanajuato, Mexico
| | | | - Alexander J. Mentzer
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Kathryn Robson
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Boubacar Coulibaly
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Yoann Seeleuthner
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
| | - Benedetta Bigio
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
| | - Zhi Li
- Institut Pasteur, Université de Paris, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
- Unit of Cytokine Signaling, Pasteur Institute, INSERM U1224, Paris, France
| | - Gilles Uzé
- Institute for Regenerative Medicine and Biotherapy, Université Montpellier, INSERM, CNRS, Montpellier, France
| | - Sandra Pellegrini
- Unit of Cytokine Signaling, Pasteur Institute, INSERM U1224, Paris, France
| | - Lazaro Lorenzo
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Paris Cité University, Imagine Institute, Paris, France
| | - Zineb Sbihi
- Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR 1163, Imagine Institute, Paris, France
| | - Sylvain Latour
- Paris Cité University, Imagine Institute, Paris, France
- Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR 1163, Imagine Institute, Paris, France
| | - Marianne Besnard
- Department of Neonatology, Centre Hospitalier de Polynésie Française, Papeete, French Polynesia
| | - Tiphaine Adam de Beaumais
- Precision Cancer Medicine Team, Institut Gustave Roussy, Villejuif, France
- Pharmacology - Pharmacogenetic Department, Hopital Saint-Louis, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Evelyne Jacqz Aigrain
- Paris Cité University, Paris, France
- Pharmacology - Pharmacogenetic Department, Hopital Saint-Louis, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Vivien Béziat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
- Paris Cité University, Imagine Institute, Paris, France
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH
| | | | | | | | - Take Naseri
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI
- Ministry of Health, Apia, Samoa
| | - Peter McNaughton
- Clinical Immunogenomics Research Consortium Australasia, Sydney, Australia
- Queensland Children’s Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Vanessa Sarkozy
- Tumbatin Developmental Services, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane Peake
- Clinical Immunogenomics Research Consortium Australasia, Sydney, Australia
- Queensland Children’s Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Annaliesse Blincoe
- Starship Child Health, Auckland, New Zealand
- Clinical Immunogenomics Research Consortium Australasia, Sydney, Australia
| | - Sarah Primhak
- Starship Child Health, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Simon Stables
- Department of Forensic Pathology, Auckland City Hospital, Auckland, New Zealand
| | - Kate Gibson
- Clinical Geneticist, South Island Hub, Genetic Health Service, Christchurch, New Zealand
| | - See-Tarn Woon
- Department of Virology and Immunology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Kylie Marie Drake
- Molecular Pathology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Adrian V.S. Hill
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Cheng-Yee Chan
- Chemical Pathology and Genetics, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Richard King
- Chemical Pathology and Genetics, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Rohan Ameratunga
- Department of Virology and Immunology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Department of Clinical Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Iotefa Teiti
- Laboratory of Research on Infectious Vector-borne Diseases, Institut Louis Malardé, Papeete, French Polynesia
| | - Maite Aubry
- Laboratory of Research on Infectious Vector-borne Diseases, Institut Louis Malardé, Papeete, French Polynesia
| | - Van-Mai Cao-Lormeau
- Laboratory of Research on Infectious Vector-borne Diseases, Institut Louis Malardé, Papeete, French Polynesia
| | - Stuart G. Tangye
- Clinical Immunogenomics Research Consortium Australasia, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
- St Vincent’s Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Shen-Ying Zhang
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
- Paris Cité University, Imagine Institute, Paris, France
| | - Emmanuelle Jouanguy
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
- Paris Cité University, Imagine Institute, Paris, France
| | - Paul Gray
- Clinical Immunogenomics Research Consortium Australasia, Sydney, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
- Paris Cité University, Imagine Institute, Paris, France
| | - Andrés Moreno-Estrada
- National Laboratory of Genomics for Biodiversity (LANGEBIO) - UGA, CINVESTAV, Irapuato, Guanajuato, Mexico
| | - Ryan L. Minster
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Lluis Quintana-Murci
- Institut Pasteur, Université de Paris, CNRS UMR2000, Human Evolutionary Genetics Unit, Paris, France
- Chair of Human Genomics and Evolution, Collège de France, Paris, France
| | - Andrew C. Wood
- Starship Child Health, Auckland, New Zealand
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
- Paris Cité University, Imagine Institute, Paris, France
- Department of Pediatrics, Necker Hospital for Sick Children, Assistance Publique – Hôpitaux de Paris, Paris, France
- Howard Hughes Medical Institute, New York, NY
| |
Collapse
|
246
|
Van Goethem N, Vandromme M, Van Oyen H, Haarhuis F, Brondeel R, Catteau L, André E, Cuypers L, Blot K, Serrien B. Severity of infection with the SARS-CoV-2 B.1.1.7 lineage among hospitalized COVID-19 patients in Belgium. PLoS One 2022; 17:e0269138. [PMID: 35657787 PMCID: PMC9165825 DOI: 10.1371/journal.pone.0269138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/13/2022] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The pathogenesis of COVID-19 depends on the interplay between host characteristics, viral characteristics and contextual factors. Here, we compare COVID-19 disease severity between hospitalized patients in Belgium infected with the SARS-CoV-2 variant B.1.1.7 and those infected with previously circulating strains. METHODS The study is conducted within a causal framework to study the severity of SARS-CoV-2 variants by merging surveillance registries in Belgium. Infection with SARS-CoV-2 B.1.1.7 ('exposed') was compared to infection with previously circulating strains ('unexposed') in terms of the manifestation of severe COVID-19, intensive care unit (ICU) admission, or in-hospital mortality. The exposed and unexposed group were matched based on the hospital and the mean ICU occupancy rate during the patient's hospital stay. Other variables identified as confounders in a Directed Acyclic Graph (DAG) were adjusted for using regression analysis. Sensitivity analyses were performed to assess the influence of selection bias, vaccination rollout, and unmeasured confounding. RESULTS We observed no difference between the exposed and unexposed group in severe COVID-19 disease or in-hospital mortality (RR = 1.15, 95% CI [0.93-1.38] and RR = 0.92, 95% CI [0.62-1.23], respectively). The estimated standardized risk to be admitted in ICU was significantly higher (RR = 1.36, 95% CI [1.03-1.68]) when infected with the B.1.1.7 variant. An age-stratified analysis showed that among the younger age group (≤65 years), the SARS-CoV-2 variant B.1.1.7 was significantly associated with both severe COVID-19 progression and ICU admission. CONCLUSION This matched observational cohort study did not find an overall increased risk of severe COVID-19 or death associated with B.1.1.7 infection among patients already hospitalized. There was a significant increased risk to be transferred to ICU when infected with the B.1.1.7 variant, especially among the younger age group. However, potential selection biases advocate for more systematic sequencing of samples from hospitalized COVID-19 patients.
Collapse
Affiliation(s)
- Nina Van Goethem
- Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Epidemiology and Biostatistics, Institut de recherche expérimentale et clinique, Faculty of Public Health, Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium
| | - Mathil Vandromme
- Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Herman Van Oyen
- Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Freek Haarhuis
- Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Ruben Brondeel
- Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Lucy Catteau
- Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Emmanuel André
- University Hospitals Leuven, Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, Leuven, Belgium
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Laboratory Clinical Bacteriology and Mycology, Rega Institute for Medical Research, Leuven, Belgium
| | - Lize Cuypers
- University Hospitals Leuven, Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, Leuven, Belgium
| | | | | | - Koen Blot
- Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Ben Serrien
- Scientific Directorate of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| |
Collapse
|
247
|
Yeh HC, Kraschnewski JL, Kong L, Lehman EB, Heilbrunn ES, Williams P, Poger JM, Francis E, Bryce CL. Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland. BMJ Open Diabetes Res Care 2022; 10:10/3/e002774. [PMID: 35680172 PMCID: PMC9184995 DOI: 10.1136/bmjdrc-2022-002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify the demographic and clinical characteristics associated with adverse COVID-19 outcomes across a 12-month period in 2020 and 2021. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study using electronic health records from five academic health systems in Pennsylvania and Maryland, including patients with COVID-19 with type 2 diabetes or at risk of type 2 diabetes. Patients were classified based on 30-day outcomes: (1) no hospitalization; (2) hospitalization only; or (3) a composite measure including admission to the intensive care unit (ICU), intubation, or death. Analyses were conducted in patients with type 2 diabetes and patients at risk of type 2 diabetes separately. RESULTS We included 15 725 patients with COVID-19 diagnoses between March 2020 and February 2021. Older age and higher Charlson Comorbidity Index scores were associated with higher odds of adverse outcomes, while COVID-19 diagnoses later in the study period were associated with lower odds of severe outcomes. In patients with type 2 diabetes, individuals on insulin treatment had higher odds for ICU/intubation/death (OR=1.59, 95% CI 1.27 to 1.99), whereas those on metformin had lower odds (OR=0.56, 95% CI 0.45 to 0.71). Compared with non-Hispanic White patients, Hispanic patients had higher odds of hospitalization in patients with type 2 diabetes (OR=1.73, 95% CI 1.36 to 2.19) or at risk of type 2 diabetes (OR=1.77, 95% CI 1.43 to 2.18.) CONCLUSIONS: Adults who were older, in racial minority groups, had multiple chronic conditions or were on insulin treatment had higher risks for severe COVID-19 outcomes. This study reinforced the urgency of preventing COVID-19 and its complications in vulnerable populations. TRIAL REGISTRATION NUMBER NCT02788903.
Collapse
Affiliation(s)
- Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Kraschnewski
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Emily S Heilbrunn
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Pamela Williams
- Cancer and Chronic Disease Bureau, Maryland Department of Health, Baltimore, Maryland, USA
| | - Jennifer M Poger
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erica Francis
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Cindy L Bryce
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
248
|
Baksh RA, Strydom A, Pape SE, Chan LF, Gulliford MC. Susceptibility to COVID-19 Diagnosis in People with Down Syndrome Compared to the General Population: Matched-Cohort Study Using Primary Care Electronic Records in the UK. J Gen Intern Med 2022; 37:2009-2015. [PMID: 35386043 PMCID: PMC8985744 DOI: 10.1007/s11606-022-07420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, people with Down syndrome (DS) have experienced a more severe disease course and higher mortality rates than the general population. It is not yet known whether people with DS are more susceptible to being diagnosed with COVID-19. OBJECTIVE To explore whether DS is associated with increased susceptibility to COVID-19. DESIGN Matched-cohort study design using anonymised primary care electronic health records from the May 2021 release of Clinical Practice Research Datalink (CPRD) Aurum. SETTING Electronic health records from approximately 1400 general practices (GPs) in England. PARTICIPANTS 8854 people with DS and 34,724 controls matched for age, gender and GP who were registered on or after the 29th January 2020. MEASUREMENTS The primary outcome was COVID-19 diagnosis between January 2020 and May 2021. Conditional logistic regression models were fitted to estimate associations between DS and COVID-19 diagnosis, adjusting for comorbidities. RESULTS Compared to controls, people with DS were more likely to be diagnosed with COVID-19 (7.4% vs 5.6%, p ≤ 0.001, odds ratio (OR) = 1.35; 95% CI = 1.23-1.48). There was a significant interaction between people with DS and a chronic respiratory disease diagnosis excluding asthma and increased odds of a COVID-19 diagnosis (OR = 1.71; 95% CI = 1.20-2.43), whilst adjusting for a number of comorbidities. CONCLUSION Individuals with DS are at increased risk for contracting COVID-19. Those with underlying lung conditions are particularly vulnerable during viral pandemics and should be prioritised for vaccinations.
Collapse
Affiliation(s)
- R Asaad Baksh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. .,The LonDowns Consortium, London, UK.
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,The LonDowns Consortium, London, UK
| | - Sarah E Pape
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,The LonDowns Consortium, London, UK
| | - Li F Chan
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London, UK
| | - Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
| |
Collapse
|
249
|
Edlow AG, Castro VM, Shook LL, Kaimal AJ, Perlis RH. Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy. JAMA Netw Open 2022; 5:e2215787. [PMID: 35679048 PMCID: PMC9185175 DOI: 10.1001/jamanetworkopen.2022.15787] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/06/2022] [Indexed: 12/23/2022] Open
Abstract
Importance Epidemiologic studies suggest maternal immune activation during pregnancy may be associated with neurodevelopmental effects in offspring. Objective To evaluate whether in utero exposure to SARS-CoV-2 is associated with risk for neurodevelopmental disorders in the first 12 months after birth. Design, Setting, and Participants This retrospective cohort study examined live offspring of all mothers who delivered between March and September 2020 at any of 6 Massachusetts hospitals across 2 health systems. Statistical analysis was performed from October to December 2021. Exposures Maternal SARS-CoV-2 infection confirmed by a polymerase chain reaction test during pregnancy. Main Outcomes and Measures Neurodevelopmental disorders determined from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes over the first 12 months of life; sociodemographic and clinical features of mothers and offspring; all drawn from the electronic health record. Results The cohort included 7772 live births (7466 pregnancies, 96% singleton, 222 births to SARS-CoV-2 positive mothers), with mean (SD) maternal age of 32.9 (5.0) years; offspring were 9.9% Asian (772), 8.4% Black (656), and 69.0% White (5363); 15.1% (1134) were of Hispanic ethnicity. Preterm delivery was more likely among exposed mothers: 14.4% (32) vs 8.7% (654) (P = .003). Maternal SARS-CoV-2 positivity during pregnancy was associated with greater rate of neurodevelopmental diagnoses in unadjusted models (odds ratio [OR], 2.17 [95% CI, 1.24-3.79]; P = .006) as well as those adjusted for race, ethnicity, insurance status, offspring sex, maternal age, and preterm status (adjusted OR, 1.86 [95% CI, 1.03-3.36]; P = .04). Third-trimester infection was associated with effects of larger magnitude (adjusted OR, 2.34 [95% CI, 1.23-4.44]; P = .01). Conclusions and Relevance This cohort study of SARS-CoV-2 exposure in utero found preliminary evidence that maternal SARS-CoV-2 may be associated with neurodevelopmental sequelae in some offspring. Prospective studies with longer follow-up duration will be required to exclude confounding and confirm these associations.
Collapse
Affiliation(s)
- Andrea G. Edlow
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Victor M. Castro
- Center for Quantitative Health and Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Research Information Science and Computing, Mass General Brigham, Somerville, Massachusetts
| | - Lydia L. Shook
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Roy H. Perlis
- Center for Quantitative Health and Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
250
|
Dattani S, Howard DM, Lewis CM, Sham PC. Clarifying the causes of consistent and inconsistent findings in genetics. Genet Epidemiol 2022; 46:372-389. [PMID: 35652173 PMCID: PMC9544854 DOI: 10.1002/gepi.22459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
As research in genetics has advanced, some findings have been unexpected or shown to be inconsistent between studies or datasets. The reasons these inconsistencies arise are complex. Results from genetic studies can be affected by various factors including statistical power, linkage disequilibrium, quality control, confounding and selection bias, as well as real differences from interactions and effect modifiers, which may be informative about the mechanisms of traits and disease. Statistical artefacts can manifest as differences between results but they can also conceal underlying differences, which implies that their critical examination is important for understanding the underpinnings of traits. In this review, we examine these factors and outline how they can be identified and conceptualised with structural causal models. We explain the consequences they have on genetic estimates, such as genetic associations, polygenic scores, family‐ and genome‐wide heritability, and describe methods to address them to aid in the estimation of true effects of genetic variation. Clarifying these factors can help researchers anticipate when results are likely to diverge and aid researchers' understanding of causal relationships between genes and complex traits.
Collapse
Affiliation(s)
- Saloni Dattani
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, Li Ka Shing (LKS) Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - David M Howard
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Cathryn M Lewis
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Pak C Sham
- Department of Psychiatry, State Key Laboratory of Brain and Cognitive Sciences, and Centre for Panoromic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| |
Collapse
|