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Murthy SC, Gordon SM, Lowry AM, Blackstone EH. Evolution of serious and life-threatening COVID-19 pneumonia as the SARS-CoV-2 pandemic progressed: an observational study of mortality to 60 days after admission to a 15-hospital US health system. BMJ Open 2024; 14:e075028. [PMID: 38977360 DOI: 10.1136/bmjopen-2023-075028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE In order to predict at hospital admission the prognosis of patients with serious and life-threatening COVID-19 pneumonia, we sought to understand the clinical characteristics of hospitalised patients at admission as the SARS-CoV-2 pandemic progressed, document their changing response to the virus and its variants over time, and identify factors most importantly associated with mortality after hospital admission. DESIGN Observational study using a prospective hospital systemwide COVID-19 database. SETTING 15-hospital US health system. PARTICIPANTS 26 872 patients admitted with COVID-19 to our Northeast Ohio and Florida hospitals from 1 March 2020 to 1 June 2022. MAIN OUTCOME MEASURES 60-day mortality (highest risk period) after hospital admission analysed by random survival forests machine learning using demographics, medical history, and COVID-19 vaccination status, and viral variant, symptoms, and routine laboratory test results obtained at hospital admission. RESULTS Hospital mortality fell from 11% in March 2020 to 3.7% in March 2022, a 66% decrease (p<0.0001); 60-day mortality fell from 17% in May 2020 to 4.7% in May 2022, a 72% decrease (p<0.0001). Advanced age was the strongest predictor of 60-day mortality, followed by admission laboratory test results. Risk-adjusted 60-day mortality had all patients been admitted in March 2020 was 15% (CI 3.0% to 28%), and had they all been admitted in May 2022, 12% (CI 2.2% to 23%), a 20% decrease (p<0.0001). Dissociation between observed and predicted decrease in mortality was related to temporal change in admission patient profile, particularly in laboratory test results, but not vaccination status or viral variant. CONCLUSIONS Hospital mortality from COVID-19 decreased substantially as the pandemic evolved but persisted after hospital discharge, eclipsing hospital mortality by 50% or more. However, after accounting for the many, even subtle, changes across the pandemic in patients' demographics, medical history and particularly admission laboratory results, a patient admitted early in the pandemic and predicted to be at high risk would remain at high risk of mortality if admitted tomorrow.
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Affiliation(s)
- Sudish C Murthy
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ashley M Lowry
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
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Li X, Sheng D, Chen K, Wang Q. Consequence of COVID-19 on allergic asthma outcomes: a systematic review and meta-analysis. Allergol Immunopathol (Madr) 2024; 52:73-80. [PMID: 38970268 DOI: 10.15586/aei.v52i4.1116] [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: 04/24/2024] [Accepted: 05/27/2024] [Indexed: 07/08/2024]
Abstract
Asthma is a common chronic lung disease, and COVID-19 pandemic as a respiratory viral disease led to lung infection and resulted in millions of deaths. So, the impact of COVID-19 on asthma outcomes and the risk of being infected or hospitalized should be clarified. Systematic review and meta-analysis on the outcomes and risk of asthma for people with COVID-19 was done by searching electronic databases between 1 December 2019 and 31 July 2023. A total of 48 studies from 27 countries spread across all continents were included in the review. The prevalence of asthma among COVID-19 patients was 7.9%, and the analysis demonstrated a 16.5% reduction in the risk ratio for acquiring COVID-19 among subjects with asthma compared to those without asthma. There was no statistically significant difference in hospitalization risk, ICU admission risk, and death risk for COVID-19 patients with no asthma compared to those with asthma. The risk of death from COVID-19 was similar between nonasthmatics and asthmatics. The findings indicated that subjects with asthma may be at a lower risk of having infection with COVID-19 compared to those without asthma, but they have a similar risk of hospitalization and mortality.
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Affiliation(s)
- Xiaoqing Li
- Department of Infectious Diseases, Ningbo Yinzhou No. 2 Hospital, Ningbo Zhejiang, 315000, China
| | - Dandan Sheng
- Department of Tuberculosis, Yantai Qishan Hospital, Yantai Shandong, 264001, China
| | - Kai Chen
- Department of Infectious Diseases, Ningbo Yinzhou No. 2 Hospital, Ningbo Zhejiang, 315000, China
| | - Qiao Wang
- Department of Respiratory and Critical Care Medicine, Huzhou Traditional Chinese Medicine Hospital, Huzhou, Zhejiang, 313000, China; ,
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Scolari FL, Rover MM, Trott G, da Silva MMD, de Souza D, de Carli Schardosim RF, da Rosa Minho dos Santos R, de Souza Roldão E, Mocellin D, de Souza JMB, Miozzo AP, Rech GS, Itaqui CR, de Mesquita J, Estivalete GPM, Freitas HJM, dos Santos CVP, da Luz LG, Kern M, Marcolino MS, Barreto BB, Schwartzman PR, Antonio ACP, Falavigna M, Robinson CC, Polanczy CA, Rosa RG. Impact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study. CRITICAL CARE SCIENCE 2024; 36:e20240258en. [PMID: 38896723 PMCID: PMC11152444 DOI: 10.62675/2965-2774.20240258-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/15/2024] [Indexed: 06/21/2024]
Abstract
RATIONALE Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce. PURPOSE To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19. METHODS This will be a multicenter case-control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance. RESULTS The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes. CONCLUSION This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.
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Affiliation(s)
- Fernando Luís Scolari
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Marciane Maria Rover
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Geraldine Trott
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Mariana Motta Dias da Silva
- Hospital Moinhos de VentoResearch InstitutePorto AlegreRSBrazilResearch Institute, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Denise de Souza
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | | | - Rosa da Rosa Minho dos Santos
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Emelyn de Souza Roldão
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Duane Mocellin
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | | | - Aline Paula Miozzo
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Gabriela Soares Rech
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Carolina Rothmann Itaqui
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Juliana de Mesquita
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | | | - Hellen Jordan Martins Freitas
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | | | - Lucas Gobetti da Luz
- Hospital Moinhos de VentoDepartment of NephrologyPorto AlegreRSBrazilDepartment of Nephrology, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Marcelo Kern
- Hospital Moinhos de VentoDepartment of Internal MedicinePorto AlegreRSBrazilDepartment of Internal Medicine, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Milena Soriano Marcolino
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartment of Clinical MedicineBelo HorizonteMGBrazilDepartment of Clinical Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.
| | - Bruna Brandão Barreto
- Universidade Federal da BahiaFaculdade de Medicina da BahiaDepartment of Internal Medicine and Diagnostic SupportSalvadorBABrazilDepartment of Internal Medicine and Diagnostic Support, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - Salvador (BA), Brazil.
| | - Paulo R. Schwartzman
- Hospital Moinhos de VentoDepartamento de CardiologiaPorto AlegreRSBrazilDepartamento de Cardiologia, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Ana Carolina Peçanha Antonio
- Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegreIntensive Care UnitPorto AlegreRSBrazilIntensive Care Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.
| | - Maicon Falavigna
- Research Unit, Inova MedicalPorto AlegreRSBrasilResearch Unit, Inova Medical - Porto Alegre (RS), Brasil
| | - Caroline Cabral Robinson
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Carisi Anne Polanczy
- Hospital Moinhos de VentoDepartamento de CardiologiaPorto AlegreRSBrazilDepartamento de Cardiologia, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Regis Goulart Rosa
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
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Porter AK, Kleinschmidt SE, Andres KL, Reusch CN, Krisko RM, Taiwo OA, Olsen GW, Longnecker MP. Occurrence of COVID-19 and serum per- and polyfluoroalkyl substances: A case-control study among workers with a wide range of exposures. GLOBAL EPIDEMIOLOGY 2024; 7:100137. [PMID: 38293561 PMCID: PMC10826147 DOI: 10.1016/j.gloepi.2024.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Per- and polyfluoroalkyl substances (PFAS) are a broad class of synthetic chemicals; some are present in most humans in developed countries. Some studies suggest that certain PFAS may have immunotoxic effects in humans, which could put individuals with high levels of exposure at increased risk for infectious diseases such as COVID-19. We conducted a case-control study to examine the association between COVID-19 diagnosis and PFAS serum concentrations among employees and retirees from two 3 M facilities, one of which historically generated perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS). Participants completed enrollment and follow-up study visits in the Spring of 2021. Participants were categorized as cases if they reported a COVID-19 diagnosis or became sick with at least one symptom of COVID-19 when someone else in their household was diagnosed, otherwise they were categorized as a control. COVID-19 diagnosis was modeled in relation to concentration of serum PFAS measured at enrollment after adjusting for covariates. The analytic sample comprised 573 individuals, 111 cases (19.4%) and 462 controls (80.6%). In adjusted models, the odds ratio of COVID-19 was 0.94 per interquartile range (14.3 ng/mL) increase in PFOS (95% confidence interval 0.85, 1.04). Results for PFOA, PFHxS, and perfluorononanoic acid (PFNA) were similar. Other PFAS present at lower concentrations were examined as categorical variables (above the limit of quantification [LOQ], yes vs. no [referent category]), and also showed no positive associations. In our study, which used individual-level data and included people with high occupational exposure, the serum concentrations of all PFAS examined were not associated with an increased odds ratio for COVID-19. At this point, the epidemiologic data supporting no association of COVID-19 occurrence with PFAS exposure are stronger than those suggesting a positive association.
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Affiliation(s)
- Anna K. Porter
- Ramboll U.S. Consulting, 3214 Charles B. Root Wynd, Suite 130, Raleigh, NC 27612, United States of America
| | - Sarah E. Kleinschmidt
- 3M Company, Corporate Occupational Medicine, St. Paul, MN 55144, United States of America
| | - Kara L. Andres
- 3M Company, Corporate Occupational Medicine, St. Paul, MN 55144, United States of America
| | - Courtney N. Reusch
- 3M Company, Corporate Occupational Medicine, St. Paul, MN 55144, United States of America
| | - Ryan M. Krisko
- 3M Company, Environment, Health, Safety and Product Stewardship, St. Paul, MN 55144, United States of America
| | - Oyebode A. Taiwo
- 3M Company, Corporate Occupational Medicine, St. Paul, MN 55144, United States of America
| | - Geary W. Olsen
- 3M Company, Corporate Occupational Medicine, St. Paul, MN 55144, United States of America
| | - Matthew P. Longnecker
- Ramboll U.S. Consulting, 3214 Charles B. Root Wynd, Suite 130, Raleigh, NC 27612, United States of America
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Serratrice C, Jean M, Herrmann F, di Silvestro K, Trombert V, Moro D, Lacroix O, Coutaz M, Graf C, Zekry D, Mendes A. Long-Term Mortality in Very Old Survivors of COVID-19. J Am Med Dir Assoc 2024; 25:105047. [PMID: 38825322 DOI: 10.1016/j.jamda.2024.105047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES This report aimed to describe mortality at 18 months in older survivors of the first wave of COVID-19. DESIGN Observational cohort study. SETTING AND PARTICIPANTS Patients aged ≥65 years hospitalized for COVID-19 in the acute geriatric wards of 2 centers. METHODS Characteristics of deceased and survivors were compared by Fisher exact, Mann-Whitney U, or 2-tailed t tests. Survival rates were analysed by Cox proportional hazards regression models. RESULTS Of a total of 323 patients admitted during the first wave, 196 survived the acute phase, with 34 patients who died in the 18 months after hospital discharge (17.3%). Higher mortality was observed in patients living in nursing homes (P = .033) and in those who were hospitalized after discharge during the follow-up period (97.1% vs 72.8%, P = .001). There was no difference in survival curves according to age, sex, presence of dyspnea, and dementia. Living in a nursing home significantly increased the mortality rates in the multivariate model adjusted for age and sex (hazard ratio 3.07, 95% CI 1.47-6.40; P = .007). CONCLUSIONS AND IMPLICATIONS No excess mortality was observed during 18 months in older survivors of COVID-19. Living in a nursing home was associated with decreased survival rates.
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Affiliation(s)
- Christine Serratrice
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Michèle Jean
- Division of Geriatrics, Hospital of Valais, Martigny, Switzerland
| | - François Herrmann
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Katharine di Silvestro
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Véronique Trombert
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Davide Moro
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Océana Lacroix
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Martial Coutaz
- Division of Geriatrics, Hospital of Valais, Martigny, Switzerland
| | - Christophe Graf
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Aged, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Aline Mendes
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
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Ye J, Huang Y, Chu C, Li J, Liu G, Li W, Gao C. Association Between Artificial Intelligence Based Chest Computed Tomography and Clinical/Laboratory Characteristics with Severity and Mortality in COVID-19 Hospitalized Patients. J Inflamm Res 2024; 17:2977-2989. [PMID: 38764494 PMCID: PMC11102184 DOI: 10.2147/jir.s456440] [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] [Received: 12/23/2023] [Accepted: 04/23/2024] [Indexed: 05/21/2024] Open
Abstract
Background Some patients with COVID-19 rapidly develop respiratory failure or mortality, underscoring the necessity for early identification of those prone to severe illness. Numerous studies focus on clinical and lab traits, but only few attend to chest computed tomography. The current study seeks to numerically quantify pulmonary lesions using early-phase CT scans calculated through artificial intelligence algorithms in conjunction with clinical and laboratory helps clinicians to early identify the development of severe illness and death in a group of COVID-19 patients. Methods From December 15, 2022, to January 30, 2023, 191 confirmed COVID-19 patients admitted to Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine were consecutively enrolled. All patients underwent chest CT scans and serum tests within 48 hours prior to admission. Variables significantly linked to critical illness or mortality in univariate analysis were subjected to multivariate logistic regression models post collinearity assessment. Adjusted odds ratio, 95% confidence intervals, sensitivity, specificity, Youden index, receiver-operator-characteristics (ROC) curves, and area under the curve (AUC) were computed for predicting severity and in-hospital mortality. Results Multivariate logistic analysis revealed that myoglobin (OR = 1.003, 95% CI 1.001-1.005), APACHE II score (OR = 1.387, 95% CI 1.216-1.583), and the infected CT region percentage (OR = 113.897, 95% CI 4.939-2626.496) independently correlated with in-hospital COVID-19 mortality. Prealbumin stood as an independent safeguarding factor (OR = 0.965, 95% CI 0.947-0.984). Neutrophil counts (OR = 1.529, 95% CI 1.131-2.068), urea nitrogen (OR = 1.587, 95% CI 1.222-2.062), SOFA score(OR = 3.333, 95% CI 1.476-7.522), qSOFA score(OR = 15.197, 95% CI 3.281-70.384), PSI score(OR = 1.053, 95% CI 1.018-1.090), and the infected CT region percentage (OR = 548.221, 95% CI 2.615-114,953.586) independently linked to COVID-19 patient severity.
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Affiliation(s)
- Jiawei Ye
- Department of Emergency Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, People’s Republic of China
| | - Yingying Huang
- Dementia Research Centre, Faculty of Medicine, Health and Human Sciences, Macquarie UniversitySydney, Australia
| | - Caiting Chu
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, People’s Republic of China
| | - Juan Li
- Department of Emergency Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, People’s Republic of China
| | - Guoxiang Liu
- Department of Emergency Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, People’s Republic of China
| | - Wenjie Li
- Department of Emergency Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, People’s Republic of China
| | - Chengjin Gao
- Department of Emergency Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, People’s Republic of China
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Vásquez-Gómez JA, Saracini C. Insights from Chilean NCDs Hospitalization Data during COVID-19. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:770. [PMID: 38792953 PMCID: PMC11123363 DOI: 10.3390/medicina60050770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
The COVID-19 pandemic has affected the lifestyles of people of all ages, conditions and occupations. Social distance, remote working, changes in diet and a lack of physical activity have directly and indirectly affected many aspects of mental and physical health, particularly in patients with many comorbidities and non-communicable diseases (NCDs). In our paper, we analyzed COVID-19 hospitalized and non-hospitalized cases according to comorbidities to assess the average monthly percentage change (AMPC) and monthly percentage change (MPC) using open access data from the Chilean Ministry of Science, Technology, Knowledge and Innovation. As expected, the infection mainly affected patients with comorbidities, including cardiovascular risk factors. The hospitalized cases with obesity and chronic lung disease increased throughout the period of June 2020-August 2021 (AMPC = ↑20.8 and ↑19.4%, respectively, p < 0.05), as did all the non-hospitalized cases with comorbidities throughout the period (AMPC = ↑15.6 to ↑30.3 [p < 0.05]). The increases in hospitalizations and non-hospitalizations with comorbidities may be associated with physical inactivity. A healthy lifestyle with regular physical activity may have had a protective effect on the COVID-19 severity and related events in the post-pandemic period, especially for the NCD population.
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Affiliation(s)
- Jaime Andrés Vásquez-Gómez
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Vicerrectoría de Investigación y Postgrado, Universidad Católica del Maule, Talca 3460000, Chile;
| | - Chiara Saracini
- Centro de Investigación en Neuropsicologia y Neurociencias Cognitivas (CINPSI Neurocog), Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca 3460000, Chile
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Oats A, Phung H, Tudehope L, Sofija E. Demographics, comorbidities and risk factors for severe disease from the early SARS-CoV-2 infection cases in Queensland, Australia. Intern Med J 2024; 54:786-794. [PMID: 37955361 DOI: 10.1111/imj.16276] [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: 01/09/2023] [Accepted: 09/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Demographics and comorbidities associated with coronavirus disease 2019 (COVID-19) severity differs between subpopulations and should be determined to aid future pandemic planning and preparedness. AIM To describe the demographics and comorbidities of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Queensland (QLD), Australia, between January 2020 and May 2021. Also, to determine the relationship between these characteristics and disease severity based on the highest level of care. METHODS A retrospective case series analysis was conducted using data obtained from the Notifiable Conditions System. Data on patients confirmed with SARS-CoV-2 infection in QLD were included in this analysis. Descriptive statistics and logistic regression modelling were used to analyse factors that contributed to disease severity. RESULTS One thousand six hundred twenty-five patients with SARS-CoV-2 infection were diagnosed in the study period and analysed. The median age was 41 years and 54.3% (n = 882) were males. A total of 550 patients were hospitalised and 20 patients were admitted to the intensive care unit (ICU). In those admitted to the ICU, 95% (n = 19) were older than 45 years and 95% (n = 19) were male. Comorbidities significantly associated with hospitalisation were chronic cardiac disease (excluding hypertension) and diabetes, and for ICU admission were morbid obesity, chronic respiratory disease and chronic cardiac disease. No demographic factors were shown to be significantly associated with disease severity. CONCLUSIONS Comorbidities associated with the highest level of COVID-19 disease severity were morbid obesity, chronic respiratory disease and cardiac disease. These data can assist with identifying high-risk patients susceptible to severe COVID-19 and can be used to facilitate preparations for future pandemics.
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Affiliation(s)
- Alainah Oats
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Pharmacy Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Hai Phung
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Lucy Tudehope
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
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Meulman I, Uiters E, Cloin M, Struijs J, Polder J, Stadhouders N. From test to rest: evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01680-4. [PMID: 38499952 DOI: 10.1007/s10198-024-01680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/25/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands. METHODOLOGY This retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results. RESULTS Among the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result. DISCUSSION Our findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans.
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Affiliation(s)
- Iris Meulman
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Center for Public Health, Healthcare & Society, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Ellen Uiters
- Center for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mariëlle Cloin
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Jeroen Struijs
- Center for Public Health, Healthcare & Society, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center-Health Campus The Hague, The Hague, The Netherlands
| | - Johan Polder
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Center for Public Health, Healthcare & Society, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Niek Stadhouders
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Lee H, Nam H, Lee JR, Jung H, Lee JY. Worsening of health disparities across COVID-19 pandemic stages in Korea. Epidemiol Health 2024; 46:e2024038. [PMID: 38514197 PMCID: PMC11176714 DOI: 10.4178/epih.e2024038] [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: 08/10/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVES With the end of the coronavirus disease 2019 (COVID-19) pandemic, the health outcomes of this disease in Korea must be examined. We aimed to investigate health outcomes and disparities linked to socioeconomic status during the COVID-19 pandemic in Korea and to identify risk factors for hospitalization and mortality. METHODS This nationwide retrospective study incorporated an analysis of individuals with and without COVID-19 in Korea between January 1, 2020 and December 31, 2022. The study period was divided into 4 stages. Prevalence, hospitalization, mortality, and case-fatality rates were calculated per 100,000 population. Multivariate logistic regression was performed to identify risk factors for COVID-19 hospitalization and mortality. RESULTS Overall, the incidence rate was 40,601 per 100,000 population, the mortality rate was 105 per 100,000 population, and the case-fatality rate was 259 per 100,000 cases. A total of 12,577,367 new cases (24.5%) were recorded in stage 3 and 8,979,635 cases (17.5%) in stage 4. Medical Aid recipients displayed the lowest 3-year cumulative incidence rate (32,737 per 100,000) but the highest hospitalization (5,663 cases per 100,000), mortality (498 per 100,000), and case-fatality (1,521 per 100,000) rates. Male sex, older age, lower economic status, non-metropolitan area of residence, high Charlson comorbidity index, and disability were associated with higher risk of hospitalization and death. Vaccination was found to reduce mortality risk. CONCLUSIONS As the pandemic progressed, surges were observed in incidence, hospitalization, and mortality, exacerbating disparities associated with economic status and disability. Nevertheless, Korea has maintained a low case-fatality rate across all economic groups.
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Affiliation(s)
- Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunwoo Nam
- Seoul National University College of Medicine, Seoul, Korea
| | - Jae-ryun Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyemin Jung
- Department of Education and Human Resource Development, Seoul National University Hospital, Seoul, Korea
- Public Health Care Center, Seoul National University Hospital, Seoul, Korea
| | - Jin Yong Lee
- Public Health Care Center, Seoul National University Hospital, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
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11
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Crosby JC, Lee RA, McGwin G, Heath SL, Burkholder GA, Gravett RM, Overton ET, Locks G, Fleece ME, Franco R, Nafziger S. A COVID-19 monitoring process for healthcare workers utilizing occupational health. Occup Med (Lond) 2024; 74:71-77. [PMID: 37995321 PMCID: PMC10875928 DOI: 10.1093/occmed/kqad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Hospital-based occupational health (HBOH) is uniquely positioned to not only prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, but to care for healthcare workers (HCWs) sick with coronavirus disease 2019 (COVID-19). AIMS The primary objective of this study is to describe a system where HBOH services were adapted to provide a monitoring programme whereby HCWs with SARS-CoV-2 received daily evaluations and treatment options in order to improve access to care, and to report the clinical outcomes and predictors of hospitalization in HCWs enrolled in the programme. A secondary objective is to compare clinical outcomes to data on national HCWs with COVID-19. METHODS This retrospective cohort study used survey data collected on HCWs at a university health system with COVID-19 from 1 March 2020 through 1 December 2021. A firth regression model was used to examine the unadjusted and adjusted association between clinical factors and hospitalization. RESULTS The study cohort included 4814 HCWs with COVID-19. Overall hospitalizations were 119 (2%), and there were six deaths (0.12%). Predictors of hospitalization include several co-morbidities and symptoms. A total of 1835 HCWs monitored before vaccine or monoclonal antibody availability were compared with data on U.S. HCWs in a similar time period. The monitored HCWs had a lower rate of co-morbidities (19% versus 44%, P < 0.001), a lower hospitalization rate (3% versus 8% P < 0.001) and case-fatality rate (0.11% versus 0.95% P < 0.001). CONCLUSIONS This monitoring strategy for COVID-19 may be feasible for HBOH systems to implement and improve access to care, but more data are needed to determine if it improves outcomes.
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Affiliation(s)
- J C Crosby
- Department of Emergency Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - R A Lee
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - G McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - S L Heath
- Department of Emergency Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - G A Burkholder
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - R M Gravett
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - E T Overton
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - G Locks
- UAB Employee Health, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - M E Fleece
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - R Franco
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - S Nafziger
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
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12
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Doheny M, de Leon AP, Burström B, Liljas A, Agerholm J. Differences in Covid-19 mortality among persons 70 years and older in an integrated care setting in region Stockholm: a multi-level analysis between March 2020-February 2021. BMC Public Health 2024; 24:462. [PMID: 38355460 PMCID: PMC10865543 DOI: 10.1186/s12889-024-17904-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND In Norrtälje municipality, within Region Stockholm, there is a joint integrated care organisation providing health and social care, which may have facilitated a more coordinated response to the covid-19 pandemic compared to the otherwise decentralised Swedish system. This study compares the risk of covid-19 mortality among persons 70 years and older, in the municipalities of Stockholm, Södertälje, and Norrtälje, while considering area and individual risk factors. METHODS A population-based study using linked register data to examine covid-19 mortality among those 70 + years (N = 127,575) within the municipalities of interest between the periods March-August 2020 and September 2020-February 2021. The effect of individual and area level variables on covid-19 mortality among inhabitants in 68 catchment areas were examined using multi-level logistic models. RESULTS Individual factors associated with covid-19 mortality were sex, older age, primary education, country of birth and poorer health as indicated by the Charlson Co-morbidity Index. The area-level variables associated were high deprivation (OR: 1.56, CI: 1.18-2.08), population density (OR: 1.14, CI: 1.08-1.21), and usual care. Together, this explained 85.7% of the variation between catchment areas in period 1 and most variation was due to individual risk factors in period 2. Little of the residual variation was attributed to differences between catchment areas. CONCLUSION Integrated care in Norrtälje may have facilitated a more coordinated response during period 1, compared to municipalities with usual care. In the future, integrated care should be considered as an approach to better protect and meet the care needs of older people during emergency situations.
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Affiliation(s)
- Megan Doheny
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Aging Research Center, Tomtebodavägen 18A, plan 9, Stockholm, 171 65, Sweden.
| | - Antonio Ponce de Leon
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ann Liljas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Janne Agerholm
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Aging Research Center, Tomtebodavägen 18A, plan 9, Stockholm, 171 65, Sweden
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13
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Song S, Guo C, Wu R, Zhao H, Li Q, Dou JH, Guo FS, Wei J. Impact of the COVID-19 pandemic on cardiovascular mortality and contrast analysis within subgroups. Front Cardiovasc Med 2024; 11:1279890. [PMID: 38385134 PMCID: PMC10879411 DOI: 10.3389/fcvm.2024.1279890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
Background An increase in deaths has been perceived during the pandemic, which cannot be explained only by COVID-19. The actual number of deaths far exceeds the recorded data on deaths directly related to SARS-CoV-2 infection. Data from early and short-lived pandemic studies show a dramatic shift in cardiovascular mortality. Grounded in the post-pandemic era, macroscopic big data on cardiovascular mortality during the pandemic need to be further reviewed and studied, which is crucial for cardiovascular disease prevention and control. Methods We retrieved and collected data associated with cardiovascular disease mortality from the National Vital Statistic System from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) platform based on the ICD-10 codes. We applied regression analysis to characterize overall cardiovascular disease mortality trends from 2010 to 2023 and built a time series model to predict mortality for 2020-2023 based on mortality data from 2010 to 2019 in order to affirm the existence of the excess deaths by evaluating observed vs. predicted mortality. We also conducted subgroup analyses by sex, age and race/ethnicity for the purpose of obtaining more specific sociodemographic information. Results All-cause age-standardised mortality rates (ASMRs) for CVD dramatically increased between 2019 and 2021[annual percentage change (APC) 11.27%, p < 0.01], and then decreased in the following 2021-2023(APC: -7.0%, p < 0.01). Subgroup analyses found that the ASMR change was most pronounced in Alaska Indians/Native American people (APC: 16.5% in 2019-2021, -12.5% in 2021-2023, both p < 0.01), Hispanics (APC: 12.1% in 2019-2021, -12.2% in 2021-2023, both p < 0.05) and non-Hispanic Black people (APC:11.8% in 2019-2021, -10.3% in 2021-2023, both p < 0.01)whether during the increasing or declining phase. Similarly, the ASMR change was particularly dramatic for the 25-44 age group (APC:19.8% in 2019-2021, -15.4% in 2021-2023, both p < 0.01) and males (APC: 11.5% in 2019-2021, -7.6% in 2021-2023, both p < 0.01). By the end of 2023, the proportion of COVID-related excess death remained high among the elderly (22.4%), males (42.8%) and Alaska Indians/Native American people(39.7%). In addition, we did not find the presence of excess deaths in the young (25-44) and middle-aged cohort (45-64) in 2023, while excess deaths remained persistent in the elderly. Conclusions All-cause ASMRs for CVD increased notably during the initial two years of the COVID-19 pandemic and then witnessed a decline in 2021-2023. The cohorts (the young, males and minorities) with the steepest rise in mortality decreased at the fastest rate instead. Previous initiatives to promote cardiovascular health were effective, but further research on cardiovascular healthcare for the elderly and racial disparities should be attached to priority considering the presence of sociodemographic differences in CVD death.
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Affiliation(s)
| | | | | | | | | | | | | | - Jin Wei
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, China
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14
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Muñoz-Vergara D, Wayne PM, Kim E, Lee IM, Buring JE, Manson JE, Sesso HD. Prepandemic Physical Activity and Risk of COVID-19 Diagnosis and Hospitalization in Older Adults. JAMA Netw Open 2024; 7:e2355808. [PMID: 38349654 PMCID: PMC10865155 DOI: 10.1001/jamanetworkopen.2023.55808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Higher prepandemic physical activity (PA) levels have been associated with lower risk and severity of COVID-19. Objective To investigate the association between self-reported prepandemic PA levels and the risk and severity of COVID-19 in older US adults. Design, Setting, and Participants This cohort study combined cohorts from 3 ongoing prospective randomized clinical trials of US adults aged 45 years or older who provided prepandemic self-reports of baseline leisure-time PA and risk factors for COVID-19 outcomes using the most recent questionnaire completed as of December 31, 2019, as the baseline PA assessment. In multiple surveys from May 2020 through May 2022, participants indicated whether they had at least 1 positive COVID-19 test result or were diagnosed with or hospitalized for COVID-19. Exposure Prepandemic PA, categorized into 3 groups by metabolic equivalent hours per week: inactive (0-3.5), insufficiently active (>3.5 to <7.5), and sufficiently active (≥7.5). Main Outcome and Measures Primary outcomes were risk of COVID-19 and hospitalization for COVID-19. Multivariable logistic regression was used to estimate odd ratios (ORs) and 95% CIs for the association of COVID-19 diagnosis and/or hospitalization with each of the 2 upper PA categories vs the lowest PA category. Results The pooled cohort included 61 557 participants (mean [SD] age, 75.7 [6.4] years; 70.7% female), 20.2% of whom were inactive; 11.4%, insufficiently active; and 68.5%, sufficiently active. A total of 5890 confirmed incident cases of COVID-19 were reported through May 2022, including 626 hospitalizations. After controlling for demographics, body mass index, lifestyle factors, comorbidities, and medications used, compared with inactive individuals, those insufficiently active had no significant reduction in infection (OR, 0.96; 95% CI, 0.86-1.06) or hospitalization (OR, 0.98; 95% CI, 0.76-1.28), whereas those sufficiently active had a significant reduction in infection (OR, 0.90; 95% CI, 0.84-0.97) and hospitalization (OR, 0.73; 95% CI, 0.60-0.90). In subgroup analyses, the association between PA and SARS-CoV-2 infection differed by sex, with only sufficiently active women having decreased odds (OR, 0.87; 95% CI, 0.79-0.95; P = .04 for interaction). Conclusions and Relevance In this cohort study of adults aged 45 years or older, those who adhered to PA guidelines before the pandemic had lower odds of developing or being hospitalized for COVID-19. Thus, higher prepandemic PA levels may be associated with reduced odds of SARS-CoV-2 infection and hospitalization for COVID-19.
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Affiliation(s)
- Dennis Muñoz-Vergara
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eunjung Kim
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Julie E. Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Howard D. Sesso
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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15
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Greißel A, Schneider A, Donnachie E, Gerlach R, Tauscher M, Hapfelmeier A. Impact of pre-existing mental health diagnoses on development of post-COVID and related symptoms: a claims data-based cohort study. Sci Rep 2024; 14:2408. [PMID: 38287108 PMCID: PMC10824734 DOI: 10.1038/s41598-024-52656-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
This study aimed to examine the association of prior mental health diagnoses with the onset of Post-COVID-19 condition (PCC). We conducted a retrospective comparative cohort study and secondary analysis of routinely collected claims data from participants in statutory health insurance in Bavaria, Germany, from January 2015 to June 2022. Study participants were 619,560 patients with confirmed COVID-19, 42,969 with other respiratory tract infection (ORI), and 438,023 controls. Using diagnoses coded according to the German modification of the ICD-10, the associations between prior mental health diagnoses and a PCC diagnosis (primary outcome) or associated symptoms (secondary outcomes) were estimated using multiple Cox proportional hazards regression models. Mental disorders (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.30-1.42), anxiety (HR 1.14, 95% CI 1.07-1.20), depression (HR 1.25, 95% CI 1.19-1.30) and somatoform disorders (HR 1.30, 95% CI 1.24-1.36) were associated with higher risks for PCC. Mental disorders were associated with the same or even greater risk for a diagnosis of malaise and fatigue in the control cohort (HR 1.71, 95% CI 1.52-1.93) and ORI cohort (HR 1.43, 95% CI 1.20-1.72), than in the COVID-19 cohort (HR 1.43, 95% CI 1.35-1.51). In summary, prior mental comorbidity was associated with an increased risk of PCC and its associated symptoms in all cohorts, not specifically in COVID-19 patients.
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Affiliation(s)
- Anna Greißel
- Institute of General Practice and Health Services Research, Department of Clinical Medicine, School of Medicine and Health, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, Department of Clinical Medicine, School of Medicine and Health, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany.
| | - Ewan Donnachie
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Roman Gerlach
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Martin Tauscher
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, Department of Clinical Medicine, School of Medicine and Health, Technical University of Munich, Orleansstraße 47, 81667, Munich, Germany
- Institute of AI and Informatics in Medicine, Department of Clinical Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
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16
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Chen YSE, Gawel SH, Desai P, Rojas J, Barbian HJ, Tippireddy N, Gopinath R, Schneider S, Orzechowski A, Cloherty G, Landay A. COVID-19 waves in an urban setting 2020-2022: an electronic medical record analysis. Front Public Health 2024; 12:1323481. [PMID: 38347927 PMCID: PMC10859858 DOI: 10.3389/fpubh.2024.1323481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
Background Global and national surveillance efforts have tracked COVID-19 incidence and clinical outcomes, but few studies have compared comorbid conditions and clinical outcomes across each wave of the pandemic. We analyzed data from the COVID-19 registry of a large urban healthcare system to determine the associations between presenting comorbidities and clinical outcomes during the pandemic. Methods We analyzed registry data for all inpatients and outpatients with COVID-19 from March 2020 through September 2022 (N = 44,499). Clinical outcomes were death, hospitalization, and intensive care unit (ICU) admission. Demographic and clinical outcomes data were analyzed overall and for each wave. Unadjusted and multivariable logistic regressions were performed to explore the associations between age, sex, race, ethnicity, comorbidities, and mortality. Results Waves 2 and 3 (Alpha and Delta variants) were associated with greater hospitalizations, ICU admissions, and mortality than other variants. Chronic pulmonary disease was the most common comorbid condition across all age groups and waves. Mortality rates were higher in older patients but decreased across all age groups in later waves. In every wave, mortality was associated with renal disease, congestive heart failure, cerebrovascular disease, diabetes, and chronic pulmonary disease. Multivariable analysis found that liver disease and renal disease were significantly associated with mortality, hospitalization, and ICU admission, and diabetes was significantly associated with hospitalization and ICU admission. Conclusion The COVID-19 registry is a valuable resource to identify risk factors for clinical outcomes. Our findings may inform risk stratification and care planning for patients with COVID-19 based on age and comorbid conditions.
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Affiliation(s)
- Yi-shuan Elaine Chen
- Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Susan H. Gawel
- Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Pankaja Desai
- Rush University Medical Center, Chicago, IL, United States
| | - Juan Rojas
- Rush University Medical Center, Chicago, IL, United States
| | | | | | - Rajkamal Gopinath
- Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Sharon Schneider
- Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Anthony Orzechowski
- Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Gavin Cloherty
- Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Alan Landay
- Rush University Medical Center, Chicago, IL, United States
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17
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Jiao L, Bujnowski D, Liu P, Bakota E, Liu L, Ye Y, Dewangan A, Duong CN, Kviten E, Zaheer S, Zangeneh A, Roy R, Floyd J, Monroy J, Wiltz-Beckham D. Asthma and clinical outcomes of COVID-19 in a community setting. Public Health 2024; 226:84-90. [PMID: 38016200 DOI: 10.1016/j.puhe.2023.10.040] [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: 06/07/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES The association between asthma and COVID-19 mortality remains inconclusive. We examined the association between asthma and clinical outcomes of patients with COVID-19. STUDY DESIGN A case-control study based on a surveillance cohort in Harris County, Texas. METHODS Using the data of 21,765 patients who reported having at least one chronic health condition, we investigated the association between asthma and COVID-19 severity, characterized primarily by hospitalization and death. Unconditional logistic regression models were used to estimate the multivariable odds ratio (mOR) and its 95 % confidence interval (CI) of COVID-19 severity associated with asthma and other chronic lung diseases, adjusting for demographic and other comorbidities. A P-value < 0.005 was considered statistically significant after correcting multiple testing. RESULTS In total, 3034 patients (13.9 %) had asthma, and 774 (3.56 %) had other chronic lung diseases. The case death rate among patients with asthma and other chronic lung diseases was 0.75 % and 19.0 %, respectively. Compared to patients without the respective conditions, patients with asthma had lower odds of death (mOR = 0.44, 95 % CI: 0.27-0.69), while patients with other chronic lung diseases had higher odds of hospitalization (mOR = 2.02, 95 % CI: 1.68-2.42) and death (mOR = 1.95, 95 % CI: 1.52-2.49) (P-values < 0.005). Risk factors for COVID-19 mortality included older age, male gender, diabetes, obesity, hypertension, cardiovascular disease, active cancer, and chronic kidney disease. CONCLUSIONS The public health surveillance data suggested that preexisting asthma was inversely associated with COVID-19 mortality.
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Affiliation(s)
- L Jiao
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA.
| | - D Bujnowski
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - P Liu
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - E Bakota
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - L Liu
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - Y Ye
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - A Dewangan
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - C N Duong
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - E Kviten
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - S Zaheer
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - A Zangeneh
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - R Roy
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - J Floyd
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - J Monroy
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - D Wiltz-Beckham
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
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Liana P, Amalia E, Fertilita S, Umar TP. Neutrophil extracellular traps, demographic, clinical, and laboratory parameters in COVID-19 patients: Impact on the severity and outcome during Omicron waves in Indonesia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2024; 25:101494. [DOI: 10.1016/j.cegh.2023.101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
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Månsson Sandberg H, Landstad BJ, Tjulin Å, Brulin E. COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study. BMC PRIMARY CARE 2023; 24:269. [PMID: 38087223 PMCID: PMC10717449 DOI: 10.1186/s12875-023-02228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors. METHODS Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors. RESULTS The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion. CONCLUSIONS COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.
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Affiliation(s)
- Helena Månsson Sandberg
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Bodil J Landstad
- Faculty of Human Sciences, Mid Sweden University, Östersund, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | - Åsa Tjulin
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Emma Brulin
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
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Giardiello D, Melotti R, Barbieri G, Gögele M, Weichenberger CX, Foco L, Bottigliengo D, Barin L, Lundin R, Pramstaller PP, Pattaro C. Determinants of SARS-CoV-2 nasopharyngeal testing in a rural community sample susceptible of first infection: the CHRIS COVID-19 study. Pathog Glob Health 2023; 117:744-753. [PMID: 36992656 PMCID: PMC10614704 DOI: 10.1080/20477724.2023.2191232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
To characterize COVID-19 epidemiology, numerous population-based studies have been undertaken to model the risk of SARS-CoV-2 infection. Less is known about what may drive the probability to undergo testing. Understanding how much testing is driven by contextual or individual conditions is important to delineate the role of individual behavior and to shape public health interventions and resource allocation. In the Val Venosta/Vinschgau district (South Tyrol, Italy), we conducted a population-representative longitudinal study on 697 individuals susceptible to first infection who completed 4,512 repeated online questionnaires at four-week intervals between September 2020 and May 2021. Mixed-effects logistic regression models were fitted to investigate associations of self-reported SARS-CoV-2 testing with individual characteristics (social, demographic, and biological) and contextual determinants. Testing was associated with month of reporting, reflecting the timing of both the pandemic intensity and public health interventions, COVID-19-related symptoms (odds ratio, OR:8.26; 95% confidence interval, CI:6.04-11.31), contacts with infected individuals within home (OR:7.47, 95%CI:3.81-14.62) or outside home (OR:9.87, 95%CI:5.78-16.85), and being retired (OR:0.50, 95%CI:0.34-0.73). Symptoms and next within- and outside-home contacts were the leading determinants of swab testing predisposition in the most acute phase of the pandemics. Testing was not associated with age, sex, education, comorbidities, or lifestyle factors. In the study area, contextual determinants reflecting the course of the pandemic were predominant compared to individual sociodemographic characteristics in explaining the SARS-CoV-2 probability of testing. Decision makers should evaluate whether the intended target groups were correctly prioritized by the testing campaign.
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Affiliation(s)
- Daniele Giardiello
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Roberto Melotti
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Giulia Barbieri
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Martin Gögele
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | | | - Luisa Foco
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Daniele Bottigliengo
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Laura Barin
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Rebecca Lundin
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Peter P. Pramstaller
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
- Department of Neurology, General Central Hospital, Bolzano, Italy
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
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Srichawla BS, Quast J, Pacut P, Sivakumar S, Garcia-Dominguez MA, Belgrad J, Panda A, Carbone S, Sanders DT, Min E, Hayes NT, Bose A, Lee V, Ghasemi M. COVID-19 in the intensive care unit: Unmasking the critical factors impacting patient survival. J Investig Med 2023; 71:907-916. [PMID: 37485922 DOI: 10.1177/10815589231191813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
In the midst of the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world have been pushed to their limits as they grapple with the effects of the severe acute respiratory syndrome coronavirus 2 virus. Identifying prognostic factors that influence mortality in COVID-19 patients admitted to the ICU could offer valuable insights for clinicians seeking to prevent disease progression. A retrospective analysis was conducted on COVID-19 patients admitted to the ICU between January and September 2020. The analysis considered patient demographics, comorbidities, neurological and non-neurological symptoms, as well as laboratory markers. The multivariate logistic regression analysis aims to uncover associations between these factors and patient outcomes. Of the 387 patients included in this study, nearly half (48.5%) of the ICU patients succumbed to COVID-19. Factors that contributed to increased mortality included being 60 years of age or older, impaired consciousness, lung disease, elevated international normalized ratio (INR), and elevated blood urea nitrogen (BUN) levels. Surprisingly, symptoms such as dizziness/lightheadedness, myalgia, and headache were associated with a higher likelihood of survival. In addition, elevated D-dimer and aspartate aminotransferase (AST) levels, as well as lymphopenia, were more commonly observed in deceased patients. The study concluded that those who died in the ICU tended to be older, white, and burdened with more comorbidities and impaired consciousness. With the intriguing link between specific symptoms and survival, further research is essential to uncover the underlying pathophysiological mechanisms that influence ICU patient outcomes in the context of COVID-19.
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Affiliation(s)
| | - Jared Quast
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Peter Pacut
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | - Jillian Belgrad
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ashwin Panda
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sara Carbone
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Delia T Sanders
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Eli Min
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nicole T Hayes
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Abigail Bose
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Vanessa Lee
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mehdi Ghasemi
- University of Massachusetts Chan Medical School, Worcester, MA, USA
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22
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Garber S, Brunner JO, Heller AR, Marckmann G, Bartenschlager CC. Simulation of the mortality after different ex ante (secondary) and ex post (tertiary) triage methods in people with disabilities and pre-existing diseases. DIE ANAESTHESIOLOGIE 2023; 72:10-18. [PMID: 37733034 PMCID: PMC10692011 DOI: 10.1007/s00101-023-01336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/22/2023]
Abstract
The significant increase in patients during the COVID-19 pandemic presented the healthcare system with a variety of challenges. The intensive care unit is one of the areas particularly affected in this context. Only through extensive infection control measures as well as an enormous logistical effort was it possible to treat all patients requiring intensive care in Germany even during peak phases of the pandemic, and to prevent triage even in regions with high patient pressure and simultaneously low capacities. Regarding pandemic preparedness, the German Parliament passed a law on triage that explicitly prohibits ex post (tertiary) triage. In ex post triage, patients who are already being treated are included in the triage decision and treatment capacities are allocated according to the individual likelihood of success. Legal, ethical, and social considerations for triage in pandemics can be found in the literature, but there is no quantitative assessment with respect to different patient groups in the intensive care unit. This study addressed this gap and applied a simulation-based evaluation of ex ante (primary) and ex post triage policies in consideration of survival probabilities, impairments, and pre-existing conditions. The results show that application of ex post triage based on survival probabilities leads to a reduction in mortality in the intensive care unit for all patient groups. In the scenario close to a real-world situation, considering different impaired and prediseased patient groups, a reduction in mortality of approximately 15% was already achieved by applying ex post triage on the first day. This mortality-reducing effect of ex post triage is further enhanced as the number of patients requiring intensive care increases.
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Affiliation(s)
- Sara Garber
- Working Group for Health Care Operations/Health Information Management, Faculty of Business and Economics, Faculty of Medicine, University of Augsburg, Universitätsstr. 16, 86159, Augsburg, Germany
| | - Jens O Brunner
- Working Group for Health Care Operations/Health Information Management, Faculty of Business and Economics, Faculty of Medicine, University of Augsburg, Universitätsstr. 16, 86159, Augsburg, Germany
- Professor of Decision Science in Healthcare, Department of Technology, Management, and Economics, Technical University of Denmark, Lyngby, Denmark
| | - Axel R Heller
- Clinic for Anaesthesiology and Operative Intensive Care, Medical Faculty, University Hospital of Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
| | - Georg Marckmann
- Institute for Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Lessingstr. 2, 80336, Munich, Germany
| | - Christina C Bartenschlager
- Working Group for Health Care Operations/Health Information Management, Faculty of Business and Economics, Faculty of Medicine, University of Augsburg, Universitätsstr. 16, 86159, Augsburg, Germany
- Professor of Applied Data Science in Healthcare, Nürnberg School of Health, Klinikum Nürnberg and Ohm University of Applied Sciences Nuremberg, Keßlerplatz 12, Nuremberg, Germany
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23
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Sidorenkov G, Vonk JM, Grzegorczyk M, Cortés-Ibañez FO, de Bock GH. Factors associated with SARS-COV-2 positive test in Lifelines. PLoS One 2023; 18:e0294556. [PMID: 38019869 PMCID: PMC10686451 DOI: 10.1371/journal.pone.0294556] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) can affect anyone, however, it is often mixed with other respiratory diseases. This study aimed to identify the factors associated with SARS-COV-2 positive test. METHODS Participants from the Northern Netherlands representative of the general population were included if filled in the questionnaire about well-being between June 2020-April 2021 and were tested for SARS-COV-2. The outcome was a self-reported test as measured by polymerase chain reaction. The data were collected on age, sex, household, smoking, alcohol use, physical activity, quality of life, fatigue, symptoms and medications use. Participants were matched on sex, age and the timing of their SARS-COV-2 tests maintaining a 1:4 ratio and classified into those with a positive and negative SARS-COV-2 using logistic regression. The performance of the model was compared with other machine-learning algorithms by the area under the receiving operating curve. RESULTS 2564 (20%) of 12786 participants had a positive SARS-COV-2 test. The factors associated with a higher risk of SARS-COV-2 positive test in multivariate logistic regression were: contact with someone tested positive for SARS-COV-2, ≥1 household members, typical SARS-COV-2 symptoms, male gender and fatigue. The factors associated with a lower risk of SARS-COV-2 positive test were higher quality of life, inhaler use, runny nose, lower back pain, diarrhea, pain when breathing, sore throat, pain in neck, shoulder or arm, numbness or tingling, and stomach pain. The performance of the logistic models was comparable with that of random forest, support vector machine and gradient boosting machine. CONCLUSIONS Having a contact with someone tested positive for SARS-COV-2 and living in a household with someone else are the most important factors related to a positive SARS-COV-2 test. The loss of smell or taste is the most prominent symptom associated with a positive test. Symptoms like runny nose, pain when breathing, sore throat are more likely to be indicative of other conditions.
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Affiliation(s)
- Grigory Sidorenkov
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith M. Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco Grzegorczyk
- Computer Science and Artificial Intelligence, University of Groningen—Bernoulli Institute for Mathematics, Groningen, Netherlands
| | - Francisco O. Cortés-Ibañez
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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24
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Finnerty JP, Hussain ABMA, Ponnuswamy A, Kamil HG, Abdelaziz A. Asthma and COPD as co-morbidities in patients hospitalised with Covid-19 disease: a global systematic review and meta-analysis. BMC Pulm Med 2023; 23:462. [PMID: 37993829 PMCID: PMC10664669 DOI: 10.1186/s12890-023-02761-5] [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: 04/14/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Factors predisposing to increased mortality with COVID-19 infection have been identified as male sex, hypertension, obesity, and increasing age. Early studies looking at airway diseases gave some contradictory results. The purpose of our study was to determine global variation in studies in patients hospitalized with COVID-19 in the prevalence of COPD and asthma; and to determine whether the presence of asthma or COPD affected mortality in the same hospital population. METHODS A systematic review and meta-analysis of the published literature of COPD and asthma as co-morbidities in patients hospitalized with COVID-19 was performed, looking firstly at the prevalence of these diseases in patients hospitalized with COVID-19, and secondly at the relative risk of death from any cause for patients with asthma or COPD. RESULTS Prevalence of both airway diseases varied markedly by region, making meaningful pooled global estimates of prevalence invalid and not of clinical utility. For individual studies, the interquartile range for asthma prevalence was 4.21 to 12.39%, and for COPD, 3.82 to 11.85%. The relative risk of death with COPD for patients hospitalized with COVID-19 was 1.863 (95% CI 1.640-2.115), while the risk with asthma was 0.918 (95% CI 0.767 to 1.098) with no evidence of increased mortality. CONCLUSIONS For asthma and COPD, prevalence in patients hospitalized with COVID-19 varies markedly by region. We found no evidence that asthma predisposed to increased mortality in COVID-19 disease. For COPD, there was clear evidence of an association with increased mortality. TRIAL REGISTRATION The trial was registered with PROSPERO: registration number CRD42021289886.
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Affiliation(s)
- James Patrick Finnerty
- Countess of Chester Hospital NHS Trust, Chester, UK.
- Department of Respiratory Medicine, Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK.
| | - A B M Arad Hussain
- Alexandra Hospital, Worcestershire Acute Hospital NHS Trust, Worcester, UK
| | - Aravind Ponnuswamy
- Countess of Chester Hospital NHS Trust, Chester, UK
- University of Chester, Chester, UK
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Liu XQ, Lu GZ, Yin DL, Kang YY, Zhou YY, Wang YH, Xu J. Analysis of clinical characteristics and risk factors between elderly patients with severe and nonsevere Omicron variant infection. World J Clin Infect Dis 2023; 13:37-48. [DOI: 10.5495/wjcid.v13.i4.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to millions of confirmed cases and deaths worldwide. Elderly patients are at high risk of developing and dying from COVID-19 due to advanced age, decreased immune function, intense inflammatory response, and comorbidities. Shanghai has experienced a wave of infection with Omicron, a new variant of SARS-CoV-2, since March 2022. There is a pressing need to identify clinical features and risk factors for disease progression among elderly patients with Omicron infection to provide solid evidence for clinical policy-makers, public health officials, researchers, and the general public.
AIM To investigate clinical characteristic differences and risk factors between elderly patients with severe and nonsevere Omicron SARS-CoV-2 variant infection.
METHODS A total of 328 elderly patients with COVID-19 admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2022 to June 2022 were enrolled and divided into a severe group (82 patients) and a nonsevere group (246 patients) according to the diagnosis and treatment protocol of COVID-19 (version 7). The clinical data and laboratory results of both groups were collected and compared. A chi-square test, t test, Mann-Whitney U test, hierarchical log-rank test, univariate and multivariate logistic regression, and hierarchical analyses were used to determine significant differences.
RESULTS The severe group was older (84 vs 74 years, P < 0.001), included more males (57.3% vs 43.9%, P = 0.037), had a lower vaccination rate (P < 0.001), and had a higher proportion of comorbidities, including chronic respiratory disease (P = 0.001), cerebral infarction (P < 0.001), chronic kidney disease (P = 0.002), and neurodegenerative disease (P < 0.001), than the nonsevere group. In addition, severe disease patients had a higher inflammatory index (P < 0.001), greater need for symptomatic treatment (P < 0.001), longer hospital stay (P = 0.011), extended viral shedding time (P = 0.014), and higher mortality than nonsevere disease patients (P < 0.001). No difference was observed in the application of Paxlovid in the severe and nonsevere groups (P = 0.817). Oxygen saturation, cerebral infarction, and D-dimer were predictive factors for developing severe disease in patients with COVID-19, with D-dimer having an excellent role (area under the curve: 90.1%, 95%CI: 86.1-94.0%). In addition, D-dimer was a risk factor for developing severe COVID-19 according to multivariate stratified analysis.
CONCLUSION The clinical course of severe COVID-19 is complex, with a higher need for symptomatic treatment. D-dimer is a suitable biomarker for identifying patients at risk for developing severe COVID-19.
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Affiliation(s)
- Xiao-Qin Liu
- Department of Infectious Disease, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Guan-Zhu Lu
- Department of Infectious Disease, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Dong-Lin Yin
- Department of Infectious Disease, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yao-Yue Kang
- Department of Infectious Disease, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yuan-Yuan Zhou
- Department of Infectious Disease, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yu-Huan Wang
- Department of Infectious Disease, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jie Xu
- Department of Infectious Disease, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Yun J, Kang B, Lee JR, Lee H, Lee JY. Prevalence and severity of COVID-19 among children and adolescents with autism spectrum disorders in the Republic of Korea. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2397-2406. [PMID: 36935608 PMCID: PMC10030889 DOI: 10.1177/13623613231160631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
LAY ABSTRACT It is more difficult to prevent coronavirus disease 2019 in children and adolescents with autism spectrum disorder, as they have trouble communicating and adjusting to their new daily lives like wearing masks and social distancing. However, there have not been many studies that focused on coronavirus disease 2019 among children and adolescents with autism spectrum disorder. We included all Korean citizens under the age of 19 as our study subjects. Among them, we found out the prevalence, severity, and case fatality of coronavirus disease 2019 in children and adolescents with and without autism spectrum disorder. The prevalence of coronavirus disease 2019 among children and adolescents with autism spectrum disorder was lower than that of those without autism spectrum disorder. For severity, children and adolescents with autism spectrum disorder were more likely to enter severe stages of disease and had higher hospitalization rates than those without autism spectrum disorder. There were no deaths among children and adolescents with autism spectrum disorder, while a few died among children and adolescents without autism spectrum disorder. However, due to the small number of deaths, it was difficult to determine whether there was a link between autism spectrum disorder and coronavirus disease 2019 deaths. We found that the appropriate quarantine policies have played a great role in sustaining overall low prevalence and higher hospitalization rates among children and adolescents with autism spectrum disorder than those without autism spectrum disorder. Furthermore, because Korea has fewer schools and facilities (i.e. personal care, social training, and skilled nursing facility) for children and adolescents with autism spectrum disorder than other countries, those with autism spectrum disorder have fewer social contacts than even before the COVID-19 pandemic.
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Affiliation(s)
- Jieun Yun
- Cheongju University, Republic of Korea
| | - Beomjun Kang
- Seoul National University College of Medicine, Republic of Korea
| | - Jae-ryun Lee
- Seoul National University Bundang Hospital, Republic of Korea
| | - Hyejin Lee
- Seoul National University College of Medicine, Republic of Korea
- Seoul National University Bundang Hospital, Republic of Korea
| | - Jin Yong Lee
- Seoul National University College of Medicine, Republic of Korea
- Seoul National University Hospital, Republic of Korea
- Health Insurance Review and Assessment Service (HIRA), Republic of Korea
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27
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Kananen L, Molnár C, Ansker F, Kozlowska DJ, Hägg S, Jylhävä J, Religa D, Raaschou P. Anticoagulant treatment and COVID-19 mortality among older adults living in nursing homes in Sweden. Health Sci Rep 2023; 6:e1692. [PMID: 38028709 PMCID: PMC10644256 DOI: 10.1002/hsr2.1692] [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] [Received: 09/08/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Anticoagulants (AC) were introduced in March 2020 as standard of care in nursing home (NH) residents affected with COVID-19 in the Stockholm region, Sweden. ACs are proven to reduce the risk of complications and mortality from COVID-19 among patients of other ages and settings, but there is limited scientific evidence underpinning this practice in the NH setting. Methods This matched cohort study included 182 NH residents in the Stockholm Region diagnosed with COVID-19 in March-May 2020. The main exposure was any AC treatment. Exposed (n = 91), 49% prevalent (pre-COVID-19 diagnosis) AC and 51% incident AC were compared with unexposed controls (n = 91). The outcome was 28-days all-cause mortality after COVID-19 infection. The mortality odds ratios (OR) were assessed using logistic regression, adjusted for age, sex, multimorbidity, and mobility, also stratified by incident or prevalent AC-type, age group, and sex. Results Of the 182 individuals diagnosed with COVID-19 (median age 88 years, 68% women), 39% died within 28 days after diagnosis. Use of either incident or prevalent AC was associated with a reduced, adjusted 28-day mortality (OR[95% CI]: 0.31[0.16-0.62]). In stratified analyses, the association was significant in both age groups: 70-89 (OR: 0.37 [0.15-0.89]) and 90-99 years of age (OR: 0.22 [0.07-0.65]. In sex-stratified analysis, the AC-lowering effect was significant in women only (OR: 0.28[0.11-0.67]). In the analyses stratified by AC type, the mortality-lowering effect was observed for both prevalent AC (OR: 0.35[0.12-0.99]) and incident AC (OR: 0.29[0.11-0.76]). Conclusions Both prevalent and incident use of ACs in prophylactic dosing was associated with reduced 28-day mortality among older individuals with COVID-19 in a NH setting. The effect was seen across age-strata and in women. The findings present new insight in best practice for individuals diagnosed with COVID-19 in the NH setting.
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Affiliation(s)
- Laura Kananen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
- Faculty of Social Sciences (Health Sciences), and Gerontology Research CenterTampere UniversityTampereFinland
- Faculty of Medicine and Health Technology, and Gerontology Research CenterTampere UniversityTampereFinland
| | - Christian Molnár
- Department of Neurobiology, Care Sciences and Society (NVS)Karolinska InstitutetStockholmSweden
- Familjeläkarna SÄBOFamiljeläkarna i SaltsjöbadenStockholmSweden
| | - Fredrik Ansker
- Familjeläkarna SÄBOFamiljeläkarna i SaltsjöbadenStockholmSweden
| | | | - Sara Hägg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
- Faculty of Social Sciences (Health Sciences), and Gerontology Research CenterTampere UniversityTampereFinland
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society (NVS)Karolinska InstitutetStockholmSweden
| | - Pauline Raaschou
- Department of Medicine Solna, Clinical Epidemiology Section & Clinical Pharmacology UnitKarolinska InstitutetSolnaStockholmSweden
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Assaf S, Stenberg H, Jesenak M, Tarasevych SP, Hanania NA, Diamant Z. Asthma in the era of COVID-19. Respir Med 2023; 218:107373. [PMID: 37567514 DOI: 10.1016/j.rmed.2023.107373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
Since its global invasion in 2019, COVID-19 has affected several aspects of patients' lives and posed a significant impact on the health care system. Several patient populations were identified to be at high risk of contracting SARS-CoV-2 infection and/or developing severe COVID-19-related sequelae. Conversely, anyone who has contracted SARS-CoV-2 is at risk to experience symptoms and signs consistent with post-COVID manifestations. Patients with asthma were initially thought to be at increased risk and severity for SARS-CoV-2 infection. However, accumulating evidence demonstrates that asthma endotypes/phenotypes and comorbidities influence the risk stratification in this population. Furthermore, initial concerns about the potentially increased risk of poor outcomes with asthma treatments such as inhaled corticosteroids and biologics have not been substantiated. In this review, we provide an update on COVID-19 and asthma, including risk of susceptibility, clinical manifestations and course in this population as well as discuss recommendations for management.
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Affiliation(s)
- Sara Assaf
- Section of Pulmonary and Critical Care Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Henning Stenberg
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Milos Jesenak
- Departments of Pulmonology and Phthisiology and Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovak Republic
| | | | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zuzana Diamant
- Dept of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Belgium; Dept of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Dept Clin Pharm & Pharmacol, Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands.
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Wijkström J, Caldinelli A, Bruchfeld A, Nowak A, Artborg A, Stendahl M, Segelmark M, Lindholm B, Bellocco R, Rydell H, Evans M. Results of the first nationwide cohort study of outcomes in dialysis and kidney transplant patients before and after vaccination for COVID-19. Nephrol Dial Transplant 2023; 38:2607-2616. [PMID: 37433606 PMCID: PMC10615630 DOI: 10.1093/ndt/gfad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Patients on kidney replacement therapy (KRT) have been identified as a vulnerable group during the coronavirus disease 2019 (COVID-19) pandemic. This study reports the outcomes of COVID-19 in KRT patients in Sweden, a country where patients on KRT were prioritized early in the vaccination campaign. METHODS Patients on KRT between January 2019 and December 2021 in the Swedish Renal Registry were included. Data were linked to national healthcare registries. The primary outcome was monthly all-cause mortality over 3 years of follow-up. The secondary outcomes were monthly COVID-19-related deaths and hospitalizations. The results were compared with the general population using standardized mortality ratios. The difference in risk for COVID-19-related outcomes between dialysis and kidney transplant recipients (KTRs) was assessed in multivariable logistic regression models before and after vaccinations started. RESULTS On 1 January 2020, there were 4097 patients on dialysis (median age 70 years) and 5905 KTRs (median age 58 years). Between March 2020 and February 2021, mean all-cause mortality rates increased by 10% (from 720 to 804 deaths) and 22% (from 158 to 206 deaths) in dialysis and KTRs, respectively, compared with the same period in 2019. After vaccinations started, all-cause mortality rates during the third wave (April 2021) returned to pre-COVID-19 mortality rates among dialysis patients, while mortality rates remained increased among transplant recipients. Dialysis patients had a higher risk for COVID-19 hospitalizations and death before vaccinations started {adjusted odds ratio [aOR] 2.1 [95% confidence interval (CI) 1.7-2.5]} but a lower risk after vaccination [aOR 0.5 (95% CI 0.4-0.7)] compared with KTRs. CONCLUSIONS The COVID-19 pandemic in Sweden resulted in increased mortality and hospitalization rates among KRT patients. After vaccinations started, a distinct reduction in hospitalization and mortality rates was observed among dialysis patients, but not in KTRs. Early and prioritized vaccinations of KRT patients in Sweden probably saved many lives.
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Affiliation(s)
- Julia Wijkström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Aurora Caldinelli
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- University of Milano-Bicocca, Department of Statistics and Quantitative Methods, Milano, Italy
| | - Annette Bruchfeld
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Alexandra Nowak
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica Artborg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Stendahl
- Department of Internal Medicine, Ryhov Hospital, Jönköping, Sweden
- Swedish Renal Register, Jönköping, Sweden
| | - Mårten Segelmark
- Swedish Renal Register, Jönköping, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skane University Hospital, Lund, Sweden
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Rino Bellocco
- University of Milano-Bicocca, Department of Statistics and Quantitative Methods, Milano, Italy
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helena Rydell
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Renal Register, Jönköping, Sweden
| | - Marie Evans
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Renal Register, Jönköping, Sweden
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Kuper H, Smythe T. Are people with disabilities at higher risk of COVID-19-related mortality?: a systematic review and meta-analysis. Public Health 2023; 222:115-124. [PMID: 37541064 PMCID: PMC10308224 DOI: 10.1016/j.puhe.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/08/2023] [Accepted: 06/23/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES To undertake a systematic review and meta-analysis to estimate the relative risk of COVID-19-related mortality among people with disabilities compared to people without disabilities. STUDY DESIGN Systematic review and meta-analysis. METHODS We systematically searched four databases from March 1, 2020, to August 15, 2022. We included prospective studies with a baseline assessment of disability and a longitudinal assessment of the COVID-19-related mortality. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. We undertook random-effects meta-analyses to calculate pooled adjusted hazard ratios for COVID-19-related mortality for people with disabilities, also disaggregated by disability type and study setting. RESULTS We identified 2596 articles throughout the electronic data search, and 56 studies were included in the review. Most (73%) had a moderate risk of bias. The pooled adjusted effect estimate for COVID-19-related mortality in people with disabilities compared to those without was 2.7 (95% confidence interval [CI]: 2.4-3.2). Heterogeneity between the studies was high (τ2 = 0.28, I2 = 97%). Effect estimates were highest for population-based samples (3.3, 95% CI: 2.7-3.9), compared to hospital settings (2.1, 95% CI: 1.7-2.7). Risk was not elevated among people with disabilities in care home settings (1.6, 95% CI: 0.7-3.5). Disaggregation by disability type showed that people with intellectual disabilities were at the highest relative risk of COVID-19 mortality. DISCUSSION Risk of COVID-19 mortality is elevated among people with disabilities, especially people with intellectual disabilities. Efforts are needed to collect better routine data on disability and to include people with disabilities in the pandemic response for COVID-19.
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Affiliation(s)
- H Kuper
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - T Smythe
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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31
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da Silva MVG, Pereira LRG, de Avó LRDS, Germano CMR, Melo DG. Enhancing understanding of SARS-CoV-2 infection among individuals with Down syndrome: An integrative review. SAO PAULO MED J 2023; 142:e2023015. [PMID: 37610949 PMCID: PMC10445757 DOI: 10.1590/1516-3180.2023.0015.r1.230523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/14/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Down syndrome (DS) is a non-rare genetic condition that affects approximately 1 in every 800 live births worldwide. Further, it is associated with comorbidities, anatomical alterations of the respiratory tract, and immunological dysfunctions that make individuals more susceptible to respiratory infections. OBJECTIVE To systematize the current scientific knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among individuals with DS. DESIGN AND SETTING This integrative review was conducted at the Universidade Federal de São Carlos, São Paulo, Brazil. METHODS This review was conducted in the following databases: the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), PubMed, and Web of Science, using MeSH descriptors. The search included English or Portuguese studies published between January 1, 2020, and October 14, 2022. RESULTS A total of 55 articles from 24 countries were selected, comprising 21 case-control or cohort studies, 23 case reports or series, and 11 narrative reviews or opinion studies. The articles were grouped into five categories: previous comorbidities, coronavirus disease 2019 (COVID-19) clinical features and evolution, cytokine storm and interleukins, living in institutions as a risk factor, and behavioral actions as a protective factor against SARS-CoV-2 infection. CONCLUSION Individuals with DS are more susceptible to COVID-19 infection due to variables such as previous comorbidities, immunological factors, and their habitable environments. These aspects confer a higher risk of infection and an unfavorable clinical course. The precise pathways involved in the pathophysiology of COVID-19 in individuals with DS are not clear, thus requiring further studies. SYSTEMATIC REVIEW REGISTRATION The Open Science Framework registered the research protocol (https://osf.io/jyb97/).
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Affiliation(s)
- Maria Vitoria Gomes da Silva
- Medical Undergraduate Student, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | | | - Lucimar Retto da Silva de Avó
- MD, PhD. Associate Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Carla Maria Ramos Germano
- MD, PhD. Associate Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Débora Gusmão Melo
- MD, PhD. Full Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
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Alhmoud E, Barazi R, Saad M, Al Khiyami D, El Ajez R, Bakdach D, Omrani A, Ibrahim W, El Anany R, Al-Hail M. Characteristics and outcomes of adult patients with asthma presenting with COVID-19: A comparative cohort study. Qatar Med J 2023; 2023:15. [PMID: 37565045 PMCID: PMC10411356 DOI: 10.5339/qmj.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/10/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Bronchial asthma affects about 20% of Qatar's population. The impact of asthma on COVID-19 outcomes is controversial. The aim of this study was to explore the impact of asthma on COVID-19 outcomes and the predictors of COVID-19-related morbidity and mortality in a cohort of asthma patients infected by COVID-19. METHODS This is a retrospective cohort study of adult patients with asthma infected with COVID-19, who were recruited from Hamad Medical Corporation (HMC), the main healthcare system in Qatar. Patients were matched to a control group of non-asthmatic COVID-19 patients (1:2) based on sex, age, and other comorbidities. RESULTS Between March and August 2020, 616 patients with asthma met the inclusion criteria. The need for hospitalization among patients with asthma was independently associated with older age (adjusted odds ratio [aOR] for 10 years, 1.32; 95% confidence interval [CI], 1.13-1.54; p = 0.001) and hypertension (aOR, 2.4; 95% CI, 1.43-3.93; p = 0.001) but not with the use of inhaled corticosteroids (ICS), long-acting beta2 agonists, montelukast, or tiotropium. Patients with asthma required less hospitalization for COVID-19 than non-asthmatic patients (28.2% vs. 37.3%, respectively; aOR, 0.59; 95% CI, 0.77-0.90; p < 0.001). However, admission to the intensive care unit (ICU) was comparable between both groups (3.3% vs. 2.2%; aOR, 1.64; 95% CI, 0.78-3.43; p = 0.193). No difference in mortality rate was observed between the two groups. CONCLUSIONS In Qatar, adult patients with asthma do not appear to be at higher risk of COVID-19-related hospitalization or ICU admission compared to the general adult COVID-19-infected population. Older age and hypertension were the only significant predictors of COVID-19-related hospitalization among patients with asthma. Further larger studies are required to confirm such an association.
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Affiliation(s)
- Eman Alhmoud
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: 0000-0002-3871-7088
| | - Raja Barazi
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: 0000-0002-3871-7088
| | - Mohammed Saad
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: 0000-0002-3871-7088
| | - Dania Al Khiyami
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: 0000-0002-3871-7088
| | - Reem El Ajez
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: 0000-0002-3871-7088
| | - Dana Bakdach
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: 0000-0002-3871-7088
| | - Ali Omrani
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Wanis Ibrahim
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine - Qatar (WCM-Q), Qatar
| | - Rasha El Anany
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: 0000-0002-3871-7088
| | - Moza Al-Hail
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: 0000-0002-3871-7088
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Garber S, Brunner JO, Heller AR, Marckmann G, Bartenschlager CC. [Simulation of mortality after different ex-ante and ex-post-triage methods in people with disabilities and comorbidities]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01302-3. [PMID: 37358616 PMCID: PMC10400691 DOI: 10.1007/s00101-023-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 06/27/2023]
Abstract
The significant increase in patients during the COVID-19 pandemic presented the healthcare system with a variety of challenges. The intensive care unit is one of the areas particularly affected in this context. Only through extensive infection control measures as well as an enormous logistical effort was it possible to treat all patients requiring intensive care in Germany even during peak phases of the pandemic, and to prevent triage even in regions with high patient pressure and simultaneously low capacities. Regarding pandemic preparedness, the German Parliament passed a law on triage that explicitly prohibits ex post (tertiary) triage. In ex post triage, patients who are already being treated are included in the triage decision and treatment capacities are allocated according to the individual likelihood of success. Legal, ethical, and social considerations for triage in pandemics can be found in the literature, but there is no quantitative assessment with respect to different patient groups in the intensive care unit. This study addressed this gap and applied a simulation-based evaluation of ex ante (primary) and ex post triage policies in consideration of survival probabilities, impairments, and pre-existing conditions. The results show that application of ex post triage based on survival probabilities leads to a reduction in mortality in the intensive care unit for all patient groups. In the scenario close to a real-world situation, considering different impaired and prediseased patient groups, a reduction in mortality of approximately 15% was already achieved by applying ex post triage on the first day. This mortality-reducing effect of ex post triage is further enhanced as the number of patients requiring intensive care increases.
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Affiliation(s)
- Sara Garber
- Lehrstuhl für Health Care Operations/Health Information Management, Wirtschaftswissenschaftliche und Medizinische Fakultät, Universität Augsburg, Universitätsstr. 16, 86159, Augsburg, Deutschland
| | - Jens O Brunner
- Lehrstuhl für Health Care Operations/Health Information Management, Wirtschaftswissenschaftliche und Medizinische Fakultät, Universität Augsburg, Universitätsstr. 16, 86159, Augsburg, Deutschland
- Professor of Decision Science in Healthcare, Department of Technology, Management, and Economics, Technical University of Denmark, Lyngby, Dänemark
| | - Axel R Heller
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät, Universitätsklinikum Augsburg, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, Lessingstr. 2, 80336, München, Deutschland
| | - Christina C Bartenschlager
- Lehrstuhl für Health Care Operations/Health Information Management, Wirtschaftswissenschaftliche und Medizinische Fakultät, Universität Augsburg, Universitätsstr. 16, 86159, Augsburg, Deutschland
- Professur für Angewandte Datenwissenschaften im Gesundheitswesen, Nürnberg School of Health, Technische Hochschule Nürnberg Georg Simon Ohm, Klinikum Nürnberg, Nürnberg, Deutschland
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Zajic P, Hiesmayr M, Bauer P, Baron DM, Gruber A, Joannidis M, Posch M, Metnitz PGH. Nationwide analysis of hospital admissions and outcomes of patients with SARS-CoV-2 infection in Austria in 2020 and 2021. Sci Rep 2023; 13:8548. [PMID: 37236991 DOI: 10.1038/s41598-023-35349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
This retrospective study evaluated temporal and regional trends of patient admissions to hospitals, intensive care units (ICU), and intermediate care units (IMCU) as well as outcomes during the COVID-19 pandemic in Austria. We analysed anonymous data from patients admitted to Austrian hospitals with COVID-19 between January 1st, 2020 and December 31st, 2021. We performed descriptive analyses and logistic regression analyses for in-hospital mortality, IMCU or ICU admission, and in-hospital mortality following ICU admission. 68,193 patients were included, 8304 (12.3%) were primarily admitted to ICU, 3592 (5.3%) to IMCU. Hospital mortality was 17.3%; risk factors were male sex (OR 1.67, 95% CI 1.60-1.75, p < 0.001) and high age (OR 7.86, 95% CI 7.07-8.74, p < 0.001 for 90+ vs. 60-64 years). Mortality was higher in the first half of 2020 (OR 1.15, 95% CI 1.04-1.27, p = 0.01) and the second half of 2021 (OR 1.11, 95% CI 1.05-1.17, p < 0.001) compared to the second half of 2020 and differed regionally. ICU or IMCU admission was most likely between 55 and 74 years, and less likely in younger and older age groups. We find mortality in Austrian COVID-19-patients to be almost linearly associated with age, ICU admission to be less likely in older individuals, and outcomes to differ between regions and over time.
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Affiliation(s)
- Paul Zajic
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Michael Hiesmayr
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Peter Bauer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - David M Baron
- Department of Anaesthesiology, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Anastasiia Gruber
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Posch
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Philipp G H Metnitz
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Summanen M, Kosunen M, Kainu V, Cansel A, Niskanen S, Nurmi L, Leskelä RL, Isomeri O. COVID-19 hospitalisations and all-cause mortality by risk group in Finland. PLoS One 2023; 18:e0286142. [PMID: 37220129 DOI: 10.1371/journal.pone.0286142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
Ever since COVID-19 was announced as a global pandemic in March 2020, healthcare systems around the world have struggled with the burden of the disease. Vaccinations and other preventive measures have decreased this burden, but severe forms of COVID-19 leading to hospitalizations and even deaths still effect certain risk groups, such as the elderly and patients with multiple comorbidities. The objective of this retrospective observational study was to identify which risk groups are at the highest risk for a severe COVID-19 infection in Finland using national registry data ranging from January 2021 to June 2022. The data was analysed in three time periods, enabling comparisons in high-risk groups between epidemiological waves caused by different variants of SARS-CoV-2. The summary level data were stratified according to predefined groups based on two criteria: age (≥18 years, 18-59 years, and ≥60 years) and risk group. The results include analysis of infection hospitalisation rate (IHR), case fatality rate (CFR) and average length of stay (LOS) in both primary and specialty care for each risk group and age group. Our results confirm that despite the decrease in COVID-19 hospitalisations and deaths observed during the study period, a significant proportion of patients are still hospitalised, and deaths occur especially in the 60+ population. Also, even though the average length of stay of hospitalised COVID-19 patients has decreased, it is still long compared to specialty care hospitalisations in general. Old age is a significant risk factor for severe COVID-19 in all patient groups and certain risk factors such as chronic kidney disease clearly increase the risk for severe COVID-19 outcomes. Early treatment should be considered with a low threshold for risk group patients and for elderly patients in order to avoid severe disease courses, and to ease the burden on hospitals where resources are currently very strained.
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Affiliation(s)
| | - Mikko Kosunen
- Pfizer Biopharma Group, Pfizer Oy, Helsinki, Finland
| | - Ville Kainu
- Pfizer Biopharma Group, Pfizer Oy, Helsinki, Finland
| | | | | | - Lalli Nurmi
- NHG Finland, Nordic Healthcare Group, Helsinki, Finland
| | | | - Outi Isomeri
- NHG Finland, Nordic Healthcare Group, Helsinki, Finland
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Vikström L, Fjällström P, Gwon YD, Sheward DJ, Wigren-Byström J, Evander M, Bladh O, Widerström M, Molnar C, Rasmussen G, Bennet L, Åberg M, Björk J, Tevell S, Thålin C, Blom K, Klingström J, Murrell B, Ahlm C, Normark J, Johansson AF, Forsell MNE. Vaccine-induced correlate of protection against fatal COVID-19 in older and frail adults during waves of neutralization-resistant variants of concern: an observational study. THE LANCET REGIONAL HEALTH. EUROPE 2023:100646. [PMID: 37363799 PMCID: PMC10163377 DOI: 10.1016/j.lanepe.2023.100646] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
Background To inform future preventive measures including repeated vaccinations, we have searched for a clinically useful immune correlate of protection against fatal COVID-19 among nursing homes residents. Methods We performed repeated capillary blood sampling with analysis of S-binding IgG in an open cohort of nursing home residents in Sweden. We analyzed immunological and registry data from 16 September 2021 to 31 August 2022 with follow-up of deaths to 30 September 2022. The study period included implementation of the 3rd and 4th mRNA monovalent vaccine doses and Omicron virus waves. Findings A total of 3012 nursing home residents with median age 86 were enrolled. The 3rd mRNA dose elicited a 99-fold relative increase of S-binding IgG in blood and corresponding increase of neutralizing antibodies. The 4th mRNA vaccine dose boosted levels 3.8-fold. Half-life of S-binding IgG was 72 days. A total 528 residents acquired their first SARS-CoV-2 infection after the 3rd or the 4th vaccine dose and the associated 30-day mortality was 9.1%. We found no indication that levels of vaccine-induced antibodies protected against infection with Omicron VOCs. In contrast, the risk of death was inversely correlated to levels of S-directed IgG below the 20th percentile. The death risk plateaued at population average above the lower 35th percentile of S-binding IgG. Interpretation In the absence of neutralizing antibodies that protect from infection, quantification of S-binding IgG post vaccination may be useful to identify the most vulnerable for fatal COVID-19 among the oldest and frailest. This information is of importance for future strategies to protect vulnerable populations against neutralization resistant variants of concern. Funding Swedish Research Council, SciLifeLab via Knut and Alice Wallenberg Foundation, VINNOVA. Swedish Healthcare Regions, and Erling Persson Foundation.
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Affiliation(s)
- Linnea Vikström
- The Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Peter Fjällström
- The Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Yong-Dae Gwon
- The Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Daniel J Sheward
- The Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solna, Sweden
| | | | - Magnus Evander
- The Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Oscar Bladh
- The Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Micael Widerström
- The Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | | | | | - Louise Bennet
- Department of Clinical Sciences, Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mikael Åberg
- The Department of Medical Sciences, Clinical Chemistry and SciLifeLab, Uppsala University, Uppsala, Sweden
| | - Jonas Björk
- The Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Staffan Tevell
- Faculty of Medicine and Health, The Department of Infectious Diseases, Karlstad Hospital and Centre for Clinical Research and Education, Region Värmland, Örebro University, Örebro, Sweden
| | - Charlotte Thålin
- The Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Kim Blom
- The Swedish Public Health Agency, Stockholm, Sweden
| | - Jonas Klingström
- The Department of Biomedical Clinical Sciences, Linköpings University, Linköping, Sweden
| | - Ben Murrell
- The Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solna, Sweden
| | - Clas Ahlm
- The Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Johan Normark
- The Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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Kirui BK, Santosa A, Vanfleteren LE, Li H, Franzén S, Stridsman C, Nyberg F. Pre- and post-vaccination characteristics and risk factors for COVID-19 outcomes in a Swedish population-based cohort of COPD patients. ERJ Open Res 2023; 9:00711-2022. [PMID: 37377661 PMCID: PMC10291311 DOI: 10.1183/23120541.00711-2022] [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: 12/14/2022] [Accepted: 05/09/2023] [Indexed: 06/29/2023] Open
Abstract
Rationale Evidence on risk factors for Coronavirus disease 2019 (COVID-19) outcomes among patients with COPD in relation to COVID-19 vaccination remains limited. The objectives of the present study were to characterise determinants of COVID-19 infection, hospitalisation, intensive care unit (ICU) admission and death in COPD patients in their unvaccinated state compared to when vaccinated. Methods We included all COPD patients in the Swedish National Airway Register (SNAR). Events of COVID-19 infection (test and/or healthcare encounter), hospitalisation, ICU admission and death were identified from 1 January 2020 to 30 November 2021. Using adjusted Cox regression, associations between baseline sociodemographics, comorbidities, treatments, clinical measurements and COVID-19 outcomes, during unvaccinated and vaccinated follow-up time, were analysed. Results The population-based COPD cohort included 87 472 patients, among whom 6771 (7.7%) COVID-19 infections, 2897 (3.3%) hospitalisations, 233 (0.3%) ICU admissions and 882 (1.0%) COVID-19 deaths occurred. During unvaccinated follow-up, risk of COVID-19 hospitalisation and death increased with age, male sex, lower education, non-married status and being foreign-born. Comorbidities increased risk of several outcomes, e.g. respiratory failure for infection and hospitalisation (adjusted hazard ratios (HR) 1.78, 95% CI 1.58-2.02 and 2.51, 2.16-2.91, respectively), obesity for ICU admission (3.52, 2.29-5.40) and cardiovascular disease for mortality (2.80, 2.16-3.64). Inhaled COPD therapy was associated with infection, hospitalisation and death. COPD severity was also associated with COVID-19, especially hospitalisation and death. Although the risk factor panorama was similar, COVID-19 vaccination attenuated HRs for some risk factors. Conclusion This study provides population-based evidence on predictive risk factors for COVID-19 outcomes and highlights the positive implications of COVID-19 vaccination for COPD patients.
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Affiliation(s)
- Brian K. Kirui
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lowie E.G.W. Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ritsinger V, Bodegård J, Kristofi R, Thuresson M, Nathanson D, Nyström T, Eriksson J, Norhammar A. History of heart failure and chronic kidney disease and risk of all-cause death after COVID-19 during the first three waves of the pandemic in comparison with influenza outbreaks in Sweden: a registry-based, retrospective, case-control study. BMJ Open 2023; 13:e069037. [PMID: 37117003 PMCID: PMC10151240 DOI: 10.1136/bmjopen-2022-069037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES To explore how cardiorenal disease (CRD; heart failure and/or chronic kidney disease) impacted mortality in men and women hospitalised for COVID-19 during the first three waves of the pandemic in Sweden in comparison to previous influenza outbreaks. DESIGN A registry-based, retrospective, case-control study. SETTING Hospital care in Sweden. PARTICIPANTS All patients in Sweden with a main hospital diagnosis of COVID-19 (January 2020-September 2021) or influenza (January 2015-December 2019) with previous CRD were identified in registries and compared with a reference group free from CRD but with COVID-19 or influenza. PRIMARY OUTCOME MEASURE Associated risk of all-cause death during the first year was analysed using adjusted Cox proportional hazards models. RESULTS In COVID-19 patients with and without prior history of CRD (n=44 866), mean age was 79.8 years (SD 11.8) and 43% were women. In influenza patients (n=8897), mean age was 80.6 years (SD 11.5) and 45% were women. COVID-19 versus influenza was associated with higher mortality risk during the first two COVID-19 waves (HR 1.53; 95% CI 1.45 to 1.62, p<0.001 and HR 1.52; 95% CI 1.44 to 1.61, p<0.001), but not in the third wave (HR 1.07; 95% CI 0.99 to 1.14, p=0.072). CRD was an independent risk factor for all-cause death after COVID-19 in men and women (men: 1.37; 95% CI 1.31 to 1.44, p<0.001; women: 1.46; 95% CI 1.38 to 1.54, p<0.001). At ages <70 years, women with CRD had a similar mortality rate to men with CRD, while at ages ≥70 years, the mortality rate was higher in men. CONCLUSIONS Outcome after COVID-19 is worse if CRD is present. In women at ages <70 years, the presence of CRD attenuates the protective effect of female sex. COVID-19 was associated with higher mortality risk than influenza during the first two pandemic waves.
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Affiliation(s)
- Viveca Ritsinger
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
- Department of Research and Development, Region Kronoberg, Vaxjo, Sweden
| | - Johan Bodegård
- Cardiovascular, Renal and Metabolism, Medical Department, BioPharmaceuticals, AstraZeneca Nordic, Oslo, Norway
| | - Robin Kristofi
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | | | - David Nathanson
- Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
| | - Jan Eriksson
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
- Capio S:t Göran Hospital, Stockholm, Sweden
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Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0876. [PMID: 36890875 PMCID: PMC9988289 DOI: 10.1097/cce.0000000000000876] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support. DATA SOURCES A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. STUDY SELECTION Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. DATA EXTRACTION Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. DATA SYNTHESIS One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; p = 0.003) decreased from 2020 to 2021. CONCLUSIONS We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.
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Christiansen SC, Lopes Veronez C, Smith TD, Riedl MA, Zuraw BL. Hereditary Angioedema: Impact of COVID-19 pandemic stress upon disease related morbidity and well-being. Allergy Asthma Proc 2023; 44:115-121. [PMID: 36872446 PMCID: PMC9999437 DOI: 10.2500/aap.2023.44.220096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background: Individuals with hereditary angioedema (HAE) experience stress-related sequelae, including enhanced disease morbidity and reduced quality of life. The pervasive societal strain that surround the coronavirus disease 2019 (COVID-19) pandemic may theoretically pose a disproportionate risk for patients with HAE. Objective: To dissect the interrelationship(s) among the COVID-19 pandemic, stress, and HAE disease-related morbidity and overall well-being. Methods: Subjects with HAE (either due to C1-inhibitor deficiency or with normal C1 inhibitor) as well as non-HAE household members (normal controls) completed online questionnaires that covered the impact of the COVID-19 pandemic on attack frequency, observed effectiveness of HAE medications, stress, and perceived quality of life and/or well-being. The subjects scored each of the questions to reflect their current status as well as their status before being aware of the pandemic. Results: Disease morbidity and psychologic stress outcomes were significantly worse in patients with HAE during the pandemic compared with before they were aware of the pandemic. A COVID-19 infection further increased attack frequency. Control subjects also experienced deterioration of well-being and optimism. A comorbid diagnosis of anxiety, depression, or posttraumatic stress disorder (PTSD) was generally associated with worse outcomes. Women consistently showed greater decrements in wellness during the pandemic compared with men. Women also reported higher levels of comorbid anxiety, depression, or PTSD than men and experienced a higher rate of job loss during the pandemic. Conclusion: The results implicated a deleterious impact of stress in the aftermath of COVID-19 awareness on HAE morbidity. The female subjects were universally more severely affected then were the male subjects. Overall well-being and/or quality of life, and optimism for the future deteriorated after awareness of the COVID-19 pandemic for the subjects with HAE and non-HAE household controls.
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Affiliation(s)
- Sandra C Christiansen
- From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, California, and
| | - Camila Lopes Veronez
- From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, California, and
| | - Tukisa D Smith
- From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, California, and
| | - Marc A Riedl
- From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, California, and
| | - Bruce L Zuraw
- From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, California, and
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Nwaru C, Li H, Bonander C, Santosa A, Franzén S, Rosvall M, Nyberg F. Occupational role and COVID-19 among foreign-born healthcare workers in Sweden: a registry-based study. Eur J Public Health 2023; 33:202-208. [PMID: 36762873 PMCID: PMC10066486 DOI: 10.1093/eurpub/ckad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Many studies report that foreign-born healthcare workers (HCWs) in high-income countries have an elevated risk of COVID-19. However, research has not yet specifically evaluated the distribution of COVID-19 among foreign-born workers in different healthcare work groups. We examined the risk of COVID-19 infection and hospitalization among foreign-born HCWs in different occupational roles in Sweden. METHODS We linked occupational data (2019) of 783 950 employed foreign-born workers (20-65 years) to COVID-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the hazard ratio (HR) with 95% confidence intervals (95% CIs) of COVID-19 infection and hospitalization in eight healthcare occupational groups vs. non-HCWs and assessed whether region of birth modified the association between healthcare occupations and COVID-19. RESULTS All HCWs had a higher risk of COVID-19 outcomes than non-HCWs, but the risk differed by occupational role. Hospital-based assistant nurses had the highest risk (infection: HR 1.78; 95% CI 1.72-1.85; hospitalization: HR 1.79; 95% CI 1.52-2.11); allied HCWs had the lowest risk (infection: HR 1.22; 95% CI 1.10-1.35; hospitalization: HR 0.98; 95% CI 0.59-1.63). The relative hazard of the outcomes varied across foreign-born workers from different regions. For example, the relative risk of COVID-19 infection associated with being a physician compared to a non-HCW was 31% higher for African-born than European-born workers. CONCLUSIONS The risk of COVID-19 among foreign-born HCWs differed by occupational role and immigrant background. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help reduce COVID-19 risk among foreign-born HCWs.
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Affiliation(s)
- Chioma Nwaru
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Rosvall
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Social Medicine, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Alissa DA, Aburas W, Almasuood R, Almudaiheem HY, Al Aseri Z, Alrabiah F, Ezzat H, Moulana AA, Alawi MM, Al-Mutairy E, Alaama T, Alamri MS, Bamousa MS, Alshehri AA, Alosaimi MH, Alali A, Nori R, Devol EB, Mohamed G, Al-Jedai AH. Prevalence and epidemiological trends in mortality due to COVID-19 in Saudi Arabia. Public Health 2023; 215:31-38. [PMID: 36634404 DOI: 10.1016/j.puhe.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This article describes the prevalence and epidemiological trends of COVID-19 mortality in the largest registry in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN A prospective epidemiological cohort study using data from all healthcare facilities in KSA collected between March 23, 2020, and April 30, 2022. Data on the number of daily deaths directly related to COVID-19 were gathered, analyzed, and reported. METHOD Data analysis was carried out using national and regional crude case fatality rate and death per 100,000 population. Descriptive statistics using numbers and proportions were used to describe age, gender, nationality, and comorbidities. The mortality trend was plotted and compared with international figures. In addition, the most common comorbidities associated with mortality and the proportion of patients who received COVID-19 vaccine were reported. RESULTS The total reported number of deaths between March 23, 2020, and April 30, 2022, was 9085. Crude case fatality rate was 1.21%, and death per 100,000 population was 25.38, which compared favorably to figures reported by several developed countries. The highest percentages of deaths were among individuals aged between 60 and 69 years, males (71%), and individuals with diabetes (60%). Only 2.8% of mortalities occur in patients who received COVID-19 vaccine. Diabetes, hypertension, and heart failure had the highest attributable risk of mortality among patients who died due to COVID-19. CONCLUSION Case fatality rate and death per 100,000 population in KSA are among the lowest in the world due to multiple factors. Several comorbidities have been identified, namely, diabetes, hypertension, obesity, and cardiac arrhythmias.
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Affiliation(s)
- D A Alissa
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - W Aburas
- University of Hail, College of Pharmacy, Hail, Saudi Arabia
| | - R Almasuood
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - H Y Almudaiheem
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - Z Al Aseri
- Department of Emergency Medicine and Critical Care, King Saud University, Riyadh, Saudi Arabia; Adult Critical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - F Alrabiah
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - H Ezzat
- Hematology Programs, Ministry of Health, Saudi Arabia; John Hopkins Aramco Healthcare, Dharan, Saudi Arabia; University of British Columbia, Canada
| | - A A Moulana
- Forensic Medicine Center, Makkah Al Mukarramah, Saudi Arabia
| | - M M Alawi
- Infection Control & Environmental Health Unit, Department of Medical Microbiology & Parasitology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - E Al-Mutairy
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - T Alaama
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - M S Alamri
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - M S Bamousa
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Forensic Medicine General Directorate, Ministry of Health, Riyadh, Saudi Arabia
| | - A A Alshehri
- Forensic Medicine Center, Ministry of Health, Riyadh, Saudi Arabia
| | - M H Alosaimi
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Mortality Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - A Alali
- Internal Medicine and Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - R Nori
- Internal Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - E B Devol
- Department of Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - G Mohamed
- Department of Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A H Al-Jedai
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia.
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Martín-Conty JL, Polonio-López B, Sanz-García A, del Pozo Vegas C, Mordillo-Mateos L, Bernal-Jiménez JJ, Conty-Serrano R, Castro Villamor MA, López-Izquierdo R, Martín-Rodríguez F. COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study. Front Public Health 2023; 10:1076627. [PMID: 36703850 PMCID: PMC9871910 DOI: 10.3389/fpubh.2022.1076627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction COVID-19 has initially been studied in terms of an acute-phase disease, although recently more attention has been given to the long-term consequences. In this study, we examined COVID-19 as an independent risk factor for long-term mortality in patients with acute illness treated by EMS (emergency medical services) who have previously had the disease against those who have not had the disease. Methods A prospective, multicenter, ambulance-based, ongoing study was performed with adult patients with acute disease managed by EMS and transferred with high priority to the emergency department (ED) as study subjects. The study involved six advanced life support units, 38 basic life support units, and five emergency departments from Spain. Sociodemographic inputs, baseline vital signs, pre-hospital blood tests, and comorbidities, including COVID-19, were collected. The main outcome was long-term mortality, which was classified into 1-year all-cause mortality and 1-year in- and out-of-hospital mortality. To compare both the patients with COVID-19 vs. patients without COVID-19 and to compare survival vs non-survival, two main statistical analyses were performed, namely, a longitudinal analysis (Cox regression) and a logistic regression analysis. Results Between 12 March 2020 and 30 September 2021, a total of 3,107 patients were included in the study, with 2,594 patients without COVID-19 and 513 patients previously suffering from COVID-19. The mortality rate was higher in patients with COVID-19 than in patients without COVID-19 (31.8 vs. 17.9%). A logistic regression showed that patients previously diagnosed with COVID-19 presented higher rates of nursing home residency, a higher number of breaths per minute, and suffering from connective disease, dementia, and congestive heart failure. The longitudinal analysis showed that COVID-19 was a risk factor for mortality [hazard ratio 1.33 (1.10-1.61); p < 0.001]. Conclusion The COVID-19 group presented an almost double mortality rate compared with the non-COVID-19 group. The final model adjusted for confusion factors suggested that COVID-19 was a risk factor for long-term mortality.
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Affiliation(s)
- José L. Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,*Correspondence: Ancor Sanz-García ✉
| | - Carlos del Pozo Vegas
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
| | | | | | - Miguel A. Castro Villamor
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Raúl López-Izquierdo
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Hernández-Morales MDR, Maldonado-Castañeda S, Mancilla-Hernández E, Amaro-Zarate I, Aguirre-Barbosa M, Nazarala-Sanchez S. [Frequency of clinical characteristics and factors associated with mortality in patients hospitalized for COVID-19 in Puebla, Mexico]. REVISTA ALERGIA MÉXICO 2023; 69:67-71. [PMID: 36928246 DOI: 10.29262/ram.v69i2.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/28/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Mexico has a very high mortality rate from COVID19, risk factors, clinical manifestations of our population are unknown. OBJECTIVE To know risk factors for mortality from COVID19 in hospitalized patients of the Secretary of Health (SSA) Puebla, and clinical characteristics. MATERIAL AND METHODS Case-control, observational, retrospective, cross-sectional study in COVID-19 patients. 2 groups: COVID-19 patients who died and those who did not die. RESULTS 502 patients, 314 men (62.5% CI95% 58-66%), 188 women (37.5% CI95% 33-42%), mean age 54.14 +13.8, interquartile range (IQR) 45-63, age interval 19 and 90 years, hospital stay (DEIH) 1-43 days, mean 9.8+7.8 days, median 8, IQR 4-13 days. Symptoms associated with mortality: dyspnea, chest pain, MR>1. Variables associated with mortality: age = or > 65 years, greater IHD, having > 2 comorbidities (OR 1.453), diabetes (OR 1.759), hypertension (OR 6.29) and chronic kidney failure (CRF) (OR 3.16) , (p<0.05). Ferritin >500ng/ml (OR 5.1799), DHL >400 IU/L (OR 3.313) and D-dimer >2000 m/ml (OR 2.868). CONCLUSIONS Age > or = 65 years, greater IHD, > 2 comorbidities, diabetes, hypertension or CRF, increased ferritin, D-dimer or DHL, are risk factors for mortality from COVID-19.
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Affiliation(s)
| | | | | | - Irving Amaro-Zarate
- Hospital General de Huejotzingo, Secretaria de Salud del Estado de Puebla, México
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Leung C, Su L, Simões-E-Silva AC, Arocha LS, de Paiva KM, Haas P. Risk for Severe Illness and Death among Pediatric Patients with Down Syndrome Hospitalized for COVID-19, Brazil. Emerg Infect Dis 2023; 29:26-35. [PMID: 36573520 PMCID: PMC9796221 DOI: 10.3201/eid2901.220530] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Down syndrome is the most common human chromosomal disorder. Whether Down syndrome is a risk factor for severe COVID-19 outcomes in pediatric patients remains unclear, especially in low-to-middle income countries. We gathered data on patients <18 years of age with SARS-CoV-2 infection from a national registry in Brazil to assess the risk for severe outcomes among patients with Down syndrome. We included data from 14,684 hospitalized patients, 261 of whom had Down syndrome. After adjustments for sociodemographic and medical factors, patients with Down syndrome had 1.8 times higher odds of dying from COVID-19 (odds ratio 1.82, 95% CI 1.22-2.68) and 27% longer recovery times (hazard ratio 0.73, 95% CI 0.61-0.86) than patients without Down syndrome. We found Down syndrome was associated with increased risk for severe illness and death among COVID-19 patients. Guidelines for managing COVID-19 among pediatric patients with Down syndrome could improve outcomes for this population.
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Trevisan C, Tonarelli F, Zucchelli A, Parrotta I, Calvani R, Malara A, Monzani F, Gareri P, Zia G, Antonelli Incalzi R. Health trajectories in older patients hospitalized for COVID-19: Results from the GeroCovid multicenter study. Respir Med 2023; 206:107088. [PMID: 36549026 PMCID: PMC9733961 DOI: 10.1016/j.rmed.2022.107088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND COVID-19 has disproportionately affected older adults. Yet, healthcare trajectories experienced by older persons hospitalized for COVID-19 have not been investigated. This study aimed at estimating the probabilities of transitions between severity states in older adults admitted in COVID-19 acute wards and at identifying the factors associated with such dynamics. METHODS COVID-19 patients aged ≥60 years hospitalized between March and December 2020 were involved in the multicentre GeroCovid project-acute wards substudy. Sociodemographic and health data were obtained from medical records. Clinical states during hospitalization were categorized on a seven-category scale, ranging from hospital discharge to death. Based on the transitions between these states, first, we defined patients' clinical course as positive (only improvements), negative (only worsening), or fluctuating (both improvements and worsening). Second, we focused on the single transitions between clinical states and estimated their probability (through multistage Markov modeling) and associated factors (with proportional intensity models). RESULTS Of the 1024 included patients (mean age 78.1 years, 51.1% women), 637 (62.2%) had a positive, 66 (6.4%) had a fluctuating, and 321 (31.3%) had a negative clinical course. Patients with a fluctuating clinical course were younger, had better mobility and cognitive levels, fewer diseases, but a higher prevalence of cardiovascular disease and obesity. Considering the single transitions, the probability that older COVID-19 patients experienced clinical changes was higher within a 10-day timeframe, especially for milder clinical states. Older age, male sex, lower mobility level, multimorbidity, and hospitalization during the COVID-19 first wave (compared with the second one) were associated with an increased probability of progressing towards worse clinical states or with a lower recovery. CONCLUSION COVID-19 in older inpatients has a complex and dynamic clinical course. Identifying individuals more likely to experience a fluctuating clinical course and sudden worsening may help organize healthcare resources and clinical management across settings at different care intensity levels.
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Affiliation(s)
- Caterina Trevisan
- Department of Medical Science, University of Ferrara, Ferrara, Italy,Geriatrics Division, Department of Medicine (DIMED), University of Padua, Italy
| | - Francesco Tonarelli
- Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Ilaria Parrotta
- Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001, Leuven, Belgium,Corresponding author
| | - Riccardo Calvani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alba Malara
- Presidente Fondazione ANASTE-HUMANITAS, Responsabile Scientifico European Confederation of Care-Home Organisations (E.C.H.O.), Associazione Nazionale Strutture Territoriali (ANASTE) Calabria A full list of the working group members is provided in Supplementary material – Appendix 1, Italy
| | - Fabio Monzani
- Scuola di Specializzazione in Geriatria e Gerontologia Università di Pisa UOC Geriatria, Universitaria Azienda Ospedaliero-Universitaria Pisana, Italy
| | | | | | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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Patients with type 1 and type 2 diabetes hospitalized with COVID-19 in comparison with influenza: mortality and cardiorenal complications assessed by nationwide Swedish registry data. Cardiovasc Diabetol 2022; 21:282. [PMID: 36522650 PMCID: PMC9753889 DOI: 10.1186/s12933-022-01719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The risk of severe coronavirus disease 2019 (COVID-19) is increased in people with diabetes, but effects of diabetes type and other risk factors remain incompletely characterized. We studied this in a Swedish cohort of hospitalized patients with type 1 and type 2 diabetes (T1D and T2D), also including comparisons with influenza epidemics of recent years. METHODS Nationwide healthcare registries were used to identify patients. A total of 11,005 adult patients with diabetes (T1D, n = 373; T2D, n = 10,632) were hospitalized due to COVID-19 from January 1, 2020 to September 1, 2021. Moreover, 5111 patients with diabetes (304 T1D, 4807 T2D) were hospitalized due to influenza from January 1, 2015 to December 31, 2019. Main outcomes were death within 28 days after admission and new hospitalizations for heart failure (HF), chronic kidney disease (CKD), cardiorenal disease (CRD; composite of HF and CKD), myocardial infarction (MI) and stroke during 1 year of follow-up. RESULTS Number of deaths and CRD events were 2025 and 442 with COVID-19 and 259 and 525 with influenza, respectively. Age- and sex-adjusted Cox regression models in COVID-19 showed higher risk of death and HF in T1D vs. T2D, hazard ratio (HR) 1.77 (95% confidence interval 1.41-2.22) and 2.57 (1.31-5.05). With influenza, T1D was associated with higher risk of death compared with T2D, HR 1.80 (1.26-2.57). Older age and previous CRD were associated with higher risks of death and hospitalization for CRD. After adjustment for prior comorbidities, mortality differences were still significant, but there were no significant differences in cardiovascular and renal outcomes. COVID-19 relative to influenza was associated with higher risk of death in both T1D and T2D, HR 2.44 (1.60-3.72) and 2.81 (2.59-3.06), respectively. CONCLUSIONS In Sweden, patients with T1D as compared to T2D had a higher age- and sex-adjusted risk of death within 28 days and HF within one year after COVID-19 hospitalization, whereas the risks of other non-fatal cardiovascular and renal disease events were similar. Patients with T1D as well as T2D have a greater mortality rate when hospitalized due to COVID-19 compared to influenza, underscoring the importance of vaccination and other preventive measures against COVID-19 for diabetes patients.
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48
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Kananen L, Eriksdotter M, Boström A, Kivipelto M, Annetorp M, Metzner C, Bäck Jerlardtz V, Engström M, Johnson P, Lundberg L, Åkesson E, Sühl Öberg C, Hägg S, Religa D, Jylhävä J, Cederholm T. Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19. Clin Nutr 2022; 41:2973-2979. [PMID: 34389208 PMCID: PMC8318666 DOI: 10.1016/j.clnu.2021.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. METHODS We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020-January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. RESULTS After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17-4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0-7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16-3.68) and other causes (OR = 6.01; CI = 2.73-15.91). CONCLUSIONS Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.
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Affiliation(s)
- L. Kananen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Faculty of Social Sciences (Health Sciences), Gerontology Research Center, Tampere University, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Corresponding author. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M. Eriksdotter
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - A.M. Boström
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - M. Kivipelto
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - M. Annetorp
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - C. Metzner
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - V. Bäck Jerlardtz
- Department of Geriatric Medicine, Jakobsbergsgeriatriken, Stockholm, Sweden
| | - M. Engström
- Department of Geriatric Medicine, Sabbatsbergsgeriatriken, Stockholm, Sweden
| | - P. Johnson
- Department of Geriatric Medicine, Capio Geriatrik Nacka AB, Nacka, Sweden
| | - L.G. Lundberg
- Department of Geriatric Medicine, Dalengeriatriken Aleris Närsjukvård AB, Stockholm, Sweden
| | - E. Åkesson
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - C. Sühl Öberg
- Department of Geriatric Medicine, Handengeriatriken, Aleris Närsjukvård AB, Stockholm, Sweden
| | - S. Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - D. Religa
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - J. Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Faculty of Social Sciences (Health Sciences), Gerontology Research Center, Tampere University, Tampere, Finland
| | - T. Cederholm
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Kim S, Willis E, Wehlage S, Scheffer-Wentz H, Dulitz M. COVID-19 vaccine hesitancy and short-term and long-term intentions among unvaccinated young adults: a mixed-method approach. BMC Public Health 2022; 22:2030. [PMCID: PMC9638285 DOI: 10.1186/s12889-022-14448-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Background Only 63.8% of Americans who are 18-to-24-years-old have been fully vaccinated for COVID-19 as of June 1, 2022. The Grand Forks County, North Dakota is facing a similar challenge. As of June 2022, 47% of individuals in the 19-to-29-year-old age group are vaccinated. Focusing on unvaccinated individuals in their 20s, Study 1 aims to understand the ways in which receiving COVID-19 vaccines is construed using qualitative interviews; and Study 2 compares the predictors of short-term vaccination intention (i.e., next month) with those of long-term vaccination intention (i.e., three to 5 years) using an online survey. Methods For Study 1, we conducted five focus groups and four in-depth interviews via Zoom with a total of 26 unvaccinated individuals in their 20s living in the Grand Forks County. Constant comparison process was used to categorize data into themes and to recognize characteristics of the identified themes. The aim was to develop themes and associated characteristics. For Study 2, we conducted an online survey with a convenience sample of 526 unvaccinated individuals. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between attitudes, perceptions, and beliefs in misinformation and short-term and long-term vaccination intentions, accounting for demographics and socioeconomic status. Results In Study 1, two themes were identified: feelings of uncertainty sparked by profits and monetization and navigating the fear of the unknown. In Study 2, an increase in the confidence of COVID-19 vaccines showed significantly higher odds of short-term intention (OR = 2.658, 95%CI 1.770, 3.990) and long-term intention (OR = 1.568, 95% CI 1.105, 2.226). Believing in misinformation had significantly lower odds of short-term intention (OR = 0.712, 95%CI 0.513, 0.990), while more positive attitudes (OR = 1.439, 95% CI 1.024, 2.024), stronger preference in calculating the benefits of COVID-19 vaccines (OR = 2.108, 95% CI 1.541, 2.882), and greater perceived susceptibility (OR = 1.471, 95% CI 1.045, 2.070) to and severity of contracting COVID-19 (OR = 1.362, 95% CI 1.020, 1.820) were significantly associated with higher odds of long-term intention. Conclusions Short-term and long-term intentions were predicted differently. Instilling strong confidence in COVID-19 vaccines should increase both short-term and long-term intentions.
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Affiliation(s)
- Soojung Kim
- grid.266862.e0000 0004 1936 8163Department of Communication, University of North Dakota, O’Kelly Hall Room 214, 221 Centennial Dr. Stop 7169, Grand Forks, ND 58202-7169 USA
| | - Erin Willis
- grid.266190.a0000000096214564Advertising, Public Relations & Media Design, University of Colorado Boulder, Boulder, CO 80309 USA
| | - Shane Wehlage
- grid.266862.e0000 0004 1936 8163Department of Communication, University of North Dakota, O’Kelly Hall Room 214, 221 Centennial Dr. Stop 7169, Grand Forks, ND 58202-7169 USA
| | - Hannah Scheffer-Wentz
- grid.266862.e0000 0004 1936 8163Department of Communication, University of North Dakota, O’Kelly Hall Room 214, 221 Centennial Dr. Stop 7169, Grand Forks, ND 58202-7169 USA
| | - Michael Dulitz
- Opioid Response Project Coordinator and COVID-19 Data and Analytics Leader, Grand Forks Public Health, 151 S 4th Street Suite N301, Grand Forks, ND 58201 USA
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50
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Kreger JE, Hershenson MB. Effects of COVID-19 and Social Distancing on Rhinovirus Infections and Asthma Exacerbations. Viruses 2022; 14:2340. [PMID: 36366439 PMCID: PMC9698629 DOI: 10.3390/v14112340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 02/01/2023] Open
Abstract
Since their discovery in the 1950s, rhinoviruses (RVs) have been recognized as a major causative agent of the "common cold" and cold-like illnesses, accounting for more than 50% of upper respiratory tract infections. However, more than that, respiratory viral infections are responsible for approximately 50% of asthma exacerbations in adults and 80% in children. In addition to causing exacerbations of asthma, COPD and other chronic lung diseases, RVs have also been implicated in the pathogenesis of lower respiratory tract infections including bronchiolitis and community acquired pneumonia. Finally, early life respiratory viral infections with RV have been associated with asthma development in children. Due to the vast genetic diversity of RVs (approximately 160 known serotypes), recurrent infection is common. RV infections are generally acquired in the community with transmission occurring via inhalation of aerosols, respiratory droplets or fomites. Following the outbreak of coronavirus disease 2019 (COVID-19), exposure to RV and other respiratory viruses was significantly reduced due to social-distancing, restrictions on social gatherings, and increased hygiene protocols. In the present review, we summarize the impact of COVID-19 preventative measures on the incidence of RV infection and its sequelae.
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Affiliation(s)
| | - Marc B. Hershenson
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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