Ethnic disparities in hospitalisation for COVID-19 in England: The role of socioeconomic factors, mental health, and inflammatory and pro-inflammatory factors in a community-based cohort study

The Social, Demographic, and Clinical Predictors of COVID-19 Severity: a Model-based Analysis of United States Veterans

PURPOSE

This study aims to identify the contributions of individual and community social determinants of health (SDOH), demographic, and clinical factors in COVID-19 disease severity through a model-based analysis.

METHODS

This national cross-sectional study focused on hospitalization among those tested for COVID-19 and use of intensive care, analyzing data on 220,848 Veterans tested between February 20, 2020 and October 20, 2021. Multiple logistic regression models were constructed using backwards elimination. The predictive value of each model was assessed with a c-statistic.

RESULTS

Those hospitalized were older, more likely to be male, of Black or Asian race, have an income less than $39,999, live in an urban residence, and have medical comorbidities. The strongest predictors for hospitalization included Gini inequality index, race, income, heart failure, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). For intensive care, Asian race, rural residence, COPD, and CKD were the strongest predictors. C-statistics were c = 0.749 for hospitalization and c = 0.582 for ICU admission.

CONCLUSIONS

A combination of clinical, demographic, individual and community SDOH factors predict COVID-19 hospitalization with good predictive ability and can inform risk stratification, discharge planning, and public health interventions. Racial disparities were not explained by social or clinical factors. Intensive care models had low discriminative power and may be better explained by other characteristics.

Clinical Characteristics, Prognostic Factors, and Outcomes of COVID-19 in Autoimmune Rheumatic Disease Patients: A Retrospective Case-Control Study from Astana, Kazakhstan

Background: Viral infections, including coronavirus disease 2019 (COVID-19), in patients with autoimmune rheumatic diseases (AIRDs) tend to present more severe disease. This study aims to investigate the clinical characteristics and risk factors for severe infection in rheumatologic patients. Methods: We included patients with a diagnosis of AIRD and COVID-19 infection between January 2022 and July 2023. Patients with AIRDs infected with SARS-CoV-2 were matched with control patients of the general population according to age (±5 years) and sex in a 1:1 ratio. Confirmed infection was defined if a patient had a positive polymerase chain reaction (PCR) test. The severity was divided into mild, moderate, severe, and critical according to the guidelines of the United States National Institutes of Health (NIH). Results: A total of 140 individuals (37 males, 103 females; mean age 56.1 ± 11.3 years) with rheumatic disease diagnosed with COVID-19 infection were enrolled in the study. AIRDs included rheumatoid arthritis (RA) (n = 63, 45%), ankylosing spondylitis (AS) (n = 35, 25%), systemic lupus erythematosus (SLE) (n = 26, 8.6%), and systemic sclerosis (SSc) (n = 16, 11.4%). The AIRDs group had more SARS-CoV-2-related dyspnea (38.6%), arthralgia (45.7%), and depression (27.1%) than the control group (p = 0.004). The rate of lung infiltration on radiographic examination was higher in 58 (41.4%, p = 0.005) patients with rheumatic diseases than in those without them. Severe SARS-CoV-2 infection was more common in the AIRDs group than in the control group (22% vs. 12%; p = 0.043). Conclusions: Patients with AIRDs experienced more symptoms of arthralgia, depression, and dyspnea. There was a trend towards an increased severity of the disease in patients with AIRDs. Patients with arterial hypertension, diabetes, chronic lung, and kidney disease, treated with corticosteroids, had a longer duration, and high activity of autoimmune disease had an increased risk of severe COVID-19.

Application of information from external data to correct for collider bias in a Covid-19 hospitalised cohort

BACKGROUND

Throughout the Covid-19 pandemic, researchers have made use of electronic health records to research this disease in a rapidly evolving environment of questions and discoveries. These studies are prone to collider bias as they restrict the population of Covid-19 patients to only those with severe disease. Inverse probability weighting is typically used to correct for this bias but requires information from the unrestricted population. Using electronic health records from a South London NHS trust, this work demonstrates a method to correct for collider bias using externally sourced data while examining the relationship between minority ethnicities and poor Covid-19 outcomes.

METHODS

The probability of inclusion within the observed hospitalised cohort was modelled based on estimates from published national data. The model described the relationship between patient ethnicity, hospitalisation, and death due to Covid-19 - a relationship suggested to be susceptible to collider bias. The obtained probabilities (as applied to the observed patient cohort) were used as inverse probability weights in survival analysis examining ethnicity (and covariates) as a risk factor for death due to Covid-19.

RESULTS

Within the observed cohort, unweighted analysis of survival suggested a reduced risk of death in those of Black ethnicity - differing from the published literature. Applying inverse probability weights to this analysis amended this aberrant result to one more compatible with the literature. This effect was consistent when the analysis was applied to patients within only the first wave of Covid-19 and across two waves of Covid-19 and was robust against adjustments to the modelled relationship between hospitalisation, patient ethnicity, and death due to Covid-19 made as part of a sensitivity analysis.

CONCLUSIONS

In conclusion, this analysis demonstrates the feasibility of using external publications to correct for collider bias (or other forms of selection bias) induced by the restriction of a population to a hospitalised cohort using an example from the recent Covid-19 pandemic.

Barriers and Concerns that Contribute to Vaccine Hesitancy in Black, Indigenous, and People of Colour (BIPOC) Individuals in Ontario, Canada

BACKGROUND

Despite research demonstrating the effectiveness of COVID-19 vaccines, hesitancy is extremely common in minority communities. The purpose of this study was to identify key barriers and concerns that contribute to vaccine hesitancy in Black, Indigenous, and People of Colour (BIPOC) individuals and provide recommendations to address these barriers and concerns.

METHODS

The study was an online cross-sectional survey conducted among 1491 BIPOC and Caucasian adults, recruited using social media networks in August-September 2021. The questionnaire consisted of five sections that probed concerns and attitudes contributing to COVID-19 vaccine hesitancy.

RESULTS

Respondents were mostly Caucasian males (75.7%) and the average age was 29.1 years. A higher proportion of BIPOC respondents received both doses (50.6%) than Caucasian respondents (36.4%). Out of the unvaccinated, a higher percentage of BIPOC respondents did not plan on getting vaccinated (17.1%) compared to Caucasian respondents (4.2%). BIPOC respondents preferred the Pfizer-BioNTech (34.1%) vaccine whereas Caucasian respondents preferred AstraZeneca (29.3%). The biggest concern BIPOC and Caucasian respondents had with COVID-19 vaccines were side effects (56.6% vs 54.4%, respectively). BIPOC respondents identified dependability as the next biggest concern after side effects. A higher percentage of BIPOC respondents were against getting vaccinated against COVID-19 (16% vs 1.2%) compared to Caucasian respondents.

CONCLUSION

Among unvaccinated respondents, COVID-19 vaccine hesitancy was most evident in the BIPOC respondents compared to Caucasian respondents. Side effects, trustworthiness, and lack of information were identified as the three most common concerns surrounding vaccines in general. Increased accessibility to reliable and accurate vaccine information in various languages/dialects can raise awareness about COVID-19 vaccinations in BIPOC communities.

Predictors of mortality among inpatients in COVID-19 treatment centers in the city of Butembo, North Kivu, Democratic Republic of Congo

Determining the risk factors for severe disease and death among hospitalized Covid-19 patients is critical to optimize health outcomes and health services efficiency, especially in resource-constrained and humanitarian settings. This study aimed to identify the predictors of mortality of Covid-19 patients in North Kivu province in the Democratic Republic of Congo.A retrospective cohort study was conducted in 6 Covid-19 treatment centers in the city of Butembo from 1 January to 31 December 2021. The time to event (death), the outcome variable, was visualized by Kaplan-Meier curves and the log-rank test was used to confirm differences in trends. Cox regression was used for all the predictors in the bivariate analysis and multivariate analysis was done using predictors found statistically significant in the bivariate analysis. The following variables were considered for inclusion to the Cox regression model: Age, Sex, Disease length, Treatment site, History of at least one co-morbidity, Body mass index, Stage according to SpO2 and the NEWS-modified score.Among the 303 participants (mean age of 53 years), the fatality rate was 33.8 deaths per 1000 patient-days. Four predictors were independently associated with inpatient death: age category (≥ 60 years) (adjusted HR: 9.90; 95% CI: 2.68-36.27), presence of at least one comorbidity (adjusted HR: 11.39; 95% CI: 3.19-40.71); duration of illness of > 5 days before hospitalization (adjusted HR:1.70, 95% CI: 1.04-2.79) and peripheral capillary oxygen saturation (SpO2) < 90% (adjusted HR = 14.02, 95% CI: 2.23-88.32). In addition to advanced age, comorbidity, and length of disease before hospitalization, ambient air SpO2 measured by healthcare providers using low-tech, affordable and relatively accessible pulse oximetry could inform the care pathways of Covid-19 inpatients in resource-challenged health systems in humanitarian settings.

Quality of life, exercise capacity, cognition, and mental health of Chilean patients after COVID-19: an experience of a multidisciplinary rehabilitation program at a physical and rehabilitation medicine unit

Background

Post-COVID disabilities, encompassing physical, cognitive, and psychological aspects, constitute the primary health sequelae for survivors. While the rehabilitation needs post COVID-19 are now well understood, each country possesses unique characteristics in terms of populations, healthcare systems, social dynamics, and economic profiles, necessitating context-specific recommendations. This study aims to address two main objectives: (1) analyze the impact of an 8-week multidisciplinary rehabilitation program on the quality of life, functional capacity, cognition, and mental health adaptations in adults recovering from COVID-19 in northern Chile, and (2) propose a personalized model for predicting program dropouts and responses.

Methods

A total of 44 subjects were enrolled, forming two groups during the study: a treatment group (n = 32) and a dropout group (n = 12). The treatment group participated in the 8-week multidisciplinary rehabilitation program.

Results

The results indicate that (1) After 8 weeks, the quality of life of the patients in the treatment group exhibited significant improvements reflected in all aspects of the Short Form-36 Health Survey (SF36, p < 0.005) and the total score (p < 0.001), with a concurrent decrease in dysfunctionality (p < 0.001). (2) Significant improvements were also observed in various physical performance tests, including the: 6-minute walk test, 1-min sit-to-stand, dynamometry, Tinetti balance, and Berg score (p < 0.001). Moreover, physical therapy led to a reduction in neuropathic symptoms and pain, psychological therapy reduced anxiety and depression, and language therapy enhanced memory and speech (all p < 0.05). (3) Demographic and clinical history characteristics did not predict responses to rehabilitation. (4) A regression model for predicting changes in SF-36 total score, based on physical function, physical role, general health, and mental health, was established based on the data from study (p < 0.01, adjusted R2 = 0.893). (5) Classification models for predicting dropouts achieved 68% accuracy, with key predictors of treatment adherence including diabetes, hypertension, and dyslipidemia, Tinetti balance, physical role, and vitality of SF36, and performance on the 6-minute walk test and 1-minute sit-to-stand.

Conclusions

This study demonstrates significant enhancements in quality of life, improved functional performance, and reductions in mental and cognitive burdens within an 8-week rehabilitation program. Additionally, it is possible to identify patients at risk of dropping out using cost-effective, outpatient, and clinically applicable tests.

Childhood adversity and COVID-19 outcomes in the UK Biobank

OBJECTIVES

This study aims to investigate the association between childhood adversity and COVID-19-related hospitalisation and COVID-19-related mortality in the UK Biobank.

DESIGN

Cohort study.

SETTING

UK.

PARTICIPANTS

151 200 participants in the UK Biobank cohort who had completed the Childhood Trauma Screen were alive at the start of the COVID-19 pandemic (January 2020) and were still active in the UK Biobank when hospitalisation and mortality data were most recently updated (November 2021).

MAIN OUTCOME MEASURES

COVID-19-related hospitalisation and COVID-19-related mortality.

RESULTS

Higher self-reports of childhood adversity were related to greater likelihood of COVID-19-related hospitalisation in all statistical models. In models adjusted for age, ethnicity and sex, childhood adversity was associated with an odds ratio (OR) of 1.227 of hospitalisation (95% CI 1.153 to 1.306, childhood adversity z=6.49, p<0.005) and an OR of 1.25 of a COVID-19-related death (95% CI 1.11 to 1.424, childhood adversity z=3.5, p<0.005). Adjustment for potential confounds attenuated these associations, although associations remained statistically significant.

CONCLUSIONS

Childhood adversity was significantly associated with COVID-19-related hospitalisation and COVID-19-related mortality after adjusting for sociodemographic and health confounders. Further research is needed to clarify the biological and psychosocial processes underlying these associations to inform public health intervention and prevention strategies to minimise COVID-19 disparities.

Systemic inflammation and subsequent risk of amyotrophic lateral sclerosis: Prospective cohort study

BACKGROUND

While systemic inflammation has been implicated in the etiology of selected neurodegenerative disorders, its role in the development of amyotrophic lateral sclerosis (ALS), a condition with high case-fatality, is untested. Accordingly, we quantified the relationship of C-reactive protein (CRP), an acute-phase reactant and marker of systemic inflammation, with subsequent ALS occurrence.

METHODS

We used data from UK Biobank, a prospective cohort study of 502,649 participants who were aged 37 to 73 years when examined at research centers between 2006 and 2010. Venous blood was collected at baseline in the full cohort and assayed for CRP, and repeat measurement was made 3-7 years later in a representative subgroup (N = 14,514) enabling correction for regression dilution. ALS was ascertained via national hospitalization and mortality registries until 2021. We computed multivariable hazard ratios with accompanying 95% confidence intervals for log-transformed CRP expressed as standard deviation and tertiles.

RESULTS

In an analytical sample of 400,884 initially ALS-free individuals (218,203 women), a mean follow-up of 12 years gave rise to 231 hospitalizations and 223 deaths ascribed to ALS. After adjustment for covariates which included health behaviors, comorbidity, and socio-economic status, a one standard deviation higher log-CRP was associated with elevated rates of both ALS mortality (hazard ratios; 95% confidence intervals: 1.32; 1.13, 1.53) and hospitalizations (1.20; 1.00, 1.39). There was evidence of dose-response effects across tertiles of CRP for both outcomes (p for trend ≤ 0.05). Correction for regression dilution led to a strengthening of the relationship with CRP for both mortality (1.62; 1.27, 2.08) and hospitalizations (1.37; 1.05, 1.76).

CONCLUSIONS

Higher levels of CRP, a blood-based biomarker widely captured in clinical practice, is associated with moderately increased future risk of amyotrophic lateral sclerosis.

A co-produced service evaluation of ethnic minority community service user experiences of a specialist mental health service during the COVID-19 pandemic

BACKGROUND

For ethnic minority communities in the UK, the COVID-19 pandemic amplified existing health inequalities and created other consequential disadvantages like increased vulnerability to COVID-19, higher rates of hospital admissions, increased mortality and poorer mental health outcomes. While longer-term impacts of COVID-19 are considered, it is crucial for NHS mental health services to understand the specific barriers and needs of ethnic minority communities to provide consistent and equitable access to mental health services. These aspects were the focus of a service evaluation of a Sussex-wide mental health service conducted in co-production with experts-by-experience, public members, health professionals and researchers from ethnic minority communities.

METHODS

Co-designed creative workshops (n = 13) and semi-structured qualitative interviews (n = 13) were used to explore experiences of accessing specialist mental health services during the COVID-19 pandemic. Participants were: Sussex Partnership NHS Foundation Trust (SPFT) service users recruited between October 2021 and January 2022; aged 16+; from ethnic minority community backgrounds. Data was analysed using Thematic Analysis.

RESULTS

The analysis yielded five overarching themes contextualising service users' experiences: (1) limited awareness of SPFT mental health services; (2) effects of COVID-19 in gaining access to SPFT; (3) SPFT reaching out to ethnic minorities; (4) being supported, 4a) hiding my mental health status from friends and families, 4b) lack of ethnic diversity in services, and 4c) better provision of information and support services, (5) relationship between childhood experiences and current mental health. These findings led to seven key recommendations for future service developments within SPFT.

CONCLUSIONS

Although this evaluation was set in the context of COVID-19, findings have highlighted specific mental health service needs for ethnic minorities that are applicable beyond the confines of the pandemic. Many benefited from online sessions seen as more inclusive. Mental health advocates, outreach and joint working with communities could help further reduce stigmatising attitudes and improve engagement with mental health services. Improved service awareness of the impact of childhood or historical traumas experienced by ethnic minority communities on current mental health, the role of cultural awareness training and availability of culturally adapted therapies is also needed. Many service improvement recommendations provided could impact all service users.

Considering the experiences and adjustment of sexual and gender minority youths during the COVID-19 pandemic

Sexual and gender minority (SGM) adolescents and emerging adults experienced social and structural inequities and evinced more psychosocial adjustment difficulties than cisgender, heterosexual youths before the onset of the COVID-19 pandemic. The unique array of stressors confronting SGM youths during the pandemic - including separation from affirming and supportive peers, teachers and communities, and mandated co-residence with potentially rejecting family members - may have exacerbated these discrepancies. Conversely, social distancing and remote learning may have reduced direct exposure to discrimination outside the home, and many SGM youths leveraged their personal and social resources to cope with pandemic-related stressors. This review considers the empirical literature on the academic, psychological, and social consequences of the COVID-19 pandemic for SGM youths.

Physical Activity Message Framing and Ethnicity Before and During COVID-19

People of Black ethnicities are well known to be disproportionately burdened by coronavirus and have poorer health outcomes. Public health messages encouraged physical activity during the pandemic as it is evidenced to positively affect the immune system, however people of Black ethnicities are often reported as failing to achieve the recommended daily amount. Health message framing during COVID-19 specifically in relation to ethnicity and physical activity motivation has yet to be investigated. Two studies examined message frame effect on physical activity motivation prior to and at the onset of the pandemic and how this differed by ethnicity. Gain framed messages were found to positively affect physical activity motivation pre-COVID-19 and during the pandemic fear framed messages were found to positively affect physical activity motivation. Neither of these effects differed by ethnicity. Implications for future physical activity health message framing are discussed.

Health Promotion and Racial Disparity in COVID-19 Mortality Among African American Populations

COVID-19, known as Coronavirus Disease 2019, is a major health issue resulting from novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Its emergence has posed a significant menace to the global medical community and healthcare system across the world. Notably, on December 12, 2020, the Food and Drug Administration (FDA) approved the utilization of the Pfizer and Moderna COVID-19 vaccines. As of July 31, 2022, the United Stated has witnessed over 91.3 million cases of COVID-19 and nearly 1.03 million fatalities. An intriguing observation is the recent reduction in the mortality rate of COVID-19, attributed to an augmented focus on early detection, comprehensive screening, and widespread vaccination. Despite this positive trend in some demographics, it is noteworthy that the overall incidence rates of COVID-19 among African American and Hispanic populations have continued to escalate, even as mortality rates have decreased. Therefore, the objective of this research study is to present an overview of COVID-19, spotlighting the disparities among different racial and ethnic groups. It also delves into the management of COVID-19 within the minority populations. To reach our research objective, we used a publicly available COVID-19 dataset from kaggle:https://www.kaggle.com/datasets/paultimothymooney/covid19-cases-and-deaths-by-race. In addition, we obtained COVID-19 datasets from 10 different states with the highest proportion of African American populations. Many considerable strikes have been made in COVID-19. However, success rate of treatment in the African American population remains relatively limited when compared to other ethnic groups. Hence, there arises a pressing need for novel strategies and innovative approaches to not only encourage prevention measures against COVID-19, but also to increase survival rates, diminish mortality rates, and ultimately improve the health outcomes of ethnic and racial minorities.

Association between ethnic background and COVID-19 morbidity, mortality and vaccination in England: a multistate cohort analysis using the UK Biobank

OBJECTIVES

Despite growing evidence suggesting increased COVID-19 mortality among people from ethnic minorities, little is known about milder forms of SARS-CoV-2 infection. We sought to explore the association between ethnic background and the probability of testing, testing positive, hospitalisation, COVID-19 mortality and vaccination uptake.

DESIGN

A multistate cohort analysis. Participants were followed between 8 April 2020 and 30 September 2021.

SETTING

The UK Biobank, which stores medical data on around half a million people who were recruited between 2006 and 2010.

PARTICIPANTS

405 541 subjects were eligible for analysis, limited to UK Biobank participants living in England. 23 891 (6%) of participants were non-white.

PRIMARY AND SECONDARY OUTCOME MEASURES

The associations between ethnic background and testing, testing positive, hospitalisation and COVID-19 mortality were studied using multistate survival analyses. The association with single and double-dose vaccination was also modelled. Multistate models adjusted for age, sex and socioeconomic deprivation were fitted to estimate adjusted HRs (aHR) for each of the multistate transitions.

RESULTS

18 172 (4.5%) individuals tested positive, 3285 (0.8%) tested negative and then positive, 1490 (6.9% of those tested positive) were hospitalised, and 129 (0.6%) tested positive at the moment of hospital admission (ie, direct hospitalisation). Finally, 662 (17.4%) died after admission. Compared with white participants, Asian participants had an increased risk of negative to positive transition (aHR 1.24 (95% CI 1.02 to 1.52)), testing positive (95% CI 1.44 (1.33 to 1.55)) and direct hospitalisation (1.61 (95% CI 1.28 to 2.03)). Black participants had an increased risk of hospitalisation following a positive test (1.71 (95% CI 1.29 to 2.27)) and direct hospitalisation (1.90 (95% CI 1.51 to 2.39)). Although not the case for Asians (aHR 1.00 (95% CI 0.98 to 1.02)), black participants had a reduced vaccination probability (0.63 (95% CI 0.62 to 0.65)). In contrast, Chinese participants had a reduced risk of testing negative (aHR 0.64 (95% CI 0.57 to 0.73)), of testing positive (0.40 (95% CI 0.28 to 0.57)) and of vaccination (0.78 (95% CI 0.74 to 0.83)).

CONCLUSIONS

We identified inequities in testing, vaccination and COVID-19 outcomes according to ethnicity in England. Compared with whites, Asian participants had increased risks of infection and admission, and black participants had almost double hospitalisation risk, and a 40% lower vaccine uptake.

Revisiting ethnic discrepancies in COVID-19 hospitalized cohorts: a correction for collider bias

OBJECTIVES

Studies from the first waves of the coronavirus disease 2019 (COVID-19) pandemic suggest that individuals from minority ethnicities are at an increased risk of worse outcomes. Concerns exist that this relationship is potentially driven by bias from analyzing hospitalized patients only. We investigate this relationship and the possible presence of bias.

STUDY DESIGN AND SETTING

Using data from South London hospitals across two COVID-19 waves (February 2020 - May 2021), the relationship between ethnicity and COVID-19 outcomes was examined using regression models. Three iterations of each model were completed: 1) an unadjusted analysis, 2) adjusting for covariates (medical history and deprivation), and 3) adjusting for covariates and bias induced by conditioning on hospitalization.

RESULTS

Among 3,133 patients, those who were Asian had a two-fold increased risk of death during the hospital stay that was consistent across the two COVID-19 waves and was not affected by correcting for conditioning on hospitalization. However, wave-specific effects demonstrate significant differences between ethnic groups until bias from using a hospitalized cohort was corrected for.

CONCLUSION

Worsened COVID-19 outcomes in minority ethnicities may be minimized by correcting for bias induced by conditioning on hospitalization. Consideration of this bias should be a key component of study design.

Inequalities in COVID-19 severe morbidity and mortality by country of birth in Sweden

Migrants have been more affected by the COVID-19 pandemic. Whether this has varied over the course of the pandemic remains unknown. We examined how inequalities in intensive care unit (ICU) admission and death related to COVID-19 by country of birth have evolved over the course of the pandemic, while considering the contribution of social conditions and vaccination uptake. A population-based cohort study was conducted including adults living in Sweden between March 1, 2020 and June 1, 2022 (n = 7,870,441). Poisson regressions found that migrants from Africa, Middle East, Asia and European countries without EU28/EEA, UK and Switzerland had higher risk of COVID-19 mortality and ICU admission than Swedish-born. High risks of COVID-19 ICU admission was also found in migrants from South America. Inequalities were generally reduced through subsequent waves of the pandemic. In many migrant groups socioeconomic status and living conditions contributed to the disparities while vaccination campaigns were decisive when such became available.

Socio-Economic Factors Associated with Ethnic Disparities in SARS-CoV-2 Infection and Hospitalization

BACKGROUND

There is evidence that non-Italians presented higher incidence of infection and worse health outcomes if compared to native populations in the COVID-19 pandemic. The aim of the study was to compare Italian- and non-Italian-born health outcomes, accounting for socio-economic levels.

METHODS

We analyzed data relative to 906,463 people in Umbria (Italy) from 21 February 2020 to 31 May 2021. We considered the National Deprivation Index, the Urban-Rural Municipalities Index and the Human Development Index (HDI) of the country of birth. We used a multilevel logistic regression model to explore the influence of these factors on SARS-CoV-2 infection and hospitalization rates. Diagnosis in the 48 h preceding admission was an indicator of late diagnosis among hospitalized cases.

RESULTS

Overall, 54,448 persons tested positive (6%), and 9.7% of them were hospitalized. The risk of hospital admission was higher among non-Italians and was inversely related to the HDI of the country of birth. A diagnosis within 48 h before hospitalization was more frequent among non-Italians and correlated to the HDI level.

CONCLUSIONS

COVID-19 had unequal health outcomes among the population in Umbria. Reduced access to primary care services in the non-Italian group could explain our findings. Policies on immigrants' access to primary healthcare need to be improved.

COVID-19 stressors and mental health problems amongst women who arrived as refugees and those born in Australia

Women from refugee background residing in high income countries are at greater mental health risk during the COVID-19 pandemic given their higher baseline prevalence of mental disorders, trauma exposures and social adversities. During the COVID-19 pandemic we drew on data from wave-4 of the WATCH cohort study, collected between October 2019 and June 2021. We conducted a cross-sectional analysis to compare the prevalence of common mental disorders (CMDs) from the sample of 650 consecutively recruited women, 339 (52.2%) from the refugee-background who were resettled in Australia and 311 (48.8%) randomly and contemporaneously selected Australian born women. We assessed COVID-19 psychosocial stressors: 1. COVID-related material hardship and 2. COVID-related fear and stress. We examined for associations between scores on these two items and CMDs in each group respectively. Compared to Australian-born woman, women from refugee background recorded a significantly higher prevalence of Major Depressive Disorder (MDD) (19.8% vs 13.5%), PTSD (9.7% vs 5.1%), Separation Anxiety Disorder (SEPAD) (19.8% vs 13.5%) and Persistent Complicated Bereavement Disorder (PCBD) (6.5% vs 2.9%). In refugee women, associations were found between COVID-related material hardship and CMDs [MDD, Relative Risk (RR) = 1.39, 95%CI: 1.02-1.89, p = 0.02] as well as between COVID-related fear and stress and CMDs (MDD, RR = 1.74, 95%CI: 1.04-2.90, p = 0.02 p = 0.02). For Australian-born women, associations were more commonly found between CMDs and material hardship. Our study demonstrates that both women from refugee background and those born in Australia are experiencing significant rates of CMD during the pandemic and that material hardship is an associated factor. We found that women from refugee background are at greater risk for mental health problems and are more likely to report an association of those problems with fear and stress related to COVID_19. All women, and particularly those from refugee background, require urgent and specialised attention to their mental health and psychosocial problems during this pandemic.

Socio-ecological barriers to access COVID-19 vaccination among Burmese irregular migrant workers in Thailand

Thailand is a migration hub in ASEAN (Association of Southeast Asian Nations), with more than 3.9 million migrant workers, accounting for 10% of the country's workforce. The government of Thailand has moved from a pandemic to an endemic state of living with the SAR-CoV2 virus as a new normal since over half of the population has been vaccinated. There is, however, an estimated 1.3 million irregular migrant workers in Thailand who are not covered by Social Security Schemes (SSS) and are likely to have not been vaccinated. This study examines the socio-ecological barriers to accessing vaccination among Burmese irregular migrant workers in Thailand. Qualitative and quantitative data were collected from NGO (Non-Government Organizations) workers and Burmese irregular migrants through an online survey and in-depth interviews. The study reported that over 90% of Burmese irregular migrants were unvaccinated. The main reasons for the low vaccination rate include exclusion from the vaccine distribution program, high cost of the vaccine, perceived low quality of vaccine, language barriers, lack of vaccine information, private and public discrimination against migrants, fear of being detained and deported, and difficulties in finding time and transportation to go to vaccination centres. The Thai government should employ culturally competent interpreters to disseminate vaccine information and potential side effects to encourage vaccinations in order to prevent further casualties and curb the global health crisis. Moreover, it is imperative that the Thai government provide free vaccines to all immigrants regardless of their status and amnesty from deportation and detention during the vaccination period.

COVID-19 pandemic and socio-environmental inequality: A narrative review

Background and Aims

The COVID-19 pandemic has provided preliminary evidence of the existence of health, social, and environmental inequalities. This inequality encompasses inadequate access to safe water, clean air, and wastewater management, as well as limited socioeconomic and educational opportunities. These issues have not received sufficient attention during the pandemic. The purpose of this narrative review is to provide a comprehensive summary and analysis of the existing literature on a specific topic, ultimately leading to a conclusion based on the evidence presented.

Methods

The search methodology for this study involved conducting comprehensive searches of scientific databases, including PubMed, ScienceDirect, LILACS, and Google Scholar, from 2019 to 2023. The study focused on a specific theme and its relevant aspects related to global environmental health and society. Keywords such as COVID-19, inequities, and environmental health were used for searching. Additionally, the Boolean operator "AND" was used to combine these descriptors.

Results

Unequal exposure to air pollution has been reported in Africa, as well as in large parts of Asia and Latin America, according to the data that has been obtained. The pandemic has also resulted in a surge in healthcare waste generation, exacerbating the environmental impact of solid waste. Furthermore, there is evidence indicating significant disparities in the severe lack of access to sanitation services between developing nations and low-income regions. The issues related to water availability, accessibility, and quality are subject to debate. It has been reported that SARS-CoV-2 is present not only in untreated/raw water, but also in water bodies that act as reservoirs. Moreover, insufficient education, poverty, and low household income have been identified as the most significant risk factors for COVID-19 infection and mortality.

Conclusion

It is evident that addressing socio-environmental inequality and striving to narrow the gap by prioritizing vulnerable populations are imperative.

Association of socio-economic deprivation with COVID-19 incidence and fatality during the first wave of the pandemic in Italy: lessons learned from a local register-based study

BACKGROUND

COVID-19 has been characterised by its global and rapid spread, with high infection, hospitalisation, and mortality rates worldwide. However, the course of the pandemic showed differences in chronology and intensity in different geographical areas and countries, probably due to a multitude of factors. Among these, socio-economic deprivation has been supposed to play a substantial role, although available evidence is not fully in agreement. Our study aimed to assess incidence and fatality rates of COVID-19 across the levels of socio-economic deprivation during the first epidemic wave (March-May 2020) in the Italian Province of Foggia, Apulia Region.

METHODS

Based on the data of the regional active surveillance platform, we performed a retrospective epidemiological study among all COVID-19 confirmed cases that occurred in the Apulian District of Foggia, Italy, from March 1st to May 5th, 2020. Geocoded addresses were linked to the individual Census Tract (CT) of residence. Effects of socio-economic condition were calculated by means of the Socio-Economic and Health-related Deprivation Index (SEHDI) on COVID-19 incidence and fatality.

RESULTS

Of the 1054 confirmed COVID-19 cases, 537 (50.9%) were men, 682 (64.7%) were 0-64 years old, and 338 (32.1%) had pre-existing comorbidities. COVID-19 incidence was higher in the less deprived areas (p < 0.05), independently on age. The level of socio-economic deprivation did not show a significant impact on the vital status, while a higher fatality was observed in male cases (p < 0.001), cases > 65 years (p < 0.001), cases having a connection with a nursing home (p < 0.05) or having at least 1 comorbidity (p < 0.001). On the other hand, a significant protection for healthcare workers was apparent (p < 0.001).

CONCLUSIONS

Our findings show that deprivation alone does not affect COVID-19 incidence and fatality burden, suggesting that the burden of disease is driven by a complexity of factors not yet fully understood. Better knowledge is needed to identify subgroups at higher risk and implement effective preventive strategies.

Molecular Understanding of ACE-2 and HLA-Conferred Differential Susceptibility to COVID-19: Host-Directed Insights Opening New Windows in COVID-19 Therapeutics

The genetic variants of HLAs (human leukocyte antigens) play a crucial role in the virus–host interaction and pathology of COVID-19. The genetic variants of HLAs not only influence T cell immune responses but also B cell immune responses by presenting a variety of peptide fragments of invading pathogens. Peptide cocktail vaccines produced by using various conserved HLA-A2 epitopes provoke substantial specific CD8+ T cell responses in experimental animals. The HLA profiles vary among individuals and trigger different T cell-mediated immune responses in COVID-19 infections. Those with HLA-C*01 and HLA-B*44 are highly susceptible to the disease. However, HLA-A*02:01, HLA-DR*03:01, and HLA-Cw*15:02 alleles show resistance to SARS infection. Understanding the genetic association of HLA with COVID-19 susceptibility and severity is important because it can help in studying the transmission of COVID-19 and its physiopathogenesis. The HLA-C*01 and B*44 allele pathways can be studied to gain insight into disease transmission and physiopathogenesis. Therefore, integrating HLA testing is suggested in the ongoing pandemic, which will help in the rapid identification of highly susceptible populations worldwide and possibly acclimate vaccine development. Therefore, understanding the correlation between HLA and SARS-CoV-2 is critical in opening new insights into COVID-19 therapeutics, based on previous studies conducted.

Systemic inflammation and subsequent risk of amyotrophic lateral sclerosis: prospective cohort study

Importance

While systemic inflammation has been implicated in the aetiology of selected neurodegenerative disorders, its role in the development of amyotrophic lateral sclerosis (ALS) is untested.

Objective

To quantify the relationship of C-reactive protein (CRP), an acute-phase reactant and marker of systemic inflammation, with ALS occurrence.

Design Setting Participants

UK Biobank, a prospective cohort study of 502,649 participants who were aged 37 to 73 years when examined at research centres between 2006 and 2010.

Exposure

Venous blood was collected at baseline in the full cohort and assayed for CRP. Repeat measurement was made 3-7 years later in a representative subgroup (N=14,514) enabling correction for regression dilution.

Main Outcomes and Measures

ALS as ascertained via national hospitalisation and mortality registries. We computed multi-variable hazard ratios with accompanying 95% confidence intervals for log-transformed CRP expressed as standard deviation and tertiles.

Results

In an analytical sample of 400,884 individuals (218,203 women), a mean follow-up of 12 years gave rise to 231 hospitalisations and 223 deaths ascribed to ALS. After adjustment for covariates which included health behaviours, comorbidity, and socio-economic status, a one standard deviation higher log-CRP was associated with elevated rates of both ALS mortality (hazard ratios; 95% confidence intervals: 1.32; 1.13, 1.53) and hospitalisations (1.20; 1.00, 1.39). There was evidence of dose-response effects across tertiles of CRP for both outcomes (p for trend≤0.05). Correction for regression dilution led to a strengthening of the relationship with CRP for both mortality (1.62; 1.27, 2.08) and hospitalisations (1.37; 1.05, 1.76) ascribed to ALS.

Conclusions and Relevance

Higher levels of CRP, a blood-based biomarker widely captured in clinical practice, were associated with a higher subsequent risk of ALS.

Key Points

Question: Is C-reactive protein (CRP), a marker of systemic inflammation widely used in clinical practice, associated with later risk of amyotrophic lateral sclerosis (ALS)?Findings: Following 11 years disease surveillance in 400,884 individuals (218,203 women), after adjustment for covariates and correction for regression dilution, a one standard deviation higher CRP levels were associations with both mortality (hazard ratio; 95% confidence interval: 1.62; 1.27, 2.08) and hospitalisations (1.37; 1.05, 1.76) ascribed to ALS.Meaning: In the present study, CRP has a dose-response relationship with the risk of later ALS.

COVID-19 and diabetes in 2020: a systematic review

Attempts were made to review the literature on diabetic patients who experience complications when they contract COVID-19, and to determine whether ethnicity and other risk factors play an important role in the development of symptoms and their severity, as well as responding to medications. A literature search was performed using five keywords, namely COVID-19, diabetes, ethnicity, medications, and risk factors between January 2019 and December 2020 using electronic databases such as PubMed, Science Direct, Google Scholar, Springer Link, and Scopus. Forty studies were included. The review indicated that diabetes was a significant risk factor for poorer outcomes and increased mortality associated with COVID-19. There were several risk factors for diabetic patients that increased their likelihood of poorer outcomes associated with COVID-19. These included black and Asian ethnicity, male sex with high BMI. In conclusion, patients with diabetes of black or Asian origin with high BMI, male sex, and older age had an increased risk of poorer outcomes associated with COVID-19. This highlights the importance of considering the history of the patient in prioritising care and treatment.

Investigating stigma during the COVID-19 pandemic: Living conditions, social determinants and experiences of infection among employees at a tertiary referral cancer centre

AIM

Healthcare workers (HCWs) have reported negative social experiences during the COVID-19 pandemic; however, this data is largely from medical personnel. We examined living conditions, social determinants, and experiences during the COVID-19 pandemic among all cadres of employees who had recovered from COVID-19 at a tertiary referral cancer hospital in India.

METHODS

We conducted a mixed methods study combining a questionnaire-based survey followed by semi-structured interviews with open-ended questions, among hospital staff who recovered from COVID-19 between April and November 2020. We initially administered a 79-point survey to all participants; based on their responses, we used purposive sampling to identify 60 interview participants. The primary aim of the study was to examine the impact of socio-economic factors on experiences and potential stigma faced by staff during the COVID-19 pandemic.

RESULTS

We surveyed 376 participants including doctors (10 %), nurses (20 %), support staff (29 %), administrators (18 %) and scientists/technicians (22 %). Of these, 126 (34 %) participants reported negative social experiences. Stigmatisation was lower among doctors compared to other professions, decreased in the second half of the study period, and was more among those living in less affluent surroundings. Interviews revealed 3 types of negative social experiences: neighbourhood tensions around restrictions of mobility, social distancing, and harassment.

CONCLUSIONS

The first phase of the COVID-19 pandemic in India led to considerable negative social experiences among hospital employees, especially those lower in the socio-economic hierarchy, which was fuelled by restrictions imposed by the government and pressure on local neighbourhoods.

POLICY SUMMARY

It is important to not just document and count stigma experiences during global pandemics, but also to examine sociologically the conditions under which and the processes through which stigma happens.

Exploring the impact of selection bias in observational studies of COVID-19: a simulation study

BACKGROUND

Non-random selection of analytic subsamples could introduce selection bias in observational studies. We explored the potential presence and impact of selection in studies of SARS-CoV-2 infection and COVID-19 prognosis.

METHODS

We tested the association of a broad range of characteristics with selection into COVID-19 analytic subsamples in the Avon Longitudinal Study of Parents and Children (ALSPAC) and UK Biobank (UKB). We then conducted empirical analyses and simulations to explore the potential presence, direction and magnitude of bias due to this selection (relative to our defined UK-based adult target populations) when estimating the association of body mass index (BMI) with SARS-CoV-2 infection and death-with-COVID-19.

RESULTS

In both cohorts, a broad range of characteristics was related to selection, sometimes in opposite directions (e.g. more-educated people were more likely to have data on SARS-CoV-2 infection in ALSPAC, but less likely in UKB). Higher BMI was associated with higher odds of SARS-CoV-2 infection and death-with-COVID-19. We found non-negligible bias in many simulated scenarios.

CONCLUSIONS

Analyses using COVID-19 self-reported or national registry data may be biased due to selection. The magnitude and direction of this bias depend on the outcome definition, the true effect of the risk factor and the assumed selection mechanism; these are likely to differ between studies with different target populations. Bias due to sample selection is a key concern in COVID-19 research based on national registry data, especially as countries end free mass testing. The framework we have used can be applied by other researchers assessing the extent to which their results may be biased for their research question of interest.

Fairness and efficiency considerations in COVID-19 vaccine allocation strategies: A case study comparing front-line workers and 65-74 year olds in the United States

The COVID-19 epidemic in the United States has been characterized by two stark disparities. COVID-19 burden has been unequally distributed among racial and ethnic groups and at the same time the mortality rates have been sharply higher among older age groups. These disparities have led some to suggest that inequalities could be reduced by vaccinating front-line workers before vaccinating older individuals, as older individuals in the US are disproportionately Non-Hispanic White. We compare the performance of two distribution policies, one allocating vaccines to front-line workers and another to older individuals aged 65-74-year-old. We estimate both the number of lives saved and the number of years of life saved under each of the policies, overall and in every race/ethnicity groups, in the United States and every state. We show that prioritizing COVID-19 vaccines for 65-74-year-olds saves both more lives and more years of life than allocating vaccines front-line workers in each racial/ethnic group, in the United States as a whole and in nearly every state. When evaluating fairness of vaccine allocation policies, the overall benefit to impact of each population subgroup should be considered, not only the proportion of doses that is distributed to each subgroup. Further work can identify prioritization schemes that perform better on multiple equity metrics.

The Impact of the COVID-19 Pandemic on Ethnic Minority Groups With Diabetes

Major ethnic disparities in diabetes care, especially for intermediate outcomes and diabetes complications, were evident prior to the coronavirus disease 2019 (COVID-19) pandemic. Diabetes is a risk factor for severe COVID-19, and the combination of these ethnic disparities in diabetes care and outcomes may have contributed to the inequity in COVID-19 outcomes for people with diabetes. Overall, ethnic minority populations have suffered disproportionate rates of COVID-19 hospitalization and mortality. Results from the limited number of studies of COVID-19 in ethnic minority populations with diabetes are mixed, but there is some suggestion that rates of hospitalization and mortality are higher than those of White populations. Reasons for the higher incidence and severity of COVID-19-related outcomes in minority ethnic groups are complex and have been shown to be due to differences in comorbid conditions (e.g., diabetes), exposure risk (e.g., overcrowded living conditions or essential worker jobs), and access to treatment (e.g., health insurance status and access to tertiary care medical centers), which all relate to long-standing structural inequities that vary by ethnicity. While guidelines and approaches for diabetes self-management and outpatient and inpatient care during the pandemic have been published, few have recommended addressing wider structural issues. As we now plan for the recovery and improved surveillance and risk factor management, it is imperative that primary and specialist care services urgently address the disproportionate impact the pandemic has had on ethnic minority groups. This should include a focus on the larger structural barriers in society that put ethnic minorities with diabetes at potentially greater risk for poor COVID-19 outcomes.

We Should Pay More Attention to Sex Differences to Predict the Risk of Severe COVID-19: Men Have the Same Risk of Worse Prognosis as Women More Than 10 Years Older

BACKGROUND

Prioritization for novel coronavirus disease 2019 (COVID-19)-related health policies usually considers age and certain other characteristics, but sex is rarely included, despite the higher risk of severe disease in men. The aim of this study was to compare the impact of sex and age on the severity of COVID-19 by estimating the age difference in years for which the risk for men versus women is the same.

METHODS

We analyzed 23,414 Japanese COVID-19 inpatients aged 20-89 years (13,360 men and 10,054 women). We graded the severity of COVID-19 (0 to 5) according to the most intensive treatment required during hospitalization. The risk of grade 2/3/4/5 (non-invasive positive pressure ventilation/invasive mechanical ventilation/extracorporeal membrane oxygenation/death), grade 3/4/5, and separately grade 5 was analyzed using a multiple logistic regression model.

RESULTS

The odds ratio (OR) of grades 2/3/4/5, 3/4/5 (primary outcome), and 5 for men relative to women was 2.76 (95% CI, 2.44-3.12), 2.78 (95% CI, 2.42-3.19), and 2.60 (95% CI, 2.23-3.03), respectively, after adjustment for age and date of admission. These risks for men were equivalent to those for women 14.1 (95% CI, 12.3-15.8), 11.2 (95% CI, 9.7-12.8), and 7.5 (95% CI, 6.3-8.7) years older, respectively.

CONCLUSION

The risks of worse COVID-19 prognosis (grades 3/4/5) in men were equivalent to those of women 11.2 years older. Reanalyzing data extracted from four previous studies also revealed a large impact of sex difference on the severity of COVID-19. We should pay more attention to sex differences to predict the risk of COVID-19 severity and to formulate public health policy accordingly.

A haemochromatosis-causing HFE mutation is associated with SARS-CoV-2 susceptibility in the Czech population

BACKGROUND

Coronavirus disease (COVID-19), which is caused by the SARS-CoV-2 virus, has become a global pandemic. While susceptibility to COVID-19 is subject to several external factors, including hypertension, BMI, and the presence of diabetes, it is also genetically determined to a significant extent. Infectious agents require iron (Fe) for proper functioning. Carriers of mutations resulting in increased iron concentrations are understood to be at increased risk of COVID-19.

METHODS

We examined HFE genotypes associated with hereditary haemochromatosis (rs1800562 and rs1799945 SNPs) in 617 COVID-19 patients (166 asymptomatic, 246 symptomatic and 205 hospitalised survivors) and 2 559 population-based controls.

RESULTS

We found a higher frequency of the minor allele (Tyr282) of the rs1800562 polymorphism (P < 0.002) in patients compared to controls (8.5 % vs 5.5 %). Non-carriers of the minor allele were protected against SARS-Cov-2 infection (OR, 95 %CI; 0.59, 0.42-0.82). The frequency of minor allele carriers was almost identical across asymptomatic, symptomatic, and hospitalised survivors. The rs1799945 variant did not affect disease severity and its occurrence was almost identical in patients and controls (P between 0.58 and 0.84).

CONCLUSIONS

In conclusion, our results indicate that presence of the rs1800562 minor allele, which is associated with hereditary haemochromatosis (thus increased levels of plasma Fe), increases susceptibility to SARS-CoV-2.

Dying with Cancer and COVID-19, with Special Reference to Lung Cancer: Frailty as a Risk Factor

Older age and frailty have been associated with COVID-19 deaths, but frailty has seldom been studied in the context of cancer. The aim of this paper was therefore to study frailty (measured using the Hospital Frailty Risk Score) and other risk factors in patients who died with advanced cancer and a concomitant COVID-19 infection, with special reference to lung cancer. Of 4312 patients who died with cancer, 282 had concomitant COVID-19 (within the last 30 days), and these patients were significantly older, more often men, and residents of nursing homes. They often had less access to specialized palliative care, and they died more often in acute hospital settings. Patients with cancer who died with COVID-19 were more often frail (57% vs. 45%, p = 0.0002), and frailty was independently associated with COVID-19-related deaths, both in univariable and multivariable regression models, as well as when controlling for age, sex, socioeconomic factors on an area level, and comorbidity (measured using the Charlson Comorbidity Index). In the final multivariable model, where patients with cancer who died in nursing homes were excluded, belonging to the high-risk frailty group (OR 2.07 (1.31-3.27), p = 0.002) was the strongest prognostic variable in the model. In a separate analysis of a subgroup of deaths due to lung cancer (n = 653, of which 45 deaths occurred with concomitant COVID-19), the above associations were not significant, possibly due to too-few cases. In conclusion, frailty is a strong predictor of cancer deaths and should be addressed in cancer care.

Geographical distribution of trace elements (selenium, zinc, iron, copper) and case fatality rate of COVID-19: a national analysis across conterminous USA

Severe outcome particularly death is the largest burden of COVID-19. Clinical observations showed preliminary data that deficiency in certain trace elements, essential for the normal activity of immune system, may be associated with worse COVID-19 outcome. Relevant study of environmental epidemiology has yet to be explored. We investigated the geographical association between concentrations of Se, Zn, Fe and Cu in surface soils and case fatality rate of COVID-19 in USA. Two sets of database, including epidemiological data of COVID-19 (including case fatality rate, from the University of John Hopkinson) and geochemical concentration data of Se, Zn, Fe and Cu in surface soils (from the National Geochemical Survey), were mapped according to geographical location at the county level across conterminous USA. Characteristics of population, socio-demographics and residential environment by county were also collected. Seven cross-sectional sampling dates, with a 4-week interval between adjacent dates, constructed an observational investigation over 24 weeks from October 8, 2020, to March 25, 2021. Multivariable fractional (logit) outcome regression analyses were used to assess the association with adjustment for potential confounding factors. In USA counties with the lowest concentration of Zn, the case fatality rate of COVID-19 was the highest, after adjustment for other influencing factors. Associations of Se, Fe and Cu with case fatality rate of COVID-19 were either inconsistent over time or disappeared after adjustment for Zn. Our large study provides epidemiological evidence suggesting an association of Zn with COVID-19 severity, suggesting Zn deficiency should be avoided.

Demographic and Clinical Presentation of Hospitalised Patients with SARS-CoV-2 During the First Omicron Wave

Introduction: The objectives of this retrospective study were to describe clinical presentations and mortality outcomes of hospitalised patients with the COVID-19 Omicron variant within two acute district general hospitals, and to evaluate demographic factors associated with these presentations and mortality. Methods: Data was obtained over a month in 2021–2022 from multi-ethnic patients who were hospitalised and detected to have severe acute respiratory syndrome coronavirus 2 Omicron infection. Details included socio-demographic characteristics, vaccination, and mortality. Patients were subdivided into three groups: Group 1 were admitted with true COVID-19 pneumonitis, Group 2 had incidental COVID-19 on admission screening, and Group 3 were negative on admission but developed COVID-19 over 7 days post-admission. Results: Of 553 patients, only 24.1% (133/553) were in Group 1, 58.2% (322/553) in Group 2, and 17.7% (98/553) in Group 3. Patients in Group 1 and Group 3 were significantly older than those in Group 2 (p<0.001). Thirty percent of patients from Black, Asian, and minority ethnic backgrounds had COVID-19 pneumonitis compared with 19% of those with White ethnicity (p=0.002). Twenty percent of patients were admitted within nonmedical specialties, i.e., surgical specialties, paediatrics, and obstetrics. Of 36 requiring critical care, 21 were in Group 1. Of those patients, 20/21 (95%) were unvaccinated and seven of the 21 who died were all unvaccinated (100%). Common COVID-19 presentations included delirium, falls, seizures, chronic obstructive pulmonary disease, and antenatal problems. Overall, 13.7% (76/553) patients died and 4.7% (26/553) were directly attributable to COVID-19. Conclusions: This large, multi-ethnic study has described clinical presentations and mortality of hospitalised patients with Omicron. It has determined socio-demographic factors associated with these presentations, including ethnicity and vaccination rates. The study provides useful information for future COVID-19 studies examining outcomes and presentations of Omicron and future COVID-19 variants.

Risk factors for SARS-CoV-2 related mortality and hospitalization before vaccination: A meta-analysis

The literature remains scarce regarding the varying point estimates of risk factors for COVID-19 associated mortality and hospitalization. This meta-analysis investigates risk factors for mortality and hospitalization, estimates individual risk factor contribution, and determines drivers of published estimate variances. We conducted a systematic review and meta-analysis of COVID-19 related mortality and hospitalization risk factors using PRISMA guidelines. Random effects models estimated pooled risks and meta-regression analyses estimated the impact of geographic region and study type. Studies conducted in North America and Europe were more likely to have lower effect sizes of mortality attributed to chronic kidney disease (OR: 0.21, 95% CI: 0.09-0.52 and OR: 0.25, 95% CI: 0.10-0.63, respectively). Retrospective studies were more likely to have decreased effect sizes of mortality attributed to chronic heart failure compared to prospective studies (OR: 0.65, 95% CI: 0.44-0.95). Studies from Europe and Asia (OR: 0.42, 95% CI: 0.30-0.57 and OR: 0.49, 95% CI: 0.28-0.84, respectively) and retrospective studies (OR: 0.58, 95% CI: 0.47-0.73) reported lower hospitalization risk attributed to male sex. Significant geographic population-based variation was observed in published comorbidity related mortality risks while male sex had less of an impact on hospitalization among European and Asian populations or in retrospective studies.

The World-Wide Adaptations of Diabetic Management in the Face of COVID-19 and Socioeconomic Disparities: A Scoping Review

Diabetes is an increasingly prevalent chronic disease throughout the world. It is imperative for patients to have access to reliable treatment and resources in order to avoid long-term complications. Economic and social factors contribute to the accessibility of these resources and have a direct impact on diabetes management. Socioeconomic status (SES) presents challenges to diabetic management due to financial and geographical access to care, medications, educational resources, healthy food options, and physical activity. The coronavirus (COVID-19) pandemic exacerbated these challenges, especially during the height of lockdowns. Therefore, it is important to gain insight into how the pandemic challenged diabetes management, taking into consideration socioeconomic disparities. The objective is to assess how the COVID-19 pandemic has impacted the care of chronic diabetic patients internationally and determine how these outcomes vary between patients of different socioeconomic classes. The following study was designed as a scoping review and utilized PubMed, EMBASE, CINAHL, and Web of Science. A Boolean search strategy combined search terms as follows: (((COVID-19) AND (diabetes)) AND ((socioeconomic factors) OR (social inequality OR standard of living))) AND (treatment OR management). Inclusion criteria included studies addressing diabetic patients, socioeconomic variables (income, occupation, level of education, and ethnicity), glycemic control, and degree of access to quality healthcare. Studies exploring the pathophysiology of COVID-19 or diabetes mellitus were excluded. In addition, studies were chosen between the years 2020 and 2022. The search resulted in 214 articles. The full-text assessment was then conducted on the remaining 67 articles. After screening for eligibility and relevance, 19 articles were retained for this review. The results of this study indicate that 8 out of the 18 studies revealed worse outcomes for those with diabetes mellitus and concomitant COVID-19 infection. Patients with diabetes were more likely to be hospitalized and represent a larger percentage of COVID-19 fatalities. In addition, patients with diabetes and co-morbid COVID-19 infection were more likely to have a higher hemoglobin A1c (HbA1c), belong to a lower SES, and have worse glycemic control due to pandemic-associated lockdown. In order to combat the effects of the pandemic, many countries created novel and innovative management strategies. Overall, there are positive and negative effects from the pandemic on diabetic management strategies. This scoping review identified successes in diabetic treatment under pandemic conditions and areas that need optimization. The successful adaptations of many nations convey the capacity for new policy implementation to care for diabetic patients regardless of SES.

A global review of racial, ethnic and socio-economic disparities in multisystem inflammatory syndrome in children related to COVID-19

With over 500 million confirmed cases and 6.2 million deaths worldwide, the novel coronavirus has highlighted the underlying disparities in healthcare, unpreparedness to deal with a new disease and the need for monitoring and surveillance for a post-infectious syndrome as well as complicated diseases. Initially, children were thought to be spared but reports of a new phenomenon manifesting as Kawasaki-like disease, toxic shock syndrome, and multi-system inflammatory syndrome, which developed after a few weeks of severe COVID-19 infection, emerged in the pediatric population. As the pandemic progressed, increased prevalence of multi-system inflammatory syndrome in children (MIS-C) related to COVID-19 was seen in non-Hispanic blacks, Asians, and Latinos as compared to the white population drawing attention to a possible role of ethnicity and socio-economic disparities. The CDC currently reports that 31% of MIS-C cases were seen in Black Non-Hispanics and 26% in Latinos, who were historically more affected in previous pandemics. Furthermore, MIS-C cases in developing countries showed higher mortality as compared to high-income countries, which points toward the role of social determinants of health and limitations in a low-resource set up in increasing the disease burden of MIS-C, which should be treated as a public health emergency. Our review highlights the role of ethnicity, socio-economic factors, comorbidities, and differences in populations affected by MIS-C in high-income vs. low- and middle-income countries.

Variations in vaccination uptake: COVID-19 vaccination rates in Swedish municipalities

Facing the threat of the ongoing COVID-19 pandemic, vaccines are important for limiting the spread and consequences of the pandemic. In this study, we provide a descriptive overview of the within-country variations of vaccine rates by examining to what extent voter turnout, support for an anti-establishment political party (Sweden Democrats), presence of first-generation immigrants, and Evangelical religiosity are associated with the within-country variation in vaccine uptake rates. We use official register data for municipality-level vaccine rates and municipality-level regressions with regional fixed effects. Our analyses show that vaccine uptake, on average, is lower in municipalities where the anti-establishment political party Sweden Democrats has higher vote shares and where a larger share of the population is first-generation immigrants. We discuss that potential explanations for these associations between vote shares for an anti-establishment party and shares of first-generation immigrants could be lower levels of trust in institutions and language barriers.

The mental health experiences of ethnic minorities in the UK during the Coronavirus pandemic: A qualitative exploration

Background

Worldwide, the Coronavirus pandemic has had a major impact on people's health, lives, and livelihoods. However, this impact has not been felt equally across various population groups. People from ethnic minority backgrounds in the UK have been more adversely affected by the pandemic, especially in terms of their physical health. Their mental health, on the other hand, has received less attention. This study aimed to explore the mental health experiences of UK adults from ethnic minorities during the Coronavirus pandemic. This work forms part of our wider long-term UK population study "Mental Health in the Pandemic."

Methods

We conducted an exploratory qualitative study with people from ethnic minority communities across the UK. A series of in-depth interviews were conducted with 15 women, 14 men and 1 non-binary person from ethnic minority backgrounds, aged between 18 and 65 years old (mean age = 40). We utilized purposefully selected maximum variation sampling in order to capture as wide a variety of views, perceptions and experiences as possible. Inclusion criteria: adults (18+) from ethnic minorities across the UK; able to provide full consent to participate; able to participate in a video- or phone-call interview. All interviews took place via MS Teams or Zoom. The gathered data were transcribed verbatim and underwent thematic analysis following Braun and Clarke carried out using NVivo 12 software.

Results

The qualitative data analysis yielded seven overarching themes: (1) pandemic-specific mental health and wellbeing experiences; (2) issues relating to the media; (3) coping mechanisms; (4) worries around and attitudes toward vaccination; (5) suggestions for support in moving forward; (6) best and worst experiences during pandemic and lockdowns; (7) biggest areas of change in personal life. Generally, participants' mental health experiences varied with some not being affected by the pandemic in a way related to their ethnicity, some sharing positive experiences and coping strategies (exercising more, spending more time with family, community cohesion), and some expressing negative experiences (eating or drinking more, feeling more isolated, or even racism and abuse, especially toward Asian communities). Concerns were raised around trust issues in relation to the media, the inadequate representation of ethnic minorities, and the spread of fake news especially on social media. Attitudes toward vaccinations varied too, with some people more willing to have the vaccine than others.

Conclusion

This study's findings highlight the diversity in the pandemic mental health experiences of ethnic minorities in the UK and has implications for policy, practice and further research. To enable moving forward beyond the pandemic, our study surfaced the need for culturally appropriate mental health support, financial support (as a key mental health determinant), accurate media representation, and clear communication messaging from the Governments of the UK.

Host genetic diversity and genetic variations of SARS-CoV-2 in COVID-19 pathogenesis and the effectiveness of vaccination

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for the outbreak of coronavirus disease 2019 (COVID-19), has shown a vast range of clinical manifestations from asymptomatic to life-threatening symptoms. To figure out the cause of this heterogeneity, studies demonstrated the trace of genetic diversities whether in the hosts or the virus itself. With this regard, this review provides a comprehensive overview of how host genetic such as those related to the entry of the virus, the immune-related genes, gender-related genes, disease-related genes, and also host epigenetic could influence the severity of COVID-19. Besides, the mutations in the genome of SARS-CoV-2 __leading to emerging of new variants__ per se affect the affinity of the virus to the host cells and enhance the immune escape capacity. The current review discusses these variants and also the latest data about vaccination effectiveness facing the most important variants.

COVID-19 among the Pakistani immigrant population in Northern Europe--Incidence and possible causes for infection

Background

Data from several North European countries have indicated that the Pakistani immigrant populations have higher mortality, higher hospitalization rates and higher infection rates from COVID-19 than the majority populations. Therefore the aim of the study was to examine challenges faced by the Pakistani migrant community in Oslo during the pandemic.

Methods

We included data from national reports, national statistics and scientific articles and discussed them with data gained by 16 semi-structured interviews, and thereby elaborated challenges inhabitants of Norway with a Pakistani background experienced during the first year of the COVID-19 pandemic.

Results

The literature study confirmed that mortality, hospitalization, and infection rates from COVID-19 for the sub-groups of the populations with Pakistani background were consistently higher in Denmark, England and Norway, all countries that published data by ethnicity or origin, even when correcting for all known risk factors. Our interview data from Norway showed that information from the authorities was insufficient and not adapted to the needs of the minority population, especially in the early phases of the pandemic. Furthermore, information was not available in the common minority languages of the country. Another finding indicates that health literacy, particularly regarding COVID-19, seemed to be low in the Pakistani minority, and COVID-19 was not considered as a threat in Norway before death rates began rising in Pakistan.

Conclusion

Adapting information at an early stage to the countries' minority groups may help reduce the increase in COVID-19 rates.

Chronic neuropsychiatric sequelae of SARS-CoV-2: Protocol and methods from the Alzheimer's Association Global Consortium

Introduction

Coronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term.

Methods

This article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions.

Results

Successful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively. Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe.

Discussion

The Alzheimer's Association Global Consortium harmonized methodology is proposed as a model to study long-term neurocognitive sequelae of SARS-CoV-2 infection.

Key Points

The following review describes what is known so far in terms of molecular and epidemiological links among COVID-19, the brain, neurological symptoms, and AD and related dementias (ADRD)The primary objective of this large-scale collaboration is to clarify the pathogenesis of ADRD and to advance our understanding of the impact of a neurotropic virus on the long-term risk of cognitive decline and other CNS sequelae. No available evidence supports the notion that cognitive impairment after SARS-CoV-2 infection is a form of dementia (ADRD or otherwise). The longitudinal methodologies espoused by the consortium are intended to provide data to answer this question as clearly as possible controlling for possible confounders. Our specific hypothesis is that SARS-CoV-2 triggers ADRD-like pathology following the extended olfactory cortical network (EOCN) in older individuals with specific genetic susceptibility.The proposed harmonization strategies and flexible study designs offer the possibility to include large samples of under-represented racial and ethnic groups, creating a rich set of harmonized cohorts for future studies of the pathophysiology, determinants, long-term consequences, and trends in cognitive aging, ADRD, and vascular disease.We provide a framework for current and future studies to be carried out within the Consortium. and offers a "green paper" to the research community with a very broad, global base of support, on tools suitable for low- and middle-income countries aimed to compare and combine future longitudinal data on the topic.The Consortium proposes a combination of design and statistical methods as a means of approaching causal inference of the COVID-19 neuropsychiatric sequelae. We expect that deep phenotyping of neuropsychiatric sequelae may provide a series of candidate syndromes with phenomenological and biological characterization that can be further explored. By generating high-quality harmonized data across sites we aim to capture both descriptive and, where possible, causal associations.

Income differences in COVID-19 incidence and severity in Finland among people with foreign and native background: A population-based cohort study of individuals nested within households

BACKGROUND

Although intrahousehold transmission is a key source of Coronavirus Disease 2019 (COVID-19) infections, studies to date have not analysed socioeconomic risk factors on the household level or household clustering of severe COVID-19. We quantify household income differences and household clustering of COVID-19 incidence and severity.

METHODS AND FINDINGS

We used register-based cohort data with individual-level linkage across various administrative registers for the total Finnish population living in working-age private households (N = 4,315,342). Incident COVID-19 cases (N = 38,467) were identified from the National Infectious Diseases Register from 1 July 2020 to 22 February 2021. Severe cases (N = 625) were defined as having at least 3 consecutive days of inpatient care with a COVID-19 diagnosis and identified from the Care Register for Health Care between 1 July 2020 and 31 December 2020. We used 2-level logistic regression with individuals nested within households to estimate COVID-19 incidence and case severity among those infected. Adjusted for age, sex, and regional characteristics, the incidence of COVID-19 was higher (odds ratio [OR] 1.67, 95% CI 1.58 to 1.77, p < 0.001, 28.4% of infections) among individuals in the lowest household income quintile than among those in the highest quintile (18.9%). The difference attenuated (OR 1.23, 1.16 to 1.30, p < 0.001) when controlling for foreign background but not when controlling for other household-level risk factors. In fact, we found a clear income gradient in incidence only among people with foreign background but none among those with native background. The odds of severe illness among those infected were also higher in the lowest income quintile (OR 1.97, 1.52 to 2.56, p < 0.001, 28.0% versus 21.6% in the highest quintile), but this difference was fully attenuated (OR 1.08, 0.77 to 1.52, p = 0.64) when controlling for other individual-level risk factors-comorbidities, occupational status, and foreign background. Both incidence and severity were strongly clustered within households: Around 77% of the variation in incidence and 20% in severity were attributable to differences between households. The main limitation of our study was that the test uptake for COVID-19 may have differed between population subgroups.

CONCLUSIONS

Low household income appears to be a strong risk factor for both COVID-19 incidence and case severity, but the income differences are largely driven by having foreign background. The strong household clustering of incidence and severity highlights the importance of household context in the prevention and mitigation of COVID-19 outcomes.

Health-related and socio-economic burden of the COVID-19 pandemic in Vienna

Previous pandemics have rarely affected everyone equally and, so far, the COVID-19 pandemic is no exception. Emerging evidence has shown that incidence rate, hospitalisation rate, and mortality due to COVID-19 are higher among people in lower socio-economic position (SEP). In addition, first investigations indicate that not everyone is equally affected by this pandemic's collateral public health damage. Using a stratified random sample of 1,004 participants living in Vienna, a Central European city with approximately 1.9 million inhabitants, this study analysed the distribution of 10 adverse health-related and socio-economic outcomes attributable to the COVID-19 pandemic across socio-economic strata. To this end, we estimated differences in the incidence rate of these outcomes by SEP and each of its indicators using zero-inflated Poisson and logistic regression models, adjusted for age and gender. Data were collected during first lockdown measures between 27 April and 17 May 2020. Differences in the incidence rate between the two lowest and two highest SEP groups were clearly visible. Participants in the lowest SEP category had a 32.96% higher incidence rate (IRR = 1.333 [95% CI: 1.079-1.639]), and participants in the second lowest SEP category had a 44.69% higher incidence rate (IRR = 1.447 [95% CI: 1.190-1.760]) compared with participants in the highest SEP category. In sum, 6 out of 10 adverse COVID-19-related outcomes were, to a greater or lesser extent, disproportionately experienced by Viennese residents in lower SEP. Inequalities were most visible between income groups and for the outcomes job loss, worsening of the financial situation, and worse mental health. These results strengthen and extend the current evidence on the unequally distributed burden of the COVID-19 pandemic. In light of effect heterogeneity across SEP indicators, we encourage future investigators to pay increased attention to their operationalisation of SEP. Such awareness will help to correctly identify those in most urgent need of supportive polices.

Association between area-level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal

Background

Although sociodemographic factors have been linked with SARS-CoV-2 infection and hospitalizations in adults, there are little data on the association between sociodemographic characteristics and SARS-CoV-2-related hospitalization in children. The objective of this study was to determine the association between area-level material deprivation and incidence of hospitalization with SARS-CoV-2 among children.

Methods

We conducted a retrospective cohort study of all children (0 to 17 years of age) with a PCR-confirmed SARS-CoV-2 infection March 1, 2020 through May 31, 2021 at a tertiary-care paediatric hospital, in Montreal, Canada. Data were collected through chart review and included age, sex, and postal code, allowing linkage to dissemination area-level material deprivation, measured with the Pampalon Material Deprivation Index (PMDI) quintiles. We examined the association between PMDI quintiles and hospitalization using Poisson regression.

Results

During the study period, 964 children had a positive PCR-confirmed SARS-CoV-2 test and 124 were hospitalized. Children living in the most deprived quintile of PMDI represented 40.7% of hospitalizations. Incidence rate ratio of hospitalization for this group compared to the most privileged quintile was 2.42 (95%CI: 1.33; 4.41).

Conclusion

Children living in the most materially deprived areas had more than twice the rate of hospitalizations for COVID-19 than children living in most privileged areas. Special efforts should be deployed to protect children who live in disadvantaged areas, especially pending vaccination of younger children.

L’association entre la défavorisation matérielle par quartier et l’incidence d’hospitalisation chez les enfants infectés par le SRAS-CoV-2 à Montréal

Historique

Même si les facteurs sociodémographiques sont liés à l’infection par le SRAS-CoV-2 et aux hospitalisations chez les adultes, peu de données portent sur l’association entre ces caractéristiques et les hospitalisations attribuables au SRAS-CoV-2 chez les enfants. La présente étude visait à déterminer l’association entre la défavorisation matérielle par quartier et l’incidence d’hospitalisations à cause du SRAS-CoV-2 chez les enfants.

Méthodologie

Les chercheurs ont réalisé une étude de cohorte rétrospective de tous les enfants (de 0 à 17 ans) atteints d’une infection par le SRAS-CoV-2 confirmée par un test d’amplification en chaîne par polymérase après transcription inverse (PCR) entre le 1^er mars et le 31 mai 2021 dans un hôpital pédiatrique de soins tertiaires de Montréal, au Canada. Ils ont colligé les données par examen des dossiers et ont inclus l’âge, le sexe et les codes postaux, afin de pouvoir lier la défavorisation matérielle à l’échelle de l’aire de diffusion, mesurée au moyen des quintiles de l’indice de défavorisation matérielle de Pampalon. Ils ont examiné l’association entre les quintiles de cet indice et les hospitalisations à l’aide de la régression de Poisson.

Résultats

Pendant la période de l’étude, 964 enfants ont reçu un résultat positif au SRAS-CoV-2 confirmé par un test PCR, et 124 d’entre eux ont été hospitalisés. Au total, 40,7 % des enfants hospitalisés habitaient dans le quintile le plus défavorisé d’après l’indice de défavorisation matérielle de Pampalon. Le rapport du taux d’incidence des hospitalisations dans ce groupe était de 2,42 (intervalle de confiance à 95 % : 1,33; 4,41) par rapport au quintile le plus privilégié.

Conclusion

Plus du double des enfants qui habitaient dans les quartiers les plus défavorisés sur le plan matériel étaient hospitalisés à cause de la COVID-19 par rapport à ceux qui habitaient dans les quartiers les plus privilégiés. Il faudrait déployer des efforts particuliers pour protéger les enfants qui habitent dans des quartiers défavorisés, particulièrement dans l’attente de la vaccination des plus jeunes.

Importance of sex and gender factors for COVID-19 infection and hospitalisation: a sex-stratified analysis using machine learning in UK Biobank data

OBJECTIVE

To examine sex and gender roles in COVID-19 test positivity and hospitalisation in sex-stratified predictive models using machine learning.

DESIGN

Cross-sectional study.

SETTING

UK Biobank prospective cohort.

PARTICIPANTS

Participants tested between 16 March 2020 and 18 May 2020 were analysed.

MAIN OUTCOME MEASURES

The endpoints of the study were COVID-19 test positivity and hospitalisation. Forty-two individuals' demographics, psychosocial factors and comorbidities were used as likely determinants of outcomes. Gradient boosting machine was used for building prediction models.

RESULTS

Of 4510 individuals tested (51.2% female, mean age=68.5±8.9 years), 29.4% tested positive. Males were more likely to be positive than females (31.6% vs 27.3%, p=0.001). In females, living in more deprived areas, lower income, increased low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio, working night shifts and living with a greater number of family members were associated with a higher likelihood of COVID-19 positive test. While in males, greater body mass index and LDL to HDL ratio were the factors associated with a positive test. Older age and adverse cardiometabolic characteristics were the most prominent variables associated with hospitalisation of test-positive patients in both overall and sex-stratified models.

CONCLUSION

High-risk jobs, crowded living arrangements and living in deprived areas were associated with increased COVID-19 infection in females, while high-risk cardiometabolic characteristics were more influential in males. Gender-related factors have a greater impact on females; hence, they should be considered in identifying priority groups for COVID-19 infection vaccination campaigns.

Using machine learning to predict COVID-19 infection and severity risk among 4510 aged adults: a UK Biobank cohort study

Many risk factors have emerged for novel 2019 coronavirus disease (COVID-19). It is relatively unknown how these factors collectively predict COVID-19 infection risk, as well as risk for a severe infection (i.e., hospitalization). Among aged adults (69.3 ± 8.6 years) in UK Biobank, COVID-19 data was downloaded for 4510 participants with 7539 test cases. We downloaded baseline data from 10 to 14 years ago, including demographics, biochemistry, body mass, and other factors, as well as antibody titers for 20 common to rare infectious diseases in a subset of 80 participants with 124 test cases. Permutation-based linear discriminant analysis was used to predict COVID-19 risk and hospitalization risk. Probability and threshold metrics included receiver operating characteristic curves to derive area under the curve (AUC), specificity, sensitivity, and quadratic mean. Model predictions using the full cohort were marginal. The "best-fit" model for predicting COVID-19 risk was found in the subset of participants with antibody titers, which achieved excellent discrimination (AUC 0.969, 95% CI 0.934-1.000). Factors included age, immune markers, lipids, and serology titers to common pathogens like human cytomegalovirus. The hospitalization "best-fit" model was more modest (AUC 0.803, 95% CI 0.663-0.943) and included only serology titers, again in the subset group. Accurate risk profiles can be created using standard self-report and biomedical data collected in public health and medical settings. It is also worthwhile to further investigate if prior host immunity predicts current host immunity to COVID-19.

COVID-19 Contact Tracing Highlights Disparities: Household Size and Low-English Proficiency

Although it is known that coronavirus disease 2019 (COVID-19) disproportionately affects racial and ethnic minorities, our study characterizes the connection between COVID-19 susceptibility and both limited English proficiency (LEP) and large household size. We examined demographic and social data for 1130 individuals who tested positive for or were exposed to COVID-19. Analysis revealed that LEP persons were 3.2 times as likely to report difficulty obtaining supplies for quarantine. Individuals in large households were 1.9 times as likely to report difficulty obtaining supplies for quarantine and 2.0 times as likely to report inability to quarantine. This study, therefore, informs interventions targeted to these populations.

Embracing Diversity, Equity, and Inclusion in the Scientific Community—Viewpoints of the Diversity, Equity, and Inclusion Committee of the North American Vascular Biology Organization

Recent increased visibility on racial issues in the United States elicited public outcry and a collective call for action. The social justice movement has facilitated energetic discussions about race, sexual orientation, and various issues of diversity, equity, and inclusion. This article discusses issues faced by people of color that we as scientists can address, as well as challenges faced by women and internationally trained scientists in the scientific community that need immediate attention. Moreover, we highlight various ways to resolve such issues at both institutional and individual levels. Silence and incremental solutions are no longer acceptable to achieving lasting social justice and ensure prosperous societies that work for all.

The local burden of disease during the first wave of the COVID-19 epidemic in England: estimation using different data sources from changing surveillance practices

BACKGROUND

The COVID-19 epidemic has differentially impacted communities across England, with regional variation in rates of confirmed cases, hospitalisations and deaths. Measurement of this burden changed substantially over the first months, as surveillance was expanded to accommodate the escalating epidemic. Laboratory confirmation was initially restricted to clinical need ("pillar 1") before expanding to community-wide symptomatics ("pillar 2"). This study aimed to ascertain whether inconsistent measurement of case data resulting from varying testing coverage could be reconciled by drawing inference from COVID-19-related deaths.

METHODS

We fit a Bayesian spatio-temporal model to weekly COVID-19-related deaths per local authority (LTLA) throughout the first wave (1 January 2020-30 June 2020), adjusting for the local epidemic timing and the age, deprivation and ethnic composition of its population. We combined predictions from this model with case data under community-wide, symptomatic testing and infection prevalence estimates from the ONS infection survey, to infer the likely trajectory of infections implied by the deaths in each LTLA.

RESULTS

A model including temporally- and spatially-correlated random effects was found to best accommodate the observed variation in COVID-19-related deaths, after accounting for local population characteristics. Predicted case counts under community-wide symptomatic testing suggest a total of 275,000-420,000 cases over the first wave - a median of over 100,000 additional to the total confirmed in practice under varying testing coverage. This translates to a peak incidence of around 200,000 total infections per week across England. The extent to which estimated total infections are reflected in confirmed case counts was found to vary substantially across LTLAs, ranging from 7% in Leicester to 96% in Gloucester with a median of 23%.

CONCLUSIONS

Limitations in testing capacity biased the observed trajectory of COVID-19 infections throughout the first wave. Basing inference on COVID-19-related mortality and higher-coverage testing later in the time period, we could explore the extent of this bias more explicitly. Evidence points towards substantial under-representation of initial growth and peak magnitude of infections nationally, to which different parts of the country contribute unequally.