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Parsons Leigh J, FitzGerald EA, Moss SJ, Cherak MS, Brundin-Mather R, Dodds A, Stelfox HT, Dubé È, Fiest KM, Halperin DM, Ahmed SB, MacDonald SE, Straus SE, Manca T, Ng Kamstra J, Soo A, Longmore S, Kupsch S, Sept B, Halperin SA. The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses. Hum Vaccin Immunother 2024; 20:2316417. [PMID: 38390696 PMCID: PMC10896168 DOI: 10.1080/21645515.2024.2316417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- CRISMA Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, USA
| | - Michal S Cherak
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
| | | | - Alexandra Dodds
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
- Département d'anthropologie, Université Laval, Québec, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna M Halperin
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Sofia B Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terra Manca
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
- Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Josh Ng Kamstra
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Chaka A, Pan D, Irshad M, Piranie H, Wells M, Lal Z, Al-Oraibi A, Bird P, Nazareth J, Sze S, Divall P, Sullivan CS, Appleby BE, Teece L, Martin CA, Naidu J, Nellums LB, Gray LJ, Khunti K, Pareek M. Inclusion of racial and ethnic groups in clinical trials for COVID-19 and post-acute COVID-19 syndrome: An analysis of studies registered on ClinicalTrials.gov. J Infect 2024; 89:106207. [PMID: 38908523 DOI: 10.1016/j.jinf.2024.106207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Affiliation(s)
- Aasiya Chaka
- Department of Respiratory Sciences, University of Leicester, UK; Development Centre for Population Health, University of Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, UK; Development Centre for Population Health, University of Leicester, UK; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK; NIHR Leicester Biomedical Research Centre, UK; Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, UK; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong
| | - Mohannad Irshad
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Humayra Piranie
- Department of Respiratory Sciences, University of Leicester, UK
| | - Molly Wells
- Department of Respiratory Sciences, University of Leicester, UK
| | - Zainab Lal
- Department of Respiratory Sciences, University of Leicester, UK; Development Centre for Population Health, University of Leicester, UK
| | - Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, UK; Development Centre for Population Health, University of Leicester, UK; Lifespan and Population Health, School of Medicine, University of Nottingham, UK
| | - Paul Bird
- Department of Respiratory Sciences, University of Leicester, UK; Development Centre for Population Health, University of Leicester, UK; Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, UK; Development Centre for Population Health, University of Leicester, UK; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK; NIHR Leicester Biomedical Research Centre, UK
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - Pip Divall
- Education Centre Library, University Hospitals of Leicester NHS Trust, UK
| | | | - Ben E Appleby
- Department of Respiratory Sciences, University of Leicester, UK
| | - Lucy Teece
- Department of Population Health Sciences, University of Leicester, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, UK; Development Centre for Population Health, University of Leicester, UK; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK; NIHR Leicester Biomedical Research Centre, UK
| | - Jatin Naidu
- Department of Population Health Sciences, University of Leicester, UK
| | - Laura B Nellums
- College of Population Health, Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Laura J Gray
- NIHR Leicester Biomedical Research Centre, UK; Department of Population Health Sciences, University of Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK; Development Centre for Population Health, University of Leicester, UK; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK; NIHR Leicester Biomedical Research Centre, UK.
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Battle-Fisher M. Combating COVID-19 health disparities in Black, Indigenous, and People of Colour Communities-A call for critical systems thinking. J Eval Clin Pract 2024. [PMID: 38961762 DOI: 10.1111/jep.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/10/2024] [Accepted: 05/13/2024] [Indexed: 07/05/2024]
Abstract
RATIONALE The Black, Indigenous, and People of Colour populations in the United States are disproportionately affected by the emerging health threat SARS-CoV-2, which causes COVID-19. AIMS AND OBJECTIVES This paper aims to demonstrate the usefulness of critical systems thinking by using scenario planning based on epidemiological data and tying epidemiology with soft systems methodology to investigate COVID-19 disparities among disproportionately affected Black, Indigenous, and People of Colour populations. METHODS Using a review of the COVID-19 literature and publicly available US COVID-19 data, critical systems thinking is applied in a scenario planning example and a call to link soft systems methodology with epidemiology. RESULTS According to the four plausible Endgame scenarios, levels of community transmission as well as the current state transmission are based on the driving forces of the scenarios. In addition, soft systems methodology explores the effect on stakeholders and strengthens the picture of disease burden beyond sole reliance on traditional data sources. CONCLUSION This analysis underscores employing critical systems thinking to critically assess diverse methods appropriate for the ongoing complexity of global crises. It is argued that critically engaged subjectivity should be given space alongside data-dependent objectivity. COVID-19 disparities are reliant on the social determinants of health's effects as driving forces on disease transmission in Black, Indigenous, and People of Colour populations. It is moreover argued that critical systems thinking is demonstrated by linking epidemiological evidence with scenario planning and soft systems methodology. This in turn supports a critical systems thinking approach to uncover the state of health disparities among minoritized communities under COVID-19.
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Darvish S, Mahoney SA, Venkatasubramanian R, Rossman MJ, Clayton ZS, Murray KO. Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions. J Appl Physiol (1985) 2024; 137:194-222. [PMID: 38813611 DOI: 10.1152/japplphysiol.00188.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.
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Affiliation(s)
- Sanna Darvish
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | | | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kevin O Murray
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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Shao HH, Yin RX. Pathogenic mechanisms of cardiovascular damage in COVID-19. Mol Med 2024; 30:92. [PMID: 38898389 PMCID: PMC11186295 DOI: 10.1186/s10020-024-00855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND COVID-19 is a new infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Since the outbreak in December 2019, it has caused an unprecedented world pandemic, leading to a global human health crisis. Although SARS CoV-2 mainly affects the lungs, causing interstitial pneumonia and severe acute respiratory distress syndrome, a number of patients often have extensive clinical manifestations, such as gastrointestinal symptoms, cardiovascular damage and renal dysfunction. PURPOSE This review article discusses the pathogenic mechanisms of cardiovascular damage in COVID-19 patients and provides some useful suggestions for future clinical diagnosis, treatment and prevention. METHODS An English-language literature search was conducted in PubMed and Web of Science databases up to 12th April, 2024 for the terms "COVID-19", "SARS CoV-2", "cardiovascular damage", "myocardial injury", "myocarditis", "hypertension", "arrhythmia", "heart failure" and "coronary heart disease", especially update articles in 2023 and 2024. Salient medical literatures regarding the cardiovascular damage of COVID-19 were selected, extracted and synthesized. RESULTS The most common cardiovascular damage was myocarditis and pericarditis, hypertension, arrhythmia, myocardial injury and heart failure, coronary heart disease, stress cardiomyopathy, ischemic stroke, blood coagulation abnormalities, and dyslipidemia. Two important pathogenic mechanisms of the cardiovascular damage may be direct viral cytotoxicity as well as indirect hyperimmune responses of the body to SARS CoV-2 infection. CONCLUSIONS Cardiovascular damage in COVID-19 patients is common and portends a worse prognosis. Although the underlying pathophysiological mechanisms of cardiovascular damage related to COVID-19 are not completely clear, two important pathogenic mechanisms of cardiovascular damage may be the direct damage of the SARSCoV-2 infection and the indirect hyperimmune responses.
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Affiliation(s)
- Hong-Hua Shao
- Department of Infectious Diseases, HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People's Hospital of Nanning, No. 1 Erli, Changgang Road, Nanning, Guangxi, 530023, People's Republic of China
| | - Rui-Xing Yin
- Department of Infectious Diseases, HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), The Fourth People's Hospital of Nanning, No. 1 Erli, Changgang Road, Nanning, Guangxi, 530023, People's Republic of China.
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, People's Republic of China.
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Chang O, Levitt A, Khalid M, Kodeeswaran S, Markoulakis R. The prevalence of mental health and addiction concerns and factors associated with depression and anxiety during the COVID-19 pandemic in Ontario, Canada: A cross-sectional study. PLoS One 2024; 19:e0305229. [PMID: 38865358 PMCID: PMC11168667 DOI: 10.1371/journal.pone.0305229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE Higher than expected rates of mental health and/or addiction (MHA) concerns have been documented since the onset of the COVID-19 pandemic. A more up-to-date prevalence of MHA outcomes and the factors associated with the occurrence of MHA concerns remains unclear. This study examined the prevalence of MHA outcomes and factors associated with screening positive for symptoms of depression only, anxiety only, and both depression and anxiety two years into the COVID-19 pandemic in Ontario, Canada. METHOD Ontario adults ≥18 years of age (n = 5000) reported on the presence of symptoms associated with depression, anxiety, and substance use between January and March 2022. Data were also collected on pandemic-related health variables, including COVID-19 infection fear, changes in socioeconomic status and mental health since pandemic onset, satisfaction with social supports, and MHA service needs. RESULTS The prevalence of positive screening for depressive or anxiety symptoms only was 8% and 11%, respectively, while 36% screened positive for both. Moderate/high risk levels of substance use were found in 20% of participants for tobacco and 17% for both alcohol and cannabis. Moderate/high risk levels of alcohol use and certain pandemic-related factors (negative change in mental health, unmet MHA service needs) were associated with positive screening for symptoms of depression only, anxiety only, and both depression and anxiety. Satisfaction with social supports was associated with lower likelihoods of being in the depression only and both depression and anxiety groups, and non-White ethnicity was associated with depression only. CONCLUSIONS There was a continued burden of MHA issues two years into the pandemic. These results underscore the ongoing need for timely and accessible MHA services.
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Affiliation(s)
- Oswin Chang
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program and Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Maida Khalid
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Roula Markoulakis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Humaira Amanullah F, Alam T, El Hajj N, Bejaoui Y. The impact of COVID-19 on "biological aging". Front Immunol 2024; 15:1399676. [PMID: 38919619 PMCID: PMC11197383 DOI: 10.3389/fimmu.2024.1399676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
The global impact of the SARS-CoV-2 pandemic has been unprecedented, posing a significant public health challenge. Chronological age has been identified as a key determinant for severe outcomes associated with SARS-CoV-2 infection. Epigenetic age acceleration has previously been observed in various diseases including human immunodeficiency virus (HIV), Cytomegalovirus (CMV), cardiovascular diseases, and cancer. However, a comprehensive review of this topic is still missing in the field. In this review, we explore and summarize the research work focusing on biological aging markers, i.e., epigenetic age and telomere attrition in COVID-19 patients. From the reviewed articles, we identified a consistent pattern of epigenetic age dysregulation and shortened telomere length, revealing the impact of COVID-19 on epigenetic aging and telomere attrition.
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Affiliation(s)
| | - Tanvir Alam
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Nady El Hajj
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Yosra Bejaoui
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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Woodward KF, Willgerodt M, Walsh E, Johnson S. Answering the call: Experiences of nurses of color during COVID-19. Nurs Inq 2024:e12647. [PMID: 38853419 DOI: 10.1111/nin.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024]
Abstract
In the years following the COVID-19 pandemic, issues such as high job demands, burnout, and turnover continue to influence the nursing workforce, with heavier impacts to marginalized groups. Understanding the work and life contexts of nurses of color can help guide strategies for workplace equity and meaningful support. This qualitative study explored the experiences of nurses of color in the United States during the pandemic, focusing on feelings about the profession and job decisions. The overarching theme was "answering the call," with subthemes of "COVID shone a light," "being consumed by COVID," and "is it worth it?" Participants shared how their racial identities shaped their perceptions and job decisions in positive and negative ways, noting how racism impacted many facets of their work and added to the stressors felt in the workplace and the community. Findings provide insight into the underrepresented perspectives of nurses of color and suggest strategies to eliminate racism in nursing.
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Affiliation(s)
- Kyla F Woodward
- Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Mayumi Willgerodt
- Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Elaine Walsh
- Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Susan Johnson
- Nursing and Healthcare Leadership, University of Washington, Tacoma, Washington, USA
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Pan D, Nishimura H, Tang JW. Information bias for case definitions and mortality between and within studies over time undermines our understanding of COVID-19 transmission and disease severity. Clin Microbiol Infect 2024; 30:700-702. [PMID: 38341144 DOI: 10.1016/j.cmi.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/28/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, United Kingdom; Development Centre for Population Health, University of Leicester, Leicester, United Kingdom; Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, United Kingdom.
| | - Hidekazu Nishimura
- Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan
| | - Julian W Tang
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom; Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Labossière S, Couture S, Laurier C, Lemieux A, Boudreault V. The progression and mechanisms of mental illness symptoms in university student-athletes during the COVID-19 pandemic. Stress Health 2024; 40:e3354. [PMID: 38047369 DOI: 10.1002/smi.3354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/09/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
A few studies have examined mental illness symptoms in university student-athletes during the COVID-19 pandemic, but the limited use of longitudinal design limits the understanding of the progression of these symptoms and the mechanisms by which they developed. The present research aims to describe the trajectory of variation of mental illness symptoms (anxiety, depression, alcohol consumption disorders, and eating disorders) throughout the pandemic, to test causality between perceived stress and symptoms, and to identify individual characteristics (sociodemographic, perceived stress, and social support) influencing the trajectories of mental illness symptoms. On three occasions during the pandemic, 211 university student-athletes were surveyed. Latent growth models and random intercept crossed-lagged panel models were performed. Results indicate that anxiety and depressive symptoms significantly decreased throughout the COVID-19 pandemic while alcohol consumption disorder symptoms significantly increased and eating disorder symptoms did not change significantly. Second, perceived stress was a significant cause of anxiety and depressive symptoms during this pandemic. Conversely, eating disorder symptoms significantly predicted perceived stress. Finally, average perceived stress and average social support availability throughout the COVID-19 pandemic, and identifying as a visible minority, significantly predicted the trajectory of depressive symptoms, allowing for the identification of a sub-population at higher risk. Based on these findings, teaching stress management strategies should be an essential component of programs to prevent mental illness symptoms in university student-athletes. Reducing environmental stressors and their consequences among this population should also be prioritised.
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Affiliation(s)
- Sophie Labossière
- Faculty of Education, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Sophie Couture
- Faculty of Education, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Laurier
- Faculty of Education, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Annie Lemieux
- Faculty of Education, University of Sherbrooke, Sherbrooke, Québec, Canada
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Gogoi M, Qureshi I, Chaloner J, Al-Oraibi A, Reilly H, Wobi F, Agbonmwandolor JO, Ekezie W, Hassan O, Lal Z, Kapilashrami A, Nellums L, Pareek M. Discrimination, disadvantage and disempowerment during COVID-19: a qualitative intrasectional analysis of the lived experiences of an ethnically diverse healthcare workforce in the United Kingdom. Int J Equity Health 2024; 23:105. [PMID: 38783292 PMCID: PMC11118759 DOI: 10.1186/s12939-024-02198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs' experiences of challenges during the pandemic. METHODS We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts. RESULTS Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as 'intrasectionalism'. DISCUSSION Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.
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Affiliation(s)
- Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Irtiza Qureshi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- The Nottingham Centre for Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - Jonathan Chaloner
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Holly Reilly
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Fatimah Wobi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Joy Oghogho Agbonmwandolor
- David Evans Medical Research Centre, Nottingham University Hospital NHS Trust, City Hospital, Nottingham, UK
| | - Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
| | - Osama Hassan
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Zainab Lal
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Anuj Kapilashrami
- School of Health and Social Care, University of Essex, Colchester, UK
- Centre for Global Health & Intersectional Equity Research, University of Essex, Colchester, UK
| | - Laura Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- College of Population Health, Health Sciences Centre, University of New Mexico, Albuquerque, NM, USA
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.
- Development Centre for Population Health, University of Leicester, Leicester, UK.
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
- NIHR Leicester BRC, Leicester, UK.
- NIHR ARC East Midlands, Leicester, UK.
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12
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Vercoutere A, Zina MJ, Telis M, Goffard JC, Boulvain M, de Doncker L, Derisbourg S, Houben S, Delforge ML, Daelemans C, Kelen D. Seroprevalence and placental transfer of SARS-CoV-2 antibodies in unvaccinated pregnant women. BMC Infect Dis 2024; 24:509. [PMID: 38773493 PMCID: PMC11110414 DOI: 10.1186/s12879-024-09399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
PURPOSE Pregnant women are at risk of severe SARS-CoV-2 infection, potentially leading to obstetric and neonatal complications. Placental transfer of antibodies directed to SARS-CoV-2 may be protective against neonatal COVID-19, but this remains to be studied. We aimed to determine the seroprevalence of SARS-CoV-2 antibodies in a population of unvaccinated pregnant women and to determine the placental transfer of these antibodies. METHODOLOGY A total of 1197 unvaccinated women with mostly unknown pre-study SARS-CoV-2 infection status, were tested at delivery for SARS-CoV-2 spike protein IgG antibodies during the first year of the pandemic. Umbilical cord samples were collected and assessed for seropositivity if the mother was seropositive. Maternal characteristics, pregnancy and neonatal outcomes and data on SARS-CoV-2 infection were extracted from medical records. RESULTS Specific IgG were detected in 258 women (21.6%). A significant placental transfer to the newborn was observed in 81.3% of cases. The earlier in the 2nd and 3rd trimesters that the mother had contracted the disease and the more symptomatic she was, the greater the likelihood of transplacental transfer of IgG to her newborn. CONCLUSION Approximately one in five women had detectable anti-SARS-CoV-2 spike protein IgG antibodies at delivery during the first year of the pandemic, and these antibodies were significantly transferred to their fetuses. This research provides further evidence to better understand the dynamics of the placental transfer of SARS-CoV-2 IgG antibodies from mothers to their newborns, which is necessary to improve vaccination strategies.
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Affiliation(s)
- An Vercoutere
- Department of Obstetrics and Gynaecology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B.), Route de Lennik 808, 1070, Brussels, Belgium.
| | | | - Meltem Telis
- Department of Neonatology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B.), Brussels, Belgium
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B.), Brussels, Belgium
| | - Michel Boulvain
- Department of Obstetrics and Gynaecology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B.), Route de Lennik 808, 1070, Brussels, Belgium
| | - Loïc de Doncker
- Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sara Derisbourg
- Department of Obstetrics and Gynaecology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B.), Route de Lennik 808, 1070, Brussels, Belgium
| | - Sylvie Houben
- Department of Obstetrics and Gynaecology, Hôpital Delta, Chirec Hospitals, Brussels, Belgium
| | - Marie-Luce Delforge
- National Reference Center for Congenital Infections, Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B.), Brussels, Belgium
| | - Caroline Daelemans
- Department of Woman, Child and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dorottya Kelen
- Department of Neonatology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B.), Brussels, Belgium
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13
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Thompson R, Brown L, Biswas Evans R, Mahbub R, Rees A, Wilson M, Dewa LH, Ward H, Toledano MB. Change, Adversity, and Adaptation: Young People's Experience of the COVID-19 Pandemic Expressed through Artwork and Semi-Structured Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:636. [PMID: 38791850 PMCID: PMC11121572 DOI: 10.3390/ijerph21050636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024]
Abstract
This study explores how young people's mental health was affected by the COVID-19 pandemic using artwork and semi-structured interviews. The mental health impacts of the pandemic are important to understand so that policy and practice professionals can support those affected, prepare and respond to future crises, and support young people who are isolated and restricted in other contexts. Co-designed participatory art workshops and interviews were conducted with 16-18-year-olds (n = 21, 62% female) from the London-based Longitudinal cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP). Artworks and interview transcripts were qualitatively co-and analysed with young people. From interviews, six themes were identified: adaptation, restriction, change, challenges, overcoming adversity, and lockdown life. From the artwork, four themes were identified: trapped, negative mental wellbeing, positive emotions, and technology. Everyday factors such as home environment, social support, hobbies, habits, and online education were key determinants of how challenged and restricted participants felt, and their capacity to overcome this. This demonstrates the importance of wider (social and environmental) determinants and supports a systems-level public health approach to young people's mental health. For example, young people's mental health services should collaborate with other sectors to address such determinants in a holistic way. Clearer guidance and support with occupation, relationships, environment, routine and activities could mitigate the negative mental health impacts of major environmental changes on young people.
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Affiliation(s)
- Rhiannon Thompson
- School of Public Health, Imperial College London, London W12 0BZ, UK; (R.T.); (H.W.)
- National Institute for Health and Care Research (NIHR), School for Public Health Research (SPHR), London, UK
- Medical Research Centre (MRC)—Centre for Environment and Health, School of Public Health, Imperial College London, London W12 0BZ, UK
| | - Lucy Brown
- School of Public Health, Imperial College London, London W12 0BZ, UK; (R.T.); (H.W.)
- Medical Research Centre (MRC)—Centre for Environment and Health, School of Public Health, Imperial College London, London W12 0BZ, UK
- Institute of Zoology, Zoological Society, London NW1 4RY, UK
| | - Rakhi Biswas Evans
- School of Public Health, Imperial College London, London W12 0BZ, UK; (R.T.); (H.W.)
- Medical Research Centre (MRC)—Centre for Environment and Health, School of Public Health, Imperial College London, London W12 0BZ, UK
| | | | - Amelia Rees
- Public Contributor, Imperial College, London, UK
| | - Molly Wilson
- Independent Consultant, London, UK;
- The Royal Central School of Speech and Drama, London NW3 3HY, UK
| | - Lindsay H. Dewa
- School of Public Health, Imperial College London, London W12 0BZ, UK; (R.T.); (H.W.)
- NIHR Imperial Biomedical Research Centre (BRC), Imperial College London, London W2 1NY, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London W12 0BZ, UK; (R.T.); (H.W.)
- NIHR Imperial Biomedical Research Centre (BRC), Imperial College London, London W2 1NY, UK
- NIHR Applied Research Collaboration North West London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Mireille B. Toledano
- School of Public Health, Imperial College London, London W12 0BZ, UK; (R.T.); (H.W.)
- Medical Research Centre (MRC)—Centre for Environment and Health, School of Public Health, Imperial College London, London W12 0BZ, UK
- Mohn Centre for Children’s Health and Wellbeing, School of Public Health, Imperial College London, London W12 0BZ, UK
- NIHR Health Protection Research Unit (HPRU) in Environmental Exposures and Health, School of Public Health, Imperial College London, London W12 0BZ, UK
- NIHR HPRU in Chemical and Radiation Threats and Hazards, School of Public Health, Imperial College London, London W12 0BZ, UK
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14
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Ottaway Z, Campbell L, Cechin LR, Patel N, Fox J, Burns F, Hamzah L, Kegg S, Rosenvinge M, Schoeman S, Price D, Jones R, Clarke A, Maan I, Ustianowski A, Onyango D, Tariq S, Miller RF, Post FA. Clinical epidemiology of COVID-19 in people of black ethnicity living with HIV in the UK. HIV Med 2024; 25:614-621. [PMID: 38213094 DOI: 10.1111/hiv.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To describe the clinical epidemiology of COVID-19 in people of black ethnicity living with HIV in the UK. METHODS We investigated the incidence and factors associated with COVID-19 in a previously established and well-characterized cohort of black people with HIV. Primary outcomes were COVID-19 acquisition and severe COVID-19 disease (requiring hospitalization and/or resulting in death). Cumulative incidence was analysed using Nelson-Aalen methods, and associations between demographic, pre-pandemic immune-virological parameters, comorbidity status and (severe) COVID-19 were identified using Cox regression analysis. RESULTS COVID-19 status was available for 1847 (74%) of 2495 COVID-AFRICA participants (median age 49.6 years; 56% female; median CD4 cell count = 555 cells/μL; 93% HIV RNA <200 copies/mL), 573 (31%) of whom reported at least one episode of COVID-19. The cumulative incidence rates of COVID-19 and severe COVID-19 were 31.0% and 3.4%, respectively. Region of ancestry (East/Southern/Central vs. West Africa), nadir CD4 count and kidney disease were associated with COVID-19 acquisition. Diabetes mellitus [adjusted hazard ratio (aHR) = 2.39, 95% confidence interval (CI): 1.26-4.53] and kidney disease (aHR = 2.53, 95% CI: 1.26-4.53) were associated with an increased risk, and recent CD4 count >500 cells/μL (aHR = 0.49, 95% CI: 0.25-0.93) with a lower risk of severe COVID-19. CONCLUSIONS Region of ancestry was associated with COVID-19 acquisition, and immune and comorbidity statuses were associated with COVID-19 disease severity in people of black ethnicity living with HIV in the UK.
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Affiliation(s)
- Zoe Ottaway
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Lucy Campbell
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Laura R Cechin
- King's College Hospital NHS Foundation Trust, London, UK
| | - Nisha Patel
- King's College Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- King's College London, London, UK
- Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Fiona Burns
- Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, University College London, London, UK
| | - Lisa Hamzah
- St George's University Hospital NHS Foundation Trust, London, UK
| | | | | | | | - David Price
- Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Rachael Jones
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Amanda Clarke
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Irfaan Maan
- Institute for Global Health, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Shema Tariq
- Institute for Global Health, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
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15
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Mayer-Suess L, Marto JP, Strambo D, Ntaios G, Nguyen T, Kiechl S, Pechlaner R, Nogueira R, Michel P, Knoflach M. Sex differences in acute stroke metrics and outcome dependent on COVID status. Eur J Neurol 2024; 31:e16221. [PMID: 38288522 DOI: 10.1111/ene.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/10/2023] [Accepted: 01/09/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE Biological sex is known to have an impact on quality metrics of acute stroke. We aimed to determine whether COVID positivity accentuates this effect and constitutes worse outcome. METHODS The present analysis was based on the Global COVID-19 Stroke Registry, a retrospective, international, cohort study of consecutive ischemic stroke patients receiving intravenous thrombolysis and/or endovascular thrombectomy between 1 March 2020 and 30 June 2021. We investigated differences between the sexes in patient characteristics, acute stroke metrics as well as post-stroke outcome in COVID-positive and COVID-negative stroke patients undergoing acute revascularization procedures. RESULTS A total of 15,128 patients from 106 centers were recorded in the Global COVID-19 Stroke Registry, 853 (5.6%) of whom were COVID-positive. Overall, COVID-positive individuals were treated significantly slower according to every acute stroke metric compared to COVID-negative patients. We were able to show that key quality indicators in acute stroke treatment were unfavorable for COVID-negative women compared to men (last-seen-well-to-door time + 11 min in women). Furthermore, COVID-negative women had worse 3-month outcomes (3-month modified Rankin Scale score [interquartile range] 3.0 [4.0] vs. 2.0 [3.0]; p < 0.01), even after adjusting for confounders. In COVID-positive individuals no such difference between the sexes, either in acute management metrics or in 3-month outcome, was seen. CONCLUSION Known sex-related differences in acute stroke management exist and extend to times of crisis. Nevertheless, if patients were COVID-19-positive at stroke onset, women and men were treated the same, which could be attributed to structured treatment pathways.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Davide Strambo
- Stroke Centre, Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Lausanne, Switzerland
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Thanh Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raul Nogueira
- Departments of Radiology, Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Patrik Michel
- Stroke Centre, Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
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16
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Maduro G, Li W, Huynh M, Bernard-Davila B, Gould LH, Van Wye G. Descriptive study of causes of death and COVID-19-associated morbidities from the New York City electronic death record: first wave of the pandemic March-July 2020. BMJ Open 2024; 14:e072441. [PMID: 38569678 PMCID: PMC11146393 DOI: 10.1136/bmjopen-2023-072441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Assessing excess deaths from benchmarks across causes of death during the first wave of the COVID-19 pandemic and identifying morbidities most frequently mentioned alongside COVID-19 deaths in the death record. METHODS Descriptive study of death records between 11 March 2020 and 27 July 2020, from the New York City Bureau of Vital Statistics. Mortality counts and percentages were compared with the average for the same calendar period of the previous 2 years. Distributions of morbidities from among forty categories of conditions were generated citywide and by sex, race/ethnicity and four age groups. Causes of death were assumed to follow Poisson processes for Z-score construction. RESULTS Within the study period, 46 563 all-cause deaths were reported; 132.9% higher than the average for the same period of the previous 2 years (19 989). Of those 46 563 records, 19 789 (42.5%) report COVID-19 as underlying cause of death. COVID-19 was the most prevalent cause across all demographics, with respiratory conditions (prominently pneumonia), hypertension and diabetes frequently mentioned morbidities. Black non-Hispanics had greater proportions of mentions of pneumonia, hypertension, and diabetes. Hispanics had the largest proportion of COVID-19 deaths (52.9%). Non-COVID-19 excess deaths relative to the previous 2-year averages were widely reported. CONCLUSION Mortality directly due to COVID-19 was accompanied by significant increases across most other causes from their reference averages, potentially suggesting a sizable COVID-19 death undercount. Indirect effects due to COVID-19 may partially account for some increases, but findings are hardly dispositive. Unavailability of vaccines for the time period precludes any impact over excess deaths. Respiratory and cardiometabolic-related conditions were most frequently reported among COVID-19 deaths across demographic characteristics.
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Affiliation(s)
- Gil Maduro
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Wenhui Li
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Mary Huynh
- Institute for State and Local Governance, City University of New York, New York, New York, USA
| | - Blanca Bernard-Davila
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - L Hannah Gould
- Bureau of Epidemiologic Services, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Gretchen Van Wye
- Assistant Commissioner, Bureau of Vital Statistics, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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17
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Singh G, Tuczinski CM, Thatipelly RS, Aminy H, Tahir N. COVID-19 Predictors of Morbidity and Mortality. Cureus 2024; 16:e59017. [PMID: 38800341 PMCID: PMC11127750 DOI: 10.7759/cureus.59017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/29/2024] Open
Abstract
Background and objectives There are multiple factors and comorbid conditions that can impact the outcomes of COVID-19. This study aimed to assess how patients with certain comorbidities and risk factors were affected by COVID-19. Methodology This retrospective study involved 578 inpatients who presented to the emergency room (ER) due to COVID-19 infection, diagnosed with COVID-19 between 2020 and 2021. This research takes note of COVID-19 severity, particularly in individuals with comorbidities such as chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), chronic kidney disease (CKD), coronary artery disease (CAD), and hypertension. Results A two-sample t-test found that age was a significant factor affecting hospital length of stay (LOS) and mortality. An ANOVA analysis of race, DM, and CAD showed a significant effect on LOS (p-values = 0.005, 0.01, and 0.01, respectively) but not on mortality and intubation. White patients had an increased LOS compared to other ethnicities. CKD and hypertension significantly affect mortality and LOS. However, COPD did significantly influence all three variables: mortality, intubation, and LOS (p-values = 0.005, 0.013, and 0.01, respectively). A multiple ANOVA test showed that COPD, hypertension, and CKD had a significant effect on mortality, intubation, and LOS (p-values = 0.014, 0.004, and 0.01, respectively). DM showed weaker significance on mortality, intubation, and LOS (p-value = 0.108). Conclusions Patients with all three comorbid conditions (COPD, hypertension, and CKD) had increased length of stay, intubation, and mortality; thus, appropriate measures including close observation and early intervention may be necessary to prevent mortality in these patients.
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Affiliation(s)
- Gurdeep Singh
- Endocrinology, Diabetes, and Metabolism, Our Lady of Lourdes Memorial Hospital, Binghamton, USA
| | - Caroline M Tuczinski
- Endocrinology, Harpur College of Arts and Sciences, Binghamton University, Binghamton, USA
| | - Reshma S Thatipelly
- Endocrinology, Harpur College of Arts and Sciences, Binghamton University, Binghamton, USA
| | - Habib Aminy
- Family Medicine, Our Lady of Lourdes Memorial Hospital, Binghamton, USA
| | - Numair Tahir
- Family Medicine, Our Lady of Lourdes Memorial Hospital, Binghamton, USA
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18
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Fontaine G, Smith M, Langmuir T, Mekki K, Ghazal H, Noad EE, Buchan J, Dubey V, Patey AM, McCleary N, Gibson E, Wilson M, Alghamyan A, Zmytrovych K, Thompson K, Crawshaw J, Grimshaw JM, Arnason T, Brehaut J, Michie S, Brouwers M, Presseau J. One size doesn't fit all: methodological reflections in conducting community-based behavioural science research to tailor COVID-19 vaccination initiatives for public health priority populations. BMC Public Health 2024; 24:784. [PMID: 38481197 PMCID: PMC10936009 DOI: 10.1186/s12889-024-18270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Promoting the uptake of vaccination for infectious diseases such as COVID-19 remains a global challenge, necessitating collaborative efforts between public health units (PHUs) and communities. Applied behavioural science can play a crucial role in supporting PHUs' response by providing insights into human behaviour and informing tailored strategies to enhance vaccination uptake. Community engagement can help broaden the reach of behavioural science research by involving a more diverse range of populations and ensuring that strategies better represent the needs of specific communities. We developed and applied an approach to conducting community-based behavioural science research with ethnically and socioeconomically diverse populations to guide PHUs in tailoring their strategies to promote COVID-19 vaccination. This paper presents the community engagement methodology and the lessons learned in applying the methodology. METHODS The community engagement methodology was developed based on integrated knowledge translation (iKT) and community-based participatory research (CBPR) principles. The study involved collaboration with PHUs and local communities in Ontario, Canada to identify priority groups for COVID-19 vaccination, understand factors influencing vaccine uptake and co-design strategies tailored to each community to promote vaccination. Community engagement was conducted across three large urban regions with individuals from Eastern European communities, African, Black, and Caribbean communities and low socioeconomic neighbourhoods. RESULTS We developed and applied a seven-step methodology for conducting community-based behavioural science research: (1) aligning goals with system-level partners; (2) engaging with PHUs to understand priorities; (3) understanding community strengths and dynamics; (4) building relationships with each community; (5) establishing partnerships (community advisory groups); (6) involving community members in the research process; and (7) feeding back and interpreting research findings. Research partnerships were successfully established with members of prioritized communities, enabling recruitment of participants for theory-informed behavioural science interviews, interpretation of findings, and co-design of targeted recommendations for each PHU to improve COVID-19 vaccination uptake. Lessons learned include the importance of cultural sensitivity and awareness of sociopolitical context in tailoring community engagement, being agile to address the diverse and evolving priorities of PHUs, and building trust to achieve effective community engagement. CONCLUSION Effective community engagement in behavioural science research can lead to more inclusive and representative research. The community engagement approach developed and applied in this study acknowledges the diversity of communities, recognizes the central role of PHUs, and can help in addressing complex public health challenges.
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Affiliation(s)
- Guillaume Fontaine
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | | | - Tori Langmuir
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Karim Mekki
- Ottawa Public Health, 100 Constellation Dr, Nepean, ON, K2G 6J8, Canada
| | - Hanan Ghazal
- Ottawa Public Health, 100 Constellation Dr, Nepean, ON, K2G 6J8, Canada
| | | | - Judy Buchan
- Peel Public Health, 7120 Hurontario St, Mississauga, ON, L5W 1N4, Canada
| | - Vinita Dubey
- Toronto Public Health, City Hall, 100 Queen St W, Toronto, ON, M5H 2N2, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada
| | - Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Emily Gibson
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Mackenzie Wilson
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | | | | | | | - Jacob Crawshaw
- McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Trevor Arnason
- Ottawa Public Health, 100 Constellation Dr, Nepean, ON, K2G 6J8, Canada
| | - Jamie Brehaut
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Susan Michie
- Centre for Behaviour Change, University College London, Gower St, London, WC1E 6BT, UK
| | - Melissa Brouwers
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
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19
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Tondel M, Nordquist T, Helgesson M, Svartengren M. COVID-19: incidence and mortality in Sweden comparing all foreign-born to all Swedish-born individuals in different occupations in an unvaccinated cohort of year 2020. Occup Environ Med 2024; 81:136-141. [PMID: 38267211 PMCID: PMC10958322 DOI: 10.1136/oemed-2023-108952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The aim was to analyse the incidence and mortality of COVID-19 in immigrants compared with Swedish born in inpatients and outpatient registers, respectively. METHODS The study population included all persons 20-88 years of age living in Sweden, 31 December 2019, including 1 676 516 foreign-born persons and 6 037 151 Swedish-born persons. The outcome was clinical cases of COVID-19 with a positive PCR test (ICD-10 U07.01) or without a positive PCR test (U07.2) from 1 January to 31 December 2020. Persons 20-64 years of age were classified with occupational titles according to the Swedish Standard Classification of Occupations. Residing municipality of each individual was coded according to the Swedish Association of Local Authorities. Relative risks (RR) were calculated by sex in 5 years age bands using Swedish born as reference. Age-adjusted RRs (adj RR) with 95% CIs were calculated in a Poisson regression model. Rural municipalities were used as the reference category. RESULTS Foreign born had consistently higher RRs in COVID-19, regardless of sex, with a peak in 50-69 years of age. Foreign born had a higher RR of death in COVID-19 above 50 years and 40 years of age in women and men, respectively. Among occupations, male drivers had the highest adj RR 4.37 (95% CI 3.45 to 5.54) and 5.09 (4.26 to 6.07) in outpatients and inpatients, respectively (U07.1). Persons living in commuting municipalities did not show any consistent increased risk for COVID-19. CONCLUSION Foreign born have a higher risk of COVID-19 compared with Swedish-born individuals at any age and occupation before vaccination began in 2021.
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Affiliation(s)
- Martin Tondel
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Tobias Nordquist
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Magnus Helgesson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Health Equity and Working Life, Uppsala University, Uppsala, Sweden
| | - Magnus Svartengren
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
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20
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Jackson SE, Shahab L, Brown J. Trends in Exclusive Non-Cigarette Tobacco Smoking in England: A Population Survey 2013-2023. Nicotine Tob Res 2024:ntae021. [PMID: 38439612 DOI: 10.1093/ntr/ntae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION The UK Government intends to implement a "smokefree generation" policy prohibiting the sale of all tobacco products to people born after 2008. National surveys provide comprehensive data on cigarette smoking, but little is known about patterns of non-cigarette tobacco smoking across key population groups. AIMS AND METHODS Using data from a nationally representative cross-sectional survey of adults in England, collected monthly between September 2013 and September 2023 (n = 196 721), we estimated time trends in exclusive non-cigarette tobacco (eg, cigar/pipe/shisha) smoking prevalence, overall and by age, gender, occupational social grade, region, ethnicity, and vaping status. Interviews were conducted face-to-face until March 2020 and via telephone thereafter. RESULTS From September 2013 to September 2023, there was a non-linear increase in exclusive non-cigarette tobacco smoking prevalence (from 0.36% to 1.68%; prevalence ratio = 4.72 [95% CI = 3.43-6.48]). Prevalence was relatively stable up to February 2020 (at an average of 0.46%), then increased sharply at the start of the COVID-19 pandemic (at the same time as survey methods changed), to 0.90% (0.82%-0.99%) in March 2020. This was followed by a steadier rise, peaking at 1.97% in May 2022, before falling slightly to 1.68% by September 2023. In 2022/2023, 1 in 10 smokers (10.8% [9.64%-12.0%]) exclusively used non-cigarette tobacco. The rise in prevalence was observed across all subgroups but was most pronounced among younger adults (eg, reaching 3.21% of 18-year-olds vs. 1.09% of 65-year-olds). Prevalence was consistently higher among men and current vapers. CONCLUSIONS Although exclusive use of non-cigarette combustible tobacco remains rare among adults in England, it has increased in recent years, particularly among younger ages. As of September 2023, there were approximately 772 800 adult exclusive non-cigarette tobacco smokers in England; around five times more than a decade earlier. IMPLICATIONS The proportion of adults in England who do not use cigarettes at all but smoke other combustible tobacco products has increased substantially in recent years, with a particularly pronounced rise among young people. The inclusion of non-cigarette combustible tobacco products under the proposed "smokefree generation" policy is therefore likely to be important for achieving the greatest reduction in youth uptake of tobacco smoking, as it would ensure young people who are unable to legally buy cigarettes do not buy other combustible tobacco products that are similarly harmful to health.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
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21
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Khedmati Morasae E, Derbyshire DW, Amini P, Ebrahimi T. Social determinants of spatial inequalities in COVID-19 outcomes across England: A multiscale geographically weighted regression analysis. SSM Popul Health 2024; 25:101621. [PMID: 38420111 PMCID: PMC10899060 DOI: 10.1016/j.ssmph.2024.101621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
A variety of factors are associated with greater COVID-19 morbidity or mortality, due to how these factors influence exposure to (in the case of morbidity) or severity of (in the case of mortality) COVID-19 infections. We use multiscale geographically weighted regression to study spatial variation in the factors associated with COVID-19 morbidity and mortality rates at the local authority level across England (UK). We investigate the period between March 2020 and March 2021, prior to the rollout of the COVID-19 vaccination program. We consider a variety of factors including demographic (e.g. age, gender, and ethnicity), health (e.g. rates of smoking, obesity, and diabetes), social (e.g. Index of Multiple Deprivation), and economic (e.g. the Gini coefficient and economic complexity index) factors that have previously been found to impact COVID-19 morbidity and mortality. The Index of Multiple Deprivation has a significant impact on COVID-19 cases and deaths in all local authorities, although the effect is the strongest in the south of England. Higher proportions of ethnic minorities are associated with higher levels of COVID-19 mortality, with the strongest effect being found in the west of England. There is again a similar pattern in terms of cases, but strongest in the north of the country. Other factors including age and gender are also found to have significant effects on COVID-19 morbidity and mortality, with differential spatial effects across the country. The results provide insights into how national and local policymakers can take account of localized factors to address spatial health inequalities and address future infectious disease pandemics.
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Affiliation(s)
- Esmaeil Khedmati Morasae
- Research Fellow in Operational Research, Exeter University Business School, University of Exeter, UK
| | - Daniel W. Derbyshire
- Department of Public Health and Sports Science, Faculty of Health and Life Science, University of Exeter, UK
| | - Payam Amini
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Tahera Ebrahimi
- Lecturer in Finance, Business School, Manchester Metropolitan University, UK
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22
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Seamon E, Ridenhour BJ, Miller CR, Johnson-Leung J. Spatial Modeling of Sociodemographic Risk for COVID-19 Mortality. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.07.21.23292785. [PMID: 37546990 PMCID: PMC10402221 DOI: 10.1101/2023.07.21.23292785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
In early 2020, the Coronavirus Disease 19 (COVID-19) rapidly spread across the United States (US), exhibiting significant geographic variability. While several studies have examined the predictive relationships of differing factors on COVID-19 deaths, few have looked at spatiotemporal variation at refined geographic scales. The objective of this analysis is to examine this spatiotemporal variation in COVID-19 deaths with respect to association with socioeconomic, health, demographic, and political factors. We use multivariate regression applied to Health and Human Services (HHS) regions as well as nationwide county-level geographically weighted random forest (GWRF) models. Analyses were performed on data from three separate time frames which correspond to the spread of distinct viral variants in the US: pandemic onset until May 2021, May 2021 through November 2021, and December 2021 until April 2022. Multivariate regression results for all regions across three time windows suggest that existing measures of social vulnerability for disaster preparedness (SVI) are predictive of a higher degree of mortality from COVID-19. In comparison, GWRF models provide a more robust evaluation of feature importance and prediction, exposing the value of local features for prediction, such as obesity, which is obscured by coarse-grained analysis. Overall, GWRF results indicate that this more nuanced modeling strategy is useful for determining the spatial variation in the importance of sociodemographic risk factors for predicting COVID-19 mortality.
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Affiliation(s)
- Erich Seamon
- University of Idaho, Institute for Modeling, Collaboration, and Innovation, Moscow, 83843, USA
| | - Benjamin J. Ridenhour
- University of Idaho, Institute for Modeling, Collaboration, and Innovation, Moscow, 83843, USA
- University of Idaho, Department of Mathematics and Statistical Science, Moscow, 83843, USA
| | - Craig R. Miller
- University of Idaho, Institute for Modeling, Collaboration, and Innovation, Moscow, 83843, USA
- University of Idaho, Department of Biological Sciences, Moscow, 83843, USA
| | - Jennifer Johnson-Leung
- University of Idaho, Institute for Modeling, Collaboration, and Innovation, Moscow, 83843, USA
- University of Idaho, Department of Mathematics and Statistical Science, Moscow, 83843, USA
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23
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Fong WLE, Nguyen VG, Burns R, Boukari Y, Beale S, Braithwaite I, Byrne TE, Geismar C, Fragaszy E, Hoskins S, Kovar J, Navaratnam AMD, Oskrochi Y, Patel P, Tweed S, Yavlinsky A, Hayward AC, Aldridge RW. The incidence of COVID-19-related hospitalisation in migrants in the UK: Findings from the Virus Watch prospective community cohort study. J Migr Health 2024; 9:100218. [PMID: 38559897 PMCID: PMC10978526 DOI: 10.1016/j.jmh.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/11/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Background Migrants in the United Kingdom (UK) may be at higher risk of SARS-CoV-2 exposure; however, little is known about their risk of COVID-19-related hospitalisation during waves 1-3 of the pandemic. Methods We analysed secondary care data linked to Virus Watch study data for adults and estimated COVID-19-related hospitalisation incidence rates by migration status. To estimate the total effect of migration status on COVID-19 hospitalisation rates, we ran mixed-effect Poisson regression for wave 1 (01/03/2020-31/08/2020; wildtype), and mixed-effect negative binomial regressions for waves 2 (01/09/2020-31/05/2021; Alpha) and 3 (01/06/2020-31/11/2021; Delta). Results of all models were then meta-analysed. Results Of 30,276 adults in the analyses, 26,492 (87.5 %) were UK-born and 3,784 (12.5 %) were migrants. COVID-19-related hospitalisation incidence rates for UK-born and migrant individuals across waves 1-3 were 2.7 [95 % CI 2.2-3.2], and 4.6 [3.1-6.7] per 1,000 person-years, respectively. Pooled incidence rate ratios across waves suggested increased rate of COVID-19-related hospitalisation in migrants compared to UK-born individuals in unadjusted 1.68 [1.08-2.60] and adjusted analyses 1.35 [0.71-2.60]. Conclusion Our findings suggest migration populations in the UK have excess risk of COVID-19-related hospitalisations and underscore the need for more equitable interventions particularly aimed at COVID-19 vaccination uptake among migrants.
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Affiliation(s)
- Wing Lam Erica Fong
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Vincent G Nguyen
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Sarah Beale
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Isobel Braithwaite
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Thomas E Byrne
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Ellen Fragaszy
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Jana Kovar
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Annalan MD Navaratnam
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Youssof Oskrochi
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Parth Patel
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Sam Tweed
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London NW1 2DA, UK
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24
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Williams MK, Crawford CA, Zapolski TC, Hirsh AT, Stewart JC. Longer-Term Mental Health Consequences of COVID-19 Infection: Moderation by Race and Socioeconomic Status. Int J Behav Med 2024:10.1007/s12529-024-10271-9. [PMID: 38396274 DOI: 10.1007/s12529-024-10271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE While evidence suggests that the mental health symptoms of COVID-19 can persist for several months following infection, little is known about the longer-term mental health effects and whether certain sociodemographic groups may be particularly impacted. This cross-sectional study aimed to characterize the longer-term mental health consequences of COVID-19 infection and examine whether such consequences are more pronounced in Black people and people with lower socioeconomic status. METHODS 277 Black and White adults (age ≥ 30 years) with a history of COVID-19 (tested positive ≥ 6 months prior to participation) or no history of COVID-19 infection completed a 45-minute online questionnaire battery. RESULTS People with a history of COVID-19 had greater depressive (d = 0.24), anxiety (d = 0.34), post-traumatic stress disorder (PTSD) (d = 0.32), and insomnia (d = 0.31) symptoms than those without a history of COVID-19. These differences remained for anxiety, PTSD, and insomnia symptoms after adjusting for age, sex, race, education, income, employment status, body mass index, and smoking status. No differences were detected for perceived stress and general psychopathology. People with a history of COVID-19 had more than double the odds of clinically significant symptoms of anxiety (OR = 2.22) and PTSD (OR = 2.40). Education, but not race, income, or employment status, moderated relationships of interest such that COVID-19 status was more strongly and positively associated with all the mental health outcomes for those with fewer years of education. CONCLUSION The mental health consequences of COVID-19 may be significant, widespread, and persistent for at least 6 months post-infection and may increase as years of education decreases.
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Affiliation(s)
- Michelle K Williams
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA
| | - Christopher A Crawford
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA
| | - Tamika C Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD100E, 46202, Indianapolis, IN, USA.
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25
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Amele S, McCabe R, Kibuchi E, Pearce A, Hainey K, Demou E, Irizar P, Kapadia D, Taylor H, Nazroo J, Bécares L, Buchanan D, Henery P, Jayacodi S, Woolford L, Simpson CR, Sheikh A, Jeffrey K, Shi T, Daines L, Tibble H, Almaghrabi F, Fagbamigbe AF, Kurdi A, Robertson C, Pattaro S, Katikireddi SV. Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study. J Public Health (Oxf) 2024; 46:116-122. [PMID: 37861114 PMCID: PMC10901260 DOI: 10.1093/pubmed/fdad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census. METHODS Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group. RESULTS Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL. CONCLUSIONS Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health.
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Affiliation(s)
- Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow G12 8TB, UK
| | - Ronan McCabe
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow G12 8TB, UK
| | - Eliud Kibuchi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow G12 8TB, UK
| | - Anna Pearce
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow G12 8TB, UK
| | - Kirsten Hainey
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow G12 8TB, UK
| | - Evangelia Demou
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow G12 8TB, UK
| | - Patricia Irizar
- Department of Sociology, School of Social Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Dharmi Kapadia
- Department of Sociology, School of Social Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Harry Taylor
- Department of Sociology, School of Social Sciences, University of Manchester, Manchester M13 9PL, UK
| | - James Nazroo
- Department of Sociology, School of Social Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Laia Bécares
- Department of Global Health & Medicine, King's College London, London WC2B 4BG, UK
| | | | | | | | - Lana Woolford
- Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Karen Jeffrey
- Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Ting Shi
- Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Holly Tibble
- Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | | | - Adeniyi Francis Fagbamigbe
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Kurditsan Region Governorate, Erbil, Iraq
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Chris Robertson
- Public Health Scotland, Glasgow G2 6QE, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK
| | - Serena Pattaro
- Scottish Centre for Administrative Data Research, School of Social Political Sciences, University of Glasgow, Glasgow EH16 4UX, UK
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26
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Senthinathan A, Cimino S, Jaglal SB, Craven BC, Tu K, Guilcher S. The impact of the COVID-19 virus and pandemic on healthcare utilization, access, delivery, experiences, and outcomes in the spinal cord injuries/dysfunction population: A scoping review study. PLoS One 2024; 19:e0297384. [PMID: 38386642 PMCID: PMC10883570 DOI: 10.1371/journal.pone.0297384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Individuals with spinal cord injuries or disease (SCI/D) require frequent healthcare services. The COVID-19 pandemic may have impacted healthcare. Furthermore, due to secondary health conditions and comorbidities persons with SCI/D are at increased risk of experiencing severe symptoms or outcomes if infected with the COVID-19 virus. It is unclear to what extent research has investigated the pandemic and virus impacts on the SCI/D population. OBJECTIVE To identify and summarize what is reported in the literature on the impact the COVID-19 virus and pandemic had on healthcare, health outcomes, and experiences in the adult SCI/D population. METHODS Electronic databases and grey literature were searched for articles that included an adult population with a SCI/D and investigated the impact the COVID-19 virus and pandemic had on healthcare-related outcomes and experiences. Articles were double screened, and data were extracted, and synthesized to provide a descriptive summary of the findings. RESULTS Twenty-four studies were included in this review with eight qualitative, fifteen quantitative, and one mixed methods study. Sixteen studies investigated healthcare utilization/access; nine investigated care delivery, nine investigated patient outcomes, and eight investigated patient experiences, with multiple studies spanning different categories of investigation. The pandemic was detrimental to healthcare utilization, access, and outcomes, but no studies quantified these changes. Virtual care was well-received by the SCI/D population to maintain continuity of care. The SCI/D population had issues with maintaining caregiving support. It was unclear if the COVID-19 virus infection impacted individuals with SCI/D differently than the general population. CONCLUSIONS This scoping review found the pandemic negatively impacted multiple aspects of healthcare in individuals with SCI/D, however further investigation on health outcomes is required. More research, particularly large-scale quantitative studies, investigating healthcare access, utilization, and delivery, as well as patient outcomes and experiences is needed to improve care in the SCI/D population post-pandemic onset.
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Affiliation(s)
- Arrani Senthinathan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Cimino
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Sara Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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27
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Kunz M, Rott KW, Hurwitz E, Kunisaki K, Sun J, Wilkins KJ, Islam JY, Patel R, Safo SE. The Intersections of COVID-19, HIV, and Race/Ethnicity: Machine Learning Methods to Identify and Model Risk Factors for Severe COVID-19 in a Large U.S. National Dataset. AIDS Behav 2024:10.1007/s10461-024-04266-6. [PMID: 38326668 DOI: 10.1007/s10461-024-04266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
We investigate risk factors for severe COVID-19 in persons living with HIV (PWH), including among racialized PWH, using the U.S. population-sampled National COVID Cohort Collaborative (N3C) data released from January 1, 2020 to October 10, 2022. We defined severe COVID-19 as hospitalized with invasive mechanical ventilation, extracorporeal membrane oxygenation, discharge to hospice or death. We used machine learning methods to identify highly ranked, uncorrelated factors predicting severe COVID-19, and used multivariable logistic regression models to assess the associations of these variables with severe COVID-19 in several models, including race-stratified models. There were 3 241 627 individuals with incident COVID-19 cases and 81 549 (2.5%) with severe COVID-19, of which 17 445 incident COVID-19 and 1 020 (5.8%) severe cases were among PWH. The top highly ranked factors of severe COVID-19 were age, congestive heart failure (CHF), dementia, renal disease, sodium concentration, smoking status, and sex. Among PWH, age and sodium concentration were important predictors of COVID-19 severity, and the effect of sodium concentration was more pronounced in Hispanics (aOR 4.11 compared to aOR range: 1.47-1.88 for Black, White, and Other non-Hispanics). Dementia, CHF, and renal disease was associated with higher odds of severe COVID-19 among Black, Hispanic, and Other non-Hispanics PWH, respectively. Our findings suggest that the impact of factors, especially clinical comorbidities, predictive of severe COVID-19 among PWH varies by racialized groups, highlighting a need to account for race and comorbidity burden when assessing the risk of PWH developing severe COVID-19.
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Affiliation(s)
- Miranda Kunz
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, MN, USA
| | - Kollin W Rott
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, MN, USA
| | - Eric Hurwitz
- Institute of Molecular Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ken Kunisaki
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth J Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jessica Y Islam
- Cancer Epidemiology Program, Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rena Patel
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandra E Safo
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, MN, USA.
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, 2221 University Avenue SE, Suite 200, Minneapolis, MN, USA.
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28
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Karaman F, Genc A, Yerebakan Sen AN, Rashidi M, Yildirim G, Unsal Jafarov G, Acar R, Saygin Sahin B. Effects of love glove application on vital signs for COVID-19 patients in the intensive care unit. Nurs Open 2024; 11:e2106. [PMID: 38391100 PMCID: PMC10847619 DOI: 10.1002/nop2.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/11/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To evaluate the effects of love glove application on vital signs for COVID-19 patients in the intensive care unit. DESIGN A single-group pretest-posttest quasi-experimental design was used. TREND Statement Checklist was followed during the present study. METHODS The study was conducted on 30 intubated/extubated adult patients. The gloves were filled with warm water and air to prevent pressure injuries. Then they were tied together and applied to both hands of the patient for 30 min. The patient's vital signs were recorded before and after the application. A Wilcoxon signed-rank test was performed. RESULTS It was determined that respiratory rate, systolic blood pressure, diastolic blood pressure and oxygen saturation were significantly affected after the application of the love glove. The application of love gloves is a cheap and non-pharmacological method with no side effects. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the design and conduct of this study.
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Affiliation(s)
- Funda Karaman
- Department of Nursing, Faculty of Health SciencesBiruni UniversityIstanbulTurkey
| | - Asli Genc
- Department of Nursing, School of NursingUfuk UniversityAnkaraTurkey
| | - Ayse Nur Yerebakan Sen
- Department of Surgical Nursing, Institute of Graduate StudiesIstanbul University‐CerrahpasaIstanbulTurkey
| | - Mahruk Rashidi
- Department of Nursing, Faculty of Health SciencesIstanbul Gelisim UniversityIstanbulTurkey
| | - Gulay Yildirim
- Department of Nursing, Kesan Hakki Yoruk School of HealthTrakya UniversityEdirneTurkey
| | | | | | - Buse Saygin Sahin
- Department of Mental Health and Diseases Nursing, Institute of Graduate StudiesIstanbul University‐CerrahpasaIstanbulTurkey
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29
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Irizar P, Pan D, Taylor H, Martin CA, Katikireddi SV, Kannangarage NW, Gomez S, La Parra Casado D, Srinivas PN, Diderichsen F, Baggaley RF, Nellums LB, Koller TS, Pareek M. Disproportionate infection, hospitalisation and death from COVID-19 in ethnic minority groups and Indigenous Peoples: an application of the Priority Public Health Conditions analytical framework. EClinicalMedicine 2024; 68:102360. [PMID: 38545088 PMCID: PMC10965404 DOI: 10.1016/j.eclinm.2023.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 04/21/2024] Open
Abstract
The COVID-19 pandemic has resulted in disproportionate consequences for ethnic minority groups and Indigenous Peoples. We present an application of the Priority Public Health Conditions (PPHC) framework from the World Health Organisation (WHO), to explicitly address COVID-19 and other respiratory viruses of pandemic potential. This application is supported by evidence that ethnic minority groups were more likely to be infected, implying differential exposure (PPHC level two), be more vulnerable to severe disease once infected (PPHC level three) and have poorer health outcomes following infection (PPHC level four). These inequities are driven by various interconnected dimensions of racism, that compounds with socioeconomic context and position (PPHC level one). We show that, for respiratory viruses, it is important to stratify levels of the PPHC framework by infection status and by societal, community, and individual factors to develop optimal interventions to reduce inequity from COVID-19 and future infectious diseases outbreaks.
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Affiliation(s)
- Patricia Irizar
- Faculty of Humanities, School of Social Sciences, University of Manchester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, UK
| | - Harry Taylor
- Department of Global Health and Social Medicine, King’s College London, UK
| | - Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
| | | | | | | | | | | | | | - Rebecca F. Baggaley
- Leicester NIHR Biomedical Research Centre, UK
- Development Centre for Population Health, University of Leicester, UK
- Department of Population Health Sciences, University of Leicester, UK
| | - Laura B. Nellums
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
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30
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Contoli B, Tosti ME, Asta F, Minardi V, Marchetti G, Casigliani V, Scarso S, Declich S, Masocco M. Exploring COVID-19 Vaccination Willingness in Italy: A Focus on Resident Foreigners and Italians Using Data from PASSI and PASSI d'Argento Surveillance Systems. Vaccines (Basel) 2024; 12:124. [PMID: 38400108 PMCID: PMC10893094 DOI: 10.3390/vaccines12020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
(1) The COVID-19 pandemic exacerbated health disparities, both between foreign and autochthonous populations. Italy was one of the European countries that was the most affected by the COVID-19 pandemic; however, only limited data are available on vaccine willingness. This study aims to assess the propensity of foreign and autochthonous populations residing in Italy to be vaccinated and the relative associated factors. (2) Data were collected and analysed from the two Italian surveillance systems, PASSI and PASSI d'Argento, in the period of August 2020-December 2021. The data include those of the Italian resident adult population over 18 years old. A multinomial logistic regression model, stratified by citizenship, was used to assess the associations of sociodemographic, health, and COVID-19 experience variables with vaccination attitudes. (3) This study encompassed 19,681 eligible subjects. Considering the willingness to be vaccinated, foreign residents were significantly less certain to get vaccinated (49.4% vs. 60.7% among Italians). Sociodemographic characteristics, economic difficulties, and trust in local health units emerged as factors that were significantly associated with vaccine acceptance. Having received the seasonal flu vaccine was identified as a predictor of COVID-19 vaccine acceptance among foreign and Italian residents. (4) This study underscores the significance of tailoring interventions to address vaccine hesitancy based on the diverse characteristics of foreign and Italian residents. This research offers practical insights for public health strategies, highlighting the importance of tailored educational campaigns, improved communication, and nuanced interventions to enhance vaccine acceptance and uptake within both populations.
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Affiliation(s)
- Benedetta Contoli
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Maria Elena Tosti
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Federica Asta
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Valentina Minardi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
| | - Giulia Marchetti
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Salvatore Scarso
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
- Department of Public Health and Infectious Diseases, Sapienza Università di Roma, 00185 Rome, Italy
| | - Silvia Declich
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.E.T.); (G.M.); (S.S.); (S.D.)
| | - Maria Masocco
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy; (B.C.); (V.M.); (M.M.)
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Len JS, Koh CWT, Chan KR. The Functional Roles of MDSCs in Severe COVID-19 Pathogenesis. Viruses 2023; 16:27. [PMID: 38257728 PMCID: PMC10821470 DOI: 10.3390/v16010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Severe COVID-19 is a major cause of morbidity and mortality worldwide, especially among those with co-morbidities, the elderly, and the immunocompromised. However, the molecular determinants critical for severe COVID-19 progression remain to be fully elucidated. Meta-analyses of transcriptomic RNAseq and single-cell sequencing datasets comparing severe and mild COVID-19 patients have demonstrated that the early expansion of myeloid-derived suppressor cells (MDSCs) could be a key feature of severe COVID-19 progression. Besides serving as potential early prognostic biomarkers for severe COVID-19 progression, several studies have also indicated the functional roles of MDSCs in severe COVID-19 pathogenesis and possibly even long COVID. Given the potential links between MDSCs and severe COVID-19, we examine the existing literature summarizing the characteristics of MDSCs, provide evidence of MDSCs in facilitating severe COVID-19 pathogenesis, and discuss the potential therapeutic avenues that can be explored to reduce the risk and burden of severe COVID-19. We also provide a web app where users can visualize the temporal changes in specific genes or MDSC-related gene sets during severe COVID-19 progression and disease resolution, based on our previous study.
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Affiliation(s)
- Jia Soon Len
- School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore;
| | - Clara W. T. Koh
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Kuan Rong Chan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore;
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32
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Sakai K, Okoda K, Nishii M, Saji R, Ogawa F, Abe T, Takeuchi I. Combining blood glucose and SpO 2/FiO 2 ratio facilitates prediction of imminent ventilatory needs in emergency room COVID-19 patients. Sci Rep 2023; 13:22718. [PMID: 38123659 PMCID: PMC10733355 DOI: 10.1038/s41598-023-50075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
The increasing requirement of mechanical ventilation (MV) due to the novel coronavirus disease (COVID-19) is still a global threat. The aim of this study is to identify markers that can easily stratify the impending use of MV in the emergency room (ER). A total of 106 patients with COVID-19 requiring oxygen support were enrolled. Fifty-nine patients were provided MV 0.5 h (interquartile range: 0.3 to 1.4) post-admission. Clinical and laboratory data before intubation were collected. Using a multivariate logistic regression model, we identified four markers associated with the impending use of MV, including the ratio of peripheral blood oxygen saturation to fraction of inspired oxygen (SpO2/FiO2 ratio), alanine aminotransferase, blood glucose (BG), and lymphocyte counts. Among these markers, SpO2/FiO2 ratio and BG, which can be measured easily and immediately, showed higher accuracy (AUC: 0.88) than SpO2/FiO2 ratio alone (AUC: 0.84), despite no significant difference (DeLong test: P = 0.591). Moreover, even in patients without severe respiratory failure (SpO2/FiO2 ratio > 300), BG (> 138 mg/dL) was predictive of MV use. Measuring BG and SpO2/FiO2 ratio may be a simple and versatile new strategy to accurately identify ER patients with COVID-19 at high risk for the imminent need of MV.
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Affiliation(s)
- Kazuya Sakai
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kai Okoda
- Yokohama City University, School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Mototsugu Nishii
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Ryo Saji
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Fumihiro Ogawa
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University, School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
- Yokohama City University, School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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Omiyale W, Holliday J, Doherty N, Callen H, Wood N, Horn E, Burnett F, Young A, Lewington S, Fry D, Bešević J, Conroy M, Sheard S, Feng Q, Welsh S, Effingham M, Young A, Collins R, Lacey B, Allen N. Social determinants of ethnic disparities in SARS-CoV-2 infection: UK Biobank SARS-CoV-2 Serology Study. J Epidemiol Community Health 2023; 78:3-10. [PMID: 37699665 PMCID: PMC10715462 DOI: 10.1136/jech-2023-220353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The social determinants of ethnic disparities in risk of SARS-CoV-2 infection during the first wave of the pandemic in the UK remain unclear. METHODS In May 2020, a total of 20 195 adults were recruited from the general population into the UK Biobank SARS-CoV-2 Serology Study. Between mid-May and mid-November 2020, participants provided monthly blood samples. At the end of the study, participants completed a questionnaire on social factors during different periods of the pandemic. Logistic regression yielded ORs for the association between ethnicity and SARS-CoV-2 immunoglobulin G antibodies (indicating prior infection) using blood samples collected in July 2020, immediately after the first wave. RESULTS After exclusions, 14 571 participants (mean age 56; 58% women) returned a blood sample in July, of whom 997 (7%) had SARS-CoV-2 antibodies. Seropositivity was strongly related to ethnicity: compared with those of White ethnicity, ORs (adjusted for age and sex) for Black, South Asian, Chinese, Mixed and Other ethnic groups were 2.66 (95% CI 1.94-3.60), 1.66 (1.15-2.34), 0.99 (0.42-1.99), 1.42 (1.03-1.91) and 1.79 (1.27-2.47), respectively. Additional adjustment for social factors reduced the overall likelihood ratio statistics for ethnicity by two-thirds (67%; mostly from occupational factors and UK region of residence); more precise measurement of social factors may have further reduced the association. CONCLUSIONS This study identifies social factors that are likely to account for much of the ethnic disparities in SARS-CoV-2 infection during the first wave in the UK, and highlights the particular relevance of occupation and residential region in the pathway between ethnicity and SARS-CoV-2 infection.
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Affiliation(s)
- Wemimo Omiyale
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jo Holliday
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | | | - Howard Callen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Natasha Wood
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Edward Horn
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Frances Burnett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Allen Young
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Sarah Lewington
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Jelena Bešević
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Megan Conroy
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Qi Feng
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Alan Young
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Rory Collins
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Naomi Allen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
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Tobin-Salzman SC, Cooper D, McNamara BJ, Athan E, Bennett CM. Demographic Characteristics of Unvaccinated Asymptomatic and Symptomatic SARS-CoV-2 Cases in Barwon South West, Victoria, Australia. Pathogens 2023; 12:1420. [PMID: 38133303 PMCID: PMC10746993 DOI: 10.3390/pathogens12121420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
We investigated 328 SARS-CoV-2 cases in Barwon South West, Victoria, Australia, in the 2020 pre-vaccination period, comparing infections with symptoms to those that remained asymptomatic. De-identified self-reported data on case characteristics and symptom progression from three sequential questionnaires were examined. Multivariable logistic regression was used to model associations between demographic profiles and symptoms. Asymptomatic infections were more than three times as likely to be seen in ethnic minority groups than the Caucasian population after adjusting for gender and age [OR 3.2, 95% CI 1.5-6.7, p < 0.01] and were more common among cases of Asian background [OR 2.8, 95%CI 1.2-6.4]. Asymptomatic infections were also more common in youth and younger adults, but cases were approximately seven times more likely to be in seniors (≥65 years) compared with those 24 years of age or younger after adjusting for sex and ethnicity [OR 6.9, 95% CI 1.3-35.8]. The overrepresentation of ethnic minority groups among asymptomatic infections is suggestive of genetic haplotype variability by ethnic group, conferring greater cross-protection from other coronaviruses in the initial phase of the COVID-19 pandemic. Replication of this analysis in the post-vaccination era and reassessment of symptom expression according to ethnicity in a community with established vaccine and infection-induced immunity would determine whether this is a sustained association or one confined to the early stages of a pandemic in an immunologically naive population. These findings may, in part, reflect differences in testing patterns by ethnicity and true differences in disease expression, both of which are important to understand in order to inform transmission prevention strategies and tailored risk messaging according to ethnic background.
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Affiliation(s)
| | - Darcie Cooper
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Geelong, VIC 3220, Australia; (D.C.); (B.J.M.); (E.A.)
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, VIC 3220, Australia
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Bridgette J. McNamara
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Geelong, VIC 3220, Australia; (D.C.); (B.J.M.); (E.A.)
- Barwon South West Public Health Unit, Geelong, VIC 3220, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC 3008, Australia
| | - Eugene Athan
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Geelong, VIC 3220, Australia; (D.C.); (B.J.M.); (E.A.)
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, VIC 3220, Australia
- Barwon South West Public Health Unit, Geelong, VIC 3220, Australia
- Department of Infectious Diseases, Barwon Health, University of Geelong, Geelong, VIC 3220, Australia
| | - Catherine M. Bennett
- Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia;
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Geelong, VIC 3220, Australia; (D.C.); (B.J.M.); (E.A.)
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Kelly EJ, Oliver MA, Carney BC, Kolachana S, Moffatt LT, Shupp JW. Neutrophil Extracellular Traps Are Induced by Coronavirus 2019 Disease-Positive Patient Plasma and Persist Longitudinally: A Possible Link to Endothelial Dysfunction as Measured by Syndecan-1. Surg Infect (Larchmt) 2023; 24:887-896. [PMID: 38011327 DOI: 10.1089/sur.2023.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Background: Neutrophil extracellular trap (NET) formation is a mechanism that neutrophils possess to respond to host infection or inflammation. However, dysregulation of NETosis has been implicated in many disease processes. Although the exact mechanisms of their involvement remain largely unknown, this study aimed to elucidate NET formation over the time course of coronavirus disease 2019 (COVID-19) infection and their possible role in endothelial injury. Patients and Methods: Plasma samples from COVID-19-positive patients were obtained at six timepoints during hospitalization. Neutrophils were extracted from healthy donors and treated with COVID-19-positive patient plasma. Myeloperoxidase (MPO) assay was used to assess for NETosis. Syndecan-1 (SDC-1) enzyme-linked immunosorbent assay (ELISA) was run using the same samples. Immunocytochemistry allowed for further quantification of NETosis byproducts MPO and citrullinated histone 3 (CitH3). The receiver operating characteristic (ROC) curve discriminated between admission levels of SDC-1 and MPO in predicting 30-day mortality and need for ventilator support. Results: Sixty-three patients with COVID-19 were analyzed. Myeloperoxidase was upregulated at day 3, 7, and 14 (p = 0.0087, p = 0.0144, p = 0.0421). Syndecan-1 levels were elevated at day 7 and 14 (p = 0.0188, p = 0.0026). Neutrophils treated with day 3, 7, and 14 plasma expressed increased levels of MPO (p < 0.001). Immunocytochemistry showed neutrophils treated with day 3, 7, and 14 plasma expressed higher levels of MPO (p < 0.001) and higher levels of CitH3 when treated with day 7 and 14 plasma (p < 0.01 and p < 0.05). Admission SDC-1 and MPO levels were found to be independent predictors of 30-day mortality and need for ventilator support. Conclusions: Neutrophil dysregulation can be detrimental to the host. Our study shows that COVID-19 plasma induces substantial amounts of NET formation that persists over the course of the disease. Patients also exhibit increased SDC-1 levels that implicate endothelial injury in the pathogenesis of COVID-19 infection. Furthermore, MPO and SDC-1 plasma levels are predictive of poor outcomes.
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Affiliation(s)
- Edward J Kelly
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Mary A Oliver
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Department of Surgery and Biochemistry, Georgetown University School of Medicine, Washington, DC, USA
| | - Sindhura Kolachana
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Department of Surgery and Biochemistry, Georgetown University School of Medicine, Washington, DC, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Surgery and Biochemistry, Georgetown University School of Medicine, Washington, DC, USA
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Clarke G, Hussain JA, Allsop MJ, Bennett MI. Ethnicity and palliative care: we need better data - five key considerations. BMJ Support Palliat Care 2023; 13:429-431. [PMID: 35589123 PMCID: PMC10803990 DOI: 10.1136/bmjspcare-2022-003565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/13/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Insitute of Health Sciences, University of Leeds School of Medicine, Leeds, UK
| | | | - Matthew John Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Bacon AM, Charlesford J, Hyland M, Puskas T, Hughes P. Finding Silver Linings in the Covid-19 Pandemic: A 2-Wave Study in the UK. Psychol Rep 2023:332941231219788. [PMID: 38032051 DOI: 10.1177/00332941231219788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The Covid-19 pandemic has resulted in widespread anxiety, fear and depression, yet focussing only on these negative issues may obscure the opportunity to promote positivity and resilience. Traumatic events can often result in positive life changes (adversarial growth) though there is little evidence in the context of pandemics, and no previous studies in Covid-19 with the general public. The present research investigated whether adversarial growth was perceived in Covid-19 and whether this could account for variance in wellbeing, over and above effects of personality traits. Participants recruited from the UK public (N = 183) completed the Big Five Personality Inventory, the WHO-5 Wellbeing Scale and the Silver Lining Questionnaire (SLQ) measure of adversarial growth. Questionnaires were completed online, at two timepoints, nine months apart. At Time 1, wellbeing was negatively associated with trait Neuroticism and positively associated with Openness to experience. Both associations were positively mediated by SLQ score. At Time 2, SLQ score again mediated the effects of Openness on wellbeing, and also the influence of wellbeing at Time 1 on that at Time 2. Reported Silver Linings included strengthened personal relationships at Time 1, and improved ability to handle life events at Time 2. This suggests a shift from an appreciation of relationships to an awareness of personal development once life returned to some semblance of normality. Overall, results suggest that perceived adversarial growth supported wellbeing during the pandemic and highlight a focus for therapeutic intervention.
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Affiliation(s)
- Alison M Bacon
- School of Psychology, University of Plymouth, Plymouth, UK
| | | | - Michael Hyland
- School of Psychology, University of Plymouth, Plymouth, UK
| | - Tilla Puskas
- School of Psychology, University of Plymouth, Plymouth, UK
| | - Poppy Hughes
- School of Psychology, University of Plymouth, Plymouth, UK
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Maynard MJ, Orighoye O, Apekey T, Simpson E, van Dijk M, Atherton E, Blackshaw J, Ells L. Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers. Front Public Health 2023; 11:1239668. [PMID: 38074747 PMCID: PMC10701265 DOI: 10.3389/fpubh.2023.1239668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. Methods A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. Results The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Conclusion Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.
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Affiliation(s)
- Maria J. Maynard
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | - Oritseweyinmi Orighoye
- Bradford Institute for Health Research, University of Bradford, Bradford, United Kingdom
| | - Tanefa Apekey
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Ellouise Simpson
- School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Margie van Dijk
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Elizabeth Atherton
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Jamie Blackshaw
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Louisa Ells
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
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Dahmane L, Julia C, Vignier N, Sesé L, Brichler S, Benaïnous R, Bihan H, Lopez-Sublet M, Trawale D, Bouchaud O, Goupil de Bouillé J. Respective roles of social deprivation, health literacy, and clinical factors for COVID-19: a case-control study in hospitalized patients. Front Public Health 2023; 11:1239041. [PMID: 38074722 PMCID: PMC10702549 DOI: 10.3389/fpubh.2023.1239041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction To investigate the association between social deprivation and COVID-19 among hospitalized patients in an underprivileged department of the greater Paris area. Methods Individuals hospitalized for COVID-19 between March 1st and October 31, 2020, were included, matched on age and sex, and compared with patients hospitalized for any other reason with negative RT-PCR for SARS-CoV-2, through a case-control study. Clinical, socio-demographic characteristics, health literacy, and social deprivation, assessed by the EPICES score, were collected. Factors associated with COVID-19 in hospitalized patients were assessed using univariate and multivariate logistic regression models. Results 69 cases and 180 controls were included. Participants were mostly men (N = 148: 59.4%) aged 65 or older (N = 109: 44.1%). Median EPICES score was 43.2 (IQR 29.4-62.9). EPICES score > 30.17 (precariousness threshold) was not significantly associated with COVID-19 in hospitalized patients (adjusted odds ratio (aOR) = 0.46; 95% Confidence Interval (CI) [0.21-1.01]). Advanced age, higher BMI, professional activity, home area of less than 25 m2 per person, and low health literacy, were significantly associated with COVID-19 in hospitalized patients. Discussion This study highlights probable risk factors for specific exposition in disadvantaged area: maintenance of professional activity, smaller home area, and low health literacy.
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Affiliation(s)
- Lotfi Dahmane
- Department of Infectious and Tropical Diseases, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Chantal Julia
- Public Health Department, GHU Paris-Seine-Saint-Denis, APHP, Bobigny, France
- Centre de recherche en épidémiologie et statistiques sorbonne Paris cité (CRESS), Inserm, Inra, Cnam, University, Equipe de recherche en épidémiologie nutritionnelle (EREN), Bobigny, France
| | - Nicolas Vignier
- Centre d’Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Cayenne, France
- IAME, INSERM UMR 1137, Université Paris Cité, Université Sorbonne Paris Nord, UFR SMBH, Bobigny, France
- French Collaborative Institute on Migration, Institut Convergences Migrations, ICM, Aubervilliers, France
| | - Lucile Sesé
- Department of Pneumology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Ségolène Brichler
- Department of Virology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Ruben Benaïnous
- Department of Intern Medicine, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Hélène Bihan
- Department of Endocrinology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Marilucy Lopez-Sublet
- Department of Intern Medicine, AP-HP, CHU Avicenne, Centre d’Excellence ESH en Hypertension Artérielle, Bobigny, France
- INSERM UMR 942 MASCOT, Paris 13-Univrsité Paris Nord, Bobigny, France
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Damien Trawale
- INED, Institut National d’études démographiques, Aubervilliers, France
| | - Olivier Bouchaud
- Department of Infectious and Tropical Diseases, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
- Laboratoire Éducations et Promotion de la Santé, Université Sorbonne Paris Nord, LEPS, Bobigny, France
| | - Jeanne Goupil de Bouillé
- Department of Infectious and Tropical Diseases, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
- Laboratoire Éducations et Promotion de la Santé, Université Sorbonne Paris Nord, LEPS, Bobigny, France
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Gumber L, Jackson H, Gomez N, Hopkins G, Tucis D, Chakravorty M, Tighe P, Grainge MJ, Rutter M, Ferraro A, Power S, Pradère MJ, Lanyon PC, Pearce FA, Fairclough L. Antibody response to four doses of SARS-CoV-2 vaccine in rare autoimmune rheumatic diseases: an observational study. Rheumatol Adv Pract 2023; 7:rkad097. [PMID: 38515961 PMCID: PMC10956718 DOI: 10.1093/rap/rkad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/20/2023] [Indexed: 03/23/2024] Open
Abstract
Objective Antibody responses to coronavirus disease 2019 (COVID-19) vaccines are reduced among immunocompromised patients but are not well quantified among people with rare disease. We conducted an observational study to evaluate the antibody responses to the booster SARS-CoV-2 vaccine in people with rare autoimmune rheumatic diseases (RAIRD). Methods Blood samples were collected after second, before third, after third and after fourth vaccine doses. Anti-spike and anti-nucleocapsid antibody levels were measured using an in-house ELISA. Logistic regression models were built to determine the predictors for non-response. Results were compared with age- and sex-matched healthy controls. Results Forty-three people with RAIRD were included, with a median age of 56 years. Anti-spike seropositivity increased from 42.9% after second dose to 51.2% after third dose and 65.6% after fourth dose. Median anti-spike antibody levels increased from 33.6 (interquartile range 7.8-724.5) binding antibody units after second dose to 239.4 (interquartile range 35.8-1051.1) binding antibody units after the booster dose (third dose, or fourth dose if eligible). Of the participants who had sufficient antibody levels post-second dose, 22.2% had insufficient levels after the booster, and 34.9% of participants had lower antibodies after the booster than the lowest healthy control had after the second dose. Rituximab in the 6 months prior to booster (P = 0.02) and non-White ethnicity (P = 0.04) were associated with non-response. There was a dose-response relationship between the timing of rituximab and generation of sufficient antibodies (P = 0.03). Conclusion Although the booster dose increased anti-spike IgG and seropositivity rates, some people with RAIRD, particularly those on rituximab, had insufficient antibody levels despite three or four doses.
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Affiliation(s)
- Leher Gumber
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Hannah Jackson
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Nancy Gomez
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Georgina Hopkins
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Davis Tucis
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Mithun Chakravorty
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Patrick Tighe
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Matthew J Grainge
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Megan Rutter
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alastair Ferraro
- Department of Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sheila Power
- Research & Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Peter C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Fiona A Pearce
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Lucy Fairclough
- School of Life Sciences, University of Nottingham, Nottingham, UK
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Struja T, Matos J, Lam B, Cao Y, Liu X, Jia Y, Sauer CM, D'Couto H, Dankwa-Mullan I, Celi LA, Waschka AK. Evaluating equitable care in the ICU: Creating a causal inference framework to assess the impact of life-sustaining interventions across racial and ethnic groups. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.12.23296933. [PMID: 37873267 PMCID: PMC10592988 DOI: 10.1101/2023.10.12.23296933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Variability in the provision of intensive care unit (ICU)-interventions may lead to disparities between socially defined racial-ethnic groups. Research Question We used causal inference to examine the use of invasive mechanical ventilation (IMV), renal replacement therapy (RRT), and vasopressor agents (VP) to identify disparities in outcomes across race-ethnicity in patients with sepsis. Study Design and Methods Single-center, academic referral hospital in Boston, Massachusetts, USA. Retrospective analysis of treatment effect with a targeted trial design categorized by treatment assignment within the first 24 hours in the MIMIC-IV dataset (2008- 2019) using targeted maximum likelihood estimation. Of 76,943 ICU stays in MIMIC-IV, 32,971 adult stays fulfilling sepsis-3 criteria were included. The primary outcome was in-hospital mortality. Secondary outcomes were hospital-free days, and occurrence of nosocomial infection stratified by predicted mortality probability ranges and self-reported race-ethnicity. Average treatment effects by treatment type and race-ethnicity, Racial-ethnic group (REG) or White group (WG), were estimated. Results Of 19,419 admissions that met inclusion criteria, median age was 68 years, 57.4% were women, 82% were White, and mortality was 18.2%. There was no difference in mortality benefit associated with the administration of IMV, RRT, or VP between the REG and the WG. There was also no difference in hospital-free days or nosocomial infections. These findings are unchanged with different eligibility periods. Interpretation There were no differences in the treatment outcomes from three life-sustaining interventions in the ICU according to race-ethnicity. While there was no discernable harm from the treatments across mortality risk, there was also no measurable benefit. These findings highlight the need for research to understand better the risk-benefit of life-sustaining interventions in the ICU.
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Ali M, Phillips L, Kaelber DC, Bukulmez H. Characteristics of pediatric COVID-19 infections and the impact of influenza and COVID-19 vaccinations during the first two years of the pandemic. Front Pediatr 2023; 11:1046680. [PMID: 37900675 PMCID: PMC10600516 DOI: 10.3389/fped.2023.1046680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
The data regarding the demographics of SARS-CoV-2 in the pediatric population has been published based on several single-center experiences or on metanalyses over short time frames. This article reports data on the demographics of pediatric patients with COVID-19 on a global scale using the TriNetX COVID-19 Research Network. In addition, we examined the risk of COVID-19 infection in relation to the body mass index (BMI) category and the protective value of influenza and COVID-19 immunization against COVID-19 infection. The incidence of COVID-19 infection was higher in the younger age group (≤6 years old), but no gender differences. The incidence of COVID-19 infection was higher among African Americans/Black race (28.57%) White race (27.10%), and obese patients; across all age groups, all genders, all races, and ethnicities (p < 0.0001). The incidence of MIS-C was also higher in patients with obesity (OR 1.71, CI 1.36-2.14). We found that the patients who were neither vaccinated for COVID-19 nor influenza within one year before their COVID-19 diagnoses compared to those who received influenza vaccine only, had significantly higher odds for hospitalization (OR 1.19, CI 1.18-1.21), development of MIS-C (OR 1.52, CI 1.32-1.74), and more importantly mortality (OR 1.47, CI 1.26-1.71). In addition, those patients who were neither vaccinated for COVID-19 nor influenza within one year before their COVID-19 diagnoses, compared to those who received at least one dose of COVID-19 vaccine, had significantly higher odds for hospitalization (OR 1.11, CI 1.04-1.19). However, those patients who did not receive the influenza vaccine within one year before their COVID-19 diagnoses nor received the COVID-19 vaccine had much higher odds for hospitalization (OR 1.46, CI 1.41-1.51), MIS-C (OR 3.72, CI 2.11-6.56), and mortality compared to those who received both vaccinations (OR 13.55, CI 1.91-9.62). Using the multiplicative interaction scale, we found a positive interaction between the COVID-19 vaccine and the influenza vaccine; they both combined have a larger effect than each separately. Our study is the largest of its kind (to date) examining the global demographic of the pandemic and the first of a kind to find a link between influenza vaccine and COVID-19-related hospitalization, MIS-C, and mortality in the pediatric population.
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Affiliation(s)
- Mahmoud Ali
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Lynette Phillips
- College of Public Health, Kent State University, Kent, OH, United States
| | - David C. Kaelber
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
- The Departments of Internal Medicine and Population and Quantitative Health Sciences and the Center for Clinical Informatics Research and Educations, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Hulya Bukulmez
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
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Francis J, West K. Physical Activity Message Framing and Ethnicity Before and During COVID-19. HEALTH COMMUNICATION 2023; 38:2419-2429. [PMID: 35593173 DOI: 10.1080/10410236.2022.2074344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
| | - Keon West
- Department of Psychology, Goldsmiths, University of London
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D'Carmo Sodré MM, Dos Santos UR, Povoas HP, Guzmán JL, Junqueira C, Trindade TO, Gadelha SR, Romano CC, da Conceição AO, Gross E, Silva A, Rezende RP, Fontana R, da Mata CPSM, Marin LJ, de Carvalho LD. Relationship between clinical-epidemiological parameters and outcomes of patients with COVID-19 admitted to the intensive care unit: a report from a Brazilian hospital. Front Public Health 2023; 11:1241444. [PMID: 37808991 PMCID: PMC10556466 DOI: 10.3389/fpubh.2023.1241444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Background People in low-income countries, especially those with low socio-economic conditions, are likelier to test positive for SARS-CoV-2. The unequal conditions of public health systems also increase the infection rate and make early identification and treatment of at-risk patients difficult. Here, we aimed to characterize the epidemiological profile of COVID-19 patients in intensive care and identify laboratory and clinical markers associated with death. Materials and methods We conducted an observational, descriptive, and cross-sectional study in a reference hospital for COVID-19 treatment in the Southern Region of Bahia State, in Brazil, to evaluate the epidemiological, clinical, and laboratory characteristics of COVID-19 patients admitted to the intensive care unit (ICU). Additionally, we used the area under the curve (AUC) to classify survivors and non-survivors and a multivariate logistic regression analysis to assess factors associated with death. Data was collected from the hospital databases between April 2020 and July 2021. Results The use of bladder catheters (OR 79.30; p < 0.0001) and central venous catheters (OR, 45.12; p < 0.0001) were the main factors associated with death in ICU COVID-19 patients. Additionally, the number of non-survivors increased with age (p < 0.0001) and prolonged ICU stay (p < 0.0001). Besides, SAPS3 presents a higher sensibility (77.9%) and specificity (63.1%) to discriminate between survivors and non-survivor with an AUC of 0.79 (p < 0.0001). Conclusion We suggest that multi-laboratory parameters can predict patient prognosis and guide healthcare teams toward more assertive clinical management, better resource allocation, and improved survival of COVID-19 patients admitted to the ICU.
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Affiliation(s)
| | | | | | | | - Caroline Junqueira
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | | | - Sandra Rocha Gadelha
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Carla Cristina Romano
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | | | - Eduardo Gross
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Aline Silva
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Rachel Passos Rezende
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
| | - Renato Fontana
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, Bahia, Brazil
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Twohig KA, Harman K, Zaidi A, Aliabadi S, Nash SG, Sinnathamby M, Harrison I, Gallagher E, Groves N, Schwach F, Pearson C, Thornton A, Myers R, Chand M, Thelwall S, Dabrera G. Representativeness of whole-genome sequencing approaches in England: the importance for understanding inequalities associated with SARS-CoV-2 infection. Epidemiol Infect 2023; 151:e169. [PMID: 37726109 PMCID: PMC10600896 DOI: 10.1017/s0950268823001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
Whole-genome sequencing (WGS) information has played a crucial role in the SARS-CoV-2 (COVID-19) pandemic by providing evidence about variants to inform public health policy. The purpose of this study was to assess the representativeness of sequenced cases compared with all COVID-19 cases in England, between March 2020 and August 2021, by demographic and socio-economic characteristics, to evaluate the representativeness and utility of these data in epidemiological analyses. To achieve this, polymerase chain reaction (PCR)-confirmed COVID-19 cases were extracted from the national laboratory system and linked with WGS data. During the study period, over 10% of COVID-19 cases in England had WGS data available for epidemiological analysis. With sequencing capacity increasing throughout the period, sequencing representativeness compared to all reported COVID-19 cases increased over time, allowing for valuable epidemiological analyses using demographic and socio-economic characteristics, particularly during periods with emerging novel SARS-CoV-2 variants. This study demonstrates the comprehensiveness of England's sequencing throughout the COVID-19 pandemic, rapidly detecting variants of concern, and enabling representative epidemiological analyses to inform policy.
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Affiliation(s)
| | - Katie Harman
- COVID-19 Vaccines and Epidemiology Division, Public Health Programmes, Clinical and Public Health Group, UKHSA, London, UK
| | - Asad Zaidi
- COVID-19 Vaccines and Epidemiology Division, Public Health Programmes, Clinical and Public Health Group, UKHSA, London, UK
| | | | - Sophie G. Nash
- COVID-19 Vaccines and Epidemiology Division, Public Health Programmes, Clinical and Public Health Group, UKHSA, London, UK
| | - Mary Sinnathamby
- COVID-19 Vaccines and Epidemiology Division, Public Health Programmes, Clinical and Public Health Group, UKHSA, London, UK
| | - Ian Harrison
- Pathogen Genomics, Science Group, UKHSA, London, UK
| | - Eileen Gallagher
- TARZET Division, Clinical and Emerging Infections Directorate, Clinical and Public Health Group, UKHSA, London, UK
| | - Natalie Groves
- TARZET Division, Clinical and Emerging Infections Directorate, Clinical and Public Health Group, UKHSA, London, UK
| | - Frank Schwach
- TARZET Division, Clinical and Emerging Infections Directorate, Clinical and Public Health Group, UKHSA, London, UK
| | - Clare Pearson
- COVID-19 National Epidemiology Cell, UKHSA, London, UK
| | | | - Richard Myers
- TARZET Division, Clinical and Emerging Infections Directorate, Clinical and Public Health Group, UKHSA, London, UK
| | - Meera Chand
- TARZET Division, Clinical and Emerging Infections Directorate, Clinical and Public Health Group, UKHSA, London, UK
| | - Simon Thelwall
- COVID-19 Vaccines and Epidemiology Division, Public Health Programmes, Clinical and Public Health Group, UKHSA, London, UK
| | - Gavin Dabrera
- COVID-19 Vaccines and Epidemiology Division, Public Health Programmes, Clinical and Public Health Group, UKHSA, London, UK
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Duong KNC, Le LM, Veettil SK, Saidoung P, Wannaadisai W, Nelson RE, Friedrichs M, Jones BE, Pavia AT, Jones MM, Samore MH, Chaiyakunapruk N. Disparities in COVID-19 related outcomes in the United States by race and ethnicity pre-vaccination era: an umbrella review of meta-analyses. Front Public Health 2023; 11:1206988. [PMID: 37744476 PMCID: PMC10513444 DOI: 10.3389/fpubh.2023.1206988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Background Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US. Methods In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805. Results Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant (p ≤ 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60-2.71), which was supported by highly suggestive evidence; with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60-2.70) with highly suggestive evidence which remained after sensitivity analyses. Conclusion Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization compared to their White counterparts. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.
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Affiliation(s)
- Khanh N. C. Duong
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Lan M. Le
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Sajesh K. Veettil
- International Medical University, School of Pharmacy, Department of Pharmacy Practice, Kuala Lumpur, Malaysia
| | - Pantakarn Saidoung
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | | | - Richard E. Nelson
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Mike Friedrichs
- Utah Department of Health, Salt Lake City, UT, United States
| | - Barbara E. Jones
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Pulmonary & Critical Care, University of Utah, Salt Lake City, UT, United States
| | - Andrew T. Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, UT, United States
| | - Makoto M. Jones
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Matthew H. Samore
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
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Siddiq S, Ahmed S, Akram I. Clinical outcomes following COVID-19 infection in ethnic minority groups in the UK: a systematic review and meta-analysis. Public Health 2023; 222:205-214. [PMID: 35970621 PMCID: PMC9181265 DOI: 10.1016/j.puhe.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study evaluated the differences in clinical outcomes of COVID-19 infection between ethnic minorities and the White ethnic group in the UK. STUDY DESIGN Systematic review and meta-analysis. METHODS This study included adult residents in the UK with confirmed COVID-19 infection. The outcomes evaluated in this study were mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). Outcome data were compared between individuals from ethnic minority groups and individuals from a White ethnic background. MEDLINE, Embase, Cochrane, medRxiv and PROSPERO were searched for articles published between May 2020 and April 2021. The risk of bias was evaluated using the Newcastle-Ottawa Scale checklist. PROSPERO ID CRD42021248117. RESULTS Fourteen studies (767,177 participants) were included in the current review. In the adjusted analysis, the pooled odds ratio (OR) for mortality following COVID-19 infection was higher for Black (OR 1.83, 95% confidence interval [CI]: 1.21-2.76, number of studies [k] = 6), Asian (OR 1.16, 95% CI: 0.85-1.57, k = 6) and Mixed and Other (MO) ethnic groups (OR 1.12, 95% CI: 1.04-1.20, k = 5) compared with the White ethnic group. The adjusted and unadjusted ORs of ICU admission for many of the ethnic minority groups were more than double the OR values for the White ethnic group (Black ethnic group = OR 2.32, 95% CI: 1.73-3.11, k = 5; Asian ethnic group = OR 2.34, 95% CI: 1.89-2.90, k = 5; and MO ethnic group = OR 2.26, 95% CI: 1.64-3.11, k = 4). In the adjusted analysis for IMV, the ORs were similarly significantly raised in ethnic minority groups compared with the White ethnic group (Black ethic group = OR 2.03, 95% CI: 1.80-2.29, k = 3; Asian ethnic group = OR 1.84, 95% CI: 1.20-2.80, k = 3; and MO ethnic group = OR 2.09, 95% CI: 1.35-3.22, k = 3). CONCLUSION This review found that in the UK, Black, Asian and MO ethnic groups experienced increased COVID-19-related disease severity and mortality compared with the White ethnic group majority.
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Affiliation(s)
- S Siddiq
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; UK Health Security Agency, UK.
| | - S Ahmed
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; National Institute of Health Research Applied Research Collaboration for Greater Manchester (NIHR ARC-GM), UK
| | - I Akram
- Southend Clinical Commissioning Group, UK; Valkyrie Surgery, Westcliff-On-Sea, UK; West Central Primary Care Network, UK; Royal College of General Practitioners, London, UK
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Greenhouse AR, Richard D, Khakharia A, Goodman M, Phillips LS, Gazmararian JA. The Social, Demographic, and Clinical Predictors of COVID-19 Severity: a Model-based Analysis of United States Veterans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01773-5. [PMID: 37656326 DOI: 10.1007/s40615-023-01773-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/05/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
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.
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Affiliation(s)
- Alyssa R Greenhouse
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Danielle Richard
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Anjali Khakharia
- Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA, 30033, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Lawrence S Phillips
- Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA, 30033, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
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Learoyd AE, Nicholas J, Hart N, Douiri A. Revisiting ethnic discrepancies in COVID-19 hospitalized cohorts: a correction for collider bias. J Clin Epidemiol 2023; 161:94-103. [PMID: 37385305 PMCID: PMC10299938 DOI: 10.1016/j.jclinepi.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
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.
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Affiliation(s)
| | - Jennifer Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Abdel Douiri
- School of Life Course and Population Sciences, King College London, London, UK
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de Dios B, Pérez-Jacoiste A, Lalueza A, Maestro G, García-Reyne A, Lizasoain M, Lumbreras C. Disparities between Latinx migrants and Spanish natives in COVID-19 outcome in Madrid. Pathog Glob Health 2023; 117:590-595. [PMID: 36775987 PMCID: PMC10392248 DOI: 10.1080/20477724.2023.2174295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Previous studies have suggested an increased susceptibility of COVID-19 among certain populations. We analyzed whether COVID-19 presentation and mortality differ between Latinx migrants and Spanish natives. METHODS AND MATERIALS COVID-19 patients between 35-64 years old admitted between January 26th-May-5th 2020 were reviewed. Demographics, major comorbidities, symptoms, signs and analytical parameters on admission were recorded. Respiratory failure was defined as PaO2/FiO2 ≤ 200 mmHg, noninvasive or invasive mechanical ventilation requirement at any time during hospitalization. A propensity score (PS) adjustment was created between Latinx and Spanish. A multivariable logistic regression model adjusted by the PS was performed to evaluate the effects of different variables on mortality. RESULTS 894 patients: 425 (47.5%) Latinx and 469 (52.5%) Spanish natives were included. Latinx were younger (50 vs 55 years p < 0.001) and had less comorbidities (29.4% vs 55.0% p < 0.001) than Spanish natives. More often they exhibited fever (22.1% vs 9.8% p = 0.018) and had higher inflammatory markers (PCR) (11.3 mg/dl vs 7.7 mg/dl p < 0.001). Mortality seemed lower among Latinx (4.7% vs 8.7%, p = 0.017). No association was found between ethnicity and mortality. Respiratory failure [OR = 23.978 (CI 95% 9.4-60.1) p < 0.001], LDH [OR (per unitary increment) = 1.002; CI95% (1.000-1.004;p = 0.036] and PCR [OR (per unitary increment) = 1.044 (CI95% 1.06-1.08); p = 0.02] were independently associated to mortality. CONCLUSIONS We were unable to identify significant ethnic disparities between Latinx and Spanish natives in terms of COVID-19 mortality. Universal access to the health care system in Spain may have contributed to a better outcome of Latinx patients. Differences previously described might be a consequence of socioeconomic disparities.
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Affiliation(s)
- Begoña de Dios
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
- 1 Doctoral Student Rey Juan Carlos University, Madrid, Spain
| | | | - Antonio Lalueza
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Guillermo Maestro
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Ana García-Reyne
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Manuel Lizasoain
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
| | - Carlos Lumbreras
- Internal Medicine Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
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