The income gradient in COVID-19 mortality and hospitalisation: An observational study with social security administrative records in Mexico

Demographics and outcomes of hemoglobin genotype in hospitalized patients with COVID-19 and sickle cell disease in the United States

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is associated with poor outcomes in sickle cell disease (SCD) patients. However, there is a paucity of data comparing hemoglobin (Hb) genotypes in SCD and infection outcomes.

METHODS

The National Inpatient Sample was used to identify the record of hospitalizations with COVID-19 and SCD in 2020 using the International Classification of Disease, Tenth Revision codes. Study outcomes (invasive mechanical ventilation, extracorporeal membrane oxygenation, shock, vasopressor use, measures of resource utilization, and in-hospital mortality) were compared between hemoglobin SS, SC, and S-beta thalassemia (Sβ).

RESULTS

Of the 102 975 COVID-19 hospitalizations with SCD, 87.26% had HbSS, 7.16% had HbSC, and 5.58% had HbSβ. Younger patients were more likely to have HbSS, while older patients were likely to have HbSC and HbSβ. HbSS was more frequent with Blacks, while HbSβ was more prevalent with Whites and Hispanics. Though measures of resource utilization were higher in HbSS, there was no significant difference in in-hospital outcomes between the three genotypes.

CONCLUSION

There is no difference in COVID-19 outcomes among Hb genotypes in SCD. Further studies are needed to explore the reasons for this observation.

Quantifying the heterogeneous impact of lockdown policies on different socioeconomic classes during the first COVID-19 wave in Colombia

In the absence of vaccines, the most widespread reaction to curb the COVID-19 pandemic worldwide was the implementation of lockdowns or stay-at-home policies. Despite the reported usefulness of such policies, their efficiency was highly constrained by socioeconomic factors determining their feasibility and their associated outcome in terms of mobility reduction and the subsequent limitation of social activity. Here we investigate the impact of lockdown policies on the mobility patterns of different socioeconomic classes in the three major cities of Colombia during the first wave of the COVID-19 pandemic. In global terms, we find a consistent positive correlation between the reduction in mobility levels and the socioeconomic stratum of the population in the three cities, implying that those with lower incomes were less capable of adopting the aforementioned policies. Our analysis also suggests a strong restructuring of the mobility network of lowest socioeconomic strata during COVID-19 lockdown, increasing their endogenous mixing while hampering their connections with wealthiest areas due to a sharp reduction in long-distance trips.

Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina

BACKGROUND

The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions.

AIM

To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods.

METHODS

We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators.

RESULTS

Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96).

CONCLUSION

We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.

Determinants of COVID-19 vaccination worldwide: WORLDCOV, a retrospective observational study

Introduction

The COVID-19 pandemic has resulted in numerous deaths, great suffering, and significant changes in people's lives worldwide. The introduction of the vaccines was a light in the darkness, but after 18 months, a great disparity in vaccination coverage between countries has been observed. As disparities in vaccination coverage have become a global public health issue, this study aimed to analyze several variables to identify possible determinants of COVID-19 vaccination.

Methods

An ecological study was conducted using pooled secondary data sourced from institutional sites. A total of 205 countries and territories worldwide were included. A total of 16 variables from different fields were considered to establish possible determinants of COVID-19 vaccination: sociodemographic, cultural, infrastructural, economic and political variables, and health system performance indicators. The percentage of the population vaccinated with at least one dose and the total doses administered per 100 residents on 15 June 2022 were identified as indicators of vaccine coverage and outcomes. Raw and adjusted values for delivered vaccine doses in the multivariate GLM were determined using R. The tested hypothesis (i.e., variables as determinants of COVID-19 vaccination) was formulated before data collection. The study protocol was registered with the grant number NCT05471635.

Results

GDP per capita [odds = 1.401 (1.299-1.511) CI 95%], access to electricity [odds = 1.625 (1.559-1.694) CI 95%], political stability, absence of violence/terrorism [odds = 1.334 (1.284-1.387) CI 95%], and civil liberties [odds = 0.888 (0.863-0.914) CI 95%] were strong determinants of COVID-19 vaccination. Several other variables displayed a statistically significant association with outcomes, although the associations were stronger for total doses administered per 100 residents. There was a substantial overlap between raw outcomes and their adjusted counterparts.

Discussion

This pioneering study is the first to analyze the association between several different categories of indicators and COVID-19 vaccination coverage in a wide complex setting, identifying strong determinants of vaccination coverage. Political decision-makers should consider these findings when organizing mass vaccination campaigns in a pandemic context to reduce inequalities between nations and to achieve a common good from a public health perspective.

Socioeconomic determinants of stay-at-home policies during the first COVID-19 wave

Introduction

The COVID-19 pandemic has had a significant impact on public health and social systems worldwide. This study aims to evaluate the efficacy of various policies and restrictions implemented by different countries to control the spread of the virus.

Methods

To achieve this objective, a compartmental model is used to quantify the "social permeability" of a population, which reflects the inability of individuals to remain in confinement and continue social mixing allowing the spread of the virus. The model is calibrated to fit and recreate the dynamics of the epidemic spreading of 42 countries, mainly taking into account reported deaths and mobility across the populations.

Results

The results indicate that low-income countries have a harder time slowing the advance of the pandemic, even if the virus did not initially propagate as fast as in wealthier countries, showing the disparities between countries in their ability to mitigate the spread of the disease and its impact on vulnerable populations.

Discussion

This research contributes to a better understanding of the socioeconomic and environmental factors that affect the spread of the virus and the need for equitable policy measures to address the disparities in the global response to the pandemic.

A global analysis of COVID-19 infection fatality rate and its associated factors during the Delta and Omicron variant periods: an ecological study

Background

The Omicron variant of SARS-CoV-2 is more highly infectious and transmissible than prior variants of concern. It was unclear which factors might have contributed to the alteration of COVID-19 cases and deaths during the Delta and Omicron variant periods. This study aimed to compare the COVID-19 average weekly infection fatality rate (AWIFR), investigate factors associated with COVID-19 AWIFR, and explore the factors linked to the increase in COVID-19 AWIFR between two periods of Delta and Omicron variants.

Materials and methods

An ecological study has been conducted among 110 countries over the first 12 weeks during two periods of Delta and Omicron variant dominance using open publicly available datasets. Our analysis included 102 countries in the Delta period and 107 countries in the Omicron period. Linear mixed-effects models and linear regression models were used to explore factors associated with the variation of AWIFR over Delta and Omicron periods.

Findings

During the Delta period, the lower AWIFR was witnessed in countries with better government effectiveness index [β = -0.762, 95% CI (-1.238)-(-0.287)] and higher proportion of the people fully vaccinated [β = -0.385, 95% CI (-0.629)-(-0.141)]. In contrast, a higher burden of cardiovascular diseases was positively associated with AWIFR (β = 0.517, 95% CI 0.102-0.932). Over the Omicron period, while years lived with disability (YLD) caused by metabolism disorders (β = 0.843, 95% CI 0.486-1.2), the proportion of the population aged older than 65 years (β = 0.737, 95% CI 0.237-1.238) was positively associated with poorer AWIFR, and the high proportion of the population vaccinated with a booster dose [β = -0.321, 95% CI (-0.624)-(-0.018)] was linked with the better outcome. Over two periods of Delta and Omicron, the increase in government effectiveness index was associated with a decrease in AWIFR [β = -0.438, 95% CI (-0.750)-(-0.126)]; whereas, higher death rates caused by diabetes and kidney (β = 0.472, 95% CI 0.089-0.855) and percentage of population aged older than 65 years (β = 0.407, 95% CI 0.013-0.802) were associated with a significant increase in AWIFR.

Conclusion

The COVID-19 infection fatality rates were strongly linked with the coverage of vaccination rate, effectiveness of government, and health burden related to chronic diseases. Therefore, proper policies for the improvement of vaccination coverage and support of vulnerable groups could substantially mitigate the burden of COVID-19.

Changes in the epidemiological profile of SARS-CoV-2-positive individuals in Mexico across pandemic waves as an explanation of fatality reduction: a retrospective observational study

OBJECTIVES

We aim to quantify shifts in hospitalisation and mortality and how those were related to the first three phases of the epidemic and individuals' demographics and health profile among those with a positive test for SARS-CoV-2 treated at the Mexican Social Security Institute's facilities from March 2020 to October 2021.

DESIGN

Retrospective observational study using interrupted time series analysis to identify changes in hospitalisation rate and case fatality rate (CFR) by epidemic wave.

SETTING

Data from the Mexican Institute of Social Security's (IMSS) Online Influenza Epidemiological Surveillance System (SINOLAVE) that include all individuals that sought care at IMSS facilities all over Mexico.

PARTICIPANTS

All individuals included in the SINOLAVE with a positive PCR or rapid test for SARS-CoV-2.

PRIMARY AND SECONDARY OUTCOME MEASURES

Monthly test positivity rates, hospitalisation rates, CFRs and prevalence of relevant comorbidities by age group.

RESULTS

From March 2020 to October 2021, the CFR declined between 1% and 3.5%; the declines were significant for those 0-9, 20-29, 30-39, 40-49 and 70 and older. The decline was steep during the first wave and was less steep or was temporarily reversed at the beginning of the second and third waves (changes in the trend of about 0.3% and 3.8%, and between 0.7% and 3.8%, respectively, for some age groups), but then continued to the end of the analytical period. Prevalence of diabetes, hypertension and obesity among patients testing positive also declined-two for most age groups (reductions of up to 10 percentage points for diabetes, 12 percentage points for hypertension and 19 percentage points for obesity).

CONCLUSION

Data suggest that the decrease in COVID-19 fatality rate is at least partially explained by a change in the profile of those contracting the disease, that is, a falling proportion of individuals with comorbidities across all age groups.

A framework to guide research and practice response to emerging infectious diseases: Genomic-to-global considerations

Newly emerging infectious diseases (EIDs), like the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, are becoming increasingly common. Due to geographic, political, social, behavioral, and genomic differences, some populations are more vulnerable to infectious disease spread than others. The purpose of this article is to present a framework for research and practice response to emergent infectious diseases that addresses multiple transdisciplinary actions to limit exposure or mitigate adverse outcomes for individuals and communities. Recent experience with new strains of emergent infectious diseases reinforces the importance of intervening at multiple levels, from genomics to political messaging to create multipronged, transdisciplinary interventions to contain the threat. In particular, incorporation of genomics into public health nursing practice of infectious diseases management can enhance existing regional-, community-, and individual-level health promotion and protection efforts, thus impacting long-term health outcomes.

Poverty in old age in times of COVID-19-Empirical results from Austria

Early in the pandemic, researchers were cautioning that COVID-19 and the associated health policy countermeasures would have an increased negative impact on groups that were already vulnerable before the pandemic. One of these groups are older people affected by poverty, who according to official figures make up 13.9% of older population in Austria. Even before the pandemic, their living situation was considered precarious. Not without reason, this group has been identified as a high-risk group of the pandemic, due to their increased likelihood of severe COVID-19 related illness and their limited monetary resources and thus lower chances of coping with the pandemic. Nevertheless, research on this group has remained sparse to date. Therefore, the aim of the study is to focus on older people (60+ years) below the poverty line and to compare them with non-poor individuals. Data from the SHARE (Survey of Health Aging and Retirement in Europe) project is used, combining data from the two SHARE Corona Surveys (summer 2020 and summer 2021) and the SHARE Corona Special Austria Survey (December 2020) to gain the most complete picture of life situation during the pandemic. Results demonstrate that older people in poverty were more likely to report poor subjective health before as well as during the pandemic yet were significantly more likely to refuse vaccination against COVID-19, despite adhering to other measures against the pandemic to the same extent as non-poor people. Restrictions in the health care system affected both groups equally and no significant differences in the frequency of social contacts could be found. However, older people below the poverty line were significantly more likely to rely on social support to obtain necessities during the pandemic and were less likely to use the internet. Together, these results point out that disadvantage exist for the older poor in some but not all areas of life during the pandemic. This paper is aimed at providing first insights into the lives of poor older persons during a taxing time and may perhaps inspire more in-depth study of this particularly understudied population.

Evaluation of Mexican poverty reduction policies under the COVID-19 pandemic impacts

From 2019 to 2020, the Mexican economy declined for two consecutive years, especially in the last one when it was hit by a decline of 8.4% before the COVID-19 pandemic impacts which was not only one of the worst in the OECD club, but also the deepest economic recession since 1932 in the national history. At the same time, both the number of people in poverty and poverty rate in 2020 have increased compared with those registered in 2018. Through the analysis, we can find that the current Mexican government has increased the intensity and scope of the implementation of social relief policies adhered to the principal of "for the good of all, first the poor (Por el bien de todos, Primero los pobres)." However, in the context of recession caused by the COVID-19, neither the general decrease in residents' income could be avoided, nor the number of people in poverty has been reduced. Besides, in accordance with the benefits obtained by the distinct household deciles based on the income and expenditure survey published by INEGI, it showed that the implementation of government relief measures has relatively reduced the support for the low-income people and further aggravated the deterioration of poverty due to its indifferent application with respect to high-income households and the low-income ones. Therefore, the deficiencies in the response implemented in the face of the epidemic, especially poverty alleviation actions and social relief policies, have further enhanced the poverty problem at least partially. In this sense, recover and improve the economic growth rate as soon as possible will not enough to reduce the poverty, and it should be accompanied by the necessary adjustments in the poverty alleviation measures and social relief policies, especially with a focalized approach inclined to the low-income segments of the population.

Prerequisite for COVID-19 Prediction: A Review on Factors Affecting the Infection Rate

Since the year 2020, coronavirus disease 2019 (COVID-19) has emerged as the dominant topic of discussion in the public and research domains. Intensive research has been carried out on several aspects of COVID-19, including vaccines, its transmission mechanism, detection of COVID-19 infection, and its infection rate and factors. The awareness of the public related to the COVID-19 infection factors enables the public to adhere to the standard operating procedures, while a full elucidation on the correlation of different factors to the infection rate facilitates effective measures to minimize the risk of COVID-19 infection by policy makers and enforcers. Hence, this paper aims to provide a comprehensive and analytical review of different factors affecting the COVID-19 infection rate. Furthermore, this review analyses factors which directly and indirectly affect the COVID-19 infection risk, such as physical distance, ventilation, face masks, meteorological factor, socioeconomic factor, vaccination, host factor, SARS-CoV-2 variants, and the availability of COVID-19 testing. Critical analysis was performed for the different factors by providing quantitative and qualitative studies. Lastly, the challenges of correlating each infection risk factor to the predicted risk of COVID-19 infection are discussed, and recommendations for further research works and interventions are outlined.

Seroprevalence of IgM and IgG anti-SARS-COV-2 and associated factors among agricultural workers in Colombia

Background

The population of South America has been severely affected by the COVID-19 pandemic. In this region, during the year 2020, high seroprevalence percentages were reported, which have been associated with the socioeconomic characteristics of the population, mainly in urban areas. However, a relative lack of information on the dynamics of the pandemic in rural areas of these countries, where the population is more vulnerable, is still present. This study determined antibody prevalence against SARS-CoV-2 in urban and rural food producing workers in Colombia.

Methods

A total of 1242 workers, urban and rural, linked to poultry, dairy, and meat production and supply chains, were analyzed through a sociodemographic survey and two serological tests against S and N proteins of SARS-CoV-2.

Results

78.7% were male. 50.9% of the participants were rural inhabitants, with an average age of 40.9 years old. 39.2% had IgM and IgG against SARS-CoV-2 S protein and 31.3% against N protein for the same virus; 83.6% had not been tested with an RT-PCR test for COVID-19 and 75.7% did not report symptoms related to the disease. The associated risk factors were low education, OR: 1.46, greater number of cohabitants, OR: 1.36, and contact with people infected with COVID-19, OR: 2.03.

Conclusions

The seroprevalences found suggest an important interconnectivity between rural and urban areas, where asymptomatic subjects and sociodemographic factors facilitate the virus' spread in the population.

CMV seropositivity is a potential novel risk factor for severe COVID-19 in non-geriatric patients

BACKGROUND

COVID-19 has so far affected more than 250 million individuals worldwide, causing more than 5 million deaths. Several risk factors for severe disease have been identified, most of which coincide with advanced age. In younger individuals, severe COVID-19 often occurs in the absence of obvious comorbidities. Guided by the finding of cytomegalovirus (CMV)-specific T cells with some cross-reactivity to SARS-CoV-2 in a COVID-19 intensive care unit (ICU) patient, we decided to investigate whether CMV seropositivity is associated with severe or critical COVID-19. Herpes simplex virus (HSV) serostatus was investigated as control.

METHODS

National German COVID-19 bio-sample and data banks were used to retrospectively analyze the CMV and HSV serostatus of patients who experienced mild (n = 101), moderate (n = 130) or severe to critical (n = 80) disease by IgG serology. We then investigated the relationship between disease severity and herpesvirus serostatus via statistical models.

RESULTS

Non-geriatric patients (< 60 years) with severe COVID-19 were found to have a very high prevalence of CMV-seropositivity, while CMV status distribution in individuals with mild disease was similar to the prevalence in the German population; interestingly, this was not detectable in older patients. Prediction models support the hypothesis that the CMV serostatus, unlike HSV, might be a strong biomarker in identifying younger individuals with a higher risk of developing severe COVID-19, in particular in absence of other co-morbidities.

CONCLUSIONS

We identified 'CMV-seropositivity' as a potential novel risk factor for severe COVID-19 in non-geriatric individuals in the studied cohorts. More mechanistic analyses as well as confirmation of similar findings in cohorts representing the currently most relevant SARS-CoV-2 variants should be performed shortly.

Ansiedad por COVID-19 de padres y madres en el contexto del regreso a las escuelas

El propósito de la investigación fue analizar los niveles de ansiedad por COVID-19 (NAC) que presentan los padres y madres de familia ante el regreso a clases de sus hijos e hijas. Para esto se aplicó la escala de ansiedad por coronavirus, según (González-Rivera, Rosario-Rodríguez y Cruz-Santos, 2020), a través de la plataforma Google Forms. Se selecciono una muestra no probabilística por conveniencia de 88 personas, 18 padres y 70 madres de familia con al menos un hijo que estudiara en educación básica privada o pública de la ciudad de Campeche, México. Los resultados muestran diferencias significativas entre los grupos de madres de escuelas públicas y padres de escuelas privadas (P ≤ .05). Se concluye que, aunque los niveles de ansiedad por COVID que presento la muestra son mínimos, el nivel de preocupación de contagio por COVID ante el regreso a clases de su(s) hijo/a(s) es alto, sobre todo en las escuelas públicas.

The potential effects of the COVID-19 pandemic on learnings

In this paper, we use a new database for Mexico to model the possible long-run effects of the pandemic on learning. First, based on the framework of Neidhöffer et al. (2021), we estimate the loss of schooling due to the transition from in-person to remote learning using data from the National Survey on Social Mobility (ESRU-EMOVI-2017), census data, and national statistics of COVID-19 incidence. In this estimation, we account for the attenuation capacity of households by econsidering the parental educational attainment and the economic resources available to the household in the calculation of the short-run cost. Secondly, we estimate the potential long-run consequences of this shock through a calibrated learning profile for five Mexican regions following Kaffenberger and Pritchett (2020a, 2020b). Assuming the distance learning policy adopted by the Mexican government is entirely effective, our results indicate that a learning loss equivalent to the learning during a third of a school year in the short run translates into a learning loss equivalent to an entire school year further up the educational career of students. On the other hand, if the policy was ineffective, the short-run loss increases to an entire school year and becomes a loss of two years of learning in the long run. Our results suggest substantial variation at the regional level, with the most affected region, the South experiencing a loss thrice as large as that of the least affected region, the Centre region.