Socio-economic status and COVID-19-related cases and fatalities

An ecological study of COVID-19 outcomes among Florida counties

BACKGROUND

During the COVID-19 pandemic, Florida reported some of the highest numbers of cases and deaths in the US; however, county-level variation in COVID-19 outcomes has yet to be comprehensively investigated. The present ecological study aimed to assess correlates of COVID-19 outcomes among Florida counties that explain variation in case rate, mortality rate, and case fatality rate (CFR) across pandemic waves.

METHOD

We obtained county-level administrative data and COVID-19 case reports from public repositories. We tested spatial autocorrelation to assess geographic clustering in COVID-19 case rate, mortality rate, and CFR. Stepwise linear regression was employed to investigate the association between COVID-19 outcomes and 17 demographic, socioeconomic, and health-related county-level predictors.

RESULTS

We found mortality rate and CFR were significantly higher in rural counties compared to urban counties, among which significant differences in vaccination coverage were also observed. Multivariate analysis found that the percentage of the population aged over 65 years, the percentage of obese people, and the percentage of the rural population were significant predictors of COVID-19 case rate. Median age, vaccination coverage, percentage of people who smoke, and percentage of the population with diabetes were significant influencing factors for CFR. Importantly, higher vaccination coverage was significantly associated with a reduction in case rate (R = -0.26, p = 0.03) and mortality (R = -0.51, p < 0.001). Last, we found that spatial dependencies play a role in explaining variations in COVID-19 CFR among Florida counties.

CONCLUSION

Our findings emphasize the need for targeted, equitable public health strategies to reduce disparities and enhance population resilience during public health crises.

H, Figueira FAMDS, Andrade RLM, de Abreu LC. Evolution of COVID-19 in the State of São Paulo: Analysis of Incidence, Mortality and Lethality from 2020 to 2023

INTRODUCTION

COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus, which belongs to the coronavirus family. SARS-CoV-2 is related to other viruses that cause severe acute respiratory syndrome. The emergence of cases of pneumonia of unknown origin triggered the largest viral pandemic in modern times, presenting major challenges to global public health.

OBJECTIVE

To analyze the evolution of the COVID-19 pandemic in the state of São Paulo from 2020 to 2023, focusing on trends in incidence, mortality, and lethality.

METHODS

Ecological study of time series of incidence, mortality and lethality by COVID-19 in the state of São Paulo using Prais-Winsten regression considering the Weekly Percentage Change (WPC) and probability values (p), considering a significance level of 95% (95% CI). To ensure the reliability of the entered data, double-blind typing was performed by different researchers in the same database extracted from the 2024 Ministry of Health Coronavirus dashboard.

RESULTS

From February 2020 and the end of December 2023, 6,763,310 accumulated cases and 182,254 deaths were recorded. Stationary trends were observed for the year 2022, with a reduction in incidence and mortality in the year 2023. However, the epidemiological variable lethality showed a stationary trend.

CONCLUSION

The analysis of the trends in incidence, mortality, and lethality revealed variable dynamics over time, with emphasis on the significant reduction of these indicators in 2023.

Longer-Term Mental Health Consequences of COVID-19 Infection: Moderation by Race and Socioeconomic Status

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.

The feasibility of using machine learning to predict COVID-19 cases

BACKGROUND

Coronavirus Disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, emerged as a global health crisis in 2019, resulting in widespread morbidity and mortality. A persistent challenge during the pandemic has been the accuracy of reported epidemic data, particularly in underdeveloped regions with limited access to COVID-19 test kits and healthcare infrastructure. In the post-COVID era, this issue remains crucial. This study introduces a novel approach by leveraging machine learning to predict cases and uncover critical discrepancies, focusing on African regions where reported daily cases per million often deviate significantly from machine learning-predicted cases. These findings strongly suggest widespread underreporting of cases. By identifying these gaps, our research provides valuable insights for future pandemic preparedness, improving epidemic forecasting accuracy, data reliability, and response strategies to mitigate the impact of emerging global health crises.

OBJECTIVE

This study aims to assess the reliability of reported COVID-19 incidence data globally, particularly in underdeveloped regions, and to identify discrepancies between reported and predicted cases using machine learning methodologies.

METHODS

Data collected from March 2020 to September 2022 included demographic, healthcare, economic, and testing-related parameters. Several machine learning models-neural networks, decision trees, random forests, cross-validation, support vector machines, and logistic regression-were employed to predict COVID-19 incidence rates. Model performance was evaluated using testing accuracy metrics.

RESULTS

Testing accuracy rates for the models were as follows: neural networks (65.50 %), decision trees (63.76 %), random forests (63.33 %), cross-validation (55.92 %), support vector machines (63.62 %), and logistic regression (64.70 %). Comparative analysis using neural networks revealed significant discrepancies between reported and predicted COVID-19 cases, particularly in numerous African countries. These results suggest a considerable volume of underreported cases in regions with limited testing capabilities.

CONCLUSION

This study highlights the critical need for improved data accuracy and reporting mechanisms, especially in resource-constrained regions. International organizations and policymakers must implement strategies to enhance testing capacity and data reliability to better understand and manage the global impact of the pandemic. Our work emphasizes the potential of machine learning to identify gaps in epidemic reporting, facilitating evidence-based interventions.

Sociodemographic characteristics and health status of women with breast cancer and COVID 19 diagnosis by menopausal status a cross sectional study

The goal of this work is to investigate the sociodemographic characteristics and health status of women with breast cancer (BC) in association with COVID-19 by menopausal status. In a Swedish register-based cross-sectional study, we compared women with BC and with or without a positive COVID-19 test, stratified by menopausal status (age ≥ 51 years). Socioeconomic characteristics and health status (represented by diagnoses registered in 5 years- and prescription dispensed in 2 years preceding Jan 2020) were considered in association with COVID-19 diagnosis. The study population included 38,523 women with BC. Median age at BC diagnosis was 45 years (IQR = 40-48) for premenopausal- and 67 (IQR = 60-73) for postmenopausal BC. A logistic regression model was used and found the significant covariate effects (adjusted odds ratios, ORs) for a positive COVID-19 test among women with premenopausal BC to be being born outside of Europe: 1.29, (1.13-1.46), being married: 1.23, (1.12-1.36), being unemployed 1.92 (1.59-2.30), having upper secondary school education 1.25 (1.01-1.54), having > 15 outpatient visits: 1.31, (1.07-1.61), and a history of being admitted to hospital 1-5 times: 1.12 (1.01-1.25). Corresponding significant covariate effects among women with postmenopausal BC were being born outside of Europe: 1.61 (1.41-1.83), being married: 1.12 (1.04-1.21), and being unemployed 1.54 (1.40-1.69). Postmenopausal women furthermore had more outpatient visits or hospital admissions before the pandemic in COVID-19 positive patients compared to patients without a COVID-19 positive test, e.g. 1.47 (1.26-1.71) for > 15 outpatient visits compared with no visit and 6.35 (3.33-12.11) for > 15 hospital admissions compared with no admission. Varied socioeconomical and clinical conditions were more frequent among patients with a positive COVID-19 test compared to patients without a positive test among women with BC in pre- or post-menopausal status. We conclude that some characteristics of women such as unemployment, country of birth or health status measured by number of prescribed drugs were more prevalent among women who developed COVID-19 compared to women without COVID-19 diagnosis and either of menopausal status of breast cancer.

Socioeconomic status correlates with COVID-19 vaccination coverage among primary and secondary students in the most populated city of Chile

The burden of COVID-19 was heterogeneous, indicating that the effects of this disease are synergistic with both other non-communicable diseases and socioeconomic status (SES), highlighting its syndemic character. While the appearance of vaccines moderated the pandemic effects, their coverage was heterogeneous too, both when comparing different countries, and when comparing different populations within countries. Of note, once again SES appears to be a correlated factor. We analyzed publicly available data detailing the percentage of school-aged, vaccinated children in different municipalities belonging to the Metropolitan Area (MA) of Santiago, Chile. Vaccination data was compiled per school type, either public, state-subsidized, or private, at three different dates during the COVID-19 pandemic to cover the dispersion of Delta, Omicron, and its subvariants BA.4 and BA.5. We computed the median vaccination ratio for each municipality and school type and calculated their Spearman's rank correlation coefficient with each one of nine SES indices. The percentage of school-age children who received vaccinations against COVID-19 correlates with SES. This strong correlation is observed in public and state-subsidized schools, but not in private schools. Although inequity in vaccination coverage decreased over time, it remained higher among students enrolled either in public or state-subsidized schools compared to those of private schools. Although available data was insufficient to explore plausible causes behind lower vaccination coverage, it is likely that a combination of factors including the lack of proper information about the importance of vaccination, the lack of incentives for children's vaccination, low trust in the government, and limited access to vaccines for lower-income people, may all have contributed. These findings raise the need to design better strategies to overcome shortcomings in vaccination campaigns to confront future pandemics.

Changes in Subjective Cognitive and Social Functioning in Parkinson's Disease from Before to During the COVID-19 Pandemic

Background/Objectives: Social isolation and health-related consequences of the COVID-19 pandemic may have significantly impacted quality of life in people with Parkinson's disease (PwPD). The effect of the COVID-19 pandemic specifically on subjective cognition and social functioning in PwPD is poorly understood. We conducted a longitudinal analysis of changes in subjective cognitive and social functioning in PwPD before (T1, 2017-2019) and during (T2, 2021) the COVID-19 pandemic. Methods: At T1, 347 PwPD completed online surveys. At T2, 123 of them (54 males, 69 females) responded to follow-up questionnaires including Quality of Life in Neurological Disorders (Neuro-QoL) subscales, Beck Depression Inventory-II, Parkinson's Anxiety Scale, motor and non-motor experiences of daily living from the MDS-Unified Parkinson's Disease Rating Scale, and the Coronavirus Impact Scale. Results: T1-T2 declines in subjective cognition and social functioning both were correlated with more anxiety, fatigue, and motor symptoms. Additionally, declines in subjective cognition correlated with depression, and with decline in social functioning. Women reported greater COVID-19 impact than men, unrelated to cognition and social functioning; in men, personal experience with COVID-19 was associated with decline in subjective cognition. Conclusions: Our finding that subjective cognition and social functioning are associated with different motor and non-motor symptoms of PD suggests that the impacts of PD on subjective cognition and social functioning are complex, which has important implications for treatment.

The effect of COVID-19 on health insurance and mental health

BACKGROUND

The outbreak of the novel coronavirus SARS-CoV-2, first discovered in Wuhan, Hubei province of the People's Republic of China, has spread to virtually every country which caused a global pandemic. The pandemic in the United States may have caused disruption of health coverage for millions of people. Researchers have found that the pandemic has affected health insurance coverage for millions in the United States. However, there is a gap in the literature that assesses the mental health status of those affected with health insurance by the covid-19 pandemic.

OBJECTIVE

Our hypothesis postulates that those who had employer-based insurance were negatively affected and those who had public insurance were positively affected. Furthermore, we hypothesized that those who lost their health insurance experienced adverse mental health effects and conditions such as anxiety, depression, and stress. The aim of this study is to examine the effect of Covid-19 pandemic on health insurance behavior and mental health.

METHODS

We conducted a cross-sectional method to determine whether the covid-19 pandemic influenced health insurance behavior. An online questionnaire was administered to 500 adults residing in the United States through an online platform, Prolific, that helps researchers recruit participants for online research. Enrollment was on a first-come, first-served basis. Participants completed the questionnaire on March 27, 2023. The survey administered assessed the participants mental health status with their experience of healthcare during the pandemic. Two regression analysis were conducted to understand the pandemic's effect on participants health. Our dependent variable was the answers to the participants health from the pandemic using a summative scale. The independent variable was whether participants had health insurance. And if so, the type of health insurance.

RESULTS

The results showed that loss of employer health insurance has a significant effect on mental health. Furthermore, certain demographics were more likely to experience adverse health from the pandemic.

CONCLUSION

Further studies should be explored to understand the health disparities from the pandemic.

Mental health, stress, and well-being measured before (2019) and during (2020) COVID-19: a Swedish socioeconomic population-based study

OBJECTIVES

Compare mental health, stress, and well-being in the Swedish population as measured before and during the COVID-19 pandemic.

METHODS

Repeated cross-sectional design using data measured before (Jan-2019; n = 2791) and during (Oct/Nov-2020; n = 2926) COVID-19 pandemic in Swedish population-representative cohorts. Following constructs were measured: anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), stress (Perceived Stress Scale-10 items), health-related quality of life (HRQOL[Functional Assessment of Cancer Therapy-General Population]) and self-rated health (SRH) was assessed with a single-item question.

RESULTS

When adjusting for age, sex, education, and income there were significantly higher levels of anxiety (M̂ = 9.15 vs. 8.48, p < 0.01) and depression (M̂ = 3.64 vs. 3.30, p = 0.03), lower levels of stress (M̂ = 14.06 vs. 14.91, p < 0.001), but worsened HRQOL (M̂ = 76.40 vs. 77.92, p < 0.01) and SRH (M̂ = 6.91 vs. 7.20, p < 0.001), observed in 2020 compared to 2019. For the negative effects seen in anxiety, depression, HRQOL, and SRH, higher income and education had a protective effect. The decrease in stress was also correlated with higher income.

CONCLUSIONS

The COVID-19 pandemic led to a small but significant worsening in mental health and well-being in the general Swedish population, where higher socioeconomic status seemed to have a protective effect.

A scoping review on the operationalization of intersectional health research methods in studies related to the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic began in early 2020 and became a global health crisis with devastating impacts. This scoping review maps the key findings of research about the pandemic that has operationalized intersectional research methods around the world. It also tracks how these studies have engaged with methodological tenets of oppression, comparison, relationality, complexity, and deconstruction.

METHODS

Our search resulted in 14,487 articles, 5164 of which were duplicates, and 9297 studies that did not meet the inclusion criteria were excluded. In total, 14 articles were included in this review. We used thematic analysis to analyse themes within this work and Misra et al. (2021) intersectional research framework to analyse the uptake of intersectional methods within such studies.

RESULTS

The research related to the COVID-19 pandemic globally is paying attention to issues around the financial impacts of the pandemic, discrimination, gendered impacts, impacts of and on social ties, and implications for mental health. We also found strong uptake of centring research in the context of oppression, but less attention is being paid to comparison, relationality, complexity, and deconstruction.

CONCLUSIONS

Our findings show the importance of intersectional research within public health policy formation, as well as room for greater rigour in the use of intersectional methods.

Sociodemographic, Clinical, and Ventilatory Factors Influencing COVID-19 Mortality in the ICU of a Hospital in Colombia

BACKGROUND AND OBJECTIVES

The COVID-19 pandemic posed significant challenges to healthcare systems worldwide, and mortality rates were driven by a complex interaction of patient-specific factors, one of the most important being those related to the scheduling of invasive mechanical ventilation. This study examined the sociodemographic, clinical, and ventilatory factors associated with mortality in COVID-19 patients admitted to the ICU of a hospital in Colombia.

METHODS

A retrospective cohort study was conducted, involving 116 patients over the age of 18 who were admitted to the ICU with a confirmed diagnosis of COVID-19 between March 2020 and May 2021. Data were collected from the patients' medical records. Statistical analysis was performed using SPSS version 24®. Odds ratios (OR) and 95% confidence intervals were calculated to identify factors associated with COVID-19 mortality, followed by adjustment through binary logistic regression.

RESULTS

It was found that 65.5% of the patients were male, with a mean age of 64 ± 14 years, and the overall mortality rate was 49%. Factors significantly associated with higher mortality included male sex (OR: 6.9, 95% CI: 1.5-31.7), low oxygen saturation on admission (OR: 7.6, 95% CI: 1.1-55), and PEEP settings at 96 h (OR: 8, 95% CI: 1.4-45). Mortality was not influenced by socioeconomic status or health system affiliation.

CONCLUSIONS

This study identified male sex, age over 65 years, PEEP greater than 10 cmH2O at 96 h of mechanical ventilation, and low oxygen saturation as significant factors associated with higher mortality in COVID-19 patients, while no significant associations were found with socioeconomic status or health system affiliation. These findings highlight the importance of focusing on clinical management and ventilatory strategies in reducing mortality, particularly for high-risk groups, rather than relying on socioeconomic factors as predictors of outcomes.

Active sport participation and walking before and during COVID-19 pandemic in a large cohort of Polish adults: results of the National Test for Poles' Health

OBJECTIVES

The COVID-19 pandemic has led to significant changes in daily life, including changes in physical activity levels. This study aims to examine the impact of the pandemic on sport participation and walking among Polish adults.

MATERIAL AND METHODS

The data was collected using the National Test for Poles' Health, a large-scale online survey. The survey was conducted before and 1 year after the pandemic onset in Poland (March 2020 and March 2021), with >300 000 participants in each year.

RESULTS

The results revealed that the percentage of respondents engaging in at least 2 h/week of sport increased by 2.3% (from 24.6% to 26.9%) (p < 0.0001) and percentage of respondents not engaging in any sport decreased by 2.5% (from 48.0% to 45.5%) (p < 0.0001). These trends were observed across different age, sex, dwelling-place, education level, and employment groups. Percentage of respondents declaring they spend >2 h/day on walking also increased, from 5.6% to 6.6% (p < 0.0001). Furthermore, a positive association was found between sport participation and walking time (p < 0.0001).

CONCLUSIONS

The findings suggest a slight improvement in physical activity levels among Polish adults during the pandemic, which may be attributed to factors such as increased time available due to remote work and the prioritization of health during the crisis. Further research is needed to explore the long-term consequences of the pandemic on physical activity and public health. Int J Occup Med Environ Health. 2024;37(4):468-81.

Effect of the COVID-19 pandemic on the well-being of middle-aged and older Europeans

The COVID-19 pandemic has been associated with a general decline in well-being. However, there is limited evidence on the effect of the pandemic on the general population, and especially among the ageing population. We assessed the overall impact of the pandemic on the well-being of middle-aged and older adults residing in 27 European countries, focusing on the time-period before summer 2021. We used a sample of 46,209 respondents from the two population-based longitudinal Corona Surveys collected during summer 2020 and summer 2021. To test our hypotheses, we used latent change score models. All analyses were stratified by sex. The COVID-19 pandemic affected middle-aged and older Europeans' well-being irrespective of their sex. Being infected by the COVID-19 virus at the start of the pandemic had a negative impact on well-being. As expected, adults with Long COVID experienced the most pronounced decline in well-being. A novel finding was the decline in the level of well-being among adults not infected by the COVID-19 virus. Support should be provided at community levels with specific attention towards individuals with Long COVID symptoms and those infected with COVID-19 at earlier stages of the pandemic.

Identification of environmental, socioeconomic, water, sanitation, and hygiene (WaSH) factors associated with COVID-19 incidence in the Philippines: A nationwide modelling study

Despite the implementation of non-pharmaceutical interventions, the threat of coronavirus disease 2019 (COVID-19) remains significant on a global scale. Identifying external factors contributing to its spread is crucial, especially given the World Health Organization's recommendation emphasizing access to water, sanitation, and hygiene as essential in curbing COVID-19. There is a notable discrepancy in access to sanitation facilities, particularly evident in low- and middle-income countries. However, there is a lack of quantitative assessments regarding these factors. This study examines various environmental, socioeconomic, water, sanitation, and hygiene factors and their associations with COVID-19 incidence. All regions in the Philippines were categorized into clusters based on socioeconomic factors. A conceptual structural equation model (SEM) was developed using domain knowledge. The best-fitting SEM for each cluster was determined, and associations between factors and COVID-19 incidence were estimated. The correlation analysis revealed that rainfall, minimum temperature, and relative humidity were positively correlated with weekly COVID-19 incidence in urban regions. Maximum temperature, mean temperature, wind speed, and wind direction were negatively correlated with weekly COVID-19 incidence in rural regions, with time lags of 0, 3, and 7 weeks. In urban regions (Cluster 1), factors such as urbanization rate (1.00), area (-0.93), and population (0.54) were found to be associated with weekly COVID-19 incidence. Conversely, in rural regions (Cluster 2), factors including area (0.17), basic sanitation (0.84), and wind direction (0.83) showed associations with weekly COVID-19 incidence. These factors were causally associated with a latent variable reflecting the hidden confounders associated with COVID-19 incidence. It is important to note that sanitation factors were associated only in rural regions. Improving access to sanitation facilities in rural regions of the Philippines is imperative to effectively mitigate disease transmission in future pandemics. Identification of the causal effect of unobserved confounders with COVID-19 incidence is recommended for future research.

Incorporating Social Determinants of Health in Infectious Disease Models: A Systematic Review of Guidelines

BACKGROUND

Infectious disease (ID) models have been the backbone of policy decisions during the COVID-19 pandemic. However, models often overlook variation in disease risk, health burden, and policy impact across social groups. Nonetheless, social determinants are becoming increasingly recognized as fundamental to the success of control strategies overall and to the mitigation of disparities.

METHODS

To underscore the importance of considering social heterogeneity in epidemiological modeling, we systematically reviewed ID modeling guidelines to identify reasons and recommendations for incorporating social determinants of health into models in relation to the conceptualization, implementation, and interpretations of models.

RESULTS

After identifying 1,372 citations, we found 19 guidelines, of which 14 directly referenced at least 1 social determinant. Age (n = 11), sex and gender (n = 5), and socioeconomic status (n = 5) were the most commonly discussed social determinants. Specific recommendations were identified to consider social determinants to 1) improve the predictive accuracy of models, 2) understand heterogeneity of disease burden and policy impact, 3) contextualize decision making, 4) address inequalities, and 5) assess implementation challenges.

CONCLUSION

This study can support modelers and policy makers in taking into account social heterogeneity, to consider the distributional impact of infectious disease outbreaks across social groups as well as to tailor approaches to improve equitable access to prevention, diagnostics, and therapeutics.

HIGHLIGHTS

Infectious disease (ID) models often overlook the role of social determinants of health (SDH) in understanding variation in disease risk, health burden, and policy impact across social groups.In this study, we systematically review ID guidelines and identify key areas to consider SDH in relation to the conceptualization, implementation, and interpretations of models.We identify specific recommendations to consider SDH to improve model accuracy, understand heterogeneity, estimate policy impact, address inequalities, and assess implementation challenges.

Exploring the impact of recent COVID-19 infection on perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease

OBJECTIVE

This study seeks to evaluate how recent COVID-19 infection affects myocardial perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease. The goal is to enhance our understanding of COVID-19's influence on the cardiovascular system.

METHOD

Conducted at Farshchian Heart Hospital from 2022 to 2023, this case-control study enrolled patients suspected of coronary artery disease, stratified into two groups: those with confirmed COVID-19 infection within the past 6 months (study group) and those without prior COVID-19 infection (control group). Employing a 2-day protocol, stress testing and gated SPECT MPI were performed. Statistical analysis included descriptive statistics, Chi-square test, Student's t test, and Mann-Whitney U test.

RESULT

Among the 86 patients included, 43 were in each group. Significantly higher summed stress core and summed difference score values were observed in the study group compared to the control group (p < 0.05). In addition, the study group exhibited significantly altered global left ventricular ejection fraction, end-diastolic volume, and end-systolic volume (p < 0.05). Non-perfusion findings, including transient ischemic dilation and transient right ventricular visualization, were more prevalent in the study group.

CONCLUSION

Recent COVID-19 infection is associated with impaired myocardial perfusion and altered functional parameters as detected by MPI. These findings underscore the intricate interplay between COVID-19 and cardiovascular health, emphasizing the importance of comprehensive evaluation and management strategies to address cardiac complications in affected individuals. Further research is warranted to elucidate the underlying mechanisms and optimize patient care in the context of COVID-19-associated cardiovascular manifestations.

COVID-19 vaccines are effective at preventing symptomatic and severe infection among healthcare workers: A clinical review

Introduction

Health care workers (HCWs) have been at increased risk of infection during the SARS-CoV-2 pandemic and as essential workers have been prioritised for vaccination. Due to increased exposure HCW are considered a predictor of what might happen in the general population, particularly working age adults. This study aims to summarise effect of vaccination in this 'at risk' cohort.

Methods

Ovid MEDLINE and Embase were searched, and 358 individual articles were identified. Of these 49 met the inclusion criteria for review and 14 were included in a meta-analysis.

Results

Participants included were predominantly female and working age. Median time to infection was 51 days. Reported vaccine effectiveness against infection, symptomatic infection, and infection requiring hospitalisation were between 5 and 100 %, 34 and 100 %, and 65 and 100 % (respectively). No vaccinated HCW deaths were recorded in any study. Pooled estimates of protection against infection, symptomatic infection, and hospitalisation were, respectively, 84.7 % (95 % CI 72.6-91.5 %, p < 0.0001), 86.0 % (95 % CI 67.2 %-94.0 %; p < 0.0001), and 96.1 % (95 % CI 90.4 %-98.4 %). Waning protection against infection was reported by four studies, although protection against hospitalisation for severe infection persists for at least 6 months post vaccination.

Conclusions

Vaccination against SARS-CoV2 in HCWs is protective against infection, symptomatic infection, and hospitalisation. Waning protection is reported but this awaits more mature studies to understand durability more clearly. This study is limited by varying non-pharmacological responses to COVID-19 between included studies, a predominantly female and working age population, and limited information on asymptomatic transmission or long COVID protection.

The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension

The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.

Racial and Regional Disparities Surrounding In-Hospital Mortality among Patients with 2019 Novel Coronavirus Disease (COVID-19): Evidence from NIS Sample in 2020

OBJECTIVE

This study explores differences in COVID-19 in-hospital mortality rates by patient and geographic factors to identify at-risk populations and analyze how strained health disparities were exacerbated during the pandemic.

METHODS

The latest 2020 United States National Inpatient Sample (NIS) data was used to obtain a population-based estimate for patients with COVID-19. We conducted a cross-sectional retrospective data analysis, and sampling weights were used for all statistical analyses to represent nationwide in-hospital mortality of patients with COVID-19. We used multivariate logistic regression models to identify predictors for how patients with COVID-19 are associated with in-hospital death.

RESULTS

Of 200,531 patients, 88.9% did not have an in-hospital death (n=178,369), and 11.1% had in-hospital death (n=22,162). Patients older than 70 were 10 times more likely to have an in-hospital death than patients younger than 40 (p<0.001). Male patients were 37% more likely to have an in-hospital death than female patients (p<0.001). Hispanic patients were 25% more likely to have in-hospital deaths than White patients (p<0.001). In the sub-analysis, Hispanic patients in the 50-60, 60-70, and 70 age groups were 32%, 34%, and 24%, respectively, more likely to have in-hospital death than White patients (p<0.001). Patients with hypertension and diabetes were 69% and 29%, respectively, more likely to have in-hospital death than patients without hypertension and diabetes.

CONCLUSION

Health disparities in the COVID-19 pandemic occurred across races and regions and must be addressed to prevent future deaths. Age and comorbidities like diabetes have a well-established link to increased disease severity, and we have linked both to higher mortality risk. Low-income patients had a significantly increased risk of in-hospital death starting at over 40 years old.

Factors Associated With Surveillance Testing in Individuals With COVID-19 Symptoms During the Last Leg of the Pandemic: Multivariable Regression Analysis

Background

Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing had reduced, with more reliance on home testing, and those seeking testing were mostly symptomatic.

Objective

This study identifies factors associated with COVID-19 testing among individuals who were symptomatic versus asymptomatic seen at a Rapid Acceleration of Diagnostics for Underserved Populations phase 2 (RADx-UP2) testing site in West Virginia.

Methods

Demographic, clinical, and behavioral factors were collected via survey from tested individuals. Logistic regression was used to identify factors associated with the presence of individuals who were symptomatic seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportions of tested individuals who were symptomatic and social determinants of health.

Results

Among predictors, the presence of a physical (adjusted odds ratio [aOR] 1.85, 95% CI 1.3-2.65) or mental (aOR 1.53, 95% CI 0.96-2.48) comorbid condition, challenges related to a place to stay/live (aOR 307.13, 95% CI 1.46-10,6372), no community socioeconomic distress (aOR 0.99, 95% CI 0.98-1.00), no challenges in getting needed medicine (aOR 0.01, 95% CI 0.00-0.82) or transportation (aOR 0.23, 95% CI 0.05-0.64), an interaction between community socioeconomic distress and not getting needed medicine (aOR 1.06, 95% CI 1.00-1.13), and having no community socioeconomic distress while not facing challenges related to a place to stay/live (aOR 0.93, 95% CI 0.87-0.99) were statistically associated with an individual being symptomatic at the first test visit.

Conclusions

This study addresses critical limitations to the current COVID-19 testing literature, which almost exclusively uses population-level disease screening data to inform public health responses.

COVID-19 vaccination: 2023 Taiwan Association of Gerontology and Geriatrics (TAGG) consensus statements

The COVID-19 pandemic remains challenging due to the rapid evolution of the severe acute respiratory syndrome coronavirus 2. This article discusses recent findings on high-risk groups for COVID-19 mortality and morbidity, along with consensus statements from the 2023 Taiwan Association of Gerontology and Geriatrics (TAGG) meeting. It examines evidence on viral mutation mechanisms, emerging variants, and their implications for vaccination strategies. The article underscores advanced age, immunocompromised status, chronic medical conditions, occupational exposure, and socioeconomic disparities as significant risk factors for severe COVID-19 outcomes. TAGG's consensus emphasizes robust vaccination promotion, prioritizing elderly, and immunocompromised groups, individualized multi-dose regimens for immunocompromised patients, and simplified clinical guidelines. Discussions on global and regional recommendations for regular, variant-adapted boosters highlight the non-seasonal nature of COVID-19. Key agreements include escalating domestic preparedness, implementing vigorous risk-based vaccination, and adapting global guidelines to local contexts. Given ongoing viral evolution, proactive adjustment of vaccination policies is essential. Scientific consensus, tailored recommendations, and rapid knowledge dissemination are vital for optimizing COVID-19 protection among vulnerable groups in Taiwan. This article seeks to inform clinical practice and public health policy by summarizing expert-driven vaccination perspectives.

A COMPREHENSIVE REVIEW ON THE MULTIFACETED INTERACTIONS BETWEEN HOST IMMUNITY AND VIRAL PATHOGENESIS IN COVID-19

The Corona Virus Disease (COVID-19) pandemic has presented unparalleled challenges, marked by a wide array of clinical presentations spanning from asymptomatic carriage to severe respiratory compromise and multi-organ dysfunction. It is crucial to comprehend the intricate interplay between host immunity and viral pathogenesis to elucidate disease mechanisms and guide therapeutic strategies. This review delves into the multifaceted interactions between host immunity and viral pathogenesis in COVID-19, with a particular focus on the impact of host factors such as age, sex, comorbidities, and genetic predisposition on disease severity. Utilizing state-of-the-art methodologies, including multiomics approaches, has yielded an expansive molecular portrayal of COVID-19, furnishing innovative perspectives on host immune reactions, viral pathogenicity, and disease advancement. Establishing standardized methodologies for data analysis and interpretation while concurrently addressing ethical considerations and promoting interdisciplinary collaboration are crucial steps in advancing our comprehension of COVID-19 pathogenesis. Despite obstacles like complexities in data integration, this review highlights the imperative of persistent endeavors in deciphering the complex interactions between hosts and pathogens to alleviate the global health ramifications of COVID-19.

Child maltreatment during the COVID-19 pandemic: implications for child and adolescent mental health

As societies worldwide addressed the numerous challenges associated with the COVID-19 pandemic, a troubling concern emerged-the possible rise of child maltreatment, which is a pernicious risk factor for child and adolescent mental health difficulties. This narrative review aims to provide a comprehensive understanding of how the many changes and challenges associated with the pandemic influenced worldwide occurrences of child maltreatment and, subsequently, the mental health of children and adolescents. First, we present the well-established evidence regarding the impact of child maltreatment on the mental health of children and adolescents both before and during the COVID-19 pandemic. Next, we examine the existing literature on the prevalence of child maltreatment during the pandemic, explanations for conflicting findings, and key mechanisms influencing the prevalence of maltreatment. Using a heuristic model of child maltreatment and its downstream influence on child mental health, we discuss risk and protective factors for maltreatment as well as mechanisms by which maltreatment operates to influence child and adolescent mental health. Finally, based on the accumulated evidence, we provide important recommendations for advancing research on child maltreatment, emphasizing the necessity for routine monitoring of maltreatment exposure at a population level, and discussing the implications for the field of child protection. This comprehensive review aims to contribute to the understanding of the challenges arising from the intersection of the COVID-19 pandemic and child maltreatment, with the goal of informing effective interventions in the domain of child welfare.

Identification of methodological issues regarding direct impact indicators of COVID-19: a rapid scoping review on morbidity, severity and mortality

BACKGROUND

During the first epidemic wave, COVID-19 surveillance focused on quantifying the magnitude and the escalation of a growing global health crisis. The scientific community first assessed risk through basic indicators, such as the number of cases or rates of new cases and deaths, and later began using other direct impact indicators to conduct more detailed analyses. We aimed at synthesizing the scientific community's contribution to assessing the direct impact of the COVID-19 pandemic on population health through indicators reported in research papers.

METHODS

We conducted a rapid scoping review to identify and describe health indicators included in articles published between January 2020 and June 2021, using one strategy to search PubMed, EMBASE and WHO COVID-19 databases. Sixteen experts from European public health institutions screened papers and retrieved indicator characteristics. We also asked in an online survey how the health indicators were added to and used in policy documents in Europe.

RESULTS

After reviewing 3891 records, we selected a final sample of 67 articles and 233 indicators. We identified 52 (22.3%) morbidity indicators from 33 articles, 105 severity indicators (45.1%, 27 articles) and 68 mortality indicators (29.2%, 51). Respondents from 22 countries completed 31 questionnaires, and the majority reported morbidity indicators (29, 93.5%), followed by mortality indicators (26, 83.9%).

CONCLUSIONS

The indicators collated here might be useful to assess the impact of future pandemics. Therefore, their measurement should be standardized to allow for comparisons between settings, countries and different populations.

Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial

Importance

Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions.

Objectives

To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES.

Design, Setting, and Participants

This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024.

Interventions

Participants were randomized to usual care (UC) for smoking cessation (counseling plus pharmacotherapy) or UC plus abstinence-contingent financial incentives (UC plus FI).

Main Outcomes and Measures

The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (PPA) at 26 weeks after the quit date. Secondary outcomes included biochemically verified 7-day PPA at earlier follow-ups, 30-day PPA at 12 and 26 weeks, repeated 7-day PPA, and continuous abstinence. Multiple approaches were employed to handle missing outcomes at follow-up, including categorizing missing data as smoking (primary), complete case analysis, and multiple imputation.

Results

The 320 participants had a mean (SD) age of 48.9 (11.6) and were predominantly female (202 [63.1%]); 82 (25.6%) were Black, 15 (4.7%) were Hispanic, and 200 (62.5%) were White; and 146 (45.6%) participated during the COVID-19 pandemic. Overall, 161 were randomized to UC and 159 were randomized to UC plus FI. After covariate adjustment with missing data treated as smoking, assignment to UC plus FI was associated with a greater likelihood of 7-day PPA at the 4-week (adjusted odds ratio [AOR], 3.11 [95% CI, 1.81-5.34]), 8-week (AOR, 2.93 [95% CI, 1.62-5.31]), and 12-week (AOR, 3.18 [95% CI, 1.70-5.95]) follow-ups, but not at the 26-week follow-up (22 [13.8%] vs 14 [8.7%] abstinent; AOR, 1.79 [95% CI, 0.85-3.80]). However, the association of group assignment with smoking cessation reached statistical significance at all follow-ups, including 26 weeks, with multiple imputation (37.37 [23.5%] in the UC plus FI group vs 19.48 [12.1%] in the UC group were abstinent; AOR, 2.29 [95% CI, 1.14-4.63]). Repeated-measures analyses indicated that participants in the UC plus FI group were significantly more likely to achieve PPA across assessments through 26 weeks with all missing data estimation methods. Other secondary cessation outcomes also showed comparable patterns across estimation methods. Participants earned a mean (SD) of $72 ($90) (of $250 possible) in abstinence-contingent incentives. Participation during the COVID-19 pandemic reduced the likelihood of cessation across assessments.

Conclusions and Relevance

In this randomized clinical trial, incentivizing smoking cessation did not increase cessation at 26 weeks when missing data were treated as smoking; however, the UC plus FI group had greater odds of quitting at follow-ups through 12 weeks. Cessation rates were higher for the UC plus FI group at all follow-ups through 26 weeks when multiple imputation was used to estimate missing outcomes.

Trial Registration

ClinicalTrials.gov Identifier: NCT02737566.

First year of COVID-19 in Brazil: Factors associated with the spread of COVID-19 in small and large cities

AIM

To test the association between sociodemographic and social characteristics with COVID-19 cases and deaths in small and large Brazilian cities.

METHODS

This ecological study included COVID-19 data available in State Health Secretaries (managed by brasil.io API) and three national databases (IBGE, DATASUS and Embrapa). Temporal spread of COVID-19 in Brazil during the first year considered as outcome: a) days until 1st case in each city since 1st in the country; b) days until 1,000 cases/100,000 inhabitants since 1st case in each city; c) days until 1st death until 50 deaths/100,000 inhabitants. Covariates included geographic region, city social and environmental characteristics, housing conditions, job characteristics, socioeconomic and inequalities characteristics, and health services and coverage. The analysis were stratified by city size into small (<100,000 inhabitants) and large cities (≥100,00 inhabitants). Multiple linear regressions were performed to test associations of all covariates to adjust to potential confounders.

RESULTS

In small cities, the first cases were reported after 82.2 days and 1,000 cases/100,000 were reported after 117.8 days, whereas in large cities these milestones were reported after 32.1 and 127.7 days, respectively. For first death, small and large cities took 121.6 and 36.0 days, respectively. However, small cities were associated with more vulnerability factors to first case arrival in 1,000 cases/100,000 inhabitants, first death and 50 deaths/100,000 inhabitants. North and Northeast regions positively associated with faster COVID-19 incidence, whereas South and Southeast were least.

CONCLUSION

Social and built environment characteristics and inequalities were associated with COVID-19 cases spread and mortality incidence in Brazilian cities.

Socioeconomic disparities in lumbar fusion rates were exacerbated during the COVID-19 pandemic

Background

The COVID-19 pandemic disrupted healthcare access and utilization throughout the US, with variable impact on patients of different socioeconomic status (SES) and race. We characterize pre-pandemic and pandemic demographic and SES trends of lumbar fusion patients in the US.

Methods

Adults undergoing first-time lumbar fusion 1/1/2004-3/31/2021 were assessed in Clinformatics® Data Mart for patient age, geographical location, gender, race, education level, net worth, and Charlson Comorbidity Index (CCI). Multivariable regression models were used to evaluate the significance of trends over time, with a focus on pandemic trends 2020-2021 versus previous trends 2004-2019.

Results

The total 217,204 patients underwent lumbar fusions, 1/1/2004-3/31/2021. The numbers and per capita rates of lumbar fusions increased 2004-2019 and decreased in 2020 (first year of COVID-19 pandemic), with large variation in geographic distribution. There was overall a significant decrease in proportion of White patients undergoing lumbar fusion over time (OR=0.997, p<.001), though they were more likely to undergo surgery during the pandemic (OR=1.016, p<.001). From 2004-2021, patients were more likely to be educated beyond high school. Additionally, patients in the highest (>$500k) and lowest (<$25k) net worth categories had significantly more fusions over time (p<.001). During the pandemic (2020-2021), patients in higher net worth groups were more likely to undergo lumbar fusions ($150k-249k & $250k-499k: p<.001) whereas patients in the lowest net worth group had decreased rate of surgeries (p<.001). Lastly, patients' CCI increased significantly from 2004 to 2021 (coefficient=0.124, p<.001), and this trend held true during the pandemic (coefficient=0.179, p<.001).

Conclusions

To the best of our knowledge, our work represents the most comprehensive and recent characterization of SES variables in lumbar fusion rates. Unsurprisingly, lumbar fusions decreased overall with the onset of the COVID-19 pandemic. Importantly, disparities in fusion patients across patient race and wealth widened during the pandemic, reversing years of progress, a lesson we can learn for future public health emergencies.

The Impact of the COVID-19 Pandemic on Black and Hispanic Americans' Work Outcomes: a Scoping Review

In early 2020, it was hypothesized that COVID-19 would lead to disproportionately negative health and work outcomes for Black and Hispanic adults, but sufficient data had yet been collected to fully support this claim. Now, we have empirical evidence, but little has been done to aggregate this information to fully understand its impact on these communities. Utilizing 44 articles from a scoping review of three databases (PubMed, Web of Science, and Business Source Complete), this study seeks to identify the primary work-related risks that help explain Black and Hispanic adults' disparate COVID-19-related work outcomes (e.g., loss of hours, job disruption, stress). Findings illuminate four primary risks faced by Black and Hispanic workers: (1) being an essential worker, (2) type of work performed, (3) workplace factors; and (4) community and geographic factors. We conclude with policy recommendations that will help inform policy and practice for economic recovery from the pandemic for other marginalized populations.

An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis

BACKGROUND

The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information.

OBJECTIVE

This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys.

METHODS

A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems.

RESULTS

Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample's percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained.

CONCLUSIONS

General COVID-19-related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey's results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general.

The Uncontrollable Mortality Risk Hypothesis: Theoretical foundations and implications for public health

The 'Uncontrollable Mortality Risk Hypothesis' employs a behavioural ecological model of human health behaviours to explain the presence of social gradients in health. It states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviours. We outline the theoretical assumptions of the hypothesis and stress the importance of incorporating evolutionary perspectives into public health. We explain how measuring perceived uncontrollable mortality risk can contribute towards understanding socioeconomic disparities in preventative health behaviours. We emphasize the importance of addressing structural inequalities in risk exposure, and argue that public health interventions should consider the relationship between overall levels of mortality risk and health behaviours across domains. We suggest that measuring perceptions of uncontrollable mortality risk can capture the unanticipated health benefits of structural risk interventions, as well as help to assess the appropriateness of different intervention approaches.

Socioeconomic Disparities and Emergency Department Visits for Diabetic Retinopathy in California

Purpose: To investigate the association between neighborhood-level socioeconomic factors, quantified by the Distressed Communities Index, and emergency department visits for diabetic retinopathy (DR). Methods: All patients who presented to the emergency department for DR in California were analyzed using the State Emergency Department Database (2018-2020). Patients were stratified by Distressed Communities Index score and DR severity. Logistic regression was applied to explore the independent correlation between Distressed Communities Index scores and proliferative DR (PDR). Results: Of 2 725 195 emergency department visits for diabetic patients, Distressed Communities Index data were available for 2 459 577 (90.3%); 39 693 were for DR, including 13 617 (34.3%) for PDR. Hispanics (44.2%) were the largest racial/ethnic group to present for PDR, followed by non-Hispanic Whites (19.6%) and non-Hispanic Blacks (19.3%). A significant association was observed between the Distressed Communities Index and emergency department visits for PDR, with distressed neighborhoods having the highest incidence (adjusted odds ratio [aOR], 1.63; 95% CI, 1.20-2.23; P = .001). Other predictors included Hispanic ethnicity (aOR, 2.21; 95% CI, 1.97-2.48; P < .001) and Black race (aOR, 1.46; 95% CI, 1.28-1.67; P < .001) compared with White race and having Medicaid (aOR, 1.37; 95% CI, 1.13-1.65; P = .001) compared with private insurance. Conclusions: The Distressed Communities Index identified patients residing in the most distressed neighborhoods as being at the highest risk for presenting to the emergency department for PDR based on 7 socioeconomic factors. Policymakers may consider the Distressed Communities Index as a tool for targeting DR prevention strategies and improving healthcare accessibility.

The Inverted U-Shaped Relationship Between Socio-Economic Status and Infections During the COVID-19 Pandemic

Although the World Health Organization has declared that the COVID-19 pandemic no longer qualifies as a global public health emergency, it still needs to explore the response of society to the COVID-19 pandemic. Socio-economic status (SES) was proven to be linearly associated with the COVID-19 pandemic, although this relationship may be more complex due to regional differences. In the study, we analyzed and revealed the effects and mechanisms of SES on infections among low, lower-middle, upper-middle and high SES group (LSG, LMSG, UMSG, and HSG, respectively). The results showed that the relationship between SES and infections was inverted U-shaped, especially in the first three phases. In Phase I, UMSG had the highest number of infections, with an average of 238.31/1M people (95%CI: 135.47-341.15/1M people). In Phases II and III, infections decreased insignificantly with increasing SES (r = -0.01, p = 0.92; r = -0.11, p = 0.22) and the highest number of infections were found in the LMSG. In Phase IV, SES was positively related to the number of infections (r = 0.54, p < 0.001). Furthermore, the nonlinear impact of multiple factors related to SES on the infections explains the complex relationships between SES and infections. SES affected infections mainly through medical resources, demographics and vaccination, and differed across the SES groups. Particularly, demographics could exert an impact on population mobility, subsequently influencing infections in LMSG, with an indirect effect of 0.01 (p < 0.05) in Phase II. This study argues for greater attention to countries with middle SES and the need for future targeted measures to cope with infectious diseases.

Assessing Electronic Health Literacy in Individuals With the Post-COVID-19 Condition Using the German Revised eHealth Literacy Scale: Validation Study

BACKGROUND

The eHealth Literacy Scale (eHEALS) is a widely used instrument for measuring eHealth literacy (eHL). However, little is known so far about whether the instrument is valid for the assessment of eHL in persons who are affected by the post-COVID-19 condition. This is particularly important as people with the post-COVID-19 condition are frequently affected by false information from the internet.

OBJECTIVE

The objective of our study was to evaluate the validity and reliability of the German Revised eHealth Literacy Scale (GR-eHEALS) in individuals with the post-COVID-19 condition.

METHODS

A cross-sectional study was conducted from January to May 2022. The self-assessment survey consisted of the GR-eHEALS, health status- and internet use-related variables, sociodemographic data, and (post)-COVID-19-related medical data. Confirmatory factor analysis (CFA), correlational analyses, and tests of measurement invariance were deployed.

RESULTS

In total, 330 participants were included in the statistical analyses. CFA revealed that the 2-factor model reached an excellent model fit (comparative fit index=1.00, Tucker-Lewis index=0.99, root mean square error of approximation=0.036, standardized root mean square residual=0.038). Convergent validity was confirmed by significant positive correlations between eHL and knowledge of internet-based health promotion programs, experience in using these programs, and the duration of private internet use. In addition, a significantly negative relationship of eHL with internet anxiety supported convergent validity. Further, significant relationships of eHL with mental health status and internal health locus of control confirmed the criterion validity of the instrument. However, relationships of eHL with physical health status and quality of life could not be confirmed. The 2-factor model was fully measurement invariant regarding gender. Regarding age and educational level, partial measurement invariance was confirmed. The subscales as well as the overall GR-eHEALS reached good-to-excellent reliability (Cronbach α≥.86).

CONCLUSIONS

The GR-eHEALS is a reliable and largely valid instrument for assessing eHL in individuals with the post-COVID-19 condition. Measurement invariance regarding gender was fully confirmed and allows the interpretation of group differences. Regarding age and educational level, group differences should be interpreted with caution. Given the high likelihood that individuals with the post-COVID-19 condition will be confronted with misinformation on the Internet, eHL is a core competency that is highly relevant in this context, in both research and clinical practice. Therefore, future research should also explore alternative instruments to capture eHL to overcome shortcomings in the validity of the GR-eHEALS.

Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers

Importance

Access to COVID-19 testing is critical to reducing transmission and supporting early treatment decisions; when made accessible, the timeliness of testing may also be an important metric in mitigating community spread of the infection. While disparities in transmission and outcomes of COVID-19 have been well documented, the extent of timeliness of testing and the association with demographic factors is unclear.

Objectives

To evaluate demographic factors associated with delayed COVID-19 testing among health care personnel (HCP) during the COVID-19 pandemic.

Design, Setting, and Participants

This cross-sectional study used data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing study, a multicenter, test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms and testing between December 2020 and April 2022. Data analysis was conducted from March 2022 to Junne 2023.

Exposure

Displaying COVID-19-like symptoms and polymerase chain reaction testing occurring from the first day symptoms occurred up to 14 days after symptoms occurred.

Main Outcomes and Measures

Variables of interest included patient demographics (sex, age, and clinical comorbidities) and COVID-19 characteristics (vaccination status and COVID-19 wave). The primary outcome was time from symptom onset to COVID-19 testing, which was defined as early testing (≤2 days) or delayed testing (≥3 days). Associations of demographic characteristics with delayed testing were measured while adjusting for clinical comorbidities, COVID-19 characteristics, and test site using multivariable modeling to estimate relative risks and 95% CIs.

Results

A total of 5551 HCP (4859 female [82.9%]; 1954 aged 25-34 years [35.2%]; 4233 non-Hispanic White [76.3%], 370 non-Hispanic Black [6.7%], and 324 non-Hispanic Asian [5.8%]) were included in the final analysis. Overall, 2060 participants (37.1%) reported delayed testing and 3491 (62.9%) reported early testing. Compared with non-Hispanic White HCP, delayed testing was higher among non-Hispanic Black HCP (adjusted risk ratio, 1.18; 95%CI, 1.10-1.27) and for non-Hispanic HCP of other races (adjusted risk ratio, 1.17; 95% CI, 1.03-1.33). Sex and age were not associated with delayed testing. Compared with clinical HCP with graduate degrees, all other professional and educational groups had significantly delayed testing.

Conclusions and Relevance

In this cross-sectional study of HCP, compared with non-Hispanic White HCP and clinical HCP with graduate degrees, non-Hispanic Black HCP, non-Hispanic HCP of other races, and HCP all other professional and education backgrounds were more likely to have delayed COVID-19 testing. These findings suggest that time to testing may serve as a valuable metric in evaluating sociodemographic disparities in the response to COVID-19 and future health mitigation strategies.

Socioeconomic inequalities in cardiovascular disease: a causal perspective

Socioeconomic inequalities in cardiovascular disease (CVD) persist in high-income countries despite marked overall declines in CVD-related morbidity and mortality. After decades of research, the field has struggled to unequivocally answer a crucial question: is the association between low socioeconomic position (SEP) and the development of CVD causal? We review relevant evidence from various study designs and disciplinary perspectives. Traditional observational, family-based and Mendelian randomization studies support the widely accepted view that low SEP causally influences CVD. However, results from quasi-experimental and experimental studies are both limited and equivocal. While more experimental and quasi-experimental studies are needed to aid causal understanding and inform policy, high-quality descriptive studies are also required to document inequalities, investigate their contextual dependence and consider SEP throughout the lifespan; no simple hierarchy of evidence exists for an exposure as complex as SEP. The COVID-19 pandemic illustrates the context-dependent nature of CVD inequalities, with the generation of potentially new causal pathways linking SEP and CVD. The linked goals of understanding the causal nature of SEP and CVD associations, their contextual dependence, and their remediation by policy interventions necessitate a detailed understanding of society, its change over time and the phenotypes of CVD. Interdisciplinary research is therefore key to advancing both causal understanding and policy translation.

Paxlovid use is associated with lower risk of cardiovascular diseases in COVID-19 patients with autoimmune rheumatic diseases: a retrospective cohort study

BACKGROUND

Paxlovid has been shown to be effective in reducing mortality and hospitalization rates in patients with coronavirus disease 2019 (COVID-19). It is not known whether Paxlovid can reduce the risk of cardiovascular diseases (CVD) in COVID-19-surviving patients with autoimmune rheumatic diseases (AIRDs).

METHODS

TriNetX data from the US Collaborative Network were used in this study. A total of 5,671,395 patients with AIRDs were enrolled between January 1, 2010, and December 31, 2021. People diagnosed with COVID-19 were included in the cohort (n = 238,142) from January 1, 2022, to December 31, 2022. The Study population was divided into two groups based on Paxlovid use. Propensity score matching was used to generate groups with matched baseline characteristics. The hazard ratios (HRs) and 95% confidence intervals of cardiovascular outcomes, admission rate, mortality rate, and intensive care unit (ICU) admission rate were calculated between Paxlovid and non-Paxlovid groups. Subgroup analyses on sex, age, race, autoimmune diseases group, and sensitivity analyses for Paxlovid use within the first day or within 2-5 days of COVID-19 diagnosis were performed.

RESULTS

Paxlovid use was associated with lower risks of cerebrovascular complications (HR = 0.65 [0.47-0.88]), arrhythmia outcomes (HR = 0.81 [0.68-0.94]), ischemic heart disease, other cardiac disorders (HR = 0.51 [0.35-0.74]) naming heart failure (HR = 0.41 [0.26-0.63]) and deep vein thrombosis (HR = 0.46 [0.24-0.87]) belonging to thrombotic disorders in AIRD patients with COVID-19. Compared with the Non-Paxlovid group, risks of major adverse cardiac events (HR = 0.56 [0.44-0.70]) and any cardiovascular outcome mentioned above (HR = 0.76 [0.66-0.86]) were lower in the Paxlovid group. Moreover, the mortality (HR = 0.21 [0.11-0.40]), admission (HR = 0.68 [0.60-0.76]), and ICU admission rates (HR = 0.52 [0.33-0.80]) were significantly lower in the Paxlovid group than in the non-Paxlovid group. Paxlovid appears to be more effective in male, older, and Black patients with AIRD. The risks of cardiovascular outcomes and severe conditions were reduced significantly with Paxlovid prescribed within the first day of COVID-19 diagnosis.

CONCLUSIONS

Paxlovid use is associated with a lower risk of CVDs and severe conditions in COVID-19-surviving patients with AIRD.

Associations Between Psychopathological Symptom Severity Amid the Pandemic and the Childhood Sociodemographic Environment

It is well-documented that childhood socioeconomic status (SES) is associated with various health conditions in adulthood. Here, we examine the extent to which childhood SES is associated with COVID-19 pandemic anxiety and depression. Participants (n = 212), recruited from Amazon Mechanical Turk, were assessed for depression and anxiety in February 2022 for both the current context and retrospective self-perceived early pandemic depression and anxiety (April 2020). Participants also reported childhood SES and current demographics. Consistent with predated findings, we show a strong, positive correlation between depression and anxiety under both conditions. Paternal unemployment in childhood was associated with increased anxiety, while maternal occupation was not. High household education in childhood was generally associated with greater anxiety and depression, similar to past studies examining education levels and depression. However, the shift from high school to post-secondary degrees (trade school and associate's) was associated with decreased anxiety and depression, which may reflect "essential work" careers, therefore indicating a dualism. Growing up in crowded, de-individualized spaces was associated with lower anxiety and depression, suggesting better conditioning for the imposition of COVID-19 quarantines. Pandemic-related unemployment was associated with an increase in anxiety and depression. Strong political views, regardless of ideology, were associated with increased anxiety. Finally, participants in our cohort perceived their mental health to be worse in the early pandemic for anxiety and depression, up 6.6% and 7.9%, respectively. Our work suggests a complex relationship between SES, demographics, and anxiety and depression during the pandemic. These findings emphasize the importance of exploring the dynamics between early SES and mental health in adulthood, particularly during extended societal stressors.

Inequalities in healthcare use during the COVID-19 pandemic

The COVID-19 pandemic led to reductions in non-COVID related healthcare use, but little is known whether this burden is shared equally. This study investigates whether reductions in administered care disproportionately affected certain sociodemographic strata, in particular marginalised groups. Using detailed medical claims data from the Dutch universal health care system and rich full population registry data, we predict expected healthcare use based on pre-pandemic trends (2017 - Feb 2020) and compare these expectations with observed healthcare use in 2020 and 2021. Our findings reveal a 10% decline in the number of weekly treated patients in 2020 and a 3% decline in 2021 relative to prior years. These declines are unequally distributed and are more pronounced for individuals below the poverty line, females, older people, and individuals with a migrant background, particularly during the initial wave of COVID-19 hospitalisations and for middle and low urgency procedures. While reductions in non-COVID related healthcare decreased following the initial shock of the pandemic, inequalities persist throughout 2020 and 2021. Our results demonstrate that the pandemic has not only had an unequal toll in terms of the direct health burden of the pandemic, but has also had a differential impact on the use of non-COVID healthcare.

Socioeconomic deprivation and illness trajectory in the Scottish population after COVID-19 hospitalization

BACKGROUND

The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain.

METHODS

A prospective, multicentre cohort study was conducted on post-COVID-19 patients, enrolled either in-hospital or shortly post-discharge. Two evaluations were carried out: an initial assessment and a follow-up at 28-60 days post-discharge. The study encompassed research blood tests, patient-reported outcome measures, and multisystem imaging (including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging). Primary and secondary outcomes were analysed in relation to socioeconomic status, using the Scottish Index of Multiple Deprivation (SIMD). The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status.

RESULTS

Of the 252 enrolled patients (mean age 55.0 ± 12.0 years; 40% female; 23% with diabetes), deprivation status was linked with increased BMI and diabetes prevalence. 186 (74%) returned for the follow-up. Within this group, findings indicated associations between deprivation and lung abnormalities (p = 0.0085), coronary artery disease (p = 0.0128), and renal inflammation (p = 0.0421). Furthermore, patients with higher deprivation exhibited worse scores in health-related quality of life (EQ-5D-5L, p = 0.0084), illness perception (BIPQ, p = 0.0004), anxiety and depression levels (PHQ-4, p = 0.0038), and diminished physical activity (DASI, p = 0.002). At the 3-month mark, those with greater deprivation showed a higher frequency of referrals to secondary care due to ongoing COVID-19 symptoms (p = 0.0438). However, clinical outcomes were not influenced by deprivation.

CONCLUSIONS

In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.

The Relationship Between Perceived Uncontrollable Mortality Risk and Health Effort: Replication, Secondary Analysis, and Mini Meta-analysis

BACKGROUND

The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied.

PURPOSE

To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort.

METHODS

We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale-a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research.

RESULTS

PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort.

CONCLUSIONS

Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk.

Demographic and Socioeconomic Trends in Cervical Fusion Utilization from 2004 Through 2021 and the COVID-19 Pandemic

BACKGROUND

Cervical fusion rates increased in the U.S. exponentially 1990-2014, but trends leading up to/during the COVID-19 pandemic have not been fully evaluated by patient socioeconomic status (SES). Here, we provide the most recent, comprehensive characterization of demographic and SES trends in cervical fusions, including during the pandemic.

METHODS

We collected the following variables on adults undergoing cervical fusions, 1/1/2004-3/31/2021, in Optum's Clinformatics Data Mart: age, Charlson Comorbidity Index, provider's practicing state, gender, race, education, and net worth. We performed multivariate linear and logistic regression to evaluate associations of cervical fusion rates with SES variables.

RESULTS

Cervical fusion rates increased 2004-2016, then decreased 2016-2020. Proportions of Asian, Black, and Hispanic patients undergoing cervical fusions increased (OR = 1.001,1.001,1.004, P < 0.01), with a corresponding decrease in White patients (OR = 0.996, P < 0.001) over time. There were increases in cervical fusions in higher education groups (OR = 1.006, 1.002, P < 0.001) and lowest net worth group (OR = 1.012, P < 0.001). During the pandemic, proportions of White (OR = 1.015, P < 0.01) and wealthier patients (OR ≥ 1.015, P < 0.01) undergoing cervical fusions increased.

CONCLUSIONS

We present the first documented decrease in annual cervical surgery rates in the U.S. Our data reveal a bimodal distribution for cervical fusion patients, with racial-minority, lower-net-worth, and highly-educated patients receiving increasing proportions of surgical interventions. White and wealthier patients were more likely to undergo cervical fusions during the COVID-19 pandemic, which has been reported in other areas of medicine but not yet in spine surgery. There is still considerable work needed to improve equitable access to spine care for the entire U.S.

POPULATION

The trade-off between health system resiliency and efficiency: evidence from COVID-19 in European regions

The objective of this paper was to investigate the existence of a trade-off between health system resilience and the economic efficiency of the health system, using data for 173 regions in the European Union and the European Free Trade Association countries. Data Envelopment Analysis was used to measure the efficiency of regional health systems before the COVID-19 pandemic. Then, a spatial econometrics model was used to estimate whether this measure of efficiency, adjusted for several covariates, has a significant impact on regional health system resilience during the COVID-19 pandemic, measured by the number of COVID-19 deaths per hundred thousand inhabitants. The results show that COVID-19 death rates were significantly higher in regions with higher population density, higher share of employment in industry, and higher share of women in the population. Results also show that regions with higher values of the health system efficiency index in 2017 had significantly higher rates of COVID-19 deaths in 2020 and 2021, suggesting the existence of a trade-off between health system efficiency and health system resilience during the COVID-19 pandemic.

Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection

Introduction

Data on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection.

Methods

Participants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point.

Results

Following SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36-2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06-2.02; much less, OR: 2.23; 95%CI: 1.38-3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25-2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21-2.46; much less, OR: 2.08; 95%CI: 1.18-3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13-3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60-5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10-3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02-2.51; much less, OR: 2.49; 95%CI: 1.40-4.44), and more missed work (OR: 2.25; 95%CI: 1.27-3.98).

Discussion

Awareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.

Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná

OBJECTIVE

To estimate the prevalence and to analyze the factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná.

METHOD

Cross-sectional study conducted with secondary data from older people with a positive diagnosis of Covid-19 living in the State of Paraná, collected from March 1, 2020 to August 31, 2021. Prevalence ratios were obtained by adjusting the regression model.

RESULTS

A total of 16,153 deaths of older people hospitalized in the State of Paraná were analyzed. The adjusted model revealed an association between death and some factors such as: belonging to the age group of 75 to 84 years (PR = 1.28; CI95% = 1.24-1.32) and 85 years or over (PR = 1.52; CI95% = 1.45-1.59); male (PR = 1.17; CI95% = 1.13-1.21); obesity (PR = 1.23; CI95% = 1.16-1.29); other morbidities (PR = 1.25; CI95% = 1.20-1.30); and having used ventilatory support (PR = 2.60; CI95% = 2.33-2.86). Older people vaccinated against influenza had a probability of death reduced by 11% (PR = 0.89; CI95% = 0.86-0.93).

CONCLUSION

The association of age, sex, and diagnosis of previous comorbidities with unfavorable outcomes from Covid-19 was identified. Having received the flu vaccine provided protection to elderly people who contracted SARS-CoV-2.

Socioeconomic status is negatively associated with immunosenescence but positively associated with inflammation among middle-aged women in Cebu, Philippines

BACKGROUND

Socioeconomic status (SES) gradients in health are well-documented, and while biological pathways are incompletely understood, chronic inflammation and accelerated immune aging (immunosenescence) among lower SES individuals have been implicated. However, previous findings have come from samples in higher income countries, and it is unclear how generalizable they are to lower- and middle-income countries (LMIC) with different infectious exposures and where adiposity-an important contributor to chronic inflammation-might show different SES patterning. To address this gap, we explored associations between SES and inflammation and immunosenescence in a sample of women in Cebu, Philippines.

METHODS

Data came from the mothers of the Cebu Longitudinal Health and Nutrition Survey birth cohort (mean age: 47.7, range: 35-69 years). SES was measured as a combination of annual household income, education level, and assets. Chronic inflammation was measured using C-reactive protein (CRP) in plasma samples from 1,834 women. Immunosenescence was measured by the abundance of exhausted CD8T (CD8 + CD28-CD45RA-) and naïve CD8T and CD4T cells, estimated from DNA methylation in whole blood in a random subsample of 1,028. Possible mediators included waist circumference and a collection of proxy measures of pathogen exposure.

RESULTS

SES was negatively associated with the measures of immunosenescence, with slight evidence for mediation by a proxy measure for pathogen exposure from the household's drinking water source. In contrast, SES was positively associated with CRP, which was explained by the positive association with waist circumference.

CONCLUSIONS

Similar to higher income populations, in Cebu there is an SES-gradient in pathogen exposures and immunosenescence. However, lifestyle changes occurring more rapidly among higher SES individuals is contributing to a positive association between SES and adiposity and inflammation. Our results suggest more studies are needed to clarify the relationship between SES and inflammation and immunosenescence across LMIC.

Flourishing (or lack thereof) during COVID-19: College students'social-psychological well-being during the Fall 2020 semester

Objective: This exploratory quantitative study examined college students' social-psychological well-being during the COVID-19 pandemic. Participants: The sample included 1,723 students (undergraduate and graduate) at a public research university. Methods: Paired samples t-test were utilized to compare students' social-psychological well-being pre-pandemic, at the start of the Fall 2020 semester, and toward the end of the Fall 2020 semester. Regression analyses were utilized to identify predictors of students' social-psychological well-being at the start and toward the end of the Fall 2020 semester. Results: Students experienced a significant decrease in social-psychological well-being pre-pandemic to the start of the Fall 2020 semester and most had not returned to pre-pandemic levels toward the end of the semester. While demographics, housing arrangements, and course modality impacted social-psychological well-being, they only explained a small percentage of the variance in students' well-being. Conclusion: Students continued to experience low mental well-being during the Fall 2020 semester.

CHANGE AND CONTINUITY IN AMERICANS' WORK DAY CHARACTERISTICS, 2019 TO 2021

The COVID-19 pandemic spurred major, and possibly enduring, changes in paid work. In this paper we explore the continuity and change in several work day dimensions, including where it is performed, the amount of time spent working, the length of the work day, and who people are with when they work, as well as variation across population subgroups. We use nationally representative data from the American Time Use Survey (ATUS) to analyze change across the 2019 to 2021 period. While the shift to working primarily at home in 2020 is dramatic and continuing into 2021, working primarily at the workplace remains the modal experience for Americans. We find differences by gender, education, parental status, and age in which workers perform their jobs at home, and we find much more continuity in how much people work and when they work.

An online questionnaire survey on the sexual function of Chinese male adults in the COVID-19 pandemic with loosened controls

The coronavirus disease 2019 (COVID-19) may have a negative impact on the sexual health of male adults. An online questionnaire survey was conducted among male adults from February 04, 2023 to March 15, 2023 to analyze the impact of COVID-19 on the sexual health of male adults in China. Participants provided about their medical, social, lifestyle, and family situations information through questionnaires including the Brief Sexual Function Inventory (BSFI). Sexual function problems were defined based on predetermined cutoff values of the BSFI domain scores. A total of 1,250 male adults were included with median age as 32 years. According to the analysis of statistical results, sexual drive and erections firm enough to have sexual intercourse were reported to be present only a few days or less last month among 14.8 % and 11.1 % of COVID-19 survivors, respectively. Compared with uninfected persons, COVID-19 survivors had significantly lower scores on all BSFI domains and an increased risk of problems with sexual drive and erectile. In multivariate models of COVID-19 survivors, age ≥30 years, rural resident, lower education level, manual worker, lower income, and shorter duration from recovery to survey date were significantly associated with poorer overall sexual function. In this study, COVID-19 survivors was reported to have significantly poorer sexual function than uninfected persons. The COVID-19 may have had a significant impact on the sexual health of Chinese male adults. We need to focus on sexual dysfunction in COVID-19 survivors, and proactively provide effective interventions.

Report of 5146 Cases of Coronavirus Disease 2019-Related Mortality From Cook County, Illinois Causes of Death, Demographics, and Comorbidities

ABSTRACT

A cross-sectional study used 5216 laboratory-confirmed coronavirus disease 2019 (severe acute respiratory syndrome coronavirus 2)-related mortality cases in Cook County of Illinois. The data set included each case's demographic data, manner of death, and comorbidities. The age ranged from 0 to 108 years, with a median of 73.5 years. There were few mortality cases in the age group younger than 30 years, and the incidence of fatal infection increased with age. We demonstrated an increased incidence of mortality in males compared with females (P < 0.01). The urban population had a higher incidence of fatal infection than the suburban population (P < 0.01). We found a significant increase (P < 0.01) in the incidence of fatal coronavirus disease 2019 (severe acute respiratory syndrome coronavirus 2) infection in African American males compared with background frequencies. Latino population demonstrated younger ages at death compared with the non-Latino population. Obesity and hypertension significantly predict fatal outcomes in the younger age group. In comparison, dementia and hypertensive and arteriosclerotic cardiovascular disease are significant predictive factors in the older age group. In a large data set, we demonstrated that the demographical distribution of the population and comorbidities is associated with the risk of fatal complications and death.

Is there a relationship between internet access and COVID-19 mortality? Evidence from Nigeria based on a spatial analysis

With over 6.5 million deaths due to COVID-19, it has become an issue of global health concern. Early findings have identified several social determinants of deaths from COVID-19. However, very few studies have been done on the relationship between internet access and COVID-19 mortality in the context of developing countries. Using geospatial methods, this study examines the relationship between internet access and COVID-19 mortality disparity in Nigeria. In contrast to the widely reported relationship in the literature that internet access lowers the risk of COVID-19 mortality, the current study finds that geographical locations with the highest internet access are the hotspots of COVID-19 mortality in Nigeria, especially some parts of southwest Nigeria. In addition, findings show that population density and unemployment are risk factors of COVID-19 mortality. The study recommends educating the population on the use of online health information and the need to adhere strictly to non-pharmaceutical and vaccination interventions to reduce the number of deaths caused by the virus.