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Weinberger DM, Bhaskaran K, Korves C, Lucas BP, Columbo JA, Vashi A, Davies L, Justice AC, Rentsch CT. Excess mortality in US Veterans during the COVID-19 pandemic: an individual-level cohort study. Int J Epidemiol 2023; 52:1725-1734. [PMID: 37802889 PMCID: PMC10749763 DOI: 10.1093/ije/dyad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Most analyses of excess mortality during the COVID-19 pandemic have employed aggregate data. Individual-level data from the largest integrated healthcare system in the US may enhance understanding of excess mortality. METHODS We performed an observational cohort study following patients receiving care from the Department of Veterans Affairs (VA) between 1 March 2018 and 28 February 2022. We estimated excess mortality on an absolute scale (i.e. excess mortality rates, number of excess deaths) and a relative scale by measuring the hazard ratio (HR) for mortality comparing pandemic and pre-pandemic periods, overall and within demographic and clinical subgroups. Comorbidity burden and frailty were measured using the Charlson Comorbidity Index and Veterans Aging Cohort Study Index, respectively. RESULTS Of 5 905 747 patients, the median age was 65.8 years and 91% were men. Overall, the excess mortality rate was 10.0 deaths/1000 person-years (PY), with a total of 103 164 excess deaths and pandemic HR of 1.25 (95% CI 1.25-1.26). Excess mortality rates were highest among the most frail patients (52.0/1000 PY) and those with the highest comorbidity burden (16.3/1000 PY). However, the largest relative mortality increases were observed among the least frail (HR 1.31, 95% CI 1.30-1.32) and those with the lowest comorbidity burden (HR 1.44, 95% CI 1.43-1.46). CONCLUSIONS Individual-level data offered crucial clinical and operational insights into US excess mortality patterns during the COVID-19 pandemic. Notable differences emerged among clinical risk groups, emphasizing the need for reporting excess mortality in both absolute and relative terms to inform resource allocation in future outbreaks.
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Affiliation(s)
- Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline Korves
- Department of Veterans Affairs Medical Center, Clinical Epidemiology Program, White River Junction, VT, USA
| | - Brian P Lucas
- Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, VT, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jesse A Columbo
- Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, VT, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Anita Vashi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Louise Davies
- Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, VT, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Surgery—Otolaryngology Head & Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Amy C Justice
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
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Leder SC, List JM, Chandra R, Jones KT, Moy E. VA Research and Operations Uniting to Combat COVID-19 Inequities. Health Equity 2023; 7:296-302. [PMID: 37313133 PMCID: PMC10259604 DOI: 10.1089/heq.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/15/2023] Open
Abstract
As novel coronavirus 2019 disease (COVID-19) began to spread across the United States in early 2020, health care systems faced extreme demands on resources. As the country's largest single-payer health care system, the U.S. Department of Veterans Affairs (VA) was uniquely positioned to study how the virus impacted different communities and work to improve care provided to all. Early on, a literature review of prior epidemics revealed that occupational exposures and an inability to socially distance could impact some groups more than others. The VA's Office of Health Equity leveraged a general sense of community to create a collaborative research space and a dedicated analytic space to inform pandemic operations. VA researchers and operations staff were able to quickly share information and respond to updates to produce accurate and reliable publications for medical professionals and the general public. Partnerships with VA Medical Centers and Veteran Service Organizations helped to increase communication across the nation and determine the most critical needs. Although COVID-19 was dynamic in nature, VA's intentional examination of social and structural factors was crucial in informing a more equitable approach. Moving forward, these inequities must be intentionally addressed in future pandemic responses.
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Affiliation(s)
- Sarah C. Leder
- Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Justin M. List
- Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Rachel Chandra
- Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Kenneth T. Jones
- Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Ernest Moy
- Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
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Weinberger DM, Bhaskaran K, Korves C, Lucas BP, Columbo JA, Vashi A, Davies L, Justice AC, Rentsch CT. Absolute and relative excess mortality across demographic and clinical subgroups during the COVID-19 pandemic: an individual-level cohort study from a nationwide healthcare system of US Veterans. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.12.23289900. [PMID: 37293086 PMCID: PMC10246058 DOI: 10.1101/2023.05.12.23289900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Most analyses of excess mortality during the COVID-19 pandemic have employed aggregate data. Individual-level data from the largest integrated healthcare system in the US may enhance understanding of excess mortality. Methods We performed an observational cohort study following patients receiving care from the Department of Veterans Affairs (VA) between 1 March 2018 and 28 February 2022. We estimated excess mortality on an absolute scale (i.e., excess mortality rates, number of excess deaths), and a relative scale by measuring the hazard ratio (HR) for mortality comparing pandemic and pre-pandemic periods, overall, and within demographic and clinical subgroups. Comorbidity burden and frailty were measured using the Charlson Comorbidity Index and Veterans Aging Cohort Study Index, respectively. Results Of 5,905,747 patients, median age was 65.8 years and 91% were men. Overall, the excess mortality rate was 10.0 deaths/1000 person-years (PY), with a total of 103,164 excess deaths and pandemic HR of 1.25 (95% CI 1.25-1.26). Excess mortality rates were highest among the most frail patients (52.0/1000 PY) and those with the highest comorbidity burden (16.3/1000 PY). However, the largest relative mortality increases were observed among the least frail (HR 1.31, 95% CI 1.30-1.32) and those with the lowest comorbidity burden (HR 1.44, 95% CI 1.43-1.46). Conclusions Individual-level data offered crucial clinical and operational insights into US excess mortality patterns during the COVID-19 pandemic. Notable differences emerged among clinical risk groups, emphasising the need for reporting excess mortality in both absolute and relative terms to inform resource allocation in future outbreaks.
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Affiliation(s)
- Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, US
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, US
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline Korves
- Clinical Epidemiology Program, Department of Veterans Affairs Medical Center, White River Junction, VT
| | - Brian P. Lucas
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, US
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, US
| | - Jesse A. Columbo
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, US
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, US
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, US
| | - Anita Vashi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, US
- Department of Emergency Medicine, University of California, San Francisco, CA, US
| | - Louise Davies
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, US
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, US
- Department of Surgery - Otolaryngology Head & Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, US
| | - Amy C. Justice
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, US
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
- VA Connecticut Healthcare System, Department of Veterans Affairs, West Haven, CT, US
| | - Christopher T. Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
- VA Connecticut Healthcare System, Department of Veterans Affairs, West Haven, CT, US
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Weinberger DM, Rose L, Rentsch C, Asch SM, Columbo JA, King J, Korves C, Lucas BP, Taub C, Young-Xu Y, Vashi A, Davies L, Justice AC. Excess Mortality Among Patients in the Veterans Affairs Health System Compared With the Overall US Population During the First Year of the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2312140. [PMID: 37155169 PMCID: PMC10167568 DOI: 10.1001/jamanetworkopen.2023.12140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/24/2023] [Indexed: 05/10/2023] Open
Abstract
Importance During the first year of the COVID-19 pandemic, there was a substantial increase in the rate of death in the United States. It is unclear whether those who had access to comprehensive medical care through the Department of Veterans Affairs (VA) health care system had different death rates compared with the overall US population. Objective To quantify and compare the increase in death rates during the first year of the COVID-19 pandemic between individuals who received comprehensive medical care through the VA health care system and those in the general US population. Design, Setting, and Participants This cohort study compared 10.9 million enrollees in the VA, including 6.8 million active users of VA health care (those with a visit in the last 2 years), with the general population of the US, with deaths occurring from January 1, 2014, to December 31, 2020. Statistical analysis was conducted from May 17, 2021, to March 15, 2023. Main Outcomes and Measures Changes in rates of death from any cause during the COVID-19 pandemic in 2020 compared with previous years. Changes in all-cause death rates by quarter were stratified by age, sex, race and ethnicity, and region, based on individual-level data. Multilevel regression models were fit in a bayesian setting. Standardized rates were used for comparison between populations. Results There were 10.9 million enrollees in the VA health care system and 6.8 million active users. The demographic characteristics of the VA populations were predominantly male (>85% in the VA health care system vs 49% in the general US population), older (mean [SD], 61.0 [18.2] years in the VA health care system vs 39.0 [23.1] years in the US population), and had a larger proportion of patients who were White (73% in the VA health care system vs 61% in the US population) or Black (17% in the VA health care system vs 13% in the US population). Increases in death rates were apparent across all of the adult age groups (≥25 years) in both the VA populations and the general US population. Across all of 2020, the relative increase in death rates compared with expected values was similar for VA enrollees (risk ratio [RR], 1.20 [95% CI, 1.14-1.29]), VA active users (RR, 1.19 [95% CI, 1.14-1.26]), and the general US population (RR, 1.20 [95% CI, 1.17-1.22]). Because the prepandemic standardized mortality rates were higher in the VA populations prior to the pandemic, the absolute rates of excess mortality were higher in the VA populations. Conclusions and Relevance In this cohort study, a comparison of excess deaths between populations suggests that active users of the VA health system had similar relative increases in mortality compared with the general US population during the first 10 months of the COVID-19 pandemic.
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Affiliation(s)
- Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Department of Veterans Affairs Connecticut Healthcare System, West Haven
| | - Liam Rose
- Department of Veterans Affairs Medical Center, Palo Alto, California
- Surgery Policy Improvement Research and Education Center, Stanford School of Medicine, Palo Alto, California
| | - Christopher Rentsch
- Department of Veterans Affairs Connecticut Healthcare System, West Haven
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Steven M. Asch
- Department of Veterans Affairs Medical Center, Palo Alto, California
- Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, California
- Department of Health Research and Policy, Stanford School of Medicine, Palo Alto, California
| | - Jesse A. Columbo
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joseph King
- Department of Veterans Affairs Connecticut Healthcare System, West Haven
- Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Caroline Korves
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
| | - Brian P. Lucas
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Cynthia Taub
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Yinong Young-Xu
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
| | - Anita Vashi
- Department of Veterans Affairs Medical Center, Palo Alto, California
- Department of Health Research and Policy, Stanford School of Medicine, Palo Alto, California
- Department of Emergency Medicine, University of California, San Francisco
| | - Louise Davies
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
- Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Amy C. Justice
- Department of Veterans Affairs Connecticut Healthcare System, West Haven
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Liu TL, Chou SH, Murphy S, Kowalkowski M, Taylor YJ, Hole C, Sitammagari K, Priem JS, McWilliams A. Evaluating Racial/Ethnic Differences in Care Escalation Among COVID-19 Patients in a Home-Based Hospital. J Racial Ethn Health Disparities 2023; 10:817-825. [PMID: 35257312 PMCID: PMC8900643 DOI: 10.1007/s40615-022-01270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 11/25/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) has infected over 414 million people worldwide with 5.8 million deaths, as of February 2022. Telemedicine-based interventions to expand healthcare systems' capacity and reduce infection risk have rapidly increased during the pandemic, despite concerns regarding equitable access. Atrium Health Hospital at Home (AH-HaH) is a home-based program that provides advanced, hospital-level medical care and monitoring for patients who would otherwise be hospitalized in a traditional setting. Our retrospective cohort study of positive COVID-19 patients who were admitted to AH-HaH aims to investigate whether the rate of care escalation from AH-HaH to traditional hospitalization differed based on patients' racial/ethnic backgrounds. Logistic regression was used to examine the association between care escalation within 14 days from index AH-HaH admission and race/ethnicity. We found approximately one in five patients receiving care for COVID-19 in AH-HaH required care escalation within 14 days. Odds of care escalation were not significantly different for Hispanic or non-Hispanic Blacks compared to non-Hispanic Whites. However, secondary analyses showed that both Hispanic and non-Hispanic Black patients were younger and with fewer comorbidities than non-Hispanic Whites. The study highlights the need for new care models to vigilantly monitor for disparities, so that timely and tailored adaptations can be implemented for vulnerable populations.
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Affiliation(s)
- Tsai-Ling Liu
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA.
| | - Shih-Hsiung Chou
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA
| | - Stephanie Murphy
- Division of Hospital Medicine, Department of Internal Medicine, Atrium Health, Charlotte, NC, USA
| | - Marc Kowalkowski
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA
| | - Yhenneko J Taylor
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA
| | - Colleen Hole
- Population Health, Atrium Health, Charlotte, NC, USA
| | - Kranthi Sitammagari
- Division of Hospital Medicine, Department of Internal Medicine, Atrium Health, Charlotte, NC, USA
| | - Jennifer S Priem
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA
| | - Andrew McWilliams
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, USA.,Division of Hospital Medicine, Department of Internal Medicine, Atrium Health, Charlotte, NC, USA
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Bernstein EL, DeRycke EC, Han L, Farmer MM, Bastian LA, Bean-Mayberry B, Bade B, Brandt C, Crothers K, Skanderson M, Ruser C, Spelman J, Bazan IS, Justice AC, Rentsch CT, Akgün KM. Racial, Ethnic, and Rural Disparities in US Veteran COVID-19 Vaccine Rates. AJPM FOCUS 2023; 2:100094. [PMID: 37362395 PMCID: PMC10038675 DOI: 10.1016/j.focus.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background Race, ethnicity, and rurality-related disparities in coronavirus disease 2019 (COVID-19) vaccine uptake have been documented in the United States (US). Objective We determined whether these disparities existed among patients at the Department of Veterans Affairs (VA), the largest healthcare system in the US. Design Settings Participants Measurements Using VA Corporate Data Warehouse data, we included 5,871,438 patients (9.4% women) with at least one primary care visit in 2019 in a retrospective cohort study. Each patient was assigned a single race/ethnicity, which were mutually exclusive, self-reported categories. Rurality was based on 2019 home address at the zip code level. Our primary outcome was time-to-first COVID-19 vaccination between December 15, 2020-June 15, 2021. Additional covariates included age (in years), sex, geographic region (North Atlantic, Midwest, Southeast, Pacific, Continental), smoking status (current, former, never), Charlson Comorbidity Index (based on ≥1 inpatient or two outpatient ICD codes), service connection (any/none, using standardized VA-cutoffs for disability compensation), and influenza vaccination in 2019-2020 (yes/no). Results Compared with unvaccinated patients, those vaccinated (n=3,238,532; 55.2%) were older (mean age in years vaccinated=66.3, (standard deviation=14.4) vs. unvaccinated=57.7, (18.0), p<.0001)). They were more likely to identify as Black (18.2% vs. 16.1%, p<.0001), Hispanic (7.0% vs. 6.6% p<.0001), or Asian American/Pacific Islander (AA/PI) (2.0% vs. 1.7%, P<.0001). In addition, they were more likely to reside in urban settings (68.0% vs. 62.8, p<.0001). Relative to non-Hispanic White urban Veterans, the reference group for race/ethnicity-urban/rural hazard ratios reported, all urban race/ethnicity groups were associated with increased likelihood for vaccination except American Indian/Alaskan Native (AI/AN) groups. Urban Black groups were 12% more likely (Hazard Ratio (HR)=1.12 [CI 1.12-1.13]) and rural Black groups were 6% more likely to receive a first vaccination (HR=1.06 [1.05-1.06]) relative to white urban groups. Urban Hispanic, AA/PI and Mixed groups were more likely to receive vaccination while rural members of these groups were less likely (Hispanic: Urban HR=1.17 [1.16-1.18], Rural HR=0.98 [0.97-0.99]; AA/PI: Urban HR=1.22 [1.21-1.23], Rural HR=0.86 [0.84-0.88]). Rural White Veterans were 21% less likely to receive an initial vaccine compared with urban White Veterans (HR=0.79 [0.78-0.79]). AI/AN groups were less likely to receive vaccination regardless of rurality: Urban HR=0.93 [0.91-0.95]; AI/AN-Rural HR=0.76 [0.74-0.78]. Conclusions Urban Black, Hispanic, and AA/PI Veterans were more likely than their urban White counterparts to receive a first vaccination; all rural race/ethnicity groups except Black patients had lower likelihood for vaccination compared with urban White patients. A better understanding of disparities and rural outreach will inform equitable vaccine distribution.
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Affiliation(s)
- Ethan L. Bernstein
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of Pulmonary, Critical Care, and Sleep Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Eric C. DeRycke
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Ling Han
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Melissa M. Farmer
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Lori A. Bastian
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of General Internal Medicine, School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brett Bade
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of Pulmonary, Critical Care, and Sleep Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Cynthia Brandt
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kristina Crothers
- VA Puget Sound Health Care, Seattle, Washington
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Melissa Skanderson
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Christopher Ruser
- VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Juliette Spelman
- VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Isabel S. Bazan
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, Connecticut
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of General Internal Medicine, School of Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
| | - Christopher T. Rentsch
- VA Connecticut Healthcare System, West Haven, Connecticut
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kathleen M. Akgün
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Section of Pulmonary, Critical Care, and Sleep Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
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7
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Naeimi R, Sepidarkish M, Mollalo A, Parsa H, Mahjour S, Safarpour F, Almukhtar M, Mechaal A, Chemaitelly H, Sartip B, Marhoommirzabak E, Ardekani A, Hotez PJ, Gasser RB, Rostami A. SARS-CoV-2 seroprevalence in children worldwide: A systematic review and meta-analysis. EClinicalMedicine 2023; 56:101786. [PMID: 36590788 PMCID: PMC9795163 DOI: 10.1016/j.eclinm.2022.101786] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The higher hospitalisation rates of those aged 0-19 years (referred to herein as 'children') observed since the emergence of the immune-evasive SARS-CoV-2 Omicron variant and subvariants, along with the persisting vaccination disparities highlighted a need for in-depth knowledge of SARS-CoV-2 sero-epidemiology in children. Here, we conducted this systematic review to assess SARS-CoV-2 seroprevalence and determinants in children worldwide. METHODS In this systematic review and meta-analysis study, we searched international and preprinted scientific databases from December 1, 2019 to July 10, 2022. Pooled seroprevalences were estimated according to World Health Organization (WHO) regions (at 95% confidence intervals, CIs) using random-effects meta-analyses. Associations with SARS-CoV-2 seroprevalence and sources of heterogeneity were investigated using sub-group and meta-regression analyses. The protocol used in this study has been registered in PROSPERO (CRD42022350833). FINDINGS We included 247 studies involving 757,075 children from 70 countries. Seroprevalence estimates varied from 7.3% (5.8-9.1%) in the first wave of the COVID-19 pandemic to 37.6% (18.1-59.4%) in the fifth wave and 56.6% (52.8-60.5%) in the sixth wave. The highest seroprevalences in different pandemic waves were estimated for South-East Asia (17.9-81.8%) and African (17.2-66.1%) regions; while the lowest seroprevalence was estimated for the Western Pacific region (0.01-1.01%). Seroprevalence estimates were higher in children at older ages, in those living in underprivileged countries or regions, and in those of minority ethnic backgrounds. INTERPRETATION Our findings indicate that, by the end of 2021 and before the Omicron wave, around 50-70% of children globally were still susceptible to SARS-CoV-2 infection, clearly emphasising the need for more effective vaccines and better vaccination coverage among children and adolescents, particularly in developing countries and minority ethnic groups. FUNDING None.
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Affiliation(s)
- Reza Naeimi
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Abolfazl Mollalo
- Department of Public Health and Prevention Science, School of Health Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Hamid Parsa
- Department of Neurology, University of Visayas, Gullas College of Medicine, Cebu City, 600 Cebu, Philippines
| | - Sanaz Mahjour
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Fatemeh Safarpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Amal Mechaal
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, USA
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections and Viral Hepatitis, Weill Cornell Medicine-Qatar, Qatar-Foundation-Education City, Cornell University, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, USA
| | - Behnam Sartip
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elika Marhoommirzabak
- Department of Neurology, University of Visayas, Gullas College of Medicine, Cebu City, 600 Cebu, Philippines
| | - Ali Ardekani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peter J. Hotez
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robin B. Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria, Australia
- Corresponding author.
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Corresponding author.
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8
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Bauer C, Li X, Zhang K, Lee M, Guajardo E, Fisher-Hoch S, McCormick J, Fernandez ME, Reininger B. A Novel Bayesian Spatial-Temporal Approach to Quantify SARS-CoV-2 Testing Disparities for Small Area Estimation. Am J Public Health 2023; 113:40-48. [PMID: 36516388 PMCID: PMC9755943 DOI: 10.2105/ajph.2022.307127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 12/15/2022]
Abstract
Objectives. To propose a novel Bayesian spatial-temporal approach to identify and quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing disparities for small area estimation. Methods. In step 1, we used a Bayesian inseparable space-time model framework to estimate the testing positivity rate (TPR) at geographically granular areas of the census block groups (CBGs). In step 2, we adopted a rank-based approach to compare the estimated TPR and the testing rate to identify areas with testing deficiency and quantify the number of needed tests. We used weekly SARS-CoV-2 infection and testing surveillance data from Cameron County, Texas, between March 2020 and February 2022 to demonstrate the usefulness of our proposed approach. Results. We identified the CBGs that had experienced substantial testing deficiency, quantified the number of tests that should have been conducted in these areas, and evaluated the short- and long-term testing disparities. Conclusions. Our proposed analytical framework offers policymakers and public health practitioners a tool for understanding SARS-CoV-2 testing disparities in geographically small communities. It could also aid COVID-19 response planning and inform intervention programs to improve goal setting and strategy implementation in SARS-CoV-2 testing uptake. (Am J Public Health. 2023;113(1):40-48. https://doi.org/10.2105/AJPH.2022.307127).
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Affiliation(s)
- Cici Bauer
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
| | - Xiaona Li
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
| | - Kehe Zhang
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
| | - Miryoung Lee
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
| | - Esmeralda Guajardo
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
| | - Susan Fisher-Hoch
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
| | - Joseph McCormick
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
| | - Maria E Fernandez
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
| | - Belinda Reininger
- Cici Bauer, Xiaona Li, and Kehe Zhang are with the Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston. Miryoung Lee, Susan Fisher-Hoch, and Joseph McCormick are with the Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston. Esmeralda Guajardo is with the Cameron County Public Health, San Benito, TX. Maria E. Fernandez and Belinda Reininger are with the Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston
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9
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Frisco ML, Van Hook J, Thomas KJA. Racial/ethnic and nativity disparities in U.S. Covid-19 vaccination hesitancy during vaccine rollout and factors that explain them. Soc Sci Med 2022; 307:115183. [PMID: 35843179 PMCID: PMC9242888 DOI: 10.1016/j.socscimed.2022.115183] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 01/26/2023]
Abstract
While research has begun to investigate disparities in Covid-19 vaccine hesitancy between White, Black and Hispanic adults, no nationally representative studies to date have accounted for Hispanic immigrants as a unique group or fully investigated the reasons behind racial/ethnic and nativity disparities. We make these contributions by substantively drawing from what is known about the ways that immigrant fear and structural racism create conditions that produce countervailing forces that are likely to contribute to racial/ethnic and nativity disparities in vaccine hesitancy. We use OLS regression and decomposition techniques to analyze data from 1936 18-65 year-old United States (U.S.) adults who participated in the COVID-19 and its Implications for American Communities (CIAC) study during February and March 2021, a period of time that coincides with early stages of the U.S. vaccine roll-out effort that pre-dated universal adult eligibility for Covid-19 vaccination. Results indicate that U.S.-born Black adults are more vaccine hesitant than U.S.-born White adults. This disparity is largely due to differences in anti-vaccine beliefs. U.S.-born Hispanic adults are less vaccine hesitant than U.S.-born White adults in adjusted OLS regression models and personal experiences with Covid-19 drive this difference. There were not significant differences between foreign-born Hispanic and U.S.-born White adults in vaccine hesitancy. These findings suggest that foreign-born Hispanic adults did not drive early disparities in vaccine hesitancy and that alleviating concerns about anti-vaccine beliefs and utilizing personal stories have important roles in preventing future racial/ethnic disparities in Covid-19 vaccine hesitancy as new Covid-19 vaccines and booster shots are rolled out. Study findings may also have implications for reducing racial/ethnic disparities in the uptake of other new vaccines.
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Affiliation(s)
- Michelle L Frisco
- Penn State University Department of Sociology & Criminology and Population Research Institute, 211 Oswald Tower, University Park, PA, 16802, United States.
| | - Jennifer Van Hook
- Penn State University Department of Sociology & Criminology and Population Research Institute, 211 Oswald Tower, University Park, PA, 16802, United States
| | - Kevin J A Thomas
- University of Texas-Austin Department of African and African Diaspora Studies and Population Research Center, 116 Inner Campus Dr. Stop G6000, Austin, TX, 181712, United States
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10
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Ferguson JM, Mitchell-Miland C, Shahoumian TA, Moy E, Jones KT, Cohen AJ, Hausmann LRM. Temporal Variation in Individual Social Risk Factors Associated with Testing Positive for SARS-CoV-2 Among Veterans in the Veterans Health Administration. Ann Epidemiol 2022; 73:22-29. [PMID: 35753583 PMCID: PMC9221682 DOI: 10.1016/j.annepidem.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Marginalized communities have been disproportionally impacted by SARS-CoV-2. How the associations between social determinants of health and the risk of SARS-CoV-2 infection shifted across time is unknown. In this evaluation, we examine individual-level social determinants of health as social risk factors for SARS-CoV-2 infection across the first 12 months of the pandemic among US Veterans. METHODS We conducted a retrospective cohort analysis of 946,358 Veterans who sought testing or treatment for SARS-CoV-2 infection in U.S. Department of Veterans Affairs (VA) medical facilities. We estimated risk ratios for testing positive by social risk factors, adjusting for demographics, comorbidities, and time. Adjusted models were stratified by pandemic phase to assess temporal fluctuations in social risks. RESULTS Approximately 19% of Veterans tested positive for SARS-CoV-2. Larger household size was a persistent risk factor and this association increased over time. Early in the pandemic, lower county-level population density was associated with lower SARS-CoV-2 infection risk, but between June 1- August 31, 2020, this trend reversed. CONCLUSIONS Temporal fluctuations in social risks associated with Veterans' SARS-CoV-2 infection suggest the need for ongoing, real-time tracking as the social and medical environment continues to evolve.
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Affiliation(s)
- Jacqueline M Ferguson
- Center for Innovation to Implementation, Palo Alto Health Care System, US Department of Veterans, Menlo Park, CA 94025, USA.
| | - Chantele Mitchell-Miland
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15240-1001, USA; Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15240-1001, USA
| | - Troy A Shahoumian
- Population Health: Health Solutions, Veterans Health Administration Washington, DC 20005, USA
| | - Ernest Moy
- Office of Health Equity, Department of Veterans Affairs, Washington, DC 20005, USA
| | - Kenneth T Jones
- Office of Health Equity, Department of Veterans Affairs, Washington, DC 20005, USA
| | - Alicia J Cohen
- Center of Innovation in Long Term Services and Supports, Veterans Affairs Providence Healthcare System, Providence, RI 02908, USA; Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI 02903; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI 02903
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15240-1001, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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11
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Busch MP, Stramer SL, Stone M, Yu EA, Grebe E, Notari E, Saa P, Ferg R, Manrique IM, Weil N, Fink RV, Levy M, Green V, Cyrus S, Williamson PC, Haynes J, Groves J, Krysztof D, Custer B, Kleinman S, Biggerstaff BJ, Opsomer JD, Jones JM. Population-Weighted Seroprevalence From Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection, Vaccination, and Hybrid Immunity Among US Blood Donations From January to December 2021. Clin Infect Dis 2022; 75:S254-S263. [PMID: 35684973 PMCID: PMC9214177 DOI: 10.1093/cid/ciac470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination, independently and combined ("hybrid immunity"), result in partial protection from subsequent infection and strong protection from severe disease. Proportions of the US population who have been infected, vaccinated, or have hybrid immunity remain unclear, posing a challenge for assessing effective pandemic mitigation strategies. METHODS In this serial cross-sectional study, nationwide blood donor specimens collected during January-December 2021 were tested for anti-spike and anti-nucleocapsid antibodies, and donor COVID-19 vaccination history of ≥1 dose was collected. Monthly seroprevalence induced from SARS-CoV-2 infection, COVID-19 vaccination, or both, were estimated. Estimates were weighted to account for demographic differences from the general population and were compared temporally and by demographic factors. RESULTS Overall, 1 123 855 blood samples were assayed. From January to December 2021, the weighted percentage of donations with seropositivity changed as follows: seropositivity due to vaccination without previous infection, increase from 3.5% (95% confidence interval, 3.4%-3.7%) to 64.0%, (63.5%-64.5%); seropositivity due to previous infection without vaccination, decrease from 15.6% (15.2%-16.0%) to 11.7% (11.4%-12.0%); and seropositivity due to hybrid immunity, increase from 0.7% (0.6%-0.7%) to 18.9% (18.5%-19.3%). Combined seroprevalence from infection, vaccination, or both increased from 19.8% (19.3%-20.2%) to 94.5% (93.5%-94.0%). Infection- and vaccination-induced antibody responses varied significantly by age, race-ethnicity, and region, but not by sex. CONCLUSIONS Our results indicate substantial increases in population humoral immunity from SARS-CoV-2 infection, COVID-19 vaccination, and hybrid immunity during 2021. These findings are important to consider in future COVID-19 studies and long-term pandemic mitigation efforts.
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Affiliation(s)
- Michael P. Busch
- Corresponding authors Michael P. Busch, MD. PhD Vitalant Research Institute 270 Masonic Avenue San Francisco, CA 94118
| | - Susan L. Stramer
- American Red Cross, Scientific Affairs, Gaithersburg and Rockville, Maryland, USA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, USA,University of California San Francisco, San Francisco, California, USA
| | - Elaine A. Yu
- Vitalant Research Institute, San Francisco, California, USA,University of California San Francisco, San Francisco, California, USA
| | - Eduard Grebe
- Vitalant Research Institute, San Francisco, California, USA,University of California San Francisco, San Francisco, California, USA
| | - Edward Notari
- American Red Cross, Scientific Affairs, Gaithersburg and Rockville, Maryland, USA
| | - Paula Saa
- American Red Cross, Scientific Affairs, Gaithersburg and Rockville, Maryland, USA
| | | | | | | | | | | | | | | | | | - James Haynes
- American Red Cross, Scientific Affairs, Gaithersburg and Rockville, Maryland, USA
| | - Jamel Groves
- American Red Cross, Scientific Affairs, Gaithersburg and Rockville, Maryland, USA
| | - David Krysztof
- American Red Cross, Scientific Affairs, Gaithersburg and Rockville, Maryland, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA,University of California San Francisco, San Francisco, California, USA
| | - Steve Kleinman
- Vitalant Research Institute, San Francisco, California, USA
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12
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Unruh LH, Dharmapuri S, Xia Y, Soyemi K. Health disparities and COVID-19: A retrospective study examining individual and community factors causing disproportionate COVID-19 outcomes in Cook County, Illinois. PLoS One 2022; 17:e0268317. [PMID: 35576226 PMCID: PMC9109922 DOI: 10.1371/journal.pone.0268317] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/27/2022] [Indexed: 12/29/2022] Open
Abstract
Early data from the COVID-19 pandemic suggests that the disease has had a disproportionate impact on communities of color with higher infection and mortality rates within those communities. This study used demographic data from the 2018 US census estimates, mortality data from the Cook County Medical Examiner’s office, and testing results from the Illinois Department of Public Health to perform bivariate and multivariate regression analyses to explore the role race plays in COVID-19 outcomes at the individual and community levels. We used the ZCTA Social Deprivation Index (SDI), a measure of ZCTA area level deprivation based on seven demographic characteristics to quantify the socio-economic variation in health outcomes and levels of disadvantage across ZCTAs. Principal findings showed that: 1) while Black individuals make up 22% of Cook County’s population, they account for 28% of the county’s COVID-19 related deaths; 2) the average age of death from COVID-19 is seven years younger for Non-White compared with White decedents; 3) residents of Minority ZCTA areas were 1.02 times as likely to test positive for COVID-19, (Incidence Rate Ratio (IRR) 1.02, [95% CI 0.95, 1.10]); 1.77 times as likely to die (IRR 1.77, [95% CI 1.17, 2.66]); and were 1.15 times as likely to be tested (IRR 1.15, [95% CI 0.99, 1.33]). There are notable differences in COVID-19 related outcomes between racial and ethnic groups at individual and community levels. This study illustrates the health disparities and underlying systemic inequalities experienced by communities of color.
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Affiliation(s)
- Larissa H. Unruh
- Department of Emergency Medicine, John H. Stroger Jr. Hospital of Cook County Health, Chicago, Illinois, United States of America
| | - Sadhana Dharmapuri
- Cermak Health Services, Cook County Juvenile Temporary Detention Center, Chicago, Illinois, United States of America
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States of America
| | - Yinglin Xia
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Kenneth Soyemi
- Cermak Health Services, Cook County Juvenile Temporary Detention Center, Chicago, Illinois, United States of America
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States of America
- * E-mail:
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