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Alkaissy Y, Serre-Delcor N, Vicente MA, Molina I, Norman FF, Goikoetxea AJ, de Dios B, Torrús D, Navarrete Lorite MN, Rodríguez-Guardado A, Lombide I, Calabuig E, Muriel A, Perez-Molina JA. Trends in imported infections among migrants and travellers to Spain: a decade of analysis through the +Redivi network (2012-2022). J Travel Med 2024; 31:taae067. [PMID: 38691427 DOI: 10.1093/jtm/taae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND High-speed global travel, increased trade, world population growth, migration, urbanization and climate change have favoured the emergence and spread of pathogens. We aimed to analyse the evolution of imported infections in Spain during 2012-2022 and the potential impact of some of the abovementioned factors on differential morbidity patterns. METHODS In this retrospective study (January 2012 to December 2022), we analysed data collected by the +Redivi network across 25 health centres. The network's standardised database records new cases of imported infections, including patient demographics, travel history, pre-travel advice and diagnostic information. To assess outcome rates over time and potential interactions, we constructed penalized weighted models to reduce the bias related to a low event rate and used weighted logistic regression for morbidity outcomes. RESULTS We recorded 25 632 episodes, comprising 13 913 migrants, 4047 visiting friends and relatives (VFR) immigrants, 392 VFR travellers and 7280 travellers. Most immigrants came from South America (48.3%), Sub-Saharan Africa (28.5%), North Africa (6.6%), South Central Asia (5.4%) and Central America/Caribbean (5.3%). The most common regions visited by travellers were Sub-Saharan Africa (33.5%), South America (24.5%), Central America/Caribbean (13.5%), Southeast Asia (12%) and South Central Asia (10%). The proportion of diagnoses of malaria, strongyloidiasis and unspecified self-limiting febrile syndrome < 3 weeks remained unchanged during the study period. An increased frequency of diagnosis was reported for schistosomiasis, blastocystosis, giardiasis, dengue, diarrhoea, new cases of HIV, latent and pulmonary tuberculosis, whereas a decrease was reported for syphilis, chikungunya fever, Chagas disease and eosinophilia. We detected interactions between time and sex or type of participant across the different diagnoses. CONCLUSIONS Our study underscores the importance of epidemiological data in understanding infectious diseases dynamics among travellers and migrants, emphasizing how demographic shifts, migration trends and healthcare policies affect disease profiles. Comprehensive data play an essential role in enhancing public health policies and travel advice.
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Affiliation(s)
- Yam Alkaissy
- Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Nuria Serre-Delcor
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Calle de San Oleguer, 17, 08001 Barcelona, Spain
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
| | - Marta Arsuaga Vicente
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- National Referral Unit for Imported Infectious Diseases, Hospital La Paz-Carlos III, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Israel Molina
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Paseo de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Francesca F Norman
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- National Reference Centre for Imported Tropical Diseases. Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
| | | | - Begoña de Dios
- Department of Internal Medicine. Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
| | - Diego Torrús
- Unidad de Referencia de Enfermedades Importadas y Salud Internacional, Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Miguel Nicolás Navarrete Lorite
- Unidad Clínica de Enfermedades Infecciosas y Microbiologia del Hospital Universitario Virgen Macarena, Avenida Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - Azucena Rodríguez-Guardado
- Área de Gestión Clínica Medicina Interna. Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011 Oviedo, Spain
- Grupo de Microbiología Traslacional, Instituto de Investigación del Principado de Asturias, Avenida Hospital Universitario s/n, 33011 Oviedo, Spain
| | - Itxaso Lombide
- Basurto University Hospital, Avenida de Montevideo, 18, 48013 Bilbao, Spain
| | - Eva Calabuig
- La Fe University and Polytechnic Hospital, University of Valencia, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Alfonso Muriel
- Clinical Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- CIBERESP, Instituto de Salud Carlos III, Calle Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- Universidad de Alcalá, Plaza de San Diego, s/n, 28801 Alcalá de Henares, Spain
| | - Jose A Perez-Molina
- CIBERINFEC. Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta baja, 28029 Madrid, Spain
- National Reference Centre for Imported Tropical Diseases. Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
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Soler-Moratalla IM, Salmerón S, Lozoya-Moreno S, Hermosilla-Pasamar AM, Henández-Martínez A, Solís-García del Pozo J, Escribano-Talaya M, Font-Payeras MA, García-Alcaraz F. Frailty as a Risk Factor for Depression after COVID-19 Hospital Admission. Geriatrics (Basel) 2024; 9:97. [PMID: 39051261 PMCID: PMC11270407 DOI: 10.3390/geriatrics9040097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/13/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND This work aims to establish the relationship between depression and epidemiological or imaging variables, frailty, and cognitive status in patients who suffered hospital admission for COVID-19. METHODS A longitudinal observational study investigated 72 patients admitted for COVID-19 to a hospital in Spain. Patients were evaluated at discharge and six months later. Clinical, analytical, and imaging variables were collected. A neurocognitive, nutritional, and frailty (FRAIL scale) assessment of the included patients was carried out. The risk of depression was considered for a result above 5 points on the PHQ-9 scale. RESULTS The variables that were significantly related to the risk of depression 6 months after admission for COVID-19 were frailty (p = 0.006 for pre-frail and p = 0.001 for frail), small-vessel vascular disease in imaging tests (p = 0.033), vitamin D level (p = 0.006), and taking antidepressants (p = 0.011). Factors that were negatively associated with the presence of depression 6 months after discharge were a higher score on the CAMCOG cognitive scale (p = 0.041) and older age (p = 0.006). CONCLUSIONS Frailty worsened the score on the PHQ-9 depression scale in patients who required hospital admission for SARS-CoV-2 infection. It is important to implement prevention measures both for frailty and depression in these patients.
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Affiliation(s)
| | - Sergio Salmerón
- San Vicente de Paúl Nursing Home, Diputación de Albacete, 02001 Albacete, Spain
| | - Silvia Lozoya-Moreno
- Department of Geriatrics, Albacete University Hospital Complex, 02008 Albacete, Spain;
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Le Rutte EA, Shattock AJ, Marcelino I, Goldenberg S, Penny MA. Efficacy thresholds and target populations for antiviral COVID-19 treatments to save lives and costs: a modelling study. EClinicalMedicine 2024; 73:102683. [PMID: 39007067 PMCID: PMC11246010 DOI: 10.1016/j.eclinm.2024.102683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 07/16/2024] Open
Abstract
Background In 2023 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared endemic, yet hospital admissions have persisted and risen within populations at high and moderate risk of developing severe disease, which include those of older age, and those with co-morbidities. Antiviral treatments, currently only available for high-risk individuals, play an important role in preventing severe disease and hospitalisation within this subpopulation. Here, we further explore the public health and economic benefits of extending target populations for treatment, and assess efficacy thresholds for a treatment strategy to be cost-saving. Methods We adapted an individual-based transmission model of SARS-CoV-2, OpenCOVID, which was calibrated and validated to 2020-2023 Swiss, European, and Northern Hemisphere epidemiological data. We used the model to estimate hospitalisations and overall costs for preventatively treating three risk groups for a full range of treatment efficacies and coverages with, besides vaccination and hospital treatments, no other interventions in place. We further calculated efficacy thresholds for strategies to be cost-saving. A global sensitivity analysis was conducted to test the sensitivity of all outcomes for a wide range of treatment properties, emerging variant properties, and vaccination coverages. Findings In a high vaccination coverage setting, we found that a high efficacy antiviral treatment given to all those at high-risk could reduce hospitalisations by up to 40%. When expanding treatment coverage to also include all those at moderate-risk, an additional 50% of hospitalisations could be averted. Targeting both high-risk and moderate-risk groups was found to be cost-saving for a treatment efficacy greater than ∼40%. This threshold was found to be robust regardless of vaccination coverage and emerging variant properties, but highly sensitive to treatment costs. Interpretation For a sufficiently efficacious antiviral treatment, expanding the target population to include both high-risk and moderate-risk groups should be considered. Equitable treatment costs are found crucial in achieving the best possible public health and health economic outcomes. Funding Botnar Research Centre for Child Health (DZX2165 to MAP), the Swiss National Science Foundation Professorship of MAP (P00P3_203450) and Swiss National Science Foundation NFP 78 Covid-19 2020 (4079P0_198428 to MAP).
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Affiliation(s)
- Epke A. Le Rutte
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrew J. Shattock
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Telethon Kids Institute, Nedlands, WA, Australia
- Centre for Child Health Research, University of Western Australia, Crawley, WA, Australia
| | - Inês Marcelino
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
- Department of Quantitative Veterinary Epidemiology, Wageningen University & Research, Wageningen, Netherlands
| | - Sophie Goldenberg
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, USA
| | - Melissa A. Penny
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Telethon Kids Institute, Nedlands, WA, Australia
- Centre for Child Health Research, University of Western Australia, Crawley, WA, Australia
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Lenhard A, Daoud M, Donahue L, Jones S, Kip PL, Zapf RL, Minnier TE. How SWAT Changed the Conversation: Implementation of a Discharge SWAT Team Improves Morale and Facilitates Communication During the COVID-19 Pandemic. Prof Case Manag 2024:01269241-990000000-00009. [PMID: 38421720 DOI: 10.1097/ncm.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF STUDY Hospital overcrowding and delays in discharge are serious issues in the modern health care landscape and can lead to poor patient outcomes and health care personnel (HCP) burnout. The goal of this project was to develop a collaborative forum where HCP representing the entire spectrum of the inpatient care team, including case management team members, could connect to discuss challenges and barriers to patient discharge. The following describes the development, implementation, and outcomes of the discharge SWAT (Solutions, Wins, Actions, and Tactics) team, which is a 30-min virtual daily meeting where discussion is primarily centered around challenges in discharging individual patients and addressing case manager needs. The primary aim of SWAT meetings is fostering a positive atmosphere to address barriers to discharge while prioritizing patient care and outcomes. PRIMARY PRACTICE SETTING This study was conducted in a 40-hospital academic health system in the United States. METHODOLOGY AND SAMPLE SWAT meetings were first implemented at a representative flagship facility in a health system. HCP at this first facility were surveyed to assess satisfaction with SWAT meetings. SWAT meetings then were implemented at the majority of facilities in a 40-hospital academic health system. During SWAT implementation, average inpatient length of stay (LOS) and patient care transitions were monitored for participating and nonparticipating service lines. RESULTS Among surveyed HCP, the majority view SWAT meetings favorably and reported that it was a valuable use of their time and positively impacted their work in the patient discharge space. Nonprovider and case management staff in particular valued the SWAT meetings and found them beneficial. LOS remained stable for patients under the care of participating providers, despite the upheaval of the ongoing COVID-19 pandemic, and the research team also observed a positive impact of SWAT meetings on appropriate inpatient care transitions.
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Affiliation(s)
- Amanda Lenhard
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Majd Daoud
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Lisa Donahue
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Sherri Jones
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Paula L Kip
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Rachel L Zapf
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Tamra E Minnier
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
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Razimoghadam M, Yaseri M, Rezaee M, Fazaeli A, Daroudi R. Non-COVID-19 hospitalization and mortality during the COVID-19 pandemic in Iran: a longitudinal assessment of 41 million people in 2019-2022. BMC Public Health 2024; 24:380. [PMID: 38317148 PMCID: PMC10840276 DOI: 10.1186/s12889-024-17819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. METHOD This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. RESULTS During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25-0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97-2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13-1.40]) and mortality rate (OR 1.05, [1.04-1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17-0.31]) and second years (IRR 0.35, [0.26-0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21-0.42]), influenza (IRR 0.04, [0.03-0.06]) and COPD (IRR 0.39, [0.23-0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42-3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65-2.78]) and musculoskeletal (OR 1.48, [1.20-1.82), nervous system (OR 1.42, [1.26-1.60]), metabolic (OR 1.99, [1.80-2.19]) and circulatory diseases (OR 1.35, [1.31-1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19-1.49]), heart failure (OR 1.59, [1.35-1.87]) and stroke (OR 1.35, [1.24-1.47]) showed an increase in mortality rates without changes in hospitalization. CONCLUSIONS In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.
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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Aliakbar Fazaeli
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Behnoush AH, Bazmi E, Khalaji A, Jafari-Mehdiabad A, Barzegari N, Dehpour AR, Behnoush B. The trend of poisonings before and after the COVID-19 pandemic. Sci Rep 2024; 14:2098. [PMID: 38267612 PMCID: PMC10808127 DOI: 10.1038/s41598-024-52537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
The COVID-19 pandemic has substantially affected people and healthcare systems. One of the main challenges was the reduction and change in the pattern of non-COVID-19 diseases and conditions. Moreover, due to the mental burden of the pandemic, the trend of poisonings and abuses changed. In this study, we aimed to assess the trends of poisonings from different agents before and during the COVID-19 pandemic using the interrupted time series method. This study was conducted at one of the main Tehran referral centers for poisoning, Baharloo Hospital. Pre-COVID-19 period was defined as April 2018 to January 2020 while the COVID-19 time was from February 2020 to March 2022. The total number of monthly poisoning cases in addition to eight categories of drugs/substances/agents were identified, including drugs (such as psychiatric drugs, cardiovascular drugs, and analgesics), opioids, stimulants, methanol, ethanol, cannabis, pesticides, and carbon monoxide. Interrupted time series analysis was performed to compare the pre-pandemic trend of total monthly cases from each category in addition to the proportion (%) of each one. In total, 13,020 cases were poisoned during the study period, among which 6088 belonged to the pre-pandemic period and 6932 were admitted during the COVID-19 era. There was no significant difference in terms of demographic characteristics of patients before and during the pandemic (p-value > 0.05). At the beginning of the pandemic, there was a sudden fall in the number of poisoning patients (- 77.2 cases/month, p-value = 0.003), however, there was a significant increasing trend during the COVID time (3.9 cases/month, p-value = 0.006). Most of the categories had a sharp decrease at the beginning of the pandemic except for methanol and ethanol which had increases, although not significant. Cannabis also had a significant change in slope (- 0.6 cases/month, p-value = 0.016), in addition to the sudden decrease at the beginning of the pandemic (- 10 cases/month, p-value = 0.007). Regarding the proportion of each category from total monthly poisoning cases, methanol, and ethanol had immediate rises of 4.2% per month and 10.1% per month, respectively (both significant). The pandemic had significant effects on the pattern of poisonings from different agents in Iran, the most important of which were alcohol (ethanol and methanol). These differences had policy implications that can be helpful for policymakers and healthcare systems in combating similar situations in the future.
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Affiliation(s)
| | - Elham Bazmi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | | | - Nasrin Barzegari
- School of Medicine, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad-Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Behnoush
- Department of Forensic Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Razimoghadam M, Yaseri M, Effatpanah M, Daroudi R. Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals. Arch Public Health 2024; 82:5. [PMID: 38216989 PMCID: PMC10785366 DOI: 10.1186/s13690-023-01234-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic. METHODS The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR). RESULTS 1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56-0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49-165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63-0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96-0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59-1.72]) and second years (RR 1.27, [1.22-1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30-2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals' EDs. CONCLUSION In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.
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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- Pediatric department, School of Medicine, Imam Khomeini hospital, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Menezes-Filho N, Komatsu BK, Villares L. The impacts of COVID-19 hospitalizations on non-COVID-19 deaths and hospitalizations: A panel data analysis using Brazilian municipalities. PLoS One 2023; 18:e0295572. [PMID: 38096258 PMCID: PMC10721066 DOI: 10.1371/journal.pone.0295572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
The COVID-19 pandemic in Brazil has brought many challenges, particularly regarding the management of hospital capacity, and a new demand for healthcare that added to the preexisting demands, such as neoplasms, cardiovascular diseases and births. In this paper, we estimate the impact of the pandemic on the number of deaths and hospitalizations for other diseases. We construct a monthly panel data of deaths and hospitalizations for various causes by the municipality of residence and relate them to COVID-19 hospitalizations using regression models that control for municipalities fixed-effects and interactions between State and month fixed-effects. The standard errors are clustered at the municipality level. Our estimates imply that 100 more hospitalizations by COVID-19 is associated with a drop of 49 non-COVID-19 hospitalizations and an additional four deaths for other reasons (all measured per 100,000 pop.). The impact of intensive care units COVID-19 hospitalizations on mortality is larger. The groups most affected are the African Brazilians, less-educated and the elderly. Additional deaths occurred both at households and at hospitals. The main causes of additional deaths were diseases related to the circulatory and endocrine system. The decline in hospitalizations for other causes seems to be related to the overcrowding of hospitals in periods of surge in the COVID-19, alongside with the fall in the demand for care by the citizens who were afraid of COVID-19 infection. These mechanisms affected more strongly the vulnerable groups of the population. Our results highlight the importance of promoting the awareness of heightened risk of non-communicable chronic diseases during a health emergency context. This should be done preferably through already established channels with community outreach, such as the Family Health Program in Brazil.
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Affiliation(s)
- Naercio Menezes-Filho
- Ruth Cardoso Chair, Insper, São Paulo, São Paulo, Brazil
- School of Economics, Business, and Accounting, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Luana Villares
- Ruth Cardoso Chair, Insper, São Paulo, São Paulo, Brazil
- School of Economics, Business, and Accounting, University of São Paulo, São Paulo, São Paulo, Brazil
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Walkowiak MP, Domaradzki J, Walkowiak D. Unmasking the COVID-19 pandemic prevention gains: excess mortality reversal in 2022. Public Health 2023; 223:193-201. [PMID: 37672832 DOI: 10.1016/j.puhe.2023.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/11/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the long-term effectiveness of COVID-19 pandemic prevention measures in saving lives after European governments began to lift restrictions. STUDY DESIGN Excess mortality interrupted time series. METHODS Country-level weekly data on deaths were fitted to the Poisson mixed linear model to estimate excess deaths. Based on this estimate, the percentage of excess deaths above the baseline during the pandemic (week 11 in 2020 to week 15 in 2022) (when public health interventions were in place) and during the post-pandemic period (week 16 in 2022 to week 52 in 2022) were calculated. These results were fitted to the linear regression model to determine any potential relationship between mortality during these two periods. RESULTS The model used in this study had high predictive value (adjusted R2 = 59.4%). Mortality during the endemic (post-pandemic) period alone increased by 7.2% (95% confidence interval [CI]: 5.7, 8.6) above baseline, while each percentage increase in mortality during the pandemic corresponded to a 0.357% reduction (95% CI: 0.243, 0.471) in mortality during the post-pandemic period. CONCLUSIONS The most successful countries in terms of protective measures also experienced the highest mortality rates after restrictions were lifted. The model used in this study clearly shows a measure of bidirectional mortality displacement that is sufficiently clear to mask any impact of long COVID on overall mortality. Results from this study also seriously impact previous cost-benefit analyses of pandemic prevention measures, since, according to the current model, 12.2% (95% CI: 8.3, 16.1) of the gains achieved in pandemic containment were lost after restrictions were lifted.
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Affiliation(s)
- M P Walkowiak
- Department of Preventive Medicine, Poznan University of Medical Sciences, Poznań, Poland.
| | - J Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland.
| | - D Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland.
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Costello RE, Tazare J, Piehlmaier D, Herrett E, Parker EP, Zheng B, Mansfield KE, Henderson AD, Carreira H, Bidulka P, Wong AY, Warren-Gash C, Hayes JF, Quint JK, MacKenna B, Mehrkar A, Eggo RM, Katikireddi SV, Tomlinson L, Langan SM, Mathur R. Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platform. EClinicalMedicine 2023; 61:102077. [PMID: 37434746 PMCID: PMC10331810 DOI: 10.1016/j.eclinm.2023.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Background The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. Methods In this population-based, observational cohort study we used primary care electronic health record data with linkage to hospital episode statistics data and mortality data within OpenSAFELY, a data analytics platform created, with approval of NHS England, to address urgent COVID-19 research questions. We included adults aged 18 years and over registered with a TPP practice between March 1, 2018, and April 30, 2022. We excluded those with missing age, sex, geographic region, or Index of Multiple Deprivation. We grouped ethnicity (exposure), into five categories: White, Asian, Black, Other, and Mixed. We used interrupted time-series regression to estimate ethnic differences in clinical monitoring frequency (blood pressure and Hba1c measurements, chronic obstructive pulmonary disease and asthma annual reviews) before and after March 23, 2020. We used multivariable Cox regression to quantify ethnic differences in hospitalisations related to diabetes, cardiovascular disease, respiratory disease, and mental health before and after March 23, 2020. Findings Of 33,510,937 registered with a GP as of 1st January 2020, 19,064,019 were adults, alive and registered for at least 3 months, 3,010,751 met the exclusion criteria and 1,122,912 were missing ethnicity. This resulted in 14,930,356 adults with known ethnicity (92% of sample): 86.6% were White, 7.3% Asian, 2.6% Black, 1.4% Mixed ethnicity, and 2.2% Other ethnicities. Clinical monitoring did not return to pre-pandemic levels for any ethnic group. Ethnic differences were apparent pre-pandemic, except for diabetes monitoring, and remained unchanged, except for blood pressure monitoring in those with mental health conditions where differences narrowed during the pandemic. For those of Black ethnicity, there were seven additional admissions for diabetic ketoacidosis per month during the pandemic, and relative ethnic differences narrowed during the pandemic compared to the White ethnic group (Pre-pandemic hazard ratio (HR): 0.50, 95% confidence interval (CI) 0.41, 0.60, Pandemic HR: 0.75, 95% CI: 0.65, 0.87). There was increased admissions for heart failure during the pandemic for all ethnic groups, though highest in those of White ethnicity (heart failure risk difference: 5.4). Relatively, ethnic differences narrowed for heart failure admission in those of Asian (Pre-pandemic HR 1.56, 95% CI 1.49, 1.64, Pandemic HR 1.24, 95% CI 1.19, 1.29) and Black ethnicity (Pre-pandemic HR 1.41, 95% CI: 1.30, 1.53, Pandemic HR: 1.16, 95% CI 1.09, 1.25) compared with White ethnicity. For other outcomes the pandemic had minimal impact on ethnic differences. Interpretation Our study suggests that ethnic differences in clinical monitoring and hospitalisations remained largely unchanged during the pandemic for most conditions. Key exceptions were hospitalisations for diabetic ketoacidosis and heart failure, which warrant further investigation to understand the causes. Funding LSHTM COVID-19 Response Grant (DONAT15912).
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Affiliation(s)
| | - John Tazare
- London School of Hygiene and Tropical Medicine, London, UK
| | - Dominik Piehlmaier
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- University of Sussex Business School, Jubilee Building, Brighton, UK
| | - Emily Herrett
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Bang Zheng
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Joseph F. Hayes
- Division of Psychiatry, University College London, London, UK
| | - Jennifer K. Quint
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | - Rohini Mathur
- London School of Hygiene and Tropical Medicine, London, UK
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
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