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Williams C, Paulson N, Sweat J, Rutledge R, Paulson MR, Maniaci M, Burger CD. Individual- and Community-Level Predictors of Hospital-at-Home Outcomes. Popul Health Manag 2024; 27:168-173. [PMID: 38546504 DOI: 10.1089/pop.2023.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study using patient data from July 2020 to December 2022. The study includes 3 Mayo Clinic centers and community-level data from the Agency for Healthcare Research and Quality. The authors conducted binary logistic regression analyses to examine the relationship among the independent variables (patient- and community-level characteristics) and dependent variables (30-day readmission, mortality, and escalation of care back to the brick-and-mortar hospital). The study examined 1433 patients; 53% were men, 90.58% were White, and 68.2% were married. The mortality rate was 2.8%, 30-day readmission was 11.4%, and escalation back to brick-and-mortar hospitals was 8.7%. At the patient level, older age and male gender were significant predictors of 30-day mortality (P-value <0.05), older age was a significant predictor of 30-day readmission (P-value <0.05), and severity of illness was a significant predictor for readmission, mortality, and escalation back to the brick-and-mortar hospital (P-value <0.01). Patients with COVID-19 were less likely to experience readmission, mortality, or escalations (P-value <0.05). At the community level, the Gini Index and internet access were significant predictors of mortality (P-value <0.05). Race and ethnicity did not significantly predict adverse outcomes (P-value >0.05). This study showed promise in equitable treatment of diverse patient populations. The authors discuss and address health equity issues to approximate the vision of inclusive HaH delivery.
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Affiliation(s)
- Cynthia Williams
- School of Global Health Management and Informatics, University of Central Florida, Orlando, Florida, USA
| | - Nels Paulson
- Social Science Department, University of Wisconsin-Stout, Menomonie, Wisconsin, USA
| | - Jeffrey Sweat
- Social Science Department, University of Wisconsin-Stout, Menomonie, Wisconsin, USA
| | - Rachel Rutledge
- Administrative Operations, Mayo Clinic, Jacksonville, Florida, USA
| | - Margaret R Paulson
- Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Michael Maniaci
- Division of Hospital Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Charles D Burger
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Haber R, Ghezzawi M, Puzantian H, Haber M, Saad S, Ghandour Y, El Bachour J, Yazbeck A, Hassanieh G, Mehdi C, Ismail D, Abi-Kharma E, El-Zein O, Khamis A, Chakhtoura M, Mantzoros C. Mortality risk in patients with obesity and COVID-19 infection: a systematic review and meta-analysis. Metabolism 2024; 155:155812. [PMID: 38360130 DOI: 10.1016/j.metabol.2024.155812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Obesity is a risk factor for severe respiratory diseases, including COVID-19 infection. Meta-analyses on mortality risk were inconsistent. We systematically searched 3 databases (Medline, Embase, CINAHL) and assessed the quality of studies using the Newcastle-Ottawa tool (CRD42020220140). We included 199 studies from US and Europe, with a mean age of participants 41.8-78.2 years, and a variable prevalence of metabolic co-morbidities of 20-80 %. Exceptionally, one third of the studies had a low prevalence of obesity of <20 %. Compared to patients with normal weight, those with obesity had a 34 % relative increase in the odds of mortality (p-value 0.002), with a dose-dependent relationship. Subgroup analyses showed an interaction with the country income. There was a high heterogeneity in the results, explained by clinical and methodologic variability across studies. We identified one trial only comparing mortality rate in vaccinated compared to unvaccinated patients with obesity; there was a trend for a lower mortality in the former group. Mortality risk in COVID-19 infection increases in parallel to an increase in BMI. BMI should be included in the predictive models and stratification scores used when considering mortality as an outcome in patients with COVID-19 infections. Furthermore, patients with obesity might need to be prioritized for COVID-19 vaccination.
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Affiliation(s)
- Rachelle Haber
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Ghezzawi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Houry Puzantian
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
| | - Marc Haber
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sacha Saad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Ghandour
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Anthony Yazbeck
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Celine Mehdi
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Dima Ismail
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Elias Abi-Kharma
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ola El-Zein
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Assem Khamis
- Hull York Medical School, University of Hull, York, United Kingdom
| | - Marlene Chakhtoura
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Christos Mantzoros
- Beth Israel Deaconess Medical Center and Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
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Mac C, Cheung K, Alzoubi T, Atacan C, Sehar H, Liyanage S, AlShurman BA, Butt ZA. The Impact of Comorbidities among Ethnic Minorities on COVID-19 Severity and Mortality in Canada and the USA: A Scoping Review. Infect Dis Rep 2024; 16:407-422. [PMID: 38804440 PMCID: PMC11130838 DOI: 10.3390/idr16030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
(1) Current literature on ethnic minorities, comorbidities, and COVID-19 tends to investigate these factors separately, leaving gaps in our understanding about their interactions. Our review seeks to identify a relationship between ethnicity, comorbidities, and severe COVID-19 outcomes (ICU admission and mortality). We hope to enhance our understanding of the various factors that exacerbate COVID-19 severity and mortality in ethnic minorities in Canada and the USA. (2) All articles were received from PubMed, Scopus, CINAHL, and Ovid EMBASE from November 2020 to June 2022. Included articles contain information regarding comorbidities among ethnic minorities in relation to COVID-19 severity and mortality. (3) A total of 59 articles were included that examined various ethnic groups, including Black/African American, Asian, Hispanic, White/Caucasian, and Indigenous people. We found that the most examined comorbidities were diabetes, hypertension, obesity, and chronic kidney disease. A total of 76.9% of the articles (40 out of 52) found a significant association between different races and COVID-19 mortality, whereas 21.2% of the articles (11 out of 52) did not. (4) COVID-19 ICU admissions and mortality affect various ethnic groups differently, with Black patients generally having the most adverse outcomes. These outcomes may also interact with sex and age, though more research is needed assessing these variables together with ethnicity.
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Affiliation(s)
- Christina Mac
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Kylem Cheung
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Tala Alzoubi
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Can Atacan
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Hibah Sehar
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Shefali Liyanage
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Bara’ Abdallah AlShurman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.); (T.A.); (C.A.); (H.S.); (S.L.); (B.A.A.)
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Dahmane L, Julia C, Vignier N, Sesé L, Brichler S, Benaïnous R, Bihan H, Lopez-Sublet M, Trawale D, Bouchaud O, Goupil de Bouillé J. Respective roles of social deprivation, health literacy, and clinical factors for COVID-19: a case-control study in hospitalized patients. Front Public Health 2023; 11:1239041. [PMID: 38074722 PMCID: PMC10702549 DOI: 10.3389/fpubh.2023.1239041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction To investigate the association between social deprivation and COVID-19 among hospitalized patients in an underprivileged department of the greater Paris area. Methods Individuals hospitalized for COVID-19 between March 1st and October 31, 2020, were included, matched on age and sex, and compared with patients hospitalized for any other reason with negative RT-PCR for SARS-CoV-2, through a case-control study. Clinical, socio-demographic characteristics, health literacy, and social deprivation, assessed by the EPICES score, were collected. Factors associated with COVID-19 in hospitalized patients were assessed using univariate and multivariate logistic regression models. Results 69 cases and 180 controls were included. Participants were mostly men (N = 148: 59.4%) aged 65 or older (N = 109: 44.1%). Median EPICES score was 43.2 (IQR 29.4-62.9). EPICES score > 30.17 (precariousness threshold) was not significantly associated with COVID-19 in hospitalized patients (adjusted odds ratio (aOR) = 0.46; 95% Confidence Interval (CI) [0.21-1.01]). Advanced age, higher BMI, professional activity, home area of less than 25 m2 per person, and low health literacy, were significantly associated with COVID-19 in hospitalized patients. Discussion This study highlights probable risk factors for specific exposition in disadvantaged area: maintenance of professional activity, smaller home area, and low health literacy.
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Affiliation(s)
- Lotfi Dahmane
- Department of Infectious and Tropical Diseases, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Chantal Julia
- Public Health Department, GHU Paris-Seine-Saint-Denis, APHP, Bobigny, France
- Centre de recherche en épidémiologie et statistiques sorbonne Paris cité (CRESS), Inserm, Inra, Cnam, University, Equipe de recherche en épidémiologie nutritionnelle (EREN), Bobigny, France
| | - Nicolas Vignier
- Centre d’Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Cayenne, France
- IAME, INSERM UMR 1137, Université Paris Cité, Université Sorbonne Paris Nord, UFR SMBH, Bobigny, France
- French Collaborative Institute on Migration, Institut Convergences Migrations, ICM, Aubervilliers, France
| | - Lucile Sesé
- Department of Pneumology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Ségolène Brichler
- Department of Virology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Ruben Benaïnous
- Department of Intern Medicine, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Hélène Bihan
- Department of Endocrinology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Marilucy Lopez-Sublet
- Department of Intern Medicine, AP-HP, CHU Avicenne, Centre d’Excellence ESH en Hypertension Artérielle, Bobigny, France
- INSERM UMR 942 MASCOT, Paris 13-Univrsité Paris Nord, Bobigny, France
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Damien Trawale
- INED, Institut National d’études démographiques, Aubervilliers, France
| | - Olivier Bouchaud
- Department of Infectious and Tropical Diseases, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
- Laboratoire Éducations et Promotion de la Santé, Université Sorbonne Paris Nord, LEPS, Bobigny, France
| | - Jeanne Goupil de Bouillé
- Department of Infectious and Tropical Diseases, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France
- Laboratoire Éducations et Promotion de la Santé, Université Sorbonne Paris Nord, LEPS, Bobigny, France
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Micheals K, Lee MJ, Al Snih S, Walsh BK, Rojas JD. The Effect of Oxygenation Impairment and Compliance on Mortality Among Subjects With COVID-19 Requiring Mechanical Ventilation. Respir Care 2023; 68:1565-1568. [PMID: 37280073 PMCID: PMC10589116 DOI: 10.4187/respcare.10776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Khamron Micheals
- School of Public and Population Health, University of Texas Medical Branch at Galveston, Galveston, Texas; and School of Health Professions, Department of Respiratory Care, University of Texas Medical Branch at Galveston, Galveston, Texas.
| | - Mi Jung Lee
- School of Health Professions, Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Soham Al Snih
- School of Population and Public Health, Department of Population Health and Health Disparities, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Brian K Walsh
- School of Health Professions, Department of Respiratory Care, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - José D Rojas
- School of Health Professions, Department of Respiratory Care, University of Texas Medical Branch at Galveston, Galveston, Texas
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Rangel-Méndez JA, Jaimes-Gurrusquieta L, Sánchez-Cruz JF, Zarate-Murillo MI, Domínguez-Méndez J, Laviada-Molina HA, Casares-González D, Flores-Flores EM. Characteristics of COVID-19 and mortality-associated factors during the first year of the pandemic in southeast Mexico. Future Microbiol 2023; 18:1147-1157. [PMID: 37850348 DOI: 10.2217/fmb-2023-0052] [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: 03/01/2023] [Accepted: 06/20/2023] [Indexed: 10/19/2023] Open
Abstract
Aim: The present study was designed to evaluate the clinical characteristics of COVID-19 and mortality-associated factors during the first year of the pandemic in patients from southeastern Mexico. Patient & methods: A total of 953 records from patients with COVID-19 were cross-sectionally studied in a primary care hospital in southeast Mexico between 2020 and 2021. Results: The prevalent symptoms were fever (78.6%), cough (80.5%) and headache (82.8%) and dyspnea reached 13.5%. The mortality rate was 7.63% and the clinical variables associated with it were age >60 years, hypertension, severe disease, radiographic pneumonia, days to diagnosis and having two Mayan surnames. Conclusion: Future health strategies should consider age, comorbidities, disease severity, clinical manifestations and possessing ethnicity of risk (i.e., Mayan genetic background).
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Affiliation(s)
- Jorge A Rangel-Méndez
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi," Universidad Autónoma de Yucatán, Mérida, Yucatán, 97225, México
| | | | - Juan F Sánchez-Cruz
- Coordinación de Investigación en Salud del IMSS en Yucatán, Mérida, Yucatán, 97155, México
| | - Ma I Zarate-Murillo
- Unidad de Medicina Familiar 58. Instituto Mexicano del Seguro Social (IMSS), Mérida, Yucatán, 97285, México
| | - Jessica Domínguez-Méndez
- Unidad de Medicina Familiar 59, Instituto Mexicano del Seguro Social, Mérida, Yucatán, 97160, México
| | - Hugo A Laviada-Molina
- Universidad Marista de Mérida, Escuela de Ciencias de la Salud, Mérida, Yucatán, 97300, México
| | - Daniel Casares-González
- Universidad Marista de Mérida, Escuela de Ciencias de la Salud, Mérida, Yucatán, 97300, México
| | - Elideth M Flores-Flores
- Unidad de Medicina Familiar 58. Instituto Mexicano del Seguro Social (IMSS), Mérida, Yucatán, 97285, México
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Ko JY, Pham H, Anglin O, Chai SJ, Alden NB, Meek J, Anderson EJ, Weigel A, Kohrman A, Lynfield R, Rudin D, Barney G, Bennett NM, Billing LM, Sutton M, Talbot HK, Swain A, Havers FP, Taylor CA. Vaccination Status and Trends in Adult Coronavirus Disease 2019-Associated Hospitalizations by Race and Ethnicity: March 2020-August 2022. Clin Infect Dis 2023; 77:827-838. [PMID: 37132204 PMCID: PMC11019819 DOI: 10.1093/cid/ciad266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND We sought to determine whether race/ethnicity disparities in severe coronavirus disease 2019 (COVID-19) outcomes persist in the era of vaccination. METHODS Population-based age-adjusted monthly rate ratios (RRs) of laboratory-confirmed COVID-19-associated hospitalizations were calculated among adult patients from the COVID-19-Associated Hospitalization Surveillance Network, March 2020 - August 2022 by race/ethnicity. Among randomly sampled patients July 2021 - August 2022, RRs for hospitalization, intensive care unit (ICU) admission, and in-hospital mortality were calculated for Hispanic, Black, American Indian/Alaskan Native (AI/AN), and Asian/Pacific Islander (API) persons vs White persons. RESULTS Based on data from 353 807 patients, hospitalization rates were higher among Hispanic, Black, and AI/AN vs White persons March 2020 - August 2022, yet the magnitude declined over time (for Hispanic persons, RR = 6.7; 95% confidence interval [CI], 6.5-7.1 in June 2020 vs RR < 2.0 after July 2021; for AI/AN persons, RR = 8.4; 95% CI, 8.2-8.7 in May 2020 vs RR < 2.0 after March 2022; and for Black persons RR = 5.3; 95% CI, 4.6-4.9 in July 2020 vs RR < 2.0 after February 2022; all P ≤ .001). Among 8706 sampled patients July 2021 - August 2022, hospitalization and ICU admission RRs were higher for Hispanic, Black, and AI/AN patients (range for both, 1.4-2.4) and lower for API (range for both, 0.6-0.9) vs White patients. All other race and ethnicity groups had higher in-hospital mortality rates vs White persons (RR range, 1.4-2.9). CONCLUSIONS Race/ethnicity disparities in COVID-19-associated hospitalizations declined but persist in the era of vaccination. Developing strategies to ensure equitable access to vaccination and treatment remains important.
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Affiliation(s)
- Jean Y Ko
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Huong Pham
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Onika Anglin
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Department of Public Health, Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa, USA
| | - Alexander Kohrman
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Dominic Rudin
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley Swain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Fiona P Havers
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Christopher A Taylor
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
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Ikeokwu AE, Lawrence R, Osieme ED, Gidado KM, Guy C, Dolapo O. Unveiling the Impact of COVID-19 Vaccines: A Meta-Analysis of Survival Rates Among Patients in the United States Based on Vaccination Status. Cureus 2023; 15:e43282. [PMID: 37692577 PMCID: PMC10492612 DOI: 10.7759/cureus.43282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a significant number of cases and deaths worldwide. Vaccination is the most effective preventive measure against the disease. This study aimed to assess the mortality rates of COVID-19 patients in the United States and the effectiveness of Pfizer (Pfizer, NY, USA), Moderna (Moderna, MA, USA), and Janssen (Johnson & Johnson, NJ, USA) vaccines in preventing mortality. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-2020) guidelines. Eligible studies reporting on the effectiveness of COVID-19 vaccines on patient outcomes were included. The search was performed in PubMed, Cochrane, and Google Scholar databases. The data were extracted, and risk ratios (RR) were calculated for mortality outcomes. The analysis was performed using Review Manager software, and bias assessments were conducted using the Joanna Briggs Institute (JBI) Meta-Analysis tools. A total of seven studies with 21,618,297 COVID-19 patients were included in the meta-analysis. The odds ratio (OR) for mortality among unvaccinated patients compared to vaccinated patients was 2.46 (95% CI: 1.71-3.53), indicating that unvaccinated patients were 2.46 times more likely to die from COVID-19. The findings of this study support the effectiveness of COVID-19 vaccination in reducing mortality among infected individuals. Unvaccinated patients had a significantly higher risk of mortality compared to vaccinated patients. Vaccination remains a crucial strategy to mitigate the severity of the disease and reduce mortality rates. Efforts should be made to address vaccine hesitancy and ensure widespread vaccine coverage.
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Affiliation(s)
| | - Rebecca Lawrence
- College of Medicine, Richmond Gabriel University, Kingstown, VCT
| | | | | | - Cullen Guy
- College of Medicine, Washington University of Health and Science, San Pedro, BLZ
| | - Oladejo Dolapo
- College of Medicine, Richmond Gabriel University, Kingstown, VCT
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9
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Harris M, Hart J, Bhattacharya O, Russell FM. Risk factors for SARS-CoV-2 infection during the early stages of the COVID-19 pandemic: a systematic literature review. Front Public Health 2023; 11:1178167. [PMID: 37583888 PMCID: PMC10424847 DOI: 10.3389/fpubh.2023.1178167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Identifying SARS-CoV-2 infection risk factors allows targeted public health and social measures (PHSM). As new, more transmissible variants of concern (VoC) emerge, vaccination rates increase and PHSM are eased, it is important to understand any potential change to infection risk factors. The aim of this systematic literature review is to describe the risk factors for SARS-CoV-2 infection by VoC. Methods A literature search was performed in MEDLINE, PubMed and Embase databases on 5 May 2022. Eligibility included: observational studies published in English after 1 January 2020; any age group; the outcome of SARS-CoV-2 infection; and any potential risk factors investigated in the study. Results were synthesized into a narrative summary with respect to measures of association, by VoC. ROBINS-E tool was utilized for risk of bias assessment. Results Of 6,197 studies retrieved, 43 studies were included after screening. Common risk factors included older age, minority ethnic group, low socioeconomic status, male gender, increased household size, occupation/lower income level, inability to work from home, public transport use, and lower education level. Most studies were undertaken when the ancestral strain was predominant. Many studies had some selection bias due to testing criteria and limited laboratory capacity. Conclusion Understanding who is at risk enables the development of strategies that target priority groups at each of the different stages of a pandemic and helps inform vaccination strategies and other interventions which may also inform public health responses to future respiratory infection outbreaks. While it was not possible to determine changes to infection risk by recent VoC in this review, the risk factors identified will add to the overall understanding of the groups who are at greatest risk of infection in the early stages of a respiratory virus outbreak. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022330706, PROSPERO [CRD42022330706].
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Affiliation(s)
- Matthew Harris
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Asia-Pacific Health Group, Infection, Immunity and Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - John Hart
- Asia-Pacific Health Group, Infection, Immunity and Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Oashe Bhattacharya
- Asia-Pacific Health Group, Infection, Immunity and Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Fiona M. Russell
- Asia-Pacific Health Group, Infection, Immunity and Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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10
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Wei Q, Mease PJ, Chiorean M, Iles-Shih L, Matos WF, Baumgartner A, Molani S, Hwang YM, Belhu B, Ralevski A, Hadlock J. Risk factors for severe COVID-19 outcomes: a study of immune-mediated inflammatory diseases, immunomodulatory medications, and comorbidities in a large US healthcare system. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.26.23291904. [PMID: 37425752 PMCID: PMC10327270 DOI: 10.1101/2023.06.26.23291904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background COVID-19 outcomes, in the context of immune-mediated inflammatory diseases (IMIDs), are incompletely understood. Reported outcomes vary considerably depending on the patient population studied. It is essential to analyse data for a large population, while considering the effects of the pandemic time period, comorbidities, long term use of immunomodulatory medications (IMMs), and vaccination status. Methods In this retrospective case-control study, patients of all ages with IMIDs were identified from a large U.S. healthcare system. COVID-19 infections were identified based on SARS-CoV-2 NAAT test results. Controls without IMIDs were selected from the same database. Severe outcomes were hospitalisation, mechanical ventilation (MV), and death. We analysed data from 1 March 2020 to 30 August 2022, looking separately at both pre-Omicron and Omicron predominant periods. Factors including IMID diagnoses, comorbidities, long term use of IMMs, and vaccination and booster status were analysed using multivariable logistic regression (LR) and extreme gradient boosting (XGB). Findings Out of 2 167 656 patients tested for SARS-CoV-2, there were 290 855 with confirmed COVID-19 infection: 15 397 patients with IMIDs and 275 458 controls (patients without IMIDs). Age and most chronic comorbidities were risk factors for worse outcomes, whereas vaccination and boosters were protective. Patients with IMIDs had higher rates of hospitalisation and mortality compared with controls. However, in multivariable analyses, few IMIDs were rarely risk factors for worse outcomes. Further, asthma, psoriasis and spondyloarthritis were associated with reduced risk. Most IMMs had no significant association, but less frequently used IMM drugs were limited by sample size. XGB outperformed LR, with the AUROCs for models across different time periods and outcomes ranging from 0·77 to 0·92. Interpretation For patients with IMIDs, as for controls, age and comorbidities were risk factors for worse COVID-19 outcomes, whereas vaccinations were protective. Most IMIDs and immunomodulatory therapies were not associated with more severe outcomes. Interestingly, asthma, psoriasis and spondyloarthritis were associated with less severe COVID-19 outcomes than those expected for the population overall. These results can help inform clinical, policy and research decisions. Funding Pfizer, Novartis, Janssen, NIH.
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Affiliation(s)
- Qi Wei
- Institute for Systems Biology, Seattle, WA, USA
| | - Philip J Mease
- Providence St. Joseph Health/Swedish Medical Center, Rheumatology, Seattle, WA, USA
| | - Michael Chiorean
- Digestive Health Institute, Swedish Medical Center, Seattle, WA, USA
| | - Lulu Iles-Shih
- Digestive Health Institute, Swedish Medical Center, Seattle, WA, USA
| | | | | | | | | | | | | | - Jennifer Hadlock
- Institute for Systems Biology, Seattle, WA, USA
- University of Washington, Biomedical Informatics and Medical Education, Seattle, WA, USA
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11
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Candel FJ, Barreiro P, Salavert M, Cabello A, Fernández-Ruiz M, Pérez-Segura P, San Román J, Berenguer J, Córdoba R, Delgado R, España PP, Gómez-Centurión IA, González Del Castillo JM, Heili SB, Martínez-Peromingo FJ, Menéndez R, Moreno S, Pablos JL, Pasquau J, Piñana JL, On Behalf Of The Modus Investigators Adenda. Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2. Viruses 2023; 15:1449. [PMID: 37515137 PMCID: PMC10383267 DOI: 10.3390/v15071449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm3; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm3 or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.
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Affiliation(s)
- Francisco Javier Candel
- Clinical Microbiology & Infectious Diseases, Transplant Coordination, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Pablo Barreiro
- Regional Public Health Laboratory, Infectious Diseases, Internal Medicine, Hospital General Universitario La Paz, 28055 Madrid, Spain
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Miguel Salavert
- Infectious Diseases, Internal Medicine, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Alfonso Cabello
- Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28041 Madrid, Spain
| | - Pedro Pérez-Segura
- Medical Oncology, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Jesús San Román
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Juan Berenguer
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28007 Madrid, Spain
| | - Raúl Córdoba
- Haematology and Haemotherapy, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Rafael Delgado
- Clinical Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Pedro Pablo España
- Pneumology, Hospital Universitario de Galdakao-Usansolo, 48960 Vizcaya, Spain
| | | | | | - Sarah Béatrice Heili
- Intermediate Respiratory Care Unit, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Francisco Javier Martínez-Peromingo
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Geriatrics, Hospital Universitario Rey Juan Carlos, 28933 Madrid, Spain
| | - Rosario Menéndez
- Pneumology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Santiago Moreno
- Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - José Luís Pablos
- Rheumatology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Juan Pasquau
- Infectious Diseases, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - José Luis Piñana
- Haematology and Haemotherapy, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
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12
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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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13
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The Epidemiology of COVID-19 by Race/Ethnicity in Oklahoma City–County, Oklahoma (12 March 2020–31 May 2021). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148571. [PMID: 35886431 PMCID: PMC9316515 DOI: 10.3390/ijerph19148571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
We aimed to better understand the racially-/ethnically-specific COVID-19-related outcomes, with respect to time, to respond more effectively to emerging variants. Surveillance data from Oklahoma City–County (12 March 2020–31 May 2021) were used to summarize COVID-19 cases, hospitalizations, deaths, and COVID-19 vaccination status by racial/ethnic group and ZIP code. We estimated racially-/ethnically-specific daily hospitalization rates, the proportion of cases hospitalized, and disease odds ratios (OR) adjusting for sex, age, and the presence of at least one comorbidity. Hot spot analysis was performed using normalized values of cases, hospitalizations, and deaths generated from incidence rates per 100,000 population. During the study period, there were 103,030 confirmed cases, 3457 COVID-19-related hospitalizations, and 1500 COVID-19-related deaths. The daily 7-day average hospitalization rate for Hispanics peaked earlier than other groups and reached a maximum (3.0/100,000) in July 2020. The proportion of cases hospitalized by race/ethnicity was 6.09% among non-Hispanic Blacks, 5.48% among non-Hispanic Whites, 3.66% among Hispanics, 3.43% among American Indians, and 2.87% among Asian/Pacific Islanders. COVID-19 hot spots were identified in ZIP codes with minority communities. The Hispanic population experienced the first surge in COVID-19 cases and hospitalizations, while non-Hispanic Blacks ultimately bore the highest burden of COVID-19-related hospitalizations and deaths.
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14
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Peter B, Ree NI, Ferrer K, Younes L, Lepe B, Manhal K, Mydam J. Risk Factors Associated With COVID-19 Symptoms and Potential Vertical Transmission During Pregnancy: A Retrospective Cohort Study. Cureus 2022; 14:e22900. [PMID: 35265437 PMCID: PMC8898701 DOI: 10.7759/cureus.22900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
Objective The COVID-19 pandemic is of special concern for pregnant women. A growing body of evidence suggests the virus can have a deleterious impact upon outcomes related to birth and newborn health. There is a paucity of published research demonstrating the factors that influence disease severity among those who are pregnant, while a growing body of evidence demonstrates that vertical transmission occurs. Our study investigated the impact of maternal characteristics upon COVID-19 outcomes, as well as whether disease severity impacted pregnancy outcomes. Methods We conducted a retrospective cohort study of pregnant women with COVID-19 who were admitted to two public hospitals in our state between April-August, 2020. Pregnancy outcomes and clinical, laboratory, and placental data were collected. Results Thirty-four pregnant women tested positive for SARS-CoV-2. Among them, 55% (19/34) were symptomatic. Of those who were symptomatic, 68% (13/19) presented with fever and cough. Those with symptoms had a statistically significant higher pregestational mean body mass index (BMI) compared with asymptomatic women (35.7±7.9 vs 26.7±6.9, P=0.004). Screening of biochemical records demonstrated that symptomatic women had lower potassium levels compared with those who were asymptomatic (median: 3.70 mEq/L vs 4.30 mEq/L, P=0.009). The lowest potassium level (3.0 mEq/L) and one of the highest BMIs (42.4 kg/m2) was observed in the only case of postpartum mortality among the symptomatic women. We did not observe any influence of maternal COVID-19 severity on placental histopathology/infant health or evidence of vertical transmission. Conclusion High pregestational BMI and lower potassium levels were associated with the presence of COVID-19 symptoms among pregnant women.
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15
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Holden TM, Simon MA, Arnold DT, Halloway V, Gerardin J. Structural racism and COVID-19 response: higher risk of exposure drives disparate COVID-19 deaths among Black and Hispanic/Latinx residents of Illinois, USA. BMC Public Health 2022; 22:312. [PMID: 35168585 PMCID: PMC8845334 DOI: 10.1186/s12889-022-12698-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/02/2022] [Indexed: 01/15/2023] Open
Abstract
Background Structural racism has driven and continues to drive policies that create the social, economic, and community factors resulting in residential segregation, lack of access to adequate healthcare, and lack of employment opportunities that would allow economic mobility. This results in overall poorer population health for minoritized people. In 2020, Black and Hispanic/Latinx communities throughout the United States, including the state of Illinois, experienced disproportionately high rates of COVID-19 cases and deaths. Public health officials in Illinois implemented targeted programs at state and local levels to increase intervention access and reduce disparities. Methods To quantify how disparities in COVID outcomes evolved through the epidemic, data on SARS-CoV-2 diagnostic tests, COVID-19 cases, and COVID-19 deaths were obtained from the Illinois National Electronic Disease Surveillance System for the period from March 1 to December 31, 2020. Relative risks of COVID-19 cases and deaths were calculated for Black and Hispanic/Latinx vs. White residents, stratified by age group and epidemic interval. Deaths attributable to racial/ethnic disparities in incidence and case fatality were estimated with counterfactual simulations. Results Disparities in case and death rates became less drastic after May 2020, but did not disappear, and were more pronounced at younger ages. From March to May of 2020, the risk of a COVID-19 case for Black and Hispanic/Latinx populations was more than twice that of Whites across all age groups. The relative risk of COVID-19 death reached above 10 for Black and Hispanic/Latinx individuals under 50 years of age compared to age-matched Whites in the early epidemic. In all Illinois counties, relative risk of a COVID-19 case was the same or significantly increased for minoritized populations compared to the White population. 79.3 and 86.7% of disparities in deaths among Black and Hispanic/Latinx populations, respectively, were attributable to differences in age-adjusted incidence compared to White populations rather than differences in case fatality ratios. Conclusions Racial and ethnic disparities in the COVID-19 pandemic are products of society, not biology. Considering age and geography in addition to race/ethnicity can help to identify the structural factors driving poorer outcomes for certain groups. Studies and policies aimed at reducing inequalities in disease exposure may reduce disparities in mortality more than those focused on drivers of case fatality. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12698-9.
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Affiliation(s)
- Tobias M Holden
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Damon T Arnold
- Blue Cross Blue Shield of Illinois, Chicago, IL, USA.,Illinois Department of Public Health, Springfield, IL, USA
| | | | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA.
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16
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Prevalence and Correlates of SARS CoV-2 Among a Community-Based Sample Recruited Using Randomized Venue-Based Sampling. Essex County, NJ, 2020. J Racial Ethn Health Disparities 2022; 9:2387-2394. [PMID: 34748172 PMCID: PMC8574940 DOI: 10.1007/s40615-021-01175-5] [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: 06/24/2021] [Revised: 09/29/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022]
Abstract
Disparities in morbidity and mortality related to COVID-19 based on race and ethnicity have been documented in the USA. However, it is unclear if these disparities also exist at the exposure stage. To determine this, studies are needed to document the underlying burden of disease, potential disparities through serologic surveillance. Additionally, such studies can help identify where along the disease spectrum (e.g., exposure, infection, diagnosis, treatment, death) and with regard to the structural factors that necessitate public health and/or clinical interventions. Our objectives in this study were to estimate the true burden of SARS CoV-2 in the community of Essex County, NJ, an early and hard hit area, to determine the correlates of SARS CoV-2 prevalence and to determine if COVID-19 disparities seen by race/ethnicity were also reflected in SARS CoV-2 burden. We utilized venue-based-sampling (VBS) to sample members of the community in Essex County. Participants completed a short electronic survey and provided finger stick blood samples for testing. We sampled 924 residents of Essex County, New Jersey. Testing conducted in this study identified 83 (9.0%) participants as positive for SARS-CoV-2 antibodies. Importantly, our findings suggest that the true burden of SARS-Cov-2 and the pool of persons potentially spreading the virus are slightly more than six times than that suggested by PCR testing Notably, there were no significant differences in odds of testing positive for SARS CoV-2 antibodies in terms of race/ethnicity where we compared Black and Latinx participants to other race participants. Our study suggests that disparities in COVID-19 outcomes stem from potential upstream issues such as underlying conditions, access to testing, and access to care rather than disparities in exposure to the virus.
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17
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Nguyen H, Medina A, Golovko G, Evangelista L. Racial and Ethnic Differences in Fatality Risk From COVID-19. SAGE Open Nurs 2022; 8:23779608221107591. [PMID: 35769608 PMCID: PMC9234924 DOI: 10.1177/23779608221107591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/23/2021] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Studies have reported higher infection and mortality rates from coronavirus disease 2019 (COVID-19) for disadvantaged groups in the U.S. population. However, racial and ethnic differences in fatality rates, which measure deaths among those infected, are not as clear. Objectives The objectives were to (1) estimate the fatality rate after COVID-19 infection by racial and ethnic groups and (2) determine the extent preexisting health conditions account for differences in fatality rate between the racial and ethnic groups. Methods Data for all adults aged 18 and older (n = 24,834) who had a confirmed COVID-19 infection captured in the electronic health records (EHRs) of a major health care organization (HCO) from the beginning of the pandemic to March 28, 2021 were used to estimate the fatality rates for three racial and ethnic groups: Hispanic, non-Hispanic African American, and non-Hispanic White. Elixhauser's comorbidity index was calculated using the enhanced ICD-9-CM and the ICD-10 diagnosis codes. Logistic regression models were used to compare differences in fatality between racial and ethnic groups. Odds ratios and 95% confidence intervals were reported for all models. Results The age-specific fatality rates non-Hispanic White, non-Hispanic African American, and Hispanic groups were 0.23%, 1.05%, 0.55% for age group 18–59 years old; 2.44%, 4.50%, 5.28% for 60–69; 5.42%, 10.11%, 8.49% for 70–79, and 17.33%, 20.79%, 20.39% for 80–90. After adjusting for age, sex, and preexisting conditions, the fatality risk remains significantly higher for non-Hispanic African American (adjusted odds ratio [adj. OR] = 1.85, 95% CI 1.41–2.44) and Hispanic individuals (adj. OR = 1.91, 95% CI = 1.53–2.39) compared to non-Hispanic White individuals. Conclusion Hispanic and non-Hispanic African American individuals have a higher risk of fatality from COVID-19 compared to non-Hispanic White individuals. The higher risk remains after adjusting for sex, age, and preexisting conditions. Health care providers could help to increase vaccination rates in these vulnerable populations by addressing the social and cultural barriers with their patients.
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Affiliation(s)
- Hoang Nguyen
- School of Nursing, RISE Center, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ashleigh Medina
- School of Nursing, The University of Texas Medical Branch, Galveston,
TX, USA
| | - George Golovko
- Department of Pharmacology and Toxicology, The University of Texas Medical Branch, Galveston, TX, USA
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18
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DeSilva MB, Haapala J, Vazquez-Benitez G, Daley MF, Nordin JD, Klein NP, Henninger ML, Williams JTB, Hambidge SJ, Jackson ML, Donahue JG, Qian L, Lindley MC, Gee J, Weintraub ES, Kharbanda EO. Association of the COVID-19 Pandemic With Routine Childhood Vaccination Rates and Proportion Up to Date With Vaccinations Across 8 US Health Systems in the Vaccine Safety Datalink. JAMA Pediatr 2022; 176:68-77. [PMID: 34617975 PMCID: PMC8498937 DOI: 10.1001/jamapediatrics.2021.4251] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The COVID-19 pandemic has affected routine vaccine delivery in the US and globally. The magnitude of these disruptions and their association with childhood vaccination coverage are unclear. OBJECTIVES To compare trends in pediatric vaccination before and during the pandemic and to evaluate the proportion of children up to date (UTD) with vaccinations by age, race, and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This surveillance study used a prepandemic-postpandemic control design with data from 8 health systems in California, Oregon, Washington, Colorado, Minnesota, and Wisconsin in the Vaccine Safety Datalink. Children from age groups younger than 24 months and 4 to 6, 11 to 13, and 16 to 18 years were included if they had at least 1 week of health system enrollment from January 5, 2020, through October 3, 2020, over periods before the US COVID-19 pandemic (January 5, 2020, through March 14, 2020), during age-limited preventive care (March 15, 2020, through May 16, 2020), and during expanded primary care (May 17, 2020, through October 3, 2020). These individuals were compared with those enrolled during analogous weeks in 2019. EXPOSURES This study evaluated UTD status among children reaching specific ages in February, May, and September 2020, compared with those reaching these ages in 2019. MAIN OUTCOMES AND MEASURES Weekly vaccination rates for routine age-specific vaccines and the proportion of children UTD for all age-specific recommended vaccines. RESULTS Of 1 399 708 children in 2019 and 1 402 227 in 2020, 1 371 718 were female (49.0%) and 1 429 979 were male (51.0%); 334 216 Asian individuals (11.9%), 900 226 were Hispanic individuals (32.1%), and 201 619 non-Hispanic Black individuals (7.2%). Compared with the prepandemic period and 2019, the age-limited preventive care period was associated with lower weekly vaccination rates, with ratios of rate ratios of 0.82 (95% CI, 0.80-0.85) among those younger than 24 months, 0.18 (95% CI, 0.16-0.20) among those aged 4 to 6 years, 0.16 (95% CI, 0.14-0.17) among those aged 11 to 13 years, and 0.10 (95% CI, 0.08-0.13) among those aged 16 to 18 years. Vaccination rates during expanded primary care remained lower for most ages (ratios of rate ratios: <24 months, 0.96 [95% CI, 0.93-0.98]; 11-13 years, 0.81 [95% CI, 0.76-0.86]; 16-18 years, 0.57 [95% CI, 0.51-0.63]). In September 2020, 74% (95% CI, 73%-76%) of infants aged 7 months and 57% (95% CI, 56%-58%) of infants aged 18 months were UTD vs 81% (95% CI, 80%-82%) and 61% (95% CI, 60%-62%), respectively, in September 2019. The proportion UTD was lowest in non-Hispanic Black children across most age groups, both during and prior to the COVID-19 pandemic (eg, in May 2019, 70% [95% CI, 64%-75%] of non-Hispanic Black infants aged 7 months were UTD vs 82% [95% CI, 81%-83%] in all infants aged 7 months combined). CONCLUSIONS AND RELEVANCE As of September 2020, childhood vaccination rates and the proportion who were UTD remained lower than 2019 levels. Interventions are needed to promote catch-up vaccination, particularly in populations at risk for underimmunization.
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Affiliation(s)
| | | | | | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | | | | | | | | | | | | | | | - Lei Qian
- Kaiser Permanente Southern California, Pasadena
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julianne Gee
- Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric S. Weintraub
- Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Nasopharyngeal Microbiota as an early severity biomarker in COVID-19 hospitalised patients: a retrospective cohort study in a Mediterranean area. J Infect 2021; 84:329-336. [PMID: 34963638 PMCID: PMC8709923 DOI: 10.1016/j.jinf.2021.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/08/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022]
Abstract
This study aimed to analyse the diversity and taxonomic composition of the nasopharyngeal microbiota, to determine its association with COVID-19 clinical outcome. To study the microbiota, we utilized 16S rRNA sequencing of 177 samples that came from a retrospective cohort of COVID-19 hospitalized patients. Raw sequences were processed by QIIME2. The associations between microbiota, invasive mechanical ventilation (IMV), and all-cause mortality were analysed by multiple logistic regression, adjusted for age, gender, and comorbidity. The microbiota α diversity indexes were lower in patients with a fatal outcome, whereas the β diversity analysis showed a significant clustering in these patients. After multivariate adjustment, the presence of Selenomonas spp., Filifactor spp., Actinobacillus spp., or Chroococcidiopsis spp., was associated with a reduction of more than 90% of IMV. Higher diversity and the presence of certain genera in the nasopharyngeal microbiota seem to be early biomarkers of a favourable clinical evolution in hospitalized COVID-19 patients.
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Ioannou GN, Green P, Locke ER, Berry K. Factors associated with early receipt of COVID-19 vaccination and adherence to second dose in the Veterans Affairs healthcare system. PLoS One 2021; 16:e0259696. [PMID: 34851970 PMCID: PMC8635372 DOI: 10.1371/journal.pone.0259696] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background We aimed to determine factors independently associated with early COVID-19 vaccination and adherence to two-dose regimens. Methods Among persons receiving care in the Veterans Affairs (VA) healthcare system (n = 5,766,638), we identified those who received at least one dose of COVID-19 vaccination through the VA, during the first ~3months following emergency use authorization, from December 11, 2020 to March 9, 2021 (n = 1,569,099, or 27.2%, including 880,200 (56.1%) Moderna, 676,279 (43.1%) Pfizer-BioNTech and 12,620 (0.8%) Janssen vaccines). Results Follow-up for receipt of vaccination began on December 11, 2020. After adjustment for baseline characteristics ascertained as of December 11, 2020, factors significantly associated with vaccination included older age, higher comorbidity burden, higher body mass index category, Black (vs. White) race (adjusted hazard ratio [AHR] 1.19, 95% CI 1.19–1.20), Hispanic (vs. non-Hispanic) ethnicity (AHR 1.12, 95% CI 1.11–1.13), urban (vs. rural) residence (AHR 1.31, 95% CI 1.31–1.31), and geographical region, while AI/AN race (vs. White), was associated with lower vaccination rate (AHR 0.85, 95% CI 0.84–0.87). Among persons who received both doses of Moderna or Pfizer-BioNTech vaccines, 95.3% received the second dose within ±4 days of the recommended date. Among persons who received the first vaccine dose, only 3.2% did not receive the second dose within 42 days for Pfizer versus 4.0% for Moderna (p<0.001). Factors independently associated with higher likelihood of missing the second dose included younger age (10.83% in 18–50 yo vs. 2.72% in 70–75 yo), AI/AN race, female sex, rural location, geographical region and prior positive test for SARS-CoV-2. Conclusions We identified sociodemographic and clinical factors that may be used to target vaccination efforts and to further improve adherence to second vaccine dosing.
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Affiliation(s)
- George N. Ioannou
- Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, United States of America
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America
- * E-mail:
| | - Pamela Green
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America
| | - Emily R. Locke
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America
| | - Kristin Berry
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America
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Yan BW, Hwang AL, Ng F, Chu JN, Tsoh JY, Nguyen TT. Death Toll of COVID-19 on Asian Americans: Disparities Revealed. J Gen Intern Med 2021; 36:3545-3549. [PMID: 34347256 PMCID: PMC8335981 DOI: 10.1007/s11606-021-07003-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has underscored the structural inequities facing communities of color and its consequences in lives lost. However, little is known about the COVID-related disparities facing Asian Americans amidst the heightened racism and violence against this community. We analyze the mortality toll of COVID-19 on Asian Americans using multiple measures. In 2020, one in seven Asian American deaths was attributable to COVID-19. We find that while Asian Americans make up a small proportion of COVID-19 deaths in the USA, they experience significantly higher excess all-cause mortality (3.1 times higher), case fatality rate (as high as 53% higher), and percentage of deaths attributed to COVID-19 (2.1 times higher) compared to non-Hispanic Whites. Mounting evidence suggest that disproportionately low testing rates, greater disease severity at care presentation, socioeconomic factors, and racial discrimination contribute to the observed disparities. Improving data reporting and uniformly confronting racism are key components to addressing health inequities facing communities of color.
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Affiliation(s)
- Brandon W Yan
- School of Medicine, University of California San Francisco, 513 Parnassus Ave., Suite S-214, San Francisco, CA, 94143, USA.
- Asian American Research Center on Health (ARCH), San Francisco, CA, USA.
| | - Andrea L Hwang
- Asian American Research Center on Health (ARCH), San Francisco, CA, USA
| | - Fiona Ng
- School of Medicine, University of California San Francisco, 513 Parnassus Ave., Suite S-214, San Francisco, CA, 94143, USA
- Asian American Research Center on Health (ARCH), San Francisco, CA, USA
| | - Janet N Chu
- Asian American Research Center on Health (ARCH), San Francisco, CA, USA
- Division of General Internal Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Janice Y Tsoh
- Asian American Research Center on Health (ARCH), San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Tung T Nguyen
- Asian American Research Center on Health (ARCH), San Francisco, CA, USA
- Division of General Internal Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
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22
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Velasco F, Yang DM, Zhang M, Nelson T, Sheffield T, Keller T, Wang Y, Walker C, Katterapalli C, Zimmerman K, Masica A, Lehmann CU, Xie Y, Hollingsworth JW. Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19. J Hosp Med 2021; 16:659-666. [PMID: 34730508 PMCID: PMC8577697 DOI: 10.12788/jhm.3717] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths. OBJECTIVE To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors. DESIGN, SETTING, PARTICIPANTS Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020. EXPOSURES Self-reported ethnicity and primary language. MAIN OUTCOMES AND MEASURES Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes. RESULTS 32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10- 1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001). CONCLUSION The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.
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Affiliation(s)
| | - Donghan M Yang
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Minzhe Zhang
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Thomas Sheffield
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Yiqing Wang
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yang Xie
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John W Hollingsworth
- Texas Health Harris Methodist Hospital, Fort Worth, Texas
- Texas Christian University School of Medicine, Fort Worth, Texas
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23
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Ioannou GN, Ferguson JM, O’Hare AM, Bohnert ASB, Backus LI, Boyko EJ, Osborne TF, Maciejewski ML, Bowling CB, Hynes DM, Iwashyna TJ, Saysana M, Green P, Berry K. Changes in the associations of race and rurality with SARS-CoV-2 infection, mortality, and case fatality in the United States from February 2020 to March 2021: A population-based cohort study. PLoS Med 2021; 18:e1003807. [PMID: 34673772 PMCID: PMC8530298 DOI: 10.1371/journal.pmed.1003807] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We examined whether key sociodemographic and clinical risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and mortality changed over time in a population-based cohort study. METHODS AND FINDINGS In a cohort of 9,127,673 persons enrolled in the United States Veterans Affairs (VA) healthcare system, we evaluated the independent associations of sociodemographic and clinical characteristics with SARS-CoV-2 infection (n = 216,046), SARS-CoV-2-related mortality (n = 10,230), and case fatality at monthly intervals between February 1, 2020 and March 31, 2021. VA enrollees had a mean age of 61 years (SD 17.7) and were predominantly male (90.9%) and White (64.5%), with 14.6% of Black race and 6.3% of Hispanic ethnicity. Black (versus White) race was strongly associated with SARS-CoV-2 infection (adjusted odds ratio [AOR] 5.10, [95% CI 4.65 to 5.59], p-value <0.001), mortality (AOR 3.85 [95% CI 3.30 to 4.50], p-value < 0.001), and case fatality (AOR 2.56, 95% CI 2.23 to 2.93, p-value < 0.001) in February to March 2020, but these associations were attenuated and not statistically significant by November 2020 for infection (AOR 1.03 [95% CI 1.00 to 1.07] p-value = 0.05) and mortality (AOR 1.08 [95% CI 0.96 to 1.20], p-value = 0.21) and were reversed for case fatality (AOR 0.86, 95% CI 0.78 to 0.95, p-value = 0.005). American Indian/Alaska Native (AI/AN versus White) race was associated with higher risk of SARS-CoV-2 infection in April and May 2020; this association declined over time and reversed by March 2021 (AOR 0.66 [95% CI 0.51 to 0.85] p-value = 0.004). Hispanic (versus non-Hispanic) ethnicity was associated with higher risk of SARS-CoV-2 infection and mortality during almost every time period, with no evidence of attenuation over time. Urban (versus rural) residence was associated with higher risk of infection (AOR 2.02, [95% CI 1.83 to 2.22], p-value < 0.001), mortality (AOR 2.48 [95% CI 2.08 to 2.96], p-value < 0.001), and case fatality (AOR 2.24, 95% CI 1.93 to 2.60, p-value < 0.001) in February to April 2020, but these associations attenuated over time and reversed by September 2020 (AOR 0.85, 95% CI 0.81 to 0.89, p-value < 0.001 for infection, AOR 0.72, 95% CI 0.62 to 0.83, p-value < 0.001 for mortality and AOR 0.81, 95% CI 0.71 to 0.93, p-value = 0.006 for case fatality). Throughout the observation period, high comorbidity burden, younger age, and obesity were consistently associated with infection, while high comorbidity burden, older age, and male sex were consistently associated with mortality. Limitations of the study include that changes over time in the associations of some risk factors may be affected by changes in the likelihood of testing for SARS-CoV-2 according to those risk factors; also, study results apply directly to VA enrollees who are predominantly male and have comprehensive healthcare and need to be confirmed in other populations. CONCLUSIONS In this study, we found that strongly positive associations of Black and AI/AN (versus White) race and urban (versus rural) residence with SARS-CoV-2 infection, mortality, and case fatality observed early in the pandemic were ameliorated or reversed by March 2021.
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Affiliation(s)
- George N. Ioannou
- Divisions of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, United States of America
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- * E-mail:
| | - Jacqueline M. Ferguson
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, US Department of Veterans Affairs, Palo Alto, California, United States of America
| | - Ann M. O’Hare
- Nephrology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, United States of America
| | - Amy S. B. Bohnert
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Lisa I. Backus
- Department of Veterans Affairs, Population Health, Palo Alto Healthcare System, Palo Alto, California, United States of America
| | - Edward J. Boyko
- General Internal Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington, United States of America
| | - Thomas F. Osborne
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, and Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, United States of America
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke-Margolis Center for Health Policy, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - C. Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC and Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Denise M. Hynes
- Center of Innovation to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, United States of America
- Health Management and Policy, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Health Data and Informatics Program, Center for Genome Research and Biocomputing, Oregon State University, Corvallis, Oregon, United States of America
| | - Theodore J. Iwashyna
- Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan, United States of America
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Melody Saysana
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Pamela Green
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Kristin Berry
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
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24
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Garg S, Patel K, Pham H, Whitaker M, O'Halloran A, Milucky J, Anglin O, Kirley PD, Reingold A, Kawasaki B, Herlihy R, Yousey-Hindes K, Maslar A, Anderson EJ, Openo KP, Weigel A, Teno K, Ryan PA, Monroe ML, Reeg L, Kim S, Como-Sabetti K, Bye E, Shrum Davis S, Eisenberg N, Muse A, Barney G, Bennett NM, Felsen CB, Billing L, Shiltz J, Sutton M, Abdullah N, Talbot HK, Schaffner W, Hill M, Chatelain R, Wortham J, Taylor C, Hall A, Fry AM, Kim L, Havers FP. Clinical Trends Among U.S. Adults Hospitalized With COVID-19, March to December 2020 : A Cross-Sectional Study. Ann Intern Med 2021; 174:1409-1419. [PMID: 34370517 PMCID: PMC8381761 DOI: 10.7326/m21-1991] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused substantial morbidity and mortality. OBJECTIVE To describe monthly clinical trends among adults hospitalized with COVID-19. DESIGN Pooled cross-sectional study. SETTING 99 counties in 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET). PATIENTS U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020. MEASUREMENTS Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients. RESULTS Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December. LIMITATION COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. CONCLUSION Rates of COVID-19-associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Kadam Patel
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Huong Pham
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Michael Whitaker
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Jennifer Milucky
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Onika Anglin
- Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta, Georgia (K.P., O.A.)
| | - Pam D Kirley
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Arthur Reingold
- California Emerging Infections Program, Oakland, California (P.D.K., A.R.)
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado (B.K., R.H.)
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Amber Maslar
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y., A.M.)
| | - Evan J Anderson
- Emory University School of Medicine and Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (E.J.A.)
| | - Kyle P Openo
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia (K.P.O.)
| | - Andrew Weigel
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Kenzie Teno
- Iowa Department of Public Health, Des Moines, Iowa (A.W., K.T.)
| | - Patricia A Ryan
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland (P.A.R., M.L.M.)
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan (L.R., S.K.)
| | | | - Erica Bye
- Minnesota Department of Health, St. Paul, Minnesota (K.C., E.B.)
| | - Sarah Shrum Davis
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Nancy Eisenberg
- New Mexico Department of Health, Santa Fe, New Mexico (S.S.D., N.E.)
| | - Alison Muse
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Grant Barney
- New York State Department of Health, Albany, New York (A.M., G.B.)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B., C.B.F.)
| | | | - Jess Shiltz
- Ohio Department of Health, Columbus, Ohio (L.B., J.S.)
| | | | | | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - Mary Hill
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah (M.H., R.C.)
| | - Jonathan Wortham
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Christopher Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Aron Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.P., M.W., A.O., J.M., C.T., A.H.)
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Lindsay Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
| | - Fiona P Havers
- Centers for Disease Control and Prevention, Atlanta, Georgia, and U.S. Public Health Service, Rockville, Maryland (S.G., J.W., A.M.F., L.K., F.P.H.)
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25
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Otero-Rodriguez S, Moreno-Pérez O, Ramos JM, García M, Boix V, Reus S, Torrus D, Chico-Sánchez P, Sánchez-Payá J, Aldana-Macias F, Gil J, Portilla J, Merino E. Latin American Origin Is Not Associated with Worse Outcomes among Hospitalized Patients with COVID-19 in a Public Healthcare System. Microorganisms 2021; 9:1772. [PMID: 34442851 PMCID: PMC8398476 DOI: 10.3390/microorganisms9081772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 12/22/2022] Open
Abstract
Exploring differences in clinical outcomes based on race and origin among patients hospitalized for COVID-19 is a controversial issue. The ALC COVID-19 Registry includes all confirmed COVID-19 patients admitted to hospital from 3 March 2020 to 17 December 2020. The data were obtained from electronic health records in order to evaluate the differences in the clinical features and outcomes among European and Latin American patients. The follow-ups occurred after 156 days. A propensity score weighting (PSW) logistic regression model was used to estimate the odds ratio (OR, 95% CI) for Latin American origin and outcome associations. Of the 696 patients included, 46.7% were women, with a median age of 65 (IQR 53-67) years, 614 (88.2%) were European, and 82 (11.8%) were Latin American. Latin American patients were younger, with fewer comorbidities, and a higher incidence of extensive pneumonia. After adjusting for residual confounders, Latin American origin was not associated with an increased risk of death (PSW OR 0.85 (0.23-3.14)) or with the need for invasive mechanical ventilation (PSW OR 0.35 (0.12-1.03)). Latin American origin was associated with a shorter hospital stay, but without differences in how long the patient remained on mechanical ventilation. In a public healthcare system, the rates of death or mechanical ventilation in severe COVID-19 cases were found to be comparable between patients of European and Latin American origins.
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Affiliation(s)
- Silvia Otero-Rodriguez
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Unit of Infectious Diseases, Alicante General University Hospital, 03010 Alicante, Spain
| | - Oscar Moreno-Pérez
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Endocrinology and Nutrition Department, Alicante General University Hospital, 03013 Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, 03202 Elche, Spain
| | - Jose Manuel Ramos
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Clinical Medicine Department, Miguel Hernández University, 03202 Elche, Spain
- Internal Medicine Department, Alicante General University Hospital, 03010 Alicante, Spain
| | - Mar García
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Internal Medicine Department, Alicante General University Hospital, 03010 Alicante, Spain
| | - Vicente Boix
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Unit of Infectious Diseases, Alicante General University Hospital, 03010 Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, 03202 Elche, Spain
| | - Sergio Reus
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Unit of Infectious Diseases, Alicante General University Hospital, 03010 Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, 03202 Elche, Spain
| | - Diego Torrus
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Unit of Infectious Diseases, Alicante General University Hospital, 03010 Alicante, Spain
- Parasitology Area, Miguel Hernández University, 03202 Elche, Spain
| | - Pablo Chico-Sánchez
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Preventive Department, Alicante General University Hospital, 03010 Alicante, Spain
| | - José Sánchez-Payá
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Preventive Department, Alicante General University Hospital, 03010 Alicante, Spain
| | - Fernando Aldana-Macias
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Pneumology Department, Alicante General University Hospital, 03010 Alicante, Spain
| | - Joan Gil
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Pneumology Department, Alicante General University Hospital, 03010 Alicante, Spain
| | - Joaquín Portilla
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Clinical Medicine Department, Miguel Hernández University, 03202 Elche, Spain
- Internal Medicine Department, Alicante General University Hospital, 03010 Alicante, Spain
| | - Esperanza Merino
- Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (S.O.-R.); (O.M.-P.); (J.M.R.); (M.G.); (V.B.); (S.R.); (D.T.); (P.C.-S.); (J.S.-P.); (F.A.-M.); (J.G.); (J.P.)
- Unit of Infectious Diseases, Alicante General University Hospital, 03010 Alicante, Spain
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26
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Righolt CH, Zhang G, Sever E, Wilkinson K, Mahmud SM. Patterns and descriptors of COVID-19 testing and lab-confirmed COVID-19 incidence in Manitoba, Canada, March 2020-May 2021: A population-based study. ACTA ACUST UNITED AC 2021; 2:100038. [PMID: 34409400 PMCID: PMC8360706 DOI: 10.1016/j.lana.2021.100038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022]
Abstract
Background We studied lab-confirmed COVID-19 infection (LCCI) testing, incidence, and severity. Methods We included all Manitoba residents and limited our severity analysis to LCCI patients. We calculated testing, incidence and vaccination rates between March 8, 2020 and June 1, 2021. We estimated the association between patient characteristics and testing (rate ratio [RR]; Poisson regression), including the reason for testing (screening, symptomatic, contact/outbreak asymptomatic), incidence (hazard ratio [HR]; Cox regression), and severity (prevalence ratio [PR], Cox regression). Findings The overall testing rate during the second/third wave was 570/1,000 person-years, with an LCCI rate of 50/1,000 person-years. The secondary attack rate during the second/third wave was 16%. Across regions, young children (<10) had the lowest positivity for symptomatic testing, the highest positivity for asymptomatic testing, and the highest risk of LCCI as asymptomatic contact. People in the lowest income quintile had the highest risk of LCCI, 1.3-6x the hazard of those in the highest income quintile. Long-term care (LTC) residents were particularly affected in the second wave with HRs>10 for asymptomatic residents. Interpretation Although the severity of LCCI in children was low, they have a high risk of asymptomatic positivity. The groups most vulnerable to LCCI, who should remain a focus of public health, were residents of Manitoba's North, LTC facilities, and low-income neighbourhoods. Funding Canada Research Chair Program
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Affiliation(s)
| | | | | | | | - Salaheddin M. Mahmud
- Correspondence Author: Dr. Salaheddin Mahmud, MD PhD FRCPC, Professor and Director, Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337 - 750 McDermot Avenue, Winnipeg, Manitoba, R3E 0T5 Canada
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27
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Tian F, Liu X, Chao Q, Qian ZM, Zhang S, Qi L, Niu Y, Arnold LD, Zhang S, Li H, Lin H, Liu Q. Ambient air pollution and low temperature associated with case fatality of COVID-19: A nationwide retrospective cohort study in China. Innovation (N Y) 2021; 2:100139. [PMID: 34189495 PMCID: PMC8226106 DOI: 10.1016/j.xinn.2021.100139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/16/2021] [Indexed: 12/12/2022] Open
Abstract
The evidence for the effects of environmental factors on COVID-19 case fatality remains controversial, and it is crucial to understand the role of preventable environmental factors in driving COVID-19 fatality. We thus conducted a nationwide cohort study to estimate the effects of environmental factors (temperature, particulate matter [PM2.5, PM10], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]) on COVID-19 case fatality. A total of 71,808 confirmed COVID-19 cases were identified and followed up for their vital status through April 25, 2020. Exposures to ambient air pollution and temperature were estimated by linking the city- and county-level monitoring data to the residential community of each participant. For each participant, two windows were defined: the period from symptom onset to diagnosis (exposure window I) and the period from diagnosis date to date of death/recovery or end of the study period (exposure window II). Cox proportional hazards models were used to estimate the associations between these environmental factors and COVID-19 case fatality. COVID-19 case fatality increased in association with environmental factors for the two exposure windows. For example, each 10 μg/m3 increase in PM2.5, PM10, O3, and NO2 in window I was associated with a hazard ratio of 1.11 (95% CI 1.09, 1.13), 1.10 (95% CI 1.08, 1.13), 1.09 (95 CI 1.03, 1.14), and 1.27 (95% CI 1.19, 1.35) for COVID-19 fatality, respectively. A significant effect was also observed for low temperature, with a hazard ratio of 1.03 (95% CI 1.01, 1.04) for COVID-19 case fatality per 1°C decrease. Subgroup analysis indicated that these effects were stronger in the elderly, as well as in those with mild symptoms and living in Wuhan or Hubei. Overall, the sensitivity analyses also yielded consistent estimates. Short-term exposure to ambient air pollution and low temperature during the illness would play a nonnegligible part in causing case fatality due to COVID-19. Reduced exposures to high concentrations of PM2.5, PM10, O3, SO2, and NO2 and low temperature would help improve the prognosis and reduce public health burden.
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Affiliation(s)
- Fei Tian
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaobo Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, WHO Collaborating Centre for Vector Surveillance and Management, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Qingchen Chao
- Laboratory for Climate Studies, National Climate Center, China Meteorological Administration, Beijing 100081, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Siqi Zhang
- Laboratory for Climate Studies, National Climate Center, China Meteorological Administration, Beijing 100081, China
| | - Li Qi
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, WHO Collaborating Centre for Vector Surveillance and Management, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Yanlin Niu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, WHO Collaborating Centre for Vector Surveillance and Management, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Lauren D Arnold
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Huan Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, WHO Collaborating Centre for Vector Surveillance and Management, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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28
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Dhindsa S, Zhang N, McPhaul MJ, Wu Z, Ghoshal AK, Erlich EC, Mani K, Randolph GJ, Edwards JR, Mudd PA, Diwan A. Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19. JAMA Netw Open 2021; 4:e2111398. [PMID: 34032853 PMCID: PMC8150664 DOI: 10.1001/jamanetworkopen.2021.11398] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
Importance Male sex is a risk factor for developing severe COVID-19 illness. It is not known whether sex hormones contribute to this predisposition. Objective To investigate the association of concentrations of serum testosterone, estradiol, and insulinlike growth factor 1 (IGF-1, concentrations of which are regulated by sex hormone signaling) with COVID-19 severity. Design, Setting, and Participants This prospective cohort study was conducted using serum samples collected from consecutive patients who presented from March through May 2020 to the Barnes Jewish Hospital in St Louis, Missouri, with COVID-19 (diagnosed using nasopharyngeal swabs). Exposures Testosterone, estradiol, and IGF-1 concentrations were measured at the time of presentation (ie, day 0) and at days 3, 7, 14, and 28 after admission (if the patient remained hospitalized). Main Outcomes and Measures Baseline hormone concentrations were compared among patients who had severe COVID-19 vs those with milder COVID-19 illness. RNA sequencing was performed on circulating mononuclear cells to understand the mechanistic association of altered circulating hormone concentrations with cellular signaling pathways. Results Among 152 patients (90 [59.2%] men; 62 [40.8%] women; mean [SD] age, 63 [16] years), 143 patients (94.1%) were hospitalized. Among 66 men with severe COVID-19, median [interquartile range] testosterone concentrations were lower at day 0 (53 [18 to 114] ng/dL vs 151 [95 to 217] ng/dL; P = .01) and day 3 (19 [6 to 68] ng/dL vs 111 [49 to 274] ng/dL; P = .006) compared with 24 men with milder disease. Testosterone concentrations were inversely associated with concentrations of interleukin 6 (β = -0.43; 95% CI, -0.52 to -0.17; P < .001), C-reactive protein (β = -0.38; 95% CI, -0.78 to -0.16; P = .004), interleukin 1 receptor antagonist (β = -0.29; 95% CI, -0.64 to -0.06; P = .02), hepatocyte growth factor (β = -0.46; 95% CI, -0.69 to -0.25; P < .001), and interferon γ-inducible protein 10 (β = -0.32; 95% CI, -0.62 to -0.10; P = .007). Estradiol and IGF-1 concentrations were not associated with COVID-19 severity in men. Testosterone, estradiol, and IGF-1 concentrations were similar in women with and without severe COVID-19. Gene set enrichment analysis revealed upregulated hormone signaling pathways in CD14+CD16- (ie, classical) monocytes and CD14-CD16+ (ie, nonclassical) monocytes in male patients with COVID-19 who needed intensive care unit treatment vs those who did not. Conclusions and Relevance In this single-center cohort study of patients with COVID-19, lower testosterone concentrations during hospitalization were associated with increased disease severity and inflammation in men. Hormone signaling pathways in monocytes did not parallel serum hormone concentrations, and further investigation is required to understand their pathophysiologic association with COVID-19.
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Affiliation(s)
- Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, St Louis University School of Medicine, St Louis, Missouri
| | - Nan Zhang
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, Missouri
| | - Michael J. McPhaul
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Zengru Wu
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Amit K. Ghoshal
- LC-MS Core Lab, Quest Diagnostics Nichols Institute, Valencia, California
| | - Emma C. Erlich
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, Missouri
| | - Kartik Mani
- Cardiovascular Division, Washington University School of Medicine in St Louis, Missouri
- Center for Cardiovascular Research, Department of Medicine, Washington University School of Medicine in St Louis, Missouri
- John Cochran Veterans Hospital, St Louis, Missouri
| | - Gwendalyn J. Randolph
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, Missouri
| | - John R. Edwards
- Center for Pharmacogenomics, Department of Medicine, Washington University School of Medicine in St Louis, Missouri
| | - Philip A. Mudd
- Department of Emergency Medicine, Washington University School of Medicine in St Louis, Missouri
| | - Abhinav Diwan
- Cardiovascular Division, Washington University School of Medicine in St Louis, Missouri
- Center for Cardiovascular Research, Department of Medicine, Washington University School of Medicine in St Louis, Missouri
- John Cochran Veterans Hospital, St Louis, Missouri
- Department of Cell Biology and Physiology, Washington University School of Medicine in St Louis, Missouri
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, Missouri
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Cao H, Li B, Gu T, Liu X, Meng K, Zhang L. Associations of Ambient Air Pollutants and Meteorological Factors With COVID-19 Transmission in 31 Chinese Provinces: A Time Series Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211060259. [PMID: 34809490 PMCID: PMC8613882 DOI: 10.1177/00469580211060259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022]
Abstract
Evidence regarding the effects of environmental factors on COVID-19 transmission is mixed. We aimed to explore the associations of air pollutants and meteorological factors with COVID-19 confirmed cases during the outbreak period throughout China. The number of COVID-19 confirmed cases, air pollutant concentrations, and meteorological factors in China from January 25 to February 29, 2020, (36 days) were extracted from authoritative electronic databases. The associations were estimated for a single-day lag as well as moving averages lag using generalized additive mixed models. Region-specific analyses and meta-analysis were conducted in 5 selected regions from the north to south of China with diverse air pollution levels and weather conditions and sufficient sample size. Nonlinear concentration-response analyses were performed. An increase of each interquartile range in PM2.5, PM10, SO2, NO2, O3, and CO at lag4 corresponded to 1.40 (1.37-1.43), 1.35 (1.32-1.37), 1.01 (1.00-1.02), 1.08 (1.07-1.10), 1.28 (1.27-1.29), and 1.26 (1.24-1.28) ORs of daily new cases, respectively. For 1°C, 1%, and 1 m/s increase in temperature, relative humidity, and wind velocity, the ORs were 0.97 (0.97-0.98), 0.96 (0.96-0.97), and 0.94 (0.92-0.95), respectively. The estimates of PM2.5, PM10, NO2, and all meteorological factors remained significantly after meta-analysis for the five selected regions. The concentration-response relationships showed that higher concentrations of air pollutants and lower meteorological factors were associated with daily new cases increasing. Higher air pollutant concentrations and lower temperature, relative humidity and wind velocity may favor COVID-19 transmission. Controlling ambient air pollution, especially for PM2.5, PM10, NO2, may be an important component of reducing risk of COVID-19 infection. In addition, as winter months are arriving in China, the meteorological factors may play a negative role in prevention. Therefore, it is significant to implement the public health control measures persistently in case another possible pandemic.
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Affiliation(s)
- Han Cao
- Department of Biostatistics, Peking University First Hospital, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Tianlun Gu
- Department of Customer Advisory, SAS Institute Inc, Beijing, China
| | - Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Kai Meng
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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