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Alicandro G, Gerli A, La Vecchia C. Increased mortality in socioeconomic disadvantaged municipalities during the first phase of the COVID-19 pandemic in Lombardy region. Eur J Public Health 2024; 34:449-453. [PMID: 38547506 PMCID: PMC11162232 DOI: 10.1093/eurpub/ckae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Lombardy was the first European region most severely affected by the coronavirus disease 2019 pandemic in the spring of 2020. During that period, a substantial increase in socioeconomic inequality in total mortality was observed. This study aims to evaluate mortality data in the region up to September 2023 to verify whether the increased disparities between the poorest and the wealthiest municipalities persisted in the subsequent phases of the pandemic. METHODS This study analyzed mortality data from January 2019 to September 2023 in Lombardy's municipalities by month and pandemic phases characterized by the predominance of the different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Municipalities were grouped according to the average income or pension of their residents. Age-standardized mortality rates (ASMRs) and the ASMR ratio between the poorest and the wealthiest municipalities were compared throughout the study period. RESULTS In the pre-pandemic period (January 2019 - February 2020), the ASMR ratio at all ages between the poorest and the wealthiest municipalities fluctuated between 1.12 [95% confidence interval (CI): 1.07-1.16] and 1.29 (95% CI: 1.25-1.34). In March 2020, the ASMR ratio increased to 1.49 (95% CI: 1.45-1.52 95%) and returned to values registered before the pandemic thereafter. A similar pattern was observed in the analysis of mortality ≥ 65, using the average pension for group municipalities. CONCLUSIONS During the dramatic circumstances that the region faced in March 2020, pre-existing socioeconomic inequalities substantially widened. With the reorganization of the health system and the availability of vaccines, these disparities returned to the levels recorded before the pandemic.
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Affiliation(s)
- Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Department of Paediatrics, Cystic Fibrosis Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Gerli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Nahian A, Huber VC, McFadden LM. Unique SARS-CoV-2 Variants, Tourism Metrics, and B.1.2 Emergence in Early COVID-19 Pandemic: A Correlation Analysis in South Dakota. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6748. [PMID: 37754608 PMCID: PMC10531005 DOI: 10.3390/ijerph20186748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, which is the source of the coronavirus disease 2019 (COVID-19), was declared a pandemic in the March of 2020. Travel and tourism were severely impacted as restrictions were imposed to help slow the disease spread, but some states took alternative approaches to travel restrictions. This study investigated the spread of COVID-19 in South Dakota during the early pandemic period to better understand how tourism affected the movement of the virus within the region. Sequences from the fall of 2020 were retrieved from public sources. CDC and other sources were used to determine infections, deaths, and tourism metrics during this time. The data were analyzed using correlation and logistic regression. This study found that the number of unique variants per month was positively correlated with hotel occupancy, but not with the number of cases or deaths. Interestingly, the emergence of the B.1.2 variant in South Dakota was positively correlated with increased case numbers and deaths. Data show that states with a shelter-in-place order were associated with a slower emergence of the B.1.2 variant compared to states without such an order, including South Dakota. Findings suggest complex relationships between tourism, SARS-CoV-2 infections, and mitigation strategies. The unique approach that South Dakota adopted provided insights into the spread of the disease in areas without state-wide restrictions. Our results suggest both positive and negative aspects of this approach. Finally, our data highlight the need for future surveillance efforts, including efforts focused on identifying variants with known increased transmission potential to produce effective population health management.
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Affiliation(s)
| | | | - Lisa M. McFadden
- Division of Basic Biomedical Sciences, University of South Dakota, 414 E. Clark St., Vermillion, SD 57069, USA
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Bruera S, Lei X, Zhao H, Yazdany J, Chavez-MacGregor M, Giordano SH, Suarez-Almazor ME. Risks of mortality and severe coronavirus disease 19 (COVID-19) outcomes in patients with or without systemic lupus erythematosus. Lupus Sci Med 2023; 10:e000750. [PMID: 36787921 PMCID: PMC9929928 DOI: 10.1136/lupus-2022-000750] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/11/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVES We compared the outcomes of patients with or without systemic lupus erythematosus (SLE) who were diagnosed with coronavirus disease 19 (COVID-19) and evaluated factors within patients with SLE associated with severe outcomes. METHODS This retrospective cohort study used the deidentified Optum COVID-19 electronic health record dataset to identify patients with COVID-19 from 1/1/2020 to 31/12/2020. Cases with SLE were matched with general controls at a ratio of 1:10 by age, sex, race and ethnicity and COVID-19 diagnosis date. Outcomes included 30-day mortality, mechanical ventilation, hospitalisation and intensive care unit admission. We evaluated the relationship between COVID-19-related outcomes and SLE using multivariable logistic regression. In addition, within SLE cases, we examined factors associated with COVID-19 related outcomes, including disease activity and SLE therapy. RESULTS We included 687 patients matched with 6870 controls. Unadjusted rates of outcomes for patients with SLE were significantly worse than for matched controls including mortality (3.6% vs 1.8%), mechanical ventilation (6% vs 2.5%) and hospitalisation (31% vs 17.7%) (all p<0.001). After multivariable adjustment, patients with SLE had increased risks of mechanical ventilation (OR 1.81, 95% CI 1.16 to 2.82) and hospitalisation (OR 1.32, 95% CI 1.05 to 1.65). Among patients with SLE, severe disease activity was associated with increased risks of mechanical ventilation (OR 5.83, 95% CI 2.60 to 13.07) and hospitalisation (OR 3.97, 95% CI 2.37 to 6.65). Use of glucocorticoids, mycophenolate and tacrolimus before COVID-19 was associated with worse outcomes. CONCLUSION Patients with SLE had increased risk of severe COVID-19-related outcomes compared with matched controls. Patients with severe SLE disease activity or prior use of corticosteroids experienced worse outcomes.
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Affiliation(s)
- Sebastian Bruera
- Section of Allergy, Immunology, and Rheumatology, Baylor College of Medicine, Houston, Texas, USA
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jinoos Yazdany
- University of California at San Francisco, San Francisco, California, USA
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria E Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Fernández-Martínez NF, Ruiz-Montero R, Gómez-Barroso D, Rodríguez-Torronteras A, Lorusso N, Salcedo-Leal I, Sordo L. Socioeconomic differences in COVID-19 infection, hospitalisation and mortality in urban areas in a region in the South of Europe. BMC Public Health 2022; 22:2316. [PMID: 36503482 PMCID: PMC9742010 DOI: 10.1186/s12889-022-14774-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To analyse differences in confirmed cases, hospitalisations and deaths due to COVID-19 related to census section socioeconomic variables. METHODS: Ecological study in the 12 largest municipalities in Andalusia (Spain) during the first three epidemic waves of the COVID-19 (02/26/20-03/31/21), covering 2,246 census sections (unit of analysis) and 3,027,000 inhabitants. Incidence was calculated, standardised by age and sex, for infection, hospitalisation and deaths based on average gross income per household (AGI) for the census tracts in each urban area. Association studied using a Poisson Bayesian regression model with random effects for spatial smoothing. RESULTS There were 140,743 cases of COVID-19, of which 12,585 were hospitalised and 2,255 died. 95.2% of cases were attributed to the second and third waves, which were jointly analysed. We observed a protective effect of income for infection in 3/12 cities. Almeria had the largest protective effect (smoothed relative risk (SRR) = 0.84 (0.75-0.94 CI 95%). This relationship reappeared with greater magnitude in 10/12 cities for hospitalisation, lowest risk in Algeciras SRR = 0.41 (0.29-0.56). The pattern was repeated for deaths in all urban areas and reached statistical significance in 8 cities. Lowest risk in Dos Hermanas SRR = 0.35 (0.15-0.81). CONCLUSIONS Income inequalities by geographical area were found in the incidence of COVID-19. The strengths of the association increased when analysing the severe outcomes of hospitalisations and, above all, deaths.
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Affiliation(s)
- Nicolás F Fernández-Martínez
- grid.411349.a0000 0004 1771 4667Unidad de Gestión Clínica Medicina Preventiva y Salud Pública, Hospital Universitario Reina Sofía, Córdoba, 14004 Spain ,grid.428865.50000 0004 0445 6160Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Rafael Ruiz-Montero
- grid.411349.a0000 0004 1771 4667Unidad de Gestión Clínica Medicina Preventiva y Salud Pública, Hospital Universitario Reina Sofía, Córdoba, 14004 Spain ,grid.428865.50000 0004 0445 6160Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Diana Gómez-Barroso
- grid.413448.e0000 0000 9314 1427Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain ,grid.466571.70000 0004 1756 6246CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alejandro Rodríguez-Torronteras
- grid.411349.a0000 0004 1771 4667Unidad de Gestión Clínica Medicina Preventiva y Salud Pública, Hospital Universitario Reina Sofía, Córdoba, 14004 Spain
| | - Nicola Lorusso
- Dirección General de Salud Pública, Consejería de Salud y Consumo, Junta de Andalucía, Spain
| | - Inmaculada Salcedo-Leal
- grid.411349.a0000 0004 1771 4667Unidad de Gestión Clínica Medicina Preventiva y Salud Pública, Hospital Universitario Reina Sofía, Córdoba, 14004 Spain ,grid.428865.50000 0004 0445 6160Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Luis Sordo
- grid.466571.70000 0004 1756 6246CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ,grid.4795.f0000 0001 2157 7667Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Beese F, Waldhauer J, Wollgast L, Pförtner TK, Wahrendorf M, Haller S, Hoebel J, Wachtler B. Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic—A Scoping Review. Int J Public Health 2022; 67:1605128. [PMID: 36105178 PMCID: PMC9464808 DOI: 10.3389/ijph.2022.1605128] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/16/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives: International evidence of socioeconomic inequalities in COVID-19 outcomes is extensive and growing, but less is known about the temporal dynamics of these inequalities over the course of the pandemic. Methods: We systematically searched the Embase and Scopus databases. Additionally, several relevant journals and the reference lists of all included articles were hand-searched. This study follows the PRISMA guidelines for scoping reviews. Results: Forty-six studies were included. Of all analyses, 91.4% showed stable or increasing socioeconomic inequalities in COVID-19 outcomes over the course of the pandemic, with socioeconomically disadvantaged populations being most affected. Furthermore, the study results showed temporal dynamics in socioeconomic inequalities in COVID-19, frequently initiated through higher COVID-19 incidence and mortality rates in better-off populations and subsequent crossover dynamics to higher rates in socioeconomically disadvantaged populations (41.9% of all analyses). Conclusion: The identified temporal dynamics of socioeconomic inequalities in COVID-19 outcomes have relevant public health implications. Socioeconomic inequalities should be monitored over time to enable the adaption of prevention and interventions according to the social particularities of specific pandemic phases.
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Affiliation(s)
- Florian Beese
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- *Correspondence: Florian Beese,
| | - Julia Waldhauer
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lina Wollgast
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine and Faculty of Human Sciences, University of Cologne, Cologne, Germany
- Research Methods Division, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society (CHS), Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany
| | - Sebastian Haller
- Division of Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Benjamin Wachtler
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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