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Qin Q, Temkin-Greener H, Veazie P, Makineni R, Cai S. Disparities in COVID-19-Related Mortality Among Older Adults With Alzheimer's Disease and Related Dementias: Variations Over Time. J Appl Gerontol 2024:7334648241264908. [PMID: 39030708 DOI: 10.1177/07334648241264908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Older adults with Alzheimer's disease and related dementias (ADRD) had a high risk of COVID-19-related mortality. Racial and ethnic minorities were disproportionally impacted by the pandemic. The variations in disparities, including racial and ethnic disparities and disparities across communities, in COVID-19-related mortality across the different stages of the COVID-19 pandemic among the ADRD population are unknown. This observational study estimated linear probability models for community-dwelling older adults with ADRD who were diagnosed with COVID-19 in 2020 and 2021 using multiple national data (e.g., Medicare data), accounting for individual and community characteristics. Disparities in 30-day mortality were compared between 2020 and 2021. The socioeconomic disparity in COVID-19-related mortality across communities became insignificant during the later stage of the pandemic, ethnic differences in COVID-19-related mortality decreased but persisted, and racial disparity remained largely unchanged. The study provides insights into interventions to mitigate lingering disparities in health outcomes among the vulnerable population.
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Affiliation(s)
- Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajesh Makineni
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Brewer A, Hughes MC, Patel KN. Impact of Repeated Reimbursement Penalties on Hospital Total Quality Scores. J Patient Saf 2024; 20:198-201. [PMID: 38197907 DOI: 10.1097/pts.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVES The incidence of hospital-acquired conditions (HACs) is a serious public health issue with implications ranging from patient morbidity and mortality to negative financial impacts on patients and health care systems. Despite substantial efforts to address and reduce HACs, research into the effect of quality improvement programs is inconclusive. This study seeks to better understand the relationship between repeated reimbursement penalties and improvement in HAC quality scores. METHODS A quantitative comparative analysis of U.S. health care data was conducted. Data on quality outcomes and hospital characteristics were sourced from the Hospital-Acquired Condition Reduction Program from fiscal years 2018 and 2019 and the Centers for Medicare & Medicaid Services Inpatient Prospective Payment System impact files, respectively. RESULTS In total, 3123 U.S. hospitals were analyzed to compare differences between total HAC scores of hospitals with and without penalties in consecutive years. Hospitals with repeated penalties had significantly greater improvement in scores ( t497.262 = -13.00, P < 0.001), and the impact was greatest in small hospitals (<100 beds). Repeated penalties had a smaller impact on disproportionate share hospitals (Cohen d = 0.73). Among all hospitals, the effect of repeated penalties was large (Cohen d = 0.75). CONCLUSIONS This study suggests that repeated penalties can improve quality scores in U.S. hospitals. However, the effect may be exaggerated for smaller hospitals and those that serve patient populations with a relatively higher socioeconomic status. The reason disproportionate share hospitals did not show as much improvement as nondisproportionate hospitals may be because hospitals serving vulnerable populations often have fewer resources.
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Affiliation(s)
- Alice Brewer
- From the College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois
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Issa J, Wouterse B, Milkovska E, van Baal P. Quantifying income inequality in years of life lost to COVID-19: a prediction model approach using Dutch administrative data. Int J Epidemiol 2024; 53:dyad159. [PMID: 38081182 PMCID: PMC10859130 DOI: 10.1093/ije/dyad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/09/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Low socioeconomic status and underlying health increase the risk of fatal outcomes from COVID-19, resulting in more years of life lost (YLL) among the poor. However, using standard life expectancy overestimates YLL to COVID-19. We aimed to quantify YLL associated with COVID-19 deaths by sex and income quartile, while accounting for the impact of individual-level pre-existing health on remaining life expectancy for all Dutch adults aged 50+. METHODS Extensive administrative data were used to model probability of dying within the year for the entire 50+ population in 2019, considering age, sex, disposable income and health care use (n = 6 885 958). The model is used to predict mortality probabilities for those who died of COVID-19 (had they not died) in 2020. Combining these probabilities in life tables, we estimated YLL by sex and income quartile. The estimates are compared with YLL based on standard life expectancy and income-stratified life expectancy. RESULTS Using standard life expectancy results in 167 315 YLL (8.4 YLL per death) which is comparable to estimates using income-stratified life tables (167 916 YLL with 8.2 YLL per death). Considering pre-existing health and income, YLL decreased to 100 743, with 40% of years lost in the poorest income quartile (5.0 YLL per death). Despite individuals in the poorest quartile dying at younger ages, there were minimal differences in average YLL per COVID-19 death compared with the richest quartile. CONCLUSIONS Accounting for prior health significantly affects estimates of YLL due to COVID-19. However, inequality in YLL at the population level is primarily driven by higher COVID-19 deaths among the poor. To reduce income inequality in the health burden of future pandemics, policies should focus on limiting structural differences in underlying health and exposure of lower income groups.
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Affiliation(s)
- Jawa Issa
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Bram Wouterse
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Elena Milkovska
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter van Baal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Maureira L, Urquidi C, Sepúlveda-Peñaloza A, Soto-Marchant M, Matus P. Towards closing socio-economic status disparities in COVID-19 premature mortality: a nationwide and trend analysis in Chile. Int J Epidemiol 2024; 53:dyad183. [PMID: 38224273 DOI: 10.1093/ije/dyad183] [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: 08/04/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Socio-economic status (SES) disparities in coronavirus disease 2019 (COVID-19) mortality have been reported but complete information and time trends are scarce. In this study, we analysed the years of life lost (YLL) due to COVID-19 premature mortality during the pandemic in Chile and its evolution according to SES and sex compared with a counterfactual scenario [cerebrovascular accidents (stroke)]. METHOD We used Chile's national mortality databases from 2020 to 2022. YLL and age-standardized YLL and mortality rates by sex and by epidemic waves were determined. The 346 communes were stratified into SES groups according to their poverty index quintile. Negative binomial regression models were used to test trends. RESULTS In >2 years of the pandemic, the COVID-19 YLL was 975 937, corresponding to 61 174 deaths. The YLL rate per 100 000 inhabitants was 1027 for males and 594 for females. There was a heterogeneous distribution of YLL rates and the regional level. Communes in the most advantaged SES quintile (Q5) had the highest YLL during the first wave compared with those in the lowest SES quintile (Q1) (P < 0.001) but the opposite was true during the second wave. COVID-19 YLL trends declined and differences between Q1 and Q2 vs Q5 converged from the second to the fourth waves (0.33 and 0.15, Ptrend < 0.001 and Ptrend = 0.024). YLL declined but differences persisted in stroke (-0.002, Ptrend = 0.979). CONCLUSIONS COVID-19 deaths resulted in a higher impact on premature death in Chile, especially in men, with a heterogeneous geographic distribution along the territory. SES and sex disparities in COVID-19 premature mortality had narrowed by the end of the pandemic.
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Affiliation(s)
- Lea Maureira
- Instituto de Ciencia e Innovación en Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Cinthya Urquidi
- Departamento de Epidemiología y Estudios en Salud, Universidad de los Andes, Chile
| | | | - Mario Soto-Marchant
- Escuela de Tecnología Médica, Facultad de Salud y Odontología, Universidad Diego Portales, Santiago, Chile
| | - Patricia Matus
- Departamento de Epidemiología y Estudios en Salud, Universidad de los Andes, Chile
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Altmejd A, Östergren O, Björkegren E, Persson T. Inequality and COVID-19 in Sweden: Relative risks of nine bad life events, by four social gradients, in pandemic vs. prepandemic years. Proc Natl Acad Sci U S A 2023; 120:e2303640120. [PMID: 37943837 PMCID: PMC10655217 DOI: 10.1073/pnas.2303640120] [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: 03/06/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023] Open
Abstract
The COVID-19 pandemic struck societies directly and indirectly, not just challenging population health but disrupting many aspects of life. Different effects of the spreading virus-and the measures to fight it-are reported and discussed in different scientific fora, with hard-to-compare methods and metrics from different traditions. While the pandemic struck some groups more than others, it is difficult to assess the comprehensive impact on social inequalities. This paper gauges social inequalities using individual-level administrative data for Sweden's entire population. We describe and analyze the relative risks for different social groups in four dimensions-gender, education, income, and world region of birth-to experience three types of COVID-19 incidence, as well as six additional negative life outcomes that reflect general health, access to medical care, and economic strain. During the pandemic, the overall population faced severe morbidity and mortality from COVID-19 and saw higher all-cause mortality, income losses and unemployment risks, as well as reduced access to medical care. These burdens fell more heavily on individuals with low income or education and on immigrants. Although these vulnerable groups experienced larger absolute risks of suffering the direct and indirect consequences of the pandemic, the relative risks in pandemic years (2020 and 2021) were conspicuously similar to those in prepandemic years (2016 to 2019).
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Affiliation(s)
- Adam Altmejd
- Swedish Institute for Social Research, Stockholm University, Stockholm106 91, Sweden
- Department of Finance, Stockholm School of Economics, Stockholm106 91, Sweden
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University, Stockholm106 91, Sweden
- Aging Research Center, Karolinska Institutet, Stockholm171 77, Sweden
| | | | - Torsten Persson
- Institute for International Economic Studies, Stockholm University, Stockholm106 91, Sweden
- Suntory and Toyota International Centres for Economics and Related Disciplines, London School of Economics, LondonWC2A 2AE, United Kingdom
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Kolobova M, Jdanov D, Jasilionis D, Shkolnikov VM, Rau R. Variation in mortality burden of the COVID-19 pandemic across federal states in Germany. Eur J Public Health 2023; 33:930-936. [PMID: 37470231 PMCID: PMC10567244 DOI: 10.1093/eurpub/ckad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Intra-annual excess mortality is the most reliable measure of losses of lives due to short-term risk factors. The objectives of our study are (i) to estimate excess mortality across German states in the course of the coronavirus disease 2019 (COVID-19) pandemic years 2020 and 2021 and (ii) to identify possible regional-level determinants of spatial inequality in pandemic-related excess mortality. METHODS We use weekly mortality data series for the calculation of weekly death rates, standardized by age for each federal state of Germany. We estimate the expected level of mortality as state-specific mortality trends and excess mortality in 2020 and 2021. We explore ecological statistical relationships between excess mortality, COVID-19 morbidity, and selected regional socioeconomic indicators using fixed-effects regression models. RESULTS Our study shows that during the first pandemic year, there was South-to-North gradient in excess mortality in Germany, with excess mortality being higher in the South. Over the course of the second pandemic year 2021, this gradient changed to become an East-to-West gradient, with excess mortality being higher in the East. The results of the study show stronger effects of COVID-19 morbidity on excess mortality in East Germany. State-level indicators reflecting economic activity, employment, and capacity of intensive care units show significant correlations with excess mortality across the states. CONCLUSIONS The results show pronounced state-level differences in the magnitude of excess mortality during the COVID-19 pandemic in Germany. Economic activity, employment and capacity of intensive care units were the most important state-level characteristics associated with the observed spatial variations in excess mortality.
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Affiliation(s)
- Marina Kolobova
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Dmitri Jdanov
- Max Planck Institute for Demographic Research, Rostock, Germany
- International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russia
| | - Domantas Jasilionis
- Max Planck Institute for Demographic Research, Rostock, Germany
- Vytautas Magnus University, Kaunas, Lithuania
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Rostock, Germany
- International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russia
| | - Roland Rau
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of Rostock, Rostock, Germany
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Scopazzini MS, Cave RNR, Mutch CP, Ross DA, Bularga A, Chase-Topping M, Woolhouse M, Koch O, Perry MR, Mackintosh CL. Scottish Index of Multiple Deprivation (SIMD) indicators as predictors of mortality among patients hospitalised with COVID-19 disease in the Lothian Region, Scotland during the first wave: a cohort study. Int J Equity Health 2023; 22:205. [PMID: 37794428 PMCID: PMC10552319 DOI: 10.1186/s12939-023-02017-y] [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: 11/22/2021] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Sars-CoV-2, the causative agent of COVID-19, has led to more than 226,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which individual indicators of the Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality. METHODS This was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Age and sex adjusted univariable and multivariable analyses were used to determine measures of association between exposures of interest and the primary outcome. RESULTS After adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99-3.08, p = 0.053 and OR 2.17, CI 1.22-3.86, p = 0.009, respectively), but this association was not upheld in our multivariable model containing age, sex, Performance Status and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20-3.77) p = 0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28-3.00) p = 0.002)). CONCLUSIONS SIMD as an aggregate measure of deprivation was not predictive of mortality in our cohort when other exposure measures were accounted for. However, we identified a two-fold increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, exploring the impact of specific SIMD indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19.
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Affiliation(s)
- Marcello S Scopazzini
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK.
- London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Callum P Mutch
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Daniella A Ross
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Anda Bularga
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Margo Chase-Topping
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | | | - Oliver Koch
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Meghan R Perry
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Claire L Mackintosh
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
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Marks SJ, Davoodi NM, Felton R, Rothberg A, Goldberg EM. The Effect of COVID-19 on Dual-Eligible Beneficiaries: A Scoping Review. J Am Med Dir Assoc 2023; 24:1565-1572. [PMID: 37696498 PMCID: PMC10576100 DOI: 10.1016/j.jamda.2023.08.007] [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: 03/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To examine the impact of COVID-19 on clinical health outcomes and health-related social needs among Medicaid-Medicare dual-eligible beneficiaries. DESIGN Scoping review. SETTING AND PARTICIPANTS Dual eligibles during COVID-19. METHODS We performed a comprehensive scoping review including observational studies, clinical trials, and original empirical research studies of PubMed and CINAHL. We generated a list of terms related to programs that both serve dual eligibles and address our desired outcomes. With the assistance of a medical librarian, we identified relevant abstracts published during COVID-19 meeting our inclusion criteria. We performed full-text reviews of relevant abstracts and selected the final studies. We extracted the study population, design, and major findings, then conducted thematic analysis. RESULTS 1100 articles were identified, with 439 deemed relevant. On full text-review, 15 articles met inclusion criteria representing more than 86 million Medicare beneficiaries. No studies were specific only to dual eligibles. Topic areas included in this review include COVID-19 case counts (2 articles), mortality (8 articles), hospitalizations (7 articles), food insecurity (1 article), self-reported mental health (1 article), and social connectedness (2 articles). Dual eligibles had disparate COVID-19-related outcomes from Medicare-only enrollees in 12 of 15 studies. Studies show higher mortality for dual eligibles overall, but this was not true for dual eligibles in nursing homes and assisted living communities. Dual eligibles were more likely to experience food insecurity. More favorably, dual eligibles reported greater social connectedness. CONCLUSIONS AND IMPLICATIONS Dual eligibles had different outcomes from Medicare-only recipients in multiple health outcomes and health-related social needs during COVID-19, but studies are limited, particularly in terms of health-related social needs. Future work focusing on outcomes only among dual-eligible beneficiaries, integrated care programs, and fiscal alignment between Medicare and Medicaid plans may help stakeholders address health needs specific to dual eligibles.
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Affiliation(s)
- Sarah J Marks
- Department of Health Behavior and Policy and MSTP Program, Virginia Commonwealth University, Richmond, VA, USA.
| | - Natalie M Davoodi
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | | | | | - Elizabeth M Goldberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA
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Barceló MA, Saez M. Impact of the COVID-19 Pandemic on the Socioeconomic Inequalities in Mortality in Spanish Provinces. J Epidemiol Glob Health 2023; 13:453-475. [PMID: 37294460 PMCID: PMC10250865 DOI: 10.1007/s44197-023-00125-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Although many studies have assessed the socioeconomic inequalities caused by COVID-19 in several health outcomes, there are numerous issues that have been poorly addressed. For instance, have socioeconomic inequalities in mortality from COVID-19 increased? What impact has the pandemic had on inequalities in specific causes of mortality other than COVID-19? Are the inequalities in COVID-19 mortality different from other causes? In this paper we have attempted to answer these questions for the case of Spain. METHODS We used a mixed longitudinal ecological design in which we observed mortality from 2005 to 2020 in the 54 provinces into which Spain is divided. We considered mortality from all causes, not excluding, and excluding mortality from COVID-19; and cause-specific mortality. We were interested in analysing the trend of the outcome variables according to inequality, controlling for both observed and unobserved confounders. RESULTS Our main finding was that the increased risk of dying in 2020 was greater in the Spanish provinces with greater inequality. In addition, we have found that: (i) the pandemic has exacerbated socioeconomic inequalities in mortality, (ii) COVID-19 has led to gender differences in the variations in risk of dying (higher in the case of women) and (iii) only in cardiovascular diseases and Alzheimer did the increased risk of dying differ between the most and least unequal provinces. The increase in the risk of dying was different by gender (greater in women) for cardiovascular diseases and cancer. CONCLUSION Our results can be used to help health authorities know where and in which population groups future pandemics will have the greatest impact and, therefore, be able to take appropriate measures to prevent such effects.
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Affiliation(s)
- Maria A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, Girona, Spain.
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
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Acolin J, Fishman P. Beyond the biomedical, towards the agentic: A paradigm shift for population health science. Soc Sci Med 2023; 326:115950. [PMID: 37148746 PMCID: PMC10154061 DOI: 10.1016/j.socscimed.2023.115950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/02/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023]
Abstract
Life expectancy in the United States is decreasing. Health disparities are widening. Growing evidence for and integration of social and structural determinants into theory and practice has not yet improved outcomes. The COVID-19 pandemic reinforced the fact. In this paper, we argue that the biomedical model and its underlying scientific paradigm of causal determinism, which currently dominate population health, cannot meet population health needs. While criticism of the biomedical model is not new, this paper advances the field by going beyond criticism to recognize the need for a paradigm shift. In the first half of the paper, we present a critical analysis of the biomedical model and the paradigm of causal determinism. In the second half, we outline the agentic paradigm and present a structural model of health based on generalizable, group-level processes. We use the experience of the COVID-19 pandemic to illustrate the practical applications of our model. It will be important for future work to investigate the empirical and pragmatic applications of our structural model of population health.
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Affiliation(s)
- Jessica Acolin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Paul Fishman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Adair T. Premature cardiovascular disease mortality with overweight and obesity as a risk factor: estimating excess mortality in the United States during the COVID-19 pandemic. Int J Obes (Lond) 2023; 47:273-279. [PMID: 36725980 PMCID: PMC9891892 DOI: 10.1038/s41366-023-01263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND The United States has experienced high levels of excess mortality during the COVID-19 pandemic and also has high prevalence of overweight and obesity, which increases the risk of severe infection and death from the virus. This study uses multiple cause of death data to estimate excess premature cardiovascular disease mortality in the USA in 2020 for which overweight and obesity was a risk factor. METHODS The contribution of overweight and obesity to premature (35-74 years) cardiovascular disease mortality was measured as cardiovascular disease reported on the death certificate with one or more of diabetes, chronic kidney disease, obesity, lipidemias or hypertensive heart disease (DKOLH-CVD). Excess mortality was calculated as the difference between actual and expected age-standardised death rates. Expected deaths were estimated using negative binomial regressions of monthly deaths during 2010-19. RESULTS Excess DKOLH-CVD mortality in March-December 2020 was 29% (95% uncertainty interval 28-31%) for males and 30% (28-32%) for females, much higher than for all causes (males 19% (18-21%), females 16% (14-17%)). Excess mortality was higher where two or more DKOLH conditions (males 40% (37-43%), females 41% (37-44%)) or obesity (males 42% (38-45%), females 47% (43-51%)) were reported. One-half of excess DKOLH-CVD mortality was reported as due to COVID-19, lower than the four-fifths of excess all-cause deaths. For home deaths, just over 10% of excess mortality for each cause classification was reported as due to COVID-19. CONCLUSIONS Excess premature cardiovascular disease mortality in the USA for which overweight and obesity was a risk factor was considerably higher than for all causes, exacerbating adverse pre-pandemic trends. The contribution of COVID-19 to excess mortality appears significantly under-reported for home deaths.
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Affiliation(s)
- Tim Adair
- grid.1008.90000 0001 2179 088XThe Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
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Grigson PS, Hobkirk AL, Grigson PS, Hobkirk AL. Addiction III: From mouse to man. Brain Res Bull 2023; 193:22-26. [PMID: 36464128 DOI: 10.1016/j.brainresbull.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Patricia Sue Grigson
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, USA.
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, USA.
| | - Patricia Sue Grigson
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, USA
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, USA
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Chen B, Liu Y, Yan B, Wu L, Zhang X. Why were some countries more successful than others in curbing early COVID-19 mortality impact? A cross-country configurational analysis. PLoS One 2023; 18:e0282617. [PMID: 36888633 PMCID: PMC9994757 DOI: 10.1371/journal.pone.0282617] [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] [Received: 04/04/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
Why was there considerable variation in initial COVID-19 mortality impact across countries? Through a configurational lens, this paper examines which configurations of five conditions-a delayed public-health response, past epidemic experience, proportion of elderly in population, population density, and national income per capita-influence early COVID-19 mortality impact measured by years of life lost (YLL). A fuzzy-set qualitative comparative analysis (fsQCA) of 80 countries identifies four distinctive pathways associated with high YLL rate and four other different pathways leading to low YLL rate. Results suggest that there is no singular "playbook"-a set of policies that countries can follow. Some countries failed differently, whereas others succeeded differently. Countries should take into account their situational contexts to adopt a holistic response strategy to combat any future public-health crisis. Regardless of the country's past epidemic experience and national income levels, a speedy public-health response always works well. For high-income countries with high population density or past epidemic experience, they need to take extra care to protect elderly populations who may otherwise overstretch healthcare capacity.
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Affiliation(s)
- Bin Chen
- Marxe School of Public and International Affairs, Baruch College & The Graduate Center, The City University of New York, New York, New York, United States of America
| | - Yao Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Bo Yan
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- * E-mail:
| | - Long Wu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaomin Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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14
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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: 0] [Impact Index Per Article: 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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15
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Di Ciaula A, Moshammer H, Lauriola P, Portincasa P. Environmental health, COVID-19, and the syndemic: internal medicine facing the challenge. Intern Emerg Med 2022; 17:2187-2198. [PMID: 36181580 PMCID: PMC9525944 DOI: 10.1007/s11739-022-03107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. These elements cannot be neglected, and a wide view of public health aspects by a "one-health" approach is strongly and urgently recommended. According to World Health Organization, 35% of infectious diseases involving the lower respiratory tract depend on environmental factors, and infections from SARS-Cov-2 is not an exception. Furthermore, environmental pollution generates a large burden of non-communicable diseases and disabilities, increasing the individual vulnerability to COVID-19 and the chance for the resilience of large communities worldwide. In this field, the awareness of internists must increase, as privileged healthcare providers. They need to gain a comprehensive knowledge of elements characterizing COVID-19 as part of a syndemic. This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.
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Affiliation(s)
- Agostino Di Ciaula
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
- International Society of Doctors for Environment (ISDE), Geneva, Switzerland
| | - Hanns Moshammer
- International Society of Doctors for Environment (ISDE), Geneva, Switzerland
- Department of Environmental Health, Center for Public Health, Medical University Vienna, 1090 Vienna, Austria
- Department of Hygiene, Medical University of Karakalpakstan, Nukus, Uzbekistan 230100
| | - Paolo Lauriola
- International Society of Doctors for Environment (ISDE), Geneva, Switzerland
| | - Piero Portincasa
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
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16
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McGowan VJ, Bambra C. COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities. Lancet Public Health 2022; 7:e966-e975. [PMID: 36334610 PMCID: PMC9629845 DOI: 10.1016/s2468-2667(22)00223-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
COVID-19 has exacerbated endemic health inequalities resulting in a syndemic pandemic of higher mortality and morbidity rates among the most socially disadvantaged. We did a scoping review to identify and synthesise published evidence on geographical inequalities in COVID-19 mortality rates globally. We included peer-reviewed studies, from any country, written in English that showed any area-level (eg, neighbourhood, town, city, municipality, or region) inequalities in mortality by socioeconomic deprivation (ie, measured via indices of multiple deprivation: the percentage of people living in poverty or proxy factors including the Gini coefficient, employment rates, or housing tenure). 95 papers from five WHO global regions were included in the final synthesis. A large majority of the studies (n=86) found that COVID-19 mortality rates were higher in areas of socioeconomic disadvantage than in affluent areas. The subsequent discussion reflects on how the unequal nature of the pandemic has resulted from a syndemic of COVID-19 and endemic inequalities in chronic disease burden.
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Affiliation(s)
- Victoria J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Fuse-The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.
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17
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Chandran A, Purbey R, Leifheit KM, Evans KM, Baez JV, Althoff KN. County-Level Life Expectancy Change: A Novel Metric for Monitoring Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10672. [PMID: 36078387 PMCID: PMC9517827 DOI: 10.3390/ijerph191710672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Life expectancy (LE) is a core measure of population health. Studies have confirmed the predictive importance of modifiable determinants on LE, but less is known about their association with LE change over time at the US county level. In addition, we explore the predictive association of LE change with COVID-19 mortality. We used a linear regression model to calculate county-level annual LE change from 2011 to 2016, and categorized LE change (≤-0.1 years change per year as decreasing, ≥0.1 years as increasing, otherwise no change). A multinomial regression model was used to determine the association between modifiable determinants of health indicators from the County Health Rankings and LE change. A Poisson regression model was used to evaluate the relationship between change in life expectancy and COVID-19 mortality through September 2021. Among 2943 counties, several modifiable determinants of health were significantly associated with odds of being in increasing LE or decreasing LE counties, including adult smoking, obesity, unemployment, and proportion of children in poverty. The presence of an increasing LE in 2011-2016, as compared to no change, was significantly associated with a 5% decrease in COVID-19 mortality between 2019 and 2021 (β = 0.953, 95% CI: 0.943, 0.963). We demonstrated that change in LE at the county level is a useful metric for tracking public health progress, measuring the impact of public health initiatives, and gauging preparedness and vulnerability for future public health emergencies.
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Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ritika Purbey
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Kathryn M. Leifheit
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Kirsten McGhie Evans
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jocelyn Velasquez Baez
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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18
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Shesha N, Melebari S, Alghamdi S, Refaat B, Naffadi H, Alquthami K. Associations of Clinical Factors and Blood Groups With the Severity of COVID-19 Infection in Makkah City, Saudi Arabia. Front Cell Infect Microbiol 2022; 12:870096. [PMID: 35800382 PMCID: PMC9255230 DOI: 10.3389/fcimb.2022.870096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Context The possible associations between the different blood groups and clinical factors with COVID-19 infection among patients in Makkah city. Objective To investigate the relationship between ABO blood groups and COVID-19 infection in patients who were tested positive and to elucidate the most common ABO blood groups with a higher infectivity of COVID-19 and disease association. Materials and Methods This was an observational cross-sectional study that included COVID-19 patients diagnosed with PCR and who were hospitalized in Al-Noor Specialist Hospital (Makkah) during the period between March to November 2020. The ABO and Rhesus blood groups alongside the clinical characteristics were determined and retrieved from medical records and HESN of the Ministry of Health of the Kingdom of Saudi Arabia (KSA). Results The overall confirmed COVID-19 cases included in this study were 1,583 patients who underwent positive PCR testing between March and November 2020. The frequencies of blood groups were as follows: group O+ (37%), group A+ (29.2%), group B+ (22.6%), group AB+ (5.1%), group O- (2.8%), group B- (1.8%), group A- (1.1%), and group AB- (0.4%). However, no significant correlations were observed for ABO groups and Rh types with the severity of COVID-19 illness. Conversely, signs and symptoms of respiratory distress syndrome (RDS), pneumonia, and respiratory failure symptoms, alongside a history of diabetes mellitus, hypertension, chronic kidney diseases, and congestive heart failure significantly increased the risk of death from COVID-19 infection. Moreover, the rates of fever, cough, and asthma were markedly lower in the deceased group compared with the recovered group of patients. Conclusion The association between the different blood groups with the prevalence and mortality of COVID-19 among infected patients has yet to be elucidated as we found no significant differences in the observed versus expected distribution of ABO phenotypes among the included cases. The prevalence of RDS, pneumonia, and respiratory failure was found higher among hospitalized COVID-19 patients in the deceased group. However, other factors such as fever, cough, and asthma appeared to be more significantly lower than in the recovered group.
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Affiliation(s)
- Nashwa Shesha
- Serology and Immunology Department, Hera General Hospital, Makkah Healthcare Cluster, Makkah, Saudi Arabia
- *Correspondence: Nashwa Shesha,
| | - Sami Melebari
- Molecular Biology Department, The Regional Laboratory, Ministry of Health, Makkah, Saudi Arabia
| | - Saad Alghamdi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hind Naffadi
- Medical Genetics Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khalid Alquthami
- Molecular Biology Department, Al-Noor Specialist Hospital, Makkah Healthcare Cluster, Makkah, Saudi Arabia
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19
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Schlüter BS, Masquelier B, Camarda CG. Heterogeneity in subnational mortality in the context of the COVID-19 pandemic: the case of Belgian districts in 2020. Arch Public Health 2022; 80:130. [PMID: 35524287 PMCID: PMC9073828 DOI: 10.1186/s13690-022-00874-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/26/2022] [Indexed: 03/29/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to major shocks in mortality trends in many countries. Yet few studies have evaluated the heterogeneity of the mortality shocks at the sub-national level, rigorously accounting for the different sources of uncertainty. METHODS Using death registration data from Belgium, we first assess change in the heterogeneity of districts' standardized mortality ratios in 2020, when compared to previous years. We then measure the shock effect of the pandemic using district-level values of life expectancy, comparing districts' observed and projected life expectancy, accounting for all sources of uncertainty (stemming from life-table construction at district level and from projection methods at country and district levels). Bayesian modelling makes it easy to combine the different sources of uncertainty in the assessment of the shock. This is of particular interest at a finer geographical scale characterized by high stochastic variation in annual death counts. RESULTS The heterogeneity in the impact of the pandemic on all-cause mortality across districts is substantial: while some districts barely show any impact, the Bruxelles-Capitale and Mons districts experienced a decrease in life expectancy at birth of 2.24 (95% CI:1.33-3.05) and 2.10 (95% CI:0.86-3.30) years, respectively. The year 2020 was associated with an increase in the heterogeneity of mortality levels at a subnational scale in comparison to past years, measured in terms of both standardized mortality ratios and life expectancies at birth. Decisions on uncertainty thresholds have a large bearing on the interpretation of the results. CONCLUSION Developing sub-national mortality estimates taking careful account of uncertainty is key to identifying which areas have been disproportionately affected.
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Affiliation(s)
| | - Bruno Masquelier
- IACCHOS (DEMO), Catholic University of Louvain (UCLouvain), Louvain-la-Neuve, Belgium
| | - Carlo Giovanni Camarda
- Mortality, Health and Epidemiology, Institut National d'Etudes Démographiques (INED), Paris, France
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20
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Handley SC, Ledyard R, Lundsberg LS, Passarella M, Yang N, Son M, McKenney K, Greenspan J, Dysart K, Culhane JF, Burris HH. Changes in prenatal testing during the COVID-19 pandemic. Front Pediatr 2022; 10:1064039. [PMID: 36440341 PMCID: PMC9682111 DOI: 10.3389/fped.2022.1064039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery, including prenatal care. The study objective was to assess if timing of routine prenatal testing changed during the COVID-19 pandemic. METHODS Retrospective observational cohort study using claims data from a regional insurer (Highmark) and electronic health record data from two academic health systems (Penn Medicine and Yale New Haven) to compare prenatal testing timing in the pre-pandemic (03/10/2018-12/31/2018 and 03/10/2019-12/31/2019) and early COVID-19 pandemic (03/10/2020-12/31/2020) periods. Primary outcomes were second trimester fetal anatomy ultrasounds and gestational diabetes (GDM) testing. A secondary analysis examined first trimester ultrasounds. RESULTS The three datasets included 31,474 pregnant patients. Mean gestational age for second trimester anatomy ultrasounds increased from the pre-pandemic to COVID-19 period (Highmark 19.4 vs. 19.6 weeks; Penn: 20.1 vs. 20.4 weeks; Yale: 18.8 vs. 19.2 weeks, all p < 0.001). There was a detectable decrease in the proportion of patients who completed the anatomy survey <20 weeks' gestation across datasets, which did not persist at <23 weeks' gestation. There were no consistent changes in timing of GDM screening. There were significant reductions in the proportion of patients with first trimester ultrasounds in the academic institutions (Penn: 57.7% vs. 40.6% and Yale: 78.7% vs. 65.5%, both p < 0.001) but not Highmark. Findings were similar with multivariable adjustment. CONCLUSION While some prenatal testing happened later in pregnancy during the pandemic, pregnant patients continued to receive appropriately timed testing. Despite disruptions in care delivery, prenatal screening remained a priority for patients and providers during the COVID-19 pandemic.
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Affiliation(s)
- Sara C Handley
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
| | - Rachel Ledyard
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Services, Yale School of Medicine, New Haven, CT, United States
| | - Molly Passarella
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Nancy Yang
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Moeun Son
- Department of Obstetrics, Gynecology, and Reproductive Services, Yale School of Medicine, New Haven, CT, United States
| | - Kathryn McKenney
- Department of Obstetrics & Gynecology, University of Colorado, Aurora, CO, United States
| | - Jay Greenspan
- Division of Neonatology, Nemours duPont Pediatrics, Philadelphia, PA, United States.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kevin Dysart
- Division of Neonatology, Nemours duPont Pediatrics, Philadelphia, PA, United States.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jennifer F Culhane
- Department of Obstetrics & Gynecology, University of Colorado, Aurora, CO, United States
| | - Heather H Burris
- Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
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