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Ottaway Z, Campbell L, Fox J, Burns F, Hamzah L, Kegg S, Rosenvinge M, Schoeman S, Price D, Jones R, Miller RF, Tariq S, Post FA. HIV outcomes during the COVID-19 pandemic in people of Black ethnicities living with HIV in England. HIV Med 2024; 25:885-892. [PMID: 38529684 DOI: 10.1111/hiv.13640] [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: 01/25/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To describe HIV care outcomes in people of Black ethnicities living in England during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic. METHODS This was an observational cohort study of people of self-reported Black ethnicities attending for HIV care at nine HIV clinics across England. The primary outcome was a composite of antiretroviral therapy (ART) interruption and HIV viraemia (HIV RNA ≥200 copies/mL) ascertained via self-completed questionnaires and review of medical records. We used multivariable logistic regression to explore associations between ART interruption/HIV viraemia and demographic factors, pre-pandemic HIV immunovirological control, comorbidity status, and COVID-19 disease and vaccination status. RESULTS We included 2290 people (median age 49.3 years; 56% female; median CD4 cell count 555 cells/mm3; 92% pre-pandemic HIV RNA <200 copies/mL), of whom 302 (13%) reported one or more ART interruption, 312 (14%) had documented HIV viraemia ≥200 copies/mL, and 401 (18%) experienced the composite endpoint of ART interruption/HIV viraemia. In multivariable analysis, a pre-pandemic HIV RNA <200 copies/mL (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.15-0.30) and being vaccinated against SARS-CoV-2 (OR 0.41; 95% CI 0.30-0.55) were associated with reduced odds of ART interruption/HIV viraemia; pandemic-related disruptions to HIV care were common self-reported additional factors. CONCLUSIONS During the COVID-19 pandemic, one in six people of Black ethnicities in this HIV cohort experienced an ART interruption/HIV viraemia. Some of these episodes resulted from pandemic-related healthcare disruptions. Associations with suboptimal engagement in HIV care pre-pandemic and not being vaccinated against SARS-CoV-2 suggest that wider health beliefs and/or poor healthcare access may have been contributory factors.
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Affiliation(s)
- Zoe Ottaway
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Lucy Campbell
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Julie Fox
- King's College London, London, UK
- Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Fiona Burns
- Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, University College London, London, UK
| | - Lisa Hamzah
- St Georges University Hospital NHS Foundation Trust, London, UK
| | | | | | | | - David Price
- Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Rachael Jones
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
- Central and North West London Foundation Trust, London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
- Central and North West London Foundation Trust, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
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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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3
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Ottaway Z, Campbell L, Cechin LR, Patel N, Fox J, Burns F, Hamzah L, Kegg S, Rosenvinge M, Schoeman S, Price D, Jones R, Clarke A, Maan I, Ustianowski A, Onyango D, Tariq S, Miller RF, Post FA. Clinical epidemiology of COVID-19 in people of black ethnicity living with HIV in the UK. HIV Med 2024; 25:614-621. [PMID: 38213094 DOI: 10.1111/hiv.13611] [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: 09/12/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To describe the clinical epidemiology of COVID-19 in people of black ethnicity living with HIV in the UK. METHODS We investigated the incidence and factors associated with COVID-19 in a previously established and well-characterized cohort of black people with HIV. Primary outcomes were COVID-19 acquisition and severe COVID-19 disease (requiring hospitalization and/or resulting in death). Cumulative incidence was analysed using Nelson-Aalen methods, and associations between demographic, pre-pandemic immune-virological parameters, comorbidity status and (severe) COVID-19 were identified using Cox regression analysis. RESULTS COVID-19 status was available for 1847 (74%) of 2495 COVID-AFRICA participants (median age 49.6 years; 56% female; median CD4 cell count = 555 cells/μL; 93% HIV RNA <200 copies/mL), 573 (31%) of whom reported at least one episode of COVID-19. The cumulative incidence rates of COVID-19 and severe COVID-19 were 31.0% and 3.4%, respectively. Region of ancestry (East/Southern/Central vs. West Africa), nadir CD4 count and kidney disease were associated with COVID-19 acquisition. Diabetes mellitus [adjusted hazard ratio (aHR) = 2.39, 95% confidence interval (CI): 1.26-4.53] and kidney disease (aHR = 2.53, 95% CI: 1.26-4.53) were associated with an increased risk, and recent CD4 count >500 cells/μL (aHR = 0.49, 95% CI: 0.25-0.93) with a lower risk of severe COVID-19. CONCLUSIONS Region of ancestry was associated with COVID-19 acquisition, and immune and comorbidity statuses were associated with COVID-19 disease severity in people of black ethnicity living with HIV in the UK.
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Affiliation(s)
- Zoe Ottaway
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Lucy Campbell
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Laura R Cechin
- King's College Hospital NHS Foundation Trust, London, UK
| | - Nisha Patel
- King's College Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- King's College London, London, UK
- Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Fiona Burns
- Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, University College London, London, UK
| | - Lisa Hamzah
- St George's University Hospital NHS Foundation Trust, London, UK
| | | | | | | | - David Price
- Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Rachael Jones
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Amanda Clarke
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Irfaan Maan
- Institute for Global Health, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Shema Tariq
- Institute for Global Health, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
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Lam T, Saso A, Torres Ortiz A, Hatcher J, Woodman M, Chandran S, Thistlethwayte R, Best T, Johnson M, Wagstaffe H, Mai A, Buckland M, Gilmour K, Goldblatt D, Grandjean L. Socioeconomic and Demographic Risk Factors for SARS-CoV-2 Seropositivity Among Healthcare Workers in a UK Hospital: A Prospective Cohort Study. Clin Infect Dis 2024; 78:594-602. [PMID: 37647517 PMCID: PMC10954340 DOI: 10.1093/cid/ciad522] [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: 05/08/2023] [Revised: 07/26/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND To protect healthcare workers (HCWs) from the consequences of disease due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is necessary to understand the risk factors that drive exposure and infection within hospitals. Insufficient consideration of key socioeconomic variables is a limitation of existing studies that can lead to bias and residual confounding of proposed risk factors for infection. METHODS The Co-STARs study prospectively enrolled 3679 HCWs between April 2020 and September 2020. We used multivariate logistic regression to comprehensively characterize the demographic, occupational, socioeconomic, and environmental risk factors for SARS-CoV-2 seropositivity. RESULTS After adjusting for key confounders, relative household overcrowding (odds ratio [OR], 1.4 [95% confidence interval {CI}, 1.1-1.9]; P = .006), Black, Black British, Caribbean, or African ethnicity (OR, 1.7 [95% CI, 1.2-2.3]; P = .003), increasing age (ages 50-60 years: OR, 1.8 [95% CI, 1.3-2.4]; P < .001), lack of access to sick pay (OR, 1.8 [95% CI, 1.3-2.4]; P < .001). CONCLUSIONS Socioeconomic and demographic factors outside the hospital were the main drivers of infection and exposure to SARS-CoV-2 during the first wave of the pandemic in an urban pediatric referral hospital. Overcrowding and out-of-hospital SARS-CoV-2 contact are less amenable to intervention. However, lack of access to sick pay among externally contracted staff is more easily rectifiable. Our findings suggest that providing easier access to sick pay would lead to a decrease in SARS-CoV-2 transmission and potentially that of other infectious diseases in hospital settings. CLINICAL TRIALS REGISTRATION NCT04380896.
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Affiliation(s)
- Tanya Lam
- Department of Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Anja Saso
- Department of Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom
- Department of Tropical and Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Arturo Torres Ortiz
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital, London, United Kingdom
| | - Marc Woodman
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Shruthi Chandran
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | | | - Timothy Best
- Department of Microbiology, Great Ormond Street Hospital, London, United Kingdom
| | - Marina Johnson
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Helen Wagstaffe
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Annabelle Mai
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - Matthew Buckland
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - Kimberly Gilmour
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - David Goldblatt
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Louis Grandjean
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
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5
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Frey A, Tilstra AM, Verhagen MD. Inequalities in healthcare use during the COVID-19 pandemic. Nat Commun 2024; 15:1894. [PMID: 38424038 PMCID: PMC10904793 DOI: 10.1038/s41467-024-45720-2] [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: 05/08/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
The COVID-19 pandemic led to reductions in non-COVID related healthcare use, but little is known whether this burden is shared equally. This study investigates whether reductions in administered care disproportionately affected certain sociodemographic strata, in particular marginalised groups. Using detailed medical claims data from the Dutch universal health care system and rich full population registry data, we predict expected healthcare use based on pre-pandemic trends (2017 - Feb 2020) and compare these expectations with observed healthcare use in 2020 and 2021. Our findings reveal a 10% decline in the number of weekly treated patients in 2020 and a 3% decline in 2021 relative to prior years. These declines are unequally distributed and are more pronounced for individuals below the poverty line, females, older people, and individuals with a migrant background, particularly during the initial wave of COVID-19 hospitalisations and for middle and low urgency procedures. While reductions in non-COVID related healthcare decreased following the initial shock of the pandemic, inequalities persist throughout 2020 and 2021. Our results demonstrate that the pandemic has not only had an unequal toll in terms of the direct health burden of the pandemic, but has also had a differential impact on the use of non-COVID healthcare.
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Affiliation(s)
- Arun Frey
- Leverhulme Centre for Demographic Science, 42 Park End St, Oxford, OX1 1JD, UK
- Nuffield College, University of Oxford, 1 New Rd, Oxford, OX1 1NF, UK
- Amsterdam Health and Technology Institute, Paasheuvelweg 25, Amsterdam, 1105 BP, The Netherlands
- Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, USA
- Department of Sociology, University of Oxford, 42 Park End St, Oxford, OX3 7LF, UK
| | - Andrea M Tilstra
- Leverhulme Centre for Demographic Science, 42 Park End St, Oxford, OX1 1JD, UK
- Nuffield College, University of Oxford, 1 New Rd, Oxford, OX1 1NF, UK
- Department of Sociology, University of Oxford, 42 Park End St, Oxford, OX3 7LF, UK
- Nuffield Department of Population Health, University of Oxford, 42 Park End St, Oxford, OX1 1JD, UK
| | - Mark D Verhagen
- Leverhulme Centre for Demographic Science, 42 Park End St, Oxford, OX1 1JD, UK.
- Nuffield College, University of Oxford, 1 New Rd, Oxford, OX1 1NF, UK.
- Amsterdam Health and Technology Institute, Paasheuvelweg 25, Amsterdam, 1105 BP, The Netherlands.
- Department of Sociology, University of Oxford, 42 Park End St, Oxford, OX3 7LF, UK.
- Nuffield Department of Population Health, University of Oxford, 42 Park End St, Oxford, OX1 1JD, UK.
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6
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Toal CM, Fowler AJ, Pearse RM, Puthucheary Z, Prowle JR, Wan YI. Health Resource Utilisation and Disparities: an Ecological Study of Admission Patterns Across Ethnicity in England Between 2017 and 2020. J Racial Ethn Health Disparities 2023; 10:2872-2881. [PMID: 36471147 PMCID: PMC9734479 DOI: 10.1007/s40615-022-01464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The COVID-19 pandemic highlighted adverse outcomes in Asian, Black, and ethnic minority groups. More research is required to explore underlying ethnic health inequalities. In this study, we aim to examine pre-COVID ethnic inequalities more generally through healthcare utilisation to contextualise underlying inequalities that were present before the pandemic. DESIGN This was an ecological study exploring all admissions to NHS hospitals in England from 2017 to 2020. METHODS The primary outcomes were admission rates within ethnic groups. Secondary outcomes included age-specific and age-standardised admission rates. Sub-analysis of admission rates across an index of multiple deprivation (IMD) deciles was also performed to contextualise the impact of socioeconomic differences amongst ethnic categories. Results were presented as a relative ratio (RR) with 95% confidence intervals. RESULTS Age-standardised admission rates were higher in Asian (RR 1.40 [1.38-1.41] in 2019) and Black (RR 1.37 [1.37-1.38]) and lower in Mixed groups (RR 0.91 [0.90-0.91]) relative to White. There was significant missingness or misassignment of ethnicity in NHS admissions: with 11.7% of admissions having an unknown/not-stated ethnicity assignment and 'other' ethnicity being significantly over-represented. Admission rates did not mirror the degree of deprivation across all ethnic categories. CONCLUSIONS This study shows Black and Asian ethnic groups have higher admission rates compared to White across all age groups and when standardised for age. There is evidence of incomplete and misidentification of ethnicity assignment in NHS admission records, which may introduce bias to work on these datasets. Differences in admission rates across individual ethnic categories cannot solely be explained by socioeconomic status. Further work is needed to identify ethnicity-specific factors of these inequalities to allow targeted interventions at the local level.
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Affiliation(s)
- C M Toal
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK.
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK.
| | - A J Fowler
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - R M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - Z Puthucheary
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - J R Prowle
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - Y I Wan
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
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7
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Thomson WR, Puthucheary ZA, Wan YI. Critical care and pandemic preparedness and response. Br J Anaesth 2023; 131:847-860. [PMID: 37689541 PMCID: PMC10636520 DOI: 10.1016/j.bja.2023.07.026] [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: 03/08/2023] [Revised: 06/21/2023] [Accepted: 07/23/2023] [Indexed: 09/11/2023] Open
Abstract
Critical care was established partially in response to a polio epidemic in the 1950s. In the intervening 70 yr, several epidemics and pandemics have placed critical care and allied services under extreme pressure. Pandemics cause wholesale changes to accepted standards of practice, require reallocation and retargeting of resources and goals of care. In addition to clinical acumen, mounting an effective critical care response to a pandemic requires local, national, and international coordination in a diverse array of fields from research collaboration and governance to organisation of critical care networks and applied biomedical ethics in the eventuality of triage situations. This review provides an introduction to an array of topics that pertain to different states of pandemic acuity: interpandemic preparedness, alert, surge activity, recovery and relapse through the literature and experience of recent pandemics including COVID-19, H1N1, Ebola, and SARS.
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Affiliation(s)
- William R Thomson
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
| | - Zudin A Puthucheary
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Yize I Wan
- Adult Critical Care Unit, Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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8
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Webber KT, Stifano S, Davis SM, Stifano SC. Considering Social Identity Threat Alongside the Health Belief Model to Examine Mask-Wearing Intentions of Black, Latinx, and Asian Individuals in the U.S. During COVID-19. HEALTH COMMUNICATION 2023; 38:2313-2325. [PMID: 35532016 DOI: 10.1080/10410236.2022.2067384] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
During the COVID-19 pandemic, U.S. public health officials have recommended various safety protocols to "stop the spread", and atop the list is wearing a mask. Individuals from particular racial groups have also contended with a surge of racial profiling and race-based discrimination that has positioned mask-wearing as a risky yet health-promoting behavior. Using the health belief model (HBM), this study considers how racism and health intersect by examining the emotions, behavioral intentions, and health outcomes of mask-wearing among Black, Latinx, and Asian individuals. Cross-sectional survey data from 521 participants from across the United States were collected and analyzed using quantitative analyses. Results did not indicate significant differences in mask-wearing intentions between racial groups as predicted by the health belief model constructs; however, group differences in experiences of racism did shape perceptions of and behaviors related to mask-wearing. Mask-wearing was also related to more positive emotional experiences, and social cues to action predicted intentions to wear a mask. Implications for encouraging health-promoting behaviors across diverse populations during public health crises are discussed.
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Affiliation(s)
| | - Sara Stifano
- Department of Communication, University of Connecticut
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9
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Urdiales T, Dernie F, Català M, Prats-Uribe A, Prats C, Prieto-Alhambra D. Association between ethnic background and COVID-19 morbidity, mortality and vaccination in England: a multistate cohort analysis using the UK Biobank. BMJ Open 2023; 13:e074367. [PMID: 37734898 PMCID: PMC10514643 DOI: 10.1136/bmjopen-2023-074367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/26/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES Despite growing evidence suggesting increased COVID-19 mortality among people from ethnic minorities, little is known about milder forms of SARS-CoV-2 infection. We sought to explore the association between ethnic background and the probability of testing, testing positive, hospitalisation, COVID-19 mortality and vaccination uptake. DESIGN A multistate cohort analysis. Participants were followed between 8 April 2020 and 30 September 2021. SETTING The UK Biobank, which stores medical data on around half a million people who were recruited between 2006 and 2010. PARTICIPANTS 405 541 subjects were eligible for analysis, limited to UK Biobank participants living in England. 23 891 (6%) of participants were non-white. PRIMARY AND SECONDARY OUTCOME MEASURES The associations between ethnic background and testing, testing positive, hospitalisation and COVID-19 mortality were studied using multistate survival analyses. The association with single and double-dose vaccination was also modelled. Multistate models adjusted for age, sex and socioeconomic deprivation were fitted to estimate adjusted HRs (aHR) for each of the multistate transitions. RESULTS 18 172 (4.5%) individuals tested positive, 3285 (0.8%) tested negative and then positive, 1490 (6.9% of those tested positive) were hospitalised, and 129 (0.6%) tested positive at the moment of hospital admission (ie, direct hospitalisation). Finally, 662 (17.4%) died after admission. Compared with white participants, Asian participants had an increased risk of negative to positive transition (aHR 1.24 (95% CI 1.02 to 1.52)), testing positive (95% CI 1.44 (1.33 to 1.55)) and direct hospitalisation (1.61 (95% CI 1.28 to 2.03)). Black participants had an increased risk of hospitalisation following a positive test (1.71 (95% CI 1.29 to 2.27)) and direct hospitalisation (1.90 (95% CI 1.51 to 2.39)). Although not the case for Asians (aHR 1.00 (95% CI 0.98 to 1.02)), black participants had a reduced vaccination probability (0.63 (95% CI 0.62 to 0.65)). In contrast, Chinese participants had a reduced risk of testing negative (aHR 0.64 (95% CI 0.57 to 0.73)), of testing positive (0.40 (95% CI 0.28 to 0.57)) and of vaccination (0.78 (95% CI 0.74 to 0.83)). CONCLUSIONS We identified inequities in testing, vaccination and COVID-19 outcomes according to ethnicity in England. Compared with whites, Asian participants had increased risks of infection and admission, and black participants had almost double hospitalisation risk, and a 40% lower vaccine uptake.
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Affiliation(s)
- Tomás Urdiales
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
- Department of Energy Technology, Royal Institute of Technology, Stockholm, Sweden
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francesco Dernie
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Martí Català
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Albert Prats-Uribe
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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10
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Siddiq S, Ahmed S, Akram I. Clinical outcomes following COVID-19 infection in ethnic minority groups in the UK: a systematic review and meta-analysis. Public Health 2023; 222:205-214. [PMID: 35970621 PMCID: PMC9181265 DOI: 10.1016/j.puhe.2022.05.019] [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] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study evaluated the differences in clinical outcomes of COVID-19 infection between ethnic minorities and the White ethnic group in the UK. STUDY DESIGN Systematic review and meta-analysis. METHODS This study included adult residents in the UK with confirmed COVID-19 infection. The outcomes evaluated in this study were mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). Outcome data were compared between individuals from ethnic minority groups and individuals from a White ethnic background. MEDLINE, Embase, Cochrane, medRxiv and PROSPERO were searched for articles published between May 2020 and April 2021. The risk of bias was evaluated using the Newcastle-Ottawa Scale checklist. PROSPERO ID CRD42021248117. RESULTS Fourteen studies (767,177 participants) were included in the current review. In the adjusted analysis, the pooled odds ratio (OR) for mortality following COVID-19 infection was higher for Black (OR 1.83, 95% confidence interval [CI]: 1.21-2.76, number of studies [k] = 6), Asian (OR 1.16, 95% CI: 0.85-1.57, k = 6) and Mixed and Other (MO) ethnic groups (OR 1.12, 95% CI: 1.04-1.20, k = 5) compared with the White ethnic group. The adjusted and unadjusted ORs of ICU admission for many of the ethnic minority groups were more than double the OR values for the White ethnic group (Black ethnic group = OR 2.32, 95% CI: 1.73-3.11, k = 5; Asian ethnic group = OR 2.34, 95% CI: 1.89-2.90, k = 5; and MO ethnic group = OR 2.26, 95% CI: 1.64-3.11, k = 4). In the adjusted analysis for IMV, the ORs were similarly significantly raised in ethnic minority groups compared with the White ethnic group (Black ethic group = OR 2.03, 95% CI: 1.80-2.29, k = 3; Asian ethnic group = OR 1.84, 95% CI: 1.20-2.80, k = 3; and MO ethnic group = OR 2.09, 95% CI: 1.35-3.22, k = 3). CONCLUSION This review found that in the UK, Black, Asian and MO ethnic groups experienced increased COVID-19-related disease severity and mortality compared with the White ethnic group majority.
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Affiliation(s)
- S Siddiq
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; UK Health Security Agency, UK.
| | - S Ahmed
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; National Institute of Health Research Applied Research Collaboration for Greater Manchester (NIHR ARC-GM), UK
| | - I Akram
- Southend Clinical Commissioning Group, UK; Valkyrie Surgery, Westcliff-On-Sea, UK; West Central Primary Care Network, UK; Royal College of General Practitioners, London, UK
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11
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Wan YI, Puthucheary ZA, Pearse RM, Prowle JR. Characterising biological mechanisms underlying ethnicity-associated outcomes in COVID-19 through biomarker trajectories: a multicentre registry analysis. Br J Anaesth 2023; 131:491-502. [PMID: 37198030 PMCID: PMC10121108 DOI: 10.1016/j.bja.2023.04.008] [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: 02/07/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Differences in routinely collected biomarkers between ethnic groups could reflect dysregulated host responses to disease and to treatments, and be associated with excess morbidity and mortality in COVID-19. METHODS A multicentre registry analysis from patients aged ≥16 yr with SARS-CoV-2 infection and emergency admission to Barts Health NHS Trust hospitals during January 1, 2020 to May 13, 2020 (wave 1) and September 1, 2020 to February 17, 2021 (wave 2) was subjected to unsupervised longitudinal clustering techniques to identify distinct phenotypic patient clusters based on trajectories of routine blood results over the first 15 days of hospital admission. Distribution of trajectory clusters across ethnic categories was determined, and associations between ethnicity, trajectory clusters, and 30-day survival were assessed using multivariable Cox proportional hazards modelling. Secondary outcomes were ICU admission, survival to hospital discharge, and long-term survival to 640 days. RESULTS We included 3237 patients with hospital length of stay ≥7 days. In patients who died, there was greater representation of Black and Asian ethnicity in trajectory clusters for C-reactive protein and urea-to-creatinine ratio associated with increased risk of death. Inclusion of trajectory clusters in survival analyses attenuated or abrogated the higher risk of death in Asian and Black patients. Inclusion of C-reactive protein went from hazard ratio (HR) 1.36 [0.95-1.94] to HR 0.97 [0.59-1.59] (wave 1), and from HR 1.42 [1.15-1.75]) to HR 1.04 [0.78-1.39] (wave 2) in Asian patients. Trajectory clusters associated with reduced 30-day survival were similarly associated with worse secondary outcomes. CONCLUSIONS Clinical biochemical monitoring of COVID-19 and progression and treatment response in SARS-CoV-2 infection should be interpreted in the context of ethnic background.
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Affiliation(s)
- Yize I Wan
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Zudin A Puthucheary
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - John R Prowle
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
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12
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Tadayon Najafabadi B, Rayner DG, Shokraee K, Shokraie K, Panahi P, Rastgou P, Seirafianpour F, Momeni Landi F, Alinia P, Parnianfard N, Hemmati N, Banivaheb B, Radmanesh R, Alvand S, Shahbazi P, Dehghanbanadaki H, Shaker E, Same K, Mohammadi E, Malik A, Srivastava A, Nejat P, Tamara A, Chi Y, Yuan Y, Hajizadeh N, Chan C, Zhen J, Tahapary D, Anderson L, Apatu E, Schoonees A, Naude CE, Thabane L, Foroutan F. Obesity as an independent risk factor for COVID-19 severity and mortality. Cochrane Database Syst Rev 2023; 5:CD015201. [PMID: 37222292 PMCID: PMC10207996 DOI: 10.1002/14651858.cd015201] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Since December 2019, the world has struggled with the COVID-19 pandemic. Even after the introduction of various vaccines, this disease still takes a considerable toll. In order to improve the optimal allocation of resources and communication of prognosis, healthcare providers and patients need an accurate understanding of factors (such as obesity) that are associated with a higher risk of adverse outcomes from the COVID-19 infection. OBJECTIVES To evaluate obesity as an independent prognostic factor for COVID-19 severity and mortality among adult patients in whom infection with the COVID-19 virus is confirmed. SEARCH METHODS MEDLINE, Embase, two COVID-19 reference collections, and four Chinese biomedical databases were searched up to April 2021. SELECTION CRITERIA We included case-control, case-series, prospective and retrospective cohort studies, and secondary analyses of randomised controlled trials if they evaluated associations between obesity and COVID-19 adverse outcomes including mortality, mechanical ventilation, intensive care unit (ICU) admission, hospitalisation, severe COVID, and COVID pneumonia. Given our interest in ascertaining the independent association between obesity and these outcomes, we selected studies that adjusted for at least one factor other than obesity. Studies were evaluated for inclusion by two independent reviewers working in duplicate. DATA COLLECTION AND ANALYSIS: Using standardised data extraction forms, we extracted relevant information from the included studies. When appropriate, we pooled the estimates of association across studies with the use of random-effects meta-analyses. The Quality in Prognostic Studies (QUIPS) tool provided the platform for assessing the risk of bias across each included study. In our main comparison, we conducted meta-analyses for each obesity class separately. We also meta-analysed unclassified obesity and obesity as a continuous variable (5 kg/m2 increase in BMI (body mass index)). We used the GRADE framework to rate our certainty in the importance of the association observed between obesity and each outcome. As obesity is closely associated with other comorbidities, we decided to prespecify the minimum adjustment set of variables including age, sex, diabetes, hypertension, and cardiovascular disease for subgroup analysis. MAIN RESULTS: We identified 171 studies, 149 of which were included in meta-analyses. As compared to 'normal' BMI (18.5 to 24.9 kg/m2) or patients without obesity, those with obesity classes I (BMI 30 to 35 kg/m2), and II (BMI 35 to 40 kg/m2) were not at increased odds for mortality (Class I: odds ratio [OR] 1.04, 95% confidence interval [CI] 0.94 to 1.16, high certainty (15 studies, 335,209 participants); Class II: OR 1.16, 95% CI 0.99 to 1.36, high certainty (11 studies, 317,925 participants)). However, those with class III obesity (BMI 40 kg/m2 and above) may be at increased odds for mortality (Class III: OR 1.67, 95% CI 1.39 to 2.00, low certainty, (19 studies, 354,967 participants)) compared to normal BMI or patients without obesity. For mechanical ventilation, we observed increasing odds with higher classes of obesity in comparison to normal BMI or patients without obesity (class I: OR 1.38, 95% CI 1.20 to 1.59, 10 studies, 187,895 participants, moderate certainty; class II: OR 1.67, 95% CI 1.42 to 1.96, 6 studies, 171,149 participants, high certainty; class III: OR 2.17, 95% CI 1.59 to 2.97, 12 studies, 174,520 participants, high certainty). However, we did not observe a dose-response relationship across increasing obesity classifications for ICU admission and hospitalisation. AUTHORS' CONCLUSIONS Our findings suggest that obesity is an important independent prognostic factor in the setting of COVID-19. Consideration of obesity may inform the optimal management and allocation of limited resources in the care of COVID-19 patients.
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Affiliation(s)
| | - Daniel G Rayner
- Faculty Health Sciences, McMaster University, Hamilton, Canada
| | - Kamyar Shokraee
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Shokraie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Panahi
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Paravaneh Rastgou
- School of Medicine, Tabriz University of Medical Sciences, Tehran, Iran
| | | | - Feryal Momeni Landi
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pariya Alinia
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Parnianfard
- Research Center for Evidence-Based Medicine, Iranian Evidence-Based Medicine (EBM) Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nima Hemmati
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Banivaheb
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Radmanesh
- Society of Clinical Research Associates, Toronto, Canada
- Graduate division, Master of Advanced Studies in Clinical Research, University of California, San Diego, California, USA
| | - Saba Alvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parmida Shahbazi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Elaheh Shaker
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Same
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdullah Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Peyman Nejat
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alice Tamara
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic, Cardiovascular and Aging Cluster, The Indonesian Medical Education and Research Institute, Jakarta, Indonesia
| | - Yuan Chi
- Yealth Network, Beijing Yealth Technology Co., Ltd, Beijing, China
- Cochrane Campbell Global Ageing Partnership, London, UK
| | - Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada
| | - Nima Hajizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Cynthia Chan
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Jamie Zhen
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Dicky Tahapary
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Ontario, Canada
| | - Laura Anderson
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste E Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
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13
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Chenchula S, Vidyasagar K, Pathan S, Sharma S, Chavan MR, Bhagavathula AS, Padmavathi R, Manjula M, Chhabra M, Gupta R, Amerneni KC, Ghanta MK, Mudda S. Global prevalence and effect of comorbidities and smoking status on severity and mortality of COVID-19 in association with age and gender: a systematic review, meta-analysis and meta-regression. Sci Rep 2023; 13:6415. [PMID: 37076543 PMCID: PMC10115382 DOI: 10.1038/s41598-023-33314-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/11/2023] [Indexed: 04/21/2023] Open
Abstract
A COVID-19 patient often presents with multiple comorbidities and is associated with adverse outcomes. A comprehensive assessment of the prevalence of comorbidities in patients with COVID-19 is essential. This study aimed to assess the prevalence of comorbidities, severity and mortality with regard to geographic region, age, gender and smoking status in patients with COVID-19. A systematic review and multistage meta-analyses were reported using PRISMA guidelines. PubMed/MEDLINE, SCOPUS, Google Scholar and EMBASE were searched from January 2020 to October 2022. Cross-sectional studies, cohort studies, case series studies, and case-control studies on comorbidities reporting among the COVID-19 populations that were published in English were included. The pooled prevalence of various medical conditions in COVID-19 patients was calculated based on regional population size weights. Stratified analyses were performed to understand the variations in the medical conditions based on age, gender, and geographic region. A total of 190 studies comprising 105 million COVID-19 patients were included. Statistical analyses were performed using STATA software, version 16 MP (StataCorp, College Station, TX). Meta-analysis of proportion was performed to obtain pooled values of the prevalence of medical comorbidities: hypertension (39%, 95% CI 36-42, n = 170 studies), obesity (27%, 95% CI 25-30%, n = 169 studies), diabetes (27%, 95% CI 25-30%, n = 175), and asthma (8%, 95% CI 7-9%, n = 112). Moreover, the prevalence of hospitalization was 35% (95% CI 29-41%, n = 61), intensive care admissions 17% (95% CI 14-21, n = 106), and mortality 18% (95% CI 16-21%, n = 145). The prevalence of hypertension was highest in Europe at 44% (95% CI 39-47%, n = 68), obesity and diabetes at 30% (95% CI, 26-34, n = 79) and 27% (95%CI, 24-30, n = 80) in North America, and asthma in Europe at 9% (95% CI 8-11, n = 41). Obesity was high among the ≥ 50 years (30%, n = 112) age group, diabetes among Men (26%, n = 124) and observational studies reported higher mortality than case-control studies (19% vs. 14%). Random effects meta-regression found a significant association between age and diabetes (p < 0.001), hypertension (p < 0.001), asthma (p < 0.05), ICU admission (p < 0.05) and mortality (p < 0.001). Overall, a higher global prevalence of hypertension (39%) and a lower prevalence of asthma (8%), and 18% of mortality were found in patients with COVID-19. Hence, geographical regions with respective chronic medical comorbidities should accelerate regular booster dose vaccination, preferably to those patients with chronic comorbidities, to prevent and lower the severity and mortality of COVID-19 disease with novel SARS-CoV-2 variants of concern (VOC).
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Affiliation(s)
- Santenna Chenchula
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, 522503, India.
| | - Kota Vidyasagar
- Department of Pharmaceutical Sciences, University College of Pharmaceutical Sciences (UCPSc), Hanmakonda, Telangana, India
| | - Saman Pathan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - Sushil Sharma
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, 522503, India
| | - Madhav Rao Chavan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, 522503, India
| | | | - R Padmavathi
- SVS Medical College and Hospital, Mahbubnagar, Telangana, India
| | - M Manjula
- Balaji College of Nursing, Tirupathi, Andhra Pradesh, India
| | - Manik Chhabra
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, India
| | - Rupesh Gupta
- Department of Internal Medicine, GMC, Shahdol, Madhya Pradesh, India
| | | | | | - Sofia Mudda
- Department of AYUSH, All India Institute of Medical Sciences, Bhopal, India
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14
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Lu JY, Buczek A, Fleysher R, Musheyev B, Henninger EM, Jabbery K, Rangareddy M, Kanawade D, Nelapat C, Soby S, Mirhaji P, Hoogenboom WS, Duong TQ. Characteristics of COVID-19 patients with multiorgan injury across the pandemic in a large academic health system in the Bronx, New York. Heliyon 2023; 9:e15277. [PMID: 37051049 PMCID: PMC10077765 DOI: 10.1016/j.heliyon.2023.e15277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 03/16/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
Purpose To investigate the evolution of COVID-19 patient characteristics and multiorgan injury across the pandemic. Methods This retrospective cohort study consisted of 40,387 individuals tested positive for SARS-CoV-2 in the Montefiore Health System in Bronx, NY, between March 2020 and February 2022, of which 11,306 were hospitalized. Creatinine, troponin, and alanine aminotransferase were used to define acute kidney injury (AKI), acute cardiac injury (ACI) and acute liver injury, respectively. Demographics, comorbidities, emergency department visits, hospitalization, intensive care utilization, and mortality were analyzed across the pandemic. Results COVID-19 positive cases, emergency department visits, hospitalization and mortality rate showed four distinct waves with a large first wave in April 2020, two small (Alpha and Delta) waves, and a large Omicron wave in December 2021. Omicron was more infectious but less lethal (p = 0.05). Among hospitalized COVID-19 patients, age decreased (p = 0.014), female percentage increased (p = 0.023), Hispanic (p = 0.028) and non-Hispanic Black (p = 0.05) percentages decreased, and patients with pre-existing diabetes (p = 0.002) and hypertension (p = 0.04) decreased across the pandemic. More than half (53.1%) of hospitalized patients had major organ injury. Patients with AKI, ACI and its combinations were older, more likely males, had more comorbidities, and consisted more of non-Hispanic Black and Hispanic patients (p = 0.005). Patients with AKI and its combinations had 4-9 times higher adjusted risk of mortality than those without. Conclusions There were shifts in demographics toward younger age and proportionally more females with COVID-19 across the pandemic. While the overall trend showed improved clinical outcomes, a substantial number of COVID-19 patients developed multi-organ injuries over time. These findings could bring awareness to at-risk patients for long-term organ injuries and help to better inform public policy and outreach initiatives.
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Affiliation(s)
- Justin Y. Lu
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Alexandra Buczek
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Roman Fleysher
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Benjamin Musheyev
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Erin M. Henninger
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Kasra Jabbery
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Mahendranath Rangareddy
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Devdatta Kanawade
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Chandra Nelapat
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Selvin Soby
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Parsa Mirhaji
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Wouter S. Hoogenboom
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Tim Q. Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
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15
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Lokugamage AU, Rix EL, Fleming T, Khetan T, Meredith A, Hastie CR. Translating Cultural Safety to the UK. JOURNAL OF MEDICAL ETHICS 2023; 49:244-251. [PMID: 34282043 DOI: 10.1136/medethics-2020-107017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.
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Affiliation(s)
- Amali U Lokugamage
- Department of Clinical and Professional Practice, University College London Medical School, London, UK
- Department of Women's Health, Whittington Health NHS Trust, London, UK
| | - Elizabeth Liz Rix
- Faculty of Health, Southern Cross University, Gold Coast Campus, Bilinga, Queensland, Australia
| | - Tania Fleming
- School of Midwifery, Auckland University of Technology, Auckland, New Zealand
| | - Tanvi Khetan
- University College London Medical School Alumni, University College London, London, UK
| | - Alice Meredith
- University College London Medical School Alumni, University College London, London, UK
| | - Carolyn Ruth Hastie
- Department of Nursing and Midwifery, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
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16
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Mazzalai E, Giannini D, Tosti ME, D’Angelo F, Declich S, Jaljaa A, Caminada S, Turatto F, De Marchi C, Gatta A, Angelozzi A, Marchetti G, Pizzarelli S, Marceca M. Risk of Covid-19 Severe Outcomes and Mortality in Migrants and Ethnic Minorities Compared to the General Population in the European WHO Region: a Systematic Review. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2023; 24:1-31. [PMID: 36647529 PMCID: PMC9833641 DOI: 10.1007/s12134-023-01007-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans. Supplementary Information The online version contains supplementary material available at 10.1007/s12134-023-01007-x.
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Affiliation(s)
- Elena Mazzalai
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Dara Giannini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Maria Elena Tosti
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Franca D’Angelo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Declich
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Anissa Jaljaa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Chiara De Marchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Angela Gatta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Aurora Angelozzi
- Department for Organisational Development, Local Health Unit Roma 1, Rome, Italy
| | - Giulia Marchetti
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Scilla Pizzarelli
- Knowledge Unit, Documentation and Library, Istituto Superiore di Sanità, Rome, Italy
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
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17
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Resendes NM, Chada A, Torres-Morales A, Fernandez M, Diaz-Quiñones A, Gomez C, Oomrigar S, Burton L, Ruiz JG. Association between a Frailty Index from Common Laboratory Values and Vital Signs (FI-LAB) and Hospital and Post-Hospital Outcomes in Veterans with COVID-19 Infection. J Nutr Health Aging 2023; 27:89-95. [PMID: 36806863 PMCID: PMC9893965 DOI: 10.1007/s12603-023-1886-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Determine the association of higher FI-LAB scores, derived from common laboratory values and vital signs, with hospital and post-hospital outcomes in Veterans hospitalized with COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter, cohort study of 7 Veterans Health Administration (VHA) medical centers in Florida and Puerto Rico. Patients aged 18 years and older hospitalized with COVID-19 and followed for up to 1 year post discharge or until death. Clinical Frailty Measure: FI-LAB. MAIN OUTCOMES AND MEASURES Hospital and post-hospital outcomes. RESULTS Of the 671 eligible patients, 615 (91.5%) patients were included (mean [SD] age, 66.1 [14.8] years; 577 men [93.8%]; median stay, 8 days [IQR:3-15]. There were sixty-one in-hospital deaths. Veterans in the moderate and high FI-LAB groups had a higher proportion of inpatient mortality (13.3% and 20.6%, respectively) than the low group (4.1%), p <0.001. Moderate and high FI-LAB scores were associated with greater inpatient mortality when compared to the low group, OR:3.22 (95%CI:1.59-6.54), p=.001 and 6.05 (95%CI:2.48-14.74), p<0.001, respectively. Compared with low FI-LAB scores, moderate and high scores were also associated with prolonged length of stay, intensive care unit (ICU) admission, and transfer. CONCLUSIONS AND RELEVANCE In this study of patients admitted to 7 VHA Hospitals during the first surge of the pandemic, higher FI-LAB scores were associated with higher in-hospital mortality and other in-hospital outcomes; FI-LAB can serve as a validated, rapid, feasible, and objective frailty tool in hospitalized adults with COVID-19 that can aid clinical care.
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Affiliation(s)
- N M Resendes
- Natasha Melo Resendes, Miami VA Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), GRECC (11GRC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, Florida 33125, USA, Telephone: (305) 575-3388 / Fax: (305) 575-3365, E-mail: , ORCID: 0000-0003-2867-7227
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18
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Zhang L, Jiang L, Tian T, Li W, Pan Y, Wang Y. Efficacy and Safety of COVID-19 Vaccination in Older Adults: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 11:vaccines11010033. [PMID: 36679878 PMCID: PMC9862835 DOI: 10.3390/vaccines11010033] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Objective: To analyze the differences in efficacy and safety of different types of novel coronavirus pneumonia (COVID-19) vaccines in different age groups (young adults and elderly). Methods: Randomized controlled trials (RCTs) on COVID-19 vaccine in PubMed, Embase, Web of Science, and Cochrane library were searched by computer, and eight eligible studies were analyzed. Meta-analysis was performed using Stata 16.0 and RevMan5.4 software. Results: The mean geometric titer (GMT) of the virus in the elderly was significantly higher than that in the placebo group (SMD = 0.91, 95% CI (0.68, 1.15), p < 0.01), presenting no obvious difference compared with the young adults (SMD = 0.19, 95% CI (0.38, 0.01), p = 0.06). Meanwhile, the effect of multiple vaccinations was better than that of single vaccination (SMD = 0.83, 95% CI (0.33, 1.34), p < 0.01). However, the number of adverse events (AEs) in the elderly was lower than that in the young adults (OR = 0.35, 95% CI (0.29, 0.42), p < 0.01). Conclusions: The immunization effect of COVID-19 vaccine in the elderly is obvious, especially after multiple vaccinations, and the incidence of AEs in the elderly is low, which proves that the vaccination of the elderly is safe and effective.
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Affiliation(s)
- Lei Zhang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Lihong Jiang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Tian Tian
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin 150086, China
| | - Wenjing Li
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Yonghui Pan
- Fourth Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Correspondence: (Y.P.); (Y.W.)
| | - Yongchen Wang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
- Correspondence: (Y.P.); (Y.W.)
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19
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Mavragani A, Hardy F, Tucker K, Hopper A, Marchã MJM, Navaratnam AV, Briggs TWR, Yates J, Day J, Wheeler A, Eve-Jones S, Gray WK. Frailty, Comorbidity, and Associations With In-Hospital Mortality in Older COVID-19 Patients: Exploratory Study of Administrative Data. Interact J Med Res 2022; 11:e41520. [PMID: 36423306 PMCID: PMC9746678 DOI: 10.2196/41520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Older adults have worse outcomes following hospitalization with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes. OBJECTIVE We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed for machine learning algorithms. METHODS This was a retrospective study that used the Hospital Episode Statistics administrative data set from March 1, 2020, to February 28, 2021, for hospitalized patients in England aged 65 years or older. The data set was split into separate training (70%), test (15%), and validation (15%) data sets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domains of frailty were identified using the Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, and International Statistical Classification of Disease, 10th Edition codes recorded during the admission. Features were selected, preprocessed, and input into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed; the first model included the demographic, hospital-related, and disease-related items described above, as well as individual GFS domains and CCI items. The second model was similar to the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy. RESULTS In total, 215,831 patients were included. The model using the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model using the HFRS had similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures, and pressure ulcers/weight loss. The most important comorbidity items in the CCI were cancer, heart failure, and renal disease. CONCLUSIONS The physical manifestations of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who need additional support during hospitalization with COVID-19.
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Affiliation(s)
| | - Flavien Hardy
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Katie Tucker
- Innovation and Intelligent Automation Unit, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Adrian Hopper
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom.,Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Maria J M Marchã
- Science and Technology Facilities Council Distributed Research Utilising Advanced Computing High Performance Computing Facility, University College London, London, United Kingdom
| | - Annakan V Navaratnam
- University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Tim W R Briggs
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom.,Royal National Orthopaedic Hospital National Health Service Trust, London, United Kingdom
| | - Jeremy Yates
- Department of Computer Science, University College London, London, United Kingdom
| | - Jamie Day
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Andrew Wheeler
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Sue Eve-Jones
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - William K Gray
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
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20
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Leslie K, Findlay B, Ryan T, Green LI, Harvey C, Whettlock AE, Bishop J, Ponce Hardy V, Went A, Wallace L, McLeod A, Weir A, Marsh K. Epidemiology of SARS-CoV-2 during the first three waves in Scotland: a national record linkage study. J Epidemiol Community Health 2022; 77:jech-2022-219367. [PMID: 36347597 PMCID: PMC9763220 DOI: 10.1136/jech-2022-219367] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The early COVID-19 pandemic in Scotland-defined as the era before widespread access to vaccination and monoclonal antibody treatment-can be characterised into three distinct waves: March-July 2020, July 2020-April 2021 and May-August 2021. Each wave was met with various societal restrictions in an effort to reduce disease transmission and associated morbidity and mortality. Understanding the epidemiology of infections during these waves can provide valuable insights into future pandemic planning. METHODS Scottish RT-PCR testing data reported up until 8 August 2021, the day prior to most restrictions being lifted in Scotland, were included. Demographic characteristics including age, sex and social deprivation associated with transmission, morbidity and mortality were compared across waves. A case-control analysis for each wave was then modelled to further compare risk factors associated with death over time. RESULTS Of the 349 904 reported cases, there were 18 099, 197 251 and 134 554 in waves 1, 2 and 3, respectively. Hospitalisations, intensive care unit admissions and deaths appeared highest in wave 2, though risk factors associated with COVID-19 death remained similar across the waves. Higher deprivation and certain comorbidities were associated with higher deaths in all waves. CONCLUSIONS Despite the higher number of cases reported in waves 2 and 3, case fatality rates were lower: likely a combination of improved detection of infections in younger age groups, introduction of social measures and vaccination. Higher social deprivation and comorbidities resulted in higher deaths for all waves.
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Affiliation(s)
- Kirstin Leslie
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Beth Findlay
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Theresa Ryan
- Data Driven Innovation, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Leonardo I Green
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Ciaran Harvey
- Data Driven Innovation, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Alice E Whettlock
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Jen Bishop
- Data Driven Innovation, Public Health Scotland Glasgow Office, Glasgow, UK
| | | | - April Went
- Data Driven Innovation, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Lesley Wallace
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Allan McLeod
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Amanda Weir
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Kimberly Marsh
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
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21
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van Laak A, Verhees R, Knottnerus JA, Hooiveld M, Winkens B, Dinant GJ. Impact of influenza vaccination on GP-diagnosed COVID-19 and all-cause mortality: a Dutch cohort study. BMJ Open 2022; 12:e061727. [PMID: 36137620 PMCID: PMC9511012 DOI: 10.1136/bmjopen-2022-061727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES As clinical presentation and complications of both viruses overlap, it was hypothesised that influenza vaccination was associated with lower general practitioner (GP)-diagnosed COVID-19 rates and lower all-cause mortality rates. STUDY DESIGN From a primary care population-based cohort in the Netherlands, GP-diagnosed COVID-19 (between 10 March and 22 November 2020) and all-cause mortality events (between 30 December 2019 and 22 November 2020) were recorded. 223 580 persons were included, representing the influenza vaccination 2019 target group (all aged ≥60 years, and those <60 years with a medical indication). Proportional hazards regression analyses evaluated associations between influenza vaccination in 2019 and two outcomes: GP-diagnosed COVID-19 and all-cause mortality. Covariables were sex, age, comorbidities and number of acute respiratory infection primary care consultations in 2019. RESULTS A slightly positive association (HR 1.15; 95% CI 1.08 to 1.22) was found between influenza vaccination in 2019 and GP-diagnosed COVID-19, after adjusting for covariables. A slightly protective effect for all-cause mortality rates (HR 0.90; 95% CI 0.83 to 0.97) was found for influenza vaccination, after adjusting for covariables. A subgroup analysis among GP-diagnosed COVID-19 cases showed no significant association between influenza vaccination in 2019 and all-cause mortality. CONCLUSIONS Our hypothesis of a possibly negative association between influenza vaccination in 2019 and GP-diagnosed COVID-19 was not confirmed as we found a slightly positive association. A slightly protective effect on all-cause mortality was found after influenza vaccination, possibly by a wider, overall protective effect on health. Future research designs should include test-confirmed COVID-19 cases and controls, adjustments for behavioural, socioeconomic and ethnic factors and validated cause-specific mortality cases.
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Affiliation(s)
- Arjan van Laak
- Department of General Practice, CAPHRI, Maastricht UMC+, Maastricht, The Netherlands
| | - Ruud Verhees
- Department of General Practice, CAPHRI, Maastricht UMC+, Maastricht, The Netherlands
| | - J André Knottnerus
- Department of General Practice, CAPHRI, Maastricht UMC+, Maastricht, The Netherlands
| | - Mariëtte Hooiveld
- General Practice Care, Otterstraat 118, Nivel, Utrecht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Maastricht UMC+, Maastricht, The Netherlands
| | - Geert-Jan Dinant
- Department of General Practice, CAPHRI, Maastricht UMC+, Maastricht, The Netherlands
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22
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Coleman P, Barber TM, van Rens T, Hanson P, Coffey A, Oyebode O. COVID-19 Outcomes in Minority Ethnic Groups: Do Obesity and Metabolic Risk Play a Role? Curr Obes Rep 2022; 11:107-115. [PMID: 34655051 PMCID: PMC8518892 DOI: 10.1007/s13679-021-00459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE OF REVIEW Globally, minority ethnic groups have been at higher risk of COVID-19 mortality and morbidity than majority populations. This review outlines factors that may interact to create these inequalities and explores the hypothesis that differing levels of cardio-metabolic risk, according to ethnic group, play a role. RECENT FINDINGS Two UK Biobank studies have reported that the body mass index is more strongly associated with an increased risk of COVID-19 infection and mortality in minority ethnic populations than in White populations. A study of UK patients found that the strongest association between obesity and adverse COVID-19 outcomes was in people of Black ethnicity. Differences in the prevalence of obesity and its metabolic sequelae have been shown to partly mediate ethnic inequalities in COVID-19 outcomes, although not always consistently. It is possible that ethnic differences in the consequences of obesity may explain some of the remaining disparity in COVID-19 risk.
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Affiliation(s)
- Paul Coleman
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Thijs van Rens
- Department of Economics, University of Warwick, Coventry, UK
| | - Petra Hanson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alice Coffey
- Warwick Medical School, University of Warwick, Coventry, UK
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23
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Hafez W, Abdelrahman A. Factors Influencing Disease Stability and Response to Tocilizumab Therapy in Severe COVID-19: A Retrospective Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11081078. [PMID: 36009949 PMCID: PMC9405062 DOI: 10.3390/antibiotics11081078] [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: 07/19/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 01/08/2023] Open
Abstract
(1) Background: The efficacy of tocilizumab in COVID-19 has been doubted. The study aimed to investigate factors affecting disease stability and response to tocilizumab among severe COVID-19 patients. (2) Methods: This was a cohort study of 70 severe COVID-19 patients at NMC Royal Hospital, UAE, from April to June 2020. (3) Results: Elderly patients and those with cardiovascular comorbidities had a higher risk of unstable COVID-19 (p = 0.025). Regarding tocilizumab therapy timing, compared to the critical group receiving tocilizumab, the unstable severe patients receiving tocilizumab had a significantly higher rate of improvement (86%). In contrast, the late critical subgroup showed a significantly increased mortality rate (52.9%). The risk for secondary infection and adverse events following tocilizumab was higher in the late critical group than in the unstable severe and early critical groups (p = 0.024 and p = 0.006, respectively). Therapeutic doses of anticoagulation and high-dose vitamin D were correlated with better outcomes than the prophylactic dose and the treatment dose of vitamin D (p < 0.001 and p = 0.07, respectively). (4) Conclusions: elderly patients and those with cardiovascular disease developed unstable COVID-19. Tocilizumab is a potentially effective choice against severe and critical COVID-19. Early tocilizumab administration combined with therapeutic dose anticoagulation and high vitamin D doses could improve the patients’ outcomes.
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Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, Abu Dhabi P.O. BOX 764659, United Arab Emirates
- The Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo 12622, Egypt
- Correspondence: ; Tel.: +971-2203-5000
| | - Ahmed Abdelrahman
- NMC Royal Hospital, Abu Dhabi P.O. BOX 764659, United Arab Emirates
- Internal Medicine Department, Zagazig School of Medicine, Zagazig 44519, Egypt
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24
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Zago D, Pozzetto I, Pacenti M, Brancaccio G, Ragolia S, Basso M, Parisi SG. Circulating Genotypes of Hepatitis C Virus in Italian Patients before and after the Application of Wider Access Criteria to HCV Treatment. Open Microbiol J 2022. [DOI: 10.2174/18742858-v16-e2205300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aims:
The aims of this study were to report a description of the HCV genotype distribution in adult Italians and non-Italians subjects tested in the Microbiology and Virology Unit of the Padova University Hospital from January 2016 (after about one year from the availability of DAAs) to December 2018 and to compare genotype frequencies in the 12-month period before and after the application of the wider access criteria to HCV treatment.
Background:
Hepatitis C virus (HCV) infection is a major health problem, but the availability of direct-acting antivirals (DAAs) has dramatically changed HCV disease natural history because these drugs have excellent tolerability and they can eliminate the virus in almost all treated patients.
Objective:
The objective was to describe the circulating HCV genotypes in high-income countries in order to help health authorities in the future organization of DAAs treatment strategies; this aspect is not limited to drug prescription, but it also includes the identification of infected individuals who are undiagnosed, which is the limiting step to achieve the HCV elimination goal.
Methods:
Adult patients who had HCV genotype performed from 01/01/16 to 31/12/18 in the Microbiology and Virology Unit of the Padova University Hospital were included in the study: the two 12-month periods were April 2016-March 2017 (before period, BEF) and April 2017-March 2018 (after period, AFT).
Results:
Italians were 2168 (91.2%) and non-Italians were 208 (8.8%). Italians median age was 55 years, and females were older. Italians had a lower genotype 1 (p=0.0012) and higher genotype 2 frequencies (p<0.0001) with respect to non-Italians. Most patients aged 38-67 years: Italians were more represented in class age 48-57 years (p=0.0138), 68-77 years (p=0.001) and ≥78 years (p<0.0001); subjects with genotype 3 were the youngest and those with genotype 2 the oldest. Italian patients typed in the AFT and BEF were comparable; only a lower frequency of genotype 1 males and younger age in genotype 3 were found in AFT.
Conclusion:
Italians were older with respect to non-Italians, which implies that a different age based screening program could be applied. Italian genotype 3 subjects represent a cohort to focus on for the risk of therapeutic failure. Patients tested after the extended criteria for HCV treatment were very similar to those tested before, suggesting that HCV burden in Italians is higher than expected.
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25
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Leache L, Gutiérrez-Valencia M, Enguita-Germán M, Librero J, Gorricho J, Jericó C, García-Erce JA. COVID-19 infection and complications according to ABO blood group in the elderly: A population-based subcohort and meta-analysis. Vox Sang 2022; 117:1230-1234. [PMID: 35843888 PMCID: PMC9349979 DOI: 10.1111/vox.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/24/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES It is reported that ABO antibodies have a role in COVID-19 infection and severity; however, ABO antibody titres vary with advanced age. The aim was to analyse the association between ABO blood group and risk of COVID-19 infection and complications in elderly patients, and to contrast this data with findings in the overall adult population. MATERIALS AND METHODS A prospective cohort study of the Navarre (Spain) population aged ≥60 years and a meta-analysis of published studies including participants of ≥60 years were carried out. RESULTS In the Navarre elderly population, a higher risk of COVID-19 infection was identified in the A versus non-A and O group and lower risk in O versus non-O, with no significant association between hospitalization, intensive care unit admission or mortality and any of the blood groups, results that coincide with those of the overall Navarre adult population. The meta-analyses using studies that included participants of ≥60 years demonstrated a higher risk of hospitalization and mortality in A versus non-A and a lower mortality risk with B versus non-B. Similar mortality results were found in the meta-analyses of the overall adult population. CONCLUSION There are no relevant differences between the overall adult population and population aged ≥60 years in the risk of COVID-19 infection and severity according to ABO blood groups, suggesting that age-related changes in ABO would be of limited clinical significance.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mónica Enguita-Germán
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Unit of Methodology, Navarrabiomed, Pamplona, Spain.,University Hospital of Navarra (HUN), Pamplona, Spain.,Public University of Navarre (UPNA), Pamplona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Unit of Methodology, Navarrabiomed, Pamplona, Spain.,University Hospital of Navarra (HUN), Pamplona, Spain.,Public University of Navarre (UPNA), Pamplona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Javier Gorricho
- Service of Evaluation and Dissemination of Results, Navarre Health Service, Pamplona, Spain
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Jose Antonio García-Erce
- Blood and Tissue Bank of Navarre, Navarre Health Service, Pamplona, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Sciences Institute (IACS), Zaragoza, Spain.,PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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26
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Puthucheary ZA, Rice TW. Nutritional priorities in patients with severe COVID-19. Curr Opin Clin Nutr Metab Care 2022; 25:277-281. [PMID: 35703977 PMCID: PMC9247039 DOI: 10.1097/mco.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has altered the profile of critical care services internationally, as professionals around the globe have struggled to rise to the unprecedented challenge faced, both in terms of individual patient management and the sheer volume of patients that require treatment and management in intensive care. This review article sets out key priorities in nutritional interventions during the patient journey, both in the acute and recovery phases. RECENT FINDINGS The current review covers the care of the acutely unwell patient, and the evidence base for nutritional interventions in the COVID-19 population. One of the biggest differences in caring for critically ill patients with acute respiratory failure from COVID-19 is often the time prior to intubation. This represents specific nutritional challenges, as does nursing patients in the prone position or in the setting of limited resources. This article goes on to discuss nutritional support for COVID-19 sufferers as they transition through hospital wards and into the community. SUMMARY Nutritional support of patients with severe COVID-19 is essential. Given the longer duration of their critical illness, combined with hypermetabolism and energy expenditure, patients with COVID-19 are at increased risk for malnutrition during and after their hospital stay.
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Affiliation(s)
- Zudin A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London
- Adult Critical Care Unit, Royal London Hospital, London, UK
| | - Todd W Rice
- Vanderbilt Institute for Clinical and Translational Research
- Division of Allergy, Department of Medicine, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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27
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Patel HM, Khandwala S, Somani P, Li Q, Tovar S, Montano A. Determining whether ethnic minorities with severe obesity face a disproportionate risk of serious disease and death from COVID-19: outcomes from a Southern California-based retrospective cohort study. BMJ Open 2022; 12:e059132. [PMID: 35768090 PMCID: PMC9243495 DOI: 10.1136/bmjopen-2021-059132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/10/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Obesity has been recognised as a risk factor for poor outcomes associated with COVID-19. Ethnic minorities with COVID-19 have been independently found to fare poorly. We aim to determine if ethnic minorities with severe obesity-defined as a body mass index (BMI) above 40 kg/m²-experience higher rates of hospitalisation, invasive ventilation and death. DESIGN AND SETTING Retrospective cohort study from 1 March 2020 to 28 February 2021 within an integrated healthcare organisation in Southern California. PARTICIPANTS We identified 373 831 patients by COVID-19 diagnosis code or positive laboratory test. METHODS Multivariable Poisson regression with robust error variance estimated adjusted risks of hospitalisation, invasive ventilator use and death within 30 days. Risks were stratified by ethnicity and BMI. RESULTS We identified multiple differences in risk of poor outcomes across BMI categories within individual ethnic groups. Hospitalisation risk with a BMI over 45 kg/m² was greater in Asian (RR 2.31, 95% CI 1.53 to 3.49; p<0.001), Hispanic (RR 3.22, 95% CI 2.99 to 3.48; p<0.001) and Pacific Islander (RR 3.79, 95% CI 2.49 to 5.75; p<0.001) patients compared with White (RR 2.04, 95% CI 1.79 to 2.33; p<0.001) and Black (RR 2.00, 95% CI 1.70 to 2.34; p<0.001) patients. A similar trend was observed with invasive ventilation risk. The risk of death was greater in Asian (RR 3.96, 95% CI 1.88 to 8.33; p<0.001), Hispanic (RR 3.03, 95% CI 2.53 to 3.61; p<0.001) and Pacific Islander (RR 4.60, 95% CI 1.42 to 14.92; p=0.011) patients compared with White (RR 1.47, 95% CI 1.13 to 1.91; p=0.005) and Black (RR 2.83, 95% CI 1.99 to 4.02; p<0.001) patients with a BMI over 45 kg/m². CONCLUSIONS Ethnic minorities with severe obesity, particularly Asian, Hispanic and Pacific Islander patients, had a statistically significant higher risk of hospitalisation, invasive ventilator use and death due to COVID-19. Potential explanations include differences in adipose tissue deposition, overall inflammation and ACE-2 receptor expression.
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Affiliation(s)
- Hemesh Mahesh Patel
- Family Medicine and Virtual Medicine, Southern California Permanente Medical Group, Huntington Beach, California, USA
| | - Shefali Khandwala
- Family Medicine, Southern California Permanente Medical Group, Anaheim, California, USA
| | - Poonam Somani
- Internal Medicine, Southern California Permanente Medical Group, Simi Valley, California, USA
| | - Qiaowu Li
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Stephanie Tovar
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Alejandra Montano
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Odejinmi F, Mallick R, Neophytou C, Mondeh K, Hall M, Scrivener C, Tibble K, Turay-Olusile M, Deo N, Oforiwaa D, Osayimwen R. COVID-19 vaccine hesitancy: a midwifery survey into attitudes towards the COVID-19 vaccine. BMC Public Health 2022; 22:1219. [PMID: 35717164 PMCID: PMC9206526 DOI: 10.1186/s12889-022-13540-y] [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: 06/21/2021] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Ethnically minoritised people have been disproportionately affected by the COVID-19 pandemic. Emerging evidence suggests a lower uptake of the vaccine in ethnically minoritised people, particularly Black females of reproductive age. Unvaccinated pregnant women are high risk for morbidity and mortality from COVID-19. Midwives are the principal healthcare professionals responsible for counselling the pregnant population on decisions relating to vaccine uptake. The aim of this study was to explore midwifery uptake of and attitudes towards the COVID-19 vaccine in two ethnically diverse areas. Methods A 45-point questionnaire was circulated over a six-week period to midwives employed in two teaching hospitals in England; London (Barts Health NHS Trust) and Sussex (Brighton and Sussex University Hospitals NHS Trust (BSUH)). A total of 378 out of 868 midwives responded. Results were analysed to determine vaccine uptake as well as factors influencing vaccine hesitancy and decision-making between the two trusts and ethnic groups. Thematic analysis was also undertaken. Results Midwives of Black ethnicities were over 4-times less likely to have received a COVID-19 vaccine compared to midwives of White ethnicities (52% vs 85%, adjusted OR = 0.22, p = < 0.001). Overall, there were no significant differences between trusts in receipt of the COVID-19 vaccine (p = 0.13). Midwives at Barts Health were significantly more likely to have tested positive for COVID-19 compared to midwives at BSUH (adjusted OR = 2.55, p = 0.007). There was no statistical difference between ethnicities in testing positive for COVID-19 (p = 0.86). The most common concerns amongst all participants were regarding the long-term effect of the vaccine (35%), that it was developed too fast (24%), having an allergic reaction (22%) and concerns about fertility (15%). Amongst unvaccinated midwives, those of Black ethnicity had a higher occurrence of concern that the vaccine contained meat / porcine products (adjusted OR = 5.93, p = 0.04) and that the vaccine would have an adverse effect on ethnic minorities (adjusted OR = 4.42, p = 0.03). Conclusion This study highlights the significantly higher level of vaccine hesitancy amongst Black midwives and offer insights into midwives’ concerns. This can facilitate future targeted public health interventions. It is essential that vaccine hesitancy amongst midwifery staff is addressed to improve vaccine uptake in the pregnant population.
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Affiliation(s)
- Funlayo Odejinmi
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK
| | - Rebecca Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Lewes Road, Haywards Heath, RH16 4EX, UK
| | - Christina Neophytou
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK
| | - Kade Mondeh
- Newham University Hospital, Barts Health NHS Trust, Glen Rd, London, E13 8S, UK
| | - Megan Hall
- Newham University Hospital, Barts Health NHS Trust, Glen Rd, London, E13 8S, UK
| | - Claire Scrivener
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Lewes Road, Haywards Heath, RH16 4EX, UK.
| | - Katie Tibble
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Lewes Road, Haywards Heath, RH16 4EX, UK
| | - Mary Turay-Olusile
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK
| | - Nandita Deo
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK
| | - Doreen Oforiwaa
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK
| | - Rita Osayimwen
- Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR, UK
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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How do UK general practice staff understand and manage pre-diabetes? A focus group study. BJGP Open 2022; 6:BJGPO.2021.0166. [PMID: 35523431 PMCID: PMC9447313 DOI: 10.3399/bjgpo.2021.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/06/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background Preventing type 2 diabetes is a national priority; one aspect is the identification and active management of ‘prediabetes’ through lifestyle change. Aim To explore what primary care clinicians understood by ‘prediabetes’, how they communicated this diagnosis to people, how they delivered lifestyle advice, and their views on barriers to lifestyle change. Design & setting Three focus groups were undertaken with 25 individuals from primary care teams (GPs, nurses, and healthcare assistants) in Newham, a deprived and ethnically diverse part of London, UK. Method Recordings were transcribed verbatim and analysed thematically before integrating social and behavioural science theories. Results Focus groups participants described four main influences on their management of prediabetes in the consultation: social determinants, clinical aspects of diagnosis and management, patient motivation and behaviour change, and long-term care. Since most felt unable to address social determinants such as poverty, discussions with patients tended to focus on attempts to change individual behaviours and achieve particular numerical targets, with limited attention to the social context in which behaviours would play out. Conclusion Type two diabetes prevention efforts in general practice may fail to address the upstream causes of this disease. A narrow focus on numerical targets and decontextualised behaviours overlooks the social complexity of human behaviour and lifestyle choices. Within the consultation, the authors recommend that greater attention is paid to discussing the social context and meaning of particular behaviours. Beyond the consultation, collaboration between primary care clinicians, public health bodies, and local governments is required to address community-level constraints to behaviour change.
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Hainsworth E, McGrowder E, McHugh J, Bancroft E, Mahabir S, Webber W, Eeles R, Cruickshank S. How can we recruit more men of African or African-Caribbean ancestry into our research? Co-creating a video to raise awareness of prostate cancer risk and the PROFILE study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:14. [PMID: 35436967 PMCID: PMC9014400 DOI: 10.1186/s40900-022-00347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Men of African ancestry are at increased risk of developing prostate cancer (PrCa) compared to men from other backgrounds. The PROFILE study aims to understand whether genetic information can better target who needs PrCa screening. PROFILE has so far had difficulty reaching men of African or African -Caribbean ancestry to take part. In this involvement project we worked in partnership with a group of such men to co-create a video to raise awareness of PrCa risk amongst this community and promote participation in the study. METHODS We recruited seven men of African or African-Caribbean ancestry who completed an initial survey on the Cancer Patients' Voice platform. We then held an online discussion panel and maintained contact to encourage dialogue and planning of the video. Utilising a participatory approach, the ideas for the video were decided in collaboration with the panel who held expert knowledge of various communities and understood the messages that would best resonate and engage with other men of the same origins. Once the video had been edited and finalised, two members of the group expressed interest in writing up the project and are listed as co-authors. RESULTS The video in its entirety was driven by the panel's ideas. The choice of a barber shop setting; leading with a positive case study and highlighting the importance of men's family members rather than a focus on scientific language, statistics or researchers were all features that were discussed and agreed upon by the panel. The men shared the video within their networks. It was placed on websites and promoted as part of a social media campaign during Black History Month. CONCLUSIONS Groups with the greater healthcare needs and the most to gain from advances in care and treatment can often be the most excluded from research participation. This is pertinent in PrCa research where men of African or African-Caribbean ancestry are at greater risk. The project gave equal power and decision making to the men and provides an example of successful inclusive involvement. The result was a unique approach to making a study video.
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Affiliation(s)
- Emma Hainsworth
- Royal Marsden NHS Foundation Trust, 203 Fulham Rd, London, SW3 6JJ UK
| | - Eva McGrowder
- The Institute of Cancer Research SRD Building, 1st Floor D1S5, 15 Cotswold Road, Sutton, SM2 5NG Surrey UK
| | - Jana McHugh
- The Institute of Cancer Research SRD Building, 1st Floor D1S5, 15 Cotswold Road, Sutton, SM2 5NG Surrey UK
| | - Elizabeth Bancroft
- The Institute of Cancer Research SRD Building, 1st Floor D1S5, 15 Cotswold Road, Sutton, SM2 5NG Surrey UK
| | - Sean Mahabir
- Royal Marsden NHS Foundation Trust, 203 Fulham Rd, London, SW3 6JJ UK
| | | | - Rosalind Eeles
- The Institute of Cancer Research SRD Building, 1st Floor D1S5, 15 Cotswold Road, Sutton, SM2 5NG Surrey UK
| | - Susanne Cruickshank
- Royal Marsden NHS Foundation Trust, 203 Fulham Rd, London, SW3 6JJ UK
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Al Zahmi F, Habuza T, Awawdeh R, Elshekhali H, Lee M, Salamin N, Sajid R, Kiran D, Nihalani S, Smetanina D, Talako T, Neidl-Van Gorkom K, Zaki N, Loney T, Statsenko Y. Ethnicity-Specific Features of COVID-19 Among Arabs, Africans, South Asians, East Asians, and Caucasians in the United Arab Emirates. Front Cell Infect Microbiol 2022; 11:773141. [PMID: 35368452 PMCID: PMC8967254 DOI: 10.3389/fcimb.2021.773141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
BackgroundDubai (United Arab Emirates; UAE) has a multi-national population which makes it exceptionally interesting study sample because of its unique demographic factors.ObjectiveTo stratify the risk factors for the multinational society of the UAE.MethodsA retrospective chart review of 560 patients sequentially admitted to inpatient care with laboratory confirmed COVID-19 was conducted. We studied patients’ demographics, clinical features, laboratory results, disease severity, and outcomes. The parameters were compared across different ethnic groups using tree-based estimators to rank the ethnicity-specific disease features. We trained ML classification algorithms to build a model of ethnic specificity of COVID-19 based on clinical presentation and laboratory findings on admission.ResultsOut of 560 patients, 43.6% were South Asians, 26.4% Middle Easterns, 16.8% East Asians, 10.7% Caucasians, and 2.5% are under others. UAE nationals represented half of the Middle Eastern patients, and 13% of the entire cohort. Hypertension was the most common comorbidity in COVID-19 patients. Subjective complaint of fever and cough were the chief presenting symptoms. Two-thirds of the patients had either a mild disease or were asymptomatic. Only 20% of the entire cohort needed oxygen therapy, and 12% needed ICU admission. Forty patients (~7%) needed invasive ventilation and fifteen patients died (2.7%). We observed differences in disease severity among different ethnic groups. Caucasian or East-Asian COVID-19 patients tended to have a more severe disease despite a lower risk profile. In contrast to this, Middle Eastern COVID-19 patients had a higher risk factor profile, but they did not differ markedly in disease severity from the other ethnic groups. There was no noticeable difference between the Middle Eastern subethnicities—Arabs and Africans—in disease severity (p = 0.81). However, there were disparities in the SOFA score, D-dimer (p = 0.015), fibrinogen (p = 0.007), and background diseases (hypertension, p = 0.003; diabetes and smoking, p = 0.045) between the subethnicities.ConclusionWe observed variations in disease severity among different ethnic groups. The high accuracy (average AUC = 0.9586) of the ethnicity classification model based on the laboratory and clinical findings suggests the presence of ethnic-specific disease features. Larger studies are needed to explore the role of ethnicity in COVID-19 disease features.
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Affiliation(s)
- Fatmah Al Zahmi
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- *Correspondence: Fatmah Al Zahmi, ; Yauhen Statsenko, ;
| | - Tetiana Habuza
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
- Big Data Analytics Center, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rasha Awawdeh
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | | | - Martin Lee
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Nassim Salamin
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Ruhina Sajid
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | - Dhanya Kiran
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
| | | | - Darya Smetanina
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tatsiana Talako
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
- Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus
| | - Klaus Neidl-Van Gorkom
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Nazar Zaki
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
- Big Data Analytics Center, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Yauhen Statsenko
- Big Data Analytics Center, United Arab Emirates University, Al Ain, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- *Correspondence: Fatmah Al Zahmi, ; Yauhen Statsenko, ;
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Ethnic disparities in hospitalisation and hospital-outcomes during the second wave of COVID-19 infection in east London. Sci Rep 2022; 12:3721. [PMID: 35260620 PMCID: PMC8904852 DOI: 10.1038/s41598-022-07532-6] [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: 11/04/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
It is unclear if changes in public behaviours, developments in COVID-19 treatments, improved patient care, and directed policy initiatives have altered outcomes for minority ethnic groups in the second pandemic wave. This was a prospective analysis of patients aged ≥ 16 years having an emergency admission with SARS-CoV-2 infection between 01/09/2020 and 17/02/2021 to acute NHS hospitals in east London. Multivariable survival analysis was used to assess associations between ethnicity and mortality accounting for predefined risk factors. Age-standardised rates of hospital admission relative to the local population were compared between ethnic groups. Of 5533 patients, the ethnic distribution was White (n = 1805, 32.6%), Asian/Asian British (n = 1983, 35.8%), Black/Black British (n = 634, 11.4%), Mixed/Other (n = 433, 7.8%), and unknown (n = 678, 12.2%). Excluding 678 patients with missing data, 4855 were included in multivariable analysis. Relative to the White population, Asian and Black populations experienced 4.1 times (3.77-4.39) and 2.1 times (1.88-2.33) higher rates of age-standardised hospital admission. After adjustment for various patient risk factors including age, sex, and socioeconomic deprivation, Asian patients were at significantly higher risk of death within 30 days (HR 1.47 [1.24-1.73]). No association with increased risk of death in hospitalised patients was observed for Black or Mixed/Other ethnicity. Asian and Black ethnic groups continue to experience poor outcomes following COVID-19. Despite higher-than-expected rates of hospital admission, Black and Asian patients also experienced similar or greater risk of death in hospital since the start of the pandemic, implying a higher overall risk of COVID-19 associated death in these communities.
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Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis. Ann Intensive Care 2022; 12:17. [PMID: 35184215 PMCID: PMC8858439 DOI: 10.1186/s13613-021-00977-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The concept of frailty provides an age-independent, easy-to-use tool for risk stratification. We aimed to summarize the evidence on the efficacy of frailty tools in risk assessment in COVID-19 patients. METHODS The protocol was registered (CRD42021241544). Studies reporting on frailty in COVID-19 patients were eligible. The main outcomes were mortality, length of hospital stay (LOH) and intensive care unit (ICU) admission in frail and non-frail COVID-19 patients. Frailty was also compared in survivors and non-survivors. Five databases were searched up to 24th September 2021. The QUIPS tool was used for the risk of bias assessment. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI) using a random effect model. Heterogeneity was assessed using the I2 and χ2 tests. RESULTS From 3640 records identified, 54 were included in the qualitative and 42 in the quantitative synthesis. Clinical Frailty Scale (CFS) was used in 46 studies, the Hospital Frailty Risk Score (HFRS) by 4, the Multidimensional Prognostic Index (MPI) by 3 and three studies used other scores. We found that patients with frailty (CFS 4-9 or HFRS ≥ 5) have a higher risk of mortality (CFS: OR: 3.12; CI 2.56-3.81; HFRS OR: 1.98; CI 1.89-2.07). Patients with frailty (CFS 4-9) were less likely to be admitted to ICU (OR 0.28, CI 0.12-0.64). Quantitative synthesis for LOH was not feasible. Most studies carried a high risk of bias. CONCLUSIONS As determined by CFS, frailty is strongly associated with mortality; hence, frailty-based patient management should be included in international COVID-19 treatment guidelines. Future studies investigating the role of frailty assessment on deciding ICU admission are strongly warranted.
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Antoniou KM, Vasarmidi E, Russell AM, Andrejak C, Crestani B, Delcroix M, Dinh-Xuan AT, Poletti V, Sverzellati N, Vitacca M, Witzenrath M, Tonia T, Spanevello A. European Respiratory Society Statement on Long COVID-19 Follow-Up. Eur Respir J 2022; 60:13993003.02174-2021. [PMID: 35144991 PMCID: PMC9349784 DOI: 10.1183/13993003.02174-2021] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022]
Abstract
Patients diagnosed with coronavirus disease 2019 (COVID-19) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection frequently experience symptom burden post-acute infection or post-hospitalisation. We aimed to identify optimal strategies for follow-up care that may positively impact the patient's quality of life (QoL). A European Respiratory Society (ERS) Task Force convened and prioritised eight clinical questions. A targeted search of the literature defined the timeline of “long COVID” as 1–6 months post-infection and identified clinical evidence in the follow-up of patients. Studies meeting the inclusion criteria report an association of characteristics of acute infection with persistent symptoms, thromboembolic events in the follow-up period, and evaluations of pulmonary physiology and imaging. Importantly, this statement reviews QoL consequences, symptom burden, disability and home care follow-up. Overall, the evidence for follow-up care for patients with long COVID is limited. Follow-up care of patients infected with SARS-CoV-2 is crucial and may improve their quality of life. More evidence and research is emerging to understand the causes, mechanisms and risks of long COVID consequences.https://bit.ly/3J1WMWy
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Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece.,Université de Paris, Inserm U1152, Labex Inflamex, Paris, France.,Authors contributed equally
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, Exeter, UK.,Authors contributed equally
| | - Claire Andrejak
- Service de Pneumologie, CHU Amiens-Picardie, UR 4294 AGIR, université Picardie Jules-Verne, Amiens, France
| | - Bruno Crestani
- Université de Paris, Inserm U1152, Labex Inflamex, Paris, France.,Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Bichat, Paris, France
| | - Marion Delcroix
- Department of Pneumonology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Anh Tuan Dinh-Xuan
- AP-HP Centre, Hôpital Cochin, Respiratory Physiology Unit, Thoracic Diseases Department, Université de Paris, Paris, France
| | - Venerino Poletti
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Nicola Sverzellati
- Division of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Martin Witzenrath
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese.,Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Varese, Italy
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Gutiérrez‐Valencia M, Leache L, Librero J, Jericó C, Enguita Germán M, García‐Erce JA. ABO blood group and risk of COVID-19 infection and complications: A systematic review and meta-analysis. Transfusion 2022; 62:493-505. [PMID: 34773411 PMCID: PMC8661771 DOI: 10.1111/trf.16748] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Marta Gutiérrez‐Valencia
- Unit of Innovation and OrganizationNavarre Health ServicePamplonaSpain,Navarra Institute for Health Research (IdiSNA)PamplonaSpain
| | - Leire Leache
- Unit of Innovation and OrganizationNavarre Health ServicePamplonaSpain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain,Navarrabiomed ‐ Complejo Hospitalario de Navarra – UPNAPamplonaSpain,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)MadridSpain
| | - Carlos Jericó
- Department of Internal MedicineHospital Sant Joan Despí‐Moisès Broggi, Consorci Sanitari Integral. Sant Joan DespíBarcelonaSpain
| | - Mónica Enguita Germán
- Navarrabiomed ‐ Complejo Hospitalario de Navarra – UPNAPamplonaSpain,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)MadridSpain
| | - Jose Antonio García‐Erce
- Navarra's Blood and Tissue BankNavarre Health ServicePamplonaSpain,Grupo Español de Rehabilitación Multimodal (GERM)Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ)MadridSpain
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Seiffert P, Konka A, Kasperczyk J, Kawa J, Lejawa M, Maślanka-Seiffert B, Zembala-John J, Bugdol M, Romanik M, Bułdak R, Marcisz C, Derejczyk J, Religa D. Immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older residents of a long-term care facility: relation with age, frailty and prior infection status. Biogerontology 2022; 23:53-64. [PMID: 34923608 PMCID: PMC8684786 DOI: 10.1007/s10522-021-09944-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
Clinical and biological assessment of the COVID-19 vaccine efficacy in the frail population is of crucial importance. The study focuses on measuring the levels of anti-SARS-CoV-2 IgG antibodies before and after BNT162b2 mRNA COVID-19 vaccination among long-term care facility (LTCF) elderly residents. We conducted a prospective, single-center, observational study among LTCF residents. The study protocol was based on three blood sample acquisitions: first taken at baseline-5 days before the first dose of the vaccine, second-20 days after the first dose, and third-12 days after the second shot of the vaccine. The comparison was made for two cohorts: patients with and without prior COVID-19 infection. The data was collected from January to March 2021. A total number of 78 LTCF residents (55 women and 23 men) aged 62-104, 85.72 ± 7.59 years (mean ± SD), were enrolled in the study. All study participants were investigated for the presence of SARS-CoV-2 anti-spike (S) protein IgG, using a chemiluminescent immunoassay. Frailty was assessed with the Clinical Frailty Scale. Among elderly COVID-19 survivors in LTCF, a single dose of vaccine significantly increased anti-SARS-CoV-2 IgG antibody levels. IgG concentration after a single and double dose was comparable, which may suggest that elderly COVID-19 survivors do not require a second dose of vaccine. For residents without a previous history of COVID-19, two doses are needed to achieve an effective serological response. The level of anti-SARS-CoV-2 IgG antibodies after vaccination with BNT162b2 mRNA COVID-19 did not correlate with the frailty and age of the studied individuals.
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Affiliation(s)
- Piotr Seiffert
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Rheumatology Ward, Murcki Hospital, Katowice, Poland
| | - Adam Konka
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
| | - Janusz Kasperczyk
- Chair and Department of Medicine and Environmental Epidemiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jacek Kawa
- Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Mateusz Lejawa
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Joanna Zembala-John
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Chair and Department of Medicine and Environmental Epidemiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Center for Heart Diseases, Zabrze, Poland
| | - Monika Bugdol
- Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Małgorzata Romanik
- Department of Medical Microbiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Rafał Bułdak
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Czesław Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | | | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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38
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Ansari KA, Alwazzeh MJ, Alkuwaiti FA, Farooqi FA, Al Khathlan N, Almutawah H, Alahmed M, Alfaraj H, Aljarrash A, Almadhary J, Alwarthan S, Alsahlawi AM, Almashouf AB, Alqasim M, Alkuwaiti E. Early Determinants of Mortality in Hospitalized COVID-19 Patients in the Eastern Province of Saudi Arabia. Int J Gen Med 2022; 15:1689-1701. [PMID: 35210838 PMCID: PMC8858956 DOI: 10.2147/ijgm.s349598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Khalid Aziz Ansari
- Department of Respiratory Care, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Correspondence: Khalid Aziz Ansari, Email
| | - Marwan Jabr Alwazzeh
- Department of Internal Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Feras Ahmed Alkuwaiti
- Department of Internal Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faraz Ahmed Farooqi
- Department of Dental Education, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor Al Khathlan
- Department of Respiratory Care, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hussain Almutawah
- Department of Respiratory Care, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mustafa Alahmed
- Department of Respiratory Care, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hussain Alfaraj
- Department of Respiratory Care, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Aljarrash
- Department of Respiratory Care, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jaffar Almadhary
- Department of Respiratory Care, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sarah Alwarthan
- Department of Internal Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Mohammed Alsahlawi
- Department of Internal Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Bandar Almashouf
- Department of Internal Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Moammer Alqasim
- Department of Internal Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Elaf Alkuwaiti
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Sullivan MK, Lees JS, Drake TM, Docherty AB, Oates G, Hardwick HE, Russell CD, Merson L, Dunning J, Nguyen-Van-Tam JS, Openshaw P, Harrison EM, Baillie JK, Semple MG, Ho A, Mark PB. Acute kidney injury in patients hospitalized with COVID-19 from the ISARIC WHO CCP-UK Study: a prospective, multicentre cohort study. Nephrol Dial Transplant 2022; 37:271-284. [PMID: 34661677 PMCID: PMC8788218 DOI: 10.1093/ndt/gfab303] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in coronavirus disease 2019 (COVID-19). This study investigated adults hospitalized with COVID-19 and hypothesized that risk factors for AKI would include comorbidities and non-White race. METHODS A prospective multicentre cohort study was performed using patients admitted to 254 UK hospitals with COVID-19 between 17 January 2020 and 5 December 2020. RESULTS Of 85 687 patients, 2198 (2.6%) received acute kidney replacement therapy (KRT). Of 41 294 patients with biochemistry data, 13 000 (31.5%) had biochemical AKI: 8562 stage 1 (65.9%), 2609 stage 2 (20.1%) and 1829 stage 3 (14.1%). The main risk factors for KRT were chronic kidney disease (CKD) [adjusted odds ratio (aOR) 3.41: 95% confidence interval 3.06-3.81], male sex (aOR 2.43: 2.18-2.71) and Black race (aOR 2.17: 1.79-2.63). The main risk factors for biochemical AKI were admission respiratory rate >30 breaths per minute (aOR 1.68: 1.56-1.81), CKD (aOR 1.66: 1.57-1.76) and Black race (aOR 1.44: 1.28-1.61). There was a gradated rise in the risk of 28-day mortality by increasing severity of AKI: stage 1 aOR 1.58 (1.49-1.67), stage 2 aOR 2.41 (2.20-2.64), stage 3 aOR 3.50 (3.14-3.91) and KRT aOR 3.06 (2.75-3.39). AKI rates peaked in April 2020 and the subsequent fall in rates could not be explained by the use of dexamethasone or remdesivir. CONCLUSIONS AKI is common in adults hospitalized with COVID-19 and it is associated with a heightened risk of mortality. Although the rates of AKI have fallen from the early months of the pandemic, high-risk patients should have their kidney function and fluid status monitored closely.
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Affiliation(s)
- Michael K Sullivan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Thomas M Drake
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Georgia Oates
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Hayley E Hardwick
- HPRU in Infection and Emerging Diseases, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - Clark D Russell
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Laura Merson
- ISARIC Global Support Centre, University of Oxford, Oxford, UK
| | - Jake Dunning
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Peter Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Malcolm G Semple
- HPRU in Infection and Emerging Diseases, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - Antonia Ho
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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40
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Ahmad MS, Hicks SR, Watson R, Ahmed RA, Jones L, Vaselli M, Wu MS, Hayat F, Ratcliffe L, McKenna M, Hine P, Defres S, Wingfield T. A patient satisfaction survey and educational package to improve the care of people hospitalised with COVID-19: a quality improvement project, Liverpool, UK. Wellcome Open Res 2022; 6:222. [PMID: 35118199 PMCID: PMC8787571 DOI: 10.12688/wellcomeopenres.17163.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The perspectives and experiences of people hospitalised with COVID-19 have been under-reported during the coronavirus pandemic. We developed and conducted a COVID-19 patient satisfaction survey in a large university-affiliated secondary healthcare centre in Liverpool, UK, during Europe’s first coronavirus wave (April-June 2020). The survey found that care was rated highly, including among people of Black Asian and Minority Ethnic (BAME) backgrounds. However, sleep-quality and communication about medications and discharge-planning were identified as areas for improvement. Methods: To improve care for people with COVID-19 admitted to our centre, we designed an educational package for healthcare professionals working on COVID-19 wards. The package, implemented in August 2020, included healthcare worker training sessions on providing holistic care and placement of “Practice Pointers” posters. Patient satisfaction was re-evaluated during the second/third COVID-19 waves in Liverpool (September 2020 - February 2021). Results: Across waves, most (95%) respondents reported that they would recommend our hospital to friends and/or family and rated overall care highly. Comparison of the responses of second/third-wave respondents (n=101) with first-wave respondents (n=94) suggested improved patient satisfaction across most care domains but especially those related to having worries and fears addressed and being consulted about medications and their side-effects. Conclusions: People admitted with COVID-19 to our centre in Liverpool, including those from BAME backgrounds, rated the care they received highly. A simple education package improved the feedback on care received by respondents between the first and second/third waves. These UK-first findings are informing regional strategies to improve person-centred care of hospitalised people with COVID-19.
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Affiliation(s)
- Muhammad Shamsher Ahmad
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
- Clinical Infection Microbiology and Immunology, Institute of Infection and Global Health, Liverpool, UK
| | - Scott Rory Hicks
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Rebecca Watson
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Rajia Akter Ahmed
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Lewis Jones
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Marcella Vaselli
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Meng-San Wu
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Fatima Hayat
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Libuse Ratcliffe
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Mark McKenna
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Paul Hine
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
- Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
| | - Sylviane Defres
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
- Clinical Infection Microbiology and Immunology, Institute of Infection and Global Health, Liverpool, UK
- Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
| | - Tom Wingfield
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
- Clinical Infection Microbiology and Immunology, Institute of Infection and Global Health, Liverpool, UK
- Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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41
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Subramaniam A, Shekar K, Afroz A, Ashwin S, Billah B, Brown H, Kundi H, Lim ZJ, Ponnapa Reddy M, Curtis JR. Frailty and mortality associations in patients with
COVID
‐19: A Systematic Review and Meta‐analysis. Intern Med J 2022; 52:724-739. [PMID: 35066970 PMCID: PMC9314619 DOI: 10.1111/imj.15698] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023]
Abstract
Background Observational data during the pandemic have demonstrated mixed associations between frailty and mortality. Aim To examine associations between frailty and short‐term mortality in patients hospitalised with coronavirus disease 2019 (COVID‐19). Methods In this systematic review and meta‐analysis, we searched PubMed, Embase and the COVID‐19 living systematic review from 1 December 2019 to 15 July 2021. Studies reporting mortality and frailty scores in hospitalised patients with COVID‐19 (age ≥18 years) were included. Data on patient demographics, short‐term mortality (in hospital or within 30 days), intensive care unit (ICU) admission and need for invasive mechanical ventilation (IMV) were extracted. The quality of studies was assessed using the Newcastle−Ottawa Scale. Results Twenty‐five studies reporting 34 628 patients were included. Overall, 26.2% (n = 9061) died. Patients who died were older (76.7 ± 9.6 vs 69.2 ± 13.4), more likely male (risk ratio (RR) = 1.08; 95% confidence interval (CI): 1.06–1.11) and had more comorbidities. Fifty‐eight percent of patients were frail. Adjusting for age, there was no difference in short‐term mortality between frail and non‐frail patients (RR = 1.04; 95% CI: 0.84–1.28). The non‐frail patients were commonly admitted to ICU (27.2% (4256/15639) vs 29.1% (3567/12274); P = 0.011) and had a higher mortality risk (RR = 1.63; 95% CI: 1.30–2.03) than frail patients. Among patients receiving IMV, there was no difference in mortality between frail and non‐frail (RR = 1.62; 95% CI 0.93–2.77). Conclusion This systematic review did not demonstrate an independent association between frailty status and short‐term mortality in patients with COVID‐19. Patients with frailty were less commonly admitted to ICU and non‐frail patients were more likely to receive IMV and had higher mortality risk. This finding may be related to allocation decisions for patients with frailty amidst the pandemic.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
- Monash University, Peninsula Clinical School Frankston Victoria Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital Brisbane Queensland Australia
- University of Queensland, Brisbane; Queensland University of Technology Brisbane and Bond University Gold Coast Queensland Australia
| | - Afsana Afroz
- Centre for Integrated Critical Care, Department of Medicine and Radiology Melbourne Medical School Melbourne Victoria Australia
| | - Sushma Ashwin
- Department of Health Economics School of Health and social development, Deakin University Melbourne Victoria Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Hamish Brown
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
| | - Harun Kundi
- Department of Cardiology Ankara City Hospital Ankara Turkey
| | - Zheng Jie Lim
- Department of Anaesthesiology, Austin Health Heidelberg Victoria Australia
| | - Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
- Department of Intensive Care Medicine, Calvary Hospital Canberra Australian Capital Territory Australia
| | - J Randall Curtis
- Cambia Palliative Care Centre of Excellence University of Washington Seattle Washington United States of America
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine University of Washington Seattle Washington United States of America
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Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis. Crit Care Explor 2022; 4:e0616. [PMID: 35072081 PMCID: PMC8769107 DOI: 10.1097/cce.0000000000000616] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Supplemental Digital Content is available in the text. Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019.
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Abstract
OBJECTIVE Coronavirus disease 2019 is a heterogeneous disease most frequently causing respiratory tract infection, which can induce respiratory failure and multiple organ dysfunction syndrome in its severe forms. The prevalence of coronavirus disease 2019-related sepsis is still unclear; we aimed to describe this in a systematic review. DATA SOURCES MEDLINE (PubMed), Cochrane, and Google Scholar databases were searched based on a prespecified protocol (International Prospective Register for Systematic Reviews: CRD42020202018). STUDY SELECTION Studies reporting on patients with confirmed coronavirus disease 2019 diagnosed with sepsis according to sepsis-3 or according to the presence of infection-related organ dysfunctions necessitating organ support/replacement were included in the analysis. The primary end point was prevalence of coronavirus disease 2019-related sepsis among adults hospitalized in the ICU and the general ward. Among secondary end points were the need for ICU admission among patients initially hospitalized in the general ward and the prevalence of new onset of organ dysfunction in the ICU. Outcomes were expressed as proportions with respective 95% CI. DATA EXTRACTION Two reviewers independently screened and reviewed existing literature and assessed study quality with the Newcastle-Ottawa Scale and the Methodological index for nonrandomized studies. DATA SYNTHESIS Of 3,825 articles, 151 were analyzed, only five of which directly reported sepsis prevalence. Noting the high heterogeneity observed, coronavirus disease 2019-related sepsis prevalence was 77.9% (95% CI, 75.9-79.8; I2 = 91%; 57 studies) in the ICU, and 33.3% (95% CI, 30.3-36.4; I2 = 99%; 86 studies) in the general ward. ICU admission was required for 17.7% (95% CI, 12.9-23.6; I2 = 100%) of ward patients. Acute respiratory distress syndrome was the most common organ dysfunction in the ICU (87.5%; 95% CI, 83.3-90.7; I2 = 98%). CONCLUSIONS The majority of coronavirus disease 2019 patients hospitalized in the ICU meet Sepsis-3 criteria and present infection-associated organ dysfunction. The medical and scientific community should be aware and systematically report viral sepsis for prognostic and treatment implications.
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44
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Cushnan D, Bennett O, Berka R, Bertolli O, Chopra A, Dorgham S, Favaro A, Ganepola T, Halling-Brown M, Imreh G, Jacob J, Jefferson E, Lemarchand F, Schofield D, Wyatt JC. An overview of the National COVID-19 Chest Imaging Database: data quality and cohort analysis. Gigascience 2021; 10:giab076. [PMID: 34849869 PMCID: PMC8633457 DOI: 10.1093/gigascience/giab076] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The National COVID-19 Chest Imaging Database (NCCID) is a centralized database containing mainly chest X-rays and computed tomography scans from patients across the UK. The objective of the initiative is to support a better understanding of the coronavirus SARS-CoV-2 disease (COVID-19) and the development of machine learning technologies that will improve care for patients hospitalized with a severe COVID-19 infection. This article introduces the training dataset, including a snapshot analysis covering the completeness of clinical data, and availability of image data for the various use-cases (diagnosis, prognosis, longitudinal risk). An additional cohort analysis measures how well the NCCID represents the wider COVID-19-affected UK population in terms of geographic, demographic, and temporal coverage. FINDINGS The NCCID offers high-quality DICOM images acquired across a variety of imaging machinery; multiple time points including historical images are available for a subset of patients. This volume and variety make the database well suited to development of diagnostic/prognostic models for COVID-associated respiratory conditions. Historical images and clinical data may aid long-term risk stratification, particularly as availability of comorbidity data increases through linkage to other resources. The cohort analysis revealed good alignment to general UK COVID-19 statistics for some categories, e.g., sex, whilst identifying areas for improvements to data collection methods, particularly geographic coverage. CONCLUSION The NCCID is a growing resource that provides researchers with a large, high-quality database that can be leveraged both to support the response to the COVID-19 pandemic and as a test bed for building clinically viable medical imaging models.
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Affiliation(s)
- Dominic Cushnan
- AI Lab, NHSX, Skipton House, 80 London Road, London SE1 6LH,
UK
| | | | | | | | | | | | | | | | - Mark Halling-Brown
- Scientific Computing, Royal Surrey NHS Foundation Trust,
Egerton Road, Guildford GU2 7XX, UK
| | | | - Joseph Jacob
- UCL Respiratory, 1st Floor, Rayne Institute, University College
London, London WC1E 6JF, UK
| | - Emily Jefferson
- Health Data Research UK, Gibbs Building, 215 Euston Road,
London NW1 2BE, UK
- Health Informatics Centre (HIC), School of Medicine, University of
Dundee, DD1 4HN, Dundee, UK
| | | | | | - Jeremy C Wyatt
- Emeritus Professor of Digital Healthcare, University of
Southampton, Southampton SO17 1BJ, UK
- NHSX, Skipton House, 80 London Road, London SE1 6LH, UK
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45
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Wan YI, Bien Z, Apea VJ, Orkin CM, Dhairyawan R, Kirwan CJ, Pearse RM, Puthucheary ZA, Prowle JR. Acute kidney injury in COVID-19: multicentre prospective analysis of registry data. Clin Kidney J 2021; 14:2356-2364. [PMID: 34751235 PMCID: PMC8083651 DOI: 10.1093/ckj/sfab071] [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: 03/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common and important complication of coronavirus disease 2019 (COVID-19). Further characterization is required to reduce both short- and long-term adverse outcomes. Methods We examined registry data including adults with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to five London Hospitals from 1 January to 14 May 2020. Prior end-stage kidney disease was excluded. Early AKI was defined by Kidney Disease: Improving Global Outcomes creatinine criteria within 7 days of admission. Independent associations of AKI and survival were examined in multivariable analysis. Results are given as odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals. Results Among 1855 admissions, 455 patients (24.5%) developed early AKI: 200 (44.0%) Stage 1, 90 (19.8%) Stage 2 and 165 (36.3%) Stage 3 (74 receiving renal replacement therapy). The strongest risk factor for AKI was high C-reactive protein [OR 3.35 (2.53-4.47), P < 0.001]. Death within 30 days occurred in 242 (53.2%) with AKI compared with 255 (18.2%) without. In multivariable analysis, increasing severity of AKI was incrementally associated with higher mortality: Stage 3 [HR 3.93 (3.04-5.08), P < 0.001]. In 333 patients with AKI surviving to Day 7, 134 (40.2%) recovered, 47 (14.1%) recovered then relapsed and 152 (45.6%) had persistent AKI at Day 7; an additional 105 (8.2%) patients developed AKI after Day 7. Persistent AKI was strongly associated with adjusted mortality at 90 days [OR 7.57 (4.50-12.89), P < 0.001]. Conclusions AKI affected one in four hospital in-patients with COVID-19 and significantly increased mortality. Timing and recovery of COVID-19 AKI is a key determinant of outcome.
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Affiliation(s)
- Yize I Wan
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Zuzanna Bien
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Vanessa J Apea
- Blizard Institute, Queen Mary University of London, London, UK
| | - Chloe M Orkin
- Blizard Institute, Queen Mary University of London, London, UK
| | | | | | - Rupert M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Zudin A Puthucheary
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - John R Prowle
- William Harvey Research Institute, Queen Mary University of London, London, UK
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Milln J, Heard S, Gunganah K, Velauthar L, Saeed F. Clinical characteristics and pregnancy outcomes of women diagnosed with SARS-CoV-2 in London's most ethnically diverse borough: A cross-sectional study. Obstet Med 2021; 14:164-169. [PMID: 34646345 PMCID: PMC8504310 DOI: 10.1177/1753495x20985403] [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: 06/26/2020] [Revised: 10/22/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction It is unclear whether pregnant women from ethnic minority groups and with metabolic disorders are disproportionately affected by SARS-CoV-2 infection within deprived areas. No previous studies have compared pregnancy outcomes with an appropriate comparator group. Methods Cross-sectional study of 32 women with SARS-CoV-2 compared to background departmental figures from the three months prior to the outbreak. Clinical characteristics were compared to the UK Obstetric Surveillance System report. Results Estimated incidence was 10 times the national average (50.3 vs 4.9 per 1000 maternities). Women from Black (OR, 95% CI: 3.01, 1.08–7.38) and Asian (OR, 95% CI: 2.68, 1.23–6.05) ethnic groups were over-represented; however, there was no association with metabolic disorders. Babies born to women diagnosed with coronavirus were more likely to be born premature, or by caesarean delivery, however there was no difference in birthweight centile for gestational age. Conclusion Women from Black and Asian backgrounds are disproportionately affected, even within an area of high ethnic diversity. Mothers do not appear more severely affected than women nationally; however, babies are more likely to be born preterm, or by caesarean delivery, compared to usual departmental figures. It is unclear whether this is due to increased intervention or a direct result of coronavirus infection.
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Affiliation(s)
- Jack Milln
- Department of Endocrinology and Diabetes, Queen Mary University of London, London, UK.,Department of Endocrinology and Diabetes, Newham University Hospital, London
| | - Samuel Heard
- Department of Obstetrics and Gynaecology, Newham University Hospital, London
| | - Kirun Gunganah
- Department of Endocrinology and Diabetes, Newham University Hospital, London
| | | | - Ferha Saeed
- Department of Obstetrics and Gynaecology, Newham University Hospital, London
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Ahmad MS, Hicks SR, Watson R, Ahmed RA, Jones L, Vaselli M, Wu MS, Hayat F, Ratcliffe L, McKenna M, Hine P, Defres S, Wingfield T. A patient satisfaction survey and educational package to improve the care of people hospitalised with COVID-19: a quality improvement project, Liverpool, UK. Wellcome Open Res 2021; 6:222. [DOI: 10.12688/wellcomeopenres.17163.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The perspectives and experiences of people hospitalised with COVID-19 have been under-reported during the coronavirus pandemic. We developed and conducted a COVID-19 patient satisfaction survey in a large university-affiliated secondary healthcare centre in Liverpool, UK, during Europe’s first coronavirus wave (April-June 2020). The survey found that care was rated highly, including among people of Black Asian and Minority Ethnic (BAME) background. However, sleep-quality and communication about medications and discharge-planning were identified as areas for improvement. Methods: To improve care for people with COVID-19 admitted to our centre, we designed an educational package for healthcare professionals working on COVID-19 wards. The package, implemented in August 2020, included healthcare worker training sessions on providing holistic care and placement of “Practice Pointers” posters. Patient satisfaction was re-evaluated during the second/third COVID-19 waves in Liverpool (September 2020 - February 2021). Results: Across waves, most (95%) respondents reported that they would recommend our hospital to friends and/or family and rated overall care highly. Comparison of the responses of second/third-wave respondents (n=101) with first-wave respondents (n=94) suggested improved patient satisfaction across most care domains but especially those related to having worries and fears addressed and being consulted about medications and their side-effects. Conclusions: People admitted with COVID-19 to our centre in Liverpool, including those from BAME background, rated the care they received highly. A simple education package improved the feedback on care received by respondents between the first and second/third waves. These UK-first findings are informing regional strategies to improve person-centred care of hospitalised people with COVID-19.
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Wan YI, Robbins AJ, Apea VJ, Orkin CM, Pearse RM, Puthucheary ZA, Prowle JR. Ethnicity and acute hospital admissions: Multi-center analysis of routine hospital data. EClinicalMedicine 2021; 39:101077. [PMID: 34611614 PMCID: PMC8478677 DOI: 10.1016/j.eclinm.2021.101077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The effects of ethnic and social inequalities on patient outcomes in acute healthcare remain poorly understood. Methods: Prospectively-defined analysis of registry data from four acute NHS hospitals in east London including all patients ≥ 18 years with a first emergency admission between 1st January 2013 and 31st December 2018. We calculated adjusted one-year mortality risk using logistic regression. Results are presented as n (%), median (IQR), and odds ratios (OR) with 95% confidence intervals. Findings: We included 203,182 patients. 43,101 (21%) patients described themselves as Asian, 21,388 (10.5%) Black, 2,982 (1.4%) Mixed, 13,946 (6.8%) Other ethnicity, and 100,065 (49%) White. We excluded 21,700 (10.7%) patients with undisclosed ethnicity. 16,054 (7.9%) patients died within one year. Non-white patients were younger (Asian: 43 [31-62] years; Black: 48 [33-63] years; Mixed 36 [26-52] years) than White patients (55 [35-75] years), with a higher incidence of comorbid disease. In each age-group, non-white patients were more likely to be admitted to hospital. This effect was greatest in the ≥ 80 years age-group (32% non-white admitted to hospital versus 23% non-white in community population). Deprivation was associated with increased mortality in all ethnic groups (OR 1.41 [1.33-1.50]; p < 0.001). However, when adjusted for age, Asian (0.69 [0.66-0.73], p < 0.0001) and Black patients (0.79 [0.74-0.85]; p < 0.0001) experienced a lower mortality risk than White patients. Interpretation: Ethnic and social disparities are associated with important differences in acute health outcomes. However, these differences are masked by statistical adjustment because patients from ethnic minorities present at a younger age. Funding: None.
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Affiliation(s)
- Yize I. Wan
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
- Corresponding author at: William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom.
| | - Alexander J. Robbins
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - Vanessa J. Apea
- Blizard Institute, Queen Mary University of London, London E1 2AT, United Kingdom
- Department of Infection and Immunity, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - Chloe M. Orkin
- Blizard Institute, Queen Mary University of London, London E1 2AT, United Kingdom
- Department of Infection and Immunity, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - Rupert M. Pearse
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - Zudin A. Puthucheary
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - John R. Prowle
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
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Dumitrascu F, Branje KE, Hladkowicz ES, Lalu M, McIsaac DI. Association of frailty with outcomes in individuals with COVID-19: A living review and meta-analysis. J Am Geriatr Soc 2021; 69:2419-2429. [PMID: 34048599 PMCID: PMC8242611 DOI: 10.1111/jgs.17299] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Frailty leaves older adults vulnerable to adverse health outcomes. Frailty assessment is recommended by multiple COVID-19 guidelines to inform care and resource allocation. We aimed to identify, describe, and synthesize studies reporting the association of frailty with outcomes (informed by the Institute for Healthcare Improvement's Triple Aim [health, resource use, and experience]) in individuals with COVID-19. DESIGN Systematic review and meta-analysis. SETTING Studies reporting associations between frailty and outcomes in the setting of COVID-19 diagnosis. PARTICIPANTS Adults with COVID-19. MEASUREMENTS Following review of titles, abstracts and full text, we included 52 studies that contained 118,373 participants with COVID-19. Risk of bias was assessed using the Quality in Prognostic studies tool. Our primary outcome was mortality, secondary outcomes included delirium, intensive care unit admission, need for ventilation and discharge location. Where appropriate, random-effects meta-analysis was used to pool adjusted and unadjusted effect measures by frailty instrument. RESULTS The Clinical Frailty Scale (CFS) was the most used frailty instrument. Mortality was reported in 37 studies. After confounder adjustment, frailty identified using the CFS was significantly associated with mortality in COVID-19 positive patients (odds ratio 1.79, 95% confidence interval [CI] 1.49-2.14; hazard ratio 1.87, 95% CI 1.33-2.61). On an unadjusted basis, frailty identified using the CFS was significantly associated with increased odds of delirium and reduced odds of intensive care unit admission. Results were generally consistent using other frailty instruments. Patient-reported, cost and experience outcomes were rarely reported. CONCLUSION Frailty is associated with a substantial increase in mortality risk in COVID-19 patients, even after adjustment. Delirium risk is also increased. Frailty assessment may help to guide prognosis and individualized care planning, but data relating frailty status to patient-reported outcomes are urgently needed to provide a more comprehensive overview of outcomes relevant to older adults.
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Affiliation(s)
| | - Karina E. Branje
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
| | - Emily S. Hladkowicz
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- School of Rehabilitation TherapyQueen's UniversityKingstonCanada
| | - Manoj Lalu
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- Department of Anesthesiology and Pain MedicineUniversity of OttawaOttawaCanada
| | - Daniel I. McIsaac
- Department of Anesthesiology and Pain MedicineThe Ottawa HospitalOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
- Department of Anesthesiology and Pain MedicineUniversity of OttawaOttawaCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
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Hoogenboom WS, Pham A, Anand H, Fleysher R, Buczek A, Soby S, Mirhaji P, Yee J, Duong TQ. Clinical characteristics of the first and second COVID-19 waves in the Bronx, New York: A retrospective cohort study. ACTA ACUST UNITED AC 2021; 3:100041. [PMID: 34423331 PMCID: PMC8367084 DOI: 10.1016/j.lana.2021.100041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 12/29/2022]
Abstract
Background There is limited clinical patient data comparing the first and second waves of the coronavirus disease 2019 (COVID-19) in the United States and the effects of a COVID-19 resurgence on different age, racial and ethnic groups. We compared the first and second COVID-19 waves in the Bronx, New York, among a racially and ethnically diverse population. Methods Patients in this retrospective cohort study were included if they had a laboratory-confirmed SARS-CoV-2 infection by a real-time PCR test of a nasopharyngeal swab specimen detected between March 11, 2020, and January 21, 2021. Main outcome measures were critical care, in-hospital acquired disease and death. Patient demographics, comorbidities, vitals, and laboratory values were also collected. Findings A total of 122,983 individuals were tested for SARS-CoV-2 infection, of which 12,659 tested positive. The second wave was characterized by a younger demographic, fewer comorbidities, less extreme laboratory values at presentation, and lower risk of adverse outcomes, including in-hospital mortality (adj. OR = 0·23, 99·5% CI = 0·17 to 0·30), hospitalization (adj. OR = 0·65, 99·5% CI = 0·58 to 0·74), invasive mechanical ventilation (adj. OR = 0·70, 99·5% CI = 0·56 to 0·89), acute kidney injury (adj. OR = 0·62, 99·5% CI = 0·54 to 0·71), and length of stay (adj. OR = 0·71, 99·5% CI = 0·60 to 0·85), with Black and Hispanic patients demonstrating most improvement in clinical outcomes. Interpretation The second COVID-19 wave in the Bronx exhibits improved clinical outcomes compared to the first wave across all age, racial, and ethnic groups, with minority groups showing more improvement, which is encouraging news in the battle against health disparities.
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Affiliation(s)
- Wouter S. Hoogenboom
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Corresponding authors.
| | - Antoine Pham
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Harnadar Anand
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Roman Fleysher
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Alexandra Buczek
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Selvin Soby
- Center for Health Data Innovations, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Parsa Mirhaji
- Center for Health Data Innovations, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Department of Systems & Computational Biology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Judy Yee
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Tim Q. Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Corresponding authors.
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