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Aguilar-Palacio I, Maldonado L, Malo S, Castel-Feced S, Cebollada A, Aguilar-Latorre A, Rabanaque MJ. Differences in healthcare use and mortality in older adults during the COVID-19 pandemic: Exploring long-term care users' vulnerability. Heliyon 2024; 10:e34840. [PMID: 39148983 PMCID: PMC11324964 DOI: 10.1016/j.heliyon.2024.e34840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 08/17/2024] Open
Abstract
Background The objective of our study is to analyze the health care received by older adults with COVID-19 according to their place of residence (whether or not they live in a long-term care [LTC] facility) and to find out the effect of health care on mortality. Methods Retrospective cohort study based in Aragón (Spain) from March 2020 to March 2021 in patients aged 65 years or older with a confirmed COVID-19 infection. The population was classified according to their place of residence (living in a LTC or not). A propensity score was used to match individuals by sex and age. The effect of living in a LTC facility on healthcare delivery and mortality was conducted using adjusted multivariate models. Varimp was used to estimate the best predictors of mortality for both groups. Results Healthcare services utilization varied depending on whether the patients lived in a LTC facility or not. The time to diagnosis was shorter in institutionalized patients, but the time to hospital admission was longer. Length of hospital stays, risk of ICU admission and 30-day mortality were also different and remained statistically significant in the adjusted models. The variables that were more important in the association between healthcare utilization and mortality were those associated with greater severity of COVID-19. Conclusions There were differences in health care for older adults diagnosed with COVID-19 according to their place of residence. There is a need to strengthen collaboration between professionals in LTC centers and health services to provide equitable health care.
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Affiliation(s)
- Isabel Aguilar-Palacio
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Lina Maldonado
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Applied Economics, University of Zaragoza, Zaragoza, Spain
| | - Sara Malo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Sara Castel-Feced
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Alberto Cebollada
- Biocomputing Unit, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Alejandra Aguilar-Latorre
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute (ISCIII), Madrid, Spain
- Aragonese Primary Care Research Group (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - M José Rabanaque
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute (ISCIII), Madrid, Spain
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Noppert GA, Clarke P, Hoover A, Kubale J, Melendez R, Duchowny K, Hegde ST. State variation in neighborhood COVID-19 burden across the United States. COMMUNICATIONS MEDICINE 2024; 4:36. [PMID: 38429552 PMCID: PMC10907669 DOI: 10.1038/s43856-024-00459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND A lack of fine, spatially-resolute case data for the U.S. has prevented the examination of how COVID-19 infection burden has been distributed across neighborhoods, a key determinant of both risk and resilience. Without more spatially resolute data, efforts to identify and mitigate the long-term fallout from COVID-19 in vulnerable communities will remain difficult to quantify and intervene on. METHODS We leveraged spatially-referenced data from 21 states collated through the COVID Neighborhood Project to examine the distribution of COVID-19 cases across neighborhoods and states in the U.S. We also linked the COVID-19 case data with data on the neighborhood social environment from the National Neighborhood Data Archive. We then estimated correlations between neighborhood COVID-19 burden and features of the neighborhood social environment. RESULTS We find that the distribution of COVID-19 at the neighborhood-level varies within and between states. The median case count per neighborhood (coefficient of variation (CV)) in Wisconsin is 3078.52 (0.17) per 10,000 population, indicating a more homogenous distribution of COVID-19 burden, whereas in Vermont the median case count per neighborhood (CV) is 810.98 (0.84) per 10,000 population. We also find that correlations between features of the neighborhood social environment and burden vary in magnitude and direction by state. CONCLUSIONS Our findings underscore the importance that local contexts may play when addressing the long-term social and economic fallout communities will face from COVID-19.
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Affiliation(s)
- Grace A Noppert
- Institute for Social Research, University of Michigan, Ann Arbor, USA.
| | - Philippa Clarke
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Andrew Hoover
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - John Kubale
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Robert Melendez
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Kate Duchowny
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Sonia T Hegde
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
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Martinez-Beneito MA, Marí-Dell'Olmo M, Sánchez-Valdivia N, Rodríguez-Sanz M, Pérez G, Pasarín MI, Rius C, Artazcoz L, Prieto R, Pérez K, Borrell C. Socioeconomic inequalities in COVID-19 incidence during the first six waves in Barcelona. Int J Epidemiol 2023; 52:1687-1695. [PMID: 37494962 DOI: 10.1093/ije/dyad105] [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: 11/10/2022] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The emergence of SARS-CoV-2 affected urban areas. In Barcelona, six waves of COVID-19 hit the city between March 2020 and March 2022. Inequalities in the incidence of COVID-19 have been described. However, no studies have examined the daily trends of socioeconomic inequalities and how they changed during the different phases of the pandemic. The aim of this study is to analyse the dynamic socioeconomic inequalities in the incidence of COVID-19 during the six waves in Barcelona. METHODS We examined the proportion of daily cases observed in the census tracts in the lower income tercile compared with the proportion of daily cases observed in the sum of the lower and higher income terciles. Daily differences in these proportions were assessed as a function of the epidemic waves, sex, age group, daily incidence and daily change in the incidence. A logistic regression model with an autoregressive term was used for statistical analysis. RESULTS A time-dynamic effect was found for socioeconomic inequalities in the incidence of COVID-19. In fact, belonging to a lower-income area changed from being a risk factor (Waves 1, 2, 4 and 5) to being a protective factor in the sixth wave of the pandemic. Age also had a significant effect on incidence, which also changed over the different waves of the pandemic. Finally, the lower-income areas showed a comparatively lower incidence during the ascending phase of the epidemic waves. CONCLUSION Socioeconomic inequalities in COVID-19 changed by wave, age group and wave phase.
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Affiliation(s)
| | - Marc Marí-Dell'Olmo
- Unit of Data Management and Analysis, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
| | | | - Maica Rodríguez-Sanz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Unit of Research, Training and Communication, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Glòria Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Unit of COVID-19, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Isabel Pasarín
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Direction of Health Promotion, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Service of Epidemiology, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Lucía Artazcoz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Direction of Health Observatory, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Raquel Prieto
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Service of Epidemiology, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Katherine Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Service of Health Information Systems, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Executive Director, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
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Alidadi M, Sharifi A, Murakami D. Tokyo's COVID-19: An urban perspective on factors influencing infection rates in a global city. SUSTAINABLE CITIES AND SOCIETY 2023; 97:104743. [PMID: 37397232 PMCID: PMC10304317 DOI: 10.1016/j.scs.2023.104743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
This research investigates the relationship between COVID-19 and urban factors in Tokyo. To understand the spread dynamics of COVID-19, the study examined 53 urban variables (including population density, socio-economic status, housing conditions, transportation, and land use) in 53 municipalities of Tokyo prefecture. Using spatial models, the study analysed the patterns and predictors of COVID-19 infection rates. The findings revealed that COVID-19 cases were concentrated in central Tokyo, with clustering levels decreasing after the outbreaks. COVID-19 infection rates were higher in areas with a greater density of retail stores, restaurants, health facilities, workers in those sectors, public transit use, and telecommuting. However, household crowding was negatively associated. The study also found that telecommuting rate and housing crowding were the strongest predictors of COVID-19 infection rates in Tokyo, according to the regression model with time-fixed effects, which had the best validation and stability. This study's results could be useful for researchers and policymakers, particularly because Japan and Tokyo have unique circumstances, as there was no mandatory lockdown during the pandemic.
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Affiliation(s)
- Mehdi Alidadi
- Centre for Urban Research, School of Global, Urban and Social Studies, RMIT University, Melbourne, Australia
- Hiroshima University, Graduate School of Engineering and Advanced Science, Hiroshima, Japan
| | - Ayyoob Sharifi
- Hiroshima University, The IDEC Institute and Network for Education and Research on Peace and Sustainability (NERPS), Hiroshima, Japan
| | - Daisuke Murakami
- The Institute of Statistical Mathematics, Department of Statistical Data Science, Tokyo, Japan
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Sheriff R, Hong JSW, Henshall C, D'Agostino A, Tomassi S, Stein HC, Cerveri G, Cibra C, Bonora S, Giordano B, Smith T, Phiri P, Asher C, Elliot K, Zangani C, Ede R, Saad F, Smith KA, Cipriani A. Evaluation of telepsychiatry during the COVID-19 pandemic across service users, carers and clinicians: an international mixed-methods study. BMJ MENTAL HEALTH 2023; 26:e300646. [PMID: 37567731 PMCID: PMC10577786 DOI: 10.1136/bmjment-2022-300646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/14/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Worldwide uptake of telepsychiatry accelerated during the COVID-19 pandemic. OBJECTIVE To conduct an evaluation of the opinions, preferences and attitudes to telepsychiatry from service users, carers and clinicians in order to understand how telepsychiatry can be best used in the peri/post-COVID-19 era. METHODS This mixed-methods, multicentre, international study of telepsychiatry was set in two sites in England and two in Italy. Survey questionnaires and focus group topic guides were co-produced for each participant group (service users, carers and clinicians). FINDINGS In the UK, 906 service users, 117 carers and 483 clinicians, and in Italy, 164 service users, 56 carers and 72 clinicians completed the surveys. In all, 17 service users/carers and 14 clinicians participated in focus groups. Overall, telepsychiatry was seen as convenient in follow-ups with a specific purpose such as medication reviews; however, it was perceived as less effective for establishing a therapeutic relationship or for assessing acutely disturbed mental states. In contrast to clinicians, most service users and carers indicated that telepsychiatry had not improved during the COVID-19 pandemic. Most service users and carers reported that the choice of appointment modality was most often determined by the service or clinician. CONCLUSION AND RELEVANCE There were circumstances in which telepsychiatry was seen as more suitable than others and clear differences in clinician, carer and service user perspectives on telepsychiatry. CLINICAL IMPLICATIONS All stakeholders should be actively engaged in determining a hybrid model of care according to clinical features and service user and carer preferences. Clinicians should be engaged in training programmes on telepsychiatry.
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Affiliation(s)
- Rebecca Sheriff
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - James S W Hong
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Catherine Henshall
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Simona Tomassi
- Psychiatric Unit 1, Azienda ULSS 9 Scaligera, Verona, Italy
| | | | | | - Chiara Cibra
- Department of Psychiatry and Addiction, ASST Lodi, Lodi, Italy
| | - Stefano Bonora
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Barbara Giordano
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Tanya Smith
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Carolyn Asher
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Kathryn Elliot
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Caroline Zangani
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Roger Ede
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Fathi Saad
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Katharine Alison Smith
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
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Tiwari S, Petrov A, Mateshvili N, Devlin M, Golosov N, Rozanova-Smith M, Welford M, DeGroote J, Degai T, Ksenofontov S. Incorporating resilience when assessing pandemic risk in the Arctic: a case study of Alaska. BMJ Glob Health 2023; 8:bmjgh-2022-011646. [PMID: 37286235 DOI: 10.1136/bmjgh-2022-011646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/14/2023] [Indexed: 06/09/2023] Open
Abstract
The discourse on vulnerability to COVID-19 or any other pandemic is about the susceptibility to the effects of disease outbreaks. Over time, vulnerability has been assessed through various indices calculated using a confluence of societal factors. However, categorising Arctic communities, without considering their socioeconomic, cultural and demographic uniqueness, into the high and low continuum of vulnerability using universal indicators will undoubtedly result in the underestimation of the communities' capacity to withstand and recover from pandemic exposure. By recognising vulnerability and resilience as two separate but interrelated dimensions, this study reviews the Arctic communities' ability to cope with pandemic risks. In particular, we have developed a pandemic vulnerability-resilience framework for Alaska to examine the potential community-level risks of COVID-19 or future pandemics. Based on the combined assessment of the vulnerability and resilience indices, we found that not all highly vulnerable census areas and boroughs had experienced COVID-19 epidemiological outcomes with similar severity. The more resilient a census area or borough is, the lower the cumulative death per 100 000 and case fatality ratio in that area. The insight that pandemic risks are the result of the interaction between vulnerability and resilience could help public officials and concerned parties to accurately identify the populations and communities at most risk or with the greatest need, which, in turn, helps in the efficient allocation of resources and services before, during and after a pandemic. A resilience-vulnerability-focused approach described in this paper can be applied to assess the potential effect of COVID-19 and similar future health crises in remote regions or regions with large Indigenous populations in other parts of the world.
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Affiliation(s)
- Sweta Tiwari
- ARCTICenter, College of Social & Behavioral Sciences, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Andrey Petrov
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Nino Mateshvili
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Michele Devlin
- Center for Strategic Leadership, United States Army War College, Carlisle, Pennsylvania, USA
| | - Nikolay Golosov
- Department of Geography, Pennsylvania State University, Harrisburg, Pennsylvania, USA
| | - Marya Rozanova-Smith
- Department of Geography, Columbian College of Arts and Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Mark Welford
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - John DeGroote
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Tatiana Degai
- Anthropology, University of Victoria, Victoria, British Columbia, Canada
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Noppert GA, Clarke P, Hoover A, Kubale J, Melendez R, Duchowny K, Hegde ST. State Variation in Neighborhood COVID-19 Burden: Findings from the COVID Neighborhood Project. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.19.23290222. [PMID: 37293100 PMCID: PMC10246150 DOI: 10.1101/2023.05.19.23290222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A lack of fine, spatially-resolute case data for the U.S. has prevented the examination of how COVID-19 burden has been distributed across neighborhoods, a known geographic unit of both risk and resilience, and is hampering efforts to identify and mitigate the long-term fallout from COVID-19 in vulnerable communities. Using spatially-referenced data from 21 states at the ZIP code or census tract level, we documented how the distribution of COVID-19 at the neighborhood-level varies significantly within and between states. The median case count per neighborhood (IQR) in Oregon was 3,608 (2,487) per 100,000 population, indicating a more homogenous distribution of COVID-19 burden, whereas in Vermont the median case count per neighborhood (IQR) was 8,142 (11,031) per 100,000. We also found that the association between features of the neighborhood social environment and burden varied in magnitude and direction by state. Our findings underscore the importance of local contexts when addressing the long-term social and economic fallout communities will face from COVID-19.
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Affiliation(s)
| | | | - Andrew Hoover
- Institute for Social Research, University of Michigan
| | - John Kubale
- Institute for Social Research, University of Michigan
| | | | - Kate Duchowny
- Institute for Social Research, University of Michigan
| | - Sonia T Hegde
- Department of Epidemiology, Johns Hopkins University
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Zhou L, Xiao W, Zheng Z, Zhang H. Commercial dynamics in urban China during the COVID-19 recession: Vulnerability and short-term adaptation of commercial centers in Shanghai. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2023; 152:102889. [PMID: 36713474 PMCID: PMC9860259 DOI: 10.1016/j.apgeog.2023.102889] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/19/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Studying the commercial dynamics during the COVID-19 recession could help deepen our understanding of how the pandemic damages the commercial economy and how to against the pandemic. This study aims to explore the vulnerability and adaptation of commercial centers using a weekly consumption data of UnionPay cards in Shanghai. A vulnerability index and multiscale geographically weighted regressions (MGWR) are employed. Our results suggest that retail, leisure, and entertainment sectors are less vulnerable to the pandemic at the early stage, when catering, life service, and wholesale sectors are more influenced. Catering, life service, and wholesale sectors were better adapted to the second wave of the pandemic, while the retail and entertainment sectors were even more vulnerable. Further analysis using MGWR models suggests that the commercial centers with higher consumption volume are better adapted to the shock. The diversity of commercial sectors mainly reduces low-level commercial centers' vulnerability to the pandemic. The commercial centers targeting high-end consumers with wider hinterland were less adapted to the pandemic. These research outcomes reveal the disparities in commercial centers' vulnerability against COVID-19 and highlight adaptation's role during the pandemic.
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Affiliation(s)
- Lei Zhou
- School of Geographic and Biologic Information, Nanjing University of Posts and Telecommunications, Nanjing, 210023, China
| | - Weiye Xiao
- Nanjing Institute of Geography and Limnology, Chinese Academy of Sciences, Nanjing, 214000, China
| | - Zhenlong Zheng
- School of Geographic and Biologic Information, Nanjing University of Posts and Telecommunications, Nanjing, 210023, China
| | - Haiping Zhang
- School of Geographic Science, Nanjing Normal University, Nanjing, 210023, China
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9
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Irizar P, Pan D, Kapadia D, Bécares L, Sze S, Taylor H, Amele S, Kibuchi E, Divall P, Gray LJ, Nellums LB, Katikireddi SV, Pareek M. Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. EClinicalMedicine 2023; 57:101877. [PMID: 36969795 PMCID: PMC9986034 DOI: 10.1016/j.eclinm.2023.101877] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59-1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59-5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02-1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01-1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination. Funding ESRC:ES/W000849/1.
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Affiliation(s)
- Patricia Irizar
- School of Social Sciences, University of Manchester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, United Kingdom
| | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Harry Taylor
- School of Social Sciences, University of Manchester, United Kingdom
| | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Eliud Kibuchi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
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10
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Dei Bardi L, Acampora A, Cacciani L, Di Martino M, Agabiti N, Davoli M, Cesaroni G. SARS-CoV-2 spread and area economic disadvantage in the italian three-tier restrictions: a multilevel approach. BMC Public Health 2023; 23:329. [PMID: 36788600 PMCID: PMC9926448 DOI: 10.1186/s12889-023-15246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND To face the second wave of COVID-19, Italy implemented a tiered restriction system with different limitation levels (yellow = medium; orange = medium-high, red = high) at the beginning of November 2020. The restrictions systematically reduced the transmission of SARS-CoV-2 with increasing strength for increasing tier. However, it is unknown whether the effect of limitations was equal between provinces with different socioeconomic levels. Therefore, we investigated the association between the province's socioeconomic level and SARS-CoV-2 infection daily reproduction number in each restriction level. METHODS We measured the province's socioeconomic level as the percentage of individuals whose 2019 total yearly income was lower than 10,000€, using the measure as a proxy of economic disadvantage. We estimated the daily reproduction number (Rt) at the province level using the SARS-CoV-2 daily incidence data from November 2020 to May 2021. We then used multilevel linear regression models with random intercepts stratified by restriction level to estimate the association between economic disadvantage and Rt. We also adjusted the analyses for potential confounders of the association between the province's economic disadvantage and the Rt: the percentage of people with 0-5 years, the quartiles of population density, and the geographical repartition. RESULTS Overall, we found increasing Rt in yellow (+ 0.004 p < 0.01, from Rt = 0.99 to 1.08 in three weeks) and containing effects for the orange (-0.005 p < 0.01, from Rt = 1.03 to 0.93) and the red tier (-0.014 p < 0.01, from Rt = 1.05 to 0.76). More economically disadvantaged provinces had higher Rt levels in every tier, although non-significantly in the yellow level (yellow = 0.001 p = 0.19; orange = 0.002 p = 0.02; red = 0.004 p < 0.01). The results showed that the association between economic disadvantage and Rt differed by level of restriction. The number of days into the restriction and the economic disadvantage had statistically significant interactions in every adjusted model. Compared to better off, more economically disadvantaged provinces had slower increasing trends in yellow and steeper Rt reductions in orange, but they showed slower Rt reductions in the highest tier. CONCLUSION Lower tiers were more effective in more economically disadvantaged provinces, while the highest restriction level had milder effects. These results underline the importance of accounting for socioeconomic level when implementing public health measures.
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Affiliation(s)
- Luca Dei Bardi
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy. .,Sapienza University of Rome, Rome, Italy.
| | - Anna Acampora
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Laura Cacciani
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Mirko Di Martino
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Giulia Cesaroni
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
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11
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Umbrello M, Miori S, Sanna A, Lassola S, Baruzzo E, Penzo D, Pedrotti G, Perino A, Colombo A, Pace R, Magnoni S. High rates of impaired quality of life and social and economic problems at 6 months after COVID-19-related ARDS. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022. [PMCID: PMC9109430 DOI: 10.1186/s44158-022-00048-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose Assess long-term quality of life (HR-QoL) and socio-economic impact in COVID-19-related ARDS (C-ARDS) survivors. Methods C-ARDS survivors were followed up at 6 months in this prospective, cohort study. HR-QoL was assessed using SF-36 and EQ-5D-5L, and the socio-economic burden of COVID-19 was evaluated with a dedicated questionnaire. Clinical data were prospectively recorded. Results Seventy-nine survivors, age 63 [57-71], 84% male, were enrolled. The frequency of EQ-5D-5L reported problems was significantly higher among survivors compared to normal, in mobility, usual activities, and self-care; anxiety and depression and pain were not different. SF-36 scores were lower than the reference population, and physical and mental summary scores were below normal in 52% and 33% of the subjects, respectively. In the multivariable analysis, prolonged hospital length of stay (OR 1.45; p 0.02) and two or more comorbidities on admission (OR 7.42; p 0.002) were significant predictors of impaired “physical” and “mental” HR-QoL, respectively. A total of 38% subjects worsened social relations, 42% changed their employment status, and 23% required personal care support. Conclusions C-ARDS survivors have long-term impairment in HR-QoL and socio-economic problems. Prolonged hospital stay and previous comorbidities are risk factors for developing health-related issues. Supplementary Information The online version contains supplementary material available at. 10.1186/s44158-022-00048-5
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12
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Alidadi M, Sharifi A. Effects of the built environment and human factors on the spread of COVID-19: A systematic literature review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 850:158056. [PMID: 35985590 PMCID: PMC9383943 DOI: 10.1016/j.scitotenv.2022.158056] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 05/25/2023]
Abstract
Soon after its emergence, COVID-19 became a global problem. While different types of vaccines and treatments are now available, still non-pharmacological policies play a critical role in managing the pandemic. The literature is enriched enough to provide comprehensive, practical, and scientific insights to better deal with the pandemic. This research aims to find out how the built environment and human factors have affected the transmission of COVID-19 on different scales, including country, state, county, city, and urban district. This is done through a systematic literature review of papers indexed on the Web of Science and Scopus. Initially, these databases returned 4264 papers, and after different stages of screening, we found 166 relevant papers and reviewed them. The empirical papers that had at least one case study and analyzed the effects of at least one built environment factor on the spread of COVID-19 were selected. Results showed that the driving forces can be divided into seven main categories: density, land use, transportation and mobility, housing conditions, demographic factors, socio-economic factors, and health-related factors. We found that among other things, overcrowding, public transport use, proximity to public spaces, the share of health and services workers, levels of poverty, and the share of minorities and vulnerable populations are major predictors of the spread of the pandemic. As the most studied factor, density was associated with mixed results on different scales, but about 58 % of the papers reported that it is linked with a higher number of cases. This study provides insights for policymakers and academics to better understand the dynamic roles of the non-pharmacological driving forces of COVID-19 at different levels.
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Affiliation(s)
- Mehdi Alidadi
- Graduate School of Engineering and Advanced Sciences, Hiroshima University, Hiroshima, Japan.
| | - Ayyoob Sharifi
- Graduate School of Humanities and Social Science, Network for Education and Research on Peace and Sustainability (NERPS), and the Center for Peaceful and Sustainable Futures (CEPEAS), Hiroshima University, Japan.
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13
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Marra M, Strippoli E, Zengarini N, Costa G. Inequalities in the Health Impact of the First Wave of the COVID-19 Pandemic in Piedmont Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14791. [PMID: 36429508 PMCID: PMC9690941 DOI: 10.3390/ijerph192214791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
(1) Introduction: Several studies observe a social gradient in the incidence and health consequences of SARS-CoV-2 infection, but they rely mainly on spatial associations because individual-level data are lacking. (2) Objectives: To assess the impact of social inequalities in the health outcomes of COVID-19 during the first epidemic wave in Piedmont Region, Italy, evaluating the role of the unequal social distribution of comorbidities and the capacity of the healthcare system to promote equity. (3) Methods: Subjects aged over 35, resident in Piedmont on 22 February 2020, were followed up until 30 May 2020 for access to swabs, infection, hospitalization, admission to intensive care unit, in-hospital death, COVID-19, and all-cause death. Inequalities were assessed through an Index of Socioeconomic Disadvantage composed of information on education, overcrowding, housing conditions, and neighborhood deprivation. Relative incidence measures and Relative Index of Inequality were estimated through Poisson regression models, stratifying by gender and age groups (35-64 years; ≥65 years), adjusting for comorbidity. (4) Results: Social inequalities were found in the various outcomes, in the female population, and among elderly males. Inequalities in ICU were lower, but analyses only on in-patients discount the hypothesis of preferential access by the most advantaged. Comorbidities contribute to no more than 30% of inequalities. (5) Conclusions: Despite the presence of significant inequities, the pandemic does not appear to have further exacerbated health inequalities, partly due to the fairness of the healthcare system. It is necessary to reduce inequalities in the occurrence of comorbidities that confer susceptibility to COVID-19 and promote prevention policies that limit inequalities in the mechanisms of contagion and improve out-of-hospital timely treatment.
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Affiliation(s)
- Michele Marra
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Elena Strippoli
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Nicolás Zengarini
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Giuseppe Costa
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
- Department of Clinical and Biological Sciences, University of Turin, 10126 Torino, Italy
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14
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Cabrera-Mendoza B, Wendt FR, Pathak GA, De Angelis F, De Lillo A, Koller D, Polimanti R. The association of obesity-related traits on COVID-19 severity and hospitalization is affected by socio-economic status: a multivariable Mendelian randomization study. Int J Epidemiol 2022; 51:1371-1383. [PMID: 35751636 PMCID: PMC9278255 DOI: 10.1093/ije/dyac129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/18/2021] [Accepted: 05/30/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Due to its large impact on human health, socio-economic status (SES) could at least partially influence the established association between obesity and coronavirus disease 2019 (COVID-19) severity. To estimate the independent effect of body size and SES on the clinical manifestations of COVID-19, we conducted a Mendelian randomization (MR) study. METHODS Applying two-sample MR approaches, we evaluated the effects of body mass index (BMI, n = 322 154), waist circumference (WC, n = 234 069), hip circumference (n = 213 019) and waist-hip ratio (n = 210 088) with respect to three COVID-19 outcomes: severe respiratory COVID-19 (cases = 8779, controls = 1 000 875), hospitalized COVID-19 (cases = 17 992, controls = 1 810 493) and COVID-19 infection (cases = 87 870, controls = 2 210 804). Applying a multivariable MR (MVMR) approach, we estimated the effect of these anthropometric traits on COVID-19 outcomes accounting for the effect of SES assessed as household income (n = 286 301). RESULTS BMI and WC were associated with severe respiratory COVID-19 [BMI: odds ratio (OR) = 1.51, CI = 1.24-1.84, P = 3.01e-05; WC: OR = 1.48, 95% CI = 1.15-1.91, P = 0.0019] and hospitalized COVID-19 (BMI: OR = 1.50, 95% CI = 1.32-1.72, P = 8.83e-10; WC: OR = 1.41, 95% CI = 1.20-1.67, P = 3.72e-05). Conversely, income was associated with lower odds of severe respiratory (OR = 0.70, 95% CI = 0.53-0.93, P = 0.015) and hospitalized COVID-19 (OR = 0.78, 95% CI = 0.66-0.92, P = 0.003). MVMR analyses showed that the effect of these obesity-related traits on increasing the odds of COVID-19 negative outcomes becomes null when accounting for income. Conversely, the association of income with lower odds of COVID-19 negative outcomes is not affected when including the anthropometric traits in the multivariable model. CONCLUSION Our findings indicate that SES contributes to the effect of obesity-related traits on COVID-19 severity and hospitalization.
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Affiliation(s)
- Brenda Cabrera-Mendoza
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
| | - Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
| | - Flavio De Angelis
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
| | | | - Dora Koller
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
| | - Renato Polimanti
- Corresponding author. Department of Psychiatry, Yale University School of Medicine, VA CT 116A2, 950 Campbell Avenue, West Haven, CT 06516, USA. E-mail:
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15
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Beese F, Waldhauer J, Wollgast L, Pförtner TK, Wahrendorf M, Haller S, Hoebel J, Wachtler B. Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic—A Scoping Review. Int J Public Health 2022; 67:1605128. [PMID: 36105178 PMCID: PMC9464808 DOI: 10.3389/ijph.2022.1605128] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/16/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives: International evidence of socioeconomic inequalities in COVID-19 outcomes is extensive and growing, but less is known about the temporal dynamics of these inequalities over the course of the pandemic. Methods: We systematically searched the Embase and Scopus databases. Additionally, several relevant journals and the reference lists of all included articles were hand-searched. This study follows the PRISMA guidelines for scoping reviews. Results: Forty-six studies were included. Of all analyses, 91.4% showed stable or increasing socioeconomic inequalities in COVID-19 outcomes over the course of the pandemic, with socioeconomically disadvantaged populations being most affected. Furthermore, the study results showed temporal dynamics in socioeconomic inequalities in COVID-19, frequently initiated through higher COVID-19 incidence and mortality rates in better-off populations and subsequent crossover dynamics to higher rates in socioeconomically disadvantaged populations (41.9% of all analyses). Conclusion: The identified temporal dynamics of socioeconomic inequalities in COVID-19 outcomes have relevant public health implications. Socioeconomic inequalities should be monitored over time to enable the adaption of prevention and interventions according to the social particularities of specific pandemic phases.
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Affiliation(s)
- Florian Beese
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- *Correspondence: Florian Beese,
| | - Julia Waldhauer
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lina Wollgast
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine and Faculty of Human Sciences, University of Cologne, Cologne, Germany
- Research Methods Division, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society (CHS), Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany
| | - Sebastian Haller
- Division of Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Benjamin Wachtler
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Income differences in COVID-19 incidence and severity in Finland among people with foreign and native background: A population-based cohort study of individuals nested within households. PLoS Med 2022; 19:e1004038. [PMID: 35947575 PMCID: PMC9365184 DOI: 10.1371/journal.pmed.1004038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although intrahousehold transmission is a key source of Coronavirus Disease 2019 (COVID-19) infections, studies to date have not analysed socioeconomic risk factors on the household level or household clustering of severe COVID-19. We quantify household income differences and household clustering of COVID-19 incidence and severity. METHODS AND FINDINGS We used register-based cohort data with individual-level linkage across various administrative registers for the total Finnish population living in working-age private households (N = 4,315,342). Incident COVID-19 cases (N = 38,467) were identified from the National Infectious Diseases Register from 1 July 2020 to 22 February 2021. Severe cases (N = 625) were defined as having at least 3 consecutive days of inpatient care with a COVID-19 diagnosis and identified from the Care Register for Health Care between 1 July 2020 and 31 December 2020. We used 2-level logistic regression with individuals nested within households to estimate COVID-19 incidence and case severity among those infected. Adjusted for age, sex, and regional characteristics, the incidence of COVID-19 was higher (odds ratio [OR] 1.67, 95% CI 1.58 to 1.77, p < 0.001, 28.4% of infections) among individuals in the lowest household income quintile than among those in the highest quintile (18.9%). The difference attenuated (OR 1.23, 1.16 to 1.30, p < 0.001) when controlling for foreign background but not when controlling for other household-level risk factors. In fact, we found a clear income gradient in incidence only among people with foreign background but none among those with native background. The odds of severe illness among those infected were also higher in the lowest income quintile (OR 1.97, 1.52 to 2.56, p < 0.001, 28.0% versus 21.6% in the highest quintile), but this difference was fully attenuated (OR 1.08, 0.77 to 1.52, p = 0.64) when controlling for other individual-level risk factors-comorbidities, occupational status, and foreign background. Both incidence and severity were strongly clustered within households: Around 77% of the variation in incidence and 20% in severity were attributable to differences between households. The main limitation of our study was that the test uptake for COVID-19 may have differed between population subgroups. CONCLUSIONS Low household income appears to be a strong risk factor for both COVID-19 incidence and case severity, but the income differences are largely driven by having foreign background. The strong household clustering of incidence and severity highlights the importance of household context in the prevention and mitigation of COVID-19 outcomes.
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Evaluation of General Health Status of Persons Living in Socio-Economically Disadvantaged Neighborhoods in a Large European Metropolitan City. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Living in socio-economically disadvantaged neighborhoods can predispose persons to numerous health conditions. The purpose of this study was to report the general health conditions of persons living in disadvantaged neighborhoods in Rome, Italy, a large European metropolitan city. Participants were reached through the mobile facilities of the primary care services of the Dicastery for the Charity Services, Vatican City. Methods: People living in disadvantaged neighborhoods were reached with mobile medical units by doctors, nurses, and paramedics. Demographic characteristics, degree of social integration, housing conditions, and history of smoking and/or alcohol use were investigated. Unstructured interviews and general health assessments were performed to investigate common acute and/or chronic diseases, and history of positivity to COVID-19. Basic health parameters were measured; data were collected and analyzed. Results: Over a 10-month period, 436 individuals aged 18–95 years were enrolled in the study. Most lived in dormitories, whereas a few lived in unsheltered settings. Most participants (76%) were unemployed. Smoking and drinking habits were comparable to the general population. The most common pathological conditions were cardiovascular diseases in 103 subjects (23.39%), diabetes in 65 (14.9%), followed by musculoskeletal system disorders (11.7%), eye diseases (10.5%), psychiatric conditions such as anxiety and depression (9.2%), and chronic respiratory conditions (8.7%). Conclusions: Subjects in our sample showed several pathologic conditions that may be related to their living conditions, thus encouraging the development of more efficient and effective strategies for a population-tailored diagnosis and treatment.
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Effects of the COVID-19 Outbreak on the Use and Perceptions of Metropolitan Agricultural Parks—Evidence from Milan and Naples of Urban and Environmental Resilience. SUSTAINABILITY 2022. [DOI: 10.3390/su14127509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This article describes the multi-function of the metropolitan agricultural parks (MAPs) in Milan (Parco Agricolo Sud Milano) and Naples (Parco De Filippo) and their resilience within the last COVID-19 lockdown period. These parks play an important role in the urban regeneration and social inclusion processes in their relative metropolitan areas. Nevertheless, the restrictions imposed to limit COVID-19 contagions have imposed their closure or severely limited their activities, with evident consequences for the local population’s well-being. This study’s novelty is twofold: it is the first study examining the resilience and sustainability impact of MAPs during COVID-19; additionally, it is the first survey making use of Milan and Naples practices. The work uses primary and secondary data and mixed methods. Exploiting a document analysis and the elaboration of a semi-structured interview with the directors, the article lists the multiple functions of the parks and underlines their multidimensional governance vocations for fostering sustainable development—environmental, economic and social functions. The study also reveals that, during the lockdown, the parks’ activities were strongly reduced or restructured. Recreational and educational activities were lifted in Parco Agricolo Sud in Milan whilst local farms restructured their food supply and fostered their network and linkages with the urban distribution channels. MAP in Naples had to stop its activities and reorganize into a smart-working system. Lastly, our study found that economic and farm network activities were resumed with greater urgency in Milan, whereas in Naples the recovery of the social practices has taken on greater importance.
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Fogh K, Eriksen ARR, Hasselbalch RB, Kristensen ES, Bundgaard H, Nielsen SD, Jørgensen CS, Scharff BFSS, Erikstrup C, Sækmose SG, Holm DK, Aagaard B, Norsk J, Nielsen PB, Kristensen JH, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, Fischer TK, Folke F, Lippert F, Ostrowski SR, Ethelberg S, Koch A, Vangsted AM, Krause TG, Fomsgaard A, Nielsen C, Ullum H, Skov R, Iversen K. Seroprevalence of SARS-CoV-2 antibodies in social housing areas in Denmark. BMC Infect Dis 2022; 22:143. [PMID: 35144550 PMCID: PMC8830972 DOI: 10.1186/s12879-022-07102-1] [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: 05/30/2021] [Accepted: 01/29/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND COVID-19 is thought to be more prevalent among ethnic minorities and individuals with low socioeconomic status. We aimed to investigate the prevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among citizens 15 years or older in Denmark living in social housing (SH) areas. METHODS We conducted a study between January 8th and January 31st, 2021 with recruitment in 13 selected SH areas. Participants were offered a point-of-care rapid SARS-CoV-2 IgM and IgG antibody test and a questionnaire concerning risk factors associated with COVID-19. As a proxy for the general Danish population we accessed data on seroprevalence from Danish blood donors (total Ig ELISA assay) in same time period. RESULTS Of the 13,279 included participants, 2296 (17.3%) were seropositive (mean age 46.6 (SD 16.4) years, 54.2% female), which was 3 times higher than in the general Danish population (mean age 41.7 (SD 14.1) years, 48.5% female) in the same period (5.8%, risk ratios (RR) 2.96, 95% CI 2.78-3.16, p > 0.001). Seropositivity was higher among males (RR 1.1, 95% CI 1.05-1.22%, p = 0.001) and increased with age, with an OR seropositivity of 1.03 for each 10-year increase in age (95% CI 1.00-1.06, p = 0.031). Close contact with COVID-19-infected individuals was associated with a higher risk of infection, especially among household members (OR 5.0, 95% CI 4.1-6.2 p < 0,001). Living at least four people in a household significantly increased the OR of seropositivity (OR 1.3, 95% CI 1.0-1.6, p = 0.02) as did living in a multi-generational household (OR 1.3 per generation, 95% CI 1.1-1.6, p = 0.003). Only 1.6% of participants reported not following any of the national COVID-19 recommendations. CONCLUSIONS Danish citizens living in SH areas of low socioeconomic status had a three times higher SARS-CoV-2 seroprevalence compared to the general Danish population. The seroprevalence was significantly higher in males and increased slightly with age. Living in multiple generations households or in households of more than four persons was a strong risk factor for being seropositive. Results of this study can be used for future consideration of the need for preventive measures in the populations living in SH areas.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra R. R. Eriksen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus B. Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Sofie Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D. Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Bibi F. S. S. Scharff
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susanne G. Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Dorte K. Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Norsk
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Brok Nielsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jonas H. Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S. Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea K. Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R. Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ethelberg
- Statens Serum Institut, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Georeferencing of COVID-19 Positive Nasopharyngeal Swabs to Support Emergency Management in an Area of Northern Italy. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2021. [DOI: 10.3390/ijgi11010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spatial distribution heterogeneity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed in several countries. While previous studies have covered vast geographic areas, detailed analyses on smaller territories are not available to date. The aim of our study was to understand the spatial spread of SARS-CoV-2 in a province of Northern Italy through the analysis of positive nasopharyngeal (NP) swabs. The study was conducted on subjects who lived in the province of Alessandria with at least one positive NP swab between 2 March and 22 December 2020. To investigate if clustering occurred, the proportion of SARS-CoV-2 positive subjects over the total number of residents in each small administrative subregion was calculated and then mapped. A total of 17,260 subjects with at least one positive NP swab were included; the median age was 54 years (Interquartile range 38–72) and 54.9% (n = 9478) of our study population were female. Among the 192 towns scanned, 26 showed a prevalence between 5% and 7.5%, one between 7.5% and 10% and two with more than 10% positive swabs. The territories with a higher prevalence of positive subjects were located in areas with at least one nursing home and potential clusters were observed within these structures. The maps produced may be considered a useful and important monitoring system to identify areas with a significant and relevant diffusion of SARS-CoV-2.
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21
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Jolliff A, Zhao Q, Eickhoff J, Moreno M. Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study. JMIR Form Res 2021; 5:e30702. [PMID: 34609316 PMCID: PMC8641699 DOI: 10.2196/30702] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in significant changes to adolescents' daily lives and, potentially, to their mental health. The pandemic has also disproportionately affected historically marginalized and at-risk communities, including people of color, socioeconomically disadvantaged people, people identifying as female, and youth. OBJECTIVE This study aimed to understand differences in depression and anxiety among 2 groups of adolescents in the United States before and during the COVID-19 pandemic, and to examine demographic and daily activity variables associated with depression and anxiety. METHODS Online surveys were distributed in 2019 and 2020. Demographic questions were asked at the time of enrollment, and included participants' age, gender, race and ethnicity, and socioeconomic status (SES). The 8-item Patient Health Questionnaire was used to assess symptoms of depression, and the 7-item Generalized Anxiety Disorder scale was used to assess symptoms of anxiety. A total of 4 pandemic-specific daily activity questions were asked only of the pandemic group. Analyses of covariance compared depression and anxiety between prepandemic and pandemic groups. Demographic and lifestyle variables were included as covariates. RESULTS The sample comprised a total of 234 adolescents, with 100 participants in the prepandemic group and 134 participants in the pandemic group. Within the pandemic group, 94% (n=126) of adolescents reported being out of school due to the pandemic, and another 85.8% (n=115) and 57.1% (n=76) were prevented from extracurricular activities and exercise, respectively. Higher depression was seen in the pandemic group, with a least-squares adjusted mean of 7.62 (SD 1.36) compared to 6.28 (SD 1.42) in the prepandemic group, although the difference was not significant (P=.08). There was no significant difference in anxiety scores between the 2 groups (least-squares adjusted means 5.52, SD 1.30 vs 5.01, SD 1.36; P=.48). Within the pandemic group, lower SES was predictive of anxiety, such that those in the pandemic group of lower SES were more anxious than their higher-SES peers (least-squares adjusted means 11.17, SD 2.34 vs 8.66, SD 2.16; P=.02). Within the pandemic group, being out of work or school and not partaking in extracurricular activities or exercise due to the pandemic were not associated with higher depression or anxiety scores. CONCLUSIONS In this study, neither being in the pandemic group nor experiencing changes in daily activity due to the pandemic was associated with higher depression or anxiety. However, we found that adolescents from lower SES backgrounds experienced significantly more anxiety during the pandemic than their more privileged peers. Both instrumental and mental health interventions for low-income adolescents are imperative.
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Affiliation(s)
- Anna Jolliff
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, United States
| | - Qianqian Zhao
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, United States
| | - Jens Eickhoff
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, United States
| | - Megan Moreno
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, United States
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22
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Alves ATJ, Raposo LM, Nobre FF. Spatial Analysis of the Sociodemographic Characteristics, Comorbidities, Hospitalization, Signs, and Symptoms Among Hospitalized Coronavirus Disease 2019 Cases in the State of Rio De Janeiro, Brazil. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 52:38-46. [PMID: 34617799 DOI: 10.1177/00207314211044991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
After more than 1 year from the beginning of the pandemic, the coronavirus disease 2019 (COVID-19) has reached all continents. The number of infected people is still increasing, and Brazil is among the countries with the highest number of registered cases in the world. In this study, we investigated the profile of hospitalized COVID-19 cases and the eventual clusters of similar areas, using geographic information systems. The study was conducted using secondary data. Variables such as sociodemographic characteristics, comorbidities, hospitalization, signs, and symptoms among confirmed cases were considered for each microregion/city of the state of Rio de Janeiro. These proportions were used when calculating the Global Moran's I. The local indicator of spatial association was used to identify local clusters. A significant global spatial auto correlation was found in 28% of the variables. The presence of spatial autocorrelation indicates that the proportions of patients with COVID-19 according to these characteristics are spatially oriented. Moran maps reveal 2 clusters, 1 of high proportions and 1 of low proportions. Understanding the geographic patterns of COVID-19 may assist public health investigators, contributing to actions to prevent and control the pandemic in the state.
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Affiliation(s)
| | - Letícia M Raposo
- 89111Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio F Nobre
- 28125Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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23
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Yu W, Xu R, Ye T, Han C, Chen Z, Song J, Li S, Guo Y. Temperature-mortality association during and before the COVID-19 pandemic in Italy: A nationwide time-stratified case-crossover study. URBAN CLIMATE 2021; 39:100948. [PMID: 34580627 PMCID: PMC8459163 DOI: 10.1016/j.uclim.2021.100948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To identify the associations of temperature with non-COVID-19 mortality and all-cause mortality in the pandemic 2020 in comparison with the non-COVID-19 period in Italy. METHODS The data on 3,189,790 all-cause deaths (including 3,134,137 non-COVID-19 deaths) and meteorological conditions in 107 Italian provinces between February 1st and November 30th in each year of 2015-2020 were collected. We employed a time-stratified case-crossover study design combined with the distributed lag non-linear model to investigate the relationships of temperature with all-cause and non-COVID-19 mortality in the pandemic and non-pandemic periods. RESULTS Cold temperature exposure contributed higher risks for both all-cause and non-COVID-19 mortality in the pandemic period in 2020 than in 2015-2019. However, no different change was found for the impacts of heat. The relative risk (RR) of non-COVID-19 deaths and all-cause mortality at extremely cold (2 °C) in comparison with the estimated minimum mortality temperature (19 °C) in 2020 were 1.63 (95% CI: 1.55-1.72) and 1.45 (95%CI: 1.31-1.61) respectively, which were higher than all-cause mortality risk in 2015-2019 with RR of 1.19 (95%CI: 1.17-1.21). CONCLUSION Cold exposure indicated stronger impacts than high temperatures on all-cause and non-COVID-19 mortality in the pandemic year 2020 compared to its counterpart period in 2015-2019 in Italy.
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Affiliation(s)
- Wenhua Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Chunlei Han
- School of Public Health and Management, Binzhou Medical University, 346 Guanhai Road, Yantai 264003, PR China
| | - Zhuying Chen
- Department of Biomedical Engineering, The University of Melbourne, 203 Bouverie Street, Melbourne, VIC 3053, Australia
| | - Jiangning Song
- Monash Biomedicine Discovery Institute, Department of Biochemistry and Molecular Biology, Monash University, Melbourne, VIC 3800, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
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24
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COVID-19 Pandemic and Equal Access to Vaccines. Vaccines (Basel) 2021; 9:vaccines9060538. [PMID: 34063863 PMCID: PMC8224034 DOI: 10.3390/vaccines9060538] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022] Open
Abstract
The COVID-19 pandemic has evidenced the chronic inequality that exists between populations and communities as regards global healthcare. Vaccination, an appropriate tool for the prevention of infection, should be guaranteed by means of proportionate interventions to defeat such inequality in populations and communities affected by a higher risk of infection. Equitable criteria of justice should be identified and applied with respect to access to vaccination and to the order in which it should be administered. This article analyzes, as regards the worldwide distribution of anti-COVID-19 vaccines, the various ways the principle of equity has been construed and applied or even overlooked. The main obstacle to equal access to vaccines is vaccine nationalism. The perception of equity varies with the differing reference values adopted. Adequate response to needs appears to be the principal rule for achieving the criterion of equity in line with distributive justice. Priorities must be set equitably based on rational parameters in accordance with current needs. The entire process must be governed by transparency, from parameter identification to implementation. The issue of equal access to vaccination affects the entire world population, necessitating specific protective interventions. In light of this, the World Health Organization (WHO) has devised the COVAX plan to ensure that even the poorest nations of the world receive the vaccine; certain initiatives are also supported by the European Union (EU). This pandemic has brought to the fore the need to build a culture of equitable relationships both in each country’s own domain and with the rest of the world.
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