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Bonanno GA, Chen S, Bagrodia R, Galatzer-Levy IR. Resilience and Disaster: Flexible Adaptation in the Face of Uncertain Threat. Annu Rev Psychol 2024; 75:573-599. [PMID: 37566760 DOI: 10.1146/annurev-psych-011123-024224] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.
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Affiliation(s)
- George A Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA; , ,
| | - Shuquan Chen
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA; , ,
| | - Rohini Bagrodia
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA; , ,
| | - Isaac R Galatzer-Levy
- Department of Psychiatry, Grossman School of Medicine, New York University, New York, NY, USA;
- Google LLC, Mountain View, California
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Beale S, Hoskins S, Byrne T, Fong WLE, Fragaszy E, Geismar C, Kovar J, Navaratnam AMD, Nguyen V, Patel P, Yavlinsky A, Johnson AM, Van Tongeren M, Aldridge RW, Hayward A. Differential Risk of SARS-CoV-2 Infection by Occupation: Evidence from the Virus Watch prospective cohort study in England and Wales. J Occup Med Toxicol 2023; 18:5. [PMID: 37013634 PMCID: PMC10068189 DOI: 10.1186/s12995-023-00371-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Workers across different occupations vary in their risk of SARS-CoV-2 infection, but the direct contribution of occupation to this relationship is unclear. This study aimed to investigate how infection risk differed across occupational groups in England and Wales up to April 2022, after adjustment for potential confounding and stratification by pandemic phase. METHODS Data from 15,190 employed/self-employed participants in the Virus Watch prospective cohort study were used to generate risk ratios for virologically- or serologically-confirmed SARS-CoV-2 infection using robust Poisson regression, adjusting for socio-demographic and health-related factors and non-work public activities. We calculated attributable fractions (AF) amongst the exposed for belonging to each occupational group based on adjusted risk ratios (aRR). RESULTS Increased risk was seen in nurses (aRR = 1.44, 1.25-1.65; AF = 30%, 20-39%), doctors (aRR = 1.33, 1.08-1.65; AF = 25%, 7-39%), carers (1.45, 1.19-1.76; AF = 31%, 16-43%), primary school teachers (aRR = 1.67, 1.42- 1.96; AF = 40%, 30-49%), secondary school teachers (aRR = 1.48, 1.26-1.72; AF = 32%, 21-42%), and teaching support occupations (aRR = 1.42, 1.23-1.64; AF = 29%, 18-39%) compared to office-based professional occupations. Differential risk was apparent in the earlier phases (Feb 2020-May 2021) and attenuated later (June-October 2021) for most groups, although teachers and teaching support workers demonstrated persistently elevated risk across waves. CONCLUSIONS Occupational differences in SARS-CoV-2 infection risk vary over time and are robust to adjustment for socio-demographic, health-related, and non-workplace activity-related potential confounders. Direct investigation into workplace factors underlying elevated risk and how these change over time is needed to inform occupational health interventions.
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Affiliation(s)
- Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK.
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK.
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London, School of Hygiene and Tropical Medicine , Keppel Street, London, WC1E 7HT, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Annalan M D Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Martie Van Tongeren
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9NT, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
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Boucher E, Cao C, D'Mello S, Duarte N, Donnici C, Duarte N, Bennett G, Adisesh A, Arora R, Kodama D, Bobrovitz N. Occupation and SARS-CoV-2 seroprevalence studies: a systematic review. BMJ Open 2023; 13:e063771. [PMID: 36854599 PMCID: PMC9979591 DOI: 10.1136/bmjopen-2022-063771] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE To describe and synthesise studies of SARS-CoV-2 seroprevalence by occupation prior to the widespread vaccine roll-out. METHODS We identified studies of occupational seroprevalence from a living systematic review (PROSPERO CRD42020183634). Electronic databases, grey literature and news media were searched for studies published during January-December 2020. Seroprevalence estimates and a free-text description of the occupation were extracted and classified according to the Standard Occupational Classification (SOC) 2010 system using a machine-learning algorithm. Due to heterogeneity, results were synthesised narratively. RESULTS We identified 196 studies including 591 940 participants from 38 countries. Most studies (n=162; 83%) were conducted locally versus regionally or nationally. Sample sizes were generally small (median=220 participants per occupation) and 135 studies (69%) were at a high risk of bias. One or more estimates were available for 21/23 major SOC occupation groups, but over half of the estimates identified (n=359/600) were for healthcare-related occupations. 'Personal Care and Service Occupations' (median 22% (IQR 9-28%); n=14) had the highest median seroprevalence. CONCLUSIONS Many seroprevalence studies covering a broad range of occupations were published in the first year of the pandemic. Results suggest considerable differences in seroprevalence between occupations, although few large, high-quality studies were done. Well-designed studies are required to improve our understanding of the occupational risk of SARS-CoV-2 and should be considered as an element of pandemic preparedness for future respiratory pathogens.
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Affiliation(s)
- Emily Boucher
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christian Cao
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean D'Mello
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Nathan Duarte
- Faculty of Engineering, McGill University, Montreal, Québec, Canada
| | - Claire Donnici
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natalie Duarte
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Graham Bennett
- Department of Economics, McGill University, Montreal, Québec, Canada
| | - Anil Adisesh
- St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Occupational Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Health Solutions, Saint John, New Brunswick, Canada
| | - Rahul Arora
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute of Biomedical Engineering, Oxford University, Oxford, UK
| | - David Kodama
- St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Emergency Medicine, University of Toronto Department of Medicine, Toronto, Ontario, Canada
| | - Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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Jerrett M, Nau CL, Young DR, Butler RK, Batteate CM, Su J, Burnett RT, Kleeman MJ. Air pollution and meteorology as risk factors for COVID-19 death in a cohort from Southern California. ENVIRONMENT INTERNATIONAL 2023; 171:107675. [PMID: 36565571 PMCID: PMC9715495 DOI: 10.1016/j.envint.2022.107675] [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: 07/11/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Recent evidence links ambient air pollution to COVID-19 incidence, severity, and death, but few studies have analyzed individual-level mortality data with high quality exposure models. METHODS We sought to assess whether higher air pollution exposures led to greater risk of death during or after hospitalization in confirmed COVID-19 cases among patients who were members of the Kaiser Permanente Southern California (KPSC) healthcare system (N=21,415 between 06-01-2020 and 01-31-2022 of whom 99.85 % were unvaccinated during the study period). We used 1 km resolution chemical transport models to estimate ambient concentrations of several common air pollutants, including ozone, nitrogen dioxide, and fine particle matter (PM2.5). We also derived estimates of pollutant exposures from ultra-fine particulate matter (PM0.1), PM chemical species, and PM sources. We employed Cox proportional hazards models to assess associations between air pollution exposures and death from COVID-19 among hospitalized patients. FINDINGS We found significant associations between COVID-19 death and several air pollution exposures, including: PM2.5 mass, PM0.1 mass, PM2.5 nitrates, PM2.5 elemental carbon, PM2.5 on-road diesel, and PM2.5 on-road gasoline. Based on the interquartile (IQR) exposure increment, effect sizes ranged from hazard ratios (HR) = 1.12 for PM2.5 mass and PM2.5 nitrate to HR ∼ 1.06-1.07 for other species or source markers. Humidity and temperature in the month of diagnosis were also significant negative predictors of COVID-19 death and negative modifiers of the air pollution effects. INTERPRETATION Air pollution exposures and meteorology were associated the risk of COVID-19 death in a cohort of patients from Southern California. These findings have implications for prevention of death from COVID-19 and for future pandemics.
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Affiliation(s)
- Michael Jerrett
- Department of Environmental Health Sciences, University of California, Los Angeles 650 Charles Young Dr. S., 56-070 CHS Box 951772, Los Angeles, CA, 90095, United States.
| | - Claudia L Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California 100 S. Los Robles Ave., 5th Floor, Pasadena, CA 91101, United States
| | - Deborah R Young
- Department of Research & Evaluation, Kaiser Permanente Southern California 100 S. Los Robles Ave., 5th Floor, Pasadena, CA 91101, United States
| | - Rebecca K Butler
- Department of Research & Evaluation, Kaiser Permanente Southern California 100 S. Los Robles Ave., 5th Floor, Pasadena, CA 91101, United States
| | - Christina M Batteate
- Department of Environmental Health Sciences, University of California, Los Angeles 650 Charles Young Dr. S., 56-070 CHS Box 951772, Los Angeles, CA, 90095, United States
| | - Jason Su
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley 2121 Berkeley Way, Room 5302, Berkeley, CA 94720, United States
| | - Richard T Burnett
- Population Studies Division, Environmental Health Directorate, Health Canada 251 Sir Frederick Banting Driveway, Ottawa, Ontario K1A 0K9, Canada
| | - Michael J Kleeman
- Department of Civil and Environmental Engineering, University of California, Davis 1 Sheilds Avenue, Davis, CA 95616, United States
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Rhodes S, Wilkinson J, Pearce N, Mueller W, Cherrie M, Stocking K, Gittins M, Katikireddi SV, Tongeren MV. Occupational differences in SARS-CoV-2 infection: analysis of the UK ONS COVID-19 infection survey. J Epidemiol Community Health 2022; 76:jech-2022-219101. [PMID: 35817467 PMCID: PMC9484374 DOI: 10.1136/jech-2022-219101] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Concern remains about how occupational SARS-CoV-2 risk has evolved during the COVID-19 pandemic. We aimed to ascertain occupations with the greatest risk of SARS-CoV-2 infection and explore how relative differences varied over the pandemic. METHODS Analysis of cohort data from the UK Office of National Statistics COVID-19 Infection Survey from April 2020 to November 2021. This survey is designed to be representative of the UK population and uses regular PCR testing. Cox and multilevel logistic regression were used to compare SARS-CoV-2 infection between occupational/sector groups, overall and by four time periods with interactions, adjusted for age, sex, ethnicity, deprivation, region, household size, urban/rural neighbourhood and current health conditions. RESULTS Based on 3 910 311 observations (visits) from 312 304 working age adults, elevated risks of infection can be seen overall for social care (HR 1.14; 95% CI 1.04 to 1.24), education (HR 1.31; 95% CI 1.23 to 1.39), bus and coach drivers (1.43; 95% CI 1.03 to 1.97) and police and protective services (HR 1.45; 95% CI 1.29 to 1.62) when compared with non-essential workers. By time period, relative differences were more pronounced early in the pandemic. For healthcare elevated odds in the early waves switched to a reduction in the later stages. Education saw raises after the initial lockdown and this has persisted. Adjustment for covariates made very little difference to effect estimates. CONCLUSIONS Elevated risks among healthcare workers have diminished over time but education workers have had persistently higher risks. Long-term mitigation measures in certain workplaces may be warranted.
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Affiliation(s)
- Sarah Rhodes
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Neil Pearce
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mark Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
| | - Katie Stocking
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Matthew Gittins
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | | | - Martie Van Tongeren
- Centre for Occupation and Environmental Health, The University of Manchester, Manchester, UK
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Schlünssen V, du Prel JB, van Tongeren M, Godderis L, Turner MC, McElvenny D. Development of Harmonized COVID-19 Occupational Questionnaires. Ann Work Expo Health 2022; 67:4-8. [PMID: 35810354 PMCID: PMC9278210 DOI: 10.1093/annweh/wxac044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/27/2022] [Accepted: 06/06/2022] [Indexed: 01/14/2023] Open
Abstract
Harmonized tools and approaches for data collection can help to detect similarities and differences within and between countries and support the development, implementation, and assessment of effective and consistent preventive strategies. We developed open source occupational questionnaires on COVID-19 within COVID-19 working groups in the OMEGA-NET COST action (Network on the Coordination and Harmonisation of European Occupational Cohorts, omeganetcohorts.eu), and the EU funded EPHOR project (Exposome project for health and occupational research, ephor-project.eu). We defined domains to be included in order to cover key working life aspects of the COVID-19 pandemic. Where possible, we selected questionnaire items and instruments from existing questionnaire resources. Both a general occupational COVID-19 questionnaire and a specific occupational COVID-19 questionnaire are available. The general occupational COVID-19 questionnaire covers key working life aspects of the COVID-19 pandemic, including the domains: COVID-19 diagnosis and prevention, Health and demographics, Use of personal protective equipment and face covering, Health effects, Work-related effects (e.g. change in work schedule and work-life balance), Financial effects, Work-based risk factors (e.g. physical distancing, contact with COVID-19-infected persons), Psychosocial risk factors, Lifestyle risk factors, and Personal evaluation of the impact of COVID-19. For each domain, additional questions are available. The specific occupational COVID-19 questionnaire focusses on occupational risk factors and mitigating factors for SARS-CoV2 infection and COVID-19 disease and includes questions about the type of job, amount of home working, social distancing, human contact (colleagues, patients, and members of the public), commuting, and use of personal protective equipment and face coverings. The strength of this initiative is the broad working life approach to various important issues related to SARS-CoV-2 infection, COVID-19 disease, and potentially future pandemics. It requires further work to validate the questionnaires, and we welcome collaboration with researchers willing to do this. A limitation is the moderate number of questions for each of the domains in the general questionnaire. Only few questions on general core information like ethnicity, demographics, lifestyle factors, and general health status are included, but the OMEGA-NET questionnaires can be integrated in existing questionnaires about sociodemographic and health-related aspects. The questionnaires are freely accessible from the OMEGA-NET and the EPHOR homepages.
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Affiliation(s)
- Vivi Schlünssen
- Author to whom correspondence should be addressed. Tel: +45-28992499; e-mail:
| | - Jean Baptist du Prel
- Department of Occupational Health Science, University of Wuppertal, Wuppertal, Germany
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School or Health Sciences, University of Manchester, Manchester, UK
| | - Lode Godderis
- Centre for Environment and Health, KU Leuven, Leuven, Belgium,IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Michelle C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Damien McElvenny
- Centre for Occupational and Environmental Health, School or Health Sciences, University of Manchester, Manchester, UK,Research Group, Institute of Occupational Medicine, Edinburgh, UK
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Jerrett M. Air Pollution as a Risk for Death from Infectious Respiratory Disease. Am J Respir Crit Care Med 2022; 205:1374-1375. [PMID: 35353654 PMCID: PMC9875893 DOI: 10.1164/rccm.202202-0351ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Michael Jerrett
- Fielding School of Public HealthUniversity of California, Los AngelesLos Angeles, California
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Efird JT, Anderson E, Jindal C, Suzuki A. Interaction of Vitamin D and Corticosteroid Use in Hospitalized COVID-19 Patients: A Potential Explanation for Inconsistent Findings in the Literature. Curr Pharm Des 2022; 28:1695-1702. [PMID: 35440302 DOI: 10.2174/1381612828666220418132847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 12/15/2022]
Abstract
Vitamin D is an important immune-modulator with anti-inflammatory properties. While this prohormone has been studied extensively in the prevention and treatment of COVID-19, findings have been inconsistent regarding its overall benefit in patients hospitalized with COVID-19. Most studies to date have been observational in nature, not accounting for the use of corticosteroids. Furthermore, the few randomized clinical trials designed to examine the effect of vitamin D supplementation on COVID-19 outcomes have been relatively small and thus insufficiently powered to assure a balance of corticosteroid use between study arms. The current perspective addresses the interaction of vitamin D and corticosteroids as a potential explanation for the divergent results reported in the literature. Future research on vitamin D and COVID-19 will benefit by considering this interaction, especially among hospitalized patients requiring oxygen and mechanical ventilation.
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Affiliation(s)
- Jimmy T Efird
- Cooperative Studies Program Epidemiology Center, Durham (Duke) VA Health Care System, Durham, NC 27705, USA
| | | | - Charulata Jindal
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Ayako Suzuki
- Cooperative Studies Program Epidemiology Center, Durham (Duke) VA Health Care System, Durham, NC 27705, USA.,Department of Pharmaceutical Sciences and Experimental Therapeutics, Fraternal Order of Eagles Diabetes Research Center, Abboud Cardiovascular Research Center, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA.,Division of Gastroenterology, Duke University, Durham, NC 27710, USA
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Efird JT, Anderson EJ, Jindal C, Redding TS, Thompson AD, Press AM, Upchurch J, Williams CD, Choi YM, Suzuki A. The Interaction of Vitamin D and Corticosteroids: A Mortality Analysis of 26,508 Veterans Who Tested Positive for SARS-CoV-2. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:447. [PMID: 35010701 PMCID: PMC8744830 DOI: 10.3390/ijerph19010447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022]
Abstract
This data-based cohort consisted of 26,508 (7%) United States veterans out of the 399,290 who tested positive for SARS-CoV-2 from 1 March to 10 September 2020. We aimed to assess the interaction of post-index vitamin D (Vit D) and corticosteroid (CRT) use on 30-day mortality among hospitalized and non-hospitalized patients with coronavirus disease 2019 (COVID-19). Combination Vit D and CRT drug use was assessed according to four multinomial pairs (-|+, -|-, +|+, +|-). Respective categorical effects were computed on a log-binomial scale as adjusted relative risk (aRR). Approximately 6% of veterans who tested positive for SARS-CoV-2 died within 30 days of their index date. Among hospitalized patients, a significantly decreased aRR was observed for the use of Vit D in the absence of CRTs relative to patients who received CRTs but not Vit D (aRR = 0.30; multiplicity corrected, p = 0.0004). Among patients receiving systemically administered CRTs (e.g., dexamethasone), the use of Vit D was associated with fewer deaths in hospitalized patients (aRR = 0.51) compared with non-hospitalized patients (aRR = 2.5) (P-for-Interaction = 0.0071). Evaluating the effect of modification of these compounds in the context of hospitalization may aid in the management of COVID-19 and provide a better understanding of the pathophysiological mechanisms underlying this and future infectious disease outbreaks.
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Affiliation(s)
- Jimmy T. Efird
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA; (T.S.R.); (A.D.T.); (A.M.P.); (J.U.); (C.D.W.); (A.S.)
| | | | - Charulata Jindal
- Harvard Medical School, Harvard University, Boston, MA 02115, USA;
| | - Thomas S. Redding
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA; (T.S.R.); (A.D.T.); (A.M.P.); (J.U.); (C.D.W.); (A.S.)
| | - Andrew D. Thompson
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA; (T.S.R.); (A.D.T.); (A.M.P.); (J.U.); (C.D.W.); (A.S.)
| | - Ashlyn M. Press
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA; (T.S.R.); (A.D.T.); (A.M.P.); (J.U.); (C.D.W.); (A.S.)
| | - Julie Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA; (T.S.R.); (A.D.T.); (A.M.P.); (J.U.); (C.D.W.); (A.S.)
| | - Christina D. Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA; (T.S.R.); (A.D.T.); (A.M.P.); (J.U.); (C.D.W.); (A.S.)
- Department of Medicine, Duke University, Durham, NC 27710, USA
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
| | | | - Ayako Suzuki
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA; (T.S.R.); (A.D.T.); (A.M.P.); (J.U.); (C.D.W.); (A.S.)
- Division of Gastroenterology, Duke University, Durham, NC 27710, USA
- The Division of Gastroenterology, Durham VA Medical Center, Durham, NC 27705, USA
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