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Vernon-Wilson E, Tetui M, DeMarco M, Grindrod K, Waite NM. Connect, collaborate and tailor: a model of community engagement through infographic design during the COVID-19 pandemic. BMC Public Health 2024; 24:2551. [PMID: 39300382 DOI: 10.1186/s12889-024-20037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Across the globe, racial and ethnic minorities have been disproportionately affected by COVID-19 with increased risk of infection and burden from disease. Vaccine hesitancy has contributed to variation in vaccine uptake and compromised population-based vaccination programs in many countries. Connect, Collaborate and Tailor (CCT) is a Public Health Agency of Canada funded project to make new connections between public health, healthcare professionals and underserved communities in order to create culturally adapted communication about COVID-19 vaccines. This paper describes the CCT process and outcomes as a community engagement model that identified information gaps and created tailored tools to address misinformation and improve vaccine acceptance. METHODS Semi-structured interviews with CCT participants were undertaken to evaluate the effectiveness of CCT in identifying and addressing topics of concern to underserved and ethnic minority communities. Interviews also explored CCT participants' experiences of collaboration through the development of new partnerships between ethnic minority communities, public health and academic researchers, and the evolution of co-operation sharing ideas and creating infographics. Thematic analysis was used to produce representative themes. The activities described were aligned with the levels of public engagement described in the IAP2 spectrum (International Association for Public Participation). RESULTS Analysis of interviews (n = 14) revealed that shared purpose and urgency in responding to the COVID-19 pandemic motivated co-operation among CCT participants. Acknowledgement of past harm, present health, and impact of social inequities on public service access was an essential first step in establishing trust. Creating safe spaces for open dialogue led to successful, iterative cycles of consultation and feedback between participants; a process that not only helped create tailored infographics but also deepened engagement and collaboration. Over time, the infographic material development was increasingly directed by community representatives' commentary on their groups' real-time needs and communication preferences. This feedback noticeably guided the choice, style, and presentation of infographic content while also directing dissemination strategies and vaccine confidence building activities. CONCLUSIONS The CCT process to create COVID-19 vaccine communication materials led to evolving co-operation between groups who had not routinely worked together before; strong community engagement was a key driver of change. Ensuring a respectful environment for open dialogue and visibly using feedback to create information products provided a foundation for building relationships. Finally, our data indicate participants sought reinforcement of close cooperative ties and continued investment in shared responsibility for community partnership-based public health.
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Affiliation(s)
- Elizabeth Vernon-Wilson
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
| | - Moses Tetui
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mathew DeMarco
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada
| | - Nancy M Waite
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada.
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Snowden J, Weakley K. Diagnosing, managing, and studying long-COVID syndromes in children and adolescents in rural and underserved populations. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00540-4. [PMID: 39187064 DOI: 10.1016/j.anai.2024.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024]
Abstract
The COVID-19 pandemic has arguably had its greatest impact in rural and other historically hard-to-reach populations. Families in rural and underserved communities experienced COVID-19 infections at a higher rate than did their peers in other groups and experienced disproportionate morbidity and mortality. Without careful design and implementation of resources, children in these areas are also at risk of being disproportionately affected by long-term sequelae of SARS-CoV-2 infections, such as "long COVID" syndromes. Increased frequency and severity of COVID-19 infections, decreased access to health care and supporting services, environmental and social structure factors that exacerbate post-acute sequelae of COVID-19, and increased baseline frequency of health disorders that may complicate post-COVID issues, such as higher rates of obesity, asthma, diabetes, and mental health disorders, all place children and adolescents in under-resourced areas at significant risk. Unfortunately, children and adolescents in these areas have been historically under-represented in clinical research. Not only are fewer studies published with participants in rural and underserved communities, but these studies more often exhibit lower quality, with fewer randomized controlled trials and multicenter studies. This gap not only deprives people in rural and underserved areas of the country of access to cutting-edge therapy, but it also risks "evidence-based" solutions that are not generalizable because they cannot be implemented in the areas disproportionately affected by many health conditions such as long COVID. These factors significantly impede our ability to provide appropriate medical care for underserved communities. This review will discuss the impact of COVID-19 in rural and underserved communities and the factors that must be considered in designing evidence-based long-COVID solutions for children and adolescents in these areas.
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Affiliation(s)
- Jessica Snowden
- University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Kathryn Weakley
- University of Louisville and Norton Children's Hospital, Louisville, Kentucky
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3
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Kunze KL, Johnson PW. The Importance of Geographic Proximity of Convalescent Plasma Donors. Curr Top Microbiol Immunol 2024. [PMID: 39117845 DOI: 10.1007/82_2024_270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Donor-recipient proximity emerged as an important factor influencing the efficacy of COVID-19 convalescent plasma (CCP) treatment during the early stages of the COVID-19 pandemic. This relationship was uncovered while analyzing data collected in the collaborative Expanded Access Program (EAP) for CCP at Mayo Clinic, a project aimed to establish protocols for CCP use amid the uncertainty of the novel disease. Analysis of data from nearly 28,000 patients revealed a significant reduction in risk of 30-day mortality for those receiving near-sourced plasma when compared to those receiving distantly sourced plasma [pooled relative risk, 0.73 (95% CI 0.67-0.80)], prompting adjustments in treatment protocols at selected institutions, and highlighting the importance of proximity in optimizing CCP outcomes. Despite its significance, subsequent studies of CCP effectiveness in COVID-19 have often overlooked donor-recipient proximity. Our findings emphasize the importance of donor-recipient proximity in CCP treatment in the current pandemic, and we discuss potential methods for improving CCP efficacy in future pandemics. Our recommendations include prioritizing virus genotyping for vulnerable patients, establishing a robust testing infrastructure, and collecting additional donor data to enhance plasma selection. This chapter underscores the importance of comprehensive data collection and sharing to navigate the evolving landscape of newly emerging infectious diseases.
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Affiliation(s)
- Katie L Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA.
- Digital Innovation Lab, Mayo Clinic, Jacksonville, FL, USA.
| | - Patrick W Johnson
- Digital Innovation Lab, Mayo Clinic, Jacksonville, FL, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
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Ruangsomboon O, Zhong A, Kopp A, Elston B, Eldridge K, Lee S, Plenert E, Pinto AD, Glazier RH, Kiran T. Changes in Primary Care Health Services During the COVID-19 Pandemic: A Longitudinal Analysis of Data From Ontario. Healthc Policy 2024; 19:42-54. [PMID: 39229662 PMCID: PMC11411643 DOI: 10.12927/hcpol.2024.27362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
The COVID-19 pandemic significantly impacted primary care, but its effect on quality of care is not well understood. We used health administrative data to understand the changes in quality-of-care measures for primary care between October 2018 and April 2022. We examined the following domains: cancer screening, chronic disease (diabetes) management, high-risk prescribing, continuity of care and capacity of primary care services. Colorectal and breast cancer screenings declined after the pandemic and had not returned to baseline by study end. In patients living with diabetes, in-person visits and up-to-date retinopathy screening rates declined after the pandemic declaration and did not return to baseline by study end, while statin prescribing remained stable. High-risk opioid prescribing decreased over time and was not affected by the pandemic. Physician continuity remained stable, though new patient enrollments decreased over the pandemic but returned to baseline by study end. Existing disparities in colorectal cancer screening by income and recent registration widened during the pandemic. In summary, COVID-19 had a variable impact on primary care, with the strongest influence on preventive and chronic disease care that was dependent on in-person visits.
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Affiliation(s)
- Onlak Ruangsomboon
- Research Coordinator, Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Assistant Professor, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Adrina Zhong
- Student, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Beth Elston
- Senior Research Analyst, ICES Central, Toronto, ON
| | - Kirsten Eldridge
- Quality and Innovation Program Research Officer, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON
| | - Samantha Lee
- Senior Epidemiologist, ICES Central, Toronto, ON
| | - Erin Plenert
- Quality and Innovation Program Manager, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON
| | - Andrew D Pinto
- Scientist, Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Associate Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Richard H Glazier
- Associate Professor, Dalla Lana School of Public Health, University of Toronto, Senior Scientist, ICES Central, Toronto, ON
| | - Tara Kiran
- Family Physician, St. Michael's Hospital, Associate Professor, Department of Family and Community Medicine, Faculty of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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Sinha K, Gutacker N, Gu Y, Haagsma J, Kumar K, Aghdaee M. Protocol for a longitudinal study examining the trajectory of COVID-19, post-COVID, multidimensional disadvantage and health-related quality of life in India: the IndiQol Project. BMJ Open 2024; 14:e080985. [PMID: 39009459 PMCID: PMC11253756 DOI: 10.1136/bmjopen-2023-080985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/27/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has raised concerns about the persistence of symptoms after infection, commonly referred to as 'post-COVID' or 'long-COVID'. While countries in high-resource countries have highlighted the increased risk of disadvantaged communities, there is limited understanding of how COVID-19 and post-COVID conditions affect marginalised populations in low-income and middle-income countries. We study the longitudinal patterns of COVID-19, post-COVID symptoms and their impact on the health-related quality of life through the IndiQol Project. METHODS AND ANALYSIS The IndiQol Project conducts household surveys across India to collect data on the incidence of COVID-19 and multidimensional well-being using a longitudinal design. We select a representative sample across six states surveyed over four waves. A two-stage sampling design was used to randomly select primary sampling units in rural and urban areas of each State. Using power analysis, we select an initial sample of 3000 household and survey all adult household members in each wave. The survey data will be analysed using limited dependent variable models and matching techniques to provide insights into the impact of COVID-19 pandemic and post-COVID on health and well-being of individuals in India. ETHICS AND DISSEMINATION Ethics approval for the IndiQol Project was obtained from the Macquarie University Human Research Ethics Committee in Sydney, Australia and Institutional Review Board of Morsel in India. The project results will be published in peer-reviewed journals. Data collected from the IndiQol project will be deposited with the EuroQol group and will be available to use by eligible researchers on approval of request.
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Affiliation(s)
- Kompal Sinha
- Department of Economics, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Macquarie Park, New South Wales, Australia
- Australian Institute of Health Innovation, Sydney, South Wales, Australia
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Kaushalendra Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Mona Aghdaee
- Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Macquarie Park, New South Wales, Australia
- Australian Institute of Health Innovation, Sydney, South Wales, Australia
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Thompson N, Kyaw KWY, Singh L, Cikomola JC, Singh NS, Roberts B. The effect of COVID-19 on the non-COVID health outcomes of crisis-affected peoples: a systematic review. Confl Health 2024; 18:37. [PMID: 38664834 PMCID: PMC11044391 DOI: 10.1186/s13031-024-00592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic posed considerable risks to populations affected by humanitarian crises in low- and middle-income countries (LMICs). However, there is limited understanding of how the pandemic may have affected non-COVID health outcomes among crisis-affected populations. Our aim was to examine the evidence on the impact of the COVID-19 pandemic on non-COVID-19 health outcomes for crisis-affected populations in LMICs. METHODS A systematic review methodology was applied following PRISMA guidelines. Eligibility criteria were: crisis-affected populations in LMICS; COVID-19; and all health topics, except for sexual and reproductive health which was covered in a linked review. Five bibliographic databases and additional grey literature sources were searched. The search period was from 2019 to 31 July 2022. Eligible papers were extracted and analysed using a narrative synthesis approach based on the study objectives and relevant health access and systems frameworks. A quality appraisal was also conducted. FINDINGS 4320 articles were screened, and 15 eligible studies were identified and included in this review. Ten studies collected health outcomes data. Eight related to mental health, which generally showed worse mental health outcomes because of the pandemic, and pandemic-related stressors were identified. Two studies assessed physical health outcomes in children, while none addressed physical health outcomes among adults. Nine studies reported on access to healthcare, revealing worse access levels due to the pandemic and noting key barriers to care. Seven studies reported on the impact on health systems, with key challenges including reduced and distorted health care funding, reduced staff capacity, interrupted medicines and supplies, weak information and mixed-messaging, and weak leadership. All fifteen studies on the social determinants of health, particularly highlighting the effect of increasing poverty, the role of gender, and food insecurity on health outcomes. The quality of papers was limited overall. CONCLUSION This review found some limited evidence indicating negative mental health effects, increased barriers to accessing care, damage to health systems and magnified impacts on the social determinants of health for crisis-affected people during the COVID-19 pandemic. However, the small number and limited quality of the studies make the overall strength of evidence quite weak.
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Affiliation(s)
- N Thompson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - K W Y Kyaw
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - L Singh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J C Cikomola
- Faculty of Medicine, Université Catholique de Bukavu, Democratic Republic of the Congo, Central African Republic
| | - N S Singh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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7
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Hunt TN, Roberts K, Taylor EM, Quintana CP, Kossman MK. The Effect of Social Determinants of Health on Clinical Recovery Following Concussion: A Systematic Review. J Sport Rehabil 2024:1-9. [PMID: 38508176 DOI: 10.1123/jsr.2023-0068] [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: 03/01/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/22/2024]
Abstract
CONTEXT Concussion evaluations include a multifaceted approach; however, individual differences can influence test score interpretations and validity. Social determinants of health (SDoH) differentially affect disease risk and outcomes based upon social and environmental characteristics. Efforts to better define, diagnose, manage, and treat concussion have increased, but minimal efforts have focused on examining SDoH that may affect concussion recovery. OBJECTIVE This review examined previous research that examined the effect of SDoH on concussion recovery of athletes. EVIDENCE ACQUISITION CINAHL, MEDLINE, PsycInfo, and SPORTDiscus databases were used to search the terms "concussion" AND "recovery," "youth, adolescent, teen and/or adult," and "social determinants of health" and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide. EVIDENCE SYNTHESIS Seven thousand nine hundred and twenty-one articles were identified and screened for inclusion. Five studies met the inclusion criteria and were included in this systematic review. Using the Downs and Black Quality Index, the studies included in this review were deemed high quality. CONCLUSION Though limited literature exists, there is preliminary evidence to suggest that SDoH (specifically, economic stability, education access and quality, and social and community context) may have an impact on the clinical recovery from concussion. The dimensions evaluated varied between studies and the results were inconsistent. No single factor consistently affected clinical recovery; however, private insurance and race appear to have an association with the speed of recovery. Unfortunately, the potential intersection of these variables and other preinjury factors limits the ability to make clear recommendations. While most of the studies in this review are retrospective in nature, future efforts should focus on training clinicians to prospectively evaluate the effect of SDoH on concussion recovery and injury outcomes. Funding and registration for this systematic review were not obtained nor required.
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Affiliation(s)
| | | | - Erica M Taylor
- Columbus State University, Columbus, GA, USA
- The University of Kansas Medical Center, Kansas, KS, USA
| | - Carolina P Quintana
- The University of Kansas Medical Center, Kansas, KS, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Melissa K Kossman
- Columbus State University, Columbus, GA, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
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Khedmati Morasae E, Derbyshire DW, Amini P, Ebrahimi T. Social determinants of spatial inequalities in COVID-19 outcomes across England: A multiscale geographically weighted regression analysis. SSM Popul Health 2024; 25:101621. [PMID: 38420111 PMCID: PMC10899060 DOI: 10.1016/j.ssmph.2024.101621] [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: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
A variety of factors are associated with greater COVID-19 morbidity or mortality, due to how these factors influence exposure to (in the case of morbidity) or severity of (in the case of mortality) COVID-19 infections. We use multiscale geographically weighted regression to study spatial variation in the factors associated with COVID-19 morbidity and mortality rates at the local authority level across England (UK). We investigate the period between March 2020 and March 2021, prior to the rollout of the COVID-19 vaccination program. We consider a variety of factors including demographic (e.g. age, gender, and ethnicity), health (e.g. rates of smoking, obesity, and diabetes), social (e.g. Index of Multiple Deprivation), and economic (e.g. the Gini coefficient and economic complexity index) factors that have previously been found to impact COVID-19 morbidity and mortality. The Index of Multiple Deprivation has a significant impact on COVID-19 cases and deaths in all local authorities, although the effect is the strongest in the south of England. Higher proportions of ethnic minorities are associated with higher levels of COVID-19 mortality, with the strongest effect being found in the west of England. There is again a similar pattern in terms of cases, but strongest in the north of the country. Other factors including age and gender are also found to have significant effects on COVID-19 morbidity and mortality, with differential spatial effects across the country. The results provide insights into how national and local policymakers can take account of localized factors to address spatial health inequalities and address future infectious disease pandemics.
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Affiliation(s)
- Esmaeil Khedmati Morasae
- Research Fellow in Operational Research, Exeter University Business School, University of Exeter, UK
| | - Daniel W. Derbyshire
- Department of Public Health and Sports Science, Faculty of Health and Life Science, University of Exeter, UK
| | - Payam Amini
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Tahera Ebrahimi
- Lecturer in Finance, Business School, Manchester Metropolitan University, UK
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Issa J, Wouterse B, Milkovska E, van Baal P. Quantifying income inequality in years of life lost to COVID-19: a prediction model approach using Dutch administrative data. Int J Epidemiol 2024; 53:dyad159. [PMID: 38081182 PMCID: PMC10859130 DOI: 10.1093/ije/dyad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/09/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Low socioeconomic status and underlying health increase the risk of fatal outcomes from COVID-19, resulting in more years of life lost (YLL) among the poor. However, using standard life expectancy overestimates YLL to COVID-19. We aimed to quantify YLL associated with COVID-19 deaths by sex and income quartile, while accounting for the impact of individual-level pre-existing health on remaining life expectancy for all Dutch adults aged 50+. METHODS Extensive administrative data were used to model probability of dying within the year for the entire 50+ population in 2019, considering age, sex, disposable income and health care use (n = 6 885 958). The model is used to predict mortality probabilities for those who died of COVID-19 (had they not died) in 2020. Combining these probabilities in life tables, we estimated YLL by sex and income quartile. The estimates are compared with YLL based on standard life expectancy and income-stratified life expectancy. RESULTS Using standard life expectancy results in 167 315 YLL (8.4 YLL per death) which is comparable to estimates using income-stratified life tables (167 916 YLL with 8.2 YLL per death). Considering pre-existing health and income, YLL decreased to 100 743, with 40% of years lost in the poorest income quartile (5.0 YLL per death). Despite individuals in the poorest quartile dying at younger ages, there were minimal differences in average YLL per COVID-19 death compared with the richest quartile. CONCLUSIONS Accounting for prior health significantly affects estimates of YLL due to COVID-19. However, inequality in YLL at the population level is primarily driven by higher COVID-19 deaths among the poor. To reduce income inequality in the health burden of future pandemics, policies should focus on limiting structural differences in underlying health and exposure of lower income groups.
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Affiliation(s)
- Jawa Issa
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Bram Wouterse
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Elena Milkovska
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter van Baal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Smeesters PR, de Crombrugghe G, Tsoi SK, Leclercq C, Baker C, Osowicki J, Verhoeven C, Botteaux A, Steer AC. Global Streptococcus pyogenes strain diversity, disease associations, and implications for vaccine development: a systematic review. THE LANCET. MICROBE 2024; 5:e181-e193. [PMID: 38070538 DOI: 10.1016/s2666-5247(23)00318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 02/12/2024]
Abstract
The high strain diversity of Streptococcus pyogenes serves as a major obstacle to vaccine development against this leading global pathogen. We did a systematic review of studies in PubMed, MEDLINE, and Embase that reported the global distribution of S pyogenes emm-types and emm-clusters from Jan 1, 1990, to Feb 23, 2023. 212 datasets were included from 55 countries, encompassing 74 468 bacterial isolates belonging to 211 emm-types. Globally, an inverse correlation was observed between strain diversity and the UNDP Human Development Index (HDI; r=-0·72; p<0·0001), which remained consistent upon subanalysis by global region and site of infection. Greater strain diversity was associated with a lower HDI, suggesting the role of social determinants in diseases caused by S pyogenes. We used a population-weighted analysis to adjust for the disproportionate number of epidemiological studies from high-income countries and identified 15 key representative isolates as vaccine targets. Strong strain type associations were observed between the site of infection (invasive, skin, and throat) and several streptococcal lineages. In conclusion, the development of a truly global vaccine to reduce the immense burden of diseases caused by S pyogenes should consider the multidimensional diversity of the pathogen, including its social and environmental context, and not merely its geographical distribution.
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Affiliation(s)
- Pierre R Smeesters
- Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université Libre de Bruxelles, Brussels, Belgium; Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - Gabrielle de Crombrugghe
- Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Shu Ki Tsoi
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Céline Leclercq
- Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium
| | - Ciara Baker
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Joshua Osowicki
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Caroline Verhoeven
- Laboratoire d'enseignement des Mathématiques, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Botteaux
- Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
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Ling-Hu T, Simons LM, Dean TJ, Rios-Guzman E, Caputo MT, Alisoltani A, Qi C, Malczynski M, Blanke T, Jennings LJ, Ison MG, Achenbach CJ, Larkin PM, Kaul KL, Lorenzo-Redondo R, Ozer EA, Hultquist JF. Integration of individualized and population-level molecular epidemiology data to model COVID-19 outcomes. Cell Rep Med 2024; 5:101361. [PMID: 38232695 PMCID: PMC10829796 DOI: 10.1016/j.xcrm.2023.101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/07/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with enhanced transmissibility and immune escape have emerged periodically throughout the coronavirus disease 2019 (COVID-19) pandemic, but the impact of these variants on disease severity has remained unclear. In this single-center, retrospective cohort study, we examined the association between SARS-CoV-2 clade and patient outcome over a two-year period in Chicago, Illinois. Between March 2020 and March 2022, 14,252 residual diagnostic specimens were collected from SARS-CoV-2-positive inpatients and outpatients alongside linked clinical and demographic metadata, of which 2,114 were processed for viral whole-genome sequencing. When controlling for patient demographics and vaccination status, several viral clades were associated with risk for hospitalization, but this association was negated by the inclusion of population-level confounders, including case count, sampling bias, and shifting standards of care. These data highlight the importance of integrating non-virological factors into disease severity and outcome models for the accurate assessment of patient risk.
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Affiliation(s)
- Ted Ling-Hu
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL 60611, USA
| | - Lacy M Simons
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL 60611, USA
| | - Taylor J Dean
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL 60611, USA
| | - Estefany Rios-Guzman
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL 60611, USA
| | - Matthew T Caputo
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Arghavan Alisoltani
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL 60611, USA
| | - Chao Qi
- Clinical Microbiology Laboratory, Department of Pathology, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | - Michael Malczynski
- Clinical Microbiology Laboratory, Department of Pathology, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | - Timothy Blanke
- Diagnostic Molecular Biology Laboratory, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | - Lawrence J Jennings
- Clinical Microbiology Laboratory, Department of Pathology, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | - Michael G Ison
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Chad J Achenbach
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Paige M Larkin
- Department of Molecular Microbiology, Northshore University HealthSystem, Evanston, IL 60201, USA
| | - Karen L Kaul
- Department of Pathology, Northshore University HealthSystem, Evanston, IL 60201, USA
| | - Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL 60611, USA
| | - Egon A Ozer
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL 60611, USA
| | - Judd F Hultquist
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL 60611, USA.
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12
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Jang YA, Wu HY, Hsu YT, Chen YK, Chiou HY, Sytwu HK, Chen WJ, Tsou HH. Beyond the waves: Unraveling pandemic outcomes with genomic insights and immunity analysis - Evidence from 14 countries. Prev Med 2024; 178:107820. [PMID: 38092329 DOI: 10.1016/j.ypmed.2023.107820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Although the World Health Organization and many governments have recategorized COVID-19 as a generally mild to moderately severe disease, consecutive pandemic waves driven by immune escape variants have underscored the need for timely and accurate prediction of the next outbreak. Nevertheless, little attention has been paid to translating genomic data and infection- and vaccine-induced immunity into direct estimates. METHODS We retrieved epidemiologic and genomic data shortly before pandemic waves across 14 developed countries from late 2021 to mid-2022 and examined associations between early-stage variant competition, infection- and vaccine-induced immunity, and the time intervals between wave peaks. We applied regression analysis and the generalized estimating equation method to construct an inferential model. RESULTS Each per cent increase in the proportion of a new variant was associated with a 1.0% reduction in interpeak intervals on average. Curvilinear associations between vaccine-induced immunity and outcome variables were observed, suggesting that reaching a critical vaccine distribution rate may decrease the caseload of the upcoming wave. CONCLUSIONS By leveraging readily accessible pre-outbreak genomic and epidemiologic data, our results not only substantiate the predictive potential of early variant fractions but also propose that immunity acquired through infection alone may not sufficiently mitigate transmission. Conversely, a rapid and widespread vaccination initiative appears to be correlated with a decrease in disease incidence.
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Affiliation(s)
- Yung-An Jang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Hsiao-Yu Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Ya-Ting Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Yi-Kai Chen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taiwan; Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taiwan
| | - Huey-Kang Sytwu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Taiwan
| | - Wei J Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
| | - Hsiao-Hui Tsou
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taiwan.
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13
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Traister T. COVID-19 Vaccine Accessibility, Perceptions, and Attitudes in the LGBTQ+ Community. West J Nurs Res 2023; 45:1130-1138. [PMID: 37909671 DOI: 10.1177/01939459231211473] [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] [Indexed: 11/03/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer populations have historically experienced challenges accessing, trusting, and receiving health care services, which can negatively impact successful uptake of the COVID-19 vaccine series among this population. OBJECTIVE This research aimed to examine the perceptions and attitudes regarding the acceptability, accessibility, and efficacy of the COVID-19 vaccine among persons who self-identify within this community. METHODS A multidisciplinary, community-focused mixed-methods study was conducted. The quantitative portion of the study was conducted via an online survey throughout the United States for 2 months. The quantitative portion of the study consisted of multiple online focus group sessions after the completion of the survey. RESULTS The online survey had an sample of 3868 participants, with 31 participants in the focus groups. High levels of acceptability toward COVID-19 vaccines were found within this community. Concerns highlighted included the need for culturally competent care, side effects of the vaccine, and unknown effects of the vaccine with hormone replacement therapy. Racial and ethnic minority, transgender, and nonbinary participants reported higher levels of uncertainty about vaccination. CONCLUSION Findings demonstrate that most lesbian, gay, bisexual, transgender, and queer individuals felt comfortable with the COVID-19 vaccine, had a positive experience with the vaccination process, and believe that the vaccine can protect them and others from COVID-19. When developing future COVID-19 vaccination strategies and rollouts, public health officials should consider prioritizing lesbian, gay, bisexual, transgender, and queer individuals and other marginalized populations by partnering with local organizations to identify trusted organizations.
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Affiliation(s)
- Tyler Traister
- School of Nursing, Quinnipiac University, Hamden, CT, USA
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14
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Berry AA, Tjaden AH, Renteria J, Friedman-Klabanoff D, Hinkelman AN, Gibbs MA, Ahmed A, Runyon MS, Schieffelin J, Santos RP, Oberhelman R, Bott M, Correa A, Edelstein SL, Uschner D, Wierzba TF. Persistence of antibody responses to COVID-19 vaccines among participants in the COVID-19 Community Research Partnership. Vaccine X 2023; 15:100371. [PMID: 37649617 PMCID: PMC10462856 DOI: 10.1016/j.jvacx.2023.100371] [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: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction High levels of immunity to SARS-CoV-2 in the community correlate with protection from COVID-19 illness. Measuring COVID-19 antibody seroprevalence and persistence may elucidate the level and length of protection afforded by vaccination and infection within a population. Methods We measured the duration of detectable anti-spike antibodies following COVID-19 vaccination in a multistate, longitudinal cohort study of almost 13,000 adults who completed daily surveys and submitted monthly dried blood spots collected at home. Results Overall, anti-spike antibodies persisted up to 284 days of follow-up with seroreversion occurring in only 2.4% of the study population. In adjusted analyses, risk of seroreversion increased with age (adults aged 55-64: adjusted hazard ratio [aHR] 2.19 [95% confidence interval (CI): 1.22, 3.92] and adults aged > 65: aHR 3.59 [95% CI: 2.07, 6.20] compared to adults aged 18-39). Adults with diabetes had a higher risk of seroreversion versus nondiabetics (aHR 1.77 [95% CI: 1.29, 2.44]). Decreased risk of seroreversion was shown for non-Hispanic Black versus non-Hispanic White (aHR 0.32 [95% CI: 0.13, 0.79]); college degree earners versus no college degree (aHR 0.61 [95% CI: 0.46, 0.81]); and those who received Moderna mRNA-1273 vaccine versus Pfizer-BioNTech BNT162b2 (aHR 0.35 [95% CI: 0.26, 0.47]). An interaction between healthcare worker occupation and sex was detected, with seroreversion increased among male, non-healthcare workers. Conclusion We established that a remote, longitudinal, multi-site study can reliably detect antibody durability following COVID-19 vaccination. The survey platform and measurement of antibody response using at-home collection at convenient intervals allowed us to explore sociodemographic factors and comorbidities and identify predictors of antibody persistence, which has been demonstrated to correlate with protection against disease. Our findings may help inform public health interventions and policies to protect those at highest risk for severe illness and assist in determining the optimal timing of booster doses.Clinical trials registry: NCT04342884.
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Affiliation(s)
- Andrea A. Berry
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashley H. Tjaden
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - Jone Renteria
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - DeAnna Friedman-Klabanoff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amy N. Hinkelman
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, NC, USA
| | | | | | | | - John Schieffelin
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Richard Oberhelman
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Matthew Bott
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - Adolfo Correa
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Sharon L. Edelstein
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - Diane Uschner
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - Thomas F. Wierzba
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
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15
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Ward S, Restrepo AC, McHugh L. Area-level geographic and socioeconomic factors and the local incidence of SARS-CoV-2 infections in Queensland between 2020 and 2022. Aust N Z J Public Health 2023; 47:100094. [PMID: 37820533 DOI: 10.1016/j.anzjph.2023.100094] [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: 01/29/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE Calculate the incidence of SARS-CoV-2 (COVID-19) infection notifications and the influence of area-level geographic and socioeconomic factors in Queensland using real-time data from the COVID-19 Real-time Information System for Preparedness and Epidemic Response (CRISPER) project. DESIGN AND SETTING Population-level ecological study and spatial mapping of the incidence of COVID-19 infection notifications in Queensland, by postcode, 2020-2022. MAIN OUTCOME MEASURES Proportions and distribution of COVID-19 infection notifications by year, age-group, socioeconomic disadvantage, and geospatial mapping. Incidence rate ratios (IRRs) were calculated. RESULTS Between 28 January 2020 and 30 June 2022, a total of 609,569 cases of COVID-19 associated with a Queensland postcode were recorded. The highest proportion of cases occurred in 2022 (96.5%), and in the 20- to 24-year age category (IRR = 1.787). In non-Major City areas, there was also a higher incidence of COVID-19 cases in lower socioeconomic areas (IRR = 0.84) than in higher socioeconomic areas (IRR = 0.66). CONCLUSIONS Queensland experienced its highest proportion of COVID-19 cases once domestic and international borders opened. However, geographic and socioeconomic factors may have still contributed to a higher incidence of COVID-19 cases across some Queensland areas. IMPLICATIONS FOR PUBLIC HEALTH Although Australia has moved from the emergency response phase of the COVID-19 pandemic, we need to ensure ongoing prevention strategies target groups and areas that we have identified with the highest incidence.
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Affiliation(s)
- Selina Ward
- School of Public Health, University of Queensland, Herston, Australia.
| | | | - Lisa McHugh
- School of Public Health, University of Queensland, Herston, Australia
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16
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Ramalho JP, Simões DG, Aguiar P. Impact of sociodemographic and economic determinants of health on COVID-19 infection: incidence variation between reference periods. Public Health 2023; 225:305-310. [PMID: 37963420 DOI: 10.1016/j.puhe.2023.10.023] [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: 07/04/2023] [Revised: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES The COVID-19 pandemic hit Portugal in March 2020, causing widespread disruption to various aspects of society. While extensive research has been conducted on the significance of socio-economic disparities in infection risk, this study aims to enhance our understanding of their evolving relationship over time by analysing four distinct periods in 2020. STUDY DESIGN AND METHODS This retrospective observational ecological study included individuals residing in the Primary Healthcare Cluster areas of Almada-Seixal and Western Lisbon and Oeiras, who tested positive for SARS-CoV-2 through a polymerase chain reaction (PCR) test between the 2nd of March and the 8th of November of 2020. Using incidence rates for each specific neighbourhood (n = 29) and period, we explored the relationship between neighbourhood-level socio-economic variables and the risk of infection using negative-binomial regression models. RESULTS In the analysed period, a total of 8562 confirmed COVID-19 cases were identified. Overall incidence rates for each period were sequentially 2.74, 5.03, 3.99 and 14.29 COVID-19 cases per 100,000 person-days. Housing overcrowding, illiteracy rate and place of birth were associated with increased risk of infection, while age, congregate living, and employment in the secondary sector exhibited the opposite association. No association was consistent across all time periods. CONCLUSIONS Our findings support the idea that the influence of socio-economic determinants of health is not immutable throughout time. In a pandemic context where information, knowledge, beliefs, and behaviours are ever-changing and evolving, a dynamic, inclusive, and adaptable approach to disease control can lead to a more equitable distribution of improved outcomes, benefiting all strata of society.
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Affiliation(s)
- J P Ramalho
- Public Health Unit of Primary Healthcare Cluster of Western Lisbon and Oeiras, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal; National School of Public Health, NOVA University of Lisbon, Portugal.
| | - D G Simões
- National School of Public Health, NOVA University of Lisbon, Portugal; Public Health Unit of Primary Healthcare Cluster of Almada-Seixal, Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal
| | - P Aguiar
- National School of Public Health, NOVA University of Lisbon, Portugal; Public Health Research Centre (CISP/PHRC), NOVA University of Lisbon, Portugal; Comprehensive Health Research Centre (CHRC), NOVA University of Lisbon, Portugal
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17
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Caiola C, Nelson TB, Black KZ, Calogero C, Guard K, Haberstroh A, Corral I. Structural competency in pre-health and health professional learning: A scoping review. J Interprof Care 2023; 37:922-931. [PMID: 36264080 PMCID: PMC10188213 DOI: 10.1080/13561820.2022.2124238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 10/24/2022]
Abstract
Structural competency training provides guidance to healthcare providers on recognizing and addressing structural factors leading to health inequities. To inform the evidence-based progression of structural competency curriculum development, this study was designed to map the current state of the literature on structural competency training with pre-health students, healthcare professional students, and/or healthcare professionals. We performed a scoping review and identified peer-reviewed, primary research articles assessing structural competency training interventions. The category of learners, timing of the structural competency training, types of teaching and learning activities used, instruments used to measure training outcomes, and evaluation criteria were examined. Eleven (n = 11) articles met inclusion criteria, addressing all training levels, and largely focused on medical education. Active learning strategies and researcher-developed instruments to measure training outcomes were most used. Evaluation criteria largely focused on trainees' affective reactions, utility assessments, and direct measure of the trainee learning. We suggest designing interprofessional structural competency education with an emphasis on active learning strategies and standardized training curricula. Evaluation instruments integrated at different points in the health professional learning trajectory are important for evidence-based progression in curriculum development focused on achieving structural competency.
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Affiliation(s)
- Courtney Caiola
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, NC, USA
| | - Taylor B Nelson
- School of Nursing, the University of North Carolina, Chapel Hill NC, USA
| | - Kristin Z Black
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Christie Calogero
- Bachelor of Science in Nursing Student, College of Nursing, East Carolina University, Greenville, NC, USA
| | - Kaitlin Guard
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, NC, USA
| | | | - Irma Corral
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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18
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Moayad L, Zajner C, Popovic MM, Mercer G, Kertes PJ, Muni RH, Hall E, Goel N, Rana M, Kohly RP. Association Between Sociodemographic Factors and Vision Difficulty in the National Health Interview Survey: A Population-Based Analysis. Am J Ophthalmol 2023; 255:30-42. [PMID: 37343742 DOI: 10.1016/j.ajo.2023.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To investigate the relationship between social determinants of health with self-reported vision difficulty. DESIGN Cross-sectional, population-based analysis. METHODS The National Health Interview Survey (NHIS) is an annual survey based on the U.S. population ≥18 years of age. It provides self-reported data on demographic characteristics, socioeconomic factors, health status, and health care access. The 2021 NHIS database was used in this study. Adult participants of the NHIS who responded to the vision difficulty question "Do you have difficulty seeing, even when wearing glasses or contact lenses?" were included in this analysis. The outcome of interest was self-reported vision difficulty by participants. Analysis was done through univariable and multivariable logistic regression. RESULTS Overall, there were 29,464 participants included in the analysis. Univariable logistic regression showed an increased odds of self-reported vision difficulty among female (odds ratio [OR] 1.28 [95% confidence interval {CI} 1.20-1.38]; P < .001), gay, lesbian, or bisexual participants (OR 1.24 [95% CI 1.04-1.49]; P = .02), those who possessed public compared with private insurance (OR 1.83 [95% CI 1.69-1.99]; P < .001), those with less than a high school education (OR 1.88 [95% CI 1.67-2.13]; P < .001), and those with an income below the poverty threshold (OR 2.22 [95% CI 1.96-2.51]; P < .001). Multivariable analysis revealed an increased risk of vision difficulty reported amongst non-Hispanic Black participants (OR 1.65 [95% CI 1.21-2.25]; P = .002). CONCLUSIONS A multitude of sociodemographic factors are associated with self-reported vision difficulty in the U.S. POPULATION Our findings emphasize the importance of considering factors of social determinants of health in clinical practice and policymaking for patients with vision loss.
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Affiliation(s)
- Lana Moayad
- The Michael G. DeGroote School of Medicine (L.M.), McMaster University, Hamilton, Ontario, Canada
| | - Chris Zajner
- Schulich School of Medicine and Dentistry (C.Z.), Western University, London, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences (M.M.P., G.M., P.J.K., R.H.M., R.P.K.), University of Toronto, Toronto, Ontario, Canada
| | - Gareth Mercer
- Department of Ophthalmology and Vision Sciences (M.M.P., G.M., P.J.K., R.H.M., R.P.K.), University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences (M.M.P., G.M., P.J.K., R.H.M., R.P.K.), University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre (P.J.K., R.P.K.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences (M.M.P., G.M., P.J.K., R.H.M., R.P.K.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (R.H.M.), St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Neha Goel
- Department of Surgery (N.G.), Division of Surgical Oncology, University of Miami, Miami, Florida, USA
| | - Mariam Rana
- The University of Saskatchewan (M.R.), Saskatoon, Saskatchewan, Canada
| | - Radha P Kohly
- Department of Ophthalmology and Vision Sciences (M.M.P., G.M., P.J.K., R.H.M., R.P.K.), University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre (P.J.K., R.P.K.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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19
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Wang L, Hu Z, Zhou K, Kwan MP. Identifying spatial heterogeneity of COVID-19 transmission clusters and their built-environment features at the neighbourhood scale. Health Place 2023; 84:103130. [PMID: 37801805 DOI: 10.1016/j.healthplace.2023.103130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/03/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
The identification of high-risk areas for infectious disease transmission and its built-environment features are crucial for targeted surveillance and early prevention efforts. While previous research has explored the association between infectious disease incidence and urban built environment, the investigation of spatial heterogeneity of built-environment features in high-risk areas has been insufficient. This paper aims to address this gap by analysing the spatial heterogeneity of COVID-19 clusters in Shanghai at the neighbourhood scale and examining associated built-environment features. Using a spatiotemporal clustering algorithm, the study analysed 1395 reported cases in Shanghai from March 6 to March 17, 2022. Both global Poisson regression (GPR) and geographically weighted Poisson regression (GWPR) models were applied to examine the association between built-environment variables and the size of COVID-19 clusters. Our findings suggest that larger COVID-19 clusters emerging in the suburbs compared with the downtown and multiple built-environment features are significantly associated with this pattern. Specifically, neighbourhoods with a higher proportion of commercial, public service and industrial land, higher centrality of metro stations, and proximity to hospitals are positively associated with larger COVID-19 clusters, while neighbourhoods with higher land use mix and green/open spaces density are associated with smaller COVID-19 clusters. Moreover, we identified that metro stations with high centrality present the highest risk in the downtown, while commercial and public service places exhibit the highest risk in the suburbs. By highlighting the overlooked spatial heterogeneity of built-environment features for high-risk areas, this study aims to provide valuable guidance for public health departments in implementing place-based interventions to effectively prevent the spread of potential epidemics.
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Affiliation(s)
- Lan Wang
- College of Architecture and Urban Planning, Tongji University, China.
| | - Zhanzhan Hu
- College of Architecture and Urban Planning, Tongji University, China
| | - Kaichen Zhou
- College of Architecture and Urban Planning, Tongji University, China
| | - Mei-Po Kwan
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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20
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Langkulsen U, Mareke P, Lambonmung A. Migrants and Healthcare during COVID-19, the Case of Kanchanaburi Province in Thailand. Healthcare (Basel) 2023; 11:2724. [PMID: 37893798 PMCID: PMC10606567 DOI: 10.3390/healthcare11202724] [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: 08/01/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Since the outbreak of COVID-19, as reported by the WHO in December 2019 and subsequently declared a public health emergency of international concern, a distinct set of risk factors and vulnerabilities faced by migrants are affecting their exposure to the pandemic and its associated outcomes. This study aims to analyze the social determinants of health among migrants and their associated factors and compare the socio-demographic characteristics, patterns of COVID-19, and healthcare attendance and utilization among migrant workers and non-migrants. A descriptive study design was used to analyze COVID-19 morbidity among migrant workers. There were a total of 73,762 migrants living in the province by December 2021, with varied statuses and nationalities. Most of the migrants were from Myanmar, constituting about 80.1%. A total of 24,837 COVID-19 cases in Kanchanaburi province were recorded in 2020-2021. COVID-19 cases among migrant workers accounted for 22.3% during the period under review. Half, 2914 (52.7%) of the migrant female workers were victims of COVID-19 infections. Persons under the age of 18 accounted for about one-fifth of all the COVID-19 cases. Older, over 60 years old, Thais had about twice (10.1%) the COVID-19 cases compared with the older migrants (5.5%). There was a significant increase in healthcare attendance and utilization by non-migrants and migrants during the year under review. Migrants are at high risk of COVID-19 infection. Therefore, public health guidance for the prevention of COVID-19 should prioritize safeguarding the health of migrants by considering their individual characteristics and actions. Enhancing health insurance schemes for migrants, particularly vulnerable migrant groups, is critical for inclusive and expanded healthcare access. Physical, social, and economic environments that impact the health and well-being of migrants should be integral to pandemic prevention, preparedness, response, and recovery.
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Affiliation(s)
- Uma Langkulsen
- Faculty of Public Health, Thammasat University, Rangsit Campus, Bangkok 12120, Pathum Thani, Thailand;
| | - Portia Mareke
- Biomedical Research and Training Institute, Harare P.O. Box A178, Zimbabwe;
| | - Augustine Lambonmung
- Faculty of Public Health, Thammasat University, Rangsit Campus, Bangkok 12120, Pathum Thani, Thailand;
- Tamale Teaching Hospital, Ministry of Health, Tamale P.O. Box TL 16, Ghana
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Wang X, Dewidar O, Rizvi A, Huang J, Desai P, Doyle R, Ghogomu E, Rader T, Nicholls SG, Antequera A, Krentel A, Shea B, Hardy BJ, Chamberlain C, Wiysonge CS, Feng C, Juando-Prats C, Lawson DO, Obuku EA, Kristjansson E, von Elm E, Wang H, Ellingwood H, Waddington HS, Ramke J, Jull JE, Hatcher-Roberts J, Tufte J, Little J, Mbuagbaw L, Weeks L, Niba LL, Cuervo LG, Wolfenden L, Kasonde M, Avey MT, Sharp MK, Mahande MJ, Nkangu M, Magwood O, Craig P, Tugwell P, Funnell S, Noorduyn SG, Kredo T, Horsley T, Young T, Pantoja T, Bhutta Z, Martel A, Welch VA. A scoping review establishes need for consensus guidance on reporting health equity in observational studies. J Clin Epidemiol 2023; 160:126-140. [PMID: 37330072 DOI: 10.1016/j.jclinepi.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/30/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To evaluate the support from the available guidance on reporting of health equity in research for our candidate items and to identify additional items for the Strengthening Reporting of Observational studies in Epidemiology-Equity extension. STUDY DESIGN AND SETTING We conducted a scoping review by searching Embase, MEDLINE, CINAHL, Cochrane Methodology Register, LILACS, and Caribbean Center on Health Sciences Information up to January 2022. We also searched reference lists and gray literature for additional resources. We included guidance and assessments (hereafter termed "resources") related to conduct and/or reporting for any type of health research with or about people experiencing health inequity. RESULTS We included 34 resources, which supported one or more candidate items or contributed to new items about health equity reporting in observational research. Each candidate item was supported by a median of six (range: 1-15) resources. In addition, 12 resources suggested 13 new items, such as "report the background of investigators". CONCLUSION Existing resources for reporting health equity in observational studies aligned with our interim checklist of candidate items. We also identified additional items that will be considered in the development of a consensus-based and evidence-based guideline for reporting health equity in observational studies.
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Affiliation(s)
- Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Omar Dewidar
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada
| | - Anita Rizvi
- School of Psychology, University of Ottawa, Faculty of Social Sciences, Ottawa, Ontario K1N 6N5, Canada
| | - Jimmy Huang
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada
| | - Payaam Desai
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada
| | - Rebecca Doyle
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada
| | | | - Tamara Rader
- Freelance Health Research Librarian, Ottawa, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario K1H 8L6, Canada
| | - Alba Antequera
- International Health Department, ISGlobal, Hospital Clínic - Universitat de Barcelona, 585, 08007 Barcelona, Spain
| | - Alison Krentel
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Beverley Shea
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Billie-Jo Hardy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, 3010 Victoria, Australia
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, 3629, South Africa; HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
| | - Cindy Feng
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Clara Juando-Prats
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Ekwaro A Obuku
- Africa Centre for Systematic Reviews & Knowledge Translation, College of Health Sciences, Makerere University, Kampala 7062, Uganda; Department of Global Health Security, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala 7062, Uganda; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London WC1E 6BT, United Kingdom
| | - Elizabeth Kristjansson
- School of Psychology, University of Ottawa, Faculty of Social Sciences, Ottawa, Ontario K1N 6N5, Canada
| | - Erik von Elm
- Cochrane Switzerland, Unisanté Lausanne, Lausanne, CH 1010, Switzerland
| | - Harry Wang
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; University of Ottawa Faculty of Medicine, Ottawa, Ontario K1N 6N5, Canada
| | - Holly Ellingwood
- Department of Psychology, Department of Law, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - Hugh Sharma Waddington
- Environmental Health Group, Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; London International Development Centre, London, Ontario N5V 4T3, Canada
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; School of Optometry and Vision Science, University of Auckland, Auckland 1010, New Zealand
| | - Janet Elizabeth Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Janet Hatcher-Roberts
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | | | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Lawrence Mbuagbaw
- Department of Anesthesia, McMaster University, Hamilton, Ontario L8S 4L8, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4L8, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario L8N 4A6, Canada; Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, VGC6+C52, Yaoundé, Cameroon; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town 7602, South Africa
| | | | - Loveline Lum Niba
- Department of Public Health, Faculty of Health Sciences, The University of Bamenda, Amphi 340, Bambili, Bamenda, Cameroon
| | | | - Luke Wolfenden
- School of medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Mwenya Kasonde
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Marc T Avey
- Canadian Council on Animal Care, Ottawa, Ontario K2P 2R3, Canada
| | - Melissa K Sharp
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Michael Johnson Mahande
- Department of Epidemiology & Biostatistics, Kilimanjaro Christian Medical University College, Kilimanjaro M8HH+MQ4, Tanzania
| | - Miriam Nkangu
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Peter Craig
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, Glasgow G12 8QQ, UK
| | - Peter Tugwell
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Sarah Funnell
- Department of Family Medicine, Queen's University, Kingston, Ontario K7L 3N6, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Stephen G Noorduyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, 3629, South Africa
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario K1S 5N8, Canada
| | - Taryn Young
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa
| | - Tomas Pantoja
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada; Institute for Global Health and Development, The Aga Khan University, Karachi 74000, Pakistan
| | - Andrea Martel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S, Canada
| | - Vivian A Welch
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada.
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22
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Jeon J, Park J, Choi MH, Choi H, Kim MH. Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea. Epidemiol Health 2023; 45:e2023068. [PMID: 37536718 PMCID: PMC10667578 DOI: 10.4178/epih.e2023068] [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: 04/05/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES While the Korean government's response to the coronavirus disease 2019 (COVID-19) pandemic is considered effective given the relatively low mortality rate, issues of inequality have been insufficiently addressed. This study explored COVID-19-related health inequalities in Korea. METHODS Age standardization for various health inequality indices was derived using data from the Korean National Health Insurance Service, the Korea Disease Control and Prevention Agency, and the Microdata Integrated Service of Statistics Korea. The slope index of inequality (SII) and relative index of inequality (RII) were calculated for socioeconomic variables, while absolute difference (AD) and relative difference (RD) were used for gender and disability inequalities. RESULTS We observed a number of COVID-19-related health outcome inequalities. Gender inequality was particularly noticeable in infection rates, with the rate of women 1.16 times higher than that of men. In contrast, socioeconomic inequality was evident in vaccination rates, with a 4.5-fold (SII, -4.519; 95% confidence interval, -7.403 to -1.634) difference between the highest and lowest household income groups. Regarding clinical progression post-infection, consistent findings indicated higher risk for men (RD for hospitalization, 0.90; severe cases, 0.54; and fatality, 0.65), individuals with disabilities (RD for hospitalization, 2.27; severe cases, 2.29; and fatality, 2.37), and those from lower socioeconomic groups (SII for hospitalization, 1.778; severe cases, 0.089; and fatality, 0.451). CONCLUSIONS While the infection risk was nearly ubiquitous, not everyone faced the same level of risk post-infection. To prevent further health inequalities, it is crucial to develop a thoughtful policy acknowledging individual health conditions and resources.
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Affiliation(s)
- Jeangeun Jeon
- Department of Sociology, Yonsei University, Seoul, Korea
| | - Jieun Park
- Department of Sociology, Yonsei University, Seoul, Korea
| | - Min-Hyeok Choi
- Department of Preventive and Occupational & Environmental Medicine, Pusan National University Medical College, Yangsan, Korea
- Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hongjo Choi
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Myoung-Hee Kim
- Center for Public Health Data Analytics, National Medical Center, Seoul, Korea
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23
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The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019. Lancet 2023; 402:313-335. [PMID: 37393924 PMCID: PMC10375221 DOI: 10.1016/s0140-6736(23)00860-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/22/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation.
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Racape J, Dauby N, Goffard JC, Abdellaoui K, Radulescu C, Coppieters Y, Rea A. Distinct socioeconomic profile of patients hospitalised with severe COVID-19 and prepandemic respiratory infections in Brussels's deprived areas: a case-control study. BMJ Open 2023; 13:e072914. [PMID: 37479511 PMCID: PMC10364187 DOI: 10.1136/bmjopen-2023-072914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE Belgium has been hit harder by COVID-19 than other countries in Europe. While clinical risk factors are well studied, socioeconomic risk factors remained underexplored. This study's objective was to analyse the social and clinical profile of patients hospitalised for COVID-19 during the two waves of 2020, compared with a control population in 2019 in two hospitals located in Brussels' most deprived area. DESIGN AND METHODS We did a case-control study by using the minimal clinical data set in two Brussels hospitals. All patients hospitalised for COVID-19 in 2020, divided into two waves (n=3220), were compared with all patients hospitalised for viral pneumonia and respiratory diseases in 2019 (control population n=2950). Multinomial regression models were used to estimate the relative risk ratios of the association between the COVID-19 hospitalised populations (waves 1 and 2) and risk factors (social and clinical) stratified by age. RESULTS Patients under 65 years of age and hospitalised for COVID-19 presented significantly higher rates (relative rate ratio (95% CI)), especially for the first wave, of obesity 1.6 (1.2-2.2), African nationalities 1.4 (1.0-1.8), lack of health insurance 1.6 (1.3-2.1), living in high-density population areas 1.6 (1.3-2.1) and low incomes 1.7 (1.4-2.1), compared with the control population For patients over 65 years of age, we did not observe significant excess of COVID-19 hospitalisations for any risk factors, except diabetes during for the second wave but we have a significant excess mortality rate than the control population for both waves (p<0.002). CONCLUSIONS The social and clinical profile of patients hospitalised for COVID-19 compared with a population hospitalised for viral respiratory diseases differed between age groups and waves. For younger patients, risk factors were linked to patients' precarious situations. This study underlines the role of selected social health determinants and the importance of routinely collecting social data, along with clinical data, particularly among vulnerable populations.
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Affiliation(s)
- Judith Racape
- Chair in Health and Precarity, Faculty of Medicine, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Bruxelles, Belgium
- Environmental Health Research Center, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Hopital Erasme, Universite libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Kaoutar Abdellaoui
- Department of Minimal Clinical Data, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Brussels, Belgium
| | - Cristina Radulescu
- Department of Minimal Clinical Data, Hopital Erasme, Universite libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Yves Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Andrea Rea
- Group for Research on Ethnic Relations, Migrations & Equality, Faculte de Philosophie et Sciences sociales, Universite Libre de Bruxelles (ULB), Bruxelles, Belgium
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Racape J, Noel AC, Lurel J, Dauby N, Coppieters Y, Goffard JC, Rea A. Social and clinical risk factors associated with hospitalized COVID-19 patients in Brussels's deprived and multiethnic areas. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002039. [PMID: 37450479 PMCID: PMC10348590 DOI: 10.1371/journal.pgph.0002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In Belgium, the Brussels-Capital region was severely affected by the COVID-19 epidemic. Various hypotheses were mentioned in order to explain Brussels' excess disease spreading and mortality rate, but socioeconomic risk factors are increasingly recognized. This study's objective was to analyze clinical and social profiles of patients hospitalized for COVID-19, by nationality groups, in two hospitals located in Brussels's deprived and multiethnic areas. METHODS Data covered hospitalized COVID-19 patients from two Brussels hospitals (n = 787) between the 1st of March 2020 and the 31st of June 2020. Social data was collected using hospital records, and clinical data was extracted from hospitals' COVID-19 databases. Multivariable logistic regression models were used to estimate the odds ratios (OR) of the association between two outcomes (Intensive Care Unit admission and mortality) and risk factors (social and clinical). RESULTS Patients from Sub-Saharan Africa were younger, had a higher prevalence of obesity, lacked health insurance, and had the highest proportion of Intensive Care Unit (ICU) admission (27.7%) but the lowest mortality rates than other nationality groups. Patients from North Africa had a higher prevalence of diabetes compared to other nationality groups and a high proportion of European patients came from nursing homes. Patients deprived of health insurance had a higher risk of ICU admission compared to those who had insurance (OR IC95%; 1,9 1.1-3.6, p = 0.03). Other risk factors as sex and obesity were significantly associated to ICU admission and, age and hypertension were significantly associated to mortality. CONCLUSION Social and clinical profile of the patients differs between the nationality groups, and some risk factors for Intensive Care Unit admission and mortality were linked to more patients' precarious situation as the availability of health insurance. This study underlines the role of selected social health determinants and the importance of routinely collecting social along with clinical data.
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Affiliation(s)
- Judith Racape
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite libre de Bruxelles (ULB), Brussels, Belgium
- Chair in Health and Precarity, Faculty of Medecine, Universite libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Cecile Noel
- Social Department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jerome Lurel
- Department of Internal Medicine, Erasmus Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Dauby
- Environmental Health Research Centre Public Health School, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Infectious Diseases, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Yves Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Universite libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Erasmus Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Andrea Rea
- Group for Research on Ethnic Relations, Migrations & Equality, Faculty of Philosophy and Social Sciences, Universite libre de Bruxelles (ULB), Brussels, Belgium
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Green H, MacPhail C, Fernandez R. "I just wanted money for food": a qualitative study of the experiences of Australians during the COVID-19 pandemic. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-12. [PMID: 37361318 PMCID: PMC10241130 DOI: 10.1007/s10389-023-01952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
Aim The social and economic impacts that have occurred during the COVID-19 pandemic can disproportionally affect those already experiencing poverty or at risk of poverty. Therefore, this study sought to explore the relationship between well-being and social determinants of health among Australian adults during the pandemic. Subject and Methods Semi-structured interviews were undertaken with 20 participants, aged 21-65 years, from various socioeconomic areas. Results Three main themes emerged from the analysis of the data: food security; housing outcomes; and psychological and emotional impact. Participants in low socioeconomic areas struggled with food security, having to access food banks, which was precipitated by employment loss during the pandemic. Some female participants experienced worsening inequalities and lack of financial and housing stability, affecting their overall well-being. Conclusion This study identified that there was a clear social divide between adults living in low socioeconomic areas compared with those living in high socioeconomic areas, with participants in low socioeconomic areas faring worse in terms of exacerbated social determinants of health and consequent impacts on well-being.
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Affiliation(s)
- Heidi Green
- School of Health and Society, University of Wollongong, Wollongong, NSW Australia
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, St George Hospital, Kogarah, NSW Australia
| | - Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, NSW Australia
| | - Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW Australia
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Fortunato F, Lillini R, Martinelli D, Iannelli G, Ascatigno L, Casanova G, Lopalco PL, Prato R. Association of socio-economic deprivation with COVID-19 incidence and fatality during the first wave of the pandemic in Italy: lessons learned from a local register-based study. Int J Health Geogr 2023; 22:10. [PMID: 37143110 PMCID: PMC10157567 DOI: 10.1186/s12942-023-00332-9] [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: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND COVID-19 has been characterised by its global and rapid spread, with high infection, hospitalisation, and mortality rates worldwide. However, the course of the pandemic showed differences in chronology and intensity in different geographical areas and countries, probably due to a multitude of factors. Among these, socio-economic deprivation has been supposed to play a substantial role, although available evidence is not fully in agreement. Our study aimed to assess incidence and fatality rates of COVID-19 across the levels of socio-economic deprivation during the first epidemic wave (March-May 2020) in the Italian Province of Foggia, Apulia Region. METHODS Based on the data of the regional active surveillance platform, we performed a retrospective epidemiological study among all COVID-19 confirmed cases that occurred in the Apulian District of Foggia, Italy, from March 1st to May 5th, 2020. Geocoded addresses were linked to the individual Census Tract (CT) of residence. Effects of socio-economic condition were calculated by means of the Socio-Economic and Health-related Deprivation Index (SEHDI) on COVID-19 incidence and fatality. RESULTS Of the 1054 confirmed COVID-19 cases, 537 (50.9%) were men, 682 (64.7%) were 0-64 years old, and 338 (32.1%) had pre-existing comorbidities. COVID-19 incidence was higher in the less deprived areas (p < 0.05), independently on age. The level of socio-economic deprivation did not show a significant impact on the vital status, while a higher fatality was observed in male cases (p < 0.001), cases > 65 years (p < 0.001), cases having a connection with a nursing home (p < 0.05) or having at least 1 comorbidity (p < 0.001). On the other hand, a significant protection for healthcare workers was apparent (p < 0.001). CONCLUSIONS Our findings show that deprivation alone does not affect COVID-19 incidence and fatality burden, suggesting that the burden of disease is driven by a complexity of factors not yet fully understood. Better knowledge is needed to identify subgroups at higher risk and implement effective preventive strategies.
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Affiliation(s)
- Francesca Fortunato
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Roberto Lillini
- Analytical Epidemiology & Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenico Martinelli
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppina Iannelli
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Leonardo Ascatigno
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Georgia Casanova
- IRCCS-INRCA National Institute of Health & Science on Ageing, Centre for Socio-Economic Research on Ageing, Ancona, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Rosa Prato
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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AuYoung M, Rodriguez Espinosa P, Chen WT, Juturu P, Young MEDT, Casillas A, Adkins-Jackson P, Hopfer S, Kissam E, Alo AK, Vargas RA, Brown AF. Addressing racial/ethnic inequities in vaccine hesitancy and uptake: lessons learned from the California alliance against COVID-19. J Behav Med 2023; 46:153-166. [PMID: 35066696 PMCID: PMC8783654 DOI: 10.1007/s10865-022-00284-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/03/2022] [Indexed: 12/31/2022]
Abstract
Lack of trust in biomedical research, government, and health care systems, especially among racial/ethnic minorities and under-resourced communities, is a longstanding issue rooted in social injustice. The COVID-19 pandemic has further highlighted existing health and socioeconomic inequities and increased the urgency for solutions to provide access to timely, culturally, and linguistically appropriate evidence-based information about COVID-19; and ultimately to promote vaccine uptake. California's statewide alliance STOP COVID-19 CA (comprising eleven sites), leverages long standing community partnerships to better understand concerns, misinformation, and address racial/ethnic inequities in vaccine hesitancy and uptake. Using data from the California CEAL Communication Working Group, we demonstrate the wide range of strategies, communication methods, languages, and trusted messengers that have been effective in reaching diverse communities across the state. We also showcase challenges and lessons learned, such as the importance of including trusted community partners to share information or provide vaccines. These approaches, rooted in community engagement, are crucial for addressing inequities and responding to future public health emergencies.
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Affiliation(s)
| | - Patricia Rodriguez Espinosa
- Office of Community Engagement, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Wei-Ting Chen
- Office of Community Engagement, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Preeti Juturu
- Center for Health Disparities Research, University of California at Riverside, Riverside, CA, USA
| | | | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Paris Adkins-Jackson
- Division of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Suellen Hopfer
- Department of Health, Program in Public Health, University of California at Irvine, Society, & Behavior, Irvine, CA, USA
| | - Ed Kissam
- Center for Reducing Health Disparities, University of California, Davis, Davis, CA, USA
- Werner Kohnstamm Family Giving Fund, Sacramento, CA, USA
| | | | - Roberto A Vargas
- Center for Community Engagement, University of California at San Francisco, San Francisco, CA, USA
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Drake JM, Marty É, Gandhi KJK, Welch-Devine M, Bledsoe B, Shepherd M, Seymour L, Fortuin CC, Montes C. Disasters collide at the intersection of extreme weather and infectious diseases. Ecol Lett 2023; 26:485-489. [PMID: 36849208 DOI: 10.1111/ele.14188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/12/2023] [Accepted: 02/05/2023] [Indexed: 03/01/2023]
Abstract
Natural disasters interact to affect the resilience and prosperity of communities and disproportionately affect low income families and communities of colour. However, due to lack of a common theoretical framework, these are rarely quantified. Observing severe weather events (e.g. hurricanes and tornadoes) and epidemics (e.g. COVID-19) unfolding in southeastern US communities led us to conjecture that interactions among catastrophic disturbances might be much more considerable than previously recognized. For instance, hurricane evacuations increase human aggregation, a factor that affects the transmission of acute infections like SARS-CoV-2. Similarly, weather damage to health infrastructure can reduce a community's ability to provide services to people who are ill. As globalization and human population and movement continue to increase and weather events are becoming more intense, such complex interactions are expected to magnify and significantly impact environmental and human health.
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Affiliation(s)
- John M Drake
- Odum School of Ecology & Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Éric Marty
- Odum School of Ecology & Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Kamal J K Gandhi
- D.B. Warnell School of Forestry and Natural Resources, University of Georgia, Athens, Georgia, USA
| | | | - Brian Bledsoe
- College of Engineering & Institute for Resilient Infrastructure Systems, University of Georgia, Athens, Georgia, USA
| | - Marshall Shepherd
- Department of Geography and Atmospheric Sciences Program, University of Georgia, Athens, Georgia, USA
| | - Lynne Seymour
- Department of Statistics, University of Georgia, Athens, Georgia, USA
| | - Christine C Fortuin
- D.B. Warnell School of Forestry and Natural Resources, University of Georgia, Athens, Georgia, USA
- Mississippi State University, College of Forest Resources, Mississippi State, Mississippi, USA
| | - Cristian Montes
- D.B. Warnell School of Forestry and Natural Resources, University of Georgia, Athens, Georgia, USA
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Wang L, Calzavara A, Baral S, Smylie J, Chan AK, Sander B, Austin PC, Kwong JC, Mishra S. Differential Patterns by Area-Level Social Determinants of Health in Coronavirus Disease 2019 (COVID-19)-Related Mortality and Non-COVID-19 Mortality: A Population-Based Study of 11.8 Million People in Ontario, Canada. Clin Infect Dis 2023; 76:1110-1120. [PMID: 36303410 PMCID: PMC9620355 DOI: 10.1093/cid/ciac850] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Social determinants of health (SDOH) have been associated with coronavirus disease 2019 (COVID-19) outcomes. We examined patterns in COVID-19-related mortality by SDOH and compared these patterns to those for non-COVID-19 mortality. METHODS Residents of Ontario, Canada, aged ≥20 years were followed from 1 March 2020 to 2 March 2021. COVID-19-related death was defined as death within 30 days following or 7 days prior to a positive COVID-19 test. Area-level SDOH from the 2016 census included median household income; proportion with diploma or higher educational attainment; proportion essential workers, racially minoritized groups, recent immigrants, apartment buildings, and high-density housing; and average household size. We examined associations between SDOH and COVID-19-related mortality, and non-COVID-19 mortality using cause-specific hazard models. RESULTS Of 11 810 255 individuals, we observed 3880 COVID-19-related deaths and 88 107 non-COVID-19 deaths. After accounting for demographics, baseline health, and other area-level SDOH, the following were associated with increased hazards of COVID-19-related death (hazard ratio [95% confidence interval]: lower income (1.30 [1.04-1.62]), lower educational attainment (1.27 [1.07-1.52]), higher proportions essential workers (1.28 [1.05-1.57]), racially minoritized groups (1.42 [1.08-1.87]), apartment buildings (1.25 [1.07-1.46]), and large vs medium household size (1.30 [1.12-1.50]). Areas with higher proportion racially minoritized groups were associated with a lower hazard of non-COVID-19 mortality (0.88 [0.84-0.92]). CONCLUSIONS Area-level SDOH are associated with COVID-19-related mortality after accounting for demographic and clinical factors. COVID-19 has reversed patterns of lower non-COVID-19 mortality among racially minoritized groups. Pandemic responses should include strategies to address disproportionate risks and inequitable coverage of preventive interventions associated with SDOH.
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Affiliation(s)
- Linwei Wang
- MAP-Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Janet Smylie
- MAP-Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Well Living House, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne K Chan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Beate Sander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- Correspondence: S. Mishra, MAP-Centre for Urban Health Solutions, St Michael’s Hospital, Unity Health Toronto, University of Toronto, 209 Victoria St, Toronto, ON, Canada, M5B 1T8 ()
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Zaccardi F, Tan PS, Shah BR, Everett K, Clift AK, Patone M, Saatci D, Coupland C, Griffin SJ, Khunti K, Dambha-Miller H, Hippisley-Cox J. Ethnic disparities in COVID-19 outcomes: a multinational cohort study of 20 million individuals from England and Canada. BMC Public Health 2023; 23:399. [PMID: 36849983 PMCID: PMC9969387 DOI: 10.1186/s12889-023-15223-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Heterogeneous studies have demonstrated ethnic inequalities in the risk of SARS-CoV-2 infection and adverse COVID-19 outcomes. This study evaluates the association between ethnicity and COVID-19 outcomes in two large population-based cohorts from England and Canada and investigates potential explanatory factors for ethnic patterning of severe outcomes. METHODS We identified adults aged 18 to 99 years in the QResearch primary care (England) and Ontario (Canada) healthcare administrative population-based datasets (start of follow-up: 24th and 25th Jan 2020 in England and Canada, respectively; end of follow-up: 31st Oct and 30th Sept 2020, respectively). We harmonised the definitions and the design of two cohorts to investigate associations between ethnicity and COVID-19-related death, hospitalisation, and intensive care (ICU) admission, adjusted for confounders, and combined the estimates obtained from survival analyses. We calculated the 'percentage of excess risk mediated' by these risk factors in the QResearch cohort. RESULTS There were 9.83 million adults in the QResearch cohort (11,597 deaths; 21,917 hospitalisations; 2932 ICU admissions) and 10.27 million adults in the Ontario cohort (951 deaths; 5132 hospitalisations; 1191 ICU admissions). Compared to the general population, pooled random-effects estimates showed that South Asian ethnicity was associated with an increased risk of COVID-19 death (hazard ratio: 1.63, 95% CI: 1.09-2.44), hospitalisation (1.53; 1.32-1.76), and ICU admission (1.67; 1.23-2.28). Associations with ethnic groups were consistent across levels of deprivation. In QResearch, sociodemographic, lifestyle, and clinical factors accounted for 42.9% (South Asian) and 39.4% (Black) of the excess risk of COVID-19 death. CONCLUSION International population-level analyses demonstrate clear ethnic inequalities in COVID-19 risks. Policymakers should be cognisant of the increased risks in some ethnic populations and design equitable health policy as the pandemic continues.
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Affiliation(s)
- Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, England
| | - Pui San Tan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Baiju R Shah
- Department of Medicine, University of Toronto; Division of Endocrinology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Karl Everett
- Department of Medicine, University of Toronto; Division of Endocrinology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Ash Kieran Clift
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
- Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, England
| | - Martina Patone
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Defne Saatci
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Carol Coupland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, England
| | - Simon J Griffin
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, England
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, England
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, England
| | | | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England.
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Hitch D, Deféin E, Lloyd M, Rasmussen B, Haines K, Garnys E. Beyond the case numbers: Social determinants and contextual factors in patient narratives of recovery from COVID-19. Aust N Z J Public Health 2023; 47:100002. [PMID: 36709621 PMCID: PMC9883019 DOI: 10.1016/j.anzjph.2022.100002] [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: 02/27/2022] [Revised: 08/28/2022] [Accepted: 10/11/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE This study aimed to describe and contextualise COVID-19 recovery from the perspective of patient-lived experience, to inform the evolving public health response to the pandemic. METHODS Narrative interviews were completed with 37 adult Australians between six and 10 months following their COVID-19 diagnosis. Verbatim transcripts were analysed thematically and trustworthiness was supported by multiple strategies to ensure rigour. RESULTS Three themes were identified: 1) trajectories of recovery, 2) back to 'some sort of normal' and 3) the importance of work. Resumed participation in activities of daily life, the influence of social determinants of health and the impact of contextual factors were prominent features in the recovery narratives. CONCLUSIONS The COVID-19 pandemic presents both challenges and opportunities for public health systems to formulate appropriate responses and make improvements. Behind the case numbers, patient narratives described the uncertainty, diversity and multiple pathways to recovery that need to inform public health policy. IMPLICATIONS FOR PUBLIC HEALTH Looking beyond the case numbers reveals a complex landscape characterised by uncertainty, diversity and multiple pathways to recovery. The pandemic presents challenges and opportunities for public health in Australia and New Zealand, lived experience expertise is crucial to the formulation of an effective response.
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Affiliation(s)
- Danielle Hitch
- Allied Health, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, Victoria 3021, Australia; School of Health and Social Development, Deakin University, Locked Bag 20000, Geelong, Victoria 3200, Australia.
| | - Elle Deféin
- School of Health and Social Development, Deakin University, Locked Bag 20000, Geelong, Victoria 3200, Australia
| | - Melanie Lloyd
- Allied Health, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, Victoria 3021, Australia
| | - Bodil Rasmussen
- Allied Health, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, Victoria 3021, Australia,University of Southern Denmark and Steno Diabetes Center, Odense, Denmark,School of Nursing and Midwifery, Deakin University, Locked Bag 20000, Geelong, Victoria 3200, Australia,Institute of Health Transformation, Deakin University, Locked Bag 20000, Geelong, Victoria 3200, Australia
| | - Kimberley Haines
- Allied Health, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, Victoria 3021, Australia,Centre for Integrated Critical Care, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Eleanor Garnys
- Allied Health, Western Health, Sunshine Hospital, 176 Furlong Road, St. Albans, Victoria 3021, Australia,School of Health and Social Development, Deakin University, Locked Bag 20000, Geelong, Victoria 3200, Australia
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Mihic N, Abascal J, López Chicharro J, Segura F, Huurman S, Núñez de Aysa B, Bouza E. Impact and control of the COVID pandemic in an elite sports club: Real Madrid. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36:59-64. [PMID: 36336951 PMCID: PMC9910681 DOI: 10.37201/req/072.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Abstract
The incidence and risk factors for poor outcome in patients with COVID are well known, as are the protective measures in high-risk populations. In contrast, the epidemiological and clinical behavior of this disease in the population of elite athletes who are the paradigm of good health is poorly understood. Data on COVID in athletes are scarce and have focused preferentially on the consequences on sports performance of confinement measures and on the pathophysiological risks of infected athletes. Real Madrid is a large elite sports institution with facilities in the City of Madrid where 600 athletes train daily. The incidence of COVID during a study period of 671 days of observation in athletes, professional or amateur, working in the institution has been 0,74 per 1,000 days of exposure. The disease has been asymptomatic or oligosymptomatic in all athletes and did not require any hospital admissions. The different teams did not have to suspend any of its sportive commitments for COVID during the study period and there was no evidence of outbreaks of internal transmission between members of the different teams.
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Affiliation(s)
| | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Chaillon A, Bojorquez I, Sepúlveda J, Harvey-Vera AY, Rangel MG, Skaathun B, Mehta SR, Ignacio C, Porrachia M, Smith DM, Strathdee SA. Cocirculation and replacement of SARS-CoV-2 variants in crowded settings and marginalized populations along the US-Mexico border. SALUD PUBLICA DE MEXICO 2023; 65:10-18. [PMID: 36750073 PMCID: PMC10291843 DOI: 10.21149/13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To interrogate the circulating SARS-CoV-2 lin-eages and recombinant variants in persons living in migrant shelters and persons who inject drugs (PWID). MATERIALS AND METHODS We combined data from two studies with marginalized populations (migrants in shelters and persons who inject drugs) in Tijuana, Mexico. SARS-CoV-2 variants were identified on nasal swabs specimens and compared to publicly available genomes sampled in Mexico and California. RESULTS All but 2 of the 10 lineages identified were predomi-nantly detected in North and Central America. Discrepan-cies between migrants and PWID can be explained by the temporal emergence and short time span of most of these lineages in the region. CONCLUSION The results illustrate the temporo-spatial structure for SARS-CoV-2 lineage dispersal and the potential co-circulation of multiple lineages in high-risk populations with close social contacts. These conditions create the potential for recombination to take place in the California-Baja California border.
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Affiliation(s)
- Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California San Diego. San Diego, United States.
| | - Ietza Bojorquez
- Departamento de Estudios de Población, El Colegio de la Frontera Norte. Tijuana, Mexico.
| | - Jaime Sepúlveda
- Institute for Global Health Sciences, University of California. San Francisco, United States.
| | - Alicia Yolanda Harvey-Vera
- Division of Infectious Diseases and Global Public Health, University of California San Diego. San Diego, United States/Facultad de Medicina, Universidad de Xochicalco. Tijuana, Mexico/United States-Mexico Border Health Commission. Tijuana, Mexico.
| | - M Gudelia Rangel
- Departamento de Estudios de Población, El Colegio de la Frontera Norte/United States-Mexico Border Health Commission. Tijuana, Mexico.
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, University of California San Diego. San Diego, United States.
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, University of California San Diego/Veterans Affairs Health System. San Diego, United States.
| | - Caroline Ignacio
- Division of Infectious Diseases and Global Public Health, University of California San Diego. San Diego, United States.
| | - Magali Porrachia
- Division of Infectious Diseases and Global Public Health, University of California San Diego/Veterans Affairs Health System. San Diego, United States.
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego/Veterans Affairs Health System. San Diego, United States.
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego. San Diego, United States.
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Hulsegge G, Eekhout I, van de Ven HA, Burdorf A, Oude Hengel KM. Educational inequalities in self-rated health and emotional exhaustion among workers during the COVID-19 pandemic: a longitudinal study. Int Arch Occup Environ Health 2023; 96:401-410. [PMID: 36322181 PMCID: PMC9628589 DOI: 10.1007/s00420-022-01931-y] [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: 05/30/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to investigate trends in educational inequalities in poor health and emotional exhaustion during the pandemic among workers, and differences in trends between men and women. METHODS Five waves (2019-2021) from the longitudinal study 'the Netherlands Working Conditions Survey COVID-19 study' were used (response rates: 32-38%). Generalized logistic mixed models were used to estimate the changes in absolute and relative educational inequalities in poor health and emotional exhaustion for all workers (n = 12,479) and for men and women, separately. RESULTS Low and intermediate educated workers reported more often poor health (OR 2.54; 95% CI 1.71-3.77 and OR 2.09; 95% CI 1.68-2.61, respectively) than high educated workers. Intermediate educated women (OR 0.49; 95% CI 0.37-0.64) reported less emotional exhaustion than high educated women, but no differences were observed among men. The prevalence of poor health first decreased across all educational levels until March 2021, and bounced back in November 2021. A similar pattern was found for emotional exhaustion, but for low and intermediate educated workers only. Relative educational inequalities in poor health reduced among men during the pandemic, and absolute differences decreased among men and women by 2.4-2.6%. Relative educational inequalities in emotional exhaustion widened among men only. Absolute differences in emotional exhaustion first increased among both men and women, but narrowed between the last two waves. DISCUSSION Socioeconomic inequalities for poor self-rated health remained but narrowed in relative and absolute terms during the pandemic. With regard to emotional exhaustion, socioeconomic inequalities returned to pre-COVID-19 levels at the end of 2021.
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Affiliation(s)
- G. Hulsegge
- grid.4858.10000 0001 0208 7216Unit Healthy Living, Netherlands Organization for Applied Scientific Research TNO, Sylviusweg 71, 2333 BE Leiden, The Netherlands
| | - I. Eekhout
- grid.4858.10000 0001 0208 7216Unit Healthy Living, Netherlands Organization for Applied Scientific Research TNO, Sylviusweg 71, 2333 BE Leiden, The Netherlands
| | - H. A. van de Ven
- grid.4858.10000 0001 0208 7216Unit Healthy Living, Netherlands Organization for Applied Scientific Research TNO, Sylviusweg 71, 2333 BE Leiden, The Netherlands
| | - A. Burdorf
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - K. M. Oude Hengel
- grid.4858.10000 0001 0208 7216Unit Healthy Living, Netherlands Organization for Applied Scientific Research TNO, Sylviusweg 71, 2333 BE Leiden, The Netherlands
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Oh C, Zhou A, O'Brien K, Jamal Y, Wennerdahl H, Schmidt AR, Shisler JL, Jutla A, Schmidt AR, Keefer L, Brown WM, Nguyen TH. Application of neighborhood-scale wastewater-based epidemiology in low COVID-19 incidence situations. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 852:158448. [PMID: 36063927 PMCID: PMC9436825 DOI: 10.1016/j.scitotenv.2022.158448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/08/2022] [Accepted: 08/28/2022] [Indexed: 05/17/2023]
Abstract
Wastewater-based epidemiology (WBE), an emerging approach for community-wide COVID-19 surveillance, was primarily characterized at large sewersheds such as wastewater treatment plants serving a large population. Although informed public health measures can be better implemented for a small population, WBE for neighborhood-scale sewersheds is less studied and not fully understood. This study applied WBE to seven neighborhood-scale sewersheds (average population of 1471) from January to November 2021. Community testing data showed an average of 0.004 % incidence rate in these sewersheds (97 % of monitoring periods reported two or fewer daily infections). In 92 % of sewage samples, SARS-CoV-2 N gene fragments were below the limit of quantification. We statistically determined 10-2.6 as the threshold of the SARS-CoV-2 N gene concentration normalized to pepper mild mottle virus (N/PMMOV) to alert high COVID-19 incidence rate in the studied sewershed. This threshold of N/PMMOV identified neighborhood-scale outbreaks (COVID-19 incidence rate higher than 0.2 %) with 82 % sensitivity and 51 % specificity. Importantly, neighborhood-scale WBE can discern local outbreaks that would not otherwise be identified by city-scale WBE. Our findings suggest that neighborhood-scale WBE is an effective community-wide disease surveillance tool when COVID-19 incidence is maintained at a low level.
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Affiliation(s)
- Chamteut Oh
- Department of Civil and Environmental Engineering, University of Illinois Urbana-Champaign, United States.
| | - Aijia Zhou
- Department of Civil and Environmental Engineering, University of Illinois Urbana-Champaign, United States
| | - Kate O'Brien
- School of Integrative Biology, University of Illinois Urbana-Champaign, United States
| | - Yusuf Jamal
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, United States
| | - Hayden Wennerdahl
- Illinois State Water Survey, Prairie Research Institute, University of Illinois Urbana-Champaign, United States
| | - Arthur R Schmidt
- Department of Civil and Environmental Engineering, University of Illinois Urbana-Champaign, United States
| | - Joanna L Shisler
- Department of Microbiology, University of Illinois Urbana-Champaign, United States
| | - Antarpreet Jutla
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, United States
| | - Arthur R Schmidt
- Department of Civil and Environmental Engineering, University of Illinois Urbana-Champaign, United States
| | - Laura Keefer
- Illinois State Water Survey, Prairie Research Institute, University of Illinois Urbana-Champaign, United States
| | - William M Brown
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, United States
| | - Thanh H Nguyen
- Department of Civil and Environmental Engineering, University of Illinois Urbana-Champaign, United States; Institute of Genomic Biology, University of Illinois Urbana-Champaign, United States
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Sjörs Dahlman A, Anund A. Seroprevalence of SARS-CoV-2 antibodies among public transport workers in Sweden. JOURNAL OF TRANSPORT & HEALTH 2022; 27:101508. [PMID: 36188635 PMCID: PMC9515328 DOI: 10.1016/j.jth.2022.101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Public transportation is an essential societal function in crisis situations like the coronavirus disease 2019 (COVID-19) pandemic. Bus drivers and other public transport workers are essential workers that need to keep working despite the risk of contagion. The SARS-CoV-2 virus may pose an occupational health risk to public transport workers and especially to bus drivers as they interact with passengers in a confined area. By analyzing antibodies towards SARS-CoV-2 proteins in blood samples it is possible to measure if an individual has been infected by COVID-19. Here, we report the prevalence of antibodies among bus drivers and other public transport employees in Stockholm, Sweden and relate it to socio-demographic factors. METHODS Seroprevalence of IgG antibodies towards SARS-CoV-2 proteins was investigated in a sample of 262 non-vaccinated public transport workers (182 men and 40 women) recruited between April 26 and May 7, 2021. Most of the participants were bus drivers (n = 222). The relationship between socio-demographic factors and seroprevalence was investigated with logistic regression. RESULTS The seroprevalence was 50% in the total sample of public transport workers. Among bus drivers, 51% were seropositive compared to 44% seropositive among the other public transport workers. The difference was not significant. The seroprevalence was higher than the national seroprevalence in Sweden during the same period (18.3% in non-vaccinated people aged 20-64 years). The logistic regression model using Wald forward selection showed that men had a higher risk of being seropositive (OR 2.7, 95% CI 1.3 - 5.8) and there was a higher risk with increasing number of people in the household (OR 1.3, 95% CI 1.1 - 1.6). CONCLUSIONS These findings could imply an occupational risk for COVID-19 infection among public transport workers. Infection control measures are warranted during virus epidemics to assure bus drives' safety and reduce transmission in public transport.
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Affiliation(s)
- Anna Sjörs Dahlman
- The Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
- Department of Electrical Engineering and SAFER Vehicle and Traffic Safety Centre at Chalmers University of Technology, Gothenburg, Sweden
| | - Anna Anund
- The Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
- Rehabilitation Medicine, Linköping University, Linköping, Sweden and Stockholm University, Stockholm Stress Centre, Stockholm, Sweden
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Chavda VP, Vuppu S, Mishra T, Kamaraj S, Patel AB, Sharma N, Chen ZS. Recent review of COVID-19 management: diagnosis, treatment and vaccination. Pharmacol Rep 2022; 74:1120-1148. [PMID: 36214969 PMCID: PMC9549062 DOI: 10.1007/s43440-022-00425-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 02/06/2023]
Abstract
The idiopathic Coronavirus disease 2019 (COVID-19) pandemic outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has reached global proportions; the World Health Organization (WHO) declared it as a public health emergency during the month of January 30, 2020. The major causes of the rise of new variants of SARS-CoV-2 are genetic mutations and recombination. Some of the variants with high infection and transmission rates are termed as variants of concern (VOCs) like currently Omicron variants. Pregnant women, aged people, and immunosuppressed and compromised patients constitute the most susceptible human population to the SARS-CoV-2 infection, especially to the new evolving VOCs. To effectively manage the pathological condition of infection, the focus should be directed towards prevention and prophylactic approach. In this narrative review, we aimed to analyze the current scenario of COVID-19 management and discuss the treatment and prevention strategies. We also focused on the complications prevalent during the COVID-19 and post-COVID period and to discuss the novel approaches developed for mitigation of the global pandemic. We have also emphasized on the COVID-19 management approaches for the special population including children, pregnant women, aged groups, and immunocompromised patients. We conclude that the advancements in therapeutic and pharmacological domains have provided opportunities to develop and design novel diagnosis, treatment, and prevention strategies. New advanced techniques such as RT-LAMP, RT-qPCR, High-Resolution Computed Tomography, etc., efficiently diagnose patients with SARS-CoV-2 infection. In the case of treatment options, new drugs like paxlovid, combinations of β-lactum drugs and molnupiravir are found to be effective against even the new emerging variants. In addition, vaccination is an essential approach to prevent the infection or to reduce its severity. Vaccines for against COVID-19 from Comirnaty by Pfizer-BioNTech, SpikeVax by Moderna, and Vaxzevria by Oxford-AstraZeneca are approved and used widely. Similarly, numerous vaccines have been developed with different percentages of effectiveness against VOCs. New developments like nanotechnology and AI can be beneficial in providing an efficient and reliable solution for the suppression of SARS-CoV-2. Public health concerns can be efficiently treated by a unified scientific approach, public engagement, and better diagnosis.
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Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Navrangpura, Ahmedabad, 380009, Gujarat, India.
| | - Suneetha Vuppu
- Department of Biotechnology, Science, Innovation, and Society Research Lab 115, Hexagon (SMV), Vellore Institute of Technology, Vellore, 632014, Tamil Nadu, India.
| | - Toshika Mishra
- Department of Biotechnology, Science, Innovation, and Society Research Lab 115, Hexagon (SMV), Vellore Institute of Technology, Vellore, 632014, Tamil Nadu, India
| | - Sathvika Kamaraj
- Department of Biotechnology, Science, Innovation, and Society Research Lab 115, Hexagon (SMV), Vellore Institute of Technology, Vellore, 632014, Tamil Nadu, India
| | - Aayushi B Patel
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Navrangpura, Ahmedabad, 380009, Gujarat, India
| | - Nikita Sharma
- Department of Biotechnology, Science, Innovation, and Society Research Lab 115, Hexagon (SMV), Vellore Institute of Technology, Vellore, 632014, Tamil Nadu, India
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Science, College of Pharmacy and Health Sciences, St. John's University, New York, NY, 11439, USA.
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McTavish JR, Chandra PS, Stewart DE, Herrman H, MacMillan HL. Child Maltreatment and Intimate Partner Violence in Mental Health Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315672. [PMID: 36497747 PMCID: PMC9735990 DOI: 10.3390/ijerph192315672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/01/2023]
Abstract
Intimate partner violence (IPV) and child maltreatment (physical, emotional, sexual abuse, neglect, and children's exposure to IPV) are two of the most common types of family violence; they are associated with a broad range of health consequences. We summarize evidence addressing the need for safe and culturally-informed clinical responses to child maltreatment and IPV, focusing on mental health settings. This considers clinical features of child maltreatment and IPV; applications of rights-based and trauma- and violence-informed care; how to ask about potential experiences of violence; safe responses to disclosures; assessment and interventions that include referral networks and resources developed in partnership with multidisciplinary and community actors; and the need for policy and practice frameworks, appropriate training and continuing professional development provisions and resources for mental health providers. Principles for a common approach to recognizing and safely responding to child maltreatment and IPV are discussed, recognizing the needs in well-resourced and scarce resource settings, and for marginalized groups in any setting.
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Affiliation(s)
- Jill R. McTavish
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington St. North, Hamilton, ON L8L 8E7, Canada
| | - Prabha S. Chandra
- NIMHANS Hospital, Hosur Rd, near Bangalore Milk Dairy, Hombegowda Nagar, Bengaluru 560029, Karnataka, India
| | - Donna E. Stewart
- Centre for Mental Health, University Health Network, 200 Elizabeth St, 7EN229, Toronto, ON M5G 2C4, Canada
| | - Helen Herrman
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Orygen, Parkville, VIC 3052, Australia
| | - Harriet L. MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington St. North, Hamilton, ON L8L 8E7, Canada
- Department of Pediatrics, McMaster University, Health Sciences Centre 3A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
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Hamilton MA, Liu Y, Calzavara A, Sundaram ME, Djebli M, Darvin D, Baral S, Kustra R, Kwong JC, Mishra S. Predictors of all-cause mortality among patients hospitalized with influenza, respiratory syncytial virus, or SARS-CoV-2. Influenza Other Respir Viruses 2022; 16:1072-1081. [PMID: 35611399 PMCID: PMC9347457 DOI: 10.1111/irv.13004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Shared and divergent predictors of clinical severity across respiratory viruses may support clinical and community responses in the context of a novel respiratory pathogen. METHODS We conducted a retrospective cohort study to identify predictors of 30-day all-cause mortality following hospitalization with influenza (N = 45,749; 2010-09 to 2019-05), respiratory syncytial virus (RSV; N = 24 345; 2010-09 to 2019-04), or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; N = 8988; 2020-03 to 2020-12; pre-vaccine) using population-based health administrative data from Ontario, Canada. Multivariable modified Poisson regression was used to assess associations between potential predictors and mortality. We compared the direction, magnitude, and confidence intervals of risk ratios to identify shared and divergent predictors of mortality. RESULTS A total of 3186 (7.0%), 697 (2.9%), and 1880 (20.9%) patients died within 30 days of hospital admission with influenza, RSV, and SARS-CoV-2, respectively. Shared predictors of increased mortality included older age, male sex, residence in a long-term care home, and chronic kidney disease. Positive associations between age and mortality were largest for patients with SARS-CoV-2. Few comorbidities were associated with mortality among patients with SARS-CoV-2 as compared with those with influenza or RSV. CONCLUSIONS Our findings may help identify patients at greatest risk of illness secondary to a respiratory virus, anticipate hospital resource needs, and prioritize local prevention and therapeutic strategies to communities with higher prevalence of risk factors.
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Affiliation(s)
- Mackenzie A. Hamilton
- ICESTorontoOntarioCanada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
| | | | | | - Maria E. Sundaram
- ICESTorontoOntarioCanada
- Centre for Clinical Epidemiology and Population HealthMarshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | | | - Dariya Darvin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Stefan Baral
- Department of EpidemiologyJohn Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Rafal Kustra
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Jeffrey C. Kwong
- ICESTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Public Health OntarioTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
- University Health NetworkTorontoOntarioCanada
- Centre for Vaccine Preventable DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
- Department of Medicine, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Institute of Medical SciencesUniversity of TorontoTorontoOntarioCanada
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Frère J, Chatzis O, Cremer K, Merckx J, De Keukeleire M, Renard F, Ribesse N, Minner F, Ruelle J, Kabamba B, Rodriguez-Villalobos H, Bearzatto B, Delforge ML, Henin C, Bureau F, Gillet L, Robert A, Van der Linden D. SARS-CoV-2 Transmission in Belgian French-Speaking Primary Schools: An Epidemiological Pilot Study. Viruses 2022; 14:v14102199. [PMID: 36298754 PMCID: PMC9612207 DOI: 10.3390/v14102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
Schools have been a point of attention during the pandemic, and their closure one of the mitigating measures taken. A better understanding of the dynamics of the transmission of SARS-CoV-2 in elementary education is essential to advise decisionmakers. We conducted an uncontrolled non-interventional prospective study in Belgian French-speaking schools to describe the role of attending asymptomatic children and school staff in the spread of COVID-19 and to estimate the transmission to others. Each participant from selected schools was tested for SARS-CoV-2 using a polymerase chain reaction (PCR) analysis on saliva sample, on a weekly basis, during six consecutive visits. In accordance with recommendations in force at the time, symptomatic individuals were excluded from school, but per the study protocol, being that participants were blinded to PCR results, asymptomatic participants were maintained at school. Among 11 selected schools, 932 pupils and 242 school staff were included between January and May 2021. Overall, 6449 saliva samples were collected, of which 44 came back positive. Most positive samples came from isolated cases. We observed that asymptomatic positive children remaining at school did not lead to increasing numbers of cases or clusters. However, we conducted our study during a period of low prevalence in Belgium. It would be interesting to conduct the same analysis during a high prevalence period.
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Affiliation(s)
- Julie Frère
- Pediatric Infectious Diseases, Pediatric Department, CHU Liège, 4000 Liège, Belgium
| | - Olga Chatzis
- Pediatric Infectious Diseases, Specialized Pediatric Service, Pediatric Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Kelly Cremer
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, UCLouvain, 1200 Brussels, Belgium
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada
| | - Mathilde De Keukeleire
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, UCLouvain, 1200 Brussels, Belgium
| | - Florence Renard
- Office de la Naissance et de l’Enfance (ONE), 1060 Brussels, Belgium
| | - Nathalie Ribesse
- Office de la Naissance et de l’Enfance (ONE), 1060 Brussels, Belgium
| | - Frédéric Minner
- Immunology-Vaccinology Lab of the Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium
| | - Jean Ruelle
- Pôle de Microbiologie Médicale (MBLG), UCLouvain, 1200 Brussels, Belgium
- SmartGene Services, EPFL Innovation Park, 1015 Lausanne, Switzerland
| | - Benoit Kabamba
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, UCLouvain, 1200 Brussels, Belgium
- Pôle de Microbiologie Médicale (MBLG), UCLouvain, 1200 Brussels, Belgium
| | - Hector Rodriguez-Villalobos
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, UCLouvain, 1200 Brussels, Belgium
- Department of Microbiology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Bertrand Bearzatto
- Institut de Recherche Expérimentale et Clinique (IREC), Center for Applied Molecular Technologies (CTMA), UCLouvain, 1200 Brussels, Belgium
| | - Marie-Luce Delforge
- Institut de Biologie Clinique de l’Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Coralie Henin
- Federal Testing Platform for COVID-19, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Fabrice Bureau
- Immunology-Vaccinology Lab of the Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium
| | - Laurent Gillet
- Immunology-Vaccinology Lab of the Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium
| | - Annie Robert
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, UCLouvain, 1200 Brussels, Belgium
| | - Dimitri Van der Linden
- Pediatric Infectious Diseases, Specialized Pediatric Service, Pediatric Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
- Correspondence: ; Tel.: +00-32-2764-1714
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Ibarrondo O, Aguiar M, Stollenwerk N, Blasco-Aguado R, Larrañaga I, Bidaurrazaga J, Estadilla CDS, Mar J. Changes in Social and Clinical Determinants of COVID-19 Outcomes Achieved by the Vaccination Program: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12746. [PMID: 36232048 PMCID: PMC9566423 DOI: 10.3390/ijerph191912746] [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: 09/20/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The objective of this study was to assess changes in social and clinical determinants of COVID-19 outcomes associated with the first year of COVID-19 vaccination rollout in the Basque population. METHODS A retrospective study was performed using the complete database of the Basque Health Service (n = 2,343,858). We analyzed data on age, sex, socioeconomic status, the Charlson comorbidity index (CCI), hospitalization and intensive care unit (ICU) admission, and COVID-19 infection by Cox regression models and Kaplan-Meier curves. RESULTS Women had a higher hazard ratio (HR) of infection (1.1) and a much lower rate of hospitalization (0.7). With older age, the risk of infection fell, but the risks of hospitalization and ICU admission increased. The higher the CCI, the higher the risks of infection and hospitalization. The risk of infection was higher in high-income individuals in all periods (HR = 1.2-1.4) while their risk of hospitalization was lower in the post-vaccination period (HR = 0.451). CONCLUSION Despite the lifting of many control measures during the second half of 2021, restoring human mobility patterns, the situation could not be defined as syndemic, clinical determinants seeming to have more influence than social ones on COVID-19 outcomes, both before and after vaccination program implementation.
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Affiliation(s)
- Oliver Ibarrondo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, 20500 Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, 20014 Donostia-San Sebastián, Spain
| | - Maíra Aguiar
- Basque Center for Applied Mathematics, 48009 Bilbao, Spain
- Ikerbasque, Basque Foundation for Science, 48009 Bilbao, Spain
- Dipartimento di Matematica, Universita degli Studi di Trento, 38122 Trento, Italy
| | - Nico Stollenwerk
- Basque Center for Applied Mathematics, 48009 Bilbao, Spain
- Dipartimento di Matematica, Universita degli Studi di Trento, 38122 Trento, Italy
| | | | - Igor Larrañaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, 20500 Arrasate-Mondragón, Spain
- Kronikgune Institute for Health Services Research, 48902 Barakaldo, Spain
| | | | - Carlo Delfin S. Estadilla
- Basque Center for Applied Mathematics, 48009 Bilbao, Spain
- Public Health Department, University of the Basque Country, 48940 Leioa, Spain
| | - Javier Mar
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, 20500 Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, 20014 Donostia-San Sebastián, Spain
- Kronikgune Institute for Health Services Research, 48902 Barakaldo, Spain
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Arias-Uriona AM, Pérez E, Llanos J, Cuellar R, Galarza PY. [Social determinants associated with self-reporting of symptoms and access to COVID-19 testing and diagnosis in the Plurinational State of BoliviaDeterminantes sociais associados ao autorrelato de sintomas, acesso a testagem e diagnóstico de COVID-19 no Estado Plurinacional da Bolívia]. Rev Panam Salud Publica 2022; 46:e114. [PMID: 36177303 PMCID: PMC9512684 DOI: 10.26633/rpsp.2022.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To identify the prevalence of self-reporting of symptoms and access to testing and diagnosis of coronavirus-19 disease (COVID-19), as well as its association with social determinants of health (SDH). Methods Cross-sectional study with a sample of 11 728 men and 12 612 women over the age of 17, based on the National Household Survey 2020. The dependent variables were the self-reporting of symptoms, access to testing, and a positive COVID-19 test. The independent variables were age, educational level, area of residence and geographic area, ethnicity, type of household, income per capita, occupation, and health insurance. Prevalences, bivariate associations, and binomial logistical regression models (odds ratio (OR), and 95% confidence interval (CI95%) were calculated. Results Of the total individuals included, 16% reported symptoms, 10% a test, and 4.2% a positive COVID-19 test. Inequalities were observed in the reporting of COVID-19 symptoms, with a higher probability in women whose income had fallen (OR: 1.7; CI95%: 1.2-2.4) and unemployed persons (OR: 1.2; CI95%: 1.1-1.4 for men and OR: 1.3; CI95%: 1.5-1.5 for women). In contrast, with respect to access to diagnostic tests, the highest probability was observed in people with higher education (OR: 2.4; CI95%: 1.9-2.9 for men and OR: 2.7; CI95%: 2.2-3.4 for women), whose income was maintained (OR: 1.5; CI95%: 1.3-1.9 for men and OR: 1.7; CI95%: 1.4-2.0 for women) and those in the highest quartile of per capita household income (OR: 2.0; CI95%: 1.6-2.5 for men and OR: 1.6; CI95%: 1.3-2.0 for women). The probability of reporting symptoms and getting tested, and being diagnosed with COVID-19 increased with age for people with health insurance and those living in the llanos region; however, it decreased for residents of rural areas. Conclusions There are inequalities in access to testing and the reporting of COVID-19 symptoms.
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Affiliation(s)
- Ana M. Arias-Uriona
- Instituto de Investigaciones en Ciencias del Comportamiento (IICC)Universidad Católica Boliviana San PabloLa PazEstado Plurinacional de BoliviaInstituto de Investigaciones en Ciencias del Comportamiento (IICC), Universidad Católica Boliviana San Pablo, La Paz, Estado Plurinacional de Bolivia.
| | - Esdenka Pérez
- Universidad Católica Boliviana San PabloLa PazEstado Plurinacional de BoliviaUniversidad Católica Boliviana San Pablo, La Paz, Estado Plurinacional de Bolivia
| | - Javier Llanos
- Universidad Católica Boliviana San PabloLa PazEstado Plurinacional de BoliviaUniversidad Católica Boliviana San Pablo, La Paz, Estado Plurinacional de Bolivia
| | - Rafael Cuellar
- Universidad Católica Boliviana San PabloLa PazEstado Plurinacional de BoliviaUniversidad Católica Boliviana San Pablo, La Paz, Estado Plurinacional de Bolivia
| | - Pamela Y. Galarza
- Universidad Católica Boliviana San PabloLa PazEstado Plurinacional de BoliviaUniversidad Católica Boliviana San Pablo, La Paz, Estado Plurinacional de Bolivia
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Bartolomeo N, Giotta M, Tafuri S, Trerotoli P. Impact of Socioeconomic Deprivation on the Local Spread of COVID-19 Cases Mediated by the Effect of Seasons and Restrictive Public Health Measures: A Retrospective Observational Study in Apulia Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811410. [PMID: 36141682 PMCID: PMC9517341 DOI: 10.3390/ijerph191811410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 05/22/2023]
Abstract
The aim of this study was to investigate the spatiotemporal association between socioeconomic deprivation and the incidence of COVID-19 and how this association changes through the seasons due to the existence of restrictive public health measures. A retrospective observational study was conducted among COVID-19 cases that occurred in the Apulia region from 29 February 2020 to 31 December 2021, dividing the period into four phases with different levels of restrictions. A generalized estimating equation (GEE) model was applied to test the independent effect of deprivation on the incidence of COVID-19, taking into account age, sex, and regional incidence as possible confounding effects and covariates, such as season and levels of restrictions, as possible modifying effects. The highest incidence was in areas with a very high deprivation index (DI) in winter. During total lockdown, no rate ratio between areas with different levels of DI was significant, while during soft lockdown, areas with very high DI were more at risk than all other areas. The effects of social inequalities on the incidence of COVID-19 changed in association with the seasons and restrictions on public health. Disadvantaged areas showed a higher incidence of COVID-19 in the cold seasons and in the phases of soft lockdown.
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Stephen AH, Andrea SB, Banerjee D, Arafeh M, Askew M, Lueckel SN, Kheirbek T, Mermel LA, Adams CA, Levy MM, Heffernan DS. The association between household and neighborhood characteristics and COVID-19 related ICU admissions. SSM Popul Health 2022; 19:101133. [PMID: 35756546 PMCID: PMC9212995 DOI: 10.1016/j.ssmph.2022.101133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 10/26/2022] Open
Abstract
Introduction Approaches to COVID-19 mitigation can be more efficiently delivered with a more detailed understanding of where the severe cases occur. Our objective was to assess which demographic, housing and neighborhood characteristics were independently and collectively associated with differing rates of severe COVID-19. Methods A cohort of patients with SARS-CoV-2 in a single health system from March 1, 2020 to February 15, 2021 was reviewed to determine whether demographic, housing, or neighborhood characteristics are associated with higher rates of severe COVID-19 infections and to create a novel scoring index. Characteristics included proportion of multifamily homes, essential workers, and ages of the homes within neighborhoods. Results There were 735 COVID-19 ICU admissions in the study interval which accounted for 61 percent of the state's ICU admissions for COVID-19. Compared to the general population of the state those admitted to the ICU with COVID-19 were disproportionately older, male sex, and were more often Black, Indigenous, People of Color. Patients disproportionately resided in neighborhoods with three plus unit multifamily homes, homes built before 1940, homes with more than one person to a room, homes of lower average value, and in neighborhoods with a greater proportion of essential workers. From this our COVID-19 Neighborhood Index value was comparatively higher for the ICU patients (61.1) relative to the population of Rhode Island (49.4). Conclusion COVID-19-related ICU admissions are highly related to demographic, housing and neighborhood-level factors. This may guide more nuanced and targeted vaccine distribution plans and public health measures for future pandemics.
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Affiliation(s)
- Andrew H Stephen
- Alpert Medical School at Brown University, Division of Trauma and Surgical Critical Care, Department of Surgery, Providence, RI, USA
| | - Sarah B Andrea
- Lifespan Biostatistics Epidemiology & Research Design Core, Rhode Island Hospital, Providence, RI, USA.,OHSU-PSU School of Public Health, Portland, OR, USA
| | - Debasree Banerjee
- Alpert Medical School at Brown University, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Providence, RI, USA
| | - Mohammed Arafeh
- Alpert Medical School at Brown University, Division of Trauma and Surgical Critical Care, Department of Surgery, Providence, RI, USA
| | - Morgan Askew
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Stephanie N Lueckel
- Alpert Medical School at Brown University, Division of Trauma and Surgical Critical Care, Department of Surgery, Providence, RI, USA
| | - Tareq Kheirbek
- Alpert Medical School at Brown University, Division of Trauma and Surgical Critical Care, Department of Surgery, Providence, RI, USA
| | - Leonard A Mermel
- Alpert Medical School at Brown University, Division of Infectious Disease, Department of Medicine, Providence, RI, USA
| | - Charles A Adams
- Alpert Medical School at Brown University, Division of Trauma and Surgical Critical Care, Department of Surgery, Providence, RI, USA
| | - Mitchell M Levy
- Alpert Medical School at Brown University, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Providence, RI, USA
| | - Daithi S Heffernan
- Alpert Medical School at Brown University, Division of Trauma and Surgical Critical Care, Department of Surgery, Providence, RI, USA
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46
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Oppenheimer-Lewin D, Ortega-Palavecinos M, Núñez-Cortés R. [Resilience in older people during the first wave of the COVID-19 pandemic in Chile: Perspective from the social determinants of health]. Rev Esp Geriatr Gerontol 2022; 57:264-268. [PMID: 36109252 PMCID: PMC9399176 DOI: 10.1016/j.regg.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the association between social determinants of health (SDH) and resilience in older people during the first period of confinement in the COVID-19 pandemic in Chile. MATERIALS AND METHODS An observational study with a cross-sectional design was conducted using a nationally representative survey data-set. In this survey, using a systematic randomization process, a subsample of people aged ≥60 years from the community were interviewed by telephone during the first wave of the COVID-19 pandemic in Chile. Resilience was assessed using the Brief Resilient Coping Scale (BRCS) and depressive symptoms using the Patient Health Questionnaire (PHQ-9) scale. The SDH considered were: age, sex, educational level, employment status, social isolation, loneliness, discontent with housing and health care needs. RESULTS A total sample of 582 persons was obtained. The mean age was 71 years (SD: 7.64; 69% women). A significant association was obtained between low resilience and the following conditions: loneliness (OR: 1.776 [95% CI: 1.146-2.751]), high risk of social isolation (OR: 1.667 [95% CI: 1.149-2.419]), and depressive symptoms (OR: 2.602 [95% CI: 1.795-3.774]). Female gender was a protective factor (OR: 0.589 [95% CI: 0.406-0.855]). CONCLUSION The SDH, such as loneliness and social isolation, are factors associated with low resilience in older people during the COVID-19 pandemic and may be taken into account in planning public health intervention strategies.
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Affiliation(s)
| | - Maritza Ortega-Palavecinos
- Unidad de Atención Integral al Usuario de Urgencias y Trabajo Social, Hospital Dra. Eloísa Díaz Insunza, La Florida, Región Metropolitana, Chile
| | - Rodrigo Núñez-Cortés
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Shifa M, Gordon D, Leibbrandt M, Zhang M. Socioeconomic-Related Inequalities in COVID-19 Vulnerability in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10480. [PMID: 36078194 PMCID: PMC9518327 DOI: 10.3390/ijerph191710480] [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: 06/13/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Individuals' vulnerability to the risk of COVID-19 infection varies due to their health, socioeconomic, and living circumstances, which also affect the effectiveness of implementing non-pharmacological interventions (NPIs). In this study, we analysed socioeconomic-related inequalities in COVID-19 vulnerability using data from the nationally representative South African General Household Survey 2019. We developed a COVID-19 vulnerability index, which includes health and social risk factors for COVID-19 exposure and susceptibility. The concentration curve and concentration index were used to measure socioeconomic-related inequalities in COVID-19 vulnerability. Recentred influence function regression was then utilised to decompose factors that explain the socioeconomic-related inequalities in COVID-19 vulnerability. The concentration index estimates were all negative and highly significant (p < 0.01), indicating that vulnerability to COVID-19 was more concentrated among the poor. According to the decomposition analysis, higher income and education significantly (p < 0.01) positively impacted lowering socioeconomic-related COVID-19 vulnerability. Living in an urban region, being Black, and old all had significant (p < 0.01) positive impacts on increasing socioeconomic-related COVID-19 vulnerability. Our findings contribute to a better understanding of socially defined COVID-19-vulnerable populations in South Africa and the implications for future pandemic preparedness plans.
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Affiliation(s)
- Muna Shifa
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7700, South Africa
| | - David Gordon
- School for Policy Studies, University of Bristol, Bristol BS8 1TH, UK
| | - Murray Leibbrandt
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7700, South Africa
| | - Mary Zhang
- Oxford School of Global and Area Studies, University of Oxford, Oxford OX2 6LH, UK
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Lambert B, Stopard IJ, Momeni-Boroujeni A, Mendoza R, Zuretti A. Using patient biomarker time series to determine mortality risk in hospitalised COVID-19 patients: A comparative analysis across two New York hospitals. PLoS One 2022; 17:e0272442. [PMID: 35981055 PMCID: PMC9387798 DOI: 10.1371/journal.pone.0272442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/19/2022] [Indexed: 01/08/2023] Open
Abstract
A large range of prognostic models for determining the risk of COVID-19 patient mortality exist, but these typically restrict the set of biomarkers considered to measurements available at patient admission. Additionally, many of these models are trained and tested on patient cohorts from a single hospital, raising questions about the generalisability of results. We used a Bayesian Markov model to analyse time series data of biomarker measurements taken throughout the duration of a COVID-19 patient's hospitalisation for n = 1540 patients from two hospitals in New York: State University of New York (SUNY) Downstate Health Sciences University and Maimonides Medical Center. Our main focus was to quantify the mortality risk associated with both static (e.g. demographic and patient history variables) and dynamic factors (e.g. changes in biomarkers) throughout hospitalisation, by so doing, to explain the observed patterns of mortality. By using our model to make predictions across the hospitals, we assessed how predictive factors generalised between the two cohorts. The individual dynamics of the measurements and their associated mortality risk were remarkably consistent across the hospitals. The model accuracy in predicting patient outcome (death or discharge) was 72.3% (predicting SUNY; posterior median accuracy) and 71.3% (predicting Maimonides) respectively. Model sensitivity was higher for detecting patients who would go on to be discharged (78.7%) versus those who died (61.8%). Our results indicate the utility of including dynamic clinical measurements when assessing patient mortality risk but also highlight the difficulty of identifying high risk patients.
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Affiliation(s)
- Ben Lambert
- Department of Computer Science, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - Isaac J. Stopard
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amir Momeni-Boroujeni
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Rachelle Mendoza
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Alejandro Zuretti
- Department of Pathology, SUNY Downstate Health Sciences University and Maimonides Medical Center, Brooklyn, NY, United States of America
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49
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Méndez-Lizárraga CA, Castañeda-Cediel ML, Delgado-Sánchez G, Ferreira-Guerrero EE, Ferreyra-Reyes L, Canizales-Quintero S, Mongua-Rodríguez N, Tellez-Vázquez N, Jiménez-Corona ME, Bradford Vosburg K, Bello-Chavolla OY, García-García L. Evaluating the impact of mobility in COVID-19 incidence and mortality: A case study from four states of Mexico. Front Public Health 2022; 10:877800. [PMID: 35991046 PMCID: PMC9387383 DOI: 10.3389/fpubh.2022.877800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The COVID-19 pandemic in Mexico began at the end of February 2020. An essential component of control strategies was to reduce mobility. We aimed to evaluate the impact of mobility on COVID- incidence and mortality rates during the initial months of the pandemic in selected states. Methods COVID-19 incidence data were obtained from the Open Data Epidemiology Resource provided by the Mexican government. Mobility data was obtained from the Observatory for COVID-19 in the Americas of the University of Miami. We selected four states according to their compliance with non-pharmaceutical interventions and mobility index. We constructed time series and analyzed change-points for mobility, incidence, and mortality rates. We correlated mobility with incidence and mortality rates for each time interval. Using mixed-effects Poisson models, we evaluated the impact of reductions in mobility on incidence and mortality rates, adjusting all models for medical services and the percentage of the population living in poverty. Results After the initial decline in mobility experienced in early April, a sustained increase in mobility followed during the rest of the country-wide suspension of non-essential activities and the return to other activities throughout mid-April and May. We identified that a 1% increase in mobility yielded a 5.2 and a 2.9% increase in the risk of COVID-19 incidence and mortality, respectively. Mobility was estimated to contribute 8.5 and 3.8% to the variability in incidence and mortality, respectively. In fully adjusted models, the contribution of mobility to positive COVID-19 incidence and mortality was sustained. When assessing the impact of mobility in each state compared to the state of Baja California, increased mobility conferred an increased risk of incident positive COVID-19 cases in Mexico City, Jalisco, and Nuevo León. However, for COVID-19 mortality, a differential impact of mobility was only observed with Jalisco and Nuevo León compared to Baja California. Conclusion Mobility had heterogeneous impacts on COVID-19 rates in different regions of Mexico, indicating that sociodemographic characteristics and regional-level pandemic dynamics modified the impact of reductions in mobility during the COVID-19 pandemic. The implementation of non-pharmaceutical interventions should be regionalized based on local epidemiology for timely response against future pandemics.
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Affiliation(s)
| | - MLucía Castañeda-Cediel
- Posgrado en Geografía, Facultad de Filosofía y Letras, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Leticia Ferreyra-Reyes
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Sergio Canizales-Quintero
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Norma Mongua-Rodríguez
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Norma Tellez-Vázquez
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Kathryn Bradford Vosburg
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | | | - Lourdes García-García
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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50
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Pala D, Parimbelli E, Larizza C, Cheng C, Ottaviano M, Pogliaghi A, Đukić G, Jovanović A, Milićević O, Urošević V, Cerchiello P, Giudici P, Bellazzi R. A New Interactive Tool to Visualize and Analyze COVID-19 Data: The PERISCOPE Atlas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9136. [PMID: 35897503 PMCID: PMC9330557 DOI: 10.3390/ijerph19159136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/04/2022] [Accepted: 07/20/2022] [Indexed: 12/27/2022]
Abstract
Since the start of the 21st century, the world has not confronted a more serious threat to global public health than the COVID-19 pandemic. While governments initially took radical actions in response to the pandemic to avoid catastrophic collapse of their health care systems, government policies have also had numerous knock-on socioeconomic, political, behavioral and economic effects. Researchers, thus, have a unique opportunity to forward our collective understanding of the modern world and to respond to the emergency situation in a way that optimizes resources and maximizes results. The PERISCOPE project, funded by the European Commission, brings together a large number of research institutions to collect data and carry out research to understand all the impacts of the pandemic, and create predictive models that can be used to optimize intervention strategies and better face possible future health emergencies. One of the main tangible outcomes of this project is the PERISCOPE Atlas: an interactive tool that allows to visualize and analyze COVID-19-related health, economic and sociopolitical data, featuring a WebGIS and several dashboards. This paper describes the first release of the Atlas, listing the data sources used, the main functionalities and the future development.
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Affiliation(s)
- Daniele Pala
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy; (E.P.); (C.L.); (R.B.)
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Enea Parimbelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy; (E.P.); (C.L.); (R.B.)
- Telfer School of Management, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Cristiana Larizza
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy; (E.P.); (C.L.); (R.B.)
| | - Cindy Cheng
- Hochschule für Politik, The TUM School of Governance, Technical University of Munich (TUM), 80333 Munich, Germany;
| | - Manuel Ottaviano
- Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, 28040 Madrid, Spain;
| | | | - Goran Đukić
- Research & Development Department Belit Ltd., Trg Nikole Pašića 9, 11000 Belgrade, Serbia; (G.Đ.); (A.J.); (O.M.); (V.U.)
| | - Aleksandar Jovanović
- Research & Development Department Belit Ltd., Trg Nikole Pašića 9, 11000 Belgrade, Serbia; (G.Đ.); (A.J.); (O.M.); (V.U.)
| | - Ognjen Milićević
- Research & Development Department Belit Ltd., Trg Nikole Pašića 9, 11000 Belgrade, Serbia; (G.Đ.); (A.J.); (O.M.); (V.U.)
| | - Vladimir Urošević
- Research & Development Department Belit Ltd., Trg Nikole Pašića 9, 11000 Belgrade, Serbia; (G.Đ.); (A.J.); (O.M.); (V.U.)
| | - Paola Cerchiello
- Dipartimento di Scienze Economiche e Aziendali, University of Pavia, 27100 Pavia, Italy; (P.C.); (P.G.)
| | - Paolo Giudici
- Dipartimento di Scienze Economiche e Aziendali, University of Pavia, 27100 Pavia, Italy; (P.C.); (P.G.)
| | - Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy; (E.P.); (C.L.); (R.B.)
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