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Olivella-Cirici M, Perez G, Rodriguez-Sanz M, Forcadell-Díez L, Montemayor Cejas P, Pasarin M. Socioeconomic inequalities in the incidence of COVID-19 in Barcelona students. PUBLIC HEALTH IN PRACTICE 2024; 8:100527. [PMID: 39035750 PMCID: PMC11259917 DOI: 10.1016/j.puhip.2024.100527] [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: 02/19/2024] [Revised: 05/03/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Objective This study aimed to assess socioeconomic inequalities in schools regarding the COVID-19 incidence during different epidemic waves among Barcelona students, differentiating by sex and educational stage. Study design Cross-sectional ecological study. Methods We included in the study all students from childhood to secondary education in Barcelona city. The unit of analysis was the schools. The study covered the epidemic waves coinciding with the 2020-21 and 2021-22 school courses. The cumulative incidence (CI) per school and wave was calculated. Bivariate and multivariate analyses using Poisson regression were conducted to estimate relative risks. The population attributable risk, by sex and educational stage, was calculated as a measure of impact. Results In the second wave, higher CI in students was associated with greater school socioeconomic deprivation in all groups. In the younger girls, 24.5 % (5.2-41.4) of the CI was attributed to school socioeconomic vulnerability, increasing to 33.1 % (15.1-47.2) in older girls. During the sixth wave, the impact was lower in the most vulnerable schools in all strata. Conclusions Socioeconomic factors significantly impacted the incidence of COVID-19 in schools, reflecting social inequalities in Barcelona. There was an inversion of the pattern of inequalities in the sixth wave compared to the previous ones. The results emphasize the need for urgent action and targeted resources to address health inequalities in education and understand the impact of epidemic dynamics on socioeconomic context.
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Affiliation(s)
- M. Olivella-Cirici
- Agència de Salut Pública de Barcelona, Barcelona, 08023, Spain
- Medicine and Life Sciences Department (MELIS), Universitat Pompeu Fabra, Barcelona, 08003, Spain
| | - G. Perez
- Agència de Salut Pública de Barcelona, Barcelona, 08023, Spain
- Medicine and Life Sciences Department (MELIS), Universitat Pompeu Fabra, Barcelona, 08003, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain
- Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, 08041, Spain
| | - M. Rodriguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, 08023, Spain
- Medicine and Life Sciences Department (MELIS), Universitat Pompeu Fabra, Barcelona, 08003, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain
- Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, 08041, Spain
| | - Ll Forcadell-Díez
- Agència de Salut Pública de Barcelona, Barcelona, 08023, Spain
- Medicine and Life Sciences Department (MELIS), Universitat Pompeu Fabra, Barcelona, 08003, Spain
| | - P. Montemayor Cejas
- Unitat de Sistemes d’Informació i Disseny de Processos, Consorci d’Educació de Barcelona (CEB), Barcelona, 08010, Spain
- Department of Applied Economics, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, 08193, Spain
| | - M.I. Pasarin
- Agència de Salut Pública de Barcelona, Barcelona, 08023, Spain
- Medicine and Life Sciences Department (MELIS), Universitat Pompeu Fabra, Barcelona, 08003, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain
- Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, 08041, Spain
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Jain SS, Anderson SA, Steele JM, Wilson HC, Muniz JC, Soslow JH, Beroukhim RS, Maksymiuk V, Jacquemyn X, Frosch OH, Fonseca B, Harahsheh AS, Buddhe S, Ashwath RC, Thacker D, Maskatia SA, Misra N, Su JA, Siddiqui S, Vaiyani D, Vaikom-House AK, Campbell MJ, Klein J, Huang S, Mathis C, Cornicelli MD, Sharma M, Nagaraju L, Ang JY, Uppu SC, Ramachandran P, Patel JK, Han F, Mandell JG, Akam-Venkata J, DiLorenzo MP, Brumund M, Bhatla P, Eshtehardi P, Mehta K, Glover K, Dove ML, Aldawsari KA, Kumar A, Barfuss SB, Dorfman AL, Minocha PK, Yonts AB, Schauer J, Cheng AL, Robinson JD, Powell Z, Srivastava S, Chelliah A, Sanil Y, Hernandez LE, Gaur L, Antonchak M, Johnston M, Reich JD, Nair N, Drugge ED, Grosse-Wortmann L. Cardiac manifestations and outcomes of COVID-19 vaccine-associated myocarditis in the young in the USA: longitudinal results from the Myocarditis After COVID Vaccination (MACiV) multicenter study. EClinicalMedicine 2024; 76:102809. [PMID: 39290640 PMCID: PMC11406334 DOI: 10.1016/j.eclinm.2024.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024] Open
Abstract
Background We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). Methods In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The primary outcome was presence of myocardial injury as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Findings Patients with C-VAM were predominantly white (67%) adolescent males (91%, 15.7 ± 2.8 years). Their initial clinical course was more likely to be mild (80% vs. 23%, p < 0.001) and cardiac dysfunction was less common (17% vs. 68%, p < 0.0001), compared to MIS-C. In contrast, LGE on CMR was more prevalent in C-VAM (82% vs. 16%, p < 0.001). The probability of LGE was higher in males (OR 3.28 [95% CI: 0.99, 10.6, p = 0.052]), in older patients (>15 years, OR 2.74 [95% CI: 1.28, 5.83, p = 0.009]) and when C-VAM occurred after the first or second dose as compared to the third dose of mRNA vaccine. Mid-term clinical outcomes of C-VAM at a median follow-up of 178 days (IQR 114-285 days) were reassuring. No cardiac deaths or heart transplantations were reported until the time of submission of this report. LGE persisted in 60% of the patients at follow up. Interpretation Myocardial injury at initial presentation and its persistence at follow up, despite a mild initial course and favorable mid-term clinical outcome, warrants continued clinical surveillance and long-term studies in affected patients with C-VAM. Funding The U.S. Food and Drug Administration.
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Affiliation(s)
- Supriya S Jain
- Department of Pediatrics, Division of Cardiology, New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | | | | | - Hunter C Wilson
- Emory University School of Medicine, Sibley Heart Center, Atlanta, GA, USA
| | | | | | | | - Victoria Maksymiuk
- Department of Pediatrics, Division of Cardiology, New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Xander Jacquemyn
- Department of Pediatrics, Johns Hopkins School of Medicine, Helen B. Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Olivia H Frosch
- University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | - Ashraf S Harahsheh
- Children's National Hospital and the George Washington University School of Medicine & Health Sciences, WA, USA
| | | | - Ravi C Ashwath
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Deepika Thacker
- Nemours Children's Health/Nemours Cardiac Center, Wilmington, DE, USA
| | | | - Nilanjana Misra
- Cohen Children's Medical Center, Northwell Health, New York, USA
| | - Jennifer A Su
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | - Danish Vaiyani
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - M Jay Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University, Durham, NC, USA
| | - Jared Klein
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Sihong Huang
- Betz Congenital Health Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | | | | | - Madhu Sharma
- The Children's Hospital at Montefiore Bronx, New York, USA
| | | | | | - Santosh C Uppu
- The University of Texas Health Science Center, Children's Heart Institute, Houston, TX, USA
| | | | | | - Frank Han
- University of Illinois College of Medicine, Peoria, IL, USA
| | - Jason G Mandell
- University of Rochester-Golisano Children's Hospital, Rochester, NY, USA
| | | | | | - Michael Brumund
- Louisiana State University Health Sciences Center, Children's Hospital New Orleans, New Orleans, LA, USA
| | - Puneet Bhatla
- NYU Langone Health, Hassenfeld Children's Hospital, New York, NY, USA
| | | | - Karina Mehta
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University-Doernbecher Children's Hospital, Portland, OR, USA
| | | | - Matthew L Dove
- Emory University School of Medicine, Sibley Heart Center, Atlanta, GA, USA
| | | | - Anupam Kumar
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Spencer B Barfuss
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Adam L Dorfman
- University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | - Alexandra B Yonts
- Children's National Hospital and the George Washington University School of Medicine & Health Sciences, WA, USA
| | | | - Andrew L Cheng
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Joshua D Robinson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Zachary Powell
- The University of Oklahoma Health Science Oklahoma City, Oklahoma, USA
| | | | | | - Yamuna Sanil
- Riley Hospital for Children, Indianapolis, IN, USA
| | | | - Lasya Gaur
- Department of Pediatrics, Johns Hopkins School of Medicine, Helen B. Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Antonchak
- NYU Langone Health, Hassenfeld Children's Hospital, New York, NY, USA
| | - Marla Johnston
- Louisiana State University Health Sciences Center, Children's Hospital New Orleans, New Orleans, LA, USA
| | | | - Narayan Nair
- The U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Elizabeth D Drugge
- Department of Pediatrics, Division of Cardiology, New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University-Doernbecher Children's Hospital, Portland, OR, USA
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Wang-Erickson AF, Zhang X, Dauer K, Zerr DM, Adler A, Englund JA, Lee B, Schuster JE, Selvarangan R, Rohlfs C, Staat MA, Sahni LC, Boom JA, Balasubramani GK, Williams JV, Michaels MG. Prevalence of SARS-CoV-2 in Children Identified by Preprocedural Testing at 5 US Children's Hospital Systems. Pediatr Infect Dis J 2024:00006454-990000000-01018. [PMID: 39298522 DOI: 10.1097/inf.0000000000004547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
BACKGROUND The burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic children was initially presumed to be high, which influenced hospital, school and childcare policies. Before vaccines were widely available, some hospitals implemented universal preprocedural SARS-CoV-2 polymerase chain reaction testing on asymptomatic patients. Understanding SARS-CoV-2 prevalence in asymptomatic children is needed to illuminate the diversity of viral characteristics and inform policies implemented during future pandemics. METHODS Data were extracted from patient records of outpatient children who were preprocedurally tested for SARS-CoV-2 from 5 US hospital systems between March 1, 2020, and February 28, 2021. Prevalence was determined from positive test results. Adjusted odds ratios (AORs) were calculated using mixed logistic regression with the site as a random effect. RESULTS This study analyzed 93,760 preprocedural SARS-CoV-2 test results from 74,382 patients and found 2693 infections (3.6%) from 2889 positive tests (3.1%). Site-specific prevalence varied across sites. Factors modestly associated with infection included being uninsured [AOR, 1.76 (95% confidence interval [CI], 1.45-2.13)], publicly insured [AOR, 1.17 (95% CI, 1.05-1.30)], Hispanic [AOR, 1.78 (95% CI, 1.59-1.99)], Black [AOR, 1.22 (95% CI, 1.06-1.39)], elementary school age [5-11 years; AOR, 1.15 (95% CI, 1.03-1.28)], or adolescent [12-17 years; AOR, 1.26 (95% CI, 1.13-1.41)]. CONCLUSIONS SARS-CoV-2 prevalence was low in outpatient children undergoing preprocedural testing, a population that was predominantly asymptomatic at the time of testing. This study contributes evidence that suggests that undetected infection in children likely did not play a predominant role in SARS-CoV-2 transmission during the early prevaccine pandemic period when the general population was naive to the virus.
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Affiliation(s)
- Anna F Wang-Erickson
- From the Department of Pediatrics, Division of Infectious Diseases, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Institute for Infection, Inflammation, and Immunity in Children (i4Kids), Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Xueyan Zhang
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Klancie Dauer
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Danielle M Zerr
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Amanda Adler
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Janet A Englund
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA
| | | | | | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Chelsea Rohlfs
- Department of Pediatrics, Division of Infectious Diseases, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mary A Staat
- Department of Pediatrics, Division of Infectious Diseases, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Leila C Sahni
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Julie A Boom
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - G K Balasubramani
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - John V Williams
- From the Department of Pediatrics, Division of Infectious Diseases, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Institute for Infection, Inflammation, and Immunity in Children (i4Kids), Pittsburgh, PA
| | - Marian G Michaels
- From the Department of Pediatrics, Division of Infectious Diseases, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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Bergus KC, Lutz C, Cooper J, Asti L, Gil L, Criss C, Deans KJ, Minneci PC. Heterogeneity of Treatment Effects of Laser Epilation on Pilonidal Disease Recurrence: A Randomized Clinical Trial. ANNALS OF SURGERY OPEN 2024; 5:e488. [PMID: 39310334 PMCID: PMC11415133 DOI: 10.1097/as9.0000000000000488] [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: 07/10/2024] [Accepted: 08/07/2024] [Indexed: 09/25/2024] Open
Abstract
Objective To investigate the heterogeneity of treatment effects (HTE) of laser epilation in preventing pilonidal disease recurrence through analysis of prespecified clinical factors. Background Pilonidal disease is a common, painful disease affecting 1% of the population aged 15 to 30 years with postoperative recurrence rates as high as 30% to 40%. Methods Single-institution randomized controlled trial from September 2017 to September 2022 with 1-year follow-up, including patients aged 11 to 21 years with pilonidal disease undergoing gluteal cleft laser epilation and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone. Results In total, 302 patients were enrolled with 151 randomized to each intervention. 1-year follow-up was available for 96 patients in the laser group and 134 in the standard care group. There were no significant differences in treatment effects based on sex, body mass index, previous disease, prior surgical excision, or annual household income (all P > 0.05). HTE was identified by race and ethnicity (P = 0.005) and health insurance type (P = 0.001). Recurrence among non-Hispanic white patients was 4% (3/75) with laser treatment and 31.6% (31/98) with standard care versus 38.9% (7/18) with laser treatment and 38.2% (13/34) with standard care among all other racial/ethnic groups. Recurrence rates among privately insured patients were 4.0% (3/75) with laser treatment and 33.3% (29/87) with standard care versus 36.8% (7/19) with laser treatment and 29.7% (11/37) with standard care in patients with public insurance. Conclusions The effectiveness of laser epilation to reduce pilonidal disease recurrence rates may vary based on race and ethnicity and insurance type. Additional studies are warranted to investigate this potential HTE.
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Affiliation(s)
- Katherine C. Bergus
- From the Department of Pediatric Surgery, Nationwide Children’s Hospital, Center for Surgical Outcomes Research, Columbus, OH
| | - Carley Lutz
- From the Department of Pediatric Surgery, Nationwide Children’s Hospital, Center for Surgical Outcomes Research, Columbus, OH
| | - Jennifer Cooper
- From the Department of Pediatric Surgery, Nationwide Children’s Hospital, Center for Surgical Outcomes Research, Columbus, OH
| | - Lindsey Asti
- Department of Surgery, Nemours Surgical Outcomes Center, Nemours Children’s Health, Delaware Valley, Wilmington, DE
| | - Lindsay Gil
- From the Department of Pediatric Surgery, Nationwide Children’s Hospital, Center for Surgical Outcomes Research, Columbus, OH
| | - Cory Criss
- From the Department of Pediatric Surgery, Nationwide Children’s Hospital, Center for Surgical Outcomes Research, Columbus, OH
| | - Katherine J. Deans
- Department of Surgery, Nemours Surgical Outcomes Center, Nemours Children’s Health, Delaware Valley, Wilmington, DE
| | - Peter C. Minneci
- Department of Surgery, Nemours Surgical Outcomes Center, Nemours Children’s Health, Delaware Valley, Wilmington, DE
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Sumner M, Tarr GAM, Xie J, Mater A, Winston K, Gravel J, Poonai N, Burstein B, Berthelot S, Zemek R, Porter R, Wright B, Kam A, Emsley J, Sabhaney V, Beer D, Freire G, Moffatt A, Freedman SB. Social Behaviors Associated with SARS-CoV-2 Test Positivity Among Children Evaluated in Canadian Emergency Departments, 2020 to 2022: A Cross-Sectional Survey Study. Acad Pediatr 2024:S1876-2859(24)00333-4. [PMID: 39216802 DOI: 10.1016/j.acap.2024.08.016] [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] [Received: 03/11/2024] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To evaluate how social behaviors relate to SARS-CoV-2 test positivity across pediatric age groups. METHODS Multicenter, cross-sectional study recruiting children <18 years old tested for SARS-CoV-2 infection in emergency departments between 2020 and 2022. We used multivariate logistic regression to assess how self-reported social behaviors affect SARS-CoV-2 test positivity across four age groups. Causal mediation analysis quantified how mask-wearing and presence of an infected close contact mediated the SARS-CoV-2 risk of given behaviors. RESULTS Seven thousand two hundred and seventy two children were enrolled and 1457 (20.0%) tested positive for SARS-CoV-2. Attending a social gathering was associated with increased odds (aOR 1.64, 95% CI: 1.05, 2.57) of SARS-CoV-2 positivity among children aged 5-<12 years. Those attending in-person school/daycare were less likely to test positive for SARS-CoV-2 across all age categories. Attending childcare was associated with 16.3% (95% CI: -21.0%, -11.2%) and 9.0% (95% CI: -11.6%, -6.5%) reductions in the probability of testing positive for SARS-CoV-2 infection, with 53.5% (95% CI: 39.2%, 73.9%) and 22.8% (95% CI: 9.7%, 36.2%) of the effects being mediated by the presence of a close contact among <1 year and 1-<5 year age groups, respectively. Masking in public mediated the association between childcare attendance and SARS-CoV-2 positivity in children aged <1 year. CONCLUSIONS Attending social gatherings increased the risk of SARS-CoV-2 test positivity in 5-<12-year-old children, but in-person daycare/school was associated with a reduced odds of testing positive across all ages. Settings with high public health adherence (ie, schools) reduced the risk of testing positive for SARS-CoV-2, possibly from reduced close contact with SARS-CoV-2 positive individuals.
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Affiliation(s)
- Madeleine Sumner
- Schulich School of Medicine (M Sumner), Western University, London, Ontario, Canada
| | - Gillian A M Tarr
- Division of Environmental Health Sciences (G Tarr), School of Public Health, University of Minnesota, Minneapolis, Minn
| | - Jianling Xie
- Section of Pediatric Emergency Medicine (J Xie), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ahmed Mater
- Section of Pediatric Emergency (A Mater), Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kathleen Winston
- Department of Pediatrics (K Winston), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine (J Gravel), CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Naveen Poonai
- Departments of Paediatrics (N Poonai), Internal Medicine, Epidemiology and Biostatistics, Children's Hospital London Health Sciences Centre, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine (B Burstein), Montreal Children's Hospital, Department of Biostatistics, Epidemiology and Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon Berthelot
- Département de Médecine de famille et de médecine d'urgence (S Berthelot), Université Laval, Québec City, Québec, Canada
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine (R Zemek), University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert Porter
- Janeway Children's Health and Rehabilitation Centre (R Porter), Eastern Health, St Johns, Newfoundland, Canada
| | - Bruce Wright
- Division of Pediatric Emergency Medicine (B Wright), , Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - April Kam
- Division of Emergency Medicine (A Kam), Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jason Emsley
- Department of Emergency Medicine (J Emsley), IWK Children's Health Centre and QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vikram Sabhaney
- Department of Pediatrics (V Sabhaney), and British Columbia Children's Hospital Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darcy Beer
- Department of Pediatrics and Child Health (D Beer), The Children's Hospital of Winnipeg, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabrielle Freire
- Division of Emergency Medicine (G Freire), Department of Paediatrics, The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne Moffatt
- Department of Paediatrics (A Moffatt), Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology (SB Freedman), Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Golosov N, Wang S, Yu M, Karle NN, Ideki O, Abdul-Hamid B, Blaszczak-Boxe C. Socioeconomic and sociodemographic correlations to COVID-19 variability in the United States in 2020. Front Public Health 2024; 12:1359192. [PMID: 38919927 PMCID: PMC11196783 DOI: 10.3389/fpubh.2024.1359192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
The COVID-19 pandemic provided an additional spotlight on the longstanding socioeconomic/health impacts of redlining and has added to the myriad of environmental justice issues, which has caused significant loss of life, health, and productive work. The Centers for Disease Control and Prevention (CDC) reports that a person with any selected underlying health conditions is more likely to experience severe COVID-19 symptoms, with more than 81% of COVID-19-related deaths among people aged 65 years and older. The effects of COVID-19 are not homogeneous across populations, varying by socioeconomic status, PM2.5 exposure, and geographic location. This variability is supported by analysis of existing data as a function of the number of cases and deaths per capita/1,00,000 persons. We investigate the degree of correlation between these parameters, excluding health conditions and age. We found that socioeconomic variables alone contribute to ~40% of COVID-19 variability, while socioeconomic parameters, combined with political affiliation, geographic location, and PM2.5 exposure levels, can explain ~60% of COVID-19 variability per capita when using an OLS regression model; socioeconomic factors contribute ~28% to COVID-19-related deaths. Using spatial coordinates in a Random Forest (RF) regressor model significantly improves prediction accuracy by ~120%. Data visualization products reinforce the fact that the number of COVID-19 deaths represents 1% of COVID-19 cases in the US and globally. A larger number of democratic voters, larger per-capita income, and age >65 years is negatively correlated (associated with a decrease) with the number of COVID cases per capita. Several distinct regions of negative and positive correlations are apparent, which are dominated by two major regions of anticorrelation: (1) the West Coast, which exhibits high PM2.5 concentrations and fewer COVID-19 cases; and (2) the middle portion of the US, showing mostly high number of COVID-19 cases and low PM2.5 concentrations. This paper underscores the importance of exercising caution and prudence when making definitive causal statements about the contribution of air quality constituents (such as PM2.5) and socioeconomic factors to COVID-19 mortality rates. It also highlights the importance of implementing better health/lifestyle practices and examines the impact of COVID-19 on vulnerable populations, particularly regarding preexisting health conditions and age. Although PM2.5 contributes comparable deaths (~7M) per year, globally as smoking cigarettes (~8.5M), quantifying any causal contribution toward COVID-19 is non-trivial, given the primary causes of COVID-19 death and confounding factors. This becomes more complicated as air pollution was reduced significantly during the lockdowns, especially during 2020. This statistical analysis provides a modular framework, that can be further expanded with the context of multilevel analysis (MLA). This study highlights the need to address socioeconomic and environmental disparities to better prepare for future pandemics. By understanding how factors such as socioeconomic status, political affiliation, geographic location, and PM2.5 exposure contribute to the variability in COVID-19 outcomes, policymakers and public health officials can develop targeted strategies to protect vulnerable populations. Implementing improved health and lifestyle practices and mitigating environmental hazards will be essential in reducing the impact of future public health crises on marginalized communities. These insights can guide the development of more resilient and equitable health systems capable of responding effectively to similar future scenarios.
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Affiliation(s)
- Nikolay Golosov
- Department of Geography, The Pennsylvania State University, University Park, PA, United States
| | - Shujie Wang
- Department of Geography, The Pennsylvania State University, University Park, PA, United States
- Earth and Environmental Systems Institute, The Pennsylvania State University, University Park, PA, United States
| | - Manzhu Yu
- Department of Geography, The Pennsylvania State University, University Park, PA, United States
| | - Nakul N. Karle
- Department of Earth, Environment and Equity, Howard University, Washington, DC, United States
| | - Oye Ideki
- Department of Earth, Environment and Equity, Howard University, Washington, DC, United States
| | - Bishara Abdul-Hamid
- Department of Learning, Design, and Technology, Department of Performing Systems, College of Education, The Pennsylvania State University, University Park, PA, United States
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Baumer-Mouradian SH, Hofstetter AM, O'Leary ST, Opel DJ. Vaccine Confidence as Critical to Pandemic Preparedness and Response. Pediatr Clin North Am 2024; 71:499-513. [PMID: 38754938 DOI: 10.1016/j.pcl.2024.01.017] [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] [Indexed: 05/18/2024]
Abstract
Vaccine confidence is a belief that vaccines work, are safe, and are part of a trustworthy medical system. The COVID-19 pandemic exposed the fragility of the public's confidence in vaccines and the vaccine enterprise, limiting the public health impact of vaccination. In this review, we examine the critical nature of vaccine confidence to pandemic preparedness and response.
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Affiliation(s)
- Shannon H Baumer-Mouradian
- Department of Pediatrics, Medical College of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Annika M Hofstetter
- Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA 98145, USA
| | - Sean T O'Leary
- Department of Pediatrics and Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, 1890 North Revere Court, Aurora, CO 80045, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics and Palliative Care, Center for Clinical and Translational Research, Seattle Children's Research Institute, M/S: JMB-6; 1900 Ninth Avenue, Seattle, WA 98101, USA.
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8
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Payne AS, Moore K, Casazza A, Parikh K, Cora-Bramble D. Initiative to Increase Equity in Clinical Care: Experience at 1 Children's Hospital. Pediatrics 2024; 153:e2023063096. [PMID: 38747040 DOI: 10.1542/peds.2023-063096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 06/02/2024] Open
Affiliation(s)
- Asha S Payne
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine, Washington, District of Columbia; and
| | - Katharine Moore
- Children's National Hospital, Washington, District of Columbia
| | - Angelina Casazza
- Children's National Hospital, Washington, District of Columbia
- Angelina Casazza Consulting, Kensington, Maryland
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine, Washington, District of Columbia; and
| | - Denice Cora-Bramble
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine, Washington, District of Columbia; and
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9
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Simpson JN, Wright JL. Pandemic Planning, Response, and Recovery for Pediatricians: A Focus on Health Equity and Social Determinants of Health. Pediatr Clin North Am 2024; 71:515-528. [PMID: 38754939 DOI: 10.1016/j.pcl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
This article summarizes how pediatricians may be uniquely positioned to mitigate the long-term trajectory of COVID-19 on the health and wellness of pediatric patients especially with regard to screening for social determinants of health that are recognized drivers of disparate health outcomes. Health inequities, that is, disproportionately deleterious health outcomes that affect marginalized populations, have been a major source of vulnerability in past public health emergencies and natural disasters. Recommendations are provided for pediatricians to collaborate with disaster planning networks and lead strategies for public health communication and community engagement in pediatric pandemic and disaster planning, response, and recovery efforts.
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Affiliation(s)
- Joelle N Simpson
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA; Emergency Medicine & Trauma Center, Children's National Hospital, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
| | - Joseph L Wright
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA; Department of Health Policy and Management, George Washington University School of Public Health, Washington DC 20052
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10
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Rusk SA, DiBari J, Mason DM, Li M, Hong X, Wang G, Pearson C, Mirolli G, Cheng TL, Kogan MD, Zuckerman B, Wang X. The impact of COVID-19 on psychiatric clinical encounters among low-income racially-diverse children. J Child Psychol Psychiatry 2024; 65:631-643. [PMID: 37088737 PMCID: PMC10590822 DOI: 10.1111/jcpp.13809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND There is a lack of longitudinal data to examine the impact of COVID-19 on all types of clinical encounters among United States, underrepresented BIPOC (Black, Indigenous, and people of color), children. This study aims to examine the changes in all the outpatient clinical encounters during the pandemic compared to the baseline, with particular attention to psychiatric encounters and diagnoses. METHOD This study analyzed 3-year (January 2019 to December 2021) longitudinal clinical encounter data from 3,394 children in the Boston Birth Cohort, a US urban, predominantly low-income, Black and Hispanic children. Outcomes of interest were completed outpatient clinical encounters and their modalities (telemedicine vs. in person), including psychiatric care and diagnoses, primary care, emergency department (ED), and developmental and behavioral pediatrics (DBP). RESULTS The study children's mean (SD) age is 13.9 (4.0) years. Compared to 2019, psychiatric encounters increased by 38% in 2020, most notably for diagnoses of adjustment disorders, depression, and post-traumatic stress disorders (PTSD). In contrast, primary care encounters decreased by 33%, ED encounters decreased by 55%, and DBP care decreased by 16% in 2020. Telemedicine was utilized the most for psychiatric and DBP encounters and the least for primary care encounters in 2020. A remarkable change in 2021 was the return of primary care encounters to the 2019 level, but psychiatric encounters fluctuated with spikes in COVID-19 case numbers. CONCLUSIONS Among this sample of US BIPOC children, compared to the 2019 baseline, psychiatric encounters increased by 38% during 2020, most notably for the new diagnoses of adjustment disorder, depression, and PTSD. The 2021 data showed a full recovery of primary care encounters to the baseline level but psychiatric encounters remained sensitive to the pandemic spikes. The long-term impact of the pandemic on children's mental health warrants further investigation.
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Affiliation(s)
- Serena A. Rusk
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
| | - Jessica DiBari
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
| | - Dana M. Mason
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
| | - Mengmeng Li
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
| | - Colleen Pearson
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center
| | - Gabrielle Mirolli
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center
| | - Tina L. Cheng
- Department of Pediatrics, Cincinnati Children’s Hospital and University of Cincinnati
| | - Michael D. Kogan
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services
| | - Barry Zuckerman
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health
- Department of Pediatrics, Johns Hopkins University School of Medicine
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11
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Dewald F, Steger G, Fish I, Torre-Lage I, Hellriegel C, Milz E, Kolb-Bastigkeit A, Heger E, Fries M, Buess M, Marizy N, Michaelis B, Suárez I, Rubio Quintanares GH, Pirkl M, Aigner A, Oberste M, Hellmich M, Wong A, Orduz JC, Fätkenheuer G, Dötsch J, Kossow A, Moench EM, Quade G, Neumann U, Kaiser R, Schranz M, Klein F. SARS-CoV-2 Test-to-Stay in Daycare. Pediatrics 2024; 153:e2023064668. [PMID: 38596855 DOI: 10.1542/peds.2023-064668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Test-to-stay concepts apply serial testing of children in daycare after exposure to SARS-CoV-2 without use of quarantine. This study aims to assess the safety of a test-to-stay screening in daycare facilities. METHODS 714 daycare facilities and approximately 50 000 children ≤6 years in Cologne, Germany participated in a SARS-CoV-2 Pool-polymerase chain reaction (PCR) screening from March 2021 to April 2022. The screening initially comprised post-exposure quarantine and was adapted to a test-to-stay approach during its course. To assess safety of the test-to-stay approach, we explored potential changes in frequencies of infections among children after the adaptation to the test-to-stay approach by applying regression discontinuity in time (RDiT) analyses. To this end, PCR-test data were linked with routinely collected data on reported infections in children and analyzed using ordinary least squares regressions. RESULTS 219 885 Pool-PCRs and 352 305 Single-PCRs were performed. 6440 (2.93%) Pool-PCRs tested positive, and 17 208 infections in children were reported. We estimated that during a period of 30 weeks, the test-to-stay concept avoided between 7 and 20 days of quarantine per eligible daycare child. RDiT revealed a 26% reduction (Exp. Coef: 0.74, confidence interval 0.52-1.06) in infection frequency among children and indicated no significant increase attributable to the test-to-stay approach. This result was not sensitive to adjustments for 7-day incidence, season, SARS-CoV-2 variant, and socioeconomic status. CONCLUSIONS Our analyses provide evidence that suggest safety of the test-to-stay approach compared with quarantine measures. This approach offers a promising option to avoid use of quarantine after exposure to respiratory pathogens in daycare settings.
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Affiliation(s)
- Felix Dewald
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Berlin, Germany
- German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
| | - Gertrud Steger
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
| | - Irina Fish
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
| | - Ivonne Torre-Lage
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
| | | | - Esther Milz
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
| | | | - Eva Heger
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
| | - Mira Fries
- Health department of Cologne, Cologne, Germany
| | | | | | | | - Isabelle Suárez
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine, University Hospital Cologne
| | | | - Martin Pirkl
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
| | - Annette Aigner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne
| | - Anabelle Wong
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Infectious Disease Epidemiology Group, Max Planck Institute for Infection Biology, Berlin, Germany
| | | | - Gerd Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine, University Hospital Cologne
| | - Jörg Dötsch
- Department of Pediatrics, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Annelene Kossow
- Health department of Cologne, Cologne, Germany
- Institute for Hygiene, University Hospital Münster, Münster, Germany
| | | | - Gustav Quade
- MVZ Labor Dr. Quade and Kollegen GmbH, Cologne, Germany
| | - Udo Neumann
- Youth Welfare Office of Cologne, Cologne, Germany
| | - Rolf Kaiser
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
- German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
| | - Madlen Schranz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Florian Klein
- Institute of Virology, Faculty of Medicine and University Hospital Cologne
- Center for Molecular Medicine Cologne (CMMC), University of Cologne
- German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
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12
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Amjad S, Tromburg C, Adesunkanmi M, Mawa J, Mahbub N, Campbell S, Chari R, Rowe BH, Ospina MB. Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Ann Emerg Med 2024; 83:291-313. [PMID: 38069966 DOI: 10.1016/j.annemergmed.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 03/24/2024]
Abstract
STUDY OBJECTIVE Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. METHODS This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. RESULTS Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. CONCLUSION Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.
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Affiliation(s)
- Sana Amjad
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Tromburg
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Adesunkanmi
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Jannatul Mawa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazif Mahbub
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, Queen's University; Kingston, Ontario, Canada.
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13
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Araújo MVRD, Pereira-Borges RC. Racism, health and pandemic: a narrative review of the relationship between black population and COVID-19 events in 2020. CIENCIA & SAUDE COLETIVA 2024; 29:e11072023. [PMID: 38451653 DOI: 10.1590/1413-81232024293.11072023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/20/2023] [Indexed: 03/08/2024] Open
Abstract
This study aimed to analyze how scientific publications described and interpreted findings about the relationship between the Black population and events linked to COVID-19 in 2020. Narrative review with systematic search, in which a survey was conducted on articles published in 2020 in the Scopus, Medline/PubMed, and Web of Science databases. Initially, 665 articles were found, and after reading and applying the eligible criteria, the final number of 45 articles was reached. Epidemiological, observational studies, secondary data and developed in the United States predominated. Four groupings and respective findings emerged from the synthesis of information extracted: Main events in the Black population - high number of deaths and mortality rate; Direct relationships - poor health, housing, and work conditions; Intermediate relationships - low income and anti-Black prejudice; Comprehensive relationships - structural racism and social determinants of health. The identification of racial health disparities is an important finding about the dynamics of the pandemic among the Black population. However, multicausal explanations were limited. It is necessary to mobilize critical theoretical resources from ethnic and health studies to qualify research in order to support global actions to combat the SARS-CoV-2 epidemic in this group.
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Affiliation(s)
- Marcos Vinícius Ribeiro de Araújo
- Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia. R. Padre Feijó 312, casas 47 e 49, Canela. 40.110-170 Salvador BA Brasil.
| | - Ruan Carlos Pereira-Borges
- Programa de Residência Multiprofissional Hospital Metropolitano Odilon Behrens, Secretaria Municipal de Saúde de Belo Horizonte. Belo Horizonte MG Brasil
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14
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Sahli S, Størdal K. Systematic review of socioeconomic factors and COVID-19 in children and adolescents. Acta Paediatr 2024; 113:384-393. [PMID: 38193593 DOI: 10.1111/apa.17091] [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: 06/22/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
AIM To systematically review the evidence on Covid-19 infection risk, severity and vaccination uptake among children and adolescents by socioeconomic status. METHODS We conducted a systematic literature review, using the PubMed database. We searched for articles published from January 2020 to January 2022 using "MeSH" words and titles. The key terms were "COVID", "social status", "socioeconomic factor" and "children". We also searched secondary sources such as published reports and other databases. RESULTS The search identified 15 relevant articles and reports. This review shows that children of lower socioeconomic status have a higher risk of COVID-19 infection and a higher risk of being hospitalised. Mortality in a global setting was also higher in children with low socioeconomic status, though not observed in high-resourced countries. These children are also less likely to be vaccinated against the SARS-CoV-2 virus. CONCLUSIONS The higher risk of COVID-19 infection and hospitalisation and lower vaccination coverage in children and adolescents from lower socioeconomic backgrounds demonstrate health disparities also in young age. These disparities should inform health authorities in planning for future pandemics.
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Affiliation(s)
- Sarah Sahli
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ketil Størdal
- Department of Paediatric Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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15
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Romagnoli BR, Phan TLT, Lewis AM, Alderfer MA, Kazak AE, Arasteh K, Enlow PT. The Psychosocial Impact of the COVID-19 Pandemic on Families of Youth of Color: A Prospective Cohort Study. J Pediatr Psychol 2024; 49:98-106. [PMID: 37930074 PMCID: PMC10874214 DOI: 10.1093/jpepsy/jsad078] [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: 02/27/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE Prospectively examine racial and ethnic disparities in exposure to COVID-19-related stressors and their impact on families. METHODS A racially, ethnically, and socioeconomically diverse cohort of caregivers of youth (n = 1,581) representative of the population served by a pediatric healthcare system completed the COVID-19 Exposure and Family Impact Scales in Oct/Nov 2020 and March/April 2021. Linear mixed-effects models were used to examine exposure to COVID-19-related events (Exposure), impact of the pandemic on family functioning and well-being (Impact), and child and parent distress (Distress) across time and as a function of race and ethnicity, adjusting for other sociodemographic variables. RESULTS Exposure and Distress increased over time for all participants. After adjusting for sociodemographic factors, caregivers of Black and Hispanic youth reported greater Exposure than caregivers of White youth and caregivers of Black youth had a greater increase in Exposure over time than caregivers of White youth. Caregivers of White youth reported greater Impact than caregivers of Black and Other race youth. CONCLUSIONS Exposure to and impact of the COVID-19 pandemic on family psychosocial functioning varied by race and ethnicity. Although exposure to COVID-19-related events was greater among Hispanic and non-Hispanic Black families, those of marginalized races reported less family impact than non-Hispanic White families, suggesting resiliency to the pandemic. Research should examine such responses to public health crises in communities of color, with a focus on understanding protective factors. These findings suggest the importance of culturally tailored interventions and policies that support universal psychosocial screenings during times of public health crises.
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Affiliation(s)
| | - Thao-Ly T Phan
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Kamyar Arasteh
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
| | - Paul T Enlow
- Division of Behavioral Health, Nemours Children’s Health, USA
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
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16
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Portillo EN, Rees CA, Hartford EA, Foughty ZC, Pickett ML, Gutman CK, Shihabuddin BS, Fleegler EW, Chumpitazi CE, Johnson TJ, Schnadower D, Shaw KN. Research Priorities for Pediatric Emergency Care to Address Disparities by Race, Ethnicity, and Language. JAMA Netw Open 2023; 6:e2343791. [PMID: 37955894 PMCID: PMC10644218 DOI: 10.1001/jamanetworkopen.2023.43791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Importance Health care disparities are well-documented among children based on race, ethnicity, and language for care. An agenda that outlines research priorities for disparities in pediatric emergency care (PEC) is lacking. Objective To investigate research priorities for disparities in PEC among medical personnel, researchers, and health care-affiliated community organizations. Design, Setting, and Participants In this survey study, a modified Delphi approach was used to investigate research priorities for disparities in PEC. An initial list of research priorities was developed by a group of experienced PEC investigators in 2021. Partners iteratively assessed the list through 2 rounds of electronic surveys using Likert-type responses in late 2021 and early 2022. Priorities were defined as achieving consensus if they received a score of highest priority or priority by at least 60% of respondents. Asynchronous engagement of participants via online web-conferencing platforms and email correspondence with electronic survey administration was used. Partners were individuals and groups involved in PEC. Participants represented interest groups, research and medical personnel organizations, health care partners, and laypersons with roles in community and family hospital advisory councils. Participants were largely from the US, with input from international PEC research networks. Outcome Consensus agenda of research priorities to identify and address health care disparities in PEC. Results PEC investigators generated an initial list of 27 potential priorities. Surveys were completed by 38 of 47 partners (80.6%) and 30 of 38 partners (81.1%) in rounds 1 and 2, respectively. Among 30 respondents who completed both rounds, there were 7 family or community partners and 23 medical or research partners, including 4 international PEC research networks. A total of 12 research priorities achieved the predetermined consensus threshold: (1) systematic efforts to reduce disparities; (2) race, ethnicity, and language data collection and reporting; (3) recognizing and mitigating clinician implicit bias; (4) mental health disparities; (5) social determinants of health; (6) language and literacy; (7) acute pain-management disparities; (8) quality of care equity metrics; (9) shared decision-making; (10) patient experience; (11) triage and acuity score assignment; and (12) inclusive research participation. Conclusions and Relevance These results suggest a research priority agenda that may be used as a guide for investigators, research networks, organizations, and funding agencies to engage in and support high-priority disparities research topics in PEC.
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Affiliation(s)
- Elyse N. Portillo
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Emily A. Hartford
- Division of Emergency Medicine, Department of Pediatrics, University of Washington, Seattle
| | - Zachary C. Foughty
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Michelle L. Pickett
- Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Colleen K. Gutman
- Department of Emergency Medicine, University of Florida, Gainesville
- Department of Pediatrics, University of Florida, Gainesville
| | - Bashar S. Shihabuddin
- Division of Emergency Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Corrie E. Chumpitazi
- Division of Emergency Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Tiffani J. Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento
| | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kathy N. Shaw
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children’s Hospital of Philadelphia
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17
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Rush M, Hyman C, Yonts A, Szeles R, Boogaard C. Pediatric COVID-19 Vaccination in the Inpatient Setting. Hosp Pediatr 2023; 13:e329-e332. [PMID: 37807862 DOI: 10.1542/hpeds.2022-006804] [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: 10/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The inpatient setting is often underutilized as a venue for providing pediatric vaccines. During the 2019 novel coronavirus (COVID-19) pandemic, our hospital began a vaccination program to provide access to COVID-19 vaccines for eligible pediatric inpatients. Our objective was to describe the establishment and assess the impact of a COVID-19 vaccination program for pediatric inpatients. METHODS All admitted patients were screened for eligibility and interest in inpatient COVID-19 vaccination upon admission from April 27, 2021 until February 12, 2022. For those eligible for vaccination, their interest was recorded and shared with the clinical team. The clinical team completed education and/or vaccination depending on individual case. Interest in inpatient vaccination and ultimate receipt of a vaccine was recorded and analyzed. RESULTS During the study period, 1615 patients were eligible for inpatient vaccination and 1601 had their interest recorded on hospital admission. Twenty-one percent of these patients were interested, 50% declined, and 28% were unsure. Twenty-nine percent of those initially interested were given vaccine by the clinical team before discharge. Six percent of patients who were unsure and 2% of those who declined vaccine on admission were vaccinated before discharge. CONCLUSIONS The inpatient setting can be an important venue to allow for education and discussion regarding pediatric COVID-19 vaccine and to improve access to vaccination for a traditionally under-vaccinated population. Challenges remain with consistent vaccine administration even for interested pediatric inpatients.
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Affiliation(s)
| | - Cleopatra Hyman
- Department of Case Management and Revenue Cycle, Children's National Hospital, Washington, District of Columbia
| | | | - Rosemary Szeles
- Children's National Hospital, Washington, District of Columbia
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18
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Cole LD, Hammershaimb EA, Liang Y, Hendrich MA, Das D, Petrin R, Campbell JD, O’Leary S, Cataldi JR. Awareness of Multisystem Inflammatory Syndrome in Children Among US Parents: A Cross-Sectional Survey. Open Forum Infect Dis 2023; 10:ofad476. [PMID: 37795505 PMCID: PMC10546954 DOI: 10.1093/ofid/ofad476] [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: 06/21/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Little is known about parental awareness of multisystem inflammatory syndrome in children (MIS-C), a rare but severe sequela of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Via a nationally representative, cross-sectional survey of US parents conducted via Ipsos KnowledgePanel from October to November 2021, we used bivariate and multivariable analyses to describe and identify demographic variables associated with parental knowledge of and attitudes toward MIS-C and to examine associations with perceived coronavirus disease 2019 (COVID-19) severity and susceptibility. Results Response rate was 64.2% (3230/5034). Thirty-two percent of respondents had heard of MIS-C. After adjustment, higher educational level (compared to high school degree; some college: odds ratio [OR], 2.00 [95% confidence interval {CI}, 1.44-2.77]; bachelor's degree or higher: OR, 3.14 [95% CI, 2.26-4.35]), being a healthcare worker (OR, 1.82 [95% CI, 1.37-2.42]), having a child with a chronic medical condition (OR, 1.62 [95% CI, 1.22-2.14]), and experience with more severe COVID-19 (OR, 1.46 [95% CI, 1.14-1.86]) were associated with MIS-C awareness. Respondents with a child aged 12-17 years were less likely to be aware of MIS-C compared to those without (OR, 0.78 [95% CI, .63-.96]), as were male respondents (OR, 0.56 [95% CI, .46-.69]) and respondents aged 18-34 years (OR, 0.72 [95% CI, .54-.94]) compared to those aged 35-44 years. Awareness of MIS-C was associated with higher perceived COVID-19 severity and susceptibility (regression coefficients, 0.18 [95% CI, .10-.25], P < .001; 0.19 [95% CI, .11-.28], P < .001, respectively). Conclusions This survey highlights the need to increase parental awareness of MIS-C. Future studies should explore how education regarding MIS-C as a complication of SARS-CoV-2 infection could improve understanding of pediatric disease severity and susceptibility.
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Affiliation(s)
- Lyndsey D Cole
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Section of Rheumatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - E Adrianne Hammershaimb
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yuanyuan Liang
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Dhiman Das
- Ipsos US Public Affairs, Washington, District of Columbia, USA
| | - Robert Petrin
- Ipsos US Public Affairs, Washington, District of Columbia, USA
| | - James D Campbell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sean O’Leary
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine,Aurora, Colorado, USA
| | - Jessica R Cataldi
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine,Aurora, Colorado, USA
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19
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Kato MA, Zurakowski D, Adams A, Soelberg J, Staffa SJ, Bradford VA, Efune PN, Rodgers McCormick ME, Grivoyannis AD, Rossmann Beel E, Correll LR, Cheon EC, Tan GM, Thomas JJ, Fernandez AM, Teng HC, Khanna N, Raman VT, Brzenski AB, Frugoni BJ, Sheth MM, Rugnath RM, Meier PM. Prevalence of COVID-19 and Risk Factors for Infection Among Pediatric Anesthesia Patients: A Report From the PEACOC Research Network. Anesth Analg 2023; 137:383-391. [PMID: 36269171 DOI: 10.1213/ane.0000000000006227] [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: 02/04/2023]
Abstract
BACKGROUND The Pediatric Anesthesia COVID-19 Collaborative (PEACOC) is a research network to advance the care of children during the pandemic. Here we calculate the prevalence of coronavirus disease 2019 (COVID-19) among children undergoing anesthesia, look at prevalence in the population data from the Centers for Disease Control and Prevention (CDC), and assess independent risk factors for infection. METHODS This was a multicenter, retrospective, observational study. Children aged 28 days to 18 years scheduled for anesthesia services at 12 centers requiring universal COVID-19 testing from March 29, 2020 to June 30, 2020 were included. COVID-19 positivity rates among those tested were plotted and trends were assessed using the Cochran Armitage test of trend. Independent risk factors were explored using multivariable logistic regression. RESULTS Data were collected and analyzed on 33,320 anesthesia encounters including 265 children with COVID-19. Over the study period, the rates of infections in the pediatric anesthesia population did not demonstrate a significant trend. In the general population, there was a significant downward trend in infection rates ( P < .001). In exploratory analysis, multivariable risk factors for a COVID-19 positive test were Black/African American race, Hispanic ethnicity, American Society of Anesthesiologists (ASA) physical status III or above, overweight and obese body mass index (BMI), orthopedic cases, abdominal cases, emergency cases, absence of injury and trauma, and West region (all P < .05). CONCLUSIONS Rates of COVID-19 in pediatric anesthesia patients were consistently lower than in the general population. Independent risk factors of a positive test for children were identified. This is the first time universal testing for a single infectious disease was undertaken on a wide scale. As such, the association of infection with surgical case type or emergency case status is unprecedented.
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Affiliation(s)
- Meredith A Kato
- From the Department of Anesthesiology & Perioperative Medicine, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - AmandaMarie Adams
- From the Department of Anesthesiology & Perioperative Medicine, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Julie Soelberg
- From the Department of Anesthesiology & Perioperative Medicine, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria A Bradford
- Department of Anesthesiology, Albert B. Chandler Hospital, University of Kentucky, Lexington Kentucky
| | - Proshad N Efune
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Megan E Rodgers McCormick
- Department of Anesthesiology, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anastasia D Grivoyannis
- Department of Anesthesia & Critical Care Medicine, Johns Hopkins Hospital, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Rossmann Beel
- Department of Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lynnie R Correll
- Department of Anesthesiology and Perioperative Medicine, Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Eric C Cheon
- Department of Pediatric Anesthesiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Gee Mei Tan
- Department of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, Colorado
| | - James J Thomas
- Department of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, Colorado
| | - Allison M Fernandez
- Department of Anesthesia, Pain and Perioperative Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Howard C Teng
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neha Khanna
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Ohio State College of Medicine, Columbus, Ohio
| | - Vidya T Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Ohio State College of Medicine, Columbus, Ohio
| | - Alyssa B Brzenski
- Department of Anesthesiology, Rady Children's Hospital, University of California San Diego Medical Center, San Diego, California
| | - Brian J Frugoni
- Department of Anesthesiology, Rady Children's Hospital, University of California San Diego Medical Center, San Diego, California
| | - Michelle M Sheth
- Department of Anesthesiology, Children's Hospital of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Rahil M Rugnath
- Department of Anesthesiology, Children's Hospital of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Petra M Meier
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Eboigbe LI, Simon CB, Wang YS, Tyrell FA. The compounded effect of the dual pandemic on ethnic-racial minority adolescents' mental health and psychosocial well-being. Curr Opin Psychol 2023; 52:101626. [PMID: 37384949 PMCID: PMC10293782 DOI: 10.1016/j.copsyc.2023.101626] [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: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
During the COVID-19 pandemic, U.S. youth faced various stressors that affected their schooling experiences, social relationships, family dynamics, and communities. These stressors negatively impacted youths' mental health. Compared to White youths, ethnic-racial minority youths were disproportionately affected by COVID-19-related health disparities and experienced elevated worry and stress. In particular, Black and Asian American youths faced the compounded effects of a dual pandemic due to their navigation of both COVID-19-related stressors and increased exposure to racial discrimination and racial injustice, which worsened their mental health outcomes. However, protective processes such as social support, ethnic-racial identity, and ethnic-racial socialization emerged as mechanisms that attenuated the effects of COVID-related stressors on ethnic-racial youths' mental health and promoted their positive adaptation and psychosocial well-being.
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Affiliation(s)
- Loretta I Eboigbe
- Department of Psychology, University of Maryland, College Park, United States
| | - Carlisa B Simon
- Department of Psychology, University of Maryland, College Park, United States
| | - Yuqi S Wang
- Department of Psychology, University of Maryland, College Park, United States
| | - Fanita A Tyrell
- Department of Psychology, University of Maryland, College Park, United States.
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21
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Jubulis J, Goddard A, Dibrigida S, McCarthy C. Effects of Maternal SARS-CoV-2 Infection on Neonatal Discharge Planning and Care: Exacerbation of Racial and Ethnic Healthcare Disparities. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01718-y. [PMID: 37500829 DOI: 10.1007/s40615-023-01718-y] [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: 04/14/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To determine if SARS-CoV-2 disproportionately impacted infants born to racial and ethnic minorities and if virus exposure led to decreased access to care. METHODS This study was an observational case-control study, between March 2020 and March 2022 in Portland, Maine. Forty-seven cases and 47 controls were enrolled. Cases were infants born to mothers diagnosed with SARS-CoV-2 at delivery, and controls were infants matched by date of birth, born to SARS-CoV-2 negative women. Demographic data, maternal clinical data, infant outcomes, and infant discharge plans were compared using Chi squared or Fisher Exact tests. Logistic regression was used to examine the impact of race on neonatal SARS-CoV-2 exposure. RESULTS Infants exposed to SARS-CoV-2 were more likely Black or Hispanic than White and Non-Hispanic early in the pandemic, with reversal during the second year. SARS-CoV-2-exposed infants experienced delays in routine newborn outpatient care, although delay improved over the pandemic. CONCLUSION Infants exposed to SARS-CoV-2 were initially more likely to be infants of color. During this time, infants exposed to SARS-CoV-2 were also experiencing significant delays in newborn care.
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Affiliation(s)
- Jennifer Jubulis
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Portland, ME, USA.
| | - Amanda Goddard
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Portland, ME, USA
| | - Sarah Dibrigida
- Maine Medical Center Department of Pediatrics, Portland, ME, USA
| | - Carol McCarthy
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Portland, ME, USA
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22
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Grundman JB, Chung ST, Estrada E, Podolsky RH, Meyers A, Marks BE. Virtual Learning and Youth-Onset Type 2 Diabetes during the COVID-19 Pandemic. Horm Res Paediatr 2023; 97:218-224. [PMID: 37393897 PMCID: PMC11000259 DOI: 10.1159/000531720] [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: 09/22/2022] [Accepted: 06/21/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Cases and severity of presentation of youth-onset type 2 diabetes (Y-T2D) increased during the COVID-19 pandemic, yet the potential drivers of this rise remain unknown. During this time public health mandates paused in-person education and limited social interactions, resulting in radical lifestyle changes. We hypothesized that the incidence and severity of presentation of Y-T2D increased during virtual learning amidst the COVID-19 pandemic. MATERIALS AND METHODS We conducted a single-center retrospective chart review to identify all newly diagnosed cases of Y-T2D (n = 387) at a pediatric tertiary care center in Washington, DC during three predetermined learning periods as defined by learning modality in Washington, DC Public Schools: pre-pandemic in-person learning (March 11, 2018-March 13, 2020), pandemic virtual learning (March 14, 2020-August 29, 2021), and pandemic in-person learning (August 30, 2021-March 10, 2022) periods. RESULTS Incident cases were stable during pre-pandemic in-person learning (3.9 cases/month, 95% CI: 2.8-5.4 cases/month), increased to a peak during virtual learning (18.7 cases/month, 95% CI: 15.9-22.1 cases/month), and declined with return to in-person learning (4.3 cases/month, 95% CI: 2.8-6.8 cases/month). Y-T2D incidence was 16.9 (95% CI: 9.8-29.1, p < 0.001) and 5.1-fold higher (95% CI: 2.9-9.1, p < 0.001) among non-Hispanic Black and Latinx youth, respectively, throughout the study period. Overall COVID-19 infection rates at diagnosis were low (2.5%) and were not associated with diabetes incidence (p = 0.26). CONCLUSIONS This study provides timely insights into an important and modifiable correlate of Y-T2D incidence, its disproportionate impact on underserved communities, and the need to consider the effects on long-term health outcomes and preexisting healthcare inequities when designing public policy.
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Affiliation(s)
- Jody B. Grundman
- Division of Endocrinology, Children’s National Hospital, Washington, DC, USA
| | - Stephanie T. Chung
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Elizabeth Estrada
- Division of Endocrinology, Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Robert H. Podolsky
- Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC, USA
| | - Abby Meyers
- Division of Endocrinology, Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Brynn E. Marks
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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23
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Ghimire LV, Chou FS, Aljohani OA, Moon-Grady AJ. Racial and Socioeconomic Disparities in Multisystem Inflammatory Syndrome in Children in the United States. Am J Cardiol 2023; 198:50-52. [PMID: 37201231 DOI: 10.1016/j.amjcard.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Laxmi V Ghimire
- Sections of Pediatrics and; Cardiology, Department of Medicine, Concord Hospital-Laconia, Laconia, New Hampshire
| | - Fu-Sheng Chou
- Department of Neonatal-Perinatal Medicine, Kaiser Permanente Riverside Medical Center, Riverside, California
| | - Othman A Aljohani
- Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Anita J Moon-Grady
- Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
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24
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Scott JL, Lee-Johnson NM, Danos D. Place, Race, and Case: Examining Racialized Economic Segregation and COVID-19 in Louisiana. J Racial Ethn Health Disparities 2023; 10:775-787. [PMID: 35239176 PMCID: PMC8893059 DOI: 10.1007/s40615-022-01265-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
Abstract
Early COVID-19 pandemic data suggested racial/ethnic minority and low-income earning people bore the greatest burden of infection. Structural racism, the reinforcement of racial and ethnic discrimination via policy, provides a framework for understanding disparities in health outcomes like COVID-19 infection. Residential racial and economic segregation is one indicator of structural racism. Little attention has been paid to the relationship of infection to relative overall concentrations of risk (i.e., segregation of the most privileged from the most disadvantaged). We used ordinary least squares and geographically weighted regression models to evaluate the relationship between racial and economic segregation, measured by the Index of Concentration at the Extremes, and COVID-19 cases in Louisiana. We found a significant global association between racial segregation and cumulative COVID-19 case rate in Louisiana and variation across the state during the study period. The northwest and central regions exhibited a strong negative relationship indicating greater risk in areas with high concentrations of Black residents. On the other hand, the southeastern part of the state exhibited more neutral or positive relationships indicating greater risk in areas with high concentrations of White residents. Our findings that the relationship between racial segregation and COVID-19 cases varied within a state further support evidence that social and political determinants, not biological, drive racial disparities. Small area measures and measures of polarization provide localized information better suited to tailoring public health policy according to the dynamics of communities at the census tract level, which may lead to better health outcomes.
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Affiliation(s)
- Jennifer L Scott
- School of Social Work, Louisiana State University, 2167 Pleasant Hall, Baton Rouge, LA, 70803, USA.
| | - Natasha M Lee-Johnson
- School of Social Work, Louisiana State University, 2167 Pleasant Hall, Baton Rouge, LA, 70803, USA
| | - Denise Danos
- School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
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25
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Hart RJ, Baumer-Mouradian S, Bone JN, Olson P, Schroter S, Weigert RM, Chung S, Shah P, Lunoe MM, Evers M, Nelson CE, Goldman RD. Factors associated with US caregivers' uptake of pediatric COVID-19 vaccine by race and ethnicity. Vaccine 2023; 41:2546-2552. [PMID: 36906408 PMCID: PMC9986131 DOI: 10.1016/j.vaccine.2023.02.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/26/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES To assess differences in willingness to vaccinate children against COVID-19, and factors that may be associated with increased acceptance, among US caregivers of various racial and ethnic identities who presented with their child to the Emergency Department (ED) after emergency use authorization of vaccines for children ages 5-11. STUDY DESIGN A multicenter, cross-sectional survey of caregivers presenting to 11 pediatric EDs in the United States in November-December 2021. Caregivers were asked about their identified race and ethnicity and if they planned to vaccinate their child. We collected demographic data and inquired about caregiver concerns related to COVID-19. We compared responses by race/ethnicity. Multivariable logistic regression models served to determine factors that were independently associated with increased vaccine acceptance overall and among racial/ethnic groups. RESULTS Among 1916 caregivers responding, 54.67% planned to vaccinate their child against COVID-19. Large differences in acceptance were noted by race/ethnicity, with highest acceptance among Asian caregivers (61.1%) and those who did not specify a listed racial identity (61.1%); caregivers identifying as Black (44.7%) or Multi-racial (44.4%) had lower acceptance rates. Factors associated with intent to vaccinate differed by racial/ethnic group, and included caregiver COVID-19 vaccine receipt (all groups), caregiver concerns about COVID-19 (White caregivers), and having a trusted primary provider (Black caregivers). CONCLUSIONS Caregiver intent to vaccinate children against COVID-19 varied by race/ethnicity, but race/ethnicity did not independently account for these differences. Caregiver COVID-19 vaccination status, concerns about COVID-19, and presence of a trusted primary provider are important in vaccination decisions.
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Affiliation(s)
- Rebecca J Hart
- Department of Pediatrics, Norton Children's and University of Louisville School of Medicine, Louisville, KY, USA.
| | | | - Jeffrey N Bone
- Department of Pediatrics, University of British Columbia, Children's Hospital Vancouver, Canada
| | - Prasra Olson
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Stephanie Schroter
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego, San Diego, CA, USA
| | - Rachel M Weigert
- Depatrment of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - SunHee Chung
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Pareen Shah
- Department of Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Maren M Lunoe
- Department of Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Megan Evers
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Courtney E Nelson
- Department of Pediatrics, Nemours Children's Hospital - Delaware Wilmington, DE, USA
| | - Ran D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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26
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Cooper CM, Przeworski A, Smith AC, Obeid R, Short EJ. Perceptions of Social-Emotional Learning Among K-12 Teachers in the USA During the COVID-19 Pandemic. SCHOOL MENTAL HEALTH 2023; 15:1-14. [PMID: 36686286 PMCID: PMC9838265 DOI: 10.1007/s12310-022-09563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/12/2023]
Abstract
Social-emotional learning (SEL) is the process of acquiring and applying knowledge, skills, and attitudes to achieve long-term relational and emotional goals. Teachers often implement SEL strategies in the classroom; however, shifting to online schooling during the COVID-19 pandemic may have impacted teachers' perceptions of their abilities to implement SEL. This study was designed to identify whether and how teachers' perceptions of SEL changed since the onset of the COVID-19 pandemic. Teachers (N = 637) in the USA completed a demographic questionnaire, the Depression, Anxiety, and Stress Scale (DASS-21), and rated their beliefs about SEL during the pandemic on a modified version of the Comfort and Culture subscales of the Teacher SEL Beliefs Scale. Data were collected between September 2020 and March 2021. Teachers indicated that they felt neutral to comfortable with SEL and that they felt neutral to supported by their school culture for SEL during the pandemic. Lower depression symptoms, greater school poverty, and perceived general support (not specific to SEL) from the administration were associated with higher teacher comfort with SEL. Further, greater general support from the district and colleagues was associated with greater school culture supporting SEL during COVID-19. Results suggest that addressing teachers' internalizing symptoms and fostering a supportive work environment is important in aiding teachers in SEL implementation.
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Affiliation(s)
- Chelsea M. Cooper
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Amy Przeworski
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Alexandra C. Smith
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Rita Obeid
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Elizabeth J. Short
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
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27
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Das BB, Shakti D, Ghaleb S, Akam-Venkata J, Moskowitz WB, Osakwe O, Weiland MD, Arya S, Gajula V, Taylor MB. Racial and Ethnic Disparity in Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 in Mississippi, USA. Clin Pediatr (Phila) 2023; 62:8-16. [PMID: 35801262 PMCID: PMC9720419 DOI: 10.1177/00099228221108591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We aimed to study the disparity in the clinical profile and outcomes of hospitalized Multisystem Inflammatory Syndrome in Children (MIS-C) patients at our center. The second goal was to examine the temporal association with preceding SARS-CoV-2 infection by race/ethnicity in our community in Mississippi. We found the racial disparity in the prevalence of MIS-C exceeded its temporal association with SARS-CoV-2 infections. We included 51 consecutive MIS-C patients hospitalized, whose median age was 9 (interquartile range [IQR] 5-12) years, 58% were male, 71% were black, 25% were white, and 4% belonged to other groups. We found a delay between onset of symptoms and hospitalization in black patients compared with white patients with a median of 2 (IQR 0-7) vs median of 0 (0-5) urgent care visits (P = .022), respectively. Black patients were hospitalized longer (median 8, IQR 2-39 days) than whites (median 5, IQR 3-14 days), P = .047. A total of 38.9% of blacks and 23.1% of whites were admitted to intensive care unit (P = .498); 36.1% of blacks had severe cardiac involvement vs 23.1% of white patients, P = .531. Future studies of MIS-C are required to improve health equity for children.
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Affiliation(s)
- Bibhuti B. Das
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA,Bibhuti B. Das, Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, 2500 N State St., Jackson, MS 39216, USA.
| | - Divya Shakti
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephanie Ghaleb
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Jyothsna Akam-Venkata
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - William B. Moskowitz
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Onyekachukwu Osakwe
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael D. Weiland
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Sandeep Arya
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Viswanath Gajula
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Mary B. Taylor
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
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Dagi AF, Parry GJ, Labow BI, Taghinia AH. Trends in Pediatric Head and Facial Trauma During the COVID-19 Pandemic. J Craniofac Surg 2023; 34:e1-e6. [PMID: 35864579 PMCID: PMC9793995 DOI: 10.1097/scs.0000000000008776] [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: 10/24/2021] [Accepted: 04/11/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The effect of physical-distancing policies and school closures on pediatric health has been a topic of major concern in the United States during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to assess the immediate impact of these public policies on patterns of head and facial trauma in the pediatric population. MATERIALS AND METHOD The Pediatric Health Information System (PHIS) was queried to identify patient encounters at 46 children's hospitals across the United States in 2016-2020. Encounters were included if resultant in ICD-10 diagnosis for head or facial trauma in a child under 18 between April 1 and June 30 in 2020 (first COVID-19 school closures) and during the same period in the previous 4 years (for comparison). RESULTS A total of 170,832 patient encounters for pediatric head and facial trauma were recorded during the study period, including 28,030 (16.4%) in 2020 and 142,802 (83.6%) in 2016-2019. Patient encounters declined significantly in 2020 among children of all age groups relative to previous years. Relative reductions were greatest in children aged 11 to 17 (middle/high school) and 6 to 10 (elementary school), at -34.6% (95% confidence interval: -23.6%, -44%; P <0.001) and -27.7% (95% confidence interval: -18.4%, -36%; P <0.001). Variation in relative reductions by race/ethnicity, sex, and rural/urban status were not statistically significant. CONCLUSIONS Physical-distancing policies and school closures at the start of the COVID-19 pandemic correlated with significant reductions in pediatric head and facial trauma patient encounters. As in-person activities resume, reductions in head and facial trauma during the pandemic may indicate a range of possible preventable injuries in the future.
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Thomson J, Richardson T, Auger KA, Brady PW, Hall M, Hartley D, Schondelmeyer AC, Shah SS. Impact of the COVID-19 pandemic on hospitalizations of children with neurologic impairment. J Hosp Med 2023; 18:33-42. [PMID: 36504483 PMCID: PMC9877577 DOI: 10.1002/jhm.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Children with neurologic impairment (NI) are frequently hospitalized for infectious and noninfectious illnesses. The early period of the COVID-19 pandemic was associated with overall lower pediatric hospitalization rates, particularly for respiratory infections, but the effect on utilization for children with NI is unknown. METHOD This multicenter retrospective cohort study included hospitalizations of children 1-18 years of age with NI diagnosis codes from 49 children's hospitals. We calculated the percent change in the median weekly hospitalization volumes and the hospitalization resource intensity score (H-RISK), comparing the early-COVID era (March 15, 2020 to December 31, 2020) with the pre-COVID era (same timeframe of 2017-2019). Percent change was calculated over the entire study period as well as within three seasonal time periods (spring, summer, and fall/winter). Differences between infectious and noninfectious admission diagnoses were also examined. RESULTS Compared with the pre-COVID era, there was a 14.4% decrease (interquartile range [IQR]: -33.8, -11.7) in the weekly median number of hospitalizations in the early-COVID era; the weekly median H-RISK score was 11.7% greater (IQR: 8.9, 14.9). Hospitalizations decreased for both noninfectious (-11.6%, IQR: -30.0, -8.0) and infectious (-35.5%, IQR: -51.1, -31.3) illnesses in the early-COVID era. This decrease was the largest in spring 2020 and continued throughout 2020. CONCLUSIONS For children with NI, there was a substantial and significant decrease in hospitalizations for infectious and noninfectious diagnoses but an increase in illness severity during the early-COVID era compared with the pre-COVID era. Our data suggest a need to reconsider current thresholds for hospitalization and identify opportunities to support and guide families through certain illnesses without hospitalization.
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Affiliation(s)
- Joanna Thomson
- Cincinnati Children's Hospital Medical CenterDivision of Hospital MedicineCincinnatiOhioUSA
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | | | - Katherine A. Auger
- Cincinnati Children's Hospital Medical CenterDivision of Hospital MedicineCincinnatiOhioUSA
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Patrick W. Brady
- Cincinnati Children's Hospital Medical CenterDivision of Hospital MedicineCincinnatiOhioUSA
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Matt Hall
- Children's Hospital AssociationLenexaKansasUSA
| | - David Hartley
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Amanda C. Schondelmeyer
- Cincinnati Children's Hospital Medical CenterDivision of Hospital MedicineCincinnatiOhioUSA
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Samir S. Shah
- Cincinnati Children's Hospital Medical CenterDivision of Hospital MedicineCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Cincinnati Children's Hospital Medical CenterDivision of Infectious DiseasesCincinnatiOhioUSA
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Abstract
While most children with coronavirus 2019 (COVID-19) experience mild illness, some are vulnerable to severe disease and develop long-term complications. Children with disabilities, those from lower-income homes, and those from racial and ethnic minority groups are more likely to be hospitalized and to have poor outcomes following an infection. For many of these same children, a wide range of social, economic, and environmental disadvantages have made it more difficult for them to access COVID-19 vaccines. Ensuring vaccine equity in children and decreasing health disparities promotes the common good and serves society as a whole. In this article, we discuss how the pandemic has exposed long-standing injustices in historically marginalized groups and provide a summary of the research describing the disparities associated with COVID-19 infection, severity, and vaccine uptake. Last, we outline several strategies for addressing some of the issues that can give rise to vaccine inequity in the pediatric population.
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Affiliation(s)
- Carlos R Oliveira
- Corresponding Author: Carlos R. Oliveira, M.D., Ph.D., 15 York Street, PO Box 208064, New Haven, CT 06520-8064, USA. E-mail:
| | - Kristen A Feemster
- Vaccine Education Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Erlinda R Ulloa
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
- Division of Infectious Diseases, Children’s Health of Orange County, Orange, CA 92868, USA
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Mulkey SB, Williams ME, Jadeed N, Zhang A, Israel S, DeBiasi RL. Neurodevelopment in infants with antenatal or early neonatal exposure to SARS-CoV-2. Early Hum Dev 2022; 175:105694. [PMID: 36402122 DOI: 10.1016/j.earlhumdev.2022.105694] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Antenatal and neonatal viral exposure may put the developing brain at risk for abnormal neurodevelopment. A clinical program at Children's National Hospital provides detailed follow-up of infants with in utero or neonatal SARS-CoV-2 exposure. AIMS To determine impact of early SARS-CoV-2 exposure on neurodevelopment. STUDY DESIGN We performed a prospective observational study of infant evaluations between 3/2020 and 11/2021. Demographics, pregnancy and birth details, SARS-CoV-2 data, specialty consultations, and NICU records were extracted from infants' medical records. Infants had neurologic exams and developmental screening with Ages and Stages Questionnaire (ASQ). Correlations between SARS-CoV-2 exposure type and neurodevelopmental outcomes were analyzed. SUBJECTS Thirty-four infants evaluated in the SARS-CoV-2 follow-up program. OUTCOME MEASURES Abnormal neurologic exams or ASQ scores near or below suggested cut-offs. RESULTS Infants received up to three evaluations. Most (28/34; 82 %) were exposed in utero - 16 to symptomatic mothers (IU-S) and 12 to asymptomatic mothers (IU-A). Six were exposed only as a neonate. IU-S had abnormal neurologic exams at mean (SD) age 112 (24) days and ASQ scores near or below cut-offs for all domains more frequently than IU-A or neonatally exposed infants. IU-S were more likely to score below any ASQ cutoff compared to IU-A (P = .04); differences were significant for Fine Motor (P = .01) and Personal-Social (P = .02) domains. CONCLUSIONS Early SARS-CoV-2 exposure may impact neurodevelopment, especially among infants exposed in utero to symptomatic gestational parents. Vaccination and other precautions to reduce early-in-life infection may protect against neurodevelopmental delays. Children with early SARS-CoV-2 exposure should have additional longitudinal screening for neurodevelopmental delays.
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Affiliation(s)
- Sarah B Mulkey
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States; Department of Neurology, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20037, United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20037, United States.
| | - Meagan E Williams
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
| | - Nadia Jadeed
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
| | - Anqing Zhang
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
| | - Smitha Israel
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
| | - Roberta L DeBiasi
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20037, United States; Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20037, United States
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Kwolek EM. Does the light at the end of the tunnel shine for everyone? The need for early paediatric participation in vaccine trials during infectious pandemics. CLINICAL ETHICS 2022; 17:346-351. [PMID: 36471720 PMCID: PMC9659690 DOI: 10.1177/14777509211036661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
While most of the mortality associated with severe acute respiratory syndrome coronavirus 2 has been in elderly populations and adults with significant medical comorbidities, there has been death and morbidity in paediatric populations. As vaccine trial data is released to the public, many people look to the future with hope ; with good vaccine uptake there is the opportunity to reduce the spread of infectious pandemics. Initial vaccine trials were completed with adults and were expanded to include paediatric populations delaying paediatric COVID-19 vaccine initiatives. The exclusion of children from initial vaccine trials during a pandemic is not morally justifiable and fosters distrust with the pharmaceutical and medical industries and inevitably postpones vaccinating children when there is a surplus of available vaccines. The delayed vaccination of children under twelve may have significant public health and economic consequences as there may be ongoing viral transmission in the context of reopening strategies. The safety and efficacy of these candidate vaccines in children should be assessed expeditiously so that distribution to vulnerable paediatric populations is not impacted. Vaccine uptake compliance in the general population is important in establishing herd immunity and ensuring that there is thorough scientific evidence to support vaccination for children is important in establishing community trust.
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Affiliation(s)
- Erin M Kwolek
- Alberta Children’s Hospital, Canada
- Cumming School of Medicine, University
of Calgary, Canada
- Columbia University in the City of New
York, USA
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Understanding Influenza and SARS-CoV-2 Vaccine Hesitancy in Racial and Ethnic Minority Caregivers. Vaccines (Basel) 2022; 10:vaccines10111968. [PMID: 36423063 PMCID: PMC9697963 DOI: 10.3390/vaccines10111968] [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: 09/15/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: We compared influenza and SARS-CoV-2 vaccine hesitancy levels in Black, Hispanic, and White parents/caregivers and identified barriers and facilitators to vaccine acceptance. (2) Methods: This was a mixed methods study. A cross-sectional survey of ED caregivers presenting with children 6mo−18yo compared vaccine hesitancy levels among diverse caregivers. Six focus groups of survey participants, stratified by caregiver race/ethnicity and caregiver intent to receive SARS-CoV-2 vaccine, assessed facilitators and barriers of vaccination, with thematic coding using the Consolidated Framework for Implementation Research (CFIR). (3) Results: Surveys (n = 589) revealed Black caregivers had significantly higher vaccine hesitancy rates than White caregivers for pediatric influenza (42% versus 21%) and SARS-CoV-2 (63% versus 36%; both p < 0.05). Hispanic caregivers were more hesitant than White caregivers (37% flu and 58% SARS-CoV-2), but this was not significant. Qualitative analysis (n = 23 caregivers) identified barriers including vaccine side effects, lack of necessity, inadequate data/science, and distrust. Facilitators included vaccine convenience, fear of illness, and desire to protect others. (4) Conclusions: Minority caregivers reported higher levels of vaccine hesitancy for influenza and SARS-CoV-2. We identified vaccine facilitators and barriers inclusive of Black and Hispanic caregivers, which may guide interventions designed to equitably improve acceptance of pediatric vaccines.
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Clinical and Epidemiological Presentation of COVID-19 among Children in Conflict Setting. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111712. [PMID: 36360440 PMCID: PMC9688921 DOI: 10.3390/children9111712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
Background: This study aims to describe the observable symptoms of children with COVID-19 infection and analyze access to real-time polymerase chain reaction (RT-PCR) testing among children seeking care in Yemen. Method: In the period of March 2020−February 2022, data were obtained from 495 children suspected to have been infected with COVID-19 (from a larger register of 5634 patients) from the Diseases Surveillance and Infection Control Department at the Ministry of Public Health and Population in Aden, Yemen. Results: Overall, 21.4% of the children with confirmed COVID-19 infection were asymptomatic. Fever (71.4%) and cough (67.1%) were the most frequently reported symptoms among children, and children were less likely to have fever (p < 0.001), sore throat (p < 0.001) and cough (p < 0.001) compared to adults. A lower frequency of COVID-19-associated symptoms was reported among children with positive RT-PCR tests compared to children with negative tests. A lower rate of testing was conducted among children (25%) compared to adults (61%). Fewer tests were carried out among children <5 years (11%) compared to other age groups (p < 0.001), for children from other nationalities (4%) compared to Yemeni children (p < 0.001) and for girls (21%) compared to boys (30%) (p < 0.031). Conclusion: Understanding and addressing the cause of these disparities and improving guidelines for COVID-19 screening among children will improve access to care and control of the COVID-19 pandemic.
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Hipper TJ, Popek L, Davis RK, Turchi RM, Massey PM, Lege-Matsuura J, Lubell KM, Pechta L, Briseño L, Rose DA, Chatham-Stephens K, Leeb RT, Chernak E. Communication Preferences of Parents and Caregivers of Children and Youth With Special Healthcare Needs During a Hypothetical Infectious Disease Emergency. Health Secur 2022; 20:467-478. [PMID: 36459634 DOI: 10.1089/hs.2022.0033] [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: 12/04/2022] Open
Abstract
Children and youth with special healthcare needs are at risk for severe consequences during infectious disease emergencies. Messages for parents and caregivers from trusted sources, via preferred channels, that contain the information they need, may improve health outcomes for this population. In this mixed methods study, we conducted a survey (N = 297) and 80 semistructured interviews, with 70 caregivers of children and youth and 10 young adults with special healthcare needs, between April 2018 and June 2019 in Pennsylvania. The survey presented 3 scenarios (ie, storm, disease outbreak, radiation event); the interviews included questions about storms and an outbreak. This article addresses only the disease outbreak data from each set. Participants were recruited through convenience samples from an urban tertiary care children's hospital and practices in a statewide medical home network. In this article, we summarize the preferred information sources, channels, and content needs of caregivers of children and youth with special healthcare needs during an infectious disease emergency. Nearly 84% of caregivers reported that they believe their child's doctor is the best source of information. Other preferred sources include medical experts (31%); the US Centers for Disease Control and Prevention (30%); friends, family, and neighbors (21%); and local or state health and emergency management (17%). Pediatric healthcare providers play an important role in providing information to parents and caregivers of children and youth with special healthcare needs during an infectious disease emergency. Public health agencies can establish health communication plans that integrate medical practices and other reliable sources to promote the dissemination of accurate information from trusted messengers.
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Affiliation(s)
- Thomas J Hipper
- Thomas J. Hipper, MSPH, MA, is Associate Director, Center for Public Health Readiness and Communication, and an Assistant Professor, Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Leah Popek
- Leah Popek, MPH, is Project Coordinator, Center for Public Health Readiness and Communication, Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Renee K Davis
- Renee K. Davis, MD, MPH, is Program Coordinator, Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Renee M Turchi
- Renee M. Turchi, MD, MPH, is a Clinical Professor, Dornsife School of Public Health, Drexel University, Philadelphia, PA.,Renee M. Turchi is also a Professor and Chair of Pediatrics, Drexel University College of Medicine, Philadelphia, PA
| | - Philip M Massey
- Philip M. Massey PhD, MPH, is Director and an Associate Professor, Center for Public Health and Technology, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR
| | - Jennifer Lege-Matsuura
- Jennifer Lege-Matsuura, MSLIS, is a Medical Librarian, Drexel University Libraries, Drexel University, Philadelphia, PA
| | - Keri M Lubell
- Keri M. Lubell, PhD, is a Behavioral Scientist, Centers for Disease Control and Prevention, Atlanta, GA
| | - Laura Pechta
- Laura Pechta, PhD, is a Senior Health Communication Specialist, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa Briseño
- Lisa Briseño, MS, is a Health Communication Specialist, Emergency Risk Communication Branch, Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dale A Rose
- Dale A. Rose, PhD, MSc, is Deputy Director, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin Chatham-Stephens
- Kevin Chatham-Stephens, MD, MPH, is Children's Preparedness Unit Lead, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rebecca T Leeb
- Rebecca T. Leeb, PhD, is a Health Scientist/Epidemiologist, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Esther Chernak
- Esther Chernak MD, MPH, is Director, Center for Public Health Readiness and Communication, Dornsife School of Public Health, Drexel University, Philadelphia, PA.,Esther Chernak is also a Professor, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
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Kwon RH, Jung M. Associations Between Conventional Healthy Behaviors and Social Distancing During the COVID-19 Pandemic: Evidence From the 2020 Community Health Survey in Korea. J Prev Med Public Health 2022; 55:568-577. [PMID: 36475322 DOI: 10.3961/jpmph.22.351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Many studies have shown that social distancing, as a non-pharmaceutical intervention (NPI) that is one of the various measures against coronavirus disease 2019 (COVID-19), is an effective preventive measure to suppress the spread of infectious diseases. This study explored the relationships between traditional health-related behaviors in Korea and social distancing practices during the COVID-19 pandemic. METHODS Data were obtained from the 2020 Community Health Survey conducted by the Korea Disease Control and Prevention Agency (n=98 149). The dependent variable was the degree of social distancing practice to cope with the COVID-19 epidemic. Independent variables included health-risk behaviors and health-promoting behaviors. The moderators were vaccination and unmet medical needs. Predictors affecting the practice of social distancing were identified through hierarchical multiple logistic regression analysis. RESULTS Smokers (adjusted odds ratio [aOR], 0.924) and frequent drinkers (aOR, 0.933) were more likely not to practice social distancing. A greater degree of physical activity was associated with a higher likelihood of practicing social distancing (aOR, 1.029). People who were vaccinated against influenza were more likely to practice social distancing than those who were not (aOR, 1.150). However, people with unmet medical needs were less likely to practice social distancing than those who did not experience unmet medical needs (aOR, 0.757). CONCLUSIONS Social distancing practices were related to traditional health behaviors such as smoking, drinking, and physical activity. Their patterns showed a clustering effect of health inequality. Therefore, when establishing a strategy to strengthen social distancing, a strategy to protect the vulnerable should be considered concomitantly.
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Affiliation(s)
- Rang Hee Kwon
- Department of Health Science, Dongduk Women's University College of Natural Science, Seoul, Korea
| | - Minsoo Jung
- Department of Health Science, Dongduk Women's University College of Natural Science, Seoul, Korea.,Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
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Zambrano LD, Ly KN, Link-Gelles R, Newhams MM, Akande M, Wu MJ, Feldstein LR, Tarquinio KM, Sahni LC, Riggs BJ, Singh AR, Fitzgerald JC, Schuster JE, Giuliano JS, Englund JA, Hume JR, Hall MW, Osborne CM, Doymaz S, Rowan CM, Babbitt CJ, Clouser KN, Horwitz SM, Chou J, Patel MM, Hobbs C, Randolph AG, Campbell AP. Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection. Pediatr Infect Dis J 2022; 41:891-898. [PMID: 36102740 PMCID: PMC9555608 DOI: 10.1097/inf.0000000000003689] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complication that has disproportionately affected racial/ethnic minority children. We conducted a pilot study to investigate risk factors for MIS-C aiming to understand MIS-C disparities. METHODS This case-control study included MIS-C cases and SARS-CoV-2-positive outpatient controls less than 18 years old frequency-matched 4:1 to cases by age group and site. Patients hospitalized with MIS-C were admitted between March 16 and October 2, 2020, across 17 pediatric hospitals. We evaluated race, ethnicity, social vulnerability index (SVI), insurance status, weight-for-age and underlying medical conditions as risk factors using mixed effects multivariable logistic regression. RESULTS We compared 241 MIS-C cases with 817 outpatient SARS-CoV-2-positive at-risk controls. Cases and controls had similar sex, age and U.S. census region distribution. MIS-C patients were more frequently previously healthy, non-Hispanic Black, residing in higher SVI areas, and in the 95th percentile or higher for weight-for-age. In the multivariable analysis, the likelihood of MIS-C was higher among non-Hispanic Black children [adjusted odds ratio (aOR): 2.07; 95% CI: 1.23-3.48]. Additionally, SVI in the 2nd and 3rd tertiles (aOR: 1.88; 95% CI: 1.18-2.97 and aOR: 2.03; 95% CI: 1.19-3.47, respectively) were independent factors along with being previously healthy (aOR: 1.64; 95% CI: 1.18-2.28). CONCLUSIONS In this study, non-Hispanic Black children were more likely to develop MIS-C after adjustment for sociodemographic factors, underlying medical conditions, and weight-for-age. Investigation of the potential contribution of immunologic, environmental, and other factors is warranted.
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Affiliation(s)
- Laura D. Zambrano
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen N. Ly
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Link-Gelles
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Margaret M. Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Manzilat Akande
- Department of Pediatrics-Section of Critical Care, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Michael J. Wu
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leora R. Feldstein
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Keiko M. Tarquinio
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Leila C. Sahni
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Immunization Project, Houston, Texas
| | - Becky J. Riggs
- Department of Anesthesiology and Critical Care Medicine; Division of Pediatric Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Aalok R. Singh
- Pediatric Critical Care Division, Maria Fareri Children’s Hospital at Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Julie C. Fitzgerald
- Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Disease, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | - John S. Giuliano
- Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut
| | - Janet A. Englund
- Department of Pediatrics, School of Medicine, Seattle Children’s Research Institute, University of Washington, Seattle, Washington
| | - Janet R. Hume
- Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Mark W. Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Christina M. Osborne
- Department of Pediatrics, Sections of Critical Care Medicine and Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Sule Doymaz
- Division of Pediatric Critical Care, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Courtney M. Rowan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher J. Babbitt
- Division of Pediatric Critical Care Medicine, Miller Children’s and Women’s Hospital of Long Beach, Long Beach, California
| | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Steven M. Horwitz
- Department of Pediatrics, Division of Critical Care, Bristol-Myers Squibb Children’s Hospital, New Brunswick, New Jersey
| | - Janet Chou
- Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Departments of
| | - Manish M. Patel
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Charlotte Hobbs
- Pediatrics
- Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Adrienne G. Randolph
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Departments of
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Angela P. Campbell
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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Yu AG, Hall M, Agharokh L, Lee BC, Zaniletti I, Wilson KM, Williams DJ. Hospital-Level Neighborhood Opportunity and Rehospitalization for Common Diagnoses at US Children's Hospitals. Acad Pediatr 2022; 22:1459-1467. [PMID: 35728729 DOI: 10.1016/j.acap.2022.05.008] [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] [Received: 12/13/2021] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Neighborhood conditions influence child health outcomes, but data examining association between local factors and hospital utilization are lacking. We determined if hospitals' mix of patients by neighborhood opportunity correlates with rehospitalization for common diagnoses at US children's hospitals. METHODS We analyzed all discharges in 2018 for children ≤18 years at 47 children's hospitals for 14 common diagnoses. The exposure was hospital-level mean neighborhood opportunity - measured by Child Opportunity Index (COI) - for each diagnosis. The outcome was same-cause rehospitalization within 365 days. We measured association via Pearson correlation coefficient. For diagnoses with significant associations, we also examined shorter rehospitalization time windows and compared unadjusted and COI-adjusted rehospitalization rates. RESULTS There were 256,871 discharges included. Hospital-level COI ranged from 17th to 70th percentile nationally. Hospitals serving lower COI neighborhoods had more frequent rehospitalization for asthma (ρ -0.34 [95% confidence interval -0.57, -0.06]) and diabetes (ρ -0.33 [-0.56, -0.04]), but fewer primary mental health rehospitalizations (ρ 0.47 [0.21, 0.67]). There was no association for 11 other diagnoses. Secondary timepoint analysis revealed increasing correlation over time, with differences by diagnosis. Adjustment for hospital-level COI resulted in 26%, 32%, and 45% of hospitals changing >1 decile in rehospitalization rank order for diabetes, asthma, and mental health diagnoses, respectively. CONCLUSIONS Children's hospitals vary widely in their mix of neighborhoods served. Asthma, diabetes, and mental health rehospitalization rates correlate with COI, suggesting that neighborhood factors may influence outcome disparities for these conditions. Hospital outcomes may be affected by neighborhood opportunity, which has implications for benchmarking.
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Affiliation(s)
- Andrew G Yu
- Division of Hospital Medicine, Department of Pediatrics (AG Yu, L Agharokh and BC Lee), University of Texas Southwestern Medical Center and Children's Health, Dallas, Tex.
| | - Matt Hall
- Children's Hospital Association (M Hall and I Zaniletti), Lenexa, Kans
| | - Ladan Agharokh
- Division of Hospital Medicine, Department of Pediatrics (AG Yu, L Agharokh and BC Lee), University of Texas Southwestern Medical Center and Children's Health, Dallas, Tex
| | - Benjamin C Lee
- Division of Hospital Medicine, Department of Pediatrics (AG Yu, L Agharokh and BC Lee), University of Texas Southwestern Medical Center and Children's Health, Dallas, Tex
| | | | - Karen M Wilson
- Department of Pediatrics (KM Wilson), University of Rochester Medical Center, Rochester, NY
| | - Derek J Williams
- Division of Hospital Medicine, Department of Pediatrics (DJ Williams), Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
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Akil L, Barner YM, Bisht A, Okoye E, Ahmad HA. COVID-19 Incidence and Death Rates in the Southern Region of the United States: A Racial and Ethnic Association. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13990. [PMID: 36360871 PMCID: PMC9657288 DOI: 10.3390/ijerph192113990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
The SARS-CoV-2 virus responsible for the COVID-19 pandemic continues to spread worldwide, with over half a billion cases linked to over 6 million deaths globally. COVID-19 has impacted populations unequally based on income, age, race, sex, and geographical location. This study aimed to characterize COVID-19 incidence and death rate trends in six states of the southern region of the USA and to understand the demographic and racial differences in its incidence and death rates. Data for the study were collected from the COVID-19 Data tracker of the Centers for Disease Control and Prevention for the following southern states: Alabama (AL), Florida (FL), Georgia (GA), Louisiana (LA), Mississippi (MS), and Tennessee (TN). The results showed a significant geographical variation in the COVID-19 cases and related deaths. Significant variations in COVID-19 cases and death rates were observed among different races and ethnic groups. The highest number of COVID-19 cases were observed among the Hispanic and Black populations, and the highest death rates were found among non-Hispanic Blacks and Whites. The southern states included in this paper showed a high number of COVID-19 cases and high death rates during the study period. These increased rates may result from the low socioeconomic status and large minority populations.
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Affiliation(s)
- Luma Akil
- Department of Behavioral and Environmental Health, School of Public Health, College of Health Science, Jackson State University, Jackson, MS 39217, USA
| | - Yalanda M. Barner
- Department of Health Policy and Management, School of Public Health, College of Health Science, Jackson State University, Jackson, MS 39217, USA
| | - Anamika Bisht
- Department of Behavioral and Environmental Health, School of Public Health, College of Health Science, Jackson State University, Jackson, MS 39217, USA
| | - Ebele Okoye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Science, Jackson State University, Jackson, MS 39217, USA
| | - Hafiz Anwar Ahmad
- Department of Biology, College of Science, Engineering, and Technology, Jackson State University, Jackson, MS 39217, USA
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Mietus-Snyder M, Suslovic W, Delaney M, Playford MP, Ballout RA, Barber JR, Otvos JD, DeBiasi RL, Mehta NN, Remaley AT. Changes in HDL cholesterol, particles, and function associate with pediatric COVID-19 severity. Front Cardiovasc Med 2022; 9:1033660. [PMID: 36312284 PMCID: PMC9597312 DOI: 10.3389/fcvm.2022.1033660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Myriad roles for high-density lipoprotein (HDL) beyond atheroprotection include immunologic functions implicated in the severity of coronavirus disease-2019 (COVID-19) in adults. We explored whether there is an association between HDL and COVID-19 severity in youth. Methods A pediatric cohort (N = 102), who tested positive for COVID-19 across a range of disease manifestations from mild or no symptoms, to acute severe symptoms, to the multisystem inflammatory syndrome of children (MIS-C) was identified. Clinical data were collected from the medical record and reserve plasma aliquots were assessed for lipoproteins by NMR spectroscopy and assayed for HDL functional cholesterol efflux capacity (CEC). Findings were compared by COVID-19 status and symptom severity. Lipoprotein, NMR spectroscopy and CEC data were compared with 30 outpatient COVID negative children. Results Decreasing HDL cholesterol (HDL-c), apolipoprotein AI (ApoA-I), total, large and small HDL particles and HDL CEC showed a strong and direct linear dose-response relationship with increasing severity of COVID-19 symptoms. Youth with mild or no symptoms closely resembled the uninfected. An atypical lipoprotein that arises in the presence of severe hepatic inflammation, lipoprotein Z (LP-Z), was absent in COVID-19 negative controls but identified more often in youth with the most severe infections and the lowest HDL parameters. The relationship between HDL CEC and symptom severity and ApoA-I remained significant in a multiply adjusted model that also incorporated age, race/ethnicity, the presence of LP-Z and of GlycA, a composite biomarker reflecting multiple acute phase proteins. Conclusion HDL parameters, especially HDL function, may help identify youth at risk of more severe consequences of COVID-19 and other novel infectious pathogens.
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Affiliation(s)
- Michele Mietus-Snyder
- Children's National Hospital, Washington, DC, United States
- The Children's National Clinical and Translational Science Institute, Washington, DC, United States
- Division of Cardiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | | | - Meghan Delaney
- Children's National Hospital, Washington, DC, United States
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
- Division of Clinical and Laboratory Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - Martin P. Playford
- Cardiovascular and Pulmonary Branch, National Institutes of Health, Bethesda, MD, United States
| | - Rami A. Ballout
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - John R. Barber
- The Children's National Clinical and Translational Science Institute, Washington, DC, United States
| | - James D. Otvos
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Roberta L. DeBiasi
- Children's National Hospital, Washington, DC, United States
- The Children's National Clinical and Translational Science Institute, Washington, DC, United States
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
- Division of Infectious Diseases, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - Nehal N. Mehta
- Cardiovascular and Pulmonary Branch, National Institutes of Health, Bethesda, MD, United States
| | - Alan T. Remaley
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
- Clinical Center, Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, United States
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Dragano N, Dortmann O, Timm J, Mohrmann M, Wehner R, Rupprecht CJ, Scheider M, Mayatepek E, Wahrendorf M. Association of Household Deprivation, Comorbidities, and COVID-19 Hospitalization in Children in Germany, January 2020 to July 2021. JAMA Netw Open 2022; 5:e2234319. [PMID: 36190730 PMCID: PMC9530965 DOI: 10.1001/jamanetworkopen.2022.34319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Adults in disadvantaged socioeconomic positions have elevated risks of a severe course of COVID-19, but it is unclear whether this holds true for children. OBJECTIVE To investigate whether young people from disadvantaged households have a higher risk of COVID-19 hospitalization and whether differences were associated with comorbidities that predispose children to severe courses. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included all children and adolescents (aged 0-18 years) who were enrolled in a statutory health insurance carrier in Germany during the observation period of January 1, 2020, to July 13, 2021. Logistic regressions were calculated to compare children from households with and without an indication of poverty. Age, sex, days under observation, nationality, and comorbidities (eg, obesity, diabetes) were controlled for to account for explanatory factors. EXPOSURES Disadvantage on the household level was assessed by the employment status of the insurance holder (ie, employed, long- or short-term unemployed, low-wage employment, economically inactive). Socioeconomic characteristics of the area of residence were also assessed. MAIN OUTCOMES AND MEASURES Daily hospital diagnoses of COVID-19 (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes U07.1 and U07.2) were recorded. Comorbidities were assessed using inpatient and outpatient diagnoses contained in the insurance records. RESULTS A total of 688 075 children and adolescents were included, with a mean (SD) age of 8.3 (5.8) years and 333 489 (48.4%) female participants. COVID-19 hospital diagnosis was a rare event (1637 participants [0.2%]). Children whose parents were long-term unemployed were 1.36 (95% CI, 1.22-1.51) times more likely than those with employed parents to be hospitalized. Elevated odds were also found for children whose parents had low-wage employment (odds ratio, 1.29; 95% CI, 1.05-1.58). Those living in low-income areas had 3.02 (95% CI, 1.73-5.28) times higher odds of hospitalization than those in less deprived areas. Comorbidities were associated with hospitalization, but their adjustment did not change main estimates for deprivation. CONCLUSIONS AND RELEVANCE In this cohort study, children who had parents who were unemployed and those who lived in low-income areas were at higher risk of COVID-19 hospitalization. This finding suggests that attention must be paid to children with SARS-CoV-2 from vulnerable families and closer monitoring should be considered. A number of explanatory factors, including comorbidities, were taken into account, but their analysis yielded no clear picture about underlying processes.
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Affiliation(s)
- Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Germany
| | - Olga Dortmann
- Department of Health Management, Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, Duesseldorf, Germany
| | - Jörg Timm
- Institute of Virology, Heinrich Heine University, University Hospital and Medical Faculty, University of Duesseldorf, Germany
| | - Matthias Mohrmann
- Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, Duesseldorf, Germany
| | - Rosemarie Wehner
- Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, Duesseldorf, Germany
| | - Christoph J. Rupprecht
- Department of Health Policy and Health Economics, Allgemeine Ortskrankenkasse Rhineland/Hamburg – Die Gesundheitskasse, Duesseldorf, Germany
| | - Maria Scheider
- Department of Health Management, Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, Duesseldorf, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Duesseldorf, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Morten Wahrendorf
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Germany
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Asfaw A. Racial Disparity in Potential Occupational Exposure to COVID-19. J Racial Ethn Health Disparities 2022; 9:1726-1739. [PMID: 34351611 PMCID: PMC8340801 DOI: 10.1007/s40615-021-01110-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nationwide, as of 20 June 2021, COVID-19 has claimed more than 599,000 lives and infected nearly 33 million people. Studies have shown that COVID-19 disproportionately affects some racial and ethnic minority groups. This study examined whether certain racial and ethnic groups were overrepresented in occupations with potentially high COVID-19 exposure risks, relative to their share in the total workforce. The study incorporates white collar workers, who to date have not gotten as much attention in terms of workers safety. METHODS Using the March and April 2020 Current Population Survey and O*Net data, this study examined whether certain racial and ethnic groups were overrepresented in occupations with potentially high risk of exposure to COVID-19 (exposure to disease and infection at work, inability to maintain physical distancing at work, and inability to work from home) relative to their share in the total workforce. RESULTS The results showed that Black workers were overrepresented in occupations with high potential risk of exposure to disease and infection at work and inability to maintain physical distancing at work. Hispanic workers were overrepresented in occupations where potential risk of inability to work from home was the highest. CONCLUSION Occupation can be one of the risk factors for the current disproportionately high COVID-19 infection rates among Black and Hispanic workers. COVID-19-related prevention measures at high risk occupations, including providing adequate personal protective equipment, training, working space, and vaccinations, could help to reduce not only the spread of COVID-19 and infectious diseases but also their disproportionately high impact in certain minority racial and ethnic groups.
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Affiliation(s)
- Abay Asfaw
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Economic Research and Support Office (ERSO), 395 E Street, SW, Washington, DC, 20201, USA.
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43
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Banerjee T, Paul A, Srikanth V, Strümke I. Causal connections between socioeconomic disparities and COVID-19 in the USA. Sci Rep 2022; 12:15827. [PMID: 36138106 PMCID: PMC9499932 DOI: 10.1038/s41598-022-18725-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022] Open
Abstract
With the increasing use of machine learning models in computational socioeconomics, the development of methods for explaining these models and understanding the causal connections is gradually gaining importance. In this work, we advocate the use of an explanatory framework from cooperative game theory augmented with do calculus, namely causal Shapley values. Using causal Shapley values, we analyze socioeconomic disparities that have a causal link to the spread of COVID-19 in the USA. We study several phases of the disease spread to show how the causal connections change over time. We perform a causal analysis using random effects models and discuss the correspondence between the two methods to verify our results. We show the distinct advantages a non-linear machine learning models have over linear models when performing a multivariate analysis, especially since the machine learning models can map out non-linear correlations in the data. In addition, the causal Shapley values allow for including the causal structure in the variable importance computed for the machine learning model.
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Affiliation(s)
- Tannista Banerjee
- Department of Economics, Auburn University, 140 Miller Hall, Auburn, AL, 36849, USA
| | - Ayan Paul
- DESY, Notkestraße 85, 22607, Hamburg, Germany. .,Institut für Physik, Humboldt-Universität zu Berlin, 12489, Berlin, Germany.
| | - Vishak Srikanth
- BASIS Independent Silicon Valley, San Jose, CA, USA.,Stanford Online High School, Stanford, CA, USA
| | - Inga Strümke
- Department of Engineering Cybernetics, NTNU, 7034, Trondheim, Norway.,Department of Holistic Systems, SimulaMet, 0167, Oslo, Norway
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Brinkmann F, Diebner HH, Matenar C, Schlegtendal A, Eitner L, Timmesfeld N, Maier C, Lücke T. Seroconversion rate and socio-economic and ethnic risk factors for SARS-CoV-2 infection in children in a population-based cohort, Germany, June 2020 to February 2021. Euro Surveill 2022; 27. [PMID: 36111557 PMCID: PMC9479468 DOI: 10.2807/1560-7917.es.2022.27.37.2101028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Socio-economic and ethnic background have been discussed as possible risk factors for SARS-CoV-2 infections in children. Improved knowledge could lead to tailored prevention strategies and help improve infection control. Aim We aimed to identify risk factors for SARS-CoV-2 infections in children in the first and second wave of the pandemic. Methods We performed an observational population-based cohort study in children (6 months–18 years) scheduled for legally required preventive examination and their parents in a metropolitan region in Germany. Primary endpoint was the SARS-CoV-2 seroconversion rate during the study period. Risk factors assessed included age, pre-existing medical conditions, socio-economic factors and ethnicity. Results We included 2,124 children and their parents. Seroconversion rates among children in all age groups increased 3–4-fold from June 2020 to February 2021. Only 24 of 58 (41%) seropositive children reported symptoms. In 51% of infected children, at least one parent was also SARS-CoV-2-positive. Low level of parental education (OR = 3.13; 95% CI: 0.72–13.69) non-significantly increased the risk of infection. Of the total cohort, 38.5% had a migration background, 9% of Turkish and 5% of Middle Eastern origin, and had the highest risk for SARS-CoV-2 infections (OR = 6.24; 95% CI: 1.38–28.12 and OR = 6.44 (95% CI: 1.14–36.45) after adjustment for other risk factors. Conclusion In the second half of 2020, seroprevalence for SARS-CoV-2 in children increased especially in families with lower-socioeconomic status. Culture-sensitive approaches are essential to limit transmission and could serve as a blueprint for vaccination strategies.
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Affiliation(s)
- Folke Brinkmann
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Hans H Diebner
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | - Chantal Matenar
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Anne Schlegtendal
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Lynn Eitner
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | - Christoph Maier
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thomas Lücke
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
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45
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Mudd P, Romero N, Behzadpour H, Xu Q, Rana MS, Gitman L, Preciado D, Karkanitsa M, Spathies J, Sadtler K, Kalish H, Schwartzberg PL, Manthiram K. Examining multi‐level immune response to determine prevalence of
COVID
‐19 in pediatric tonsillectomy. Laryngoscope 2022. [PMID: 36102311 PMCID: PMC9538220 DOI: 10.1002/lary.30382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Pamela Mudd
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
- Department of Surgery, Division of Otolaryngology The George Washington University Washington DC USA
| | - Nahir Romero
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
- Department of Surgery, Division of Otolaryngology The George Washington University Washington DC USA
| | - Hengameh Behzadpour
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
| | - Qin Xu
- National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda Maryland USA
| | - Md Sohel Rana
- Division of Surgery Children's National Hospital Washington DC USA
| | - Lyuba Gitman
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
- Department of Surgery, Division of Otolaryngology The George Washington University Washington DC USA
| | - Diego Preciado
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
- Department of Surgery, Division of Otolaryngology The George Washington University Washington DC USA
| | - Maria Karkanitsa
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Bethesda Maryland USA
| | - Jacquelyn Spathies
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Bethesda Maryland USA
| | - Kaitlyn Sadtler
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Bethesda Maryland USA
| | - Heather Kalish
- Trans‐NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Bethesda Maryland USA
| | - Pamela L. Schwartzberg
- National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda Maryland USA
| | - Kalpana Manthiram
- National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda Maryland USA
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Tyris J, Boggs K, Bost J, Dixon G, Gayle T, Harahsheh AS, Sharron MP, Majumdar S, Krishnan A, Smith K, Goyal MK, Parikh K. Examining the Association Between MIS-C and the Child Opportunity Index at a Single Center. Hosp Pediatr 2022; 12:e342-e348. [PMID: 36082611 DOI: 10.1542/hpeds.2022-006524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe associations between the Child Opportunity Index (COI) and multisystem inflammatory syndrome of childhood (MIS-C) diagnosis among hospitalized children. METHODS We used a retrospective case control study design to examine children ≤21 years hospitalized at a single, tertiary care children's hospital between March 2020 and June 2021. Our study population included children diagnosed with MIS-C (n = 111) and a control group of children hospitalized for MIS-C evaluation who had an alternative diagnosis (n = 61). Census tract COI was the exposure variable, determined using the patient's home address mapped to the census tract. Our outcome measure was MIS-C diagnosis. Odds ratios measured associations between COI and MIS-C diagnosis. RESULTS Our study population included 111 children diagnosed with MIS-C and 61 children evaluated but ruled out for MIS-C. The distribution of census tract overall COI differed significantly between children diagnosed with MIS-C compared with children with an alternate diagnosis (P = .03). Children residing in census tracts with very low to low overall COI (2.82, 95% confidence interval [CI]: 1.29-6.17) and very low to low health/environment COI (4.69, 95% CI 2.21-9.97) had significantly higher odds of being diagnosed with MIS-C compared with children living in moderate and high to very high COI census tracts, respectively. CONCLUSION Census tract child opportunity is associated with MIS-C diagnosis among hospitalized children suggesting an important contribution of place-based determinants in the development of MIS-C.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Kaitlyn Boggs
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Gabrina Dixon
- Division of Hospital Medicine.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Tamara Gayle
- Division of Hospital Medicine.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Ashraf S Harahsheh
- Division of Cardiology.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matthew P Sharron
- Division of Critical Care Medicine.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Suvankar Majumdar
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Anita Krishnan
- Division of Cardiology.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Karen Smith
- Division of Hospital Medicine.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Kavita Parikh
- Division of Hospital Medicine.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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47
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Britto SL, Qian J, Ihekweazu FD, Kellermayer R. Racial and Ethnic Variation in Presentation, Diagnosis, Treatment, and Outcome of Pediatric Crohn Disease: A Single Center Study. J Pediatr Gastroenterol Nutr 2022; 75:313-319. [PMID: 35687587 DOI: 10.1097/mpg.0000000000003516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Disparities in health care for racial/ethnic minority children in the United States who are burdened by pediatric Crohn's disease (PCD) are not well understood. METHODS A retrospective review of the Texas Children's Hospital ImproveCareNow database from 2007 to 2015 was performed. CD patients with a minimum of 2-year follow-up were included if the onset of symptoms attributable to inflammatory bowel disease was clearly documented. We primarily aimed to identify race and ethnicity associations in diagnostic delay, presentation, treatment, and 2-year outcomes. We also examined early versus late diagnosis (ie, over 6 months from disease onset) associations with these variables unrelated to race/ethnicity. RESULTS One hundred and sixty-six PCD patients [57.8% non-Hispanic White (NH-White), 18.1% African American (AA), and 15.7% Hispanic] met selection criteria. Time to diagnosis was shorter in Hispanic patients ( P < 0.01) and they were older at diagnosis than NH-White patients ( P = 0.0164). AA patients (33%, P < 0.01) and Hispanic patients (35%, P < 0.05) had lower rates of granuloma detection than NH-White patients (63%). AA patients had lower rates of steroid-free remission (SFR) at 2 years than NH-White patients ( P < 0.05). Higher ESR and lower hemoglobin levels were associated with early diagnosis ( P < 0.01). Early diagnosis was associated with higher rates of surgery within 2 years of diagnosis ( P < 0.05). Diagnostic fecal calprotectin levels inversely associated with SFR at 2 years ( P < 0.05). Early use of biologics positively, and early use of corticosteroids negatively correlated with 2-year SFR ( P < 0.05). CONCLUSIONS Race and ethnicity may influence the diagnosis, treatment, and outcomes of PCD. This recognition presents a nidus toward establishing equity in PCD care.
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Affiliation(s)
- Savini Lanka Britto
- From the Section of Pediatric Gastroenterology, Texas Children's Hospital Baylor College of Medicine, Houston, TX
| | - Justin Qian
- From the Section of Pediatric Gastroenterology, Texas Children's Hospital Baylor College of Medicine, Houston, TX
| | - Faith Dorsey Ihekweazu
- From the Section of Pediatric Gastroenterology, Texas Children's Hospital Baylor College of Medicine, Houston, TX
| | - Richard Kellermayer
- From the Section of Pediatric Gastroenterology, Texas Children's Hospital Baylor College of Medicine, Houston, TX.,the USDA/ARS Children's Nutrition Research Center, Houston, TX
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48
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Sebastian T, Carlson JJ, Gaensbauer J, Podewils LJ. Epidemiology and Transmission Dynamics of COVID-19 in an Urban Pediatric US Population. Public Health Rep 2022; 137:1013-1022. [PMID: 35786113 PMCID: PMC9357825 DOI: 10.1177/00333549221105232] [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] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This analysis summarizes observational epidemiologic data and transmission dynamics of SARS-CoV-2 among people aged <18 years to better characterize the pediatric COVID-19 pandemic. METHODS We conducted a retrospective study of public health surveillance data among children in Denver, Colorado, who were reported to have COVID-19 from March 1, 2020, through September 30, 2021. We used descriptive statistics and bivariate rate ratios (RRs) to describe demographic and clinical characteristics, transmission dynamics, case trends, and ecological associations. RESULTS A total of 9815 children and adolescents who had COVID-19 were reported during the study period. Adolescents aged 14-17 years had the highest incidence rate (IR) per 1000 people (IR = 107.5; 3021 of 28 108). Hispanic/Latino children had a 1.6 times higher rate of infection than non-Hispanic White children (RR = 1.57; 95% CI, 1.50-1.65; P < .001). Few hospitalizations (n = 138, 1.4%) and deaths (n = 3, 0%) occurred. Most children were symptomatic (4487 of 5499, 81.6%). Within household clusters, a large proportion of pediatric cases (n = 6136) were a secondary case (n = 3959, 64.5%), followed by index case (n = 1170, 19.1%) and co-index case (n = 1007, 16.4%). Non-Hispanic White children had an increased risk of being an index or co-index case (RR = 1.14; 95% CI, 1.06-1.23; P < .001), while Hispanic/Latino children had an increased risk of being a secondary case (RR = 1.07; 95% CI, 1.03-1.11; P < .001). From 2020 to 2021, the association between pediatric case rates and neighborhoods with higher poverty and households with ≥3 people decreased. CONCLUSIONS Older children and those identifying as Hispanic/Latino had a disproportionate incidence of disease. A sizable proportion of children were considered index cases or co-index cases. Pediatric prevention strategies, especially vaccinations, are vital for pandemic control.
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Affiliation(s)
- Thresia Sebastian
- Department of Pediatrics, Denver Health
and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of
Colorado School of Medicine, Aurora, CO, USA
| | - Jesse J. Carlson
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
| | - James Gaensbauer
- Department of Pediatrics, Denver Health
and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of
Colorado School of Medicine, Aurora, CO, USA
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
- School of Public Health, University of
Colorado Anschutz Medical Campus, Denver, CO, USA
- Department of Pediatrics and Adolescent
Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Laura Jean Podewils
- Public Health Institute at Denver
Health, Denver Health and Hospital Authority, Denver, CO, USA
- School of Public Health, University of
Colorado Anschutz Medical Campus, Denver, CO, USA
- Office of Research, Denver Health and
Hospital Authority, Denver, CO, USA
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49
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Treston B, Petty-Saphon N, Collins A, Murray S, Colgan A, Fitzgerald E, Hassan M, Forde K, O'Farrell A, Sayers G, Linnane N, Franklin O, McMahon C, Leahy TR, Gavin P. Multisystem Inflammatory Syndrome in the Context of Paediatric COVID-19 infection in the Republic of Ireland April 2020 to April 2021. Acta Paediatr 2022; 111:2344-2351. [PMID: 36030064 PMCID: PMC9538218 DOI: 10.1111/apa.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
Aim Our aim was to describe the epidemiology of multisystem inflammatory syndrome in children (MIS‐C) in the Republic of Ireland, in the context of all cases of COVID‐19 in children, during the first year of the SARS‐CoV‐2 pandemic. Methods Cases of MIS‐C were identified by prospective surveillance in Irish hospitals from April 2020 to April 2021. Paediatric COVID‐19 cases and outbreaks in schools or childcare facilities were notified to and routinely investigated by Public Health. Univariate and bivariate analyses were carried out in Excel, Stata and JMP statistical package. Results Fifty‐four MIS‐C cases (median age 7.58 years; males 57%) were identified over the study period. MIS‐C incidence was higher in certain ethnicities (‘black’ 21.3/100,000 [95% CI 4.3–38.4]; and ‘Irish Traveller’ 14.7/100,000 [95% CI −5.7‐35.1]) than those of ‘white’ ethnicity (3.4 /100,000). MIS‐C cases occurred in three temporal clusters, which followed three distinct waves of community COVID‐19 infection, irrespective of school closures. Formal contact tracing identified an epidemiological link with a COVID‐19‐infected family member in the majority of MIS‐C cases (77%). In contrast, investigation of COVID‐19 school outbreaks demonstrated no epidemiological link with MIS‐C cases during the study period. Conclusion Efforts at controlling SARS‐CoV‐2 transmission in the community may be a more effective means to reduce MIS‐C incidence than school closures. Establishing a mandatory reporting structure for MIS‐C will help delineate the role of risk factors such as ethnicity and obesity and the effect of vaccination on MIS‐C incidence.
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Affiliation(s)
- Bryony Treston
- CHI Crumlin and Temple Street, Department of Infectious Diseases and Immunology, Dublin, Ireland
| | | | | | | | - Aoife Colgan
- HSE, Health Protection Surveillance Centre, Dublin, Ireland
| | - Eoin Fitzgerald
- CHI Crumlin and Temple Street, Department of Infectious Diseases and Immunology, Dublin, Ireland
| | - Mahmoud Hassan
- CHI Crumlin and Temple Street, Department of Infectious Diseases and Immunology, Dublin, Ireland
| | - Karina Forde
- CHI Crumlin and Temple Street, Department of Infectious Diseases and Immunology, Dublin, Ireland
| | | | | | - Niall Linnane
- CHI Crumlin and Temple Street, Paediatric Cardiology, Dublin, Ireland
| | - Orla Franklin
- CHI Crumlin and Temple Street, Paediatric Cardiology, Dublin, Ireland
| | - Colin McMahon
- CHI Crumlin and Temple Street, Paediatric Cardiology, Dublin, Ireland
| | - Timothy R Leahy
- CHI Crumlin and Temple Street, Department of Infectious Diseases and Immunology, Dublin, Ireland.,Department of Paediatrics, University of Dublin, Trinity College
| | - Patrick Gavin
- CHI Crumlin and Temple Street, Department of Infectious Diseases and Immunology, Dublin, Ireland
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50
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Mori Y, Tanaka M, Kozai H, Hotta K, Aoyama Y, Shigeno Y, Aoike M, Kawamura H, Tsurudome M, Ito M. Prevalence of SARS-CoV-2 antibodies among university athletic club members: A cross-sectional survey. Drug Discov Ther 2022; 16:185-190. [PMID: 35989285 DOI: 10.5582/ddt.2022.01048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
School-based coronavirus disease 2019 (COVID-19) testing is an important part of a comprehensive prevention strategy in public health. To assess the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in a university athletic club community with repeated occurrences of SARS-CoV-2 infections, we conducted a cross-sectional survey for asymptomatic antibody prevalence using a SARS-CoV-2 rapid antibody test kit. On January 26, 2021 we administered questionnaires to determine their history of contact with infected individuals and took blood samples from 129 undergraduates. The prevalence of SARS-CoV-2 antibodies among the subjects was 3.9%. Only 6.2% of the participants reported close contact with infected individuals. In this study, we clarified the prevalence of asymptomatic SARS-CoV-2 antibodies in university athletic clubs where SARS-CoV-2 infections had repeatedly occurred, which will be helpful in discussing how to identify and prevent the transmission of infections within university athletic club communities.
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Affiliation(s)
- Yukihiro Mori
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan.,Center for Nursing Practicum Support, Chubu University, Aichi, Japan
| | - Mamoru Tanaka
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan
| | - Hana Kozai
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan
| | - Kiyoshi Hotta
- Center for Nursing Practicum Support, Chubu University, Aichi, Japan
| | - Yuka Aoyama
- Department of Clinical Engineering, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Yukihiro Shigeno
- Center for Emergency Medical Technician Practicum Support, Chubu University, Aichi, Japan.,The Fire Department Headquarters in Kasugai-City, Aichi, Japan
| | - Makoto Aoike
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Hatsumi Kawamura
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Masato Tsurudome
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan.,Department of Biomedical Sciences, College of Life and Health Science, Chubu University, Aichi, Japan
| | - Morihiro Ito
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan.,Department of Biomedical Sciences, College of Life and Health Science, Chubu University, Aichi, Japan
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