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Muñoz-Del-Carpio-Toia A, Bartolo-Marchena M, Benites-Zapata VA, Herrera-Añazco P. Mortality from COVID-19 in Amazonian and Andean original indigenous populations of Peru. Travel Med Infect Dis 2023; 56:102658. [PMID: 37944653 PMCID: PMC10823918 DOI: 10.1016/j.tmaid.2023.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To compare the mortality rates from COVID-19 among indigenous populations of the Amazon and Andean regions of Peru during the years 2020, 2021 and 2022. METHODS Secondary analysis of 33,567 data from the COVID-19 Notification System of the National Epidemiology Center, Prevention and Control of Diseases (CDC-Peru), from the years 2020-2022. The variables were age, sex, belonging to the Andean or Amazonian ethnic group, number and type of symptoms and risk conditions, abnormal findings in chest X-rays, year of data collection for hospitalization and death from COVID-19. Poisson family generalized linear regression models with logarithmic linkage and robust variance were used to establish differences in mortality between ethnic groups. Crude and adjusted risk ratio (RR) with 95 % confidence intervals (CI) were calculated. RESULTS 33,567 participants with an average age of 33.6 years were included, 44.4 % were men and 70.2 % belonged to the Amazonian ethnic group. Most of those affected by COVID-19 presented 2 symptoms (38.8 %), 4.8 % presented some risk condition, 1451 (4.3 %) were hospitalized, and 433 (1.3 %) died. The adjusted analysis showed that the Andean group, compared to the Amazonian, tended to have a higher probability of death, and this association was statistically significant, RR =7.6, 95 % CI (5.5-10.5). CONCLUSIONS Patients from Andean indigenous communities had an almost 8 times higher risk of death from COVID-19.
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Affiliation(s)
| | - Marco Bartolo-Marchena
- Subdirección de Medicina Tradicional, Interculturalidad e investigación social en salud del CENSI del Instituto Nacional de Salud, Lima, Peru.
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Francis J, West K. Physical Activity Message Framing and Ethnicity Before and During COVID-19. HEALTH COMMUNICATION 2023; 38:2419-2429. [PMID: 35593173 DOI: 10.1080/10410236.2022.2074344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People of Black ethnicities are well known to be disproportionately burdened by coronavirus and have poorer health outcomes. Public health messages encouraged physical activity during the pandemic as it is evidenced to positively affect the immune system, however people of Black ethnicities are often reported as failing to achieve the recommended daily amount. Health message framing during COVID-19 specifically in relation to ethnicity and physical activity motivation has yet to be investigated. Two studies examined message frame effect on physical activity motivation prior to and at the onset of the pandemic and how this differed by ethnicity. Gain framed messages were found to positively affect physical activity motivation pre-COVID-19 and during the pandemic fear framed messages were found to positively affect physical activity motivation. Neither of these effects differed by ethnicity. Implications for future physical activity health message framing are discussed.
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Affiliation(s)
| | - Keon West
- Department of Psychology, Goldsmiths, University of London
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3
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Yedjou CG, Webster S, Osborne D, Liu J, Balagurunathan Y, Odewuni C, Latinwo L, Ngnepiepa P, Alo R, Tchounwou PB. Health Promotion and Racial Disparity in COVID-19 Mortality Among African American Populations. REPORTS ON GLOBAL HEALTH RESEARCH 2023; 6:168. [PMID: 37946735 PMCID: PMC10634601 DOI: 10.29011/2690-9480.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
COVID-19, known as Coronavirus Disease 2019, is a major health issue resulting from novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Its emergence has posed a significant menace to the global medical community and healthcare system across the world. Notably, on December 12, 2020, the Food and Drug Administration (FDA) approved the utilization of the Pfizer and Moderna COVID-19 vaccines. As of July 31, 2022, the United Stated has witnessed over 91.3 million cases of COVID-19 and nearly 1.03 million fatalities. An intriguing observation is the recent reduction in the mortality rate of COVID-19, attributed to an augmented focus on early detection, comprehensive screening, and widespread vaccination. Despite this positive trend in some demographics, it is noteworthy that the overall incidence rates of COVID-19 among African American and Hispanic populations have continued to escalate, even as mortality rates have decreased. Therefore, the objective of this research study is to present an overview of COVID-19, spotlighting the disparities among different racial and ethnic groups. It also delves into the management of COVID-19 within the minority populations. To reach our research objective, we used a publicly available COVID-19 dataset from kaggle:https://www.kaggle.com/datasets/paultimothymooney/covid19-cases-and-deaths-by-race. In addition, we obtained COVID-19 datasets from 10 different states with the highest proportion of African American populations. Many considerable strikes have been made in COVID-19. However, success rate of treatment in the African American population remains relatively limited when compared to other ethnic groups. Hence, there arises a pressing need for novel strategies and innovative approaches to not only encourage prevention measures against COVID-19, but also to increase survival rates, diminish mortality rates, and ultimately improve the health outcomes of ethnic and racial minorities.
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Affiliation(s)
- Clement G Yedjou
- Department of Biological Sciences, College of Science and Technology, Florida Agricultural and Mechanical University, 1610 S. Martin Luther King Blvd, Tallahassee, FL 32307, USA
| | - Shayla Webster
- Department of Biological Sciences, College of Science and Technology, Florida Agricultural and Mechanical University, 1610 S. Martin Luther King Blvd, Tallahassee, FL 32307, USA
| | - Daniel Osborne
- Department of Mathematics, College of Science and Technology, Florida Agricultural and Mechanical University, 1610 S. Martin Luther King Blvd, Tallahassee, FL 32307, USA
| | - Jinwei Liu
- Department of Computer Science, College of Science and Technology, Florida Agricultural and Mechanical University, 1610 S. Martin Luther King Blvd, Tallahassee, FL 32307, USA
| | | | - Carolyn Odewuni
- Department of Biological Sciences, College of Science and Technology, Florida Agricultural and Mechanical University, 1610 S. Martin Luther King Blvd, Tallahassee, FL 32307, USA
| | - Lekan Latinwo
- Department of Biological Sciences, College of Science and Technology, Florida Agricultural and Mechanical University, 1610 S. Martin Luther King Blvd, Tallahassee, FL 32307, USA
| | - Pierre Ngnepiepa
- Department of Mathematics, College of Science and Technology, Florida Agricultural and Mechanical University, 1610 S. Martin Luther King Blvd, Tallahassee, FL 32307, USA
| | - Richard Alo
- Department of Computer Science, College of Science and Technology, Florida Agricultural and Mechanical University, 1610 S. Martin Luther King Blvd, Tallahassee, FL 32307, USA
| | - Paul B Tchounwou
- RCMI Center for Urban Health Disparities Research and Innovation, Morgan State University, 1700 E. Cold Spring Lane, Baltimore, MD 21252, USA
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Hua MJ, Feinglass J. Variations in COVID-19 Hospital Mortality by Patient Race/Ethnicity and Hospital Type in Illinois. J Racial Ethn Health Disparities 2023; 10:911-919. [PMID: 35257313 PMCID: PMC8900642 DOI: 10.1007/s40615-022-01279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES It is controversial whether hospital care mitigated or exacerbated population level racial and ethnic disparities in COVID-19 mortality. To begin answering that question, this study analyzed variations in COVID-19 hospital mortality in Illinois by patient race and ethnicity and by hospital characteristics, while providing an estimate of hospital-level variation in COVID-19 mortality. METHOD This is a retrospective cohort study based on hospital administrative data for adult patients with COVID-19 discharged from acute care, non-federal Illinois hospitals from April 1, 2020 through June 30, 2021. The association of patient and hospital characteristics with the likelihood of death was analyzed using multilevel logistic regression. RESULTS There were 158,569 COVID-19-coded admissions to 181 general hospitals in Illinois; 14.5% resulted in death or discharge to hospice. Hospital deaths accounted for nearly 90% of all COVID-19-associated deaths over 15 months in Illinois. After adjusting for patient- and hospital-level characteristics, Hispanic patients had higher mortality risk (aOR 1.26, 95% CI: 1.20-1.33) as compared with non-Hispanic White patients, while non-Hispanic Black patients had lower mortality risk (aOR 0.75, 95% CI: 0.71-0.79). Safety net hospitals receiving disproportionate share hospital (DSH) funds had higher mortality risk (aOR 1.81, 95% CI: 1.43-2.30) compared with other hospitals. CONCLUSION Risk-adjusted COVID-19 hospital mortality was highest among patients of Hispanic ethnicity, while non-Hispanic Black patients had lower risk than non-Hispanic White patients. There was significant variation in hospital mortality rates, with particularly high safety net hospital mortality.
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Affiliation(s)
- Miao Jenny Hua
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine & Cook County Health, Chicago, IL, USA.
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Starkweather S, DePierro JM, Akhtar S, de Guillebon E, Kaplan C, Kaplan S, Ripp J, Peccoralo L, Feingold J, Feder A, Murrough JW, Pietrzak RH. Predictors of Mental Health Service Utilization among Frontline Healthcare Workers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5326. [PMID: 37047942 PMCID: PMC10094311 DOI: 10.3390/ijerph20075326] [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: 01/24/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
(1) Background: This study examined the prevalence and correlates of factors associated with self-reported mental health service use in a longitudinal cohort of frontline health care workers (FHCWs) providing care to patients with COVID-19 throughout 2020. (2) Methods: The study comprised a two-wave survey (n = 780) administered in April-May 2020 (T1) and November 2020-January 2021 (T2) to faculty, staff, and trainees in a large urban medical center. Factors associated with initiation, cessation, or continuation of mental health care over time were examined. (3) Results: A total of 19.1% of FHCWs endorsed currently utilizing mental health services, with 11.4% continuing, 4.2% initiating, and 3.5% ceasing services between T1 and T2. Predisposing and need-related factors, most notably a history of a mental health diagnosis and distress related to systemic racism, predicted service initiation and continuation. Among FHCWs with a prior mental health history, those with greater perceived resilience were less likely to initiate treatment at T2. Descriptive data highlighted the importance of services around basic and safety needs (e.g., reliable access to personal protective equipment) relative to mental health support in the acute phase of the pandemic. (4) Conclusions: Results may be helpful in identifying FHCWs who may benefit from mental health services.
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Affiliation(s)
- Sydney Starkweather
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jonathan M. DePierro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Saadia Akhtar
- Departments of Emergency Medicine and Graduate Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Eleanore de Guillebon
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Carly Kaplan
- Departments of Emergency Medicine and Graduate Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Sabrina Kaplan
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jonathan Ripp
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Lauren Peccoralo
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jordyn Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - James W. Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- U.S. Department of Veterans Affairs National Center for PTSD, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA
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Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample. Vaccines (Basel) 2022; 10:vaccines10122036. [PMID: 36560446 PMCID: PMC9781042 DOI: 10.3390/vaccines10122036] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022] Open
Abstract
COVID-19 has brought the disparities in health outcomes for patients to the forefront. Racial and gender identity are associated with prevalent healthcare disparities. In this study, we examine the health disparities in COVID-19 hospitalization outcome from the intersectional lens of racial and gender identity. The Agency for Healthcare Research and Quality (AHRQ) 2020 NIS dataset for hospitalizations from 1 January 2020 to 31 December 2020 was analyzed for primary outcome of in-patient mortality and secondary outcomes of intubation, acute kidney injury (AKI), AKI requiring hemodialysis (HD), cardiac arrest, stroke, and vasopressor use. A multivariate regression model was used to identify associations. A p value of <0.05 was considered significant. Men had higher rates of adverse outcomes. Native American men had the highest risk of in-hospital mortality (aOR 2.0, CI 1.7−2.4) and intubation (aOR 1.8, CI 1.5−2.1), Black men had highest risk of AKI (aOR 2.0, CI 1.9−2.0). Stroke risk was highest in Asian/Pacific Islander women (aOR 1.5, p = 0.001). We note that the intersection of gender and racial identities has a significant impact on outcomes of patients hospitalized for COVID-19 in the United States with Black, Indigenous, and people of color (BIPOC) men have higher risks of adverse outcomes.
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Farcas AM, Joiner AP, Rudman JS, Ramesh K, Torres G, Crowe RP, Curtis T, Tripp R, Bowers K, von Isenburg M, Logan R, Coaxum L, Salazar G, Lozano M, Page D, Haamid A. Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review. PREHOSP EMERG CARE 2022; 27:1058-1071. [PMID: 36369725 DOI: 10.1080/10903127.2022.2142344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.
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Affiliation(s)
- Andra M Farcas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Anjni P Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jordan S Rudman
- Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Karthik Ramesh
- School of Medicine, University of California San Diego, San Diego, California
| | | | | | | | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Karen Bowers
- Atlanta Fire Rescue Department; Department of Emergency Medicine, University of Tennessee-Chattanooga, Chattanooga, Tennessee
| | - Megan von Isenburg
- Duke University Medical Center Library, Duke University, Durham, North Carolina
| | - Robert Logan
- San Diego Fire - Rescue Department, San Diego, California
| | - Lauren Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael Lozano
- Division of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Page
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ameera Haamid
- Section of Emergency Medicine, University of Chicago School of Medicine, Chicago, Illinois
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Razi A, Azimian A, Arezumand R, Solati A, Ahmadabad HN. Associations between serum levels of C3, C4, and total classical complement activity in COVID-19 patients at the time of admission and clinical outcome. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2022. [DOI: 10.15789/2220-7619-abs-1925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the present study, we investigated the association between complement system status at the time of admission and clinical outcomes in COVID-19 patients. This single-center study was carried out with sixty-one adult patients with COVID-19 who were hospitalized at Imam Hassan Hospital of North Khorasan University of Medical Sciences (Bojnurd, Iran) with less than three days passage since onset of COVID-19 symptoms. Twenty-three healthy volunteers with demographic features similar to the patient group (matched by age and gender) were included in the study as a control group. Patient information including demographic information, demographic data, clinical characteristics, and clinical outcomes were obtained from electronic medical records. Of 61 hospitalized patients with COVID-19, 28 (47.54%) were female, and the average age was 48.78.8 years. The healthy control group included 23 cases (11 (47.8%) female, 12 (52.1%) males, mean age 46.44.4 years). Twenty-one of the 61 patients (34.4%) were admitted to the ICU, and sixteen of them (26.2%) died. Thirty-three (54.10%) patients with COVID-19 were hospitalized for less than 7 days, and 28 (45.90%) of them were hospitalized for 7 days. Our results show that length of hospital stay in the no-ICU group was significantly lower than the ICU admission or death groups (6.490.24 vs. 8.851.59 and 10.531.80, p = 0.0002). The levels of C3, C4, and CH50 were determined through the immunoturbidimetric method and single-radial-haemolysis plates, respectively, on serum samples obtained from patients at the time of admission or those in the control group. Our results indicate that C3, C4 and CH50 levels were markedly lower in COVID-19 patients than in the control group. We also found that complement parameter levels in COVID-19 patients who died or were admitted to ICU were significantly lower than in non-ICU COVID-19 patients. In general, it seems that serum level of C3, C4, and CH50 at admission may predict disease progression or adverse clinical outcome in COVID-19 patients.
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Adams C, Wortley P, Chamberlain A, Lopman BA. Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic? Ann Epidemiol 2022; 72:57-64. [PMID: 35649472 PMCID: PMC9148435 DOI: 10.1016/j.annepidem.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine whether declines in the crude U.S. COVID-19 case fatality ratio is due to improved clinical care and/or other factors. METHODS We used multivariable logistic regression, adjusted for age and other individual-level characteristics, to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia reported March 2, 2020 to March 31, 2021. RESULTS Compared to August 2020, mortality risk among cases was lowest in November 2020 (OR = 0.84; 95% CI: 0.78-0.91) and remained lower until March 2021 (OR = 0.86; 95% CI: 0.77-0.95). Among hospitalized cases, mortality risk increased in December 2020 (OR = 1.16, 95% CI: 1.07-1.27) and January 2021 (OR = 1.25; 95% CI: 1.14-1.36), before declining until March 2021 (OR = 0.90, 95% CI: 0.78-1.04). CONCLUSIONS After adjusting for other factors, including the shift to a younger age distribution of cases, we observed lower mortality risk from November 2020 to March 2021 compared to August 2020 among cases. This suggests that improved clinical management may have contributed to lower mortality risk. Among hospitalized cases, mortality risk increased again in December 2020 and January 2021, but then decreased to a risk similar to that among all cases by March 2021.
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Affiliation(s)
- Carly Adams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Pascale Wortley
- HIV Epidemiology Section, Georgia Department of Public Health, State of Georgia Building, Atlanta, GA
| | - Allison Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Stephens RJ, Evans EM, Pajor MJ, Pappal RD, Egan HM, Wei M, Hayes H, Morris JA, Becker N, Roberts BW, Kollef MH, Mohr NM, Fuller BM. A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study. Crit Care 2022; 26:179. [PMID: 35705989 PMCID: PMC9198202 DOI: 10.1186/s13054-022-04042-9] [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] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes. STUDY DESIGN AND METHODS Dual-center, retrospective cohort study conducted over 6 months (March-August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of - 3 to - 5 or Riker Sedation-Agitation Scale of 1-3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days. RESULTS 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65-7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19. CONCLUSIONS The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach.
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Affiliation(s)
- Robert J. Stephens
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, Campus Box 8054, St. Louis, MO 63110 USA
| | - Erin M. Evans
- Division of Critical Care, Departments of Emergency Medicine and Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242 USA
| | - Michael J. Pajor
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, Campus Box 8054, St. Louis, MO 63110 USA
| | - Ryan D. Pappal
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Haley M. Egan
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Max Wei
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Hunter Hayes
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Jason A. Morris
- Department of Emergency Medicine, Harvard-Affiliated Emergency Medicine Residency, Mass General Brigham, Boston, MA 02115 USA
| | - Nicholas Becker
- Department of Emergency Medicine, Mount Sinai Morningside/West, New York, NY 10025 USA
| | - Brian W. Roberts
- Department of Emergency Medicine, Cooper University Hospital, One Cooper Plaza, Camden, NJ K152 USA
| | - Marin H. Kollef
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
| | - Nicholas M. Mohr
- Division of Critical Care, Departments of Emergency Medicine and Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242 USA
| | - Brian M. Fuller
- Division of Critical Care, Departments of Anesthesiology and Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110 USA
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Pineles BL, Goodman KE, Pineles L, O'Hara LM, Nadimpalli G, Magder LS, Baghdadi JD, Parchem JG, Harris AD. Pregnancy and the Risk of In-Hospital Coronavirus Disease 2019 (COVID-19) Mortality. Obstet Gynecol 2022; 139:846-854. [PMID: 35576343 PMCID: PMC9015030 DOI: 10.1097/aog.0000000000004744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/02/2022] [Accepted: 01/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate whether pregnancy is an independent risk factor for in-hospital mortality among patients of reproductive age hospitalized with coronavirus disease 2019 (COVID-19) viral pneumonia. METHODS We conducted a retrospective cohort study (April 2020-May 2021) of 23,574 female inpatients aged 15-45 years with an International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code for COVID-19 discharged from 749 U.S. hospitals in the Premier Healthcare Database. We used a viral pneumonia diagnosis to select for patients with symptomatic COVID-19. The associations between pregnancy and in-hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation were analyzed using propensity score-matched conditional logistic regression. Models were matched for age, marital status, race and ethnicity, Elixhauser comorbidity score, payer, hospital number of beds, season of discharge, hospital region, obesity, hypertension, diabetes mellitus, chronic pulmonary disease, deficiency anemias, depression, hypothyroidism, and liver disease. RESULTS In-hospital mortality occurred in 1.1% of pregnant patients and 3.5% of nonpregnant patients hospitalized with COVID-19 and viral pneumonia (propensity score-matched odds ratio [OR] 0.39, 95% CI 0.25-0.63). The frequency of ICU admission for pregnant and nonpregnant patients was 22.0% and 17.7%, respectively (OR 1.34, 95% CI 1.15-1.55). Mechanical ventilation was used in 8.7% of both pregnant and nonpregnant patients (OR 1.05, 95% CI 0.86-1.29). Among patients who were admitted to an ICU, mortality was lower for pregnant compared with nonpregnant patients (OR 0.33, 95% CI 0.20-0.57), though mechanical ventilation rates were similar (35.7% vs 38.3%, OR 0.90, 95% CI 0.70-1.16). Among patients with mechanical ventilation, pregnant patients had a reduced risk of in-hospital mortality compared with nonpregnant patients (0.26, 95% CI 0.15-0.46). CONCLUSION Despite a higher frequency of ICU admission, in-hospital mortality was lower among pregnant patients compared with nonpregnant patients with COVID-19 viral pneumonia, and these findings persisted after propensity score matching.
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Affiliation(s)
- Beth L Pineles
- Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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12
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Smith JP, Kressel AB, Grout RW, Weaver B, Cheatham M, Tu W, Li R, Crabb DW, Harris LE, Carlos WG. Poverty, Comorbidity, and Ethnicity: COVID-19 Outcomes in a Safety Net Health System. Ethn Dis 2022; 32:113-122. [PMID: 35497398 PMCID: PMC9037656 DOI: 10.18865/ed.32.2.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To determine if race-ethnicity is correlated with case-fatality rates among low-income patients hospitalized for COVID-19. Research Design Observational cohort study using electronic health record data. Patients All patients assessed for COVID-19 from March 2020 to January 2021 at one safety net health system. Measures Patient demographic and clinical characteristics, and hospital care processes and outcomes. Results Among 25,253 patients assessed for COVID-19, 6,357 (25.2%) were COVID-19 positive: 1,480 (23.3%) hospitalized; 334 (22.6%) required intensive care; and 106 (7.3%) died. More Hispanic patients tested positive (51.8%) than non-Hispanic Black (31.4%) and White patients (16.7%, P<.001]. Hospitalized Hispanic patients were younger, more often uninsured, and less likely to have comorbid conditions. Non-Hispanic Black patients had significantly more diabetes, hypertension, obesity, chronic kidney disease, and asthma (P<.05). Non-Hispanic White patients were older and had more cigarette smoking history, COPD, and cancer. Non-Hispanic White patients were more likely to receive intensive care (29.6% vs 21.1% vs 20.8%, P=.007) and more likely to die (12% vs 7.3% vs 3.5%, P<.001) compared with non-Hispanic Black and Hispanic patients, respectively. Length of stay was similar for all groups. In logistic regression models, Medicaid insurance status independently correlated with hospitalization (OR 3.67, P<.001) while only age (OR 1.076, P<.001) and cerebrovascular disease independently correlated with in-hospital mortality (OR 2.887, P=.002). Conclusions Observed COVID-19 in-hospital mortality rate was lower than most published rates. Age, but not race-ethnicity, was independently correlated with in-hospital mortality. Safety net health systems are foundational in the care of vulnerable patients suffering from COVID-19, including patients from under-represented and low-income groups.
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Affiliation(s)
- Joseph P. Smith
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep & Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
| | - Amy B. Kressel
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
| | - Randall W. Grout
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
- Regenstrief Institute, Indianapolis, IN
| | - Bree Weaver
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Megan Cheatham
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
| | - Wanzhu Tu
- Regenstrief Institute, Indianapolis, IN
- Department of Biostatistics & Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Ruohong Li
- Department of Biostatistics & Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - David W. Crabb
- Department of Medicine, Division of Gastroenterology Hepatology, Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
| | - Lisa E. Harris
- Department of Medicine, Division of General Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
| | - William G. Carlos
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep & Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN
- Eskenazi Health, Indianapolis, IN
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Prabhakaran D, Singh K, Kondal D, Raspail L, Mohan B, Kato T, Sarrafzadegan N, Talukder SH, Akter S, Amin MR, Goma F, Gomez-Mesa J, Ntusi N, Inofomoh F, Deora S, Philippov E, Svarovskaya A, Konradi A, Puentes A, Ogah OS, Stanetic B, Issa A, Thienemann F, Juzar D, Zaidel E, Sheikh S, Ojji D, Lam CSP, Ge J, Banerjee A, Newby LK, Ribeiro ALP, Gidding S, Pinto F, Perel P, Sliwa K. Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study. Glob Heart 2022; 17:40. [PMID: 35837356 PMCID: PMC9205371 DOI: 10.5334/gh.1128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low- and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle- and high-income countries (LIC, LMIC, UMIC, HIC). METHODS Through a prospective cohort study, data on demographics and pre-existing conditions at hospital admission, clinical outcomes at hospital discharge (death, major adverse cardiovascular events (MACE), renal failure, neurological events, and pulmonary outcomes), 30-day vital status, and re-hospitalization were collected. Descriptive analyses and multivariable log-binomial regression models, adjusted for age, sex, ethnicity/income groups, and clinical characteristics, were performed. RESULTS Forty hospitals from 23 countries recruited 5,313 patients with COVID-19 (LIC = 7.1%, LMIC = 47.5%, UMIC = 19.6%, HIC = 25.7%). Mean age was 57.0 (±16.1) years, male 59.4%, pre-existing conditions included: hypertension 47.3%, diabetes 32.0%, coronary heart disease 10.9%, and heart failure 5.5%. The most frequently reported cardiovascular discharge diagnoses were cardiac arrest (5.5%), acute heart failure (3.8%), and myocardial infarction (1.6%). The rate of in-hospital deaths was 12.9% (N = 683), and post-discharge 30 days deaths was 2.6% (N = 118) (overall death rate 15.1%). The most common causes of death were respiratory failure (39.3%) and sudden cardiac death (20.0%). The predictors of overall mortality included older age (≥60 years), male sex, pre-existing coronary heart disease, renal disease, diabetes, ICU admission, oxygen therapy, and higher respiratory rates (p < 0.001 for each). Compared to Caucasians, Asians, Blacks, and Hispanics had almost 2-4 times higher risk of death. Further, patients from LIC, LMIC, UMIC versus. HIC had 2-3 times increased risk of death. CONCLUSIONS The LIC, LMIC, and UMIC's have sparse data on COVID-19. We provide robust evidence on COVID-19 outcomes in these countries. This study can help guide future health care planning for the pandemic globally.
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Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation India, Centre for Chronic Disease Control, World Heart Federation, London School of Hygiene & Tropical Medicine, GB
| | - Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana, India, and Centre for Chronic Disease Control, New Delhi, IN
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | | | | | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College, Ludhiana, Punjab, IN
| | - Toru Kato
- Department of Clinical Research, National Hospital Organization Tochigi Medical Centre, JP
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, JP
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran & School of Population and Public Health, University of British Columbia, Vancouver, CA
| | | | | | | | - Fastone Goma
- Centre for Primary Care Research/Levy Mwanawasa University Teaching Hospital, Lusaka, ZM
| | - Juan Gomez-Mesa
- Head. Cardiology Service. Fundación Valle del Lili. Cali, CO
| | - Ntobeko Ntusi
- Division of Cardiology, Department of Medicine and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, ZA
| | - Francisca Inofomoh
- Internal Medicine Department, Olabisi Onabanjo University Teaching Hospital, PMB 2001, Sagamu, NG
| | - Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, IN
| | - Evgenii Philippov
- Ryazan State Medical University, Ryazan emergency hospital, 85 Stroykova street, Ryazan, RU
| | - Alla Svarovskaya
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, RU
| | | | - Aurelio Puentes
- ISSSTE Clínica Hospital de Guanajuato, Cerro del Hormiguero S/N, Maria de la Luz, 36000 Guanajuato, Gto., Mexico, AS
| | - Okechukwu S Ogah
- Department of Medicine, College of Medicine, University of Ibadan, and University College Hospital Ibadan, NG
| | - Bojan Stanetic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, BA
| | - Aurora Issa
- Instituto Nacional de Cardiologia, Rio de Janeiro, BR
| | - Friedrich Thienemann
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa and Department of Internal Medicine, University Hospital Zurich, University of Zurich, CH
| | - Dafsah Juzar
- National Cardiovascular Center Harapan Kita Hospital, Jakarta, ID
- Department Cardiology & Vascular medicine, University of Indonesia, ID
| | - Ezequiel Zaidel
- Cardiology department, Sanatorio Güemes, and Pharmacology department, School of Medicine, University of Buenos Aires. Acuña de Figueroa 1228 (1180AAX), Buenos Aires, AR
| | - Sana Sheikh
- Department of clinical Research, Tabba Heart Institute. ST-1, block 2, Federal B area, Karachi, PK
| | - Dike Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital, NG
| | - Carolyn S P Lam
- National Heart Center Singapore and Duke-National University of Singapore, SG
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, NL
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University. Shanghai Institute of Cardiovascular Diseases, Shanghai, CN
| | | | - L Kristin Newby
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, US
| | - Antonio Luiz P Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, BR
| | | | - Fausto Pinto
- Santa Maria University Hospital, CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Lisbon, PT
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, World Heart Federation, CH
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine & Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa, World Heart Federation, CH
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Qureshi AI, Baskett WI, Huang W, Ishfaq MF, Naqvi SH, French BR, Siddiq F, Gomez CR, Shyu CR. Utilization and Outcomes of Acute Revascularization Treatments in Ischemic Stroke Patients with SARS-CoV-2 Infection. J Stroke Cerebrovasc Dis 2022; 31:106157. [PMID: 34689049 PMCID: PMC8498748 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy). MATERIALS AND METHODS We analyzed the data from 62 healthcare facilities to determine the odds of receiving acute revascularization treatments in severe acute respiratory syndrome coronavirus infected patients and determined the odds of composite of death and non-routine discharge with severe acute respiratory syndrome coronavirus infected and non-infected patients undergoing acute revascularization treatments after adjusting for potential confounders. RESULTS Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments (odds ratio 0.6, 95% confidence interval 0.5-0.8, p = 0.0001). Among ischemic stroke patients who received acute revascularization treatments, severe acute respiratory syndrome coronavirus infection was associated with increased odds of death or non-routine discharge (odds ratio 3.0, 95% confidence interval 1.8-5.1). The higher odds death or non-routine discharge (odds ratio 2.1, 95% confidence interval 1.9-2.3) with severe acute respiratory syndrome coronavirus infection were observed in all ischemic stroke patients without any modifying effect of acute revascularization treatments (interaction term for death (p = 0.9) or death or non-routine discharge (p = 0.2). CONCLUSIONS Patients with acute ischemic stroke with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments. Severe acute respiratory syndrome coronavirus infection was associated with a significantly higher rate of death or non-routine discharge among acute ischemic stroke patients receiving revascularization treatments.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Insititute and Department of Nuerology, University of Missouri, One Hospital Dr., CE507, Columbia MO 65212, USA
| | - William I Baskett
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Wei Huang
- Zeenat Qureshi Stroke Insititute and Department of Nuerology, University of Missouri, One Hospital Dr., CE507, Columbia MO 65212, USA.
| | | | - S Hasan Naqvi
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Brandi R French
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Farhan Siddiq
- Division of Neurosurgery, University of Missouri, Columbia, MO, USA
| | - Camilo R Gomez
- Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA; Department of Medicine, University of Missouri, Columbia, MO, USA; Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
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15
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Song Z, Zhang X, Patterson LJ, Barnes CL, Haas DA. Racial and Ethnic Disparities in Hospitalization Outcomes Among Medicare Beneficiaries During the COVID-19 Pandemic. JAMA HEALTH FORUM 2021; 2:e214223. [PMID: 35977303 PMCID: PMC8796953 DOI: 10.1001/jamahealthforum.2021.4223] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022] Open
Abstract
Question How did hospitalizations and racial and ethnic disparities in hospitalization outcomes change during the COVID-19 pandemic among patients with traditional Medicare? Findings In this cohort study using 100% traditional Medicare inpatient data, comprising 31 771 054 beneficiaries and 14 021 285 hospitalizations from January 2019 through February 2021, the decline in non–COVID-19 and emergence of COVID-19 hospitalizations during the pandemic was qualitatively similar among beneficiaries of different racial and ethnic minority groups. In-hospital mortality for patients with COVID-19 was higher in racial and ethnic minority groups than in White patients, driven by a Hispanic-White gap; mortality among non–COVID-19 hospitalizations also differentially increased among patients in racial and ethnic minority groups relative to White patients, driven by an increased Black-White gap. Meaning Racial and ethnic disparities in mortality were evident among COVID-19 hospitalizations and widened among non–COVID-19 hospitalizations among Medicare beneficiaries, motivating greater attention to health equity. Importance The COVID-19 pandemic has disproportionately affected racial and ethnic minority populations. However, racial and ethnic disparities in hospitalization outcomes during the pandemic—for both COVID-19 and non-COVID-19 hospitalizations—are poorly understood, especially among older populations. Objective To assess racial and ethnic differences in hospitalization outcomes during the COVID-19 pandemic among Medicare beneficiaries. Design, Setting, and Participants In the 100% traditional Medicare inpatient data, there were 31 771 054 unique beneficiaries in cross-section just before the pandemic (February 2020), among whom 26 225 623 were non-Hispanic White, 2 797 462 were Black, 692 994 were Hispanic, and 2 054 975 belonged to other racial and ethnic minority groups. There were 14 021 285 hospitalizations from January 2019 through February 2021, of which 11 353 581 were among non-Hispanic White beneficiaries, 1 656 856 among Black beneficiaries, 321 090 among Hispanic beneficiaries, and 689 758 among beneficiaries of other racial and ethnic minority groups. Sensitivity analyses tested expanded definitions of mortality and alternative model specifications. Exposures Race and ethnicity in Medicare claims from the Social Security Administration. Main Outcomes and Measures In-hospital mortality and mortality inclusive of discharges to hospice, deaths during 30-day readmissions, and 30-day all-cause mortality. Secondary outcomes included discharges to hospice and discharges to postacute care. Results The decline in non–COVID-19 and emergence of COVID-19 hospitalizations were qualitatively similar among beneficiaries of different racial and ethnic minority groups through February 2021. In-hospital COVID-19 mortality was not significantly different among Black patients relative to White patients, but was 3.5 percentage points higher among Hispanic patients (95% CI, 2.9-4.1; P < .001) and other racial and ethnic minority patients relative to White counterparts (95% CI, 3.0-4.1; P < .001). For non–COVID-19 hospitalizations, in-hospital mortality among Black patients increased by 0.5 percentage points more than it increased among White patients (95% CI, 0.3-0.6; P < .001), a 17.5% differential increase relative to the prepandemic baseline. This gap was robust to expanded definitions of mortality. Hispanic patients had similar differential increases in expanded definitions of mortality and model specification. Disparities in discharges to hospice and postacute care were evident. In aggregate across COVID-19 and non–COVID-19 hospitalizations, mortality differentially increased among racial and ethnic minority populations during the pandemic. Conclusions and Relevance In this cohort study, racial and ethnic disparities in mortality were evident among COVID-19 hospitalizations and widened among non–COVID-19 hospitalizations, motivating greater attention to health equity.
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Affiliation(s)
- Zirui Song
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - C. Lowry Barnes
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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