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Dragotakes Q, Johnson PW, Buras MR, Carter RE, Joyner MJ, Bloch E, Gebo KA, Hanley DF, Henderson JP, Pirofski LA, Shoham S, Senefeld JW, Tobian AAR, Wiggins CC, Wright RS, Paneth NS, Sullivan DJ, Casadevall A. Estimates of actual and potential lives saved in the United States from the use of COVID-19 convalescent plasma. Proc Natl Acad Sci U S A 2024; 121:e2414957121. [PMID: 39352932 DOI: 10.1073/pnas.2414957121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/23/2024] [Indexed: 10/04/2024] Open
Abstract
In the Spring of 2020, the United States of America (USA) deployed COVID-19 convalescent plasma (CCP) to treat hospitalized patients. Over 500,000 patients were treated with CCP during the first year of the pandemic. In this study, we estimated the number of actual inpatient lives saved by CCP treatment in the United States of America based on CCP weekly use, weekly national mortality data, and CCP mortality reduction data from meta-analyses of randomized controlled trials and real-world data. We also estimate the potential number of lives saved if CCP had been deployed for 100% of hospitalized patients or used in 15 to 75% of outpatients. Depending on the assumptions modeled in stratified analyses, we estimated that CCP saved between 16,476 and 66,296 lives. The CCP ideal use might have saved as many as 234,869 lives and prevented 1,136,133 hospitalizations. CCP deployment was a successful strategy for ameliorating the impact of the COVID-19 pandemic in the USA. This experience has important implications for convalescent plasma use in future infectious disease emergencies.
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Affiliation(s)
- Quigly Dragotakes
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, MD 21205
| | - Patrick W Johnson
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL 32224
| | - Matthew R Buras
- Division of Biostatistics and Clinical Trials, Department of Quantitative Health Sciences, Scottsdale, AZ 85259
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905
| | - Evan Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - Daniel F Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - Jeffrey P Henderson
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, Louis, St. Louis, MO 63110
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Albert Einstein College of Medicine, New York, NY 10461
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - Jonathon W Senefeld
- Department of Health and Kinesiology, University of Illinois Urbana-Champaign, Urbana, IL 61801
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - Chad C Wiggins
- Department of Kinesiology, Michigan State University, East Lansing, MI 48823
| | - R Scott Wright
- Departments of Cardiovascular Medicine and Human Research Protection Program, Mayo Clinic, Rochester, MN 55905
| | - Nigel S Paneth
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48823
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI 48823
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, MD 21205
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, MD 21205
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Bonnet F, Grigoriev P, Sauerberg M, Alliger I, Mühlichen M, Camarda CG. Spatial Variation in Excess Mortality Across Europe: A Cross-Sectional Study of 561 Regions in 21 Countries. J Epidemiol Glob Health 2024; 14:470-479. [PMID: 38376764 PMCID: PMC11176282 DOI: 10.1007/s44197-024-00200-0] [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: 08/31/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To measure the burden of the COVID-19 pandemic in 2020 at the subnational level by estimating excess mortality, defined as the increase in all-cause mortality relative to an expected baseline mortality level. METHODS Statistical and demographic analyses of regional all-cause mortality data provided by the vital statistics systems of 21 European countries for 561 regions in Central and Western Europe. Life expectancy losses at ages 0 and 60 for males and females were estimated. RESULTS We found evidence of a loss in life expectancy in 391 regions, whilst only three regions exhibit notable gains in life expectancy in 2020. For 12 regions, losses of life expectancy amounted to more than 2 years and three regions showed losses greater than 3 years. We highlight geographical clusters of high mortality in Northern Italy, Spain and Poland, whilst clusters of low mortality were found in Western France, Germany/Denmark and Norway/Sweden. CONCLUSIONS Regional differences of loss of life expectancy are impressive, ranging from a loss of more than 4 years to a gain of 8 months. These findings provide a strong rationale for regional analysis, as national estimates hide significant regional disparities.
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Affiliation(s)
- Florian Bonnet
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France.
| | - Pavel Grigoriev
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France
| | - Markus Sauerberg
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Ina Alliger
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | | | - Carlo-Giovanni Camarda
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France
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3
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Bonnet F, Grigoriev P, Sauerberg M, Alliger I, Mühlichen M, Camarda CG. Spatial disparities in the mortality burden of the covid-19 pandemic across 569 European regions (2020-2021). Nat Commun 2024; 15:4246. [PMID: 38762653 PMCID: PMC11102496 DOI: 10.1038/s41467-024-48689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/08/2024] [Indexed: 05/20/2024] Open
Abstract
Since its emergence in December 2019, the COVID-19 pandemic has resulted in a significant increase in deaths worldwide. This article presents a detailed analysis of the mortality burden of the COVID-19 pandemic across 569 regions in 25 European countries. We produce age and sex-specific excess mortality and present our results using Age-Standardised Years of Life Lost in 2020 and 2021, as well as the cumulative impact over the two pandemic years. Employing a forecasting approach based on CP-splines that considers regional diversity and provides confidence intervals, we find notable losses in 362 regions in 2020 (440 regions in 2021). Conversely, only seven regions experienced gains in 2020 (four regions in 2021). We also estimate that eight regions suffered losses exceeding 20 years of life per 1000 population in 2020, whereas this number increased to 75 regions in 2021. The contiguity of the regions investigated in our study also reveals the changing geographical patterns of the pandemic. While the highest excess mortality values were concentrated in the early COVID-19 outbreak areas during the initial pandemic year, a clear East-West gradient appeared in 2021, with regions of Slovakia, Hungary, and Latvia experiencing the highest losses. This research underscores the importance of regional analyses for a nuanced comprehension of the pandemic's impact.
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Affiliation(s)
- Florian Bonnet
- French Institute for Demographic Studies (INED), Aubervilliers, France.
| | - Pavel Grigoriev
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Markus Sauerberg
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Ina Alliger
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
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Corrao G, Porcu G, Tratsevich A, Cereda D, Pavesi G, Bertolaso G, Franchi M. Estimating All-Cause Deaths Averted in the First Two Years of the COVID-19 Vaccination Campaign in Italy. Vaccines (Basel) 2024; 12:413. [PMID: 38675795 PMCID: PMC11055119 DOI: 10.3390/vaccines12040413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Comparing deaths averted by vaccination campaigns is a crucial public health endeavour. Excess all-cause deaths better reflect the impact of the pandemic than COVID-19 deaths. We used a seasonal autoregressive integrated moving average with exogenous factors model to regress daily all-cause deaths on annual trend, seasonality, and environmental temperature in three Italian regions (Lombardy, Marche and Sicily) from 2015 to 2019. The model was used to forecast excess deaths during the vaccinal period (December 2020-October 2022). We used the prevented fraction to estimate excess deaths observed during the vaccinal campaigns, those which would have occurred without vaccination, and those averted by the campaigns. At the end of the vaccinal period, the Lombardy region proceeded with a more intensive COVID-19 vaccination campaign than other regions (on average, 1.82 doses per resident, versus 1.67 and 1.56 in Marche and Sicily, respectively). A higher prevented fraction of all-cause deaths was consistently found in Lombardy (65% avoided deaths, as opposed to 60% and 58% in Marche and Sicily). Nevertheless, because of a lower excess mortality rate found in Lombardy compared to Marche and Sicily (12, 24 and 23 per 10,000 person-years, respectively), a lower rate of averted deaths was observed (22 avoided deaths per 10,000 person-years, versus 36 and 32 in Marche and Sicily). In Lombardy, early and full implementation of adult COVID-19 vaccination was associated with the largest reduction in all-cause deaths compared to Marche and Sicily.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (G.C.); (A.T.); (M.F.)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (G.C.); (A.T.); (M.F.)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- Specialization School of Health Statistics and Biometrics, University of Padua, 35131 Padua, Italy
| | - Alina Tratsevich
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (G.C.); (A.T.); (M.F.)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Danilo Cereda
- Preventive Unit of Welfare Department, Lombardy Region, 20124 Milan, Italy;
| | - Giovanni Pavesi
- General Directorate of Welfare Department, Lombardy Region, 20124 Milan, Italy;
| | | | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (G.C.); (A.T.); (M.F.)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
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Bielinski SJ, Manemann SM, Lopes GS, Jiang R, Weston SA, Reichard RR, Norman AD, Vachon CM, Takahashi PY, Singh M, Larson NB, Roger VL, St Sauver JL. The Importance of Estimating Excess Deaths Regionally During the COVID-19 Pandemic. Mayo Clin Proc 2024; 99:437-444. [PMID: 38432749 PMCID: PMC10914321 DOI: 10.1016/j.mayocp.2023.11.007] [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: 04/20/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 03/05/2024]
Abstract
National or statewide estimates of excess deaths have limited value to understanding the impact of the COVID-19 pandemic regionally. We assessed excess deaths in a 9-county geographically defined population that had low rates of COVID-19 and widescale availability of testing early in the pandemic, well-annotated clinical data, and coverage by 2 medical examiner's offices. We compared mortality rates (MRs) per 100,000 person-years in 2020 and 2021 with those in the 2019 reference period and MR ratios (MRRs). In 2020 and 2021, 177 and 219 deaths, respectively, were attributed to COVID-19 (MR = 52 and 66 per 100,000 person-years, respectively). COVID-19 MRs were highest in males, older persons, those living in rural areas, and those with 7 or more chronic conditions. Compared with 2019, we observed a 10% excess death rate in 2020 (MRR = 1.10 [95% CI, 1.04 to 1.15]), with excess deaths in females, older adults, and those with 7 or more chronic conditions. In contrast, we did not observe excess deaths overall in 2021 compared with 2019 (MRR = 1.04 [95% CI, 0.99 to 1.10]). However, those aged 18 to 39 years (MRR = 1.36 [95% CI, 1.03 to 1.80) and those with 0 or 1 chronic condition (MRR = 1.28 [95% CI, 1.05 to 1.56]) or 7 or more chronic conditions (MRR = 1.09 [95% CI, 1.03 to 1.15]) had increased mortality compared with 2019. This work highlights the value of leveraging regional populations that experienced a similar pandemic wave timeline, mitigation strategies, testing availability, and data quality.
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Affiliation(s)
- Suzette J Bielinski
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
| | - Sheila M Manemann
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Guilherme S Lopes
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Susan A Weston
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Aaron D Norman
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Celine M Vachon
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Nicholas B Larson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Véronique L Roger
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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Barry MC, Pathak EB, Swanson J, Cen R, Menard J, Salemi JL, Nembhard WN. Epidemiology of COVID-19 in Infants in the United States: Incidence, Severity, Fatality, and Variants of Concern. Pediatr Infect Dis J 2024; 43:217-225. [PMID: 38134379 DOI: 10.1097/inf.0000000000004201] [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] [Indexed: 12/24/2023]
Abstract
BACKGROUND The clinical spectrum of infant COVID-19 ranges from asymptomatic infection to life-threatening illness, yet epidemiologic surveillance has been limited for infants. METHODS Using COVID-19 case data (restricted to reporting states) and national mortality data, we calculated incidence, hospitalization, mortality and case fatality rates through March 2022. RESULTS Reported incidence of COVID-19 was 64.1 new cases per 1000 infant years (95% CI: 63.3-64.9). We estimated that 594,012 infants tested positive for COVID-19 nationwide by March 31, 2022. Viral variant comparisons revealed that incidence was 7× higher during the Omicron (January-March 2022) versus the pre-Delta period (June 2020-May 2021). The cumulative case hospitalization rate was 4.1% (95% CI: 4.0%-4.3%). For every 74 hospitalized infants, one infant death occurred, but overall COVID-19-related infant case fatality was low, with 7.0 deaths per 10,000 cases (95% CI: 5.6-8.7). Nationwide, 333 COVID-19 infant deaths were reported. Only 13 infant deaths (3.9%) were the result of usually lethal congenital anomalies. The majority of infant decedents were non-White (28.2% Black, 26.1% Hispanic, 8.1% Asian, Indigenous or multiracial). CONCLUSIONS More than half a million US infants contracted COVID-19 by March 2022. Longitudinal assessment of long-term infant SARS-CoV-2 infection sequelae remains a critical research gap. Extremely low infant vaccination rates (<5%), waning adult immunity and continued viral exposure risks suggest that infant COVID-19 will remain a persistent public health problem. Our study underscores the need to increase vaccination rates for mothers and infants, decrease viral exposure risks and improve health equity.
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Affiliation(s)
- Megan C Barry
- From the College of Public Health, University of South Florida, Tampa, Florida
| | | | - Justin Swanson
- From the College of Public Health, University of South Florida, Tampa, Florida
| | - Ruiqi Cen
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Janelle Menard
- Women's Institute for Independent Social Enquiry, Olney, Maryland
| | - Jason L Salemi
- From the College of Public Health, University of South Florida, Tampa, Florida
| | - Wendy N Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Bonnet F, Camarda CG. Estimating subnational excess mortality in times of pandemic. An application to French départements in 2020. PLoS One 2024; 19:e0293752. [PMID: 38241216 PMCID: PMC10798530 DOI: 10.1371/journal.pone.0293752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/18/2023] [Indexed: 01/21/2024] Open
Abstract
The COVID-19 pandemic's uneven impact on subnational regions highlights the importance of understanding its local-level mortality impact. Vital statistics are available for an increasing number of countries for 2020, 2021, and 2022, facilitating the computation of subnational excess mortality and a more comprehensive assessment of its burden. However, this calculation faces two important methodological challenges: it requires appropriate mortality projection models; and small populations imply considerable, though commonly neglected, uncertainty in the estimates. We address both issues using a method to forecast mortality at the subnational level, which incorporates uncertainty in the computation of mortality measures. We illustrate our approach by examining French départements (NUTS 3 regions, or 95 geographical units), and produce sex-specific estimates for 2020. This approach is highly flexible, allowing one to estimate excess mortality during COVID-19 in most demographic scenarios and for past pandemics.
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Affiliation(s)
- Florian Bonnet
- Institut national d’études démographiques (INED), Aubervilliers, France
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8
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Shakor ASA, Samsudin EZ, Chen XW, Ghazali MH. Factors associated with COVID-19 brought-in deaths: A data-linkage comparative cross-sectional study. J Infect Public Health 2023; 16:2068-2078. [PMID: 37950972 DOI: 10.1016/j.jiph.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/22/2023] [Accepted: 10/15/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND The phenomenon of Coronavirus disease 2019 (COVID-19) brought-in-dead (BID), i.e., COVID-19 deaths occurring outside hospital settings, suggests missed opportunities for life-saving care. However, much is still unknown with regards to its potential determinants. The present study aimed to examine the factors associated with COVID-19 BID by integrating new variables from multiple databases. METHODS This multi-database comparative cross-sectional study examined COVID-19 in-patient deaths (IPD) and COVID-19 BID (n = 244 in each group) in Selangor, Malaysia. BID cases, IPD cases, and their sociodemographic, clinical, and health behaviour factors were identified from the COVID-19 mortality investigation reports submitted to the Selangor State Health Department between 14 February 2022 and 31 March 2023. Data linkage was used to connect three open-source databases-GitHub-MOH, Socioeconomic Data and Applications Center, and OpenStreetMap-and identify health infrastructure and geospatial factors. The groups were compared using chi-square tests, independent t-tests, and logistic regression analyses to identify factors associated with COVID-19 BID. RESULTS The COVID-19 IPD and BID cases were comparable. After adjusting for confounders, non-Malaysian nationality (AOR: 3.765, 95% CI: 1.163, 12.190), obesity (AOR: 5.272, 95% CI: 1.131, 24.567), not seeking treatment while unwell (AOR: 5.385, 95% CI: 3.157, 9.186), and a higher percentage of COVID-19-dedicated beds occupied on the date of death (AOR: 1.165, 95% CI: 1.078, 1.259) were associated with increased odds of COVID-19 BID. On the other hand, being married (AOR: 0.396, 95% CI: 0.158, 0.997) and the interaction between the percentage of COVID-19-dedicated beds occupied and the percentage of ventilators in use (AOR: 0.996, 95% CI: 0.994, 0.999) emerged as protective factors. CONCLUSION These findings indicated that certain groups have higher odds of COVID-19 BID and thus, require closer monitoring. Considering that COVID-19 BID is influenced by various elements beyond clinical factors, intensifying public health initiatives and multi-organisational collaboration is necessary to address this issue.
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Affiliation(s)
- Ameerah Su'ad Abdul Shakor
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia; Surveillance and Crisis Preparedness Unit, Public Health Division, Selangor State Health Department, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia.
| | - Ely Zarina Samsudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia.
| | - Xin Wee Chen
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia.
| | - Muhammad Haikal Ghazali
- Communicable Disease Control Unit, Public Health Division, Selangor State Health Department, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia.
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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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10
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Plant E, Mccloskey R, Shamputa IC, Chandra K, Atkinson P, Fraser J, Pishe T, Price P. Nursing Home Residents' Use of Radiography in New Brunswick: A Case for Mobile Radiography? Healthc Policy 2023; 18:31-46. [PMID: 36917452 PMCID: PMC10019512 DOI: 10.12927/hcpol.2023.27036] [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: 03/11/2023] Open
Abstract
Introduction Identifying ways to eliminate unnecessary transfer of nursing home (NH) residents to hospitals provides an opportunity to improve outcomes and use scarce healthcare resources more efficiently. This study's goal was to better understand where NH residents access X-ray (XR) and computed tomography (CT) scans and to determine if there was a case for mobile radiography policies in New Brunswick. Methods A retrospective analysis of all the visits to the emergency department (ED) and outpatient imaging departments in two hospitals in Saint John, New Brunswick, in 2020, that involved XR or CT investigations was conducted. Results There were 521 visits by 311 unique NH residents and 920 investigations (688 XR and 232 CT scans). Most investigations were ordered in the ED (696 of 920; 75.6%; confidence interval: 72.8-78.3%). Of the NH residents who visited the ED and received either an XR or a CT scan, 33.2% received only XR imaging and were discharged back to the NH after a mean ED stay of 5.15 hours. Discussion The pattern of NH residents' use of the ED for their imaging needs supports the creation of mobile XR policies to deliver more safe and efficient care in a Canadian medium population urban centre.
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Affiliation(s)
- Eric Plant
- Candidate, Dalhousie University Medicine, Saint John, NB, Primary Care Paramedic, Ambulance New Brunswick
| | - Rose Mccloskey
- Professor, Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB
| | - Isdore Chola Shamputa
- Associate Professor, Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB
| | - Kavish Chandra
- Assistant Professor, Department of Emergency Medicine, Saint John Regional Hospital, Dalhousie University, Director of Research, Department Emergency Medicine, Saint John Regional Hospital, Saint John, NB
| | - Paul Atkinson
- Professor, Department of Emergency Medicine, Saint John Regional Hospital, Dalhousie University, Head, Department of Emergency Medicine, Horizon Health Network, Saint John, NB
| | - Jacqueline Fraser
- Emergency Department Research Coordinator, Saint John Regional Hospital, Saint John, NB, Assistant Managing Editor, Canadian Journal of Emergency Medicine
| | - Tushar Pishe
- Provincial Medical Director, Ambulance and Transport Services, Department of Health, New Brunswick, Assistant Professor, Department of Emergency Medicine, Saint John Regional Hospital, Dalhousie University, Saint John, NB
| | - Patrick Price
- Researcher, Dalhousie University Medicine, Saint John, NB
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11
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Shin E, Choe YJ, Ryu B, Kim NY, Lee HJ, Kim DH, Kim SS, Kwon D, Yun KW, Park SE, Choi EH, Lee S, Lee H. Pediatric Deaths Associated With Coronavirus Disease 2019 (COVID-19) in Korea. J Korean Med Sci 2023; 38:e21. [PMID: 36647219 PMCID: PMC9842489 DOI: 10.3346/jkms.2023.38.e21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/19/2022] [Indexed: 01/04/2023] Open
Abstract
As of September 3, 2022, 5,388,338 coronavirus disease 2019 (COVID-19) cases and 46 deaths (3 in 2021 and 43 in 2022) were reported in children ≤ 18 years in Korea. Cumulative confirmed cases accounted for 67.3% of the population aged ≤ 18 years and case fatality rate was 0.85/100,000. Among 46 fatal cases, 58.7% were male and median age was 7 years. Underlying diseases were present in 47.8%; neurologic diseases (63.6%) and malignancy (13.6%) most common. Only four had history of COVID-19 immunization. COVID-19 associated deaths occurred at median 2 days from diagnosis (range: -1 to 21). Among COVID-19 deaths, 41.3% occurred before admission; 2 before hospital arrival and 17 in the emergency department. Among children whose cause was documented, myocarditis, respiratory and multiorgan failure were most common. COVID-19 associated death was seen early after diagnosis in children and public health policies to provide access to medical care for children with COVID-19 are essential during the pandemic.
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Affiliation(s)
- Eunjeong Shin
- Data Analysis Team, Epidemiological Investigation and Analysis Task Force, Central Disease Control Headquarters, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Boyeong Ryu
- Data Analysis Team, Epidemiological Investigation and Analysis Task Force, Central Disease Control Headquarters, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Na-Young Kim
- Data Analysis Team, Epidemiological Investigation and Analysis Task Force, Central Disease Control Headquarters, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Hyun Ju Lee
- Data Analysis Team, Epidemiological Investigation and Analysis Task Force, Central Disease Control Headquarters, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Dong Hwi Kim
- Data Analysis Team, Epidemiological Investigation and Analysis Task Force, Central Disease Control Headquarters, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Seong-Sun Kim
- Data Analysis Team, Epidemiological Investigation and Analysis Task Force, Central Disease Control Headquarters, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Donghyok Kwon
- Data Analysis Team, Epidemiological Investigation and Analysis Task Force, Central Disease Control Headquarters, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sangwon Lee
- Data Analysis Team, Epidemiological Investigation and Analysis Task Force, Central Disease Control Headquarters, Korea Disease Control and Prevention Agency, Cheongju, Korea.
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
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12
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Paglino E, Lundberg DJ, Zhou Z, Wasserman JA, Raquib R, Luck AN, Hempstead K, Bor J, Preston SH, Elo IT, Stokes AC. Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.04.23.22274192. [PMID: 35547848 PMCID: PMC9094106 DOI: 10.1101/2022.04.23.22274192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the overall impact of the Covid-19 pandemic that is not biased by differences in testing or cause-of-death assignment. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating and mitigating factors, and inform response efforts, including allocating resources to affected communities. We estimated all-cause excess mortality for the United States from March 2020 through February 2022 by county and month using a Bayesian hierarchical model trained on data from 2015 to 2019. An estimated 1,159,580 excess deaths occurred during the first two years of the pandemic (first: 620,872; second: 538,708). Overall, excess mortality decreased in large metropolitan counties, but increased in nonmetro counties, between the first and second years of the pandemic. Despite the initial concentration of mortality in large metropolitan Northeast counties, beginning in February 2021, nonmetro South counties had the highest cumulative relative excess mortality. These results highlight the need for investments in rural health as the pandemic's disproportionate impact on rural areas continues to grow.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Zhenwei Zhou
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | | | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA
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13
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Aburto JM, Tilstra AM, Floridi G, Dowd JB. Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality. Proc Natl Acad Sci U S A 2022; 119:e2205813119. [PMID: 35998219 PMCID: PMC9436308 DOI: 10.1073/pnas.2205813119] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic triggered global declines in life expectancy. The United States was hit particularly hard among high-income countries. Early data from the United States showed that these losses varied greatly by race/ethnicity in 2020, with Hispanic and Black Americans suffering much larger losses in life expectancy compared with White people. We add to this research by examining trends in lifespan inequality, average years of life lost, and the contribution of specific causes of death and ages to race/ethnic life-expectancy disparities in the United States from 2010 to 2020. We find that life expectancy in 2020 fell more for Hispanic and Black males (4.5 and 3.6 y, respectively) compared with White males (1.5 y). These drops nearly eliminated the previous life-expectancy advantage for the Hispanic compared with the White population, while dramatically increasing the already large gap in life expectancy between Black and White people. While the drops in life expectancy for the Hispanic population were largely attributable to official COVID-19 deaths, Black Americans saw increases in cardiovascular diseases and "deaths of despair" over this period. In 2020, lifespan inequality increased slightly for Hispanic and White populations but decreased for Black people, reflecting the younger age pattern of COVID-19 deaths for Hispanic people. Overall, the mortality burden of the COVID-19 pandemic hit race/ethnic minorities particularly hard in the United States, underscoring the importance of the social determinants of health during a public health crisis.
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Affiliation(s)
- José Manuel Aburto
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark; Odense 5000, Denmark
| | - Andrea M. Tilstra
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
- University of Colorado Population Center, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO 80302
| | - Ginevra Floridi
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
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14
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Hansen CL, Viboud C, Chaves SS. The Use of Death Certificate Data to Characterize Mortality Associated With Respiratory Syncytial Virus, Unspecified Bronchiolitis, and Influenza in the United States, 1999-2018. J Infect Dis 2022; 226:S255-S266. [PMID: 35968872 PMCID: PMC9377031 DOI: 10.1093/infdis/jiac187] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Death certificate data can improve our understanding of the mortality burden associated with respiratory syncytial virus (RSV) and influenza. METHODS We used International Classification of Diseases, Tenth Revision codes listed on death certificates to characterize deaths from 1999 to 2018 as RSV, influenza, and unspecified bronchiolitis. We described the distribution of each cause of death by age, sex, race/ethnicity, place of death, and contributing causes of death. RESULTS Over the 20-year study period, RSV, bronchiolitis, and influenza were listed as the underlying causes of death on 932, 1046, and 52 293 death certificates, respectively. Children <1 year of age accounted for 39% of RSV and bronchiolitis deaths, while 72% of influenza deaths were in adults ≥65 years. Children <1 year were more likely to die outside of the hospital from RSV, bronchiolitis, or influenza compared to all causes (P < .01), and black infants had the highest mortality rate for all 3 causes. Most infants dying from RSV did not have a high-risk condition listed on the death certificate. Death certificates captured 20%-60% of estimated excess RSV-attributable mortality in infants and <1% in seniors. CONCLUSIONS Thorough reporting on death certificates is an important public health goal, especially as new therapeutics become available. Infants had higher odds of dying out of hospital from respiratory pathogens compared to other causes, and race/ethnicity alone did not explain this disparity.
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Affiliation(s)
- Chelsea L Hansen
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
- Brotman Baty Institute for Precision Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandra S Chaves
- Department of Modeling, Epidemiology and Data Science, Sanofi, Lyon, France
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
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15
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Zhang W, Huggins T, Zheng W, Liu S, Du Z, Zhu H, Raza A, Tareq AH. Assessing the Dynamic Outcomes of Containment Strategies against COVID-19 under Different Public Health Governance Structures: A Comparison between Pakistan and Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9239. [PMID: 35954595 PMCID: PMC9368361 DOI: 10.3390/ijerph19159239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
COVID-19 scenarios were run using an epidemiological mathematical model (system dynamics model) and counterfactual analysis to simulate the impacts of different control and containment measures on cumulative infections and deaths in Bangladesh and Pakistan. The simulations were based on national-level data concerning vaccination level, hospital capacity, and other factors, from the World Health Organization, the World Bank, and the Our World in Data web portal. These data were added to cumulative infections and death data from government agencies covering the period from 18 March 2020 to 28 February 2022. Baseline curves for Pakistan and Bangladesh were obtained using piecewise fitting with a consideration of different events against the reported data and allowing for less than 5% random errors in cumulative infections and deaths. The results indicate that Bangladesh could have achieved more reductions in each key outcome measure by shifting its initial lockdown at least five days backward, while Pakistan would have needed to extend its lockdown to achieve comparable improvements. Bangladesh's second lockdown appears to have been better timed than Pakistan's. There were potential benefits from starting the third lockdown two weeks earlier for Bangladesh and from combining this with the fourth lockdown or canceling the fourth lockdown altogether. Adding a two-week lockdown at the beginning of the upward slope of the second wave could have led to a more than 40 percent reduction in cumulative infections and a 35 percent reduction in cumulative deaths for both countries. However, Bangladesh's reductions were more sensitive to the duration of the lockdown. Pakistan's response was more constrained by medical resources, while Bangladesh's outcomes were more sensitive to both vaccination timing and capacities. More benefits were lost when combining multiple scenarios for Bangladesh compared to the same combinations in Pakistan. Clearly, cumulative infections and deaths could have been highly impacted by adjusting the control and containment measures in both national settings. However, COVID-19 outcomes were more sensitive to adjustment interventions for the Bangladesh context. Disaggregated analyses, using a wider range of factors, may reveal several sub-national dynamics. Nonetheless, the current research demonstrates the relevance of lockdown timing adjustments and discrete adjustments to several other control and containment measures.
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Affiliation(s)
- Weiwei Zhang
- Research Institute of Economics and Management, Southwestern University of Finance and Economics, Chengdu 610074, China; (W.Z.); (H.Z.); (A.R.)
| | - Thomas Huggins
- Division of Science & Technology, BNU-HKBU United International College, Zhuhai 519087, China;
| | - Wenwen Zheng
- Personal Finance Department, HQ of China Construction Bank, Beijing 100033, China;
| | - Shiyong Liu
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai 519087, China
| | - Zhanwei Du
- Division of Epidemiology and Biostatistics, School of Public Health, Hong Kong University, Hong Kong, China;
| | - Hongli Zhu
- Research Institute of Economics and Management, Southwestern University of Finance and Economics, Chengdu 610074, China; (W.Z.); (H.Z.); (A.R.)
| | - Ahmad Raza
- Research Institute of Economics and Management, Southwestern University of Finance and Economics, Chengdu 610074, China; (W.Z.); (H.Z.); (A.R.)
| | - Ahmad Hussen Tareq
- Ministry of National Health Services Regulations and Coordination, Islamabad 44010, Pakistan;
- Health Services Academy, Islamabad 44010, Pakistan
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16
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Paglino E, Lundberg DJ, Cho A, Wasserman JA, Raquib R, Luck AN, Hempstead K, Bor J, Elo IT, Preston SH, Stokes AC. Excess all-cause mortality across counties in the United States, March 2020 to December 2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022. [PMID: 35547848 DOI: 10.1101/2022.06.29.222770652022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Official Covid-19 death counts have underestimated the mortality impact of the Covid-19 pandemic in the United States. Excess mortality, which compares observed deaths to deaths expected in the absence of the pandemic, is a useful measure for assessing the total effect of the pandemic on mortality levels. In the present study, we produce county-level estimates of excess mortality for 3,127 counties between March 2020 and December 2021. We fit two hierarchical linear models to county-level death rates from January 2015 to December 2019 and predict expected deaths for each month during the pandemic. We compare observed deaths to these estimates to obtain excess deaths for each county-month. An estimated 936,911 excess deaths occurred during 2020 and 2021, of which 171,168 (18.3%) were not assigned to Covid-19 on death certificates as an underlying cause of death. Urban counties in the Far West, Great Lakes, Mideast, and New England experienced a substantial mortality disadvantage in 2020, whereas rural counties in these regions had higher mortality in 2021. In the Southeast, Southwest, Rocky Mountain, and Plains regions, there was a rural mortality disadvantage in 2020, which was exacerbated in 2021. The proportion of excess deaths assigned to Covid-19 was lower in 2020 (76.3%) than in 2021 (87.0%), suggesting that a larger fraction of excess deaths was assigned to Covid-19 later in the pandemic. However, in rural areas and in the Southeast and Southwest a large share of excess deaths was still not assigned to Covid-19 during 2021. SIGNIFICANCE Deaths during the Covid-19 pandemic have been primarily monitored through death certificates containing reference to Covid-19. This approach has missed more than 170,000 deaths related to the pandemic between 2020 and 2021. While the ascertainment of Covid-19 deaths improved during 2021, the full effects of the pandemic still remained obscured in some regions. County-level estimates of excess mortality are useful for studying geographic inequities in the mortality burden associated with the pandemic and identifying specific regions where the full mortality burden was significantly underreported (i.e. Southeast). They can also be used to inform resource allocation decisions at the federal and state levels and encourage uptake of preventive measures in communities with low vaccine uptake.
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17
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Pathak EB, Menard JM, Garcia RB, Salemi JL. Joint Effects of Socioeconomic Position, Race/Ethnicity, and Gender on COVID-19 Mortality among Working-Age Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5479. [PMID: 35564872 PMCID: PMC9102098 DOI: 10.3390/ijerph19095479] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/29/2022]
Abstract
Substantial racial/ethnic and gender disparities in COVID-19 mortality have been previously documented. However, few studies have investigated the impact of individual socioeconomic position (SEP) on these disparities. Objectives: To determine the joint effects of SEP, race/ethnicity, and gender on the burden of COVID-19 mortality. A secondary objective was to determine whether differences in opportunities for remote work were correlated with COVID-19 death rates for sociodemographic groups. Design: Annual mortality study which used a special government tabulation of 2020 COVID-19-related deaths stratified by decedents' SEP (measured by educational attainment), gender, and race/ethnicity. Setting: United States in 2020. Participants: COVID-19 decedents aged 25 to 64 years old (n = 69,001). Exposures: Socioeconomic position (low, intermediate, and high), race/ethnicity (Hispanic, Black, Asian, Indigenous, multiracial, and non-Hispanic white), and gender (women and men). Detailed census data on occupations held by adults in 2020 in each of the 36 sociodemographic groups studied were used to quantify the possibility of remote work for each group. Main Outcomes and Measures: Age-adjusted COVID-19 death rates for 36 sociodemographic groups. Disparities were quantified by relative risks and 95% confidence intervals. High-SEP adults were the (low-risk) referent group for all relative risk calculations. Results: A higher proportion of Hispanics, Blacks, and Indigenous people were in a low SEP in 2020, compared with whites. COVID-19 mortality was five times higher for low vs. high-SEP adults (72.2 vs. 14.6 deaths per 100,000, RR = 4.94, 95% CI 4.82-5.05). The joint detriments of low SEP, Hispanic ethnicity, and male gender resulted in a COVID-19 death rate which was over 27 times higher (178.0 vs. 6.5 deaths/100,000, RR = 27.4, 95% CI 25.9-28.9) for low-SEP Hispanic men vs. high-SEP white women. In regression modeling, percent of the labor force in never remote jobs explained 72% of the variance in COVID-19 death rates. Conclusions and Relevance: SARS-CoV-2 infection control efforts should prioritize low-SEP adults (i.e., the working class), particularly the majority with "never remote" jobs characterized by inflexible and unsafe working conditions (i.e., blue collar, service, and retail sales workers).
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Affiliation(s)
- Elizabeth B. Pathak
- Women’s Institute for Independent Social Enquiry (WiiSE), Olney, MD 20832, USA; (J.M.M.); (R.B.G.)
| | - Janelle M. Menard
- Women’s Institute for Independent Social Enquiry (WiiSE), Olney, MD 20832, USA; (J.M.M.); (R.B.G.)
| | - Rebecca B. Garcia
- Women’s Institute for Independent Social Enquiry (WiiSE), Olney, MD 20832, USA; (J.M.M.); (R.B.G.)
- Premise Health, Brentwood, TN 37027, USA
| | - Jason L. Salemi
- College of Public Health, University of South Florida, Tampa, FL 33620, USA;
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18
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Kessler RC, Chiu WT, Hwang IH, Puac-Polanco V, Sampson NA, Ziobrowski HN, Zaslavsky AM. Changes in Prevalence of Mental Illness Among US Adults During Compared with Before the COVID-19 Pandemic. Psychiatr Clin North Am 2022; 45:1-28. [PMID: 35219431 PMCID: PMC8585610 DOI: 10.1016/j.psc.2021.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors review trend and cohort surveys and administrative data comparing prevalence of mental disorders during, versus, and before the COVID-19 pandemic and changes in mental health disparities. Best evidence suggests clinically significant anxiety-depression point prevalence increased by relative-risk (RR) = 1.3 to 1.5 during the pandemic compared with before. This level of increase is much less than the implausibly high RR = 5.0 to 8.0 estimates reported in trend studies early in the pandemic based on less-appropriate comparisons. Changes in prevalence also occurred during the pandemic, but relative prevalence appears not to have changed substantially over this time.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Ste 215, Boston, MA 02115-5899, USA.
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Ste 215, Boston, MA 02115-5899, USA
| | - Irving H Hwang
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Ste 215, Boston, MA 02115-5899, USA
| | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Ste 215, Boston, MA 02115-5899, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Ste 215, Boston, MA 02115-5899, USA
| | - Hannah N Ziobrowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Ste 215, Boston, MA 02115-5899, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Ste 215, Boston, MA 02115-5899, USA
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19
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Helleringer S, Queiroz BL. Commentary: Measuring excess mortality due to the COVID-19 pandemic: progress and persistent challenges. Int J Epidemiol 2022; 51:85-87. [PMID: 34904168 PMCID: PMC8856005 DOI: 10.1093/ije/dyab260] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Stéphane Helleringer
- New York University—Abu Dhabi Campus, Division of Social Science, Program in Social Research and Public Policy, Abu Dhabi, United Arab Emirates and
| | - Bernardo Lanza Queiroz
- Universidade Federal de Minas Gerais, Department of Demography and Centro de Desenvolvimento e Planejamento Regional (CEDEPLAR), Belo Horizonte, Minas Gerais, Brazil
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20
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A Mathematical Study of COVID-19 Spread by Vaccination Status in Virginia. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We introduce a novel n-stage vaccination model and corresponding system of differential equations that stratify a population according to their vaccination status. The model is an extension of the classical SIR-type models commonly used for time-course simulations of infectious disease spread and allows for the mitigation effects of vaccination to be uncoupled from other factors, such as changes in social behavior and the prevalence of virus variants. We fit the model to the Virginia Department of Health data on new COVID-19 cases, hospitalizations, and deaths broken down by vaccination status. The model suggests that, from 23 January through 11 September, fully vaccinated individuals were 89.8% less likely to become infected with COVID-19 and that the B.1.617.2 (Delta) variant is 2.08 times more transmissible than previously circulating strains of COVID-19. We project the model trajectories into the future to predict the impact of booster shots.
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21
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The Public Health Role of Medical Examiner Offices During COVID-19 and Other Mass Fatality Events. Am J Forensic Med Pathol 2022; 43:101-104. [PMID: 35125383 PMCID: PMC9076122 DOI: 10.1097/paf.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The public health role of a medical examiner office (MEO) in a pandemic is largely undefined; however, death data may be useful in strategic planning. Deaths reportable to MEO are defined in statute, with discretion as to the assumption of jurisdiction. We analyzed the daily reported death numbers (DRDNs) in our jurisdiction from March 1, 2020, to March 31, 2021, and compared them with hospital admission and COVID-19 fatality data over the same period. The DRDN from an MEO is easily obtained and may be useful as a supplemental and surrogate metric in certain pandemic mass casualty decisions. Hospital admission data were analyzed in real time and with a 2-week time-shift, as deaths lag hospital admissions as a disease surveillance metric. Moderate correlation was observed between DRDN and hospital admissions (r = 0.570), and this improved to strong correlation (0.645) when the 2-week time-shift was incorporated into the analysis. Both evaluations were statistically significant (P < 0.0001). The DRDN also moderately correlated (r = 0.412) with the number of COVID-19 deaths. Because death certification and hospital diagnosis may be delayed, real-time trend recognition in a pandemic may benefit from use of DRDN from MEO.
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22
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Luck AN, Preston SH, Elo IT, Stokes AC. The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality. SSM Popul Health 2021; 17:101012. [PMID: 34961843 PMCID: PMC8697426 DOI: 10.1016/j.ssmph.2021.101012] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 12/18/2021] [Indexed: 11/24/2022] Open
Abstract
Despite a growing body of literature focused on racial/ethnic disparities in Covid-19 mortality, few previous studies have examined the pandemic's impact on 2020 cause-specific mortality by race and ethnicity. This paper documents changes in mortality by underlying cause of death and race/ethnicity between 2019 and 2020. Using age-standardized death rates, we attribute changes for Black, Hispanic, and White populations to various underlying causes of death and show how these racial and ethnic patterns vary by age and sex. We find that although Covid-19 death rates in 2020 were highest in the Hispanic community, Black individuals faced the largest increase in all-cause mortality between 2019 and 2020. Exceptionally large increases in mortality from heart disease, diabetes, and external causes of death accounted for the adverse trend in all-cause mortality within the Black population. Within Black and White populations, percentage increases in all-cause mortality were similar for men and women, as well as for ages 25–64 and 65+. Among the Hispanic population, however, percentage increases in mortality were greatest for working-aged men. These findings reveal that the overall impact of the pandemic on racial/ethnic disparities in mortality was much larger than that captured by official Covid-19 death counts alone.
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Affiliation(s)
- Anneliese N Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel H Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Irma T Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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