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Azizi A, Mahadevan A, Arora JS, Chiao E, Tanjasiri S, Dayyani F. Associations between language, telehealth, and clinical outcomes in patients with cancer during the COVID-19 pandemic. Cancer Med 2024; 13:e70099. [PMID: 39312904 PMCID: PMC11419674 DOI: 10.1002/cam4.70099] [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: 02/22/2024] [Revised: 07/23/2024] [Accepted: 08/01/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic prompted a surge in telehealth utilization. However, language barriers have emerged as a potential obstacle to effective telemedicine engagement, impacting millions of limited English proficient (LEP) individuals. Understanding the role of language spoken in telehealth outcomes is critical, particularly in cancer care, in which consistent follow-up and communication are vital. The primary objective was to assess the impact of telehealth utilization and primary language spoken on clinical outcomes in cancer patients. METHODS This study utilized a retrospective cohort design, encompassing cancer patients seen at the Chao Family Comprehensive Cancer Center between March 1, 2020, and December 31, 2022. The study incorporated both in-person and telehealth visits, examining the association between encounter type and clinical outcomes. RESULTS The study included 7890 patients with more than one outpatient visit during the study period. There was decreased telehealth utilization in non-English speaking cancer patients throughout the pandemic. Increased telehealth utilization was associated with higher rates of admission, irrespective of cancer type. Additionally, telehealth visits were associated with longer duration of subsequent admissions compared to in-person visits. Spanish-speaking patients utilizing telehealth had higher rates of re-admission compared to English speakers utilizing telehealth. Patients who died had higher rates of telehealth utilization compared to patients who survived. CONCLUSIONS AND RELEVANCE This study demonstrates that primary language spoken is associated with differences in telehealth utilization and associated outcomes in cancer patients. These differences suggest that the interplay of telehealth and language could contribute to widening of disparities in clinical outcomes in these populations. The study underscores the need to optimize telehealth usage and minimize its limitations to enhance the quality of cancer care in a telehealth-driven era.
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Affiliation(s)
- Armon Azizi
- School of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Aditya Mahadevan
- School of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Jagmeet S. Arora
- School of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Elaine Chiao
- School of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Sora Tanjasiri
- Department of Health, Society and Behavior, Program of Public HealthUniversity of California IrvineIrvineCaliforniaUSA
| | - Farshid Dayyani
- Division of Hematology/OncologyUniversity of California Irvine HealthOrangeCaliforniaUSA
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Woolf SH, Lee JH, Chapman DA, Sabo RT, Zimmerman E. Excess Death Rates by State During the COVID-19 Pandemic: United States, 2020‒2023. Am J Public Health 2024; 114:882-891. [PMID: 39024530 PMCID: PMC11306623 DOI: 10.2105/ajph.2024.307731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Objectives. To estimate state-level excess death rates during 2020 to 2023 and examine differences by region and partisan orientation. Methods. We modeled death and population counts from the Centers for Disease Control and Prevention to estimate excess death rates for the United States, 9 census divisions, and 50 states. We compared excess death rates for states with different partisan orientations, measured by the party of the seated governor and the level of partisan representation in state legislatures. Results. The United States experienced 1 277 697 excess deaths between March 2020 and July 2023. Almost 90% of these deaths were attributed to COVID-19, and 51.5% occurred after vaccines were available. The highest excess death rates first occurred in the Northeast and then shifted to the South and Mountain states. Between weeks ending June 20, 2020, through March 19, 2022, excess death rates were higher in states with Republican governors and greater Republican representation in state legislatures. Conclusions. Excess death rates during the COVID-19 pandemic varied considerably across the US states and were associated with partisan representation in state government, although the influence of confounding variables cannot be excluded. (Am J Public Health. 2024;114(9):882-891. https://doi.org/10.2105/AJPH.2024.307731).
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Affiliation(s)
- Steven H Woolf
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
| | - Jong Hyung Lee
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
| | - Derek A Chapman
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
| | - Roy T Sabo
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
| | - Emily Zimmerman
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
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Shiels MS, Haque AT, Freedman ND, Kim HR, Berrington de González A, Albert PS. Age-Specific Cancer Mortality in the US During the COVID-19 Pandemic, March to December 2020. Cancer Epidemiol Biomarkers Prev 2024; 33:1023-1027. [PMID: 38847607 PMCID: PMC11293979 DOI: 10.1158/1055-9965.epi-24-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/02/2024] [Accepted: 06/05/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND It is important to understand the impact of the COVID-19 pandemic on cancer death rates in 2020 in the US. We estimated whether there were larger-than-expected changes in cancer mortality rates from March to December 2020 after accounting for temporal and seasonal patterns using data from January 2011 to February 2020 by cancer type and age. METHODS We obtained death counts and underlying causes of death by cancer type, month/year (2011-2020), and age group from the National Center for Health Statistics and population estimates from the US Census Bureau. Poisson regression was used to test for significant changes in cancer death rates from March to December 2020 compared with prior years. RESULTS After accounting for temporal trends and seasonal patterns, total cancer death rates were significantly lower than expected during March to December 2020 among 55- to 64-year-olds and ≥75-year-olds, but not in other age groups. Cancer death rates were 2% lower than expected from March to June among 55- to 64-year-olds and 2% to 3% lower from March to July and December among ≥75-year-olds. Among ≥75-year-olds, colorectal cancer death rates were lower from March to June [rate ratios (RR) = 0.94-0.96; P < 0.05]; however, lung cancer death rates were 5% lower across each month (all RRs = 0.95; P < 0.05). CONCLUSIONS In the US, cancer death rates based on the underlying cause of death were broadly similar to expected rates from March to December 2020. However, cancer death rates were lower than expected among 55- to 64-year-olds and ≥75-year-olds, likely due to COVID-19 as a competing cause of death. IMPACT Cancer mortality rates from 2020 should be interpreted with caution.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Anika T Haque
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Neal D Freedman
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Hae-Rin Kim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, Maryland
| | | | - Paul S Albert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Qin Q, Temkin-Greener H, Veazie P, Makineni R, Cai S. Disparities in COVID-19-Related Mortality Among Older Adults With Alzheimer's Disease and Related Dementias: Variations Over Time. J Appl Gerontol 2024:7334648241264908. [PMID: 39030708 DOI: 10.1177/07334648241264908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Older adults with Alzheimer's disease and related dementias (ADRD) had a high risk of COVID-19-related mortality. Racial and ethnic minorities were disproportionally impacted by the pandemic. The variations in disparities, including racial and ethnic disparities and disparities across communities, in COVID-19-related mortality across the different stages of the COVID-19 pandemic among the ADRD population are unknown. This observational study estimated linear probability models for community-dwelling older adults with ADRD who were diagnosed with COVID-19 in 2020 and 2021 using multiple national data (e.g., Medicare data), accounting for individual and community characteristics. Disparities in 30-day mortality were compared between 2020 and 2021. The socioeconomic disparity in COVID-19-related mortality across communities became insignificant during the later stage of the pandemic, ethnic differences in COVID-19-related mortality decreased but persisted, and racial disparity remained largely unchanged. The study provides insights into interventions to mitigate lingering disparities in health outcomes among the vulnerable population.
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Affiliation(s)
- Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajesh Makineni
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Thyagaturu H, Taha A, Ali S, Roma N, Duhan S, Patel N, Sattar Y, Gonuguntla K, Sandhyavenu H, Badu I, Michos ED, Balla S. Disparities by sex, race, and region in acute myocardial infarction-related outcomes during the early COVID-19 pandemic: the national inpatient sample analysis. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:153-171. [PMID: 39021522 PMCID: PMC11249665 DOI: 10.62347/wkbj1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/29/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Disparities in acute myocardial infarction (AMI)-related outcomes have been reported before the COVID-19 pandemic. We studied in-hospital outcomes of AMI across demographic groups in the United States during the early COVID-19 pandemic. METHODS The National Inpatient Sample (NIS) database was queried for 2020 to identify AMI-related hospitalizations based on appropriate ICD-10-CM codes categorized by sex, race, and hospital region categories. The primary outcome was in-hospital mortality in females, racial and ethnic minority groups, and Northeast hospital region compared with males, White patients, and Midwest hospital region, respectively. Multivariable regression analysis was used to calculate the adjusted odds ratio and mean difference. RESULTS A total of 820,893 AMI-related hospitalizations were identified during the study period. On adjusted analysis, during the early COVID-19 pandemic, females had lower odds of in-hospital mortality [aOR 0.89 (0.85-0.92); P < 0.01] and revascularization [aOR 0.68 (0.66-0.69); P < 0.01] than males. Racial and ethnic based analysis showed that Asian/Pacific Islander patients had higher odds of in-hospital mortality [aOR 1.13 (1.03-1.25); P < 0.01] than White patients. During the early COVID-19 pandemic, Northeast and Western region hospitals had higher odds of in-hospital mortality, lower odds of revascularization, longer length of stay, and higher total hospitalization costs than Midwest region hospitals. CONCLUSIONS Our study disclosed disparities in AMI-related mortality and revascularization by sex, race and ethnic, and region during the early COVID-19 pandemic. Special attention should be given to at-risk populations. Whether these disparities continue in the post-vaccination era warrants further study.
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Affiliation(s)
| | - Amro Taha
- Department of Internal Medicine, Weiss Memorial HospitalChicago, IL, USA
| | - Shafaqat Ali
- Department of Medicine, Louisiana State UniversityShreveport, LA, USA
| | - Nicholas Roma
- Department of Internal Medicine, St Luke’s University HospitalBethlehem, PA, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of BaltimoreBaltimore, MD, USA
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical CenterWoonsocket, RI, USA
| | - Yasar Sattar
- Department of Cardiology, West Virginia UniversityMorgantown, WV, USA
| | | | | | - Irisha Badu
- Department of Medicine, Onslow Memorial HospitalJacksonville, NC, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Sudarshan Balla
- Department of Cardiology, West Virginia UniversityMorgantown, WV, USA
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Ko DT, Brophy JM, Mamas MA, McCrindle BW, Wijeysundera HC. Social Determinants of Health in Cardiovascular Disease: A Call to Action. Can J Cardiol 2024; 40:969-972. [PMID: 38663527 DOI: 10.1016/j.cjca.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Dennis T Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Newcastle, United Kingdom
| | - Brian W McCrindle
- University of Toronto, Toronto, Ontario, Canada; Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
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Miano TA, Barreto EF, McNett M, Martin N, Sakhuja A, Andrews A, Basu RK, Ablordeppey EA. Toward Equitable Kidney Function Estimation in Critical Care Practice: Guidance From the Society of Critical Care Medicine's Diversity, Equity, and Inclusion in Renal Clinical Practice Task Force. Crit Care Med 2024; 52:951-962. [PMID: 38407240 PMCID: PMC11098700 DOI: 10.1097/ccm.0000000000006237] [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] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Accurate glomerular filtration rate (GFR) assessment is essential in critically ill patients. GFR is often estimated using creatinine-based equations, which require surrogates for muscle mass such as age and sex. Race has also been included in GFR equations, based on the assumption that Black individuals have genetically determined higher muscle mass. However, race-based GFR estimation has been questioned with the recognition that race is a poor surrogate for genetic ancestry, and racial health disparities are driven largely by socioeconomic factors. The American Society of Nephrology and the National Kidney Foundation (ASN/NKF) recommend widespread adoption of new "race-free" creatinine equations, and increased use of cystatin C as a race-agnostic GFR biomarker. DATA SOURCES Literature review and expert consensus. STUDY SELECTION English language publications evaluating GFR assessment and racial disparities. DATA EXTRACTION We provide an overview of the ASN/NKF recommendations. We then apply an Implementation science methodology to identify facilitators and barriers to implementation of the ASN/NKF recommendations into critical care settings and identify evidence-based implementation strategies. Last, we highlight research priorities for advancing GFR estimation in critically ill patients. DATA SYNTHESIS Implementation of the new creatinine-based GFR equation is facilitated by low cost and relative ease of incorporation into electronic health records. The key barrier to implementation is a lack of direct evidence in critically ill patients. Additional barriers to implementing cystatin C-based GFR estimation include higher cost and lack of test availability in most laboratories. Further, cystatin C concentrations are influenced by inflammation, which complicates interpretation. CONCLUSIONS The lack of direct evidence in critically ill patients is a key barrier to broad implementation of newly developed "race-free" GFR equations. Additional research evaluating GFR equations in critically ill patients and novel approaches to dynamic kidney function estimation is required to advance equitable GFR assessment in this vulnerable population.
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Affiliation(s)
- Todd A. Miano
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Erin F. Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN, United States of America
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, Ohio
| | - Niels Martin
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankit Sakhuja
- Division of Data Driven and Digital Medicine, The Charles Bronfman Institute for Personalized Medicine and Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adair Andrews
- Society of Critical Care Medicine, Mount Prospect, IL
| | - Rajit K. Basu
- Ann & Robert Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Enyo Ama Ablordeppey
- Washington University School of Medicine, Department of Anesthesiology and Emergency Medicine, St. Louis, Missouri
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Ahrens KA, Rossen LM, Milkowski C, Gelsinger C, Ziller E. Excess deaths associated with COVID-19 by rurality and demographic factors in the United States. J Rural Health 2024; 40:491-499. [PMID: 38082546 PMCID: PMC11164822 DOI: 10.1111/jrh.12815] [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: 08/10/2023] [Revised: 10/21/2023] [Accepted: 11/30/2023] [Indexed: 06/12/2024]
Abstract
PURPOSE To estimate percent excess deaths during the COVID-19 pandemic by rural-urban residence in the United States and to describe rural-urban disparities by age, sex, and race/ethnicity. METHODS Using US mortality data, we used overdispersed Poisson regression models to estimate monthly expected death counts by rurality of residence, age group, sex, and race/ethnicity, and compared expected death counts with observed deaths. We then summarized excess deaths over 6 6-month time periods. FINDINGS There were 16.9% (95% confidence interval [CI]: 16.8, 17.0) more deaths than expected between March 2020 and February 2023. The percent excess varied by rurality (large central metro: 18.2% [18.1, 18.4], large fringe metro: 15.6% [15.5, 15.8], medium metro: 18.1% [18.0, 18.3], small metro: 15.5% [15.3, 15.7], micropolitan rural: 16.3% [16.1, 16.5], and noncore rural: 15.8% [15.6, 16.1]). The percent excess deaths were 20.2% (20.1, 20.3) for males and 13.6% (13.5, 13.7) for females, and highest for Hispanic persons (49% [49.0, 49.6]), followed by non-Hispanic Black persons (28% [27.5, 27.9]) and non-Hispanic White persons (12% [11.6, 11.8]). The 6-month time periods with the highest percent excess deaths for large central metro areas were March 2020-August 2020 and September 2020-February 2021; for all other areas, these time periods were September 2020-February 2021 and September 2021-February 2022. CONCLUSION Percent excess deaths varied by rurality, age group, sex, race/ethnicity, and time period. Monitoring excess deaths by rurality may be useful in assessing the impact of the pandemic over time, as rural-urban patterns appear to differ.
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Affiliation(s)
- Katherine A. Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Lauren M. Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA
| | - Carly Milkowski
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Catherine Gelsinger
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Erika Ziller
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
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Maduro G, Li W, Huynh M, Bernard-Davila B, Gould LH, Van Wye G. Descriptive study of causes of death and COVID-19-associated morbidities from the New York City electronic death record: first wave of the pandemic March-July 2020. BMJ Open 2024; 14:e072441. [PMID: 38569678 PMCID: PMC11146393 DOI: 10.1136/bmjopen-2023-072441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Assessing excess deaths from benchmarks across causes of death during the first wave of the COVID-19 pandemic and identifying morbidities most frequently mentioned alongside COVID-19 deaths in the death record. METHODS Descriptive study of death records between 11 March 2020 and 27 July 2020, from the New York City Bureau of Vital Statistics. Mortality counts and percentages were compared with the average for the same calendar period of the previous 2 years. Distributions of morbidities from among forty categories of conditions were generated citywide and by sex, race/ethnicity and four age groups. Causes of death were assumed to follow Poisson processes for Z-score construction. RESULTS Within the study period, 46 563 all-cause deaths were reported; 132.9% higher than the average for the same period of the previous 2 years (19 989). Of those 46 563 records, 19 789 (42.5%) report COVID-19 as underlying cause of death. COVID-19 was the most prevalent cause across all demographics, with respiratory conditions (prominently pneumonia), hypertension and diabetes frequently mentioned morbidities. Black non-Hispanics had greater proportions of mentions of pneumonia, hypertension, and diabetes. Hispanics had the largest proportion of COVID-19 deaths (52.9%). Non-COVID-19 excess deaths relative to the previous 2-year averages were widely reported. CONCLUSION Mortality directly due to COVID-19 was accompanied by significant increases across most other causes from their reference averages, potentially suggesting a sizable COVID-19 death undercount. Indirect effects due to COVID-19 may partially account for some increases, but findings are hardly dispositive. Unavailability of vaccines for the time period precludes any impact over excess deaths. Respiratory and cardiometabolic-related conditions were most frequently reported among COVID-19 deaths across demographic characteristics.
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Affiliation(s)
- Gil Maduro
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Wenhui Li
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Mary Huynh
- Institute for State and Local Governance, City University of New York, New York, New York, USA
| | - Blanca Bernard-Davila
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - L Hannah Gould
- Bureau of Epidemiologic Services, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Gretchen Van Wye
- Assistant Commissioner, Bureau of Vital Statistics, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Woodruff RC, Tong X, Khan SS, Shah NS, Jackson SL, Loustalot F, Vaughan AS. Trends in Cardiovascular Disease Mortality Rates and Excess Deaths, 2010-2022. Am J Prev Med 2024; 66:582-589. [PMID: 37972797 PMCID: PMC10957309 DOI: 10.1016/j.amepre.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) mortality increased during the initial years of the COVID-19 pandemic, but whether these trends endured in 2022 is unknown. This analysis describes temporal trends in CVD death rates from 2010 to 2022 and estimates excess CVD deaths from 2020 to 2022. METHODS Using national mortality data from the National Vital Statistics System, deaths among adults aged ≥35 years were classified by underlying cause of death International Classification of Diseases 10th Revision codes for CVD (I00-I99), heart disease (I00-I09, I11, I13, I20-I51), and stroke (I60-I69). Analyses in Joinpoint software identified trends in CVD age-adjusted mortality rates (AAMR) per 100,000 and estimated the number of excess CVD deaths from 2020 to 2022. RESULTS During 2010-2022, 10,951,403 CVD deaths occurred (75.6% heart disease, 16.9% stroke). The national CVD AAMR declined by 8.9% from 2010 to 2019 (456.6-416.0 per 100,000) and then increased by 9.3% from 2019 to 2022 to 454.5 per 100,000, which approximated the 2010 rate (456.7 per 100,000). From 2020 to 2022, 228,524 excess CVD deaths occurred, which was 9% more CVD deaths than expected based on trends from 2010 to 2019. Results varied by CVD subtype and population subgroup. CONCLUSIONS Despite stabilization of the public health emergency, declines in CVD mortality rates reversed in 2020 and remained high in 2022, representing almost a decade of lost progress and over 228,000 excess CVD deaths. Findings underscore the importance of prioritizing prevention and management of CVD to improve outcomes.
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Affiliation(s)
- Rebecca C Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia.
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nilay S Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
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Cheslack-Postava K, Forthal S, Musa GJ, Ryan M, Bresnahan M, Sapigao RG, Lin S, Fan B, Svob C, Geronazzo-Alman L, Hsu YJ, Skokauskas N, Hoven CW. Persistence of anxiety among Asian Americans: racial and ethnic heterogeneity in the longitudinal trends in mental well-being during the COVID-19 pandemic. Soc Psychiatry Psychiatr Epidemiol 2024; 59:599-609. [PMID: 37624465 DOI: 10.1007/s00127-023-02553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To examine within-individual time trends in mental well-being and factors influencing heterogeneity of these trends. METHODS Longitudinal telephone survey of adults over 3 waves from the New York City (NYC) Metropolitan area during the COVID-19 Pandemic. Participants reported depression using the Patient Health Questionnaire (PHQ)-8, anxiety using the Generalized Anxiety Disorder (GAD)-7, and past 30-day increases in tobacco or alcohol use at each wave. Adjusted mixed effects logistic regression models assessed time trends in mental well-being. RESULTS There were 1227 respondents. Over 3 study waves, there were statistically significant decreasing time trends in the odds of each outcome (adjusted OR (95% CI) 0.47 (0.37, 0.60); p < 0.001 for depression; aOR (95% CI) 0.55 (0.45, 0.66); p < 0.001 for anxiety; aOR (95% CI) 0.50 (0.35, 0.71); p < 0.001 for past 30-day increased tobacco use; aOR (95% CI) 0.31 (0.24, 0.40); p < 0.001 for past 30-day increased alcohol use). Time trends for anxiety varied by race and ethnicity (p value for interaction = 0.05, 4 df); anxiety declined over time among white, Black, Hispanic, and Other race and ethnicity but not among Asian participants. CONCLUSIONS In a demographically varied population from the NYC Metropolitan area, depression, anxiety and increased substance use were common during the first months of the pandemic, but decreased over the following year. While this was consistently the case across most demographic groups, the odds of anxiety among Asian participants did not decrease over time.
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Affiliation(s)
- Keely Cheslack-Postava
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA.
| | - Sarah Forthal
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - George J Musa
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Megan Ryan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Michaeline Bresnahan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Rosemarie G Sapigao
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- CUNY Graduate School of Public Health and Health Policy, New York, USA
| | - Susan Lin
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Bin Fan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Connie Svob
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lupo Geronazzo-Alman
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Yi-Ju Hsu
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
| | - Norbert Skokauskas
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Christina W Hoven
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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12
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Tsai MM, Anderson CE, Whaley SE, Yepez CE, Ritchie LD, Au LE. Associations of Increased WIC Benefits for Fruits and Vegetables With Food Security and Satisfaction by Race and Ethnicity. Prev Chronic Dis 2024; 21:E19. [PMID: 38547021 PMCID: PMC10996387 DOI: 10.5888/pcd21.230288] [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: 04/02/2024] Open
Abstract
Introduction The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition support for racially and ethnically diverse populations. In 2021, the monthly cash value benefit (CVB) for the purchase of fruits and vegetables increased from $9 to $35 and was later adjusted to $24. This study investigated, by racial and ethnic groups, whether CVB increases were associated with increases in CVB redemption, household food security, child fruit and vegetable intake, satisfaction with CVB amount, and likelihood of continued participation in WIC if the CVB returned to $9 per month. Methods We conducted a longitudinal study of WIC participants (N = 1,770) in southern California at 3 time points, from April 2021 through May 2022; the CVB amount was $9 at baseline, $35 at Survey 2, and $24 at Survey 3. Racial and ethnic groups were Hispanic English-speakers, Hispanic Spanish-speakers, non-Hispanic Asian, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. We used mixed-effect and modified Poisson regressions to evaluate outcomes by group. Results At baseline, groups differed significantly in dollars of CVB redeemed, percentage of CVB redeemed, household food security, and satisfaction with CVB amount. After the increase in CVB, we found increases in all groups in CVB redemption, household food security, and satisfaction. Non-Hispanic Black and Hispanic English-speaking groups, who had low levels of satisfaction at baseline, had larger increases in satisfaction than other groups. Reported likelihood of continued WIC participation if the monthly CVB returned to $9 also differed significantly by group, ranging from 62.5% to 90.0%. Conclusion The increase in CVB for children receiving WIC benefited all racial and ethnic groups. Continued investment in an augmented CVB could improve health outcomes for a racially and ethnically diverse WIC population.
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Affiliation(s)
- Marisa M Tsai
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Oakland, California
- University of California, Division of Agriculture and Natural Resources, 1111 Franklin St, 11th Floor, Oakland, CA 94607
| | - Christopher E Anderson
- Public Health Foundation Enterprises WIC Program, Division of Research and Evaluation, City of Industry, California
| | - Shannon E Whaley
- Public Health Foundation Enterprises WIC Program, Division of Research and Evaluation, City of Industry, California
| | - Catherine E Yepez
- Public Health Foundation Enterprises WIC Program, Division of Research and Evaluation, City of Industry, California
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Oakland, California
| | - Lauren E Au
- Department of Nutrition, University of California, Davis
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13
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Singh GK, Lee H. Widening Disparities in COVID-19 Mortality and Life Expectancy Among 15 Major Racial and Ethnic Groups in the United States, 2020-2021. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01966-6. [PMID: 38453784 DOI: 10.1007/s40615-024-01966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
Persistent and often widening racial/ethnic and socioeconomic inequalities in health have long existed in the US. Although racial/ethnic disparities in COVID-19 mortality are well documented, COVID-19 mortality risks and resultant reductions in life expectancy during the pandemic for detailed racial and ethnic groups in the US, including Asian and Hispanic subgroups, are not known. We used 2020-2021 US mortality data to estimate age-adjusted COVID-19 mortality rates, life expectancy, and the consequent declines in life expectancy due to COVID-19 overall and for the 15 largest racial/ethnic groups. We used standard life table methodology, cause-elimination life tables, and inequality indices to analyze trends in racial/ethnic disparities. The number of COVID-19 deaths increased from 350,827 in 2020 to 416,890 in 2021. COVID-19 death rates varied 7-fold among the racial/ethnic groups; Japanese and Chinese had the lowest mortality rates and Mexicans and American Indians/Alaska Natives (AIANs) had the highest rates. In 2021, life expectancy ranged from 70.3 years for Blacks and 70.6 years for AIANs to 85.2 years for Japanese and 87.7 years for Chinese. The life-expectancy gap was wide- 22.4 years in 2020 and 23.2 years in 2021. COVID-19 mortality had the greatest impact in reducing the life expectancy of Mexicans (3.53 years in 2020 and 3.78 years in 2021), Central/South Americans (4.86 years in 2020 and 3.50 years in 2021), and AIANs (2.51 years in 2020 and 2.38 years in 2021). Racial/ethnic inequalities in COVID-19 mortality, life expectancy, and resultant reductions in life expectancy during the pandemic widened between 2020 and 2021.
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Affiliation(s)
- Gopal K Singh
- The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., 20738, Riverdale, MD, USA.
| | - Hyunjung Lee
- Department of Public Policy and Public Affairs, John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, 100 William T Morrissey Blvd, 02125, Boston, MA, USA
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14
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Miller GF, Barnett SBL, Florence CS, McDavid Harrison K, Dahlberg LL, Mercy JA. Costs of Fatal and Nonfatal Firearm Injuries in the U.S., 2019 and 2020. Am J Prev Med 2024; 66:195-204. [PMID: 38010238 PMCID: PMC10843794 DOI: 10.1016/j.amepre.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Firearm-related injuries are among the five leading causes of death for people aged 1-44 years in the U.S. The immediate and long-term harms of firearm injuries pose an economic burden on society. Fatal and nonfatal firearm injury costs in the U.S. were estimated providing up-to-date economic burden estimates. METHODS Counts of nonfatal firearm injuries were obtained from the 2019-2020 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Data on nonfatal injury intent were obtained from the National Electronic Injury Surveillance System - Firearm Injury Surveillance System. Counts of deaths (firearm as underlying cause) were obtained from the 2019-2020 multiple cause-of-death mortality data from the National Vital Statistics System. Analyses were conducted in 2023. RESULTS The total cost of firearm related injuries and deaths in the U.S. for 2020 was $493.2 billion, a 16 percent increase compared with 2019. There are significant disparities in the cost of firearm deaths in 2019-2020, with non-Hispanic Black people, males, and young and middle-aged groups being the most affected. CONCLUSIONS Most of the nonfatal firearm injury-related costs are attributed to hospitalization. These findings highlight the racial/ethnic differences in fatal firearm injuries and the disproportionate cost burden to urban areas. Addressing this important public health problem can help ameliorate the costs to our society from the rising rates of firearm injuries.
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Affiliation(s)
- Gabrielle F Miller
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sarah Beth L Barnett
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Curtis S Florence
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen McDavid Harrison
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda L Dahlberg
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James A Mercy
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Poucineau J, Khlat M, Lapidus N, Espagnacq M, Chouaïd C, Delory T, Le Coeur S. Impact of the COVID-19 Pandemic on COPD Patient Mortality: A Nationwide Study in France. Int J Public Health 2024; 69:1606617. [PMID: 38362309 PMCID: PMC10868525 DOI: 10.3389/ijph.2024.1606617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives: We investigated the mortality patterns of chronic obstructive pulmonary disease (COPD) patients in France relative to a control population, comparing year 2020 to pre-pandemic years 2017-2019. Methods: COPD patient and sex, age and residence matched control cohorts were created from the French National Health Data System. Survival was analyzed using Cox regressions and standardized rates. Results: All-cause mortality increased in 2020 compared to 2019 in the COPD population (+4%), but to a lesser extent than in the control population (+10%). Non-COVID-19 mortality decreased to a greater extent in COPD patients (-5%) than in the controls (-2%). Death rate from COVID-19 was twice as high in the COPD population relative to the control population (547 vs. 279 per 100,000 person-years). Conclusion: The direct impact of the pandemic in terms of deaths from COVID-19 was much greater in the COPD population than in the control population. However, the larger decline in non-COVID-19 mortality in COPD patients could reflect a specific protective effect of the containment measures on this population, counterbalancing the direct impact they had been experiencing.
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Affiliation(s)
- Jonas Poucineau
- Institut National d’Études Démographiques (INED), Paris, France
- Institut de Recherche et Documentation en Économie de la Santé (IRDES), Paris, France
| | - Myriam Khlat
- Institut National d’Études Démographiques (INED), Paris, France
| | - Nathanaël Lapidus
- Faculté de Santé, Sorbonne Université, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1136 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Hôpital Saint-Antoine, Paris, France
| | - Maude Espagnacq
- Institut de Recherche et Documentation en Économie de la Santé (IRDES), Paris, France
| | - Christos Chouaïd
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955 Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Hospital Center Intercommunal De Créteil, Créteil, France
| | - Tristan Delory
- Institut National d’Études Démographiques (INED), Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1136 Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Centre Hospitalier Annecy Genevois (CH Annecy), Metz-Tessy, France
| | - Sophie Le Coeur
- Institut National d’Études Démographiques (INED), Paris, France
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16
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Nguyen KH, Zhao R, Chen S, Vaish AK, Bednarczyk RA, Vasudevan L. Population Attributable Fraction of Nonvaccination of COVID-19 Due to Vaccine Hesitancy, United States, 2021. Am J Epidemiol 2024; 193:121-133. [PMID: 37552958 DOI: 10.1093/aje/kwad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/07/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
Understanding the extent of coronavirus disease 2019 (COVID-19) nonvaccination attributable to vaccine hesitancy versus other barriers can help prioritize approaches for increasing vaccination uptake. Using data from the Centers for Disease Control and Prevention's Research and Development Survey, a nationally representative survey fielded from May 1 to June 30, 2021 (n = 5,458), we examined the adjusted population attribution fraction (PAF) of COVID-19 vaccine hesitancy attributed to nonvaccination according to sociodemographic characteristics and health-related variables. Overall, the adjusted PAF of nonvaccination attributed to vaccine hesitancy was 76.1%. The PAF was highest among adults who were ≥50 years of age (87.9%), were non-Hispanic White (83.7%), had a bachelor's degree or higher (82.7%), had an annual household income of at least $75,000 (85.5%), were insured (82.4%), and had a usual place for health care (80.7%). The PAF was lower for those who were current smokers (65.3%) compared with never smokers (77.9%), those who had anxiety or depression (65.2%) compared with those who did not (80.1%), and those who had a disability (64.5%) compared with those who did not (79.2%). Disparities in PAF suggest areas for prioritization of efforts for intervention and development of messaging campaigns that address all barriers to uptake, including hesitancy and access, to advance health equity and protect individuals from COVID-19.
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17
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Griffee MJ, Thomson DA, Fanning J, Rosenberger D, Barnett A, White NM, Suen J, Fraser JF, Li Bassi G, Cho SM. Race and ethnicity in the COVID-19 Critical Care Consortium: demographics, treatments, and outcomes, an international observational registry study. Int J Equity Health 2023; 22:260. [PMID: 38087346 PMCID: PMC10717789 DOI: 10.1186/s12939-023-02051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Improving access to healthcare for ethnic minorities is a public health priority in many countries, yet little is known about how to incorporate information on race, ethnicity, and related social determinants of health into large international studies. Most studies of differences in treatments and outcomes of COVID-19 associated with race and ethnicity are from single cities or countries. METHODS We present the breadth of race and ethnicity reported for patients in the COVID-19 Critical Care Consortium, an international observational cohort study from 380 sites across 32 countries. Patients from the United States, Australia, and South Africa were the focus of an analysis of treatments and in-hospital mortality stratified by race and ethnicity. Inclusion criteria were admission to intensive care for acute COVID-19 between January 14th, 2020, and February 15, 2022. Measurements included demographics, comorbidities, disease severity scores, treatments for organ failure, and in-hospital mortality. RESULTS Seven thousand three hundred ninety-four adults met the inclusion criteria. There was a wide variety of race and ethnicity designations. In the US, American Indian or Alaska Natives frequently received dialysis and mechanical ventilation and had the highest mortality. In Australia, organ failure scores were highest for Aboriginal/First Nations persons. The South Africa cohort ethnicities were predominantly Black African (50%) and Coloured* (28%). All patients in the South Africa cohort required mechanical ventilation. Mortality was highest for South Africa (68%), lowest for Australia (15%), and 30% in the US. CONCLUSIONS Disease severity was higher for Indigenous ethnicity groups in the US and Australia than for other ethnicities. Race and ethnicity groups with longstanding healthcare disparities were found to have high acuity from COVID-19 and high mortality. Because there is no global system of race and ethnicity classification, researchers designing case report forms for international studies should consider including related information, such as socioeconomic status or migration background. *Note: "Coloured" is an official, contemporary government census category of South Africa and is a term of self-identification of race and ethnicity of many citizens of South Africa.
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Affiliation(s)
- Matthew J Griffee
- Department of Anesthesiology, University of Utah School of Medicine, 30 N Mario Capecchi Drive, HELIX Tower 5N100, Salt Lake City, UT, 84112, USA.
| | - David A Thomson
- Department of Anaesthesia and Perioperative Medicine, Division of Critical Care, University of Cape Town, Cape Town, South Africa
| | - Jonathon Fanning
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Adrian Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nicole M White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- St Andrew's War Memorial Hospital, UnitingCare, Spring Hill, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- St Andrew's War Memorial Hospital, UnitingCare, Spring Hill, QLD, Australia
- Wesley Medical Research Foundation, Auchenflower, QLD, Australia
- Wesley Hospital, Spring Hill, Auchenflower, QLD, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Sung-Min Cho
- Departments of Neurology, Surgery, Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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18
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Ioannidis JPA, Zonta F, Levitt M. Variability in excess deaths across countries with different vulnerability during 2020-2023. Proc Natl Acad Sci U S A 2023; 120:e2309557120. [PMID: 38019858 PMCID: PMC10710037 DOI: 10.1073/pnas.2309557120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Excess deaths provide total impact estimates of major crises, such as the COVID-19 pandemic. We evaluated excess death trajectories across countries with accurate death registration and population age structure data and assessed relationships with vulnerability indicators. Using the Human Mortality Database on 34 countries, excess deaths were calculated for 2020-2023 (to week 29, 2023) using 2017-2019 as reference, with adjustment for 5 age strata. Countries were divided into less and more vulnerable; the latter had per capita nominal GDP < $30,000, Gini > 0.35 for income inequality and/or at least ≥2.5% of their population living in poverty. Excess deaths (as proportion of expected deaths, p%) were inversely correlated with per capita GDP (r = -0.60), correlated with proportion living in poverty (r = 0.66), and modestly correlated with income inequality (r = 0.45). Incidence rate ratio for deaths was 1.062 (95% CI, 1.038-1.087) in more versus less vulnerable countries. Excess deaths started deviating in the two groups after the first wave. Between-country heterogeneity diminished gradually within each group. Less vulnerable countries had mean p% = -0.8% and 0.4% in 0-64 and >65-y-old strata. More vulnerable countries had mean p% = 7.0% and 7.2%, respectively. Lower death rates were seen in children of age 0-14 y during 2020-2023 versus prepandemic years. While the pandemic hit some countries earlier than others, country vulnerability dominated eventually the cumulative impact. Half the analyzed countries witnessed no substantial excess deaths versus prepandemic levels, while the others suffered major death tolls.
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Affiliation(s)
- John P. A. Ioannidis
- Department of Medicine, Stanford University, Stanford, CA94305
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA94305
- Department of Biomedical Data Science, Stanford University, Stanford, CA94305
- Department of Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA94305
| | - Francesco Zonta
- Department of Biological Sciences, Xi’an Jiaotong Liverpool University, Suzhou215123, China
| | - Michael Levitt
- Department of Structural Biology, Stanford University, Stanford, CA94305
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19
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Hui Yeo Y, Zhang Y, He X, Lv F, Patel JK, Ji F, Cheng S. Temporal trend of acute myocardial infarction-related mortality and associated racial/ethnic disparities during the omicron outbreak. J Transl Int Med 2023; 11:468-470. [PMID: 38130642 PMCID: PMC10732487 DOI: 10.2478/jtim-2023-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yue Zhang
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xinyuan He
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Fan Lv
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jignesh K. Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Fanpu Ji
- Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi Province, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, Shaanxi Province, China
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Xi’an, Shaanxi Province, China
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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20
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Amorrortu RP, Zhao Y, Keenan RJ, Gilbert SM, Rollison DE. Factors Associated with Self-reported COVID-19 Infection and Hospitalization among Patients Seeking Care at a Comprehensive Cancer Center. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01855-4. [PMID: 37917235 DOI: 10.1007/s40615-023-01855-4] [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: 06/21/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND COVID-19 infection severity differs by race and ethnicity, but its long-term effect on cancer-related outcomes is unknown. Therefore, information on COVID-19 history is critical to ascertain among new cancer patients in order to advance research on its impact on cancer outcomes and potentially related health disparities. METHODS A cross-sectional study was conducted among 16,025 new patients seeking care at Moffitt Cancer Center (MCC) between 2021 and 2022. Patient self-reported histories of COVID-19 infection and other pre-existing health conditions were obtained from electronic questionnaires administered to all new MCC patients. Associations between demographics and COVID-19 infection and hospitalization were examined. RESULTS A total of 1,971 patients (12.3%) reported ever having COVID-19. Self-reported COVID-19 history was significantly more prevalent in Hispanic vs. non-Hispanic patients (OR = 1.24, 1.05-1.45) and less prevalent in Asian versus White patients (OR = 0.49, 95% 0.33-0.70). Among patients who ever had COVID-19, 10.6% reported a COVID-19-related hospitalization. Males had higher odds of a COVID-19 related hospitalization than females (OR = 1.50, 95% CI = 1.09-2.05), as did Black/African American patients (OR = 2.11, 95% CI = 1.18-3.60) and patients of races other than Black/African American and Asian (OR = 2.61, 95% CI = 1.43-4.54) compared to White patients. Hispanic patients also experienced higher odds of hospitalization (OR = 2.06, 95% CI-1.29- 3.23) compared with non-Hispanic patients of all races in a sensitivity analysis that combined race/ethnicity. Pre-existing lung and breathing problems were associated with higher odds of being hospitalized with COVID-19 (OR = 2.38, 95% CI = 1.61-3.48), but these and other health conditions did not explain the observed associations between race and COVID-19 hospitalization. CONCLUSIONS Higher rates of COVID-19 hospitalization were observed among patients identifying as Black/African American or Hispanic independent of pre-existing health conditions. Future studies evaluating long-term effects of COVID-19 should carefully examine potential racial/ethnic disparities in cancer outcomes.
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Affiliation(s)
- Rossybelle P Amorrortu
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB 8th 8108, Tampa, FL, 33612, USA
| | - Yayi Zhao
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB 8th 8108, Tampa, FL, 33612, USA
| | - Robert J Keenan
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Scott M Gilbert
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB 8th 8108, Tampa, FL, 33612, USA.
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21
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Pothisiri W, Prasitsiriphon O, Apakupakul J, Ploddi K. Gender differences in estimated excess mortality during the COVID-19 pandemic in Thailand. BMC Public Health 2023; 23:1900. [PMID: 37784059 PMCID: PMC10544589 DOI: 10.1186/s12889-023-16828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There is a limited body of research specifically examining gender inequality in excess mortality and its variations across age groups and geographical locations during the COVID-19 pandemic. This study aims to fill this gap by analyzing the patterns of gender inequality in excess all-cause mortality in Thailand during the COVID-19 pandemic. METHODS Data pertaining to all-cause deaths and population between January 1, 2010, and December 31, 2021, were obtained from Thailand's Bureau of Registration Administration. A seasonal autoregressive integrated moving average (SARIMA) technique was used to estimate excess mortality during the pandemic between January 2020 to December 2021. Gender differential excess mortality was measured as the difference in age-standardized mortality rates between men and women. RESULTS Our SARIMA-based estimate of all-cause mortality in Thailand during the COVID-19 pandemic amounted to 1,032,921 deaths, with COVID-19-related fatalities surpassing official figures by 1.64 times. The analysis revealed fluctuating patterns of excess and deficit in all-cause mortality rates across different phases of the pandemic, as well as among various age groups and regions. In 2020, the most pronounced gender disparity in excess all-cause mortality emerged in April, with 4.28 additional female deaths per 100,000, whereas in 2021, the peak gender gap transpired in August, with 7.52 more male deaths per 100,000. Individuals in the 80 + age group exhibited the largest gender gap for most of the observed period. Gender differences in excess mortality were uniform across regions and over the period observed. Bangkok showed the highest gender disparity during the peak of the fourth wave, with 24.18 more male deaths per 100,000. CONCLUSION The findings indicate an overall presence of gender inequality in excess mortality during the COVID-19 pandemic in Thailand, observed across age groups and regions. These findings highlight the need for further attention to be paid to gender disparities in mortality and call for targeted interventions to address these disparities.
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Affiliation(s)
- Wiraporn Pothisiri
- College of Population Studies, Chulalongkorn University, Bangkok, Thailand
| | | | - Jutarat Apakupakul
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nontaburi, Thailand
| | - Kritchavat Ploddi
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nontaburi, Thailand
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22
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Woolf SH. Policies Have Consequences: Measuring Excess Deaths During the COVID-19 Pandemic. Am J Public Health 2023; 113:1046-1049. [PMID: 37672735 PMCID: PMC10484145 DOI: 10.2105/ajph.2023.307390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Steven H Woolf
- Steven H. Woolf is with the Center on Society and Health and the Department of Family Medicine, Virginia Commonwealth University, Richmond
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23
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Chen R, Charpignon ML, Raquib RV, Wang J, Meza E, Aschmann HE, DeVost MA, Mooney A, Bibbins-Domingo K, Riley AR, Kiang MV, Chen YH, Stokes AC, Glymour MM. Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US. JAMA Neurol 2023; 80:919-928. [PMID: 37459088 PMCID: PMC10352932 DOI: 10.1001/jamaneurol.2023.2226] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/27/2023] [Indexed: 07/20/2023]
Abstract
Importance Adults with Alzheimer disease and related dementias (ADRD) are particularly vulnerable to the direct and indirect effects of the COVID-19 pandemic. Deaths associated with ADRD increased substantially in pandemic year 1. It is unclear whether mortality associated with ADRD declined when better prevention strategies, testing, and vaccines became widely available in year 2. Objective To compare pandemic-era excess deaths associated with ADRD between year 1 and year 2 overall and by age, sex, race and ethnicity, and place of death. Design, Setting, and Participants This time series analysis used all death certificates of US decedents 65 years and older with ADRD as an underlying or contributing cause of death from January 2014 through February 2022. Exposure COVID-19 pandemic era. Main Outcomes and Measures Pandemic-era excess deaths associated with ADRD were defined as the difference between deaths with ADRD as an underlying or contributing cause observed from March 2020 to February 2021 (year 1) and March 2021 to February 2022 (year 2) compared with expected deaths during this period. Expected deaths were estimated using data from January 2014 to February 2020 fitted with autoregressive integrated moving average models. Results Overall, 2 334 101 death certificates were analyzed. A total of 94 688 (95% prediction interval [PI], 84 192-104 890) pandemic-era excess deaths with ADRD were estimated in year 1 and 21 586 (95% PI, 10 631-32 450) in year 2. Declines in ADRD-related deaths in year 2 were substantial for every age, sex, and racial and ethnic group evaluated. Pandemic-era ADRD-related excess deaths declined among nursing home/long-term care residents (from 34 259 [95% PI, 25 819-42 677] in year 1 to -22 050 [95% PI, -30 765 to -13 273] in year 2), but excess deaths at home remained high (from 34 487 [95% PI, 32 815-36 142] in year 1 to 28 804 [95% PI, 27 067-30 571] in year 2). Conclusions and Relevance This study found that large increases in mortality with ADRD as an underlying or contributing cause of death occurred in COVID-19 pandemic year 1 but were largely mitigated in pandemic year 2. The most pronounced declines were observed for deaths in nursing home/long-term care settings. Conversely, excess deaths at home and in medical facilities remained high in year 2.
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Affiliation(s)
- Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Marie-Laure Charpignon
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge
| | - Rafeya V. Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Jingxuan Wang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Erika Meza
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Hélène E. Aschmann
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Michelle A. DeVost
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Alyssa Mooney
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
- Editor in Chief, JAMA
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz, Santa Cruz
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - M. Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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24
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Strassle PD, Green AL, Colbert CA, Stewart AL, Nápoles AM. COVID-19 vaccination willingness and uptake among rural Black/African American, Latino, and White adults. J Rural Health 2023; 39:756-764. [PMID: 36863851 PMCID: PMC10474244 DOI: 10.1111/jrh.12751] [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] [Indexed: 03/04/2023]
Abstract
PURPOSE The purpose of this study was to assess differences in COVID-19 vaccine willingness and uptake between rural and nonrural adults, and within rural racial-ethnic groups. METHODS We utilized data from the COVID-19's Unequal Racial Burden online survey, which included 1,500 Black/African American, Latino, and White rural adults (n = 500 each). Baseline (12/2020-2/2021) and 6-month follow-up (8/2021-9/2021) surveys were administered. A cohort of nonrural Black/African American, Latino, and White adults (n = 2,277) was created to compare differences between rural and nonrural communities. Multinomial logistic regression was used to assess associations between rurality, race-ethnicity, and vaccine willingness and uptake. FINDINGS At baseline, only 24.9% of rural adults were extremely willing to be vaccinated and 28.4% were not at all willing. Rural White adults were least willing to be vaccinated, compared to nonrural White adults (extremely willing: aOR = 0.44, 95% CI = 0.30-0.64). At follow-up, 69.3% of rural adults were vaccinated; however, only 25.3% of rural adults who reported being unwilling to vaccinate were vaccinated at follow-up, compared to 95.6% of adults who were extremely willing to be vaccinated and 76.3% who were unsure. Among those unwilling to vaccinate at follow-up, almost half reported distrust in the government (52.3%) and drug companies (46.2%); 80% reported that nothing would change their minds regarding vaccination. CONCLUSIONS By August 2021, almost 70% of rural adults were vaccinated. However, distrust and misinformation were prevalent among those unwilling to vaccinate at follow-up. To continue to effectively combat COVID-19 in rural communities, we need to address misinformation to increase COVID-19 vaccination rates.
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Affiliation(s)
- Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Alexis L. Green
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Caleb A. Colbert
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Anita L. Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, San Francisco, CA
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
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25
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Ioannidis JPA, Zonta F, Levitt M. Variability in excess deaths across countries with different vulnerability during 2020-2023. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.24.23289066. [PMID: 37162934 PMCID: PMC10168510 DOI: 10.1101/2023.04.24.23289066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Excess deaths provide total impact estimates of major crises, such as the COVID-19 pandemic. We evaluated excess death's trajectories during 2020-2023 across countries with accurate death registration and population age structure data; and assessed relationships with economic indicators of vulnerability. Using the Human Mortality Database on 34 countries, excess deaths were calculated for 2020-2023 (to week 29, 2023) using 2017-2019 as reference, with weekly expected death calculations and adjustment for 5 age strata. Countries were divided into less and more vulnerable; the latter had per capita nominal GDP<$30,000, Gini>0.35 for income inequality and/or at least 2.5% of their population living in poverty. Excess deaths (as proportion of expected deaths, p%) were inversely correlated with per capita GDP (r=-0.60), correlated with proportion living in poverty (r=0.66) and modestly correlated with income inequality (r=0.45). Incidence rate ratio for deaths was 1.06 (95% confidence interval, 1.04-1.08) in the more versus less vulnerable countries. Excess deaths started deviating in the two groups after the first wave. Between-country heterogeneity diminished over time within each of the two groups. Less vulnerable countries had mean p%=-0.8% and 0.4% in 0-64 and >65 year-old strata while more vulnerable countries had mean p%=7.0% and 7.2%, respectively. Usually lower death rates were seen in children 0-14 years old during 2020-2023 versus pre-pandemic years. While the pandemic hit some countries earlier than others, country vulnerability dominated eventually the cumulative impact. Half of the analyzed countries witnessed no substantial excess deaths versus pre-pandemic levels, while the other half suffered major death tolls.
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Affiliation(s)
- John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA 94305, USA
| | - Francesco Zonta
- Department of Biological Sciences, Xi'An Jiaotong Liverpool University, Suzhou 215123, China
| | - Michael Levitt
- Department of Structural Biology, Stanford University, Stanford, CA 94305, USA
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26
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Oh R, Kim MH, Lee J, Ha R, Kim J. Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea? Epidemiol Health 2023; 45:e2023072. [PMID: 37591788 PMCID: PMC10728611 DOI: 10.4178/epih.e2023072] [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: 03/16/2023] [Accepted: 07/03/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19). METHODS From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea's cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities. RESULTS All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased. CONCLUSIONS In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.
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Affiliation(s)
- Rora Oh
- Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Myoung-Hee Kim
- Center for Public Health Data Analytics, National Medical Center, Seoul, Korea
| | - Juyeon Lee
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rangkyoung Ha
- Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Jungwook Kim
- Department of Social Welfare, Seoul National University, Seoul, Korea
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27
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Luck AN, Elo IT, Preston SH, Paglino E, Hempstead K, Stokes AC. COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:71. [PMID: 37780841 PMCID: PMC10540502 DOI: 10.1007/s11113-023-09817-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/14/2023] [Indexed: 10/03/2023]
Abstract
Racial/ethnic and age disparities in COVID-19 and all-cause mortality during 2020 are well documented, but less is known about their evolution over time. We examine changes in age-specific mortality across five pandemic periods in the United States from March 2020 to December 2022 among four racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) for ages 35+. We fit Gompertz models to all-cause and COVID-19 death rates by 5-year age groups and construct age-specific racial/ethnic mortality ratios across an Initial peak (Mar-Aug 2020), Winter peak (Nov 2020-Feb 2021), Delta peak (Aug-Oct 2021), Omicron peak (Nov 2021-Feb 2022), and Endemic period (Mar-Dec 2022). We then compare to all-cause patterns observed in 2019. The steep age gradients in COVID-19 mortality in the Initial and Winter peak shifted during the Delta peak, with substantial increases in mortality at working ages, before gradually returning to an older age pattern in the subsequent periods. We find a disproportionate COVID-19 mortality burden on racial and ethnic minority populations early in the pandemic, which led to an increase in all-cause mortality disparities and a temporary elimination of the Hispanic mortality advantage at certain age groups. Mortality disparities narrowed over time, with racial/ethnic all-cause inequalities during the Endemic period generally returning to pre-pandemic levels. Black and Hispanic populations, however, faced a younger age gradient in all-cause mortality in the Endemic period relative to 2019, with younger Hispanic and Black adults in a slightly disadvantageous position and older Black adults in a slightly advantageous position, relative to before the pandemic.
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Affiliation(s)
- Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | - Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, USA
| | | | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, USA
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28
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Ioannidis JPA, Zonta F, Levitt M. Flaws and uncertainties in pandemic global excess death calculations. Eur J Clin Invest 2023; 53:e14008. [PMID: 37067255 PMCID: PMC10404446 DOI: 10.1111/eci.14008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 04/18/2023]
Abstract
Several teams have been publishing global estimates of excess deaths during the COVID-19 pandemic. Here, we examine potential flaws and underappreciated sources of uncertainty in global excess death calculations. Adjusting for changing population age structure is essential. Otherwise, excess deaths are markedly overestimated in countries with increasingly aging populations. Adjusting for changes in other high-risk indicators, such as residence in long-term facilities, may also make a difference. Death registration is highly incomplete in most countries; completeness corrections should allow for substantial uncertainty and consider that completeness may have changed during pandemic years. Excess death estimates have high sensitivity to modelling choice. Therefore different options should be considered and the full range of results should be shown for different choices of pre-pandemic reference periods and imposed models. Any post-modelling corrections in specific countries should be guided by pre-specified rules. Modelling of all-cause mortality (ACM) in countries that have ACM data and extrapolating these models to other countries is precarious; models may lack transportability. Existing global excess death estimates underestimate the overall uncertainty that is multiplicative across diverse sources of uncertainty. Informative excess death estimates require risk stratification, including age groups and ethnic/racial strata. Data to-date suggest a death deficit among children during the pandemic and marked socioeconomic differences in deaths, widening inequalities. Finally, causal explanations require great caution in disentangling SARS-CoV-2 deaths, indirect pandemic effects and effects from measures taken. We conclude that excess deaths have many uncertainties, but globally deaths from SARS-CoV-2 may be the minority of calculated excess deaths.
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Affiliation(s)
- John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Francesco Zonta
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai, China
| | - Michael Levitt
- Department of Structural Biology, Stanford University, Stanford, California, USA
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29
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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. SCIENCE ADVANCES 2023; 9:eadf9742. [PMID: 37352359 PMCID: PMC10289647 DOI: 10.1126/sciadv.adf9742] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/18/2023] [Indexed: 06/25/2023]
Abstract
Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the COVID-19 pandemic's mortality impact. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating factors, and inform response efforts. 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 1,179,024 excess deaths occurred during the first 2 years of the pandemic (first: 634,830; second: 544,194). Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Despite the initial concentration of mortality in large metropolitan Northeastern counties, nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. These results highlight the need for investments in rural health as the pandemic's rural impact grows.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Zhenwei Zhou
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, 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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30
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Weber G, Cabras I, Peredo AM, Yanguas-Parra P, Prime K. Exploring resilience in public services within marginalised communities during COVID-19: The case of coal mining regions in Colombia. JOURNAL OF CLEANER PRODUCTION 2023; 415:137880. [PMID: 37362962 PMCID: PMC10285674 DOI: 10.1016/j.jclepro.2023.137880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
This paper examines the impact of COVID-19 on marginalised communities and its effects on the provision of public services. Focusing on two coal mining regions in Colombia during the pandemic crisis, and examining Indigenous and Afro-Colombian communities, we analyze the provision of public services at a local level, identifying both shortcomings and resilience. Findings show that the lack of resilient public services amplified the effects of COVID-19 and its containment measures, exacerbating existing structural inequalities within local marginalised communities. It also reinforced the control exercised by coal mining companies within local economies. However, the substantial lack of public service provision also provided space for the development and strengthening of several resilience strategies among local communities, such as solidarity networks and schemes and the revitalization of local environmental knowledge. The study identifies multiple shortcomings in how the national and local administrations handled the COVID-19 outbreak and highlights the potential of enhancing resilience in public services to support marginalised communities in times of crisis.
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Affiliation(s)
- Gabriel Weber
- ESSCA, School of Management, Angers, Bordeaux, France
| | - Ignazio Cabras
- ESSCA, School of Management, Angers, Bordeaux, France
- Newcastle Business School, Northumbria University, Newcastle, UK
| | - Ana Maria Peredo
- Telfer School of Management, University of Ottawa (Canada) and School of Environmental Studies, University of Victoria, Canada
| | | | - Karla Prime
- Newcastle Business School, Northumbria University, Newcastle, UK
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31
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Holm RH, Osborne Jelks N, Schneider R, Smith T. Beyond COVID-19: Designing Inclusive Public Health Surveillance by Including Wastewater Monitoring. Health Equity 2023; 7:377-379. [PMID: 37351532 PMCID: PMC10282970 DOI: 10.1089/heq.2022.0055] [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] [Accepted: 05/09/2023] [Indexed: 06/24/2023] Open
Abstract
Wastewater-based epidemiology is a promising and expanding public health surveillance method. The current wastewater testing trajectory to monitor primarily at community wastewater treatment plants was necessitated by immediate needs of the pandemic. Going forward, specific consideration should be given to monitoring vulnerable and underserved communities to ensure inclusion and rapid response to public health threats. This is particularly important when clinical testing data are insufficient to characterize community virus levels and spread in specific locations. Now is a timely call to action for equitably protecting health in the United States, which can be guided with intentional and inclusive wastewater monitoring.
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Affiliation(s)
- Rochelle H. Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | | | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
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Qin Q, Veazie P, Temkin-Greener H, Makineni R, Cai S. Racial/Ethnic Differences in Risk Factors Associated With Severe COVID-19 Among Older Adults With ADRD. J Am Med Dir Assoc 2023; 24:855-861.e7. [PMID: 37015322 PMCID: PMC9995316 DOI: 10.1016/j.jamda.2023.02.111] [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: 11/14/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To examine racial/ethnic differences in risk factors, and their associations with COVID-19-related outcomes among older adults with Alzheimer's disease and related dementias (ADRD). DESIGN Observational study. SETTING AND PARTICIPANTS National Medicare claims data and the Minimum Data Set 3.0 from April 1, 2020, to December 31, 2020, were linked in this study. We included community-dwelling fee-for-service Medicare beneficiaries with ADRD, diagnosed with COVID-19 between April 1, 2020, and December 1, 2020 (N = 138,533). METHODS Two outcome variables were defined: hospitalization within 14 days and death within 30 days of COVID-19 diagnosis. We obtained information on individual sociodemographic characteristics, chronic conditions, and prior health care utilization based on the Medicare claims and the Minimum Dataset. Machine learning methods, including lasso regression and discriminative pattern mining, were used to identify risk factors in racial/ethnic subgroups (ie, White, Black, and Hispanic individuals). The associations between identified risk factors and outcomes were evaluated using logistic regression and compared across racial/ethnic subgroups using the coefficient comparison approach. RESULTS We found higher risks of COVID-19-related outcomes among Black and Hispanic individuals. The areas under the curve of the models with identified risk factors were 0.65 to 0.68 for mortality and 0.61 to 0.62 for hospitalization across racial/ethnic subgroups. Although some identified risk factors (eg, age, gender) for COVID-19-related outcomes were common among all racial/ethnic subgroups, other risk factors (eg, hypertension, obesity) varied by racial/ethnic subgroups. Furthermore, the associations between some common risk factors and COVID-19-related outcomes also varied by race/ethnicity. Being male was related to 138.2% (95% CI: 1.996-2.841), 64.7% (95% CI: 1.546-1.755), and 37.1% (95% CI: 1.192-1.578) increased odds of death among Hispanic, White, and Black individuals, respectively. In addition, the racial/ethnic disparity in COVID-19-related outcomes could not be completely explained by the identified risk factors. CONCLUSIONS AND IMPLICATIONS Racial/ethnic differences were detected in the likelihood of having COVID-19-related outcomes, specific risk factors, and relationships between specific risk factors and COVID-19-related outcomes. Future research is needed to elucidate the reasons for these differences.
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Affiliation(s)
- Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Peter Veazie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajesh Makineni
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Caraballo C, Massey DS, Ndumele CD, Haywood T, Kaleem S, King T, Liu Y, Lu Y, Nunez-Smith M, Taylor HA, Watson KE, Herrin J, Yancy CW, Faust JS, Krumholz HM. Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020. JAMA 2023; 329:1662-1670. [PMID: 37191702 PMCID: PMC10189563 DOI: 10.1001/jama.2023.7022] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
Importance Amid efforts in the US to promote health equity, there is a need to assess recent progress in reducing excess deaths and years of potential life lost among the Black population compared with the White population. Objective To evaluate trends in excess mortality and years of potential life lost among the Black population compared with the White population. Design, setting, and participants Serial cross-sectional study using US national data from the Centers for Disease Control and Prevention from 1999 through 2020. We included data from non-Hispanic White and non-Hispanic Black populations across all age groups. Exposures Race as documented in the death certificates. Main outcomes and measures Excess age-adjusted all-cause mortality, cause-specific mortality, age-specific mortality, and years of potential life lost rates (per 100 000 individuals) among the Black population compared with the White population. Results From 1999 to 2011, the age-adjusted excess mortality rate declined from 404 to 211 excess deaths per 100 000 individuals among Black males (P for trend <.001). However, the rate plateaued from 2011 through 2019 (P for trend = .98) and increased in 2020 to 395-rates not seen since 2000. Among Black females, the rate declined from 224 excess deaths per 100 000 individuals in 1999 to 87 in 2015 (P for trend <.001). There was no significant change between 2016 and 2019 (P for trend = .71) and in 2020 rates increased to 192-levels not seen since 2005. The trends in rates of excess years of potential life lost followed a similar pattern. From 1999 to 2020, the disproportionately higher mortality rates in Black males and females resulted in 997 623 and 628 464 excess deaths, respectively, representing a loss of more than 80 million years of life. Heart disease had the highest excess mortality rates, and the excess years of potential life lost rates were largest among infants and middle-aged adults. Conclusions and relevance Over a recent 22-year period, the Black population in the US experienced more than 1.63 million excess deaths and more than 80 million excess years of life lost when compared with the White population. After a period of progress in reducing disparities, improvements stalled, and differences between the Black population and the White population worsened in 2020.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Daisy S. Massey
- University of Massachusetts T.H. Chan School of Medicine, Worcester
| | - Chima D. Ndumele
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | | | - Shayaan Kaleem
- Department of Human Biology, University of Toronto, Toronto, Ontario, Canada
| | | | - Yuntian Liu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Herman A. Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Karol E. Watson
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Clyde W. Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | | | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Rao A, Alnababteh MH, Avila-Quintero VJ, Flores JM, Laing NE, Boyd DA, Yu J, Ahmed N, Groninger H, Zaaqoq AM. Association Between Patient Race and Ethnicity and Outcomes With COVID-19: A Retrospective Analysis From a Large Mid-Atlantic Health System. J Intensive Care Med 2023; 38:472-478. [PMID: 36594202 DOI: 10.1177/08850666221149956] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND Members of racial and ethnic minority groups have been disproportionately impacted by coronavirus-2019 (COVID-19). The objective of the study is to describe associations between race and ethnicity on clinical outcomes such as need for mechanical ventilation and mortality. METHODS Retrospective cohort study of patients with severe COVID-19 infection admitted within a large, not-for-profit healthcare system in the mid-Atlantic region between March and July, 2020. Patient demographic data and clinical outcomes were abstracted from the electronic health record. Logistic regressions were performed to estimate associations between race and ethnicity and the clinical outcomes. RESULTS The study population (N = 2931) was stratified into 1 of 3 subgroups: non-Hispanic White (n = 466), non-Hispanic Black (n = 1611), and Hispanic (n = 654). The average age of White, Black, and Hispanic patients was 69 ± 17.06, 64 ± 15.9, and 50 ± 15.53 years old, respectively (P < .001). Compared to White patients, Black and Hispanic patients were at increased odds of needing mechanical ventilation due to COVID-19 pneumonia (odds ratio [OR] Black = 1.35, 95% confidence interval [CI] = 1.04 to 1.75, P < .05; OR Hispanic = 1.43, 95% CI = 1.06 to 1.93, P < .05). When compared to White patients, Hispanic patients were at decreased odds of death (OR = 0.45, 95% CI = 0.32 to 0.63, P < .001). However, when adjusting for age, there were no statistically significant differences in the odds of death between these groups (adjusted OR [aOR] Black = 1.05, 95% CI = 0.80 to 1.38, P = .71; aOR Hispanic = 1.10, 95% CI = 0.76 to 1.60, P = .62). CONCLUSION Our analysis demonstrated that Hispanic patients were more likely require mechanical ventilation but had lower mortality when compared to White patients, with lower average age likely mediating this association. These findings emphasize the importance of outreach efforts to communities of color to increase prevention measures and vaccination uptake to reduce infection with COVID-19.
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Affiliation(s)
- Anirudh Rao
- Department of Medicine, 12230Georgetown University School of Medicine, Washington DC, USA
- Section of Palliative Care, Department of Medicine, 8405MedStar Washington Hospital Center, Washington DC, USA
| | - Muhtadi H Alnababteh
- Department of Critical Care Medicine, 8405MedStar Washington Hospital Center, Washington DC, USA
| | | | - Jose M Flores
- 12228Yale University School of Medicine, New Haven, CT, USA
| | - Nina E Laing
- Department of Medicine, 12230Georgetown University School of Medicine, Washington DC, USA
- Section of Palliative Care, Department of Medicine, 8405MedStar Washington Hospital Center, Washington DC, USA
| | - David A Boyd
- Section of Palliative Care, Department of Medicine, 8405MedStar Washington Hospital Center, Washington DC, USA
| | - Jennifer Yu
- Department of Critical Care Medicine, 8405MedStar Washington Hospital Center, Washington DC, USA
| | - Naheed Ahmed
- 121577MedStar Health Research Institute, Hyattsville, MD, USA
| | - Hunter Groninger
- Department of Medicine, 12230Georgetown University School of Medicine, Washington DC, USA
- Section of Palliative Care, Department of Medicine, 8405MedStar Washington Hospital Center, Washington DC, USA
| | - Akram M Zaaqoq
- Department of Medicine, 12230Georgetown University School of Medicine, Washington DC, USA
- Department of Critical Care Medicine, 8405MedStar Washington Hospital Center, Washington DC, USA
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Temporal variation of excess deaths from diabetes during the COVID-19 pandemic in the United States. J Infect Public Health 2023; 16:483-489. [PMID: 36801628 PMCID: PMC9873362 DOI: 10.1016/j.jiph.2023.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/06/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although the COVID-19 pandemic has persisted for more than two years with the evident excess mortality from diabetes, few studies have investigated its temporal patterns. This study aims to estimate the excess deaths from diabetes in the United States (US) during the COVID-19 pandemic and evaluate the excess deaths by spatiotemporal pattern, age groups, sex, and race/ethnicity. METHODS Diabetes as one of multiple causes of death or an underlying cause of death were both considered into analyses. The Poisson log-linear regression model was used to estimate weekly expected counts of deaths during the pandemic with adjustments for long-term trend and seasonality. Excess deaths were measured by the difference between observed and expected death counts, including weekly average excess deaths, excess death rate, and excess risk. We calculated the excess estimates by pandemic wave, US state, and demographic characteristic. RESULTS From March 2020 to March 2022, deaths that diabetes as one of multiple causes of death and an underlying cause of death were about 47.6 % and 18.4 % higher than the expected. The excess deaths of diabetes had evident temporal patterns with two large percentage increases observed during March 2020, to June 2020, and June 2021 to November 2021. The regional heterogeneity and underlying age and racial/ethnic disparities of the excess deaths were also clearly observed. CONCLUSIONS This study highlighted the increased risks of diabetes mortality, heterogeneous spatiotemporal patterns, and associated demographic disparities during the pandemic. Practical actions are warranted to monitor disease progression, and lessen health disparities in patients with diabetes during the COVID-19 pandemic.
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Luck AN, Stokes AC, Hempstead K, Paglino E, Preston SH. Associations between mortality from COVID-19 and other causes: A state-level analysis. PLoS One 2023; 18:e0281683. [PMID: 36877692 PMCID: PMC9987806 DOI: 10.1371/journal.pone.0281683] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/17/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the high death toll from COVID-19 was accompanied by a rise in mortality from other causes of death. The objective of this study was to identify the relationship between mortality from COVID-19 and changes in mortality from specific causes of death by exploiting spatial variation in these relationships across US states. METHODS We use cause-specific mortality data from CDC Wonder and population estimates from the US Census Bureau to examine relationships at the state level between mortality from COVID-19 and changes in mortality from other causes of death. We calculate age-standardized death rates (ASDR) for three age groups, nine underlying causes of death, and all 50 states and the District of Columbia between the first full year of the pandemic (March 2020-February 2021) and the year prior (March 2019-February 2020). We then estimate the relationship between changes in cause-specific ASDR and COVID-19 ASDR using linear regression analysis weighted by the size of the state's population. RESULTS We estimate that causes of death other than COVID-19 represent 19.6% of the total mortality burden associated with COVID-19 during the first year of the COVID-19 pandemic. At ages 25+, circulatory disease accounted for 51.3% of this burden while dementia (16.4%), other respiratory diseases (12.4%), influenza/pneumonia (8.7%) and diabetes (8.6%) also contribute. In contrast, there was an inverse association across states between COVID-19 death rates and changes in death rates from cancer. We found no state-level association between COVID-19 mortality and rising mortality from external causes. CONCLUSIONS States with unusually high death rates from COVID-19 experienced an even larger mortality burden than implied by those rates alone. Circulatory disease served as the most important route through which COVID-19 mortality affected death rates from other causes of death. Dementia and other respiratory diseases made the second and third largest contributions. In contrast, mortality from neoplasms tended to decline in states with the highest death rates from COVID-19. Such information may help to inform state-level responses aimed at easing the full mortality burden of the COVID-19 pandemic.
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Affiliation(s)
- Anneliese N. Luck
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | | | - Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
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Han L, Zhao S, Li S, Gu S, Deng X, Yang L, Ran J. Excess cardiovascular mortality across multiple COVID-19 waves in the United States from March 2020 to March 2022. NATURE CARDIOVASCULAR RESEARCH 2023; 2:322-333. [PMID: 39195997 DOI: 10.1038/s44161-023-00220-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/24/2023] [Indexed: 08/29/2024]
Abstract
The COVID-19 pandemic has limited the access of patients with cardiovascular diseases to healthcare services, causing excess deaths. However, a detailed analysis of temporal variations of excess cardiovascular mortality during the COVID-19 pandemic has been lacking. Here we estimate time-varied excess cardiovascular deaths (observed deaths versus expected deaths predicted by the negative binomial log-linear regression model) in the United States. From March 2020 to March 2022 there were 90,160 excess cardiovascular deaths, or 4.9% more cardiovascular deaths than expected. Two large peaks of national excess cardiovascular mortality were observed during the periods of March-June 2020 and June-November 2021, coinciding with two peaks of COVID-19 deaths, but the temporal patterns varied by state, age, sex and race and ethnicity. The excess cardiovascular death percentages were 5.7% and 4.0% in men and women, respectively, and 3.6%, 8.8%, 7.5% and 7.7% in non-Hispanic White, Black, Asian and Hispanic people, respectively. Our data highlight an urgent need for healthcare services optimization for patients with cardiovascular diseases in the COVID-19 era.
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Affiliation(s)
- Lefei Han
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, China
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siyuan Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siyu Gu
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, China
| | - Xiaobei Deng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Jinjun Ran
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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How Did the Two Years of the COVID-19 Pandemic Affect the Outcomes of the Patients with Inflammatory Rheumatic Diseases in Lithuania? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020311. [PMID: 36837512 PMCID: PMC9960818 DOI: 10.3390/medicina59020311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Background and objectives: the COVID-19 pandemic globally caused more than 18 million deaths over the period of 2020-2021. Although inflammatory rheumatic diseases (RD) are generally associated with premature mortality, it is not yet clear whether RD patients are at a greater risk for COVID-19-related mortality. The aim of our study was to evaluate mortality and causes of death in a retrospective inflammatory RD patient cohort during the COVID-19 pandemic years. Methods: We identified patients with a first-time diagnosis of inflammatory RD and followed them up during the pandemic years of 2020-2021. Death rates, and sex- and age-standardized mortality ratios (SMRs) were calculated for the prepandemic and pandemic periods. Results: We obtained data from 11,636 patients that had been newly diagnosed with inflammatory RD and followed up until the end of 2021 or their death. The mean duration of the follow-up was 5.5 years. In total, 1531 deaths occurred between 2013 and 2021. The prevailing causes of death in the prepandemic period were cardiovascular diseases, neoplasms, and diseases of the respiratory system. In the pandemic years, cardiovascular diseases and neoplasms remained the two most common causes of death, with COVID-19 in third place. The SMR of the total RD cohort was 0.83. This trend was observed in rheumatoid arthritis and spondyloarthropathy patients. The SMR in the group of connective-tissue diseases and vasculitis was higher at 0.93, but did not differ from that of the general population. The excess of deaths in the RD cohort during the pandemic period was negative (-27.2%), meaning that RD patients endured the pandemic period better than the general population did. Conclusions: The COVID-19 pandemic did not influence the mortality of RD patients. Strict lockdown measures, social distancing, and early vaccination were the main factors that resulted in reduced mortality in this cohort during the pandemic years.
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Barnes JM, Chino JP, Chino F. Racial and Ethnic Disparities in Coexisting Cancer and COVID-19 Mortality. J Gen Intern Med 2023; 38:1344-1347. [PMID: 36750506 PMCID: PMC9904866 DOI: 10.1007/s11606-023-08069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Justin M Barnes
- Department of Radiation Oncology, Center for Advanced Medicine, Washington University School of Medicine, 4921 Parkview Place, Lower Level, St. Louis, MO, 63110, USA.
| | - Junzo P Chino
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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McAlister FA, Hsu Z, Dong Y, Tsuyuki RT, van Walraven C, Bakal JA. Frequency and Type of Outpatient Visits for Patients With Cardiovascular Ambulatory-Care Sensitive Conditions During the COVID-19 Pandemic and Subsequent Outcomes: A Retrospective Cohort Study. J Am Heart Assoc 2023; 12:e027922. [PMID: 36734338 PMCID: PMC9973663 DOI: 10.1161/jaha.122.027922] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Because the impact of changes in how outpatient care was delivered during the COVID-19 pandemic is uncertain, we designed this study to examine the frequency and type of outpatient visits between March 1, 2019 to February 29, 2020 (prepandemic) and from March 1, 2020 to February 28, 2021 (pandemic) and specifically compared outcomes after virtual versus in-person outpatient visits during the pandemic. Methods and Results Population-based retrospective cohort study of all 3.8 million adults in Alberta, Canada. We examined all physician visits and 30- and 90-day outcomes, with a focus on those adults with the cardiovascular ambulatory-care sensitive conditions heart failure, hypertension, and diabetes. Our primary outcome was emergency department visit or hospitalization, evaluated using survival analysis accounting for competing risk of death. Although in-person outpatient visits decreased by 38.9% in the year after March 1, 2020 (10 142 184 versus 16 592 599 in the prior year), the introduction of virtual visits (7 152 147; 41.4% of total) meant that total outpatient visits increased by 4.1% in the first year of the pandemic for Albertan adults. Outpatient visit frequency (albeit 41.4% virtual, 58.6% in-person) and prescribing patterns were stable in the first year after pandemic onset for patients with the cardiovascular ambulatory-care sensitive conditions we examined, but laboratory test frequency declined by 20% (serum creatinine) to 47% (glycosylated hemoglobin). In the first year of the pandemic, virtual outpatient visits were associated with fewer subsequent emergency department visits or hospitalizations (compared with in-person visits) for patients with heart failure (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.85-0.96] at 30 days and 0.96 [95% CI, 0.92-1.00] at 90 days), hypertension (aHR, 0.88 [95% CI, 0.85-0.91] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days), or diabetes (aHR, 0.90 [95% CI, 0.87-0.93] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days). Conclusions The adoption and rapid uptake of virtual outpatient care during the COVID-19 pandemic did not negatively impact frequency of follow-up, prescribing, or short-term outcomes, and could have potentially positively impacted some of these for adults with heart failure, diabetes, or hypertension in a setting where there was an active reimbursement policy for virtual visits. Given declines in laboratory monitoring and screening activities, further research is needed to evaluate whether long-term outcomes will differ.
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Affiliation(s)
- Finlay A. McAlister
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada,Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Zoe Hsu
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Yuan Dong
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Ross T. Tsuyuki
- Departments of Pharmacology, Medicine, and EPICORE Centre, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Carl van Walraven
- Division of General Internal MedicineOttawa Hospital and the Ottawa Health Research InstituteOttawaOntarioCanada
| | - Jeffrey A. Bakal
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada,Provincial Research Data Services, Alberta Health ServicesEdmontonAlbertaCanada
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Gao X, Lv F, He X, Zhao Y, Liu Y, Zu J, Henry L, Wang J, Yeo YH, Ji F, Nguyen MH. Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States. J Hepatol 2023; 78:16-27. [PMID: 35988691 PMCID: PMC9611810 DOI: 10.1016/j.jhep.2022.07.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/30/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The pandemic has resulted in an increase of deaths not directly related to COVID-19 infection. We aimed to use a national death dataset to determine the impact of the pandemic on people with liver disease in the USA, focusing on alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). METHODS Using data from the National Vital Statistic System from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) platform and ICD-10 codes, we identified deaths associated with liver disease. We evaluated observed vs. predicted mortality for 2020-2021 based on trends from 2010-2019 with joinpoint and prediction modelling analysis. RESULTS Among 626,090 chronic liver disease-related deaths between 2010 and 2021, Age-standardised mortality rates (ASMRs) for ALD dramatically increased between 2010-2019 and 2020-2021 (annual percentage change [APC] 3.5% to 17.6%, p <0.01), leading to a higher observed ASMR (per 100,000 persons) than predicted for 2020 (15.67 vs. 13.04) and 2021 (17.42 vs. 13.41). ASMR for NAFLD also increased during the pandemic (APC: 14.5%), whereas the rates for hepatitis B and C decreased. Notably, the ASMR rise for ALD was most pronounced in non-Hispanic Whites, Blacks, and Alaska Indians/Native Americans (APC: 11.7%, 10.8%, 18.0%, all p <0.05), with similar but less critical findings for NAFLD, whereas rates were steady for non-Hispanic Asians throughout 2010-2021 (APC: 4.9%). The ASMR rise for ALD was particularly severe for the 25-44 age group (APC: 34.6%, vs. 13.7% and 12.6% for 45-64 and ≥65, all p <0.01), which were also all higher than pre-COVID-19 rates (all p <0.01). CONCLUSIONS ASMRs for ALD and NAFLD increased at an alarming rate during the COVID-19 pandemic with the largest disparities among the young, non-Hispanic White, and Alaska Indian/Native American populations. IMPACT AND IMPLICATIONS The pandemic has led to an increase of deaths directly and indirectly related to SARS-CoV-2 infection. As shown in this study, age-standardised mortality rates for alcohol-associated liver disease and non-alcoholic fatty liver disease substantially increased during the COVID-19 pandemic in the USA and far exceeded expected levels predicted from past trends, especially among the young, non-Hispanic White, and Alaska Indian/Native American populations. However, much of this increase was not directly related to COVID-19. Therefore, for the ongoing pandemic as well as its recovery phase, adherence to regular monitoring and care for people with chronic liver disease should be prioritised and awareness should be raised among patients, care providers, healthcare systems, and public health policy makers.
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Affiliation(s)
- Xu Gao
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Fan Lv
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, PR China
| | - Xinyuan He
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yunyu Zhao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yi Liu
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jian Zu
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, PR China.
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jinhai Wang
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yee Hui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, PR China.
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA.
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Majee W, Anakwe A, Onyeaka K, Harvey IS. The Past Is so Present: Understanding COVID-19 Vaccine Hesitancy Among African American Adults Using Qualitative Data. J Racial Ethn Health Disparities 2023; 10:462-474. [PMID: 35182372 PMCID: PMC8857529 DOI: 10.1007/s40615-022-01236-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND African Americans (AAs) are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. OBJECTIVE The present study aims to explore vaccine attitudes and intentions among program participants, understand the role of an African American faith-based wellness program in COVID-19 awareness and vaccine uptake, and solicit potential solutions for this deep-rooted public health problem. METHODS Data were collected through 21 in-depth interviews among individuals involved within a community-based wellness program. Sixteen phone and five in-person interviews were conducted with church leaders, lifestyle coaches, and program participants. All interviews were audio-recorded, transcribed verbatim, and inductively and thematically analyzed by three researchers. FINDINGS Live Well by Faith (LWBF) acted as a trusted information source for COVID-19 resources for the AA community. Services provided by Live Well by Faith included enrolling community members for vaccines, negotiating vaccine provision to and facilitating the establishment of vaccine clinics at AA churches, and connecting community members to healthcare providers. Despite the role Live Well by Faith played, VH was a significant concern due, in part, to historical mistrust of government and pharmaceutical companies conducting unethical healthcare research among Black populations. Other factors included uncertainty about vaccination (vaccines' safety, efficacy, and necessity), social media misinformation, and political affiliation. Participants expressed the need for government to commit resources towards addressing historical factors and building trust with minority populations. CONCLUSION Resource targeting programs such as Live Well by Faith that engage faith and community leaders in co-designed shared and culturally grounded interventions can help restore and strengthen trust in vaccines and governments and reduce vaccine hesitancy.
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Affiliation(s)
- Wilson Majee
- Department of Health Sciences, University of Missouri, Columbia, MO USA ,Department of Occupational Therapy, Faculty of Community & Health Science, University of the Western Cape, Cape Town, South Africa
| | - Adaobi Anakwe
- Department of Health Sciences, University of Missouri, Columbia, MO USA
| | - Kelechi Onyeaka
- Masters of Public Health Program, University of Missouri, Columbia, MO USA
| | - Idethia S. Harvey
- Department of Health Sciences, University of Missouri, Columbia, MO USA
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Neighbors HW, Mattingly DT, Johnson J, Morse K. The contribution of research to racial health equity? Blame and responsibility in navigating the status quo of anti-black systemic racism. Soc Sci Med 2023; 316:115209. [PMID: 35927144 DOI: 10.1016/j.socscimed.2022.115209] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/17/2022] [Accepted: 07/06/2022] [Indexed: 01/11/2023]
Abstract
Thirty-seven years ago, the Secretary's Task Force on Black and Minority Health called attention to a "national paradox" of persistent Black-White health disparities despite overall health improvements for the nation (HHS, 1985). Subsequent updates to the "Heckler Report" came to the same conclusion; Black Americans continued to exhibit poorer health in comparison to White Americans (Satcher et al., 2005). Current population health statistics demonstrate Black-White health disparities comparable to 1985 (AHRQ, 2018; Shiels et al., 2021; Wall et al., 2018). Although psychological, behavioral, social, and economic factors all contribute to Black-White differences in health, there is a noticeable increase in discussions about the importance of systemic racism in producing racial health disparities. This article addresses three questions relevant to research on racism and the health of Black Americans: (1) Why has academic public health research on racism failed to reduce racial health disparities? (2) What can academic public health scientists do differently to reduce the impact of systemic racism on inequities among Black and White Americans? (3) What can Black Americans do in the face of present-day anti-Black systemic racism? We argue that to convert the vision of health equity into a visible reality, health equity research scientists must move beyond discussion, observation, and description. We also argue that to demonstrate progress in reducing racial health disparities, health equity scientists will need to work much more directly on eradicating racism as a fundamental cause of health differences between Black and White Americans. As scientists, the challenge we face is how to accomplish this mission without leaving the realm of science. Racism is a social determinant of Black health and social determinants are political problems. Political problems require political solutions.
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Affiliation(s)
- Harold W Neighbors
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.
| | - Delvon T Mattingly
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 4810, USA.
| | - Janay Johnson
- Department of Family Science, University of Maryland School of Public Health, 4200 Valley Dr, College Park, MD, 20742, USA.
| | - Kayla Morse
- Detroit Health Department, Third Floor, 100 Mack Avenue, Detroit, MI, 48201, USA.
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McCoy RG, Campbell RL, Mullan AF, Bucks CM, Clements CM, Reichard RR, Jeffery MM. Changes in all-cause and cause-specific mortality during the first year of the COVID-19 pandemic in Minnesota: population-based study. BMC Public Health 2022; 22:2291. [PMID: 36474190 PMCID: PMC9727873 DOI: 10.1186/s12889-022-14743-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in unprecedented increases in mortality in the U.S. and worldwide. To better understand the impact of the COVID-19 pandemic on mortality in the state of Minnesota, U.S.A., we characterize the changes in the causes of death during 2020 (COVID-19 period), compared to 2018-2019 (baseline period), assessing for differences across ages, races, ethnicities, sexes, and geographic characteristics. METHODS Longitudinal population-based study using Minnesota death certificate data, 2018-2020. Using Poisson regression models adjusted for age and sex, we calculated all-cause and cause-specific (by underlying causes of death) mortality rates per 100,000 Minnesotans, the demographics of the deceased, and years of life lost (YLL) using the Chiang's life table method in 2020 relative to 2018-2019. RESULTS We identified 89,910 deaths in 2018-2019 and 52,030 deaths in 2020. The mean daily mortality rate increased from 123.1 (SD 11.7) in 2018-2019 to 144.2 (SD 22.1) in 2020. COVID-19 comprised 9.9% of deaths in 2020. Other categories of causes of death with significant increases in 2020 compared to 2018-2019 included assault by firearms (RR 1.68, 95% CI 1.34-2.11), accidental poisonings (RR 1.49, 95% CI 1.37-1.61), malnutrition (RR 1.48, 95% CI 1.17-1.87), alcoholic liver disease (RR, 95% CI 1.14-1.40), and cirrhosis and other chronic liver diseases (RR 1.28, 95% CI 1.09-1.50). Mortality rates due to COVID-19 and non-COVID-19 causes were higher among racial and ethnic minority groups, older adults, and non-rural residents. CONCLUSIONS The COVID-19 pandemic was associated with a 17% increase in the death rate in Minnesota relative to 2018-2019, driven by both COVID-19 and non-COVID-19 causes. As the COVID-19 pandemic enters its third year, it is imperative to examine and address the factors contributing to excess mortality in the short-term and monitor for additional morbidity and mortality in the years to come.
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Affiliation(s)
- Rozalina G. McCoy
- grid.66875.3a0000 0004 0459 167XDivision of Community Internal Medicine, Geriatrics, and Palliative Care. Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA ,grid.66875.3a0000 0004 0459 167XMayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN 55905 USA ,Mayo Clinic Ambulance, Rochester, MN 55905 USA ,grid.66875.3a0000 0004 0459 167XDivision of Health Care Delivery Research, Mayo Clinic, Rochester, MN 55905 USA
| | - Ronna L. Campbell
- grid.66875.3a0000 0004 0459 167XDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Aidan F. Mullan
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905 USA
| | - Colin M. Bucks
- grid.66875.3a0000 0004 0459 167XDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Casey M. Clements
- grid.66875.3a0000 0004 0459 167XDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - R. Ross Reichard
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA
| | - Molly M. Jeffery
- grid.66875.3a0000 0004 0459 167XDivision of Health Care Delivery Research, Mayo Clinic, Rochester, MN 55905 USA ,grid.66875.3a0000 0004 0459 167XDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
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45
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Li S, Han L, Shi H, Chong MKC, Zhao S, Ran J. Excess deaths from Alzheimer's disease and Parkinson's disease during the COVID-19 pandemic in the USA. Age Ageing 2022; 51:6936401. [PMID: 36571781 DOI: 10.1093/ageing/afac277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND COVID-19 pandemic has indirect impacts on patients with chronic medical conditions, which may increase mortality risks for various non-COVID-19 causes. This study updates excess death statistics for Alzheimer's disease (AD) and Parkinson's disease (PD) up to 2022 and evaluates their demographic and spatial disparities in the USA. METHODS This is an ecological time-series analysis of AD and PD mortality in the USA from January 2018 to March 2022. Poisson log-linear regressions were utilised to fit the weekly death data. Excess deaths were calculated with the difference between the observed and expected deaths under a counterfactual scenario of pandemic absence. RESULTS From March 2020 to March 2022, we observed 41,115 and 10,328 excess deaths for AD and PD, respectively. The largest percentage increases in excess AD and PD deaths were found in the initial pandemic wave. For people aged ≥85 years, excess mortalities of AD and PD (per million persons) were 3946.0 (95% confidence interval [CI]: 2954.3, 4892.3) and 624.3 (95% CI: 369.4, 862.5), which were about 23 and 9 times higher than those aged 55-84 years, respectively. Females had a three-time higher excess mortality of AD than males (182.6 vs. 67.7 per million persons). The non-Hispanic Black people experienced larger increases in AD or PD deaths (excess percentage: 31.8% for AD and 34.6% for PD) than the non-Hispanic White population (17.1% for AD and 14.7% for PD). CONCLUSION Under the continuing threats of COVID-19, efforts should be made to optimise health care capacity for patients with AD and PD.
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Affiliation(s)
- Siyuan Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Lefei Han
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Haoting Shi
- School of Clinical Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Marc K C Chong
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jinjun Ran
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Racial Disparity in Oxygen Saturation Measurements by Pulse Oximetry: Evidence and Implications. Ann Am Thorac Soc 2022; 19:1951-1964. [PMID: 36166259 DOI: 10.1513/annalsats.202203-270cme] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The pulse oximeter is a ubiquitous clinical tool used to estimate blood oxygen concentrations. However, decreased accuracy of pulse oximetry in patients with dark skin tones has been demonstrated since as early as 1985. Most commonly, pulse oximeters may overestimate the true oxygen saturation in individuals with dark skin tones, leading to higher rates of occult hypoxemia (i.e., clinically unrecognized low blood oxygen saturation). Overestimation of oxygen saturation in patients with dark skin tones has serious clinical implications, as these patients may receive insufficiently rigorous medical care when pulse oximeter measurements suggest that their oxygen saturation is higher than the true value. Recent studies have linked pulse oximeter inaccuracy to worse clinical outcomes, suggesting that pulse oximeter inaccuracy contributes to known racial health disparities. The magnitude of device inaccuracy varies by pulse oximeter manufacturer, sensor type, and arterial oxygen saturation. The underlying reasons for decreased pulse oximeter accuracy for individuals with dark skin tones may be related to failure to control for increased absorption of red light by melanin during device development and insufficient inclusion of individuals with dark skin tones during device calibration. Inadequate regulatory standards for device approval may also play a role in decreased accuracy. Awareness of potential pulse oximeter limitations is an important step for providers and may encourage the consideration of additional clinical information for management decisions. Ultimately, stricter regulatory requirements for oximeter approval and increased manufacturer transparency regarding device performance are required to mitigate this racial bias.
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Holm RH, Brick JM, Amraotkar AR, Hart JL, Mukherjee A, Zeigler J, Bushau-Sprinkle AM, Anderson LB, Walker KL, Talley D, Keith RJ, Rai SN, Palmer KE, Bhatnagar A, Smith T. Public Awareness of and Support for the Use of Wastewater for SARS-CoV-2 Monitoring: A Community Survey in Louisville, Kentucky. ACS ES&T WATER 2022; 2:1891-1898. [PMID: 37552721 PMCID: PMC9063986 DOI: 10.1021/acsestwater.1c00405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 05/16/2023]
Abstract
The majority of sewer systems in the United States and other countries are operated by public utilities. In the absence of any regulation, the public perception of wastewater monitoring for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose. We conducted a survey in August 2021 as part of an ongoing COVID-19 community prevalence study in Louisville/Jefferson County, KY, US. The survey comprised seven questions about wastewater awareness and privacy concerns and was sent to approximately 35 000 households randomly distributed within the county. A total of 1220 adults were involved in the probability sample, and data from 981 respondents were used in the analysis. A total of 2444 adults additionally responded to the convenience sample, and data from 1751 respondents were used in the analysis. The samples were weighted to obtain estimates representative of all adults in the county. Public awareness of tracking the virus that causes COVID-19 in sewers was low. Opinions strongly support the public disclosure of monitoring results. Responses showed that people more strongly supported measurements in the largest areas (>50 000 households), typically representing population levels found in a large community wastewater treatment plant. Those with a history of COVID-19 infection were more likely to support highly localized monitoring. Understanding wastewater surveillance strategies and privacy concern thresholds requires an in-depth and comprehensive analysis of public opinion for continued success and effective public health monitoring.
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Affiliation(s)
- Rochelle H. Holm
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - J. Michael Brick
- Westat, Incorporated, 1600
Research Boulevard, Rockville, Maryland 20850, United States
| | - Alok R. Amraotkar
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - Joy L. Hart
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
- Department of Communication, College of Arts and
Sciences, University of Louisville, 2010 South Avery Court
Walk, Louisville, Kentucky 40208, United States
| | - Anish Mukherjee
- Department of Bioinformatics and Biostatistics, School
of Public Health and Information Science, University of
Louisville, 505 South Hancock Street, Louisville, Kentucky 40202,
United States
| | - Jacob Zeigler
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - Adrienne M. Bushau-Sprinkle
- Center for Predictive Medicine for Biodefense and
Emerging Infectious Diseases, University of Louisville, 505
South Hancock Street, Louisville, Kentucky 40202, United States
| | - Lauren B. Anderson
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
- Center for Healthy Air, Water and Soil,
University of Louisville, 302 East Muhammad Ali Boulevard,
Louisville, Kentucky 40202, United States
| | - Kandi L. Walker
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
- Department of Communication, College of Arts and
Sciences, University of Louisville, 2010 South Avery Court
Walk, Louisville, Kentucky 40208, United States
| | - Daymond Talley
- Louisville/Jefferson County Metropolitan
Sewer District, Morris Forman Water Quality Treatment Center, 4522
Algonquin Parkway, Louisville, Kentucky 40211, United States
| | - Rachel J. Keith
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - Shesh N. Rai
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
- Department of Bioinformatics and Biostatistics, School
of Public Health and Information Science, University of
Louisville, 505 South Hancock Street, Louisville, Kentucky 40202,
United States
- Brown Cancer Center, School of Medicine,
University of Louisville, 505 South Hancock Street,
Louisville, Kentucky 40202, United States
- Center for Integrative Environmental
Health Sciences, 500 South Preston Street, Louisville, Kentucky 40202,
United States
| | - Kenneth E. Palmer
- Center for Predictive Medicine for Biodefense and
Emerging Infectious Diseases, University of Louisville, 505
South Hancock Street, Louisville, Kentucky 40202, United States
- Department of Pharmacology and Toxicology, School of
Medicine, University of Louisville, 323 East Chestnut Street,
Louisville, Kentucky 40202, United States
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - Ted Smith
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
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Frenk J, Godal T, Gómez-Dantés O, Store JG. A reinvigorated multilateralism in health: lessons and innovations from the COVID-19 pandemic. Lancet 2022; 400:1565-1568. [PMID: 36216020 PMCID: PMC9544940 DOI: 10.1016/s0140-6736(22)01943-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Julio Frenk
- Office of the President, University of Miami, Coral Gables, FL 33146, USA.
| | - Tore Godal
- Norwegian Ministry of Health and Care Services, Oslo, Norway
| | | | - Jonas Gahr Store
- Office of the Prime Minister, Government of Norway, Oslo, Norway
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Martin KA, Harrington K, Huang X, Khan SS. Pulmonary embolism–related mortality during the
COVID
‐19 pandemic: Data from the United States. Res Pract Thromb Haemost 2022; 6:e12845. [PMID: 36408295 PMCID: PMC9667396 DOI: 10.1002/rth2.12845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/30/2022] [Accepted: 10/15/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Karlyn A. Martin
- Division of Hematology/Oncology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Katharine Harrington
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Xiaoning Huang
- Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Sadiya S. Khan
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
- Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
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50
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Buckley C, Ye Y, Kerr WC, Mulia N, Puka K, Rehm J, Probst C. Trends in mortality from alcohol, opioid, and combined alcohol and opioid poisonings by sex, educational attainment, and race and ethnicity for the United States 2000-2019. BMC Med 2022; 20:405. [PMID: 36280833 PMCID: PMC9590383 DOI: 10.1186/s12916-022-02590-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The ongoing opioid epidemic and increases in alcohol-related mortality are key public health concerns in the USA, with well-documented inequalities in the degree to which groups with low and high education are affected. This study aimed to quantify disparities over time between educational and racial and ethnic groups in sex-specific mortality rates for opioid, alcohol, and combined alcohol and opioid poisonings in the USA. METHODS The 2000-2019 Multiple Cause of Death Files from the National Vital Statistics System (NVSS) were used alongside population counts from the Current Population Survey 2000-2019. Alcohol, opioid, and combined alcohol and opioid poisonings were assigned using ICD-10 codes. Sex-stratified generalized least square regression models quantified differences between educational and racial and ethnic groups and changes in educational inequalities over time. RESULTS Between 2000 and 2019, there was a 6.4-fold increase in opioid poisoning deaths, a 4.6-fold increase in combined alcohol and opioid poisoning deaths, and a 2.1-fold increase in alcohol poisoning deaths. Educational inequalities were observed for all poisoning outcomes, increasing over time for opioid-only and combined alcohol and opioid mortality. For non-Hispanic White Americans, the largest educational inequalities were observed for opioid poisonings and rates were 7.5 (men) and 7.2 (women) times higher in low compared to high education groups. Combined alcohol and opioid poisonings had larger educational inequalities for non-Hispanic Black men and women (relative to non-Hispanic White), with rates 8.9 (men) and 10.9 (women) times higher in low compared to high education groups. CONCLUSIONS For all types of poisoning, our analysis indicates wide and increasing gaps between those with low and high education with the largest inequalities observed for opioid-involved poisonings for non-Hispanic Black and White men and women. This study highlights population sub-groups such as individuals with low education who may be at the highest risk of increasing mortality from combined alcohol and opioid poisonings. Thereby the findings are crucial for the development of targeted public health interventions to reduce poisoning mortality and the socioeconomic inequalities related to it.
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Affiliation(s)
- Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health & Department of Psychiatry, University of Toronto, Toronto, Canada.,Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada. .,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation. .,Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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