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Spetz M, Natt och Dag Y, Li H, Nwaru C, Santosa A, Nyberg F, Rosvall M. The sociodemographic patterning of sick leave and determinants of longer sick leave after mild and severe COVID-19: a nationwide register-based study in Sweden. Eur J Public Health 2024; 34:121-128. [PMID: 37889580 PMCID: PMC10843940 DOI: 10.1093/eurpub/ckad191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Studies on sociodemographic differences in sick leave after coronavirus disease 2019 (COVID-19) are limited and research on COVID-19 long-term health consequences has mainly addressed hospitalized individuals. The aim of this study was to investigate the social patterning of sick leave and determinants of longer sick leave after COVID-19 among mild and severe cases. METHODS The study population, from the Swedish multi-register observational study SCIFI-PEARL, included individuals aged 18-64 years in the Swedish population, gainfully employed, with a first positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 1 January 2020 until 31 August 2021 (n = 661 780). Using logistic regression models, analyses were adjusted for sociodemographic factors, vaccination, prior sick leave, comorbidities and stratified by hospitalization. RESULTS In total, 37 420 (5.7%) individuals were on sick leave due to COVID-19 in connection with their first positive COVID-19 test. Individuals on sick leave were more often women, older, had lower income and/or were born outside Sweden. These differences were similar across COVID-19 pandemic phases. The highest proportion of sick leave was seen in the oldest age group (10.3%) with an odds ratio of 4.32 (95% confidence interval 4.18-4.47) compared with the youngest individuals. Among individuals hospitalized due to COVID-19, the sociodemographic pattern was less pronounced, and in some models, even reversed. The intersectional analysis revealed considerable variability in sick leave between sociodemographic groups (range: 1.5-17.0%). CONCLUSION In the entire Swedish population of gainfully employed individuals, our findings demonstrated evident sociodemographic differences in sick leave due to COVID-19. In the hospitalized group, the social patterning was different and less pronounced.
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Affiliation(s)
- Malin Spetz
- Department of School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Yvonne Natt och Dag
- Department of School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- Department of School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Chioma Nwaru
- Department of School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- Department of School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Nyberg
- Department of School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Maria Rosvall
- Department of School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Social Medicine, Regionhälsan, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Kusumaningrum FM, Dewi FST, Santosa A, Pangastuti HS, Yeung P. Factors related to quality of life in community-dwelling adults in Sleman Regency, Special Region of Yogyakarta, Indonesia: Results from a cross-sectional study. PLoS One 2024; 19:e0296245. [PMID: 38165996 PMCID: PMC10760755 DOI: 10.1371/journal.pone.0296245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 12/09/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Quality of life studies in low- and middle-income countries have demonstrated the influence of socioeconomic factors on the quality of life (QoL). However, further studies are required to confirm this association in developing countries with rapidly ageing populations. Using Ferrans et al.'s QoL model, this study aimed to identify the factors associated with the QoL of community-dwelling adults in Indonesia. METHODS A cross-sectional study among 546 community-dwelling adults aged 50+ years was conducted in Yogyakarta, Indonesia, in 2018. QoL was measured using the Short Form 12 questionnaire, which consists of a summary of physical and mental health. We performed stepwise logistic regression analyses to determine odds ratios (ORs) with 95% confidence intervals (CIs) and examined the association between the QoL (physical and mental health) and demographic characteristics, socioeconomic status, financial management behaviour, multimorbidity status, nutritional status, cognitive impairment status, depression status, and independence. Statistical significance was set at p<0.05. RESULTS Among the respondents, 15% reported poor physical health, and 9.2% reported poor mental health. Good physical health was significantly associated with the absence of chronic disease (OR 2.39; 95% CI: 1.07-5.33), independence in activities of daily living (OR 3.90; 95% CI 1.57-9.67) and instrumental activities of daily living (OR 4.34; 95% CI 2.28-8.26). Absence of depression was significantly associated with good mental health (OR 2.80; 95% CI 1.3-5.96). CONCLUSION The QoL of community-dwelling adults in Indonesia is associated with activities of daily living and instrumental activities of daily living, as well as the absence of chronic disease and depression. Efforts should be made to prevent chronic disease and delay functional decline through healthy lifestyles and routine physical and mental health screenings.
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Affiliation(s)
- Fitrina Mahardani Kusumaningrum
- Faculty of Medicine, Department of Health Behavior, Public Health and Nursing, Environment and Social Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Public Health and Nursing, Doctoral Program in Medicine and Health Science, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fatwa Sari Tetra Dewi
- Faculty of Medicine, Department of Health Behavior, Public Health and Nursing, Environment and Social Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Public Health and Nursing, Sleman Health and Demographic Surveillance System, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ailiana Santosa
- Institute of Medicine, Sahlgrenska Academy, School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Heny Suseani Pangastuti
- Faculty of Medicine, Medical-Surgical Nursing Department, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Polly Yeung
- School of Social Work, Massey University, Palmerston North, New Zealand
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Lundberg-Morris L, Leach S, Xu Y, Martikainen J, Santosa A, Gisslén M, Li H, Nyberg F, Bygdell M. Covid-19 vaccine effectiveness against post-covid-19 condition among 589 722 individuals in Sweden: population based cohort study. BMJ 2023; 383:e076990. [PMID: 37993131 PMCID: PMC10666099 DOI: 10.1136/bmj-2023-076990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To investigate the effectiveness of primary covid-19 vaccination (first two doses and first booster dose within the recommended schedule) against post-covid-19 condition (PCC). DESIGN Population based cohort study. SETTING Swedish Covid-19 Investigation for Future Insights-a Population Epidemiology Approach using Register Linkage (SCIFI-PEARL) project, a register based cohort study in Sweden. PARTICIPANTS All adults (≥18 years) with covid-19 first registered between 27 December 2020 and 9 February 2022 (n=589 722) in the two largest regions of Sweden. Individuals were followed from a first infection until death, emigration, vaccination, reinfection, a PCC diagnosis (ICD-10 diagnosis code U09.9), or end of follow-up (30 November 2022), whichever came first. Individuals who had received at least one dose of a covid-19 vaccine before infection were considered vaccinated. MAIN OUTCOME MEASURE The primary outcome was a clinical diagnosis of PCC. Vaccine effectiveness against PCC was estimated using Cox regressions adjusted for age, sex, comorbidities (diabetes and cardiovascular, respiratory, and psychiatric disease), number of healthcare contacts during 2019, socioeconomic factors, and dominant virus variant at time of infection. RESULTS Of 299 692 vaccinated individuals with covid-19, 1201 (0.4%) had a diagnosis of PCC during follow-up, compared with 4118 (1.4%) of 290 030 unvaccinated individuals. Covid-19 vaccination with any number of doses before infection was associated with a reduced risk of PCC (adjusted hazard ratio 0.42, 95% confidence interval 0.38 to 0.46), with a vaccine effectiveness of 58%. Of the vaccinated individuals, 21 111 received one dose only, 205 650 received two doses, and 72 931 received three or more doses. Vaccine effectiveness against PCC for one dose, two doses, and three or more doses was 21%, 59%, and 73%, respectively. CONCLUSIONS The results of this study suggest a strong association between covid-19 vaccination before infection and reduced risk of receiving a diagnosis of PCC. The findings highlight the importance of primary vaccination against covid-19 to reduce the population burden of PCC.
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Affiliation(s)
- Lisa Lundberg-Morris
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susannah Leach
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- AstraZeneca, Mölndal, Sweden
| | - Yiyi Xu
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jari Martikainen
- Bioinformatics and Data Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Bygdell
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lundberg CE, Santosa A, Björk J, Brandén M, Cronie O, Lindgren M, Edqvist J, Åberg M, Adiels M, Rosengren A. Age and sex differences in cause-specific excess mortality and years of life lost associated with COVID-19 infection in the Swedish population. Eur J Public Health 2023; 33:916-922. [PMID: 37263601 PMCID: PMC10567253 DOI: 10.1093/eurpub/ckad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic. METHODS In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017-19 in the whole Swedish population. RESULTS COVID-19 deaths contributed 9.9% of total deaths (98 441 deaths, 960 305 YLL) in 2020, accounting for 75 151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19 141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65-110 years and women aged 75-110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020. CONCLUSIONS Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.
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Affiliation(s)
- Christina E Lundberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Maria Brandén
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
- Institute for Analytical Sociology, Linköping University, Norrköping, Sweden
| | - Ottmar Cronie
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Jon Edqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Martin Adiels
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Region Västra Götaland, Gothenburg, Sweden
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Kirui BK, Santosa A, Vanfleteren LE, Li H, Franzén S, Stridsman C, Nyberg F. Pre- and post-vaccination characteristics and risk factors for COVID-19 outcomes in a Swedish population-based cohort of COPD patients. ERJ Open Res 2023; 9:00711-2022. [PMID: 37377661 PMCID: PMC10291311 DOI: 10.1183/23120541.00711-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/09/2023] [Indexed: 06/29/2023] Open
Abstract
Rationale Evidence on risk factors for Coronavirus disease 2019 (COVID-19) outcomes among patients with COPD in relation to COVID-19 vaccination remains limited. The objectives of the present study were to characterise determinants of COVID-19 infection, hospitalisation, intensive care unit (ICU) admission and death in COPD patients in their unvaccinated state compared to when vaccinated. Methods We included all COPD patients in the Swedish National Airway Register (SNAR). Events of COVID-19 infection (test and/or healthcare encounter), hospitalisation, ICU admission and death were identified from 1 January 2020 to 30 November 2021. Using adjusted Cox regression, associations between baseline sociodemographics, comorbidities, treatments, clinical measurements and COVID-19 outcomes, during unvaccinated and vaccinated follow-up time, were analysed. Results The population-based COPD cohort included 87 472 patients, among whom 6771 (7.7%) COVID-19 infections, 2897 (3.3%) hospitalisations, 233 (0.3%) ICU admissions and 882 (1.0%) COVID-19 deaths occurred. During unvaccinated follow-up, risk of COVID-19 hospitalisation and death increased with age, male sex, lower education, non-married status and being foreign-born. Comorbidities increased risk of several outcomes, e.g. respiratory failure for infection and hospitalisation (adjusted hazard ratios (HR) 1.78, 95% CI 1.58-2.02 and 2.51, 2.16-2.91, respectively), obesity for ICU admission (3.52, 2.29-5.40) and cardiovascular disease for mortality (2.80, 2.16-3.64). Inhaled COPD therapy was associated with infection, hospitalisation and death. COPD severity was also associated with COVID-19, especially hospitalisation and death. Although the risk factor panorama was similar, COVID-19 vaccination attenuated HRs for some risk factors. Conclusion This study provides population-based evidence on predictive risk factors for COVID-19 outcomes and highlights the positive implications of COVID-19 vaccination for COPD patients.
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Affiliation(s)
- Brian K. Kirui
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lowie E.G.W. Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Dong X, Ng N, Santosa A. Family structure and depressive symptoms among older adults in China: A marginal structural model analysis. J Affect Disord 2023; 324:364-369. [PMID: 36566935 DOI: 10.1016/j.jad.2022.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/26/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mental well-being in the aging population is inevitably linked to families due to the reliance of older adults on family members. This study investigates the causal relationship between family structure and depressive symptoms among Chinese older adults in general and between gender and residential areas. METHODS We used China Health and Retirement Longitudinal Study (CHARLS) panel data, covering four data collection rounds over seven years. Family structure was classified into single-member, couple, nuclear family, and extended family. Taking into account time-varying confounding, we estimated the causal effects of family structure on depressive symptoms using marginal structural models. RESULTS Older people with cumulative exposure to single-member family type had an increased odds of depressive symptoms by an average of 33 % (95 % CI: 1.22-1.44) than their counterparts who lived in the couple family. Additionally, older people living in extended families also had 6 % higher odds of experiencing depressive symptoms (95 % CI: 1.00, 1.11). The longitudinal associations were consistent across gender groups and residential areas (p-value for interaction is 0.6638 for gender and 0.7043 for the residential area). LIMITATION The time-varying confounders (e.g., chronic health conditions) included in the analysis are based on self-reported data, which may be subject to measurement errors. CONCLUSION The risk of depressive symptoms is greater for older individuals living alone and in extended families. Screening for depression in the older population, particularly those living in "at-risk" households, is recommended.
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Affiliation(s)
- Xiaowei Dong
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Nawi Ng
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Nwaru C, Li H, Bonander C, Santosa A, Franzén S, Rosvall M, Nyberg F. Occupational role and COVID-19 among foreign-born healthcare workers in Sweden: a registry-based study. Eur J Public Health 2023; 33:202-208. [PMID: 36762873 PMCID: PMC10066486 DOI: 10.1093/eurpub/ckad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Many studies report that foreign-born healthcare workers (HCWs) in high-income countries have an elevated risk of COVID-19. However, research has not yet specifically evaluated the distribution of COVID-19 among foreign-born workers in different healthcare work groups. We examined the risk of COVID-19 infection and hospitalization among foreign-born HCWs in different occupational roles in Sweden. METHODS We linked occupational data (2019) of 783 950 employed foreign-born workers (20-65 years) to COVID-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the hazard ratio (HR) with 95% confidence intervals (95% CIs) of COVID-19 infection and hospitalization in eight healthcare occupational groups vs. non-HCWs and assessed whether region of birth modified the association between healthcare occupations and COVID-19. RESULTS All HCWs had a higher risk of COVID-19 outcomes than non-HCWs, but the risk differed by occupational role. Hospital-based assistant nurses had the highest risk (infection: HR 1.78; 95% CI 1.72-1.85; hospitalization: HR 1.79; 95% CI 1.52-2.11); allied HCWs had the lowest risk (infection: HR 1.22; 95% CI 1.10-1.35; hospitalization: HR 0.98; 95% CI 0.59-1.63). The relative hazard of the outcomes varied across foreign-born workers from different regions. For example, the relative risk of COVID-19 infection associated with being a physician compared to a non-HCW was 31% higher for African-born than European-born workers. CONCLUSIONS The risk of COVID-19 among foreign-born HCWs differed by occupational role and immigrant background. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help reduce COVID-19 risk among foreign-born HCWs.
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Affiliation(s)
- Chioma Nwaru
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Rosvall
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Social Medicine, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bygdell M, Leach S, Lundberg L, Gyll D, Martikainen J, Santosa A, Li H, Gisslén M, Nyberg F. A comprehensive characterization of patients diagnosed with post-COVID-19 condition in Sweden 16 months after the introduction of the International Classification of Diseases Tenth Revision diagnosis code (U09.9): a population-based cohort study. Int J Infect Dis 2023; 126:104-113. [PMID: 36410693 PMCID: PMC9678230 DOI: 10.1016/j.ijid.2022.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The objective of this study was to provide a comprehensive characterization of patients diagnosed with post-COVID-19 condition (PCC) during the first 16 months of use of the International Classification of Diseases revision 10 (ICD-10) diagnosis code U09.9 in Sweden. METHODS We used data from national registers and primary health care databases for all adult inhabitants of the two largest regions in Sweden, comprising 4.1 million inhabitants (approximately 40% of the Swedish population). We present the cumulative incidence and incidence rate of PCC overall and among subgroups and describe patients with COVID-19 with or without PCC regarding sociodemographic characteristics, comorbidities, subsequent diseases, COVID-19 severity, and virus variants. RESULTS Of all registered COVID-19 cases available for PCC diagnosis (n = 506,107), 2.0% (n = 10,196) had been diagnosed with PCC using ICD-10 code U09.9 as of February 15, 2022 in the two largest regions in Sweden. The cumulative incidence was higher among women than men (2.3% vs 1.6%, P <0.001). The majority of PCC cases (n = 7162, 70.2%) had not been hospitalized for COVID-19. This group was more commonly female (69.9% vs 52.9%, P <0.001), had a tertiary education (51.0% vs 44.1%, P <0.001), and was older (median age difference 5.7 years, P <0.001) than non-hospitalized patients with COVID-19 without PCC. CONCLUSION This characterization furthers the understanding of patients diagnosed with PCC and could support policy makers with appropriate societal and health care resource allocation.
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Affiliation(s)
- Maria Bygdell
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Susannah Leach
- Department of Microbiology and Immunology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa Lundberg
- Department of Microbiology and Immunology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Gyll
- Region Uppsala, Svartbäcken Primary Care, Uppsala, Sweden
| | - Jari Martikainen
- Bioinformatics and Data Centre, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
Background Hypertension remains a problem of public health across various socioeconomic groups, despite its high prevalence. However, few studies account for geographical variation in examining socioeconomic inequalities and hypertension in Indonesia. Objective To investigate the burden of hypertension in Indonesia based on prevalence, awareness, treatment, and control of hypertension among adults; and assess whether or not the burdens vary according to geographical variation and socioeconomic status Methods In Wave 5 of the Indonesian Family Life Survey in 2015, 32,034 individuals aged 15 and over participated in the study. Concentration Curves (CC) and Concentration Indexes (CI) were used to analyse socioeconomic inequality. We used multilevel logistic regression to assess biological, geographical variation, and socioeconomic factors associated with the burden of hypertension, adjusting for potential covariates. Results The prevalence of hypertension in Indonesia was 26.1%, and only 26.9% of those with hypertension were aware of their condition. Approximately 22.5% of hypertensive patients received treatment, but only 28.2% had controlled blood pressure and reached the therapeutic goal. Low socioeconomic groups were more prone to hypertension (CI = −0.047 in urban and CI = −0.075 in rural). In contrast, awareness, treatment, and control of hypertension were more concentrated in higher socioeconomic groups. Conclusions The high prevalence of hypertension, low awareness of the condition, poor compliance with treatment, and poor control of the condition, as well as the existing socioeconomic inequality, make this a significant determinant of public health issue in Indonesia. There is a need for effective programs for the prevention of hypertension and better management of hypertensive patients.
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Affiliation(s)
- Yusuf Ari Mashuri
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Xu Y, Li H, Kirui B, Santosa A, Gisslén M, Leach S, Wettermark B, Vanfleteren LEGW, Nyberg F. Effectiveness of COVID-19 Vaccines over 13 Months Covering the Period of the Emergence of the Omicron Variant in the Swedish Population. Vaccines (Basel) 2022; 10:vaccines10122074. [PMID: 36560484 PMCID: PMC9782222 DOI: 10.3390/vaccines10122074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND We estimated real-world vaccine effectiveness (VE) against COVID-19 infection, hospitalization, ICU admission, and death up to 13 months after vaccination. VE before and after the emergence of Omicron was investigated. METHODS We used registered data from the entire Swedish population above age 12 (n = 9,153,456). Cox regression with time-varying exposure was used to estimate weekly/monthly VE against COVID-19 outcomes from 27 December 2020 to 31 January 2022. The analyses were stratified by age, sex, and vaccine type (BNT162b2, mRNA-1273, and AZD1222). RESULTS Two vaccine doses offered good long-lasting protection against infection before Omicron (VE were above 85% for all time intervals) but limited protection against Omicron infection (dropped to 43% by week four and no protection by week 14). For severe COVID-19 outcomes, higher VE was observed during the entire follow-up period. Among individuals above age 65, the mRNA vaccines showed better VE against infection than AZD1222 but similar high VE against hospitalization. CONCLUSIONS Our findings provide strong evidence for long-term maintained protection against severe COVID-19 by the basic two-dose schedule, supporting more efforts to encourage unvaccinated persons to get the basic two doses, and encourage vaccinated persons to get a booster to ensure better population-level protection.
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Affiliation(s)
- Yiyi Xu
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Correspondence: ; Tel.: +46-76-083-0937
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Brian Kirui
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Susannah Leach
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Björn Wettermark
- Pharmacoepidemiology & Social Pharmacy, Department of Pharmacy, Uppsala University, 752 36 Uppsala, Sweden
| | - Lowie E. G. W. Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
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11
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Rosengren A, Söderberg M, Lundberg CE, Lindgren M, Santosa A, Edqvist J, Åberg M, Gisslén M, Robertson J, Cronie O, Sattar N, Lagergren J, Brandén M, Björk J, Adiels M. COVID-19 in people aged 18-64 in Sweden in the first year of the pandemic: Key factors for severe disease and death. Glob Epidemiol 2022; 4:100095. [PMID: 36447481 PMCID: PMC9683858 DOI: 10.1016/j.gloepi.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Studies on risk factors for severe COVID-19 in people of working age have generally not included non-working persons or established population attributable fractions (PAFs) for occupational and other factors. Objectives We describe the effect of job-related, sociodemographic, and other exposures on the incidence, relative risks and PAFs of severe COVID-19 in individuals aged 18-64. Methods We conducted a registry-based study in Swedish citizens aged 18-64 from 1 January 2020 to 1 February 2021 with respect to COVID-19-related hospitalizations and death. Results Of 6,205,459 persons, 272,043 (7.5%) were registered as infected, 3399 (0.05%) needed intensive care, and 620 (0.01%) died, with an estimated case fatality rate of 0.06% over the last 4-month period when testing was adequate. Non-Nordic origin was associated with a RR for need of intensive care of 3·13, 95%CI 2·91-3·36, and a PAF of 32·2% after adjustment for age, sex, work, region and comorbidities. In a second model with occupation as main exposure, and adjusted for age, sex, region, comorbidities and origin, essential workers had an RR of 1·51, 95%CI, 1·35-1·6, blue-collar workers 1·18, 95%CI 1·06-1·31, school staff 1·21, 95%CI 1·01-1·46, and health and social care workers 1·89, 95%CI 1·67-2·135) compared with people able to work from home, with altogether about 13% of the PAF associated with these occupations. Essential workers and blue-collar workers, but no other job categories had higher risk of death, adjusted RRs of 1·79, 95%CI 1·34-2·38 and 1·37, 95%CI 1·04-1·81, with adjusted PAFs of altogether 9%. Conclusion Among people of working age in Sweden, overall mortality and case fatality were low. Occupations that require physical presence at work were associated with elevated risk of needing intensive care for COVID-19, with 14% cases attributable to this factor, and 9% of deaths.
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Affiliation(s)
- Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden,Corresponding author at: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mia Söderberg
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina E. Lundberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Ailiana Santosa
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Edqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - Magnus Gisslén
- Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefina Robertson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ottmar Cronie
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Naveed Sattar
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Sweden,School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom
| | - Maria Brandén
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden,Institute for Analytical Sociology (IAS), Linköping University, Norrköping, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Spetz M, Lundberg L, Nwaru C, Li H, Santosa A, Ng N, Leach S, Gisslén M, Hammar N, Nyberg F, Rosvall M. An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: A nationwide register-based study in Sweden. Vaccine 2022; 40:6640-6648. [PMID: 36210254 PMCID: PMC9515344 DOI: 10.1016/j.vaccine.2022.09.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years. METHODS National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. FINDINGS By 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. INTERPRETATION Our study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. FUNDING SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.
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Affiliation(s)
- M. Spetz
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden,Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Gotaland, Gothenburg, Sweden,Corresponding author at: School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 463, 405 30 Gothenburg, Sweden
| | - L. Lundberg
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Clinical Pharmacology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - C. Nwaru
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - H. Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - A. Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - N. Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - S. Leach
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Clinical Pharmacology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - M. Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - N. Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - F. Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - M. Rosvall
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden,Department of Social Medicine, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
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13
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Nwaru C, Li H, Bonander C, Santosa A, Franzén S, Rosvall M, Nyberg F. Occupational role and Covid-19 among foreign-born healthcare workers: a registry-based study. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Studies have shown an elevated risk of Covid-19 among foreign-born healthcare workers (HCWs), but data on the distribution of the risk in different occupational roles are lacking. Such data are needed for the effective control of Covid-19 risk among HCWs. Here, we examined the risk of Covid-19 infection and hospitalization in foreign-born HCWs in different occupational roles in Sweden.
Methods
We prospectively linked occupational data (2018-2019) of 783950 employed foreign-born (20-65 years) workers to Covid-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the risk of Covid-19 infection and hospitalization in foreign-born HCWs in eight different occupational groups compared to non-HCWs, and to assess whether the associations varied by region of birth. The analyses were adjusted for sociodemographic and socioeconomic factors, comorbidities, and Covid-19 vaccination.
Results
All HCWs had a higher risk of Covid-19 outcomes than non-HCWs, but the risk differed by occupational role. Assistant nurses had the highest risk both for Covid-19 infection (HR 1.80; 95%CI 1.74-1.87) and hospitalization (HR 1.85; 95%CI 1.57-2.18); other allied HCWs had the lowest risk (infection: HR 1.23; 95%CI 1.11-1.36; hospitalization: HR 1.02; 95%CI 0.63-1.67)). In some healthcare occupations, the relative risk of Covid-19 varied by region of birth. For example, physicians and dental nurses/hygienists of African and Asian origin had a higher risk of Covid-19 infection than European-born in the same occupation. In contrast, European-born assistant nurses had a greater risk of both outcomes than non-European-born in the same occupation.
Conclusions
The risk of Covid-19 among foreign-born HCWs varied by occupational role and region of birth. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help to reduce Covid-19 risk among foreign-born HCWs.
Key messages
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Affiliation(s)
- C Nwaru
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - H Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - C Bonander
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - A Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - S Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - M Rosvall
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
- Primary Heath Care, Regionhälsan, Region Västra Götaland , Gothenburg, Sweden
| | - F Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
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14
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Rosengren A, Lundberg CE, Söderberg M, Santosa A, Edqvist J, Lindgren M, Åberg M, Gisslén M, Robertson J, Cronie O, Sattar N, Lagergren J, Brandén M, Björk J, Adiels M. Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden. J Intern Med 2022; 292:641-653. [PMID: 35612518 PMCID: PMC9348046 DOI: 10.1111/joim.13522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults. OBJECTIVES We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above. METHODS We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021. RESULTS Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55-64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8-9.1) and 22.5 (95% CI 19.6-25.7) for mortality, with PAFs of 21.9% (95% CI 20.9-22.9) and 33.3% (95% CI 32.4-34.3), respectively. CONCLUSION Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.
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Affiliation(s)
- Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Christina E Lundberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mia Söderberg
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Edqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - Magnus Gisslén
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefina Robertson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ottmar Cronie
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Naveed Sattar
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Maria Brandén
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden.,Institute for Analytical Sociology (IAS), Linköping University, Norrköping, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Martin Adiels
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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Mousa SI, Nyberg F, Hajiebrahimi M, Bertilsson R, Nåtman J, Santosa A, Wettermark B. Initiation of antihypertensive drugs to patients with confirmed COVID-19 - a population-based cohort study in Sweden. Basic Clin Pharmacol Toxicol 2022; 131:196-204. [PMID: 35726121 PMCID: PMC9349802 DOI: 10.1111/bcpt.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022]
Abstract
Purpose Hypertension is an important risk factor for severe outcomes in patients with COVID‐19, and antihypertensive drugs may have a protective effect. However, the pandemic may have negatively impacted health care services for chronic diseases. The aim of this study was to assess initiations of antihypertensive medicines in patients infected by COVID‐19. Methods A cohort study including all Swedish residents 20–80 years old with a COVID‐19 positive test compared with an unexposed group without COVID‐19 matched for age, sex, and index date (date of confirmed COVID‐19). Data were collected within SCIFI‐PEARL, a study including linked data on COVID tests, hospital diagnoses, dispensed prescriptions, and socioeconomic data from Swedish national registers. Initiations of different antihypertensive drugs were studied from March 2020 until October 2020. Associations between COVID‐19 and initiation of antihypertensives were assessed by a multivariable Cox proportional hazards model. Results A total of 224 582 patients (exposed and unexposed) were included. After adjusting for cardiovascular comorbidities and education level, ACEi was the most commonly initiated antihypertensive agent to patients with COVID‐19. Hazard ratio and 95% confidence interval for initiation of drug therapy was 1.83 [1.53–2.19] for ACEi, followed by beta‐blockers 1.74 [1.55–1.95], calcium channel blockers 1.61 [1.41–1.83], angiotensin receptor blockers 1.61 [1.40–1.86], and diuretics 1.53 [1.32–1.77]. Conclusion All antihypertensive medicines were initiated more frequently in COVID‐19 patients. This can either be associated with hypertension caused by the COVID‐19 infection, more frequent diagnosis of hypertension among people with COVID‐19 since they consult health care, or residual confounding factors not adjusted for in the study.
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Affiliation(s)
- Salar Issa Mousa
- Pharmacoepidemiology & Social Pharmacy, Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Rebecka Bertilsson
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Jonatan Nåtman
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Wettermark
- Pharmacoepidemiology & Social Pharmacy, Department of Pharmacy, Uppsala University, Uppsala, Sweden.,Pharmacy Centre, Faculty of Medicine, Vilnius university, Vilnius, Lithuania
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Ma M, Santosa A, Kong KO, Xu C, Xiang JTG, Teng GG, Mak A, Tay SH, Ng VWW, Koh JZE, Fong W, Chew LC, Low A, Law A, Poh YJ, Yeo SI, Leung YY, Goh WR, Yu CT, Roslan NE, Angkodjojo S, Phang KF, Arkachaisri T, Sriranganathan M, Tan TC, Cheung P, Lahiri M. POS0200 POST-mRNA VACCINE FLARES IN AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES: INTERIM RESULTS FROM THE CORONAVIRUS NATIONAL VACCINE REGISTRY FOR IMMUNE DISEASES SINGAPORE (CONVIN-SING). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPublished data suggest no increased rate of flare of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination; however, the studies are limited by small sample size, short follow up or at risk of selection bias (voluntary physician reports or patient surveys).ObjectivesTo study flares of AIIRD within three months of the first dose of an anti-SARS-COV2 mRNA vaccine.MethodsA retrospective cohort study of consecutive AIIRD patients ≥ 12 years old, across six public hospitals in Singapore who received at least one dose of an mRNA (Pfizer/BioNTech or Moderna) vaccine. Data were censored at the first post-vaccine clinic visit when the patient had flared or if ≥ three months had elapsed since the first dose of the vaccine, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis and time to flare was examined using a Nelson Aalen cumulative hazard estimate (Figure 1).Figure 1.Nelson-Aalen curve of flares over timeResults2339 patients (74% Chinese, 72% female) of median (IQR) age 64 (53, 71) years were included in the interim analysis (Table 1). 2112 (90%) had the Pfizer/BioNTech vaccine and 195 (8%) had Moderna, with a median (IQR) interval of 21 (21, 23) days between the two doses. The most common AIIRD diagnoses were Rheumatoid arthritis (1063, 45%), Psoriatic arthritis (296, 12.6%) and Systemic lupus erythematosus (SLE) (288, 12.3%). 186 (8%) were treated with biologics/ targeted disease modifying agents. 2125 (91%) patients were in low disease activity or remission. Treatment was interrupted for vaccination in only 18 (0.8%) patients. Seven (0.3%) patients had previous COVID-19 infection.Table 1.Patient characteristicsBaseline characteristicsNo flares(n = 1887, %)Flares within 0—3 months of 1st vaccine dose (n= 272, %)Flares outside of 0 – 3 months after 1st vaccine dose (n = 180, %)Age (median years, IQR)64 (53, 71)61 (50, 69)65 (55, 71)RaceChinese1386 (73)206 (76)129 (72)Malay193 (10)28 (10)20 (11)Indian195 (10)27 (10)26 (14)GenderFemale1367 (72)200 (74)117 (65)Vaccine typePfizer/BioNTech1713 (92)239 (90)160 (90)Moderna149 (8)28 (10)18 (10)DiagnosisRheumatoid Arthritis831 (44)139 (51)93 (52)Systemic Lupus Erythematosus269 (14)20 (7)9 (5)Psoriatic Arthritis225 (12)42 (15)29 (16)Spondyloarthropathies141 (7)21 (7)17 (9)Sjogren’s Syndrome114 (6)15 (6)8 (4)Systemic sclerosis94 (5)4 (1)6 (3)Baseline Physician Disease ActivityRemission1007 (53)99 (36)63 (35)Low Disease Activity731 (39)128 (47)97 (54)Moderate Disease Activity134 (7)40 (15)20 (11)High Disease Activity15 (1)5 (2)0452 (19%) flares were recorded during 9798.8 patient-months [4.6/100 patient-months, median (IQR) follow up duration 4.2 (3.3, 5.3) months], of which 272 (11.6%) patients flared within the 3-month period of interest and 180 (7.7%) flared outside of the 3-month period (Table 1). Median (IQR) time-to-flare was 40.5 (18, 56.6) days. 60 (22.1%) were mild and self-limiting, 170 (62.5%) were mild-moderate and 42 (15.4%) were severe. 190 (69.8%) of those who flared required escalation of treatment and 15 (5.5%) required hospital admission. 239 (10.2%) had improved disease activity after the vaccine.On multivariate Cox regression analysis, patients in the oldest age tertile [median (IQR) 74 (71, 79) years] were less likely to flare [HR 0.80 (95% CI 0.63, 1.00), p = 0.05] Patients with inflammatory arthritis (compared with connective tissue disease, vasculitis and others) and patients with baseline active disease were more likely to flare [HR 1.72 (95% CI 1.35, 2.20), p < 0.001 and 1.82 (95% CI 1.39, 2.39), p < 0.001 respectively]ConclusionThere was a moderately high rate of AIIRD flares after mRNA vaccination; however, there was no clustering of flares in the immediate post-vaccine period to suggest causality. Older patients were less likely to flare, while those with inflammatory arthritis and active disease at baseline were more likely to flare.Disclosure of InterestsMargaret Ma Grant/research support from: Support grant from multiple companies for the Singapore Biologics registry, Amelia Santosa Speakers bureau: Amgen Talk, Consultant of: Pfizer ad board, Kok Ooi Kong: None declared, Chuanhui Xu: None declared, Johnston Tang Gin Xiang: None declared, Gim Gee Teng Speakers bureau: Boehringer Ingleheim, Anselm Mak Speakers bureau: J&J and GSK, Grant/research support from: GSK - the supported studies programme, Sen Hee Tay: None declared, Victoria Wei Wen Ng: None declared, Joshua Zhi En Koh: None declared, Warren Fong Speakers bureau: speaker for Abbvie, DKSH, GSK, Novartis, Li-Ching Chew Speakers bureau: pfizer and Abbvie, Consultant of: Pfizer and Abbvie Advisory Board meeting, Grant/research support from: Abbvie educational grant for ultrasound conference, Andrea Low Speakers bureau: Boehringer Ingeilheim, Consultant of: Consultant/steering group committee for BI and J&J, annie law: None declared, Yih Jia Poh: None declared, Siaw Ing Yeo Grant/research support from: Multiple pharmaceutical companies for the support of the National Biologics Registry, Ying Ying Leung Speakers bureau: Abbvie, DKSH, Jassen, Novartis and Pfizer, Wei-Rui Goh: None declared, Chuah Tyng Yu: None declared, Nur Emillia Roslan: None declared, Stanley Angkodjojo Speakers bureau: Boehringer Ingeilheim, Consultant of: Abbvie and DKSH, Kee Fong Phang: None declared, Thaschawee Arkachaisri: None declared, Melonie Sriranganathan: None declared, Teck Choon TAN: None declared, Peter Cheung Consultant of: Ad board for Boehringer Ingleheim, novartis, janssen and abbvie, Grant/research support from: Novartis, Manjari Lahiri Speakers bureau: J&J, DSKH, Consultant of: DSKH, Gilead, Grant/research support from: Multiple pharma companies contributed to the Singapore Biologics registryNovartis
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Spetz M, Lundberg L, Nwaru C, Li H, Santosa A, Leach S, Gisslén M, Hammar N, Rosvall M, Nyberg F. The social patterning of Covid-19 vaccine uptake in older adults: A register-based cross-sectional study in Sweden. Lancet Reg Health Eur 2022; 15:100331. [PMID: 35252941 PMCID: PMC8881226 DOI: 10.1016/j.lanepe.2022.100331] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Methods Findings Interpretation Funding
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Nwaru CA, Santosa A, Franzén S, Nyberg F. Occupation and COVID-19 diagnosis, hospitalisation and ICU admission among foreign-born and Swedish-born employees: a register-based study. J Epidemiol Community Health 2022; 76:jech-2021-218278. [PMID: 34996808 PMCID: PMC8761595 DOI: 10.1136/jech-2021-218278] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research on occupation and risk of COVID-19 among foreign-born workers is lacking. We investigated whether working in essential occupations was associated with COVID-19 diagnosis, hospitalisation and intensive care unit (ICU) admission and whether foreign-born workers in similar occupations as Swedish-born individuals had a higher risk of the studied outcomes. METHODS Occupational data (2018-2019) of 326 052 employees (20-65 years) who were resident in Sweden as of 1 January 2020 were linked to COVID-19 data registered from 1 January 2020 to 28 February 2021. We analysed the risk of COVID-19 outcomes in different occupational groups and in four immigrant/occupation intersectional groups using Cox proportional hazards regression with adjustments for sociodemographic and socioeconomic characteristics and pre-existing comorbidities. RESULTS We identified 29797, 1069 and 152 cases of COVID-19 diagnosis, hospitalisations and ICU admissions, respectively, in our cohort. Workers in essential occupations had an elevated risk of COVID-19 diagnosis, hospitalisation, and ICU admissions. Healthcare workers had a higher risk of all the outcomes compared with other essential workers. Relative to Swedish-born workers in non-essential occupations, foreign-born workers in essential occupations had 1.85 (95% CI 1.78 to 1.93), 3.80 (95% CI 3.17 to 4.55) and 3.79 (95% CI 2.33 to 6.14) times higher risk of COVID-19 diagnosis, hospitalisation and ICU admission, respectively. The corresponding risks among Swedish-born workers in essential occupations were 1.44 (95% CI 1.40 to 1.49), 1.30 (95% CI 1.08 to 1.56) and 1.46 (95% CI 0.90 to 2.38). CONCLUSION Occupation was associated with COVID-19 outcomes and contributed to the burden of COVID-19 among foreign-born individuals in this study.
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Affiliation(s)
- Chioma Adanma Nwaru
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chew NW, Ngiam JN, Tham SM, Lim ZY, Li TYW, Cen S, Yap ES, Tambyah PA, Santosa A, Cross GB, Sia CH. Fever as a predictor of adverse outcomes in COVID-19. QJM 2021; 114:706-714. [PMID: 33533902 PMCID: PMC7928573 DOI: 10.1093/qjmed/hcab023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/INTRODUCTION There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. AIM We examined the associations between symptomology, presence of fever and outcomes of a COVID-19 cohort. DESIGN AND METHODS Between 23 January and 30 April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into four groups based on symptomology and fever-Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic and Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. RESULTS There were differences in ferritin (P=0.003), C-reactive protein (CRP) levels (P<0.001) and lymphopenia (P=0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, P=0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (P<0.001). The presence of fever (OR 4.096, 95% CI 1.737-9.656, P=0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin and CRP. Presence of symptoms was not associated with the composite end-point. DISCUSSION/CONCLUSION In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.
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Affiliation(s)
- N W Chew
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Address correspondence to Dr C.-H. Sia, c/o Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore 119228.
| | - J N Ngiam
- Department of Medicine, National University Health System, Singapore
| | - S M Tham
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - Z Y Lim
- Department of Medicine, National University Health System, Singapore
| | - T Y W Li
- Department of Medicine, National University Health System, Singapore
| | - S Cen
- Department of Medicine, National University Health System, Singapore
| | - E S Yap
- Department of Haematology, National Cancer Institute Singapore, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P A Tambyah
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Santosa
- Division of Rheumatology, University Medicine Cluster, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - G B Cross
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - C -H Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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20
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Santosa A, Rosengren A, Ramasundarahettige C, Rangarajan S, Chifamba J, Lear SA, Poirier P, Yeates KE, Yusuf R, Orlandini A, Weida L, Sidong L, Yibing Z, Mohan V, Kaur M, Zatonska K, Ismail N, Lopez-Jaramillo P, Iqbal R, Palileo-Villanueva LM, Yusufali AH, AlHabib KF, Yusuf S. Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries. JAMA Netw Open 2021; 4:e2138920. [PMID: 34910150 PMCID: PMC8674745 DOI: 10.1001/jamanetworkopen.2021.38920] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Stress may increase the risk of cardiovascular disease (CVD). Most studies on stress and CVD have been conducted in high-income Western countries, but whether stress is associated with CVD in other settings has been less well studied. OBJECTIVE To investigate the association of a composite measure of psychosocial stress and the development of CVD events and mortality in a large prospective study involving populations from 21 high-, middle-, and low-income countries across 5 continents. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the Prospective Urban Rural Epidemiology study, collected between January 2003 and March 2021. Participants included individuals aged 35 to 70 years living in 21 low-, middle-, and high-income countries. Data were analyzed from April 8 to June 15, 2021. EXPOSURES All participants were assessed on a composite measure of psychosocial stress assessed at study entry using brief questionnaires concerning stress at work and home, major life events, and financial stress. MAIN OUTCOMES AND MEASURES The outcomes of interest were stroke, major coronary heart disease (CHD), CVD, and all-cause mortality. RESULTS A total of 118 706 participants (mean [SD] age 50.4 [9.6] years; 69 842 [58.8%] women and 48 864 [41.2%] men) without prior CVD and with complete baseline and follow-up data were included. Of these, 8699 participants (7.3%) reported high stress, 21 797 participants (18.4%) reported moderate stress, 34 958 participants (29.4%) reported low stress, and 53 252 participants (44.8%) reported no stress. High stress, compared with no stress, was more likely with younger age (mean [SD] age, 48.9 [8.9] years vs 51.1 [9.8] years), abdominal obesity (2981 participants [34.3%] vs 10 599 participants [19.9%]), current smoking (2319 participants [26.7%] vs 10 477 participants [19.7%]) and former smoking (1571 participants [18.1%] vs 3978 participants [7.5%]), alcohol use (4222 participants [48.5%] vs 13 222 participants [24.8%]), and family history of CVD (5435 participants [62.5%] vs 20 255 participants [38.0%]). During a median (IQR) follow-up of 10.2 (8.6-11.9) years, a total of 7248 deaths occurred. During the course of follow-up, there were 5934 CVD events, 4107 CHD events, and 2880 stroke events. Compared with no stress and after adjustment for age, sex, education, marital status, location, abdominal obesity, hypertension, smoking, diabetes, and family history of CVD, as the level of stress increased, there were increases in risk of death (low stress: hazard ratio [HR], 1.09 [95% CI, 1.03-1.16]; high stress: 1.17 [95% CI, 1.06-1.29]) and CHD (low stress: HR, 1.09 [95% CI, 1.01-1.18]; high stress: HR, 1.24 [95% CI, 1.08-1.42]). High stress, but not low or moderate stress, was associated with CVD (HR, 1.22 [95% CI, 1.08-1.37]) and stroke (HR, 1.30 [95% CI, 1.09-1.56]) after adjustment. CONCLUSIONS AND RELEVANCE This cohort study found that higher psychosocial stress, measured as a composite score of self-perceived stress, life events, and financial stress, was significantly associated with mortality as well as with CVD, CHD, and stroke events.
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Affiliation(s)
- Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Chinthanie Ramasundarahettige
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Jephat Chifamba
- College of Health Sciences, Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University c/o Healthy Heart Program, St Paul’s Hospital, Vancouver, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Karen E. Yeates
- Department of Medicine, Etherington Hall, Queen’s University, Kingston, Canada
| | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | - Andreas Orlandini
- Estudios Clínicos Latino America, Instituto Cardiovascular de Rosario, Santa Fe, Argentina
| | - Liu Weida
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Li Sidong
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Zhu Yibing
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr, Mohan’s Diabetes Specialities Centre, Chennai, India
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Khalid F. AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salim Yusuf
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada
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Nyberg F, Franzén S, Lindh M, Vanfleteren L, Hammar N, Wettermark B, Sundström J, Santosa A, Björck S, Gisslén M. Swedish Covid-19 Investigation for Future Insights - A Population Epidemiology Approach Using Register Linkage (SCIFI-PEARL). Clin Epidemiol 2021; 13:649-659. [PMID: 34354377 PMCID: PMC8331198 DOI: 10.2147/clep.s312742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background In response to the Covid-19 pandemic, we designed and initiated a nationwide linked multi-register, regularly updated, observational study for timely response to urgent scientific questions. Aim To describe the SCIFI-PEARL (Swedish Covid-19 Investigation for Future Insights - a Population Epidemiology Approach using Register Linkage) linked database encompassing essentially all known diagnosed Swedish Covid-19 patients plus a large general population comparison cohort and outline its utility in the current and future phases of the pandemic. Methods Individuals with Covid-19 from the entire country are identified on a regularly updated basis, from different sources: all individuals from SmiNet, the national database of notifiable diseases, with positive SARS-CoV-2 polymerase chain reaction (PCR) test results; patients identified in the healthcare system by condition (ICD-10) or procedure codes in the National Patient Register or Cause-of-Death Register; patients identified through several disease-specific national quality registers (NQRs); and in two regions additionally patients identified in primary care. A comparison population was obtained by stratified random sampling from Swedish national population registers. Data from all these registers plus the National Prescribed Drug Register, the Cancer Register, national sociodemographic registers, some additional NQRs, the National Vaccination Register, and further data sources, are then linked to all study subjects (Covid-19 cases and population cohort). New cases in the study population and all data for all subjects are updated every few months, as required. Conclusion and Utility The SCIFI-PEARL study cohort captures Swedish residents with Covid-19 on an ongoing basis, includes a representative general population comparison cohort, and links to a broad range of national and regional healthcare data for a comprehensive longitudinal view of the Covid-19 pandemic. By combining high-quality national registers with short time delay and continuous repeated linkage and updating, the project brings timely and internationally relevant data for epidemiological research on SARS-CoV-2. Our efforts provide an example and important learnings for similar efforts internationally in the future.
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Affiliation(s)
- Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lowie Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Björn Wettermark
- Pharmacoepidemiology & Social Pharmacy, Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Johan Sundström
- Clinical Epidemiology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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Ng N, Eriksson M, Guerrero E, Gustafsson C, Kinsman J, Lindberg J, Lindgren H, Lindvall K, Lundgren AS, Lönnberg G, Sahlen KG, Santosa A, Richter Sundberg L, Weinehall L, Wennberg P. Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme. Front Public Health 2021; 9:593453. [PMID: 33732674 PMCID: PMC7957003 DOI: 10.3389/fpubh.2021.593453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The Västerbotten Intervention Programme (VIP) in the Region Västerbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD. Methods: STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019–2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated. Discussion: The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps. Ethics: STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985). Dissemination: The collaboration between Umeå University and Region Västerbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.
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Affiliation(s)
- Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.,School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Eriksson
- Department of Social Work, Faculty of Social Sciences, Umeå University, Umeå, Sweden
| | - Esteban Guerrero
- Department of Computing Science, Faculty of Science and Technology, Umeå University, Umeå, Sweden
| | | | - John Kinsman
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Jens Lindberg
- Department of Social Work, Faculty of Social Sciences, Umeå University, Umeå, Sweden
| | - Helena Lindgren
- Department of Computing Science, Faculty of Science and Technology, Umeå University, Umeå, Sweden
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Anna Sofia Lundgren
- Department of Culture and Media Studies, Faculty of Arts and Humanities, Umeå University, Umeå, Sweden
| | - Göran Lönnberg
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Klas-Göran Sahlen
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linda Richter Sundberg
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Public Health Unit, Region Västerbotten, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden
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23
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Santosa A, Zhang Y, Weinehall L, Zhao G, Wang N, Zhao Q, Wang W, Ng N. Gender differences and determinants of prevalence, awareness, treatment and control of hypertension among adults in China and Sweden. BMC Public Health 2020; 20:1763. [PMID: 33228600 PMCID: PMC7685617 DOI: 10.1186/s12889-020-09862-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Failure to promote early detection and better management of hypertension will contribute to the increasing burden of cardiovascular diseases. This study aims to assess the gender differences in the prevalence, awareness, treatment and control of hypertension, together with its associated factors, in China and Sweden. Methods We used data from two cross-sectional studies: the Västerbotten Intervention Program in northern Sweden (n = 25,511) and the Shanghai survey in eastern China (n = 25,356). We employed multivariable logistic regression to examine the socio-demographics, lifestyle behaviours, and biological factors associated with the prevalence, awareness, treatment and control of hypertension. Results Men had a higher prevalence of hypertension (43% in Sweden, 39% in China) than their female counterparts (29 and 36%, respectively). In Sweden, men were less aware of, less treated for, and had less control over their hypertension than women. Chinese men were more aware of, had similar levels of treatment for, and had less control over their hypertension compared to women. Awareness and control of hypertension was lower in China compared to Sweden. Only 33 and 38% of hypertensive Chinese men and women who were treated reached the treatment goals, compared with a respective 48 and 59% in Sweden. Old age, impaired glucose tolerance or diabetes, a family history of hypertension or cardiovascular diseases, low physical activity and overweight or obesity were found to increase the odds of hypertension and its diagnosis. Conclusions This study shows the age and gender differences in the prevalence, awareness, treatment and control of hypertension among adults in China and Sweden. Multisectoral intervention should be developed to address the increasing burden of sedentary lifestyle, overweight and obesity and diabetes, all of which are linked to the prevention and control of hypertension. Development and implementation of the gender- and context-specific intervention for the prevention and control of hypertension facilitates understanding with regard to the implementation barriers and facilitators. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09862-4.
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Affiliation(s)
- Ailiana Santosa
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden.,Global Public Health, School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, 41390, Gothenburg, Sweden
| | - Yue Zhang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden
| | - Genming Zhao
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Na Wang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Qi Zhao
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Weibing Wang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China.
| | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden. .,Global Public Health, School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, 41390, Gothenburg, Sweden.
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24
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Santosa A, Ng N, Zetterberg L, Eriksson M. Study Protocol: Social Capital as a Resource for the Planning and Design of Socially Sustainable and Health Promoting Neighborhoods- A Mixed Method Study. Front Public Health 2020; 8:581078. [PMID: 33194986 PMCID: PMC7604308 DOI: 10.3389/fpubh.2020.581078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Promoting inclusive, safe, resilient, and sustainable communities is one of the 17 Sustainable Development Goals ratified in 2015 by 193 UN member states, not least in Sweden. Social sustainability involves preserving particular societal values (e.g., local identity) as well as developing values (e.g., social cohesion) that are perceived as needed. Socially sustainable development also implies promoting integration and preventing segregation. Social capital is one important indicator to measure how socially sustainable an area is. This project aims to explore how social capital can be used as a conceptual tool in developing housing policy for social sustainability in Umeå Municipality. Methods: The three sub-studies in this project combine quantitative and qualitative methods. We will conduct a review of the municipality's documents to understand how the ideas of social sustainability have influenced political declarations and implemented social and housing policies and interventions during the period 2006–2020. The quantitative study includes a longitudinal follow-up to the 2006 survey's respondents to assess the longitudinal impacts of neighborhood social capital on health and well-being; as well as a new repeated cross-sectional survey to investigate how social capital has changed in local neighborhoods from 2006 to 2020. The qualitative study includes case studies in neighborhoods with different social capital dynamics to understand how different resident sub-groups perceive their neighborhoods and how implemented social and housing policies have influenced the social capital dynamics and responded to the needs of different sub-groups. The project is run in close collaboration with the Commission for a Socially Sustainable Umeå. Discussions: This project will create new and unique perspectives on long-term structural changes of relevance for a socially sustainable housing policy; knowledge that is highly valuable for continuous municipal planning; and will outline recommendations to guide local housing policies for social sustainable neighborhoods in Umeå Municipality. Ethics: This study has been assessed and approved by the Swedish Ethics Review Authority (Dnr: 2019-04395; Dnr: 2020-00160; Dnr 2020-02757). Dissemination: The dissemination goals of this project are (1) sustained engagement of key stakeholders throughout the project and (2) dissemination of the research findings through popular science, conferences, and scientific papers.
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Affiliation(s)
- Ailiana Santosa
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nawi Ng
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Liv Zetterberg
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Malin Eriksson
- Department of Social Work, Umeå University, Umeå, Sweden
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25
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Lindgren H, Guerrero E, Jingar M, Lindvall K, Ng N, Richter Sundberg L, Santosa A, Weinehall L. The STAR-C Intelligent Coach: A Cross-Disciplinary Design Process of a Behavior Change Intervention in Primary Care. Stud Health Technol Inform 2020; 273:203-208. [PMID: 33087613 DOI: 10.3233/shti200640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A broad range of aspects are needed to be taken into consideration in the design and development of personalized coaching systems based on artificial intelligence methodologies. This research presents the initial phase of joining different professional and stakeholder perspectives on behavior change technologies into a flexible design proposal for a digital coaching system. The diversity and sometimes opposed views on content, behavior, purposes and context were managed using a structured argument-based design approach, which also feed into the behavior of the personalized system. Results include a set of personalization strategies that will be further elaborated with the target user group to manage sensitive issues such as ethics, social norms, privacy, motivation, autonomy and social relatedness.
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Affiliation(s)
| | | | - Monika Jingar
- Department of Computing Science, Umeå University, Sweden
| | | | - Nawi Ng
- Department of Epidemiology and Global Health, Umeå University
| | | | - Ailiana Santosa
- Department of Epidemiology and Global Health, Umeå University
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Umeå University
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26
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Kodriati N, Hayati EN, Santosa A, Pursell L. Fatherhood and Smoking Problems in Indonesia: Exploration of Potential Protective Factors for Men Aged 18-49 Years from the United Nations Multi-Country Study on Men and Violence. Int J Environ Res Public Health 2020; 17:ijerph17196965. [PMID: 32977630 PMCID: PMC7579021 DOI: 10.3390/ijerph17196965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/24/2022]
Abstract
Background: Despite the sustained high prevalence of smoking among Indonesian adult men, little is known about possible protective factors in this group. This study examined the relationship between key characteristics of masculinity (e.g., fatherhood status, being the main breadwinner or sole provider for the family) and current smoking behaviours (smoking status and cigarettes smoked per day (CPD)) among Indonesian men aged 18–49 years. Methods: In total, 2540 Indonesian men aged 18–49 participated in the United Nations Multi-Country Study on Men and Violence, 2012. Fatherhood status was categorised into three groups: nonfathers, new fathers and more experienced fathers. The association between fatherhood status and current smoking, as well as fatherhood status and cigarettes smoked per day (CPD), was estimated by employing logistic and zero-inflated negative binomial regressions, respectively. Results: Socioeconomic factors were associated with smoking behaviour among Indonesian adult men. The odds of smoking among new fathers and more experienced fathers were 2.3 (95% CI: 1.09–4.79) and 1.5 times (95% CI: 1.08–2.17) higher compared with nonfathers, respectively. Men who had a shared income with their partner or received income from their parents smoked 13% (95% CI 0.79–0.95) and 11% fewer CPD (95% CI 0.79–0.99) compared with men who were the main breadwinner, respectively. Conclusions: In this study, fatherhood represents an aspect of traditionally masculine roles, offering a new perspective for looking at smoking problems in Indonesia. Other key aspects of traditional masculinity characteristics, the breadwinner role, occupation and sources of family income had significant associations with smoking status and CPD. Men smoked fewer CPD as fathers and when sharing the financial responsibility for their family equally with their spouse.
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Affiliation(s)
- Nurul Kodriati
- School of Health Sciences, National University of Ireland, H91 TK33 Galway, Ireland; (N.K.); (L.P.)
| | - Elli Nur Hayati
- Faculty of Psychology, Post Graduate Program, University of Ahmad Dahlan, Yogyakarta 55166, Indonesia;
| | - Ailiana Santosa
- Department of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30 Goteborg, Sweden
- Correspondence:
| | - Lisa Pursell
- School of Health Sciences, National University of Ireland, H91 TK33 Galway, Ireland; (N.K.); (L.P.)
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27
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Miao Jonasson J, Hendryx M, Shadyab AH, Kelley E, Johnson KC, Kroenke CH, Garcia L, Lawesson S, Santosa A, Sealy-Jefferson S, Lin X, Cene CW, Liu S, Valdiviezo C, Luo J. Social Support, Social Network Size, Social Strain, Stressful Life Events, and Coronary Heart Disease in Women With Type 2 Diabetes: A Cohort Study Based on the Women's Health Initiative. Diabetes Care 2020; 43:1759-1766. [PMID: 32499383 PMCID: PMC7372045 DOI: 10.2337/dc19-2065] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We studied associations between social support, social network size, social strain, or stressful life events and risk of coronary heart disease (CHD) in postmenopausal women with type 2 diabetes. RESEARCH DESIGN AND METHODS From the Women's Health Initiative, 5,262 postmenopausal women with type 2 diabetes at baseline were included. Cox proportional hazards regression models adjusted for demographics, depressive symptoms, anthropometric variables, and lifestyle factors were used to examine associations between social factors and CHD. RESULTS A total of 672 case subjects with CHD were observed during an average 12.79 (SD 6.29) years of follow-up. There was a significant linear trend toward higher risk of CHD as the number of stressful life events increased (P for trend = 0.01; hazard ratio [HR] [95% CI] for the third and fourth quartiles compared with first quartile: 1.27 [1.03-1.56] and 1.30 [1.04-1.64]). Being married or in an intimate relationship was related to decreased risk of CHD (HR 0.82 [95% CI 0.69-0.97]). CONCLUSIONS Among postmenopausal women with type 2 diabetes, higher levels of stressful life events were associated with higher risk of CHD. Experience of stressful life events might be considered as a risk factor for CHD among women with type 2 diabetes.
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Affiliation(s)
- Junmei Miao Jonasson
- School of Public Health and Community Medicine at the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, IN
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA
| | - Erika Kelley
- Department of Reproductive Biology, School of Medicine, Case Western Reserve University, Cleveland, OH.,Department of Obstetrics and Gynecology, University Hospitals MacDonald Women's Hospital, Cleveland, OH
| | - Karen C Johnson
- Department of Preventive Medicine, School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lorena Garcia
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA
| | - Sofia Lawesson
- Department of Health, Medicine and Caring Sciences, School of Medicine, Linköping University, Linköping, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine at the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shawnita Sealy-Jefferson
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA
| | - Xiaochen Lin
- School of Public Health, Brown University, Providence, RI
| | - Crystal W Cene
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Simin Liu
- School of Public Health, Brown University, Providence, RI
| | - Carolina Valdiviezo
- MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN
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Kodriati N, Hayati EN, Santosa A, Pursell L. Perceived social benefits versus perceived harms of smoking among Indonesian boys aged 12-16 years: A secondary analysis of Global Youth Tobacco Survey 2014. Tob Prev Cessat 2020; 6:8. [PMID: 32548345 PMCID: PMC7291914 DOI: 10.18332/tpc/115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking among boys has not been prioritised as a gender issue despite its high prevalence worldwide. In Indonesia, steep increases in prevalence have been observed in adolescent boys. This study explored how smoking-related beliefs are associated with smoking among this group. METHODS Data extracted from the Global Youth Tobacco Survey Indonesia 2014, provided a nationally representative sample of 2729 male students aged 12–16 years. Measures of smoking-related beliefs were derived from eight survey items using principal component analysis. Associations between resulting components and smoking outcomes were modelled using logistic regression. RESULTS Smoking prevalence was found to be almost tripling between ages 12 to 16 years. Smoking-related belief items clustered into two components: perceived social benefits and perceived harms. The four beliefs representing smoking’s perceived social benefits and measures of smokers in the boys’ social circles increased with age while the four beliefs representing smoking’s perceived harms remained stable except an item of safe to smoke for one or two years, which increased with age. The two components of smoking-related beliefs were associated with smoking in opposite ways that represent boys’ masculine tendency for risk-taking and risk minimisation. For example, score increases for perceived benefits were positively associated with susceptibility to future tobacco use (OR=1.6; 95% CI: 1.3–1.9) but an increased score of perceived harm was negatively associated with susceptibility to future tobacco use (OR=0.8; 95% CI: 0.7–0.9). CONCLUSIONS Indonesian boys experience a rapid increase in smoking outcomes and smoking reported among their social circle. The sustained high percentage of smoking harms but also increased social benefits are similar to the concept of risk minimisation that is closely related to the masculine tendency to undermine health hazards of tobacco. Therefore, it is important to focus on these highly gender-related issues within the country.
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Affiliation(s)
- Nurul Kodriati
- School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Elli Nur Hayati
- Faculty of Psychology, University of Ahmad Dahlan, Yogyakarta, Indonesia
| | - Ailiana Santosa
- Department of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Lisa Pursell
- School of Health Sciences, National University of Ireland Galway, Galway, Ireland
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Ng N, Santosa A, Weinehall L, Malmberg G. Living alone and mortality among older people in Västerbotten County in Sweden: a survey and register-based longitudinal study. BMC Geriatr 2020; 20:7. [PMID: 31906868 PMCID: PMC6945693 DOI: 10.1186/s12877-019-1330-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 10/29/2019] [Indexed: 01/01/2023] Open
Abstract
Background Living alone is increasingly common and has been depicted as an important cause of mortality. We examined the association between living alone and mortality risks among older men and women in northern Sweden, by linking two unique longitudinal datasets. Methods We used the Linnaeus database, which links several population registers on socioeconomic and health. This register-based study included 22,226 men and 23,390 women aged 50 and 60 years in Västerbotten County who had participated in the Västerbotten Intervention Program (VIP) during 1990–2006, with a total of 445,823 person-years of observation. We conducted Cox-proportional hazard regression to assess the risk of living alone on the mortality that was observed between 1990 and 2015, controlling for socio-demographic factors, chronic disease risk factors and access to social capital. Results Older men and women who lived alone with no children at home were at a significantly higher risk of death compared to married/cohabiting couples with children at home (with an adjusted hazard ratio of 1.38, 95% CI of 1.26–1.50 in men and 1.27, 95% CI of 1.13–1.42 in women). Living alone was an even stronger factor than the well-established chronic disease risk factors and a lack of access to social capital. Conclusions A significant association between living alone and mortality among the older adult population in Sweden was observed. Providing good social support for older people is important in preventing the negative health impact of living alone.
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Affiliation(s)
- Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden. .,Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden. .,Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ailiana Santosa
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden.,Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Gunnar Malmberg
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden.,Department of Geography, Umeå University, Umeå, Sweden
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30
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Zhang Y, Santosa A, Wang N, Wang W, Ng N, Zhao Q, Jiang Y, Weinehall L, Zhao G. Prevalence and the Association of Body Mass Index and Other Risk Factors with Prediabetes and Type 2 Diabetes Among 50,867 Adults in China and Sweden: A Cross-Sectional Study. Diabetes Ther 2019; 10:2061-2077. [PMID: 31512070 PMCID: PMC6848580 DOI: 10.1007/s13300-019-00690-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Understanding socioeconomic differences for prediabetes and type 2 diabetes (T2DM) can offer guidance for the most effective development of both prevention and intervention programmes in different settings. This study aims to determine the prevalence and risk factors for prediabetes and T2DM and to explore the effect of high body mass index (BMI) on the probability of T2DM being present among adults in China and Sweden. METHODS This study enrolled 25,356 adults (35-64 years old) from the Shanghai Survey in China and 25,511 adults (aged 40, 50, 60) from the Västerbotten Intervention Programme in Sweden. Data on haemoglobin A1c, capillary fasting plasma glucose, 2-h plasma glucose and self-reported diagnoses of T2DM were used in the analysis. Multinomial logistic regression was used to examine the determinants of prediabetes and T2DM. The average predicted probabilities of T2DM developing or presenting were determined for the different ages and levels of BMI in each population. RESULTS Chinese participants had a higher adjusted prevalence of T2DM (men 12.8% vs. 4.6%; women 10.6% vs. 3.1%) and prediabetes (men 12.4% vs. 12.2%; women 14.4% vs. 12.2%) than Swedish participants. Age, overweightedness/obesity, hypertension and a family history of diabetes were significant risk factors for prediabetes and T2DM. In both populations, the predicted probability of T2DM increased as the BMI increased in all age groups. At the same BMI level, Chinese participants were more likely to have T2DM compared to their Swedish counterparts. The average predicted probability of T2DM was less than 20% in nearly all age groups among Swedish women. CONCLUSIONS Chinese adults had the higher prevalence of prediabetes and T2DM and a higher probability of T2DM at the same BMI level compared with Swedish adults. These results indicate the importance of addressing the ongoing obesity epidemic as a matter of urgency in order to curb what has become an apparent diabetes epidemic in both countries.
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Affiliation(s)
- Yue Zhang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ailiana Santosa
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Na Wang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Weibing Wang
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Qi Zhao
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yonggen Jiang
- Songjiang District Centre for Disease Prevention and Control, Shanghai, China
| | - Lars Weinehall
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - Genming Zhao
- School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
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Lestari SK, Ng N, Kowal P, Santosa A. Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison. Int J Environ Res Public Health 2019; 16:ijerph16081341. [PMID: 31013975 PMCID: PMC6518276 DOI: 10.3390/ijerph16081341] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/27/2019] [Accepted: 04/11/2019] [Indexed: 11/16/2022]
Abstract
The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007–2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01–1.29), Ghana (OR = 1.22, 95% CI: 1.01–1.48) and India (OR = 1.65, 95% CI: 1.37–1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54–4.31) and South Africa (OR = 4.11, 95% CI: 1.79–9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.
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Affiliation(s)
- Septi Kurnia Lestari
- Department of Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden.
- Centre for Demographic and Ageing Research, Umeå University, 90187 Umeå, Sweden.
| | - Nawi Ng
- Department of Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden.
- Centre for Demographic and Ageing Research, Umeå University, 90187 Umeå, Sweden.
| | - Paul Kowal
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand.
- Vantage Health Solutions, Yangon 11072, Myanmar.
| | - Ailiana Santosa
- Centre for Demographic and Ageing Research, Umeå University, 90187 Umeå, Sweden.
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32
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Lahiri M, Santosa A, Mujumdar S, Lim TK. ISQUA18-1769Developing A Culturally Relevant Quality and Innovation Distinction Track for Residents in Training. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - S Mujumdar
- Medical Affairs - Clinical Governance, NATIONAL UNIVERSITY HOSPITAL, Singapore, Singapore
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Teo SL, Santosa A, Bigliardi PL. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap Induced by Fexofenadine. J Investig Allergol Clin Immunol 2017; 27:191-193. [PMID: 28570227 DOI: 10.18176/jiaci.0158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S L Teo
- National University Hospital, Singapore
| | - A Santosa
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P L Bigliardi
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.,Experimental Dermatology Group, Institute of Medical Biology, A *STAR, Singapore
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Affiliation(s)
- N Ng
- Umeå University, Umeå, Sweden
| | | | - P Kowal
- World Health Organization, Geneva, Switserland
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Affiliation(s)
- M. M. Liau
- Department of Dermatology; National University Health System (NUHS); 1E Kent Ridge Rd Singapore 119228 Singapore
| | - A. Santosa
- Department of Dermatology; National University Hospital; Singapore Singapore
| | - J. Huang
- Department of Pathology; National University Health System (NUHS); 1E Kent Ridge Rd Singapore 119228 Singapore
| | - L. C. Tan
- Department of Dermatology; National University Health System (NUHS); 1E Kent Ridge Rd Singapore 119228 Singapore
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Carter K, Cheung PP, Rome K, Santosa A, Lahiri M. Increasing podiatry referrals for patients with inflammatory arthritis at a tertiary hospital in Singapore: A quality improvement project. Foot (Edinb) 2017; 31:6-12. [PMID: 28282539 DOI: 10.1016/j.foot.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/18/2016] [Accepted: 12/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Foot disease is highly prevalent in people with inflammatory arthritis and is often under-recognized. Podiatry intervention can significantly reduce foot pain and disability, with timely access being the key factor. The aim of this study was to plan and implement a quality improvement project to identify the barriers to, and improve, uptake of podiatry services among patients with inflammatory arthritis-related foot problems seen at a tertiary hospital in Singapore. METHOD A 6-month quality improvement program was conducted by a team of key stakeholders using quality improvement tools to identify, implement and test several interventions designed to improve uptake of podiatry services. The number of patients referred for podiatry assessment was recorded on a weekly basis by an experienced podiatrist. The criterion for appropriate referral to podiatry was those patients with current or previous foot problems such as foot pain, swelling and deformity. RESULTS Interventions included education initiatives, revised workflow, development of national guidelines for inflammatory arthritis, local podiatry guidelines for the management of foot and ankle problems, routine use of outcome measures, and introduction of a fully integrated rheumatology-podiatry service with reduced cost package. Referral rates increased from 8% to 11%, and were sustained beyond the study period. Complete incorporation of podiatry into the rheumatology consultation as part of the multidisciplinary team package further increased referrals to achieve the target of full uptake of the podiatry service. CONCLUSION Through a structured quality improvement program, referrals to podiatry increased and improved the uptake and acceptance of rheumatology-podiatry services.
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Affiliation(s)
- K Carter
- Podiatry Department, Rehabilitation Centre, National University Health System Singapore, Singapore.
| | - P P Cheung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Health System Singapore, Singapore
| | - K Rome
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - A Santosa
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Health System Singapore, Singapore
| | - M Lahiri
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, Department of Medicine, National University Health System Singapore, Singapore
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Affiliation(s)
- Ailiana Santosa
- Centre for Demographic and Ageing Research, Umeå University, Umeå 90187, Sweden.
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Carter K, Lahiri M, Cheung PP, Santosa A, Rome K. Prevalence of foot problems in people with inflammatory arthritis in Singapore. J Foot Ankle Res 2016; 9:37. [PMID: 27594920 PMCID: PMC5010761 DOI: 10.1186/s13047-016-0169-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/26/2016] [Indexed: 01/21/2023] Open
Abstract
Background Foot problems are highly prevalent in people with inflammatory arthritis reported from studies in the UK, Europe and New Zealand, but there is limited evidence from Southeast Asia. The study aim was to evaluate the prevalence of foot problems in people with inflammatory arthritis in Singapore. Methods People with inflammatory arthritis were recruited from the rheumatology outpatient clinic of a tertiary hospital in Singapore. Disease and clinical characteristics included age, sex, disease duration, current blood tests and medications. The Leeds Foot Impact Scale was used to evaluate foot impairment/disability and the Modified Health Assessment Questionnaire was used to assess global function. Results We recruited 101 people with inflammatory arthritis, of which 50 % were female. The majority of participants were Chinese (70 %). The mean (SD) age was 52 (15) years, and the mean (SD) disease duration was 9.3 (0.3) years. The most commonly reported inflammatory arthritic conditions were rheumatoid arthritis (46), gout (31) and spondyloarthritis (15 %). The mean (SD) of the total Leeds Foot Impact Scale was 17 (13) indicating moderate to severe levels of foot impairment and activity limitation. Over 80 of participants reported foot pain during the course of their condition, and 48 % reported current foot pain. Despite the high prevalence of foot pain, only 21 participants (21 %) had been referred to a podiatrist. Conclusion This is the first study to investigate the prevalence of foot problems in people with inflammatory arthritis from Singapore. The majority of the participants reported foot problems, but had not been referred to a podiatry service. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0169-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Carter
- Podiatry Department, Rehabilitation Centre, National University Health System Singapore, Singapore, Singapore
| | - M Lahiri
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Division of Rheumatology, Department of Medicine, National University Health System Singapore, Singapore, Singapore
| | - P P Cheung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Division of Rheumatology, Department of Medicine, National University Health System Singapore, Singapore, Singapore
| | - A Santosa
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Division of Rheumatology, Department of Medicine, National University Health System Singapore, Singapore, Singapore
| | - K Rome
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
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Carter K, Lahiri M, Cheung PP, Santosa A, Rome K. Footwear characteristics in people with inflammatory arthritis in Singapore. J Foot Ankle Res 2016; 9:29. [PMID: 27540415 PMCID: PMC4989501 DOI: 10.1186/s13047-016-0161-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/03/2016] [Indexed: 11/26/2022] Open
Abstract
Background Foot problems are common in people with inflammatory arthritis. Despite suitable footwear having the potential to alleviate pain, improve mobility and maintain independence, previous studies have found many people with inflammatory arthritis wearing poorly fitting and inappropriate footwear. Footwear styles and characteristics have not been reported in a Singapore inflammatory arthritis population. The objective of this study was to identify current footwear styles and characteristics of footwear worn by people with inflammatory arthritis in Singapore. Methods One-hundred-and-one participants with inflammatory arthritis were recruited from the rheumatology outpatient clinic of a large public hospital in Singapore. Disease and clinical characteristics were recorded. A patient-reported outcome included current foot pain. An objective footwear assessment of style, age of shoe, fit and construction was conducted. Results The majority of participants were Chinese women with a mean (SD) age was 52.0 (15.0) years old and a mean (SD) disease duration of 9.3 (0.3) years. We found 50 % of participants (n = 51) reported footwear problems. Sandals (n = 27, 26 %), flip-flops (n = 19, 19 %) and moccasin type (n = 19, 19 %) was the most common footwear choice. Evaluation of footwear characteristics found that there was a lack of motion control features. Only 32 (32 %) participants had correctly fitting footwear with regard to length, width and depth. No participant was wearing therapeutic footwear. Conclusion This study provides the first insight into footwear preferences of people with inflammatory arthritis in Singapore. Use of slip-on and poorly fitting footwear was found to be common in people with inflammatory arthritis. Further research on footwear preferences in Southeast-Asian communities needs to take into account cultural habit and preference, socio-economic status, footwear options and affordability.
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Affiliation(s)
- K Carter
- Podiatry Department, Rehabilitation Centre, National University Health System, Singapore, Singapore
| | - M Lahiri
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Division of Rheumatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - P P Cheung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Division of Rheumatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - A Santosa
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Division of Rheumatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - K Rome
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
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Carter K, Lahiri M, Cheung P, Santosa A, Rome K. THU0643-HPR Prevalence of Foot Problems in People with Inflammatory Arthritis in Singapore. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Premkumar A, Pawa C, Lahiri M, Santosa A. SAT0481 Clinical Features Associated with Higher Mortality in Adults with Septic Arthritis - A 10-Year Retrospective Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carter K, Lahiri M, Cheung P, Santosa A, Rome K. AB1119-HPR Evaluation of The Podiatric Need of People with Inflammatory Arthritis in Singapore. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Santosa A, Tan CS, Teng GG, Fong W, Lim A, Law WG, Chan G, Ng SC, Low AHL. Lung and gastrointestinal complications are leading causes of death in SCORE, a multi-ethnic Singapore systemic sclerosis cohort. Scand J Rheumatol 2016; 45:499-506. [DOI: 10.3109/03009742.2016.1153141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Santosa
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - CS Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - GG Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - W Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - A Lim
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - WG Law
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - G Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - SC Ng
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore, Singapore
| | - AHL Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore, Singapore
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Santosa A, Byass P. Diverse Empirical Evidence on Epidemiological Transition in Low- and Middle-Income Countries: Population-Based Findings from INDEPTH Network Data. PLoS One 2016; 11:e0155753. [PMID: 27187781 PMCID: PMC4871496 DOI: 10.1371/journal.pone.0155753] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/04/2016] [Indexed: 12/21/2022] Open
Abstract
Background Low- and middle-income countries are often described as being at intermediate stages of epidemiological transition, but there is little population-based data with reliable cause of death assignment to examine the situation in more detail. Non-communicable diseases are widely seen as a coming threat to population health, alongside receding burdens of infection. The INDEPTH Network has collected empirical population data in a number of health and demographic surveillance sites in low- and middle-income countries which permit more detailed examination of mortality trends over time. Objective To examine cause-specific mortality trends across all ages at INDEPTH Network sites in Africa and Asia during the period 1992–2012. Emphasis is given to the 15–64 year age group, which is the main focus of concern around the impact of the HIV pandemic and emerging non-communicable disease threats. Methods INDEPTH Network public domain data from 12 sites that each reported at least five years of cause-specific mortality data were used. Causes of death were attributed using standardised WHO verbal autopsy methods, and mortality rates were standardised for comparison using the INDEPTH standard population. Annual changes in mortality rates were calculated for each site. Results A total of 96,255 deaths were observed during 9,487,418 person years at the 12 sites. Verbal autopsies were completed for 86,039 deaths (89.4%). There were substantial variations in mortality rates between sites and over time. HIV-related mortality played a major part at sites in eastern and southern Africa. Deaths in the age group 15–64 years accounted for 43% of overall mortality. Trends in mortality were generally downwards, in some cases quite rapidly so. The Bangladeshi sites reflected populations at later stages of transition than in Africa, and were largely free of the effects of HIV/AIDS. Conclusions To some extent the patterns of epidemiological transition observed followed theoretical expectations, despite the impact of the HIV pandemic having a major effect in some locations. Trends towards lower overall mortality, driven by decreasing infections, were the general pattern. Low- and middle-income country populations appear to be in an era of rapid transition.
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Affiliation(s)
- Ailiana Santosa
- Umeå Centre for Global Health Research, Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
- Center for Demographic and Ageing Research, Umeå University, 90187 Umeå, Sweden
- * E-mail:
| | - Peter Byass
- Umeå Centre for Global Health Research, Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Santosa A, Schröders J, Vaezghasemi M, Ng N. Inequality in disability-free life expectancies among older men and women in six countries with developing economies. J Epidemiol Community Health 2016; 70:855-61. [PMID: 26994068 PMCID: PMC5013163 DOI: 10.1136/jech-2015-206640] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/24/2016] [Indexed: 12/14/2022]
Abstract
Background It is unclear whether the increase in life expectancy (LE) globally is coupled with a postponement of morbidity and disability. Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in LE, disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies. Methods This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health (SAGE) in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007–2010. Disability was measured with the activity of daily living (ADL) instrument. The DFLE was estimated using the Sullivan method based on the standard period life table and ADL-disability proportions. Results The disability prevalence ranged from 13% in China to 54% in India. The prevalence of disability was highest and occurred at younger age in both sexes in India. Women were more disadvantaged with higher prevalence of disability across all age groups, and the situation was worst among older women in Mexico and the Russian Federation. Though women had higher LE, their proportion of remaining LE free from disability was lower than men. Conclusions There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.
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Affiliation(s)
- Ailiana Santosa
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Julia Schröders
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Masoud Vaezghasemi
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden Umeå Centre for Gender Studies (UCGSs), Umeå University, Umeå, Sweden
| | - Nawi Ng
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Tan CSL, Teng GG, Chong KJ, Cheung PP, Lim AYN, Wee HL, Santosa A. Utility of the Morisky Medication Adherence Scale in gout: a prospective study. Patient Prefer Adherence 2016; 10:2449-2457. [PMID: 27980395 PMCID: PMC5144895 DOI: 10.2147/ppa.s119719] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The outcomes of any chronic illness often depend on patients' adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand. OBJECTIVE We set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT). METHODS This cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR) and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. RESULTS Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069, P=0.521). MMAS-8 did not differ between those who did or did not achieve target serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777). Adherence was associated with age (β=0.256, P=0.015) and education level (P=0.011) but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal consistency was acceptable (α=0.725) and test-retest reliability was satisfactory (ICC =0.70, 95% confidence interval [CI] 0.36-0.88). CONCLUSION MMAS-8 had limited construct validity in assessing medication adherence to ULT in our gout patients. Nevertheless, it identified patients bothered or worried about ULT side effects, and those with underlying anxiety or depression, for whom targeted education and coping support may be useful.
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Affiliation(s)
- CSL Tan
- University Medicine Cluster, Division of Rheumatology, National University Health System
| | - GG Teng
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - KJ Chong
- Department of Medicine, Yong Loo Lin School of Medicine
| | - PP Cheung
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - AYN Lim
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - HL Wee
- Department of Pharmacy, Faculty of Science
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - A Santosa
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
- Correspondence: A Santosa, University Medicine Cluster, Division of Rheumatology, National University Health System, Level 10 Tower Block, 1E Lower Kent Ridge Road, Singapore 119228, Singapore, Fax +65 6872 4130, Email
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Lee W, Teo FSW, Santosa A, Teng GG. Eosinophilic Granulomatosis with Polyangiitis preceding allergic bronchopulmonary aspergillosis. Eur Ann Allergy Clin Immunol 2015; 47:228-231. [PMID: 26549342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 61-year-old Chinese man with long-standing, stable Eosinophilic Granulomatosis with Polyangiitis (EGPA) and asthma, presented with acute hypoxemia and declining obstructive pulmonary function. Elevated serum IgE levels, positive Aspergillus fumigatus specific IgE and CT findings of central bronchiectasis with small airway mucoid impaction confirmed new development of Allergic Bronchopulmonary Aspergillosis (ABPA). The maintenance therapy for EGPA, azathioprine, was discontinued. Prednisolone 0.5 mg/kg/day and Itraconazole improved his symptoms and IgE levels. To our knowledge, ABPA occurring in a patient with EGPA has not been reported. Differentiation of EGPA with asthmatic flare vs ABPA vs asthma with aspergillus hypersensitivity is discussed. Heightened Th2 immunity where eosinophils play a central role may link these conditions.
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Affiliation(s)
- W Lee
- University Medicine Cluster, Internal Medicine Residency, National University Health System, Singapore
| | - F S W Teo
- University Medicine Cluster, Division of Respiratory and Critical Care Medicine, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - A Santosa
- University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - G G Teng
- University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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Santosa A, Byass P P. Recent mortality transition from INDEPTH health surveillance data in low and middle-income countries. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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49
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Santosa A, Rocklöv J, Norberg M, Högberg U, Weinehall L, Wall S, Byass P. What kills middle-aged Swedes? A Prospective cohort study on NCD risk factors and mortality. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Santosa A, Teng G, Tan C, Fong W, Law W, Chan G, Wong E, Teo H, Lee P, Low A. FRI0450 Predictors of Mortality in Systemic Sclerosis: The Singapore Scleroderma Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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