The impact of COVID-19 on life expectancy across socioeconomic groups in Denmark

BACKGROUND

Denmark was one of the few countries that experienced an increase in life expectancy in 2020, and one of the few to see a decrease in 2021. Because COVID-19 mortality is associated with socioeconomic status (SES), we hypothesize that certain subgroups of the Danish population experienced changes in life expectancy in 2020 and 2021 that differed from the country overall. We aim to quantify life expectancy in Denmark in 2020 and 2021 by SES and compare this to recent trends in life expectancy (2014-2019).

METHODS

We used Danish registry data from 2014 to 2021 for all individuals aged 30+. We classified the study population into SES groups using income quartiles and calculated life expectancy at age 30 by year, sex, and SES, and the differences in life expectancy from 2019 to 2020 and 2020 to 2021. We compared these changes to the average 1-year changes from 2014 to 2019 with 95% confidence intervals. Lastly, we decomposed these changes by age and cause of death distinguishing seven causes, including COVID-19, and a residual category.

RESULTS

We observed a mortality gradient in life expectancy changes across SES groups in both pandemic years. Among women, those of higher SES experienced a larger increase in life expectancy in 2020 and a smaller decrease in 2021 compared to those of lower SES. Among men, those of higher SES experienced an increase in life expectancy in both 2020 and 2021, while those of lower SES experienced a decrease in 2021. The impact of COVID-19 mortality on changes in life expectancy in 2020 was counterbalanced by improvements in non-COVID-19 mortality, especially driven by cancer and cardiovascular mortality. However, in 2021, non-COVID-19 mortality contributed negatively even for causes as cardiovascular mortality that has generally a positive impact on life expectancy changes, resulting in declines for most SES groups.

CONCLUSIONS

COVID-19 mortality disproportionally affected those of lower SES and exacerbated existing social inequalities in Denmark. We conclude that in health emergencies, particular attention should be paid to those who are least socially advantaged to avoid widening the already existing mortality gap with those of higher SES. This research contributes to the discussion on social inequalities in mortality in high-income countries.

Benefits and harms of social media use: A latent profile analysis of emerging adults

The rise in social media use among emerging adults in the United States has been well-documented, but researchers are still working on identifying how the type-not just the frequency-of use impacts psychological well-being. We identified "profiles" of social media use among young adults based on the frequency and purposes of use, and examined their associations with benefits and harms to psychosocial well-being, using data from 2828 incoming undergraduate students (M age = 18.29 years; age range: 17 to 25 years). Using Latent Profile Analysis, we identified three unique profiles of individuals who used social media with varying levels of intensity across different purposes: Active Users (32.4%), Passive Users (25.3%), and Average Users (42.4%). Each profile was associated with varying levels of beneficial and harmful psychosocial outcomes. Compared to Average Users, (a) Active Users reported significantly better psychosocial well-being, but also more harmful outcomes; and (b) Passive Users experienced significantly lower levels of perceived social media benefits and social connectedness, while also reporting less problematic social media use and social media stress. Implications of these findings for research and practice are discussed.

Quantifying the HIV treatment cascade in a South African health sub-district by gender: retrospective cohort study

OBJECTIVES

To quantify the HIV care cascade in a Cape Town sub-district to understand rates of linkage to and engagement in HIV care.

METHODS

We used routinely collected data to reconstruct the treatment cascade for 8382 infected individuals who tested HIV + in 2012/2013. We obtained data on patient gender, year of initial HIV-positive test, age at testing and initial CD4 cell count and defined five stages of the HIV care cascade. We quantified attrition across cascade stages.

RESULTS

Two-thirds of the sample (5646) were women. Men were older at time of first testing (36.5 vs. 31.3 years) and had more advanced HIV disease at diagnosis (298 vs. 404 CD4 cells/µL for women). The median duration of follow-up was 818 days. Among women, 90.5% attended an initial HIV care visit, 54.6% became eligible for antiretroviral therapy under local guidelines during follow-up, 49.3% initiated ART and 45.6% achieved a therapeutic response. Among men, 88.0% attended an initial HIV care visit, 67.4% became ART eligible during follow-up, 48.0% initiated ART and 42.4% achieved a therapeutic response. Approximately 3% of women and 5% of men died during follow-up.

CONCLUSIONS

We were able to reconstruct the HIV treatment cascade using routinely collected data. In this setting, rates of engagement in care differ by gender in key stages of the cascade, with men faring worse than women at each cascade point. This highlights the need for interventions aimed at encouraging earlier testing, linkage, ART initiation and retention among men.

Free L-tryptophan plasma levels in antisocial violent offenders

RATIONALE

Several studies have shown that impulsive violent behavior is associated with reduced serotonin metabolism in the brain, but no data exist on possible alterations of the serotonin precursor (free L-tryptophan) levels among violent offenders.

OBJECTIVES

To study free L-tryptophan and kynurenine plasma levels among antisocial violent offenders.

METHODS

Free L-tryptophan and competing amino acid (CAA) plasma levels were measured among 19 male impulsive antisocial violent offenders and 19 age-matched healthy male controls.

RESULTS

Mean free L-tryptophan/(CAA) plasma levels were 160% (95% CI 116%-204%) higher among offenders than controls (P=0.000). Seventeen of the 19 offenders (89.5%) had values of more than 2 SD above the mean value of controls. The levels of kynurenine, the major metabolite of tryptophan, were slightly increased in offenders.

CONCLUSION

Free plasma L-tryptophan/CAA levels were markedly increased among antisocial violent offenders indicating a disturbed tryptophan metabolism.

Dopamine D(2)/D(3)-receptor and transporter densities in nucleus accumbens and amygdala of type 1 and 2 alcoholics

Alcohol acts through mechanisms involving the brain neurotransmitter dopamine (DA) with the nucleus accumbens as the key zone for mediating these effects. We evaluated the densities of DA D(2)/D(3) receptors and transporters in the nucleus accumbens and amygdala of post-mortem human brains by using [(125)l]epidepride and [(125)I]PE2I as radioligands in whole hemispheric autoradiography of Cloninger type 1 and 2 alcoholics and healthy controls. When compared with controls, the mean binding of [(125)I]epidepride to DA D(2)/D(3) receptors was 20% lower in the nucleus accumbens and 41% lower in the amygdala, and [(125)I]PE2I binding to DA transporters in the nucleus accumbens was 39% lower in type 1 alcoholics. These data indicate that dopaminergic functions in these limbic areas may be impaired among type 1 alcoholics, due to the substantially lower number of receptor sites. Our results suggest that such a reduction may result in the chronic overuse of alcohol as an attempt to stimulate DA function.

Effects of sonication of clinical specimens on detection of cytomegalovirus in shell vial cultures

BACKGROUND

The centrifugation-enhanced shell vial (SV) method of virus culturing has decreased the time to laboratory detection of many viruses, and has become the principal method for the rapid detection of cytomegalovirus (CMV) in clinical specimens.

OBJECTIVES

To examine the use of sonication and centrifugation of clinical specimens as a means of optimizing the sensitivity of SV detection of CMV, decreasing the toxicity of specimens to the SV monolayer, and facilitating the examination and interpretation of SV monolayers.

STUDY DESIGN

A total of 350 clinical specimens submitted for CMV culture were processed and then divided in half, with one-half sonicated for 1 min in a cup-horn-equipped sonicator, and the other half left unsonicated. Sonicated specimens were centrifuged to recover a cell-free supernatant. SVs containing MRC-5 fibroblast monolayers were inoculated with either the unsonicated whole specimen or the cell-free supernatant, and were stained with monoclonal antibodies directed against the immediate-early antigen of CMV after 24 and 48 h of incubation.

RESULTS

While no significant difference was observed in the overall number of specimens in which CMV was detected following sonication, sonication did afford a 31% increase in the number of CMV-positive specimens detected at 24 h. A significant reduction in toxicity of all specimens except for blood was observed for the sonicated specimens, although sonication of blood increased the number of blood specimens toxic to the monolayer by 40%. Use of the cell-free inoculum following sonication facilitated microscopic examination and interpretation of SV monolayers without adversely affecting the sensitivity of the culture.

CONCLUSIONS

Sonication of clinical specimens prior to shell vial culturing for CMV is beneficial and can help to reduce specimen toxicity, facilitate interpretation of monolayers, and allow the earlier detection of a positive specimen.

Accumulation of 99mTc-low-density lipoprotein in human malignant glioma

Low-density lipoprotein (LDL) uptake in gliomas was studied to find out if LDL has potential as a drug carrier of boron, especially for boron neutron capture therapy. Single photon emission tomography (SPET) was performed 2 h and 20 h after intravenous injection of autologous 99mTc-labelled LDL in four patients with untreated and five patients with recurrent glioma. 99mTc-LDL uptake was compared with the uptake of 99mTc-labelled human serum albumin (HSA), an established blood pool marker. The intra- and peritumoral distributions of radioactivity in the SPET images were not identical for radiolabelled LDL and HSA. The mean LDL tumour to brain ratio, determined from transversal SPET slices at 20 h post injection, was 1.5 in untreated and 2.2 in recurrent gliomas; the corresponding ratios for HSA were 1.6 and 3.4. The brain to blood ratio remained constant at 2 h and 20 h in both types of tumours. These data are not consistent with highly selective, homogeneous uptake of LDL in gliomas. However, the different tumoral distribution and rate of uptake of 99mTc-LDL, as compared with 99mTc-HSA, indicate that the uptake of LDL is different from that of HSA and that further studies on the mechanism of LDL uptake in glioma are warranted.

Rostral ventrolateral medulla: a source of the glutamatergic innervation of the sympathetic intermediolateral nucleus

To determine whether the sympathoexcitatory projection from the rostral ventrolateral medulla (RVL) to the sympathetic intermediolateral nucleus (IML) of the spinal cord might use glutamate as an excitatory transmitter, we performed a dual-label, transport and immunocytochemical ultrastructural study. Axon terminals within the IML were examined to determine whether anterogradely transported Phaseolus vulgaris-leucoagglutinin (PHA-L) following injections into the RVL, was colocalized with glutamate immunoreactivity using an antibody to hemocyanin-conjugated L-glutamate (Hepler et al., J. Histochem. Cytochem., 36 (1988) 13-22). Transported PHA-L was visualized with the peroxidase-antiperoxidase technique while glutamate-like immunoreactivity was localized within the same section of the thoracic spinal cord with immunoautoradiography. By light microscopy, PHA-L immunoreactivity was found within a plexus of fine fibers and varicose processes localized to the IML. Silver grains indicative of glutamate immunoreactivity were concentrated over the IML and also over the superficial layers of the dorsal horn. Electron microscopic analysis revealed PHA-L immunoreactivity in axons and axon terminals within the IML. They ranged in diameter from 0.5 to 2.0 microns, contained numerous small clear and 0-3 large, dense-core vesicles, and formed primarily asymmetric synaptic contacts on small dendrites of IML neurons. Some of the PHA-L immunoreactive terminals making asymmetric (excitatory) synaptic contacts on the small dendrites of IML neurons also contained glutamate-like immunoreactivity. We conclude that at least a portion of the input to the IML from the RVL uses glutamate as its transmitter.(ABSTRACT TRUNCATED AT 250 WORDS)