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Dreyer NA, Knuth KB, Xie Y, Reynolds MW, Mack CD. COVID-19 Vaccination Reactions and Risk of Breakthrough Infections Among People With Diabetes: Cohort Study Derived From Community Reporters. JMIR Diabetes 2024; 9:e45536. [PMID: 38412008 PMCID: PMC10933718 DOI: 10.2196/45536] [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] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/16/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND This exploratory study compares self-reported COVID-19 vaccine side effects and breakthrough infections in people who described themselves as having diabetes with those who did not identify as having diabetes. OBJECTIVE The study uses person-reported data to evaluate differences in the perception of COVID-19 vaccine side effects between adults with diabetes and those who did not report having diabetes. METHODS This is a retrospective cohort study conducted using data provided online by adults aged 18 years and older residing in the United States. The participants who voluntarily self-enrolled between March 19, 2021, and July 16, 2022, in the IQVIA COVID-19 Active Research Experience project reported clinical and demographic information, COVID-19 vaccination, whether they had experienced any side effects, test-confirmed infections, and consented to linkage with prescription claims. No distinction was made for this study to differentiate prediabetes or type 1 and type 2 diabetes nor to verify reports of positive COVID-19 tests. Person-reported medication use was validated using pharmacy claims and a subset of the linked data was used for a sensitivity analysis of medication effects. Multivariate logistic regression was used to estimate the adjusted odds ratios of vaccine side effects or breakthrough infections by diabetic status, adjusting for age, gender, education, race, ethnicity (Hispanic or Latino), BMI, smoker, receipt of an influenza vaccine, vaccine manufacturer, and all medical conditions. Evaluations of diabetes medication-specific vaccine side effects are illustrated graphically to support the examination of the magnitude of side effect differences for various medications and combinations of medications used to manage diabetes. RESULTS People with diabetes (n=724) reported experiencing fewer side effects within 2 weeks of vaccination for COVID-19 than those without diabetes (n=6417; mean 2.7, SD 2.0 vs mean 3.1, SD 2.0). The adjusted risk of having a specific side effect or any side effect was lower among those with diabetes, with significant reductions in fatigue and headache but no differences in breakthrough infections over participants' maximum follow-up time. Diabetes medication use did not consistently affect the risk of specific side effects, either using self-reported medication use or using only diabetes medications that were confirmed by pharmacy health insurance claims for people who also reported having diabetes. CONCLUSIONS People with diabetes reported fewer vaccine side effects than participants not reporting having diabetes, with a similar risk of breakthrough infection. TRIAL REGISTRATION ClinicalTrials.gov NCT04368065; https://clinicaltrials.gov/study/NCT04368065.
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Affiliation(s)
| | | | - Yiqiong Xie
- Real World Solutions, IQVIA, Durham, NC, United States
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Largent J, Xie Y, Knuth KB, Toovey S, Reynolds MW, Brinkley E, Mack CD, Dreyer NA. Cognitive and other neuropsychiatric symptoms in COVID-19: analysis of person-generated longitudinal health data from a community-based registry. BMJ Open 2023; 13:e069118. [PMID: 37336535 DOI: 10.1136/bmjopen-2022-069118] [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] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To describe cognitive symptoms in people not hospitalised at study enrolment for SARS-CoV-2 infection and associated demographics, medical history, other neuropsychiatric symptoms and SARS-CoV-2 vaccination. DESIGN Longitudinal observational study. SETTING Direct-to-participant registry with community-based recruitment via email and social media including Google, Facebook and Reddit, targeting adult US residents. Demographics, medical history, COVID-19-like symptoms, tests and vaccinations were collected through enrolment and follow-up surveys. PARTICIPANTS Participants who reported positive COVID-19 test results between 15 December 2020 and 13 December 2021. Those with cognitive symptoms were compared with those not reporting such symptoms. MAIN OUTCOME MEASURE Self-reported cognitive symptoms (defined as 'feeling disoriented or having trouble thinking' from listed options or related written-in symptoms) RESULTS: Of 3908 participants with a positive COVID-19 test result, 1014 (25.9%) reported cognitive symptoms at any time point during enrolment or follow-up, with approximately half reporting moderate/severe symptoms. Cognitive symptoms were associated with other neuropsychiatric symptoms, including dysgeusia, anosmia, trouble waking up, insomnia, headache, anxiety and depression. In multivariate analyses, female sex (OR, 95% CI): 1.7 (1.3 to 2.2), age (40-49 years (OR: 1.5 (1.2-1.9) compared with 18-29 years), history of autoimmune disease (OR: 1.5 (1.2-2.1)), lung disease (OR: 1.7 (1.3-2.2)) and depression (OR: 1.4 (1.1-1.7)) were associated with cognitive symptoms. Conversely, black race (OR: 0.6 (0.5-0.9)) and COVID-19 vaccination before infection (OR: 0.6 (0.4-0.7)) were associated with reduced occurrence of cognitive symptoms. CONCLUSIONS In this study, cognitive symptoms among COVID-19-positive participants were associated with female gender, age, autoimmune disorders, lung disease and depression. Vaccination and black race were associated with lower occurrence of cognitive symptoms. A constellation of neuropsychiatric and psychological symptoms occurred with cognitive symptoms. Our findings suggest COVID-19's full health and economic burden may be underestimated. TRIAL REGISTRATION NUMBER NCT04368065.
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Affiliation(s)
- Joan Largent
- Real World Solutions, IQVIA Inc, Durham, North Carolina, USA
| | - Yiqiong Xie
- Real World Solutions, IQVIA Inc, Durham, Massachusetts, USA
| | - Kendall B Knuth
- Real World Solutions, IQVIA Inc, Durham, North Carolina, USA
| | | | | | - Emma Brinkley
- Real World Solutions, IQVIA Inc, Durham, North Carolina, USA
| | | | - Nancy A Dreyer
- Real World Solutions, IQVIA Inc, Durham, North Carolina, USA
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Reynolds MW, Xie Y, Knuth KB, Mack CD, Brinkley E, Toovey S, Dreyer NA. COVID-19 Vaccination Breakthrough Infections in a Real-World Setting: Using Community Reporters to Evaluate Vaccine Effectiveness. Infect Drug Resist 2022; 15:5167-5182. [PMID: 36090603 PMCID: PMC9451035 DOI: 10.2147/idr.s373183] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Matthew W Reynolds
- Real World Solutions, IQVIA, Cambridge, MA, USA
- Correspondence: Matthew W Reynolds, Real-World Solutions, IQVIA, 201 Broadway, Cambridge, MA, 02139, USA, Email
| | - Yiqiong Xie
- Real World Solutions, IQVIA, Cambridge, MA, USA
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Gora Combs K, Fliss MD, Knuth KB, Cox ME, Trangenstein PJ. The Societal Cost of Excessive Drinking in North Carolina, 2017. N C Med J 2022; 83:214-220. [PMID: 35504714 DOI: 10.18043/ncm.83.3.214] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Excessive drinking, including binge and heavy drinking, is a leading cause of morbidity and mortality in North Carolina. In 2010, excessive drinking cost North Carolina $7.03 billion, and this analysis aimed to update this figure for 2017.METHODS Following the methods of Sacks, et al. (2015), we obtained proxies for the 2010 and 2017 incidence and price for 26 alcohol-attributable cost components. We then multiplied each component's 2010 cost by the incidence trend (2017 incidence/2010 incidence) and price trend (2017 price/2010 price) to estimate the 2017 cost. Finally, we summed these cost components to calculate the total cost and allocated them by payer and county.RESULTS Excessive drinking cost $9.72 billion in North Carolina in 2017, which equals approximately $2.09 per standard drink. Government paid $4.43 billion (45.6%), drinkers paid $3.76 billion (38.7%), and persons other than the drinker paid $1.53 billion (15.7%).LIMITATIONS These methods relied on alcohol-attributable fractions, which were calculated using scientific literature and national data. If consumption patterns differ between the United States and North Carolina, these fractions may not generalize. Scaling processes may over- or underestimate individual cost components, so total state costs should be interpreted as estimates.CONCLUSIONS The societal costs from excessive drinking are high but spread across public sectors. This can make it difficult to attribute this burden to alcohol. While drinkers paid less than half of the costs of excessive drinking, a broad range of stakeholders bore the burden. Evidence-based strategies to reduce excessive drinking may decrease these costs.
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Affiliation(s)
- Katherine Gora Combs
- Graduate research assistant and PhD student in epidemiology, Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Michael D Fliss
- Research scientist, Injury Prevention Research Center, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina and Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Kendall B Knuth
- Epidemiology research associate II, IQVIA, Durham, North Carolina
| | - Mary E Cox
- Substance use epidemiologist, Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
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Tanz LJ, Christensen A, Knuth KB, Hoffman MN, Dandeneau D, Koehler K, Moore Z, Herndon S, Davidson K, Fleischauer A. Characteristics of an Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury-North Carolina, 2019. N C Med J 2021; 82:384-392. [PMID: 34750211 DOI: 10.18043/ncm.82.6.384] [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: 11/11/2022]
Abstract
BACKGROUND In August 2019, the North Carolina Division of Public Health (NCDPH) began investigating e-cigarette, or vaping, product use-associated lung injury (EVALI) cases as part of a national response. We describe clinical, epidemiologic, and laboratory findings of North Carolina EVALI patients.METHODS NCDPH requested that physicians report cases of respiratory illness or bilateral pulmonary infiltrates or opacities in patients who reported using e-cigarette, or vaping, products and had no infection or alternative plausible diagnoses. We reviewed medical records, interviewed patients, and tested vaping products for substances.RESULTS During August 13, 2019-February 18, 2020, 78 EVALI cases were reported in North Carolina. Median age of cases was 24 years (range: 13-72 years); 49 (63%) patients were male. Symptoms included cough (n = 70; 90%), shortness of breath (n = 66; 85%), and gastrointestinal symptoms (n = 63; 81%). Seventy-five patients (96%) were hospitalized, 32 (41%) required intensive care, and 12 (16%) required mechanical ventilation; none died. Among 20 patients interviewed, most reported using tetrahydrocannabinol (THC) (n = 16; 80%) or nicotine-containing products (n = 14; 70%). All obtained THC-containing products from informal sources, such as family, friends, or dealers, as THC is illegal in North Carolina. Among 82 products tested, 74 (90%) contained THC, cannabidiol, or cannabinol; 54 (66%) contained vitamin E acetate.LIMITATIONS In North Carolina, EVALI is not reportable by law, and THC is illegal. Thus, cases and exposures are likely underreported.CONCLUSIONS THC-containing products, particularly those containing vitamin E acetate, are associated with EVALI. Persons should not use these products, particularly from informal sources. Continued communication of health risks to persons who use e-cigarette, or vaping, products is essential.
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Affiliation(s)
- Lauren J Tanz
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia; epidemic intelligence service officer, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
| | - Ariel Christensen
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Kendall B Knuth
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina; CSTE applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, Georgia
| | - Molly N Hoffman
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina; CSTE applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, Georgia
| | - Dana Dandeneau
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina; CSTE applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, Georgia
| | - Kate Koehler
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Zack Moore
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Sally Herndon
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Kevin Davidson
- Pulmonology & Critical Care, WakeMed Hospital, Raleigh, North Carolina
| | - Aaron Fleischauer
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; career epidemiology field officer, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
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Fliss MD, Cox ME, Wallace JW, Simon MC, Knuth KB, Proescholdbell S. Measuring and Mapping Alcohol Outlet Environment Density, Clusters, and Racial and Ethnic Disparities in Durham, North Carolina, 2017. Prev Chronic Dis 2021; 18:E89. [PMID: 34554907 PMCID: PMC8462284 DOI: 10.5888/pcd18.210127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mike Dolan Fliss
- University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina.,North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina.,170 Rosenau Hall, CB #7400, 135 Dauer Dr, Chapel Hill, NC 27599 7400.
| | - Mary E Cox
- North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina
| | - John W Wallace
- North Carolina Institute for Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Matthew C Simon
- North Carolina Institute for Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Kendall B Knuth
- North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina.,Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia
| | - Scott Proescholdbell
- North Carolina Division of Public Health, Injury and Violence Prevention Branch, Raleigh, North Carolina
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