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Antoniou T, McCormack D, Tadrous M, Gomes T. Alpha-1 adrenergic antagonists and the risk of hospitalization or death in non-hospitalized patients with COVID-19: A population-based study. Fundam Clin Pharmacol 2024. [PMID: 38575851 DOI: 10.1111/fcp.13004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/29/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Alpha-1 receptor antagonists may interfere with IL-6 signaling and could therefore be a potential treatment for COVID-19. However, the effectiveness of these drugs in mitigating the risk of clinical deterioration among non-hospitalized patients with COVID-19 is unknown. OBJECTIVES The aim of this study is to examine the association between alpha-1 antagonist exposure and the 30-day risk of a hospital encounter or death in nonhospitalized patients with COVID-19. METHODS We conducted a population-based cohort study of Ontario residents aged 35 years and older who were eligible for public drug coverage and who had a positive test for SARS-CoV-2 between January 1, 2020, and March 1, 2021. We matched each individual receiving an alpha-1 antagonist at the time of their positive test with two non-exposed individuals using propensity scores. Our outcome was a composite of a hospital admission, emergency department visit, or death, 1 to 30 days following the positive test. RESULTS We matched 3289 alpha-1 antagonist exposed patients to 6189 unexposed patients. Overall, there was no difference in the 30-day risk of the primary outcome among patients exposed to alpha-1 antagonists at the time of their diagnosis relative to unexposed individuals (28.8% vs. 28.0%; OR 1.00, 95% CI 0.91 to 1.11). In a secondary analysis, individuals exposed to alpha-1 antagonists had a lower risk of death in the 30 days following a COVID diagnosis (OR 0.79; 95% CI 0.66 to 0.93). CONCLUSION Alpha-1 antagonists did not mitigate the 30-day risk of clinical deterioration in non-hospitalized patients with COVID-19. Our findings do not support the general repurposing of alpha-1 antagonists as a treatment for such patients, although there may be subgroups of patients in whom further research is warranted.
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Affiliation(s)
- Tony Antoniou
- Department of Family and Community Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Daniel McCormack
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mina Tadrous
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Worthington J, Sun Z, Fu R, Lew JB, Chan KKW, Li Q, Eskander A, Hui H, McLoughlin K, Caruana M, Peacock S, Yong JHE, Canfell K, Feletto E, Malagón T. COVID-related disruptions to colorectal cancer screening, diagnosis, and treatment could increase cancer Burden in Australia and Canada: A modelling study. PLoS One 2024; 19:e0296945. [PMID: 38557758 PMCID: PMC10984523 DOI: 10.1371/journal.pone.0296945] [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: 06/15/2023] [Accepted: 12/20/2023] [Indexed: 04/04/2024] Open
Abstract
COVID-19 disrupted cancer control worldwide, impacting preventative screening, diagnoses, and treatment services. This modelling study estimates the impact of disruptions on colorectal cancer cases and deaths in Canada and Australia, informed by data on screening, diagnosis, and treatment procedures. Modelling was used to estimate short- and long-term effects on colorectal cancer incidence and mortality, including ongoing impact of patient backlogs. A hypothetical mitigation strategy was simulated, with diagnostic and treatment capacities increased by 5% from 2022 to address backlogs. Colorectal cancer screening dropped by 40% in Canada and 6.3% in Australia in 2020. Significant decreases to diagnostic and treatment procedures were also observed in Australia and Canada, which were estimated to lead to additional patient wait times. These changes would lead to an estimated increase of 255 colorectal cancer cases and 1,820 colorectal cancer deaths in Canada and 234 cases and 1,186 deaths in Australia over 2020-2030; a 1.9% and 2.4% increase in mortality, respectively, vs a scenario with no screening disruption or diagnostic/treatment delays. Diagnostic and treatment capacity mitigation would avert 789 and 350 deaths in Canada and Australia, respectively. COVID-related disruptions had a significant impact on colorectal cancer screening, diagnostic, and treatment procedures in Canada and Australia. Modelling demonstrates that downstream effects on disease burden could be substantial. However, backlogs can be managed and deaths averted with even small increases to diagnostic and treatment capacity. Careful management of resources can improve patient outcomes after any temporary disruption, and these results can inform targeted approaches early detection of cancers.
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Affiliation(s)
| | - Zhuolu Sun
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jie-Bin Lew
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | - Kelvin K. W. Chan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Harriet Hui
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | | | - Michael Caruana
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- BC Cancer Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia, Canada
| | | | - Karen Canfell
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | | | - Talía Malagón
- Department of Oncology, McGill University, Montréal, Canada
- St Mary’s Research Centre, Montréal West Island CIUSSS, Montréal, Canada
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Schmidt RA, Everett K, Perez-Brumer A, Strike C, Rush B, Gomes T. A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy. Addiction 2024. [PMID: 38476027 DOI: 10.1111/add.16459] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND AIMS Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. DESIGN This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. SETTING AND PARTICIPANTS The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. MEASUREMENTS We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. FINDINGS Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). CONCLUSION Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.
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Affiliation(s)
- Rose A Schmidt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- ICES, Toronto, Canada
| | | | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Brian Rush
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Tara Gomes
- ICES, Toronto, Canada
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Management and Evaluation at the University of Toronto, Institute of Health Policy, Toronto, Ontario, Canada
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4
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Wu S, Li Y, Baral S, Mishra S, Koh M, Golding H, Kwong JC, Wei X. Protection of prior SARS-CoV-2 infection, COVID-19 boosters, and hybrid immunity against Omicron severe illness: A population-based cohort study of five million residents in Canada. PLoS One 2024; 19:e0299304. [PMID: 38394091 PMCID: PMC10889649 DOI: 10.1371/journal.pone.0299304] [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: 08/21/2023] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Evidence on protection of different patterns of infection- and vaccine-acquired immunity against Omicron-associated severe illness is useful in planning booster vaccination strategies. We examined protection of prior SARS-CoV-2 infection, a third or a fourth COVID-19 vaccine dose, and hybrid immunity against Omicron-associated severe illness. METHODS AND FINDINGS This population-based cohort study followed five million individuals with at least one SARS-CoV-2 RT-PCR test before November 21, 2021 until an Omicron-associatedhospitalization or death. We used Cox regression models to estimate risks of Omicron-associated hospitalization and a composite severe outcome (hospitalized and death), among individuals with infection- and/or vaccination-acquired immunity. Individuals who were unvaccinated and had no history of a prior infection severed as the reference group. Both adjusted hazard ratios (HR) and corresponding protection (one minus adjusted HR), with 95% confidence intervals (CIs), were reported. Three doses provided 94% (95%CI 93-95) and 93% (95%CI 91-94) protection against Omicron-associated hospitalization at 2-3 and ≥3 months post-vaccination respectively, similar to the protection conferred by three doses and a prior infection (2-3 months: 99%, 95%CI 97-100; ≥3 months: 97%, 95%CI 92-99) and four doses (1 month: 87%, 95%CI 79-92; 1-2 months: 96%, 95%CI 92-98). In individuals ≥65 years old, protection of four doses increased to 95% (95%CI 91-98) at 1-2 months, significantly higher than that of three doses over the follow-up period. Similar results were observed with the composite severe outcome. CONCLUSION At least three antigenic exposures, achieved by vaccination or infection, confers significant protection against Omicron-associated hospitalization and death in all age groups. Our findings support a third dose for the overall population, regardless of prior infection status, and a fourth dose for the elderly to maintain high level of immunity and substantially reduce risk of severe illness at individual level.
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Affiliation(s)
- Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yanhong Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Maria Koh
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Haley Golding
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jeffrey C. Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
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5
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Driedger M, Daneman N, Brown K, Gold WL, Jorgensen SC, Maxwell C, Schwartz KL, Morris AM, Thiruchelvam D, Langford B, Leung E, MacFadden D. The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections. Microbiol Spectr 2023; 11:e0263023. [PMID: 37975711 PMCID: PMC10783801 DOI: 10.1128/spectrum.02630-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
IMPORTANCE Bacterial infections are a significant cause of morbidity and mortality worldwide. In the wake of the COVID-19 pandemic, previous studies have demonstrated pandemic-related shifts in the epidemiology of bacterial bloodstream infections (BSIs) in the general population and in specific hospital systems. Our study uses a large, comprehensive data set stratified by setting [community, long-term care (LTC), and hospital] to uniquely demonstrate how the effect of the COVID-19 pandemic on BSIs and testing practices varies by healthcare setting. We showed that, while the number of false-positive blood culture results generally increased during the pandemic, this effect did not apply to hospitalized patients. We also found that many infections were likely under-recognized in patients in the community and in LTC, demonstrating the importance of maintaining healthcare for these groups during crises. Last, we found a decrease in infections caused by certain pathogens in the community, suggesting some secondary benefits of pandemic-related public health measures.
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Affiliation(s)
- Matt Driedger
- Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Daneman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Kevin Brown
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Wayne L. Gold
- The University Health Network, Toronto, Ontario, Canada
| | | | | | - Kevin L. Schwartz
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | | | | | - Bradley Langford
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | | | - Derek MacFadden
- Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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6
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Stephenson R, Sarhangian V, Park J, Sankar A, Baxter NN, Stukel TA, Simpson AN, Wijeysundera DN, Wilton AS, de Mestral C, Hwang SW, Pincus D, Campbell RJ, Urbach DR, Irish J, Gomez D, Chan TCY. Evolution of the surgical procedure gap during and after the COVID-19 pandemic in Ontario, Canada: cross-sectional and modelling study. Br J Surg 2023; 110:1887-1889. [PMID: 37724806 PMCID: PMC10638533 DOI: 10.1093/bjs/znad289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Rachel Stephenson
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Vahid Sarhangian
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jangwon Park
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Ashwin Sankar
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nancy N Baxter
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Duminda N Wijeysundera
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Charles de Mestral
- Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Daniel Pincus
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Campbell
- ICES, Toronto, Ontario, Canada
- Department of Ophthalmology, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada
| | - David R Urbach
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David Gomez
- Unity Health Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Timothy C Y Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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7
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Powis M, Sutradhar R, Patrikar A, Cheung M, Gong I, Vijenthira A, Hicks LK, Wilton D, Krzyzanowska MK, Singh S. Factors associated with timely COVID-19 vaccination in a population-based cohort of patients with cancer. J Natl Cancer Inst 2023; 115:146-154. [PMID: 36321960 PMCID: PMC9905967 DOI: 10.1093/jnci/djac204] [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: 07/05/2022] [Revised: 09/21/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In many jurisdictions, cancer patients were prioritized for COVID-19 vaccination because of increased risk of infection and death. To understand sociodemographic disparities that affected timely receipt of COVID-19 vaccination among cancer patients, we undertook a population-based study in Ontario, Canada. METHODS Patients older than 18 years and diagnosed with cancer January 2010 to September 2020 were identified using administrative data; vaccination administration was captured between approval (December 2020) up to February 2022. Factors associated with time to vaccination were evaluated using multivariable Cox proportional hazards regression. RESULTS The cohort consisted of 356 535 patients, the majority of whom had solid tumor cancers (85.9%) and were not on active treatment (74.1%); 86.8% had received at least 2 doses. The rate of vaccination was 25% lower in recent (hazard ratio [HR] = 0.74, 95% confidence interval [CI] = 0.72 to 0.76) and nonrecent immigrants (HR = 0.80, 95% CI = 0.79 to 0.81). A greater proportion of unvaccinated patients were from neighborhoods with a high concentration of new immigrants or self-reported members of racialized groups (26.0% vs 21.3%, standardized difference = 0.111, P < .001), residential instability (27.1% vs 23.0%, standardized difference = 0.094, P < .001), or material deprivation (22.1% vs 16.8%, standardized difference = 0.134, P < .001) and low socioeconomic status (20.9% vs 16.0%, standardized difference = 0.041, P < .001). The rate of vaccination was 20% lower in patients from neighborhoods with the lowest socioeconomic status (HR = 0.82, 95% CI = 0.81 to 0.84) and highest material deprivation (HR = 0.80, 95% CI = 0.78 to 0.81) relative to those in more advantaged neighborhoods. CONCLUSIONS Despite funding of vaccines and prioritization of high-risk populations, marginalized patients were less likely to be vaccinated. Differences are likely due to the interplay between systemic barriers to access and cultural or social influences affecting uptake.
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Affiliation(s)
- Melanie Powis
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aditi Patrikar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Matthew Cheung
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Inna Gong
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abi Vijenthira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa K Hicks
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Oncology, St. Michael’s Hospital—Unity Health, Toronto, ON, Canada
| | - Drew Wilton
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simron Singh
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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