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Bacong AM, Chu R, Le A, Bui V, Wang NE, Palaniappan LP. Increased COVID-19 mortality among immigrants compared with US-born individuals: a cross-sectional analysis of 2020 mortality data. Public Health 2024; 231:173-178. [PMID: 38703491 DOI: 10.1016/j.puhe.2024.03.016] [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: 12/21/2023] [Revised: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Multiple studies have shown that racially minoritized groups had disproportionate COVID-19 mortality relative to non-Hispanic White individuals. However, there is little known regarding mortality by immigrant status nationally in the United States, despite being another vulnerable population. STUDY DESIGN This was an observational cross-sectional study using mortality vital statistics system data to calculate proportionate mortality ratios (PMRs) and mortality rates due to COVID-19 as the underlying cause. METHODS Rates were compared by decedents' identified race, ethnicity (Hispanic vs non-Hispanic), and immigrant (immigrants vs US born) status. Asian race was further disaggregated into "Asian Indian," "Chinese," "Filipino," "Japanese," "Korean," and "Vietnamese." RESULTS Of the over 3.4 million people who died in 2020, 10.4% of all deaths were attributed to COVID-19 as the underlying cause (n = 351,530). More than double (18.9%, n = 81,815) the percentage of immigrants who died of COVID-19 compared with US-born decedents (9.1%, n = 269,715). PMRs due to COVID-19 were higher among immigrants compared with US-born individuals for non-Hispanic White, non-Hispanic Black, Hispanic, and most disaggregated Asian groups. Among disaggregated Asian immigrants, age- and sex-adjusted PMR due to COVID-19 ranged from 1.58 times greater mortality among Filipino immigrants (95% confidence interval [CI]: 1.53, 1.64) to 0.77 times greater mortality among Japanese immigrants (95% CI: 0.68, 0.86). Age-adjusted mortality rates were also higher among immigrant individuals compared with US-born people. CONCLUSIONS Immigrant individuals experienced greater mortality due to COVID-19 compared with their US-born counterparts. As COVID-19 becomes more endemic, greater clinical and public health efforts are needed to reduce disparities in mortality among immigrants compared with their US-born counterparts.
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Affiliation(s)
- A M Bacong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA; Stanford University Center for Asian Health Research and Education, Stanford, CA, USA.
| | - R Chu
- Stanford University Center for Asian Health Research and Education, Stanford, CA, USA; University of California, Los Angeles Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA, USA; Asian American Studies Department, University of California, Los Angeles, Los Angeles, CA, USA
| | - A Le
- University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - V Bui
- University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - N E Wang
- Stanford University Center for Asian Health Research and Education, Stanford, CA, USA; Stanford University School of Medicine, Department of Medicine, Division of Emergency Medicine, Stanford, CA, USA
| | - L P Palaniappan
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA; Stanford University Center for Asian Health Research and Education, Stanford, CA, USA
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Santi BM, Verhoef PA. COVID-19 Hospitalization in Hawai'i and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination. JAMA Netw Open 2024; 7:e243696. [PMID: 38691362 PMCID: PMC11063802 DOI: 10.1001/jamanetworkopen.2024.3696] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024] Open
Abstract
Importance The people of Hawai'i have both high rates of health insurance and high levels of racial and ethnic diversity, but the degree to which insurance status and race and ethnicity contribute to health outcomes in COVID-19 remains unknown. Objective To evaluate the associations of insurance coverage, race and ethnicity (using disaggregated race and ethnicity data), and vaccination with outcomes for COVID-19 hospitalization. Design, Setting, and Participants This retrospective cohort study included hospitalized patients at a tertiary care medical center between March 2020 and March 2022. All patients hospitalized for acute COVID-19, identified based on diagnosis code or positive results on polymerase chain reaction-based assay for SARS-CoV-2, were included in analysis. Data were analyzed from May 2022 to May 2023. Exposure COVID-19 requiring hospitalization. Main Outcome and Measures Electronic medical record data were collected for all patients. Associations among race and ethnicity, insurance coverage, receipt of at least 1 COVID-19 vaccine, intensive care unit (ICU) transfer, in-hospital mortality, and COVID-19 variant wave (pre-Delta vs Delta and Omicron) were assessed using adjusted multivariable logistic regression. Results A total of 1176 patients (median [IQR] age of 58 [41-71] years; 630 [54%] male) were hospitalized with COVID-19, with a median (IQR) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 (25-36) and Sequential Organ Failure Assessment score of 1 (0-2). The sample included 16 American Indian or Alaska Native patients, 439 Asian (not otherwise specified) patients, 15 Black patients, 66 Chinese patients, 246 Filipino patients, 76 Hispanic patients, 107 Japanese patients, 10 Korean patients, 299 Native Hawaiian patients, 523 Pacific Islander (not otherwise specified) patients, 156 Samoan patients, 5 Vietnamese patients, and 311 White patients (patients were able to identify as >1 race or ethnicity). When adjusting for age, BMI, sex, medical comorbidities, and socioeconomic neighborhood status, there were no differences in either ICU transfer (eg, Medicare vs commercial insurance: odds ratio [OR], 0.84; 95% CI, 0.43-1.64) or in-hospital mortality (eg, Medicare vs commercial insurance: OR, 0.85; 95% CI, 0.36-2.03) as a function of insurance type. Disaggregation of race and ethnicity revealed that Filipino patients were more likely to die in the hospital (OR, 1.79; 95% CI, 1.04-3.03; P = .03). When considering variant waves, mortality among Filipino patients was highest during the pre-Delta time period (OR, 2.72; 95% CI, 1.02-7.14; P = .04), when mortality among Japanese patients was lowest (OR, 0.19; 95% CI, 0.03-0.78; P = .04); mortality among Native Hawaiian patients was lowest during the Delta and Omicron period (OR, 0.35; 95% CI, 0.13-0.79; P = .02). Patients with Medicare, compared with those with commercial insurance, were more likely to have received at least 1 COVID-19 vaccine (OR, 1.85; 95% CI, 1.07-3.21; P = .03), but all patients, regardless of insurance type, who received at least 1 COVID-19 vaccine had reduced ICU admission (OR, 0.40; 95% CI, 0.21-0.70; P = .002) and in-hospital mortality (OR, 0.42; 95% CI, 0.21-0.79; P = .01). Conclusions and Relevance In this cohort study of hospitalized patients with COVID-19, those with government-funded insurance coverage (Medicare or Medicaid) had similar outcomes compared with patients with commercial insurance, regardless of race or ethnicity. Disaggregation of race and ethnicity analysis revealed substantial outcome disparities and suggests opportunities for further study of the drivers underlying such disparities. Additionally, these findings illustrate that vaccination remains a critical tool to protect patients from COVID-19 mortality.
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Affiliation(s)
- Brock M. Santi
- Department of Medicine, John A. Burns School of Medicine, University of Hawaiʻi, Honolulu
| | - Philip A. Verhoef
- Department of Medicine, John A. Burns School of Medicine, University of Hawaiʻi, Honolulu
- Hawaiʻi Permanente Medical Group, Honolulu
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Aguilar Ticona JP, Nery N, Hitchings M, Belitardo EMMA, Fofana MO, Dorión M, Victoriano R, Cruz JS, Oliveira Santana J, de Moraes LEP, Cardoso CW, Ribeiro GS, Reis MG, Khouri R, Costa F, Ko AI, Cummings DAT. Overestimation of Severe Acute Respiratory Syndrome Coronavirus 2 Household Transmission in Settings of High Community Transmission: Insights From an Informal Settlement Community in Salvador, Brazil. Open Forum Infect Dis 2024; 11:ofae065. [PMID: 38516384 PMCID: PMC10957159 DOI: 10.1093/ofid/ofae065] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/31/2024] [Indexed: 03/23/2024] Open
Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has spread globally. However, the contribution of community versus household transmission to the overall risk of infection remains unclear. Methods Between November 2021 and March 2022, we conducted an active case-finding study in an urban informal settlement with biweekly visits across 1174 households with 3364 residents. Individuals displaying coronavirus disease 2019 (COVID-19)-related symptoms were identified, interviewed along with household contacts, and defined as index and secondary cases based on reverse-transcription polymerase chain reaction (RT-PCR) and symptom onset. Results In 61 households, we detected a total of 94 RT-PCR-positive cases. Of 69 sequenced samples, 67 cases (97.1%) were attributed to the Omicron BA.1* variant. Among 35 of their households, the secondary attack rate was 50.0% (95% confidence interval [CI], 37.0%-63.0%). Women (relative risk [RR], 1.6 [95% CI, .9-2.7]), older individuals (median difference, 15 [95% CI, 2-21] years), and those reporting symptoms (RR, 1.73 [95% CI, 1.0-3.0]) had a significantly increased risk for SARS-CoV-2 secondary infection. Genomic analysis revealed substantial acquisition of viruses from the community even among households with other SARS-CoV-2 infections. After excluding community acquisition, we estimated a household secondary attack rate of 24.2% (95% CI, 11.9%-40.9%). Conclusions These findings underscore the ongoing risk of community acquisition of SARS-CoV-2 among households with current infections. The observed high attack rate necessitates swift booster vaccination, rapid testing availability, and therapeutic options to mitigate the severe outcomes of COVID-19.
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Affiliation(s)
- Juan P Aguilar Ticona
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Nivison Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Matt Hitchings
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | | | - Mariam O Fofana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Murilo Dorión
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Renato Victoriano
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
| | - Jaqueline S Cruz
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
| | - Juliet Oliveira Santana
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
| | | | - Cristiane W Cardoso
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
- Centro de Informações Estratégicas de Vigilância em Saúde (CIEVS), Secretaria Municipal de Saúde de Salvador, Salvador, Brazil
| | - Guilherme S Ribeiro
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Mitermayer G Reis
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Ricardo Khouri
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
| | - Federico Costa
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Albert I Ko
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Ministério da Saúde, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Derek A T Cummings
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Biology, University of Florida, Gainesville, Florida, USA
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Comunale BA, Hsu YJ, Larson RJ, Singh A, Jackson-Ward E, Engineer LD. Vitamin D Supplementation and Prior Oral Poliovirus Vaccination Decrease Odds of COVID-19 Outcomes among Adults Recently Inoculated with Inactivated Poliovirus Vaccine. Vaccines (Basel) 2024; 12:121. [PMID: 38400105 PMCID: PMC10892023 DOI: 10.3390/vaccines12020121] [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: 12/28/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Structural and functional commonalities between poliovirus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggest that poliovirus inoculation may induce antibodies that mitigate the coronavirus disease (COVID-19). No known studies have evaluated COVID-19 risk factors in adults recently vaccinated against poliovirus. STUDY OBJECTIVE Among adults with no history of COVID-19 infection or vaccination, who recently received an inactivated poliovirus vaccine (IPV), we sought to determine which biological factors and social determinants of health (SDOH) may be associated with (1) testing positive for SARS-CoV-2, (2) experiencing COVID-19 symptoms, and (3) a longer duration of COVID-19 symptoms. METHODS The influence of biological factors and SDOH on SARS-CoV-2 infection and COVID-19 symptoms were evaluated among 282 adults recently inoculated with IPV. Participant-reported surveys were analyzed over 12 months post-enrollment. Bivariate and multivariate linear and logistic regression models identified associations between variables and COVID-19 outcomes. RESULTS Adjusting for COVID-19 vaccinations, variants, and other SDOH, secondary analyses revealed that underlying conditions, employment, vitamin D, education, and the oral poliovirus vaccination (OPV) were associated with COVID-19 outcomes. The odds of testing positive for SARS-CoV-2 and experiencing symptoms were significantly reduced among participants who took vitamin D (OR 0.12 and OR 0.09, respectively). Unemployed or part-time working participants were 72% less likely to test positive compared with full-time workers. No prior dose of OPV was one of the strongest predictors of SARS-CoV-2 infection (OR 4.36) and COVID-19 symptoms (OR 6.95). CONCLUSIONS Findings suggest that prophylactic measures and mucosal immunity may mitigate the risk and severity of COVID-19 outcomes. Larger-scale studies may inform future policies.
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Affiliation(s)
- Brittany A. Comunale
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Robin J. Larson
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
- Department of Palliative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Aditi Singh
- Department of Biological Sciences, University of California, San Diego, La Jolla, CA 92161, USA
| | - Erin Jackson-Ward
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Lilly D. Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Novelli S, Opatowski L, Manto C, Rahib D, de Lamballerie X, Warszawski J, Meyer L, EpiCoV Study Group OBOT. Risk Factors for Community and Intrahousehold Transmission of SARS-CoV-2: Modeling in a Nationwide French Population-Based Cohort Study, the EpiCoV Study. Am J Epidemiol 2024; 193:134-148. [PMID: 37605838 PMCID: PMC10773479 DOI: 10.1093/aje/kwad174] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/05/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023] Open
Abstract
We assessed the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from household and community exposure according to age, family ties, and socioeconomic and living conditions using serological data from a nationwide French population-based cohort study, the Epidémiologie et Conditions de Vie (EpiCoV) Study. A history of SARS-CoV-2 infection was defined by a positive anti-SARS-CoV-2 enzyme-linked immunosorbent assay immunoglobulin G result in November-December 2020. We applied stochastic chain binomial models fitted to the final distribution of household infections to data from 17,983 individuals aged ≥6 years from 8,165 households. Models estimated the competing risks of being infected from community and household exposure. The age group 18-24 years had the highest risk of extrahousehold infection (8.9%, 95% credible interval (CrI): 7.5, 10.4), whereas the oldest (≥75 years) and youngest (6-10 years) age groups had the lowest risk, at 2.6% (95% CrI: 1.8, 3.5) and 3.4% (95% CrI: 1.9, 5.2), respectively. Extrahousehold infection was also associated with socioeconomic conditions. Within households, the probability of person-to-person transmission increased with age, from 10.6% (95% CrI: 5.0, 17.9) among children aged 6-10 years to 43.1% (95% CrI: 32.6, 53.2) among adults aged 65-74 years. Transmission was higher between partners (29.9%, 95% CrI: 25.6, 34.3) and from mother to child (29.1%, 95% CrI: 21.4, 37.3) than between individuals related by other family ties. In 2020 in France, the main factors identified for extrahousehold SARS-CoV-2 infection were age and socioeconomic conditions. Intrahousehold infection mainly depended on age and family ties.
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Affiliation(s)
| | - Lulla Opatowski
- Correspondence to Dr. Lulla Opatowski, Epidemiology and Modelling of Antibiotic Evasion Unit, Institut Pasteur, 25 rue du Docteur Roux, Paris 75015, France (e-mail: )
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Iwu-Jaja C, Ndlovu NL, Rachida S, Yousif M, Taukobong S, Macheke M, Mhlanga L, van Schalkwyk C, Pulliam JRC, Moultrie T, le Roux W, Schaefer L, Pocock G, Coetzee LZ, Mans J, Bux F, Pillay L, de Villiers D, du Toit AP, Jambo D, Gomba A, Groenink S, Madgewick N, van der Walt M, Mutshembele A, Berkowitz N, Suchard M, McCarthy K. The role of wastewater-based epidemiology for SARS-CoV-2 in developing countries: Cumulative evidence from South Africa supports sentinel site surveillance to guide public health decision-making. Sci Total Environ 2023; 903:165817. [PMID: 37506905 DOI: 10.1016/j.scitotenv.2023.165817] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
The uptake of wastewater-based epidemiology (WBE) for SARS-CoV-2 as a complementary tool for monitoring population-level epidemiological features of the COVID-19 pandemic in low-and-middle-income countries (LMICs) is low. We report on the findings from the South African SARS-CoV-2 WBE surveillance network and make recommendations regarding the implementation of WBE in LMICs. Eight laboratories quantified influent wastewater collected from 87 wastewater treatment plants in all nine South African provinces from 01 June 2021 to 31 May 2022 inclusive, during the 3rd and 4th waves of COVID-19. Correlation and regression analyses between wastewater levels of SARS-CoV-2 and district laboratory-confirmed caseloads were conducted. The sensitivity and specificity of novel 'rules' based on WBE data to predict an epidemic wave were determined. Amongst 2158 wastewater samples, 543/648 (85 %) samples taken during a wave tested positive for SARS-CoV-2 compared with 842 positive tests from 1512 (55 %) samples taken during the interwave period. Overall, the regression-co-efficient was 0,66 (95 % confidence interval = 0,6-0,72, R2 = 0.59), ranging from 0.14 to 0.87 by testing laboratory. Early warning of the 4th wave of SARS-CoV-2 in Gauteng Province in November-December 2021 was demonstrated. A 50 % increase in log copies of SARS-CoV-2 compared with a rolling mean over the previous five weeks was the most sensitive predictive rule (58 %) to predict a new wave. Our findings support investment in WBE for SARS-CoV-2 surveillance in LMICs as an early warning tool. Standardising test methodology is necessary due to varying correlation strengths across laboratories and redundancy across testing plants. A sentinel site model can be used for surveillance networks without affecting WBE finding for decision-making. Further research is needed to identify optimal test frequency and the need for normalisation to population size to identify predictive and interpretive rules to support early warning and public health action.
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Affiliation(s)
- Chinwe Iwu-Jaja
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa.
| | - Nkosenhle Lindo Ndlovu
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa.
| | - Said Rachida
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa
| | - Mukhlid Yousif
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Setshaba Taukobong
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa
| | - Mokgaetji Macheke
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa
| | - Laurette Mhlanga
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Cari van Schalkwyk
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Juliet R C Pulliam
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Tom Moultrie
- Centre for Actuarial Research, University of Cape Town, South Africa
| | - Wouter le Roux
- Water Centre, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Lisa Schaefer
- Water Centre, Council for Scientific and Industrial Research, Pretoria, South Africa
| | | | | | - Janet Mans
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Faizal Bux
- Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
| | - Leanne Pillay
- Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
| | | | - A P du Toit
- Lumegen Laboratories (Pty) Ltd, Potchefstroom, South Africa
| | - Don Jambo
- National Institute for Occupational Health, South Africa
| | | | | | | | | | | | | | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerrigan McCarthy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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7
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Natalia YA, Faes C, Neyens T, Hammami N, Molenberghs G. Key risk factors associated with fractal dimension based geographical clustering of COVID-19 data in the Flemish and Brussels region, Belgium. Front Public Health 2023; 11:1249141. [PMID: 38026374 PMCID: PMC10654974 DOI: 10.3389/fpubh.2023.1249141] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction COVID-19 remains a major concern globally. Therefore, it is important to evaluate COVID-19's rapidly changing trends. The fractal dimension has been proposed as a viable method to characterize COVID-19 curves since epidemic data is often subject to considerable heterogeneity. In this study, we aim to investigate the association between various socio-demographic factors and the complexity of the COVID-19 curve as quantified through its fractal dimension. Methods We collected population indicators data (ethnic composition, socioeconomic status, number of inhabitants, population density, the older adult population proportion, vaccination rate, satisfaction, and trust in the government) at the level of the statistical sector in Belgium. We compared these data with fractal dimension indicators of COVID-19 incidence between 1 January - 31 December 2021 using canonical correlation analysis. Results Our results showed that these population indicators have a significant association with COVID-19 incidences, with the highest explanatory and predictive power coming from the number of inhabitants, population density, and ethnic composition. Conclusion It is important to monitor these population indicators during a pandemic, especially when dealing with targeted interventions for a specific population.
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Affiliation(s)
| | - Christel Faes
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Thomas Neyens
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- I-BioStat, Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Naïma Hammami
- Department of Care, Team Infection Prevention and Vaccination, Brussels, Belgium
| | - Geert Molenberghs
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- I-BioStat, Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
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Bassanello M, Geppini R, Bonsembiante E, Coli U, Farencena A, D’Aquino M, Gambaro A, Buja A, Baldovin T. Risk of SARS-CoV-2 transmission in the close contacts in a small rural area in the Veneto Region (NE-Italy): past evidence for future scenarios. Front Public Health 2023; 11:1223109. [PMID: 37732097 PMCID: PMC10507707 DOI: 10.3389/fpubh.2023.1223109] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Background During the first pandemic phase of COVID-19, an epidemiological study, named First survey, was conducted on the population of a small rural area in northern Italy. In spring 2020, the results showed how a prolonged lockdown slowed down the spread of the virus. Methods After contacting positive First Survey subjects and their families, those who decided to join voluntarily underwent a blood test to assess the presence of qualitative lgG about 2 months after the previous one. This was to determine if IgG persisted in individuals who tested positive in the First Survey as well as to assess the antibody status of their close family members, to determine if they were unintentionally infected. Results Based on serological analysis, 35.1% of the samples contained blood IgG. In subjects who tested positive during the First Survey, 62.5% remained IgG positive more than 2 months later. Among family members who were exposed to a positive relative, 23.7% were infected. Linear regression analysis showed that the presence of an infected person within a household resulted in the infection spreading to the others, but not excessively. Induced isolation extinguished the infection regardless of the extent of the contagion (intra-family or extra-family). Micro-outbreaks of SARS-Cov-2 infection which arose in the same household from extra-familial infections played a decisive role on the statistical significance of IgG-positive subjects (p < 0.001). Discussion The study reveal 52.6% of the IgG-positive subjects in the Second Survey came from the First Survey and 47.4% were family members previously in contact with positive subjects. Data suggest that there have been undiagnosed patients feeding the spread of the virus since the beginning of the pandemic. In conclusion, for future pandemics, it will be necessary: i) to ensure the rapid isolation of symptomatic patients and the early identification of their close contacts, ii) to carry out the maximum number of tests in the shortest possible time, both on symptomatic and asymptomatic subjects, and iii) to implement information campaigns to make people aware of their risks, and implement clear, non-conflicting communication.
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Affiliation(s)
- Marco Bassanello
- Emergency and Health Department, Monastier di Treviso Hospital, Treviso, Italy
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Ruggero Geppini
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
| | | | - Ugo Coli
- Health Department, Monastier di Treviso Hospital, Treviso, Italy
| | - Aldo Farencena
- Laboratory and Microbiology Monastier di Treviso Hospital, Treviso, Italy
| | | | - Andrea Gambaro
- Department of Environmental Sciences, Informatics and Statistics (DAIS), Ca’ Foscari University of Venice, Venice, Italy
| | - Alessandra Buja
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Tatjana Baldovin
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
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Freise D, Schiele V, Schmitz H. Housing situations and local COVID-19 infection dynamics using small-area data. Sci Rep 2023; 13:14301. [PMID: 37652980 PMCID: PMC10471764 DOI: 10.1038/s41598-023-40734-0] [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: 03/15/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
Low socio-economic status is associated with higher SARS-CoV-2 incidences. In this paper we study whether this is a result of differences in (1) the frequency, (2) intensity, and/or (3) duration of local SARS-CoV-2 outbreaks depending on the local housing situations. So far, there is not clear evidence which of the three factors dominates. Using small-scale data from neighborhoods in the German city Essen and a flexible estimation approach which does not require prior knowledge about specific transmission characteristics of SARS-CoV-2, behavioral responses or other potential model parameters, we find evidence for the last of the three hypotheses. Outbreaks do not happen more often in less well-off areas or are more severe (in terms of the number of cases), but they last longer. This indicates that the socio-economic gradient in infection levels is at least in parts a result of a more sustained spread of infections in neighborhoods with worse housing conditions after local outbreaks and suggests that in case of an epidemic allocating scarce resources in containment measures to areas with poor housing conditions might have the greatest benefit.
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Affiliation(s)
| | | | - Hendrik Schmitz
- Paderborn University, Paderborn, Germany.
- RWI Essen, Essen, Germany.
- Leibniz Science Campus Ruhr, Essen, Germany.
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Czerwiński M, Stępień M, Juszczyk G, Sadkowska-Todys M, Zieliński A, Rutkowski J, Rosińska M. Reversed urban-rural gradient in COVID-19 seroprevalence and related factors in a nationally representative survey, Poland, 29 March to 14 May 2021. Euro Surveill 2023; 28:2200745. [PMID: 37650908 PMCID: PMC10472750 DOI: 10.2807/1560-7917.es.2023.28.35.2200745] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/11/2023] [Indexed: 09/01/2023] Open
Abstract
BackgroundWe anticipated that people in rural areas and small towns with lower population density, lower connectivity and jobs less dependent on social interaction will be less exposed to COVID-19. Still, other variables correlated with socioeconomic inequalities may have a greater impact on transmission.AimWe investigated how COVID-19 affected rural and urban communities in Poland, focussing on the most exposed groups and disparities in SARS-CoV-2 transmission.MethodsA random digit dial sample of Polish adults stratified by region and age was drawn from 29 March to 14 May 2021. Serum samples were tested for anti-S1 and anti-N IgG antibodies, and positive results in both assays were considered indicative of past infection. Seroprevalence estimates were weighted to account for non-response. Adjusted odds ratios (AORs) were calculated using multivariable logistic regression.ResultsThere was serological evidence of infection in 32.2% (95% CI: 30.2-34.4) of adults in rural areas/small towns (< 50,000 population) and 26.6% (95% CI: 24.9-28.3) in larger cities. Regional SARS-CoV-2 seroprevalence ranged from 23.4% (95% CI: 18.3-29.5) to 41.0% (95% CI: 33.5-49.0) and was moderately positively correlated (R = 0.588; p = 0.017; n = 16) with the proportion of respondents living in rural areas or small cities. Upon multivariable adjustment, both men (AOR = 1.60; 95% CI: 1.09-2.35) and women (AOR = 2.26; 95% CI: 1.58-3.21) from these areas were more likely to be seropositive than residents of larger cities.ConclusionsWe found an inverse urban-rural gradient of SARS-CoV-2 infections during early stages of the COVID-19 pandemic in Poland and suggest that vulnerabilities of populations living in rural areas need to be addressed.
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Affiliation(s)
- Michał Czerwiński
- National Institute of Public Health NIH-National Research Institute (NIPH NIH-NRI), Warsaw, Poland
| | - Małgorzata Stępień
- National Institute of Public Health NIH-National Research Institute (NIPH NIH-NRI), Warsaw, Poland
| | - Grzegorz Juszczyk
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | | | - Adam Zieliński
- National Institute of Public Health NIH-National Research Institute (NIPH NIH-NRI), Warsaw, Poland
| | - Jakub Rutkowski
- National Institute of Public Health NIH-National Research Institute (NIPH NIH-NRI), Warsaw, Poland
| | - Magdalena Rosińska
- National Institute of Public Health NIH-National Research Institute (NIPH NIH-NRI), Warsaw, Poland
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Kim N, Anneser E, Chu MT, Nguyen KH, Stopka TJ, Corlin L. Household conditions, COVID-19, and equity: Insight from two nationally representative surveys. Res Sq 2023:rs.3.rs-3129530. [PMID: 37461724 PMCID: PMC10350171 DOI: 10.21203/rs.3.rs-3129530/v1] [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] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background With people across the United States spending increased time at home since the emergence of COVID-19, housing characteristics may have an even greater impact on health. Therefore, we assessed associations between household conditions and COVID-19 experiences. Methods We used data from two nationally representative surveys: the Tufts Equity Study (TES; n = 1449 in 2021; n = 1831 in 2022) and the Household Pulse Survey (HPS; n = 147,380 in 2021; n = 62,826 in 2022). In the TES, housing conditions were characterized by heating/cooling methods; smoking inside the home; visible water damage/mold; age of housing unit; and self-reported concern about various environmental factors. In TES and HPS, household size was assessed. Accounting for sampling weights, we examined associations between each housing exposure and COVID-19 outcomes (diagnosis, vaccination) using separate logistic regression models with covariates selected based on an evidence-based directed acyclic graph. Results Having had COVID-19 was more likely among people who reported poor physical housing condition (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.17-4.59; 2021), visible water damage or mold/musty smells (OR = 1.50; 95% CI = 1.10-2.03; 2022), and larger household size (5+ versus 1-2 people; OR = 1.53, 95% CI = 1.34-1.75, HPS 2022). COVID-19 vaccination was less likely among participants who reported smoke exposure inside the home (OR = 0.53; 95% CI = 0.31-0.90; 2022), poor water quality (OR = 0.42; 95% CI = 0.21-0.85; 2021), noise from industrial activity/construction (OR = 0.44; 95% CI = 0.19-0.99; 2022), and larger household size (OR = 0.57; 95% CI = 0.46-0.71; HPS 2022). Vaccination was also positively associated with poor indoor air quality (OR = 1.96; 95% CI = 1.02-3.72; 2022) and poor physical housing condition (OR = 2.27; 95% CI = 1.01-5.13; 2022). Certain heating/cooling sources were associated with COVID-19 outcomes. Conclusions Our study found poor housing conditions associated with increased COVID-19 burden, which may be driven by systemic disparities in housing, healthcare, and financial access to resources during the COVID-19 pandemic.
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Hassani A, Omaleki V, Erikat J, Frost E, Streuli S, Sahid R, Yusufi H, Fielding-Miller R. Overcrowded housing reduces COVID-19 mitigation measures and lowers emotional health among San Diego refugees from September to November of 2020. PLoS One 2023; 18:e0286993. [PMID: 37339139 DOI: 10.1371/journal.pone.0286993] [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] [Received: 07/26/2022] [Accepted: 05/29/2023] [Indexed: 06/22/2023] Open
Abstract
Refugee communities are vulnerable to housing insecurity, which drives numerous health disparity outcomes in a historically marginalized population. The COVID-19 pandemic has only worsened the ongoing affordable housing crisis in the United States while continuing to highlight disparities in health outcomes across populations. We conducted interviewer-administered surveys with refugee and asylum seekers in San Diego County at the height of the COVID-19 pandemic to understand the social effects and drivers of COVID-19 in one of the largest refugee communities in the United States. Staff from a community-based refugee advocacy and research organization administered the surveys from September-November 2020. 544 respondents participated in the survey, which captured the diversity of the San Diego refugee community including East African (38%), Middle Eastern (35%), Afghan (17%), and Southeast Asian (11%) participants. Nearly two-thirds of respondents (65%) reported living in overcrowded conditions (> 1 individual per room) and 30% in severely crowded conditions (> 1.5 individuals per room). For each additional person per room, self-reported poor emotional health increased. Conversely, family size was associated with a lower likelihood of reporting poor emotional health. Crowded housing was significantly associated with a lower probability of accessing a COVID-19 diagnostic test, with every additional reported person per room there was approximately an 11% increase in the probability of having never accessed a COVID-19 testing. Access to affordable housing had the largest effect size and was associated with fewer people per room. Overcrowding housing is a structural burden that reduces COVID-19 risk mitigation behaviors. Improved access to affordable housing units or receiving vouchers could reduce overcrowded housing in vulnerable refugee communities.
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Affiliation(s)
- Ashkan Hassani
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
| | - Vinton Omaleki
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
| | - Jeanine Erikat
- Partnership for the Advancement of New Americans, San Diego, California, United States of America
| | - Elizabeth Frost
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
- Joint Doctoral Program in Public Health (Global Health), San Diego State University, San Diego, California, United States of America
| | - Samantha Streuli
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
| | - Ramla Sahid
- Partnership for the Advancement of New Americans, San Diego, California, United States of America
| | - Homayra Yusufi
- Partnership for the Advancement of New Americans, San Diego, California, United States of America
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, California, United States of America
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Kelly MS, Mohammed A, Okin D, Alba GA, Jesudasen SJ, Flanagan S, Dandawate NA, Gavralidis A, Chang LL, Moin EE, Witkin AS, Hibbert KA, Kadar A, Gordan PL, Bebell LM, Hauptman M, Valeri L, Lai PS. Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients With COVID-19. Crit Care Explor 2023; 5:e0927. [PMID: 37332365 PMCID: PMC10270487 DOI: 10.1097/cce.0000000000000927] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Which social factors explain racial and ethnic disparities in COVID-19 access to care and outcomes remain unclear. OBJECTIVES We hypothesized that preferred language mediates the association between race, ethnicity and delays to care. DESIGN SETTING AND PARTICIPANTS Multicenter, retrospective cohort study of adults with COVID-19 consecutively admitted to the ICU in three Massachusetts hospitals in 2020. MAIN OUTCOME AND MEASURES Causal mediation analysis was performed to evaluate potential mediators including preferred language, insurance status, and neighborhood characteristics. RESULTS Non-Hispanic White (NHW) patients (157/442, 36%) were more likely to speak English as their preferred language (78% vs. 13%), were less likely to be un- or under-insured (1% vs. 28%), lived in neighborhoods with lower social vulnerability index (SVI) than patients from racial and ethnic minority groups (SVI percentile 59 [28] vs. 74 [21]) but had more comorbidities (Charlson comorbidity index 4.6 [2.5] vs. 3.0 [2.5]), and were older (70 [13.2] vs. 58 [15.1] years). From symptom onset, NHW patients were admitted 1.67 [0.71-2.63] days earlier than patients from racial and ethnic minority groups (p < 0.01). Non-English preferred language was associated with delay to admission of 1.29 [0.40-2.18] days (p < 0.01). Preferred language mediated 63% of the total effect (p = 0.02) between race, ethnicity and days from symptom onset to hospital admission. Insurance status, social vulnerability, and distance to the hospital were not on the causal pathway between race, ethnicity and delay to admission. CONCLUSIONS AND RELEVANCE Preferred language mediates the association between race, ethnicity and delays to presentation for critically ill patients with COVID-19, although our results are limited by possible collider stratification bias. Effective COVID-19 treatments require early diagnosis, and delays are associated with increased mortality. Further research on the role preferred language plays in racial and ethnic disparities may identify effective solutions for equitable care.
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Affiliation(s)
- Michael S Kelly
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Adna Mohammed
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Okin
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - George A Alba
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Shelby Flanagan
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- New England Pediatric Environmental Health Specialty Unit, Boston, MA
| | - Nupur A Dandawate
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Alexander Gavralidis
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Leslie L Chang
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Emily E Moin
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alison S Witkin
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kathryn A Hibbert
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Aran Kadar
- Division of Pulmonary Medicine and Critical Care, Newton-Wellesley Hospital, Newton, MA
| | - Patrick L Gordan
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Lisa M Bebell
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Marissa Hauptman
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Peggy S Lai
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Orford S, Fan Y, Hubbard P. Urban public health emergencies and the COVID-19 pandemic. Part 1: Social and spatial inequalities in the COVID-city. Urban Stud 2023; 60:1329-1345. [PMID: 37273497 PMCID: PMC10230294 DOI: 10.1177/00420980231170740] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
COVID-19 has had unprecedented impacts on urban life on a global scale, representing the worst pandemic in living memory. In this introduction to the first of two parts of a Special Issue on urban public health emergencies, we suggest that the COVID-19 outbreak, and associated attempts to manage the pandemic, reproduced and ultimately exacerbated the social and spatial divides that striate the contemporary city. Here, we draw on evidence from the papers in Part 1 of the Special Issue to summarise the uneven urban geographies of COVID-19 evident at the inter- and intra-urban level, emphasising the particular vulnerabilities and risks borne by racialised workers who found it difficult to practise social distancing in either their home or working life. Considering the interplay of environmental, social and biological factors that conspired to create hotspots of COVID-19 infection, and the way these are connected to the racialised capitalism that underpins contemporary urban development, this introduction suggests that reflection on public health emergencies in the city is not just essential from a policy perspective but helps enrich theoretical debates on the nature of contemporary urbanisation in its 'planetary' guise.
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Hong J, de Roulet A, Foglia C, Saldinger P, Chao SY. Outcomes of a Colorectal Enhanced Recovery After Surgery Protocol Modified for a Diverse and Urban Community. J Surg Res 2023; 286:74-84. [PMID: 36774706 DOI: 10.1016/j.jss.2022.12.044] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 12/06/2022] [Accepted: 12/18/2022] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) colorectal programs have been shown to improve the length of stay (LOS) without increasing hospital resource utilization at academic centers worldwide. A multidisciplinary ERAS protocol that includes preoperative, intraoperative, and postoperative management guidelines was recently implemented at our urban, racially diverse, and academically affiliated community hospital. A delivery option was provided to reduce barriers to care. Given our unique patient population, the objective of our study was to determine if improvements in outcomes were reproducible in our hospital. METHODS This is a retrospective study of patients undergoing elective colectomy at New York-Presbyterian Queens Hospital between January 1, 2015, and December 31, 2020. Patient outcomes were compared between surgeries performed under standard practice (all colectomies prior to April 2017) and those performed after the implementation of the ERAS protocol. Demographic and perioperative data were abstracted from a prospectively derived database used to submit data to the National Surgical Quality Improvement Program. Additional data were obtained from chart review. RESULTS Six hundred five elective colectomies were performed by 12 surgeons (range 1-228 cases) during the study period. Of these, 22 were performed open (41% followed ERAS), 467 were performed laparoscopically (57% followed ERAS), and 116 were performed robotically (74% followed ERAS). The average patient age was 64 y. Of which, 55% were male; 34% were Asian, 27% were non-Hispanic Caucasian, 27% were Hispanic, and 11% were Black or African American (all P-values > 0.05 for ERAS versus non-ERAS). Average duration of procedure was longer in the ERAS group (262 min versus 243 min, P = 0.04), although when stratified by procedure type, this relationship held true only for laparoscopic procedures. Hospital LOS was significantly shorter in the ERAS group (4.3 versus 5.4 d, P < 0.001) and this relationship held true for procedures performed both laparoscopically (4.2 versus 5.3 d, P = 0.01) and robotically (4.1 versus 5.1 d, P = 0.04). Of the ERAS group, patients who opted for delivery of ERAS components (n = 205) had the shortest LOS when compared to patients who picked up components (n = 91) or opted out of ERAS (n = 309) (4.1 versus 4.4 versus 5.2 d, P = 0.003). No significant differences were found for 30-d mortality, 30-d readmission, wound infection, or other postoperative complications (all P-values > 0.05). CONCLUSIONS Implementation of an ERAS protocol in an urban, diverse, academically affiliated community hospital is associated with reductions in LOS for colectomies performed both laparoscopically and robotically. Facilitating ERAS compliance with a delivery option was also associated with improvements in hospital LOS. Preoperative nutrition supplementation was not associated with outcomes. No differences in mortality, readmission rates, or rates of postoperative complications were found.
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Affiliation(s)
- Julie Hong
- Department of Surgery, NewYork-Presbyterian/Queens, Flushing, New York.
| | - Amory de Roulet
- Department of Surgery, NewYork-Presbyterian/Queens, Flushing, New York
| | - Christopher Foglia
- Department of Surgery, NewYork-Presbyterian/Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Pierre Saldinger
- Department of Surgery, NewYork-Presbyterian/Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Steven Y Chao
- Department of Surgery, NewYork-Presbyterian/Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
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Abdulaziz HMM, Saleh MA, Elrggal ME, Omar ME, Hawash SA, Attiya AMN, Salem KM, Sabry AAA. Egyptian hemodialysis patients' willingness to receive the COVID-19 vaccine booster dose: a multicenter survey. J Nephrol 2023; 36:1329-1340. [PMID: 36862285 PMCID: PMC9979119 DOI: 10.1007/s40620-023-01586-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/13/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Health authorities have struggled to increase vaccination uptake since the COVID-19 vaccines became available. However, there have been increasing concerns about declining immunity after the initial COVID-19 vaccination with the emergence of new variants. Booster doses were implemented as a complementary policy to increase protection against COVID-19. Egyptian hemodialysis (HD) patients have shown a high rate of hesitancy to COVID-19 primary vaccination, yet their willingness to receive booster doses is unknown. This study aimed to assess COVID-19 vaccine booster hesitancy and its associated factors in Egyptian HD patients. METHODS A face-to-face interview was conducted with closed-ended questionnaires distributed to healthcare workers in seven Egyptian HD centers, mainly located in three Egyptian governorates, between the 7th of March and the 7th of April 2022. RESULTS Among 691 chronic HD patients, 49.3% (n = 341) were willing to take the booster dose. The main reason for booster hesitancy was the opinion that a booster dose is unnecessary (n = 83, 44.9%). Booster vaccine hesitancy was associated with female gender, younger age, being single, Alexandria and urban residency, the use of a tunneled dialysis catheter, not being fully vaccinated against COVID-19. Odds of booster hesitancy were higher among participants who did not receive full COVID-19 vaccination and among those who were not planning to take the influenza vaccine (10.8 and 4.2, respectively). CONCLUSION COVID-19 booster-dose hesitancy among HD patients in Egypt represents a major concern, is associated with vaccine hesitancy with respect to other vaccines and emphasizes the need to develop effective strategies to increase vaccine uptake.
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Affiliation(s)
- Hoda Mahmoud Mohammad Abdulaziz
- Mansoura Nephrology and Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Marwa Ahmed Saleh
- Mansoura Nephrology and Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Essam Elrggal
- Kidney and Urology Center, Alexandria, Egypt
- Nephrology department, AlQabbary Specialty Hospital, Alexandria, Egypt
| | - Mariam E Omar
- Faculty of Medicine, Alexandria Main University Hospital (AMUH), Alexandria University, Alexandria, Egypt
| | | | | | - Karem Mohamed Salem
- Department of Internal Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Alaa Abdel-Aziz Sabry
- Mansoura Nephrology and Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Haggerty BB, Kennedy DP, Bradbury TN, Karney BR. Lasting Declines in Couples' Social Network Interactions in the First Years of COVID. Pers Soc Psychol Bull 2023:1461672231169591. [PMID: 37158231 PMCID: PMC10695142 DOI: 10.1177/01461672231169591] [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] [Indexed: 05/10/2023]
Abstract
Since the onset of COVID-19, a rise in loneliness has raised concerns about the social impact of lockdowns and distancing mandates. Yet, to date, the effects of the pandemic on social networks have been studied only indirectly. To evaluate how the pandemic affected social networks, the current analyses analyzed five waves of detailed social network interviews conducted before and during the first 18 months of the pandemic in a sample especially vulnerable to contracting the virus: mostly non-White couples (243 husbands and 250 wives) recruited from lower income neighborhoods. Pre-COVID interviews asked spouses to name 24 individuals with whom they interact regularly. Post-COVID interviews indicated a nearly 50% decline in face-to-face interactions and a nearly 40% decline in virtual interactions, with little recovery over the first 18 months of the pandemic. Compared with less affluent couples, those with higher incomes maintained more of their network relationships, especially when virtual interactions were taken into account.
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Abstract
The COVID-19 pandemic disproportionately affected Native American people and communities across the United States. Despite unequal losses during the pandemic, Native Americans have high vaccination rates. We provide insight into perspectives of COVID-19 and vaccinations through in-depth interviews with Native Americans. Through this research, we provide a holistic view of how Native Americans perceive vaccines by pairing Indigenous perspectives of risk and the Health Belief Model. We discuss the importance of tribal sovereignty in developing health communication strategies, and the need for messaging that is trusted and culturally appropriate.
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Affiliation(s)
| | - Amanda D. Boyd
- Washington State University, Pullman,
USA
- Washington State University, Seattle,
USA
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19
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Cao X, Li Y, Zi Y, Zhu Y. The shift of percent excess mortality from zero-COVID policy to living-with-COVID policy in Singapore, South Korea, Australia, New Zealand and Hong Kong SAR. Front Public Health 2023; 11:1085451. [PMID: 37020822 PMCID: PMC10067885 DOI: 10.3389/fpubh.2023.1085451] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/28/2023] [Indexed: 03/22/2023] Open
Abstract
Introduction With the economic recession and pandemic fatigue, milder viral variants and higher vaccine coverage along the time lay the basis for lifting anti-COVID policies to restore COVID-19 normalcy. However, when and how to adjust the anti-COVID policies remain under debate in many countries. Methods In this study, four countries (Singapore, South Korea, Australia, and New Zealand) and one region (Hong Kong SAR), that have shifted from the zero-COVID (ZC) policy to or close to the living-with-COVID (LWC) during or after the Omicron outbreak, were selected as research objects. All-cause mortality data were collected for these objects from 2009 to 2019. The expected mortality was estimated by a simple linear regression method. Excess mortality over time was calculated as the difference between the expected mortality and the observed mortality. Finally, percent excess mortality (PEM) was calculated as the excess mortality divided by the expected mortality. Results In the examined four countries, PEM fluctuated around 0% and was lower than 10% most of the time under the ZC policy before 2022. After shifting to the LWC policy, all the examined countries increased the PEM. Briefly, countries with high population density (Singapore and South Korea) experienced an average PEM of 20-40% during the first half of 2022, and followed by a lower average PEM of 15-18% during the second half of 2022. For countries with low population density under the LWC policy, Australia experienced an average PEM of 39.85% during the first half of 2022, while New Zealand was the only country in our analysis that achieved no more than 10% in average PEM all the time. On the contrary, Hong Kong SAR under their ZC policy attained an average PEM of 71.14% during the first half of 2022, while its average PEM decreased to 9.19% in the second half of 2022 with LWC-like policy. Conclusion PEM under different policies within each country/region overtime demonstrated that the mortality burden caused by COVID-19 had been reduced overtime. Moreover, anti-COVID policies are suggested to control the excess mortality to achieve as low as 10% in PEM.
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Affiliation(s)
- Xiaohan Cao
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yunlong Zi
- Thrust of Sustainable Energy and Environment, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, Guangdong, China
| | - Yuyan Zhu
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China
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Panattoni LE, McDermott CL, Li L, Sun Q, Fedorenko CR, Sanchez HA, Kreizenbeck KL, Shankaran V, Ramsey SD. Effect of the COVID-19 Pandemic on Place of Death Among Medicaid and Commercially Insured Patients With Cancer in Washington State. J Clin Oncol 2023; 41:1610-1617. [PMID: 36417688 PMCID: PMC10489265 DOI: 10.1200/jco.22.00070] [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] [Received: 01/12/2022] [Revised: 08/15/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The COVID-19 pandemic-related disruptions in health care delivery might have affected end-of-life care in patients with cancer. We examined changes in place of death and hospice support for Medicaid and commercially insured patients during the pandemic. PATIENTS AND METHODS We linked Washington State cancer registry records with claims from Medicaid and two commercial insurers for patients with solid tumor age 18-64 years. The study included 322 Medicaid and 162 commercial patients who died between March 2017 and June 2019 (pre-COVID-19), along with 90 Medicaid and 47 commercial patients who died between March and June 2020 (COVID-19). Place of death was categorized as hospital, hospice (home or nonhospital facility), and home without hospice. Place of death was compared using adjusted multinomial logistic regressions stratified by payer and time period (pre-COVID-19 v COVID-19). The clinical and sociodemographic factors associated with dying at home without hospice were examined, and adjusted marginal effects (ME) are reported. RESULTS In the adjusted pre-COVID-19 analysis, Medicaid patients were more likely than commercially insured patients to die in hospital (48% v 36%; adjusted ME, 11%; P = .02). In the pre-COVID-19/COVID-19 analysis, Medicaid patients' place of death shifted from hospital (48% v 32%; ME, -16%; P < .01) to home without hospice (19.9% v 38.0%; ME, 16.5%; P < .01). However, there were no statistically significant changes pre-COVID-19/COVID-19 for commercial patients. As a result, during COVID-19, Medicaid patients were more likely than commercial patients to die at home without hospice (38% v 22%; ME, 16%; P = .04) as were male versus female patients (ME, 16%; P < .01). CONCLUSION The pandemic might have disproportionately worsened the end-of-life experience for Medicaid enrollees with cancer. Attention should be paid to societal and health system factors that decrease access to care for Medicaid patients.
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Affiliation(s)
- Laura E. Panattoni
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- PRECISIONheor, Los Angeles, CA
| | - Cara L. McDermott
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| | - Li Li
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine R. Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hayley A. Sanchez
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Karma L. Kreizenbeck
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
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Greene SK, Tabaei BP, Culp GM, Levin-Rector A, Kishore N, Baumgartner J. Effects of Return-to-Office, Public Schools Reopening, and Vaccination Mandates on COVID-19 Cases Among Municipal Employee Residents of New York City. J Occup Environ Med 2023; 65:193-202. [PMID: 36576876 DOI: 10.1097/JOM.0000000000002776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE On September 13, 2021, teleworking ended for New York City municipal employees, and Department of Education employees returned to reopened schools. On October 29, COVID-19 vaccination was mandated. We assessed these mandates' short-term effects on disease transmission. METHODS Using difference-in-difference analyses, we calculated COVID-19 incidence rate ratios (IRRs) among residents 18 to 64 years old by employment status before and after policy implementation. RESULTS IRRs after (September 23-October 28) versus before (July 5-September 12) the return-to-office mandate were similar between office-based City employees and non-City employees. Among Department of Education employees, the IRR after schools reopened was elevated by 28.4% (95% confidence interval, 17.3%-40.3%). Among City employees, the IRR after (October 29-November 30) versus before (September 23-October 28) the vaccination mandate was lowered by 20.1% (95% confidence interval, 13.7%-26.0%). CONCLUSIONS Workforce mandates influenced disease transmission, among other societal effects.
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Henke RM. Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-288. [PMID: 36646664 DOI: 10.1177/08901171221140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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23
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Witt WP, Harlaar N, Palmer A. The Impact of COVID-19 on Pregnant Women and Children: Recommendations for Health Promotion. Am J Health Promot 2023; 37:282-288. [PMID: 36646662 DOI: 10.1177/08901171221140641e] [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] [Indexed: 01/18/2023]
Abstract
COVID-19 continues to have severe repercussions on children and pregnant women. The repercussions include not only the direct impact of COVID-19 (ie, children getting infected by COVID-19) but also indirect impacts (eg, safeguarding from child maltreatment, obesogenic behaviors, language and socioemotional development, educational consequences [eg, interrupted learning]; social isolation; mental health; behavioral health [eg, increased substance use in adolescence]; health and economic impact of COVID-19 on caregivers and family relationships. It has also shed light on long-standing structural and socioeconomic issues, including equity in nutrition and food security, housing, childcare, and internet access. Using a socioecological, life course, and population health approach, we discuss the implications for pregnant women and children's health and well-being and give recommendations for mitigating the short and long-term deleterious impact COVID- 19 on women, children, and their families.
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Khan MM, Odoi A, Odoi EW. Geographic disparities in COVID-19 testing and outcomes in Florida. BMC Public Health 2023; 23:79. [PMID: 36631768 PMCID: PMC9832260 DOI: 10.1186/s12889-022-14450-9] [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: 03/23/2022] [Accepted: 10/25/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Understanding geographic disparities in Coronavirus Disease 2019 (COVID-19) testing and outcomes at the local level during the early stages of the pandemic can guide policies, inform allocation of control and prevention resources, and provide valuable baseline data to evaluate the effectiveness of interventions for mitigating health, economic and social impacts. Therefore, the objective of this study was to identify geographic disparities in COVID-19 testing, incidence, hospitalizations, and deaths during the first five months of the pandemic in Florida. METHODS: Florida county-level COVID-19 data for the time period March-July 2020 were used to compute various COVID-19 metrics including testing rates, positivity rates, incidence risks, percent of hospitalized cases, hospitalization risks, case-fatality rates, and mortality risks. High or low risk clusters were identified using either Kulldorff's circular spatial scan statistics or Tango's flexible spatial scan statistics and their locations were visually displayed using QGIS. RESULTS Visual examination of spatial patterns showed high estimates of all COVID-19 metrics for Southern Florida. Similar to the spatial patterns, high-risk clusters for testing and positivity rates and all COVID-19 outcomes (i.e. hospitalizations and deaths) were concentrated in Southern Florida. The distributions of these metrics in the other parts of Florida were more heterogeneous. For instance, testing rates for parts of Northwest Florida were well below the state median (11,697 tests/100,000 persons) but they were above the state median for North Central Florida. The incidence risks for Northwest Florida were equal to or above the state median incidence risk (878 cases/100,000 persons), but the converse was true for parts of North Central Florida. Consequently, a cluster of high testing rates was identified in North Central Florida, while a cluster of low testing rate and 1-3 clusters of high incidence risks, percent of hospitalized cases, hospitalization risks, and case fatality rates were identified in Northwest Florida. Central Florida had low-rate clusters of testing and positivity rates but it had a high-risk cluster of percent of hospitalized cases. CONCLUSIONS Substantial disparities in the spatial distribution of COVID-19 outcomes and testing and positivity rates exist in Florida, with Southern Florida counties generally having higher testing and positivity rates and more severe outcomes (i.e. hospitalizations and deaths) compared to Northern Florida. These findings provide valuable baseline data that is useful for assessing the effectiveness of preventive interventions, such as vaccinations, in various geographic locations in the state. Future studies will need to assess changes in spatial patterns over time at lower geographical scales and determinants of any identified patterns.
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Affiliation(s)
- Md Marufuzzaman Khan
- Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN, USA
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Evah W Odoi
- Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN, USA.
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25
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Boudou M, Khandelwal S, Óhaiseadha C, Garvey P, O'dwyer J, Hynds P. Spatio-temporal evolution of COVID-19 in the Republic of Ireland and the Greater Dublin Area (March to November 2020): A space-time cluster frequency approach. Spat Spatiotemporal Epidemiol 2023. [DOI: 10.1016/j.sste.2023.100565] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Alidadi M, Sharifi A. Effects of the built environment and human factors on the spread of COVID-19: A systematic literature review. Sci Total Environ 2022; 850:158056. [PMID: 35985590 PMCID: PMC9383943 DOI: 10.1016/j.scitotenv.2022.158056] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 05/25/2023]
Abstract
Soon after its emergence, COVID-19 became a global problem. While different types of vaccines and treatments are now available, still non-pharmacological policies play a critical role in managing the pandemic. The literature is enriched enough to provide comprehensive, practical, and scientific insights to better deal with the pandemic. This research aims to find out how the built environment and human factors have affected the transmission of COVID-19 on different scales, including country, state, county, city, and urban district. This is done through a systematic literature review of papers indexed on the Web of Science and Scopus. Initially, these databases returned 4264 papers, and after different stages of screening, we found 166 relevant papers and reviewed them. The empirical papers that had at least one case study and analyzed the effects of at least one built environment factor on the spread of COVID-19 were selected. Results showed that the driving forces can be divided into seven main categories: density, land use, transportation and mobility, housing conditions, demographic factors, socio-economic factors, and health-related factors. We found that among other things, overcrowding, public transport use, proximity to public spaces, the share of health and services workers, levels of poverty, and the share of minorities and vulnerable populations are major predictors of the spread of the pandemic. As the most studied factor, density was associated with mixed results on different scales, but about 58 % of the papers reported that it is linked with a higher number of cases. This study provides insights for policymakers and academics to better understand the dynamic roles of the non-pharmacological driving forces of COVID-19 at different levels.
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Affiliation(s)
- Mehdi Alidadi
- Graduate School of Engineering and Advanced Sciences, Hiroshima University, Hiroshima, Japan.
| | - Ayyoob Sharifi
- Graduate School of Humanities and Social Science, Network for Education and Research on Peace and Sustainability (NERPS), and the Center for Peaceful and Sustainable Futures (CEPEAS), Hiroshima University, Japan.
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27
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Vazquez R, Navarrete A, Thien Nguyen A, Montiel GI. “A Voice to Uplift Other People”: A Case Study of Integrating Organizing Methods in an FQHC-Based COVID-19 Vaccine Initiative in Latinx Communities. Journal of Humanistic Psychology 2022. [DOI: 10.1177/00221678221125330] [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: 11/16/2022]
Abstract
The COVID-19 pandemic added another layer of trauma for working-class communities who have experienced trauma from systemic inequity and racism. Early pandemic response efforts failed to reach the most vulnerable Latinx communities in the United States due to historic disinvestment in these communities. Federally Qualified Health Centers (FQHCs) were uniquely positioned to respond to the pandemic through testing and vaccine implementation because of their footprint in these communities. However, to advance equitable COVID-19 recovery and long-term, trauma-informed community resilience, FQHCs need to expand their role beyond immediate response through testing and vaccine deployment. Applying Freirean principles of liberation to an integrated model for crisis recovery and community resilience-building, this article presents a case study of the implementation of a COVID-19 vaccine outreach and education initiative at AltaMed Health Services, one of the largest FQHCs in the United States. Findings suggest that leveraging organizing and empowerment strategies to implement COVID-19 vaccine distribution in working-class communities contributes to pathways for community health and well-being, infrastructure for crisis response and recovery, equitable service and information delivery ecosystems, and engaged and empowered communities. Lessons from this study can provide a blueprint for integrating strategies for long-term community resilience, capacity-building, and empowerment in crisis response and community harm mitigation initiatives. Findings from this study also present a model for enhancing the role of FQHCs to facilitate community organizing and engagement for health equity.
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28
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Lewis HC, Marcato AJ, Meagher N, Valenciano M, Villanueva‐Cabezas J, Spirkoska V, Fielding JE, Karahalios A, Subissi L, Nardone A, Cheng B, Rajatonirina S, Okeibunor J, Aly EA, Barakat A, Jorgensen P, Azim T, Wijesinghe PR, Le L, Rodriguez A, Vicari A, Van Kerkhove MD, McVernon J, Pebody R, Price DJ, Bergeri I, Alemu MA, Alvi Y, Bukusi EA, Chung PS, Dambadarjaa D, Das AK, Dub T, Dulacha D, Ebrahim F, González‐Duarte MA, Guruge D, Heraud J, Heredia‐Melo DC, Herman‐Roloff A, Herring BL, Inbanathan FY, Islam F, Jeewandara KC, Kant S, Khan W, Lako R, Leite J, Malavige GN, Mandakh U, Mariam W, Mend T, Mize VA, Musa S, Nohynek H, Olu OO, Osorio‐Merchán MB, Pereyaslov D, Randremanana RV, de Dieu Randria MJ, Ransom J, Saxena S, Sharma P, Sreedevi A, Satheesh M, Subhashini KJ, Tippet‐Barr BA, Usha A, Wamala JF, Watare SH, Yadav K. Transmission of SARS-CoV-2 in standardised first few X cases and household transmission investigations: A systematic review and meta-analysis. Influenza Other Respir Viruses 2022; 16:803-819. [PMID: 36825117 PMCID: PMC9343340 DOI: 10.1111/irv.13002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
We aimed to estimate the household secondary infection attack rate (hSAR) of SARS-CoV-2 in investigations aligned with the WHO Unity Studies Household Transmission Investigations (HHTI) protocol. We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines. We searched Medline, Embase, Web of Science, Scopus and medRxiv/bioRxiv for "Unity-aligned" First Few X cases (FFX) and HHTIs published 1 December 2019 to 26 July 2021. Standardised early results were shared by WHO Unity Studies collaborators (to 1 October 2021). We used a bespoke tool to assess investigation methodological quality. Values for hSAR and 95% confidence intervals (CIs) were extracted or calculated from crude data. Heterogeneity was assessed by visually inspecting overlap of CIs on forest plots and quantified in meta-analyses. Of 9988 records retrieved, 80 articles (64 from databases; 16 provided by Unity Studies collaborators) were retained in the systematic review; 62 were included in the primary meta-analysis. hSAR point estimates ranged from 2% to 90% (95% prediction interval: 3%-71%; I 2 = 99.7%); I 2 values remained >99% in subgroup analyses, indicating high, unexplained heterogeneity and leading to a decision not to report pooled hSAR estimates. FFX and HHTI remain critical epidemiological tools for early and ongoing characterisation of novel infectious pathogens. The large, unexplained variance in hSAR estimates emphasises the need to further support standardisation in planning, conduct and analysis, and for clear and comprehensive reporting of FFX and HHTIs in time and place, to guide evidence-based pandemic preparedness and response efforts for SARS-CoV-2, influenza and future novel respiratory viruses.
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Affiliation(s)
- Hannah C. Lewis
- World Health OrganizationGenevaSwitzerland,World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Adrian J. Marcato
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Niamh Meagher
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Marta Valenciano
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Juan‐Pablo Villanueva‐Cabezas
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,The Nossal Institute for Global HealthThe University of MelbourneMelbourneAustralia
| | - Violeta Spirkoska
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - James E. Fielding
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | - Anthony Nardone
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Brianna Cheng
- World Health OrganizationGenevaSwitzerland,School of Population and Global HealthMcGill UniversityMontrealQuebecCanada
| | | | - Joseph Okeibunor
- World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Eman A. Aly
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | - Amal Barakat
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | | | - Tasnim Azim
- World Health Organization, Regional Office for South‐East AsiaNew DelhiIndia
| | | | - Linh‐Vi Le
- World Health Organization, Regional Office for the Western PacificManilaPhilippines
| | - Angel Rodriguez
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | - Andrea Vicari
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | | | - Jodie McVernon
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia
| | - Richard Pebody
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | - David J. Price
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | | | | | - Yasir Alvi
- Department of Community Medicine Hamdard Institute of Medical Sciences and Research New Delhi India
| | | | - Pui Shan Chung
- World Health Organization, Regional Office for the Western Pacific Manila Philippines
| | - Davaalkham Dambadarjaa
- School of Public Health Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Ayan K. Das
- Department of Microbiology Hamdard Institute of Medical Science and Research New Delhi India
- Hakeem Abdul Hameed Centenary Hospital New Delhi India
| | - Timothée Dub
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | - Faiqa Ebrahim
- World Health Organization Country Office Addis Ababa Ethiopia
| | | | | | | | | | | | - Belinda L. Herring
- World Health Organization, Regional Office for Africa Brazzaville Republic of Congo
| | | | - Farzana Islam
- Hamdard Institute of Medical Sciences and Research (HIMSR) New Delhi India
| | - Kamal Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Nugegoda Sri Lanka
| | - Shashi Kant
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Wasiq Khan
- World Health Organization, Regional Office for the Eastern Mediterranean Cairo Egypt
| | | | - Juliana Leite
- World Health Organization, Regional Office for the Americas (Pan American Health Organization) Washington DC USA
| | | | - Undram Mandakh
- Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Warisha Mariam
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Tsogt Mend
- National Center for Communicable Diseases Ulaanbaatar Mongolia
| | | | - Sanjin Musa
- Institute for Public Health of the Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herzegovina
- Sarajevo School of Science and Technology Sarajevo Bosnia and Herzegovina
| | - Hanna Nohynek
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | | | | | | | | | - James Ransom
- Centers for Disease Control and Prevention Juba South Sudan
| | - Sonal Saxena
- Department of Microbiology Maulana Azad Medical College New Delhi India
| | - Pragya Sharma
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Aswathy Sreedevi
- Department of Community Medicine Amrita Institute of Medical Sciences Kochi Kerala India
| | - Mini Satheesh
- Kerala University of Health Sciences Kerala India
- Government Medical College Thiruvananthapuram Kerala India
| | - K. J. Subhashini
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Beth A. Tippet‐Barr
- U.S. Centers for Disease Control and Prevention Nairobi Kenya
- Nyanja Health Research Institute Salima Malawi
| | - Anuja Usha
- Regional Prevention of Epidemic and Infectious Disease Cell Government of Kerala Kerala India
| | | | | | - Kapil Yadav
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
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Piroddi C. Non-pharmaceutical Interventions and Social Distancing as Intersubjective Care and Collective Protection. Asian Bioeth Rev 2022; 14:379-395. [PMID: 35990569 PMCID: PMC9375195 DOI: 10.1007/s41649-022-00212-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
The paper discusses non-pharmaceutical interventions (NPIs) as a collective form of protection that, in terms of health justice, benefits groups at risk, allowing them to engage in social life and activities during health crises. More specifically, the paper asserts that NPIs that realize social distancing are justifiable insofar as they are constitutive of a type of social protection that allows everyone, especially social disadvantaged agents, to access the public health sphere and other fundamental social spheres, such as the family and civil society.
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Wong R, Grullon JR, Lovier MA. COVID-19 Risk Factors and Predictors for Handwashing, Masking, and Social Distancing Among a National Prospective Cohort of U.S. Older Adults. Public Health 2022. [PMID: 36152400 PMCID: PMC9385770 DOI: 10.1016/j.puhe.2022.08.002] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022]
Abstract
Objectives Older adults have a disproportionately higher COVID-19 risk; however, there is limited research investigating adherence to the major COVID-19 mitigation behaviors (handwashing, masking, social distancing) for older populations. We examined COVID-19 risk factors and predictors for adherence to COVID-19 mitigation behaviors among a national sample of US older adults. Study design Data were retrieved for 3257 respondents from a nationally representative prospective sample of US Medicare beneficiaries aged ≥65 years. COVID-19 variables were collected in 2020, whereas all other data were collected in 2019. Methods We used multiple logistic regression to analyze COVID-19 risk factors and predictors for handwashing, masking, and social distancing to minimize COVID-19 spread. All models applied survey sampling weights. Results Factors significantly associated with increased odds of COVID-19 diagnosis among US older adults were Hispanic ethnicity (adjusted odds ratio [aOR] = 2.83, P = .01), income (aOR = 0.71, P = .04), residential care or nursing home (aOR = 2.62, P = .01), and generalized anxiety disorder (aOR = 2.38, P = .04). We identified multiple factors significantly associated with adherence to handwashing, masking, and social distancing. Most notably, older males had a significantly lower odds of practicing all three COVID-19 mitigation behaviors, and Black older adults had a significantly higher odds of masking (aOR = 7.94, P < .001) and social distancing (aOR = 2.33, P = .01). Conclusions When prioritizing COVID-19 prevention efforts for older adults, risk factors that should be considered are race and ethnicity, income, residential setting, and anxiety. To effectively mitigate COVID-19 disease spread, public health professionals must also recognize sociodemographic and health factors may influence whether older adults adhere to handwashing, masking, and social distancing.
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Elrayies GM. Prophylactic Architecture: Formulating the Concept of Pandemic-Resilient Homes. Buildings 2022; 12:927. [DOI: 10.3390/buildings12070927] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The lockdown instituted during the COVID-19 pandemic has drawn the world’s attention to the importance of homes as integrated structures for practicing all aspects of life. The home has been transformed from a mere place to live into a complete piece of infrastructure accommodating all activities of life, including study, work, shopping, exercise, entertainment, and even telehealth. Although quarantines were necessary to protect against viral infection, we have faced social and psychological challenges due to the failure of the current home design to accommodate the new lockdown lifestyle during the pandemic. Thus, this study aims to set a foundation for the development and design of resilient homes in a post-quarantine world by establishing a comprehensive framework for quarantine-resilient homes. The framework was established on the basis of the relevant literature and proposals from architects and experts. It brings a perspective to the future requirements of homes so as to provide architects, stakeholders, and policymakers with the appropriate knowledge to mitigate the impact of lockdowns on mental health and well-being in residential buildings by focusing on the physical and architectural environment.
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Zhong X, Zhou Z, Li G, Kwizera MH, Muennig P, Chen Q. Neighborhood disparities in COVID-19 outcomes in New York city over the first two waves of the outbreak. Ann Epidemiol 2022; 70:45-52. [PMID: 35487451 PMCID: PMC9042413 DOI: 10.1016/j.annepidem.2022.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/25/2022] [Accepted: 04/18/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess the association of neighborhood demographic and socioeconomic characteristics with COVID-19 incidence and mortality in New York City (NYC) over the first two waves of outbreak. METHODS This retrospective study used neighborhood-level data from 177 modified ZIP code tabulation areas in NYC between March 01, 2020 and April 30, 2021. RESULTS Neighborhoods that were most severely impacted in wave 1 were also more affected in wave 2. Neighborhoods with a higher percentage of seniors (≥75 years), males, Black and Hispanic population, and large-size households had higher incidence rates of COVID-19 in wave 1 but not in wave 2. Neighborhoods with higher percentage of Black and Hispanic population and lower insurance coverage had higher death rate per capita and case fatality ratio in wave 1, and neighborhoods with higher percentage of Black and Asian population had elevated case fatality ratio in wave 2. Median household income was negatively associated with incidence rate and death rate per capita but not associated with case fatality ratio in both waves. Neighborhoods with more seniors had higher death rate and case fatality ratio in both waves. CONCLUSIONS Neighborhood disparities in COVID-19 incidence and mortality across NYC neighborhoods were dynamic during the first two waves of outbreak.
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Affiliation(s)
- Xiaobo Zhong
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ziqi Zhou
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Guohua Li
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Muhire H Kwizera
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
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Levin AT, Owusu-Boaitey N, Pugh S, Fosdick BK, Zwi AB, Malani A, Soman S, Besançon L, Kashnitsky I, Ganesh S, McLaughlin A, Song G, Uhm R, Herrera-Esposito D, de Los Campos G, Peçanha Antonio ACP, Tadese EB, Meyerowitz-Katz G. Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis and public policy implications. BMJ Glob Health 2022; 7:bmjgh-2022-008477. [PMID: 35618305 PMCID: PMC9136695 DOI: 10.1136/bmjgh-2022-008477] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [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: 01/09/2022] [Accepted: 05/05/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The infection fatality rate (IFR) of COVID-19 has been carefully measured and analysed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries. METHODS We systematically reviewed the literature to identify all COVID-19 serology studies in developing countries that were conducted using representative samples collected by February 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. We analysed the serology data using a Bayesian model that incorporates conventional sampling uncertainty as well as uncertainties about assay sensitivity and specificity. We then calculated IFRs using individual case reports or aggregated public health updates, including age-specific estimates whenever feasible. RESULTS In most locations in developing countries, seroprevalence among older adults was similar to that of younger age cohorts, underscoring the limited capacity that these nations have to protect older age groups.Age-specific IFRs were roughly 2 times higher than in high-income countries. The median value of the population IFR was about 0.5%, similar to that of high-income countries, because disparities in healthcare access were roughly offset by differences in population age structure. CONCLUSION The burden of COVID-19 is far higher in developing countries than in high-income countries, reflecting a combination of elevated transmission to middle-aged and older adults as well as limited access to adequate healthcare. These results underscore the critical need to ensure medical equity to populations in developing countries through provision of vaccine doses and effective medications.
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Affiliation(s)
- Andrew T Levin
- Economics, Dartmouth College, Hanover, New Hampshire, USA.,National Bureau for Economic Research, Cambridge, Massachusetts, USA
| | - Nana Owusu-Boaitey
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sierra Pugh
- Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Bailey K Fosdick
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Anthony B Zwi
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Anup Malani
- Law School, University of Chicago, Chicago, Illinois, USA
| | - Satej Soman
- Harris School of Public Policy, University of Chicago, Chicago, Illinois, USA
| | - Lonni Besançon
- Faculty of Information and Technology, Monash University, Clayton, Victoria, Australia
| | - Ilya Kashnitsky
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Sachin Ganesh
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Gayeong Song
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | - Rine Uhm
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Gustavo de Los Campos
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | | | | | - Gideon Meyerowitz-Katz
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, New South Wales, Australia .,School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
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Abstract
There were more than 800,000 confirmed coronavirus disease 2019 (COVID-19) deaths in the United States (U.S) by the end of 2021. The health consequences of COVID-19, however, have not affected all residents equally. In this review, we synthesize recent evidence suggesting that high levels of poverty in the U.S. compared to other high-income countries, as well as historic and ongoing racial/ethnic discrimination, have exacerbated the health consequences of COVID-19, particularly for racial/ethnic minorities. We discuss four mechanisms through which poverty and discrimination affect COVID-19-related health consequences: greater pre-existing health challenges, reduced access to healthcare, lower-quality neighbourhood and housing conditions, and unequal exposure to high-risk occupations. Evidence suggests that economic and policy institutions that contributed to higher pre-pandemic poverty rates in the U.S., particularly among racial/ethnic minorities, have been central determinants of unequal health outcomes during the COVID-19 pandemic.
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Affiliation(s)
- Zachary Parolin
- Department of Social and Political Sciences, Bocconi University, Milan, Italy,Corresponding Author: Zachary Parolin, Bocconi University, Via Roentgen 1, Rm. 3.C1.18 20136 Milan, Italy
| | - Emma K. Lee
- Columbia University Center on Poverty and Social Policy, New York, NY, USA
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