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Ly KN, Yin S, Spradling PR. Disparities in Social Vulnerability and Premature Mortality among Decedents with Hepatitis B, United States, 2010-2019. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01968-4. [PMID: 38472630 DOI: 10.1007/s40615-024-01968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Current US hepatitis B mortality rates remain three times higher than the national target. Mortality reduction will depend on addressing hepatitis B disparities influenced by social determinants of health. OBJECTIVES This study aims to describe characteristics of hepatitis B-listed decedents, which included US birthplace status and county social vulnerability attributes and quantify premature mortality. METHODS We conducted a cross-sectional analysis of 17,483 hepatitis B-listed decedents using the 2010-2019 US Multiple-Cause-of-Death data merged with the county-level Social Vulnerability Index (SVI). Outcomes included the distribution of decedents according to US birthplace status and residence in higher versus lower death burden counties by sociodemographic characteristics, years of potential life lost (YPLL), and SVI quartiles. RESULTS Most hepatitis B-listed decedents were US-born, male, and born during 1945-1965. Median YPLL was 17.2; 90.0% died prematurely. US-born decedents were more frequently White, non-college graduates, unmarried, and had resided in a county with < 500,000 people; non-US-born decedents were more frequently Asian/Pacific Islander, college graduates, married, and had resided in a county with ≥ 1 million people. Higher death burden (≥ 20) counties were principally located in coastal states. US-born decedents more frequently resided in counties in the highest SVI quartile for "Household Characteristics" and "Uninsured," whereas non-US-born decedents more frequently resided in counties in the highest SVI quartile for "Racial/Ethnic Minority Status" and "Housing Type/Transportation." CONCLUSION This analysis found substantial premature hepatitis B mortality and residence in counties ranked high in social vulnerability. Successful interventions should be tailored to disproportionately affected populations and the social vulnerability features of their geographic areas.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA.
| | - Shaoman Yin
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA.
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Dantuluri KL, Buahin A, Uschner D, DeWitt ME, Rossman W, Dunn CO, Hetherington TC, Priem J, Castri P, Lagarde WH, Gibbs M, Ahmed A. Association of social vulnerability index and masking adherence among children enrolled in COVID-19 community research partnership study. BMC Public Health 2024; 24:410. [PMID: 38331791 PMCID: PMC10854168 DOI: 10.1186/s12889-024-17931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Individuals with high social vulnerability index (SVI) have poorer outcomes with COVID-19. Masking reduces transmission of COVID-19 among children, but how SVI plays a role in masking behavior is unknown. We aimed to measure the association of SVI with masking adherence among children during the COVID-19 pandemic. METHODS We conducted a multi-site, prospective syndromic surveillance study among children aged 2 - 17 years in the Southeastern United States by daily electronic surveys which solicited symptoms of COVID-19-like illness, infection with or exposure to SARS-CoV-2, masking habits, and any receipt of COVID-19 vaccines. Parents/guardians submitted surveys for their children; adolescents 13 years and older could opt to submit their own surveys. Multivariable and univariate linear models were used to measure the associations of different predictors such as SVI with masking adherence. RESULTS One thousand four hundred sixty-one children from 6 states and 55 counties predominately from North and South Carolina were included in the analysis. Most children in the cohort were 5 - 11 years old, non-Hispanic White, from urban counties, and with low-moderate SVI. Overall masking adherence decreased over time, and older children had higher masking adherence throughout the study period compared with younger children. Children who resided in urban counties had greater masking adherence throughout the study period than those who resided in suburban or rural counties. Masking adherence was higher among children with both low and medium SVI than those with high SVI. CONCLUSIONS Despite being at risk for more severe outcomes with COVID-19, children with high SVI had lower levels of masking adherence compared to those with low SVI. Our findings highlight opportunities for improved and targeted messaging in these vulnerable communities.
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Affiliation(s)
- Keerti L Dantuluri
- Department of Pediatrics (Infectious Diseases) at Levine Children's Hospital and Wake Forest University School of Medicine, Atrium Health, 1001 Blythe Blvd, Medical Education Building, P.O. Box 32861, Charlotte, NC, 28203, USA.
| | - Asare Buahin
- Department of Biostatistics and Bioinformatics and The Biostatistics Center at The George Washington University, Washington, D.C., USA
| | - Diane Uschner
- Department of Biostatistics and Bioinformatics and The Biostatistics Center at The George Washington University, Washington, D.C., USA
| | - Michael E DeWitt
- Section on Infectious Diseases, Department of Medicine at Wake Forest University School of Medicine and the Department of Biology, Wake Forest University, Winston-Salem, NC, USA
| | - Whitney Rossman
- Center for Outcomes Research and Evaluation at Atrium Health, Charlotte, NC, USA
| | - Connell O Dunn
- Department of Emergency Medicine Research at Atrium Health, Charlotte, NC, USA
| | | | - Jennifer Priem
- Center for Outcomes Research and Evaluation at Atrium Health, Charlotte, NC, USA
| | - Paola Castri
- Department of Neurology (Pediatric Neurology) at Wake Forest Baptist, Winston Salem, NC, USA
| | - William H Lagarde
- Department of Pediatrics (Endocrinology) at WakeMed, Raleigh, NC, USA
| | - Michael Gibbs
- Department of Emergency Medicine at Atrium Health, Charlotte, NC, USA
| | - Amina Ahmed
- Department of Pediatrics (Infectious Diseases) at Levine Children's Hospital and Wake Forest University School of Medicine, Atrium Health, 1001 Blythe Blvd, Medical Education Building, P.O. Box 32861, Charlotte, NC, 28203, USA
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Katzow MW, Steinway C, Zuzarte A, Chen J, Fishbein J, Jan S. Sociodemographic Disparities in Ambulatory Pediatric Telemedicine Utilization During COVID-19. Telemed J E Health 2024; 30:57-66. [PMID: 37579076 DOI: 10.1089/tmj.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Objective: Few studies have examined sociodemographic disparities in ambulatory pediatric telemedicine utilization during the coronavirus disease 2019 pandemic. We aimed to (1) assess disparities in telemedicine visit completion during the first 6 weeks of the pandemic in 2020 and (2) determine if these disparities were significantly different from those present in 2019, when all visits occurred in person. Methods: We compared sociodemographic characteristics of patients with successful versus unsuccessful telemedicine visits from March 10, 2020 to April 18, 2020, using generalized linear mixed models. We performed the same analysis for in-person visits from the same period in 2019. We tested for differences across years using interaction terms in a combined 2019-2020 model. Results: Of 3,639 telemedicine visits scheduled, 3,033 (83.3%) were successful. In 2020, Black/African American race was significantly associated with lower odds of telemedicine visit success (odds ratio 0.65 [95% confidence interval 0.49-0.87]) compared with White race, after adjusting for age, gender, ethnicity, insurance type, visit timing, visit specialty, social vulnerability index, and internet access. In 2019, racial identity other than White was significantly associated with lower odds of in-person visit success than White, as was public insurance compared with private. In the full 2019-2020 model, in-person visits (2019) had lower odds of success than telemedicine visits (2020), and neither race, insurance type, nor any other sociodemographic characteristic had significant interactions with year. Conclusions: Racial disparities were evident in telemedicine utilization early in the pandemic; however, these disparities were not significantly different from those seen in 2019, when all visits were in person. Furthermore, telemedicine may improve access to care overall, despite having no significant impact on inequity. Efforts to eliminate racial disparities in ambulatory pediatric health care utilization are necessary across visit modalities.
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Affiliation(s)
- Michelle W Katzow
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Caren Steinway
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Andrea Zuzarte
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Jack Chen
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Joanna Fishbein
- Biostatistics Unit, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Sophia Jan
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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4
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Rayner DG, Gou D, Chen JZX, Zhu E, Lin VW, Fu N. Prognostic factors for multisystem inflammatory syndrome in children: A systematic review and meta-analysis. Acta Paediatr 2024; 113:39-47. [PMID: 37815153 DOI: 10.1111/apa.16999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/07/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
AIM Multisystem inflammatory syndrome in children (MIS-C) is a novel condition that can occur post-SARS-CoV-2 infection in children and adolescents. There is a paucity of evidence on the prognostic factors associated with MIS-C. The aim of this systematic review and meta-analysis was to summarise the prognostic factors for MIS-C development. METHODS Five databases were systematically searched from January 2020 to May 2023 for studies reporting on prognostic factors for MIS-C using multivariable regression models. Random-effects meta-analyses were conducted to pool odds ratios for each prognostic factor. Risk of bias was rated using QUIPS and the GRADE framework was used to assess the certainty of evidence for each unique factor. RESULTS Twelve observational studies (N = 18 024) were included, and 13 unique prognostic factors were amenable to meta-analysis. With moderate certainty, age <12 years, male sex and Black race probably increase the risk of MIS-C. Malignancy and underlying respiratory disease probably decrease the risk of MIS-C. Low-certainty evidence suggests that Asian race may increase the risk of MIS-C, and comorbidity may decrease the risk of MIS-C. CONCLUSION Current literature presents several prognostic factors related to MIS-C following SARS-CoV-2 infection. Further research is necessary to elucidate the pathophysiologic mechanisms related to MIS-C.
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Affiliation(s)
- Daniel G Rayner
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David Gou
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jason Z X Chen
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Evelyn Zhu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Vallen W Lin
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Fu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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5
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Melgar M, Abrams JY, Godfred-Cato S, Shah AB, Garg A, Strunk A, Narasimhan M, Koptyev J, Norden A, Musheyev D, Rashid F, Tannenbaum R, Estrada-Y-Martin RM, Patel B, Karanth S, Achenbach CJ, Hall GT, Hockney SM, Caputo M, Abbo LM, Beauchamps L, Morris S, Cifuentes RO, de St Maurice A, Bell DS, Prabaker KK, Sanz Vidorreta FJ, Bryant E, Cohen DK, Mohan R, Libby CP, SooHoo S, Domingo TJ, Campbell AP, Belay ED. A Multicenter Retrospective Cohort Study to Characterize Patients Hospitalized With Multisystem Inflammatory Syndrome in Adults and Coronavirus Disease 2019 in the United States, 2020-2021. Clin Infect Dis 2023; 77:1395-1405. [PMID: 37384794 PMCID: PMC10654854 DOI: 10.1093/cid/ciad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/02/2023] [Accepted: 06/27/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated multisystem inflammatory syndrome in adults (MIS-A) requires distinguishing it from acute coronavirus disease 2019 (COVID-19) and may affect clinical management. METHODS In this retrospective cohort study, we applied the US Centers for Disease Control and Prevention case definition to identify adults hospitalized with MIS-A at 6 academic medical centers from 1 March 2020 to 31 December 2021. Patients MIS-A were matched by age group, sex, site, and admission date at a 1:2 ratio to patients hospitalized with acute symptomatic COVID-19. Conditional logistic regression was used to compare demographic characteristics, presenting symptoms, laboratory and imaging results, treatments administered, and outcomes between cohorts. RESULTS Through medical record review of 10 223 patients hospitalized with SARS-CoV-2-associated illness, we identified 53 MIS-A cases. Compared with 106 matched patients with COVID-19, those with MIS-A were more likely to be non-Hispanic black and less likely to be non-Hispanic white. They more likely had laboratory-confirmed COVID-19 ≥14 days before hospitalization, more likely had positive in-hospital SARS-CoV-2 serologic testing, and more often presented with gastrointestinal symptoms and chest pain. They were less likely to have underlying medical conditions and to present with cough and dyspnea. On admission, patients with MIS-A had higher neutrophil-to-lymphocyte ratio and higher levels of C-reactive protein, ferritin, procalcitonin, and D-dimer than patients with COVID-19. They also had longer hospitalization and more likely required intensive care admission, invasive mechanical ventilation, and vasopressors. The mortality rate was 6% in both cohorts. CONCLUSIONS Compared with patients with acute symptomatic COVID-19, adults with MIS-A more often manifest certain symptoms and laboratory findings early during hospitalization. These features may facilitate diagnosis and management.
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Affiliation(s)
- Michael Melgar
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph Y Abrams
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shana Godfred-Cato
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami B Shah
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jonathan Koptyev
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Alexandra Norden
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - David Musheyev
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Fahmida Rashid
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rachel Tannenbaum
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rosa M Estrada-Y-Martin
- Divisions of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at UTHealth, The University of Texas at Houston, Houston, Texas, USA
| | - Bela Patel
- Divisions of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at UTHealth, The University of Texas at Houston, Houston, Texas, USA
| | - Siddharth Karanth
- Divisions of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at UTHealth, The University of Texas at Houston, Houston, Texas, USA
| | - Chad J Achenbach
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gavin T Hall
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sara M Hockney
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew Caputo
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lilian M Abbo
- Department of Infection Prevention and Control, Jackson Health System, Miami, Florida, USA
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laura Beauchamps
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephen Morris
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Renzo O Cifuentes
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Annabelle de St Maurice
- Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Department of Clinical Epidemiology and Infection Prevention, University of California, Los Angeles, Los Angeles, California, USA
| | - Douglas S Bell
- Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
- Clinical and Translational Science Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Kavitha K Prabaker
- Department of Clinical Epidemiology and Infection Prevention, University of California, Los Angeles, Los Angeles, California, USA
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Fernando J Sanz Vidorreta
- Clinical and Translational Science Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Evan Bryant
- Department of Clinical Epidemiology and Infection Prevention, University of California, Los Angeles, Los Angeles, California, USA
| | - David K Cohen
- Department of Clinical Epidemiology and Infection Prevention, University of California, Los Angeles, Los Angeles, California, USA
| | - Rohith Mohan
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christopher P Libby
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Spencer SooHoo
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tristel J Domingo
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Angela P Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ermias D Belay
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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6
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Zambrano LD, Wu MJ, Martin L, Malloch L, Chen S, Newhams MM, Kucukak S, Son MB, Sanders C, Patterson K, Halasa N, Fitzgerald JC, Leroue MK, Hall M, Irby K, Rowan CM, Wellnitz K, Sahni LC, Loftis L, Bradford TT, Staat M, Babbitt C, Carroll CL, Pannaraj PS, Kong M, Schuster JE, Chou J, Patel MM, Randolph AG, Campbell AP, Hobbs CV. Risk Factors for Multisystem Inflammatory Syndrome in Children: A Case-control Investigation. Pediatr Infect Dis J 2023; 42:e190-e196. [PMID: 37000922 PMCID: PMC10265536 DOI: 10.1097/inf.0000000000003900] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND In a 2020 pilot case-control study using medical records, we reported that non-Hispanic Black children were more likely to develop multisystem inflammatory syndrome in children (MIS-C) after adjustment for sociodemographic factors and underlying medical conditions. Using structured interviews, we investigated patient, household, and community factors underlying MIS-C likelihood. METHODS MIS-C case patients hospitalized in 2021 across 14 US pediatric hospitals were matched by age and site to outpatient controls testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 3 months of the admission date. Caregiver interviews queried race/ethnicity, medical history, and household and potential community exposures 1 month before MIS-C hospitalization (case-patients) or after SARS-CoV-2 infection (controls). We calculated adjusted odds ratios (aOR) using mixed-effects multivariable logistic regression. RESULTS Among 275 case patients and 496 controls, race/ethnicity, social vulnerability and patient or family history of autoimmune/rheumatologic disease were not associated with MIS-C. In previously healthy children, MIS-C was associated with a history of hospitalization for an infection [aOR: 4.8; 95% confidence interval (CI): 2.1-11.0]. Household crowding (aOR: 1.7; 95% CI: 1.2-2.6), large event attendance (aOR: 1.7; 95% CI: 1.3-2.1), school attendance with limited masking (aOR: 2.6; 95% CI: 1.1-6.6), public transit use (aOR: 1.8; 95% CI: 1.4-2.4) and co-resident testing positive for SARS-CoV-2 (aOR: 2.2; 95% CI: 1.3-3.7) were associated with increased MIS-C likelihood, with risk increasing with the number of these factors. CONCLUSIONS From caregiver interviews, we clarify household and community exposures associated with MIS-C; however, we did not confirm prior associations between sociodemographic factors and MIS-C.
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Affiliation(s)
- Laura D. Zambrano
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael J. Wu
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lora Martin
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lacy Malloch
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sabrina Chen
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Margaret M. Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Suden Kucukak
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Mary Beth Son
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cameron Sanders
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kayla Patterson
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie C. Fitzgerald
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew K. Leroue
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark Hall
- Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital Columbus, Ohio
| | - Katherine Irby
- Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, Arkansas
| | - Courtney M. Rowan
- Division of Pediatric Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Kari Wellnitz
- Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Leila C. Sahni
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Laura Loftis
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Tamara T. Bradford
- Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children’s Hospital of New Orleans, New Orleans, Louisiana
| | - Mary Staat
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Christopher Babbitt
- Miller Children’s and Women’s Hospital of Long Beach, Long Beach, California
| | - Christopher L. Carroll
- Division of Pediatric Critical Care, Connecticut Children’s Hospital, Hartford, Connecticut
| | - Pia S. Pannaraj
- Division of Infectious Diseases, Children’s Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, California
| | - Michele Kong
- Department of Pediatrics, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer E. Schuster
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Janet Chou
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Manish M. Patel
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adrienne G. Randolph
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Angela P. Campbell
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charlotte V. Hobbs
- Division of Infectious Disease, Department of Pediatrics, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi
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7
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Sinha A, Rubin S, Jarvis JM. Promoting Functional Recovery in Critically Ill Children. Pediatr Clin North Am 2023; 70:399-413. [PMID: 37121633 PMCID: PMC11113330 DOI: 10.1016/j.pcl.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Over two-thirds of pediatric critical illness survivors will experience functional impairments that persist after discharge, that is, post-intensive care syndrome in pediatrics (PICS-p). Risk factors include child and family characteristics, invasive procedures, and social determinants of health. Approaches to remediate PICS-p include early rehabilitation, minimizing sedation, psychosocial resources for caregivers, delivery of family-centered care, and longitudinal screening for PICS-p. Challenges include feasible and validated approaches to screening, and resources and coordination for multidisciplinary care. Next steps should include resources to identify and address adverse social determinants of health and examination of treatment efficacy and implementation equity.
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Affiliation(s)
- Amit Sinha
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA
| | - Sarah Rubin
- Department of Critical Care Medicine, University of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd Floor, Pittsburgh, PA 15224, USA
| | - Jessica M Jarvis
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA.
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Bembea MM, Loftis LL, Thiagarajan RR, Young CC, McCadden TP, Newhams MM, Kucukak S, Mack EH, Fitzgerald JC, Rowan CM, Maddux AB, Kolmar AR, Irby K, Heidemann S, Schwartz SP, Kong M, Crandall H, Havlin KM, Singh AR, Schuster JE, Hall MW, Wellnitz KA, Maamari M, Gaspers MG, Nofziger RA, Lim PPC, Carroll RW, Coronado Munoz A, Bradford TT, Cullimore ML, Halasa NB, McLaughlin GE, Pannaraj PS, Cvijanovich NZ, Zinter MS, Coates BM, Horwitz SM, Hobbs CV, Dapul H, Graciano AL, Butler AD, Patel MM, Zambrano LD, Campbell AP, Randolph AG. Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs. Pediatr Crit Care Med 2023; 24:356-371. [PMID: 36995097 PMCID: PMC10153593 DOI: 10.1097/pcc.0000000000003212] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Extracorporeal membrane oxygenation (ECMO) has been used successfully to support adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiac or respiratory failure refractory to conventional therapies. Comprehensive reports of children and adolescents with SARS-CoV-2-related ECMO support for conditions, including multisystem inflammatory syndrome in children (MIS-C) and acute COVID-19, are needed. DESIGN Case series of patients from the Overcoming COVID-19 public health surveillance registry. SETTING Sixty-three hospitals in 32 U.S. states reporting to the registry between March 15, 2020, and December 31, 2021. PATIENTS Patients less than 21 years admitted to the ICU meeting Centers for Disease Control criteria for MIS-C or acute COVID-19. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The final cohort included 2,733 patients with MIS-C ( n = 1,530; 37 [2.4%] requiring ECMO) or acute COVID-19 ( n = 1,203; 71 [5.9%] requiring ECMO). ECMO patients in both groups were older than those without ECMO support (MIS-C median 15.4 vs 9.9 yr; acute COVID-19 median 15.3 vs 13.6 yr). The body mass index percentile was similar in the MIS-C ECMO versus no ECMO groups (89.9 vs 85.8; p = 0.22) but higher in the COVID-19 ECMO versus no ECMO groups (98.3 vs 96.5; p = 0.03). Patients on ECMO with MIS-C versus COVID-19 were supported more often with venoarterial ECMO (92% vs 41%) for primary cardiac indications (87% vs 23%), had ECMO initiated earlier (median 1 vs 5 d from hospitalization), shorter ECMO courses (median 3.9 vs 14 d), shorter hospital length of stay (median 20 vs 52 d), lower in-hospital mortality (27% vs 37%), and less major morbidity at discharge in survivors (new tracheostomy, oxygen or mechanical ventilation need or neurologic deficit; 0% vs 11%, 0% vs 20%, and 8% vs 15%, respectively). Most patients with MIS-C requiring ECMO support (87%) were admitted during the pre-Delta (variant B.1.617.2) period, while most patients with acute COVID-19 requiring ECMO support (70%) were admitted during the Delta variant period. CONCLUSIONS ECMO support for SARS-CoV-2-related critical illness was uncommon, but type, initiation, and duration of ECMO use in MIS-C and acute COVID-19 were markedly different. Like pre-pandemic pediatric ECMO cohorts, most patients survived to hospital discharge.
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Affiliation(s)
- Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura L Loftis
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Ravi R Thiagarajan
- Division of Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Cameron C Young
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Timothy P McCadden
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Margaret M Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Suden Kucukak
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Elizabeth H Mack
- Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC
| | - Julie C Fitzgerald
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Courtney M Rowan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Aline B Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Amanda R Kolmar
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Katherine Irby
- Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - Sabrina Heidemann
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Central Michigan University, Detroit, MI
| | - Stephanie P Schwartz
- Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, NC
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Hillary Crandall
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT
| | - Kevin M Havlin
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Louisville, and Norton Children's Hospital, Louisville, KY
| | - Aalok R Singh
- Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Jennifer E Schuster
- Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO
| | - Mark W Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Kari A Wellnitz
- Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Mia Maamari
- Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Health Medical Center, Dallas, TX
| | - Mary G Gaspers
- Department of Pediatrics and Banner Children's at Diamond Children's Medical Center, University of Arizona, Tucson, AZ
| | - Ryan A Nofziger
- Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, OH
| | - Peter Paul C Lim
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Ryan W Carroll
- Division of Pediatric Critical Care Medicine, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA
| | - Alvaro Coronado Munoz
- Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX
| | - Tamara T Bradford
- Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans, LA
| | - Melissa L Cullimore
- Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Gwenn E McLaughlin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL
| | - Pia S Pannaraj
- Division of Infectious Diseases, Children's Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CA
| | - Natalie Z Cvijanovich
- Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Matt S Zinter
- Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California San Francisco, San Francisco, CA
| | - Bria M Coates
- Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Steven M Horwitz
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Charlotte V Hobbs
- Department of Pediatrics, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS
| | - Heda Dapul
- Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, NY
| | - Ana Lia Graciano
- Department of Pediatrics, Division of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew D Butler
- Division of Pediatric Critical Care, St. Christopher's Hospital for Children, Philadelphia, PA
| | - Manish M Patel
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Laura D Zambrano
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Angela P Campbell
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
- Departments of Anesthesia and Pediatrics, Harvard Medical School, Boston, MA
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Racial Disparities and Common Respiratory Infectious Diseases in Children of the United States: A Systematic Review and Meta-Analysis. Diseases 2023; 11:diseases11010023. [PMID: 36810537 PMCID: PMC9944874 DOI: 10.3390/diseases11010023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Due to the lack of sufficient data on the relationship between racial disparities and the occurrence of infectious respiratory diseases in children, the aim of this systematic review and meta-analysis is to evaluate the presence of racial gaps in the occurrence of respiratory infectious diseases in children. This study follows the PRISMA flow guidelines for systematic reviews and the standards of meta-analysis for 20 quantitative studies conducted from 2016 to 2022 including 2,184,407 participants. As evidenced from the review, in the U.S., racial disparities are present among children, with Hispanic and Black children carrying the burden of infectious respiratory disease occurrence. Several factors are contributory to these outcomes among Hispanic and Black children, including higher rates of poverty; higher rates of chronic conditions, such as asthma and obesity; and seeking care outside of the home. However, vaccinations can be used to reduce the risk of infection among Black and Hispanic children. Whether a child is very young or a teen, racial disparities are present in occurrence rates of infectious respiratory diseases, with the burden resting among minorities. Therefore, it is important for parents to be aware of the risk of infectious diseases and to be aware of resources, such as vaccines.
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Kocivnik N, Velnar T. A Review Pertaining to SARS-CoV-2 and Autoimmune Diseases: What Is the Connection? LIFE (BASEL, SWITZERLAND) 2022; 12:life12111918. [PMID: 36431053 PMCID: PMC9698792 DOI: 10.3390/life12111918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious viral disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It is known that infection with SARS-CoV-2 can lead to various autoimmune and autoinflammatory diseases. There are few reports in the literature on the association between SARS-CoV-2 and autoimmune diseases, and the number of reports has been increasing since 2020. Autoimmune diseases and SARS-CoV-2 infections are intertwined in several ways. Both conditions lead to immune-mediated tissue damage, the immune response is accompanied by the increased secretion of inflammatory cytokines and both conditions can be treated using immunomodulatory drugs. Patients with certain autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, type 1 diabetes, cardiac sarcoidosis, idiopathic pulmonary fibrosis, autoimmune hepatitis, multiple sclerosis and others, are more susceptible to SARS-CoV-2 infection, either because of the active autoimmune disease or because of the medications used to treat it. Conversely, SARS-CoV-2 infection can also cause certain autoimmune diseases. In this paper, we describe the development of autoimmune diseases after COVID-19 and the recovery from COVID-19 in people with autoimmune diseases.
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Affiliation(s)
- Nina Kocivnik
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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