1
|
Spreco A, Andersson C, Sjödahl R, Niward K. 60-day mortality and the role of SARS-CoV-2 in hospital admissions of immunocompromised patients during later Omicron period: a population-based study in Sweden. Infect Dis (Lond) 2025; 57:561-573. [PMID: 39955754 DOI: 10.1080/23744235.2025.2465828] [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: 10/09/2024] [Revised: 01/17/2025] [Accepted: 02/05/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND Real-world data on hospitalised SARS-CoV-2-positive patients are important for post-pandemic preventive measures. OBJECTIVES This study aims to explore 60-day mortality of immunocompromised patients hospitalised in later Omicron period, accounting for the relevance of COVID-19 for hospital care. METHODS A retrospective population-based cohort study in Östergötland County, Sweden, included all adult patients with a positive SARS-CoV-2 PCR test within 3 weeks of hospital admission. Clinical data including functional level (combined assessment of frailty and performance status), and COVID-19's impact on hospital care were collected from medical records. An adjusted binary logistic regression model was applied for the main outcome of 60-day COVID-19-related mortality, with immunosuppression as the main exposure. RESULTS 1128 hospitalised SARS-CoV-2-positive patients were included in the analysis whereof 12.9% were immunocompromised. Hospital admission due to COVID-19 was significantly more common among immunocompromised than non-immunocompromised (71.9% vs 49.5%), and 60-day COVID-19 mortality was 10.5% and 8.0% (p = 0.41), respectively. The median age of patients hospitalised due to COVID-19 was 78 years, with most having low/very low functional levels and ≥3 comorbidities. Adjusted for possible confounders, immunosuppression showed a significantly increased risk of 60-day COVID-19-related mortality (OR 2.41, 95% CI 1.06-5.47, p = 0.04). CONCLUSION A majority of COVID-19-related hospitalisations during later Omicron period in a high immunity population, involved people over 70 years with low/very low functional levels and multiple comorbidities. Immunocompromised patients had a 2.5 times higher risk of 60-day COVID-19-related mortality. These findings underscore the need for targeted preventive measures in vulnerable elderly and immunocompromised populations to mitigate COVID-19-related hospitalisations and deaths.
Collapse
Affiliation(s)
- Armin Spreco
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
- Regional Executive Office, Region Östergötland, Linköping, Sweden
| | - Christer Andersson
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
- Regional Executive Office, Region Östergötland, Linköping, Sweden
| | - Rune Sjödahl
- Regional Executive Office, Region Östergötland, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katarina Niward
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| |
Collapse
|
2
|
Newnham EA, Mergelsberg ELP, Stanley S, Hood S, Tearne J, Celenza A, Stevenson T, Mavaddat N, Demore G, Kavanagh H, McEvoy PM. A longitudinal study of healthcare workers' mental health during Western Australia's unique policy response to COVID-19. BJPsych Open 2024; 10:e222. [PMID: 39635774 PMCID: PMC11698194 DOI: 10.1192/bjo.2024.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/12/2024] [Accepted: 09/19/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Western Australia's response to the COVID-19 pandemic was swift and effective in implementing public health protections and preventing the spread of the virus for the first 2 years. However, healthcare staff continued to be at increased risk of mental health concerns. AIMS To investigate the longitudinal patterns of post-traumatic stress symptoms (PTSS), depression and anxiety among healthcare workers in Western Australia, and the risk and protective factors associated with changes in status during the first wave. METHOD Participants comprised 183 healthcare staff working at tertiary hospitals and major clinics across Perth, for whom longitudinal data were available. Questionnaire data were collected before Western Australia's first major COVID-19 community wave in early 2022 and following the first wave in late 2022. Online surveys comprised validated measures assessing psychological symptoms, risk and protective factors, and original measures of workplace factors. RESULTS Overall rates of PTSS, depression and anxiety remained stable across the two assessment points. However, latent growth models revealed that those with lower PTSS, depression or anxiety symptoms at baseline reported a larger increase in symptoms over time, and those with higher symptoms at baseline had a smaller decline over time, indicating a 'catch-up' effect. Workplace stressors, sleep difficulties and trauma exposure were key risk factors for changes in psychological symptoms from baseline, and workplace and social supports played protective roles. CONCLUSIONS Improvements in systemic workplace factors are needed to support healthcare workers' mental health during periods of acute stress, even in settings with high levels of emergency preparedness.
Collapse
Affiliation(s)
- Elizabeth A. Newnham
- School of Population Health, Curtin University, Australia; and Curtin enAble Institute, Perth, Australia
| | | | - Susanne Stanley
- Division of Psychiatry, School of Medicine, The University of Western Australia, Australia
| | - Sean Hood
- Division of Psychiatry, School of Medicine, The University of Western Australia, Australia; and Sir Charles Gairdner Hospital Mental Health Unit, North Metropolitan Health Service Mental Health, Public Health and Dental Services (MHPHDS), Perth, Australia
| | - Jessica Tearne
- State Major Trauma Unit, Royal Perth Hospital, Perth, Australia; and Department of Clinical Psychology and Clinical Neuropsychology, Fiona Stanley Hospital, Perth, Australia
| | - Antonio Celenza
- Emergency Department, Sir Charles Gairdner Hospital, Perth, Australia; and Emergency Medicine Division, School of Medicine, The University of Western Australia, Australia
| | - Teresa Stevenson
- Rockingham Peel Group Mental Health Services, Rockingham, Australia
| | - Nahal Mavaddat
- Discipline of General Practice, School of Medicine, The University of Western Australia, Australia
| | - Gavin Demore
- Emergency Medicine Division, School of Medicine, The University of Western Australia, Australia; and Western Australia Country Health Service, Perth, Australia
| | - Hyranthi Kavanagh
- Department of Clinical Psychology and Clinical Neuropsychology, Fiona Stanley Hospital, Perth, Australia
| | - Peter M. McEvoy
- School of Population Health, Curtin University, Australia; Curtin enAble Institute, Perth, Australia; and Centre for Clinical Interventions, North Metropolitan Health Service, Perth, Australia
| |
Collapse
|
3
|
Lyeo JS, Liberda EN, Ahmed F, Charania NA, Moriarity RJ, Tsuji LJ, White JP, Zuk AM, Spence ND. Recognising the heterogeneity of Indigenous Peoples during the COVID-19 pandemic: a scoping review across Canada, Australia, New Zealand and the USA. BMJ PUBLIC HEALTH 2024; 2:e001341. [PMID: 40018612 PMCID: PMC11816692 DOI: 10.1136/bmjph-2024-001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 11/11/2024] [Indexed: 03/01/2025]
Abstract
Objectives The COVID-19 pandemic has had a disproportionate impact on the health of Indigenous Peoples in Canada, Australia, New Zealand and the USA, as reflected in the growing literature. However, Indigenous Peoples are often homogenised, with key differences often overlooked, failing to capture the complexity of issues and may lead to suboptimal public health policy-making. The objective of this review was to assess the extent to which the heterogeneity of the Indigenous Peoples in Canada, Australia, New Zealand and the USA has been reflected in COVID-19 research. Design This study took the form of a scoping review. Data sources Medline, Embase, CINAHL and Web of Science were searched for studies investigating COVID-19 pandemic outcomes among Indigenous Peoples in Canada, Australia, New Zealand and the USA. The search dates included January 2019 to January 2024. Eligibility criteria All citations yielded by this search were subjected to title and abstract screening, full-text review and data extraction. We included original, peer-reviewed research investigating COVID-19-related outcomes among Indigenous Peoples in Canada, Australia, New Zealand or the USA. Data extraction and synthesis Data extraction was conducted as an iterative process, reaching consensus between two of the study authors. All included studies were analysed through a combination of quantitative descriptive summary and qualitative thematic analysis. Results Of the 9795 citations found by the initial search, 428 citations were deemed eligible for inclusion. Of these citations: 72.9% compared Indigenous participants to non-Indigenous participants; 10.0% aggregated Indigenous and non-white participants; and 17.1% provided findings for Indigenous participants exclusively. Conclusions By overlooking the heterogeneity that exists among Indigenous Peoples in Canada, Australia, New Zealand and the USA, researchers and policy-makers run the risk of masking inequities and the unique needs of groups of Indigenous Peoples. This may lead to inefficient policy recommendations and unintentionally perpetuate health disparities during public health crises.
Collapse
Affiliation(s)
- Joonsoo Sean Lyeo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eric N Liberda
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Fatima Ahmed
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Nadia A Charania
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
| | - Robert J Moriarity
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Leonard J Tsuji
- Department of Health and Society, University of Toronto, Toronto, Ontario, Canada
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jerry P White
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Aleksandra M Zuk
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, Ontario, Canada
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Nicholas D Spence
- Department of Health and Society, University of Toronto, Toronto, Ontario, Canada
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Law L, Lo WJ, House C, Rawlins M, Boan P, Musk M. The Western Australian experience of COVID-19 after the borders reopened: evaluation of public health modelling predictions. Intern Med J 2024; 54:234-241. [PMID: 38064419 DOI: 10.1111/imj.16299] [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: 08/21/2023] [Accepted: 11/18/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Western Australia (WA) serves as a unique global case study on the impact of coronavirus disease 2019 (COVID-19) on an isolated, prepared and highly vaccinated population. This study builds upon the study performed by House et al. through an extended data set. AIM To examine the impact of COVID-19 at the only quaternary hospital in WA following the border opening from 3 March to 17 July 2022. PARTICIPANTS A total of 257 adults were admitted with COVID-19 under either respiratory or the intensive care unit (ICU). OUTCOMES Admission numbers, disease severity, ICU admission, prevalence of COVID-19 deterioration risk factors, length of stay and mortality. RESULTS A total of 257 patients were admitted with COVID-19, under respiratory (81.7%) and ICU (18.3%). COVID-19 was the primary reason for admission for 67.7%. Ten patients died during the study, with seven deaths attributed to COVID pneumonitis. COVID-19 severity was 37.4% mild, 37.0% moderate, 18.3% severe and 7.4% critical. Risk factors for requiring ICU included incomplete immunisation status (P = 0.011), chronic kidney disease (P = 0.008) and Aboriginal and Torres Strait Islander (ATSI) ethnicity. The WA Department of Health predicted that the number of hospitalisations and ICU cases were significantly higher than the actual number of cases. CONCLUSION The number of hospitalisations and ICU COVID-19 cases were significantly less than predicted, likely due to high population vaccination rates prior to border opening. The main risk factors for COVID-19 severity were incomplete immunisation and ATSI ethnicity.
Collapse
Affiliation(s)
- Lynden Law
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Wei Juen Lo
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Caris House
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | - Peter Boan
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Michael Musk
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| |
Collapse
|