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Cortes-Ramirez J, Wilches-Vega J, Caicedo-Velasquez B, Paris-Pineda O, Sly P. Spatiotemporal hierarchical Bayesian analysis to identify factors associated with COVID-19 in suburban areas in Colombia. Heliyon 2024; 10:e30182. [PMID: 38707376 PMCID: PMC11068642 DOI: 10.1016/j.heliyon.2024.e30182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction The pandemic had a profound impact on the provision of health services in Cúcuta, Colombia where the neighbourhood-level risk of Covid-19 has not been investigated. Identifying the sociodemographic and environmental risk factors of Covid-19 in large cities is key to better estimate its morbidity risk and support health strategies targeting specific suburban areas. This study aims to identify the risk factors associated with the risk of Covid-19 in Cúcuta considering inter -spatial and temporal variations of the disease in the city's neighbourhoods between 2020 and 2022. Methods Age-adjusted rate of Covid-19 were calculated in each Cúcuta neighbourhood and each quarter between 2020 and 2022. A hierarchical spatial Bayesian model was used to estimate the risk of Covid-19 adjusting for socioenvironmental factors per neighbourhood across the study period. Two spatiotemporal specifications were compared (a nonparametric temporal trend; with and without space-time interaction). The posterior mean of the spatial and spatiotemporal effects was used to map the Covid-19 risk. Results There were 65,949 Covid-19 cases in the study period with a varying standardized Covid-19 rate that peaked in October-December 2020 and April-June 2021. Both models identified an association of the poverty and stringency indexes, education level and PM10 with Covid-19 although the best fit model with a space-time interaction estimated a strong association with the number of high-traffic roads only. The highest risk of Covid-19 was found in neighbourhoods in west, central, and east Cúcuta. Conclusions The number of high-traffic roads is the most important risk factor of Covid-19 infection in Cucuta. This indicator of mobility and connectivity overrules other socioenvironmental factors when Bayesian models include a space-time interaction. Bayesian spatial models are important tools to identify significant determinants of Covid-19 and identifying at-risk neighbourhoods in large cities. Further research is needed to establish causal links between these factors and Covid-19.
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Affiliation(s)
- J. Cortes-Ramirez
- Centre for Data Science. Queensland University of Technology, Australia
- Faculty of Medical and Health Sciences, University of Santander, Colombia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Australia
| | - J.D. Wilches-Vega
- Faculty of Medical and Health Sciences, University of Santander, Colombia
| | - B. Caicedo-Velasquez
- Epidemiology Research Group, Faculty of Public Health, University of Antioquia, Colombia
| | - O.M. Paris-Pineda
- Faculty of Medical and Health Sciences, University of Santander, Colombia
| | - P.D. Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Australia
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Brown RD, Pepper GV. The Uncontrollable Mortality Risk Hypothesis: Theoretical foundations and implications for public health. Evol Med Public Health 2024; 12:86-96. [PMID: 38807860 PMCID: PMC11132133 DOI: 10.1093/emph/eoae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
The 'Uncontrollable Mortality Risk Hypothesis' employs a behavioural ecological model of human health behaviours to explain the presence of social gradients in health. It states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviours. We outline the theoretical assumptions of the hypothesis and stress the importance of incorporating evolutionary perspectives into public health. We explain how measuring perceived uncontrollable mortality risk can contribute towards understanding socioeconomic disparities in preventative health behaviours. We emphasize the importance of addressing structural inequalities in risk exposure, and argue that public health interventions should consider the relationship between overall levels of mortality risk and health behaviours across domains. We suggest that measuring perceptions of uncontrollable mortality risk can capture the unanticipated health benefits of structural risk interventions, as well as help to assess the appropriateness of different intervention approaches.
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Affiliation(s)
- Richard D Brown
- Psychology Department, Northumbria University, Newcastle, UK
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Brown R, Pepper G. The Relationship Between Perceived Uncontrollable Mortality Risk and Health Effort: Replication, Secondary Analysis, and Mini Meta-analysis. Ann Behav Med 2024; 58:192-204. [PMID: 38190133 PMCID: PMC10858306 DOI: 10.1093/abm/kaad072] [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] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied. PURPOSE To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort. METHODS We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale-a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research. RESULTS PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort. CONCLUSIONS Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk.
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Affiliation(s)
- Richard Brown
- Psychology Department, Northumbria University, Newcastle, UK
| | - Gillian Pepper
- Psychology Department, Northumbria University, Newcastle, UK
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Fernández Villalobos NV, Marsall P, Torres Páez JC, Strömpl J, Gruber J, Lotto Batista M, Pohl D, Concha G, Frickmann H, de la Hoz Restrepo FP, Schneiderhan-Marra N, Krause G, Dulovic A, Strengert M, Kann S. Humoral immune response to SARS-CoV-2 and endemic coronaviruses in urban and indigenous children in Colombia. COMMUNICATIONS MEDICINE 2023; 3:151. [PMID: 37864073 PMCID: PMC10589283 DOI: 10.1038/s43856-023-00376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/29/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Although anti-SARS-CoV-2 humoral immune responses and epidemiology have been extensively studied, data gaps remain for certain populations such as indigenous people or children especially in low- and middle-income countries. To address this gap, we evaluated SARS-CoV-2 seroprevalence and humoral immunity towards the parental B.1 strain, local SARS-CoV-2 variants, and endemic coronaviruses in children from Colombia from March to April 2021. METHODS We performed a cross-sectional seroprevalence study with 80 children from Bogotá and expanded our analysis by comparing results with an independent observational study of 82 children from the Wiwa community living in the north-eastern Colombian territories. Antibody IgG titers towards SARS-CoV-2 and the endemic coronaviruses as well as ACE2 binding inhibition as a proxy for neutralization towards several SARS-CoV-2 variants were analyzed using two multiplex-based immunoassays. RESULTS While we find seroprevalence estimates of 21.3% in children from Bogotá, seroprevalence is higher with 34.1% in Wiwa children. We observe a robust induction of antibodies towards the surface-exposed spike protein, its S1-, S2- and receptor-binding-subdomains in all SARS-CoV-2 seropositive children. Only nucleocapsid-specific IgG is significantly lower in the indigenous participants. ACE2 binding inhibition is low for all SARS-CoV-2 variants examined. We observe a dominance of NL63 S1 IgG levels in urban and indigenous children which suggests an early exposure to this respiratory virus independent of living conditions and geographic location. SARS-CoV-2 seropositivity does not correlate with antibody levels towards any of the four endemic coronaviruses indicating the absence of cross-protective immunity. CONCLUSIONS Overall, antibody titers, but in particular ACE2 binding inhibition are low within Colombian samples, requiring further investigation to determine any potential clinical significance.
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Affiliation(s)
| | - Patrick Marsall
- Multiplex Immunoassays, NMI Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - Johanna Carolina Torres Páez
- Department of Epidemiology, PhD Programme, Helmholtz Centre for Infection Research (HZI), Braunschweig-Hannover, Germany
| | - Julia Strömpl
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Jens Gruber
- Multiplex Immunoassays, NMI Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - Martín Lotto Batista
- Department of Epidemiology, PhD Programme, Helmholtz Centre for Infection Research (HZI), Braunschweig-Hannover, Germany
- Global Health Resilience, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Daria Pohl
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Gustavo Concha
- Organization Wiwa Yugumaiun Bunkauanarrua Tayrona (OWYBT), Department Health Advocacy, Valledupar, Colombia
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | | | - Nicole Schneiderhan-Marra
- Multiplex Immunoassays, NMI Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Braunschweig-Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Alex Dulovic
- Multiplex Immunoassays, NMI Natural and Medical Sciences Institute at the University of Tübingen (NMI), Reutlingen, Germany
| | - Monika Strengert
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany.
| | - Simone Kann
- Medical Mission Institute, Würzburg, Germany
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Williams ME, Berl MM, Corn E, Ansusinha E, Arroyave-Wessel M, Zhang A, Cure C, Mulkey SB. Positive and negative effects of the COVID-19 pandemic on families of young children in rural Colombia and implications for child outcome research. Child Care Health Dev 2023; 49:825-833. [PMID: 37012218 PMCID: PMC10524562 DOI: 10.1111/cch.13120] [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] [Received: 09/07/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic has impacted the lives of children and families worldwide. The objective of this study is to examine exposures and impact of the COVID-19 pandemic on preschool-aged children and caregivers in the Atlántico region of Colombia. METHODS The COVID-19 Exposure and Family Impact Scales (CEFIS) questionnaire was administered in Fall 2021 to 63 caregivers of children in Sabanalarga, Colombia enrolled in a neurodevelopment study as healthy controls. The CEFIS assesses pandemic-related exposures/events and impact; higher scores indicate greater exposure and negative impact. Descriptive and correlation analyses among exposure and impact scores were conducted. RESULTS Caregivers reported a mean (standard deviation[SD]) of 11.1 (3.2) among 25 COVID-19-related exposures/events; most common types included stay-at-home orders, school closures, disruptions to living conditions and income loss. Total number of events was correlated with higher caregiver (P < .001) and child distress (P = .002). However, the mean (SD) impact score of 2.0 (0.6) suggests a trend toward more positive impact than negative. Caregivers reported improvements to sleep, exercise and family interactions. Some caregivers (n = 21) qualitatively reported negative effects including unemployment, fear/anxiety and inability to visit family, and positive effects such as unification, family closeness and spending more time with children. CONCLUSIONS This study highlights the importance of comprehensively exploring positive and negative impacts of COVID-19 and families' subsequent resilience and transformation. Using tools like the CEFIS, those seeking to mitigate negative impacts can contextualize data to better understand study outcomes and tailor services, resources and policy to families' unique needs. CEFIS data likely depend on timing, economic/public health resources and cultural values; future work should prioritize understanding the generalizability of CEFIS findings across samples.
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Affiliation(s)
| | - Madison M. Berl
- Children’s National Hospital, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | | | - Anqing Zhang
- Children’s National Hospital, Washington, DC, USA
| | | | - Sarah B. Mulkey
- Children’s National Hospital, Washington, DC, USA
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Bakkeli NZ. Predicting COVID-19 exposure risk perception using machine learning. BMC Public Health 2023; 23:1377. [PMID: 37464274 DOI: 10.1186/s12889-023-16236-z] [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: 07/12/2022] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Self-perceived exposure risk determines the likelihood of COVID-19 preventive measure compliance to a large extent and is among the most important predictors of mental health problems. Therefore, there is a need to systematically identify important predictors of such risks. This study aims to provide insight into forecasting and understanding risk perceptions and help to adjust interventions that target various social groups in different pandemic phases. METHODS This study was based on survey data collected from 5001 Norwegians in 2020 and 2021. Interpretable machine learning algorithms were used to predict perceived exposure risks. To detect the most important predictors, the models with best performance were chosen based on predictive errors and explained variances. Shapley additive values were used to examine individual heterogeneities, interpret feature impact and check interactions between the key predictors. RESULTS Gradient boosting machine exhibited the best model performance in this study (2020: RMSE=.93, MAE=.74, RSQ=.22; 2021: RMSE=.99, MAE=.77, RSQ=.12). The most influential predictors of perceived exposure risk were compliance with interventions, work-life conflict, age and gender. In 2020, work and occupation played a dominant role in predicting perceived risks whereas, in 2021, living and behavioural factors were among the most important predictors. Findings show large individual heterogeneities in feature importance based on people's sociodemographic backgrounds, work and living situations. CONCLUSION The findings provide insight into forecasting risk groups and contribute to the early detection of vulnerable people during the pandemic. This is useful for policymakers and stakeholders in developing timely interventions targeting different social groups. Future policies and interventions should be adapted to the needs of people with various life situations.
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Affiliation(s)
- Nan Zou Bakkeli
- Centre for Research on Pandemics & Society; Consumption Research Norway, Oslo Metropolitan University, P.O. Box 4, St Olavs Plass, Oslo, 0130, Norway.
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Ledesma JR, Isaac CR, Dowell SF, Blazes DL, Essix GV, Budeski K, Bell J, Nuzzo JB. Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure. BMJ Glob Health 2023; 8:e012203. [PMID: 37414431 PMCID: PMC10335545 DOI: 10.1136/bmjgh-2023-012203] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Previous studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials in surveillance system quality and demographics. Here, we address limitations of previous comparisons by exploring country-level relationships between pandemic preparedness measures and comparative mortality ratios (CMRs), a form of indirect age standardisation, of excess COVID-19 mortality. METHODS We indirectly age standardised excess COVID-19 mortality, from the Institute for Health Metrics and Evaluation modelling database, by comparing observed total excess mortality to an expected age-specific COVID-19 mortality rate from a reference country to derive CMRs. We then linked CMRs with data on country-level measures of pandemic preparedness from the Global Health Security (GHS) Index. These data were used as input into multivariable linear regression analyses that included income as a covariate and adjusted for multiple comparisons. We conducted a sensitivity analysis using excess mortality estimates from WHO and The Economist. RESULTS The GHS Index was negatively associated with excess COVID-19 CMRs (table 2; β= -0.21, 95% CI= -0.35 to -0.08). Greater capacities related to prevention (β= -0.11, 95% CI= -0.22 to -0.00), detection (β= -0.09, 95% CI= -0.19 to -0.00), response (β = -0.19, 95% CI= -0.36 to -0.01), international commitments (β= -0.17, 95% CI= -0.33 to -0.01) and risk environments (β= -0.30, 95% CI= -0.46 to -0.15) were each associated with lower CMRs. Results were not replicated using excess mortality models that rely more heavily on reported COVID-19 deaths (eg, WHO and The Economist). CONCLUSION The first direct comparison of COVID-19 excess mortality rates across countries accounting for under-reporting and age structure confirms that greater levels of preparedness were associated with lower excess COVID-19 mortality. Additional research is needed to confirm these relationships as more robust national-level data on COVID-19 impact become available.
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Affiliation(s)
- Jorge Ricardo Ledesma
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Scott F Dowell
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - David L Blazes
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | | | | | - Jennifer B Nuzzo
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Pandemic Center, Brown University School of Public Health, Providence, Rhode Island, USA
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Castañeda-Orjuela C, Hilarion Gaitan L, Diaz-Jimenez D, Cotes-Cantillo K, Garfield R. Maternal mortality in Colombia during the COVID-19 pandemic: time series and social inequities. BMJ Open 2023; 13:e064960. [PMID: 37015796 PMCID: PMC10083746 DOI: 10.1136/bmjopen-2022-064960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/26/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE The impact of the COVID-19 pandemic goes beyond morbidity and mortality from that disease. Increases in maternal mortality have also been described but have not been extensively studied to date. This study aimed to examine changes in maternal mortality and identify correlates and predictors of excess maternal mortality in Colombia during the pandemic. SETTING Analysis of data from the national epidemiological surveillance databases of Colombia (Sivigila). PARTICIPANTS Deaths among 6342 Colombian pregnant women who experienced complications associated with pregnancy, childbirth or the perperium during 2008-2020 were included in this study. For inequalities analysis, a subsample of 1055 women from this group who died in 2019 or 2020 years were analysed. METHODS We collected data from the national surveillance system (Sivigila) on maternal mortality. Analysis was carried out in two stages, starting with a time series modelling using the Box-Jenkins approach. Data from Sivigila for 2008-2019 were used to establish a baseline of expected mortality levels. Both simple and complex inequality metrics, with the maternal mortality ratios (MMRs), were then calculated using the Multidimensional Poverty Index as a socioeconomic proxy. RESULTS Maternal deaths in 2020 were 12.6% (95% CI -21.4% to 95.7%) higher than expected. These excess deaths were statistically significant in elevation for the months of July (97.4%, 95% CI 35.1% to 250.0%) and August (87.8%, 95% CI 30.5% to 220.8%). The MMR was nearly three times higher in the poorest municipalities compared with the most affluent communities in 2020. CONCLUSIONS The COVID-19 pandemic had considerable impact on maternal health, not only by leading to increased deaths, but also by increasing social health inequity. Barriers to access and usage of essential health services are a challenge to achieving health-related Sustainable Development Goals.
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Affiliation(s)
| | | | - Diana Diaz-Jimenez
- Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia
| | - Karol Cotes-Cantillo
- Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia
| | - Richard Garfield
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Choudhary R, Carter E, Monzon J, Stewart A, Slotnick J, Samayoa Jerez LL, Rodriguez Araujo DS, Zielinski-Gutierrez E, Suchdev PS. Sociodemographic Factors Associated with COVID-19 Vaccination among People in Guatemalan Municipalities. Vaccines (Basel) 2023; 11:745. [PMID: 37112656 PMCID: PMC10143355 DOI: 10.3390/vaccines11040745] [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: 03/06/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
The Republic of Guatemala's reported COVID-19 vaccination coverage is among the lowest in the Americas and there are limited studies describing the disparities in vaccine uptake within the country. We performed a cross-sectional ecological analysis using multi-level modeling to identify sociodemographic characteristics that were associated with low COVID-19 vaccination coverage among Guatemalan municipalities as of 30 November 2022. Municipalities with a higher proportion of people experiencing poverty (β = -0.25, 95% CI: -0.43--0.07) had lower vaccination coverage. Municipalities with a higher proportion of people who had received at least a primary education (β = 0.74, 95% CI: 0.38-1.08), children (β = 1.07, 95% CI: 0.36-1.77), people aged 60 years and older (β = 2.94, 95% CI: 1.70-4.12), and testing for SARS-CoV-2 infection (β = 0.25, 95% CI: 0.14-0.36) had higher vaccination coverage. In the simplified multivariable model, these factors explained 59.4% of the variation in COVID-19 vaccination coverage. Poverty remained significantly associated with low COVID-19 vaccination coverage in two subanalyses restricting the data to the time period of the highest national COVID-19-related death rate and to COVID-19 vaccination coverage only among those aged 60 years or older. Poverty is a key factor associated with low COVID-19 vaccination and focusing public health interventions in municipalities most affected by poverty may help address COVID-19 vaccination and health disparities in Guatemala.
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Affiliation(s)
- Rewa Choudhary
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Emily Carter
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Jose Monzon
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City 01015, Guatemala
| | - Allison Stewart
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City 01015, Guatemala
| | - Jennifer Slotnick
- U.S. Agency for International Development (USAID), Guatemala City 01016, Guatemala
| | | | | | - Emily Zielinski-Gutierrez
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City 01015, Guatemala
| | - Parminder S. Suchdev
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City 01015, Guatemala
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Qualitative assessment of the impacts of the COVID-19 pandemic on migration, access to healthcare, and social wellbeing among Venezuelan migrants and refugees in Colombia. J Migr Health 2023; 7:100187. [PMID: 37007283 PMCID: PMC10039780 DOI: 10.1016/j.jmh.2023.100187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/12/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023] Open
Abstract
Background Colombia hosts a large number of Venezuelan migrants and refugees who are uniquely vulnerable and have been markedly impacted by the COVID-19 pandemic. It is necessary to understand their experiences to inform future policy decisions both in Colombia and during disease outbreaks in other humanitarian contexts in the future. As part of a larger study focused on HIV among Venezuelans residing in Colombia, qualitative interviews were conducted to understand this population's experiences and access to healthcare. Methods Interviews were conducted with Venezuelan migrants and refugees as well as stakeholders such as care providers, humanitarian workers, and government officials. Interviews were recorded, transcribed, and coded using thematic content analysis. Select quotes were translated and edited for length and/or clarity. Results Venezuelan migrants and refugees reported high levels of housing instability, job instability, increased barriers to accessing healthcare, and complications in engaging in the HIV care continuum, among other impacts of the COVID-19 pandemic. Stakeholders reported complications in provision of care and obtaining medicines, difficulty maintaining contact with patients, increased discrimination and xenophobia targeting Venezuelan migrants and refugees, increased housing instability among Venezuelan migrants and refugees, and other impacts as a result of the COVID-19 pandemic. Conclusions This study demonstrates the unique impacts of the COVID-19 pandemic among Venezuelans residing in Colombia by both compounding extant vulnerabilities and introducing new challenges, such as high rates of eviction. Colombia has enacted increasingly inclusive migration policies for Venezuelan refugees and migrants within the country; findings from this study underscore the necessity for such policies both in and outside of the Colombian context.
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Irizar P, Pan D, Kapadia D, Bécares L, Sze S, Taylor H, Amele S, Kibuchi E, Divall P, Gray LJ, Nellums LB, Katikireddi SV, Pareek M. Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. EClinicalMedicine 2023; 57:101877. [PMID: 36969795 PMCID: PMC9986034 DOI: 10.1016/j.eclinm.2023.101877] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59-1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59-5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02-1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01-1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination. Funding ESRC:ES/W000849/1.
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Affiliation(s)
- Patricia Irizar
- School of Social Sciences, University of Manchester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, United Kingdom
| | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Harry Taylor
- School of Social Sciences, University of Manchester, United Kingdom
| | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Eliud Kibuchi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
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12
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Larsen T, Bosworth ML, Ayoubkhani D, Schofield R, Ali R, Khunti K, Walker AS, Glickman M, Harrison C, Nafilyan V. Inequalities in SARS-CoV-2 case rates by ethnicity, religion, measures of socioeconomic position, English proficiency, and self-reported disability: cohort study of 39 million people in England during the alpha and delta waves. BMJ MEDICINE 2023; 2:e000187. [PMID: 37063237 PMCID: PMC10568121 DOI: 10.1136/bmjmed-2022-000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 01/18/2023] [Indexed: 04/05/2023]
Abstract
Objective To examine sociodemographic inequalities in people with SARS-CoV-2 during the second (alpha) and third (delta) waves of the covid-19 pandemic. Design Retrospective, population based cohort study. Setting Resident population of England. Participants 39 006 194 people aged 10 years and older who were enumerated in the 2011 census, registered with the NHS, and alive on 1 September 2020. Main outcome measures Age standardised SARS-CoV-2 case rates (ie, the number of people who received a positive test result per 100 000 person weeks at risk) during the second wave (1 September 2020 to 22 May 2021) or third wave (23 May to 10 December 2021) of the pandemic. Age standardised rates were calculated by sociodemographic characteristics and adjusted rate ratios were estimated using generalised linear regression models with a Poisson distribution (models were adjusted for covariates including sex, age, geographical variables, and sociodemographic characteristics). Results During the study period, 5 767 584 people (14.8% of the study population) tested positive for SARS-CoV-2. In the second wave, the fully adjusted relative risks of having a positive test were highest for the Bangladeshi and Pakistani ethnic groups compared with the white British group, with rate ratios of 1.75 (95% confidence interval 1.73 to 1.77) and 1.69 (1.68 to 1.70), respectively. Muslim and Sikh religious groups had fully adjusted rate ratios of 1.51 (1.50 to 1.51) and 1.64 (1.63 to 1.66), respectively, compared with the Christian group. Greater area deprivation, disadvantaged socioeconomic position, living in a care home, and low English language proficiency were also associated with higher relative risk of having a positive test. However, the inequalities among groups varied over time. Being Christian, white British, without a disability, and from a more advantaged socioeconomic position were associated with increased relative risk of testing positive during the third wave. Conclusion Research is urgently needed to understand the large sociodemographic inequalities in SARS-CoV-2 case rates in order to inform policy interventions in future waves or pandemics.
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Affiliation(s)
- Tim Larsen
- Office for National Statistics, Newport, UK
| | | | | | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ann Sarah Walker
- Nuffield Department of Medicine, Univerity of Oxford, Oxford, UK
| | | | | | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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13
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Rodriguez-Villamizar LA, Marín D, Piñeros-Jiménez JG, Rojas-Sánchez OA, Serrano-Lomelin J, Herrera V. Intraurban Geographic and Socioeconomic Inequalities of Mortality in Four Cities in Colombia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:992. [PMID: 36673751 PMCID: PMC9859133 DOI: 10.3390/ijerph20020992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Mortality inequalities have been described across Latin American countries, but less is known about inequalities within cities, where most populations live. We aimed to identify geographic and socioeconomic inequalities in mortality within the urban areas of four main cities in Colombia. We analyzed mortality due to non-violent causes of diseases in adults between 2015 and 2019 using census sectors as unit of analysis in Barranquilla, Bogotá, Cali, and Medellín. We calculated smoothed Bayesian mortality rates as main health outcomes and used concentration indexes (CInd) for assessing inequalities using the multidimensional poverty index (MPI) as the socioeconomic measure. Moran eigenvector spatial filters were calculated to capture the spatial patterns of mortality and then used in multivariable models of the association between mortality rates and quintiles of MPI. Social inequalities were evident but not consistent across cities. The most disadvantaged groups showed the highest mortality rates in Cali. Geographic inequalities in mortality rates, regardless of the adults and poverty distribution, were identified in each city, suggesting that other social, environmental, or individual conditions are impacting the spatial distribution of mortality rates within the four cities.
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Affiliation(s)
| | - Diana Marín
- School of Medicine, Universidad Pontificia Bolivariana, Medellin 050031, Colombia
| | | | - Oscar Alberto Rojas-Sánchez
- Division of Public Health Research, Project Bank Team, National Institute of Health-INS Colombia, Bogotá 111321, Colombia
| | | | - Victor Herrera
- Department of Public Health, School of Medicine, Universidad Industrial de Santander, Bucaramanga 681012, Colombia
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14
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Brown R, Sillence E, Pepper G. A qualitative study of perceptions of control over potential causes of death and the sources of information that inform perceptions of risk. Health Psychol Behav Med 2022; 10:632-654. [PMID: 35923580 PMCID: PMC9341328 DOI: 10.1080/21642850.2022.2104284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Richard Brown
- Department of Psychology, Northumbria University, Newcastle, UK
| | | | - Gillian Pepper
- Department of Psychology, Northumbria University, Newcastle, UK
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15
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Area-level inequalities in Covid-19 outcomes in Brazil in 2020 and 2021: An analysis of 1,894,165 severe Covid-19 cases. Prev Med 2022; 164:107298. [PMID: 36220401 PMCID: PMC9547655 DOI: 10.1016/j.ypmed.2022.107298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022]
Abstract
The study aims to analyze inequalities in Covid-19 outcomes in Brazil in 2020/2021 according to the per capita Gross Domestic Product (pcGDP) of municipalities. All cases of Severe Acute Respiratory Syndrome (SARS) who were hospitalized or died, regardless of hospitalization, registered in Brazil in 2020 and 2021 were analyzed (n = 2,902,742), including those with a confirmed diagnosis of Covid-19 (n = 1,894,165). We calculated lethality due to Covid-19, the performance of diagnostic tests among patients with SARS, and the hospital care received by those with Covid-19 according to the pcGDP of the patients' municipalities of residence. Data were analyzed for each epidemiological week and the risk of each outcome was estimated using Poisson regression. Municipalities in the lowest pcGDP decile had (i) 30% (95%CI 28%-32%) higher lethality from Covid-19, (ii) three times higher proportion of patients with SARS without the collection of biological material for the diagnosis of Covid-19, (iii) 16% (95%CI 15%-16%) higher proportion of SARS patients testing in a period longer than two days from the onset of symptoms, (iv) 140% (95%CI 134%-145%) higher absence of CT scan use. There is deep socioeconomic inequality among Brazilian municipalities regarding the occurrence of Covid-19 negative outcomes.
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Valderrama-Beltrán SL, Cuervo-Rojas J, Ariza B, Cardozo C, Ángel J, Martinez-Vernaza S, Juliana Soto M, Arcila J, Salgado D, Rondón M, Cepeda M, Castellanos JC, Gómez-Restrepo C, Franco MA. Cumulative incidence, prevalence, seroconversion, and associated factors for SARS-CoV-2 infection among healthcare workers of a University Hospital in Bogotá, Colombia. PLoS One 2022; 17:e0274484. [PMID: 36121816 PMCID: PMC9484677 DOI: 10.1371/journal.pone.0274484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to determine the cumulative incidence, prevalence, and seroconversion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its associated factors among healthcare workers (HCWs) of a University Hospital in Bogotá, Colombia. An ambispective cohort was established from March 2020 to February 2021. From November 2020 to February 2021, SARS-CoV-2 antibodies were measured on two occasions 14–90 days apart to determine seroprevalence and seroconversion. We used multivariate log-binomial regression to evaluate factors associated with SARS-CoV-2 infection. Among 2,597 HCWs, the cumulative incidence of infection was 35.7%, and seroprevalence was 21.5%. A reduced risk of infection was observed among those aged 35–44 and ≥45 years (adjusted relative risks [aRRs], 0.84 and 0.83, respectively), physicians (aRR, 0.77), those wearing N95 respirators (aRR, 0.82) and working remotely (aRR, 0.74). Being overweight (aRR, 1.18) or obese (aRR, 1.24); being a nurse or nurse assistant (aRR, 1.20); working in the emergency room (aRR, 1.45), general wards (aRR, 1.45), intensive care unit (aRR, 1.34), or COVID-19 areas (aRR, 1.17); and close contact with COVID-19 cases (aRR, 1.47) increased the risk of infection. The incidence of SARS-CoV-2 infection found in this study reflects the dynamics of the first year of the pandemic in Bogotá. A high burden of infection calls for strengthening prevention and screening measures for HCWs, focusing especially on those at high risk.
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Affiliation(s)
- Sandra Liliana Valderrama-Beltrán
- PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Infectious Diseases Research Group, Bogotá, Colombia
- * E-mail: (SLVB); (MAF)
| | - Juliana Cuervo-Rojas
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Beatriz Ariza
- Clinical Laboratory Science Research Group, Clinical Laboratory, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Claudia Cardozo
- Clinical Laboratory Science Research Group, Clinical Laboratory, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juana Ángel
- Institute of Human Genetics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Samuel Martinez-Vernaza
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Infectious Diseases Research Group, Bogotá, Colombia
| | - María Juliana Soto
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Infectious Diseases Research Group, Bogotá, Colombia
| | - Julieth Arcila
- Clinical Laboratory Science Research Group, Clinical Laboratory, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Diana Salgado
- Clinical Laboratory Science Research Group, Clinical Laboratory, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Martín Rondón
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Julio Cesar Castellanos
- Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Manuel Antonio Franco
- Institute of Human Genetics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- * E-mail: (SLVB); (MAF)
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Montenegro-Hoyos AC, Muñoz-Carvajal EA, Wallberg BN, Seguel ME, Rosales SA, Viña-Trillos NA, Torres-Avilés DS, Villarroel AE, Gaymer CF, Squeo FA. Biodiversity in Times of COVID-19 and its Relationship with the Socio-Economic and Health Context: A Look from the Digital Media. ENVIRONMENTAL MANAGEMENT 2022; 70:369-380. [PMID: 35739401 PMCID: PMC9225815 DOI: 10.1007/s00267-022-01674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has caused a pause in people's activities and a socio-economic crisis worldwide due to confinement. This situation is an unprecedented opportunity to understand how these changes may impact biodiversity and its conservation, as well as to study human-nature interaction. Biodiversity plays an essential role in conservation and economic activities, and in countries with greater inequality and low gross domestic product (GDP), biodiversity could have a low priority. Moreover, how biodiversity is prioritized in a society impacts how the citizens view it, and digital news tends to shape biodiversity narratives. The aim of this work was to determine the main trends in biodiversity-related news categories during the COVID-19 pandemic in countries with terrestrial and marine hotspots and relate them to the socioeconomic and public health context of each country. For this, we searched for news on biodiversity and Covid-19 in the first 6 months of the pandemic and related them to GDP, Gini-index, deaths, and infections by Covid-19. Results showed that conservation, public policies, and use of natural resources stood out as the main news categories across countries, with a positive narrative and mostly related to terrestrial rather than marine environments. On the other hand, the socio-economic and public health characteristics of each country had an influence on which aspect of the biodiversity was reflected in the media. For example, countries with greater inequality were associated with tourism news, additionally, countries with low GDP, high cases, and deaths by Covid-19 were associated with news about cultural diversity. In contrast, countries with high GDP and low inequality were associated with news about zoonosis, research and development, public policies, and alien and invasive species.
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Affiliation(s)
- Angie C Montenegro-Hoyos
- Departamento de Biología, Facultad de Ciencias, Universidad de La Serena, La Serena, Chile.
- División de Ecología Vegetal-Centro de Ornitología y Biodiversidad (CORBIDI), Lima, Perú.
- Instituto de Ecología y Biodiversidad (IEB), La Serena, Chile.
| | - Eduardo A Muñoz-Carvajal
- Departamento de Biología, Facultad de Ciencias, Universidad de La Serena, La Serena, Chile
- Centro de Estudios Avanzados en Zonas Áridas (CEAZA), La Serena, Chile
| | - Britt N Wallberg
- Departamento de Biología, Facultad de Ciencias, Universidad de La Serena, La Serena, Chile
- Instituto de Ecología y Biodiversidad (IEB), La Serena, Chile
| | - Mylene E Seguel
- Departamento de Biología Marina, Facultad de Ciencias del Mar, Universidad Católica del Norte, Coquimbo, Chile
| | - Sergio A Rosales
- Departamento de Biología Marina, Facultad de Ciencias del Mar, Universidad Católica del Norte, Coquimbo, Chile
| | - Natalia A Viña-Trillos
- Departamento de Ecología, Facultad de Ciencias, Universidad Católica de la Santísima Concepción. Casilla 297, Concepción, Chile
- Programa de Doctorado en Ciencias Mención Biodiversidad y Biorecursos, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Denisse S Torres-Avilés
- Departamento de Biología Marina, Facultad de Ciencias del Mar, Universidad Católica del Norte, Coquimbo, Chile
- Departamento de Repoblación y Cultivo, Instituto de Fomento Pesquero, Valparaíso, Chile
| | - Alejandro E Villarroel
- Departamento de Biología, Facultad de Ciencias, Universidad de La Serena, La Serena, Chile
- Instituto de Conservación, Biodiversidad y Territorio, Facultad de Ciencias Forestales y Recursos Naturales, Universidad Austral de Chile, Valdivia, Chile
| | - Carlos F Gaymer
- Centro de Estudios Avanzados en Zonas Áridas (CEAZA), La Serena, Chile
- Departamento de Biología Marina, Facultad de Ciencias del Mar, Universidad Católica del Norte, Coquimbo, Chile
- Millennium Nucleus for Ecology and Sustainable Management of Oceanic Islands (ESMOI), Coquimbo, Chile
| | - Francisco A Squeo
- Departamento de Biología, Facultad de Ciencias, Universidad de La Serena, La Serena, Chile
- Instituto de Ecología y Biodiversidad (IEB), La Serena, Chile
- Centro de Estudios Avanzados en Zonas Áridas (CEAZA), La Serena, Chile
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18
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Schippers MC, Ioannidis JPA, Joffe AR. Aggressive measures, rising inequalities, and mass formation during the COVID-19 crisis: An overview and proposed way forward. Front Public Health 2022; 10:950965. [PMID: 36159300 PMCID: PMC9491114 DOI: 10.3389/fpubh.2022.950965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
A series of aggressive restrictive measures were adopted around the world in 2020-2022 to attempt to prevent SARS-CoV-2 from spreading. However, it has become increasingly clear the most aggressive (lockdown) response strategies may involve negative side-effects such as a steep increase in poverty, hunger, and inequalities. Several economic, educational, and health repercussions have fallen disproportionately on children, students, young workers, and especially on groups with pre-existing inequalities such as low-income families, ethnic minorities, and women. This has led to a vicious cycle of rising inequalities and health issues. For example, educational and financial security decreased along with rising unemployment and loss of life purpose. Domestic violence surged due to dysfunctional families being forced to spend more time with each other. In the current narrative and scoping review, we describe macro-dynamics that are taking place because of aggressive public health policies and psychological tactics to influence public behavior, such as mass formation and crowd behavior. Coupled with the effect of inequalities, we describe how these factors can interact toward aggravating ripple effects. In light of evidence regarding the health, economic and social costs, that likely far outweigh potential benefits, the authors suggest that, first, where applicable, aggressive lockdown policies should be reversed and their re-adoption in the future should be avoided. If measures are needed, these should be non-disruptive. Second, it is important to assess dispassionately the damage done by aggressive measures and offer ways to alleviate the burden and long-term effects. Third, the structures in place that have led to counterproductive policies should be assessed and ways should be sought to optimize decision-making, such as counteracting groupthink and increasing the level of reflexivity. Finally, a package of scalable positive psychology interventions is suggested to counteract the damage done and improve humanity's prospects.
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Affiliation(s)
- Michaéla C. Schippers
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands,*Correspondence: Michaéla C. Schippers
| | - John P. A. Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, United States,Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States,Department of Statistics, Stanford University, Stanford, CA, United States,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, United States
| | - Ari R. Joffe
- Division of Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada,John Dossetor Health Ethics Center, University of Alberta, Edmonton, AB, Canada
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Mena G, Aburto JM. Unequal impact of the COVID-19 pandemic in 2020 on life expectancy across urban areas in Chile: a cross-sectional demographic study. BMJ Open 2022; 12:e059201. [PMID: 35985781 PMCID: PMC9395593 DOI: 10.1136/bmjopen-2021-059201] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To quantify the impact of the COVID-19 pandemic on life expectancy in Chile categorised by rural and urban areas, and to correlate life expectancy changes with socioeconomic factors at the municipal level. DESIGN Retrospective cross-sectional demographic analysis using aggregated national all-cause death data stratified by year, sex and municipality during the period 2010-2020. SETTING AND POPULATION Chilean population by age, sex and municipality from 2002 to 2020. MAIN OUTCOME MEASURES Stratified mortality rates using a Bayesian methodology. These were based on vital and demographic statistics from the national institute of statistics and department of vital statistics of ministry of health. With this, we assessed the unequal impact of the pandemic in 2020 on life expectancy across Chilean municipalities for males and females and analysed previous mortality trends since 2010. RESULTS Life expectancy declined for both males and females in 2020 compared with 2019. Urban areas were the most affected, with males losing 1.89 years and females 1.33 years. The strength of the decline in life expectancy correlated positively with indicators of social deprivation and poverty. Also, inequality in life expectancy between municipalities increased, largely due to excess mortality among the working-age population in socially disadvantaged municipalities. CONCLUSIONS Not only do people in poorer areas live shorter lives, they also have been substantially more affected by the COVID-19 pandemic, leading to increased population health inequalities. Quantifying the impact of the COVID-19 pandemic on life expectancy provides a more comprehensive picture of the toll.
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Affiliation(s)
- Gonzalo Mena
- Department of Statistics, Oxford University, Oxford, UK
| | - José Manuel Aburto
- Leverhulme Centre for Demographic Science and Nuffield College, University of Oxford, Oxford, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Inderdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
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Garzón-Orjuela N, Eslava-Schmalbach J, Gil F, Guarnizo-Herreño CC. Plan de seguro de salud: factor que más contribuye a las desigualdades en la mortalidad por COVID-19 en Colombia. Rev Panam Salud Publica 2022; 46:e78. [PMID: 35990530 PMCID: PMC9384892 DOI: 10.26633/rpsp.2022.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 12/04/2022] Open
Abstract
Objetivo. Cuantificar las desigualdades socioeconómicas en la mortalidad por COVID-19 en Colombia y evaluar en qué medida el tipo de seguro de salud, la carga de enfermedades concomitantes, la zona de residencia y el origen étnico explican estas desigualdades. Métodos. Se analizaron los datos de una cohorte retrospectiva de casos de COVID-19. Se estimó el índice relativo de desigualdad (IRD) y el índice de desigualdad basado en la pendiente (IDP) utilizando modelos de supervivencia con todos los participantes, y estratificándolos por edad y sexo. El porcentaje de reducción del IRD y el IDP se calculó después de ajustar con respecto a factores que podrían ser relevantes. Resultados. Se pusieron en evidencia desigualdades notables en toda la cohorte y en los subgrupos (edad y sexo). Las desigualdades fueron mayores en los adultos más jóvenes y disminuyeron de manera gradual con la edad, pasando de un IRD de 5,65 (intervalo de confianza de 95% [IC 95%] = 3,25-9,82) en los participantes menores de 25 años a un IRD de 1,49 (IC 95% = 1,41-1,58) en los mayores de 65 años. El tipo de seguro de salud fue el factor más importante, al cual se atribuyó 20% de las desigualdades relativas y 59% de las absolutas. Conclusiones. La mortalidad por COVID-19 en Colombia presenta importantes desigualdades socioeconómicas. El seguro de salud aparece como el factor que más contribuye a estas desigualdades, lo cual plantea retos al diseño de las estrategias de salud pública.
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Affiliation(s)
| | | | - Fabian Gil
- Pontificia Universidad Javeriana, Bogotá, Colombia
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21
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Ruiz-Gómez F, Fernández-Niño JA. La lucha contra la COVID-19: una perspectiva desde América Latina y el Caribe. Rev Panam Salud Publica 2022; 46:e60. [PMID: 35990521 PMCID: PMC9384896 DOI: 10.26633/rpsp.2022.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Julián Alfredo Fernández-Niño
- Director de Epidemiología y Demografía del Ministerio de Salud y Protección Social, Bogotá, Colombia; científico adjunto en el Departamento de Salud Internacional de la Escuela de Salud Pública Bloomberg (Universidad Johns Hopkins), Baltimore, Estados Unidos de América
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22
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Ruiz-Gómez F, Fernández-Niño JA. The Fight Against COVID-19: A Perspective From Latin America and the Caribbean. Am J Public Health 2022; 112:S576-S578. [PMID: 35977336 PMCID: PMC9382143 DOI: 10.2105/ajph.2022.306811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Fernando Ruiz-Gómez
- Fernando Ruiz-Gómez is the Colombian Minister of Health and Social Protection and Julián Alfredo Fernández-Niño is the Director of Epidemiology and Demography, Ministry of Health and Social Protection of Colombia, Bogotá D.C., Colombia. Julián Alfredo Fernández-Niño is also assistant scientist in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Julián Alfredo Fernández-Niño
- Fernando Ruiz-Gómez is the Colombian Minister of Health and Social Protection and Julián Alfredo Fernández-Niño is the Director of Epidemiology and Demography, Ministry of Health and Social Protection of Colombia, Bogotá D.C., Colombia. Julián Alfredo Fernández-Niño is also assistant scientist in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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23
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Garzón-Orjuela N, Eslava-Schmalbach J, Gil F, Guarnizo-Herreño CC. Health Insurance Scheme: Main Contributor to Inequalities in COVID-19 Mortality in Colombia. Am J Public Health 2022; 112:S586-S590. [PMID: 35977331 PMCID: PMC9382140 DOI: 10.2105/ajph.2021.306637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities. Methods. We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors. Results. We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively. Conclusions. Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insurance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies. (Am J Public Health. 2022;112(S6):S586-S590. https://doi.org/10.2105/AJPH.2021.306637).
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Affiliation(s)
- Nathaly Garzón-Orjuela
- Nathaly Garzón-Orjuela is with the Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia. Javier Eslava-Schmalbach is with the Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, and Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Fabian Gil is with the Clinical Epidemiology and Biostatistics Department, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia. Carol C. Guarnizo-Herreño is with the Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Javier Eslava-Schmalbach
- Nathaly Garzón-Orjuela is with the Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia. Javier Eslava-Schmalbach is with the Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, and Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Fabian Gil is with the Clinical Epidemiology and Biostatistics Department, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia. Carol C. Guarnizo-Herreño is with the Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Fabian Gil
- Nathaly Garzón-Orjuela is with the Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia. Javier Eslava-Schmalbach is with the Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, and Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Fabian Gil is with the Clinical Epidemiology and Biostatistics Department, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia. Carol C. Guarnizo-Herreño is with the Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Carol C Guarnizo-Herreño
- Nathaly Garzón-Orjuela is with the Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia. Javier Eslava-Schmalbach is with the Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, and Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Fabian Gil is with the Clinical Epidemiology and Biostatistics Department, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia. Carol C. Guarnizo-Herreño is with the Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
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24
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Maza-Arnedo F, Paternina-Caicedo A, Sosa CG, de Mucio B, Rojas-Suarez J, Say L, Cresswell JA, de Francisco LA, Serruya S, Lic DCFP, Urbina L, Hilaire ES, Munayco CV, Gil F, Rousselin E, Contreras L, Stefan A, Becerra AV, Degraff E, Espada F, Conde V, Mery G, Castaño VHÁ, Umbarila ALT, Romero ILT, Alfonso YCR, Lovato Silva R, Calle J, Díaz -Viscensini CM, Frutos VNB, Laguardia EV, Padilla H, Ciganda A, Colomar M. Maternal mortality linked to COVID-19 in Latin America: Results from a multi-country collaborative database of 447 deaths. LANCET REGIONAL HEALTH. AMERICAS 2022; 12:100269. [PMID: 35539820 PMCID: PMC9073212 DOI: 10.1016/j.lana.2022.100269] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background This study aimed to describe the clinical characteristics of maternal deaths associated with COVID-19 registered in a collaborative Latin-American multi-country database. Methods This was an observational study implemented from March 1st 2020 to November 29th 2021 in eight Latin American countries. Information was based on the Perinatal Information System from the Latin American Center for Perinatology, Women and Reproductive Health. We summarized categorical variables as frequencies and percentages and continuous variables into median with interquartile ranges. Findings We identified a total of 447 deaths. The median maternal age was 31 years. 86·4% of women were infected antepartum, with most of the cases (60·3%) detected in the third trimester of pregnancy. The most frequent symptoms at first consultation and admission were dyspnea (73·0%), fever (69·0%), and cough (59·0%). Organ dysfunction was reported in 90·4% of women during admission. A total of 64·8% women were admitted to critical care for a median length of eight days. In most cases, the death occurred during the puerperium, with a median of seven days between delivery and death. Preterm delivery was the most common perinatal complication (76·9%) and 59·9% were low birth weight. Interpretation This study describes the characteristics of maternal deaths in a comprehensive multi-country database in Latin America during the COVID-19 pandemic. Barriers faced by Latin American pregnant women to access intensive care services when required were also revealed. Decision-makers should strengthen severity awareness, and referral strategies to avoid potential delays. Funding Latin American Center for Perinatology, Women and Reproductive Health.
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Affiliation(s)
- Fabian Maza-Arnedo
- Grupo de Investigación en Cuidados Intensivos y Obstetricia (GRICIO), Universidad de Cartagena, Colombia
| | | | - Claudio G. Sosa
- Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Bremen de Mucio
- Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - José Rojas-Suarez
- Grupo de Investigación en Cuidados Intensivos y Obstetricia (GRICIO), Universidad de Cartagena, Colombia,Corporación Universitaria Rafael Núñez, Cartagena, Colombia
| | - Lale Say
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Jenny A. Cresswell
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Luis Andrés de Francisco
- Family, Health Promotion and Life Course (FPL), Pan American Health Organization-World Health Organization, United States
| | - Suzanne Serruya
- Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | | | | | - Erika Saint Hilaire
- San Lorenzo de Los Mina Children Maternity Hospital, Santo Domingo, Dominican Republic
| | - César V. Munayco
- National Epidemiology, Prevention, and Disease Control Center, Ministry of Health, Perú
| | - Fabiola Gil
- National Epidemiology, Prevention, and Disease Control Center, Ministry of Health, Perú
| | | | | | - Allan Stefan
- Dr Leonardo Martínez Valenzuela Hospital, San Pedro Sula, Honduras
| | | | | | | | | | - Gustavo Mery
- Family, Promotion and Life Course, PAHO Representation, Costa Rica
| | | | | | | | | | | | - Jakeline Calle
- Ministry of Public Health and Welfare, Asunción, Paraguay
| | | | | | | | | | - Alvaro Ciganda
- Clinical and Research Unit (UNICEM), Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay,Clinical and Research Unit (UNICEM), Montevideo, Uruguay,Corresponding author at: Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay.
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25
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An analysis of how health systems integrated priority-setting in the pandemic planning in a sample of Latin America and the Caribbean countries. Health Res Policy Syst 2022; 20:58. [PMID: 35642055 PMCID: PMC9153233 DOI: 10.1186/s12961-022-00861-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Latin America and the Caribbean (LAC) are among those regions most affected by the COVID-19 pandemic worldwide. The COVID-19 pandemic has strained health systems in the region. In this context of severe healthcare resource constraints, there is a need for systematic priority-setting to support decision-making which ensures the best use of resources while considering the needs of the most vulnerable groups. The aim of this paper was to provide a critical description and analysis of how health systems considered priority-setting in the COVID-19 response and preparedness plans of a sample of 14 LAC countries; and to identify the associated research gaps. METHODS A documentary analysis of COVID-19 preparedness and response plans was performed in a sample of 14 countries in the LAC region. We assessed the degree to which the documented priority-setting processes adhered to established quality indicators of effective priority-setting included in the Kapiriri and Martin framework. We conducted a descriptive analysis of the degree to which the reports addressed the quality parameters for each individual country, as well as a cross-country comparison to explore whether parameters varied according to independent variables. RESULTS While all plans were led and supported by the national governments, most included only a limited number of quality indicators for effective priority-setting. There was no systematic pattern between the number of quality indicators and the country's health system and political contexts; however, the countries that had the least number of quality indicators tended to be economically disadvantaged. CONCLUSION This study adds to the literature by providing the first descriptive analysis of the inclusion of priority-setting during a pandemic, using the case of COVID-19 response and preparedness plans in the LAC region. The analysis found that despite the strong evidence of political will and stakeholder participation, none of the plans presented a clear priority-setting process, or used a formal priority-setting framework, to define interventions, populations, geographical regions, healthcare setting or resources prioritized. There is need for case studies that analyse how priority-setting actually occurred during the COVID-19 pandemic and the degree to which the implementation reflected the plans and the parameters of effective priority-setting, as well as the impact of the prioritization processes on population health, with a focus on the most vulnerable groups.
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26
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Arregocés-Castillo L, Fernández-Niño J, Rojas-Botero M, Palacios-Clavijo A, Galvis-Pedraza M, Rincón-Medrano L, Pinto-Álvarez M, Ruiz-Gómez F, Trejo-Valdivia B. Effectiveness of COVID-19 vaccines in older adults in Colombia: a retrospective, population-based study of the ESPERANZA cohort. THE LANCET HEALTHY LONGEVITY 2022; 3:e242-e252. [PMID: 35340743 PMCID: PMC8937302 DOI: 10.1016/s2666-7568(22)00035-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Soto A, Quiñones-Laveriano DM, Azañero J, Chumpitaz R, Claros J, Salazar L, Rosales O, Nuñez L, Roca D, Alcantara A. Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital. PLoS One 2022; 17:e0264789. [PMID: 35235613 PMCID: PMC8890646 DOI: 10.1371/journal.pone.0264789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/16/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital. METHODS Retrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipólito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO2) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors. RESULTS We included 1418 patients. Median age was 58 years (IQR 47-68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4-13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02-1.03), history of surgery (HR 1.89; 95%CI 1.31-2.74), lower oxygen saturation at admission (HR 4.08; CI95% 2.72-8.05 for SaO2<70% compared to SaO2>94%), the presence of poor general condition (HR 1.81; 95% CI 1.29-2.53), altered state of consciousness (HR 1.58; 95%CI 1.18-2.11) and leukocyte levels (HR 1.01; 95%CI 1.00-1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18-1.76) and azithromycin (HR 1.25; 95%CI 1.03-1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37-0. 86) in comparison to no steroid use. CONCLUSION A high mortality was found in our cohort. Low oxygen saturation at admission, age, and the presence of hematological and biochemical alterations were associated with higher mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was probably associated with unfavorable outcomes. The use of corticosteroids at moderate doses was associated with lower mortality.
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Affiliation(s)
- Alonso Soto
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Dante M. Quiñones-Laveriano
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru
| | - Johan Azañero
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Rafael Chumpitaz
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - José Claros
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Lucia Salazar
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Oscar Rosales
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
| | - Liz Nuñez
- Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru
| | - David Roca
- Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru
| | - Andres Alcantara
- Departament of Internal Medicine, Hospital Nacional Hipólito Unanue, Lima, Peru
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Fernández-Niño JA. [La salud pública: más allá de la pandemia por COVID-19]. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:5-8. [PMID: 35471165 PMCID: PMC9033187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Indexed: 10/29/2022]
Affiliation(s)
- Julián Alfredo Fernández-Niño
- Director de Epidemiología y Demografía, Ministerio de Salud y Protección SocialMinisterio de Salud y Protección Social
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29
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Gaviria-Mendoza A, Mejía-Mazo DA, Duarte-Blandón C, Castrillón-Spitia JD, Machado-Duque ME, Valladales-Restrepo LF, Machado-Alba JE. Self-medication and the ‘infodemic’ during mandatory preventive isolation due to the COVID-19 pandemic. Ther Adv Drug Saf 2022; 13:20420986221072376. [PMID: 35237406 PMCID: PMC8882931 DOI: 10.1177/20420986221072376] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/16/2021] [Indexed: 12/23/2022] Open
Abstract
Aim: Quarantine due to the COVID-19 pandemic altered the supply and demand of
health services. This, together with the ‘infodemic’ and generalized panic,
could alter the patterns of self-medication in the population. The objective
was to characterize the patterns of self-medication in four cities of
Colombia during mandatory preventive isolation in 2020. Methods: This was a cross-sectional study done in four Colombian cities during
mandatory national preventive isolation between June and September 2020. A
sample of 397 adults who responded to an online survey, based on the
Instrument for Systematic Data Collection for Self-medication
(Instrumento de Recolección Sistemática de Datos para la
Automedicación–IRIS-AM), was obtained. The use of social
networks (including WhatsApp) as the source of information about medications
was explored. Results: The 397 people surveyed had a median age of 31.0 years, and 58.2% were women.
The prevalence of self-medication during lockdown was 34.3%
(n = 136). Medications targeting the nervous system
(n = 117; 86.0% of those participants with
self-medication) and the musculoskeletal system (n = 68;
50.0%) were the most commonly used. Ten (7.4%) of the self-medicated
patients reported doing so to prevent COVID-19, and 15 (11.0%) named social
networks as the source of information. Conclusion: More than one-third of the participants reported self-medication during
COVID-19 lockdown, mainly with analgesic-type nervous system medications.
People who reported self-medication to prevent COVID-19 often got their
information from social networks, the Internet, and WhatsApp. Plain Language Summary
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Affiliation(s)
- Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología
y Farmacovigilancia, Universidad Tecnológica de Pereira–Audifarma S.A.,
Pereira, Colombia Grupo de Investigación Biomedicina, Fundación
Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Danny Alberto Mejía-Mazo
- Grupo de Investigación en Farmacoepidemiología
y Farmacovigilancia, Universidad Tecnológica de Pereira–Audifarma S.A.,
Pereira, Colombia
| | - Carolina Duarte-Blandón
- Grupo de Investigación en Farmacoepidemiología
y Farmacovigilancia, Universidad Tecnológica de Pereira–Audifarma S.A.,
Pereira, Colombia
| | - Juan Daniel Castrillón-Spitia
- Grupo de Investigación en Farmacoepidemiología
y Farmacovigilancia, Universidad Tecnológica de Pereira–Audifarma S.A.,
Pereira, Colombia Grupo de Investigación Biomedicina, Fundación
Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Manuel Enrique Machado-Duque
- Grupo de Investigación en Farmacoepidemiología
y Farmacovigilancia, Universidad Tecnológica de Pereira–Audifarma S.A.,
Pereira, Colombia Grupo de Investigación Biomedicina, Fundación
Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología
y Farmacovigilancia, Universidad Tecnológica de Pereira–Audifarma S.A.,
Pereira, Colombia Grupo de Investigación Biomedicina, Fundación
Universitaria Autónoma de las Américas, Pereira, Colombia
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Lamichhane DK, Shrestha S, Kim HC. District-Level Risk Factors for COVID-19 Incidence and Mortality in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052659. [PMID: 35270351 PMCID: PMC8910479 DOI: 10.3390/ijerph19052659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
The recent global pandemic of the novel coronavirus disease 2019 (COVID-19) is affecting the entire population of Nepal, and the outcome of the epidemic varies from place to place. A district-level analysis was conducted to identify socio-demographic risk factors that drive the large variations in COVID-19 mortality and related health outcomes, as of 22 January 2021. Data on COVID-19 extracted from relevant reports and websites of the Ministry of Health and Population of Nepal, and the National Population and Housing Census and the Nepal Demographic and Health Survey were the main data sources for the district-level socio-demographic characteristics. We calculated the COVID-19 incidence, recovered cases, and deaths per 100,000 population, then estimated the associations with the risk factors using regression models. COVID-19 outcomes were positively associated with population density. A higher incidence of COVID-19 was associated with districts with a higher percentage of overcrowded households and without access to handwashing facilities. Adult literacy rate was negatively associated with the COVID-19 incidence. Increased mortality was significantly associated with a higher obesity prevalence in women and a higher smoking prevalence in men. Access to health care facilities reduced mortality. Population density was the most important driver behind the large variations in COVID-19 outcomes. This study identifies critical risk factors of COVID-19 outcomes, including population density, crowding, education, and hand hygiene, and these factors should be considered to address inequities in the burden of COVID-19 across districts.
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Affiliation(s)
- Dirga Kumar Lamichhane
- Department of Occupational and Environmental Medicine, School of Medicine, Inha University, Incheon 22212, Korea;
- Correspondence:
| | - Sabina Shrestha
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, School of Medicine, Inha University, Incheon 22212, Korea;
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Machine Learning-Based COVID-19 Patients Triage Algorithm Using Patient-Generated Health Data from Nationwide Multicenter Database. Infect Dis Ther 2022; 11:787-805. [PMID: 35174469 PMCID: PMC8853007 DOI: 10.1007/s40121-022-00600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction A prompt severity
assessment model of patients with confirmed infectious diseases could enable efficient diagnosis while alleviating burden on the medical system. This study aims to develop a SARS-CoV-2 severity assessment model and establish a medical system that allows patients to check the severity of their cases and informs them to visit the appropriate clinic center on the basis of past treatment data of other patients with similar severity levels. Methods This paper provides the development processes of a severity assessment model using machine learning techniques and its application on SARS-CoV-2-infected patients. The proposed model is trained on a nationwide data set provided by a Korean government agency and only requires patients’ basic personal data, allowing them to judge the severity of their own cases. After modeling, the boosting-based decision tree model was selected as the classifier while mortality rate was interpreted as the probability score. The data set was collected from all Korean citizens with confirmed COVID-19 between February 2020 and July 2021 (N = 149,471). Results The experiments achieved high model performance with an approximate precision of 0.923 and area under the curve of receiver operating characteristic (AUROC) score of 0.950 [95% tolerance interval (TI) 0.940–0.958, 95% confidence interval (CI) 0.949–0.950]. Moreover, our experiments identified the most important variables affecting the severity in the model via sensitivity analysis. Conclusion A prompt severity assessment model for managing infectious people has been attained through using a nationwide data set. It has demonstrated its superior performance by surpassing that of conventional risk assessments. With the model’s high performance and easily accessible features, the triage algorithm is expected to be particularly useful when patients monitor their health status by themselves through smartphone applications.
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Hernández-Vásquez A, Chavez-Ecos F, Barrenechea-Pulache A, Comandé D, Bendezu-Quispe G. Seroprevalence and lethality by SARS-CoV-2 in indigenous populations of Latin America and the Caribbean: a systematic review. PeerJ 2022; 9:e12552. [PMID: 35003919 PMCID: PMC8684739 DOI: 10.7717/peerj.12552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background Latin America and the Caribbean (LAC) has presented some of the highest numbers of cases and deaths due to COVID-19 in the world. Even though indigenous communities represent 8% of the total population in this region, the impact of COVID-19 on this historically vulnerable population has only been briefly explored. Thus, this study aimed to estimate the seroprevalence and lethality attributable to SARS-CoV-2 in the indigenous population of LAC. Methods A systematic review was conducted utilizing multiple databases (registry PROSPERO: CRD42020207862). Studies published in English, Spanish or Portuguese were selected between December 1st, 2019, and April 14th, 2021. The evaluation of the quality of the study was carried out utilizing the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A qualitative synthesis of the data analyzed was conducted following the MOOSE and PRISMA declarations. Results Fifteen studies met the inclusion criteria. Eleven studies were carried out in a Brazilian population, three in a Mexican population, and one in a Colombian population. Four studies reported data about the seroprevalence of SARS-CoV-2 in indigenous populations of Brazil (range: 4.2–81.65%). Twelve studies reported lethality in indigenous people (eight in Brazil, three in Mexico, and one in Colombia). In Brazil, a lethality of 53.30% was described in a hospital setting and between 1.83% and 4.03% in community studies. In Mexico, the lethality of COVID-19 ranged between 16.5% and 19.9%. Meanwhile, in Colombia, a lethality of 3.41% was reported. Most studies were deemed to be of good quality. Conclusions Despite COVID-19 affecting indigenous populations of LAC, there is limited evidence of the seroprevalence and lethality of the infection by SARS-CoV-2 in this population. Future investigations should ensure standardized methods that allow comparability among studies and ensure the precision of the results obtained.
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Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Fabian Chavez-Ecos
- Sociedad Científica de Estudiantes de Medicina de Ica, Universidad Nacional "San Luis Gonzaga", Ica, Peru
| | | | - Daniel Comandé
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Guido Bendezu-Quispe
- Centro de Investigación Epidemiológica en Salud Global, Universidad Privada Norbert Wiener, Lima, Peru
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Hennis AJM, Coates A, Del Pino S, Ghidinelli M, Gomez Ponce de Leon R, Bolastig E, Castellanos L, Oliveira E Souza R, Luciani S. COVID-19 and inequities in the Americas: lessons learned and implications for essential health services. Rev Panam Salud Publica 2022; 45:e130. [PMID: 34987555 PMCID: PMC8713468 DOI: 10.26633/rpsp.2021.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022] Open
Abstract
The COVID-19 pandemic has exacerbated social, economic, and health-related disparities, which disproportionately affect persons living in conditions of vulnerability. Such populations include ethnic groups who face discrimination and experience barriers to accessing comprehensive health care. The COVID-19 pandemic has exposed these health disparities, and disruptions of essential health services have further widened the gaps in access to health care. Noncommunicable diseases are more prevalent among groups most impacted by poor social determinants of health and have been associated with an increased likelihood of severe COVID-19 disease and higher mortality. Disruptions in the provision of essential health services for noncommunicable diseases, mental health, communicable diseases such as HIV, tuberculosis, and malaria, and maternal and child health services (including sexual and reproductive health), are projected to also increase poor health outcomes. Other challenges have been an increased frequency of interpersonal violence and food insecurity. Countries in the Americas have responded to the disruptions caused by the pandemic by means of health service delivery through telemedicine and other digital solutions and stepping up social service support interventions. As vaccinations for COVID-19 create the opportunity to overcome the pandemic, countries must strengthen primary health care and essential health services with a view to ensuring equity, if the region is to achieve universal health coverage in fulfillment of the Sustainable Development Goals.
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Affiliation(s)
- Anselm J M Hennis
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Anna Coates
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Sandra Del Pino
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Massimo Ghidinelli
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Rodolfo Gomez Ponce de Leon
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Edwin Bolastig
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Luis Castellanos
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Renato Oliveira E Souza
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Silvana Luciani
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
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Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022; 9:2227-2236. [PMID: 34581998 PMCID: PMC8477716 DOI: 10.1007/s40615-021-01162-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022]
Abstract
This study aimed to estimate the number of excess deaths among Indigenous Peoples associated with the COVID-19 pandemic in 2020 and to assess the disparities in excess mortality between Indigenous and non-Indigenous Brazilians. A time series analysis of weekly mortality data including all deaths from January 2015 to December 2020 was conducted. The number of expected deaths for 2020 was estimated using an over-dispersed Poisson model that accounts for demographic changes, temporal trends, and seasonal effects in mortality. Weekly excess deaths were calculated as the difference between the number of observed deaths and the expected deaths. Regional differences in Indigenous mortality were investigated. A significant increase in Indigenous mortality was observed from April 1 to December 31, 2020. An estimated 1149 (95% CI 1018-1281) excess deaths was found among Indigenous Brazilians in 2020, representing a 34.8% increase from the expected deaths for this population. The overall increase in non-Indigenous mortality was 18.1%. The Indigenous population living in the Brazilian Amazon area was the earliest-affected Indigenous group, with one of the highest proportional increases in mortality. Disparities in excess mortality revealed a disproportionate burden of COVID-19 among Indigenous Brazilians compared to their non-Indigenous counterparts. Findings highlight the importance of implementing an effective emergency plan that addresses the increased vulnerability of Indigenous Peoples to COVID-19.
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Gadeyne S, Rodriguez-Loureiro L, Surkyn J, Van Hemelrijck W, Nusselder W, Lusyne P, Vanthomme K. Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium. Int J Equity Health 2021; 20:258. [PMID: 34922557 PMCID: PMC8684273 DOI: 10.1186/s12939-021-01594-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were 'all in it together'. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. METHODS We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. RESULTS Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. CONCLUSION The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period.
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Affiliation(s)
- Sylvie Gadeyne
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Lucia Rodriguez-Loureiro
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Johan Surkyn
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Wanda Van Hemelrijck
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
- Netherlands Interdisciplinary Demographic Institute-KNAW/University of Groningen, Lange Houtstraat 19, The Hague, CV, NL-2511, The Netherlands
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, GD, 3015, The Netherlands
| | - Patrick Lusyne
- Statbel, Directorate General Statistics - Statistics Belgium, North Gate - Boulevard du Roi Albert II, 16 - 1000, Brussels, Belgium
| | - Katrien Vanthomme
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
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A decomposition analysis for socioeconomic inequalities in health status associated with the COVID-19 diagnosis and related symptoms during Brazil's first wave of infections ☆. ECONOMIA 2021; 22:251-264. [PMCID: PMC8483987 DOI: 10.1016/j.econ.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/28/2021] [Indexed: 10/28/2023]
Abstract
Recent studies have shown that COVID-19 affects different population groups asymmetrically. This work uses data from the National Survey of Households—PNAD COVID-19/IBGE—to quantify the socioeconomic inequality in health during the first wave of COVID-19 infections in Brazil. We use the concentration curve, the concentration index, and a decomposition analysis to verify the factors that most influence the inequalities in the specified health variables. We find a positive concentration index for the incidence rate, indicating a greater concentration of diagnoses (number of tests) among groups with higher income levels. When considering symptoms similar to a COVID-19 infection, inequality practically disappears. Among people with higher income, a pre-existing disease has a more significant contribution to the concentration of COVID-19 in the presence of correlated symptoms than in its diagnosis. Tests of dominance support the findings. Moreover, the decomposition results show that if the inequalities were explained only by race (non-white) and place of living (North and Northeast), there would be a concentration of COVID-19 among the poorest.
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Aburto JM. The Need for All-Cause Mortality Data to Aid Our Understanding of the COVID-19 Pandemic in Latin America. Am J Public Health 2021; 111:1721-1722. [PMID: 34554816 PMCID: PMC8561204 DOI: 10.2105/ajph.2021.306478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/04/2022]
Affiliation(s)
- José Manuel Aburto
- José Manuel Aburto is with the Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK, and the Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
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Varela AR, Florez LJH, Tamayo-Cabeza G, Contreras-Arrieta S, Restrepo SR, Laajaj R, Gutierrez GB, Guevara YPR, Caballero-Díaz Y, Florez MV, Osorio E, Barbieri IS, Sanchez DR, Nuñez LL, Bernal R, Oliveros SR, Zapata LS, Guevara-Suarez M, Uribe AG, Behrentz E. Factors Associated With SARS-CoV-2 Infection in Bogotá, Colombia: Results From a Large Epidemiological Surveillance Study. LANCET REGIONAL HEALTH. AMERICAS 2021; 2:100048. [PMID: 34458886 PMCID: PMC8382233 DOI: 10.1016/j.lana.2021.100048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Epidemiologic surveillance of COVID-19 is essential to collect and analyse data to improve public health decision making during the pandemic. There are few initiatives led by public-private alliances in Colombia and Latin America. The CoVIDA project contributed with RT-PCR tests for SARS-CoV-2 in mild or asymptomatic populations in Bogotá. The present study aimed to determine the factors associated with SARS-CoV-2 infection in working adults. METHODS COVID-19 intensified sentinel epidemiological surveillance study, from April 18, 2020, to March 29, 2021. The study included people aged 18 years or older without a history of COVID-19. Two main occupational groups were included: healthcare and essential services workers with high mobility in the city. Social, demographic, and health-related factors were collected via phone survey. Afterwards, the molecular test was conducted to detect SARS-CoV-2 infection. FINDINGS From the 58,638 participants included in the study, 3,310 (5·6%) had a positive result. A positive result was associated with the age group (18-29 years) compared with participants aged 60 or older, participants living with more than three cohabitants, living with a confirmed case, having no affiliation to the health system compared to those with social health security, reporting a very low socioeconomic status compared to those with higher socioeconomic status, and having essential occupations compared to healthcare workers. INTERPRETATION The CoVIDA study showed the importance of intensified epidemiological surveillance to identify groups with increased risk of infection. These groups should be prioritised in the screening, contact tracing, and vaccination strategies to mitigate the pandemic. FUNDING The CoVIDA study was funded through donors managed by the philanthropy department of Universidad de los Andes.
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Affiliation(s)
| | | | | | | | | | - Rachid Laajaj
- Department of Economics, Universidad de los Andes, Bogotá, Colombia
| | | | | | | | - Martha Vives Florez
- Department of Biological Sciences, Universidad de los Andes, Bogotá, Colombia
| | - Elkin Osorio
- Secretaría Distrital de Salud de Bogotá D.C, Colombia
| | | | | | | | - Raquel Bernal
- Department of Economics, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Marcela Guevara-Suarez
- Applied genomics research group, Vicerrectoría de Investigación y Creación, Universidad de los Andes, Bogotá, Colombia
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Direct and Indirect Proof of SARS-CoV-2 Infections in Indigenous Wiwa Communities in North-Eastern Colombia-A Cross-Sectional Assessment Providing Preliminary Surveillance Data. Vaccines (Basel) 2021; 9:vaccines9101120. [PMID: 34696227 PMCID: PMC8539650 DOI: 10.3390/vaccines9101120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 02/06/2023] Open
Abstract
To provide initial data on local SARS-CoV-2 epidemiology and spread in indigenous communities in north-eastern Colombia, respiratory swabs and serum samples from volunteers of indigenous communities were examined in March and April 2021. Samples from non-indigenous Colombians from the same villages were included as well. While previous exposure to SARS-CoV-2 was assessed by analysing serum samples for IgG and IgM with a rapid antibody point-of-care-test (POCT), screening for active infections was carried out with an antigen POCT test and real-time PCR from nasal swabs. In 380 indigenous and 72 non-indigenous volunteers, 61 (13.5%) active infections and an additional 113 (25%) previous infections were identified using diagnostic serology and molecular assays. Previous infections were more frequent in non-indigenous volunteers, and relevant associations of clinical features with active or previous SARS-CoV-2 infections were not observed. Symptoms reported were mild to moderate. SARS-CoV-2 was frequent in the assessed Colombian indigenous communities, as 38.5% of the study participants showed signs of exposure to SARS-CoV-2, which confirms the need to include these indigenous communities in screening and vaccination programs.
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Shultz JM, Berg RC, Bernal Acevedo OA, Ocampo Cañas JA, Escobar VAP, Muñoz O, Espinel Z, Uribe-Restrepo JM. Complex correlates of Colombia's COVID-19 surge. ACTA ACUST UNITED AC 2021; 3:100072. [PMID: 34541569 PMCID: PMC8432891 DOI: 10.1016/j.lana.2021.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Affiliation(s)
- James M Shultz
- Associate Professor, Educator Track, Director and Senior Fellow, Comprehensive Drug Research Center (CDRC) ,Director, Center for Disaster & Extreme Event Preparedness (DEEP Center), Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 Street Room 1507, Miami FL USA 33136
| | - Ryan C Berg
- Senior Fellow, Americas Program, Center for Strategic and International Studies (CSIS), Washington, DC
| | | | | | - Victoria A Pinilla Escobar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida 33136
| | - Omar Muñoz
- Jackson Memorial Medical Center, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA 33136
| | - Zelde Espinel
- Sylvester Comprehensive Cancer Center, Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA 33136
| | - José Miguel Uribe-Restrepo
- Associate Professor, Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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Oroszi B, Juhász A, Nagy C, Horváth JK, McKee M, Ádány R. Unequal burden of COVID-19 in Hungary: a geographical and socioeconomic analysis of the second wave of the pandemic. BMJ Glob Health 2021; 6:bmjgh-2021-006427. [PMID: 34518205 PMCID: PMC8438581 DOI: 10.1136/bmjgh-2021-006427] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/16/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction We describe COVID-19 morbidity, mortality, case fatality and excess death in a country-wide study of municipalities in Hungary, exploring the association with socioeconomic status. Methods The spatial distribution of morbidity, mortality and case fatality was mapped using hierarchical Bayesian smoothed indirectly standardised ratios. Indirectly standardised ratios were used to evaluate the association between deprivation and the outcome measures. We looked separately at morbidity and mortality in the 10 districts with the highest and 10 districts with the lowest share of Roma population. Results Compared with the national average, the relative incidence of cases was 30%–36% lower in the most deprived quintile but the relative mortality and case fatality were 27%–32% higher. Expressed as incidence ratios relative to the national average, the most deprived municipalities had a relative incidence ratio of 0.64 (CI: 0.62 to 0.65) and 0.70 (CI: 0.69 to 0.72) for males and females, respectively. The corresponding figures for mortality were 1.32 (CI: 1.20 to 1.44) for males and 1.27 (CI: 1.16 to 1.39) for females and for case fatality 1.27 (CI: 1.16 to 1.39) and 1.32 (CI: 1.20 to 1.44) for males and females, respectively. The excess death rate (per 100 000) increased with deprivation levels (least deprived: 114.12 (CI: 108.60 to 119.84) and most deprived: 158.07 (CI: 149.30 to 167.23)). The 10 districts where Roma formed the greatest share of the population had an excess mortality rate 17.46% higher than the average for the most deprived quintile. Conclusions Those living in more deprived municipalities had a lower risk of being identified as a confirmed COVID-19 case but had a higher risk of death. An inverse association between trends in morbidity and mortality by socioeconomic conditions should be a cause for concern and points to the need for responses, including those involving vaccination, to pay particular attention to inequalities and their causes.
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Affiliation(s)
- Beatrix Oroszi
- Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Attila Juhász
- Department of Public Health, Government Office of the Capital City Budapest, Budapest, Hungary
| | - Csilla Nagy
- Department of Public Health, Government Office of the Capital City Budapest, Budapest, Hungary
| | | | - Martin McKee
- European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, London, UK
| | - Róza Ádány
- MTA-DE-Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary .,Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Roy MP. Risk factors for Covid-19 in India. Monaldi Arch Chest Dis 2021; 92. [PMID: 34523326 DOI: 10.4081/monaldi.2021.1954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/09/2021] [Indexed: 01/08/2023] Open
Abstract
Like many developing countries, India was devastated by the raging pandemic of Covid 19. With the active involvement of the government and the community, the disaster was fought with. However, the impact was uneven across the country. The present study aimed to identify the factors responsible for variation in case burden of Covid-19. Data on demographic factors and co-morbidities were obtained from different sources available in the public domain. Descriptive statistics were used for comparison between states. A total of 30 states were taken into account. Correlation was used to find out association between different factors and the burden of Covid-19. Data on Covid were collected till 9th May, 2021. The burden of Covid-19 was strongly related to the literacy status and economy of the state (r = 0.574 and 0.730, respectively). The burden of self-reported hypertension and diabetes was also statistically linked to the burden of Covid-19 (r = 0.539 and 0.721, respectively). Overweight and obesity were also associated with the burden of Covid-19 (r = 0.614 and 0.561, respectively). Therefore, in areas with a high proportion of patients with co-morbidities, limited resources may be mobilized for a better outcome. As the states with poor literacy and health condition suffered the most. Tailored intervention is wanted to reach the poor and vulnerable.
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Affiliation(s)
- Manas Pratim Roy
- Public Health Specialist, Ministry of Health and Family Welfare, New Delhi.
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Roy MP. Factors associated with mortality from COVID 19: Indian perspective. Lung India 2021; 38:501-502. [PMID: 34472537 PMCID: PMC8509161 DOI: 10.4103/lungindia.lungindia_403_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Manas Pratim Roy
- Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India
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Rodríguez-Artalejo F, García-Esquinas E. Joy is short-lived in the house of the poor. J Epidemiol Community Health 2021; 75:608-609. [PMID: 33888554 DOI: 10.1136/jech-2021-216797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid-School of Medicine and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA Food, CEI UAM+CSIC, Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid-School of Medicine and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Méndez Paz F, Laura A. Rodríguez-Villamizar LA, Idrovo AJ. Fracking and glyphosate amid COVID-19 pandemic in Colombia. Rev Salud Publica (Bogota) 2021. [DOI: 10.15446/rsap.v23n1.96204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Despite the congratulations that Colombia received from the Pan American Health Organization for its good management during the first months of pandemic (1), supposedly for using scientific evidence for decision-making, the start of the fracking pilots (unconventional hydraulic fracturing procedure) and return to use glyphosate against illicit crops leaves glimpse inconsistencies in decision-making in public health by the Colombian government. The pandemic taught that environmental protection is essential to avoid the emergence of future epidemics (2). However, it is precisely in the midst of the pandemic that the Colombian government makes decisions without listening to science, ignoring the precautionary principle even against the national constitution.
As of the end of March 2021, two unconventional reservoir fracking pilot projects had been approved for development without a rigorous assessment of the potentially associated adverse health effects (3). These will be carried out in the department of Santander, the most seismically active department in Colombia (4). On the other hand, the government is making the return of glyphosate a reality, as previously mentioned (5). The Decree 380 (April 12, 2021) regulates spraying with glyphosate, leaving only the National Narcotics Council to endorse the decision. This Decree was even signed by the current Minister of Health, Fernando Ruiz, who was Vice Minister of Health in 2015 and publicly endorsed then to ban the use of glyphosate because of its potential carcinogenic effects, according to the International Agency for Research on Cancer (IARC). This change in the government´s decision is not explained on scientific grounds, as the evidence supporting the adverse effects of glyphosate on health remains even more conclusive now (6).
These two political decisions are added to others that aggravate the armed internal conflict in Colombia, precisely when next year there will be presidential elections. Anti-science in environmental health increases its power in Colombia, following the trend of Latin American countries with denialist governments such as Brazil. The territories and populations directly affected by these decisions are the most socioeconomically disadvantaged in the country. Perhaps for this reason it is not surprising that the Colombian scientific evidence shows that the policies implemented in the management of the pandemic have not succeeded in reducing social inequalities (7), but have probably widened them, and that public health surveillance has been limited, with achievements only in some regions (8).
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Nuñez-Ramos JA, Forero Illera E, Quintero Barrios JL, Macareno Arroyo HA, Larios Sanjuan DJ, Manzur Barbur MC, Mejia Sanjuanelo AM, Mendoza Quevedo MD, Viasus-Perez DF. Prognostic Factors in Hospitalized COVID-19 Patients at the Start of the Pandemic in Colombia: A Retrospective Cohort Study. Cureus 2021; 13:e14865. [PMID: 34113503 PMCID: PMC8177023 DOI: 10.7759/cureus.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Different factors are critical when assessing COVID-19 mortality, and can explain why severity differs so widely among populations. However, there is little information regarding prognostic factors and mortality in COVID-19 from Latin American countries. Objectives To determine prognostic factors in hospitalized COVID-19 patients and to evaluate the impact of tocilizumab use in patients with hyperinflammatory syndrome and severe disease defined by the National Early Warning Score 2 (NEWS2) with a value greater than or equal to seven points. Materials and methods This retrospective cohort study included hospitalized COVID-19 patients from May to July 2020. A multivariate logistic regression analysis was performed to determine independent factors associated with mortality. Results A total of 136 patients required hospital admission. In-hospital mortality was 39.7%. Mortality was observed to be potentiated by older age, LDH serum levels and the presence of type 2 diabetes mellitus. Lymphopenia and lower PaO2/FiO2 ratio were more common in these patients. Similarly, patients who died were classified more frequently with severe disease. The independent factors associated with in-hospital mortality were age greater than 65 years, type 2 diabetes mellitus, NEWS2 greater than or equal to seven points and LDH greater than 400U/L. The use of Tocilizumab alone was not related with decreased in-hospital mortality. Subgroup analysis performed in patients with hyperinflammation and severe disease showed similar results. Conclusions COVID-19 mortality in hospitalized patients was high and mainly related with older age, comorbidities, LDH and the severity of disease at hospital admission.
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Affiliation(s)
- Jose A Nuñez-Ramos
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Internal Medicine, Hospital Universidad del Norte, Barranquilla, COL
| | - Elias Forero Illera
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Rheumatology, Hospital Universidad del Norte, Barranquilla, COL
| | - Jorge Luis Quintero Barrios
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Pulmonology, Hospital Universidad del Norte, Barranquilla, COL
| | - Hugo Andres Macareno Arroyo
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Internal Medicine, Hospital Universidad del Norte, Barranquilla, COL
| | - Didier Johanna Larios Sanjuan
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Internal Medicine, Hospital Universidad del Norte, Barranquilla, COL
| | - Maria Carolina Manzur Barbur
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Internal Medicine, Hospital Universidad del Norte, Barranquilla, COL
| | - Ana Milena Mejia Sanjuanelo
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Internal Medicine, Hospital Universidad del Norte, Barranquilla, COL
| | - Mauro Duvan Mendoza Quevedo
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Internal Medicine, Hospital Universidad del Norte, Barranquilla, COL
| | - Diego Fernando Viasus-Perez
- Health Sciences Division, Universidad del Norte, Barranquilla, COL
- Infectious Diseases, Hospital Universidad del Norte, Barranquilla, COL
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da Silva MG, Pereira PMB, Portela WF, Daros GC, Barbosa CRDA, Vanassi BM, Parma GOC, de Bitencourt RM, Iser BPM. Epidemiology of COVID-19 Among Indigenous Populations in Brazil. J Racial Ethn Health Disparities 2021; 9:960-966. [PMID: 33844167 PMCID: PMC8040762 DOI: 10.1007/s40615-021-01035-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 01/10/2023]
Abstract
Background Due to social and geographical isolation, indigenous people are more vulnerable to adverse conditions; however, there is a lack of data on the epidemics’ impact on these populations. Thus, this article’s objective was to describe the epidemiological situation of COVID-19 in indigenous communities in Brazil. Methods This descriptive observational study was carried out in indigenous communities in the municipality of Amaturá (Amazonas, Brazil). Individuals from the Alto Rio Solimões Special Indigenous Sanitary District (DSEI) who met the Sars-Cov-2 infection case definitions during the period between January and August 2020 were included. For case notification, the definitions adopted by the Ministry of Health of Brazil and by the Special Secretariat for Indigenous Health were considered. Results Out of the entire population served by the Alto Rio Solimões DSEI (n = 2890), 109 indigenous people were suspected of having been infected with Sars-Cov-R during the study period; a total of 89 cases were actually confirmed (rate: 3.08 cases/100,000 inhabitants). Most patients diagnosed with COVID-19 were female (56.2%), with a mean age of 32.4 (± 23.6) years. Predominant symptoms were fever (76.4%), dry cough (64%), and headache (60.7%). Complications occurred in 7.9% of the patients; no deaths were reported. Conclusion These results enhance the observation that indigenous populations, even if relatively isolated, are exposed to COVID-19. The disease cases assessed showed a favorable evolution, which does not mean reducing the need for caring of this population.
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Affiliation(s)
- Marina Goulart da Silva
- Behavioral Neuroscience Laboratory, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil. .,Postgraduate Program in Health Sciences, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil.
| | - Pablo Michel Barcelos Pereira
- Behavioral Neuroscience Laboratory, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil.,Alto Rio Solimões Indigenous Special Health District, Tabatinga, Amazonas, Brazil
| | | | - Guilherme Cabreira Daros
- Behavioral Neuroscience Laboratory, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil
| | | | - Bruna Muraro Vanassi
- Medical College, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Gabriel Oscar Cremona Parma
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil.,Geoprocessing Laboratory, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Rafael Mariano de Bitencourt
- Behavioral Neuroscience Laboratory, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil.,Postgraduate Program in Health Sciences, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Betine Pinto Moehlecke Iser
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Tubarão, Santa Catarina, Brazil
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