Mechanisms of socioeconomic differences in COVID-19 screening and hospitalizations

Trends of respiratory viruses and factors associated with severe acute respiratory infection in patients presenting at a university hospital: a 6-year retrospective study across the COVID-19 pandemic

Background

The COVID-19 pandemic significantly disrupted the epidemiology of respiratory viruses, altering seasonal patterns and reducing circulation. While recovery trends have been observed, factors associated with severe acute respiratory infections (SARIs) during pre- and post-pandemic periods remain underexplored in middle-income countries.

Objective

This study aimed to analyze the trends in respiratory virus circulation and identify factors associated with SARI in patients attending a tertiary care university hospital in western Mexico over a six-year period spanning the pre-pandemic, pandemic, and post-pandemic phases.

Methods

A retrospective study was conducted using data from 19,088 symptomatic patients tested for respiratory viruses between 2018 and 2024. Viral trends were analyzed through interrupted time series (ITS) modeling, incorporating locally estimated scatterplot smoothing (LOESS) and raw positivity rates. Additionally, ITS analysis was performed to evaluate temporal changes in SARI proportions across different phases of the pandemic. Multivariate logistic regression models were applied to determine independent risk factors for SARI across different time periods.

Results

During the pandemic (2020-2021), respiratory virus positivity rates significantly declined, particularly for influenza, which experienced a sharp reduction but rebounded post-2022. Respiratory syncytial virus (RSV) demonstrated a delayed resurgence, whereas other respiratory viruses exhibited heterogeneous rebound patterns. ITS modeling of SARI proportions revealed a significant pre-pandemic increasing trend, followed by a slower rise during the pandemic, and a sharp post-pandemic drop in early 2022, before resuming an upward trajectory. Among older adults (>65 years), a marked increase in SARI was observed at the beginning of the pandemic, while younger groups showed more stable patterns. Logistic regression identified advanced age, male sex, cardiovascular disease, obesity, and immunosuppression as major risk factors for SARI, while vaccination consistently showed a protective effect across all periods and subgroups.

Conclusion

The COVID-19 pandemic induced persistent shifts in respiratory virus circulation, disrupting seasonal dynamics and modifying the burden of SARI. The findings underscore the importance of continuous surveillance, targeted vaccination programs, and early diagnostics to mitigate severe outcomes. These results highlight the need for adaptive public health strategies in middle-income countries to address evolving respiratory disease threats.

Using Regional Sero-Epidemiology SARS-CoV-2 Anti-S Antibodies in the Dominican Republic to Inform Targeted Public Health Response

Incidence of COVID-19 has been associated with sociodemographic factors. We investigated variations in SARS-CoV-2 seroprevalence at sub-national levels in the Dominican Republic and assessed potential factors influencing variation in regional-level seroprevalence. Data were collected in a three-stage cross-sectional national serosurvey from June to October 2021. Seroprevalence of antibodies against the SARS-CoV-2 spike protein (anti-S) was estimated and adjusted for selection probability, age, and sex. Multilevel logistic regression was used to estimate the effect of covariates on seropositivity for anti-S and correlates of 80% protection (PT80) against symptomatic infection for the ancestral and Delta strains. A total of 6683 participants from 134 clusters in all 10 regions were enrolled. Anti-S, PT80 for the ancestral and Delta strains odds ratio varied across regions, Enriquillo presented significant higher odds for all outcomes compared with Yuma. Compared to being unvaccinated, receiving ≥2 doses of COVID-19 vaccine was associated with a significantly higher odds of anti-S positivity (OR 85.94, [10.95-674.33]) and PT80 for the ancestral (OR 4.78, [2.15-10.62]) and Delta strains (OR 3.08, [1.57-9.65]) nationally and also for each region. Our results can help inform regional-level public health response, such as strategies to increase vaccination coverage in areas with low population immunity against currently circulating strains.

Income inequality and its association with COVID-19 cases and deaths: a cross-country analysis in the Eastern Mediterranean region

INTRODUCTION

There is limited evidence on the associations between economic and social disparities in the Eastern Mediterranean region (EMR) with COVID-19 infections and deaths. This study aims to investigate the relationship between income inequalities using Gini coefficients and COVID-19 cases and deaths per million population in the EMR countries.

METHODS

Country-level data on monthly COVID-19 cases and deaths between March 2020 and October 2021, along with data on selected confounders, were collected from publicly available databases. Mixed-effect negative binomial and inverse hyperbolic sine transformation regressions were estimated to examine the association.

RESULTS

The study showed that, in the EMR, a unit increase in Gini coefficient is associated with approximately 7.2% and 3.9% increase in COVID-19 cases and deaths per million population, respectively. The magnitude and direction of the association between income inequality and COVID-19 cases and deaths per-million population still remain the same after excluding four warzone countries from the analysis.

CONCLUSION

This increase in COVID-19 cases and deaths is underpinned by the fact that a large number of the population in the region is living in conditions of poverty, with inadequate housing, comorbidities and limited or virtually no access to essential healthcare services. Healthcare policy-makers across countries in the region need to implement effective interventions in areas of income inequality, where it may be linked to increasing the risk of COVID-19 cases and deaths.

Family socioeconomic position and changes in planned health care for children with chronic diseases during the COVID-19 pandemic in Italy

Introduction

In this study, we aimed at evaluating whether, during the COVID-19 pandemic, children affected by chronic diseases were impacted by the deferral of planned healthcare caused by the restriction measures.

Design

This study was conducted using data from the Italian NINFEA birth cohort, which include children born between 2005 and 2016. Women who completed the 4-year NINFEA follow-up questionnaire before November 2020 (N = 5,307) were invited to complete a questionnaire targeted at evaluating the impacts of the pandemic on their children's health. The questionnaire asked mothers to report whether their children had a chronic disease or condition that required one or more regular health checks by a doctor in 2019 (used as a reference period) and whether the children had problems getting routine health checks after March 2020.

Results

We obtained information on 3,721 children. Out of 353 children with a chronic disease that required at least one medical visit in 2019, 130 (36.8%) experienced problems during the pandemic. Lower family income was associated with a higher risk of experiencing health access problems. We observed that children living in families at lower income tertiles had more chance of experiencing healthcare access problems than children living in families at the highest income tertiles (prevalence rate ratio for a tertile decrease in family income: 1.22; 95% CIs: 1.02-1.49).

Conclusion

Our study underlines that the COVID-19 pandemic may have caused healthcare access problems for children with prevalent chronic diseases, especially among those living in households with a low socioeconomic position.

Neighborhood and racial influences on triple negative breast cancer: evidence from Northeast Ohio

PURPOSE

Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with higher recurrence rates and poorer prognoses and most prevalent among non-Hispanic Black women. Studies of multiple health conditions and care processes suggest that neighborhood socioeconomic position is a key driver of health disparities. We examined roles of patients' neighborhood-level characteristics and race on prevalence, stage at diagnosis, and mortality among patients diagnosed with BC at a large safety-net healthcare system in Northeast Ohio.

METHODS

We used tumor registry to identify BC cases from 2007 to 2020 and electronic health records and American Community Survey for individual- and area-level factors. We performed multivariable regression analyses to estimate associations between neighborhood-level characteristics, measured by the Area Deprivation Index (ADI), race and comparative TNBC prevalence, stage at diagnosis, and total mortality.

RESULTS

TNBC was more common among non-Hispanic Black (53.7%) vs. non-Hispanic white patients (46.4%). Race and ADI were individually significant predictors of TNBC prevalence, stage at diagnosis, and total mortality. Race remained significantly associated with TNBC subtype, adjusting for covariates. Accounting for TNBC status, a more disadvantaged neighborhood was significantly associated with a worse stage at diagnosis and higher death rates.

CONCLUSION

Our findings suggest that both neighborhood socioeconomic position and race are strongly associated with TNBC vs. other BC subtypes. The burden of TNBC appears to be highest among Black women in the most socioeconomically disadvantaged neighborhoods. Our study suggests a complex interplay of social conditions and biological disease characteristics contributing to racial disparities in BC outcomes.

Stress and Stressors: The Impact of the COVID-19 Pandemic on Students, Faculty and Staff at a Historically Black College/University

Due to COVID-19 restrictions, academic institutions have changed their modus operandi, particularly in adopting distance learning in lieu of face-to-face instruction. This has sometimes produced unanticipated effects on students. The purpose of this study was to determine COVID-19 pandemic stressors and coping mechanisms utilized as relief measures by students, faculty, and staff in the College of Health Sciences at a historically Black institution. Cross-sectional study.

SAMPLING

A convenience sample of 209 students, 34 faculty, and 9 staff from the College of Health Sciences at a historically Black institution participated in this study.

INSTRUMENT

A 32-item Qualtrics survey was utilized to gather demographic data, COVID-19-related stressors, and coping mechanisms.

ANALYSIS

Descriptive statistics, Chi-square test for categorical variables, and Cochran-Mantel-Haenszel tests for ordinal variables were used. Female students, African American students (AAS), and undergraduates perceived stress related to the risk of contagion during the pandemic higher than the male students (P-value = 0.0096), other races (P-value = 0.0249) and graduate students (P-value = 0.0141) respectively. Female students perceived more stress related to relationships with relatives (P-value = 0.0128). Caucasian students compared to others (P-value = 0.0240) and graduate students compared to undergraduate students (P-value = 0.0011) reported less perceived stress related to the relationships with other colleagues. Top coping strategies of students and staff included interaction with family and friends, social media, hand hygiene, and meditation/spiritualty. Except for "avoidance of public spaces/transportation", all other mechanisms were the same for faculty.

Effectiveness of CoronaVac and BNT162b2 COVID-19 mass vaccination in Colombia: A population-based cohort study

Background

In February 2021, Colombia began mass vaccination against COVID-19 using mainly BNT162b2 and CoronaVac vaccines. We aimed to estimate vaccine effectiveness (VE) to prevent COVID-19 symptomatic cases, hospitalization, critical care admission, and deaths in a cohort of 796,072 insured subjects older than 40 years in northern Colombia, a setting with a high SARS-CoV-2 transmission.

Methods

We identified individuals vaccinated between March 1st of 2021 and August 15th of 2021. We included symptomatic cases, hospitalizations, critical care admissions, and deaths in patients with confirmed COVID-19 as main outcomes. We calculated VE for each outcome from the hazard ratio in Cox proportionally hazards regressions (adjusted by age, sex, place of residence, diabetes, human immunodeficiency virus, cancer, hypertension, tuberculosis, neurological diseases, and chronic renal disease), with 95% confidence intervals (CI).

Findings

A total of 719,735 insured participants of 40 and more years were followed. We found 21,545 laboratory-confirmed symptomatic COVID-19 among unvaccinated population, along with 2874 hospitalizations, 1061 critical care admissions, and 1329 deaths, for a rate of 207.2 per million person-days, 27.1 per million person-days, 10.0 per million person-days, and 12.5 per million person-days, respectively. We found CoronaVac was not effective for any outcome in subjects above 80 years old; but for people 40-79 years of age, we found two doses of CoronaVac reduced hospitalization (33.1%; 95% CI, 14.5-47.7), critical care admission (47.2%; 95% CI, 18.5-65.8), and death (55.7%; 95% CI, 32.5-70.0). We found BNT162b2 was effective for all outcomes in the entire population of subjects above 40 years of age, significantly declining for subjects ≥80 years.

Interpretation

Two doses of either CoronaVac in population between 40 and 79 years of age, or BNT162b2 among vaccinated above 40 years old significantly reduced deaths of confirmed COVID-19 in a cohort of individuals from Colombia. Vaccine effectiveness for CoronaVac and BNT162b2 declined with increasing age.

Funding

UK National Institute for Health Research, the European Union's Horizon 2020 research and innovation programme, and the Bill & Melinda Gates Foundation.

Antirheumatic Drug Intake Influence on Occurrence of COVID-19 Infection in Ambulatory Patients with Immune-Mediated Inflammatory Diseases: A Cohort Study

Introduction

We aimed to study the prevalence of a history of COVID-19 infection among patients suffering from systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren’s syndrome (SjS) or psoriatic arthritis (PsA), and the potential influence of long-term hydroxychloroquine (HCQ) intake.

Methods

We performed an observational monocentric cohort study at the Adolphe de Rothschild Foundation Hospital ophthalmology division (Paris, France). Electronic medical records (EMR) data were searched for keywords associated with SLE, RA, SjS, or PsA. Patients were contacted by phone and were interviewed using a standardized questionnaire. The primary outcome was the occurrence of a positive COVID-19 test result during the study period. We determined the adjusted association between various antirheumatic drugs intake, COVID-19 risk factors, and occurrence of COVID-19 using a logistic regression model. This study is registered on ClinicalTrials.gov (Identifier: NCT04345159).

Results

Patients were recruited between Apr 17, 2020, and Apr 30, 2020 and were recontacted between Oct 6, 2020, and Nov 2, 2020. A total of 569 patients were included, of whom 459 patients were eligible for data analysis. One hundred and eighty-one patients were treated with long-term HCQ and 18 patients had tested positive for COVID-19. No antirheumatic drug intake, including HCQ intake, was significantly associated with an increased or decreased risk of developing COVID-19 infection.

Conclusions

No antirheumatic drug intake was associated with an increased or decreased risk of developing COVID-19 infection in our cohort of patients suffering from immune-mediated inflammatory diseases.