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Goldman N, Park SS, Beltrán-Sánchez H. Life expectancy among Native Americans during the COVID-19 pandemic: estimates, uncertainty, and obstacles. Am J Epidemiol 2024; 193:846-852. [PMID: 38140861 PMCID: PMC11145904 DOI: 10.1093/aje/kwad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/15/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Few reliable estimates have been available for assessing the impact of the COVID-19 pandemic on mortality among Native Americans. Using deidentified publicly available data on deaths and populations by age, we estimated life expectancy for the years 2019-2022 for single-race non-Hispanic Native Americans. Life expectancy in 2022 was 67.8 years, 2.3 years higher than in 2021 but a huge 4-year loss from 2019. Although our life expectancy estimates for 2022 varied under different assumptions about racial/ethnic classification and age misreporting errors, all estimates were lower than the average for middle-income countries. Estimates of losses and gains in life expectancy were consistent across assumptions. Large reductions in COVID-19 death rates between 2021 and 2022 were largely offset by increases in rates of death from unintentional injuries (particularly drug overdoses), chronic liver disease, diabetes, and heart disease, underscoring the difficulties facing Native Americans in achieving reductions in mortality, let alone returning to levels of mortality prior to the pandemic. Serious data problems have persisted for many years, but the scarcity and inadequacy of estimates during the pandemic have underscored the urgent need for timely and accurate demographic data on the Native American population.
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Affiliation(s)
- Noreen Goldman
- Corresponding author: Noreen Goldman, Office of Population Research and Princeton School of Public and International Affairs, 243 Wallace Hall, Princeton University, Princeton, NJ 08544 ()
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Vandenbroucke JP, Pearce N. Excess Mortality Calculations to Assess the Impact of the COVID-19 Pandemic: Concepts and Methodological Issues. Am J Public Health 2024; 114:593-598. [PMID: 38547492 PMCID: PMC11079831 DOI: 10.2105/ajph.2024.307572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
We discuss some intriguing methodological aspects of excess mortality analyses, which have been widely used to describe the impact of the COVID-19 pandemic. We describe the main ways of presenting excess mortality: as a mortality rate (incidence rate) or as a percentage increase (relative risk or rate ratio). We discuss what should be regarded as the null value of excess mortality (i.e., when countries or regions can be judged as having fared equally well) and when age and sex standardization, adjustment for other determinants of the spread of a pandemic, or both is necessary. We discuss the level of detail by time and place and person that may be necessary. We note that an excess mortality comparison is essentially a difference-in-differences analysis. We conclude that, although one cannot rule out using excess mortality analyses for causal effect estimates, such analyses will remain most fruitful for generating hypotheses about both the efficiency of measures to curtail the pandemic and factors that cannot be influenced. Nevertheless, a judicious use of arguments and counterarguments can then lead to identifying best practices for various situations. (Am J Public Health. 2024;114(6):593-598. https://doi.org/10.2105/AJPH.2024.307572).
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Affiliation(s)
- Jan P Vandenbroucke
- Jan P. Vandenbroucke and Neil Pearce are with the Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK. Jan P. Vandenbroucke is also with the Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark, and the Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands
| | - Neil Pearce
- Jan P. Vandenbroucke and Neil Pearce are with the Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK. Jan P. Vandenbroucke is also with the Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark, and the Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands
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Rossen LM, Resendez A, Behdin A, Louis MS. Trends and disparities in deaths among young persons in the US during the COVID-19 pandemic. Ann Epidemiol 2024; 91:37-43. [PMID: 38309641 PMCID: PMC10922572 DOI: 10.1016/j.annepidem.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE To examine changes in death rates by demographic group and by the leading causes of death in U.S. persons 1 to 24 years of age during the COVID-19 pandemic. METHODS A retrospective cross-sectional study using mortality data from the National Vital Statistics System from April 2017 to March 2023. Pre-pandemic death rates were compared with death rates during the pandemic overall, by race/ethnicity, age, sex, and cause group. RESULTS Age-adjusted death rates in young persons 1-24 years of age increased by 14.3% during the pandemic. Injury-related causes accounted for 78.2% of the increase, driven mainly by increases in homicides and unintentional injuries related to drug overdose, firearms, and motor-vehicle traffic crashes. Non-Hispanic Black and Hispanic teens and young adults experienced the largest increases in deaths overall and across the leading causes of death. CONCLUSIONS During the COVID-19 pandemic, injury-related causes accounted for the majority of the increases in deaths in children and young adults, driven mainly by firearms, drug overdoses, and motor vehicle traffic crashes. Findings highlight the importance of understanding the drivers of these marked increases in injury-related mortality and the need for injury prevention efforts among children even in the context of an infectious disease pandemic.
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Affiliation(s)
- Lauren M Rossen
- Division of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, United States.
| | - Adriana Resendez
- Milken Institute School of Public Health, George Washington University, United States
| | - Amanda Behdin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Michael St Louis
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Kandula S, Keyes KM, Yaari R, Shaman J. Excess Mortality in the United States, 2020-21: County-level Estimates for Population Groups and Associations with Social Vulnerability. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.14.24301290. [PMID: 38293208 PMCID: PMC10827264 DOI: 10.1101/2024.01.14.24301290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
To assess the excess mortality burden of Covid-19 in the United States, we estimated sex, age and race stratified all-cause excess deaths in each county of the US during 2020 and 2021. Using spatial Bayesian models trained on all recorded deaths between 2003-2019, we estimated 463,187 (95% uncertainty interval (UI): 426,139 - 497,526) excess deaths during 2020, and 544,105 (95% UI: 492,202 - 592,959) excess deaths during 2021 nationally, with considerable geographical heterogeneity. Excess mortality rate (EMR) nearly doubled for each 10-year increase in age and was consistently higher among men than women. EMR in the Black population was 1.5 times that of the White population nationally and as high as 3.8 times in some states. Among the 25-54 year population excess mortality was highest in the American Indian/Alaskan Native (AI/AN) population among the four racial groups studied, and in a few states was as high as 6 times that of the White population. Strong association of EMR with county-level social vulnerability was estimated, including positive associations with prevalence of disability (standardized effect: 40.6 excess deaths per 100,000), older population (37.6), poverty (23.6), and unemployment (18.5), whereas population density (-50), higher education (-38.6), and income (-35.4) were protective. Together, these estimates provide a more reliable and comprehensive understanding of the mortality burden of the pandemic in the US thus far. They suggest that Covid-19 amplified social and racial disparities. Short-term measures to protect more vulnerable groups in future Covid-19 waves and systemic corrective steps to address long-term societal inequities are necessary.
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Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | | | - Rami Yaari
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY
- Columbia Climate School, Columbia University, New York, NY
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Bernstine T, Edelstein M, Krupik D. Pediatric injury attendances in different population groups in Israel before, during, and after COVID-19 lockdowns: a descriptive study, 2018-2022. Int J Emerg Med 2023; 16:82. [PMID: 37932688 PMCID: PMC10626697 DOI: 10.1186/s12245-023-00565-2] [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: 06/06/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Lockdowns and quarantines during the COVID-19 pandemic influenced healthcare services' usage patterns such as emergency department (ED) attendance. During the pandemic, Israel issued three lockdowns (March-May 2020, September-October 2020, and December 2020-February 2021) to mitigate the spread of COVID-19. Little is known about the impact of these lockdowns on ED attendance for injuries in the diverse population of Northern Israel. METHODS We described patterns of ED attendance before, during, and after COVID-19 lockdowns. We extracted data from medical records of all northern Israeli children aged 0-17 years old who attended Ziv Medical Center (ZMC) emergency department (ED) due to injury, between 01/01/2018 and 10/02/2022. We compared the volume and characteristics of ED attendance during lockdown periods to the same time periods in the 2 years before the pandemic and 1 year after the lockdowns, using chi-square tests. RESULTS Seven thousand six hundred nineteen northern children attended ZMC ED during the time periods of the study for injuries and were analyzed. Mean attendance numbers during lockdowns decreased compared to previous years, with an increase in injuries proportion (67.8% (1502/2216) vs. 52.7% (2038/3868) p < 0.001). The proportion of 0-4-year-olds attending for injuries during the lockdown increased compared to pre-pandemic (39.68% vs. 30.7%, p < 0.0001). Minority population attendance decreased (27.47% vs. 30.71% p = 0.02). Hospitalization rates increased (13.21% vs. 10.65% p = 0.01). Post-lockdown periods saw a return to the pre-pandemic age and ethnicity distribution. CONCLUSIONS Compared to previous years, the volume of injuries was lower during lockdowns for all ages, with a relative increase in the proportion of injuries among younger children attending the ED. A lower proportion of attendance from minority groups suggests different health-seeking behavior patterns during emergencies compared to the general population. Understanding these differences will help better plan for future emergencies.
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Affiliation(s)
- Tomer Bernstine
- Azrieli Faculty of Medicine, Bar Ilan University, Tsfat, Israel.
| | - Michael Edelstein
- Azrieli Faculty of Medicine, Bar Ilan University, Tsfat, Israel
- Research Institute, Ziv Medical Center, Tsfat, Israel
| | - Danna Krupik
- Azrieli Faculty of Medicine, Bar Ilan University, Tsfat, Israel
- Pediatric Emergency Department, Ziv Medical Center, Tsfat, Israel
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Formanack A, Doshi A, Valdez R, Williams I, Moorman JR, Chernyavskiy P. Race, Class, and Place Modify Mortality Rates for the Leading Causes of Death in the United States, 1999-2021. J Gen Intern Med 2023; 38:2686-2694. [PMID: 36973572 PMCID: PMC10042402 DOI: 10.1007/s11606-023-08062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Race and ethnicity, socioeconomic class, and geographic location are well-known social determinants of health in the US. Studies of population mortality often consider two, but not all three of these risk factors. OBJECTIVES To disarticulate the associations of race (whiteness), class (socioeconomic status), and place (county) with risk of cause-specific death in the US. DESIGN We conducted a retrospective analysis of death certificate data. Bayesian regression models, adjusted for age and race/ethnicity from the American Community Survey and the county Area Deprivation Index, were used for inference. MAIN MEASURES County-level mortality for 11 leading causes of death (1999-2019) and COVID-19 (2020-2021). KEY RESULTS County "whiteness" and socioeconomic status modified death rates; geospatial effects differed by cause of death. Other factors equal, a 20% increase in county whiteness was associated with 5-8% increase in death from three causes and 4-15% reduction in death from others, including COVID-19. Other factors equal, advantaged counties had significantly lower death rates, even when juxtaposed with disadvantaged ones. Patterns of residual risk, measured by spatial county effects, varied by cause of death; for example: cancer and heart disease death rates were better explained by age, socioeconomic status, and county whiteness than were COVID-19 and suicide deaths. CONCLUSIONS There are important independent contributions from race, class, and geography to risk of death in the US.
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Affiliation(s)
| | - Ayush Doshi
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ishan Williams
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - J Randall Moorman
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.
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DAWES DANIEL, GONZALEZ JUAN. The Politics of Population Health. Milbank Q 2023; 101:224-241. [PMID: 37096618 PMCID: PMC10126954 DOI: 10.1111/1468-0009.12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Despite increased spending and consuming more health care services than any other country in the world, the United States global health rankings experience continued decline, including worsening performance in life expectancy and mortality owing to lack of investment in and strategies on the upstream determinants of health. These determinants of health are found in our access to adequate, affordable, and nutritious food options; safe housing, blue and green spaces; reliable and safe transportation; education and literacy; opportunities for economic stability; and sanitation, among other important factors and all share a common root driver in the political determinants of health. Health systems are increasingly investing in programs and exerting influence over policies to address these upstream determinants of health, including population health management, however these programs will continue to be hindered without addressing the political determinants through government, voting, and policy. Although these investments are laudable, it is important to understand what gives rise to the social determinants of health and-more importantly-why have they disproportionately and detrimentally affected historically marginalized communities and vulnerable populations for so long? Deeply entrenched and pervasive throughout society, the political determinants of health are the fundamental instigators of these unjust and inequitable outcomes.
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Affiliation(s)
- DANIEL DAWES
- Meharry Medical College Ringgold Standard InstitutionInstitute of Global Health Equity
| | - JUAN GONZALEZ
- Meharry Medical College Ringgold Standard InstitutionInstitute of Global Health Equity
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Kambouris ME. Global Catastrophic Biological Risks in the Post-COVID-19 World: Time to Act Is Now. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2023; 27:153-170. [PMID: 36946656 DOI: 10.1089/omi.2022.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Global Catastrophic Biological Risks (GCBRs) refer to events with biological agents that can result in unprecedented or catastrophic disasters that are beyond the collective response-abilities of nation-states and the existing governance instruments of global governance and international affairs. This article offers a narrative review, with a view to new hypothesis development to rethink GCBRs after coronavirus disease 2019 (COVID-19) so as to better prepare for future pandemics and ecological crises, if not to completely prevent them. To determine GCBRs' spatiotemporal contexts, define causality, impacts, differentiate the risk and the event, would improve theorization of GCBRs compared to the impact-centric current definition. This could in turn lead to improvements in preparedness, response, allocation of resources, and possibly deterrence, while actively discouraging lack of due biosecurity diligence. Critical governance of GCBRs in ways that unpack the political power-related dimensions could be particularly valuable because the future global catastrophic events might be different in quality, scale, and actors. Theorization of GCBRs remains an important task going forward in the 21st century in ways that draw from experiences in the field, while integrating flexibility, versatility, and critically informed responses to GCBRs.
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McAlister FA, Hsu Z, Dong Y, Tsuyuki RT, van Walraven C, Bakal JA. Frequency and Type of Outpatient Visits for Patients With Cardiovascular Ambulatory-Care Sensitive Conditions During the COVID-19 Pandemic and Subsequent Outcomes: A Retrospective Cohort Study. J Am Heart Assoc 2023; 12:e027922. [PMID: 36734338 PMCID: PMC9973663 DOI: 10.1161/jaha.122.027922] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Because the impact of changes in how outpatient care was delivered during the COVID-19 pandemic is uncertain, we designed this study to examine the frequency and type of outpatient visits between March 1, 2019 to February 29, 2020 (prepandemic) and from March 1, 2020 to February 28, 2021 (pandemic) and specifically compared outcomes after virtual versus in-person outpatient visits during the pandemic. Methods and Results Population-based retrospective cohort study of all 3.8 million adults in Alberta, Canada. We examined all physician visits and 30- and 90-day outcomes, with a focus on those adults with the cardiovascular ambulatory-care sensitive conditions heart failure, hypertension, and diabetes. Our primary outcome was emergency department visit or hospitalization, evaluated using survival analysis accounting for competing risk of death. Although in-person outpatient visits decreased by 38.9% in the year after March 1, 2020 (10 142 184 versus 16 592 599 in the prior year), the introduction of virtual visits (7 152 147; 41.4% of total) meant that total outpatient visits increased by 4.1% in the first year of the pandemic for Albertan adults. Outpatient visit frequency (albeit 41.4% virtual, 58.6% in-person) and prescribing patterns were stable in the first year after pandemic onset for patients with the cardiovascular ambulatory-care sensitive conditions we examined, but laboratory test frequency declined by 20% (serum creatinine) to 47% (glycosylated hemoglobin). In the first year of the pandemic, virtual outpatient visits were associated with fewer subsequent emergency department visits or hospitalizations (compared with in-person visits) for patients with heart failure (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.85-0.96] at 30 days and 0.96 [95% CI, 0.92-1.00] at 90 days), hypertension (aHR, 0.88 [95% CI, 0.85-0.91] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days), or diabetes (aHR, 0.90 [95% CI, 0.87-0.93] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days). Conclusions The adoption and rapid uptake of virtual outpatient care during the COVID-19 pandemic did not negatively impact frequency of follow-up, prescribing, or short-term outcomes, and could have potentially positively impacted some of these for adults with heart failure, diabetes, or hypertension in a setting where there was an active reimbursement policy for virtual visits. Given declines in laboratory monitoring and screening activities, further research is needed to evaluate whether long-term outcomes will differ.
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Affiliation(s)
- Finlay A. McAlister
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada,Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Zoe Hsu
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Yuan Dong
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada
| | - Ross T. Tsuyuki
- Departments of Pharmacology, Medicine, and EPICORE Centre, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Carl van Walraven
- Division of General Internal MedicineOttawa Hospital and the Ottawa Health Research InstituteOttawaOntarioCanada
| | - Jeffrey A. Bakal
- Alberta Strategy for Patient Oriented Research Support UnitEdmontonAlbertaCanada,Provincial Research Data Services, Alberta Health ServicesEdmontonAlbertaCanada
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Sleffel JA, Gaynor MM, Paredez MR, Helmandollar-Siegeler FR, Urry JR, Kadyan V. Functional outcomes in inpatient rehabilitation facilities during the COVID-19 pandemic: An observational study. Ann Phys Rehabil Med 2023; 66:101722. [PMID: 36549046 PMCID: PMC9678817 DOI: 10.1016/j.rehab.2022.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/06/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Justin A. Sleffel
- Corresponding author at: 2776 Elizabeth Blvd., Twin Falls, ID 83301, USA
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Brown ML, Trotter CE, Huang W, Contreras Castro K, DeMuth WD, Bing EG. COVID-19 and mental health among college students in the southwestern United States. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 36701420 DOI: 10.1080/07448481.2022.2153601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/20/2022] [Accepted: 11/04/2022] [Indexed: 06/17/2023]
Abstract
Objective: We examined COVID-19-related experiences, mental health, and future plans among US undergraduate and graduate students in the initial months of the pandemic. Participants: 72 students (68% female; 51.4% white; age x- =24.4) from 21 colleges in the US southwest concurrently enrolled in a stress-reduction study. Methods: Between March and June 2020, participants completed an online survey about demographics, personal and vicarious COVID-19 experiences, mood, and future plans. Anxiety and depression symptoms were assessed with the GAD-7 and PHQ-9, respectively. Results: Worry about COVID-19 was associated with anxiety and depression symptoms and personal and vicarious experiences with COVID-19. COVID-19 worry varied by illness severity and level of intimacy with those impacted. Most participants reported changing educational (66.7%) and life (55.6%) plans due to COVID-19. Conclusions: Given the continued impact of COVID-19 on physical/emotional health and future plans, universities should assist students in managing COVID-19-related stress so they can continue to learn and grow.
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Affiliation(s)
- Megan L Brown
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
- Center for Global Health Impact and Institute for Leadership Impact, Southern Methodist University, Dallas, Texas, USA
| | - Claire E Trotter
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas, USA
| | - Wen Huang
- Center for Global Health Impact and Institute for Leadership Impact, Southern Methodist University, Dallas, Texas, USA
- Department of Teaching and Learning, Southern Methodist University, Dallas, Texas, USA
| | - Kaitlyn Contreras Castro
- Center for Global Health Impact and Institute for Leadership Impact, Southern Methodist University, Dallas, Texas, USA
| | - William Dylan DeMuth
- Center for Global Health Impact and Institute for Leadership Impact, Southern Methodist University, Dallas, Texas, USA
- University of Texas Health San Antonio Long School of Medicine, San Antonio, Texas, USA
| | - Eric G Bing
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
- Center for Global Health Impact and Institute for Leadership Impact, Southern Methodist University, Dallas, Texas, USA
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas, USA
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Rossen LM, Nørgaard SK, Sutton PD, Krause TG, Ahmad FB, Vestergaard LS, Mølbak K, Anderson RN, Nielsen J. Excess all-cause mortality in the USA and Europe during the COVID-19 pandemic, 2020 and 2021. Sci Rep 2022; 12:18559. [PMID: 36329082 PMCID: PMC9630804 DOI: 10.1038/s41598-022-21844-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Both the USA and Europe experienced substantial excess mortality in 2020 and 2021 related to the COVID-19 pandemic. Methods used to estimate excess mortality vary, making comparisons difficult. This retrospective observational study included data on deaths from all causes occurring in the USA and 25 European countries or subnational areas participating in the network for European monitoring of excess mortality for public health action (EuroMOMO). We applied the EuroMOMO algorithm to estimate excess all-cause mortality in the USA and Europe during the first two years of the COVID-19 pandemic, 2020-2021, and compared excess mortality by age group and time periods reflecting three primary waves. During 2020-2021, the USA experienced 154.5 (95% Uncertainty Interval [UI]: 154.2-154.9) cumulative age-standardized excess all-cause deaths per 100,000 person years, compared with 110.4 (95% UI: 109.9-111.0) for the European countries. Excess all-cause mortality in the USA was higher than in Europe for nearly all age groups, with an additional 44.1 excess deaths per 100,000 person years overall from 2020-2021. If the USA had experienced an excess mortality rate similar to Europe, there would have been approximately 391 thousand (36%) fewer excess deaths in the USA.
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Affiliation(s)
- Lauren M Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA.
| | - Sarah K Nørgaard
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Paul D Sutton
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA
| | - Tyra G Krause
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Farida B Ahmad
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA
| | - Lasse S Vestergaard
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Kåre Mølbak
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert N Anderson
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA
| | - Jens Nielsen
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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Aschmann HE, Riley AR, Chen R, Chen YH, Bibbins-Domingo K, Stokes AC, Glymour MM, Kiang MV. Dynamics of racial disparities in all-cause mortality during the COVID-19 pandemic. Proc Natl Acad Sci U S A 2022; 119:e2210941119. [PMID: 36126098 PMCID: PMC9546535 DOI: 10.1073/pnas.2210941119] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
As research documenting disparate impacts of COVID-19 by race and ethnicity grows, little attention has been given to dynamics in mortality disparities during the pandemic and whether changes in disparities persist. We estimate age-standardized monthly all-cause mortality in the United States from January 2018 through February 2022 for seven racial/ethnic populations. Using joinpoint regression, we quantify trends in race-specific rate ratios relative to non-Hispanic White mortality to examine the magnitude of pandemic-related shifts in mortality disparities. Prepandemic disparities were stable from January 2018 through February 2020. With the start of the pandemic, relative mortality disadvantages increased for American Indian or Alaska Native (AIAN), Native Hawaiian or other Pacific Islander (NHOPI), and Black individuals, and relative mortality advantages decreased for Asian and Hispanic groups. Rate ratios generally increased during COVID-19 surges, with different patterns in the summer 2021 and winter 2021/2022 surges, when disparities approached prepandemic levels for Asian and Black individuals. However, two populations below age 65 fared worse than White individuals during these surges. For AIAN people, the observed rate ratio reached 2.25 (95% CI = 2.14, 2.37) in October 2021 vs. a prepandemic mean of 1.74 (95% CI = 1.62, 1.86), and for NHOPI people, the observed rate ratio reached 2.12 (95% CI = 1.92, 2.33) in August 2021 vs. a prepandemic mean of 1.31 (95% CI = 1.13, 1.49). Our results highlight the dynamic nature of racial/ethnic disparities in mortality and raise alarm about the exacerbation of mortality inequities for Indigenous groups due to the pandemic.
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Affiliation(s)
- Hélène E. Aschmann
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz, Santa Cruz, CA 95064
| | - Ruijia Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304
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Serving the public? A content analysis of COVID-19 public service announcements airing from March - December of 2020 in the U.S. Prev Med Rep 2022; 29:101971. [PMID: 36090963 PMCID: PMC9444310 DOI: 10.1016/j.pmedr.2022.101971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/28/2022] [Accepted: 08/27/2022] [Indexed: 11/21/2022] Open
Abstract
The objective of this research was to examine the health messages conveyed in public service announcements (PSAs) affiliated with the U.S. federal government response to the COVID-19 pandemic in 2020. To do so, we conducted a content analysis of 132 federally-affiliated PSAs that were aired 170,820 times between March 12 and December 16, 2020. Using a quantitative coding instrument, we analyzed health behavioral guidance, messages about groups, people depicted, and other PSA features. We calculated frequencies of exposure to messages at the airing-level to account for the varying number of times each PSA was aired. Far more PSAs aired between March and June than between July and December. The most common health guidance was to stay at home (80.7%), practice social distancing (61.9%), and wash hands (54.5%); 36.1% of airings included guidance to wear masks. Few PSAs referenced group differences in risk of infection or transmission, nor did they reference scientific evidence or the future availability of vaccines. PSAs aired in 2020 missed opportunities to convey important information to the public and to center health equity in public communication.
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Youn HM, Quan J, Mak IL, Yu EYT, Lau CS, Ip MSM, Tang SCW, Wong ICK, Lau KK, Lee MSF, Ng CS, Grépin KA, Chao DVK, Ko WWK, Lam CLK, Wan EYF. Long-term spill-over impact of COVID-19 on health and healthcare of people with non-communicable diseases: a study protocol for a population-based cohort and health economic study. BMJ Open 2022; 12:e063150. [PMID: 35973704 PMCID: PMC9385580 DOI: 10.1136/bmjopen-2022-063150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has a significant spill-over effect on people with non-communicable diseases (NCDs) over the long term, beyond the direct effect of COVID-19 infection. Evaluating changes in health outcomes, health service use and costs can provide evidence to optimise care for people with NCDs during and after the pandemic, and to better prepare outbreak responses in the future. METHODS AND ANALYSIS This is a population-based cohort study using electronic health records of the Hong Kong Hospital Authority (HA) CMS, economic modelling and serial cross-sectional surveys on health service use. This study includes people aged ≥18 years who have a documented diagnosis of diabetes mellitus, hypertension, cardiovascular disease, cancer, chronic respiratory disease or chronic kidney disease with at least one attendance at the HA hospital or clinic between 1 January 2010 and 31 December 2019, and without COVID-19 infection. Changes in all-cause mortality, disease-specific outcomes, and health services use rates and costs will be assessed between pre-COVID-19 and-post-COVID-19 pandemic or during each wave using an interrupted time series analysis. The long-term health economic impact of healthcare disruptions during the COVID-19 pandemic will be studied using microsimulation modelling. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be used to evaluate the effect of different modes of supplementary care on health outcomes. ETHICS AND DISSEMINATION The study was approved by the institutional review board of the University of Hong Kong, the HA Hong Kong West Cluster (reference number UW 21-297). The study findings will be disseminated through peer-reviewed publications and international conferences.
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Affiliation(s)
- Hin Moi Youn
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jianchao Quan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chak Sing Lau
- School of Clinical Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mary Sau Man Ip
- Division of Respiratory, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sydney Chi Wai Tang
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
- School of Pharmacy, University College London, London, UK
- Aston Pharmacy School, Aston University, Birmingham, UK
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Michael Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong SAR, China
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Carmen S Ng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Karen Ann Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Health Care, Hospital Authority Kowloon East Cluster, Hong Kong SAR, China
| | - Welchie Wai Kit Ko
- Department of Family Medicine and Primary Health Care, Hospital Authority Hong Kong West Cluster, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
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Aliseda-Alonso A, Lis SBD, Lee A, Pond EN, Blauer B, Rutkow L, Nuzzo JB. The Missing COVID-19 Demographic Data: A Statewide Analysis of COVID-19-Related Demographic Data From Local Government Sources and a Comparison With Federal Public Surveillance Data. Am J Public Health 2022; 112:1161-1169. [PMID: 35830674 DOI: 10.2105/ajph.2022.306892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To collect and standardize COVID-19 demographic data published by local public-facing Web sites and analyze how this information differs from Centers for Disease Control and Prevention (CDC) public surveillance data. Methods. We aggregated and standardized COVID-19 data on cases and deaths by age, gender, race, and ethnicity from US state and territorial governmental sources between May 24 and June 4, 2021. We describe the standardization process and compare it with the CDC's process for public surveillance data. Results. As of June 2021, the CDC's public demographic data set included 80.9% of total cases and 46.7% of total deaths reported by states, with significant variation across jurisdictions. Relative to state and territorial data sources, the CDC consistently underreports cases and deaths among African American and Hispanic or Latino individuals and overreports deaths among people older than 65 years and White individuals. Conclusions. Differences exist in amounts of data included and demographic composition between the CDC's public surveillance data and state and territory reporting, with large heterogeneity across jurisdictions. A lack of standardization and reporting mechanisms limits the production of complete real-time demographic data.
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Affiliation(s)
- Angel Aliseda-Alonso
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Sara Bertran de Lis
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Adam Lee
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Emily N Pond
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Beth Blauer
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Lainie Rutkow
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Jennifer B Nuzzo
- Angel Aliseda-Alonso, Sara Bertran de Lis, Adam Lee, and Beth Blauer are with the Centers for Civic Impact, Johns Hopkins University, Baltimore, MD. Emily N. Pond is with the Center for Health Security, Johns Hopkins University Bloomberg School of Public Health. Lainie Rutkow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. Jennifer B. Nuzzo is with the Center for Health Security, the Department of Environmental Health and Engineering, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
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17
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Relationship of frailty with excess mortality during the COVID-19 pandemic: a population-level study in Ontario, Canada. Aging Clin Exp Res 2022; 34:2557-2565. [PMID: 35776284 DOI: 10.1007/s40520-022-02173-1] [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: 05/04/2022] [Accepted: 06/07/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND There is a paucity of the literature on the relationship between frailty and excess mortality due to the COVID-19 pandemic. METHODS The entire community-dwelling adult population of Ontario, Canada, as of January 1st, 2018, was identified using the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort. Residents of long-term care facilities were excluded. Frailty was categorized through the Johns Hopkins Adjusted Clinical Groups (ACG® System) frailty indicator. Follow-up was until December 31st, 2020, with March 11th, 2020, indicating the beginning of the COVID-19 pandemic. Using multivariable Cox models with patient age as the timescale, we determined the relationship between frailty status and pandemic period on all-cause mortality. We evaluated the modifier effect of frailty using both stratified models as well as incorporating an interaction between frailty and the pandemic period. RESULTS We identified 11,481,391 persons in our cohort, of whom 3.2% were frail based on the ACG indicator. Crude mortality increased from 0.75 to 0.87% per 100 person years from the pre- to post-pandemic period, translating to ~ 13,800 excess deaths among the community-dwelling adult population of Ontario (HR 1.11 95% CI 1.09-1.11). Frailty was associated with a statistically significant increase in all-cause mortality (HR 3.02, 95% CI 2.99-3.06). However, all-cause mortality increased similarly during the pandemic in frail (aHR 1.13, 95% CI 1.09-1.16) and non-frail (aHR 1.15, 95% CI 1.13-1.17) persons. CONCLUSION Although frailty was associated with greater mortality, frailty did not modify the excess mortality associated with the pandemic.
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18
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Riley AR. Contesting Narratives of Inevitability: Heterogeneity in Latino-White Inequities in COVID-19. Am J Public Health 2022; 112:956-958. [PMID: 35617657 DOI: 10.2105/ajph.2022.306909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alicia R Riley
- Alicia R. Riley is an assistant professor of sociology and core faculty in global and community health, Sociology Department, University of California, Santa Cruz
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