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Olds PK, Musinguzi N, Geisler BP, Haberer JE. Evaluating disparities by social determinants in hospital admission decisions for patients with COVID-19 quaternary hospital early in the pandemic. Medicine (Baltimore) 2023; 102:e33178. [PMID: 36897732 PMCID: PMC9997198 DOI: 10.1097/md.0000000000033178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
The COVID-19 pandemic has highlighted significant disparities in hospital outcomes when focusing on social determinants of health. Better understanding the drivers of these disparities is not only critical for COVID-19 care but also to ensure equitable treatment more generally. In this paper, we look at how hospital admission patterns, both to the medical ward and the intensive care unit (ICU), may have differed by race, ethnicity, and social determinants of health. We conducted a retrospective chart review of all patients who presented to the Emergency Department of a large quaternary hospital between March 8 and June 3, 2020. We built logistic regression models to analyze how race, ethnicity, area deprivation index, English as a primary language, homelessness, and illicit substance use impacted the likelihood of admission while controlling for disease severity and timing of admission in relation to the start of data collection. We had 1302 recorded Emergency Department visits of patients diagnosed with SARS-CoV-2. White, Hispanic, and African American patients made up 39.2%, 37.5%, and 10.4% of the population respectively. Primary language was recorded as English for 41.2% and non-English for 30% of patients. Among the social determinants of health assessed, we found that illicit drug use significantly increased the likelihood for admission to the medical ward (odds ratio 4.4, confidence interval 1.1-17.1, P = .04), and that having a language other than English as a primary language significantly increased the likelihood of ICU admission (odds ratio 2.6, confidence interval 1.2-5.7, P = .02). Illicit drug use was associated with an increased likelihood of medical ward admission, potentially due to clinician concerns for complicated withdrawal or blood-stream infections from intravenous drug use. The increased likelihood of ICU admission associated with a primary language other than English may have been driven by communication difficulties or differences in disease severity that our model did not detect. Further work is required to better understand drivers of disparities in hospital COVID-19 care.
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Affiliation(s)
- Peter K. Olds
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Benjamin P. Geisler
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Ludwig Maximilian University Munich, Munich, Germany
| | - Jessica E. Haberer
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Mbarara University of Science and Technology, Mbarara, Uganda
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Javid FA, Waheed FA, Zainab N, Khan H, Amin I, Bham A, Ghoghawala M, Sheraz A, Haloub R. COVID-19 and diabetes in 2020: a systematic review. J Pharm Policy Pract 2023; 16:42. [PMID: 36895058 PMCID: PMC9998019 DOI: 10.1186/s40545-023-00546-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
Attempts were made to review the literature on diabetic patients who experience complications when they contract COVID-19, and to determine whether ethnicity and other risk factors play an important role in the development of symptoms and their severity, as well as responding to medications. A literature search was performed using five keywords, namely COVID-19, diabetes, ethnicity, medications, and risk factors between January 2019 and December 2020 using electronic databases such as PubMed, Science Direct, Google Scholar, Springer Link, and Scopus. Forty studies were included. The review indicated that diabetes was a significant risk factor for poorer outcomes and increased mortality associated with COVID-19. There were several risk factors for diabetic patients that increased their likelihood of poorer outcomes associated with COVID-19. These included black and Asian ethnicity, male sex with high BMI. In conclusion, patients with diabetes of black or Asian origin with high BMI, male sex, and older age had an increased risk of poorer outcomes associated with COVID-19. This highlights the importance of considering the history of the patient in prioritising care and treatment.
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Affiliation(s)
- Farideh A Javid
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK.
| | - Fadi Abdul Waheed
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Nisa Zainab
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Hamza Khan
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Ibrahim Amin
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Ammar Bham
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Mohammed Ghoghawala
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Aneem Sheraz
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Radi Haloub
- Biotech and Pharmaceutical Management, Global Business School for Health (GBSH), University College London (UCL), London, UK
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Mmerem JI, Unigwe US, Iroezindu MO, Chukwu KS, Ezenwosu IL, Okorie GO, Chika-Igwenyi NM, Nwatu CB, Onodugo OD. Demographic characteristics, clinical presentation and in-hospital outcome among patients with Covid-19 in a Nigerian tertiary hospital. Malawi Med J 2023; 35:43-57. [PMID: 38124701 PMCID: PMC10645895 DOI: 10.4314/mmj.v35i1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background We described the demographic/clinical characteristics and in-hospital outcome of patients with COVID-19 at the University of Nigeria Teaching Hospital (UNTH) during the first wave to inform evidence-based responses during subsequent waves in Africa. Methodology We conducted retrospective cohort analyses of adult patients ≥18 years with PCR or GeneXpert-confirmed SARS-CoV-2 infection. Data was extracted from patients' medical records from 1st May to 30th September 2020. Based on disease severity, patients were either hospitalized (82) or managed at home (90). Logistic regression and cox-proportional hazard models were used to determine predictors of severe COVID-19 disease and in-hospital mortality, respectively. Results Of 172 cases, 113 (65.7%) were males, and the mean age was 45 ± 19 years. The majority were urban dwellers (72.1%), 19.8% had a positive history of contact with a confirmed/suspected case, 15.7% were healthcare workers while 68 (39.5%) had co-morbidities. Symptomatic patients comprised 73.3% of cases. Fever (p=0.02) and breathlessness (p=0.03) were commoner in males while diarrhoea (p<0.01) was predominant in females. On multivariate analysis, severe COVID-19 was predicted by the presence of co-morbidity (AOR= 14.44, 95% C.I= 4.79- 43.58, p <0.001)and prior antibiotic/antimalarial use (AOR= 6.35, 95% C.I= 2.24- 18.05, p =0.001) while being a non-healthcare worker (AOR= 0.18, 95% C.I= 0.04-0.78, p=0.02) was protective. However, none of the variables assessed predicted in-hospital mortality. Conclusion Our findings underscore the contributions of demographic variables in COVID-19 transmission and gender differences in clinical presentation. Underlying comorbidity likewise prior antimicrobial use increased the likelihood of severe COVID-19. The absence of mortality predictors in our study may be related to the relatively small number of deaths. Further studies are recommended to unravel the predominance of severe disease in healthcare workers.
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Affiliation(s)
- Juliet I Mmerem
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Federal Medical Centre, Owerri, Imo State, Nigeria
| | - Uche S Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Michael O Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Kyrian S Chukwu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Ifeyinwa L Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Geofrey O Okorie
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Enugu State University Teaching Hospital, Parklane, Enugu, Enugu State, Nigeria
| | - Nneka M Chika-Igwenyi
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chidinma B Nwatu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Obinna D Onodugo
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
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Tang Q, Gao L, Tong Z, Li W. Hyperlipidemia, COVID-19 and acute pancreatitis: A tale of three entities. Am J Med Sci 2022; 364:257-263. [PMID: 35381217 PMCID: PMC8977370 DOI: 10.1016/j.amjms.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/04/2022] [Accepted: 03/30/2022] [Indexed: 01/09/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the ongoing pandemic of coronavirus disease 2019 (COVID-19), which presented as not only respiratory symptoms, but various digestive manifestations including pancreatic injury and acute pancreatitis (AP). The underlying mechanism is still unclear. Hypertriglyceridemia has become one of the leading causes of AP in recent years and hyperlipidemia is highly reported in COVID-19 cases. The current narrative review aimed to explore the associations between AP, COVID-19 and hyperlipidemia. Substantial cases of COVID-19 patients complicated with AP were reported, while the incidence of AP in the COVID-19 population was relatively low. Hyperlipidemia was common in COVID-19 patients with a pooled incidence of 32.98%. Hyperlipidemia could be a mediating factor in the pathogenesis of AP in COVID-19 patients. Further studies are warranted to clarify the relationship among AP, lipid metabolism disorders and COVID-19.
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Affiliation(s)
- Qiuyi Tang
- Medical School, Southeast University, Nanjing, Jiangsu, China; Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China
| | - Lin Gao
- Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China
| | - Zhihui Tong
- Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China.
| | - Weiqin Li
- Medical School, Southeast University, Nanjing, Jiangsu, China; Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China.
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Niv Y, Eliakim-Raz N, Bar-Lavi Y, Green M, Dreiher J, Hupert A, Freedman L, Weiss Y, Zetland R, Luz S, Menachemi D, Kuniavski M, Rahav G, Sagi R, Goldschmidt N, Mahalla H. Comparing Covid-19 pandemic waves in hospitalized patients - a retrospective, multicenter, cohort study. Clin Infect Dis 2022; 75:e389-e396. [PMID: 35142823 PMCID: PMC8903399 DOI: 10.1093/cid/ciac119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Covid-19 disease was first diagnosed in Israel at the end of February 2020. Until the end of June 2021 842,536 confirmed cases and 6428 deaths were accumulated. The aim of our multicenter retrospective cohort study is to describe the demographic and clinical characteristics of hospitalized patients and to compare the pandemic waves before immunization. METHODS Out of 22302 patients hospitalized in general medical centers we randomly selected 6329 admissions for the study. Of these, 3582 and 1106 were eligible for the study in the first period (1 st & 2 nd waves), and in the second period (3 rd wave), respectively. RESULTS Thirty-day mortality was higher in the 2nd period than in the 1st period, 25.20% versus 13.68% (P<0.001). Invasive mechanical ventilation supported 9.19% and 14.21% of the patients in the 1st period and 2nd period, respectively. Extracorporeal Membrane Oxygenation (ECMO) was used more than twice as often on the 2nd period . CONCLUSIONS Invasive ventilation, use of ECMO and mortality rate were 1.5 to 2 times higher on the 2 nd period than in the 1 st period. Patients of the 2 nd period had a more severe presentation and higher mortality than those of the 1 st period.
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Affiliation(s)
- Yaron Niv
- Division of Quality and Safety, Ministry of Health, Israel.,Ariel University, Faculty of Medicine, Israel
| | - Noa Eliakim-Raz
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Tel Aviv University, Israel
| | - Yaron Bar-Lavi
- Department of Critical Care Medicine, Rambam Medical Center, Technion, Israel
| | | | - Jacob Dreiher
- Hospital Management, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Amit Hupert
- Unit of Bio-Statistics, Gertner Institue, Sheba Medical Center, Israel
| | - Laurence Freedman
- Unit of Bio-Statistics, Gertner Institue, Sheba Medical Center, Israel
| | - Yoram Weiss
- Hospital Management, Hadasa Ein-Cerem, Jerusalem, Israel
| | - Riki Zetland
- Nursing Management, Rabin Medical Center, Israel
| | - Shirli Luz
- Nursing Division, Ministry of Health, Israel
| | | | | | - Gaila Rahav
- Department of Infectious Diseases, Sheba Medical Center, Israel
| | - Ram Sagi
- Directorate of Government Medical Centers, Ministry of Health, Israel
| | | | - Hanna Mahalla
- Division of Quality and Safety, Ministry of Health, Israel
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Choong CKC, Belger M, Koch AE, Meyers KJ, Marconi VC, Abedtash H, Faries D, Krishnan V. Comparative Effectiveness of Dexamethasone in Hospitalized COVID-19 Patients in the United States. Adv Ther 2022; 39:4723-4741. [PMID: 35962234 PMCID: PMC9374287 DOI: 10.1007/s12325-022-02267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION To compare the mortality of hospitalized patients with COVID-19 between those that required supplemental oxygen and received dexamethasone with a comparable set of patients who did not receive dexamethasone. METHODS We utilized the Premier Health Database to identify hospitalized adult patients with COVID-19 from July 1, 2020-January 31, 2021. Index date was when patients first initiated oxygen therapy. The primary endpoint was in-hospital mortality for patients receiving dexamethasone versus those not receiving dexamethasone 1-day pre- to 1-day post-index period. Secondary endpoints included 28-day mortality, time to in-hospital mortality, progression to invasive mechanical ventilation or death, time to discharge, and proportion discharged alive by day 28. Twenty-three models using weighting, matching, stratification, and regression were deployed through the concept of frequentist model average (FMA) to estimate the effect of dexamethasone on all-cause mortality up to the 28-day hospitalization period. RESULTS A total of 1,208,881 patients with COVID-19 were screened; as an inpatient 255,216 used oxygen, and 251,536 were included in the analysis. In the dexamethasone group, odds of in-hospital mortality were higher than those of the comparator (FMA: odds ratio [OR] 1.15, 95% CI 1.08, 1.22). Using a best fit model, OR for in-hospital mortality was non-significant for the dexamethasone group compared with the comparator (OR 1.02, 95% CI 0.92, 1.14). Dexamethasone treatment was associated with poorer outcomes versus the comparator group across the majority of secondary endpoints, except for number of days in hospital, which was lower in the dexamethasone group versus the comparator group (mean difference - 2.14, 95% CI - 2.43, - 1.47). CONCLUSIONS Hospitalized adult patients with COVID-19 who required supplemental oxygen and received dexamethasone did not have a survival benefit versus similar patients not receiving dexamethasone. The dexamethasone group was not associated with favorable responses for outcomes such as progression to death or mechanical ventilation and time to in-hospital death.
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Affiliation(s)
| | - Mark Belger
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Alisa E. Koch
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Kristin J. Meyers
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Vincent C. Marconi
- Rollins School of Public Health and the Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA USA
| | - Hamed Abedtash
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Douglas Faries
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | - Venkatesh Krishnan
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
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Ohsfeldt RL, Choong CK, Mc Collam PL, Abedtash H, Kelton KA, Burge R. Inpatient Hospital Costs for COVID-19 Patients in the United States. Adv Ther 2021; 38:5557-95. [PMID: 34609704 DOI: 10.1007/s12325-021-01887-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
Introduction Reliable cost and resource use data for COVID-19 hospitalizations are crucial to better inform local healthcare resource decisions; however, available data are limited and vary significantly. Methods COVID-19 hospital admissions data from the Premier Healthcare Database were evaluated to estimate hospital costs, length of stay (LOS), and discharge status. Adult COVID-19 patients (ICD-10-CM: U07.1) hospitalized in the US from April 1 to December 31, 2020, were identified. Analyses were stratified by patient and hospital characteristics, levels of care during hospitalization, and discharge status. Factors associated with changes in costs, LOS, and discharge status were estimated using regression analyses. Monthly trends in costs, LOS, and discharge status were examined. Results Of the 247,590 hospitalized COVID-19 patients, 49% were women, 76% were aged ≥ 50, and 36% were admitted to intensive care units (ICU). Overall median hospital LOS, cost, and cost/day were 6 days, US$11,267, and $1772, respectively; overall median ICU LOS, cost, and cost/day were 5 days, $13,443, and $2902, respectively. Patients requiring mechanical ventilation had the highest hospital and ICU median costs ($47,454 and $41,510) and LOS (16 and 11 days), respectively. Overall, 14% of patients died in hospital and 52% were discharged home. Older age, Black and Caucasian race, hypertension and obesity, treatment with extracorporeal membrane oxygenation, and discharge to long-term care facilities were major drivers of costs, LOS, and risk of death. Admissions in December had significantly lower median hospital and ICU costs and LOS compared to April. Conclusion The burden from COVID-19 in terms of hospital and ICU costs and LOS has been substantial, though significant decreases in cost and LOS and increases in the share of hospital discharges to home were observed from April to December 2020. These estimates will be useful for inputs to economic models, disease burden forecasts, and local healthcare resource planning. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01887-4.
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Ando W, Horii T, Uematsu T, Hanaki H, Atsuda K, Otori K. Impact of overlapping risks of type 2 diabetes and obesity on coronavirus disease severity in the United States. Sci Rep 2021; 11:17968. [PMID: 34504112 PMCID: PMC8429758 DOI: 10.1038/s41598-021-96720-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022] Open
Abstract
The impact of overlapping risk factors on coronavirus disease (COVID-19) severity is unclear. To evaluate the impact of type 2 diabetes (T2D) and obesity on COVID-19 severity, we conducted a cohort study with 28,095 anonymized COVID-19 patients using data from the COVID-19 Research Database from January 1, 2020 to November 30, 2020. The mean age was 50.8 ± 17.5 years, and 11,802 (42%) patients were male. Data on age, race, sex, T2D complications, antidiabetic medication prescription, and body mass index ≥ 30 kg/m2 (obesity) were analysed using Cox proportional hazard models, with hospitalization risk and critical care within 30 days of COVID-19 diagnosis as the main outcomes. The risk scores were 0–4 for age ≥ 65 years, male sex, T2D, and obesity. Among the participants, 11,294 (61.9%) had obesity, and 4445 (15.8%) had T2D. T2D, obesity, and male sex were significantly associated with COVID-19 hospitalization risk. Regarding hospitalization risk scores, compared with those for hospitalization risk score 0 and critical care risk score 0, hazard ratios [95% confidence intervals] were 19.034 [10.470–34.600] and 55.803 [12.761–244.015] (P < 0.001) (P < 0.001), respectively, for risk score 4. Complications from diabetes and obesity increased hospitalization and critical care risks for COVID-19 patients.
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Affiliation(s)
- Wataru Ando
- Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of Pharmacy, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan.
| | - Takeshi Horii
- Laboratory of Pharmacy Practice and Science 1, Division of Clinical Pharmacy, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara City, Kanagawa, 252-0375, Japan
| | - Takayuki Uematsu
- Biomedical Laboratory, Division of Biomedical Research, Kitasato University Medical Center, 6-100 Arai, Kitamoto City, Saitama, 364-8501, Japan
| | - Hideaki Hanaki
- Infection Control Research Center, Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan
| | - Koichiro Atsuda
- Laboratory of Pharmacy Practice and Science 1, Division of Clinical Pharmacy, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara City, Kanagawa, 252-0375, Japan
| | - Katsuya Otori
- Department of Clinical Pharmacy, Center for Clinical Pharmacy and Sciences, Kitasato University School of Pharmacy, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan
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Trivedi MM, Das A. Did the Timing of State Mandated Lockdown Affect the Spread of COVID-19 Infection? A County-level Ecological Study in the United States. J Prev Med Public Health 2021; 54:238-244. [PMID: 34370936 PMCID: PMC8357543 DOI: 10.3961/jpmph.21.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/01/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Previous pandemics have demonstrated that several demographic, geographic, and socioeconomic factors may play a role in increased infection risk. During this current coronavirus disease 2019 (COVID-19) pandemic, our aim was to examine the association of timing of lockdown at the county level and aforementioned risk factors with daily case rate (DCR) in the United States. Methods: A cross-sectional study using publicly available data was performed including Americans with COVID-19 infection as of May 24, 2020. The United States counties with >100 000 population and >50 cases per 100 000 people were included. The independent variable was the days required from the declaration of lockdown to reach the target case rate (50/100 000 cases) while the dependent (outcome) variable was the DCR per 100 000 on the day of statistical calculation (May 24, 2020) after adjusting for multiple confounding socio-demographic, geographic, and health-related factors. Each independent factor was correlated with outcome variables and assessed for collinearity with each other. Subsequently, all factors with significant association to the outcome variable were included in multiple linear regression models using stepwise method. Models with best R2 value from the multiple regression were chosen. Results: The timing of mandated lockdown order had the most significant association on the DCR per 100 000 after adjusting for multiple socio-demographic, geographic and health-related factors. Additional factors with significant association with increased DCR include rate of uninsured and unemployment. Conclusions: The timing of lockdown order was significantly associated with the spread of COVID-19 at the county level in the United States.
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Affiliation(s)
- Megh M Trivedi
- Pediatric Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anirudha Das
- Pediatric Institute, Cleveland Clinic, Cleveland, OH, USA
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