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Alshanqeeti S, Szpunar S, Anne P, Saravolatz L, Bhargava A. Epidemiology, clinical features and outcomes of hospitalized patients with COVID-19 by vaccination status: a multicenter historical cohort study. Virol J 2024; 21:71. [PMID: 38515170 PMCID: PMC10958885 DOI: 10.1186/s12985-024-02325-x] [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] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/25/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION COVID-19 disease resulted in over six million deaths worldwide. Although vaccines against SARS-CoV-2 demonstrated efficacy, breakthrough infections became increasingly common. There is still a lack of data regarding the severity and outcomes of COVID-19 among vaccinated compared to unvaccinated individuals. METHODS This was a historical cohort study of adult COVID-19 patients hospitalized in five Ascension hospitals in southeast Michigan. Electronic medical records were reviewed. Vaccine information was collected from the Michigan Care Improvement Registry. Data were analyzed using Student's t-test, analysis of variance, the chi-squared test, the Mann-Whitney and Kruskal-Wallis tests, and multivariable logistic regression. RESULTS Of 341 patients, the mean age was 57.9 ± 18.3 years, 54.8% (187/341) were female, and 48.7% (166/341) were black/African American. Most patients were unvaccinated, 65.7%, 8.5%, and 25.8% receiving one dose or at least two doses, respectively. Unvaccinated patients were younger than fully vaccinated (p = 0.001) and were more likely to be black/African American (p = 0.002). Fully vaccinated patients were 5.3 times less likely to have severe/critical disease (WHO classification) than unvaccinated patients (p < 0.001) after controlling for age, BMI, race, home steroid use, and serum albumin levels on admission. The case fatality rate in fully vaccinated patients was 3.4% compared to 17.9% in unvaccinated patients (p = 0.003). Unvaccinated patients also had higher rates of complications. CONCLUSIONS Patients who were unvaccinated or partially vaccinated had more in-hospital complications, severe disease, and death as compared to fully vaccinated patients. Factors associated with severe COVID-19 disease included advanced age, obesity, low serum albumin, and home steroid use.
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Affiliation(s)
- Shatha Alshanqeeti
- Department of Internal Medicine, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, 48236, Detroit, MI, USA
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, USA
| | - Premchand Anne
- Department of Internal Medicine, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, 48236, Detroit, MI, USA
- Department of Pediatrics, Ascension St. John Hospital, Detroit, MI, USA
| | - Louis Saravolatz
- Department of Internal Medicine, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, 48236, Detroit, MI, USA
- Division of Infectious Disease, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA
- Thomas Mackey Center for Infectious Disease Research, Ascension St John Hospital, Detroit, MI, USA
| | - Ashish Bhargava
- Department of Internal Medicine, Ascension St. John Hospital, 19251 Mack Avenue, Suite 340, 48236, Detroit, MI, USA.
- Division of Infectious Disease, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA.
- Thomas Mackey Center for Infectious Disease Research, Ascension St John Hospital, Detroit, MI, USA.
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Abdelmalek FM, Angriman F, Moore J, Liu K, Burry L, Seyyed-Kalantari L, Mehta S, Gichoya J, Celi LA, Tomlinson G, Fralick M, Yarnell CJ. Association between Patient Race and Ethnicity and Use of Invasive Ventilation in the United States. Ann Am Thorac Soc 2024; 21:287-295. [PMID: 38029405 DOI: 10.1513/annalsats.202305-485oc] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
Rationale: Outcomes for people with respiratory failure in the United States vary by patient race and ethnicity. Invasive ventilation is an important treatment initiated based on expert opinion. It is unknown whether the use of invasive ventilation varies by patient race and ethnicity. Objectives: To measure 1) the association between patient race and ethnicity and the use of invasive ventilation; and 2) the change in 28-day mortality mediated by any association. Methods: We performed a multicenter cohort study of nonintubated adults receiving oxygen within 24 hours of intensive care admission using the Medical Information Mart for Intensive Care IV (MIMIC-IV, 2008-2019) and Phillips eICU (eICU, 2014-2015) databases from the United States. We modeled the association between patient race and ethnicity (Asian, Black, Hispanic, White) and invasive ventilation rate using a Bayesian multistate model that adjusted for baseline and time-varying covariates, calculated hazard ratios (HRs), and estimated 28-day hospital mortality changes mediated by differential invasive ventilation use. We reported posterior means and 95% credible intervals (CrIs). Results: We studied 38,258 patients, 52% (20,032) from MIMIC-IV and 48% (18,226) from eICU: 2% Asian (892), 11% Black (4,289), 5% Hispanic (1,964), and 81% White (31,113). Invasive ventilation occurred in 9.2% (3,511), and 7.5% (2,869) died. The adjusted rate of invasive ventilation was lower in Asian (HR, 0.82; CrI, 0.70-0.95), Black (HR, 0.78; CrI, 0.71-0.86), and Hispanic (HR, 0.70; CrI, 0.61-0.79) patients compared with White patients. For the average patient, lower rates of invasive ventilation did not mediate differences in 28-day mortality. For a patient on high-flow nasal cannula with inspired oxygen fraction of 1.0, the odds ratios for mortality if invasive ventilation rates were equal to the rate for White patients were 0.97 (CrI, 0.91-1.03) for Asian patients, 0.96 (CrI, 0.91-1.03) for Black patients, and 0.94 (CrI, 0.89-1.01) for Hispanic patients. Conclusions: Asian, Black, and Hispanic patients had lower rates of invasive ventilation than White patients. These decreases did not mediate harm for the average patient, but we could not rule out harm for patients with more severe hypoxemia.
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Affiliation(s)
| | - Federico Angriman
- Institute of Health Policy, Management, and Evaluation
- Interdepartmental Division of Critical Care Medicine
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Julie Moore
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- University Health Network/Sinai Health, Toronto, Ontario, Canada
| | - Kuan Liu
- Institute of Health Policy, Management, and Evaluation
| | - Lisa Burry
- Interdepartmental Division of Critical Care Medicine
- Leslie Dan Faculty of Pharmacy, and
- University Health Network/Sinai Health, Toronto, Ontario, Canada
| | - Laleh Seyyed-Kalantari
- Department of Electrical Engineering and Computer Science, Lassonde School of Engineering, York University, Toronto, Ontario, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine
- University Health Network/Sinai Health, Toronto, Ontario, Canada
| | - Judy Gichoya
- Department of Radiology and Biomedical Informatics, Emory University, Atlanta, Georgia
| | - Leo Anthony Celi
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - George Tomlinson
- Institute of Health Policy, Management, and Evaluation
- University Health Network/Sinai Health, Toronto, Ontario, Canada
| | - Michael Fralick
- University Health Network/Sinai Health, Toronto, Ontario, Canada
| | - Christopher J Yarnell
- Institute of Health Policy, Management, and Evaluation
- Interdepartmental Division of Critical Care Medicine
- University Health Network/Sinai Health, Toronto, Ontario, Canada
- Department of Critical Care Medicine and
- Scarborough Health Network Research Institute, Scarborough Health Network, Toronto, Ontario, Canada
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3
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Oh H, Marsiglia FF, Pepin S, Ayers S, Wu S. Health Behavior and Attitudes During the COVID-19 Pandemic Among Vulnerable and Underserved Latinx in the Southwest USA. Prev Sci 2024; 25:279-290. [PMID: 36862363 PMCID: PMC9978289 DOI: 10.1007/s11121-023-01512-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Abstract
The COVID-19 pandemic highlighted deep-rooted health disparities, particularly among Latinx immigrants living on the Mexico-US border. This article investigates differences between populations and adherence to COVID-19 preventive measures. This study investigated whether there are differences between Latinx recent immigrants, non-Latinx Whites, and English-speaking Latinx in their attitudes and adherence to COVID-19 preventive measures. Data came from 302 participants who received a free COVID-19 test at one of the project sites between March and July 2021. Participants lived in communities with poorer access to COVID-19 testing. Choosing to complete the baseline survey in Spanish was a proxy for being a recent immigrant. Survey measures included the PhenX Toolkit, COVID-19 mitigating behaviors, attitudes toward COVID-19 risk behaviors and mask wearing, and economic challenges during the COVID-19 pandemic. With multiple imputation, ordinary least squares (OLS) regression was used to analyze between-group differences in mitigating attitudes and behaviors toward COVID-19 risk. Adjusted OLS regression analyses showed that Latinx surveyed in Spanish perceived COVID-19 risk behaviors as more unsafe (b = 0.38, p = .001) and had stronger positive attitudes toward mask wearing (b = 0.58, p = .016), as compared to non-Latinx Whites. No significant differences emerged between Latinx surveyed in English and non-Latinx Whites (p > .05). Despite facing major structural, economic, and systemic disadvantages, recent Latinx immigrants showed more positive attitudes toward public health COVID-19 mitigating measures than other groups. The findings have implications for future prevention research about community resilience, practice, and policy.
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Affiliation(s)
| | | | | | | | - Shiyou Wu
- Arizona State University, Phoenix, AZ, USA
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Slutske WS, Conner KL, Kirsch JA, Smith SS, Piasecki TM, Johnson AL, McCarthy DE, Nez Henderson P, Fiore MC. Explaining COVID-19 related mortality disparities in American Indians and Alaska Natives. Sci Rep 2023; 13:20974. [PMID: 38017023 PMCID: PMC10684501 DOI: 10.1038/s41598-023-48260-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023] Open
Abstract
American Indian and Alaska Native (AI/AN) individuals are more likely to die with COVID-19 than other groups, but there is limited empirical evidence to explain the cause of this inequity. The objective of this study was to determine whether medical comorbidities, area socioeconomic deprivation, or access to treatment can explain the greater COVID-19 related mortality among AI/AN individuals. The design was a retrospective cohort study of harmonized electronic health record data of all inpatients with COVID-19 from 21 United States health systems from February 2020 through January 2022. The mortality of AI/AN inpatients was compared to all Non-Hispanic White (NHW) inpatients and to a matched subsample of NHW inpatients. AI/AN inpatients were more likely to die during their hospitalization (13.2% versus 7.1%; odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.48, 2.65) than their matched NHW counterparts. After adjusting for comorbidities, area social deprivation, and access to treatment, the association between ethnicity and mortality was substantially reduced (OR 1.59, 95% CI 1.15, 2.22). The significant residual relation between AI/AN versus NHW status and mortality indicate that there are other important unmeasured factors that contribute to this inequity. This will be an important direction for future research.
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Affiliation(s)
- Wendy S Slutske
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Conner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Julie A Kirsch
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas M Piasecki
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Adrienne L Johnson
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Michael C Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Devarashetty SP, Grewal US, Le Blanc K, Walton J, Jones T, Shi R, Master SR, Mansour RP, Ramadas P. Sickle cell disease and coronavirus disease-2019 (COVID-19) infection: a single-center experience. Postgrad Med J 2023; 99:1008-1012. [PMID: 37399057 DOI: 10.1093/postmj/qgad033] [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] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Sickle cell disease (SCD) has been found to be associated with an increased risk of hospitalization and death from coronavirus disease-2019 (COVID-19). We sought to study clinical outcomes in patients with SCD and a diagnosis of COVID-19 infection. METHODS We conducted a retrospective analysis of adult patients (>18 years) with SCD who were diagnosed with COVID-19 infection between 1 March 2020 and 31 March 2021. Data on baseline characteristics and overall outcomes were collected and analyzed using SAS 9.4 for Windows. RESULTS A total of 51 patients with SCD were diagnosed with COVID-19 infection in the study period, out of which 39.3% were diagnosed and managed in the outpatient setting/emergency room (ER) and 60.3% in the inpatient setting. Disease-modifying therapy such as hydroxyurea did not impact inpatient vs outpatient/ER management (P > 0.05). Only 5.71% (n = 2) required intensive care unit admission and were mechanically ventilated and 3.9% (2 patients) died of complications of COVID-19 infection. CONCLUSION We identified a lower mortality (3.9%) rate among patients in our cohort in comparison to previous studies and a higher burden of inpatient hospitalizations as compared to outpatient/ER management. Further prospective data are needed to validate these findings. Key messages What is already known on this topic COVID-19 has been shown to have a disproportionately unfavorable impact on African Americans, including longer hospital stays, higher rates of ventilator dependence, and a higher overall mortality rate. Limited data also suggest that sickle cell disease (SCD) is associated with an increased risk of hospitalization and death from COVID-19. What this study adds Our analysis did not show a higher mortality due to COVID-19 in patients with SCD. However, we identified a high burden of inpatient hospitalizations in this population. COVID-19-related outcomes did not improve with the use of disease-modifying therapies. How this study might affect research, practice, or policy These results will aid in decision making for triage of patients with COVID-19 and SCD and ensure the most appropriate use of healthcare resources. Our analysis underscores the need for more robust data to identify patients at higher risk of severe disease and/or mortality, necessitating inpatient hospitalization and aggressive management.
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Affiliation(s)
- Sindhu P Devarashetty
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Udhayvir S Grewal
- Division of Internal Medicine, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Kimberly Le Blanc
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Jacqueline Walton
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Tabitha Jones
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Runhua Shi
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Samip R Master
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Richard P Mansour
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Poornima Ramadas
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
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Wilcox DR, Rudmann EA, Ye E, Noori A, Magdamo C, Jain A, Alabsi H, Foy B, Triant VA, Robbins GK, Westover MB, Das S, Mukerji SS. Cognitive concerns are a risk factor for mortality in people with HIV and coronavirus disease 2019. AIDS 2023; 37:1565-1571. [PMID: 37195278 PMCID: PMC10355333 DOI: 10.1097/qad.0000000000003595] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Data supporting dementia as a risk factor for coronavirus disease 2019 (COVID-19) mortality relied on ICD-10 codes, yet nearly 40% of individuals with probable dementia lack a formal diagnosis. Dementia coding is not well established for people with HIV (PWH), and its reliance may affect risk assessment. METHODS This retrospective cohort analysis of PWH with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR positivity includes comparisons to people without HIV (PWoH), matched by age, sex, race, and zipcode. Primary exposures were dementia diagnosis, by International Classification of Diseases (ICD)-10 codes, and cognitive concerns, defined as possible cognitive impairment up to 12 months before COVID-19 diagnosis after clinical review of notes from the electronic health record. Logistic regression models assessed the effect of dementia and cognitive concerns on odds of death [odds ratio (OR); 95% CI (95% confidence interval)]; models adjusted for VACS Index 2.0. RESULTS Sixty-four PWH were identified out of 14 129 patients with SARS-CoV-2 infection and matched to 463 PWoH. Compared with PWoH, PWH had a higher prevalence of dementia (15.6% vs. 6%, P = 0.01) and cognitive concerns (21.9% vs. 15.8%, P = 0.04). Death was more frequent in PWH ( P < 0.01). Adjusted for VACS Index 2.0, dementia [2.4 (1.0-5.8), P = 0.05] and cognitive concerns [2.4 (1.1-5.3), P = 0.03] were associated with increased odds of death. In PWH, the association between cognitive concern and death trended towards statistical significance [3.92 (0.81-20.19), P = 0.09]; there was no association with dementia. CONCLUSION Cognitive status assessments are important for care in COVID-19, especially among PWH. Larger studies should validate findings and determine long-term COVID-19 consequences in PWH with preexisting cognitive deficits.
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Affiliation(s)
- Douglas R. Wilcox
- Department of Neurology, Massachusetts General Hospital
- Department of Neurology, Brigham and Women's Hospital
- Department of Neurology, Harvard Medical School
| | - Emily A. Rudmann
- Neuroimmunology and Neuro-Infectious Diseases Division, Department of Neurology, Massachusetts General Hospital, Boston
- Division of Infectious Diseases, Vaccine and Immunotherapy Center, Massachusetts General Hospital, Charlestown
| | - Elissa Ye
- Department of Neurology, Massachusetts General Hospital
| | - Ayush Noori
- Department of Neurology, Massachusetts General Hospital
| | - Colin Magdamo
- Department of Neurology, Massachusetts General Hospital
| | - Aayushee Jain
- Department of Neurology, Massachusetts General Hospital
| | - Haitham Alabsi
- Department of Neurology, Massachusetts General Hospital
- Department of Neurology, Harvard Medical School
| | - Brody Foy
- Center for Systems Biology, Massachusetts General Hospital, and Department of Systems Biology, Harvard Medical School
| | - Virginia A. Triant
- Division of Infectious Diseases
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - M. Brandon Westover
- Department of Neurology, Massachusetts General Hospital
- Department of Neurology, Harvard Medical School
| | - Sudeshna Das
- Department of Neurology, Massachusetts General Hospital
- Department of Neurology, Harvard Medical School
| | - Shibani S. Mukerji
- Neuroimmunology and Neuro-Infectious Diseases Division, Department of Neurology, Massachusetts General Hospital, Boston
- Division of Infectious Diseases, Vaccine and Immunotherapy Center, Massachusetts General Hospital, Charlestown
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Halaseh RM, Drescher GS, Al-Ahmad M, Masri IH, Alayon AL, Ghawanmeh M, Arar T, Mohammad SAD, Pavate R, Bakri MH, Al-Tarbsheh A, AlGhadir-AlKhalaileh M. Risk Factors and Outcomes Associated With Re-Intubation Secondary to Respiratory Failure in Patients With COVID-19 ARDS. Respir Care 2023; 69:respcare.10881. [PMID: 37438052 PMCID: PMC10753619 DOI: 10.4187/respcare.10881] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND COVID-19 is associated with variable symptoms and clinical sequelae. Studies have examined the clinical course of these patients, finding a prolonged need for invasive ventilation and variable re-intubation rates. However, no research has investigated factors and outcomes related to re-intubation secondary to respiratory failure among patients with COVID-19 with ARDS. METHODS We conducted a single-center, retrospective study on subjects intubated for ARDS secondary to COVID-19. The primary outcome was re-intubation status; secondary outcomes were hospital and ICU stay and mortality. Data were analyzed using between-group comparisons using chi-square testing for categorical information and Student t test for quantitative data. Univariate and multivariate logistic regression was performed to determine factors related to re-intubation and mortality as dependent variables. RESULTS One hundred and fourteen subjects were included, of which 32% required re-intubation. No between-group differences were detected for most demographic variables or comorbidities. No differences were detected in COVID-19 treatments, noninvasive respiratory support, mechanical circulatory support, or duration of ventilation. Midazolam (odds ratio [OR] 5.55 [95% CI 1.83-16.80], P = .002), fentanyl (OR 3.64 [95% CI 1.26-10.52], P = .02), and APACHE II scores (OR 1.08 [95% CI 1.030-1.147], P = .005) were independently associated with re-intubation (area under the curve = 0.81). Re-intubated subjects had extended hospital (36.7 ± 22.7 d vs 26.1 ± 12.1 d, P = .01) and ICU (29.6 ± 22.4 d vs 15.8 ± 10.4 d, P < .001) stays. More subjects died who failed extubation (49% vs 3%, P < .001). Age (OR 1.07 [95% CI 1.02-1.23], P = .005), male sex (OR 4.9 [95% CI 1.08-22.35], P = .041), positive Confusion Assessment Method for the ICU (CAM-ICU) (OR 5.43 [95% CI 1.58-18.62], P = .007), and re-intubation (OR 12.75 [95% CI 2.80-57.10], P < .001) were independently associated with death (area under the curve = 0.93). CONCLUSIONS Midazolam, fentanyl, and higher APACHE II scores were independently associated with re-intubation secondary to respiratory failure in subjects with COVID-19-related ARDS. Furthermore, age, male sex, positive CAM-ICU, and re-intubation were independently associated with mortality. Re-intubation also correlated with prolonged hospital and ICU stay.
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Affiliation(s)
- Ramez M Halaseh
- Pulmonary and Critical Care Department, Cleveland Clinic Florida, Weston, Florida.
| | - Gail S Drescher
- Respiratory Therapy Department, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ma'amoon Al-Ahmad
- Internal Medicine Department, University of Florida Health, Gainesville, Florida
| | - Ihab H Masri
- Pulmonary and Critical Care Department, MedStar Washington Hospital Center, Washington, District of Columbia
| | | | - Malik Ghawanmeh
- Cardiology Department, George Washington University Hospital, Washington, District of Columbia
| | - Tareq Arar
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Saad Al-Deen Mohammad
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Rea Pavate
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Mouaz Haj Bakri
- Internal Medicine Department, University of Florida Health, Gainesville, Florida
| | - Ali Al-Tarbsheh
- Pulmonary and Critical Care Department, Cleveland Clinic Florida, Weston, Florida
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Valero-Bover D, Monterde D, Carot-Sans G, Cainzos-Achirica M, Comin-Colet J, Vela E, Clèries M, Folguera J, Abilleira S, Arrufat M, Lejardi Y, Solans Ò, Dedeu T, Coca M, Pérez-Sust P, Pontes C, Piera-Jiménez J. Is Age the Most Important Risk Factor in COVID-19 Patients? The Relevance of Comorbidity Burden: A Retrospective Analysis of 10,551 Hospitalizations. Clin Epidemiol 2023; 15:811-825. [PMID: 37408865 PMCID: PMC10319286 DOI: 10.2147/clep.s408510] [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: 02/14/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose To assess the contribution of age and comorbidity to the risk of critical illness in hospitalized COVID-19 patients using increasingly exhaustive tools for measuring comorbidity burden. Patients and Methods We assessed the effect of age and comorbidity burden in a retrospective, multicenter cohort of patients hospitalized due to COVID-19 in Catalonia (North-East Spain) between March 1, 2020, and January 31, 2022. Vaccinated individuals and those admitted within the first of the six COVID-19 epidemic waves were excluded from the primary analysis but were included in secondary analyses. The primary outcome was critical illness, defined as the need for invasive mechanical ventilation, transfer to the intensive care unit (ICU), or in-hospital death. Explanatory variables included age, sex, and four summary measures of comorbidity burden on admission extracted from three indices: the Charlson index (17 diagnostic group codes), the Elixhauser index and count (31 diagnostic group codes), and the Queralt DxS index (3145 diagnostic group codes). All models were adjusted by wave and center. The proportion of the effect of age attributable to comorbidity burden was assessed using a causal mediation analysis. Results The primary analysis included 10,551 hospitalizations due to COVID-19; of them, 3632 (34.4%) experienced critical illness. The frequency of critical illness increased with age and comorbidity burden on admission, irrespective of the measure used. In multivariate analyses, the effect size of age decreased with the number of diagnoses considered to estimate comorbidity burden. When adjusting for the Queralt DxS index, age showed a minimal contribution to critical illness; according to the causal mediation analysis, comorbidity burden on admission explained the 98.2% (95% CI 84.1-117.1%) of the observed effect of age on critical illness. Conclusion Comorbidity burden (when measured exhaustively) explains better than chronological age the increased risk of critical illness observed in patients hospitalized with COVID-19.
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Affiliation(s)
- Damià Valero-Bover
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - David Monterde
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Josep Comin-Colet
- Cardiology Department, Bellvitge University Hospital (IDIBELL), Barcelona, Spain
- Department of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- CIBER Cardiovascular (CIBERCV), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Emili Vela
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Montse Clèries
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Júlia Folguera
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Sònia Abilleira
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | - Òscar Solans
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Health Department, eHealth Unit, Barcelona, Spain
| | - Toni Dedeu
- WHO European Centre for Primary Health Care, Almaty, Kazakhstan
| | - Marc Coca
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | | | - Caridad Pontes
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Pharmacology, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain
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9
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McConnell KH, Hajat A, Sack C, Mooney SJ, Khosropour CM. Associations Between Insurance, Race and Ethnicity, and COVID-19 Hospitalization, Beyond Underlying Health Conditions: A Retrospective Cohort Study. AJPM Focus 2023; 2:100120. [PMID: 37362398 PMCID: PMC10260262 DOI: 10.1016/j.focus.2023.100120] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Introduction : People of lower socioeconomic position (SEP) and people of color (POC) experience higher risks of severe COVID-19, but understanding of these associations beyond the effect of underlying health conditions (UHCs) is limited. Moreover, few studies have focused on young adults, who have had the highest incidence of COVID-19 during much of the pandemic. Methods : We conducted a retrospective cohort study using electronic health record data from the University of Washington Medicine healthcare system. Our study population included individuals aged 18-39 years who tested positive for SARS-CoV-2 from February 2020 to March 2021. Using regression modeling, we estimated adjusted risk ratios (aRRs) and differences (aRDs) of COVID-19 hospitalization by SEP (using health insurance as a proxy) and race and ethnicity. We adjusted for any UHC to examine these associations beyond the effect of UHCs. Results: Among 3,101 individuals, the uninsured/publicly insured had a 1.9-fold higher risk of hospitalization (aRR [95% CI]=1.9 [1.0, 3.6]) and 9 additional hospitalizations per 1,000 SARS-CoV-2 positive persons (aRD [95% CI]=9 [-1, 20]) compared to the privately insured. Hispanic or Latine, non-Hispanic (NH) Asian, NH Black, and NH Native Hawaiian or Pacific Islander patients had a 1.5-, 2.7-, 1.4-, and 2.1-fold-higher risk of hospitalization (aRR [95% CI]=1.5 [0.7, 3.1]; 2.7 [1.1, 6.5]; 1.4 [0.6, 3.3]; 2.1 [0.5, 9.1]), respectively, compared to NH White patients. Conclusions: Though they should be interpreted with caution given low precision, our findings suggest the increased risk of COVID-19 hospitalization among young adults of lower SEP and young adults of color may be driven by forces other than UHCs, including social determinants of health.
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Affiliation(s)
- Kate H. McConnell
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Coralynn Sack
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Christine M. Khosropour
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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10
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Antwi-Amoabeng D, Beutler BD, Ulanja MB, Neelam V, Gbadebo TD. Effect of atrial fibrillation on mortality in SARS-CoV-2 patients: A propensity score-matched analysis of nationwide hospitalizations in the United States. Heliyon 2023; 9:e17199. [PMID: 37325454 PMCID: PMC10256628 DOI: 10.1016/j.heliyon.2023.e17199] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background Atrial fibrillation (AF) is one of the most common arrhythmias encountered in patients with SARS-CoV-2 infection. There are racial disparities in the incidence of AF and COVID-19. Several studies have reported an association between AF and mortality. However, it remains to be determined if AF represents an independent risk factor for COVID-19-related mortality. Methods A propensity score-matched (PSM) analysis was performed using data from the National Inpatient Sample to assess the risk of mortality among patients hospitalized with SARS-CoV-2 infection and incident AF from March 2020 through December 2020. Results AF was less common among patients who tested positive for SARS-CoV-2 as compared to those who tested negative (6.8% vs 7.4%, p < 0.001). White individuals with the virus had an increased incidence of AF but had lower mortality rates relative to Black and Hispanic patients. After PSM analysis, AF retained a significantly increased odds of mortality among patients with SARS-CoV-2 (OR: 1.35, CI: 1.29-1.41, p < 0.001). Conclusion This PSM analysis shows that AF is an independent risk factor for inpatient mortality in those with SARS-CoV-2 infection and that White patients, while having a higher burden of SARS-CoV-2 and AF, demonstrate a significantly lower mortality rate as compared to their Black and Hispanic counterparts.
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Affiliation(s)
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Mark B Ulanja
- Christus Ochsner St. Patrick Hospital, Lake Charles, LA, USA
| | - Vijay Neelam
- Christus Ochsner St. Patrick Hospital, Lake Charles, LA, USA
| | - T David Gbadebo
- East Atlanta Cardiology, Atlanta, GA, USA
- Emory Decatur Hospital, Atlanta, GA, USA
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11
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Contreras J, Fincannon A, Khambaty T, Villalonga-Olives E. Emergent Social Capital during the Coronavirus Pandemic in the United States in Hispanics/Latinos. Int J Environ Res Public Health 2023; 20:ijerph20085465. [PMID: 37107747 PMCID: PMC10138722 DOI: 10.3390/ijerph20085465] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 05/11/2023]
Abstract
The coronavirus pandemic has drastically impacted many groups that have been socially and economically marginalized such as Hispanics/Latinos in the United States (U.S.). Our aim was to understand how bonding social capital, bridging social capital, and trust played a role in Hispanics/Latinos over the course of the COVID-19 outbreak, as well as explore the negative consequences of social capital. We performed focus group discussions via Zoom (n = 25) between January and December 2021 with Hispanics/Latinos from Baltimore, MD, Washington, DC, and New York City, NY. Our findings suggest that Hispanics/Latinos experienced bridging and bonding social capital. Of particular interest was how social capital permeated the Hispanic/Latino community's socioeconomic challenges during the pandemic. The focus groups revealed the importance of trust and its role in vaccine hesitancy. Additionally, the focus groups discussed the dark side of social capital including caregiving burden and spread of misinformation. We also identified the emergent theme of racism. Future public health interventions should invest in social capital, especially for groups that have been historically marginalized or made vulnerable, and consider the promotion of bonding and bridging social capital and trust. When prospective disasters occur, public health interventions should support vulnerable populations that are overwhelmed with caregiving burden and are susceptible to misinformation.
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Affiliation(s)
- Jennifer Contreras
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Alexandra Fincannon
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Tasneem Khambaty
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, USA
| | - Ester Villalonga-Olives
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
- Correspondence:
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12
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Broffman L, Harrison S, Zhao M, Goldman A, Patnaik I, Zhou M. The Relationship Between Broadband Speeds, Device Type, Demographic Characteristics, and Care-Seeking Via Telehealth. Telemed J E Health 2023; 29:425-431. [PMID: 35867048 DOI: 10.1089/tmj.2022.0058] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study sought to examine the complex relationship between individual and environmental characteristics, broadband access, device type (computer or smartphone), and telehealth utilization as it relates to the digital divide. Methods: We analyzed a combination of electronic health record and publicly available zip code-level data for 2,770 men seeking treatment on a large, nationally available, direct-to-consumer telehealth platform. Using logistic regression, we determined the likelihood of accessing the platform through a smartphone (vs. a computer) based on key features of the environment, including broadband access and income, and demographic characteristics, including age and race. Results: We found that living in areas with higher rates of broadband adoption significantly decreased the likelihood of accessing virtual care using a smartphone (odds ratio [OR] = 0.17, p < 0.001). Compared with the 18-29 age category, the odds of accessing virtual care using a smartphone decreased for men between the age categories of 40-59 (OR = 0.63, p < 0.01) and over 60 (OR = 0.29, p < 0.001) years. Belonging to historically marginalized communities of color (Black, Hispanic, and Native American) almost doubled the odds of using a smartphone to access the platform (OR = 1.8, p < 0.001). Broadband availability and median area income were not significantly associated with mobile use. Conclusions: Telehealth platform design and policy solutions intended to expand access to virtual care should be flexible enough to accommodate the sometimes competing needs of patients who are at the greatest risk of being left behind.
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Affiliation(s)
| | | | - Michael Zhao
- Roman Health Ventures, Inc., New York, New York, USA
| | - Alex Goldman
- Roman Health Ventures, Inc., New York, New York, USA
| | - Ira Patnaik
- Roman Health Ventures, Inc., New York, New York, USA
| | - Megan Zhou
- Roman Health Ventures, Inc., New York, New York, USA
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13
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Victor SE, Trieu TH, Seymour NE. Associations with LGBTQ+ mental health disparities during the COVID-19 pandemic. Psychology & Sexuality 2023. [DOI: 10.1080/19419899.2023.2179938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
| | - Terry H. Trieu
- Texas Tech University, Department of Psychological Sciences
| | - Nicole E. Seymour
- Center for Behavioral Medicine, Missouri Department of Mental Health
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14
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Potter GE, Bonnett T, Rubenstein K, Lindholm DA, Rapaka RR, Doernberg SB, Lye DC, Mularski RA, Hynes NA, Kline S, Paules CI, Wolfe CR, Frank MG, Rouphael NG, Deye GA, Sweeney DA, Colombo RE, Davey RT, Mehta AK, Whitaker JA, Castro JG, Amin AN, Colombo CJ, Levine CB, Jain MK, Maves RC, Marconi VC, Grossberg R, Hozayen S, Burgess TH, Atmar RL, Ganesan A, Gomez CA, Benson CA, Lopez de Castilla D, Ahuja N, George SL, Nayak SU, Cohen SH, Lalani T, Short WR, Erdmann N, Tomashek KM, Tebas P. Temporal Improvements in COVID-19 Outcomes for Hospitalized Adults: A Post Hoc Observational Study of Remdesivir Group Participants in the Adaptive COVID-19 Treatment Trial. Ann Intern Med 2022; 175:1716-1727. [PMID: 36442063 PMCID: PMC9709721 DOI: 10.7326/m22-2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The COVID-19 standard of care (SOC) evolved rapidly during 2020 and 2021, but its cumulative effect over time is unclear. OBJECTIVE To evaluate whether recovery and mortality improved as SOC evolved, using data from ACTT (Adaptive COVID-19 Treatment Trial). DESIGN ACTT is a series of phase 3, randomized, double-blind, placebo-controlled trials that evaluated COVID-19 therapeutics from February 2020 through May 2021. ACTT-1 compared remdesivir plus SOC to placebo plus SOC, and in ACTT-2 and ACTT-3, remdesivir plus SOC was the control group. This post hoc analysis compared recovery and mortality between these comparable sequential cohorts of patients who received remdesivir plus SOC, adjusting for baseline characteristics with propensity score weighting. The analysis was repeated for participants in ACTT-3 and ACTT-4 who received remdesivir plus dexamethasone plus SOC. Trends in SOC that could explain outcome improvements were analyzed. (ClinicalTrials.gov: NCT04280705 [ACTT-1], NCT04401579 [ACTT-2], NCT04492475 [ACTT-3], and NCT04640168 [ACTT-4]). SETTING 94 hospitals in 10 countries (86% U.S. participants). PARTICIPANTS Adults hospitalized with COVID-19. INTERVENTION SOC. MEASUREMENTS 28-day mortality and recovery. RESULTS Although outcomes were better in ACTT-2 than in ACTT-1, adjusted hazard ratios (HRs) were close to 1 (HR for recovery, 1.04 [95% CI, 0.92 to 1.17]; HR for mortality, 0.90 [CI, 0.56 to 1.40]). Comparable patients were less likely to be intubated in ACTT-2 than in ACTT-1 (odds ratio, 0.75 [CI, 0.53 to 0.97]), and hydroxychloroquine use decreased. Outcomes improved from ACTT-2 to ACTT-3 (HR for recovery, 1.43 [CI, 1.24 to 1.64]; HR for mortality, 0.45 [CI, 0.21 to 0.97]). Potential explanatory factors (SOC trends, case surges, and variant trends) were similar between ACTT-2 and ACTT-3, except for increased dexamethasone use (11% to 77%). Outcomes were similar in ACTT-3 and ACTT-4. Antibiotic use decreased gradually across all stages. LIMITATION Unmeasured confounding. CONCLUSION Changes in patient composition explained improved outcomes from ACTT-1 to ACTT-2 but not from ACTT-2 to ACTT-3, suggesting improved SOC. These results support excluding nonconcurrent controls from analysis of platform trials in rapidly changing therapeutic areas. PRIMARY FUNDING SOURCE National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Gail E Potter
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland (G.E.P.)
| | - Tyler Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland (T.B., K.R.)
| | - Kevin Rubenstein
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland (T.B., K.R.)
| | - David A Lindholm
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas (D.A.L.)
| | - Rekha R Rapaka
- University of Maryland Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland (R.R.R.)
| | - Sarah B Doernberg
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California (S.B.D.)
| | - David C Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Yong Loo Lin School of Medicine, and Lee Kong Chian School of Medicine, Singapore (D.C.L.)
| | - Richard A Mularski
- Department of Pulmonary and Critical Care Medicine, Northwest Permanente PC, and Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (R.A.M.)
| | - Noreen A Hynes
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (N.A.H.)
| | - Susan Kline
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School, Minneapolis, Minnesota (S.K.)
| | - Catharine I Paules
- Division of Infectious Diseases, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (C.I.P.)
| | - Cameron R Wolfe
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina (C.R.W.)
| | - Maria G Frank
- Department of Medicine, Denver Health Hospital Authority, Denver, Colorado, and University of Colorado School of Medicine, Aurora, Colorado (M.G.F.)
| | - Nadine G Rouphael
- Hope Clinic, Emory Vaccine Center, Infectious Diseases Division, Atlanta, Georgia (N.G.R.)
| | - Gregory A Deye
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (G.A.D., S.U.N., K.M.T.)
| | - Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California (D.A.S.)
| | - Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, Washington, Infectious Diseases Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland (R.E.C.)
| | - Richard T Davey
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (R.T.D.)
| | - Aneesh K Mehta
- Division of Infectious Diseases, Emory University School of Medicine, and National Emerging Special Pathogens Training and Education Center, Atlanta, Georgia (A.K.M.)
| | - Jennifer A Whitaker
- Departments of Molecular Virology and Microbiology and Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas (J.A.W.)
| | - Jose G Castro
- Division of Infectious Diseases, University of Miami, Miami, Florida (J.G.C.)
| | - Alpesh N Amin
- Department of Medicine, University of California, Irvine, Irvine, California (A.N.A.)
| | - Christopher J Colombo
- Madigan Army Medical Center, Tacoma, Washington, and Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland (C.J.C.)
| | - Corri B Levine
- Department of Internal Medicine, Division of Infectious Disease, University of Texas Medical Branch, Galveston, Texas (C.B.L.)
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Disease and Geographic Medicine, UT Southwestern Medical Center, and Parkland Health & Hospital System, Dallas, Texas (M.K.J.)
| | - Ryan C Maves
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, and Infectious Diseases Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland (R.C.M.)
| | - Vincent C Marconi
- Emory University School of Medicine, Rollins School of Public Health, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia (V.C.M.)
| | - Robert Grossberg
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (R.G.)
| | - Sameh Hozayen
- Department of Medicine, Division of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota (S.H.)
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (T.H.B.)
| | - Robert L Atmar
- Department of Medicine, Baylor College of Medicine, Houston, Texas (R.L.A.)
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and Walter Reed National Military Medical Center, Bethesda, Maryland (A.G.)
| | - Carlos A Gomez
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska (C.A.G.)
| | - Constance A Benson
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California (C.A.B.)
| | - Diego Lopez de Castilla
- Division of Infectious Diseases, Evergreen Health Medical Center, Kirkland, Washington (D.L.)
| | - Neera Ahuja
- Department of Internal Medicine, Stanford University Medical Center, Palo Alto, California (N.A.)
| | - Sarah L George
- Saint Louis University and St. Louis VA Medical Center, Saint Louis, Missouri (S.L.G.)
| | - Seema U Nayak
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (G.A.D., S.U.N., K.M.T.)
| | - Stuart H Cohen
- Division of Infectious Diseases, University of California, Davis, Sacramento, California (S.H.C.)
| | - Tahaniyat Lalani
- Naval Medical Center Portsmouth, Portsmouth, Virginia, Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland (T.L.)
| | - William R Short
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania (W.R.S.)
| | - Nathaniel Erdmann
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (N.E.)
| | - Kay M Tomashek
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (G.A.D., S.U.N., K.M.T.)
| | - Pablo Tebas
- Division of Infectious Diseases/Clinical Trials Unit, University of Pennsylvania, Philadelphia, Pennsylvania (P.T.)
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15
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Erben Y, Prudencio M, Marquez CP, Jansen-West KR, Heckman MG, White LJ, Dunmore JA, Cook CN, Lilley MT, Qosja N, Song Y, Hanna Al Shaikh R, Daughrity LM, Bartfield JL, Day GS, Oskarsson B, Nicholson KA, Wszolek ZK, Hoyne JB, Gendron TF, Meschia JF, Petrucelli L. Neurofilament light chain and vaccination status associate with clinical outcomes in severe COVID-19. iScience 2022; 25:105272. [PMID: 36213006 PMCID: PMC9531935 DOI: 10.1016/j.isci.2022.105272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 02/08/2023] Open
Abstract
Blood neurofilament light chain (NFL) is proposed to serve as an estimate of disease severity in hospitalized patients with coronavirus disease 2019 (COVID-19). We show that NFL concentrations in plasma collected from 880 patients with COVID-19 within 5 days of hospital admission were elevated compared to controls. Higher plasma NFL associated with worse clinical outcomes including the need for mechanical ventilation, intensive care, prolonged hospitalization, and greater functional disability at discharge. No difference in the studied clinical outcomes between black/African American and white patients was found. Finally, vaccination associated with less disability at time of hospital discharge. In aggregate, our findings support the utility of measuring NFL shortly after hospital admission to estimate disease severity and show that race does not influence clinical outcomes caused by COVID-19 assuming equivalent access to care, and that vaccination may lessen the degree of COVID-19-caused disability.
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Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - Christopher P. Marquez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Michael G. Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Launia J. White
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Judith A. Dunmore
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Casey N. Cook
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | | | - Neda Qosja
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Yuping Song
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rana Hanna Al Shaikh
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Björn Oskarsson
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Katharine A. Nicholson
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital (MGH), Boston, MA 02114, USA
| | | | - Jonathan B. Hoyne
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Tania F. Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - James F. Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
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16
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Pond EN, Rutkow L, Blauer B, Aliseda Alonso A, Bertran de Lis S, Nuzzo JB. Disparities in SARS-CoV-2 Testing for Hispanic/Latino Populations: An Analysis of State-Published Demographic Data. J Public Health Manag Pract 2022; 28:330-333. [PMID: 35149661 PMCID: PMC9112961 DOI: 10.1097/phh.0000000000001510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 11/30/2022]
Abstract
Racial and ethnic minorities in the United States have been disproportionately affected by the COVID-19 pandemic, experiencing increased risk of infection, hospitalization, and death. In this study, we sought to examine race- and ethnicity-based differences in SARS-CoV-2 testing. We used publicly available US state dashboards to extract demographic data for COVID-19 cases and tests. Poisson regression models were used to model the effect of race and ethnicity on the number of SARS-CoV-2 tests performed per case. In total, just 8 states reported testing data by race and ethnicity. In regression models, race and ethnicity was a significant predictor of testing rate per case. In all states, Hispanic/Latino patients had a significantly lower testing rate than their non-Hispanic/Latino counterparts, with an incident rate ratio varying from 0.45 to 0.81, depending on the state and referent race category. These results suggest disparities in testing access among Hispanic/Latino individuals, who are already at a disproportionate risk for infection and severe outcomes.
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Affiliation(s)
- Emily N. Pond
- Center for Health Security (Ms Pond and Dr Nuzzo) and Departments of Health Policy and Management (Dr Rutkow), Environmental Health and Engineering (Dr Nuzzo), and Epidemiology (Dr Nuzzo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Centers for Civic Impact, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland (Ms Blauer, Aliseda Alonso, and Dr Bertran de Lis)
| | - Lainie Rutkow
- Center for Health Security (Ms Pond and Dr Nuzzo) and Departments of Health Policy and Management (Dr Rutkow), Environmental Health and Engineering (Dr Nuzzo), and Epidemiology (Dr Nuzzo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Centers for Civic Impact, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland (Ms Blauer, Aliseda Alonso, and Dr Bertran de Lis)
| | - Beth Blauer
- Center for Health Security (Ms Pond and Dr Nuzzo) and Departments of Health Policy and Management (Dr Rutkow), Environmental Health and Engineering (Dr Nuzzo), and Epidemiology (Dr Nuzzo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Centers for Civic Impact, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland (Ms Blauer, Aliseda Alonso, and Dr Bertran de Lis)
| | - Angel Aliseda Alonso
- Center for Health Security (Ms Pond and Dr Nuzzo) and Departments of Health Policy and Management (Dr Rutkow), Environmental Health and Engineering (Dr Nuzzo), and Epidemiology (Dr Nuzzo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Centers for Civic Impact, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland (Ms Blauer, Aliseda Alonso, and Dr Bertran de Lis)
| | - Sara Bertran de Lis
- Center for Health Security (Ms Pond and Dr Nuzzo) and Departments of Health Policy and Management (Dr Rutkow), Environmental Health and Engineering (Dr Nuzzo), and Epidemiology (Dr Nuzzo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Centers for Civic Impact, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland (Ms Blauer, Aliseda Alonso, and Dr Bertran de Lis)
| | - Jennifer B. Nuzzo
- Center for Health Security (Ms Pond and Dr Nuzzo) and Departments of Health Policy and Management (Dr Rutkow), Environmental Health and Engineering (Dr Nuzzo), and Epidemiology (Dr Nuzzo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Centers for Civic Impact, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland (Ms Blauer, Aliseda Alonso, and Dr Bertran de Lis)
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17
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Kirson N, Swallow E, Lu J, Foroughi C, Bookhart B, DeMartino JK, Maynard J, Shivdasani Y, Eid D, Lefebvre P. Increasing COVID-19 Vaccination in the United States: Projected Impact on Cases, Hospitalizations, and Deaths by Age and Racial Group. Public Health 2022; 210:99-106. [PMID: 35921739 PMCID: PMC9221930 DOI: 10.1016/j.puhe.2022.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
Objectives Minority populations in the United States face a disproportionate burden of illness from COVID-19 infection and have lower vaccination rates compared with other groups. This study estimated the equity implications of increased COVID-19 vaccination in the United States, with a focus on the number of cases, hospitalizations, and deaths avoided. Study design This was an observational real-world modeling study. Methods Data from the Centers for Disease Control and Prevention (CDC) were used to identify the remaining unvaccinated US population by county, age, and race as of October 22, 2021. The number of COVID-19 cases, hospitalizations, and deaths avoided were calculated based on case incidence and death data from the CDC, along with data on race- and age-specific hospitalization multipliers, under a scenario in which half of the remaining unvaccinated population per county, race, and age group obtained a full vaccine regimen. Results Vaccinating half of the remaining unvaccinated population in each age and race subgroup within counties would result in an estimated 22.09 million COVID-19 cases avoided, 1.38 million hospitalizations avoided, and 150,000 deaths avoided over 12 months. Some minority groups, particularly Black and Hispanic/Latino populations, were projected to experience substantial benefits from increased vaccination rates as they face both lower vaccination rates and worse outcomes if infected with COVID-19. Conclusions Increasing COVID-19 vaccination in the United States not only benefits the population as a whole but also serves as a potentially useful lever to reduce the disproportionate burden of COVID-19 illness among minority populations.
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Affiliation(s)
- N Kirson
- Analysis Group, Inc., Boston, MA, USA
| | - E Swallow
- Analysis Group, Inc., Boston, MA, USA.
| | - J Lu
- Analysis Group, Inc., Menlo Park, CA, USA
| | | | - B Bookhart
- Janssen Scientific Affairs, Titusville, NJ, USA
| | | | - J Maynard
- Analysis Group, Inc., Boston, MA, USA
| | | | - D Eid
- Analysis Group, Inc., Boston, MA, USA
| | - P Lefebvre
- Analysis Group, Inc., Montreal, Quebec, Canada
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18
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Abstract
This mixed design synthesis aimed to estimate the infection fatality rate (IFR) of Coronavirus Disease 2019 (COVID-19) in community-dwelling elderly populations and other age groups from seroprevalence studies. Protocol: https://osf.io/47cgb. Eligible were seroprevalence studies done in 2020 and identified by any of four existing systematic reviews; with ≥ 500 participants aged ≥ 70 years; presenting seroprevalence in elderly people; aimed to generate samples reflecting the general population; and whose location had available data on cumulative COVID-19 deaths in elderly (primary cutoff ≥ 70 years; ≥ 65 or ≥ 60 also eligible). We extracted the most fully adjusted (if unavailable, unadjusted) seroprevalence estimates; age- and residence-stratified cumulative COVID-19 deaths (until 1 week after the seroprevalence sampling midpoint) from official reports; and population statistics, to calculate IFRs adjusted for test performance. Sample size-weighted IFRs were estimated for countries with multiple estimates. Thirteen seroprevalence surveys representing 11 high-income countries were included in the main analysis. Median IFR in community-dwelling elderly and elderly overall was 2.9% (range 1.8–9.7%) and 4.5% (range 2.5–16.7%) without accounting for seroreversion (2.2% and 4.0%, respectively, accounting for 5% monthly seroreversion). Multiple sensitivity analyses yielded similar results. IFR was higher with larger proportions of people > 85 years. The IFR of COVID-19 in community-dwelling elderly is lower than previously reported.
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Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, CA, USA.
- Stanford Prevention Research Center, Medical School Office Building, Room X306, 1265 Welch Road, Stanford, CA, 94305, USA.
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Keller MB, Wang J, Nason M, Warner S, Follmann D, Kadri SS. Preintubation Sequential Organ Failure Assessment Score for Predicting COVID-19 Mortality: External Validation Using Electronic Health Record From 86 U.S. Healthcare Systems to Appraise Current Ventilator Triage Algorithms. Crit Care Med 2022. [PMID: 35302957 DOI: 10.1097/CCM.0000000000005534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES: Prior research has hypothesized the Sequential Organ Failure Assessment (SOFA) score to be a poor predictor of mortality in mechanically ventilated patients with COVID-19. Yet, several U.S. states have proposed SOFA-based algorithms for ventilator triage during crisis standards of care. Using a large cohort of mechanically ventilated patients with COVID-19, we externally validated the predictive capacity of the preintubation SOFA score for mortality prediction with and without other commonly used algorithm elements. DESIGN: Multicenter, retrospective cohort study using electronic health record data. SETTING: Eighty-six U.S. health systems. PATIENTS: Patients with COVID-19 hospitalized between January 1, 2020, and February 14, 2021, and subsequently initiated on mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 15,122 mechanically ventilated patients with COVID-19, SOFA score alone demonstrated poor discriminant accuracy for inhospital mortality in mechanically ventilated patients using the validation cohort (area under the receiver operating characteristic curve [AUC], 0.66; 95% CI, 0.65–0.67). Discriminant accuracy was even poorer using SOFA score categories (AUC, 0.54; 95% CI, 0.54–0.55). Age alone demonstrated greater discriminant accuracy for inhospital mortality than SOFA score (AUC, 0.71; 95% CI, 0.69–0.72). Discriminant accuracy for mortality improved upon addition of age to the continuous SOFA score (AUC, 0.74; 95% CI, 0.73–0.76) and categorized SOFA score (AUC, 0.72; 95% CI, 0.71–0.73) models, respectively. The addition of comorbidities did not substantially increase model discrimination. Of 36 U.S. states with crisis standards of care guidelines containing ventilator triage algorithms, 31 (86%) feature the SOFA score. Of these, 25 (81%) rely heavily on the SOFA score (12 exclusively propose SOFA; 13 place highest weight on SOFA or propose SOFA with one other variable). CONCLUSIONS: In a U.S. cohort of over 15,000 ventilated patients with COVID-19, the SOFA score displayed poor predictive accuracy for short-term mortality. Our findings warrant reappraisal of the SOFA score’s implementation and weightage in existing ventilator triage pathways in current U.S. crisis standards of care guidelines.
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20
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Akman C, Bardakçı O, Daş M, Akdur G, Akdur O. The Effectiveness of National Early Warning Score, Quick Sequential Organ Failure Assessment, Charlson Comorbidity Index, and Elixhauser Comorbidity Index Scores in Predicting Mortality Due to COVID-19 in Elderly Patients. Cureus 2022; 14:e23012. [PMID: 35464509 PMCID: PMC9001189 DOI: 10.7759/cureus.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction: As the mortality rate in coronavirus disease 2019 (COVID-19) patients older than 65 years is considerable, evaluation of in-hospital mortality is crucial. This study aimed to evaluate in-hospital mortality in COVID-19 patients older than 65 years using the National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (q-SOFA), Charlson Comorbidity Index (CCI), and Elixhauser Comorbidity Index (ECI). Methods: This retrospective study included data from 480 patients with confirmed COVID-19 and age over 65 years who were evaluated in a university emergency department in Turkey. Data from eligible but deceased COVID-19 patients was also included. NEWS, q-SOFA, CCI, and ECI scores were retrospectively calculated. All clinical data was accessed from the information management system of the hospital, retrieved, and analyzed. Results: In-hospital mortality was seen in 169 patients (169/480). Low oxygen saturation, high C-reactive protein (CRP) and urea levels, and high q-SOFA and ECI scores helped us identify mortality in high-risk patients. A statistically significant difference was found in mortality estimation between q-SOFA and ECI (p <0.001), respectively. Conclusion: Q-SOFA and ECI can be used both easily and practically in the early diagnosis of in-hospital mortality in COVID-19 positive patients over 65 years of age admitted to the emergency department. Low oxygen saturation, high CRP and urea levels, and high q-SOFA and ECI scores are helpful in identifying high-risk patients.
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21
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Lett E, Asabor E, Beltrán S, Cannon AM, Arah OA. Conceptualizing, Contextualizing, and Operationalizing Race in Quantitative Health Sciences Research. Ann Fam Med 2022; 20:157-163. [PMID: 35045967 PMCID: PMC8959750 DOI: 10.1370/afm.2792] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023] Open
Abstract
Differences in health outcomes across racial groups are among the most commonly reported findings in health disparities research. Often, these studies do not explicitly connect observed disparities to mechanisms of systemic racism that drive adverse health outcomes among racialized and other marginalized groups in the United States. Without this connection, investigators inadvertently support harmful narratives of biologic essentialism or cultural inferiority that pathologize racial identities and inhibit health equity. This paper outlines pitfalls in the conceptualization, contextualization, and operationalization of race in quantitative population health research and provides recommendations on how to appropriately engage in scientific inquiry aimed at understanding racial health inequities. Race should not be used as a measure of biologic difference, but rather as a proxy for exposure to systemic racism. Future studies should go beyond this proxy use and directly measure racism and its health impacts.VISUAL ABSTRACTAppeared as Annals "Online First" article.
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Affiliation(s)
- Elle Lett
- Center for Health Equity Advancement, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Applied Transgender Studies, Chicago, Illinois
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emmanuella Asabor
- Center for Health Equity Advancement, University of Pennsylvania, Philadelphia, Pennsylvania
- Yale University School of Medicine, New Haven, Connecticut
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut
| | - Sourik Beltrán
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
- Department of Statistics, University of California, Los Angeles College of Letters and Science, Los Angeles, California
- Department of Public Health, Aarhus University, Aarhus, Denmark
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22
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Joseph A, Uribe-Leitz T, Dey T, Havens J, Cooper Z, Raykar N. Racial and neighborhood disparities in mortality among hospitalized COVID-19 patients in the United States: An analysis of the CDC case surveillance database. PLOS Glob Public Health 2022; 2:e0000701. [PMID: 36962563 PMCID: PMC10022015 DOI: 10.1371/journal.pgph.0000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Black and Hispanic populations have higher overall COVID-19 infection and mortality odds compared to Whites. Some state-wide studies conducted in the early months of the pandemic found no in-hospital racial disparities in mortality. METHODS We performed chi-square and logistic regression analyses on the CDC COVID-19 Case Surveillance Restricted Database. The primary outcome of the study was all-cause in-hospital mortality. The primary exposures were racial group (White, Black, Hispanic and Others) and neighborhood type (low vulnerability, moderate vulnerability, high vulnerability, very high vulnerability). FINDINGS The overall unadjusted mortality rate was 33% and was lowest among Hispanics. In the fully adjusted models, Blacks and Hispanics had higher overall odds of dying [OR of 1.20 (95% CI 1.15, 1.25) and 1.23 (95% CI 1.17, 1.28) respectively] compared with White patients, and patients from neighborhoods with very high vulnerability had the highest mortality odds in the Northeast, Midwest and overall [Adjusted OR 2.08 (95% CI 1.91, 2.26)]. In the Midwest, Blacks and Hispanics had higher odds of mortality compared with Whites, but this was not observed in other regions. INTERPRETATION Among hospitalized COVID-19 patients, Blacks and Hispanics were more likely to die compared to Whites in the Midwest. Patients from highly vulnerable neighborhoods also had the highest likelihood of death in the Northeast and Midwest. These results raise important questions on our efforts to curb healthcare disparities and structural racism in the healthcare setting.
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Affiliation(s)
- Atarere Joseph
- Department of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, United States of America
| | - Tarsicio Uribe-Leitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston Massachusetts, United States of America
- Division of Sport and Health Sciences, Department of Epidemiology, Technical University of Munich, Munich, Germany
| | - Tanujit Dey
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Joaquim Havens
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Nakul Raykar
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston Massachusetts, United States of America
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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23
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Jiao J, Chen Y, Azimian A. Exploring temporal varying demographic and economic disparities in COVID-19 infections in four U.S. areas: based on OLS, GWR, and random forest models. Comput Urban Sci 2021; 1:27. [PMID: 34901952 DOI: 10.1007/s43762-021-00028-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/22/2021] [Indexed: 10/27/2022]
Abstract
Although studies have previously investigated the spatial factors of COVID-19, most of them were conducted at a low resolution and chose to limit their study areas to high-density urbanized regions. Hence, this study aims to investigate the economic-demographic disparities in COVID-19 infections and their spatial-temporal patterns in areas with different population densities in the United States. In particular, we examined the relationships between demographic and economic factors and COVID-19 density using ordinary least squares, geographically weighted regression analyses, and random forest based on zip code-level data of four regions in the United States. Our results indicated that the demographic and economic disparities are significant. Moreover, several areas with disadvantaged groups were found to be at high risk of COVID19 infection, and their infection risk changed at different pandemic periods. The findings of this study can contribute to the planning of public health services, such as the adoption of smarter and comprehensive policies for allocating economic recovery resources and vaccines during a public health crisis.
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24
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Sempere A, Salvador F, Monforte A, Sampol J, Espinosa-Pereiro J, Miarons M, Bosch-Nicolau P, Guillén-del-Castillo A, Aznar ML, Campos-Varela I, Sánchez-Montalvá A, Leguízamo-Martínez LM, Oliveira I, Antón A, Almirante B. COVID-19 Clinical Profile in Latin American Migrants Living in Spain: Does the Geographical Origin Matter? J Clin Med 2021; 10:5213. [PMID: 34830495 PMCID: PMC8622310 DOI: 10.3390/jcm10225213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to describe and compare the clinical characteristics of hospitalized patients with COVID-19 pneumonia according to their geographical origin. This is a retrospective case-control study of hospitalized patients with confirmed COVID-19 pneumonia treated at Vall d'Hebron University Hospital (Barcelona) during the first wave of the pandemic. Cases were defined as patients born in Latin America and controls were randomly selected among Spanish patients matched by age and gender. Demographic and clinical variables were collected, including comorbidities, symptoms, vital signs and analytical parameters, intensive care unit admission and outcome at 28 days after admission. Overall, 1080 hospitalized patients were registered: 774 (71.6%) from Spain, 142 (13.1%) from Latin America and the rest from other countries. Patients from Latin America were considered as cases and 558 Spanish patients were randomly selected as controls. Latin American patients had a higher proportion of anosmia, rhinorrhea and odynophagia, as well as higher mean levels of platelets and lower mean levels of ferritin than Spanish patients. No differences were found in oxygen requirement and mortality at 28 days after admission, but there was a higher proportion of ICU admissions (28.2% vs. 20.2%, p = 0.0310). An increased proportion of ICU admissions were found in patients from Latin America compared with native Spanish patients when adjusted by age and gender, with no significant differences in in-hospital mortality.
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Affiliation(s)
- Abiu Sempere
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Arnau Monforte
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Júlia Sampol
- Department of Pneumology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Juan Espinosa-Pereiro
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Marta Miarons
- Department of Pharmacy, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Pau Bosch-Nicolau
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | | | - Maria Luisa Aznar
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Isabel Campos-Varela
- Liver Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Lina María Leguízamo-Martínez
- Department of Pharmacovigilance and Pharmacoepidemiology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Inés Oliveira
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Andrés Antón
- Department of Microbiology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Benito Almirante
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
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25
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Li Y, Nazaroff WW, Bahnfleth W, Wargocki P, Zhang Y. The COVID-19 pandemic is a global indoor air crisis that should lead to change: A message commemorating 30 years of Indoor Air. Indoor Air 2021; 31:1683-1686. [PMID: 34661309 PMCID: PMC8653253 DOI: 10.1111/ina.12928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 05/19/2023]
Affiliation(s)
- Yuguo Li
- Department of Mechanical EngineeringThe University of Hong KongHong Kong SARChina
| | | | - William Bahnfleth
- Department of Architectural EngineeringPennsylvania State University (Penn State)University ParkPAUSA
| | - Pawel Wargocki
- Department of Civil EngineeringTechnical University of DenmarkLyngbyDenmark
| | - Yinping Zhang
- Department of Building ScienceTsinghua UniversityBeijingChina
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26
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Grekousis G, Wang R, Liu Y. Mapping the geodemographics of racial, economic, health, and COVID-19 deaths inequalities in the conterminous US. Appl Geogr 2021; 135:102558. [PMID: 34511662 PMCID: PMC8416553 DOI: 10.1016/j.apgeog.2021.102558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 05/09/2023]
Abstract
A large number of studies have examined individual-level factors that increase COVID-19 fatalities. However, no research has focused on the geodemographic classification of the most susceptible communities to COVID-19. In this cross-sectional ecological study, we used local fuzzy geographically-weighted clustering to create the socioeconomic profile of the US counties in relation to COVID-19 death rates. We demonstrate that living in a county which has households with lower income, people with a lack of health insurance, a high African-American percentage, and lower education level, lead to 27.12% higher COVID-19 death rates than the national median, and 72.56% higher compared to the least vulnerable counties. Compared to counties with a high COVID-19 death rate, counties with a low COVID-19 death rate have 44.90% higher annual median household income and nearly double house worth (89.51% more). Results show that the effects of the COVID-19 pandemic are not universal and that the minoritised and impoverished populations suffer more. Our analysis can effectively pinpoint the most vulnerable counties and importantly allows for understanding the socioeconomic context in which tailored interventions can be applied to mitigate COVID-19 deaths.
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Affiliation(s)
- George Grekousis
- School of Geography and Planning, Sun Yat-sen University, China
- Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-sen University, China
- Guangdong Provincial Engineering Research Center for Public Security and Disaster, China
| | - Ruoyu Wang
- Institute of Geography, School of GeoSciences, University of Edinburgh, UK
| | - Ye Liu
- School of Geography and Planning, Sun Yat-sen University, China
- Guangdong Key Laboratory for Urbanization and Geo-simulation, Sun Yat-sen University, China
- Guangdong Provincial Engineering Research Center for Public Security and Disaster, China
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Olanipekun T, Abe T, Sobukonla T, Tamizharasu J, Gamo L, Kuete NT, Bakinde N, Westney G, Snyder RH. Association between race and risk of ICU mortality in mechanically ventilated COVID-19 patients at a safety net hospital. J Natl Med Assoc 2021; 114:18-25. [PMID: 34615602 PMCID: PMC8443330 DOI: 10.1016/j.jnma.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/28/2021] [Revised: 08/09/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022]
Abstract
Purpose To determine racial differences in intensive care unit (ICU) mortality outcomes among mechanically ventilated patients with severe coronavirus disease 2019 (COVID-19) infection in a safety net hospital. Methods We retrospectively analyzed a cohort of patients ≥ 18 years old with confirmed severe acute respiratory syndrome-CoV-2 disease associated respiratory failure who were treated with invasive mechanical ventilation and admitted to the ICU from May 1, 2020 – July 30 -2020 at Grady Memorial Hospital, Atlanta, Georgia – a safety net hospital. We evaluated the association between mortality and demographics, co-morbidities, inpatient laboratory, and radiological parameters. Results Among 181 critically ill mechanically ventilated African American patients treated at a safety net hospital, the mortality rate was 33%. On stratified analysis by race (Table 2), mortality rates were significantly higher in African Americans (39%) and Hispanics (26.3%), compared to Whites (18.9%). On multivariate regression, African Americans were 3 times more likely to die in the ICU compared to Whites (OR 3.1 95% CI 1.6 -5.5). Likewise, the likelihood of mortality was higher in Hispanics compared to Whites (OR 1.3 95% CI 1.0 -3.9). Conclusions Our study demonstrated a high ICU mortality rate in a cohort of mechanically ventilated patients with severe COVID-19 infection treated at a safety net hospital. African Americans and Hispanics had significantly higher risks of ICU mortality compared to Whites. These study findings further elucidate the disproportionately higher burden of COVID-19 infection in African Americans and Hispanics.
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Affiliation(s)
- Titilope Olanipekun
- Department of Hospital Medicine, Covenant Health System, Knoxville, TN, United States.
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Timothy Sobukonla
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Jothika Tamizharasu
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Linda Gamo
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Nelson T Kuete
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Nicolas Bakinde
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Gloria Westney
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Richard H Snyder
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, United States
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