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Vandenbroucke JP, Pearce N. Excess Mortality Calculations to Assess the Impact of the COVID-19 Pandemic: Concepts and Methodological Issues. Am J Public Health 2024; 114:593-598. [PMID: 38547492 PMCID: PMC11079831 DOI: 10.2105/ajph.2024.307572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
We discuss some intriguing methodological aspects of excess mortality analyses, which have been widely used to describe the impact of the COVID-19 pandemic. We describe the main ways of presenting excess mortality: as a mortality rate (incidence rate) or as a percentage increase (relative risk or rate ratio). We discuss what should be regarded as the null value of excess mortality (i.e., when countries or regions can be judged as having fared equally well) and when age and sex standardization, adjustment for other determinants of the spread of a pandemic, or both is necessary. We discuss the level of detail by time and place and person that may be necessary. We note that an excess mortality comparison is essentially a difference-in-differences analysis. We conclude that, although one cannot rule out using excess mortality analyses for causal effect estimates, such analyses will remain most fruitful for generating hypotheses about both the efficiency of measures to curtail the pandemic and factors that cannot be influenced. Nevertheless, a judicious use of arguments and counterarguments can then lead to identifying best practices for various situations. (Am J Public Health. 2024;114(6):593-598. https://doi.org/10.2105/AJPH.2024.307572).
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Affiliation(s)
- Jan P Vandenbroucke
- Jan P. Vandenbroucke and Neil Pearce are with the Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK. Jan P. Vandenbroucke is also with the Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark, and the Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands
| | - Neil Pearce
- Jan P. Vandenbroucke and Neil Pearce are with the Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK. Jan P. Vandenbroucke is also with the Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark, and the Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands
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Antonio-Villa NE, Bello-Chavolla OY, Fermín-Martínez CA, Ramírez-García D, Vargas-Vázquez A, Basile-Alvarez MR, Núñez-Luna A, Sánchez-Castro P, Fernández-Chirino L, Díaz-Sánchez JP, Dávila-López G, Posadas-Sánchez R, Vargas-Alarcón G, Caballero AE, Florez JC, Seiglie JA. Diabetes subgroups and sociodemographic inequalities in Mexico: a cross-sectional analysis of nationally representative surveys from 2016 to 2022. Lancet Reg Health Am 2024; 33:100732. [PMID: 38616917 PMCID: PMC11015526 DOI: 10.1016/j.lana.2024.100732] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
Background Differences in the prevalence of four diabetes subgroups have been reported in Mexico compared to other populations, but factors that may contribute to these differences are poorly understood. Here, we estimate the prevalence of diabetes subgroups in Mexico and evaluate their correlates with indicators of social disadvantage using data from national representative surveys. Methods We analyzed serial, cross-sectional Mexican National Health and Nutrition Surveys spanning 2016, 2018, 2020, 2021, and 2022, including 23,354 adults (>20 years). Diabetes subgroups (obesity-related [MOD], severe insulin-deficient [SIDD], severe insulin-resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks based on a previously validated algorithm. We used the density-independent social lag index (DISLI) as a proxy of state-level social disadvantage. Findings We identified 4204 adults (median age: 57, IQR: 47-66, women: 64%) living with diabetes, yielding a pooled prevalence of 16.04% [95% CI: 14.92-17.17]. When stratified by diabetes subgroup, prevalence was 6.62% (5.69-7.55) for SIDD, 5.25% (4.52-5.97) for MOD, 2.39% (1.95-2.83) for MARD, and 1.27% (1.00-1.54) for SIRD. SIDD and MOD clustered in Southern Mexico, whereas MARD and SIRD clustered in Northern Mexico and Mexico City. Each standard deviation increase in DISLI was associated with higher odds of SIDD (OR: 1.12, 95% CI: 1.06-1.12) and lower odds of MOD (OR: 0.93, 0.88-0.99). Speaking an indigenous language was associated with higher odds of SIDD (OR: 1.35, 1.16-1.57) and lower odds of MARD (OR 0.58, 0.45-0.74). Interpretation Diabetes prevalence in Mexico is rising in the context of regional and sociodemographic inequalities across distinct diabetes subgroups. SIDD is a subgroup of concern that may be associated with inadequate diabetes management, mainly in marginalized states. Funding This research was supported by Instituto Nacional de Geriatría in Mexico.
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Affiliation(s)
| | | | - Carlos A. Fermín-Martínez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniel Ramírez-García
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Martín Roberto Basile-Alvarez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandra Núñez-Luna
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Paulina Sánchez-Castro
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Juan Pablo Díaz-Sánchez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Gael Dávila-López
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rosalinda Posadas-Sánchez
- Departamento de Endocrinología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Gilberto Vargas-Alarcón
- Dirección de Investigación, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - A. Enrique Caballero
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jose C. Florez
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jacqueline A. Seiglie
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
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Garduño-Alanis A, Contreras-Manzano A, Salgado JC, Lamadrid-Figueroa H, Curi-Quinto K, Barquera S. A high density of ultra-processed food, alcohol & tobacco retail stores, and social inequalities are associated with higher mortality rates of non-communicable diseases in Mexican adults: 2005 to 2021. PLoS One 2024; 19:e0301387. [PMID: 38598474 PMCID: PMC11006154 DOI: 10.1371/journal.pone.0301387] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading causes of mortality in Mexico. Factors contributing to NCDs-related deaths may vary across small geographic areas such as municipalities. We aimed to predict municipal-level factors associated with NCD mortality in Mexican adults from 2005 to 2021 using the small-area analysis (SSA) approach. METHODS We gathered data on population sociodemographic, access to healthcare services, and mortality records at the municipal-level from census and public institutions from 2005 to 2021. We identified municipal predictors of NCDs mortality rates (MR) using negative binomial regression models. RESULTS A total of 584,052 observations of Mexican adults were analyzed. The national expected NCDs MR per 100,000 inhabitants was 210.7 (95%CI: 196.1-226.7) in 2005 and increased to 322.4 (95%CI: 300.3-346.4) by 2021. Predictors of NCDs mortality (quintile 5 vs. quintile 1) included; indigeneity (IRR = 1.15, 95%CI: 1.12-1.19), poverty (IRR = 1.14, 95%CI: 1.13-1.15), affiliation with Mexican Social Security Institute (IRR = 1.11, 95%CI: 1.09-1.14), households with television (IRR = 1.14, 95%CI: 1.11-1.17), and high density of ultra-processed food, alcohol & tobacco retail stores (IRR = 1.15, 95%CI: 1.13-1.17). The greatest increases in MR were observed in municipalities from Oaxaca (>200% increments). CONCLUSION There was an overall increase in NCDs MR from 2005 to 2021, with a significant geographic variation among Mexican municipalities. The results of this study highlight the importance of identifying priority areas in the country that urgently require public policies focused on local factors associated with deaths from NCDs, such as the regulation of the ultra-processed food, alcohol & tobacco retail stores, and efforts to reduce social inequalities.
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Affiliation(s)
- Adriana Garduño-Alanis
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- National Council of Humanities, Science and Technology, Mexico
- Autonomous University of the State of Mexico, Toluca, State of Mexico, Mexico
| | - Alejandra Contreras-Manzano
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- National Council of Humanities, Science and Technology, Mexico
| | - Juan Carlos Salgado
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- National Council of Humanities, Science and Technology, Mexico
| | - Héctor Lamadrid-Figueroa
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Pulido J, Barrio G, Donat M, Politi J, Moreno A, Cea-Soriano L, Guerras JM, Huertas L, Mateo-Urdiales A, Ronda E, Martínez D, Lostao L, Belza MJ, Regidor E. Excess Mortality During 2020 in Spain: The Most Affected Population, Age, and Educational Group by the COVID-19 Pandemic. Disaster Med Public Health Prep 2024; 18:e27. [PMID: 38372080 DOI: 10.1017/dmp.2024.17] [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] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education. METHODS An observational study was carried out, using linked populations and deaths' data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017-2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison. RESULTS All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25-64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people. CONCLUSION Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.
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Affiliation(s)
- José Pulido
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gregorio Barrio
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Donat
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Julieta Politi
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Almudena Moreno
- Department of Sociology, Universidad Pública de Navarra, Spain
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia Huertas
- Instituto Valenciano de Estadística, Valencia, Spain
- National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Elena Ronda
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Preventive Medicine and Public Health Area, Universidad de Alicante, Alicante, Spain
| | - David Martínez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Lourdes Lostao
- Department of Sociology, Universidad Pública de Navarra, Spain
| | - María José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Regidor
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Meraz-Cruz N, Manzano-León N, Sandoval-Colin DE, García de León Méndez MDC, Quintana-Belmares R, Tapia LS, Osornio-Vargas AR, Buxton MA, O'Neill MS, Vadillo-Ortega F. Effects of PM 10 Airborne Particles from Different Regions of a Megacity on In Vitro Secretion of Cytokines by a Monocyte Line during Different Seasons. Toxics 2024; 12:149. [PMID: 38393244 PMCID: PMC10892217 DOI: 10.3390/toxics12020149] [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] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Several epidemiological studies have demonstrated that particulate matter (PM) in air pollution can be involved in the genesis or aggravation of different cardiovascular, respiratory, perinatal, and cancer diseases. This study assessed the in vitro effects of PM10 on the secretion of cytokines by a human monocytic cell line (THP-1). We compared the chemotactic, pro-inflammatory, and anti-inflammatory cytokines induced by PM10 collected for two years during three different seasons in five different Mexico City locations. MIP-1α, IP-10, MCP-1, TNF-α, and VEGF were the main secretion products after stimulation with 80 μg/mL of PM10 for 24 h. The THP-1 cells showed a differential response to PM10 obtained in the different sites of Mexico City. The PM10 from the north and the central city areas induced a higher pro-inflammatory cytokine response than those from the south. Seasonal pro-inflammatory cytokine secretion always exceeded anti-inflammatory secretion. The rainy-season-derived particles caused the lowest pro-inflammatory effects. We concluded that toxicological assessment of airborne particles provides evidence supporting their potential role in the chronic exacerbation of local or systemic inflammatory responses that may worsen the evolution of some chronic diseases.
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Affiliation(s)
- Noemi Meraz-Cruz
- Unidad de Vinculación Científica de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
| | - Natalia Manzano-León
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Daniel Eduardo Sandoval-Colin
- Unidad de Vinculación Científica de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
| | | | - Raúl Quintana-Belmares
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Laura Sevilla Tapia
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Alvaro R Osornio-Vargas
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Miatta A Buxton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Marie S O'Neill
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Environmental Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Felipe Vadillo-Ortega
- Unidad de Vinculación Científica de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
- Department of Environmental Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Wai AKC, Yip TF, Wong YH, Chu CK, Lee T, Yu KHO, So WL, Wong JYH, Wong CKH, Ho JW, Rainer T. The Effect of the COVID-19 Pandemic on Non-COVID-19 Deaths: Population-Wide Retrospective Cohort Study. JMIR Public Health Surveill 2024; 10:e41792. [PMID: 38349717 PMCID: PMC10866203 DOI: 10.2196/41792] [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: 08/09/2022] [Revised: 08/23/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Health care avoidance in the COVID-19 pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behavior during pandemic waves and inferred its impact on excess non-COVID-19 deaths. OBJECTIVE This study aimed to measure the impact of hospital avoidance on excess non-COVID-19 deaths in public hospitals in Hong Kong. METHODS This was a retrospective cohort study involving 11,966,786 patients examined between January 1, 2016, and December 31, 2021, in Hong Kong. All data were linked to service, treatment, and outcomes. To estimate excess mortality, the 2-stage least squares method was used with daily tallies of emergency department (ED) visits and 28-day mortality. Records for older people were categorized by long-term care (LTC) home status, and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. The primary outcome was actual excess death in 2020 and 2021. The 2-stage least squares method was used to estimate the daily excess 28-day mortality by daily reduced visits. RESULTS Compared with the prepandemic (2016-2019) average, there was a reduction in total ED visits in 2020 of 25.4% (548,116/2,142,609). During the same period, the 28-day mortality of non-COVID-19 ED deaths increased by 7.82% (2689/34,370) compared with 2016-2019. The actual excess deaths in 2020 and 2021 were 3143 and 4013, respectively. The estimated total excess non-COVID-19 28-day deaths among older people in 2020 to 2021 were 1958 (95% CI 1100-2820; no time lag). Deaths on arrival (DOAs) or deaths before arrival (DBAs) increased by 33.6% (1457/4336) in 2020, while non-DOA/DBAs increased only by a moderate 4.97% (1202/24,204). In both types of deaths, the increases were higher during wave periods than in nonwave periods. Moreover, non-LTC patients saw a greater reduction in ED visits than LTC patients across all waves, by more than 10% (non-LTC: 93,896/363,879, 25.8%; LTC: 7,956/67,090, 11.9%). Most of the comorbidity subsets demonstrated an annualized reduction in visits in 2020. Renal diseases and severe liver diseases saw notable increases in deaths. CONCLUSIONS We demonstrated a statistical method to estimate hospital avoidance behavior during a pandemic and quantified the consequent excess 28-day mortality with a focus on older people, who had high frequencies of ED visits and deaths. This study serves as an informed alert and possible investigational guideline for health care professionals for hospital avoidance behavior and its consequences.
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Affiliation(s)
- Abraham Ka-Chung Wai
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Accident & Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Accident & Emergency, Queen Mary Hospital, Hong Kong, China (Hong Kong)
| | - Tsz Fung Yip
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yui Hang Wong
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Chun Kit Chu
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Teddy Lee
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Ken Hung On Yu
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wang Leong So
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Janet Y H Wong
- School of Nursing & Health Studies, Hong Kong Metropolitan University, Kowloon, China (Hong Kong)
| | - Carlos King-Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joshua W Ho
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Timothy Rainer
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Paglino E, Lundberg DJ, Wrigley-Field E, Zhou Z, Wasserman JA, Raquib R, Chen YH, Hempstead K, Preston SH, Elo IT, Glymour MM, Stokes AC. Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths. Proc Natl Acad Sci U S A 2024; 121:e2313661121. [PMID: 38300867 PMCID: PMC10861891 DOI: 10.1073/pnas.2313661121] [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: 08/11/2023] [Accepted: 12/06/2023] [Indexed: 02/03/2024] Open
Abstract
In the United States, estimates of excess deaths attributable to the COVID-19 pandemic have consistently surpassed reported COVID-19 death counts. Excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by pandemic health care interruptions, and/or deaths from the pandemic's socioeconomic impacts. The geographic and temporal distribution of these deaths may help to evaluate which explanation is most plausible. We developed a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 mo of the pandemic. From March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally [90% PI (Posterior Interval): 1,046,000 to 1,340,204]. A total of 162,886 of these excess natural-cause deaths (90% PI: 14,276 to 308,480) were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was greater in nonmetropolitan counties (36.0 deaths), the West (Rocky Mountain states: 31.6 deaths; Pacific states: 25.5 deaths), and the South (East South Central states: 26.0 deaths; South Atlantic states: 25.0 deaths; West South Central states: 24.2 deaths). In contrast, reported COVID-19 death counts surpassed estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths correlated temporally with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or prior month. This suggests that many excess deaths reported to non-COVID-19 natural causes during the first 30 mo of the pandemic in the United States were unrecognized COVID-19 deaths.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA19104
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA02118
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA98195
| | - Elizabeth Wrigley-Field
- Department of Sociology and Minnesota Population Center, University of Minnesota, Minneapolis, MN55455
| | - Zhenwei Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA02118
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA02118
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA94158
| | | | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA19104
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA19104
| | - M. Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, Boston, MA02118
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA02118
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8
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Bello-Chavolla OY, Fermín-Martínez CA, Ramírez-García D, Vargas-Vázquez A, Fernández-Chirino L, Basile-Alvarez MR, Sánchez-Castro P, Núñez-Luna A, Antonio-Villa NE. Prevalence and determinants of post-acute sequelae after SARS-CoV-2 infection (Long COVID) among adults in Mexico during 2022: a retrospective analysis of nationally representative data. Lancet Reg Health Am 2024; 30:100688. [PMID: 38327277 PMCID: PMC10847769 DOI: 10.1016/j.lana.2024.100688] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/26/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
Background Post-acute sequelae after SARS-CoV-2 infection (PASC) remains a concerning long-term complication of COVID-19. Here, we aimed to characterize the epidemiology of PASC in Mexico during 2022 and identify potential associations of covariates with PASC prevalence using nationally representative data. Methods We analyzed data from the 2022 Mexican National Health and Nutrition Survey (ENSANUT) from 24,434 participants, representing 85,521,661 adults ≥20 years. PASC was defined using both the National Institute for Health and Care Excellence (NICE) definition and a PASC score ≥12. Estimates of PASC prevalence were stratified by age, sex, rural vs. urban setting, social lag quartiles, number of reinfections, vaccination status and periods of predominance of SARS-CoV-2 circulating variants. Determinants of PASC were assessed using log-binomial regression models adjusted by survey weights. Findings Persistent symptoms after SARS-CoV-2 infection were reported by 12.44% (95% CI 11.89-12.99) of adults ≥20 years in Mexico in 2022. The most common persistent symptoms were fatigue, musculoskeletal pain, headache, cough, loss of smell or taste, fever, post-exertional malaise, brain fog, anxiety, and chest pain. PASC was present in 21.21% (95% CI 19.74-22.68) of subjects with previously diagnosed COVID-19. Over 28.6% of patients with PASC reported symptoms persistence ≥6 months and 14.05% reported incapacitating symptoms. Higher PASC prevalence was associated with SARS-CoV-2 reinfections, depressive symptoms and living in states with high social lag. PASC prevalence, particularly its more severe forms, decreased with COVID-19 vaccination and for infections during periods of Omicron variant predominance. Interpretation PASC remains a significant public health burden in Mexico as the COVID-19 pandemic transitions into endemic. Promoting SARS-CoV-2 reinfection prevention and booster vaccination may be useful in reducing PASC burden. Funding This research was supported by Instituto Nacional de Geriatría in Mexico.
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Affiliation(s)
| | - Carlos A. Fermín-Martínez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniel Ramírez-García
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | - Martín Roberto Basile-Alvarez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Paulina Sánchez-Castro
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandra Núñez-Luna
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Roberti J, Leslie HH, Doubova SV, Ranilla JM, Mazzoni A, Espinoza L, Calderón R, Arsenault C, García-Elorrio E, García PJ. Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries. Lancet Glob Health 2024; 12:e145-e155. [PMID: 38096887 PMCID: PMC10716623 DOI: 10.1016/s2214-109x(23)00488-6] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/14/2023] [Accepted: 10/10/2023] [Indexed: 12/17/2023]
Abstract
The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country. We created binary outcomes in coverage, user experience, system competence, and confidence in the system and calculated the slope index of inequality by income and education. Although access to care was high, only a third of respondents reported having a high-quality source of care and 25% of those with mental health needs had those needs met. Two-thirds of adults were able to access relevant preventive care and 42% of older adults were screened for cardiovascular disease. Telehealth access, communication and autonomy in most recent visit, reasonable waiting times, and receiving preventive health checks showed inequalities favouring people with a high income. In Uruguay, inequality between government and social security services explained a substantial proportion of disparities in preventive health access. In other study countries, inequalities were also substantial within government and social security subsectors. Essential health system functions are unequal in these four Latin American countries.
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Affiliation(s)
- Javier Roberti
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; Epidemiology and Public Health Research Centre, National Council for Scientific and Technical Research, Buenos Aires, Argentina.
| | - Hannah H Leslie
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico
| | | | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Laura Espinoza
- School of Public Health, Cayetano Heredia University, Lima, Peru
| | - Renzo Calderón
- School of Public Health, Cayetano Heredia University, Lima, Peru; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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10
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Fermín-Martínez CA, Paz-Cabrera CD, Basile-Alvarez MR, Castro PS, Núñez-Luna A, Perezalonso-Espinosa J, Ramírez-García D, Antonio-Villa NE, Vargas-Vázquez A, Fernández-Chirino L, Carrillo-Herrera KB, Cabrera-Quintana LA, Rojas-Martínez R, Seiglie JA, Bello-Chavolla OY. Prevalence of prediabetes in Mexico: a retrospective analysis of nationally representative surveys spanning 2016-2022. Lancet Reg Health Am 2023; 28:100640. [PMID: 38076414 PMCID: PMC10701418 DOI: 10.1016/j.lana.2023.100640] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023]
Abstract
Background Characterizing prediabetes phenotypes may be useful in guiding diabetes prevention efforts; however, heterogeneous criteria to define prediabetes have led to inconsistent prevalence estimates, particularly in low- and middle-income countries. Here, we estimated trends in prediabetes prevalence in Mexico across different prediabetes definitions and their association with prevalent cardiometabolic conditions. Methods We conducted a serial cross-sectional analysis of National Health and Nutrition Surveys in Mexico (2016-2022), totalling 22 081 Mexican adults. After excluding individuals with diagnosed or undiagnosed diabetes, we defined prediabetes using ADA (impaired fasting glucose [IFG] 100-125 mg/dL and/or HbA1c 5.7-6.4%), WHO (IFG 110-125 mg/dL), and IEC criteria (HbA1c 6.0-6.4%). Prevalence trends of prediabetes over time were evaluated using weighted Poisson regression and its association with prevalent cardiometabolic conditions with weighted logistic regression. Findings The prevalence of prediabetes (either IFG or high HbA1c [ADA]) in Mexico was 20.9% in 2022. Despite an overall downward trend in prediabetes (RR 0.973, 95% CI 0.957-0.988), this was primarily driven by decreases in prediabetes by ADA-IFG (RR 0.898, 95% CI 0.880-0.917) and WHO-IFG criteria (RR 0.919, 95% CI 0.886-0.953), while prediabetes by ADA-HbA1c (RR 1.055, 95% CI 1.033-1.077) and IEC-HbA1C criteria (RR 1.085, 95% CI 1.045-1.126) increased over time. Prediabetes prevalence increased over time in adults >40 years, with central obesity, self-identified as indigenous or living in urban areas. For all definitions, prediabetes was associated with an increased risk of cardiometabolic conditions. Interpretation Prediabetes rates in Mexico from 2016 to 2022 varied based on defining criteria but consistently increased for HbA1c-based definitions and high-risk subgroups. Funding This research was supported by Instituto Nacional de Geriatría in Mexico. JAS was supported by NIH/NIDDK Grant# K23DK135798.
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Affiliation(s)
- Carlos A. Fermín-Martínez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - César Daniel Paz-Cabrera
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Especialidad en Medicina Preventiva, Instituto Nacional de Salud Pública, Mexico City, Mexico
| | - Martín Roberto Basile-Alvarez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Paulina Sánchez Castro
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandra Núñez-Luna
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Daniel Ramírez-García
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Arsenio Vargas-Vázquez
- Especialidad en Medicina Preventiva, Instituto Nacional de Salud Pública, Mexico City, Mexico
| | | | | | | | | | - Jacqueline A. Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, MA, USA
- Department of Medicine, Harvard Medical School, MA, USA
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11
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Iwashyna TJ, Seelye S, Berkowitz TS, Pura J, Bohnert ASB, Bowling CB, Boyko EJ, Hynes DM, Ioannou GN, Maciejewski ML, O’Hare AM, Viglianti EM, Womer J, Prescott HC, Smith VA. Late Mortality After COVID-19 Infection Among US Veterans vs Risk-Matched Comparators: A 2-Year Cohort Analysis. JAMA Intern Med 2023; 183:1111-1119. [PMID: 37603339 PMCID: PMC10442778 DOI: 10.1001/jamainternmed.2023.3587] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 08/22/2023]
Abstract
Importance Despite growing evidence of persistent problems after acute COVID-19, how long the excess mortality risk associated with COVID-19 persists is unknown. Objective To measure the time course of differential mortality among Veterans who had a first-documented COVID-19 infection by separately assessing acute mortality from later mortality among matched groups with infected and uninfected individuals who survived and were uncensored at the start of each period. Design, Settings, and Participants This retrospective cohort study used prospectively collected health record data from Veterans Affairs hospitals across the US on Veterans who had COVID-19 between March 2020 and April 2021. Each individual was matched with up to 5 comparators who had not been infected with COVID-19 at the time of matching. This match balanced, on a month-by-month basis, the risk of developing COVID-19 using 37 variables measured in the 24 months before the date of the infection or match. A primary analysis censored comparators when they developed COVID-19 with inverse probability of censoring weighting in Cox regression. A secondary analysis did not censor. Data analyses were performed from April 2021 through June 2023. Exposure First-documented case of COVID-19 (SARS-CoV-2) infection. Main Outcome Measures Hazard ratios for all-cause mortality at clinically meaningful intervals after infection: 0 to 90, 91 to 180, 181 to 365, and 366 to 730 days. Results The study sample comprised 208 061 Veterans with first-documented COVID-19 infection (mean [SD] age, 60.5 (16.2) years; 21 936 (10.5) women; 47 645 [22.9] Black and 139 604 [67.1] White individuals) and 1 037 423 matched uninfected comparators with similar characteristics. Veterans with COVID-19 had an unadjusted mortality rate of 8.7% during the 2-year period after the initial infection compared with 4.1% among uninfected comparators, with censoring if the comparator later developed COVID-19-an adjusted hazard ratio (aHR) of 2.01 (95% CI, 1.98-2.04). The risk of excess death varied, being highest during days 0 to 90 after infection (aHR, 6.36; 95% CI, 6.20-6.51) and still elevated during days 91 to 180 (aHR, 1.18; 95% CI, 1.12-1.23). Those who survived COVID-19 had decreased mortality on days 181 to 365 (aHR, 0.92; 95% CI, 0.89-0.95) and 366 to 730 (aHR, 0.89; 95% CI, 0.85-0.92). These patterns were consistent across sensitivity analyses. Conclusion and Relevance The findings of this retrospective cohort study indicate that although overall 2-year mortality risk was worse among those infected with COVID-19, by day 180 after infection they had no excess mortality during the next 1.5 years.
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Affiliation(s)
- Theodore J. Iwashyna
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
- School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sarah Seelye
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
| | - Theodore S. Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - John Pura
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Amy S. B. Bohnert
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Departments of Anesthesiology and Psychiatry, University of Michigan Medical School, Ann Arbor
| | - C. Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Durham VA Geriatric Research Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Edward J. Boyko
- VA Puget Sound Health Care System Hospital and Specialty Medicine Service and Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Denise M. Hynes
- VA Center to Improve Veteran Involvement in Care, Portland, Oregon
- College of Public Health and Human Sciences and Center for Quantitative Life Sciences, Oregon State University, Corvallis
- School of Nursing, Oregon Health and Science University, Portland
| | - George N. Ioannou
- VA Puget Sound Health Care System Hospital and Specialty Medicine Service and Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Ann M. O’Hare
- VA Puget Sound Health Care System Hospital and Specialty Medicine Service and Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Elizabeth M. Viglianti
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - James Womer
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hallie C. Prescott
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
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12
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Munguía-Realpozo P, Mendoza-Pinto C, Etchegaray-Morales I, Solis-Poblano JC, Ayón-Aguilar J, Ramírez-Lara E, Orbe-Sosa J, Méndez-Martínez S, García-Carrasco M. Trends in mortality in patients with systemic autoimmune rheumatic diseases (SARD) during the COVID-19 pandemic in Mexico. Rheumatol Int 2023; 43:1611-1619. [PMID: 37349634 DOI: 10.1007/s00296-023-05371-w] [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: 05/18/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
The study aimed to analyze the influence of the COVID-19 pandemic on mortality rates in patients with systemic autoimmune rheumatic diseases (SARD) in Mexico. We selected SARD-related deaths using National Open Data and Information from the Ministry of Health, Mexico, and ICD-10 codes. We assessed the observed compared to the predicted mortality values for 2020 and 2021, employing trends from 2010 to 2019 with joinpoint and prediction modelling analyses. Among 12,742 deaths due to SARD between 2010 and 2021, the age-standardized mortality rate (ASMR) increased significantly between 2010 and 2019 (pre-pandemic) (annual percentage change [APC] 1.1%; 95% CI 0.2-2.1), followed by a non-significant decrease during the pandemic period (APC 13.9%; 95% CI 13.9-5.3). In addition, the observed ASMR of 1.19 for 2020 for SARD and of 1.14 for 2021 were lower than the predicted values of 1.25 (95% CI 1.22-1.28) for 2020 and 1.25 (95% CI 1.20-1.30) for 2021. Similar findings were identified for specific SARD, mainly systemic lupus erythematosus (SLE), or by sex or age group. Interestingly, the observed mortality rates for SLE in the Southern region of 1.00 in 2020 and 1.01 in 2021 were both significantly greater than the predicted values of 0.71 (95% CI 0.65-0.77) in 2020 and 0.71 (95% CI 0.63-0.79). In Mexico, the observed SARD mortality rates were not higher than the expected values during the pandemic, except for SLE in the Southern region. No differences by sex or age group were identified.
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Affiliation(s)
- Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Calle 13 Sur 2702, Los Volcanes, 72420, Puebla, Mexico
| | - Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Calle 13 Sur 2702, Los Volcanes, 72420, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Calle 13 Sur 2702, Los Volcanes, 72420, Puebla, Mexico.
| | - Juan Carlos Solis-Poblano
- Department of Haematology, Specialties Hospital UMAE, Instituto Mexicano del Seguro Social, Puebla, Mexico
| | - Jorge Ayón-Aguilar
- Coordinación Médica de Investigación en Salud, Instituto Mexicano del Seguro Social, Delegación Puebla, Puebla, Mexico
| | - Edith Ramírez-Lara
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico
| | - Jacsiry Orbe-Sosa
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Calle 13 Sur 2702, Los Volcanes, 72420, Puebla, Mexico
| | - Socorro Méndez-Martínez
- Coordinación de Planeación y Enlace Institucional, Instituto Mexicano del Seguro Social, Delegación Puebla, Puebla, Mexico
| | - Mario García-Carrasco
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Calle 13 Sur 2702, Los Volcanes, 72420, Puebla, Mexico
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13
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Addey T, Alegre-Díaz J, Bragg F, Trichia E, Wade R, Santacruz-Benitez R, Ramirez-Reyes R, Garcilazo-Ávila A, Gonzáles-Carballo C, Bello-Chavolla OY, Antonio-Villa NE, Aguilar-Ramirez D, Friedrichs LG, Lewington S, Peto R, Collins R, Berumen J, Emberson JR, Kuri-Morales P, Tapia-Conyer R. Educational and social inequalities and cause-specific mortality in Mexico City: a prospective study. Lancet Public Health 2023; 8:e670-e679. [PMID: 37633676 PMCID: PMC7615266 DOI: 10.1016/s2468-2667(23)00153-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Social inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify social, including educational, inequalities in mortality among adults in Mexico City. METHODS The Mexico City Prospective Study recruited 150 000 adults aged 35 years and older from two districts of Mexico City between 1998 and 2004. Participants were followed up until Jan 1, 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 years associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors. FINDINGS Among 143 478 participants aged 35-74 years, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 1·84; 95% CI 1·71-1·98), equivalent to approximately 6 years lower life expectancy, with an RR of 1·78 (1·67-1·90) among participants with incomplete primary, 1·62 (1·53-1·72) with complete primary, and 1·34 (1·25-1·42) with secondary education. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 3·65; 95% CI 3·05-4·38 for no education vs tertiary education) and from infectious diseases (2·67; 2·00-3·56), but there was an apparent higher rate of death from all specific causes studied with lower education, with the exception of cancer for which there was little association. Lifestyle factors (ie, smoking, alcohol drinking, and leisure time physical activity) and related physiological correlates (ie, adiposity, diabetes, and blood pressure) accounted for about four-fifths of the association of education with premature mortality. INTERPRETATION In this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality. FUNDING Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit.
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Affiliation(s)
- Thomas Addey
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jesus Alegre-Díaz
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eirini Trichia
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Wade
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rogelio Santacruz-Benitez
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Raúl Ramirez-Reyes
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Adrián Garcilazo-Ávila
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Carlos Gonzáles-Carballo
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | - Diego Aguilar-Ramirez
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Louisa Gnatiuc Friedrichs
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jaime Berumen
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jonathan R Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Pablo Kuri-Morales
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Roberto Tapia-Conyer
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
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14
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Bello-Chavolla OY, Antonio-Villa NE, Valdés-Ferrer SI, Fermín-Martínez CA, Fernández-Chirino L, Vargas-Vázquez A, Ramírez-García D, Mancilla-Galindo J, Kammar-García A, Ávila-Funes JA, Zúñiga-Gil CH, García-Grimshaw M, Ceballos-Liceaga SE, Carbajal-Sandoval G, Montes-González JA, Zaragoza-Jiménez CA, García-Rodríguez G, Cortés-Alcalá R, Reyes-Terán G, López-Gatell H, Gutiérrez-Robledo LM. Effectiveness of a nationwide COVID-19 vaccination program in Mexico against symptomatic COVID-19, hospitalizations, and death: a retrospective analysis of national surveillance data. Int J Infect Dis 2023; 129:188-196. [PMID: 36775188 PMCID: PMC9918316 DOI: 10.1016/j.ijid.2023.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/05/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVES Vaccination has been effective in ameliorating the impact of COVID-19. Here, we report vaccine effectiveness (VE) of the nationally available COVID-19 vaccines in Mexico. METHODS Retrospective analysis of a COVID-19 surveillance system to assess the VE of the BNT162b2, messenger RNA (mRNA)-12732, Gam-COVID-Vac, Ad5-nCoV, Ad26.COV2.S, ChAdOx1, and CoronaVac vaccines against SARS-CoV-2 infection, COVID-19 hospitalization, and death in Mexico. The VE was estimated using time-varying Cox proportional hazard models in vaccinated and unvaccinated adults, adjusted for age, sex, and comorbidities. VE was also estimated for adults with diabetes, aged ≥60 years, and comparing the predominance of SARS-CoV-2 variants B.1.1.519 and B.1.617.2. RESULTS We assessed 793,487 vaccinated and 4,792,338 unvaccinated adults between December 24, 2020 and September 27, 2021. The VE against SARS-CoV-2 infection was the highest for fully vaccinated individuals with mRNA-12732 (91.5%, 95% confidence interval [CI] 90.3-92.4) and Ad26.COV2.S (82.2%, 95% CI 81.4-82.9); for COVID-19 hospitalization, BNT162b2 (84.3%, 95% CI 83.6-84.9) and Gam-COVID-Vac (81.4% 95% CI 79.5-83.1), and for mortality, BNT162b2 (89.8%, 95% CI 89.2-90.2) and mRNA-12732 (93.5%, 95% CI 86.0-97.0). The VE decreased for all vaccines in adults aged ≥60 years, people with diabetes, and periods of Delta variant predominance. CONCLUSION All the vaccines implemented in Mexico were effective against SARS-CoV-2 infection, COVID-19 hospitalization, and death. Mass vaccination with multiple vaccines is useful to maximize vaccination coverage.
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Affiliation(s)
| | - Neftali Eduardo Antonio-Villa
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico; MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Fermín-Martínez
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico; MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luisa Fernández-Chirino
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico; Facultad de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniel Ramírez-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico; Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
| | | | | | - Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Ricardo Cortés-Alcalá
- Dirección General de Promoción de la Salud, Secretaría de Salud, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
| | - Hugo López-Gatell
- Subsecretaría de Prevención y Promoción de la Salud, Secretaría de Salud Direccion General de Epidemiologia, SecretarIa de Salud, Mexico City, Mexico
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Paglino E, Lundberg DJ, Zhou Z, Wasserman JA, Raquib R, Hempstead K, Preston SH, Elo IT, Stokes AC. Differences Between Reported COVID-19 Deaths and Estimated Excess Deaths in Counties Across the United States, March 2020 to February 2022. medRxiv 2023:2023.01.16.23284633. [PMID: 36712059 PMCID: PMC9882565 DOI: 10.1101/2023.01.16.23284633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Accurate and timely tracking of COVID-19 deaths is essential to a well-functioning public health surveillance system. The extent to which official COVID-19 death tallies have captured the true toll of the pandemic in the United States is unknown. In the current study, we develop a Bayesian hierarchical model to estimate monthly excess mortality in each county over the first two years of the pandemic and compare these estimates to the number of deaths officially attributed to Covid-19 on death certificates. Overall, we estimated that 268,176 excess deaths were not reported as Covid-19 deaths during the first two years of the Covid-19 pandemic, which represented 23.7% of all excess deaths that occurred. Differences between excess deaths and reported COVID-19 deaths were substantial in both the first and second year of the pandemic. Excess deaths were less likely to be reported as COVID-19 deaths in the Mountain division, in the South, and in nonmetro counties. The number of excess deaths exceeded COVID-19 deaths in all Census divisions except for the New England and Middle Atlantic divisions where there were more COVID-19 deaths than excess deaths in large metro areas and medium or small metro areas. Increases in excess deaths not assigned to COVID-19 followed similar patterns over time to increases in reported COVID-19 deaths and typically preceded or occurred concurrently with increases in reported COVID-19 deaths. Estimates from this study can be used to inform targeting of resources to areas in which the true toll of the COVID-19 pandemic has been underestimated.
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Affiliation(s)
- Eugenio Paglino
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Zhenwei Zhou
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | | | - Rafeya Raquib
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | | | - Samuel H. Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Irma T. Elo
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA
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Bello-Chavolla OY, Antonio-Villa NE, Fermín-Martínez CA, Fernández-Chirino L, Vargas-Vázquez A, Ramírez-García D, Basile-Alvarez MR, Hoyos-Lázaro AE, Carrillo-Larco RM, Wexler DJ, Manne-Goehler J, Seiglie JA. Diabetes-Related Excess Mortality in Mexico: A Comparative Analysis of National Death Registries Between 2017-2019 and 2020. Diabetes Care 2022; 45:2957-2966. [PMID: 36286591 PMCID: PMC7613876 DOI: 10.2337/dc22-0616] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Received: 03/29/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate diabetes-related mortality in Mexico in 2020 compared with 2017-2019 after the onset of the coronavirus disease 2019 (COVID-19) pandemic. RESEARCH DESIGN AND METHODS This retrospective, state-level study used national death registries of Mexican adults aged ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes listing diabetes as the primary cause of death, excluding certificates with COVID-19 as the primary cause of death. Spatial and negative binomial regression models were used to characterize the geographic distribution and sociodemographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared with average 2017-2019 rates. RESULTS We identified 148,437 diabetes-related deaths in 2020 (177 per 100,000 inhabitants) vs. an average of 101,496 deaths in 2017-2019 (125 per 100,000 inhabitants). In-hospital diabetes-related deaths decreased by 17.8% in 2020 versus 2017-2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes (130 per 100,000 inhabitants). Compared with 2018-2019 data, hyperglycemic hyperosmolar state and diabetic ketoacidosis were the two contributing causes with the highest increase in mortality (128% and 116% increase, respectively). Diabetes-related excess mortality clustered in southern Mexico and was highest in states with higher social lag, rates of COVID-19 hospitalization, and prevalence of HbA1c ≥7.5%. CONCLUSIONS Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately outside the hospital, and were largely attributable to type 2 diabetes and hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020.
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Affiliation(s)
| | - Neftali Eduardo Antonio-Villa
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A. Fermín-Martínez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luisa Fernández-Chirino
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniel Ramírez-García
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Martín Roberto Basile-Alvarez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana Elena Hoyos-Lázaro
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Deborah J. Wexler
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jennifer Manne-Goehler
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jacqueline A. Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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