1
|
Faksova K, Walsh D, Jiang Y, Griffin J, Phillips A, Gentile A, Kwong JC, Macartney K, Naus M, Grange Z, Escolano S, Sepulveda G, Shetty A, Pillsbury A, Sullivan C, Naveed Z, Janjua NZ, Giglio N, Perälä J, Nasreen S, Gidding H, Hovi P, Vo T, Cui F, Deng L, Cullen L, Artama M, Lu H, Clothier HJ, Batty K, Paynter J, Petousis-Harris H, Buttery J, Black S, Hviid A. COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals. Vaccine 2024; 42:2200-2211. [PMID: 38350768 DOI: 10.1016/j.vaccine.2024.01.100] [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: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The Global COVID Vaccine Safety (GCoVS) Project, established in 2021 under the multinational Global Vaccine Data Network™ (GVDN®), facilitates comprehensive assessment of vaccine safety. This study aimed to evaluate the risk of adverse events of special interest (AESI) following COVID-19 vaccination from 10 sites across eight countries. METHODS Using a common protocol, this observational cohort study compared observed with expected rates of 13 selected AESI across neurological, haematological, and cardiac outcomes. Expected rates were obtained by participating sites using pre-COVID-19 vaccination healthcare data stratified by age and sex. Observed rates were reported from the same healthcare datasets since COVID-19 vaccination program rollout. AESI occurring up to 42 days following vaccination with mRNA (BNT162b2 and mRNA-1273) and adenovirus-vector (ChAdOx1) vaccines were included in the primary analysis. Risks were assessed using observed versus expected (OE) ratios with 95 % confidence intervals. Prioritised potential safety signals were those with lower bound of the 95 % confidence interval (LBCI) greater than 1.5. RESULTS Participants included 99,068,901 vaccinated individuals. In total, 183,559,462 doses of BNT162b2, 36,178,442 doses of mRNA-1273, and 23,093,399 doses of ChAdOx1 were administered across participating sites in the study period. Risk periods following homologous vaccination schedules contributed 23,168,335 person-years of follow-up. OE ratios with LBCI > 1.5 were observed for Guillain-Barré syndrome (2.49, 95 % CI: 2.15, 2.87) and cerebral venous sinus thrombosis (3.23, 95 % CI: 2.51, 4.09) following the first dose of ChAdOx1 vaccine. Acute disseminated encephalomyelitis showed an OE ratio of 3.78 (95 % CI: 1.52, 7.78) following the first dose of mRNA-1273 vaccine. The OE ratios for myocarditis and pericarditis following BNT162b2, mRNA-1273, and ChAdOx1 were significantly increased with LBCIs > 1.5. CONCLUSION This multi-country analysis confirmed pre-established safety signals for myocarditis, pericarditis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis. Other potential safety signals that require further investigation were identified.
Collapse
Affiliation(s)
- K Faksova
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - D Walsh
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - Y Jiang
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - J Griffin
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - A Phillips
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - A Gentile
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J C Kwong
- ICES, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - K Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - M Naus
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Z Grange
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - S Escolano
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - G Sepulveda
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Shetty
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - C Sullivan
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - Z Naveed
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Giglio
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J Perälä
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - S Nasreen
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - H Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - P Hovi
- Department of Public Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - T Vo
- Faculty of Social Sciences, Tampere University, Finland
| | - F Cui
- School of Public Health, Peking University, China
| | - L Deng
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - L Cullen
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - M Artama
- Faculty of Social Sciences, Tampere University, Finland
| | - H Lu
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - H J Clothier
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - K Batty
- Auckland UniServices Limited at University of Auckland, New Zealand
| | - J Paynter
- School of Population Health, University of Auckland, New Zealand
| | - H Petousis-Harris
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - J Buttery
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - S Black
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - A Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Greenwald ZR, Werb D, Feld JJ, Austin PC, Fridman D, Bayoumi AM, Gomes T, Kendall CE, Lapointe-Shaw L, Scheim AI, Bartlett SR, Benchimol EI, Bouck Z, Boucher LM, Greenaway C, Janjua NZ, Leece P, Wong WW, Sander B, Kwong JC. Validation of case-ascertainment algorithms using health administrative data to identify people who inject drugs in Ontario, Canada. J Clin Epidemiol 2024:111332. [PMID: 38522754 DOI: 10.1016/j.jclinepi.2024.111332] [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: 11/23/2023] [Revised: 02/12/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Health administrative data can be used to improve the health of people who inject drugs by informing public health surveillance and program planning, monitoring, and evaluation. However, methodological gaps in the use of these data persist due to challenges in accurately identifying injection drug use at the population level. In this study, we validated case-ascertainment algorithms for identifying people who inject drugs using health administrative data in Ontario, Canada. STUDY DESIGN AND SETTING Data from cohorts of people with recent (past 12 month) injection drug use, including those participating in community-based research studies or seeking drug treatment were linked to health administrative data in Ontario from 1992-2020. We assessed the validity of algorithms to identify injection drug use over varying lookback periods (i.e., all years of data [1992 onwards] or within the past 1-5 years), including inpatient and outpatient physician billing claims for drug use, emergency department visits or hospitalizations for drug use or injection-related infections, and opioid agonist treatment (OAT). RESULTS Algorithms were validated using data from 15,241 people with recent IDU (918 in community cohorts, 14,323 seeking drug treatment). An algorithm consisting of ≥1 physician visit, emergency department visit or hospitalization for drug use, or OAT record could effectively identify IDU history (91.6% sensitivity, 94.2% specificity) and recent IDU (using 3 years lookback: 80.4% sensitivity, 99% specificity) among community cohorts. Algorithms were generally more sensitive among people who inject drugs seeking drug treatment. CONCLUSION Validated algorithms using health administrative data performed well in identifying people who inject drugs. Despite high sensitivity and specificity, the positive predictive value of these algorithms will vary depending on the underlying prevalence of injection drug use in the population in which they are applied.
Collapse
Affiliation(s)
- Zoë R Greenwald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
| | - Jordan J Feld
- Department of Medicine, University of Toronto, Toronto, Canada; Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada; University Health Network, Toronto, Canada
| | - Peter C Austin
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Ahmed M Bayoumi
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; Department of Medicine, University of Toronto, Toronto, Canada; Division of General Internal Medicine, St. Michael's Hospital, Unity Health Toronto,; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto. Canada
| | - Tara Gomes
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto. Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Ontario Drug Policy Research Network, Toronto, Canada
| | - Claire E Kendall
- ICES, Toronto, Canada; Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; Department of Medicine, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | - Ayden I Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, United States; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eric I Benchimol
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada; Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Zachary Bouck
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto. Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, Montreal, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Canada; Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation & Outcome Sciences, St Paul's Hospital Vancouver, Vancouver, Canada
| | - Pamela Leece
- Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - William Wl Wong
- ICES, Toronto, Canada; School of Pharmacy, University of Waterloo, Kitchener, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
| | - Beate Sander
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; University Health Network, Toronto, Canada; Public Health Ontario, Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; University Health Network, Toronto, Canada; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| |
Collapse
|
3
|
Naveed Z, Chu C, Tadrous M, Veroniki AA, Li J, Rouleau I, Febriani Y, Calzavara A, Buchan SA, Nasreen S, Schwartz KL, Wilton J, Seo CY, Thampi N, Wilson SE, Naus M, De Serres G, Janjua NZ, Kwong JC. A multiprovincial retrospective analysis of the incidence of myocarditis or pericarditis after mRNA vaccination compared to the incidence after SARS-CoV-2 infection. Heliyon 2024; 10:e26551. [PMID: 38439866 PMCID: PMC10909657 DOI: 10.1016/j.heliyon.2024.e26551] [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: 10/06/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
Objective To compare myocarditis/pericarditis risk after COVID-19 mRNA vaccination versus SARS-CoV-2 infection, and to assess if myocarditis/pericarditis risk varies by vaccine dosing interval. Methods In this retrospective cohort study, we used linked databases in Quebec, Ontario, and British Columbia between January 26, 2020, and September 9, 2021. We included individuals aged 12 or above who received an mRNA vaccine as the second dose or were SARS-CoV-2-positive by RT-PCR. The outcome was hospitalization/emergency department visit for myocarditis/pericarditis within 21 days of exposure. We calculated age- and sex-stratified incidence ratios (IRs) of myocarditis/pericarditis following mRNA vaccination versus SARS-CoV-2 infection. We also calculated myocarditis/pericarditis incidence by vaccine type, homologous/heterologous schedule, and dosing interval. We pooled province-specific estimates using meta-analysis. Results Following 18,860,817 mRNA vaccinations and 860,335 SARS-CoV-2 infections, we observed 686 and 160 myocarditis/pericarditis cases, respectively. Myocarditis/pericarditis incidence was lower after vaccination than infection (IR [BNT162b2/SARS-CoV-2], 0.14; 95%CI, 0.07-0.29; IR [mRNA-1273/SARS-CoV-2], 0.28; 95%CI, 0.20-0.39). Within the vaccinated cohort, myocarditis/pericarditis incidence was lower with longer dosing intervals; IR (56 or more days/15-30 days) was 0.28 (95%CI, 0.19-0.41) for BNT162b2 and 0.26 (95%CI, 0.18-0.38) for mRNA-1273. Conclusion Myocarditis/pericarditis risk was lower after mRNA vaccination than SARS-CoV-2 infection, and with longer intervals between primary vaccine doses.
Collapse
Affiliation(s)
- Zaeema Naveed
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Cherry Chu
- Women's College Hospital, Toronto, ON, Canada
| | - Mina Tadrous
- Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Areti-Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Julia Li
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Isabelle Rouleau
- Institut National de Santé Publique Du Québec, Biological Risks Division, Montreal, QC, Canada
| | - Yossi Febriani
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, QC, Canada
| | | | - Sarah A. Buchan
- ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Sharifa Nasreen
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kevin L. Schwartz
- ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | - Nisha Thampi
- Public Health Ontario, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Sarah E. Wilson
- ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Monika Naus
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Gaston De Serres
- Institut National de Santé Publique Du Québec, Biological Risks Division, Montreal, QC, Canada
- Institut National de Sante Publique Du Québec, Biological and Occupational Risks Division, Quebec City, QC, Canada
- Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, QC, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Outcomes and Evaluation, St Paul's Hospital, Vancouver, BC, Canada
| | - Jeffrey C. Kwong
- ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Canadian Immunization Research Network (CIRN) Provincial Collaborative Network investigators
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Institut National de Santé Publique Du Québec, Biological Risks Division, Montreal, QC, Canada
- Centre Hospitalier Universitaire (CHU) de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Institut National de Sante Publique Du Québec, Biological and Occupational Risks Division, Quebec City, QC, Canada
- Laval University, Department of Social and Preventive Medicine, Faculty of Medicine, Quebec City, QC, Canada
- Centre for Health Outcomes and Evaluation, St Paul's Hospital, Vancouver, BC, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| |
Collapse
|
4
|
Forouzannia F, Hamadeh A, Passos-Castilho AM, Erman A, Yu A, Feng Z, Janjua NZ, Sander B, Greenaway C, Wong WWL. Impact of new direct-acting antiviral therapy on the prevalence and undiagnosed proportion of chronic hepatitis C infection. Liver Int 2024. [PMID: 38445848 DOI: 10.1111/liv.15875] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/20/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Patients with chronic hepatitis C (CHC) can be cured with the new highly effective interferon-free combination treatments (DAA) that were approved in 2014. However, CHC is a largely silent disease, and many individuals are unaware of their infections until the late stages of the disease. The impact of wider access to effective treatments and improved awareness of the disease on the number of infections and the number of patients who remain undiagnosed is not known in Canada. Such evidence can guide the development of strategies and interventions to reduce the burden of CHC and meet World Health Organization's (WHO) 2030 elimination targets. The purpose of this study is to use a back-calculation framework informed by provincial population-level health administrative data to estimate the prevalence of CHC and the proportion of cases that remain undiagnosed in the three most populated provinces in Canada: British Columbia (BC), Ontario and Quebec. METHODS We have conducted a population-based retrospective analysis of health administrative data for the three provinces to generate the annual incidence of newly diagnosed CHC cases, decompensated cirrhosis (DC), hepatocellular carcinoma (HCC) and HCV treatment initiations. For each province, the data were stratified in three birth cohorts: individuals born prior to 1945, individuals born between 1945 and 1965 and individuals born after 1965. We used a back-calculation modelling approach to estimate prevalence and the undiagnosed proportion of CHC. The historical prevalence of CHC was inferred through a calibration process based on a Bayesian Markov chain Monte Carlo (MCMC) algorithm. The algorithm constructs the historical prevalence of CHC for each cohort by comparing the model-generated outcomes of the annual incidence of the CHC-related health events against the data set of observed diagnosed cases generated in the retrospective analysis. RESULTS The results show a decreasing trend in both CHC prevalence and undiagnosed proportion in BC, Ontario and Quebec. In 2018, CHC prevalence was estimated to be 1.23% (95% CI: .96%-1.62%), .91% (95% CI: .82%-1.04%) and .57% (95% CI: .51%-.64%) in BC, Ontario and Quebec respectively. The CHC undiagnosed proportion was assessed to be 35.44% (95% CI: 27.07%-45.83%), 34.28% (95% CI: 26.74%-41.62%) and 46.32% (95% CI: 37.85%-52.80%) in BC, Ontario and Quebec, respectively, in 2018. Also, since the introduction of new DAA treatment in 2014, CHC prevalence decreased from 1.39% to 1.23%, .97% to .91% and .65% to .57% in BC, Ontario and Quebec respectively. Similarly, the CHC undiagnosed proportion decreased from 38.78% to 35.44%, 38.70% to 34.28% and 47.54% to 46.32% in BC, Ontario and Quebec, respectively, from 2014 to 2018. CONCLUSIONS We estimated that the CHC prevalence and undiagnosed proportion have declined for all three provinces since the new DAA treatment has been approved in 2014. Yet, our findings show that a significant proportion of HCV cases remain undiagnosed across all provinces highlighting the need to increase investment in screening. Our findings provide essential evidence to guide decisions about current and future HCV strategies and help achieve the WHO goal of eliminating hepatitis C in Canada by 2030.
Collapse
Affiliation(s)
| | - Abdullah Hamadeh
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | | | - Aysegul Erman
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - William W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Puyat JH, Fowokan A, Wilton J, Janjua NZ, Wong J, Grennan T, Chambers C, Kroch A, Costiniuk CT, Cooper CL, Lauscher D, Strong M, Burchell AN, Anis AH, Samji H. Risk of COVID-19 hospitalization in people living with HIV and HIV-negative individuals and the role of COVID-19 vaccination: A retrospective cohort study. Int J Infect Dis 2023; 135:49-56. [PMID: 37419410 DOI: 10.1016/j.ijid.2023.06.026] [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: 05/11/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE To examine the risk of hospitalization within 14 days of COVID-19 diagnosis among people living with HIV (PLWH) and HIV-negative individuals who had laboratory-confirmed SARS-CoV-2 infection. METHODS We used Cox proportional hazard models to compare the relative risk of hospitalization in PLWH and HIV-negative individuals. Then, we used propensity score weighting to examine the influence of sociodemographic factors and comorbid conditions on risk of hospitalization. These models were further stratified by vaccination status and pandemic period (pre-Omicron: December 15, 2020, to November 21, 2021; Omicron: November 22, 2021, to October 31, 2022). RESULTS The crude hazard ratio (HR) for risk of hospitalization in PLWH was 2.44 (95% confidence interval [CI]: 2.04-2.94). In propensity score-weighted models that included all covariates, the relative risk of hospitalization was substantially attenuated in the overall analyses (adjusted HR [aHR]: 1.03; 95% CI: 0.85-1.25), in vaccinated (aHR 1.00; 95% CI: 0.69-1.45), inadequately vaccinated (aHR: 1.04; 95% CI: 0.76-1.41) and unvaccinated individuals (aHR: 1.15; 95% CI: 0.84-1.56). CONCLUSION PLWH had about two times the risk of COVID-19 hospitalization than HIV-negative individuals in crude analyses which attenuated in propensity score-weighted models. This suggests that the risk differential can be explained by sociodemographic factors and history of comorbidity, underscoring the need to address social and comorbid vulnerabilities (e.g., injecting drugs) that were more prominent among PLWH.
Collapse
Affiliation(s)
- Joseph H Puyat
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada.
| | - Adeleke Fowokan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Cecilia T Costiniuk
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Curtis L Cooper
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Aslam H Anis
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada; CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
| |
Collapse
|
6
|
Hamill V, Wong S, Benselin J, Krajden M, Hayes PC, Mutimer D, Yu A, Dillon JF, Gelson W, Velásquez García HA, Yeung A, Johnson P, Barclay ST, Alvarez M, Toyoda H, Agarwal K, Fraser A, Bartlett S, Aldersley M, Bathgate A, Binka M, Richardson P, Morling JR, Ryder SD, MacDonald D, Hutchinson S, Barnes E, Guha IN, Irving WL, Janjua NZ, Innes H. Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: population based cohort study. BMJ 2023; 382:e074001. [PMID: 37532284 PMCID: PMC10394680 DOI: 10.1136/bmj-2022-074001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES To quantify mortality rates for patients successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals and compare these rates with those of the general population. DESIGN Population based cohort study. SETTING British Columbia, Scotland, and England (England cohort consists of patients with cirrhosis only). PARTICIPANTS 21 790 people who were successfully treated for hepatitis C in the era of interferon-free antivirals (2014-19). Participants were divided into three liver disease severity groups: people without cirrhosis (pre-cirrhosis), those with compensated cirrhosis, and those with end stage liver disease. Follow-up started 12 weeks after antiviral treatment completion and ended on date of death or 31 December 2019. MAIN OUTCOME MEASURES Crude and age-sex standardised mortality rates, and standardised mortality ratio comparing the number of deaths with that of the general population, adjusting for age, sex, and year. Poisson regression was used to identify factors associated with all cause mortality rates. RESULTS 1572 (7%) participants died during follow-up. The leading causes of death were drug related mortality (n=383, 24%), liver failure (n=286, 18%), and liver cancer (n=250, 16%). Crude all cause mortality rates (deaths per 1000 person years) were 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively. All cause mortality was considerably higher than the rate for the general population across all disease severity groups and settings; for example, all cause mortality was three times higher among people without cirrhosis in British Columbia (standardised mortality ratio 2.96, 95% confidence interval 2.71 to 3.23; P<0.001) and more than 10 times higher for patients with end stage liver disease in British Columbia (13.61, 11.94 to 15.49; P<0.001). In regression analyses, older age, recent substance misuse, alcohol misuse, and comorbidities were associated with higher mortality rates. CONCLUSION Mortality rates among people successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals are high compared with the general population. Drug and liver related causes of death were the main drivers of excess mortality. These findings highlight the need for continued support and follow-up after successful treatment for hepatitis C to maximise the impact of direct acting antivirals.
Collapse
Affiliation(s)
- Victoria Hamill
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
- Joint first authors
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Joint first authors
| | - Jennifer Benselin
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David Mutimer
- Liver and Hepatology Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, UK
| | - William Gelson
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hector A Velásquez García
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Fraser
- Aberdeen Royal Infirmary, Aberdeen, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Sofia Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Aldersley
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
| | | | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Paul Richardson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Joanne R Morling
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
- Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Stephen D Ryder
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Douglas MacDonald
- Gastroenterology and Hepatology, Royal Free London NHS Foundation Trust, London, UK
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Eleanor Barnes
- Nuffield Department of Medicine and the Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - William L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital Vancouver, British Columbia, Canada
| | - Hamish Innes
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
- Lifespan and Population Health, University of Nottingham, Nottingham, UK
| |
Collapse
|
7
|
Snell G, Marshall AD, van Gennip J, Bonn M, Butler-McPhee J, Cooper CL, Kronfli N, Williams S, Bruneau J, Feld JJ, Janjua NZ, Klein M, Cunningham N, Grebely J, Bartlett SR. Public reimbursement policies in Canada for direct-acting antiviral treatment of hepatitis C virus infection: A descriptive study. Can Liver J 2023; 6:190-200. [PMID: 37503523 PMCID: PMC10370724 DOI: 10.3138/canlivj-2022-0040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/28/2023] [Indexed: 07/29/2023]
Abstract
Background Direct-acting antiviral (DAA) therapies have simplified HCV treatment, and publicly funded Canadian drug plans have eliminated disease-stage restrictions for reimbursement of DAA therapies. However other policies which complicate, delay, or prevent treatment initiation still persist. We aim to describe these plans' existing reimbursement criteria and appraise whether they hinder treatment access. Methods We reviewed DAA reimbursement policies of 16 publicly funded drug plans published online and provided by contacts with in-depth knowledge of prescribing criteria. Data were collected from May to July 2022. Primary outcomes were: (1) if plans have arranged to accept point-of-care HCV RNA testing for diagnosis; testing requirements for (2) HCV genotype, (3) fibrosis stage, and (4) chronic infection; (5) time taken and method used to approve reimbursement requests; (6) providers eligible to prescribe DAAs; and (7) restrictions on re-treatment. Results Fifteen (94%) plans have at least one policy in place which limits simplified HCV treatment. Many plans continue to require results of genotype or fibrosis staging, limit eligible prescribers, and take longer than 1 day to approve coverage requests. One plan discourages treatment for re-infection. Conclusion Reimbursement criteria set by publicly funded Canadian drug plans continue to limit timely, equitable access to HCV treatment. Eliminating clinically irrelevant pre-authorization testing, expanding eligible prescribers, expediting claims processing, and broadening coverage of treatment for reinfection will improve access to DAAs. The federal government could further enhance efforts by introducing a federal HCV elimination strategy or federal high-cost drug PharmaCare program.
Collapse
Affiliation(s)
- Gaelen Snell
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Nova Scotia, Canada
| | | | - Curtis L Cooper
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nadine Kronfli
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Sarah Williams
- Calgary Liver Unit, Alberta Health Services, Calgary, Alberta, Canada
| | - Julie Bruneau
- Centre Hospitalier de l’Université de Montréal Research Center, Quebec, Canada
| | - Jordan J Feld
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marina Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Nance Cunningham
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jason Grebely
- The Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
8
|
Wong AW, Tran KC, Binka M, Janjua NZ, Sbihi H, Russell JA, Carlsten C, Levin A, Ryerson CJ. Use of latent class analysis and patient reported outcome measures to identify distinct long COVID phenotypes: A longitudinal cohort study. PLoS One 2023; 18:e0286588. [PMID: 37267379 DOI: 10.1371/journal.pone.0286588] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES We sought to 1) identify long COVID phenotypes based on patient reported outcome measures (PROMs) and 2) determine whether the phenotypes were associated with quality of life (QoL) and/or lung function. METHODS This was a longitudinal cohort study of hospitalized and non-hospitalized patients from March 2020 to January 2022 that was conducted across 4 Post-COVID Recovery Clinics in British Columbia, Canada. Latent class analysis was used to identify long COVID phenotypes using baseline PROMs (fatigue, dyspnea, cough, anxiety, depression, and post-traumatic stress disorder). We then explored the association between the phenotypes and QoL (using the EuroQoL 5 dimensions visual analogue scale [EQ5D VAS]) and lung function (using the diffusing capacity of the lung for carbon monoxide [DLCO]). RESULTS There were 1,344 patients enrolled in the study (mean age 51 ±15 years; 780 [58%] were females; 769 (57%) were of a non-White race). Three distinct long COVID phenotypes were identified: Class 1) fatigue and dyspnea, Class 2) anxiety and depression, and Class 3) fatigue, dyspnea, anxiety, and depression. Class 3 had a significantly lower EQ5D VAS at 3 (50±19) and 6 months (54 ± 22) compared to Classes 1 and 2 (p<0.001). The EQ5D VAS significantly improved between 3 and 6 months for Class 1 (median difference of 6.0 [95% CI, 4.0 to 8.0]) and Class 3 (median difference of 5.0 [95% CI, 0 to 8.5]). There were no differences in DLCO between the classes. CONCLUSIONS There were 3 distinct long COVID phenotypes with different outcomes in QoL between 3 and 6 months after symptom onset. These phenotypes suggest that long COVID is a heterogeneous condition with distinct subpopulations who may have different outcomes and warrant tailored therapeutic approaches.
Collapse
Affiliation(s)
- Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Karen C Tran
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mawuena Binka
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - James A Russell
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Christopher Carlsten
- Department of Medicine, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adeera Levin
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| |
Collapse
|
9
|
Iyaniwura SA, Ringa N, Adu PA, Mak S, Janjua NZ, Irvine MA, Otterstatter M. Understanding the impact of mobility on COVID-19 spread: A hybrid gravity-metapopulation model of COVID-19. PLoS Comput Biol 2023; 19:e1011123. [PMID: 37172027 DOI: 10.1371/journal.pcbi.1011123] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/24/2023] [Accepted: 04/24/2023] [Indexed: 05/14/2023] Open
Abstract
The outbreak of the severe acute respiratory syndrome coronavirus 2 started in Wuhan, China, towards the end of 2019 and spread worldwide. The rapid spread of the disease can be attributed to many factors including its high infectiousness and the high rate of human mobility around the world. Although travel/movement restrictions and other non-pharmaceutical interventions aimed at controlling the disease spread were put in place during the early stages of the pandemic, these interventions did not stop COVID-19 spread. To better understand the impact of human mobility on the spread of COVID-19 between regions, we propose a hybrid gravity-metapopulation model of COVID-19. Our modeling framework has the flexibility of determining mobility between regions based on the distances between the regions or using data from mobile devices. In addition, our model explicitly incorporates time-dependent human mobility into the disease transmission rate, and has the potential to incorporate other factors that affect disease transmission such as facemasks, physical distancing, contact rates, etc. An important feature of this modeling framework is its ability to independently assess the contribution of each factor to disease transmission. Using a Bayesian hierarchical modeling framework, we calibrate our model to the weekly reported cases of COVID-19 in thirteen local health areas in Metro Vancouver, British Columbia (BC), Canada, from July 2020 to January 2021. We consider two main scenarios in our model calibration: using a fixed distance matrix and time-dependent weekly mobility matrices. We found that the distance matrix provides a better fit to the data, whilst the mobility matrices have the ability to explain the variance in transmission between regions. This result shows that the mobility data provides more information in terms of disease transmission than the distances between the regions.
Collapse
Affiliation(s)
- Sarafa A Iyaniwura
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Notice Ringa
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Prince A Adu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunny Mak
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Passos-Castilho AM, Murphy DG, Blouin K, Benedetti A, Panagiotoglou D, Bruneau J, Klein MB, Kwong JC, Sander B, Janjua NZ, Greenaway C. A population-based study of reported hepatitis C diagnoses from 1998 to 2018 in immigrants and nonimmigrants in Quebec, Canada. J Viral Hepat 2023. [PMID: 37070269 DOI: 10.1111/jvh.13837] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
Immigrants living in low hepatitis C (HCV) prevalence countries bear a disproportionate HCV burden, but there are limited HCV population-based studies focussed on this population. We estimated rates and trends of reported HCV diagnoses over a 20-year period in Quebec, Canada, to investigate subgroups with the highest rates and changes over time. A population-based cohort of all reported HCV diagnoses in Quebec (1998-2018) linked to health administrative and immigration databases. HCV rates, rate ratios (RR) and trends overall and stratified by immigrant status and country of birth were estimated using Poisson regression. Among 38,348 HCV diagnoses, 14% occurred in immigrants, a median of 7.5 years after arrival. The average annual HCV rate/100,000 decreased for immigrants and nonimmigrants, but the risk (RR) among immigrants increased over the study period [35.7 vs. 34.5 (RR = 1.03) and 18.4 vs. 12.7 (1.45) between 1998-2008 and 2009-2018]. Immigrants from middle-income Europe & Central Asia [55.8 (RR = 4.39)], sub-Saharan Africa [51.7 (RR = 4.06)] and South Asia [32.8 (RR = 2.58)] had the highest rates between 2009 and 2018. Annual HCV rates decreased more slowly among immigrants vs. nonimmigrants (-5.9% vs. -8.9%, p < 0.001), resulting in a 2.5-fold (9%-21%) increase in the proportion of HCV diagnoses among immigrants (1998-2018). The slower decline in HCV rates among immigrants over the study period highlights the need for targeted screening for this population, particularly those from sub-Saharan Africa, Asia and middle-income Europe. These data can inform micro-elimination efforts in Canada and other low-HCV-prevalence countries.
Collapse
Affiliation(s)
- Ana Maria Passos-Castilho
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Donald G Murphy
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Karine Blouin
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Québec, Québec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Julie Bruneau
- CHUM Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Division of Infectious Diseases, Jewish General Hospital, Montreal, Québec, Canada
| |
Collapse
|
11
|
Naveed Z, Velásquez García HA, Wong S, Wilton J, McKee G, Mahmood B, Binka M, Rasali D, Janjua NZ. Association of COVID-19 Infection With Incident Diabetes. JAMA Netw Open 2023; 6:e238866. [PMID: 37071420 PMCID: PMC10114057 DOI: 10.1001/jamanetworkopen.2023.8866] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Importance SARS-CoV-2 infection may lead to acute and chronic sequelae. Emerging evidence suggests a higher risk of diabetes after infection, but population-based evidence is still sparse. Objective To evaluate the association between COVID-19 infection, including severity of infection, and risk of diabetes. Design, Setting, and Participants This population-based cohort study was conducted in British Columbia, Canada, from January 1, 2020, to December 31, 2021, using the British Columbia COVID-19 Cohort, a surveillance platform that integrates COVID-19 data with population-based registries and administrative data sets. Individuals tested for SARS-CoV-2 by real-time reverse transcription-polymerase chain reaction (RT-PCR) were included. Those who tested positive for SARS-CoV-2 (ie, those who were exposed) were matched on sex, age, and collection date of RT-PCR test at a 1:4 ratio to those who tested negative (ie, those who were unexposed). Analysis was conducted January 14, 2022, to January 19, 2023. Exposure SARS-CoV-2 infection. Main Outcomes and Measures The primary outcome was incident diabetes (insulin dependent or not insulin dependent) identified more than 30 days after the specimen collection date for the SARS-CoV-2 test with a validated algorithm based on medical visits, hospitalization records, chronic disease registry, and prescription drugs for diabetes management. Multivariable Cox proportional hazard modeling was performed to evaluate the association between SARS-CoV-2 infection and diabetes risk. Stratified analyses were performed to assess the interaction of SARS-CoV-2 infection with diabetes risk by sex, age, and vaccination status. Results Among 629 935 individuals (median [IQR] age, 32 [25.0-42.0] years; 322 565 females [51.2%]) tested for SARS-CoV-2 in the analytic sample, 125 987 individuals were exposed and 503 948 individuals were unexposed. During the median (IQR) follow-up of 257 (102-356) days, events of incident diabetes were observed among 608 individuals who were exposed (0.5%) and 1864 individuals who were not exposed (0.4%). The incident diabetes rate per 100 000 person-years was significantly higher in the exposed vs nonexposed group (672.2 incidents; 95% CI, 618.7-725.6 incidents vs 508.7 incidents; 95% CI, 485.6-531.8 incidents; P < .001). The risk of incident diabetes was also higher in the exposed group (hazard ratio [HR], 1.17; 95% CI, 1.06-1.28) and among males (adjusted HR, 1.22; 95% CI, 1.06-1.40). The risk of diabetes was higher among people with severe disease vs those without COVID-19, including individuals admitted to the intensive care unit (HR, 3.29; 95% CI, 1.98-5.48) or hospital (HR, 2.42; 95% CI, 1.87-3.15). The fraction of incident diabetes cases attributable to SARS-CoV-2 infection was 3.41% (95% CI, 1.20%-5.61%) overall and 4.75% (95% CI, 1.30%-8.20%) among males. Conclusions and Relevance In this cohort study, SARS-CoV-2 infection was associated with a higher risk of diabetes and may have contributed to a 3% to 5% excess burden of diabetes at a population level.
Collapse
Affiliation(s)
- Zaeema Naveed
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Héctor A Velásquez García
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Geoffrey McKee
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Bushra Mahmood
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Drona Rasali
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
12
|
O’Brien SF, Caffrey N, Yi QL, Bolotin S, Janjua NZ, Binka M, Thanh CQ, Stein DR, Lang A, Colquhoun A, Pambrun C, Reedman CN, Drews SJ. Cross-Canada Variability in Blood Donor SARS-CoV-2 Seroprevalence by Social Determinants of Health. Microbiol Spectr 2023; 11:e0335622. [PMID: 36625634 PMCID: PMC9927354 DOI: 10.1128/spectrum.03356-22] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023] Open
Abstract
We compared the seroprevalence of SARS-CoV-2 anti-nucleocapsid antibodies in blood donors across Canadian regions in 2021. The seroprevalence was the highest in Alberta and the Prairies, and it was so low in Atlantic Canada that few correlates were observed. Being male and of young age were predictive of seropositivity. Racialization was associated with higher seroprevalence in British Columbia and Ontario but not in Alberta and the Prairies. Living in a materially deprived neighborhood predicted higher seroprevalence, but it was more linear across quintiles in Alberta and the Prairies, whereas in British Columbia and Ontario, the most affluent 60% were similarly low and the most deprived 40% similarly elevated. Living in a more socially deprived neighborhood (more single individuals and one parent families) was associated with lower seroprevalence in British Columbia and Ontario but not in Alberta and the Prairies. These data show striking variability in SARS-CoV-2 seroprevalence across regions by social determinants of health. IMPORTANCE Canadian blood donors are a healthy adult population that shows clear disparities associated with racialization and material deprivation. This underscores the pervasiveness of the socioeconomic gradient on SARS-CoV-2 infections in Canada. We identify regional differences in the relationship between SARS-CoV-2 seroprevalence and social determinants of health. Cross-Canada studies, such as ours, are rare because health information is under provincial jurisdiction and is not available in sufficient detail in national data sets, whereas other national seroprevalence studies have insufficient sample sizes for regional comparisons. Ours is the largest seroprevalence study in Canada. An important strength of our study is the interpretation input from a public health team that represented multiple Canadian provinces. Our blood donor seroprevalence study has informed Canadian public health policy at national and provincial levels since the start of the SARS-CoV-2 pandemic.
Collapse
Affiliation(s)
- Sheila F. O’Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Niamh Caffrey
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Qi-Long Yi
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Shelly Bolotin
- Center for Vaccine Preventable Disease, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Naveed Z. Janjua
- BC Centre for Disease Control, British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, British Columbia, Vancouver, Canada
| | - Mawuena Binka
- BC Centre for Disease Control, British Columbia, Vancouver, Canada
| | - Caroline Quach Thanh
- Department of Microbiology, Infectious Diseases & Immunology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Infection Prevention & Control, Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Derek R. Stein
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda Lang
- Roy Romanow Provincial laboratory, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Amy Colquhoun
- Population Health Assessment, Alberta Health, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Chantale Pambrun
- Medical Affairs & Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology & Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cassandra N. Reedman
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Steven J. Drews
- Medical Microbiology Department, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine & Pathology, Division of Diagnostic and Applied Microbiology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
13
|
Velásquez García HA, Adu PA, Harrigan S, Wilton J, Rasali D, Binka M, Sbihi H, Smolina K, Janjua NZ. Risk factors for COVID-19 hospitalization after COVID-19 vaccination: a population-based cohort study in Canada. Int J Infect Dis 2023; 127:116-123. [PMID: 36503044 PMCID: PMC9731811 DOI: 10.1016/j.ijid.2022.12.001] [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: 08/17/2022] [Revised: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES With the uptake of COVID-19 vaccines, there is a need for population-based studies to assess risk factors for COVID-19-related hospitalization after vaccination and how they differ from unvaccinated individuals. METHODS We used data from the British Columbia COVID-19 Cohort, a population-based cohort that includes all individuals (aged ≥18 years) who tested positive for SARS-CoV-2 by real-time reverse transcription-polymerase chain reaction from January 1, 2021 (after the start of vaccination program) to December 31, 2021. We used multivariable logistic regression models to assess COVID-19-related hospitalization risk by vaccination status and age group among confirmed COVID-19 cases. RESULTS Of the 162,509 COVID-19 cases included in the analysis, 8,546 (5.3%) required hospitalization. Among vaccinated individuals, an increased odds of hospitalization with increasing age was observed for older age groups, namely those aged 50-59 years (odds ratio [OR] = 2.95, 95% confidence interval [CI]: 2.01-4.33), 60-69 years (OR = 4.82, 95% CI: 3.29, 7.07), 70-79 years (OR = 11.92, 95% CI: 8.02, 17.71), and ≥80 years (OR = 24.25, 95% CI: 16.02, 36.71). However, among unvaccinated individuals, there was a graded increase in odds of hospitalization with increasing age, starting at age group 30-39 years (OR = 2.14, 95% CI: 1.90, 2.41) to ≥80 years (OR = 41.95, 95% CI: 35.43, 49.67). Also, comparing all the age groups to the youngest, the observed magnitude of association was much higher among unvaccinated individuals than vaccinated ones. CONCLUSION Alongside a number of comorbidities, our findings showed a strong association between age and COVID-19-related hospitalization, regardless of vaccination status. However, age-related hospitalization risk was reduced two-fold by vaccination, highlighting the need for vaccination in reducing the risk of severe disease and subsequent COVID-19-related hospitalization across all population groups.
Collapse
Affiliation(s)
- Héctor A. Velásquez García
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada,Corresponding authors
| | - Prince A. Adu
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sean Harrigan
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - James Wilton
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Drona Rasali
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mawuena Binka
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Hind Sbihi
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Kate Smolina
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Naveed Z. Janjua
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada,Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, Canada,Corresponding authors
| |
Collapse
|
14
|
Gan WQ, Buxton JA, Palis H, Janjua NZ, Scheuermeyer FX, Xavier CG, Zhao B, Desai R, Slaunwhite AK. Drug overdose and the risk of cardiovascular diseases: a nested case-control study. Clin Res Cardiol 2023; 112:187-196. [PMID: 34654963 DOI: 10.1007/s00392-021-01945-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND North America has been experiencing an unprecedented epidemic of drug overdose. This study investigated the associations of drug overdose with the risk of cardiovascular disease (CVD) and 11 major CVD subtypes. METHODS This nested case-control study was based on a cohort of 20% random sample of residents in British Columbia, Canada, who were aged 18-80 years and did not have known CVD at baseline (n = 617,863). During a 4-year follow-up period, persons who developed incident CVD were identified as case subjects, and the onset date of CVD was defined as the index date. For each case subject, we used incidence density sampling to randomly select up to five control subjects from the cohort members who were alive and did not have known CVD by the index date, were admitted to an emergency department or hospital on the index date for non-CVD causes, and were matched on age, sex, and region of residence. Overdose exposure on the index date and each of the previous 5 days was examined for each subject. RESULTS This study included 16,113 CVD case subjects (mean age 53 years, 59% male) and 66,875 control subjects. After adjusting for covariates, overdose that occurred on the index date was strongly associated with CVD [odds ratio (OR), 2.9; 95% confidence interval (CI), 2.4-3.5], especially for arrhythmia (OR, 8.6; 95% CI, 6.2-12.0), ischemic stroke (OR, 5.3; 95% CI, 2.0-14.1), hemorrhagic stroke (OR, 3.1; 95% CI, 1.2-8.3), and myocardial infarction (OR, 3.0; 95% CI, 1.5-5.8). The CVD risk was decreased but remained significantly elevated for overdose that occurred on the previous day, and was not observed for overdose that occurred on each of the previous 2-5 days. CONCLUSIONS Drug overdose appears to be associated with increased risk of cardiovascular diseases.
Collapse
Affiliation(s)
- Wen Qi Gan
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada.
| | - Jane A Buxton
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Heather Palis
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Canadian Network on Hepatitis C, Montreal, QC, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Chloé G Xavier
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada
| | - Bin Zhao
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada
| | - Roshni Desai
- First Nations Health Authority, Vancouver, BC, Canada
| | - Amanda K Slaunwhite
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
15
|
Fowokan A, Samji H, Puyat JH, Janjua NZ, Wilton J, Wong J, Grennan T, Chambers C, Kroch A, Costiniuk CT, Cooper CL, Burchell AN, Anis A. Effectiveness of COVID-19 vaccines in people living with HIV in British Columbia and comparisons with a matched HIV-negative cohort: a test-negative design. Int J Infect Dis 2023; 127:162-170. [PMID: 36462571 PMCID: PMC9711901 DOI: 10.1016/j.ijid.2022.11.035] [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: 08/18/2022] [Revised: 10/24/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES We estimated the effectiveness of COVID-19 vaccines against laboratory-confirmed SARS-CoV-2 infection among people living with HIV (PLWH) and compared the estimates with a matched HIV-negative cohort. METHODS We used the British Columbia COVID-19 Cohort, a population-based data platform, which integrates COVID-19 data on SARS-CoV-2 tests, laboratory-confirmed cases, and immunizations with provincial health services data. The vaccine effectiveness (VE) was estimated with a test-negative design using the multivariable logistic regression. RESULTS The adjusted VE against SARS-CoV-2 infection was 71.1% (39.7, 86.1%) 7-59 days after two doses, rising to 89.3% (72.2, 95.9%) between 60 and 89 days. VE was preserved 4-6 months after the receipt of two doses, after which noticeable waning was observed (51.3% [4.8, 75.0%]). In the matched HIV-negative cohort (n = 375,043), VE peaked at 91.4% (90.9, 91.8%) 7-59 days after two doses and was sustained for up to 4 months, after which evidence of waning was observed, dropping to 84.2% (83.4, 85.0%) between 4 and 6 months. CONCLUSION The receipt of two COVID-19 vaccine doses was effective against SARS-CoV-2 infection among PLWH pre-Omicron. VE estimates appeared to peak later in PLWH than in the matched HIV-negative cohort and the degree of waning was relatively quicker in PLWH; however, peak estimates were comparable in both populations.
Collapse
Affiliation(s)
- Adeleke Fowokan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada,Corresponding author at: Hasina Samji, Senior Scientist British Columbia Centre for Disease Control, Provincial Health Services Authority, Assistant Professor
- Faculty of Health Sciences, Simon Fraser University, 655 West 12th Avenue, Vancouver British Columbia, V5Z 4R4
| | - Joseph H. Puyat
- British Columbia Centre for Disease Control, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada,Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Cecilia T. Costiniuk
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Ann N. Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, Canada
| | - Aslam Anis
- School of Population and Public Health, University of British Columbia, Vancouver, Canada,Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
| | | |
Collapse
|
16
|
Russell SL, Klaver BRA, Harrigan SP, Kamelian K, Tyson J, Hoang L, Taylor M, Sander B, Mishra S, Prystajecky N, Janjua NZ, Zlosnik JEA, Sbihi H. Clinical severity of Omicron subvariants BA.1, BA.2, and BA.5 in a population-based cohort study in British Columbia, Canada. J Med Virol 2023; 95:e28423. [PMID: 36546412 DOI: 10.1002/jmv.28423] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/08/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
The SARS-CoV-2 variant Omicron emerged in late 2021. In British Columbia (BC), Canada, and globally, three genetically distinct subvariants of Omicron, BA.1, BA.2, and BA.5, emerged and became dominant successively within an 8-month period. SARS-CoV-2 subvariants continue to circulate in the population, acquiring new mutations that have the potential to alter infectivity, immunity, and disease severity. Here, we report a propensity-matched severity analysis from residents of BC over the course of the Omicron wave, including 39,237 individuals infected with BA.1, BA.2, or BA.5 based on paired high-quality sequence data and linked to comprehensive clinical outcomes data between December 23, 2021 and August 31, 2022. Relative to BA.1, BA.2 cases were associated with a 15% and 28% lower risk of hospitalization and intensive care unit (ICU) admission (aHRhospital = 1.17; 95% confidence interval [CI] = 1.096-1.252; aHRICU = 1.368; 95% CI = 1.152-1.624), whereas BA.5 infections were associated with an 18% higher risk of hospitalization (aHRhospital = 1.18; 95% CI = 1.133-1.224) after accounting for age, sex, comorbidities, vaccination status, geography, and social determinants of health. Phylogenetic analysis revealed no specific subclades associated with more severe clinical outcomes for any Omicron subvariant. In summary, BA.1, BA.2, and BA.5 subvariants were associated with differences in clinical severity, emphasizing how variant-specific monitoring programs remain critical components of patient and population-level public health responses as the pandemic continues.
Collapse
Affiliation(s)
- Shannon L Russell
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Braeden R A Klaver
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Sean P Harrigan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Kimia Kamelian
- Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - John Tyson
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marsha Taylor
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Beate Sander
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP-Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Prystajecky
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - James E A Zlosnik
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
17
|
Binka M, Klaver B, Cua G, Wong AW, Fibke C, Velásquez García HA, Adu P, Levin A, Mishra S, Sander B, Sbihi H, Janjua NZ. An Elastic Net Regression Model for Identifying Long COVID Patients Using Health Administrative Data: A Population-Based Study. Open Forum Infect Dis 2022; 9:ofac640. [PMID: 36570972 PMCID: PMC9780702 DOI: 10.1093/ofid/ofac640] [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: 10/13/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background Long coronavirus disease (COVID) patients experience persistent symptoms after acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Healthcare utilization data could provide critical information on the disease burden of long COVID for service planning; however, not all patients are diagnosed or assigned long COVID diagnostic codes. We developed an algorithm to identify individuals with long COVID using population-level health administrative data from British Columbia (BC), Canada. Methods An elastic net penalized logistic regression model was developed to identify long COVID patients based on demographic characteristics, pre-existing conditions, COVID-19-related data, and all symptoms/conditions recorded >28-183 days after the COVID-19 symptom onset/reported (index) date of known long COVID patients (n = 2430) and a control group (n = 24 300), selected from all adult COVID-19 cases in BC with an index date on/before October 31, 2021 (n = 168 111). Known long COVID cases were diagnosed in a clinic and/or had the International Classification of Diseases, Tenth Revision, Canada (ICD-10-CA) code for "post COVID-19 condition" in their records. Results The algorithm retained known symptoms/conditions associated with long COVID, demonstrating high sensitivity (86%), specificity (86%), and area under the receiver operator curve (93%). It identified 25 220 (18%) long COVID patients among the remaining 141 381 adult COVID-19 cases, >10 times the number of known cases. Known and predicted long COVID patients had comparable demographic and health-related characteristics. Conclusions Our algorithm identified long COVID patients with a high level of accuracy. This large cohort of long COVID patients will serve as a platform for robust assessments on the clinical course of long COVID, and provide much needed concrete information for decision-making.
Collapse
Affiliation(s)
- Mawuena Binka
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Braeden Klaver
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Georgine Cua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chad Fibke
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Héctor A Velásquez García
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Adeera Levin
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Hind Sbihi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia V6Z IY6, Canada
| |
Collapse
|
18
|
Chambers C, Samji H, Cooper CL, Costiniuk CT, Janjua NZ, Kroch AE, Arbess G, Benoit AC, Buchan SA, Chung H, Kendall CE, Kwong JC, Langlois MA, Lee SM, Mbuagbaw L, McCullagh J, Moineddin R, Nambiar D, Walmsley S, Anis AH, Burchell AN. Coronavirus disease 2019 vaccine effectiveness among a population-based cohort of people living with HIV. AIDS 2022; 36:F17-F26. [PMID: 36254892 PMCID: PMC9696686 DOI: 10.1097/qad.0000000000003405] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/29/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE People with HIV were underrepresented in coronavirus disease 2019 (COVID-19) vaccine clinical trials. We estimated vaccine effectiveness (VE) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for the BNT162b2, mRNA-1273, and ChAdOx1 vaccines among a population-based cohort of people with HIV in Ontario, Canada. DESIGN Test-negative design. METHODS We identified people with HIV aged ≥19 years who were tested for SARS-CoV-2 by RT-PCR between December 14, 2020 (first availability of COVID-19 vaccines) and November 21, 2021 (pre-Omicron circulation). Outcomes included any infection, symptomatic infection, and COVID-19-related hospitalization/death. We compared the odds of vaccination between test-positive cases and test-negative controls using multivariable logistic regression with adjustment for age, sex, region, calendar time, SARS-CoV-2 test histories, influenza vaccination, comorbidities, and neighborhood-level socio-economic status. VE was derived as (1 - adjusted odds ratio) × 100%. RESULTS Among 21 023 adults living with HIV, there were 801 (8.3%) test-positive cases and 8,879 (91.7%) test-negative controls. 20.1% cases and 47.8% of controls received ≥1 COVID-19 vaccine dose; among two-dose recipients, 93.4% received ≥1 mRNA dose. Two-dose VE ≥7 days before specimen collection was 82% (95% confidence interval [CI] = 74-87%) against any infection, 94% (95% CI = 82-98%) against symptomatic infection, and 97% (95% CI = 85-100%) against hospitalization/death. Against any infection, VE declined from 86% (95% CI = 77-92%) within 7-59 days after the second dose to 66% (95% CI = -15-90%) after ≥180 days; we did not observe evidence of waning protection for other outcomes. CONCLUSION Two doses of COVID-19 vaccine offered substantial protection against symptomatic illness and hospitalization/death in people with HIV prior to the emergence of the Omicron variant. Our findings do not support a broad conclusion that COVID-19 VE is lower among people with HIV in populations that, for the most part, are attending HIV care, taking antiretroviral medication, and are virally suppressed.
Collapse
Affiliation(s)
- Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto
- Unity Health Toronto, Toronto, ON
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | | | | | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver
- School of Population and Public Health, University of British Columbia
- Canadian HIV Trials Network, Vancouver, BC
| | - Abigail E. Kroch
- Dalla Lana School of Public Health, University of Toronto
- Ontario HIV Treatment Network
- Public Health Ontario
| | - Gordon Arbess
- Unity Health Toronto, Toronto, ON
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto
| | - Anita C. Benoit
- Dalla Lana School of Public Health, University of Toronto
- Department of Health and Society, University of Toronto Scarborough, Scarborough
- Women's College Research Institute, Women's College Hospital
| | - Sarah A. Buchan
- Dalla Lana School of Public Health, University of Toronto
- Public Health Ontario
- ICES (formerly Institute for Clinical Evaluative Sciences)
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto
| | - Hannah Chung
- ICES (formerly Institute for Clinical Evaluative Sciences)
| | - Claire E. Kendall
- ICES (formerly Institute for Clinical Evaluative Sciences)
- Bruyère Research Institute
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa
| | - Jeffrey C. Kwong
- Dalla Lana School of Public Health, University of Toronto
- Public Health Ontario
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto
- ICES (formerly Institute for Clinical Evaluative Sciences)
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto
- University Health Network, Toronto
| | - Marc-André Langlois
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa
| | | | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University
- Department of Anesthesia, Faculty of Health Sciences
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto
| | - Devan Nambiar
- Gay Men's Sexual Health Alliance, Toronto, ON, Canada
| | | | - Aslam H. Anis
- School of Population and Public Health, University of British Columbia
- Canadian HIV Trials Network, Vancouver, BC
| | - Ann N. Burchell
- Dalla Lana School of Public Health, University of Toronto
- Unity Health Toronto, Toronto, ON
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto
- ICES (formerly Institute for Clinical Evaluative Sciences)
| |
Collapse
|
19
|
Naveed Z, Li J, Wilton J, Spencer M, Naus M, Velásquez García HA, Kwong JC, Rose C, Otterstatter M, Janjua NZ. Comparative Risk of Myocarditis/Pericarditis Following Second Doses of BNT162b2 and mRNA-1273 Coronavirus Vaccines. J Am Coll Cardiol 2022; 80:1900-1908. [PMID: 36357091 PMCID: PMC9639791 DOI: 10.1016/j.jacc.2022.08.799] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
Background Postmarketing evaluations have linked myocarditis to COVID-19 mRNA vaccines. However, few population-based analyses have directly compared the safety of the 2 mRNA COVID-19 vaccines. Objectives This study aimed to compare the risk of myocarditis, pericarditis, and myopericarditis between BNT162b2 and mRNA-1273. Methods We used data from the British Columbia COVID-19 Cohort (BCC19C), a population-based cohort study. The exposure was the second dose of an mRNA vaccine. The outcome was diagnosis of myocarditis, pericarditis, or myopericarditis during a hospitalization or an emergency department visit within 21 days of the second vaccination dose. We performed multivariable logistic regression to assess the association between vaccine product and the outcomes of interest. Results The rates of myocarditis and pericarditis per million second doses were higher for mRNA-1273 (n = 31, rate 35.6; 95% CI: 24.1-50.5; and n = 20, rate 22.9; 95% CI: 14.0-35.4, respectively) than BNT162b2 (n = 28, rate 12.6; 95% CI: 8.4-18.2 and n = 21, rate 9.4; 95% CI: 5.8-14.4, respectively). mRNA-1273 vs BNT162b2 had significantly higher odds of myocarditis (adjusted OR [aOR]: 2.78; 95% CI: 1.67-4.62), pericarditis (aOR: 2.42; 95% CI: 1.31-4.46) and myopericarditis (aOR: 2.63; 95% CI: 1.76-3.93). The association between mRNA-1273 and myocarditis was stronger for men (aOR: 3.21; 95% CI: 1.77-5.83) and younger age group (18-39 years; aOR: 5.09; 95% CI: 2.68-9.66). Conclusions Myocarditis/pericarditis following mRNA COVID-19 vaccines is rare, but we observed a 2- to 3-fold higher odds among individuals who received mRNA-1273 vs BNT162b2. The rate of myocarditis following mRNA-1273 receipt is highest among younger men (age 18-39 years) and does not seem to be present at older ages. Our findings may have policy implications regarding the choice of vaccine offered.
Collapse
Affiliation(s)
- Zaeema Naveed
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Julia Li
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Michelle Spencer
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Monika Naus
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Héctor A Velásquez García
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Caren Rose
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Outcomes and Evaluation, St Paul's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
20
|
Feld JJ, Klein MB, Rahal Y, Lee SS, Mohammed S, King A, Smyth D, Gonzalez YS, Nugent A, Janjua NZ. Timing of elimination of hepatitis C virus in Canada's provinces. Can Liver J 2022; 5:493-506. [PMID: 38144411 PMCID: PMC10735197 DOI: 10.3138/canlivj-2022-0003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 12/26/2023]
Abstract
BACKGROUND: Infection with chronic hepatitis C virus is a global public health concern. A recent study concluded that Canada is on track to achieve hepatitis C elimination goals set by the World Health Organization if treatment levels are maintained. However, recently a falling temporal trend in treatments in Canada was observed, with most provinces seeing a decrease before the global coronavirus pandemic. This study assesses the timing of elimination of hepatitis C in the 10 provinces of Canada. METHODS: Previously published disease and economic burden model of hepatitis C infection was populated with the latest epidemiological and cost data for each Canadian province. Five scenarios were modelled: maintaining the status quo, decreasing diagnosis and treatment levels by 10% annually, decreasing diagnosis and treatment levels by 20% annually, increasing them by 10% annually, and assuming a scenario with no post-coronavirus pandemic recovery in treatment levels. Year of achieving hepatitis C elimination, necessary annual treatments for elimination, and associated disease and economic burden were determined for each province. RESULTS: If status quo is maintained, Manitoba, Ontario, and Québec are off track to achieve hepatitis C elimination by 2030 and would require 540, 7,700, and 2,800 annual treatments, respectively, to get on track. Timely elimination would save 170 lives and CAD $122.6 million in direct medical costs in these three provinces. CONCLUSIONS: Three of Canada's provinces-two of them the most populous in the country-are off track to achieve the hepatitis C elimination goal. Building frameworks and innovative approaches to prevention, testing, and treatment will be necessary to achieve this goal.
Collapse
Affiliation(s)
- Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marina B Klein
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | | | - Samuel S Lee
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Alexandra King
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Daniel Smyth
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Arlene Nugent
- AbbVie, Inc., North Chicago, Illinois, United States
| | - Naveed Z Janjua
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
21
|
Adu PA, Iyaniwura SA, Mahmood B, Jeong D, Makuza JD, Cua G, Binka M, García HAV, Ringa N, Wong S, Yu A, Irvine MA, Otterstatter M, Janjua NZ. Association between close interpersonal contact and vaccine hesitancy: Findings from a population-based survey in Canada. Front Public Health 2022; 10:971333. [PMID: 36267997 PMCID: PMC9577316 DOI: 10.3389/fpubh.2022.971333] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023] Open
Abstract
Background Vaccine hesitancy threatens efforts to bring the coronavirus disease 2019 (COVID-19) pandemic to an end. Given that social or interpersonal contact is an important driver for COVID-19 transmission, understanding the relationship between contact rates and vaccine hesitancy may help identify appropriate targets for strategic intervention. The purpose of this study was to assess the association between interpersonal contact and COVID-19 vaccine hesitancy among a sample of unvaccinated adults in the Canadian province of British Columbia (BC). Methods Unvaccinated individuals participating in the BC COVID-19 Population Mixing Patterns Survey (BC-Mix) were asked to indicate their level of agreement to the statement, "I plan to get the COVID-19 vaccine." Multivariable multinomial logistic regression was used to assess the association between self-reported interpersonal contact and vaccine hesitancy, adjusting for age, sex, ethnicity, educational attainment, occupation, household size and region of residence. All analyses incorporated survey sampling weights based on age, sex, geography, and ethnicity. Results Results were based on survey responses collected between March 8, 2021 and December 6, 2021, by a total of 4,515 adults aged 18 years and older. Overall, 56.7% of respondents reported that they were willing to get the COVID-19 vaccine, 27.0% were unwilling and 16.3% were undecided. We found a dose-response association between interpersonal contact and vaccine hesitancy. Compared to individuals in the lowest quartile (least contact), those in the fourth quartile (highest contact), third quartile and second quartile groups were more likely to be vaccine hesitant, with adjusted odd ratios (aORs) of 2.85 (95% CI: 2.02, 4.00), 1.91(95% CI: 1.38, 2.64), 1.78 (95% CI: 1.13, 2.82), respectively. Conclusion Study findings show that among unvaccinated people in BC, vaccine hesitancy is greater among those who have high contact rates, and hence potentially at higher risk of acquiring and transmitting infection. This may also impact future uptake of booster doses.
Collapse
Affiliation(s)
- Prince A. Adu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sarafa A. Iyaniwura
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,Department of Mathematics, University of British Columbia, Vancouver, BC, Canada
| | - Bushra Mahmood
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jean Damascene Makuza
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Georgine Cua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Héctor A. Velásquez García
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Notice Ringa
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mike A. Irvine
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada,Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada,*Correspondence: Naveed Z. Janjua
| |
Collapse
|
22
|
Harrigan SP, Wilton J, Chong M, Abdia Y, Garcia HV, Rose C, Taylor M, Mishra S, Sander B, Hoang L, Tyson J, Krajden M, Prystajecky N, Janjua NZ, Sbihi H. Clinical Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant Relative to Delta in British Columbia, Canada: A Retrospective Analysis of Whole-Genome Sequenced Cases. Clin Infect Dis 2022; 76:e18-e25. [PMID: 36041009 PMCID: PMC9452171 DOI: 10.1093/cid/ciac705] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/18/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In late 2021, the Omicron severe acute respiratory syndrome coronavirus 2 variant emerged and rapidly replaced Delta as the dominant variant. The increased transmissibility of Omicron led to surges in case rates and hospitalizations; however, the true severity of the variant remained unclear. We aimed to provide robust estimates of Omicron severity relative to Delta. METHODS This retrospective cohort study was conducted with data from the British Columbia COVID-19 Cohort, a large provincial surveillance platform with linkage to administrative datasets. To capture the time of cocirculation with Omicron and Delta, December 2021 was chosen as the study period. Whole-genome sequencing was used to determine Omicron and Delta variants. To assess the severity (hospitalization, intensive care unit [ICU] admission, length of stay), we conducted adjusted Cox proportional hazard models, weighted by inverse probability of treatment weights (IPTW). RESULTS The cohort was composed of 13 128 individuals (7729 Omicron and 5399 Delta). There were 419 coronavirus disease 2019 hospitalizations, with 118 (22%) among people diagnosed with Omicron (crude rate = 1.5% Omicron, 5.6% Delta). In multivariable IPTW analysis, Omicron was associated with a 50% lower risk of hospitalization compared with Delta (adjusted hazard ratio [aHR] = 0.50, 95% confidence interval [CI] = 0.43 to 0.59), a 73% lower risk of ICU admission (aHR = 0.27, 95% CI = 0.19 to 0.38), and a 5-day shorter hospital stay (aß = -5.03, 95% CI = -8.01 to -2.05). CONCLUSIONS Our analysis supports findings from other studies that have demonstrated lower risk of severe outcomes in Omicron-infected individuals relative to Delta.
Collapse
Affiliation(s)
| | | | - Mei Chong
- British Columbia Centre for Disease Control, British Columbia (BC), Canada
| | - Younathan Abdia
- British Columbia Centre for Disease Control, British Columbia (BC), Canada
| | | | - Caren Rose
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, School of Population and Public Health, BC, Canada
| | - Marsha Taylor
- British Columbia Centre for Disease Control, British Columbia (BC), Canada
| | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, Canada,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada,Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada,Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Public Health Ontario Toronto, Canada,ICES, Toronto, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, Pathology and Laboratory Medicine, BC, Canada
| | - John Tyson
- British Columbia Centre for Disease Control, British Columbia (BC), Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, Pathology and Laboratory Medicine, BC, Canada
| | - Natalie Prystajecky
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, Pathology and Laboratory Medicine, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, School of Population and Public Health, BC, Canada,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Hind Sbihi
- Corresponding author: Hind Sbihi (, 1-604-707-2662), Vancouver, BC. Canada
| |
Collapse
|
23
|
Makuza JD, Jeong D, Soe P, Bartlett S, Velásquez García HA, Binka M, Adu P, Dushimiyimana D, Dushimiyimana V, Maliza C, Nisingizwe MP, Rwibasira G, Tuyishime A, Janjua NZ. Impact of COVID-19 pandemic on HCV care cascade in Rwanda: Ecological study from July 2019 to June 2021. Clin Liver Dis (Hoboken) 2022; 20:25-30. [PMID: 35899240 PMCID: PMC9306435 DOI: 10.1002/cld.1235] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Interview and Audio Recording.
Collapse
Affiliation(s)
- Jean Damascene Makuza
- BC Centre for Disease ControlVancouverBritish ColumbiaCanada,University of British ColumbiaSchool of Population and Public HealthVancouverBritish ColumbiaCanada,Rwanda Biomedical CenterKigaliRwanda
| | - Dahn Jeong
- BC Centre for Disease ControlVancouverBritish ColumbiaCanada,University of British ColumbiaSchool of Population and Public HealthVancouverBritish ColumbiaCanada
| | - Phyumar Soe
- University of British ColumbiaSchool of Population and Public HealthVancouverBritish ColumbiaCanada
| | - Sofia Bartlett
- BC Centre for Disease ControlVancouverBritish ColumbiaCanada
| | - Héctor A. Velásquez García
- BC Centre for Disease ControlVancouverBritish ColumbiaCanada,University of British ColumbiaSchool of Population and Public HealthVancouverBritish ColumbiaCanada
| | - Mawuena Binka
- BC Centre for Disease ControlVancouverBritish ColumbiaCanada
| | - Prince Adu
- BC Centre for Disease ControlVancouverBritish ColumbiaCanada,University of British ColumbiaSchool of Population and Public HealthVancouverBritish ColumbiaCanada
| | | | | | | | - Marie Paul Nisingizwe
- University of British ColumbiaSchool of Population and Public HealthVancouverBritish ColumbiaCanada
| | | | | | - Naveed Z. Janjua
- BC Centre for Disease ControlVancouverBritish ColumbiaCanada,University of British ColumbiaSchool of Population and Public HealthVancouverBritish ColumbiaCanada
| |
Collapse
|
24
|
Fibke CD, Joffres Y, Tyson JR, Colijn C, Janjua NZ, Fjell C, Prystajecky N, Jassem A, Sbihi H. Spike Mutation Profiles Associated With SARS-CoV-2 Breakthrough Infections in Delta Emerging and Predominant Time Periods in British Columbia, Canada. Front Public Health 2022; 10:915363. [PMID: 35859775 PMCID: PMC9289444 DOI: 10.3389/fpubh.2022.915363] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background COVID-19 vaccination is a key public health measure in the pandemic response. The rapid evolution of SARS-CoV-2 variants introduce new groups of spike protein mutations. These new mutations are thought to aid in the evasion of vaccine-induced immunity and render vaccines less effective. However, not all spike mutations contribute equally to vaccine escape. Previous studies associate mutations with vaccine breakthrough infections (BTI), but information at the population level remains scarce. We aimed to identify spike mutations associated with SARS-CoV-2 vaccine BTI in a community setting during the emergence and predominance of the Delta-variant. Methods This case-control study used both genomic, and epidemiological data from a provincial COVID-19 surveillance program. Analyses were stratified into two periods approximating the emergence and predominance of the Delta-variant, and restricted to primary SARS-CoV-2 infections from either unvaccinated individuals, or those infected ≥14 days after their second vaccination dose in a community setting. Each sample's spike mutations were concatenated into a unique spike mutation profile (SMP). Penalized logistic regression was used to identify spike mutations and SMPs associated with SARS-CoV-2 vaccine BTI in both time periods. Results and Discussion This study reports population level relative risk estimates, between 2 and 4-folds, of spike mutation profiles associated with BTI during the emergence and predominance of the Delta-variant, which comprised 19,624 and 17,331 observations, respectively. The identified mutations cover multiple spike domains including the N-terminal domain (NTD), receptor binding domain (RBD), S1/S2 cleavage region, fusion peptide and heptad regions. Mutations in these different regions imply various mechanisms contribute to vaccine escape. Our profiling method identifies naturally occurring spike mutations associated with BTI, and can be applied to emerging SARS-CoV-2 variants with novel groups of spike mutations.
Collapse
Affiliation(s)
- Chad D. Fibke
- BC Centre for Disease Control, UBC BCCDC, Vancouver, BC, Canada
| | - Yayuk Joffres
- BC Center for Disease Control, Data and Analytics Services, Vancouver, BC, Canada
| | - John R. Tyson
- Public Health Laboratory, BC Center for Disease Control, Vancouver, BC, Canada
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
| | - Naveed Z. Janjua
- BC Center for Disease Control, Data and Analytics Services, Vancouver, BC, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Chris Fjell
- Public Health Laboratory, BC Center for Disease Control, Vancouver, BC, Canada
| | - Natalie Prystajecky
- Public Health Laboratory, BC Center for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Agatha Jassem
- Public Health Laboratory, BC Center for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Hind Sbihi
- BC Center for Disease Control, Data and Analytics Services, Vancouver, BC, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Hind Sbihi
| |
Collapse
|
25
|
Mueller PP, Chen Q, Ayer T, Nemutlu GS, Hajjar A, Bethea ED, Peters MLB, Lee BP, Janjua NZ, Kanwal F, Chhatwal J. Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication. J Hepatol 2022; 77:55-62. [PMID: 35157959 PMCID: PMC9618359 DOI: 10.1016/j.jhep.2022.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Successful treatment of chronic hepatitis C with oral direct-acting antivirals (DAAs) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance. METHODS We developed a microsimulation model of the natural history of HCC in individuals with hepatitis C and advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) vs. no surveillance. RESULTS In virologically cured patients with cirrhosis, the incremental cost-effectiveness ratio (ICER) of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the starting age (40-65). Compared with no surveillance, surveillance detected 130 additional HCCs in 'very early'/early stage and yielded 51 additional QALYs per 1,000 patients with cirrhosis. In virologically cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the starting age (40-50). Compared with no surveillance, surveillance detected 24 additional HCCs in 'very early'/early stage and yielded 12 additional QALYs per 1,000 patients with advanced fibrosis. CONCLUSION Biannual surveillance for HCC in patients cured of hepatitis C is cost-effective until the age of 70 for patients with cirrhosis, and until the age of 60 for patients with stable advanced fibrosis. LAY SUMMARY Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based biannual screening for liver cancer is cost-effective up to age 70 in those with cirrhosis and up to age 60 in those with stable advanced fibrosis.
Collapse
Affiliation(s)
- Peter P. Mueller
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Qiushi Chen
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;,Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park, PA, USA
| | - Turgay Ayer
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gizem S. Nemutlu
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Hajjar
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily D. Bethea
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;,Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA
| | - Mary Linton B. Peters
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;,Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brian P. Lee
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada;,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Fasiha Kanwal
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA;,Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
26
|
Lockart I, Yeo MGH, Hajarizadeh B, Dore G, Danta M, Abe K, Carrat F, Lusivika‐Nzinga C, Degasperi E, Di Marco V, Hou J, Howell J, Janjua NZ, Wong S, Kumada T, Lleo A, Persico M, Lok AS, Wei L, Yang M, Nabatchikova E, Nguyen MH, Antonio Pineda J, Reig M, Shiha G, Yu M, Tsai P. HCC incidence after hepatitis C cure among patients with advanced fibrosis or cirrhosis: A meta-analysis. Hepatology 2022; 76:139-154. [PMID: 35030279 PMCID: PMC9303770 DOI: 10.1002/hep.32341] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS HCV cure reduces but does not eliminate the risk of HCC. HCC surveillance is recommended in populations where the incidence exceeds 1.5% per year. In cirrhosis, HCC surveillance should continue after HCV cure, although it is uncertain if this should be indefinite. For patients with advanced fibrosis (F3), guidelines are inconsistent in their recommendations. We evaluated the incidence of HCC after HCV cure among patients with F3 fibrosis or cirrhosis. APPROACH AND RESULTS This systematic review and meta-analysis identified 44 studies (107,548 person-years of follow-up) assessing the incidence of HCC after HCV cure among patients with F3 fibrosis or cirrhosis. The incidence of HCC was 2.1 per 100 person-years (95% CI, 1.9-2.4) among patients with cirrhosis and 0.5 per 100 person-years (95% CI, 0.3-0.7) among patients with F3 fibrosis. In a meta-regression analysis among patients with cirrhosis, older age (adjusted rate ratio [aRR] per 10-year increase in mean/median age, 1.32; 95% CI, 1.00-1.73) and prior decompensation (aRR per 10% increase in the proportion of patients with prior decompensation, 1.06; 95% CI, 1.01-1.12) were associated with an increased incidence of HCC. Longer follow-up after HCV cure was associated with a decreased incidence of HCC (aRR per year increase in mean/median follow-up, 0.87; 95% CI, 0.79-0.96). CONCLUSIONS Among patients with cirrhosis, the incidence of HCC decreases over time after HCV cure and is lowest in patients with younger age and compensated cirrhosis. The substantially lower incidence in F3 fibrosis is below the recommended threshold for cost-effective screening. The results should encourage the development of validated predictive models that better identify at-risk individuals, especially among patients with F3 fibrosis.
Collapse
Affiliation(s)
- Ian Lockart
- Faculty of MedicineSt. Vincent's Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia,St. Vincent’s HospitalSydneyNew South WalesAustralia
| | - Malcolm G. H. Yeo
- Faculty of MedicineSt. Vincent's Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
| | - Behzad Hajarizadeh
- The Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Gregory J. Dore
- St. Vincent’s HospitalSydneyNew South WalesAustralia,The Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mark Danta
- Faculty of MedicineSt. Vincent's Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia,St. Vincent’s HospitalSydneyNew South WalesAustralia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Iyaniwura SA, Falcão RC, Ringa N, Adu PA, Spencer M, Taylor M, Colijn C, Coombs D, Janjua NZ, Irvine MA, Otterstatter M. Mathematical modeling of COVID-19 in British Columbia: An age-structured model with time-dependent contact rates. Epidemics 2022; 39:100559. [PMID: 35447505 PMCID: PMC8993502 DOI: 10.1016/j.epidem.2022.100559] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/21/2021] [Revised: 03/02/2022] [Accepted: 03/29/2022] [Indexed: 02/08/2023] Open
Abstract
Following the emergence of COVID-19 at the end of 2019, several mathematical models have been developed to study the transmission dynamics of this disease. Many of these models assume homogeneous mixing in the underlying population. However, contact rates and mixing patterns can vary dramatically among individuals depending on their age and activity level. Variation in contact rates among age groups and over time can significantly impact how well a model captures observed trends. To properly model the age-dependent dynamics of COVID-19 and understand the impacts of interventions, it is essential to consider heterogeneity arising from contact rates and mixing patterns. We developed an age-structured model that incorporates time-varying contact rates and population mixing computed from the ongoing BC Mix COVID-19 survey to study transmission dynamics of COVID-19 in British Columbia (BC), Canada. Using a Bayesian inference framework, we fit four versions of our model to weekly reported cases of COVID-19 in BC, with each version allowing different assumptions of contact rates. We show that in addition to incorporating age-specific contact rates and mixing patterns, time-dependent (weekly) contact rates are needed to adequately capture the observed transmission dynamics of COVID-19. Our approach provides a framework for explicitly including empirical contact rates in a transmission model, which removes the need to otherwise model the impact of many non-pharmaceutical interventions. Further, this approach allows projection of future cases based on clear assumptions of age-specific contact rates, as opposed to less tractable assumptions regarding transmission rates.
Collapse
Affiliation(s)
- Sarafa A. Iyaniwura
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada,Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, British Columbia, Canada,Corresponding author at: Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebeca C. Falcão
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada,Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Notice Ringa
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Prince A. Adu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Spencer
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marsha Taylor
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Caroline Colijn
- Department of Mathematics and Statistics, Simon Fraser University, Burnaby, BC, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A. Irvine
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
28
|
Hosseini-Hooshyar S, Hajarizadeh B, Bajis S, Law M, Janjua NZ, Fierer DS, Chromy D, Rockstroh JK, Martin TCS, Ingiliz P, Hung CC, Dore GJ, Martinello M, Matthews GV. Risk of hepatitis C reinfection following successful therapy among people living with HIV: a global systematic review, meta-analysis, and meta-regression. The Lancet HIV 2022; 9:e414-e427. [DOI: 10.1016/s2352-3018(22)00077-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022]
|
29
|
Ringa N, Iyaniwura SA, David S, Irvine MA, Adu P, Spencer M, Janjua NZ, Otterstatter MC. Social Contacts and Transmission of COVID-19 in British Columbia, Canada. Front Public Health 2022; 10:867425. [PMID: 35592086 PMCID: PMC9110764 DOI: 10.3389/fpubh.2022.867425] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/25/2022] [Indexed: 01/08/2023] Open
Abstract
Background Close-contact rates are thought to be a driving force behind the transmission of many infectious respiratory diseases. Yet, contact rates and their relation to transmission and the impact of control measures, are seldom quantified. We quantify the response of contact rates, reported cases and transmission of COVID-19, to public health contact-restriction orders, and examine the associations among these three variables in the province of British Columbia, Canada. Methods We derived time series data for contact rates, daily cases and transmission of COVID-19 from a social contacts survey, reported case counts and by fitting a transmission model to reported cases, respectively. We used segmented regression to investigate impacts of public health orders; Pearson correlation to determine associations between contact rates and transmission; and vector autoregressive modeling to quantify lagged associations between contacts rates, daily cases, and transmission. Results Declines in contact rates and transmission occurred concurrently with the announcement of public health orders, whereas declines in cases showed a reporting delay of about 2 weeks. Contact rates were a significant driver of COVID-19 and explained roughly 19 and 20% of the variation in new cases and transmission, respectively. Interestingly, increases in COVID-19 transmission and cases were followed by reduced contact rates: overall, daily cases explained about 10% of the variation in subsequent contact rates. Conclusion We showed that close-contact rates were a significant time-series driver of transmission and ultimately of reported cases of COVID-19 in British Columbia, Canada and that they varied in response to public health orders. Our results also suggest possible behavioral feedback, by which increased reported cases lead to reduced subsequent contact rates. Our findings help to explain and validate the commonly assumed, but rarely measured, response of close contact rates to public health guidelines and their impact on the dynamics of infectious diseases.
Collapse
Affiliation(s)
- Notice Ringa
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sarafa A. Iyaniwura
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Mathematics, Institute of Applied Mathematics, University of British Columbia, Vancouver, BC, Canada
| | - Samara David
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mike A. Irvine
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Prince Adu
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Spencer
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Naveed Z. Janjua
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael C. Otterstatter
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
30
|
Yasseen AS, Kwong JC, Feld JJ, Kustra R, MacDonald L, Greenaway CC, Janjua NZ, Mazzulli T, Sherman M, Lapointe-Shaw L, Sander B, Crowcroft NS. The viral hepatitis B care cascade: A population-based comparison of immigrant groups. Hepatology 2022; 75:673-689. [PMID: 34537985 DOI: 10.1002/hep.32162] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS The global burden of viral hepatitis B is substantial, and monitoring infections across the care cascade is important for elimination efforts. There is little information on care disparities by immigration status, and we aimed to quantify disease burden among immigrant subgroups. APPROACH AND RESULTS In this population-based, retrospective cohort study, we used linked laboratory and health administrative records to describe the HBV care cascade in five distinct stages: (1) lifetime prevalence; (2) diagnosis; (3) engagement with care; (4) treatment initiation; and (5) treatment continuation. Infections were identified based on at least one reactive antigen or nucleic acid test, and lifetime prevalence was estimated as the sum of diagnosed and estimated undiagnosed cases. Care cascades were compared between long-term residents and immigrant groups, including subgroups born in hepatitis B endemic countries. Stratified analyses and multivariable Poisson regression were used to identify drivers for cascade progression. Between January 1997 and December 2014, 2,014,470 persons were included, 50,475 with infections, of whom 30,118 were engaged with care, 11,450 initiated treatment, and 6554 continued treatment >1 year. Lifetime prevalence was estimated as 163,309 (1.34%) overall, 115,722 (3.42%) among all immigrants, and 50,876 (9.37%) among those from highly endemic countries. Compared to long-term residents, immigrants were more likely to be diagnosed (adjusted rate ratio [aRR], 4.55; 95% CI, 4.46, 4.63), engaged with care (aRR, 1.07; 95% CI, 1.04, 1.09), and initiate treatment (aRR, 1.09; 95% CI, 1.03, 1.16). CONCLUSIONS In conclusion, immigrants fared well compared to long-term residents along the care cascade, having higher rates of diagnosis and slightly better measures in subsequent cascade stages, although intensified screening efforts and better strategies to facilitate linkage to care are still needed.
Collapse
Affiliation(s)
- Abdool S Yasseen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan J Feld
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Liane MacDonald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Christina C Greenaway
- Division of Infectious Diseases, Jewish General Hospital, Montreal, Quebec, Canada.,Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Tony Mazzulli
- Public Health Ontario, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | | | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Xia Y, Ma H, Moloney G, Velásquez García HA, Sirski M, Janjua NZ, Vickers D, Williamson T, Katz A, Yiu K, Kustra R, Buckeridge DL, Brisson M, Baral SD, Mishra S, Maheu-Giroux M. Geographic concentration of SARS-CoV-2 cases by social determinants of health in metropolitan areas in Canada: a cross-sectional study. CMAJ 2022; 194:E195-E204. [PMID: 35165131 PMCID: PMC8900797 DOI: 10.1503/cmaj.211249] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Understanding inequalities in SARS-CoV-2 transmission associated with the social determinants of health could help the development of effective mitigation strategies that are responsive to local transmission dynamics. This study aims to quantify social determinants of geographic concentration of SARS-CoV-2 cases across 16 census metropolitan areas (hereafter, cities) in 4 Canadian provinces, British Columbia, Manitoba, Ontario and Quebec. Methods: We used surveillance data on confirmed SARS-CoV-2 cases and census data for social determinants at the level of the dissemination area (DA). We calculated Gini coefficients to determine the overall geographic heterogeneity of confirmed cases of SARS-CoV-2 in each city, and calculated Gini covariance coefficients to determine each city’s heterogeneity by each social determinant (income, education, housing density and proportions of visible minorities, recent immigrants and essential workers). We visualized heterogeneity using Lorenz (concentration) curves. Results: We observed geographic concentration of SARS-CoV-2 cases in cities, as half of the cumulative cases were concentrated in DAs containing 21%–35% of their population, with the greatest geographic heterogeneity in Ontario cities (Gini coefficients 0.32–0.47), followed by British Columbia (0.23–0.36), Manitoba (0.32) and Quebec (0.28–0.37). Cases were disproportionately concentrated in areas with lower income and educational attainment, and in areas with a higher proportion of visible minorities, recent immigrants, high-density housing and essential workers. Although a consistent feature across cities was concentration by the proportion of visible minorities, the magnitude of concentration by social determinant varied across cities. Interpretation: Geographic concentration of SARS-CoV-2 cases was observed in all of the included cities, but the pattern by social determinants varied. Geographically prioritized allocation of resources and services should be tailored to the local drivers of inequalities in transmission in response to the resurgence of SARS-CoV-2.
Collapse
Affiliation(s)
- Yiqing Xia
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Huiting Ma
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Gary Moloney
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Héctor A Velásquez García
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Monica Sirski
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Naveed Z Janjua
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - David Vickers
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Tyler Williamson
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Alan Katz
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Kristy Yiu
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Rafal Kustra
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Marc Brisson
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Stefan D Baral
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Sharmistha Mishra
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont.
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics (Xia, Buckeridge, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Xia, Ma, Moloney, Yiu, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; School of Population and Public Health (Velásquez García, Janjua), University of British Columbia; British Columbia Centre for Disease Control (Velásquez García, Janjua), Vancouver, BC; Departments of Community Health Sciences and Family Medicine (Sirski, Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Community Health Sciences (Vickers, Williamson) and Centre for Health Informatics (Williamson), University of Calgary, Calgary, Alta.; Dalla Lana School of Public Health (Kustra), University of Toronto, Toronto, Ont.; Département de médecine sociale et préventive (Brisson), Faculté de médecine, Université Laval, Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Division of Infectious Diseases (Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| |
Collapse
|
32
|
Wilton J, Wong S, Purssell R, Abdia Y, Chong M, Karim ME, MacInnes A, Bartlett SR, Balshaw RF, Gomes T, Yu A, Alvarez M, Dart RC, Krajden M, Buxton JA, Janjua NZ. Association Between Prescription Opioid Therapy for Noncancer Pain and Hepatitis C Virus Seroconversion. JAMA Netw Open 2022; 5:e2143050. [PMID: 35019983 PMCID: PMC8756332 DOI: 10.1001/jamanetworkopen.2021.43050] [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: 11/14/2022] Open
Abstract
IMPORTANCE Initiation of injection drug use may be more frequent among people dispensed prescription opioid therapy for noncancer pain, potentially increasing the risk of hepatitis C virus (HCV) acquisition. OBJECTIVE To assess the association between medically dispensed long-term prescription opioid therapy for noncancer pain and HCV seroconversion among individuals who were initially injection drug use-naive. DESIGN, SETTING, AND PARTICIPANTS A population-based, retrospective cohort study of individuals tested for HCV in British Columbia, Canada, with linkage to outpatient pharmacy dispensations, was conducted. Individuals with an initial HCV-negative test result followed by 1 additional test between January 1, 2000, and December 31, 2017, and who had no history of substance use at baseline (first HCV-negative test), were included. Participants were followed up from baseline to the last HCV-negative test or estimated date of seroconversion (midpoint between HCV-positive and the preceding HCV-negative test). EXPOSURES Episodes of prescription opioid use for noncancer pain were defined as acute (<90 days) or long-term (≥90 days). Prescription opioid exposure status (long-term vs prescription opioid-naive/acute) was treated as time-varying in survival analyses. In secondary analyses, long-term exposure was stratified by intensity of use (chronic vs. episodic) and by average daily dose in morphine equivalents (MEQ). MAIN OUTCOMES AND MEASURES Multivariable Cox regression models were used to assess the association between time-varying prescription opioid status and HCV seroconversion. RESULTS A total of 382 478 individuals who had more than 1 HCV test were included, of whom more than half were female (224 373 [58.7%]), born before 1974 (201 944 [52.8%]), and younger than 35 years at baseline (196 298 [53.9%]). Participants were followed up for 2 057 668 person-years and 1947 HCV seroconversions occurred. Of the participants, 41 755 people (10.9%) were exposed to long-term prescription opioid therapy at baseline or during follow-up. The HCV seroconversion rate per 1000 person-years was 0.8 among the individuals who were prescription opioid-naive/acute (1489 of 1947 [76.5%] seroconversions; 0.4% seroconverted within 5 years) and 2.1 with long-term prescription opioid therapy (458 of 1947 [23.5%] seroconversions; 1.1% seroconverted within 5 years). In multivariable analysis, exposure to long-term prescription opioid therapy was associated with a 3.2-fold (95% CI, 2.9-3.6) higher risk of HCV seroconversion (vs prescription opioid-naive/acute). In separate Cox models, long-term chronic use was associated with a 4.7-fold higher risk of HCV seroconversion (vs naive/acute use 95% CI, 3.9-5.8), and long-term higher-dose use (≥90 MEQ) was associated with a 5.1-fold higher risk (vs naive/acute use 95% CI, 3.7-7.1). CONCLUSIONS AND RELEVANCE In this cohort study of people with more than 1 HCV test, long-term prescription opioid therapy for noncancer pain was associated with a higher risk of HCV seroconversion among individuals who were injection drug use-naive at baseline or at prescription opioid initiation. These results suggest injection drug use initiation risk is higher among people dispensed long-term therapy and may be useful for informing approaches to identify and prevent HCV infection. These findings should not be used to justify abrupt discontinuation of long-term therapy, which could increase risk of harms.
Collapse
Affiliation(s)
- James Wilton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Roy Purssell
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Younathan Abdia
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation & Outcome Sciences, St Paul's Hospital Vancouver, British Columbia, Canada
| | - Aaron MacInnes
- Pain Management Clinic, Jim Pattison Outpatient Care & Surgical Centre, Fraser Health Authority, Surrey, British Columbia, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sofia R. Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rob F. Balshaw
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Richard C. Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, Colorado
- Department of Emergency Medicine, University of Colorado Health Sciences Center, Denver
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane A. Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation & Outcome Sciences, St Paul's Hospital Vancouver, British Columbia, Canada
| |
Collapse
|
33
|
Stockdale JE, Anderson SC, Edwards AM, Iyaniwura SA, Mulberry N, Otterstatter MC, Janjua NZ, Coombs D, Colijn C, Irvine MA. Quantifying transmissibility of SARS-CoV-2 and impact of intervention within long-term healthcare facilities. R Soc Open Sci 2022; 9:211710. [PMID: 35242355 PMCID: PMC8753163 DOI: 10.1098/rsos.211710] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/02/2021] [Indexed: 05/03/2023]
Abstract
Estimates of the basic reproduction number (R 0) for COVID-19 are particularly variable in the context of transmission within locations such as long-term healthcare (LTHC) facilities. We sought to characterize the heterogeneity of R 0 across known outbreaks within these facilities. We used a unique comprehensive dataset of all outbreaks that occurred within LTHC facilities in British Columbia, Canada as of 21 September 2020. We estimated R 0 in 18 LTHC outbreaks with a novel Bayesian hierarchical dynamic model of susceptible, exposed, infected and recovered individuals, incorporating heterogeneity of R 0 between facilities. We further compared these estimates to those obtained with standard methods that use the exponential growth rate and maximum likelihood. The total size of outbreaks varied dramatically, with range of attack rates 2%-86%. The Bayesian analysis provided an overall estimate of R 0 = 2.51 (90% credible interval 0.47-9.0), with individual facility estimates ranging between 0.56 and 9.17. Uncertainty in these estimates was more constrained than standard methods, particularly for smaller outbreaks informed by the population-level model. We further estimated that intervention led to 61% (52%-69%) of all potential cases being averted within the LTHC facilities, or 75% (68%-79%) when using a model with multi-level intervention effect. Understanding of transmission risks and impact of intervention are essential in planning during the ongoing global pandemic, particularly in high-risk environments such as LTHC facilities.
Collapse
Affiliation(s)
| | - Sean C. Anderson
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, Canada
| | - Andrew M. Edwards
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, Canada
- Department of Biology, University of Victoria, Victoria, Canada
| | - Sarafa A. Iyaniwura
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Nicola Mulberry
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Michael C. Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, Canada
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Michael A. Irvine
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| |
Collapse
|
34
|
Gan WQ, Buxton JA, Scheuermeyer FX, Palis H, Zhao B, Desai R, Janjua NZ, Slaunwhite AK. Risk of cardiovascular diseases in relation to substance use disorders. Drug Alcohol Depend 2021; 229:109132. [PMID: 34768052 DOI: 10.1016/j.drugalcdep.2021.109132] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Substance use disorder (SUD) has become increasingly prevalent worldwide, this study investigated the associations of SUD and alcohol, cannabis, opioid, or stimulant use disorder with cardiovascular disease (CVD) and 11 major CVD subtypes. METHODS This study was based on a 20% random sample of residents in British Columbia, Canada, who were aged 18 - 80 years at baseline on January 1, 2015. Using linked administrative health data during 2010 - 2014, we identified people with various SUDs and prevalent CVDs at baseline, and examined the cross-sectional associations between SUDs and CVDs. After excluding people with CVDs at baseline, we followed the cohort for 4 years to identify people who developed incident CVDs, and examined the longitudinal associations between SUDs and CVDs. RESULTS The cross-sectional analysis at baseline included 778,771 people (mean age 45 years, 50% male), 13,279 (1.7%) had SUD, and 41,573 (5.3%) had prevalent CVD. After adjusting for covariates, people with SUD were 2.7 (95% confidence interval [CI], 2.5 - 2.8) times more likely than people without SUD to have prevalent CVD. The longitudinal analysis included 617,863 people, 17,360 (2.8%) developed incident CVD during the follow-up period. After adjusting for covariates, people with SUD were 1.7 (95% CI, 1.6 - 1.9) times more likely than people without SUD to develop incident CVD. The cross-sectional and longitudinal associations were more pronounced for people with opioid or stimulant use disorder. CONCLUSIONS People with SUD are more likely to have prevalent CVD and develop incident CVD compared with people without SUD.
Collapse
Affiliation(s)
- Wen Qi Gan
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.
| | - Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Heather Palis
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Bin Zhao
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Roshni Desai
- First Nations Health Authority, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Canadian Network on Hepatitis C, Montreal, Quebec, Canada
| | - Amanda K Slaunwhite
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
35
|
Binka M, Bartlett S, Velásquez García HA, Darvishian M, Jeong D, Adu P, Alvarez M, Wong S, Yu A, Samji H, Krajden M, Wong J, Janjua NZ. Impact of COVID-19-related public health measures on HCV testing in British Columbia, Canada: An interrupted time series analysis. Liver Int 2021; 41:2849-2856. [PMID: 34592046 PMCID: PMC8662267 DOI: 10.1111/liv.15074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Public health measures introduced to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), also disrupted various healthcare services in many regions worldwide, including British Columbia (BC), Canada. We assessed the impact of these measures, first introduced in BC in March 2020, on hepatitis C (HCV) testing and first-time HCV-positive diagnoses within the province. METHODS De-identified HCV testing data for BC residents were obtained from the provincial Public Health Laboratory. Weekly changes in anti-HCV, HCV RNA and genotype testing episodes and first-time HCV-positive (anti-HCV/RNA/genotype) diagnoses from January 2018 to December 2020 were assessed and associations were determined using segmented regression models examining rates before vs after calendar week 12 of 2020, when measures were introduced. RESULTS Average weekly HCV testing and first-time HCV-positive diagnosis rates fell immediately following the imposition of public health measures by 62.3 per 100 000 population and 2.9 episodes per 1 000 000 population, respectively (P < .0001 for both), and recovered in subsequent weeks to near pre-March 2020 levels. Average weekly anti-HCV positivity rates decreased steadily pre-restrictions and this trend remained unchanged afterwards. CONCLUSIONS Reductions in HCV testing and first-time HCV-positive diagnosis rates, key drivers of progression along the HCV care cascade, occurred following the introduction of COVID-19-related public health measures. Further assessment will be required to better understand the full impact of these service disruptions on the HCV care cascade and to inform strategies for the re-engagement of people who may have been lost to care because of these measures.
Collapse
Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada
| | - Sofia Bartlett
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada,Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
| | | | - Maryam Darvishian
- British Columbia Cancer Research CentreVancouverBritish ColumbiaCanada
| | - Dahn Jeong
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada,School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Prince Adu
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada,School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Maria Alvarez
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada
| | - Stanley Wong
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada
| | - Amanda Yu
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada
| | - Hasina Samji
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada,Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
| | - Mel Krajden
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada,Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
| | - Jason Wong
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada,School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease ControlVancouverBritish ColumbiaCanada,School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| |
Collapse
|
36
|
Wilton J, Abdia Y, Chong M, Karim ME, Wong S, MacInnes A, Balshaw R, Zhao B, Gomes T, Yu A, Alvarez M, Dart RC, Krajden M, Buxton JA, Janjua NZ, Purssell R. Prescription opioid treatment for non-cancer pain and initiation of injection drug use: large retrospective cohort study. BMJ 2021; 375:e066965. [PMID: 34794949 PMCID: PMC8600402 DOI: 10.1136/bmj-2021-066965] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/12/2022]
Abstract
OBJECTIVE To assess the association between long term prescription opioid treatment medically dispensed for non-cancer pain and the initiation of injection drug use (IDU) among individuals without a history of substance use. DESIGN Retrospective cohort study. SETTING Large administrative data source (containing information for about 1.7 million individuals tested for hepatitis C virus or HIV in British Columbia, Canada) with linkage to administrative health databases, including dispensations from community pharmacies. PARTICIPANTS Individuals age 11-65 years and without a history of substance use (except alcohol) at baseline. MAIN OUTCOME MEASURES Episodes of prescription opioid use for non-cancer pain were identified based on drugs dispensed between 2000 and 2015. Episodes were classified by the increasing length and intensity of opioid use (acute (lasting <90 episode days), episodic (lasting ≥90 episode days; with <90 days' drug supply and/or <50% episode intensity), and chronic (lasting ≥90 episode days; with ≥90 days' drug supply and ≥50% episode intensity)). People with a chronic episode were matched 1:1:1:1 on socioeconomic variables to those with episodic or acute episodes and to those who were opioid naive. IDU initiation was identified by a validated administrative algorithm with high specificity. Cox models weighted by inverse probability of treatment weights assessed the association between opioid use category (chronic, episodic, acute, opioid naive) and IDU initiation. RESULTS 59 804 participants (14 951 people from each opioid use category) were included in the matched cohort, and followed for a median of 5.8 years. 1149 participants initiated IDU. Cumulative probability of IDU initiation at five years was highest for participants with chronic opioid use (4.0%), followed by those with episodic use (1.3%) and acute use (0.7%), and those who were opioid naive (0.4%). In the inverse probability of treatment weighted Cox model, risk of IDU initiation was 8.4 times higher for those with chronic opioid use versus those who were opioid naive (95% confidence interval 6.4 to 10.9). In a sensitivity analysis limited to individuals with a history of chronic pain, cumulative risk for those with chronic use (3.4% within five years) was lower than the primary results, but the relative risk was not (hazard ratio 9.7 (95% confidence interval 6.5 to 14.5)). IDU initiation was more frequent at higher opioid doses and younger ages. CONCLUSIONS The rate of IDU initiation among individuals who received chronic prescription opioid treatment for non-cancer pain was infrequent overall (3-4% within five years) but about eight times higher than among opioid naive individuals. These findings could have implications for strategies to prevent IDU initiation, but should not be used as a reason to support involuntary tapering or discontinuation of long term prescription opioid treatment.
Collapse
Affiliation(s)
- James Wilton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Younathan Abdia
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Aaron MacInnes
- Pain Management Clinic, JPOCSC, Fraser Health Authority, Surrey, BC, Canada
- Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rob Balshaw
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Bin Zhao
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Emergency Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Roy Purssell
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
37
|
Salway T, Butt ZA, Wong S, Abdia Y, Balshaw R, Rich AJ, Ablona A, Wong J, Grennan T, Yu A, Alvarez M, Rossi C, Gilbert M, Krajden M, Janjua NZ. A Computable Phenotype Model for Classification of Men Who Have Sex With Men Within a Large Linked Database of Laboratory, Surveillance, and Administrative Healthcare Records. Front Digit Health 2021; 2:547324. [PMID: 34713035 PMCID: PMC8521949 DOI: 10.3389/fdgth.2020.547324] [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: 06/03/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Most public health datasets do not include sexual orientation measures, thereby limiting the availability of data to monitor health disparities, and evaluate tailored interventions. We therefore developed, validated, and applied a novel computable phenotype model to classify men who have sex with men (MSM) using multiple health datasets from British Columbia, Canada, 1990-2015. Methods: Three case surveillance databases, a public health laboratory database, and five administrative health databases were linked and deidentified (BC Hepatitis Testers Cohort), resulting in a retrospective cohort of 727,091 adult men. Known MSM status from the three disease case surveillance databases was used to develop a multivariable model for classifying MSM in the full cohort. Models were selected using "elastic-net" (GLMNet package) in R, and a final model optimized area under the receiver operating characteristics curve. We compared characteristics of known MSM, classified MSM, and classified heterosexual men. Findings: History of gonorrhea and syphilis diagnoses, HIV tests in the past year, history of visit to an identified gay and bisexual men's clinic, and residence in MSM-dense neighborhoods were all positively associated with being MSM. The selected model had sensitivity of 72%, specificity of 94%. Excluding those with known MSM status, a total of 85,521 men (12% of cohort) were classified as MSM. Interpretation: Computable phenotyping is a promising approach for classification of sexual minorities and investigation of health outcomes in the absence of routinely available self-report data.
Collapse
Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Younathan Abdia
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Robert Balshaw
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Aidan Ablona
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Carmine Rossi
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
38
|
Pearce ME, Bartlett SR, Yu A, Lamb J, Reitz C, Wong S, Alvarez M, Binka M, Velásquez Garcia H, Jeong D, Clementi E, Adu P, Samji H, Wong J, Buxton J, Yoshida E, Elwood C, Sauve L, Pick N, Krajden M, Janjua NZ. Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study. BMC Womens Health 2021; 21:330. [PMID: 34511082 PMCID: PMC8436483 DOI: 10.1186/s12905-021-01470-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Women living with hepatitis C virus (HCV) are rarely addressed in research and may be overrepresented within key populations requiring additional support to access HCV care and treatment. We constructed the HCV care cascade among people diagnosed with HCV in British Columbia, Canada, as of 2019 to compare progress in care and treatment and to assess sex/gender gaps in HCV treatment access. METHODS The BC Hepatitis Testers Cohort includes 1.7 million people who tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 2000 to 2019. Test results were linked to medical visits, hospitalizations, cancers, prescription drugs, and mortality data. Six HCV care cascade stages were identified: (1) antibody diagnosed; (2) RNA tested; (3) RNA positive; (4) genotyped; (5) initiated treatment; and (6) achieved sustained virologic response (SVR). HCV care cascade results were assessed for women, and an 'inverse' cascade was created to assess gaps, including not being RNA tested, genotyped, or treatment initiated, stratified by sex. RESULTS In 2019, 52,638 people with known sex were anti-HCV positive in BC; 37% (19,522) were women. Confirmatory RNA tests were received by 86% (16,797/19,522) of anti-HCV positive women and 83% (27,353/33,116) of men. Among people who had been genotyped, 68% (6756/10,008) of women and 67% (12,640/18,828) of men initiated treatment, with 94% (5023/5364) of women and 92% (9147/9897) of men achieving SVR. Among the 3252 women and 6188 men not yet treated, higher proportions of women compared to men were born after 1975 (30% vs. 21%), had a mental health diagnosis (42% vs. 34%) and had used injection drugs (50% vs. 45%). Among 1619 women and 2780 men who had used injection drugs and were not yet treated, higher proportions of women than men used stimulants (64% vs. 57%), and opiates (67% vs. 60%). CONCLUSIONS Women and men appear to be equally engaged into the HCV care cascade; however, women with concurrent social and health conditions are being left behind. Treatment access may be improved with approaches that meet the needs of younger women, those with mental health diagnoses, and women who use drugs.
Collapse
Affiliation(s)
- Margo E Pearce
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada.
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jess Lamb
- AIDS Network Kootenay Outreach and Support Society, Kimberly, BC, Canada
| | - Cheryl Reitz
- East Kootenay Network of People who Use Drugs, Kimberly, BC, Canada
- British Columbia Hepatitis Network Society, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Emilia Clementi
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Prince Adu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Eric Yoshida
- Division of Gastroenterology, Department of Medicine, UBC, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Chelsea Elwood
- Department of Obstetrics and Gynecology, UBC, Vancouver, Canada
- BC Women's Hospital Research Institute, Vancouver, BC, Canada
| | - Laura Sauve
- BC Women's Hospital Research Institute, Vancouver, BC, Canada
- Division of Infectious Diseases, Department of Pediatrics, UBC, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Neora Pick
- BC Women's Hospital Research Institute, Vancouver, BC, Canada
- Division of Infectious Diseases, Department of Medicine, UBC, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| |
Collapse
|
39
|
Chung H, He S, Nasreen S, Sundaram ME, Buchan SA, Wilson SE, Chen B, Calzavara A, Fell DB, Austin PC, Wilson K, Schwartz KL, Brown KA, Gubbay JB, Basta NE, Mahmud SM, Righolt CH, Svenson LW, MacDonald SE, Janjua NZ, Tadrous M, Kwong JC. Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study. BMJ 2021; 374:n1943. [PMID: 34417165 PMCID: PMC8377789 DOI: 10.1136/bmj.n1943] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death). DESIGN Test negative design study. SETTING Ontario, Canada between 14 December 2020 and 19 April 2021. PARTICIPANTS 324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2. INTERVENTIONS BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. MAIN OUTCOME MEASURES Laboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes. RESULTS Of 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation. CONCLUSIONS Two doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.
Collapse
Affiliation(s)
| | | | | | - Maria E Sundaram
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah A Buchan
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Sarah E Wilson
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | | | | | - Deshayne B Fell
- ICES, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Peter C Austin
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, ON, Canada
- Bruyère and Ottawa Hospital Research Institutes, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin L Schwartz
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
| | - Kevin A Brown
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence W Svenson
- Analytics and Performance Reporting Branch, Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| |
Collapse
|
40
|
Yasseen AS, Kwong JC, Feld JJ, Janjua NZ, Greenaway C, Lapointe-Shaw L, Sherman M, Mazzulli T, Kustra R, MacDonald L, Sander B, Crowcroft NS. Viral hepatitis C cascade of care: A population-level comparison of immigrant and long-term residents. Liver Int 2021; 41:1775-1788. [PMID: 33655665 DOI: 10.1111/liv.14840] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Viral hepatitis C represents a major global burden, particularly among immigrant-receiving countries such as Canada, where knowledge of disparities in hepatitis C virus among immigrant groups for micro-elimination efforts is lacking. We quantify the hepatitis C cascades of care among immigrants and long-term residents prior to the introduction of direct-acting antiviral medications. METHODS Using laboratory and health administrative records, we described the hepatitis C virus cascades of care in terms of diagnosis, engagement with care, treatment initiation, and clearance in Ontario, Canada (1997-2014). We stratified the cascade by immigrant and long-term resident groups and identify drivers at each stage using multivariable Poisson regression. RESULTS We included 940 245 individuals in the study with an estimated hepatitis C prevalence of 167 923 (1.4%) overall, 23 759 (0.7%) among all immigrants, and 6019 (1.1%) among immigrants from hepatitis C endemic countries. Overall there were 104 616 individuals with reactive antibody results, 73 861 tested for viral RNA, 52 388 with viral RNA detected, 50 805 genotyped, 13 159 on treatment and 3919 with evidence of viral clearance. Compared to long-term residents, immigrants showed increased nucleic-acid testing (aRR: 1.09 [95%CI: 1.08, 1.10]), treatment initiation (aRR: 1.46 [95%CI: 1.38, 1.54]), and higher clearance rates (aRR: 1.07 [95%CI: 1.03, 1.11]). CONCLUSIONS Hepatitis C virus is more prevalent among long-term residents compared to immigrants overall, however, immigrants from endemic countries are an important subgroup to consider for future screening and linkage to care initiatives. These findings are prior to the introduction of newer medications and provide a population-based benchmark for follow-up studies and evaluation of treatment programs and surveillance activities.
Collapse
Affiliation(s)
- Abdool S Yasseen
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Jordan J Feld
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control - Hepatitis Testers Cohort, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Christina Greenaway
- Division of Infectious Diseases, SMBD-Jewish General Hospital, McGill University Montreal, Montreal, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Tony Mazzulli
- Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Mount Sinai Hospital/University Health Network Department of Microbiology, Toronto, ON, Canada
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Liane MacDonald
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Beate Sander
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| |
Collapse
|
41
|
Young J, Wong S, Janjua NZ, Klein MB. Comparing direct acting antivirals for hepatitis C using observational data - Why and how? Pharmacol Res Perspect 2021; 8:e00650. [PMID: 32894643 PMCID: PMC7507378 DOI: 10.1002/prp2.650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022] Open
Abstract
The World Health Organisation's goal of hepatitis C virus (HCV) elimination by 2030 will require lower drug prices. Estimates of comparative efficacy promote competition between pharmaceutical companies but direct acting antivirals have been approved for the treatment of HCV without comparative trials. We emulated a randomized trial to answer the question of whether easy to treat patients with genotype 1 HCV could be treated with sofosbuvir/ledipasvir (SOF/LDV) rather than sofosbuvir/velpatasvir (SOF/VEL). Patients without comorbidities or end stage liver disease were selected from the British Colombia Hepatitis Testers Cohort. To create a conceptual trial, we matched each patient starting SOF/VEL (a ‘case’) to the patient starting SOF/LDV with the closest propensity score (a ‘control’). We estimated the probability of treatment failure under a Bayesian logistic model with a random effect for each case‐control set and used that model to give an estimate of a risk difference for the conceptual trial. Treatment failure was recorded for 27 of 825 (3%) cases and for 29 of 602 (5%) matched controls. Estimates from our model were treatment success rates of 97% (95% credible interval, CrI, 95%‐98%) for treatment with SOF/VEL, 95% (95% CrI 93%‐97%) for treatment with SOF/LDV and a risk difference between treatments of 2% (95% CrI 0%‐4%). This risk difference is evidence that SOF/LDV is not inferior to SOF/VEL for easy to treat patients with genotype 1 HCV. The approach is a template for comparing drugs when there are no data from comparative trials.
Collapse
Affiliation(s)
- Jim Young
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| |
Collapse
|
42
|
Bartlett SR, Wong S, Yu A, Pearce M, MacIsaac J, Nouch S, Adu P, Wilton J, Samji H, Clementi E, Velasquez H, Jeong D, Binka M, Alvarez M, Wong J, Buxton J, Krajden M, Janjua NZ. The impact of current opioid agonist therapy on hepatitis C virus treatment initiation among people who use drugs from in the DAA era: A population-based study. Clin Infect Dis 2021; 74:575-583. [PMID: 34125883 DOI: 10.1093/cid/ciab546] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/20/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Evidence that opioid agonist therapy (OAT) is associated with increased odds of hepatitis C virus (HCV) treatment initiation among people who use drugs (PWUD) is emerging. The objective of this study was to determine the association between current OAT and HCV treatment initiation among PWUD in a population-level linked administrative dataset. METHODS The British Columbia (BC) Hepatitis Testers Cohort was used for this study, which includes all people tested for or diagnosed with HCV in BC, linked to medical visits, hospitalizations, laboratory, prescription drug, and mortality data from 1992 until 2019. PWUD with injecting drug use or opioid use disorder and chronic HCV infection were identified for inclusion in this study. HCV treatment initiation was the main outcome, and subdistribution proportional hazards modeling was used to assess the relationship with current OAT. RESULTS 13,803 PWUD with chronic HCV were included in this study. Among those currently on OAT at the end of the study period, 47% (2,704/5,770) had started HCV treatment, whereas 22% (1778/8033) of those not currently on OAT has started HCV treatment .. Among PWUD with chronic HCV infection, current OAT was associated with higher likelihood of HCV treatment initiation in time to event analysis (adjusted hazard ratio 1.84 [95%CI, 1.50, 2.26]). CONCLUSIONS Current OAT was associated with a higher likelihood of HCV treatment initiation. However, many PWUD with HCV currently receiving OAT have yet to receive HCV treatment. Enhanced integration between substance use care and HCV treatment is needed to improve the overall health of PWUD.
Collapse
Affiliation(s)
- Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Margo Pearce
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia MacIsaac
- Division of Addiction Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Susan Nouch
- Department of Family and Community Practice, Vancouver Coastal Health, Vancouver, BC, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Prince Adu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Emilia Clementi
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hector Velasquez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
43
|
Valerio H, Alavi M, Law M, McManus H, Tillakeratne S, Bajis S, Martinello M, Matthews GV, Amin J, Janjua NZ, Krajden M, George J, Degenhardt L, Grebely J, Dore GJ. Opportunities to enhance linkage to hepatitis C care among hospitalised people with recent drug dependence in New South Wales, Australia: A population-based linkage study. Clin Infect Dis 2021; 73:2037-2044. [PMID: 34107022 DOI: 10.1093/cid/ciab526] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People who inject drugs are at greater risk of hepatitis C virus (HCV) infection and hospitalisation, yet admissions are not utilised for HCV treatment initiation. We aimed to assess the extent to which people with HCV notification, including those with evidence of recent drug dependence, are hospitalised while eligible for direct-acting antiviral (DAA) therapy, and treatment uptake according to hospitalisation in the DAA era. METHODS We conducted a longitudinal, population-based cohort study of people living with HCV in the DAA era (March 2016-December 2018) through analysis of linked databases in New South Wales, Australia. Kaplan Meier estimates were used to report HCV treatment uptake by frequency, length, and cause-specific hospitalisation. RESULTS Among 57,467 people, 14,938 (26%) had evidence of recent drug dependence, 50% (n=7,506) of whom were hospitalised while DAA eligible. Incidence of selected cause-specific hospitalisation was highest for mental health-related (15.84 per 100 person-years [PY]), drug-related (15.20 per 100PY), and injection-related infectious disease (9.15 per 100PY) hospitalisations, and lowest for alcohol use disorder (4.58 per 100PY) and liver-related (3.13 per 100PY). 65% (n=4,898) of those hospitalised had been admitted >2 times and 46% (n=3,437) were hospitalised >7 days. By the end of 2018, DAA therapy was lowest for those hospitalised >2 times, for >7 days, and those whose first admission was for injection-related infectious disease, mental health disorders, and drug-related complications. CONCLUSIONS Among people who have evidence of recent drug dependence, frequent hospitalisation-particularly mental health, drug, and alcohol admissions-presents an opportunity for engagement in HCV care.
Collapse
Affiliation(s)
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,Department of Health Systems and Populations, Maquarie University, Sydney, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | | |
Collapse
|
44
|
Yasseen AS, Kwong JC, Kustra R, Holder L, Chung H, Macdonald L, Janjua NZ, Mazzulli T, Feld J, Crowcroft NS. Validating viral hepatitis B and C diagnosis codes: a retrospective analysis using Ontario's health administrative data. Can J Public Health 2021; 112:502-512. [PMID: 33417192 PMCID: PMC8076389 DOI: 10.17269/s41997-020-00435-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to determine the criterion validity of using diagnosis codes for hepatitis B virus (HBV) and hepatitis C virus (HCV) to identify infections. METHODS Using linked laboratory and administrative data in Ontario, Canada, from January 2004 to December 2014, we validated HBV/HCV diagnosis codes against laboratory-confirmed infections. Performance measures (sensitivity, specificity, and positive predictive value) were estimated via cross-validated logistic regression and we explored variations by varying time windows from 1 to 5 years before (i.e., prognostic prediction) and after (i.e., diagnostic prediction) the date of laboratory confirmation. Subgroup analyses were performed among immigrants, males, baby boomers, and females to examine the robustness of these measures. RESULTS A total of 1,599,023 individuals were tested for HBV and 840,924 for HCV, with a resulting 41,714 (2.7%) and 58,563 (7.0%) infections identified, respectively. HBV/HCV diagnosis codes ± 3 years of laboratory confirmation showed high specificity (99.9% HBV; 99.8% HCV), moderate positive predictive value (70.3% HBV; 85.8% HCV), and low sensitivity (12.8% HBV; 30.8% HCV). Varying the time window resulted in limited changes to performance measures. Diagnostic models consistently outperformed prognostic models. No major differences were observed among subgroups. CONCLUSION HBV/HCV codes should not be the only source used for monitoring the population burden of these infections, due to low sensitivity and moderate positive predictive values. These results underscore the importance of ongoing laboratory and reportable disease surveillance systems for monitoring viral hepatitis in Ontario.
Collapse
Affiliation(s)
- Abdool S Yasseen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- ICES, Toronto, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- ICES, Toronto, Canada
- University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | | | - Liane Macdonald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
| | - Naveed Z Janjua
- Hepatitis Testers Cohort, British Columbia Centre for Diseases Control, Vancouver, Canada
| | - Tony Mazzulli
- Public Health Ontario, Toronto, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Microbiology, Mount Sinai Hospital/University Health Network, Toronto, Canada
| | - Jordan Feld
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- ICES, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- ICES, Toronto, Canada.
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
- Department of Microbiology, Mount Sinai Hospital/University Health Network, Toronto, Canada.
| |
Collapse
|
45
|
Anderson SC, Mulberry N, Edwards AM, Stockdale JE, Iyaniwura SA, Falcao RC, Otterstatter MC, Janjua NZ, Coombs D, Colijn C. How much leeway is there to relax COVID-19 control measures? Epidemics 2021; 35:100453. [PMID: 33971429 PMCID: PMC7970422 DOI: 10.1016/j.epidem.2021.100453] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/23/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
Following successful non-pharmaceutical interventions (NPI) aiming to control COVID-19, many jurisdictions reopened their economies and borders. As little immunity had developed in most populations, re-establishing higher contact carried substantial risks, and therefore many locations began to see resurgence in COVID-19 cases. We present a Bayesian method to estimate the leeway to reopen, or alternatively the strength of change required to re-establish COVID-19 control, in a range of jurisdictions experiencing different COVID-19 epidemics. We estimated the timing and strength of initial control measures such as widespread distancing and compared the leeway jurisdictions had to reopen immediately after NPI measures to later estimates of leeway. Finally, we quantified risks associated with reopening and the likely burden of new cases due to introductions from other jurisdictions. We found widely varying leeway to reopen. After initial NPI measures took effect, some jurisdictions had substantial leeway (e.g., Japan, New Zealand, Germany) with > 0.99 probability that contact rates were below 80% of the threshold for epidemic growth. Others had little leeway (e.g., the United Kingdom, Washington State) and some had none (e.g., Sweden, California). For most such regions, increases in contact rate of 1.5-2 fold would have had high (> 0.7) probability of exceeding past peak sizes. Most jurisdictions experienced June-August trajectories consistent with our projections of contact rate increases of 1-2-fold. Under such relaxation scenarios for some regions, we projected up to ∼100 additional cases if just one case were imported per week over six weeks, even between jurisdictions with comparable COVID-19 risk. We provide an R package covidseir to enable jurisdictions to estimate leeway and forecast cases under different future contact patterns. Estimates of leeway can establish a quantitative basis for decisions about reopening. We recommend a cautious approach to reopening economies and borders, coupled with strong monitoring for changes in transmission.
Collapse
Affiliation(s)
- Sean C Anderson
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, BC, Canada; Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
| | - Nicola Mulberry
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada
| | - Andrew M Edwards
- Pacific Biological Station, Fisheries and Oceans Canada, Nanaimo, BC, Canada; Department of Biology, University of Victoria, Victoria, BC, Canada
| | | | - Sarafa A Iyaniwura
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Rebeca C Falcao
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Michael C Otterstatter
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, University of British Columbia, Vancouver, BC, Canada
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Burnaby, BC, Canada; Department of Mathematics, Imperial College London, London, UK.
| |
Collapse
|
46
|
Coye AE, Bornstein KJ, Bartholomew TS, Li H, Wong S, Janjua NZ, Tookes HE, St Onge JE. Hospital Costs of Injection Drug Use in Florida. Clin Infect Dis 2021; 72:499-502. [PMID: 32564077 DOI: 10.1093/cid/ciaa823] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/04/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022] Open
Abstract
People who inject drugs (PWID) experience significant injection-related infections (IRIs) at significant healthcare system cost. This study used and validated an algorithm based on the International Classification of Diseases, Tenth Revision, to estimate hospitalized PWID populations, assess the total statewide morbidity for IRIs among PWID, and calculate associated costs of care.
Collapse
Affiliation(s)
- Austin E Coye
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | - Hua Li
- Department of Public Health Sciences, Division of Biostatistics, Biostatistics Collaboration and Consulting Core, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stanley Wong
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hansel E Tookes
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joan E St Onge
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
47
|
Ho H, Janjua NZ, McGrail KM, Harrison M, Law MR. The impact of public coverage of newer hepatitis C medications on utilization, adherence, and costs in British Columbia. PLoS One 2021; 16:e0247843. [PMID: 33647068 PMCID: PMC7920374 DOI: 10.1371/journal.pone.0247843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background Sofosbuvir and ledipasvir-sofosbuvir are both newer direct-acting antiviral agents for the treatment of hepatitis C. The high list prices for both drugs have led to concern about the budget impact for public drug coverage programs. Therefore, we studied the impact of public prescription drug coverage for both drugs on utilization, adherence, and public and private expenditure in British Columbia, Canada. Methods We used provincial administrative claims data from January 2014 to June 2017 for all individuals historically tested for either hepatitis C and/or human immunodeficiency virus. Using interrupted time series analysis, we examined the impact of public insurance coverage on treatment uptake, adherence (proportion of days covered), and public and private expenditures. Results Over our study period, 4,462 treatment initiations were eligible for analysis (1,131 sofosbuvir and 3,331 ledipasvir-sofosbuvir, which include 19 patients initiated on both treatments). We found the start of public coverage for sofosbuvir and ledipasvir-sofosbuvir increased treatment uptake by 154%. Adherence rates were consistently high and did not change with public coverage. Finally, public expenditure increased after the policy change, and crowded out some private expenditure. Conclusion Public coverage for high-cost drugs for hepatitis C dramatically increased use of these drugs, but did not reduce adherence. From a health policy perspective, public payers should be prepared for increased treatment uptake following the availability of public coverage. However, they should not be concerned that populations without private insurance coverage will be less adherent and not finish their treatment course.
Collapse
Grants
- FDN-148412 CIHR
- NHC-348216 CIHR
- PHE-337680 CIHR
- PJT-156066 CIHR
- Canadian Institutes of Health Research
- Canadian Agency for Drugs and Technologies in Health
- Canada Research Chairs
- Michael Smith Foundation for Health Research
- Amgen Canada, AstraZeneca Canada, Eli Lilly Canada, GlaxoSmithKline, Merck Canada, Novartis Pharmaceuticals Canada, Pfizer Canada, Boehringer Ingelheim (Canada), Hoffman-La Roche, LifeScan Canada, and Lundbeck Canada
Collapse
Affiliation(s)
- Harriet Ho
- The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Kimberlyn M. McGrail
- The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Harrison
- Centre for Health Evaluation and Outcomes Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michael R. Law
- The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
48
|
Adu PA, Rossi C, Binka M, Wong S, Wilton J, Wong J, Butt ZA, Bartlett S, Jeong D, Pearce M, Darvishian M, Yu A, Alvarez M, Velásquez García HA, Krajden M, Janjua NZ. HCV reinfection rates after cure or spontaneous clearance among HIV-infected and uninfected men who have sex with men. Liver Int 2021; 41:482-493. [PMID: 33305525 DOI: 10.1111/liv.14762] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) reinfection among high-risk groups threatens HCV elimination goals. We assessed HCV reinfection rates among men who have sex with men (MSM) in British Columbia (BC), Canada. METHODS We used data from the BC Hepatitis Testers Cohort, which includes nearly 1.7 million individuals tested for HCV or HIV in BC. MSM who had either achieved sustained virologic response (SVR) after successful HCV treatment, or spontaneous clearance (SC) and had ≥1 subsequent HCV RNA measurement, were followed from the date of SVR or SC until the earliest of reinfection, death, or last HCV RNA measurement. Predictors of reinfection were identified by Cox proportional modelling. The earliest study start date was 6 November 1997 and latest end date was 13 April 2018. RESULTS Of 1349 HCV-positive MSM who met the inclusion criteria, 493 had SC while 856 achieved SVR. 349 (25.65%) had HIV coinfection. We identified 98 reinfections during 5203 person-years (PYs) yielding a reinfection rate of 1.88/100PYs. The reinfection rate among SC (2.74/100PYs) was more than twice that of those with SVR (1.03/100 PYs). Problematic alcohol use (aHR 1.73, 95% CI 1.003-2.92), injection drug use (aHR 2.60, 95% CI 1.57-4.29) and HIV coinfection (aHR 2.04, 95% CI 1.29-3.23) were associated with increased risk of HCV reinfection. Mental health counselling history (aHR 0.24, 95% CI 0.13-0.46) was associated with reduced HCV reinfection risk. CONCLUSIONS There is the need to engage MSM in harm reduction and prevention services following treatment to reduce reinfection risk.
Collapse
Affiliation(s)
- Prince A Adu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmine Rossi
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Analysis Group, Inc., Montreal, Quebec, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sofia Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margo Pearce
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maryam Darvishian
- British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
49
|
Darvishian M, Butt ZA, Wong S, Yoshida EM, Khinda J, Otterstatter M, Yu A, Binka M, Rossi C, McKee G, Pearce M, Alvarez M, Wong J, Cook D, Grennan T, Buxton J, Tyndall M, Woods R, Krajden M, Bhatti P, Janjua NZ. Elevated risk of colorectal, liver, and pancreatic cancers among HCV, HBV and/or HIV (co)infected individuals in a population based cohort in Canada. Ther Adv Med Oncol 2021; 13:1758835921992987. [PMID: 33633801 PMCID: PMC7887683 DOI: 10.1177/1758835921992987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Studies of the impact of hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV mono and co-infections on the risk of cancer, particularly extra-hepatic cancer, have been limited and inconsistent in their findings. Methods: In the British Columbia Hepatitis Testers Cohort, we assessed the risk of colorectal, liver, and pancreatic cancers in association with HCV, HBV and HIV infection status. Using Fine and Gray adjusted proportional subdistribution hazards models, we assessed the impact of infection status on each cancer, accounting for competing mortality risk. Cancer occurrence was ascertained from the BC Cancer Registry. Results: Among 658,697 individuals tested for the occurrence of all three infections, 1407 colorectal, 1294 liver, and 489 pancreatic cancers were identified. Compared to uninfected individuals, the risk of colorectal cancer was significantly elevated among those with HCV (Hazard ration [HR] 2.99; 95% confidence interval [CI] 2.55–3.51), HBV (HR 2.47; 95% CI 1.85–3.28), and HIV mono-infection (HR 2.30; 95% CI 1.47–3.59), and HCV/HIV co-infection. The risk of liver cancer was significantly elevated among HCV and HBV mono-infected and all co-infected individuals. The risk of pancreatic cancer was significantly elevated among individuals with HCV (HR 2.79; 95% CI 2.01–3.70) and HIV mono-infection (HR 2.82; 95% CI 1.39–5.71), and HCV/HBV co-infection. Discussion/Conclusion: Compared to uninfected individuals, the risk of colorectal, pancreatic and liver cancers was elevated among those with HCV, HBV and/or HIV infection. These findings highlight the need for targeted cancer prevention and diligent clinical monitoring for hepatic and extrahepatic cancers in infected populations.
Collapse
Affiliation(s)
- Maryam Darvishian
- BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC V5Z 1L3, Canada
| | - Zahid A Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Stanley Wong
- BC Centre for Disease Control, Vancouver, Canada
| | | | | | | | - Amanda Yu
- BC Centre for Disease Control, Vancouver, Canada
| | | | | | - Geoff McKee
- University of British Columbia, Vancouver, Canada
| | - Margo Pearce
- BC Centre for Disease Control, Vancouver, Canada
| | | | - Jason Wong
- BC Centre for Disease Control, Vancouver, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Vancouver, Canada
| | - Jane Buxton
- BC Centre for Disease Control, Vancouver, Canada
| | - Mark Tyndall
- University of British Columbia, Vancouver, Canada
| | - Ryan Woods
- Cancer Control Research, BC Cancer Research Centre, Vancouver, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, Canada
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Centre, Vancouver, Canada
| | | |
Collapse
|
50
|
Valerio H, Alavi M, Law M, Tillakeratne S, Amin J, Janjua NZ, Krajden M, George J, Matthews GV, Hajarizadeh B, Degenhardt L, Grebely J, Dore GJ. High hepatitis C treatment uptake among people with recent drug dependence in New South Wales, Australia. J Hepatol 2021; 74:293-302. [PMID: 32931879 DOI: 10.1016/j.jhep.2020.08.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS High HCV treatment uptake among people at most risk of transmission is essential to achieve elimination. We aimed to characterise subpopulations of people with HCV based on drug dependence, to estimate direct-acting antiviral (DAA) uptake in an unrestricted treatment era, and to evaluate factors associated with treatment uptake among people with recent drug dependence. METHODS HCV notifications in New South Wales, Australia (1995-2017) were linked to opioid agonist therapy (OAT), hospitalisations, incarcerations, HIV notifications, deaths, and prescription databases. Drug dependence was defined as hospitalisation due to injectable drugs or receipt of OAT, with indicators in 2016-2018 considered recent. Records were weighted to account for spontaneous clearance. Logistic regression was used to analyse factors associated with treatment uptake among those with recent drug dependence. RESULTS 57,467 people were estimated to have chronic HCV throughout the DAA era. Treatment uptake was highest among those with recent (47%), compared to those with distant (38%), and no (33%) drug dependence. Among those with recent drug dependence, treatment was more likely among those with HIV (adjusted odds ratio [aOR] 1.71; 95% CI 1.24-2.36), recent incarceration (aOR 1.10; 95% CI 1.01-1.19), and history of alcohol use disorder (aOR 1.22; 95% CI 1.13-1.31). Treatment was less likely among women (aOR 0.78; 95% CI 0.72-0.84), patients of Indigenous ethnicity (aOR 0.75; 95% CI 0.69-0.81), foreign-born individuals (aOR 0.86; 95% CI 0.78-0.96), those with outer-metropolitan notifications (aOR 0.90; 95% CI 0.82-0.98), HBV coinfection (aOR 0.69; 95% CI 0.59-0.80), and >1 recent hospitalisation (aOR: 0.91; 95% CI 0.84-0.98). CONCLUSIONS These data provide evidence of high DAA uptake among people with recent drug dependence, including those who are incarcerated. Enhancing this encouraging initial uptake among high-risk populations will be essential to achieve HCV elimination. LAY SUMMARY To facilitate HCV elimination, those at highest risk of infection and transmission are a treatment priority. This study shows the successes of Australia's universal provision of DAA therapy in reducing the barriers to treatment which have historically persisted among people who inject drugs. Despite higher DAA therapy uptake among those with recent drug dependence, gaps remain. Strategies which aim to reduce marginalisation and increase treatment uptake to ensure equitable HCV elimination must be advanced.
Collapse
Affiliation(s)
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Department of Health Systems and Populations, Maquarie University, Sydney, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, Australia
| | | | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | | |
Collapse
|