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Park Y, Kim SH, Ha A, Kim YK, Yoon HJ, Kang JH, Kim SE, Kim YJ, Bae YS. Impact of metabolic health and weight transition on COVID-19 risk: A population-based cohort study. Public Health 2025; 245:105777. [PMID: 40449477 DOI: 10.1016/j.puhe.2025.105777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 03/10/2025] [Accepted: 05/01/2025] [Indexed: 06/03/2025]
Abstract
OBJECTIVES Obesity and metabolic health are known factors influencing COVID-19 severity. However, the effect of changes in metabolic health and weight status on COVID-19 outcomes remains unclear. To investigate the association between changes in metabolic health and weight status over time and COVID-19-related risks. STUDY DESIGN Retrospective population-based cohort study. METHODS This retrospective population-based cohort study used data from South Korea's National Health Information Service collected between January 2014 and December 2021. A total of 284,719 participants who underwent health screening both in 2014-2015 and 2016-2017 were divided into the metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO) groups. RESULTS Among initial MHNO participants, those who became MHO (hazard ratio (HR) 1·082, 95 % confidence intervals 1·01-1·16) and MUO (1·18, 1·11-1·26) had elevated risk for COVID-19 compared with those who remained MHNO. Conversely, participants who transitioned from MUO to MUNO (0·89, 0·84-0·95) were associated with a lower risk of COVID-19. Improvements in metabolic health did not mitigate COVID-19-related risks. Transitioning from MHNO to MHO (3·57, 1·38-9·26) was associated with a significantly higher risk of death due to COVID-19. CONCLUSIONS Changes in metabolic health and obesity status significantly influence COVID-19 outcomes. Addressing obesity and promoting metabolic health are critical for mitigating the impact of COVID-19.
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Affiliation(s)
- Yujin Park
- Healthcare Data Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Republic of Korea
| | - Su Hwan Kim
- Department of Information Statistics, Gyeongsang National University, Jinju-si, Gyeongsangnam-do, 52828, Republic of Korea
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Jeju-do, 63241, Republic of Korea; Department of Ophthalmology, Jeju National University College of Medicine, Jeju-si, Jeju-do, 63241, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, 03080, Republic of Korea; EyeLight Data Science Laboratory, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Hyung-Jin Yoon
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Republic of Korea; Institute for Clinical Nutrition, Sungkyunkwan University School of Medicine, Seoul, 16419, Republic of Korea; Institute for Future Healthcare, Sungkyunkwan University School of Medicine, Seoul, 16419, Republic of Korea
| | - So-Eun Kim
- Division of Healthcare Planning, Big Data Research Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Republic of Korea
| | - Yoon Ji Kim
- Division of Healthcare Planning, Big Data Research Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Republic of Korea
| | - Ye Seul Bae
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Republic of Korea; Division of Healthcare Planning, Big Data Research Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Republic of Korea.
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Graff K, Choi YJ, Silveira L, Smith C, Abuogi L, DeCamp LR, Jarjour J, Friedman C, Ware MA, Kaar JL. Lessons learned for preventing health disparities in future pandemics: the role of social vulnerabilities among children diagnosed with severe COVID-19 early in the pandemic. AIMS Public Health 2025; 12:124-136. [PMID: 40248413 PMCID: PMC11999811 DOI: 10.3934/publichealth.2025009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 09/09/2024] [Accepted: 11/12/2024] [Indexed: 04/19/2025] Open
Abstract
Background Hispanic ethnicity is associated with an increased risk for severe disease in children with COVID-19. Identifying underlying contributors to this disparity can lead to improved health care utilization and prevention strategies. Methods This is a retrospective cohort study of children 2-20 years of age with positive SARS-CoV-2 testing from March-October 2020. Univariable and multivariable logistic regression models were fitted to identify demographic, comorbid health conditions, and social vulnerabilities as predictors of severe COVID-19 (need for hospital admission or respiratory support). Results We included 1572 children with COVID-19, of whom 45% identified as Hispanic. Compared to non-Hispanic children, patients who identified as Hispanic were more often obese (28% vs. 14%, p < 0.0001), preferred a non-English language (31% vs. 3%, p < 0.0001), and had Medicaid or no insurance (79% vs. 33%, p < 0.0001). In univariable analyses, children who identified as Hispanic were more likely to require hospital admission (OR 2.4, CI: 1.57-3.80) and respiratory support (OR 2.4, CI: 1.38-4.14). In multivariable analyses, hospital admission was associated with obesity (OR 1.9, CI: 1.15-3.08), non-English language (OR 2.4, CI: 1.35-4.23), and Medicaid insurance (OR 2.0, CI: 1.10-3.71), but ethnicity was not a significant predictor of severe disease. Conclusions and Relevance The high rates of severe COVID-19 observed in Hispanic children early in the pandemic appeared to be secondary to underlying co-morbidities and social vulnerabilities that may have influenced access to care, such as language and insurance status. Pediatric providers and public health officials should tailor resource allocation to better target this underserved patient population.
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Affiliation(s)
- Kelly Graff
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ye Ji Choi
- University of Colorado School of Public Health, Aurora, CO, USA
| | - Lori Silveira
- Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Christiana Smith
- Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Lisa Abuogi
- Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Lisa Ross DeCamp
- Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Jane Jarjour
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Chloe Friedman
- University of Colorado School of Public Health, Aurora, CO, USA
| | - Meredith A. Ware
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jill L Kaar
- Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
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Williams MS, McKinney SJ, Cheskin LJ. Social and Structural Determinants of Health and Social Injustices Contributing to Obesity Disparities. Curr Obes Rep 2024; 13:617-625. [PMID: 38878122 PMCID: PMC11306445 DOI: 10.1007/s13679-024-00578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE OF REVIEW: To analyze how social and structural determinants of health and social injustice impact the risk of obesity, its treatment and treatment outcomes, and to explore the implications for prevention and future treatment interventions. RECENT FINDINGS: Racial and ethnic minorities, such as non-Hispanic Black adults and Hispanic adults, and adults with a low socioeconomic status have a greater risk of obesity than non-Hispanic white adults and adults with a high socioeconomic status. The underlying causes of obesity disparities include obesogenic neighborhood environments, inequities in access to obesity treatment, and lack of access to affordable nutrient-dense foods. Experts have called for interventions that address the social and structural determinants of obesity disparities. Population-based interventions that focus on improving neighborhood conditions, discouraging the consumption of unhealthy foods and beverages, expanding access to obesity treatment, and ensuring equitable access to fruits and vegetables have been proven to be effective. There is a growing body of evidence that shows the relationship between social and structural determinants of health and injustice on disparities in obesity among racial and ethnic minorities and individuals with a low SES. Population-based, equity-focused interventions that address the underlying causes of obesity disparities are needed to reduce obesity disparities and improve the health outcomes of minoritized and marginalized groups.
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Affiliation(s)
- Michelle S Williams
- George Mason University, College of Public Health, Department of Global and Community Health, Fairfax, VA, 22030, United States
| | - Sheila J McKinney
- Jackson State University, School of Public Health, Department of Epidemiology and Biostatistics, Jackson, MS, 39217, United States
| | - Lawrence J Cheskin
- George Mason University, College of Public Health, Department of Nutrition and Food Studies, Fairfax, VA, 22030, United States.
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD, 21205, USA.
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Obita G, Burns M, Nnyanzi LA, Kuo CH, Barengo NC, Alkhatib A. Childhood obesity and comorbidities-related perspective and experience of parents from Black and Asian minority ethnicities in England: a qualitative study. Front Public Health 2024; 12:1399276. [PMID: 39175897 PMCID: PMC11340680 DOI: 10.3389/fpubh.2024.1399276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualized factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority populations. METHODS Following ethical approval, families (n = 180) from ethnic minority populations in the Northeast of England were contacted through flyers, community social groups and online forum. Of the 180 families contacted, 22 expressed interests, of whom 12 parents were eligible to participate in the study, and one family dropped out due to time constraints. Therefore 11 parents from ethnic minority communities living with at least one child with obesity were interviewed. Each family was separately visited at home and took part in a semi-structured interview based on the study's qualitative, descriptive phenomenological design. Nine of the families had one child who was diagnosed with an obesity-related comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems or respiratory disorder). Semi-structured interviews were standardized around parents' perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity impact on their lives. All interviews were analyzed using qualitative thematic analysis. RESULTS Parents' perspectives revealed 11 themes centered around experience of living with a child with obesity, risks, and impact of obesity related Non-Communicable Diseases; and access to support, and barriers unique to minority ethnic groups. Parents revealed social disadvantages, fear of victimization by social services, perceptions on their cultural and religious traditions, and racial stigmatization related to their child's weight. Parents reported closer bonding with their children to protect them from the untoward consequences of overweight, and little awareness of healthcare obesity prevention programs. Work pressure, lack of time, absence of guidance from professionals were seen as barriers to healthy lifestyle, while support from friends and closer family bond in adopting healthy lifestyle behaviors were facilitators. However, there was little awareness or access to current healthcare obesity preventive offerings. CONCLUSION Minority ethnic communities' perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle interventions are needed beyond those administered by the primary healthcare system.
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Affiliation(s)
- George Obita
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Mark Burns
- James Cook University Hospital, South Tees Hospital Trusts, Middlesbrough, United Kingdom
| | | | - Chia-Hua Kuo
- Institute of Sport Science, University of Taipei, Taipei, Taiwan
| | - Noël C. Barengo
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
- Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- Institute of Sport Science, University of Taipei, Taipei, Taiwan
- College of Life Sciences, Birmingham City University, Birmingham, United Kingdom
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Bogojevic M, Bansal V, Pattan V, Singh R, Tekin A, Sharma M, La Nou AT, LeMahieu AM, Hanson AC, Schulte PJ, Deo N, Qamar S, Zec S, Valencia Morales DJ, Perkins N, Kaufman M, Denson JL, Melamed R, Banner‐Goodspeed VM, Christie AB, Tarabichi Y, Heavner S, Kumar VK, Walkey AJ, Gajic O, Bhagra S, Kashyap R, Lal A, Domecq JP, Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID‐19 Registry Investigator Group. Association of hypothyroidism with outcomes in hospitalized adults with COVID-19: Results from the International SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry. Clin Endocrinol (Oxf) 2024; 101:85-93. [PMID: 35180316 PMCID: PMC9111656 DOI: 10.1111/cen.14699] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is associated with high rates of morbidity and mortality. Primary hypothyroidism is a common comorbid condition, but little is known about its association with COVID-19 severity and outcomes. This study aims to identify the frequency of hypothyroidism in hospitalized patients with COVID-19 as well as describe the differences in outcomes between patients with and without pre-existing hypothyroidism using an observational, multinational registry. METHODS In an observational cohort study we enrolled patients 18 years or older, with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection between March 2020 and February 2021. The primary outcomes were (1) the disease severity defined as per the World Health Organization Scale for Clinical Improvement, which is an ordinal outcome corresponding with the highest severity level recorded during a patient's index COVID-19 hospitalization, (2) in-hospital mortality and (3) hospital-free days. Secondary outcomes were the rate of intensive care unit (ICU) admission and ICU mortality. RESULTS Among the 20,366 adult patients included in the study, pre-existing hypothyroidism was identified in 1616 (7.9%). The median age for the Hypothyroidism group was 70 (interquartile range: 59-80) years, and 65% were female and 67% were White. The most common comorbidities were hypertension (68%), diabetes (42%), dyslipidemia (37%) and obesity (28%). After adjusting for age, body mass index, sex, admission date in the quarter year since March 2020, race, smoking history and other comorbid conditions (coronary artery disease, hypertension, diabetes and dyslipidemia), pre-existing hypothyroidism was not associated with higher odds of severe disease using the World Health Organization disease severity index (odds ratio [OR]: 1.02; 95% confidence interval [CI]: 0.92, 1.13; p = .69), in-hospital mortality (OR: 1.03; 95% CI: 0.92, 1.15; p = .58) or differences in hospital-free days (estimated difference 0.01 days; 95% CI: -0.45, 0.47; p = .97). Pre-existing hypothyroidism was not associated with ICU admission or ICU mortality in unadjusted as well as in adjusted analysis. CONCLUSIONS In an international registry, hypothyroidism was identified in around 1 of every 12 adult hospitalized patients with COVID-19. Pre-existing hypothyroidism in hospitalized patients with COVID-19 was not associated with higher disease severity or increased risk of mortality or ICU admissions. However, more research on the possible effects of COVID-19 on the thyroid gland and its function is needed in the future.
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Affiliation(s)
- Marija Bogojevic
- Department of Medicine, Division of Pulmonary and Critical Care MedicineMultidisciplinary Epidemiology and Translational Research in Intensive Care Group (METRIC), Mayo ClinicRochesterMinnesotaUSA
- Division of Endocrinology and Metabolism, Department of MedicineSUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Vikas Bansal
- Department of Medicine, Division of Pulmonary and Critical Care MedicineMultidisciplinary Epidemiology and Translational Research in Intensive Care Group (METRIC), Mayo ClinicRochesterMinnesotaUSA
| | - Vishwanath Pattan
- Division of Endocrinology and Metabolism, Department of MedicineSUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Romil Singh
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Mayank Sharma
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Abigail T. La Nou
- Division of Critical Care Medicine Mayo Clinic Health SystemEau ClaireWisconsinUSA
| | - Allison M. LeMahieu
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Andrew C. Hanson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Phillip J. Schulte
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Neha Deo
- Mayo Clinic Alix School of MedicineRochesterMinnesotaUSA
| | - Shahraz Qamar
- Postbaccalaureate Research Education Program, Mayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Simon Zec
- Department of Medicine, Division of Pulmonary and Critical Care MedicineMultidisciplinary Epidemiology and Translational Research in Intensive Care Group (METRIC), Mayo ClinicRochesterMinnesotaUSA
| | - Diana J. Valencia Morales
- Department of Medicine, Division of Pulmonary and Critical Care MedicineMultidisciplinary Epidemiology and Translational Research in Intensive Care Group (METRIC), Mayo ClinicRochesterMinnesotaUSA
| | - Nicholas Perkins
- Department of Medicine, Prisma HealthGreenvilleSouth CarolinaUSA
| | - Margit Kaufman
- Department of Anesthesiology & Critical CareEnglewood Hospital and Medical CenterEnglewoodNew JerseyUSA
| | - Joshua L. Denson
- Section of Pulmonary Diseases, Critical Care, and Environmental MedicineTulane University School of MedicineNew OrleansLouisianaUSA
| | - Roman Melamed
- Department of Critical CareAbbott Northwestern Hospital, Allina HealthMinneapolisMinnesotaUSA
| | - Valerie M. Banner‐Goodspeed
- Department of Anesthesia, Critical Care & Pain MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Amy B. Christie
- Department of Trauma Critical Care, The Medical Center Navicent HealthMercer University School of MedicineMaconGeorgiaUSA
| | - Yasir Tarabichi
- Division of Pulmonary and Critical Care MedicineMetroHealthClevelelandOhioUSA
| | - Smith Heavner
- Department of Public Health ScienceClemson UniversityClemsonSouth CarolinaUSA
| | | | - Allan J. Walkey
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Pulmonary CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Ognjen Gajic
- Department of Medicine, Division of Pulmonary and Critical Care MedicineMultidisciplinary Epidemiology and Translational Research in Intensive Care Group (METRIC), Mayo ClinicRochesterMinnesotaUSA
| | - Sumit Bhagra
- Division of EndocrinologyMayo Clinic Health SystemAustinMinnesotaUSA
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care MedicineMultidisciplinary Epidemiology and Translational Research in Intensive Care Group (METRIC), Mayo ClinicRochesterMinnesotaUSA
| | - Juan Pablo Domecq
- Division of Nephrology and Hypertension, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
- Division of Critical Care, Department of Internal MedicineMayo Clinic Health SystemMankatoMinnesotaUSA
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Alomran AA, Althubaiti KA, Alabdullah HA, Al Bisher HB, Awadh A, Al Shankiti HA, Almazyad L, Aljandul LA, Aljohani AT, Dhafar OW, Alzahrani ZA, Kharaba AM. Body Mass Index as a Predictor of COVID-19 Severity in ICU Patients in Saudi Arabia: A Retrospective Analysis. Cureus 2024; 16:e52470. [PMID: 38371162 PMCID: PMC10873537 DOI: 10.7759/cureus.52470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction The global coronavirus disease 2019 (COVID-19) pandemic has prompted research into various risk factors, including the role of body mass index (BMI) in disease severity. This study specifically examines the correlation between BMI and the severity of COVID-19 among intensive care unit (ICU) patients in Saudi Arabia, addressing a gap in region-specific data. The study aims to assess the impact of BMI on the severity of COVID-19 in a Saudi Arabian ICU patient cohort, providing insights into how this relationship varies in different demographic contexts. Materials and methods Employing a retrospective cohort design, the study analyzed data from adult ICU patients in Saudi Arabia diagnosed with COVID-19. It focused on variables like BMI at admission, demographic information, and COVID-19 outcomes including severity, recovery, and mortality. Statistical analysis involved regression models, adjusting for age, gender, and comorbidities. Results Unlike global observations, the study found no significant correlation between BMI and COVID-19 severity in the Saudi Arabian context. This suggests that in this specific demographic, other factors may be more critical in determining the severity of the disease. Conclusion Our findings challenge the global consensus on BMI as a key factor in COVID-19 severity, highlighting the importance of regional differences in disease dynamics. They underscore the need for localized healthcare strategies and further research into diverse demographic factors affecting COVID-19. This study contributes to a broader understanding of the pandemic and encourages region-specific approaches in both clinical and public health spheres.
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Affiliation(s)
| | | | | | - Heba B Al Bisher
- College of Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | - Atheer Awadh
- College of Medicine, Taif University, Taif , SAU
| | | | - Laura Almazyad
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Leen A Aljandul
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abrar T Aljohani
- Family Medicine, Faculty of Medicine, Ibn Sina National College for Medical Sciences, Jeddah, SAU
| | - Obay W Dhafar
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Ayman M Kharaba
- Internal Medicine Intensive Critical Care Unit, King Fahad Hospital, Madinah, SAU
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Öz M, Erol S, Gürün Kaya A, Işık Ö, Çiftci F, Çınar G, Uzun Ç, Azap A, Çiledağ A, Kaya A, Özdemir Kumbasar Ö. Recovery from Respiratory Failure in Patients with Coronavirus Disease 2019. THORACIC RESEARCH AND PRACTICE 2023; 25:26 - 34. [PMID: 38015163 PMCID: PMC11160421 DOI: 10.5152/thoracrespract.2023.23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/25/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) can cause hypoxic respiratory failure; long-term oxygen therapy (LTOT) duration is unknown. MATERIAL AND METHODS The aim was to investigate which patients would need LTOT after COVID-19 pneumonia. This single-center, prospective study was conducted at the Ankara University Faculty of Medicine, Department of Chest Diseases, between May 2021 and December 2021. The 70 patients hospitalized for COVID-19 pneumonia and discharged with LTOT due to hypoxemic respiratory failure were included. Patients were divided into 2 groups as group I (LTOT requirement <3 months) and group II (LTOT requirement continued ≥3 months). RESULTS The mean age was 64.4 ± 13.5 years, and 44 (62.9%) of them were male. The most frequently encountered comorbidities were cardiovascular disease (57.1%) and lung disease (22.9%). While PaO2 levels increased in both groups during the follow-up period, this increment was significantly higher in group I (PaO2: 66.6 ± 9.9 mm Hg, P < .001). The factors affecting the LTOT requirement were evaluated using binary logistic regression. On multivariate analyses of lymphocytes, ferritin, C-reactive protein, PaO2, SaO2, subpleural reticulation, and number of lobes affected (≥3 lobes), the SaO2 level and presence of subpleural reticulation were significantly different between the 2 groups [odds ratio (OR) (95% CI): 0.853 (0.749-0.971), P = .016] and [OR (95% CI): 0.171 (0.042-0.733), P = .017], respectively. CONCLUSION A significant proportion of patients who develop respiratory failure due to COVID-19 recover within the first 3 months. Factors determining the LTOT requirement for more than 3 months were SaO2 and the presence of subpleural reticulation.
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Affiliation(s)
- Miraç Öz
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serhat Erol
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aslıhan Gürün Kaya
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özlem Işık
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Çiftci
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Güle Çınar
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Çağlar Uzun
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydın Çiledağ
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Akın Kaya
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
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Maynard MJ, Orighoye O, Apekey T, Simpson E, van Dijk M, Atherton E, Blackshaw J, Ells L. Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers. Front Public Health 2023; 11:1239668. [PMID: 38074747 PMCID: PMC10701265 DOI: 10.3389/fpubh.2023.1239668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. Methods A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. Results The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Conclusion Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.
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Affiliation(s)
- Maria J. Maynard
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | - Oritseweyinmi Orighoye
- Bradford Institute for Health Research, University of Bradford, Bradford, United Kingdom
| | - Tanefa Apekey
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Ellouise Simpson
- School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Margie van Dijk
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Elizabeth Atherton
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Jamie Blackshaw
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Louisa Ells
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
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9
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Piernas C, Merino J. Interwoven challenges of covid-19, poor diet, and cardiometabolic health. BMJ 2023; 383:e076810. [PMID: 37813430 PMCID: PMC10561014 DOI: 10.1136/bmj-2023-076810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
- Carmen Piernas
- Department of Biochemistry and Molecular Biology II, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jordi Merino
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
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10
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AlBahrani S, Al-Maqati TN, Al Naam YA, Alqahtani JS, Alqahtani AS, AlRabeeah S, Aldhahir AM, Alkhalaf F, Alzuraiq HR, Alenezi MH, Alzahrani A, Bakkar M, Albahrani Z, Maawadh RM. The Association of Body Mass Index with COVID-19 Complications and Survival Rate at a Tertiary Hospital. Life (Basel) 2023; 13:1572. [PMID: 37511947 PMCID: PMC10381797 DOI: 10.3390/life13071572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
A high body mass index (BMI) is a known risk factor for coronavirus infection in hospitalized patients. Our study examined the association between BMI and complications and the survival rate among COVID-19 patients. This retrospective analysis used data from a tertiary hospital in the Eastern Region of Saudi Arabia during two waves of the COVID-19 pandemic. The study included 600 participants, with the majority being between 41 and 60 years old (41.3%) and men comprising 63.5% of the sample. Approximately 42.5% of patients were obese, and 31.3% were overweight. The results showed that BMI was significantly linked to respiratory diseases (p = 0.013); end-stage renal disease (p = 0.021); and cardiovascular disease (p = 0.003) but not diabetes mellitus (p = 0.064). Death occurred in 10.8% of patients; 33.8% were admitted to the ICU; 13.8% needed mechanical ventilation; and 60.7% had lung infiltration. Obese patients with oxygen saturation levels below 93% were 2.45 times more likely to require mechanical ventilation than those in the normal-weight group. Overweight and obese patients were also more likely to require mechanical ventilation than normal-weight patients, with odds ratios of 3.66 and 2.81, respectively. The BMI categorized was not associated with survival rate in COVID-19-hospitalized patients using Kaplan-Meier survival plots (p = 0.061). However, the BMI categorized was associated with survival rate in COVID-19 ICU patients (p < 0.001). In addition, the overweight showed a statistically significant higher hazard ratio of 2.22 (p = 0.01) compared to normal-weight patients using a Cox regression model. A high BMI was identified as an independent risk factor for reduced oxygen saturation (<93%), the need for mechanical ventilation, lung infiltration, mortality, and longer ICU stays in COVID-19 patients.
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Affiliation(s)
- Salma AlBahrani
- Internal Medicine Department, King Fahad Military Medical Complex, Dammam 34313, Saudi Arabia
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34313, Saudi Arabia
| | - Thekra N. Al-Maqati
- Department of Clinical Laboratory Sciences, Prince Sultan Military College of Health Sciences, Dammam 31448, Saudi Arabia; (Y.A.A.N.)
| | - Yaser A. Al Naam
- Department of Clinical Laboratory Sciences, Prince Sultan Military College of Health Sciences, Dammam 31448, Saudi Arabia; (Y.A.A.N.)
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 31448, Saudi Arabia
| | - Abdullah S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 31448, Saudi Arabia
| | - Saad AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 31448, Saudi Arabia
| | - Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Faisal Alkhalaf
- Department of Clinical Laboratory Sciences, Prince Sultan Military College of Health Sciences, Dammam 31448, Saudi Arabia; (Y.A.A.N.)
| | - Hind R. Alzuraiq
- Pharmacy Department, King Fahad Military Medical Complex, Dammam 34313, Saudi Arabia
| | - Maryam Hamad Alenezi
- Medical Administration Department, King Fahad Military Medical Complex, Dammam 34313, Saudi Arabia
| | - Amal Alzahrani
- Training Department, King Fahad Military Medical Complex, Dammam 34313, Saudi Arabia
| | - Mohanad Bakkar
- Internal Medicine Department, King Fahad Military Medical Complex, Dammam 34313, Saudi Arabia
| | - Zainab Albahrani
- Internal Medicine Department, National Guard Hospital, Alhassa 31982, Saudi Arabia
| | - Rawan M. Maawadh
- Department of Clinical Laboratory Sciences, Prince Sultan Military College of Health Sciences, Dammam 31448, Saudi Arabia; (Y.A.A.N.)
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11
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Kimani RW. Racism, colonialism and the implications for nursing scholarship: A discussion paper. J Adv Nurs 2023; 79:1745-1753. [PMID: 36882970 PMCID: PMC10389119 DOI: 10.1111/jan.15634] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/23/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
AIM A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry. DESIGN Discussion paper. DATA SOURCES A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022. IMPLICATIONS FOR NURSING The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID-19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing. CONCLUSION Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship. NO PATIENT OR PUBLIC CONTRIBUTION The paper is a discursive paper using pertinent nursing literature. IMPACT For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.
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Affiliation(s)
- Rachel Wangari Kimani
- Laboratory of the Neurogenetics of Language, Rockefeller University, New York, New York, USA
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12
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Islam NS, Wyatt LC, Ali SH, Zanowiak JM, Mohaimin S, Goldfeld K, Lopez P, Kumar R, Beane S, Thorpe LE, Trinh-Shevrin C. Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial. Circ Cardiovasc Qual Outcomes 2023; 16:e009321. [PMID: 36815464 PMCID: PMC10033337 DOI: 10.1161/circoutcomes.122.009321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/16/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Blood pressure (BP) control is suboptimal in minority communities, including Asian populations. We evaluate the feasibility, adoption, and effectiveness of an integrated CHW-led health coaching and practice-level intervention to improve hypertension control among South Asian patients in New York City, Project IMPACT (Integrating Million Hearts for Provider and Community Transformation). The primary outcome was BP control, and secondary outcomes were systolic BP and diastolic BP at 6-month follow-up. METHODS A randomized-controlled trial took place within community-based primary care practices that primarily serve South Asian patients in New York City between 2017 and 2019. A total of 303 South Asian patients aged 18-85 with diagnosed hypertension and uncontrolled BP (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) within the previous 6 months at 14 clinic sites consented to participate. After completing 1 education session, individuals were randomized into treatment (n=159) or control (n=144) groups. Treatment participants received 4 additional group education sessions and individualized health coaching over a 6-month period. A mixed effect generalized linear model with a logit link function was used to assess intervention effectiveness for controlled hypertension (Yes/No), adjusting for practice level random effect, age, sex, baseline systolic BP, and days between BP measurements. RESULTS Among the total enrolled population, mean age was 56.8±11.2 years, and 54.1% were women. At 6 months among individuals with follow-up BP data (treatment, n=154; control, n=137), 68.2% of the treatment group and 41.6% of the control group had controlled BP (P<0.001). In final adjusted analysis, treatment group participants had 3.7 [95% CI, 2.1-6.5] times the odds of achieving BP control at follow-up compared with the control group. CONCLUSIONS A CHW-led health coaching intervention was effective in achieving BP control among South Asian Americans in New York City primary care practices. Findings can guide translation and dissemination of this model across other communities experiencing hypertension disparities. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03159533.
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Affiliation(s)
- Nadia S Islam
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Laura C Wyatt
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Shahmir H Ali
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, (S.H.A.)
| | - Jennifer M Zanowiak
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Sadia Mohaimin
- School of Osteopathic Medicine, University of the Incarnate Word (S.M.)
| | - Keith Goldfeld
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Priscilla Lopez
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | | | | | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
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13
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Fleming DJM, Dorsch TE, Serang S, Hardiman AL, Blazo JA, Farrey T, Lerner JB, Solomon J. The association of families' socioeconomic and demographic characteristics with parents' perceived barriers to returning to youth sport following the COVID-19 pandemic. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 65:102348. [PMID: 36465329 PMCID: PMC9710102 DOI: 10.1016/j.psychsport.2022.102348] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Developmentally appropriate sport contexts have the potential to positively influence young people's physiological, psychological, and social outcomes. However, little is known about how families returned to sport in the wake of COVID-19-related restrictions or how socioeconomic and demographic factors influenced parents' perceptions of barriers to returning. A nationally representative sample (N = 6183) of American youth sport parents completed a questionnaire in which they provided demographic information and answered questions related to the barriers they perceived in returning to sport, such as the risk of their child getting sick. Structural equation modeling was used to examine the relationships among a range of socioeconomic and demographic factors and these barriers to returning. Results suggest that parents from racially minoritized and urban neighborhoods held higher levels of concern over health-related and practical barriers to returning to sport. Findings highlight the importance of designing available, equitable, and appropriate youth sport contexts.
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Affiliation(s)
| | | | | | | | | | - Tom Farrey
- Aspen Institute Project Play Initiative, United States
| | | | - Jon Solomon
- Aspen Institute Project Play Initiative, United States
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14
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Harris CM, Wright SM. Inpatient outcomes comparing White and Black patients with obesity hospitalized for COVID-19 infection. J Natl Med Assoc 2023; 115:157-163. [PMID: 36682964 PMCID: PMC9859723 DOI: 10.1016/j.jnma.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Comparisons between Black and White patients with obesity hospitalized with COVID-19 have not been fully studied. We sought to determine outcomes differences between these two groups. METHODS National Inpatient Sample database year 2020 was studied using multivariable regression to compare Black and White patients with obesity and COVID-19 infection. Outcomes were in-hospital mortality, length of stay, and hospital charges. RESULTS 205,365 Black and White patients with obesity were hospitalized for COVID-19. 141,010 (68.6%) were White and 64,355 (31.3%) were Black. Black patients were younger (mean age [± standard error] 55.5 ± 0.14 vs. 62.1± 0.11; p < 0.01), more likely female (63.2% vs 50.9%; p < 0.01), and had lower mean comorbidity (Elixhauser score means [± standard error] 4.4 ± 0.02 vs. 4.6 ± 0.01; p < 0.01) than White patients. Black patients had lower odds of in-hospital mortality (adjusted Odds Ratio {aOR}=0.86 CI [0.77-0.97]; p = 0.01), longer hospital stays (adjusted Mean Difference {aMD}=0.32 days CI [0.14-0.51]; p < 0.01) and incurred higher, though non-significant hospital charges (aMD = $2,144 CI [-2270-+6560]; p = 0.34) than White patients. CONCLUSION During the first year of the pandemic, Black patients with obesity and COVID-19 were less likely to die during the incident hospitalization but used greater hospital resources compared to White patients.
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Affiliation(s)
- Ché Matthew Harris
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, United States.
| | - Scott Mitchell Wright
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, United States
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15
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Mavragani A, Cleare AE, Smith CM, Rosas LG, King AC. Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study. JMIR Form Res 2022; 6:e42191. [PMID: 36512404 PMCID: PMC9795401 DOI: 10.2196/42191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. OBJECTIVE In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. METHODS We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants' homes and reported descriptively. RESULTS The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was -3.4 (95% CI -4.6 to -2.2) kg for detailed and -3.3 (95% CI -4.4 to -2.2) kg for simplified. CONCLUSIONS A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. TRIAL REGISTRATION ASPREDICTED #66674; https://aspredicted.org/ka478.pdf.
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Affiliation(s)
| | | | | | - Lisa Goldman Rosas
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Abby C King
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.,Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, United States
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16
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Chun Y, Roll S, Miller S, Lee H, Larimore S, Grinstein-Weiss M. Racial and Ethnic Disparities in Housing Instability During the COVID-19 Pandemic: the Role of Assets and Income Shocks. JOURNAL OF ECONOMICS, RACE, AND POLICY 2022; 6:63-81. [PMCID: PMC9716543 DOI: 10.1007/s41996-022-00109-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/03/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022]
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17
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Borgatti AC, Crockett KB, Jacob AE, Davis AL, Dutton GR. Correlates of psychological distress among adults with obesity during the COVID-19 pandemic. Psychol Health 2022; 37:1547-1564. [PMID: 35156476 PMCID: PMC9946156 DOI: 10.1080/08870446.2022.2038790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 11/03/2021] [Accepted: 01/04/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The present study evaluated changes in stress and loneliness among participants with obesity engaged in weight loss self-management in the United States (US) during COVID-19, and identified factors that may increase risk or protect against psychosocial distress during this time. DESIGN Participants who were enrolled in a weight self-management program prior to the COVID-19 pandemic (N = 55, 91% female, 36% Caucasian, mean age = 49.8 years) completed an online survey about social, economic and health behaviour changes during COVID-19 and their relationship to changes in perceived stress and loneliness. MAIN OUTCOME MEASURES Perceived Stress (PSS-4), Loneliness (PROMIS loneliness and social isolation questionnaire). RESULTS Compared to pre-COVID assessments, stress and loneliness increased 40% two months into the COVID-19 pandemic-related shutdown. Higher body mass index (BMI) and social distancing were associated with increases in both loneliness and stress. Alcohol intake was associated with increased stress, and working from home was associated with increased loneliness. CONCLUSION Individuals with obesity endorsed increased stress and loneliness during COVID-19, which may be exacerbated among those with a higher BMI and greater adherence to social distancing guidelines. Ongoing attention to psychosocial well-being among individuals with obesity will remain imperative both during the ongoing pandemic and beyond.
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Affiliation(s)
- Alena C Borgatti
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Department of Psychology, UAB, Birmingham, AL, USA
| | - Kaylee B Crockett
- Department of Health Care Organization and Policy, School of Public Health, UAB, Birmingham, AL, USA
| | | | - Andrea L Davis
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Department of Psychology, UAB, Birmingham, AL, USA
| | - Gareth R Dutton
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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18
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Wang Y, Reyes L, Greenfield EA, Allred SR. Municipal Ethnic Composition and Disparities in COVID-19 Infections in New Jersey: A Blinder-Oaxaca Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13963. [PMID: 36360847 PMCID: PMC9656431 DOI: 10.3390/ijerph192113963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 has disproportionally impacted Latinx and Black communities in the US. Our study aimed to extend the understanding of ethnic disparities in COVID-19 case rates by using a unique dataset of municipal case rates across New Jersey (NJ) during the first 17 months of the pandemic. We examined the extent to which there were municipal-level ethnic disparities in COVID-19 infection rates during three distinct spikes in case rates over this period. Furthermore, we used the Blinder-Oaxaca decomposition analysis to identify municipal-level exposure and vulnerability factors that contributed to ethnic disparities and how the contributions of these factors changed across the three initial waves of infection. Two clear results emerged. First, in NJ, the COVID-19 infection risk disproportionally affected Latinx communities across all three waves during the first 17 months of the pandemic. Second, the exposure and vulnerability factors that most strongly contributed to higher rates of infection in Latinx and Black communities changed over time as the virus, alongside medical and societal responses to it, also changed. These findings suggest that understanding and addressing ethnicity-based COVID-19 disparities will require sustained attention to the systemic and structural factors that disproportionately place historically marginalized ethnic communities at greater risk of contracting COVID-19.
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Affiliation(s)
- Yuqi Wang
- Department of Social Work, China Youth University of Political Studies, Beijing 100089, China
| | - Laurent Reyes
- School of Social Welfare, University of California, Berkeley, CA 94720, USA
| | | | - Sarah R. Allred
- Department of Psychology, Rutgers University, Camden, NJ 08102, USA
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19
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Baranov V, Grosjean P, Khan FJ, Walker S. The impact of COVID-related economic shocks on household mental health in Pakistan. HEALTH ECONOMICS 2022; 31:2208-2228. [PMID: 35822574 PMCID: PMC9350311 DOI: 10.1002/hec.4571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
We combine data collected just prior to the unfolding of COVID-19 with follow-up data from July 2020 to document the adverse economic effects of the pandemic and resulting impact on parental and child mental well-being in peri-urban Pakistan. 22% of the households in our sample are affected by job loss, with monthly income down 38% on average. Our difference-in-difference results show that job loss is associated with a 0.88 standard deviation (SD) increase in adult mental distress scores (K10), a 0.43 SD reduction in a Hope index of children's aspirations, agency and future pathways, and a 0.39 SD increase in children's depression symptoms. In addition, we observe higher levels of parental stress and anger reported by children, as well as an increase in reported prevalence of domestic violence. Overall, we document that the pandemic has disproportionately and negatively affected the economic and mental well-being of the most vulnerable households in our sample.
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Affiliation(s)
- Victoria Baranov
- Department of EconomicsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Pauline Grosjean
- University of New South WalesSchool of EconomicsSydneyNew South WalesAustralia
| | - Fatima Jamal Khan
- University of New South WalesSchool of EconomicsSydneyNew South WalesAustralia
| | - Sarah Walker
- University of New South WalesSchool of EconomicsSydneyNew South WalesAustralia
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20
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Apolonio JS, da Silva Júnior RT, Cuzzuol BR, Araújo GRL, Marques HS, Barcelos IDS, Santos LKDS, Malheiro LH, Lima de Souza Gonçalves V, Freire de Melo F. Syndemic aspects between COVID-19 pandemic and social inequalities. World J Methodol 2022; 12:350-364. [PMID: 36186746 PMCID: PMC9516541 DOI: 10.5662/wjm.v12.i5.350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/22/2022] [Accepted: 07/25/2022] [Indexed: 02/08/2023] Open
Abstract
Although the coronavirus disease 2019 (COVID-19) pandemic has reached all over the world population, it has demonstrated a heterogeneous impact on different populations. The most vulnerable communities which coexist daily with the social inequalities like low access to hygiene and personal protection products, crowded residences, and higher levels of chronic diseases have a higher risk of contact and the spread of infection, beyond unfavorable clinical outcomes. The elevation of the risk of infection exposure can be related to gender due to the presence of a larger contingent of women in essential services, as well as frontline and cleaning professionals who regardless of gender have the greatest exposure to the virus. Such exposures can contribute to the development of fear of contaminating themselves or their family members associated also with the work stress, both of which are related to the emergence of mental disturbances in these populations. Furthermore, conditions of unsanitary living and low socioeconomic status, populations at war, pre-existing social barriers, and ethnicity have contributed to more impact of the pandemic both in the exposure to the virus and access to health services, COVID-19 management, and management of other pathologies. At the same time, factors such as the closing of non-essential services, the loss of jobs, and the increase in household spending aggravated the social vulnerabilities and impacted the family economy. Lastly, the COVID-19 pandemic contributed still more to the impact on women's health since it propitiated a favorable environment for increasing domestic violence rates, through the segregation of women from social life, and increasing the time of the victims with their aggressors.
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Affiliation(s)
- Jonathan Santos Apolonio
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Beatriz Rocha Cuzzuol
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Glauber Rocha Lima Araújo
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Universidade Estadual do Sudoeste da Bahia, Campus Vitória da Conquista, Vitória da Conquista 45083-900, Bahia, Brazil
| | - Isadora de Souza Barcelos
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Luana Kauany de Sá Santos
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Luciano Hasimoto Malheiro
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Fabrício Freire de Melo
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista 45029-094, Bahia, Brazil
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21
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Acholonu NO, Stanford FC. Sugary Beverage Advertising to Black and Hispanic Youth in the United States: A Call for Action. Pediatr Ann 2022; 51:e370-e372. [PMID: 36098611 PMCID: PMC9908358 DOI: 10.3928/19382359-20220706-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The obesity epidemic remains a major public health issue worldwide, and it is pronounced in the United States. As rates of obesity continue to increase, children now experience obesity at younger ages, which predisposes them to early-onset obesity-related diseases. Of note, Black and Hispanic children experience obesity at higher rates compared with their White counterparts. Although there are many factors that contribute to higher rates of obesity, the increased consumption of sugar-sweetened beverages is one such contributor. Despite the dire state of obesity in these populations, sugar-sweetened beverage companies continue to increase their advertisements to Black and Hispanic children, which can negatively influence the childhood obesity epidemic. This article discusses the effect that sugar-sweetened beverages and their advertisements have on children in underrepresented communities. [Pediatr Ann. 2022;51(9):e370-e372.].
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22
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Crandell I, Rockwell M, Whitehead P, Carter KF, Hanlon A. Examination of the Moderating Effect of Race on the Relationship between Vitamin D Status and COVID-19 Test Positivity Using Propensity Score Methods. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2022; 41:646-657. [PMID: 34473011 PMCID: PMC9338428 DOI: 10.1080/07315724.2021.1948932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION With a well-established role in inflammation and immune function, vitamin D status has emerged as a potential factor for coronavirus disease-2019 (COVID-19). OBJECTIVE The purpose of this study was to evaluate the moderating effect of race on the relationship between vitamin D status and the risk of COVID-19 test positivity, and to compare propensity score (PS) model results to those obtained from classical bivariate and multivariable models, which have primarily comprised the literature to date. METHODS Electronic health record (EHR) data from TriNetX (unmatched n = 21,629; matched n = 16,602) were used to investigate the effect of vitamin D status, as measured by 25-hydroxyvitamin D [25(OH)D], on the odds of experiencing a positive COVID-19 test using multivariable logistic regression models with and without PS methodology. RESULTS Having normal (≥ 30 ng/mL) versus inadequate 25(OH)D (< 30 ng/mL) was not associated with COVID-19 positivity overall (OR = 0.913, p = 0.18), in White individuals (OR = 0.920, p = 0.31), or in Black individuals (OR = 1.006, p = 0.96). When 25(OH)D was analyzed on a continuum, a 10 ng/mL increase in 25(OH)D lowered the odds of having a positive COVID-19 test overall (OR = 0.949, p = 0.003) and among White (OR = 0.935, p = 0.003), but not Black individuals (OR = 0.994, p = 0.75). CONCLUSIONS Models which use weighting and matching methods resulted in smaller estimated effect sizes than models which do not use weighting or matching. These findings suggest a minimal protective effect of vitamin D status on COVID-19 test positivity in White individuals and no protective effect in Black individuals.
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Affiliation(s)
- Ian Crandell
- Center for Biostatistics and Health Data Sciences, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA
| | - Michelle Rockwell
- Family and Community Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Fralin Life Sciences Institute, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Phyllis Whitehead
- Department of Ethics and Palliative Medicine, Carilion Clinic, Roanoke, Virginia, USA
- Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Kimberly Ferren Carter
- Department of Nursing Research and Evidence-based practice, Carilion Clinic, Roanoke, Virginia, USA
| | - Alexandra Hanlon
- Center for Biostatistics and Health Data Sciences, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA
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23
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Iqbal H, West J, McEachan RRC, Haith‐Cooper M. Developing an obesity research agenda with British Pakistani women living in deprived areas with involvement from multisectoral stakeholders: Research priority setting with a seldom heard group. Health Expect 2022; 25:1619-1632. [PMID: 35484840 PMCID: PMC9327852 DOI: 10.1111/hex.13504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION British Pakistani women have exceptionally high rates of obesity and yet are seldom heard in a research priority setting concerning weight management. The objectives of this study were (i) to ascertain what multisectoral professionals perceive to be the most pressing unmet obesity needs or topic areas that need more research in relation to Pakistani women living in deprived areas of Bradford and (ii) to determine the top 10 obesity health priorities for this group to develop an obesity research agenda. METHODS A two-step process was adopted using the following: (i) a survey of a wide range of multisectoral professional stakeholders (n = 159) and (ii) a ranking exercise involving Pakistani women living in deprived areas of Bradford (n = 32) to select and prioritize their top 10 obesity health concerns and unmet needs from a list of 31 statements identified in the survey and previous research. Survey data were analysed using inductive content analysis and themes were identified. Themes were translated into statements to be ranked by Pakistani women. The ranking exercise was conducted by telephone either via voice or video call. Data were analysed using a reverse scoring system. RESULTS Survey responses were grouped into statements reflecting the following three categories: education needs; healthy behaviour barriers and mental well-being. The highest rankings were given by Pakistani women to statements on mental health and the need for education. The top 10 prioritized statements were developed with members of the public into an obesity research agenda that reflected the target population. CONCLUSION Actively engaging British Pakistani women in setting research priorities provided a unique opportunity to understand the key areas they think are important for future research. The culminating research agenda can be used by researchers to advance the field of obesity research in Pakistani communities, thus producing research outputs that are relevant to and have impact in this population. PATIENT OR PUBLIC CONTRIBUTION Participants in the ranking exercise collected data. Public contributors were involved in developing the prioritized statements into a research agenda.
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Affiliation(s)
- Halima Iqbal
- Born in BradfordBradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation TrustBradfordUK,Faculty of Health StudiesUniversity of BradfordBradfordUK
| | - Jane West
- Faculty of Health StudiesUniversity of BradfordBradfordUK
| | | | - Melanie Haith‐Cooper
- Born in BradfordBradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation TrustBradfordUK
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24
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Yu P, Tan Z, Li Z, Xu Y, Zhang J, Xia P, Tang X, Ma J, Xu M, Liu X, Shen Y. Obesity and clinical outcomes in COVID-19 patients without comorbidities, a post-hoc analysis from ORCHID trial. Front Endocrinol (Lausanne) 2022; 13:936976. [PMID: 35966085 PMCID: PMC9372447 DOI: 10.3389/fendo.2022.936976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Large body of studies described individuals with obesity experiencing a worse prognosis in COVID-19. However, the effects of obesity on the prognosis of COVID-19 in patients without comorbidities have not been studied. Therefore, the current study aimed to provide evidence of the relationship between obesity and clinical outcomes in COVID-19 patients without comorbidities. Methods A total of 116 hospitalized COVID-19 patients without comorbidities from the ORCHID study (Patients with COVID-19 from the Outcomes Related to COVID-19 Treated with Hydroxychloroquine among Inpatients with Symptomatic Disease) were included. Obesity is defined as a BMI of ≥30 kg/m2. A Cox regression analysis was used to estimate the hazard ratio (HR) for discharge and death after 28 days. Results The percentage of obesity in COVID-19 patients without comorbidities was 54.3% (63/116). Discharge at 28 days occurred in 56/63 (84.2%) obese and 51/53 (92.2%) non-obese COVID-19 patients without comorbidities. Four (3.4%) COVID-19 patients without any comorbidities died within 28 days, among whom 2/63 (3.2%) were obese and 2/53 (3.8%) were non-obese. Multivariate Cox regression analyses showed that obesity was independently associated with a decreased rate of 28-day discharge (adjusted HR: 0.55, 95% CI: 0.35-0.83) but was not significantly associated with 28-day death (adjusted HR: 0.94, 95% CI: 0.18-7.06) in COVID-19 patients without any comorbidities. Conclusions Obesity was independently linked to prolonged hospital length of stay in COVID-19 without any comorbidity. Larger prospective trials are required to assess the role of obesity in COVID-19 related deaths.
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Affiliation(s)
- Peng Yu
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China
| | - Ziqi Tan
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhangwang Li
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Yi Xu
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Zhang
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Panpan Xia
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China
| | - Xiaoyi Tang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Minxuan Xu
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China
| | - Xiao Liu
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China
| | - Yunfeng Shen
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China
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25
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Luo J, Rosales M, Wei G, Stoddard GJ, Kwok AC, Jeyapalina S, Agarwal JP. Hospitalization, mechanical ventilation, and case-fatality outcomes in US veterans with COVID-19 disease between years 2020-2021. Ann Epidemiol 2022; 70:37-44. [PMID: 35462045 PMCID: PMC9021125 DOI: 10.1016/j.annepidem.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Although veterans represent a significant proportion (7%) of the USA population, the COVID-19 disease impact within this group has been underreported. To bridge this gap, this study was undertaken. METHOD A total of 419,559 veterans, who tested positive for COVID-19 disease in the Veterans Affairs hospital system from March 1st, 2020 to December 31st, 2021 with 60-days follow-up, was included in this retrospective review. Primary outcome measures included age-adjusted incidences and relative incidences of COVID-19 hospitalization, mechanical ventilation, and case-fatality outcomes. RESULTS Of this veteran cohort with COVID-19 disease, predominately 85.7% were male, 59.1% were White veterans, 27.5% were ages 50-64, and 40.5% were obese. Although Black veterans were at 63% higher relative risk (RR) for hospitalization incidences, they had a similar risk RR for in-hospital deaths compared to the White-veteran referent. Asian, American Indian/Alaska Native races, advanced age ≥65, and the underweight were at high RR for mechanical ventilator and/or in-hospital deaths compared to respective referent groups. Veterans who are ≥85 years old had a nearly 5-fold higher incidence of death compared respective referent group. The monthly outcomes for hospitalization, ventilation, and case-fatality data showed decreasing trends with time. CONCLUSION An increased incidence of death was associated with age ≥65 years and underweight veterans compared to the referent group. Age-adjusted data, however, did not show any increased incidence of death in Black veterans compared to White veterans. RATINGS OF THE QUALITY OF THE EVIDENCE 3 (Case-control studies; retrospective cohort study).
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Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Guo Wei
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Gregory J Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Sujee Jeyapalina
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT.
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT.
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26
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Food Environment Inequalities and Moderating Effects of Obesity on Their Relationships with COVID-19 in Chicago. SUSTAINABILITY 2022. [DOI: 10.3390/su14116498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The COVID-19 outbreak has raised challenges for people with health problems. Obesity is a global issue related to COVID-19. The Centers for Disease Control (CDC) finds that obesity worsens COVID-19 outcomes. As body mass index increases, the COVID-19 death risk increases. Additionally, due to different restriction policies, the pandemic has transformed our food environment. Thus, it is important to develop an antivirus-enabled paradigm to decrease the COVID-19 spreading rate in neighborhoods with obesity concerns and design a sustainable and healthy food environment. It is found that both COVID-19 and obesity inequalities are associated with food environment inequalities, but few studies have examined the moderating effects of obesity and food environment on COVID-19. According to the Chicago Department of Public Health, more than 30% of the Chicago adult population is obese. Additionally, Chicago has 340,676 COVID-19 cases during the period between 1 March 2020 and 26 November 2021. This study uses regression models to examine the moderating effects of obesity and food environment on COVID-19 in Chicago. Besides food environment factors, green spaces and transportation access are considered. The results show COVID-19 is concentrated in areas with a high obesity rate and low food access. A 1 percent increase in obesity rate is associated with a 2.83 percent increase in COVID-19 death rate in a community. Additionally, the moderating effects of obesity on the association between food environment and COVID-19 are shown in the results.
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27
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Iqbal H, West J, McEachan RRC, Haith-Cooper M. Exploring the obesity concerns of British Pakistani women living in deprived inner-city areas: A qualitative study. Health Expect 2022; 25:1821-1831. [PMID: 35514272 PMCID: PMC9327845 DOI: 10.1111/hex.13527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner‐city areas of Bradford. Methods Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically. Results This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women‐only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information. Conclusion These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels. Patient or Public Contribution Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis.
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Affiliation(s)
- Halima Iqbal
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK.,Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jane West
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | | | - Melanie Haith-Cooper
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
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28
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Grigsby-Toussaint D, Champagne A, Uhr J, Silva E, Noh M, Bradley A, Rashleigh P. US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study. JMIR INFODEMIOLOGY 2022; 2:e30885. [PMID: 35578642 PMCID: PMC9092478 DOI: 10.2196/30885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/12/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Abstract
Background Black women in the United States disproportionately suffer adverse pregnancy and birth outcomes compared to White women. Economic adversity and implicit bias during clinical encounters may lead to physiological responses that place Black women at higher risk for adverse birth outcomes. The novel coronavirus disease of 2019 (COVID-19) further exacerbated this risk, as safety protocols increased social isolation in clinical settings, thereby limiting opportunities to advocate for unbiased care. Twitter, 1 of the most popular social networking sites, has been used to study a variety of issues of public interest, including health care. This study considers whether posts on Twitter accurately reflect public discourse during the COVID-19 pandemic and are being used in infodemiology studies by public health experts. Objective This study aims to assess the feasibility of Twitter for identifying public discourse related to social determinants of health and advocacy that influence maternal health among Black women across the United States and to examine trends in sentiment between 2019 and 2020 in the context of the COVID-19 pandemic. Methods Tweets were collected from March 1 to July 13, 2020, from 21 organizations and influencers and from 4 hashtags that focused on Black maternal health. Additionally, tweets from the same organizations and hashtags were collected from the year prior, from March 1 to July 13, 2019. Twint, a Python programming library, was used for data collection and analysis. We gathered the text of approximately 17,000 tweets, as well as all publicly available metadata. Topic modeling and k-means clustering were used to analyze the tweets. Results A variety of trends were observed when comparing the 2020 data set to the 2019 data set from the same period. The percentages listed for each topic are probabilities of that topic occurring in our corpus. In our topic models, tweets on reproductive justice, maternal mortality crises, and patient care increased by 67.46% in 2020 versus 2019. Topics on community, advocacy, and health equity increased by over 30% in 2020 versus 2019. In contrast, tweet topics that decreased in 2020 versus 2019 were as follows: tweets on Medicaid and medical coverage decreased by 27.73%, and discussions about creating space for Black women decreased by just under 30%. Conclusions The results indicate that the COVID-19 pandemic may have spurred an increased focus on advocating for improved reproductive health and maternal health outcomes among Black women in the United States. Further analyses are needed to capture a longer time frame that encompasses more of the pandemic, as well as more diverse voices to confirm the robustness of the findings. We also concluded that Twitter is an effective source for providing a snapshot of relevant topics to guide Black maternal health advocacy efforts.
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Affiliation(s)
- Diana Grigsby-Toussaint
- Department of Epidemiology School of Public Health Brown University Providence, RI United States
- Department of Behavioral and Social Sciences School of Public Health Brown University Providence, RI United States
| | | | - Justin Uhr
- Brown University Library Providence, RI United States
| | - Elizabeth Silva
- Department of Behavioral and Social Sciences School of Public Health Brown University Providence, RI United States
| | - Madeline Noh
- Department of Anthropology School of Public Health Brown University Providence, RI United States
| | - Adam Bradley
- Brown University Library Providence, RI United States
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Nightingale ES, Abbott S, Russell TW, Lowe R, Medley GF, Brady OJ. The local burden of disease during the first wave of the COVID-19 epidemic in England: estimation using different data sources from changing surveillance practices. BMC Public Health 2022; 22:716. [PMID: 35410184 PMCID: PMC8996221 DOI: 10.1186/s12889-022-13069-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The COVID-19 epidemic has differentially impacted communities across England, with regional variation in rates of confirmed cases, hospitalisations and deaths. Measurement of this burden changed substantially over the first months, as surveillance was expanded to accommodate the escalating epidemic. Laboratory confirmation was initially restricted to clinical need ("pillar 1") before expanding to community-wide symptomatics ("pillar 2"). This study aimed to ascertain whether inconsistent measurement of case data resulting from varying testing coverage could be reconciled by drawing inference from COVID-19-related deaths. METHODS We fit a Bayesian spatio-temporal model to weekly COVID-19-related deaths per local authority (LTLA) throughout the first wave (1 January 2020-30 June 2020), adjusting for the local epidemic timing and the age, deprivation and ethnic composition of its population. We combined predictions from this model with case data under community-wide, symptomatic testing and infection prevalence estimates from the ONS infection survey, to infer the likely trajectory of infections implied by the deaths in each LTLA. RESULTS A model including temporally- and spatially-correlated random effects was found to best accommodate the observed variation in COVID-19-related deaths, after accounting for local population characteristics. Predicted case counts under community-wide symptomatic testing suggest a total of 275,000-420,000 cases over the first wave - a median of over 100,000 additional to the total confirmed in practice under varying testing coverage. This translates to a peak incidence of around 200,000 total infections per week across England. The extent to which estimated total infections are reflected in confirmed case counts was found to vary substantially across LTLAs, ranging from 7% in Leicester to 96% in Gloucester with a median of 23%. CONCLUSIONS Limitations in testing capacity biased the observed trajectory of COVID-19 infections throughout the first wave. Basing inference on COVID-19-related mortality and higher-coverage testing later in the time period, we could explore the extent of this bias more explicitly. Evidence points towards substantial under-representation of initial growth and peak magnitude of infections nationally, to which different parts of the country contribute unequally.
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Affiliation(s)
- Emily S Nightingale
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
- Centre for Mathematical Modelling of Infectious Disease (CMMID), London School of Hygiene & Tropical Medicine, London, UK.
| | - Sam Abbott
- Centre for Mathematical Modelling of Infectious Disease (CMMID), London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Timothy W Russell
- Centre for Mathematical Modelling of Infectious Disease (CMMID), London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Disease (CMMID), London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Barcelona Supercomputing Centre (BSC), Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Disease (CMMID), London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver J Brady
- Centre for Mathematical Modelling of Infectious Disease (CMMID), London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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30
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McCain JL, Wang X, Connell K, Morgan J. Assessing the impact of insurance type on COVID-19 mortality in black and white patients in the largest healthcare system in the state of georgia. J Natl Med Assoc 2022; 114:218-226. [PMID: 35090747 PMCID: PMC8761546 DOI: 10.1016/j.jnma.2022.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/28/2022]
Abstract
IMPORTANCE The increased COVID-19 mortality for Black individuals over White individuals may be explained by the known racial disparities in access to insurance. OBJECTIVE To determine whether racial disparities in COVID-19 mortality still exist when Blacks and Whites are equally insured. DESIGN Routinely collected data on race, mortality, type of insurance, known risk factors, and lab results from the EPIC Patient Management System were analyzed using a multivariable logistic regression model. SETTING Piedmont Healthcare is the largest hospital system in Georgia. Due to its multiple locations across the state of Georgia, it receives a relatively equitably insured population. PARTICIPANTS All patients hospitalized with a positive COVID-19 status between March 1 and November 30, 2020. MAIN OUTCOMES We hypothesized that Black patients would not have higher odds of mortality than White patients, and that type of insurance would predict COVID-19 mortality. RESULTS 6,881 (3,674 Black, 3,207 White; 48% male, mean age = 60) patients were included. Race was not a significant predictor of COVID-19 mortality (p>0.05). When controlling for age and insurance, the mortality rate for Black patients was not statistically significant from that for White patients (p>0.05). Compared to those relying on Medicare, patients with commercial (OR=0.68, 95% CI: 0.48-0.96) or out-of-pocket (self-pay) insurance (OR=0.22, 95% CI: 0.03-0.88) had lower odds of mortality. CONCLUSIONS National trends of racial disparities in COVID-19 mortality may be partially explained by disparities in insurance.
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Affiliation(s)
- Jessica L McCain
- Piedmont Healthcare, Executive Director of the COVID Task Force, 1800 Howell Mill Road, Piedmont Healthcare, Inc., Atlanta, GA 30318
| | - Xinyue Wang
- Piedmont Healthcare, Executive Director of the COVID Task Force, 1800 Howell Mill Road, Piedmont Healthcare, Inc., Atlanta, GA 30318
| | - Kate Connell
- Piedmont Healthcare, Executive Director of the COVID Task Force, 1800 Howell Mill Road, Piedmont Healthcare, Inc., Atlanta, GA 30318
| | - Jayne Morgan
- Piedmont Healthcare, Executive Director of the COVID Task Force, 1800 Howell Mill Road, Piedmont Healthcare, Inc., Atlanta, GA 30318.
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Li J, Wang X, Yuan B. Population distribution by ethnicities and the disparities in health risk and coping in the United States during the pandemic: the spatial and time dynamics. Arch Public Health 2022; 80:93. [PMID: 35337382 PMCID: PMC8948454 DOI: 10.1186/s13690-022-00858-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background As a multi-ethnic country, the US is increasingly concerned about ethnic minorities facing disproportionate health risks of the coronavirus disease 2019 (COVID-19) pandemic. This study attempted to provide a macro picture of the associations between population distribution by ethnicity and the vulnerability to COVID-19 in terms of infection risk and vaccination coverage in the US. Methods This study used multi-source data from New York Times, County Health Rankings & Roadmap Program (2020), and the Center for Disease Control and Prevention. Multiple linear regressions were performed at equidistant time points (May 2020-Jan 2021, with one-month interval between each time point) to reveal the association between population distribution by ethnicities and the infection risk and the dynamics over time. Besides, multiple linear regressions were also conducted at equidistant time points (Jan 2021-Aug 2021) to reveal whether health disparities between ethnicities would hold true for the COVID-19 vaccination coverage (in total population, and among those > 12, > 18, and > 65 years of age). Results Both the COVID-19 confirmed cases (population standardized) and the vaccination coverage (in total population, and among those > 12, > 18, and > 65 years of age) were significantly associated with the population distribution by ethnicity (e.g., population percentage of ethnic minorities). Above associations were statistically significant for non-Hispanic blacks and Hispanics, but not for Asian Americans. Conclusions A proportion of socioeconomically-disadvantageous population could be a key intuitive reflection of the risk level of this public health crisis. The policy focusing on the vulnerable population is important in this pandemic.
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Affiliation(s)
- Jiannan Li
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Xinmeng Wang
- School of Tourism Management, Sun Yat-Sen University, West Xingang Rd. 135, Guangzhou, 510275, China
| | - Bocong Yuan
- School of Tourism Management, Sun Yat-Sen University, West Xingang Rd. 135, Guangzhou, 510275, China.
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Aminian A, Tu C, Milinovich A, Wolski KE, Kattan MW, Nissen SE. Association of Weight Loss Achieved Through Metabolic Surgery With Risk and Severity of COVID-19 Infection. JAMA Surg 2022; 157:221-230. [PMID: 34964827 PMCID: PMC8717211 DOI: 10.1001/jamasurg.2021.6496] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Obesity is an established risk factor for severe COVID-19 infection. However, it is not known whether losing weight is associated with reduced adverse outcomes of COVID-19 infection. OBJECTIVE To investigate the association between a successful weight loss intervention and improved risk and severity of COVID-19 infection in patients with obesity. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved adult patients with a body mass index of 35 or higher (calculated as weight in kilograms divided by height in meters squared) who underwent weight loss surgery between January 1, 2004, and December 31, 2017, at the Cleveland Clinic Health System (CCHS). Patients in the surgical group were matched 1:3 to patients who did not have surgical intervention for their obesity (control group). The source of data was the CCHS electronic health record. Follow-up was conducted through March 1, 2021. EXPOSURES Weight loss surgery including Roux-en-Y gastric bypass and sleeve gastrectomy. MAIN OUTCOMES AND MEASURES Distinct outcomes were examined before and after COVID-19 outbreak on March 1, 2020. Weight loss and all-cause mortality were assessed between the enrollment date and March 1, 2020. Four COVID-19-related outcomes were analyzed in patients with COVID-19 diagnosis between March 1, 2020, and March 1, 2021: positive SARS-CoV-2 test result, hospitalization, need for supplemental oxygen, and severe COVID-19 infection (a composite of intensive care unit admission, need for mechanical ventilation, or death). RESULTS A total of 20 212 patients (median [IQR] age, 46 [35-57] years; 77.6% female individuals [15 690]) with a median (IQR) body mass index of 45 (41-51) were enrolled. The overall median (IQR) follow-up duration was 6.1 (3.8-9.0) years. Before the COVID-19 outbreak, patients in the surgical group compared with control patients lost more weight (mean difference at 10 years from baseline: 18.6 [95% CI, 18.4-18.7] percentage points; P < .001) and had a 53% lower 10-year cumulative incidence of all-cause non-COVID-19 mortality (4.7% [95% CI, 3.7%-5.7%] vs 9.4% [95% CI, 8.7%-10.1%]; P < .001). Of the 20 212 enrolled patients, 11 809 were available on March 1, 2020, for an assessment of COVID-19-related outcomes. The rates of positive SARS-CoV-2 test results were comparable in the surgical and control groups (9.1% [95% CI, 7.9%-10.3%] vs 8.7% [95% CI, 8.0%-9.3%]; P = .71). However, undergoing weight loss surgery was associated with a lower risk of hospitalization (adjusted hazard ratio [HR], 0.51; 95% CI, 0.35-0.76; P < .001), need for supplemental oxygen (adjusted HR, 0.37; 95% CI, 0.23-0.61; P < .001), and severe COVID-19 infection (adjusted HR, 0.40; 95% CI, 0.18-0.86; P = .02). CONCLUSIONS AND RELEVANCE This cohort study found that, among patients with obesity, substantial weight loss achieved with surgery was associated with improved outcomes of COVID-19 infection. The findings suggest that obesity can be a modifiable risk factor for the severity of COVID-19 infection.
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Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathy E. Wolski
- Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven E. Nissen
- Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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Kahn AR, Schwalm CM, Wolfson JA, Levine JM, Johnston EE. COVID-19 in Children with Cancer. Curr Oncol Rep 2022; 24:295-302. [PMID: 35113354 PMCID: PMC8811341 DOI: 10.1007/s11912-022-01207-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW This study aims to describe what is currently known about how children with cancer have been affected by the COVID-19 pandemic, including morbidity and mortality, interruptions in cancer care and delays in diagnosis, and psychosocial effects. Here we summarize the literature on how this patient population has fared during the pandemic, reviewing multiple smaller reports along with two large registries. RECENT FINDINGS Although children with cancer generally have better outcomes with COVID-19 infection than adults with cancer, their risks of hospitalization, ICU admission, and death are greatly increased compared to the general pediatric population. There are socioeconomic and ethnic disparities present in these effects. Children with cancer experience significant risks from the COVID-19 pandemic. It has yet to be seen how delays and interruptions of cancer treatment and direct organ toxicities caused by the virus itself may affect long-term outcomes in these patients.
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Affiliation(s)
- Alissa R Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph's University Medical Center, 703 Main Street, Paterson, NJ, 07503, USA.
| | - Carla M Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, 601 John Street, Kalamazoo, MI, 49007, USA
| | - Julie Ann Wolfson
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue S, Lowder Suite 500, Birmingham, AL, USA
| | - Jennifer M Levine
- Pediatric Hematology-Oncology, Department of Pediatrics, Weill Cornell Medicine, 525 East 68th St, Payson 6, New York, NY, 10024, USA
| | - Emily E Johnston
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue S, Lowder Suite 500, Birmingham, AL, USA.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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Gao M, Wang Q, Piernas C, Astbury NM, Jebb SA, Holmes MV, Aveyard P. Associations between body composition, fat distribution and metabolic consequences of excess adiposity with severe COVID-19 outcomes: observational study and Mendelian randomisation analysis. Int J Obes (Lond) 2022; 46:943-950. [PMID: 35031696 PMCID: PMC8758930 DOI: 10.1038/s41366-021-01054-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/26/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022]
Abstract
Background Higher body mass index (BMI) and metabolic consequences of excess weight are associated with increased risk of severe COVID-19, though their mediating pathway is unclear. Methods A prospective cohort study included 435,504 UK Biobank participants. A two-sample Mendelian randomisation (MR) study used the COVID-19 Host Genetics Initiative in 1.6 million participants. We examined associations of total adiposity, body composition, fat distribution and metabolic consequences of excess weight, particularly type 2 diabetes, with incidence and severity of COVID-19, assessed by test positivity, hospital admission, intensive care unit (ICU) admission and death. Results BMI and body fat were associated with COVID-19 in the observational and MR analyses but muscle mass was not. The observational study suggested the association with central fat distribution was stronger than for BMI, but there was little evidence from the MR analyses than this was causal. There was evidence that strong associations of metabolic consequences with COVID-19 outcomes in observational but not MR analyses. Type 2 diabetes was strongly associated with COVID-19 in observational but not MR analyses. In adjusted models, the observational analysis showed that the association of BMI with COVID-19 diminished, while central fat distribution and metabolic consequences of excess weight remained strongly associated. In contrast, MR showed the reverse, with only BMI retaining a direct effect on COVID-19. Conclusions Excess total adiposity is probably casually associated with severe COVID-19. Mendelian randomisation data do not support causality for the observed associations of central fat distribution or metabolic consequences of excess adiposity with COVID-19.
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Affiliation(s)
- Min Gao
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK. .,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
| | - Qin Wang
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, UK
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Michael V Holmes
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.,Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, UK.,Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK. .,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
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Scalsky RJ, Chen YJ, Ying Z, Perry JA, Hong CC. The Social and Natural Environment's Impact on SARS-CoV-2 Infections in the UK Biobank. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010533. [PMID: 35010792 PMCID: PMC8744630 DOI: 10.3390/ijerph19010533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022]
Abstract
COVID-19 has caused a global pandemic with considerable impact. Studies have examined the influence of socioeconomic status and air pollution on COVID-19 risk but in low detail. This study seeks to further elucidate the nuances of socioeconomic status, as defined by the Index of Multiple Deprivation (IMD), air pollution, and their relationship. We examined the effect of IMD and air pollution on the likelihood of testing positive for SARS-CoV-2 among 66,732 UKB participants tested for SARS-CoV-2 from 16 March 2020 through 16 March 2021. Logistic regression was performed controlling for age, sex, ancestry and IMD or air pollution in the respective models. IMD and its sub-scores were significantly associated with increased risk of testing positive for SARS-CoV-2. All particulate matter less than 2.5 μm (PM2.5), nitrogen oxide (NOx), and nitrogen dioxide (NO2) levels were associated with increased likelihood of testing positive for SARS-CoV-2. Measures of green space and natural environment around participants' homes were associated with reduced likelihood of SARS-CoV-2. Socioeconomic status and air pollution have independent effects on the risk of testing positive for SARS-CoV-2. Green space and natural environment space in the proximity of people's homes may mediate the effect of air pollution on the risk of testing positive for SARS-CoV-2.
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Affiliation(s)
- Ryan J. Scalsky
- Medical Scientist Training Program, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Yi-Ju Chen
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (Y.-J.C.); (Z.Y.)
| | - Zhekang Ying
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (Y.-J.C.); (Z.Y.)
| | - James A. Perry
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (Y.-J.C.); (Z.Y.)
- Correspondence: (J.A.P.); (C.C.H.)
| | - Charles C. Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (Y.-J.C.); (Z.Y.)
- Correspondence: (J.A.P.); (C.C.H.)
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Shannon J, Abraham A, Bagwell Adams G, Hauer M. Racial disparities for COVID19 mortality in Georgia: Spatial analysis by age based on excess deaths. Soc Sci Med 2021; 292:114549. [PMID: 34776290 PMCID: PMC8734109 DOI: 10.1016/j.socscimed.2021.114549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/28/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022]
Abstract
Introduction This study uses multiple measures of excess deaths to analyze racial disparities in COVID-19 mortality across Georgia. Methods The Georgia Department of Public Health provided monthly mortality data for 2010–2020 stratified by race/ethnicity, age, county, and recorded cause of death. We first calculate crude mortality rates by health district during the time period for all groups for March through June for our historical period to identify significant time-series outliers in 2020 distinguishable from general trend variations. We then calculate the mean and standard deviation of mortality rates by age and racial subgroup to create historic confidence intervals that contextualize rates in 2020. Lastly, we use risk ratios to identify disparities in mortality between Black and White mortality rates both in the 2010–2019 period and in 2020. Results Time-series analysis identified three health districts with significant increases in mortality in 2020, located in metro Atlanta and Southwest Georgia. Mortality rates decreased sharply in 2020 for children in both racial categories in all sections of the state, but rose in a majority of districts for both categories in adult and older populations. Risk ratios also increased significantly in 2020 for children and older populations, showing rising disparities in mortality during the pandemic even as crude mortality rates declined for children classified as Black. Conclusions Increased mortality during the COVID-19 outbreak disproportionately affected African-Americans, possibly due, in part, to pre-existing disparities prior to the pandemic linked to social determinants of health. The pandemic deepened these disparities, perhaps due to unequal resources to effectively shelter-in-place or access medical care. Future research may identify local factors underlying geographically heterogenous differences in mortality rates to inform future policy interventions.
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Affiliation(s)
- Jerry Shannon
- Department of Geography & Department of Financial Planning, Housing, and Consumer Economics University of Georgia, 210 Field St., Room 204, Athens, 30602, GA, USA.
| | - Amanda Abraham
- Department of Public Administration and Policy University of Georgia, 280F Baldwin Hall, Athens, 30602, GA, USA.
| | - Grace Bagwell Adams
- Department of Health Policy and Management University of Georgia, 211D Wright Hall, Athens, 30602, GA, USA.
| | - Mathew Hauer
- Department of Sociology Florida State University, Bellamy Building 0526, Tallahassee, FL, 32306, USA.
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Cassiello-Robbins C, Rosenthal MZ, Ammirati RJ. Delivering Transdiagnostic Treatment Over Telehealth During the COVID-19 Pandemic: Application of the Unified Protocol. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:555-572. [PMID: 34108830 PMCID: PMC8177307 DOI: 10.1016/j.cbpra.2021.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/19/2021] [Indexed: 01/23/2023]
Abstract
The COVID-19 pandemic has necessitated an abrupt transition to remote delivery of psychology services at a time when patients and practicing clinicians are experiencing an increase in life stressors (e.g., job loss, social isolation, need to adapt to telehealth practice), which can exacerbate mental health concerns and contribute to clinician burnout. Because the COVID-19 pandemic is affecting diverse individuals in myriad ways, these circumstances can elicit a wide range of emotions and emotional responses. Thus, treatment during this time must be able to address heterogeneous presenting problems while placing minimal burden on clinicians who are adjusting to continuously changing circumstances. Transdiagnostic, emotion-focused, cognitive behavioral treatments (CBT), such as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), may be particularly well suited to address the challenges faced by practicing psychologists, and their patients, in the current COVID-19 pandemic. This paper discusses the applicability and adaptability of transdiagnostic treatments to telehealth, focusing primarily on the UP in the context of the COVID-19 pandemic. Further, while many CBT skills (e.g., mindfulness) can be easily translated to tele-delivery, other skills, such as exposure, can be more difficult to implement remotely, especially in the midst of a pandemic. Thus, this paper also provides practical suggestions for clinicians with regard to implementing the UP remotely.
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Abstract
Obesity is a growing human health concern worldwide and imposes adverse effects on many cell types and organ systems, including the kidneys. Obesity interferes with various cellular processes by increasing lipid accumulation and oxidation, insulin resistance, and inflammation. Autophagy is an important cellular process to maintain hemostasis and preserve resources, but might be altered in obesity. Interestingly, experimental studies have shown either an increase or a decrease in the rate of autophagy, and accumulation of byproducts and mediators of this cascade in kidneys of obese individuals. Hence, whether autophagy is beneficial or detrimental under these conditions remains unresolved. This review summarizes emerging evidence linking superfluous fat accumulation to alterations in autophagy. Elucidating the role of autophagy in the pathogenesis and complications of obesity in the kidney might help in the identification of therapeutic targets to prevent or delay the development of chronic kidney disease in obese subjects. Autophagy, kidney, obesity, lipids.
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Affiliation(s)
- Ramyar Ghandriz
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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Rippe JM. Lifestyle Medicine: A Critical Key to Restoring Health. Am J Lifestyle Med 2021; 15:484-486. [PMID: 34646093 DOI: 10.1177/15598276211008394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Salerno S, Sun Y, Morris EL, He X, Li Y, Pan Z, Han P, Kang J, Sjoding MW, Li Y. Comprehensive evaluation of COVID-19 patient short- and long-term outcomes: Disparities in healthcare utilization and post-hospitalization outcomes. PLoS One 2021; 16:e0258278. [PMID: 34614008 PMCID: PMC8494298 DOI: 10.1371/journal.pone.0258278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Understanding risk factors for short- and long-term COVID-19 outcomes have implications for current guidelines and practice. We study whether early identified risk factors for COVID-19 persist one year later and through varying disease progression trajectories. METHODS This was a retrospective study of 6,731 COVID-19 patients presenting to Michigan Medicine between March 10, 2020 and March 10, 2021. We describe disease progression trajectories from diagnosis to potential hospital admission, discharge, readmission, or death. Outcomes pertained to all patients: rate of medical encounters, hospitalization-free survival, and overall survival, and hospitalized patients: discharge versus in-hospital death and readmission. Risk factors included patient age, sex, race, body mass index, and 29 comorbidity conditions. RESULTS Younger, non-Black patients utilized healthcare resources at higher rates, while older, male, and Black patients had higher rates of hospitalization and mortality. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss anemia were risk factors for these outcomes. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss were associated with lower discharge and higher inpatient mortality rates. CONCLUSIONS This study found differences in healthcare utilization and adverse COVID-19 outcomes, as well as differing risk factors for short- and long-term outcomes throughout disease progression. These findings may inform providers in emergency departments or critical care settings of treatment priorities, empower healthcare stakeholders with effective disease management strategies, and aid health policy makers in optimizing allocations of medical resources.
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Affiliation(s)
- Stephen Salerno
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Yuming Sun
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Emily L. Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Xinwei He
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Yajing Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Ziyang Pan
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Peisong Han
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Jian Kang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Michael W. Sjoding
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
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Yarlagadda S, Townsend MJ, Palad CJ, Stanford FC. Coverage of obesity and obesity disparities on American Board of Medical Specialties (ABMS) examinations. J Natl Med Assoc 2021; 113:486-492. [PMID: 33875239 PMCID: PMC8521551 DOI: 10.1016/j.jnma.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
Obesity is a widespread disease which adversely impacts all organ systems and disproportionately affects African Americans and other minority groups. Physicians across medical specialties must possess current knowledge of obesity as an important, distinct disease with biological and social causes. Coverage of obesity on board certification examinations, which influence standards in medical knowledge and practice in each specialty, has not previously been examined. The member boards of the American Board of Medical Specialties offer a content outline or "blueprint" detailing material tested. We parsed the 24 available general certification exam blueprints for mentions of obesity and related keywords. We categorized blueprints into three tiers: mention of obesity (Tier 1), mention of related terminology but not obesity (Tier 2), and no mention of obesity or related terminology (Tier 3). We analyzed mentions of obesity and related terms by blueprint word count and procedural versus non-procedural specialties. Six (25.0%) of 24 board exam blueprints mentioned obesity (Tier 1), fifteen (62.5%) mentioned related terminology only (Tier 2), and three (12.5%) mentioned neither obesity nor related terminology (Tier 3). There was no significant difference in obesity-related mentions between procedural and non-procedural specialties (X2, p = .50). None of the blueprints included racial/ethnic disparities related to obesity. Word count was not significantly correlated with mentions of obesity in linear regression (p = .42). The absence of any mention of obesity on most content outlines and of racial/ethnic disparities on all content outlines indicates need for increased coverage of the diagnosis, prevention, and treatment of obesity across all board examinations.
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Affiliation(s)
- Siddharth Yarlagadda
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Neuroendocrine Division, Department of Pediatrics- Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA.
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Survival of In-Hospital Cardiac Arrest in COVID-19 Infected Patients. Healthcare (Basel) 2021; 9:healthcare9101315. [PMID: 34682995 PMCID: PMC8544395 DOI: 10.3390/healthcare9101315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background: There are limited data regarding the outcome of in-hospital cardiopulmonary resuscitation (CPR) in COVID-19 patients. In this study, we compared the outcomes of in-hospital cardiac arrests (IHCA) before and at the peak of the COVID-19 pandemic at Montefiore Medical Center in the Bronx, New York, United States. We also identified the most common comorbidities associated with poor outcomes in our community. Methods: This was a multi-site, single-center, retrospective, observational study. Inclusion criteria for COVID patients were all confirmed positive cases who had in-hospital cardiac arrest (IHCA) between 1 March 2020 and 30 June 2020. The non-COVID cohort included all cardiac arrest cases who had IHCA in 2019. We excluded all out-of-hospital cardiac arrest (OHCA). We compared actual survival to that predicted by the GO-FAR score, a validated prediction model for determining survival following IHCA. Results: There were 334 cases in 2019 compared to 450 cases during the specified period in 2020. Patients who initially survived cardiac arrest but then had their code statuses changed to do not resuscitate (DNR) were excluded. Groups were similar in terms of sex distribution, and both had an average age of about 66 years. Seventy percent of COVID patients were of Black or Hispanic ethnicity. A shockable rhythm was present in 7% of COVID patients and 17% of non-COVID patients (p < 0.05). COVID patients had higher BMI (30.7 vs. 28.4, p < 0.05), higher prevalence of diabetes mellitus (58% vs. 38%, p < 0.05), and lower incidence of coronary artery disease (22% vs. 35%, p < 0.05). Both groups had almost similar predicted average survival rates based on the GO-FAR score, but only 1.5% of COVID patients survived to discharge compared to 7% of non-COVID patients (p < 0.05). Conclusion: The rate of survival to hospital discharge in COVID-19 patients who suffer IHCA is worse than in non-COVID patients, and lower than that predicted by the GO-FAR score. This finding may help inform our patient population about risk factors associated with high mortality in COVID-19 infection, as well as educate hospitalized patients and healthcare proxies in the setting of code status designation.
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Wang H, Ai H, Fu Y, Li Q, Cui R, Ma X, Ma YF, Wang Z, Liu T, Long Y, Qu K, Liu C, Zhang J. Development of an Early Warning Model for Predicting the Death Risk of Coronavirus Disease 2019 Based on Data Immediately Available on Admission. Front Med (Lausanne) 2021; 8:699243. [PMID: 34490294 PMCID: PMC8416661 DOI: 10.3389/fmed.2021.699243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction: COVID-19 has overloaded worldwide medical facilities, leaving some potentially high-risk patients trapped in outpatient clinics without sufficient treatment. However, there is still a lack of a simple and effective tool to identify these patients early. Methods: A retrospective cohort study was conducted to develop an early warning model for predicting the death risk of COVID-19. Seventy-five percent of the cases were used to construct the prediction model, and the remaining 25% were used to verify the prediction model based on data immediately available on admission. Results: From March 1, 2020, to April 16, 2020, a total of 4,711 COVID-19 patients were included in our study. The average age was 63.37 ± 16.70 years, of which 1,148 (24.37%) died. Finally, age, SpO2, body temperature (T), and mean arterial pressure (MAP) were selected for constructing the model by univariate analysis, multivariate analysis, and a review of the literature. We used five common methods for constructing the model and finally found that the full model had the best specificity and higher accuracy. The area under the ROC curve (AUC), specificity, sensitivity, and accuracy of full model in train cohort were, respectively, 0.798 (0.779, 0.816), 0.804, 0.656, and 0.768, and in the validation cohort were, respectively, 0.783 (0.751, 0.815), 0.800, 0.616, and 0.755. Visualization tools of the prediction model included a nomogram and an online dynamic nomogram (https://wanghai.shinyapps.io/dynnomapp/). Conclusion: We developed a prediction model that might aid in the early identification of COVID-19 patients with a high probability of mortality on admission. However, further research is required to determine whether this tool can be applied for outpatient or home-based COVID-19 patients.
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Affiliation(s)
- Hai Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haibo Ai
- Rehabilitation Medicine Department, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Yunong Fu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qinglin Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruixia Cui
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaohua Ma
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan-Fen Ma
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zi Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tong Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yunxiang Long
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kai Qu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Surgical ICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Rutland-Lawes J, Wallinheimo AS, Evans SL. Risk factors for depression during the COVID-19 pandemic: a longitudinal study in middle-aged and older adults. BJPsych Open 2021; 7:e161. [PMID: 34470694 PMCID: PMC8438514 DOI: 10.1192/bjo.2021.997] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/21/2021] [Accepted: 08/06/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and resultant social restrictions have had widespread psychological ramifications, including a rise in depression prevalence. However, longitudinal studies on sociodemographic risk factors are lacking. AIMS To quantify longitudinal changes in depression symptoms during the pandemic compared with a pre-pandemic baseline, in middle-aged and older adults, and identify the risk factors contributing to this. METHOD A total of 5331 participants aged ≥50 years were drawn from the English Longitudinal Study of Ageing. Self-reported depression symptoms in June/July 2020 were compared with baseline data from 2-3 years prior. Regression models investigated sociodemographic and lifestyle variables that could explain variance in change in depression. RESULTS Within-participant depression scores increased significantly from pre-pandemic levels: 14% met the criteria for clinical depression at baseline, compared with 26% during the pandemic. Younger age, female gender, higher depression scores at baseline, living alone and having a long-standing illness were significant risk factors. Gender-stratified regression models indicated that older age was protective for women only, whereas urban living increased risk among women only. Being an alcohol consumer was a protective factor among men only. CONCLUSIONS Depression in UK adults aged ≥50 years increased significantly during the pandemic. Being female, living alone and having a long-standing illness were prominent risk factors. Younger women living in urban areas were at particularly high risk, suggesting such individuals should be prioritised for support. Findings are also informative for future risk stratification and intervention strategies, particularly if social restrictions are reimposed as the COVID-19 crisis continues to unfold.
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Affiliation(s)
| | | | - Simon L. Evans
- Faculty of Health and Medical Sciences, University of Surrey, UK
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Fraser T, Aldrich DP, Page-Tan C. Bowling alone or distancing together? The role of social capital in excess death rates from COVID19. Soc Sci Med 2021; 284:114241. [PMID: 34303289 PMCID: PMC9756415 DOI: 10.1016/j.socscimed.2021.114241] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 06/09/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
Much attention on the spread and impact of the ongoing pandemic has focused on institutional factors such as government capacity along with population-level characteristics such as race, income, and age. This paper draws on a growing body of evidence that bonding, bridging, and linking social capital - the horizontal and vertical ties that bind societies together - impact public health to explain why some U.S. counties have seen higher (or lower) excess deaths during the COVID19 pandemic than others. Drawing on county-level reports from the Centers for Disease Control and Prevention (CDC) since February 2020, we calculated the number of excess deaths per county compared to 2018. Starting with a panel dataset of county observations over time, we used coarsened exact matching to create smaller but more similar sets of communities that differ primarily in social capital. Controlling for several factors, including politics and governance, health care quality, and demographic characteristics, we find that bonding and linking social capital reduce the toll of COVID-19 on communities. Public health officials and community organizations should prioritize building and maintaining strong social ties and trust in government to help combat the pandemic.
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Affiliation(s)
- Timothy Fraser
- PhD Candidate, Dept. of Political Science, Northeastern University, 960A Renaissance Park, 360 Huntington Ave, Boston, MA, 02115, USA.
| | - Daniel P Aldrich
- Professor of Political Science, Public Policy and Urban Affairs and Director of Security and Resilience Program, Northeastern University, 215H Renaissance Park, 360 Huntington Avenue, Boston, MA, 02115, USA.
| | - Courtney Page-Tan
- Assistant Professor of Human Resilience, Embry-Riddle Aeronautical University, Embry-Riddle Aeronautical University, Dept. of Security and Emergency Services, 1 Aerospace Boulevard, Daytona Beach, FL, 32114, USA.
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Churpek MM, Gupta S, Spicer AB, Parker WF, Fahrenbach J, Brenner SK, Leaf DE. Hospital-Level Variation in Death for Critically Ill Patients with COVID-19. Am J Respir Crit Care Med 2021; 204:403-411. [PMID: 33891529 PMCID: PMC8480242 DOI: 10.1164/rccm.202012-4547oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/22/2021] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Variation in hospital mortality has been described for coronavirus disease 2019 (COVID-19), but the factors that explain these differences remain unclear. OBJECTIVE Our objective was to utilize a large, nationally representative dataset of critically ill adults with COVID-19 to determine which factors explain mortality variability. METHODS In this multicenter cohort study, we examined adults hospitalized in intensive care units with COVID-19 at 70 United States hospitals between March and June 2020. The primary outcome was 28-day mortality. We examined patient-level and hospital-level variables. Mixed-effects logistic regression was used to identify factors associated with interhospital variation. The median odds ratio (OR) was calculated to compare outcomes in higher- vs. lower-mortality hospitals. A gradient boosted machine algorithm was developed for individual-level mortality models. MEASUREMENTS AND MAIN RESULTS A total of 4,019 patients were included, 1537 (38%) of whom died by 28 days. Mortality varied considerably across hospitals (0-82%). After adjustment for patient- and hospital-level domains, interhospital variation was attenuated (OR decline from 2.06 [95% CI, 1.73-2.37] to 1.22 [95% CI, 1.00-1.38]), with the greatest changes occurring with adjustment for acute physiology, socioeconomic status, and strain. For individual patients, the relative contribution of each domain to mortality risk was: acute physiology (49%), demographics and comorbidities (20%), socioeconomic status (12%), strain (9%), hospital quality (8%), and treatments (3%). CONCLUSION There is considerable interhospital variation in mortality for critically ill patients with COVID-19, which is mostly explained by hospital-level socioeconomic status, strain, and acute physiologic differences. Individual mortality is driven mostly by patient-level factors. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Affiliation(s)
- Matthew M Churpek
- University of Wisconsin Madison, 5228, Medicine; Division of Pulmonary and Critical Care, Madison, Wisconsin, United States;
| | - Shruti Gupta
- Brigham and Women's Hospital Department of Medicine, 370908, Division of Renal Medicine, Boston, Massachusetts, United States
| | - Alexandra B Spicer
- University of Wisconsin-Madison, 5228, Medicine; Division of Pulmonary and Critical Care, Madison, Wisconsin, United States
| | - William F Parker
- The University of Chicago, 2462, Department of Medicine, Chicago, Illinois, United States
| | - John Fahrenbach
- The University of Chicago, 2462, Department of Medicine, Chicago, Illinois, United States
| | - Samantha K Brenner
- Hackensack University Medical Center, 3673, Internal Medicine, Hackensack, New Jersey, United States
| | - David E Leaf
- Brigham and Women's Hospital, 1861, Division of Renal Medicine, Boston, Massachusetts, United States
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47
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Rippe J, Foreyt JP. COVID-19 and Obesity: A Pandemic Wrapped in an Epidemic. Am J Lifestyle Med 2021; 15:364-365. [PMID: 34366732 DOI: 10.1177/1559827621995393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- James Rippe
- University of Massachusetts Medical School, Worcester, Massachusetts
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48
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Hicks PM, Murtaugh MA, DeAngelis MM. The possible impact of increased physical intimate partner violence during the COVID-19 pandemic on ocular health. SAGE Open Med 2021; 9:20503121211035263. [PMID: 34377470 PMCID: PMC8326617 DOI: 10.1177/20503121211035263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022] Open
Abstract
During the COVID-19 outbreak, sheltering at home has led to an increase in physical intimate partner violence cases. Intimate partner violence-sustained ocular injuries may be higher during the pandemic due to the increase in physical intimate partner violence. Left untreated, intimate partner violence-related ocular or orbital trauma can lead to permanent vision loss. Even with treatment, patients often lose vision from intimate partner violence-related traumatic ocular injuries. Eye care providers and eye care facilities should understand the community services available to intimate partner violence survivors to better care for these patients. Due to the potential lasting economic burden and social strain of this pandemic, eye care providers and facilities should stay vigilant as there may still be a sustained increase in intimate partner violence even after the global COVID-19 pandemic.
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Affiliation(s)
- Patrice M Hicks
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Maureen A Murtaugh
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Margaret M DeAngelis
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology, University of Buffalo, Buffalo, NY, USA
- VA Western New York Healthcare System, Buffalo, NY, USA
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49
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Kandula S, Shaman J. Investigating associations between COVID-19 mortality and population-level health and socioeconomic indicators in the United States: A modeling study. PLoS Med 2021; 18:e1003693. [PMID: 34255766 PMCID: PMC8277036 DOI: 10.1371/journal.pmed.1003693] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND With the availability of multiple Coronavirus Disease 2019 (COVID-19) vaccines and the predicted shortages in supply for the near future, it is necessary to allocate vaccines in a manner that minimizes severe outcomes, particularly deaths. To date, vaccination strategies in the United States have focused on individual characteristics such as age and occupation. Here, we assess the utility of population-level health and socioeconomic indicators as additional criteria for geographical allocation of vaccines. METHODS AND FINDINGS County-level estimates of 14 indicators associated with COVID-19 mortality were extracted from public data sources. Effect estimates of the individual indicators were calculated with univariate models. Presence of spatial autocorrelation was established using Moran's I statistic. Spatial simultaneous autoregressive (SAR) models that account for spatial autocorrelation in response and predictors were used to assess (i) the proportion of variance in county-level COVID-19 mortality that can explained by identified health/socioeconomic indicators (R2); and (ii) effect estimates of each predictor. Adjusting for case rates, the selected indicators individually explain 24%-29% of the variability in mortality. Prevalence of chronic kidney disease and proportion of population residing in nursing homes have the highest R2. Mortality is estimated to increase by 43 per thousand residents (95% CI: 37-49; p < 0.001) with a 1% increase in the prevalence of chronic kidney disease and by 39 deaths per thousand (95% CI: 34-44; p < 0.001) with 1% increase in population living in nursing homes. SAR models using multiple health/socioeconomic indicators explain 43% of the variability in COVID-19 mortality in US counties, adjusting for case rates. R2 was found to be not sensitive to the choice of SAR model form. Study limitations include the use of mortality rates that are not age standardized, a spatial adjacency matrix that does not capture human flows among counties, and insufficient accounting for interaction among predictors. CONCLUSIONS Significant spatial autocorrelation exists in COVID-19 mortality in the US, and population health/socioeconomic indicators account for a considerable variability in county-level mortality. In the context of vaccine rollout in the US and globally, national and subnational estimates of burden of disease could inform optimal geographical allocation of vaccines.
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Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, New York, United States of America
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, New York, United States of America
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50
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Lu Y, Chen L, Liu X, Yang Y, Sullivan WC, Xu W, Webster C, Jiang B. Green spaces mitigate racial disparity of health: A higher ratio of green spaces indicates a lower racial disparity in SARS-CoV-2 infection rates in the USA. ENVIRONMENT INTERNATIONAL 2021; 152:106465. [PMID: 33684736 PMCID: PMC9754786 DOI: 10.1016/j.envint.2021.106465] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 05/04/2023]
Abstract
There is striking racial disparity in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates in the United States. We hypothesize that the disparity is significantly smaller in areas with a higher ratio of green spaces. County level data on the SARS-CoV-2 infection rates of black and white individuals in 135 of the most urbanized counties across the United States were collected. The total population in these counties is 132,350,027, comprising 40.3% of the U.S. population. The ratio of green spaces by land-cover type in each county was extracted from satellite imagery. A hierarchical regression analysis measured cross-sectional associations between racial disparity in infection rates and green spaces, after controlling for socioeconomic, demographic, pre-existing chronic disease, and built-up area factors. We found a higher ratio of green spaces at the county level is significantly associated with a lower racial disparity in infection rates. Four types of green space have significant negative associations with the racial disparity in SARS-CoV-2 infection rates. A theoretical model with five core mechanisms and one circumstantial mechanism is presented to interpret the findings.
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Affiliation(s)
- Yi Lu
- Department of Architecture and Civil Engineering, College of Engineering, City University of Hong Kong, Hong Kong Special Administrative Region
| | - Long Chen
- Department of Architecture and Civil Engineering, College of Engineering, City University of Hong Kong, Hong Kong Special Administrative Region
| | - Xueming Liu
- Virtual Reality Lab of Urban Environments and Human Health, HKUrbanLabs, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yuwen Yang
- Virtual Reality Lab of Urban Environments and Human Health, HKUrbanLabs, The University of Hong Kong, Hong Kong Special Administrative Region; Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
| | - William C Sullivan
- Smart, Healthy Communities Initiative, University of Illinois at Urbana-Champaign, USA
| | - Wenyan Xu
- Virtual Reality Lab of Urban Environments and Human Health, HKUrbanLabs, The University of Hong Kong, Hong Kong Special Administrative Region; Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Chris Webster
- HKUrbanLabs, Faculty of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Bin Jiang
- Virtual Reality Lab of Urban Environments and Human Health, HKUrbanLabs, The University of Hong Kong, Hong Kong Special Administrative Region; Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong Special Administrative Region.
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