ABSTRACT
Background: Pulmonary tuberculosis is still a public health problem, and surveillance data analysis has not been done much. Recently a global pandemic of COVID-19 has the potential in disturbing TB elimination pro-grams and treatment. This study aims to comprehensively analyse the incidence rate (IR) and Case Fatality Rate (CFR) of pulmonary tuberculosis in East Java from 2015–2020 and during COVID-19 and the strategies for optimizing tuberculosis disease control. Methodology: The study analyzed annual surveillance data using an analytical descriptive design. The Varia-bles were analyzed with Spearman correlation with a level of evidence of 95% (p<0.05). Results: The prevalence of pulmonary tuberculosis in East Java fluctuated from 2015–2020. In 2020 and dur-ing the COVID-19 pandemic, the number of cases and morbidity rates increased. Statistic results confirm the presence of a significant correlation between the values of Incidence rate (IR) and Case Fatality rate (CFR) (p = 0.032), IR and Treatment Success Rate (TSR) (p = 0.020), and CFR and TSR (p = 0.002). Population density is not correlated with the number of new cases (p = 0.667). Treatment rates have increased to 51%; cure and treatment rates have decreased to 76% and 89%, respectively, and there was a 4% increase in mortality dur-ing COVID-19. Conclusions: COVID-19 has tremendously affected the treatment of pulmonary TB cases in East Java, Indone-sia by increasing the incidence rate and decreasing the fatality rate. The pandemic promotes fear in the com-munity to check their medical status and improve the quality of their health in East Java.
ABSTRACT
Introduction: the first COVID-19 case in Brazil was confirmed on February 26, 2020. As of March 17, 2023, the Ministry of Health reported 699,634 deaths from COVID-19, with a case fatality rate of 1.9%. The impact of the COVID-19 pandemic in Brazil extends to socioeconomic and healthcare systems, reflecting significant regional disparities. Objective: To analyze mortality, incidence, and case fatality rates for COVID-19 in the states of Paraná and Santa Catarina, in the southern region of Brazil. Methods: This is an ecological time-series study using official Brazilian secondary data for COVID-19 cases and deaths. Data were extracted from the dashboard of the State Health Department of Santa Catarina and Paraná. Temporal series were developed for trend analysis using the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software (College Station, TX, USA, 2013). Results: In the analysis of rates over the entire period, trends for mortality, case fatality, and incidence in the state of Santa Catarina are decreasing, decreasing, and stationary, respectively. In Paraná, rates over the entire period showed a stationary trend for mortality, decreasing for case fatality, and increasing for incidence. Conclusion: COVID-19 had a devastating effect on the states of Santa Catarina and Paraná. Both states experienced the progression of the COVID-19 pandemic, with higher case fatality and mortality rates observed in Paraná, while Santa Catarina had a higher incidence rate over the three years of the COVID-19 pandemic.
ABSTRACT
Resumen Coronavirus 19 (COVID-19), es una enfermedad viral prevalente y diseminada a nivel mundial, considerada una pandemia con alta tasa de mortalidad. A la fecha no existen estudios que describan la influencia de las variables asociadas a la enfermedad en el estado fronterizo de Tamaulipas, México. El objetivo del presente estudio fue evaluar y analizar las características, complicaciones, tasas de letalidad y factores de riesgo asociados a mortalidad en paciente positivos a COVID-19 en el estado de Tamaulipas, a un año de la emergencia local. Se utilizó la frecuencia de casos observados en relación a características, complicaciones y comorbilidades para estimar prevalencias y tasas de letalidad. Se ajustó un modelo de regresión logística multivariada para estimar los factores de riesgo significativos y se utilizaron curvas de supervivencia de Kaplan-Meier para describir las comorbilidades más importantes. Los análisis indicaron una mayor infección en pacientes en edad productiva, con una probabilidad significativa de muerte a partir de los 40 años, más evidente en pacientes masculinos. Los riesgos asociados a la hospitalización, como intubación endotraqueal y neumonía, son factores muy importantes. Las comorbilidades con alta prevalencia (diabetes, hipertensión y obesidad) y enfermedad renal crónica (ERC) están asociados significativamente (P < 0.01) a mayor mortalidad por COVID-19 en pacientes positivos. El presente estudio demostró algunos patrones generales de prevalencia y tasas de letalidad por COVID-19, por lo que se sugieren particularidades en los factores asociados a mortalidad en la población de Tamaulipas que requieren atención en sus grupos vulnerables, sobre todo en posibles casos de rebrotes de la enfermedad.
Abstract Coronavirus 19 (COVID-19) is a prevalent and globally disseminated viral disease that has become a pandemic associated with a high case fatality rate. To date, there are no published studies that describe the influence of the variables associated with the disease, specifically in the border state of Tamaulipas, Mexico. The objective of the present study was to assess the characteristics, complications, fatality rates and risk factors associated to mortality in patients positive to COVID-19 in Tamaulipas, one year after the local emergency. Descriptive frequency of characteristics, complications for prevalence and case fatality rates were used. A multivariate logistic regression model was adjusted to estimate the meaningful risk factors, and Kaplan-Meier survival curves were used to describe the most important comorbidities. The analysis indicated higher infection rates in patients of productive age, with a significant death probability in male patients from the age of 40. The risks associated with hospitalization, such as endotracheal intubation and the presence of pneumonia are important risk factors. Comorbidities with high prevalence; diabetes, hypertension, obesity, and chronic kidney disease (CKD) were significantly associated (P < 0.01) with higher COVID-19 mortality risk in the assessed population. The present study demonstrated some COVID-19 general patterns on frequency and mortality rates. It also suggested particularities in factors associated to mortality in the Tamaulipas population, which require proper attention in vulnerable groups, especially in future outbreaks of the disease.
ABSTRACT
Resumen Introducción: La distribución espacial y temporal de la infección por SARS-CoV-2 sobrepasa las áreas endémicas de enfermedades transmitidas por vector (ETV), cuya vigilancia en México ha cambiado sustancialmente a partir del primer caso confirmado de COVID-19. Objetivos: Estimar y comparar las tasas de incidencia de las ETV antes y después de la introducción del SARS-CoV-2 en México. Métodos: Estudio retrospectivo de casos de ETV de 2014 a 2021. Las tasas de incidencia de cada ETV en el periodo previo (2014-2019) y posterior (2020-2021) a la introducción del SARS-CoV-2 en México fueron calculadas y comparadas. Resultados: Antes de la introducción del SARS-CoV-2, las tasas de incidencia de las ETV fueron altas y posterior a la introducción del coronavirus hubo un descenso en los índices epidemiológicos; sin embargo, solo se identificó diferencia estadística significativa en la tasa de incidencia de la malaria (p ≤ 0.05) y otras rickettsias (p ≤ 0.05). Conclusiones: Algunas medidas para reducir los casos de COVID-19, como el distanciamiento social, el confinamiento domiciliario, la reducción en el aforo en el transporte público y el trabajo en casa, probablemente contribuyeron a disminuir temporalmente el número de casos de las ETV; sin embargo, puede haber rebrote de las ETV en el futuro cercano.
Abstract Introduction: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case. Objectives: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico. Methods: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared. Results: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05). Conclusions: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.
ABSTRACT
Objetivos: descrever os aspectos epidemiológicos, espaciais e temporais da leishmaniose visceral humana, no município de Sobral, no período de 2007 a 2019. Métodos: foi realizado um estudo epidemiológico descritivo e ecológico de análise espacial e temporal, com uso dos programas Quantum-Gis e Joinpoint. Resultados: foram confirmados 316 casos novos, predominantemente, no sexo masculino, nas faixas etárias de 1 a 4 anos (26,3%) e de 20 a 39 anos (24,0%), na zona urbana. Febre (95,9%), fraqueza (85,1%), emagrecimento (80,1%), palidez (73,7%), esplenomegalia (75,6%) e hepatomegalia (69,3%) foram os sinais clínicos mais frequentes. A doença se concentrou em quatro bairros: Terrenos Novos, Centro, Expectativa e Sinhá Saboia, expressando áreas mais densas (quentes). A incidência e a letalidade foram crescentes no início do período e decrescentes no final, com uma inversão destes indicadores no ano de 2014. Conclusão: em Sobral, a leishmaniose visceral humana é um agravo considerado relevante para o serviço de vigilância em saúde com necessidade de intensificação das ações de controle entomológico, zoonótico e de manejo ambiental, principalmente nas áreas mais densas.
Objectives: the objective was to describe the epidemiological, spatial, and temporal aspects of human visceral leishmaniasis, in the municipality of Sobral, from 2007 to 2019. Methods: A descriptive, spatial and temporal ecological study was carried out using Quantum-Gis and Joinpoint programs. Results: 316 new cases were confirmed, predominantly in males, in the age groups of 1 to 4 years (26.3%) and 20 to 39 years (24.0%), mainly in the urban area. Fever (95.9%), weakness (85.1%), weight loss (80.1%), pallor (73.7%), splenomegaly (75.6%), and hepatomegaly (69.3%) were the most frequent clinical signs. The disease was concentrated in four neighborhoods (Terrenos Novos, Centro, Expectativa, and Sinhá Saboia), hot spots. The incidence and case-fatality increased at the beginning of the period but decreased at the end, with an inversion in these in the year 2014. Conclusion: In Sobral, human visceral leishmaniasis is a disease considered relevant to the health surveillance service, with the need to intensify entomological, zoonotic, and environmental management actions, especially in denser areas.
Subject(s)
Leishmaniasis, Visceral , Signs and Symptoms , Health Surveillance , Epidemiology , Mortality , Indicators and Reagents , Age GroupsABSTRACT
Background: Among many responsibilities, the doctors from the COVID war room of our institute were assigned to take telephonic follow-up of discharged COVID patients to provide any medical assistance if needed. During this process, few relatives of the patient’s informed back that the patients had died after discharge from the COVID wards. Aim and Objective: Such data of death in the COVID patients after discharged are limited in India; hence, we conducted this study so that more information is generated. Materials and Methods: Relatives of these COVID patients were asked about date and place of death. Other data including gender, age, date of admission, date of discharge, and requirement of oxygen were available with the COVID war room and were used for evaluation. Results: Out of the 892 COVID discharged patients (between August and October 2020) who could be contacted, 19 (2.13%) patients (6 females and 13 males) had died after discharge from the COVID ward. Characteristics of these 19 patients included higher age (n = 11 were 61–80 years old and n = 3 were >80 years old), hospital stay of 11–20 days (n = 12), and required oxygen support (n = 12). Most deaths occurred within 20 days (n = 16) after discharge from the COVID ward. Conclusions: The current study reports deaths occurring COVID patients after discharge. Most of these deaths occurred within 4 weeks of cure and in elderly patients. More research with long-term follow-up is needed in “cured” COVID-19 patients so that appropriate preventive measures can be undertaken in the future.
ABSTRACT
Abstract Objective To compare death rates by COVID-19 between pregnant or postpartum and nonpregnant women during the first and second waves of the Brazilian pandemic. Methods In the present population-based evaluation data from the Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe, in the Portuguese acronym), we included women with c (ARDS) by COVID-19: 47,768 in 2020 (4,853 obstetric versus 42,915 nonobstetric) and 66,689 in 2021 (5,208 obstetric versus 61,481 nonobstetric) and estimated the frequency of in-hospital death. Results We identified 377 maternal deaths in 2020 (first wave) and 804 in 2021 (second wave). The death rate increased 2.0-fold for the obstetric (7.7 to 15.4%) and 1.6-fold for the nonobstetric groups (13.9 to 22.9%) from 2020 to 2021 (odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.47-0.58 in 2020 and OR: 0.61; 95%CI: 0.56- 0.66 in 2021; p < 0.05). In women with comorbidities, the death rate increased 1.7-fold (13.3 to 23.3%) and 1.4-fold (22.8 to 31.4%) in the obstetric and nonobstetric groups, respectively (OR: 0.52; 95%CI: 0.44-0.61 in 2020 to OR: 0.66; 95%CI: 0.59-0.73 in 2021; p <0.05). In women without comorbidities, the mortality rate was higher for nonobstetric (2.4 times; 6.6 to 15.7%) than for obstetric women (1.8 times; 5.5 to 10.1%; OR: 0.81; 95%CI: 0.69-0.95 in 2020 and OR: 0.60; 95%CI: 0.58-0.68 in 2021; p <0.05). Conclusion There was an increase in maternal deaths from COVID-19 in 2021 compared with 2020, especially in patients with comorbidities. Death rates were even higher in nonpregnant women, with or without comorbidities.
Resumo Objetivo Comparar as taxas de mortalidade por COVID-19 entre gestantes ou puérperas e não gestantes durante a primeira e segunda ondas da pandemia brasileira. Métodos Na presente avaliação dos dados do Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe), incluímos mulheres com síndrome respiratória aguda grave por COVID-19: 47.768 em 2020 (4.853 obstétricas versus 42.915 não obstétricas) e 66.689 em 2021 (5.208 obstétricas versus 61.481 não obstétricas) e estimamos a frequência de óbito intra-hospitalar. Resultados Identificamos 377 óbitos maternos em 2020 e 804 em 2021. A taxa de mortalidade por COVID-19 aumentou 2,0 vezes no grupo obstétrico (de 7,7 para 15,4%) e 1,6 vezes no grupo não obstétrico (de 13,9 para 22,9%) de 2020 a 2021 (odds ratio [OR]: 0,52; intervalo de confiança [IC] 95%: 0,47-0,58 em 2020 e OR: 0,61; IC95%: 0,56-0,66 em 2021; p <0,05). Em mulheres com comorbidades, a taxa de óbitos aumentou 1,7 vezes (de 13,3 para 23,3%) e 1,4 vezes (de 22,8 para 31,4%) para os grupos obstétricos e não obstétricos, respectivamente (OR: 0,52; IC95%: 0,44-0,61 em 2020 para OR: 0,66; IC95%: 0,59-0,73 em 2021; p <0,05). Em mulheres sem comorbidades, a taxa de mortalidade foi maior para as não obstétricas (2,4 vezes; de 6,6% para 15,7%) do que para mulheres obstétricas (1,8 vezes; de 5,5 para 10,1%; OR: 0,81; IC95%: 0,69-0,95 em 2020 e OR: 0,60; IC95%: 0,58-0,68 em 2021; p < 0,05). Conclusão Houve aumento das mortes maternas por COVID-19 em 2021 em relação a 2020, principalmente naquelas com comorbidades. As taxas de mortalidade foram ainda maiores em mulheres não grávidas, com ou sem comorbidades.
Subject(s)
Humans , Female , Pregnancy , Respiratory Distress Syndrome, Newborn , Brazil , Maternal Mortality , Mortality , Maternal Death , COVID-19/mortalityABSTRACT
Objective:The risk factors and survival conditions of cardiomyopathy in childhood septic shock were retrospectively analyzed.Methods:Children with septic shock admitted to the PICU at Children′s Hospital of Chongqing Medical University from January 2015 to March 2021 were collected.The case group included children with septic shock and cardiomyopathy.The propensity score matching method was used to match children with septic shock without cardiomyopathy in a 1∶2 ratio as the control group.Basic clinical data, myocardial biomarkers, cardiac ultrasound indicators, organ function indicators and clinical outcome indicators were collected from two groups.Results:Forty-six patients were included in the case group and 92 patients in the control group.There were no significant differences in age, sex, pediatric critical care score, and basic disease between two groups.Moreover, left ventricular ejection fraction[51.0%(43.0%, 62.0%) vs.65.5%(60.6%, 69.0%)], left ventricle short-axis shortening rate (FS)[26%(21%, 33%) vs.35%(32%, 38%)], and oxygenation index(PaO 2/FiO 2)[324.0(234.3, 400.0) mmHg vs.400.0(265.8, 445.0)mmHg] in case group were lower than those in control group, while the incidence of the ST segment changes of the ECG index (21.7% vs.3.3%), lactate[3.20(1.20, 5.87)mmol/L vs.1.80(1.20, 3.40)mmol/L], and vasoactive drug score[25.14(14.84, 42.70)points vs.15.04(10.00, 26.70) points] in case group were higher than those in control group, the differences were all statistically significant (all P<0.05). The differences of PICU mortality (15.2% vs.14.1%) and 28 d mortality (29.1% vs.29.3%) between two groups were not significant ( P>0.05). The Logistic regression analysis showed that the FS was associated with cardiomyopathy occurring in septic shock[ OR (95% CI): 0.795 (0.714~0.870), P<0.001]. Children with septic shock with elevated cardiac troponin I had an increased risk of death. Conclusion:FS is an independent risk factor for cardiomyopathy in septic shock.There is no difference in survival between septic shock with and without cardiomyopathy.Cardiac troponin I is associated with the prognosis of septic shock in children.
ABSTRACT
Objective:The risk factors and survival conditions of cardiomyopathy in childhood septic shock were retrospectively analyzed.Methods:Children with septic shock admitted to the PICU at Children′s Hospital of Chongqing Medical University from January 2015 to March 2021 were collected.The case group included children with septic shock and cardiomyopathy.The propensity score matching method was used to match children with septic shock without cardiomyopathy in a 1∶2 ratio as the control group.Basic clinical data, myocardial biomarkers, cardiac ultrasound indicators, organ function indicators and clinical outcome indicators were collected from two groups.Results:Forty-six patients were included in the case group and 92 patients in the control group.There were no significant differences in age, sex, pediatric critical care score, and basic disease between two groups.Moreover, left ventricular ejection fraction[51.0%(43.0%, 62.0%) vs.65.5%(60.6%, 69.0%)], left ventricle short-axis shortening rate (FS)[26%(21%, 33%) vs.35%(32%, 38%)], and oxygenation index(PaO 2/FiO 2)[324.0(234.3, 400.0) mmHg vs.400.0(265.8, 445.0)mmHg] in case group were lower than those in control group, while the incidence of the ST segment changes of the ECG index (21.7% vs.3.3%), lactate[3.20(1.20, 5.87)mmol/L vs.1.80(1.20, 3.40)mmol/L], and vasoactive drug score[25.14(14.84, 42.70)points vs.15.04(10.00, 26.70) points] in case group were higher than those in control group, the differences were all statistically significant (all P<0.05). The differences of PICU mortality (15.2% vs.14.1%) and 28 d mortality (29.1% vs.29.3%) between two groups were not significant ( P>0.05). The Logistic regression analysis showed that the FS was associated with cardiomyopathy occurring in septic shock[ OR (95% CI): 0.795 (0.714~0.870), P<0.001]. Children with septic shock with elevated cardiac troponin I had an increased risk of death. Conclusion:FS is an independent risk factor for cardiomyopathy in septic shock.There is no difference in survival between septic shock with and without cardiomyopathy.Cardiac troponin I is associated with the prognosis of septic shock in children.
ABSTRACT
Objective:At present, emergency acute heart failure unit has been gradually carried out in China. This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure (AHF) within 6 months after discharge.Methods:Patients with AHF admitted to Emergency Department and Department of Cardiology, Peking University People's Hospital between December 2019 and December 2020, were prospectively collected. Patients with complicated malignant tumor, stage 4-5 chronic kidney disease, automatic discharge, and incomplete medical history were excluded. The baseline data, past medical history, admission condition, and auxiliary examination were collected. After discharge, the information of oral drugs, hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation. Patients were divided into the emergency acute heart failure unit treatment group (emergency AHFU group), emergency routine treatment group (outside AHFU group) and cardiology treatment group according to the different treatment locations. SPSS 25.0 software was used for comparison between groups, and a P<0.05 was considered as statistically significant. ResuIts:A total of 238 patients with AHF were enrolled, 28 patients died in hospital, and 210 patients were followed up. Four cases were excluded from malignant tumor during follow-up, and 6 cases were lost to follow-up. There were 40 cases in the emergency AHFU group, 67 cases in the outside AHFU group, and 93 cases in the cardiology treatment group. According to the prognosis, the patients were divided into the poor prognosis group ( n=83) and good prognosis group ( n=145). The age, sex, vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission, and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher (52.5% vs. 32.8%, P<0.05). The utilization rate of angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor enkephalinase inhibitors, β-blockers, diuretics and other oral drugs was higher in the emergency AHFU group after discharge, and patients also had more regular follow-up (95% vs. 79.1%, P<0.05). The 6-month readmission rate (15.0% vs. 40.3%, P<0.05) and the 6-month readmission and mortality composite results of patients in the emergency AHFU group (17.5% vs. 43.3%, P<0.05) were significantly lower than those in the outside AHFU group. COX regression analysis showed that the readmission rate of patients in the emergency AHFU group was lower than that in the outside AHFU group ( OR=2.882, 95% CI:1.267~6.611, P=0.12). Compared with the cardiology treatment group, the AHFU group had higher systolic blood pressure, faster heart rate, NT-probNP level, higher proportion of NYHA grade Ⅳ and Killip grade Ⅲ cardiac function (all P<0.05). The proportion of non-invasive mechanical ventilation in the AHFU group was significantly higher than that in the cardiology treatment group (52.5% vs. 30.1%, P<0.05). After discharge, there were no significant differences between angiotensin converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor enkephalinase inhibitors and β-blockers. There were also no significant differences in readmission and mortality rate 6 months after discharge. Binary logistics regression analysis found that the independent risk factors of AHF were routine emergency treatment, age, female sex, coronary heart disease, and BUN peak. Conclusions:The emergency acute heart failure unit is an independent protective factor for acute heart failure and reduced readmission rates within 6 months and readmission and mortality composite outcomes. Older age, female sex, coronary heart disease and elevated BUN peak are independent risk factors affecting the prognosis of AHF, which should be identified and preventive measures should be taken early.
ABSTRACT
Objective:The epidemiological characteristics of PICU deaths in 2017 in the Affiliated Hospital of Guizhou Medical University, Guizhou Provincial People′s Hospital, and Guiyang Children′s Hospital were summarized and analyzed to provide a basis for formulating intervention measures to effectively reduce the mortality rate of children.Methods:The clinical datas of PICU deaths in three tertiary hospitals in 2017 were collected retrospectively.The cases were divided according to different ages and lengths of hospitalization.And gender, age, length of death, length of hospitalization, and death diseases were summarized and analyzed.Results:In 2017, the PICU of the three tertiary hospitals admitted 2 092 children, of which 139 (6.64%) died, including 84 males and 55 females.The months with the highest case fatality rates were January, February, July and August.The fatality rates were 9.14% (18/197), 9.04% (15/166), 13.25% (20/151), 7.93% (13/164), respectively.There was statistically significant difference in the mortality of children admitted in each month ( P=0.038). Among the death cases, the infant group (29 days to 1 year old) accounted for the largest proportion with 58 cases (41.73%), followed by the preschool group (3 to 7 years old) with 37 cases (26.62%), the infant group (1 to 3 years old) with 24 cases(17.27%), and the school-age group (7 to 14 years old) with 20 cases(14.38%). The top three death diseases were: 39 cases (28.06%) of bronchial pneumonia (severe), 28 cases (20.14%) of hematological tumors and solid tumors, and 23 cases (16.55%) of trauma.The difference of its distribution in different age groups was statistically significant( P<0.05). The patients were divided into four groups according to the length of hospital stay.The time ≤1 d group had the highest mortality of 54 cases (38.85%), -3 d group and -7 d group both had 32 cases (23.02%), the >7 d group had the lowest mortality of 21 cases (15.11%). Conclusion:In 2017, January, February and July, August are the peak months of deaths in PICUs in Guizhou, with the highest number of infant deaths.Bronchial pneumonia(severe), hematological tumors and solid tumors, and trauma are the top three death diseases.
ABSTRACT
AbstractIntroduction. This study shows statistical information regarding COVID-19 in Colombia up to this date (March 1-2022). Specifically, the daily, monthly and cumulative evolution of infections and deaths, correlated with the distribution of the population according to age and gender. Objective. Show statistical information about COVID-19 that allows help to plan and design, in future Pandemics, public health policy strategies in Colombia. Methods. Daily information since the official declaration of Pandemic in Colombia (March 16 2020) was obtained by the National Health Institute (INS) and was organized in a database in order to conduct respective analysis. This information was compared to similar studies obtained based on the bibliographical review. Results and Conclusions. Results and conclusions are similar to those found in the reference literature: most part of those dead by COVID-19 are of senior age and male gender. Regarding Case Fatality Rate (CFR), it notoriously increases with age. The most vulnerable population displays an average age of ≥ 52.8 years. The less vulnerable population are young persons under 30 years of age, but specifically, those within the age range of 10 and 20 years. Gompertz and Logistic models can mathematically simulate the evolution of deaths and the evolution of CFR according to age
ResumenIntroducción. Este estudio muestra información estadística sobre el COVID-19 en Colombia a la fecha (1 de marzo de 2022). Específicamente, la evolución diaria, mensual y acumulada de contagios y defunciones, correlacionada con la distribución de la población según edad y sexo. Objetivo. Mostrar información estadística sobre COVID-19 que permita ayudar a planificar y diseñar, en futuras Pandemias, estrategias de política de salud pública en Colombia. Metodología. La información diaria desde la declaratoria oficial de Pandemia en Colombia (16 de marzo de 2020) fue obtenida del Instituto Nacional de Salud (INS) y fue organizada en una base de datos para realizar los análisis respectivos. Esta información se comparó con estudios similares obtenidos a partir de revisión bibliográfica. Resultados y conclusiones. Los resultados y conclusiones son similares a los encontrados en la literatura de referencia: la mayor parte de los fallecidos por COVID-19 son de edad avanzada y sexo masculino. En cuanto a la tasa de letalidad (CFR), ésta aumenta notoriamente con la edad. La población más vulnerable presenta una edad promedio ≥ 52.8 años. La población menos vulnerable son los jóvenes menores de 30 años, pero específicamente, los que se encuentran en el rango de edad de 10 y 20 años. Los modelos Gompertz y Logistic pueden simular matemáticamente la evolución de las muertes y la evolución de la CFR según la edad.
Subject(s)
Humans , COVID-19 , Health Strategies , Pandemics , InfectionsABSTRACT
Objective: to analyse the pandemic after one year in terms of the evolution of morbidity and mortality and factors that may contribute to this evolution Design: This is a secondary analysis of data gathered to respond to the COVID-19 pandemic. The number of cases, incidence rate, cumulative incidence rate, number of deaths, case fatality rate and their trends were analysed during the first year of the pandemic. Testing and other public health measures were also described according to the information available. Settings: The 15 States members of the Economic Community of West African States (ECOWAS) were considered. Results: As of 31st March 2021, the ECOWAS region reported 429,760 COVID-19 cases and 5,620 deaths. In the first year, 1,110.75 persons were infected per million, while 1.31% of the confirmed patients died. The ECOWAS region represents 30% of the African population. One year after the start of COVID-19 in ECOWAS, this region reported 10% of the cases and 10% of the deaths in the continent. Cumulatively, the region has had two major epidemic waves; however, countries show different patterns. The case fatality rate presented a fast growth in the first months and then decreased to a plateau. Conclusion: We learn that the context of COVID-19 is specific to each country. This analysis shows the importance of better understanding each country's response. During this first year of the pandemic, the problem of variants of concern and the vaccination were not posed.
Subject(s)
Residence Characteristics , Mortality , Vaccination , Pandemics , COVID-19 , Africa, WesternABSTRACT
INTRODUCTION: COVID-19 impacted health systems worldwide; the virus quickly spread in Brazil, reaching its 27 Federative units peculiarly. The northern country region recorded the lowest number of cases and accumulated deaths from the disease. However, it is a region of sizeable territorial extension and low demographic density, marked by socioeconomic inequalities and vulnerable groups, such as indigenous tribes, riverine peoples, and quilombolas. Sociodemographic factors may contribute to the dissemination of the coronavirus in this territory; thus, studies are needed to analyze the epidemiological indicators related to the pandemic. OBJECTIVE: to evaluate incidence, mortality, and case fatality of COVID-19 trends in the state of Amapá, Brazil, from March 2020 to April 2021. METHODS: an ecological time-series study was conducted with publicly accessible data from the Health Department of the State of Amapá. Incidence and mortality rates per 100,000 inhabitants and percentage case fatality were calculated. Crude rates were calculated by municipalities, age, and sex, per month. The Prais-Winsten regression test was performed, and the trends of monthly rates were classified as increasing, decreasing, or flat. RESULTS: during the study period, there were 99.936 cases and 1,468 deaths accumulated by COVID-19 in the State of Amapá, Brazil. Macapá and Santana's cities, which have the highest demographic density and Human Development Index (HDI), had the highest number of cases and deaths. The most vulnerable population was elderly males aged 70 years or over; these individuals had the highest cumulative incidence, case fatality, and mortality rates. The second wave of the disease (October 2020 to April 2021) illustrated a more aggravating scenario, with increasing incidence and mortality rates. CONCLUSION: the COVID-19 pandemic in the state of Amapá, Brazil, is in increasing evolution, which illustrates that non-pharmacological prevention measures and acceleration of vaccination must be strengthened to avoid the development of future waves of the disease.
INTRODUÇÃO: a COVID-19 impactou os sistemas de saúde em todo o mundo, rapidamente o vírus disseminou-se no Brasil, atingindo de modo distinto as 27 unidades Federativas do país. A região norte do Brasil registrou o menor número de casos e óbitos acumulados da doença. Entretanto, trata-se de região de grande extensão territorial e baixa densidade demográfica, marcada por desigualdades socioeconômicas, presença de população vulnerável como tribos indígenas, povos ribeirinhos e quilombolas. Os fatores sociodemográficos podem contribuir para a disseminação do coronavírus na região, assim, fazem-se necessários estudos que analisem os indicadores epidemiológicos relacionados à pandemia. OBJETIVO: avaliar as tendências da incidência, mortalidade e letalidade da COVID-19 no estado do Amapá, durante o período de março de 2020 a abril de 2021. MÉTODO: foi realizado um estudo ecológico de séries temporais, com dados de livre acesso, oriundos da Secretaria de Saúde do Estado do Amapá. Foi calculado a taxa de incidência e mortalidade por 100.000 habitantes e letalidade percentual. As taxas brutas foram calculadas por municípios, idade e sexo e por mês. Foi realizado o teste de regressão de Prais-Winsten, as tendências das taxas mensais foram classificadas em crescentes, decrescentes ou estacionárias. RESULTADOS: houve 99,936 casos e 1,468 óbitos acumulados por COVID-19 no Estado do Amapá durante o período estudado. As cidades de Macapá e Santana, que apresentaram densidades demográficas e Índice de Desenvolvimento Humano (IDH) mais elevados, apresentaram o maior número de casos e óbitos. A população mais vulnerável foi constituída pelos idosos do sexo masculino, com idade igual ou superior a 70 anos, estes indivíduos apresentaram as maiores taxas acumuladas de incidência, letalidade e mortalidade. A segunda onda da doença (outubro de 2020 a abril de 2021) ilustrou um cenário mais agravante, com crescentes nas taxas de incidência e mortalidade. CONCLUSÃO: a pandemia da COVID-19 no estado do Amapá está em crescente evolução, o que ilustra que medidas de prevenção não farmacológicas e aceleração à vacinação devem ser fortalecidas para evitar o desenvolvimento de futuras ondas da doença.
Subject(s)
Epidemiology , Incidence , Pandemics , COVID-19/mortality , COVID-19ABSTRACT
INTRODUCTION: Inserted in the vulnerable context of the Brazilian Amazon, the state of Tocantins has suffered damages with the dissemination of COVID-19 in its territory; however, little evidence is published from this state. OBJECTIVE: This study aims to analyze the case-fatality, mortality, and incidence of COVID-19 in Tocantins. METHODS: This is an ecological study, population-based, time-series analysis of COVID-19 cases and deaths in the state of Tocantins from March 2020 to August 2021. RESULTS: During the examined period, 219,031 COVID-19 cases, and 3,594 deaths were registered due to disease. Two possible occurrence peaks were characterized in this time-series analysis. Remarkably, the Second Wave had the highest lethality rates (3.02% - April 2021), mortality (39.81 deaths per 100,000 inhabitants - March 2021), and incidence (1,938.88 cases per 100,000 inhabitants - March 2021). At the end of the period, mortality, incidence, and lethality showed flat trends, suggesting a positive outcome of the vaccination program. CONCLUSION: The prevention, surveillance, and control actions of COVID-19 cases in Tocantins State have been directed to mitigate the deleterious effects of the pandemic. Nevertheless, efforts are still needed to decrease lethality, mortality, and incidence trends, and ultimately to achieve control of the COVID-19 pandemic in the region
INTRODUÇÃO: Inserido em vulnerável contexto da Amazônia Brasileira, o estado de Tocantis tem sofrido danos com a disseminação da COVID-19 em seu território; entretanto, escassas evidências têm sido publicadas sobre este estado. OBJETIVO: O objetivo deste estudo é analisar a letalidade, mortalidade e incidência da COVID-19 em Tocantins. MÉTODO: Este é um estudo ecológico, de base populacional, com análises de séries temporais de casos e óbitos de COVID-19 no estado do Tocantins de março de 2020 a agosto de 2021. RESULTADOS: No período examinado, foram registrados 219.031 casos de COVID-19 e 3,594 óbitos devido a doença. Foram caracterizadas nesta análise de série temporal a formação de duas possíveis ondas. Notavelmente, a segunda onda apresentou as maiores taxas de letalidade (3,02% - abril de 2021), mortalidade (39,81 óbitos por 100.000 habitantes - março de 2021) e incidência (1.938,88 casos por 100.000 habitantes - março de 2021). No final do período, a mortalidade, incidência e letalidade apresentaram tendências estacionárias, sugerindo um resultado positivo do programa de vacinação. CONCLUSÃO: As ações de prevenção, vigilância e controle dos casos de COVID-19 no Estado do Tocantins têm sido direcionadas para mitigar os efeitos deletérios da pandemia. No entanto, esforços ainda são necessários para diminuir as tendências da letalidade, mortalidade e, em última instância, para alcançar o controle da pandemia de COVID-19 na região.
Subject(s)
Humans , COVID-19/mortality , Brazil/epidemiology , Time Series Studies , Incidence , Ecological Studies , Sociodemographic FactorsABSTRACT
INTRODUCTION: coronavirus 2019 Disease (COVID-19) was quickly declared a pandemic, and Brazil is facing the most significant health and hospital crisis in its history. From March to June 2021 represented 50.8% of all deaths in the State of Espirito Santo OBJECTIVE: to analyze the lethality and mortality by COVID-19 in the State of Espirito Santo from March 2020 to June 2021. METHODS: an ecological study was carried out, using a time series of public and official data available on the Health Department of the State of Espirito Santo, Brazil. Were considered information about cases and deaths (from March 2020 to June 2021) of COVID-19. Percentage case-fatality and mortality and incidence rates per 100,000 population were calculated. Time-series analyses were performed using the Prais-Winsten regression model, estimating the Daily Percent Change (DPC), and the trends were classified as flat, increasing, or decreasing. Significant differences were considered when p<0.05. RESULTS: 524,496 confirmed cases of COVID-19 as of June 30, 2021, and 11,516 progressed to death. The presence of cardiovascular diseases represents more than half of confirmed comorbidities (54.37%) in patients with COVID-19, followed by diabetes (19.95%) and obesity (9.34%). Men had higher mortality and lethality, especially in older age groups, but the incidence was higher among women. A characteristic profile of two waves was observed; the first wave was extended from March to October 2020 and the second complete wave from November 2020 to June 2021. During the second wave, high peaks of incidence, lethality, and mortality were recorded. At the end of the second wave, the incidence rate remained with increasing trends (p < 0.05), with a DPC of 2.06%. CONCLUSION: the peak concentration of cases, deaths, and indicators of lethality, mortality evidenced even after one year of pandemic, characterizes the severity of the COVID-19 pandemic, still in entire evolution in the State Espirito Santo and Brazil.
INTRODUÇÃO: a doença do Coronavírus 2019 (COVID-19) foi rapidamente declarada pandemia, e o Brasil está enfrentando a crise hospitalar e de saúde mais significativa de sua história. De março a junho de 2021 representou 50,8% de todas as mortes no Estado do Espírito Santo. OBJETIVO: analisar a letalidade e mortalidade por COVID-19 no Estado do Espírito Santo no período de março de 2020 a junho de 2021. MÉTODO: foi realizado um estudo ecológico, utilizando uma série histórica de dados públicos e oficiais disponíveis na Secretaria de Saúde do Estado do Espírito Santo, Brasil. Foram consideradas informações sobre casos e óbitos (de março de 2020 a junho de 2021) da COVID-19. Foram calculadas as percentagens de letalidade e mortalidade e taxas de incidência por 100.000 habitantes. As análises de séries temporais foram realizadas usando o modelo de regressão de Prais-Winsten, estimando a variação percentual diária (DPC), e as tendências foram classificadas como estacionaria, crescentes ou decrescentes. Diferenças significativas foram consideradas quando p <0,05. RESULTADOS: 524.496 casos confirmados de COVID-19 até 30 de junho de 2021 e 11.516 evoluíram para óbito. A presença de doenças cardiovasculares representa mais da metade das comorbidades confirmadas (54,37%) em pacientes com COVID-19, seguida de diabetes (19,95%) e obesidade (9,34%). Os homens apresentaram maior mortalidade e letalidade, principalmente nas faixas etárias mais velhas, mas a incidência foi maior entre as mulheres. Observou-se um perfil característico de duas ondas; a primeira onda foi estendida de março a outubro de 2020 e a segunda onda completa de novembro de 2020 a junho de 2021. Durante a segunda onda, altos picos de incidência, letalidade e mortalidade foram registrados. Ao final da segunda onda, a taxa de incidência manteve-se com tendência crescente (p <0,05), com DPC de 2,06%. CONCLUSÃO: o pico de concentração de casos, óbitos e indicadores de letalidade, mortalidade evidenciados mesmo após um ano de pandemia, caracteriza a gravidade da pandemia COVID-19, ainda em evolução total no Estado do Espírito Santo e Brasil.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Health Profile , COVID-19/mortality , Brazil/epidemiology , Incidence , Prevalence , Ecological Studies , Spatio-Temporal AnalysisABSTRACT
INTRODUCTION: the initial spread of the pandemic in Brazil was mainly affected by patterns of socioeconomic vulnerability. It should be noted that the Central-West region of Brazil is one of the regions with the lowest number of cases, but the states of this region together have the highest mortality rate of COVID-19 in the country. Goiás was the most affected state of this region, with the highest number of deaths in the area. OBJECTIVE: to assess the incidence of mortality and lethality caused by COVID-19 from March 2020 to June 2021 in the State of Goiás, Brazil. METHODS: an ecological study, using a series of time series of public and official data of the Department of Health of the State of Goiás, Brazil. Information was collected on cases and deaths from COVID-19 from March 2020 to June 2021. Mortality, case fatality, and incidence rates were calculated. The Prais-Wisten regression model was used to build time series. The daily percent change (DPC) and the effective reproductive number (Rt) were estimated. RESULTS: Goiás had a predominance of a greater viral spread during the first and the beginning of the second wave, with Rt higher than 1. The second wave from December 2020 to June 2021 was more lethal and had higher mortality rates than the first wave. It was observed, higher scores of case fatality and mortality belonged to males and the elderly. CONCLUSION: an analysis of mortality and case fatality rates helps understand the COVID-19 pandemic behavior in Goiás. It is essential to monitor epidemiological indicators and strengthen intervention strategies to contain the pandemic in this state.
INTRODUÇÃO: a propagação inicial da pandemia no Brasil foi afetada principalmente por padrões de vulnerabilidade socioeconômica. Ressalta-se que a região Centro-Oeste do Brasil é uma das regiões com menor número de casos, mas os estados dessa região juntos apresentaram a maior taxa de mortalidade por COVID-19 do país. Goiás foi o estado mais afetado da região, com o maior número de óbitos. OBJETIVO: avaliar a incidência, mortalidade e letalidade por COVID-19 no Estado de Goiás, Brasil, no período de março de 2020 a junho de 2021. MÉTODO: estudo ecológico, utilizando séries temporais de dados públicos e oficiais da Secretaria de Saúde do Estado de Goiás, Brasil. As informações foram coletadas sobre casos e óbitos de COVID-19 de março de 2020 a junho de 2021. Mortalidade, letalidade e taxas de incidência foram calculadas. O modelo de regressão Prais-Wisten foi usado para construir séries temporais. A mudança percentual diária (DPC) e o número reprodutivo efetivo (Rt) foram estimados. RESULTADOS: Goiás teve predomínio de maior disseminação viral durante a primeira onda e o início da segunda onda, com Rt maior que 1. A segunda onda, dezembro de 2020 a junho de 2021, foi mais letal e apresentou taxas de mortalidade maiores que a primeira onda. Observou-se que os maiores escores de letalidade e mortalidade pertenciam ao sexo masculino e aos idosos CONCLUSÃO: uma análise das taxas de mortalidade e letalidade ajuda a entender o comportamento da pandemia do COVID-19 em Goiás. É fundamental monitorar indicadores epidemiológicos e fortalecer estratégias de intervenção para conter a pandemia neste estado.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , COVID-19/mortality , Brazil/epidemiology , Incidence , Ecological Studies , Sociodemographic FactorsABSTRACT
INTRODUCTION: By late 2019, China notified a new disease rising, and with the agent's identification, it was called COVID-19. Despite the efforts of the World Health Organization (WHO) and worldwide countries, the disease spread out of control; on March 11, WHO declared the pandemic state. Brazil is the biggest country in South America, demarcated into 26 states with different economic, cultural, and social aspects. Paraná is one of the Brazilian federative units, it is the sixth more economically important and ranks second in Education. Its first COVID-19 case was confirmed on March 12, 2020, and the first death was on March 27, two weeks after the first death in Brazil. OBJECTIVE: This study objective is to determine the mortality and case-fatality rates of COVID-19 in the State of Paraná, Brazil, from March 1, 2020, to March 31, 2021. METHODS: It is an ecological time-series study, using all cases (854,326) and deaths (17,229 deaths) of COVID-19 reported in public and official database of the State of Paraná Health Department. Case fatality and mortality rates were stratified by sex and age. For trend analysis, the period was divided into a first "wave" (March to November 2020) and a second "wave" (December 2020 to March 2021). The Prais-Winsten regression model for population mortality and case-fatality rates allowed classifying whether it increased, decreased, or was flat. RESULTS: Women were more affected by the number of cases, with 454,056 cases (53.15%) confirmed and 7,257 fatalities (42.12%). A total of 400,270 men (46.85%) were infected and 9,972(57.87%) died. For the first year of COVID-19, in the State of Paraná, the incidence was calculated as 7404.12/100,000 inhabitants, the mortality was 149.32/100,000 inhabitants, and the case-fatality rate was 2.02%. We saw a tendency for decreasing the case-fatality rate (DPC = -0,18; p<0,001). The mortality and incidence showed an increasing trend (DPC=1,13, p<0,001; DPC=1,58, p<0,001, respectively. CONCLUSION: The level and variability of transmission during this first year of pandemic suggest that the disease in the State of Paraná was never under control.
INTRODUÇÃO: no final de 2019, a China notificou o surgimento de uma nova doença, com a identificação do agente, passou a chamar-se COVID-19. Apesar dos esforços da Organização Mundial da Saúde (OMS) e de países em todo o mundo, a doença se espalhou fora de controle; em 11 de março, a OMS declarou o estado de pandemia. O Brasil é o maior país da América do Sul, demarcado em 26 estados com diferentes aspectos econômicos, culturais e sociais. O Paraná é uma das unidades federativas brasileiras, é o sexto mais importante economicamente e o segundo em Educação. Seu primeiro caso de COVID-19 foi confirmado em 12 de março de 2020, e o primeiro óbito em 27 de março, duas semanas após o primeiro óbito no Brasil. OBJETIVO: o objetivo deste estudo é determinar as taxas de mortalidade e letalidade da COVID-19 no Estado do Paraná, Brasil, de 1º de março de 2020 a 31 de março de 2021. MÉTODO: trata-se de um estudo ecológico de série temporal que avaliou todos os casos (854.326) e óbitos (17.229 óbitos) da COVID-19 notificados em banco de dados público e oficial da Secretaria de Saúde do Estado do Paraná. As taxas de letalidade e mortalidade foram estratificadas por sexo e idade. Para análise de tendência, o período foi dividido em uma "primeira onda" (março a novembro de 2020) e uma "segunda onda" (dezembro de 2020 a março de 2021). O modelo de regressão de Prais-Winsten para taxas de mortalidade populacional e letalidade permitiu classificar as tendências em crescentes, decrescentes ou estacionárias. RESULTADOS: as mulheres foram as mais afetadas pelo número de casos, com 454.056 casos (53,15%) confirmados e 7.257 óbitos (42,12%). Um total de 400.270 homens (46,85%) foram infectados e 9.972 (57,87%) morreram. Para o primeiro ano da COVID-19, no Estado do Paraná a incidência foi calculada em 7.404,12/100.000 habitantes, a mortalidade foi de 149,32 / 100.000 habitantes e a letalidade foi de 2,02%. Observamos uma tendência de diminuição da taxa de letalidade (DPC= -0,18; p <0,001). A mortalidade e incidência apresentaram tendência crescentes (DPC=1,13, p <0,001; DPC= 1,58, p <0,001, respectivamente. CONCLUSÃO: o nível e a variabilidade da transmissão durante este primeiro ano de pandemia sugerem que a doença no Estado do Paraná nunca esteve sob controle.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , COVID-19/mortality , Brazil/epidemiology , Mortality/trends , Spatio-Temporal Analysis , Sociodemographic FactorsABSTRACT
Introducción: El cáncer de mama constituye la primera causa de muerte en los cánceres en Chile según Globocan 2018. Dentro de los factores que explican esta alta mortalidad encontramos una baja tasa de detección y de realización de mamografías en los niveles socioeconómicos altos. Es por esto que comprender las causas de defunción y los factores que afectan en la mortalidad y letalidad por cáncer de mama en los últimos 17 años nos permitirá enfocar las políticas públicas de los próximos 50 años. Los objetivos generales de este trabajo fueron caracterizar los egresos hospitalarios en los pacientes por cáncer de mama según la edad, el sexo, la previsión, el nivel socioeconómico y educacional en Chile durante los años 2001 al 2016 y calcular la mortalidad y letalidad específica en estas mismas variables durante los años 2001 a 2016. El objetivo específico es asociar las variables socioeconómicas y educacionales, estimando los Odd's ratios de las variables en los egresos hospitalarios por cáncer de mama en Chile durante los años 2001 al 2016. Materiales y Métodos: Estudio de cohorte longitudinal retrospectivo en 81,072 egresos hospitalarios y 20,220 defunciones obtenidas de la página DEIS MINSAL, años 2001-2016. Para el análisis univariado se efectuó una regresión de ajuste de tasas Prais-weinstein según edad y sexo según modelo OMS de ajuste de tasas. Para las variables de tipo discreta se describieron mediante porcentajes y tasas y para las variables de tipo continua se utilizó mediana y desviación estándar. Se efectuó un test de smirnov-kolmolgorov para determinar el tipo de distribución y de normalidad de las muestras. Para las variables de tipo dicotómica se utilizó un modelo de regresión logística binaria para describir estas variables y determinar la posible asociación entre el nivel socioeconómico y educacional de las pacientes diagnosticadas por cáncer de mama. Resultados: Murieron 1,88 veces más personas de nivel socioeconómico alto con un IC entre 1,83- 1,94 con respecto a la población de nivel socioeconómico bajo. En cambio, las personas con un mayor nivel educacional murieron 0,5 veces menos según la regresión realizada respecto al bajo nivel educacional con un IC entre 0,47- 0,52, pero a menor nivel educacional aumentó 20 veces la mortalidad, constituyendo una causa inversa. Respecto al sexo las mujeres murieron 2,08 veces más que los hombres. Para el nivel socioeconómico alto en relación al bajo un OR [1.88 (1.83 a 1,94)], p<0,0001], para el nivel educacional alto en relación al bajo fue a favor del mayor nivel educacional con OR [0,5 (0,47 - 0,52)] y en cuanto a la comparación de sexos un OR [1,04 (1,03-2,17), p=0,039]. Es decir, la diferencia entre mortalidad que hubo fue significativa para todos los intervalos tanto para sexo, nivel educacional como para nivel socioeconómico. Se encontró una constante de 0,013 de mortalidad basal, es decir, todos tienen 1,3% de riesgo de morir por cáncer de mama independiente del nivel socioeconómico, educacional y del sexo. Conclusión: Existen diferencias estadísticamente significativas respecto a la mortalidad entre los niveles socioeconómicos altos y bajos y también en nivel educacional, sin embargo, al realizar los métodos de regresión se obtuvo una mayor mortalidad y mayor riesgo de morir por cáncer de mama en los niveles socioeconómicos más altos asociados a, probablemente, la menor cantidad de tamizajes y realización de mamografías en este estrato. A partir del año 2008 se observó un incremento a los niveles originales observados al inicio del segundo milenio incrementando las diferencias existentes en los índices de desigualdad tanto por nivel educacional como por nivel socioeconómico incrementando en 20 veces respecto al nivel educacional, y 1.88 respecto al nivel socioeconómico.
Introduction: Breast cancer is the leading cause of death in cancers in Chile according to Globocan 2018. Among the factors that explain this high mortality, we find a low rate of detection and performance of mammograms in high socioeconomic levels. This is why understanding the causes of death and the factors that affect mortality and fatality from breast cancer in the last 17 years will allow us to focus on public policies for the next 50 years Materials and Methods: Retrospective longitudinal cohort study in 79,996 hospital discharges and 20,220 deaths obtained from the DEIS MINSAL page, years 2001 -2016. For the univariate analysis, a Prais-Weinstein rate adjustment regression was performed according to age and sex according to the WHO rate adjustment model. For discrete type variables, they were described by percentages and rates, and median and standard deviation were used for continuous type variables. A smirnov-kolmolgorov test was performed to determine the type of distribution and normality of the samples. For dichotomous variables, a binary logistic regression model was used to describe these variables and determine the possible association between the socioeconomic and educational level of the patients diagnosed with breast cancer. Abstract: In this observational, longitudinal and retrospective study with 101.292 patients that includes men and women of all ages with diagnosis of breast cancer all along Chile, we´ll analyze the impact of socioeconomic level, evaluated through educational level and money income, into the prevalence, mortality and lethality of breast cancer in the years 2001 to 2016. Results: People with a high socioeconomic level died 1.88 times more, with a CI between 1.83 and 1.94, than those with a low socioeconomic level. On the other hand, people with a higher educational level died 0.5 times less according to the regression carried out with respect to the low educational level with a CI between 0.47 and 0.52, but the lower the educational level the mortality increased 20 times, constituting an inverse cause. Regarding sex, women died 2.08 times more than men. For the high socioeconomic level in relation to the low one an OR [1.88 (1.83 to 1.94)], p<0.0001], for the high educational level in relation to the low one it was in favor of the higher educational level with OR [0.5 (0.47 - 0.52)] and as for the comparison of sexes an OR [1.04 (1.03-2.17), p=0.039]. In other words, the difference between mortality was significant for all the intervals for sex, educational level and socioeconomic level. A constant baseline mortality of 0.013 was found, i.e., everyone has a 1.3% risk of dying from breast cancer regardless of socioeconomic level, educational level and sex. Conclusions: There are statistically significant differences in mortality between high and low socioeconomic levels and also in educational level; however, when regression methods were used, a higher mortality and higher risk of dying from breast cancer was obtained in the higher socioeconomic levels, probably associated with the lower number of screenings and mammograms performed in this stratum. As of 2008, an increase to the original levels observed at the beginning of the second millennium was observed, increasing the existing differences in the inequality indexes both by educational level and socioeconomic level, increasing by 20 times with respect to educational level, and 1.88 times with respect to socioeconomic level.
Subject(s)
Humans , Male , Female , Social Class , Breast Neoplasms/epidemiology , Mortality , Educational Status , Breast Neoplasms/diagnosis , Poisson Distribution , Chile/epidemiology , Age and Sex DistributionABSTRACT
RESUMEN Objetivo. Identificar las características clínicas y epidemiológicas relacionadas a la letalidad en pacientes hospitalizados por COVID-19 en el Hospital Simón Bolívar de Cajamarca, durante junio-agosto de 2020. Materiales y métodos. Cohorte retrospectiva, con información recolectada de historias clínicas y sistemas oficiales de vigilancia epidemiológica (NOTIWEB, SISCOVID y SINADEF), sobre pacientes hospitalizados con diagnóstico confirmado de COVID-19. Se recolectó información sobre factores sociodemográficos y clínicos, considerando como desenlace el egreso (fallece/sobrevive) y los días de hospitalización. Resultados. La tasa de letalidad intrahospitalaria fue 39,6%, encontrándose diferencias significativas entre el tiempo de hospitalización y la condición de egreso en las personas mayores de 60 años (p<0,001). La edad mayor de 60 años (HR: 2,87; IC95%: 1,76-4,68),) solicitud de cama UCI no atendida (HR: 3,49; IC95%: 2,02-6,05), saturación de oxígeno menor a 80% al ingreso (HR: 2,73; IC95%: 1,35-5,53) y el uso de ivermectina (HR: 1,68; IC95% 1,06-2,68) fueron factores asociados a letalidad. El modelo de Machine Learning (ML) elegido consideró que las variables con mayor importancia fueron la saturación de oxígeno, la edad mayor de 60 años, tiempo de hospitalización y tiempo de síntomas. Conclusión. Los factores que podrían incrementar la letalidad en pacientes hospitalizados por COVID-19 fueron la edad, saturación de oxígeno menor a 80%, uso de ivermectina en la terapéutica hospitalaria y la solicitud no atendida de camas UCI. Futuros estudios con una mejor representatividad podrían confirmar estas posibles relaciones a nivel regional o nacional.
ABSTRACT Objective. To identify the clinical and epidemiological characteristics related to lethality in patients hospitalized for COVID-19 at the Simón Bolívar Hospital in Cajamarca, during June-August 2020. Materials and Methods. This was a retrospective cohort, that used information collected from clinical records and official epidemiological surveillance systems (NOTIWEB, SISCOVID and SINADEF), on hospitalized patients with confirmed COVID-19 diagnosis. Information was collected on sociodemographic and clinical factors, considering discharge (death/survival) and days of hospitalization as outcomes. Results. The in-hospital fatality rate was 39.6%, and significant differences were found between hospitalization time and status at discharge in people over 60 years of age (p<0.001). Age older than 60 years (HR: 2.87; 95% CI: 1.76-4.68),) unattended ICU bed request (HR: 3.49; 95% CI: 2.02-6.05), oxygen saturation less than 80% at admission (HR: 2.73; 95% CI: 1.35-5.53) and the use of ivermectin (HR: 1.68; 95%CI 1.06-2.68) were factors associated with lethality. The chosen ML model considered that the most important variables were oxygen saturation, age over 60 years, time of hospitalization and time of the onset of symptoms. Conclusion. The factors that could increase lethality in patients hospitalized for COVID-19 were age, oxygen saturation less than 80%, use of ivermectin as part of hospital treatment and unattended request for ICU beds. Future studies with better representativeness could confirm these possible relationships at the regional or national level.