ABSTRACT
Objective: To examine the influence of having a baseline metabolic disorder (diabetes, hypertension, and/or obesity) on the risk of developing new clinical sequelae potentially related to SARS-CoV-2 in a large sample of commercially insured adults in the US. Design, setting, and participants Deidentified data were collected from the IBM/Watson MarketScan Commercial Claims and Encounters (CCAE) Databases and Medicare Supplemental and Coordination of Benefits (MDCR) Databases from 2019 to 2021. A total of 839,344 adults aged 18 and above with continuous enrollment in the health plan were included in the analyses. Participants were grouped into four categories based on their COVID-19 diagnosis and whether they had at least one of the three common metabolic disorders at baseline (diabetes, obesity, or hypertension). Measures and methods ICD-10-CM codes were used to determine new symptoms and conditions after the acute phase of SARS-CoV-2 infection, defined as ending 21 days after initial diagnosis date, or index period for those who did not have a COVID-19 diagnosis. Propensity score matching (PSM) was used to create comparable reference groups. Cox proportional hazard models were conducted to estimate hazard ratios and 95% confidence intervals. Results Among the 772,377 individuals included in the analyses, 36,742 (4.8%) without and 20,912 (2.7%) with a baseline metabolic disorder were diagnosed with COVID-19. On average, COVID-19 patients with baseline metabolic disorders had more 2.4 more baseline comorbidities compared to those without baseline metabolic disorders. Compared to adults with no baseline metabolic condition, the risks of developing new clinical sequelae were highest among COVID-19 patients with a baseline metabolic condition (HRs ranging from 1.51 to 3.33), followed by those who had a baseline metabolic condition but with no COVID-19 infection (HRs ranging from 1.33 to 2.35), and those who had COVID-19 but no baseline metabolic condition (HRs ranging from 1.34 to 2.85). Conclusions In a large national cohort of commercially insured adults, COVID-19 patients with a baseline metabolic condition had the highest risk of developing new clinical sequelae post-acute infection phase, followed by those who had baseline metabolic condition but no COVID-19 infection and those who had COVID-19 but no baseline metabolic disorder.
Subject(s)
Metabolic Diseases , Diabetes Mellitus , Obesity , Hypertension , COVID-19 , AtaxiaABSTRACT
We assessed how many U.S. deaths would have been averted each year, 1933-2021, if U.S. age-specific mortality rates had equaled those of other wealthy nations. The annual number of excess deaths in the U.S. increased steadily beginning in the late 1970s, reaching 626,353 in 2019. Excess deaths surged during the COVID-19 pandemic. In 2021, there were 1,092,293 “Missing Americans” and 25 million years of life lost due to excess mortality relative to peer nations. In 2021, half of all deaths under 65 years and 91% of the increase in under-65 mortality since 2019 would have been avoided if the U.S. had the mortality rates of its peers. Black and Native Americans made up a disproportionate share of Missing Americans, although the majority were White. One sentence summary In 2021, 1.1 million U.S. deaths – including 1 in 2 deaths under age 65 years – would have been averted if the U.S. had the mortality rates of other wealthy nations.
Subject(s)
COVID-19ABSTRACT
ABSTRACT Official Covid-19 death counts have underestimated the mortality impact of the Covid-19 pandemic in the United States. Excess mortality, which compares observed deaths to deaths expected in the absence of the pandemic, is a useful measure for assessing the total effect of the pandemic on mortality levels. In the present study, we produce county-level estimates of excess mortality for 3,127 counties between March 2020 and December 2021. We fit two hierarchical linear models to county-level death rates from January 2015 to December 2019 and predict expected deaths for each month during the pandemic. We compare observed deaths to these estimates to obtain excess deaths for each county-month. An estimated 936,911 excess deaths occurred during 2020 and 2021, of which 171,168 (18.3%) were not assigned to Covid-19 on death certificates as an underlying cause of death. Urban counties in the Far West, Great Lakes, Mideast, and New England experienced a substantial mortality disadvantage in 2020, whereas rural counties in these regions had higher mortality in 2021. In the Southeast, Southwest, Rocky Mountain, and Plains regions, there was a rural mortality disadvantage in 2020, which was exacerbated in 2021. The proportion of excess deaths assigned to Covid-19 was lower in 2020 (76.3%) than in 2021 (87.0%), suggesting that a larger fraction of excess deaths was assigned to Covid-19 later in the pandemic. However, in rural areas and in the Southeast and Southwest a large share of excess deaths was still not assigned to Covid-19 during 2021. SIGNIFICANCE Deaths during the Covid-19 pandemic have been primarily monitored through death certificates containing reference to Covid-19. This approach has missed more than 170,000 deaths related to the pandemic between 2020 and 2021. While the ascertainment of Covid-19 deaths improved during 2021, the full effects of the pandemic still remained obscured in some regions. County-level estimates of excess mortality are useful for studying geographic inequities in the mortality burden associated with the pandemic and identifying specific regions where the full mortality burden was significantly underreported (i.e. Southeast). They can also be used to inform resource allocation decisions at the federal and state levels and encourage uptake of preventive measures in communities with low vaccine uptake.
Subject(s)
COVID-19 , DeathABSTRACT
Introduction A small body of epidemiological research suggests that working in an essential sector is a risk factor for SARS-CoV-2 infection or subsequent disease or mortality. However, there is limited evidence to date on the US, or on how the risks associated with essential work differ across demographic subgroups defined by age, sex, and race/ethnicity. Methods Using publicly available data from the National Center for Health Statistics on deaths occurring in the US in 2020, we calculated per-capita COVID-19 mortality by industry and occupation. We additionally calculated per-capita COVID-19 mortality by essential industry—essential or not—by age group, sex, and race/ethnicity. Results Among non-military individuals and individuals with a known industry or occupation, there were 48,030 reported COVID-19 deaths, representing 25.1 COVID-19 deaths per 100,000 working-age individuals after age standardization. Per-capita age-standardized COVID-19 mortality was 1.96 times higher among essential workers than among workers in non-essential industries, representing an absolute difference of 14.9 per 100,000. Across industry, per-capita age-standardized COVID-19 mortality was highest in the following industries: accommodation and food services (45.4 per 100,000); transportation and warehousing (43.4); agriculture, forestry, fishing and hunting (42.3); mining (39.6); and construction (38.7). Discussion Given that SARS-CoV-2 is an airborne virus, we call for collaborative efforts to ensure that workplace settings are properly ventilated and that workers have access to effective masks. We also urge for paid sick leave, which can help increase vaccine access and minimize disease transmission.
Subject(s)
COVID-19ABSTRACT
Objective: To control a second-wave COVID-19 outbreak, the state of Victoria in Australia experienced one of the world’s first long and strict lockdowns over July-October 2020, while the rest of Australia experienced ‘COVID-normal’ with minimal restrictions. We (1) investigate trajectories of parent/child mental health outcomes; and (2) identify baseline demographic, individual, and COVID-19-related factors associated with mental health trajectories. Method: Online community sample of 1,877 Australian parents with rapid repeated assessment over 10 time-points over April-October, 2020. Measures assessed parent mental health (Depression, Anxiety and Stress Scales-21); child depression symptoms (13-item Short Mood and Feelings Questionnaire); and child anxiety symptoms (four-items from Brief Spence Children’s Anxiety Scale). Results: Mental health trajectories shadowed COVID-19 infection rates. Victorians reported a large peak in mental health symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardized regression coefficient [β]=·09-·39), parent/child diagnoses (β=·11-·22), couple conflict (β=·09-·19), and COVID-19 stressors, such as worry/concern about COVID-19, illness, and loss of job (β=·07-·22), predicted elevated trajectories. Effects of predictors on parent and child mental health trajectories are illustrated in an online interactive app for readers (https://lingtax.shinyapps.io/CPAS_trend/). Conclusion: Our findings provide evidence of worse trajectories of parent and child mental health symptoms associated with strict, sustained, COVID-19 lockdown in Victoria, compared to non-locked states in the rest of Australia. We identified several baseline factors that may be useful in detecting high risk families who are likely to require additional support early on in future lockdowns.
Subject(s)
COVID-19 , Anxiety Disorders , Intellectual DisabilityABSTRACT
Objectives: To examine the subjective wellbeing of Australian parents raising children and adolescents (0-18 years) during ‘stage three’ COVID-19 restrictions (April 2020), in comparison with subjective wellbeing in parents assessed over an 18-year period prior to the pandemic. We also aimed to examine socio-demographic and COVID-19 predictors of subjective wellbeing during the pandemic. Methods: Cross-sectional data were from: (1) the COVID-19 Pandemic Adjustment Survey (CPAS, N=2,365 parents of a child 0-18 years, 8-28th April, 2020); and, (2) a pre-pandemic database bringing together over 18-years of national data on subjective wellbeing (N=17,529 adults living with children, collected in annual surveys over 2002-2019). Results: Levels of subjective wellbeing during the pandemic were considerably lower than ratings prior to the pandemic (Personal Wellbeing Index, mean [SD]=65.3 [17.0]; compared to [SD]=75.8 [11.9], p<0.001). Within the pandemic data, subjective wellbeing was lower in parents with low education, language other-than-English, receiving income assistance (i.e., a government benefit), single parents, and young parents. Subjective wellbeing was also lower in fathers, parents raising a child with a neurodevelopmental condition, parents with physical or mental health problems, and parents reporting COVID-related stressors, such as employment changes, financial strain, negative feelings/attributions about COVID-19, and supervising children while working-from-home. Unexpectedly, parent engagement with news media about the pandemic was associated with higher subjective wellbeing. Conclusion: Subjective wellbeing in parents raising children aged 0-18 years appears to be disproportionately impacted by the COVID-19 pandemic and associated social restrictions in Australia. Specific at-risk groups, for which government intervention may be warranted, include parents in socially disadvantaged contexts, parents with pre-existing mental health difficulties, and parents facing significant COVID-19 related work changes.
Subject(s)
COVID-19 , Intellectual DisabilityABSTRACT
It has been assumed that the COVID-19 pandemic has negatively impacted parental and family relationships due to issues including economic problems, strains of home confinement and social isolation. Despite these assumptions, there has been little research to date investigating the impact of COVID-19 stressors on parents’ relationship wellbeing and loneliness. Hence, there is an insufficient evidence base with which to guide policy or action in this most critical arena. The current study reports data from a large national representative sample (N=1,829) of Australian parents, surveyed during the early phases of the COVID-19 lockdown. Drawing on widely studied relationship models of vulnerability-stress and stress-buffering, Structural Equation Models (SEM) were derived to test the extent that COVID-19 stressors, personal vulnerabilities (mental health problems, attachment insecurity), relationship adaptation processes (constructive communication, partner support), and the interactions between these variables, predicted relationship quality and loneliness. After controlling for pre-pandemic stressors, relationship adaptations buffered the negative effects of COVID-19 stressors and personal vulnerabilities on relationship quality and loneliness. The findings provide support for a model of stress-buffering over a model of vulnerability-stress. The findings have important implications for the identification of parents at risk of relationship difficulties and social disconnection during the pandemic, and for policy and practice in how best to strengthen relationships and human connection during COVID-19.
Subject(s)
COVID-19 , Intellectual DisabilityABSTRACT
The COVID-19 pandemic presents significant risks to the mental health and wellbeing of families. This study aimed to examine: (1) patterns of parent and child (0–18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19 compared to pre-pandemic data; and (2) associations between parent, child, and family outcomes during the pandemic and both pre-existing risk factors and COVID-19 stressors. Participants were Australian mothers (81%) and fathers aged 18 years and over who were parents of a child 0–18 years (N=2,365). Parents completed an online self-report survey assessing mental health, substance use, couple conflict, parenting, and family functioning during ‘stage three’ COVID-19 restrictions in April 2020. Data were compared to pre-pandemic data from four Australian population-based cohorts. Compared to pre-pandemic estimates, during the pandemic period parents reported higher rates of parent mental health symptoms (Cohen’s d=0.26-.81, all p<.001), higher parenting irritability (d=0.17-.46, all p<.001), lower family positive expressiveness (d=-0.18, p<.001), and higher alcohol consumption (22% vs 12% drinking four or more days per week, p<.001). In multivariable analyses, pre-existing financial deprivation and COVID-19 stressors were associated with greater severity in parent and child mental health symptoms, parent emotion dysregulation, parenting irritability, couple conflict and family positive/negative expressiveness. Parents and children with pre-existing mental health conditions had elevated difficulties during the pandemic across most domains. Our data suggest wide-ranging, detrimental family impacts associated with the COVID-19 pandemic; and support policy actions to assist families with financial supports, leave entitlements, and social housing.
Subject(s)
COVID-19ABSTRACT
The present study utilised a strengths-based approach to investigate the association between resilience and indicators of mental health in a large sample of Australian parents at the time of the COVID-19 pandemic. The study was nested within a large longitudinal cohort study of Australian parents of a child aged 0‐18 years. Hierarchical regression models were run to examine the relationship between the variables of interest. Of 2,110 respondents included, 1701 (80.6%) were female. Higher resilience was associated with lower levels of stress, anxiety, and depression. Loneliness was a key contributor to mental health outcomes. An increase in extraversion was associated with improved resilience. The relationship between resilience and depression was influenced by the level of partner support. Interventions targeting mental health of parents at the time of pandemics should focus on reducing loneliness while working with the constraints of imposed social isolation, and to include partners.
Subject(s)
Anxiety Disorders , Intellectual Disability , COVID-19ABSTRACT
Background: The COVID-19 pandemic presents significant risks to the mental health and wellbeing of Australian families. Employment and economic uncertainty, chronic stress, anxiety, and social isolation are likely to have negative impacts on parent mental health, couple and family relationships, as well as child health and development. Objective: This study aims to: (1) provide timely information on the mental health impacts of the emerging COVID-19 crisis in a close to representative sample of Australian parents and children (0-18 years); (2) identify adults and families most at risk of poor mental health outcomes; and, (3) identify factors to target through clinical and public health intervention to reduce risk. Specifically, this study will investigate the extent to which the COVID-19 pandemic is associated with increased risk for parents’ mental health, lower wellbeing, loneliness, and alcohol use; parent-parent and parent-child relationships (both verbal and physical); and child and adolescent mental health problems. Methods: The study aims to recruit a close to representative sample of at least 2,000 adults aged 18 years and over living in Australia who are parents of a child 0-4 years (early childhood, N=400); 5-12 years (primary school N=800); and 13-18 years (secondary school, N=800). The design will be a longitudinal cohort study using an online recruitment methodology. Participants will be invited to complete an online baseline self-report survey (20 minutes) followed by a series of shorter online surveys (10 minutes) scheduled every two weeks for the duration of the COVID-19 pandemic (i.e., estimated to be 14 surveys over 6 months). Results: The study will employ post stratification weights to address differences between the final sample and the national population in geographic communities across Australia. Associations will be analyzed using multilevel modeling with time-variant and time-invariant predictors of change in trajectory over the testing period. Conclusions: This study will provide timely information on the mental health impacts of the COVID-19 crisis on parents and children in Australia; identify communities, parents, families, and children most at risk of poor outcomes; and, identify potential factors to address in clinical and public health interventions to reduce risk.