ABSTRACT
Background and Objectives: Circulatory System Diseases (CSD) patterns vary over time and between countries, related to lifestyle risk factors, associated in turn with socio-economic circumstances. Current global CSD epidemics in developing economies are similar in scale to those observed previously in the USA and Australasia. Australia exhibits an important macroeconomic phenomenon as a rapidly transitioning economy with high immigration throughout the 19th and 20th centuries. We wished to examine how that historical immigration related to CSD patterns subsequently. Methods and Setting: We provide a novel empirical analysis employing census-derived place of birth by age bracket and sex from 1891 to 1986, in order to map patterns of immigration against CSD mortality rates from 1907 onwards. Age-specific generalised additive models for both CSD mortality in the general population, and all-cause mortality for the foreign-born (FB) only, from 1910 to 1980 were also devised for both males and females. Results: The % FB fell from 32% in 1891 to 9.8% in 1947. Rates of CSD rose consistently, particularly from the 1940s onwards, peaked in the 1960s, then declined sharply in the 1980s and showed a strong period effect across age groups and genders. The main effects of age and census year and their interaction were highly statistically significant for CSD mortality for males (p < 0.001, each term) and for females (p < 0.001, each term). The main effect of age was statistically significant for all-cause mortality minus net migration rates for the FB males (p =0.005) and for FB females, both age (p < 0.001) and the interaction term (p=0.002) were significant. Conclusions: We argue our empirical calculations, supported by historical and socio-epidemiological evidence, employing immigration patterns as a proxy for epidemiological transition, affirm the lifecourse hypothesis that both early life circumstances and later life lifestyle drive CSD patterns.
Subject(s)
Mastocytosis, SystemicABSTRACT
The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in long term care facilities to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff, and visitors. Databases (including MedRXiv pre-published repository) were systematically searched to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff, or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities, and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2-85.4% in residents and 0.6-62.6% in staff. Mortality rates ranged from 5.3-55.3% in residents. Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in long term care facilities.