ABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have exacerbated existing socioeconomic inequalities in health. In Argentina, public hospitals serve the poorest uninsured segment of the population, while private hospitals serve patients with health insurance. This study aimed to assess whether socioeconomic inequalities in low birth weight (LBW) risk changed during the first wave of the COVID-19 pandemic. METHODS: This multicenter cross-sectional study included 15929 infants. A difference-in-difference (DID) analysis of socioeconomic inequalities between public and private hospitals in LBW risk in a pandemic cohort (March 20 to July 19, 2020) was compared with a prepandemic cohort (March 20 to July 19, 2019) by using medical records obtained from ten hospitals. Infants were categorized by weight as LBW < 2500 g, very low birth weight (VLBW) < 1500 g and extremely low birth weight (ELBW) < 1000 g. Log binomial regression was performed to estimate risk differences with an interaction term representing the DID estimator. Covariate-adjusted models included potential perinatal confounders. FINDINGS: Of the 8437 infants in the prepandemic cohort, 4887 (57â¢9%) were born in public hospitals. The pandemic cohort comprised 7492 infants, 4402 (58â¢7%) of whom were born in public hospitals. The DID estimators indicated no differences between public versus private hospitals for LBW risk (-1â¢8% [95% CI -3â¢6, 0â¢0]) and for ELBW risk (-0â¢1% [95% CI -0â¢6, 0â¢3]). Significant differences were found between public versus private hospitals in the DID estimators (-1â¢2% [95% CI, -2â¢1, -0â¢3]) for VLBW risk. The results were comparable in covariate-adjusted models. INTERPRETATION: In this study, we found evidence of decreased disparities between public and private hospitals in VLBW risk. Our findings suggest that measures that prioritize social spending to protect the most vulnerable pregnant women during the pandemic contributed to better birth outcomes. FUNDING: No funding was secured for this study.
ABSTRACT
Editorial.
Subject(s)
COVID-19 , Education, Medical , Editorial Policies , Humans , Pandemics , SARS-CoV-2ABSTRACT
Introduction: In the context of the COVID-19 pandemic, WHO published considerations regarding people with disabilities. The aim of this work was to know if these considerations can be fulfilled and if there are differences in their fulfillment between age groups. Method: Descriptive study aimed at people with disabilities in Argentina. A survey was conducted about the four WHO recommendations for this population in online mode, between the 28th and 39th days of preventive and compulsory social isolation. Statistical analysis was according to the nature of the variables, X2 with Fisher's correction was used to determine the differences between groups. Results: 309 surveys were collected from 18 provinces of Argentina. 230(74.4%[69.1-79.1]) were answered by caregivers and 79(25.5%[20.7-30.7]) by people with disabilities. Persons with disabilities were 138(44.7%[39.0-50.4]) children and adolescents and 171(55.3%[49.5-60.9]) adults and older adults. People with disabilities were able to comply with the WHO recommendations regarding reducing exposure to COVID-19 and to be prepared in case of contracting it. There were difficulties in the number of caregivers needed, since 266(66.6%[61.0-71.8]) have this possibility, and difficulties in 55(32.1%[25.1-39.6]) adults and older adults that do not carry out educational-therapeutic activities. There are feelings of anxiety, distress, or depression in people with disabilities and their caregivers. Conclusion: In Argentina, it is possible to comply with the WHO recommendations to avoid exposure to the virus and to be prepared in case of infection. Challenges remain to be solved in terms of accompanying people with disabilities in their physical and mental health.
Introducción: En el contexto de la pandemia del COVID-19 la OMS publicó consideraciones relativas a las personas con discapacidad. El objetivo del trabajo fue conocer si estas consideraciones pueden cumplirse y si existen diferencias en su cumplimiento entre grupos etarios. Método: Estudio descriptivo dirigido a personas con discapacidad de Argentina. Se realizó una encuesta sobre las cuatro recomendaciones de la OMS para esta población en modalidad online, entre los días 28° y 39° del aislamiento social preventivo y obligatorio. El análisis estadístico fue según naturaleza de las variables, para determinar las diferencias entre grupos se usó X2 con corrección de Fisher. Resultados: Se recolectaron 309 encuestas de 18 provincias de Argentina. 230(74,4%[69,1-79,1]) fueron respondidas por cuidadores y 79(25,5%[20,7-30,7]) por personas con discapacidad. Las personas con discapacidad fueron 138(44,7%[39,0-50,4]) niños, niñas y adolescentes y 171(55,3%[49,5-60,9]) adultos y adultos mayores. Las personas con discapacidad pudieron cumplir con las recomendaciones de la OMS en cuanto a disminuir la exposición a COVID-19 y estar preparados en caso de contraerlo. Hubo dificultades en la cantidad de cuidadores necesarios, ya que 266(66,6%[61,0-71,8]) tiene esta posibilidad, y en que 55(32,1%[25,1-39,6]) adultos y adultos mayores no realizan actividades educativas-terapéuticas. Existen sentimientos de ansiedad, angustia o depresión en personas con discapacidad y sus cuidadores. Conclusión: En Argentina se está pudiendo cumplir con las recomendaciones de la OMS para evitar la exposición al virus y estar preparados en caso de contagio. Quedan desafíos por resolver en cuanto al acompañamiento de las personas con discapacidad en su salud física y mental.