ABSTRACT
Background To face the second COVID-19 wave, Italy implemented a tiered restriction system with different risk levels (yellow=low;orange=medium, red=high). It is unknown whether the effect of the tiers was equal among provinces with varying levels of socioeconomic deprivation (SED). At each restriction level, we analyzed the impact of the province's SED on the SARS-CoV-2 daily reproduction number (Rt). Methods We considered the Rt (Nov 2020-May 2021) as the dependent variable and the SED as the independent variable. The Rt was estimated using daily incidence data from the Civil Protection Department as the instantaneous Rt. The province SED was measured using the percentage of individuals whose yearly income was less than 10,000€ (2019 data from the Ministry of Economy and Finance). We used multilevel linear regression models with random intercepts stratified by restriction level to estimate the effect of the SED on Rt (β) and its Standard Error (SE). Our analyses adjusted the estimates for the number of days into the tier first and then for other covariates. Results We found different levels and trends of Rt by SED in every restriction. Days-adjusted models found a containing effect for the red and the orange tier, while the Rt had an increasing trend in yellow. Higher SED was associated with higher Rt: β was positive and significant in red (β = 0.004 SE = 0.001) and orange (β = 0.002 SE = 0.001) but not in the lowest tier (β = 0.001 SE = 0.001). We found a significant interaction between the number of days into the restriction and the SED in the complete models. Compared to less deprived, more deprived provinces had slower Rt reduction in the highest tier. However, they had steeper Rt reductions in orange and slower increasing trends in yellow. Conclusions The highest restriction had milder effects in more deprived provinces, while lower tiers were more effective. These results underline the importance of accounting for SED when implementing public health measures. Key messages • Area-level deprivation can modify the effects of public health measures. • Socioeconomic characteristics of the areas should be considered when implementing policies aimed to prevent the spread of epidemics.
ABSTRACT
Background: The impact of the severe acute respiratory syndrome Coronavirus 2 disease (COVID-19) pandemic on people with systemic autoimmune rheumatic diseases (SARDs) remains to be fully established. It is unclear whether SARDs are an independent risk factor for COVID-19 infection and poor outcome. Objectives: The aim of our study is to assess the incidence and prognosis of test-proven SARS-CoV-2 infection during the frst COVID-19 wave in a large population of SARD patients of the Lazio Italian region. Methods: We retrospectively evaluated in a cohort of 4.716.119 subjects aged over 18 years and affiliated to the health system of the Lazio Italian Region, the incidence and 30-day outcomes of COVID-19 infection in 40.490 SARD pts and compared to the affiliated population as incidence rate ratio adjusted for demographics and comorbidities (adjIRR). SARD diagnosis and comorbidities were derived from medical administrative records using the Chronic Related Group classifcation system. Data on COVID-19 infection were derived from a dedicated regional digital network. Results: The risk of COVID-19 infection was increased in patients with Psoriatic Arthritis (adjIRR=1.21, 95% CI 1.10-1.33) and Undifferentiated Connective Tissue Disease (adjIRR=1.26, 95% CI 1.03-1.54). The risk of hospitalisation was higher in patients with Axial Spondylarthritis (adjIRR=2.16, 95% CI 1.45-3.22), and Systemic Vasculitis (adjIRR=1.81, 95% CI 1.07-3.06) while the risk of Intensive care unit admission was higher in Systemic Erythematous Lupus (adjIRR=3.67, 95% CI 1.52-8.83) and primary Sjögren Syndrome (adjIRR=4.13, 95% CI 1.71-9.96) patients. An increased COVID-19 mortality was reported in patients with Rheumatoid Arthritis (adjIRR=1.50, 95% CI 1.04-2.17), Systemic Erythematous Lupus (adjIRR=2.67, 95% CI 1.10-6.44), primary Sjögren Syndrome (adjIRR=2.51, 95% CI 1.12-5.62), and Scleroderma (adjIRR=4.60, 95% CI 2.06-10.29). Conclusion: The incidence of severe COVID-19 is not increased in the same percentage in SARDs. Each SARD presents a peculiar pattern in terms of increased risk of COVID-19 incidence, hospitalisation, intensive care unit admission and death, that is not linked to the immunosuppressive behaviour of the disease.
ABSTRACT
BACKGROUND AND AIMS: Patients with chronic kidney disease (CKD) represent a frail population with severe co-morbidities and different degrees of immune dysfunction. These patients might be at higher risk of SARS-CoV-2 infection and might experience severe consequences of COVID-19. In March 2020, the Lazio Regional Dialysis and Transplantation Registry (LRDTR) implemented a questionnaire to obtain information on dialysis patients who have developed SARS-CoV-2 infection. The aims of this study is to evaluate the incidence and the short-term lethality of SARS-CoV-2 infection in the population undergoing dialysis treatment in Lazio Region. METHOD: A cohort of patients treated in the dialysis units of Lazio Region was enrolled. Prevalent dialysis patients at 1/1/2020 and incident patients during the period 01/01/2020-08/01/2020 were included. The LRDTR collects information on dialysis patients from the start of chronic dialysis treatments with biannual update and immediately informing about the end of dialytic treatment (death, renal transplant, etc). Infection was traced in the LRDTR from March 2020 to 08/13/2020. The information on vital status was obtained from LRDTR and the mortality Lazio registry up to 10/30/2020. Poisson models, crude and adjusted for sex and age, were used to estimate incident rate of infection and mortality rate on dialysis patients and on dialysis patients who have developed SARS-CoV-2 infection, and respective confidence intervals of 95% (CI95%). RESULTS: During the study period, the estimate of the number of patients undergoing dialysis treatment was 5196 in Lazio Region, 65% were males with mean age of 70 years. Thirty-seven patients were infected with SARS-CoV-2: 70% males, mean age 73 years. These patients were treated in 24 different dialysis units. The cumulative incidence rate of SARS-CoV-2 infection was 0.71% (95% CI 0.52-0.98) and the adjusted incidence rate was 3.3 ∗100,000 Person Days (PD) (95% CI 2.4-4.7). The distribution of positive swabs by month was: 21 in March 7 in April, 6 in May, 1 in June, 2 in July. Twenty-seven patients had symptoms while 10 patients, who have had contact with infected individuals, had positive swabs in absence of symptoms. Infected and hospitalised dialysis patients were 78%. Of the 29 hospitalized patients: 6 were in sub-intensive care, 16 in intensive care, of these 7 needed intubations, 9 underwent non-invasive ventilation. The adjusted cumulative mortality rate in dialysis patients was 6.8% (95% CI 6.0-7.6), the same measure for SARS-CoV-2 infected patients was 37.4% (95% CI 19.8-70.4) with an average follow-up of 205 PD. The adjusted mortality rate was 3.3 ∗ 10,000PD (95% CI: 2.9-3.7) among dialysis patients and 21.2∗10,000PD (95% CI: 11.1-40.7) among infected dialysis patients. CONCLUSION: This study highlights a greater susceptibility of dialysis patients to SARS-CoV-2 infection, with a rate three times higher than that observed in the general population (source: Civil Protection Department). Mortality risk for dialysis patients with SARS-CoV-2 infection is about 6 times higher than in the dialysis patients it suggesting a major impact of infection on this fragile population.