ABSTRACT
Background Accumulated evidence on risk factors for adverse COVID-19 outcomes revealed that old age and male sex are main associates, next to pre-existing comorbidities, as analysed from scattered single cohorts of hospitalised COVID-19 patients of accessible electronic medical records. Hence, evidence from federated analyses is called for to provide a more comprehensive and robust analyses of risk factors. Methods Using the unCoVer network, i.e., a research platform of 29 partners for the expert use of patient data as routinely gathered in real-world healthcare settings, present analyses restricted to available data of four hospitals from Spain, Slovakia, Romania and Bosnia and Herzegovina covering 8,287 hospitalised COVID-19 patients. In-hospital death after COVID-19 diagnosis was examined in relation to common pre-existing comorbidities using virtual pooling of logistic regression models adjusted for age and sex. Results Patients were on average 60.1 (± 20.9) years, 50.7% were male, almost half (43.3%) had at least one pre-existing comorbidity (17.4% having obesity, 21.9% hypertension, 18.0% diabetes and 13.7% cardiovascular diseases (CVD)), and 12.6% died during hospitalisation. Patients with comorbidities had a higher risk of mortality that was increasing with the number of comorbidities: from a virtual pooled odds ratio of 1.16 (95%CI: 0.96, 1.40) for one vs none to 1.30 (1.04, 1.64) and 2.14 (1.64, 2.79) for two and three or more comorbidities, respectively. Of the comorbidities, highest risk was seen for CVD (1.68;1.40, 2.01), followed by hypertension (1.40;1.19, 1.64) and diabetes (1.27;1.07, 1.50), and the lowest for obesity (1.13;0.94, 1.37). Conclusions By federated analyses, this study confirmed that the number of comorbidities was a strong risk factor for in-hospital death after COVID-19, in particular CVD. The unCoVer platform pursues using scattered data sources by innovative computational resources and integrated information for enhanced impact. Key messages Federated analyses, capable of streamlining ethical and legal aspects, provide unique opportunities for robust results to inform public health. Higher COVID-19 in-hospital mortality risk with increasing number of comorbidities.
ABSTRACT
Background During the COVID-19 pandemic, most settings experienced healthcare service disruptions. The majority of cytological screening procedures were postponed to focus on assisting patients infected with COVID-19. In this study, we aimed to analyse the impact of the impact of the COVID-19 pandemic on the uptake of cervical cancer screening in Slovakia. Methods Data on cytological screening procedures were obtained from two of the three health insurance companies in Slovakia for the years 2019 and 2020, covering the population of women aged 15 and older. All data were calculated stratified for age groups. Rates of cytological screenings were calculated as the number of procedures per women registered in the insurance company in the same age group and rate ratios were calculated as ratios of the rates for the years 2020 and 2019 for the same age group. Incidence rates were calculated as the number of newly diagnosed cervical cancer cases per women registered in the insurance company in the respective year. Results Rate ratios of cytological screening procedures revealed that in both examined health insurance companies, the rate of cytological exams was lower in 2020 compared to 2019 (0.95 and 0.89). This was observed across all age groups. The results showed a clear and statistically significant age gradient, indicating that the level of disruption increased with age. The age group 60-69 years had the highest incidence rate of cervical cancer in 2019, at 54.3 per 100 000. In 2020, the highest rate was 48.3 in the age group 50-59 years. The lowest rates were in children and young adults (<20 years). Conclusions This study confirms the significant impact of the pandemic on cervical cancer screening uptake in Slovakia, which may have delayed the diagnosis of cervical cancer into later stages of the disease with a worse prognosis. This may lead to increased mortality and years lived with disability due to this disease in Slovakia. Key messages • Disruptions in cervical cancer screenings were observed in Slovakia during the COVID-19 pandemic which may result in an increase in cervical cancer incidence and mortality. • Strategies should be implemented to maintain cancer screening programs during health emergencies to avoid excessive mortality and morbidity.