ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) had been a stronger hit in Deep South compared with other developed regions in the United States, and vaccination remains a top priority for all eligible individuals. However, there are limited data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age group, which is of critical importance for future vaccine planning. Racial/ethnic disparities were found in the COVID-19 vaccination, but the vast majority of evidence was generated from studies at the individual level. There is an urgent need for evidence at the population level to reveal and evaluate the booster coverage in racial/ethnic minority communities, which could identify vulnerable communities and inform future healthcare policymaking and resource allocation. We evaluated county-level COVID-19 booster coverage by age group in the Deep South and examined its relationship with residential segregation. Method(s): We conducted an ecological study at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of five Deep South states from December 15, 2021 to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster coverage by age group (e.g., 12 to 17 years old, 18 to 64 years old, and at least 65 years old) by the end of the study period. We examined the longitudinal relationships between residential segregation, interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson mixed model. Result(s): As of October 19, 2022, among the 418 counties, the median percentage of booster coverage was 40% (interquartile range [IQR]: 37.8-43.0%). Compared with elders, youth and adults had lower percentages of booster uptake. There was geospatial heterogeneity in the COVID-19 booster coverage. Results of the Poisson mixed model found that as time increased, higher segregated counties had lower percentages of booster coverage. Such relationships were consistent across the age groups. Conclusion(s): The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccine planning should focus on youth and adults. Healthcare facilities and resources are needed in racial/ethnic minority communities. Residential segregation and COVID-19 booster coverage by age group in the 418 counties across the five Deep South states from December 15, 2021 to October 19, 2022.
ABSTRACT
Background: Long-term consequences of COVID-19 are well characterized in general populations. Yet it remains unclear how existing HIV infection attributes to the risks of long-term consequences in people with coinfection of HIV/SARSCoV- 2. This study aims to examine the long-term consequences of people living with HIV (PLWH) at 12 months after the first SARS-CoV-2 infection. Method(s): Using the National COVID Cohort Collaborative (N3C), Electronic Health Records (EHR) sampled from 50 states and over 75 healthcare systems in the US, we constructed a cohort of PLWH with COVID-19 between March 1, 2020 and January 15, 2021, a historical control group (HIV individuals without COVID-19 between March 1, 2018 and January 15, 2019, two years predating the pandemic), and a contemporary control group (PLWH without COVID-19 between March 1, 2020 and January 15, 2021) to mitigate time/selection biases. The time of HIV infection was before March 1, 2020 for the cases and contemporary controls and, before March 1, 2018 for historical controls. The date of the first COVID-19 infection marked the start of a 12-month follow-up in the COVID-19 group. The start of follow-up in the contemporary controls was assigned by matching the same distribution of start dates of COVID-19 cases. We used logistic regression to examine odds ratios of health consequences at 12 months post COVID-19 comparing against contemporary and historical controls, respectively. Result(s): We identified 5,619, 41,791, and 24,240 patients for COVID-19 cases, contemporary controls, and historical controls, respectively. The COVID-19 group had significantly higher odds in acute respiratory distress syndrome [OR: 3.45, 95% CI (2.98, 3.99)], hypertension [OR: 1.41, 95% CI (1.29, 1.54)], congestive heart failure [OR: 1.36, 95% CI (1.14, 1.63)], myocardial infarction [OR: 1.51, 95% CI (1.22, 1.86)], and diabetes [OR: 1.62, 95% CI (1.42, 1.84)], compared to contemporary controls. Odds in these outcomes were significantly higher when compared to historical controls (Figure 1). Conclusion(s): This sentinel study for the first time reported elevated risks of multi-system dysfunction (i.e., respiratory, cardiovascular, and metabolic) among PLWH at 12 months post COVID-19. To our knowledge, it is the largest EHR cohort study assessing long-term consequences in PLWH. Our findings call for immediate attention to the post-COVID care among PLWH, including followup guidelines, care planning, and health policy tailored for PLWH.
ABSTRACT
INTRODUCTION: Existing studies examining the impact of the pandemic on engagement in HIV care often capture cross-sectional status, while lacking longitudinal evaluations. This study examined the impact of the pandemic on the longitudinal dynamic change of retention in care and viral suppression status. METHOD(S): The electronic health record (EHR) data of this population-level cohort study were retrieved from the statewide electronic HIV/AIDS reporting system in South Carolina (SC). The study population was people with HIV (PWH) who had at least one year's symmetric follow up observation record before and after the pandemic. Multivariable generalized linear mixed regression models were employed to analyze the impact of the pandemic on these outcomes, adjusting for socio-demographic characteristics and preexisting comorbidities. RESULT(S): In the adjusted models, PWH had a lower likelihood of retention in care (adjusted odds ratio [aOR]: 0.806, 95%CI: 0.769, 0.844) and a higher probability of virological failure (aOR: 1.240, 95%CI: 1.169, 1.316) during the peri-pandemic period than pre-pandemic period. Results from interaction effect analysis from each cohort revealed that the negative effect of the pandemic on retention in care was more severe among PWH with high comorbidity burden than those without any comorbidity;meanwhile, a more striking virological failure was observed among PWH who reside in urban areas than in rural areas. CONCLUSION(S): The COVID-19 pandemic has a negative impact on retention in care and viral suppression among PWH in South Carolina, particularly for individuals with comorbidities and residing in urban areas. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
ABSTRACT
Geospatial social media (GSM) data has been increasingly used in public health due to its rich, timely, and accessible spatial information, particularly in infectious disease research. This review synthesized 86 research articles that use GSM data in infectious diseases published between December 2013 and March 2022. These articles cover 12 infectious disease types ranging from respiratory infectious diseases to sexually transmitted diseases with spatial levels varying from the neighborhood, county, state, and country. We categorized these studies into three major infectious disease research domains: surveillance, explanation, and prediction. With the assistance of advanced computing, statistical and spatial methods, GSM data has been widely and deeply applied to these domains, particularly in surveillance and explanation domains. We further identified four knowledge gaps in terms of contextual information use, application scopes, spatiotemporal dimension, and data limitations and proposed innovation opportunities for future research. Our findings will contribute to a better understanding of using GSM data in infectious diseases studies and provide insights into strategies for using GSM data more effectively in future research.
ABSTRACT
Background: HIV infection might accelerate aging process and people living with HIV (PLWH) have been observed to have a higher risk of severe COVID-19 outcomes. However, it is unclear whether the worse COVID-19 outcomes can be attributed to the accelerated aging process. This study aimed to examine: 1) the causal effect of HIV infection on severe COVID-19 outcomes;and 2) the threshold of age difference at which PLWH and non-HIV patients will have comparable COVID-19 outcomes. Methods: We identified COVID-19 positive adults between Jan 1, 2020, and Oct 18, 2021, from the U.S. National COVID Cohort Collaborative (N3C), a nationally-sampled electronic medical record repository. We identified PLWH by clinical diagnosis, drug exposure, and laboratory results. Among COVID-19 cases, PLWH were matched 1:1 to non-HIV persons using exact matching (by gender, race, and ethnicity) and propensity score matching (PSM) (by age, gender, race, ethnicity, and pre-COVID comorbidities). To determine age threshold, PLWH were matched to older non-HIV patients with an age differences between 1 to 15 years. We used conditional logistic regression for exact matched data and standard logistic regression for PSM data. Subgroup analyses stratified by CD4 counts (≥200 or CD4<200 cells/mm) were also conducted. Results: Among a total of 2,422,870 COVID-19 positive adults, we identified 15,188 PLWH. Among PLWH with CD4 data, 872 (14.03%) had CD4<200. Using exact match, PLWH had a significantly higher odds of COVID-19-associated hospitalization [OR: 1.95, 95%CI:(1.88,2.02)] or death [OR: 2.05, 95%CI:(1.90,2.22)] compared to non-HIV persons. By repeating PSM modeling with incrementally increasing ages, PLWH persistently had a higher risk of death compared to non-HIV persons until the age difference reached 6 years, while the threshold of age difference for the comparable hospitalization outcome extended to 14 years. Furthermore, when matching PLWH with CD4<200 with non-HIV persons, the threshold of age difference increased to 10 years for similar odds of mortality and at least 15 years for similar odds of hospitalization. PLWH with CD4≥200 more likely to be hospitalized, though had similar outcomes for death, than non-HIV persons. Conclusion: We find that the worse COVID-19 outcomes, among PWH may be potentially related to aging in HIV. Further investigation of the biological mechanisms at the intersections of HIV infection itself (eg, lower CD4 counts) and accelerated aging in HIV causing worse COVID-19 outcomes is needed.