ABSTRACT
Objectives: Social determinants of health (SDoH) including income, education, employment, and housing are known to affect health outcomes;while use in real-world database studies are limited. This study assessed socioeconomic differences in burden of disease and utilization of COVID-19 specific medications in a large cohort of patients in the US. Method(s): A total of 17,682,111 patients having a COVID-19 diagnosis between 4/1/2020 and 4/30/2022 were identified in the IQVIA longitudinal medical and pharmacy claims databases of >277 million patients. For SDoH, a 3-digit zip code median Area Deprivation Index (ADI) (v2.0 University of Wisconsin School of Medicine and Public Health 2015) was calculated for each patient, maintaining patient privacy. The ADI is a validated tool ranking neighborhoods by socioeconomic disadvantage. Medical and pharmacy utilization was assessed and stratified by ADI pentiles, where 0-20 was the least disadvantaged, and 81-100 was the most disadvantaged. Result(s): The proportion of patients having a claim with COVID-19 diagnosis was higher in the most disadvantaged (7.75%) compared to the least disadvantaged group (5.94%) (US overall: 6.37%). Medical claims prior to COVID-19 diagnosis were highest in the least disadvantaged, while prior pharmacy utilization was highest in the most-disadvantaged group. There was sparse use of COVID-19 medications overall;the least disadvantaged patients had the lowest use of COVID-19 specific medications. Casirivimab/imdevimab use was highest in the 61-80 (2.01%) and 81-100 (1.79%) ADI groups, and remdesivir use was highest in the moderately disadvantaged (ADI 41-60 and 61-80) groups (both 2.33%). Utilization of hydroxychloroquine (unapproved for COVID-19) increased from 0.91% in the least to 2.13% in the most disadvantaged groups. Conclusion(s): This study shows unequal burden of COVID-19 prevalence by SDoH, with the most disadvantaged having a higher disease burden and utilization of certain approved and unapproved COVID-19 medications, highlighting the need for further study of the reasons for these disparities.Copyright © 2023
ABSTRACT
Objectives: COVID-19 infected over 150 million people and caused over 1 million deaths in the US. This study evaluates several variables thought to be associated with mortality risk in the COVID-19 population. Method(s): The IQVIA longitudinal medical and pharmacy claims databases identified 17,682,111 patients with a COVID-19 diagnosis between 4/1/2020-4/30/2022 from a population of >277 million patients in the US. Patients were linked to Veritas Data Research fact-of-death records (90% complete compared to CDC reporting) and confirmed deaths were flagged. Confirmed mortality rates (CMR) were evaluated by age group, socioeconomic status (SES) using the Area Deprivation Index (v2.0, University of Wisconsin, 2015), co-morbidities and COVID-specific (approved and unapproved) treatments. Result(s): Of the 563,744 patients (3.2%) identified as dead (3.67% in men, 2.85% in women overall), CMR was lowest in patients aged 0-17 (0.08%), highest in age 65-75 (5.92%) and >75 (16.40%). Patients in the lowest 40% of SES had CMR of 4.43% while in the highest 20% was 1.56%. Respiratory failure, pneumonia and sepsis were the most common acute diagnoses accompanying COVID-19 deaths in all SES. In patients with comorbid dementia or Alzheimer's disease, CMR were 21.62% and 23.40% respectively. Additionally, congestive heart failure (15.79%), atrial fibrillation (15.50%), chronic kidney disease (15.30%) and COPD (12.19%) were associated with high CMR. Among patients receiving approved therapies, casirivimab/imdevimab and remdesivir had CMR of 1.41% and 12.63% respectively, while for those receiving unapproved therapies, ivermectin and hydroxychloroquine had CMR of 2.54% and 2.45%. Conclusion(s): Compared to the 1.1% case-mortality rate (Johns Hopkins 2023) among US COVID-19 patients, we found CMR exceeded 3% among those with a medical claim for COVID-19. Advanced age, dementia, and cardio-renal disease were associated with mortality. Patients with the lowest SES had approximately 3 times the confirmed mortality rate compared to those in the highest SES group.Copyright © 2023
ABSTRACT
Objectives: According to the CDC, as of December 2022, almost one in three Americans had confirmed COVID-19 infection;yet only a small portion generated healthcare claims related to COVID-19. Higher burden of COVID-19 cases in Northeastern states compared to other US regions has been documented. This study examined the regional variation in demographic characteristics and treatment patterns among patients with a claim for COVID-19 in a nationwide US claims database. Method(s): Analysis of data from over 277 million patients in IQVIA's longitudinal medical and pharmacy claims databases resulted in a cohort of 17,682,111 patients with COVID-19 diagnosis between 4/1/2020 and 4/30/2022. Demographic characteristics and treatment rates for key approved and un-approved COVID-19 therapies were assessed and stratified by region. Result(s): Among patients in the database, 6.4% had a COVID-19 diagnosis. The proportion was higher in the Northeast (7.1%) and South (6.9%) compared with the West (4.8%). The highest proportion of patients were aged 18-44 years (32.7% in South to 35.2% in West). Over a fifth of the patients were >= 65 years old (US overall= 23.7%;22.5% in Northeast to 25.8% in Midwest). Approximately 57% of the patients nationally and within each region were women. For approved medications, utilization ranged from 1.7% in Northeast to 2.7% in Midwest (overall:2.2%) for remdesivir;0.7% in Northeast to 2.2% in South (overall: 1.5%) for casirivimab/imdevimab. For unapproved medications, utilization ranged from 0.9% in Northeast to 1.6% in South (overall:1.3%) for hydroxychloroquine and 0.4% in Northeast to 1.8% in South (overall:1.1%) for ivermectin. Conclusion(s): Less than one in five US cases of COVID-19 had a claim with diagnosis of COVID-19. Use of COVID-19 specific medications remained low throughout the pandemic. Despite the higher disease burden, proportion of patients with claims and receiving COVID-19 treatment were low nationally, particularly in the northeast US region.Copyright © 2023
ABSTRACT
Background Delta and Omicron are two main variants that have been prevalent since 2021. However, the Omicron variant of severe acute respiratory syndrome coronavirus 2 shows a less severe clinical presentation and high transmissibility. Therefore, we carried out this retrospective study to evaluate Omicron severity compared with the Delta variant and further comprehend the differences in clinical characteristics in patients with the Omicron variant. Methods We extracted clinical data and compared clinical severity, symptoms, vaccination status, laboratory parameters, viral shedding time, and computed tomography (CT) imaging between the two groups of patients, which included 109 COVID-19 cases with the Delta variant and 183 cases with the Omicron variant, from January 19 to April 1, 2022, in Beijing Ditan Hospital. In addition, the Beijing Center for Disease Prevention and Control conducted whole-genome sequencing. Results We obtained 94 strains of variants of concern/Delta and 110 strains of variants of concern/Omicron. For the 110 Omicron strains, three were assigned as BA.1.1, 53 as BA.2, and 54 as BA.2.2. Among patients with the Delta variant, 54% (59/109) were moderate, which was significantly higher than that of patients with the Omicron variant (7% (12/183), P < 0.001). The number of patients with mild symptoms in the Omicron group was significantly higher than in the Delta group (80% vs. 35%, P < 0.001). Compared with the Omicron group, patients with underlying diseases or obesity, 60 years or older, or unvaccinated in the Delta group had more severe disease, and there was a significant difference between the two groups. The viral shedding time in the Omicron group was shorter than in the Delta group ((11.9 ± 5.9) vs. (14.0 ± 5.8) days, P = 0.003). Among the 183 patients in the Omicron group, 104 (57%) had dry or sore throat symptoms, more than those in the Delta group (34% (37/109);P < 0.001). In the Delta group, patients in the moderate group had more fever and cough symptoms than those in the mild group. The remission time of CT imaging in the Omicron group was shorter than in the Delta group ((9.0 ± 5.2) vs. (13.2 ± 4.2) days, P = 0.018). Conclusions Patients with Delta variants are more likely to have pneumonia, mainly with fever and cough symptoms, while patients with the Omicron variant are mostly mild, with more prominent dry or sore throat symptoms. In addition, patients with the Omicron variant have a short viral shedding time and rapid absorption of pneumonia. © Wolters Kluwer Health, Inc. All rights reserved.
ABSTRACT
Objective To explore the occurrence and influencing factors of serum uric acid elevation in patients with coronavirus disease 2019 (COVID-19) treated with favipiravir. Methods Medical records of patients with COVID-19 who were hospitalized in Beijing Ditan Hospital between June 1, 2020 and June 30, 2021 and treated with the 5- or 10-day regimen of favipiravir were collected and retrospectively analyzed. After favipiravir withdrawal, if the elevation in serum uric acid was >=30% of baseline level, it was defined as serum uric acid elevation. Then patients were divided into serum uric acid elevation group and non-serum uric acid elevation group. The clinical characteristics such as gender, age, body mass index, comorbidities, smoking and drinking behavior, COVID-19 grade, favipiravir regimen, and serum uric acid level and renal function before treatment in patients between the 2 groups were compared. Influencing factors of favipiravir-associated serum uric acid elevation was analyzed using multivariate logistic regression method. Results A total of 179 patients were included in the analysis, including 104 (58.1%) males and 75 (41.9%) females, aged from 19 to 70 years with a median age of 43 years. The level of serum uric acid in 179 patients after favipiravir treatment was significantly higher than before [(451+/-119) mumol/L vs. (332+/-94) mumol/L, P<0.001]. The change rate of serum uric acid from baseline level ranged from -57.1% to 157.8% with the median of 38.6%. The elevation in serum uric acid of >= 30% of baseline level occurred in 108 (60.3%) patients. The incidences of serum uric acid elevation in patients treated with 5-day and 10-day regi- mens of favipiravir were 46.8% (36/77) and 70.6% (72/102), respectively, and the difference between them was significant (P=0.001). Multivariate logistic regression analysis showed that body mass index 24.0 to <28.0 kg/m2 (OR=3.109, 95%CI: 1.209-7.994, P=0.019) and 10-day regimen of favipiravir (OR=3.017, 95%CI: 1.526-5.964, P=0.001) were independent risk factors for favipiravir-associated serum uric acid elevation. Conclusions More than half of COVID-19 patients treated with favipiravir can develop serum uric acid elevation. Overweight and 10-day regimen of favipiravir are independent risk factors for serum uric acid elevation in patients.Copyright © 2022 Adverse Drug Reactions Journal.
ABSTRACT
The current environment is complex and uncertain. COVID-19 not only brings challenges to the government’s public health governance, but also disrupts the industrial supply chain and poses a crisis to the survival and transformation development of enterprises, which has raised severe tests to the resilience of enterprises and has also become an important issue for scholars to study. The existing academic research and practical experience show that resilience is the key ability to support enterprises to survive the crisis, and stability and adaptability are the main characteristics of resilient enterprises. Stable performance improves enterprise operation efficiency, and adaptability improves strategic flexibility. This paper focuses on the quantitative study of enterprise resilience, analyzes the relationship between stability and adaptability from the perspective of paradox, and selects efficiency and flexibility as discriminant variables from the outcomes of resilience. Based on the financial data of the resilient enterprises and the control group, the variables affecting the resilience of enterprises were determined by discriminant analysis and the measurement indexes were constructed to establish the calculation method of enterprise resilience. By calculating the scores of resilient enterprises and the control group, it is found that the scores of resilient enterprises are significantly higher than the control group in terms of stability and adaptability, which verifies the paradoxical relationship between them. This shows that the resilient firm is not an either-or choice between stability and adaptability, and there is a continuously distributed behavior space between them. Therefore, resilient enterprises adapt to the changing and highly uncertain business environment through constant change and innovation while maintaining the bottom line of survival in the crisis. © 2022, Editorial Board of Journal of Systems Engineering Society of China. All right reserved.
ABSTRACT
Objective To explore the occurrence and influencing factors of serum uric acid elevation in patients with coronavirus disease 2019 (COVID⁃19) treated with favipiravir. Methods Medical records of patients with COVID⁃19 who were hospitalized in Beijing Ditan Hospital between June 1, 2020 and June 30, 2021 and treated with the 5- or 10-day regimen of favipiravir were collected and retrospectively analyzed. After favipiravir withdrawal, if the elevation in serum uric acid was ≥30% of baseline level, it was defined as serum uric acid elevation. Then patients were divided into serum uric acid elevation group and non-serum uric acid elevation group. The clinical characteristics such as gender, age, body mass index, comorbidities, smoking and drinking behavior, COVID⁃19 grade, favipiravir regimen, and serum uric acid level and renal function before treatment in patients between the 2 groups were compared. Influencing factors of favipiravir⁃associated serum uric acid elevation was analyzed using multivariate logistic regression method. Results A total of 179 patients were included in the analysis, including 104 (58.1%) males and 75 (41.9%) females, aged from 19 to 70 years with a median age of 43 years. The level of serum uric acid in 179 patients after favipiravir treatment was significantly higher than before [(451±119) μmol/L vs. (332±94) μmol/L, P<0.001]. The change rate of serum uric acid from baseline level ranged from -57.1% to 157.8% with the median of 38.6%. The elevation in serum uric acid of ≥ 30% of baseline level occurred in 108 (60.3%) patients. The incidences of serum uric acid elevation in patients treated with 5-day and 10-day regi⁃ mens of favipiravir were 46.8% (36/77) and 70.6% (72/102), respectively, and the difference between them was significant (P=0.001). Multivariate logistic regression analysis showed that body mass index 24.0 to <28.0 kg/m2 (OR=3.109, 95%CI: 1.209-7.994, P=0.019) and 10-day regimen of favipiravir (OR=3.017, 95%CI: 1.526-5.964, P=0.001) were independent risk factors for favipiravir⁃associated serum uric acid elevation. Conclusions More than half of COVID⁃19 patients treated with favipiravir can develop serum uric acid elevation. Overweight and 10-day regimen of favipiravir are independent risk factors for serum uric acid elevation in patients. © 2022 Adverse Drug Reactions Journal.
ABSTRACT
Using bibliometric analysis, this research provides a comprehensive, systematic, and visual overview of 441 studies related to smart tourism, which were published between 2010 and 2021, thus considering the state of research and trends in this research field from the beginning of smart tourism research to the entry of the fifth-generation mobile communication technology era and the explosion of COVID-19. It also offers insights into its future research agenda and advancing the development of smart tourism. This paper can provide intuitive and valuable information to promote theoretical and practical research on smart tourism.
ABSTRACT
Objective: To understand the psychological status and influencing factors of college students during the online teaching under the COVID-19 outbreak, so as to provide scientific basis for the mental health education of the population group in the future. Methods: Using the method of stratified cluster sampling and self-compiled questionnaire, the students of a vocational college in Hebei province were investigated by network questionnaire. Results: Among the 4827 college students surveyed, 1138 showed anxiety, with a detection rate of 23.6%. The detection rate of depression was 10.7% in 516 patients. The incidence of anxiety was 21.4% in boys and 24.6% in girls (chi2=6.024,P=0.014);The incidence of depression was 9.4% in boys and 11.3% in girls (chi 2=4.248, {mathrm {P}}=0.039);The results of the unconditioned Logistic regression showed that: female and senior students with poor hardware and network conditions, dissatisfaction with online teaching, difficulty in completing homework, and poor self-control were more likely to suffer from anxiety. The OR values(95% CI)were 0.646(0.590sim0.706),0.899(0.853sim0.946), 0.822(0.752sim0.899), 1.151(1.019sim1.301), 1.221(1.144sim1.303), and 0.867(0.840sim0.895), respectively. And female students with poor hardware and network conditions, dissatisfaction with online teaching, difficulty in completing assignments, and poor self-control were more likely to suffer from depression. The OR values(95% CI) were 0.863 (0.757sim0.985), 0.841(0.739sim0.956), 1.243(1.059sim1.460), 1.059(1.012sim1.107) and 0.904(0.864sim0.946), respectively. Conclusion: The psychological problems of anxiety and depression in college students during online teaching should not be ignored. Colleges and universities should strengthen the psychological counseling for college students and promote their healthy growth. © 2020 IEEE.
ABSTRACT
In early 2020, the outbreak of new coronavirus pneumonia broke out globally, and the assessment criteria for organ transplant donor infections also brought new changes. Under the situation of the new crown epidemic, it is necessary to update the infection assessment criteria for organ transplantation with regard to donor quality. The infectious pathogen spectrum of the absolute contraindications of donor organ donation has been updated, and the procedures for evaluating donor quality infections have changed accordingly. This review analyzes the infections from the donors by classification, and summarizes the treatment measures taken by the donors infected by different pathogens, and summarizes the evaluation standards and evaluation procedures of the donors' infection quality. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
ABSTRACT
The study focuses on instant delivery service (IDS) for online to offline (O2O) business model in take-out food and new retail industries. The O2O-IDS system is defined as an organization management system consisting of the O2O and IDS platforms that interact with each other. IDS is a new type of logistics service in O2O model. The many-to-many cooperation between O2O and IDS faces disruptions due to many factors, such as 2019 novel coronavirus, which lower the operational efficiency of O2O-IDS system. Therefore, resilience theory is introduced to the O2O-IDS system research based on the idea that reducing vulnerability can improve resilience. An optimization model is constructed through the concepts of key cooperation relationship, loss of system function and performance impact index (PII), etc. The key cooperation relationship was identified through optimizing maximum loss of system function. The model gave the ranking of the cooperation by calculating the PII of the partnership, and the study proposed a reasonable protection strategy according to the budget. In addition, resilience is assessed and quantified by drawing a curve of loss of system function, and under different number of disruptions, the more smoothness the curve is, the better resilient the system would be. The example of O2O-IDS system showed that the optimization strategy proposed in this paper can significantly improve the system's ability to prepare, mitigate and prevent risks. © 2021, Editorial Board of Journal of Systems Engineering Society of China. All right reserved.
ABSTRACT
Objective: This study aimed to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) epidemic on the disease status of patients with inflammatory bowel disease (IBD) through a questionnaire survey and to study the factors that cause its impact. Methods: The questionnaire included the Harvey-Bradshow index (HBI), 6-point Mayo score, the short inflammatory bowel disease questionnaire (SIBDQ), self-evaluations of the disease status, and COVID-19 epidemiological related information problems. Questionnaires were distributed to IBD patients in Hubei Province every month within 4 months after the outbreak. Based on the results of the monthly questionnaire survey, we compared and analyzed the patient's disease status. Then positive feedback would be given to guide the self-management of IBD patients during the epidemic after the results were obtained. Results: A total of 65 qualified questionnaires were included during the four questionnaire analyses. No one of the patients self-reported a diagnosis of COVID-19. Our results showed that the disease activity of IBD patients was the worst in the second month, which was statistically different from the results of the other 3 months'. Patients with ulcerative colitis (UC) were mainly the deterioration of the patients who had activity, while patients with Crohn's disease (CD) mainly enter the active stage from remission. Failure to seek medical advice during the epidemic was a risk factor for disease activity (OR = 10.765, P = .049), and maintenance medication regimen was a protective factor for disease activity (OR = 0.264, P = .048). The number of patients who changed the medication regimen in the second month was the largest (30.77%), which was significantly different from the other 3 months. Among the reasons for changing the medication regimen, “unable to go to the hospital for routine treatment” was consistent with the change in the number of medication regimens. The use of Remicade in CD patients was minimized in the second month, and the use of adalimumab gradually increased within these 4 months. In the second month, the use of Remicade and adalimumab was significantly different from that before the outbreak (P = .065). The seeking for medical advice of these patients was most affected in the second month, the number of people who were completely unable to seek medical advice was the largest in the second month, which was significantly different from the subsequent survey results. The number of patient with good quality of life were the least in the second month, and the median SIBDQ score was the lowest, but no significant statistical difference was obtained. Conclusions: The disease status of IBD patients in Hubei Province had been affected to varying degrees within 4 months of the COVID- 19 epidemic. The patient's disease activity, quality of life, medical and medication conditions were most affected in the second month. This circumstance might be because the first 2 months of our investigation coincided with the period when Hubei traffic control was implemented. According to our survey results, doctors should try their best to ensure IBD patients could seek medical advice smoothly during the epidemic, methods such as online medical treatment could be used to maintain doctor-patient communication. Meanwhile, ensure patients maintain medication plans were also important.