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2.
Open Forum Infectious Diseases ; 8(Supplement_1):S388-S388, 2021.
Article in English | PMC | ID: covidwho-1570001

ABSTRACT

Background Covid-19 has caused significant global mortality. Multiple vaccines have demonstrated efficacy in clinical trials though real-world effectiveness of vaccines against Covid-19 mortality in clinically and demographically diverse populations has not yet been reported. Methods We used a retrospective cohort assembled from a cross-institution comprehensive data repository. Established patients of the health care system were categorized as not immunized, partially immunized, or fully immunized against SARS-CoV-2 with an mRNA vaccine through April 4, 2021. Outcomes were Covid-19 related hospitalization and death. Results Of the 91,134 established patients, 70.2% were not immunized, 4.5% were partially immunized and 25.4% were fully immunized. Among the fully immunized 0.7% had a Covid-19 hospitalization, whereas 3.4% among the partially immunized and 2.7% non-immunized individuals were hospitalized with Covid-19. Of the 225 deaths among Covid-19 hospitalizations, 219 (97.3%) were in the not immunized, 5 (2.2%) in the partially immunized, and 1 (0.0041%) in the fully immunized group. mRNA vaccines were 96% (95%CI: 95 — 99) effective at preventing Covid-19 related hospitalization and 98.7% (95%CI: 91.0 — 99.8) effective at preventing Covid-19 related death when participants were fully vaccinated. Partial vaccination was 77% (95%CI: 71 — 82) effective at preventing hospitalization and 64.2% (95%CI: 13.0 — 85.2) effective at preventing death. Vaccine effectiveness at preventing hospitalization was conserved across subgroups of age, race, ethnicity, Area Deprivation Index, and Charlson Comorbidity Index. Conclusions In a large, diverse cohort in the United States, full immunization with mRNA vaccines was highly effective in the real-world scenario at preventing Covid-19 related hospitalization and death. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Financial support for the COVID-19 Surveillance and Outcomes Registry (CURATOR) was provided by Houston Methodist and the Houston Methodist Academic Institute. The study was partially funded by the Yale Institute for Global Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Houston Methodist Institutional Review Board (PRO 00025445:1) All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data are collected under the Houston Methodist IRB approved project, CURATOR. Reasonable requests for a fully de-identified dataset can be made to the corresponding author. These requests will be evaluated on an individual basis by the CURATOR governance committee and the IRB.

3.
Open forum infectious diseases ; 8(Suppl 1):S388-S388, 2021.
Article in English | EuropePMC | ID: covidwho-1564947

ABSTRACT

Background The effectiveness of Severe Acute Respiratory Syndrome Coronavirus 2 vaccines after two doses needs to be demonstrated beyond clinical trials. Methods In a retrospective cohort assembled from a cross-institution comprehensive data repository, established patients of the health care system were categorized as having received no doses, one dose or two doses of SARS-CoV-2 mRNA vaccine through April 4, 2021. Outcomes were COVID-19 related hospitalization and death. Results Of 94,018 patients 27.7% had completed two doses and 3.1% had completed one dose of a COVID-19 mRNA vaccine. The two dose group was older with more comorbidities. 1.0% of the two dose group had a COVID-19 hospitalization, compared to 4.0% and 2.7% in the one dose and no dose groups respectively. The adjusted Cox proportional-hazards model based vaccine effectiveness after two doses (vs. no dose) was 96%(95% confidence interval(CI):95–97), compared to 78%(95%CI:76–82) after one dose. After two doses, vaccine effectiveness for COVID-19 mortality was 97.9%(95%CI:91.7–99.5), and 53.5%(95%CI:0.28–80.8) after one dose. Vaccine effectiveness at preventing hospitalization was conserved across age, race, ethnicity, Area Deprivation Index and Charlson Comorbidity Indices. Cohort Enrollment and Distribution by Immunization Status and Vaccine effectiveness against mortality Cohort members are described by their immunization status and hospitalization at the end of the study period ending April 4th, 2021. Percentages compare this population to the total established patients. Each group is then divided into when hospitalized events occurred across immunization status. These percentages compare the number of events to the population in the immunization status at the end of the analysis period. Odds ratios for mortality were calculated and vaccine effectiveness calculated as 1 minus odds ratio times 100%. Conclusion In a large, diverse US cohort, receipt of two doses of an mRNA vaccine was highly effective in the real-world at preventing COVID-19 related hospitalizations and deaths with a substantive difference in effectiveness between one and two doses. Disclosures All Authors: No reported disclosures

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-294877

ABSTRACT

Background: Atrial arrythmias have been frequently noted in patients with COVID-19, with high prevalence in those requiring mechanical ventilation. The clinical implications of pre-existing atrial arrythmias, or such ‘COVID-associated’ atrial arrythmias is yet to be studied.<br><br>Objective: To report clinical outcomes of COVID-19 infection in patients with pre-existing and new-onset Atrial arrythmias, and compare these outcomes with patients without Atrial arrythmias.<br><br>Methods: Analysis of a large multicenter research network TriNETX was performed including patients more than 16 years of age diagnosed with COVID-19. Outcomes of COVID-19 in patients with Atrial fibrillation or flutter were compared to those without a history of these arrythmias. Propensity score matching was performed to control for known risk factors of severe COVID-19.<br><br>Results: A total of 394,338 patients with COVID-19 were included, of which 19,405 patients (4.92%) carried a diagnosis of Atrial fibrillation/flutter. These were further classified into pre-existing Atrial fibrillation/flutter (n=14,973), pre-existing Atrial fibrillation (n=14,494), new-onset Atrial fibrillation/flutter (n=3,812) and new-onset Atrial fibrillation (n=3,521) for sub-group analysis. Patients with Atrial fibrillation/flutter had increased risk of mortality, hospitalization, critical care need, and mechanical ventilation when compared to the control group. New-onset atrial fibrillation/flutter was associated with even worse outcomes, with a 20-fold and 4-fold higher risk of mortality than control group at 30 days in unmatched and matched analyses respectively. <br><br>Conclusion: Patients with pre-existing or new onset Atrial fibrillation/flutter are at risk of poor outcomes with COVID-19. Further, new-onset atrial fibrillation portends markedly worse outcomes in COVID-19 disease.

5.
Expert Rev Vaccines ; 21(1): 37-45, 2022 01.
Article in English | MEDLINE | ID: covidwho-1488108

ABSTRACT

INTRODUCTION: Vaccination is the most effective strategy to mitigating COVID-19 and restoring societal function. As the pandemic evolves with no certainty of a herd immunity threshold, universal vaccination of at-risk populations is desirable. However, vaccine hesitancy threatens the return to normalcy, and healthcare workers (HCWs) must embrace their ambassadorial role of shoring up vaccine confidence. Unfortunately, voluntary vaccination has been suboptimal among HCWs in the United States, a priority group for whom immunization is essential for maintaining health system capacity and the safety of high-risk patients in their care. Consequently, some health systems have implemented mandates to improve compliance. AREAS COVERED: This article discusses the ethical and practical considerations of mandatory COVID-19 vaccination policies for HCWs utilizing some components of the World Health Organization's framework and the unique context of a pandemic with evolving infection dynamics. EXPERT OPINION: COVID-19 vaccine mandates for universal immunization of HCWs raise ethical and practical debates about their appropriateness, especially when the vaccines are pending full approval in most jurisdictions. Given the superiority of the vaccines to safety and testing protocols and their favorable safety profile, we encourage health systems to adopt vaccination mandates through participatory processes that address the concerns of stakeholders.


Subject(s)
COVID-19 Vaccines , Health Personnel , Vaccination , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Health Personnel/legislation & jurisprudence , Humans , Policy , Social Justice , United States/epidemiology , Vaccination/legislation & jurisprudence
7.
Sci Rep ; 11(1): 19450, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1447321

ABSTRACT

Recent reports linked acute COVID-19 infection in hospitalized patients to cardiac abnormalities. Studies have not evaluated presence of abnormal cardiac structure and function before scanning in setting of COVD-19 infection. We sought to examine cardiac abnormalities in consecutive group of patients with acute COVID-19 infection according to the presence or absence of cardiac disease based on review of health records and cardiovascular imaging studies. We looked at independent contribution of imaging findings to clinical outcomes. After excluding patients with previous left ventricular (LV) systolic dysfunction (global and/or segmental), 724 patients were included. Machine learning identified predictors of in-hospital mortality and in-hospital mortality + ECMO. In patients without previous cardiovascular disease, LV EF < 50% occurred in 3.4%, abnormal LV global longitudinal strain (< 16%) in 24%, and diastolic dysfunction in 20%. Right ventricular systolic dysfunction (RV free wall strain < 20%) was noted in 18%. Moderate and large pericardial effusion were uncommon with an incidence of 0.4% for each category. Forty patients received ECMO support, and 79 died (10.9%). A stepwise increase in AUC was observed with addition of vital signs and laboratory measurements to baseline clinical characteristics, and a further significant increase (AUC 0.91) was observed when echocardiographic measurements were added. The performance of an optimized prediction model was similar to the model including baseline characteristics + vital signs and laboratory results + echocardiographic measurements.


Subject(s)
COVID-19/complications , Heart Diseases/etiology , Heart Diseases/mortality , Hospitalization/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Clinical Decision Rules , Echocardiography , Extracorporeal Membrane Oxygenation , Female , Heart Diseases/diagnostic imaging , Hospital Mortality/trends , Humans , Machine Learning , Male , Middle Aged , Models, Theoretical , Prognosis , ROC Curve , Retrospective Studies , Young Adult
10.
J Am Heart Assoc ; 10(15): e019671, 2021 08 03.
Article in English | MEDLINE | ID: covidwho-1329070

ABSTRACT

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Influenza infection is associated with an increased risk of cardiovascular events (myocardial infarction, stroke, and heart failure exacerbation) and mortality, and all-cause mortality in patients with CVD. Infection with influenza leads to a systemic inflammatory and thrombogenic response in the host body, which further causes destabilization of atherosclerotic plaques. Influenza vaccination has been shown to be protective against cardiovascular and cerebrovascular events in several observational and prospective studies of at-risk populations. Hence, many international guidelines recommend influenza vaccination for adults of all ages, especially for individuals with high-risk conditions such as CVD. Despite these long-standing recommendations, influenza vaccine uptake among US adults with CVD remains suboptimal. Specifically, vaccination uptake is strikingly low among patients aged <65 years, non-Hispanic Black individuals, those without health insurance, and those with diminished access to healthcare services. Behavioral factors such as perceived vaccine efficacy, vaccine safety, and attitudes towards vaccination play an important role in vaccine acceptance at the individual and community levels. With the ongoing COVID-19 pandemic, there is a potential threat of a concurrent epidemic with influenza. This would be devastating for vulnerable populations such as adults with CVD, further stressing the need for ensuring adequate influenza vaccination coverage. In this review, we describe a variety of strategies to improve the uptake of influenza vaccination in patients with CVD through improved understanding of key sociodemographic determinants and behaviors that are associated with vaccination, or the lack thereof. We further discuss the potential use of relevant strategies for COVID-19 vaccine uptake among those with CVD.


Subject(s)
COVID-19 , Health Services Misuse/prevention & control , Influenza Vaccines/therapeutic use , Patient Acceptance of Health Care , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Cardiovascular Diseases/epidemiology , Health Knowledge, Attitudes, Practice , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , SARS-CoV-2 , Vaccination Coverage
11.
BMJ Open ; 11(6): e048006, 2021 06 21.
Article in English | MEDLINE | ID: covidwho-1280428

ABSTRACT

OBJECTIVE: To evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA. METHODS: Publicly available data from The COVID Tracking Project at The Atlantic were accessed between 9 September 2020 and 14 September 2020. For each state and the District of Columbia, % infection, % death, and % population proportion for subgroups of race (African American/black (AA/black), Asian, American Indian or Alaska Native (AI/AN), and white) and ethnicity (Hispanic/Latino, non-Hispanic) were recorded. Crude and normalised disparity estimates were generated for COVID-19 infection (CDI and NDI) and mortality (CDM and NDM), computed as absolute and relative difference between % infection or % mortality and % population proportion per state. Choropleth map display was created as thematic representation proportionate to CDI, NDI, CDM and NDM. RESULTS: The Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median 158%, IQR 100%-200%). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median 50%, IQR 25%-100%). The AA population had the most disproportionate mortality, with a median of 46% higher mortality than the % population proportion (median 46%, IQR 18%-66%). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian populations, with 100% excess infections than the % population proportion seen in nine states for AI/AN and seven states for Asian populations. There was no disproportionate impact in the white population in any state. CONCLUSIONS: There are racial/ethnic disparities in COVID-19 infection/mortality, with distinct state-wise patterns across the USA based on racial/ethnic composition. There were missing and inconsistently reported racial/ethnic data in many states. This underscores the need for standardised reporting, attention to specific regional patterns, adequate resource allocation and addressing the underlying social determinants of health adversely affecting chronically marginalised groups.


Subject(s)
COVID-19 , Health Status Disparities , Humans , SARS-CoV-2 , United States/epidemiology
13.
Circ Cardiovasc Qual Outcomes ; 14(6): e008118, 2021 06.
Article in English | MEDLINE | ID: covidwho-1218255

ABSTRACT

BACKGROUND: Social determinants of health (SDOH) may limit the practice of coronavirus disease 2019 (COVID-19) risk mitigation guidelines with health implications for individuals with underlying cardiovascular disease (CVD). Population-based evidence of the association between SDOH and practicing such mitigation strategies in adults with CVD is lacking. We used the National Opinion Research Center's COVID-19 Household Impact Survey conducted between April and June 2020 to evaluate sociodemographic disparities in adherence to COVID-19 risk mitigation measures in a sample of respondents with underlying CVD representing 18 geographic areas of the United States. METHODS: CVD status was ascertained by self-reported history of receiving heart disease, heart attack, or stroke diagnosis. We built de novo, a cumulative index of SDOH burden using education, insurance, economic stability, 30-day food security, urbanicity, neighborhood quality, and integration. We described the practice of measures under the broad strategies of personal protection (mask, hand hygiene, and physical distancing), social distancing (avoiding crowds, restaurants, social activities, and high-risk contact), and work flexibility (work from home, canceling/postponing work). We reported prevalence ratios and 95% CIs for the association between SDOH burden (quartiles of cumulative indices) and practicing these measures adjusting for age, sex, race/ethnicity, comorbidity, and interview wave. RESULTS: Two thousand thirty-six of 25 269 (7.0%) adults, representing 8.69 million in 18 geographic areas of the United States, reported underlying CVD. Compared with the least SDOH burden, fewer individuals with the greatest SDOH burden practiced all personal protection (75.6% versus 89.0%) and social distancing measures (41.9% versus 58.9%) and had any flexible work schedule (26.2% versus 41.4%). These associations remained statistically significant after full adjustment: personal protection (prevalence ratio, 0.83 [95% CI, 0.73-0.96]; P=0.009), social distancing (prevalence ratio, 0.69 [95% CI, 0.51-0.94]; P=0.018), and work flexibility (prevalence ratio, 0.53 [95% CI, 0.36-0.79]; P=0.002). CONCLUSIONS: SDOH burden is associated with lower COVID-19 risk mitigation practices in the CVD population. Identifying and prioritizing individuals whose medical vulnerability is compounded by social adversity may optimize emerging preventive efforts, including vaccination guidelines.


Subject(s)
COVID-19/prevention & control , Cardiovascular Diseases/epidemiology , Physical Distancing , Social Determinants of Health , Adult , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Communicable Disease Control , Cross-Sectional Studies , Humans , Pandemics , SARS-CoV-2 , United States/epidemiology
16.
Mayo Clin Proc Innov Qual Outcomes ; 5(2): 456-465, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1193429

ABSTRACT

OBJECTIVE: To evaluate interest in coronary artery calcium (CAC) among the general public during the past 17 years and to compare trends with real-world data on number of CAC procedures performed. METHODS: We used Google Trends, a publicly available database, to access search query data in a systematic and quantitative fashion to search for CAC-related key terms. Search terms included calcium test, heart score, calcium score, coronary calcium, and calcium test score. We accessed Google Trends in January 2021 and analyzed data from 2004 to 2020. RESULTS: From 2004 to December 31, 2020, CAC-related search interest (in relative search volume) increased continually worldwide (+201.9%) and in the United States (+354.8%). Three main events strongly influenced search interest in CAC: reports of a CAC scan of the president of the United States led to a transient 10-fold increase in early January 2018. American College of Cardiology/American Heart Association guideline release led to a sustained increase, and lockdown after the global pandemic due to COVID-19 led to a transient decrease. Real-world data on performed CAC scans showed an increase between 2006 and 2017 (+200.0%); during the same time period, relative search volume for CAC-related search terms increased in a similar pattern (+70.6%-1511.1%). For the search term coronary calcium scan near me, a potential representative of active online search for CAC scanning, we found a +28.8% increase in 2020 compared with 2017. CONCLUSION: Google Trends, a valuable tool for assessing public interest in health-related topics, suggests increased overall interest in CAC during the last 17 years that mirrors real-world usage data. Increased interest is seemingly linked to reports of CAC testing in world leaders and endorsement in major guidelines.

17.
JMIR Med Inform ; 9(2): e26773, 2021 Feb 23.
Article in English | MEDLINE | ID: covidwho-1097262

ABSTRACT

BACKGROUND: The COVID-19 pandemic has exacerbated the challenges of meaningful health care digitization. The need for rapid yet validated decision-making requires robust data infrastructure. Organizations with a focus on learning health care (LHC) systems tend to adapt better to rapidly evolving data needs. Few studies have demonstrated a successful implementation of data digitization principles in an LHC context across health care systems during the COVID-19 pandemic. OBJECTIVE: We share our experience and provide a framework for assembling and organizing multidisciplinary resources, structuring and regulating research needs, and developing a single source of truth (SSoT) for COVID-19 research by applying fundamental principles of health care digitization, in the context of LHC systems across a complex health care organization. METHODS: Houston Methodist (HM) comprises eight tertiary care hospitals and an expansive primary care network across Greater Houston, Texas. During the early phase of the pandemic, institutional leadership envisioned the need to streamline COVID-19 research and established the retrospective research task force (RRTF). We describe an account of the structure, functioning, and productivity of the RRTF. We further elucidate the technical and structural details of a comprehensive data repository-the HM COVID-19 Surveillance and Outcomes Registry (CURATOR). We particularly highlight how CURATOR conforms to standard health care digitization principles in the LHC context. RESULTS: The HM COVID-19 RRTF comprises expertise in epidemiology, health systems, clinical domains, data sciences, information technology, and research regulation. The RRTF initially convened in March 2020 to prioritize and streamline COVID-19 observational research; to date, it has reviewed over 60 protocols and made recommendations to the institutional review board (IRB). The RRTF also established the charter for CURATOR, which in itself was IRB-approved in April 2020. CURATOR is a relational structured query language database that is directly populated with data from electronic health records, via largely automated extract, transform, and load procedures. The CURATOR design enables longitudinal tracking of COVID-19 cases and controls before and after COVID-19 testing. CURATOR has been set up following the SSoT principle and is harmonized across other COVID-19 data sources. CURATOR eliminates data silos by leveraging unique and disparate big data sources for COVID-19 research and provides a platform to capitalize on institutional investment in cloud computing. It currently hosts deeply phenotyped sociodemographic, clinical, and outcomes data of approximately 200,000 individuals tested for COVID-19. It supports more than 30 IRB-approved protocols across several clinical domains and has generated numerous publications from its core and associated data sources. CONCLUSIONS: A data-driven decision-making strategy is paramount to the success of health care organizations. Investment in cross-disciplinary expertise, health care technology, and leadership commitment are key ingredients to foster an LHC system. Such systems can mitigate the effects of ongoing and future health care catastrophes by providing timely and validated decision support.

18.
Am J Prev Cardiol ; 5: 100150, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1064774

ABSTRACT

INTRODUCTION: The importance of receiving an annual influenza vaccine among patients with atherosclerotic cardiovascular disease (ASCVD) is well established. With the rapid community spread and the possibility of another wave of COVID-19 infections in the fall, receiving an influenza vaccine is of particular importance to mitigate the risk associated with overlapping influenza and COVID-19 infections. METHODS: We utilized cross-sectional data from the 2016 to 2019 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative U.S. telephone-based survey of adults 18 years or older. Race/ethnicity was our exposure of interest. We assessed the relative difference in influenza vaccination by race/ethnicity for each U.S. state in the overall U.S. population and among those with ASCVD as prevalence of receipt of influenza vaccination among Blacks or Hispanics minus prevalence among Whites divided by prevalence among Whites. We used multivariable-adjusted logistic regression models to evaluate the association between socioeconomic risk factors and receipt of influenza vaccination. RESULTS: The study population consisted of 1,747,397 participants of whom 21% were older than 65 years, 51% women, 63% White, 12% Black, 17% Hispanic, and 9% with history of ASCVD. The receipt of influenza vaccine was 38% in the overall population and 51% among those with self-reported ASCVD, which translates to approximately to 97 million and 12 million US adults, respectively. The receipt of influenza vaccine among individuals with ASCVD was 54% for Whites, 45% for Blacks, and 42% for Hispanics (p<0.001). In the overall U.S. population, the median (interquartile range) relative difference for influenza vaccination between Blacks and Whites was 17% (-27%, -9%) and -22% (-29%, -9%) between Hispanics and Whites across all U.S. states. Among individuals with and without ASCVD, age older than 65 years, greater than college education, higher income, and having a primary care physician were significantly associated with higher odds of receipt of influenza vaccination, while being employed, lack of healthcare coverage, Black race, and delay in healthcare access were significantly inversely associated with having received an influenza vaccine. CONCLUSIONS: Only 50% patients with ASCVD receive influenza vaccines. The receipt of influenza vaccination among individuals with ASCVD is lower among Blacks and Hispanics compared to Whites with significant state-level variation. There are important socioeconomic determinants that are associated with receipt of the influenza vaccine.

19.
PLoS One ; 16(1): e0245556, 2021.
Article in English | MEDLINE | ID: covidwho-1030292

ABSTRACT

INTRODUCTION: Sex is increasingly recognized as an important factor in the epidemiology and outcome of many diseases. This also appears to hold for coronavirus disease 2019 (COVID-19). Evidence from China and Europe has suggested that mortality from COVID-19 infection is higher in men than women, but evidence from US populations is lacking. Utilizing data from a large healthcare provider, we determined if males, as compared to females have a higher likelihood of SARS-CoV-2 susceptibility, and if among the hospitalized COVID-19 patients, male sex is independently associated with COVID-19 severity and poor in-hospital outcomes. METHODS AND FINDINGS: Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, we conducted a cross-sectional analysis of data from a COVID-19 Surveillance and Outcomes Registry (CURATOR). Data were extracted from Electronic Medical Records (EMR). A total of 96,473 individuals tested for SARS-CoV-2 RNA in nasopharyngeal swab specimens via Polymerized Chain Reaction (PCR) tests were included. For hospital-based analyses, all patients admitted during the same time-period were included. Of the 96,473 patients tested, 14,992 (15.6%) tested positive, of whom 4,785 (31.9%) were hospitalized and 452 (9.5%) died. Among all patients tested, men were significantly older. The overall SARS-CoV-2 positivity among all tested individuals was 15.5%, and was higher in males as compared to females 17.0% vs. 14.6% [OR 1.20]. This sex difference held after adjusting for age, race, ethnicity, marital status, insurance type, median income, BMI, smoking and 17 comorbidities included in Charlson Comorbidity Index (CCI) [aOR 1.39]. A higher proportion of males (vs. females) experienced pulmonary (ARDS, hypoxic respiratory failure) and extra-pulmonary (acute renal injury) complications during their hospital course. After adjustment, length of stay (LOS), need for mechanical ventilation, and in-hospital mortality were significantly higher in males as compared to females. CONCLUSIONS: In this analysis of a large US cohort, males were more likely to test positive for COVID-19. In hospitalized patients, males were more likely to have complications, require ICU admission and mechanical ventilation, and had higher mortality than females, independent of age. Sex disparities in COVID-19 vulnerability are present, and emphasize the importance of examining sex-disaggregated data to improve our understanding of the biological processes involved to potentially tailor treatment and risk stratify patients.


Subject(s)
COVID-19/epidemiology , Cities/epidemiology , Severity of Illness Index , COVID-19/diagnosis , Cross-Sectional Studies , Disease Susceptibility , Female , Humans , Male , Middle Aged , Prognosis , Sex Distribution , United States/epidemiology
20.
Circ Heart Fail ; 13(10): e007218, 2020 10.
Article in English | MEDLINE | ID: covidwho-805484

ABSTRACT

Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world's highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.


Subject(s)
Epidemics , Heart Failure/ethnology , Age of Onset , Asia/epidemiology , Health Services Needs and Demand , Heart Failure/diagnosis , Heart Failure/prevention & control , Humans , Needs Assessment , Prevalence , Preventive Health Services , Prognosis , Risk Assessment , Risk Factors , Time Factors
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