Dangerous liaisons? Applying the social harm perspective to the social inequality, housing and health trifecta during the Covid-19 pandemic

Global rates of excess mortality attributable to the Covid-19 pandemic provide a fresh impetus to make sense of the associations between income inequality, housing inequality and the social gradient in health, suggesting new questions about the ways in which housing and health are treated in the framing and development of public policy. The first half of the paper uses a social harm lens to examine the threefold associations of the social inequality, housing and health trifecta and offers new insights for policy analysis which foregrounds the production, transmission, and experience of various types of harm which occur within the home. The main body of the paper then draws upon the outcomes of an international systematic literature mapping review of 213 Covid-19 research papers to demonstrate three specific harms associated with stay-at-home lockdowns: (i) intimate partner and domestic violence, (ii) poor mental health and (iii) health harming behaviours. The reported findings are interpreted using a social harm perspective and some implications for policy analysis are illustrated. The paper concludes with a reflection on the efficacy of social harm as a lens for policy analysis and suggests directions for further research in housing studies and zemiology.

The First Wave of COVID-19 in Forensic Psychiatry: A Rapid Review Series

At the beginning of the pandemic, experts expected an increasing number of hospitalizations in forensic settings, uncontrollable outbreaks of COVID-19, and deterioration of mental health of residents within institutions. Certain publications corroborated these concerns;however, no synthesis of the results of empirical publications at the initial stage of the pandemic has yet been conducted. Three rapid reviews were conducted on these topics. Besides almost a two-fold decrease in the total number of urgent consultations/hospitalizations, there were no changes in the number of involuntary hospitalizations, suicide attempts, and psychoses. The COVID-19 morbidity and mortality rates in secure institutions were compatible with the general population. However, the lockdown period was associated with a significant increase in self-harm in secure settings.

Immigrant Legal Status among Essential Frontline Workers in the United States during the COVID-19 Pandemic Era: IMR

Emerging evidence suggests that the COVID-19 pandemic has extracted a substantial toll on immigrant communities in the United States, due in part to increased potential risk of exposure for immigrants to COVID-19 in the workplace. In this article, we use federal guidance on which industries in the United States were designated essential during the COVID-19 pandemic, information about the ability to work remotely, and data from the 2019 American Community Survey to estimate the distribution of essential frontline workers by nativity and immigrant legal status. Central to our analysis is a proxy measure of working in the primary or secondary sector of the segmented labor market. Our results indicate that a larger proportion of foreign-born workers are essential frontline workers compared to native-born workers and that 70 percent of unauthorized immigrant workers are essential frontline workers. Disparities in essential frontline worker status are most pronounced for unauthorized immigrant workers and native-born workers in the secondary sector of the labor market. These results suggest that larger proportions of foreign-born workers, and especially unauthorized immigrant workers, face greater risk of potential exposure to COVID-19 in the workplace than native-born workers. Social determinants of health such as lack of access to health insurance and living in overcrowded housing indicate that unauthorized immigrant essential frontline workers may be more vulnerable to poor health outcomes related to COVID-19 than other groups of essential frontline workers. These findings help to provide a plausible explanation for why COVID-19 mortality rates for immigrants are higher than mortality rates for native-born residents.

Selection Effects and COVID-19 Mortality Risk after Pfizer vs. Moderna Vaccination: Evidence from Linked Mortality and Vaccination Records.

Prior research generally finds that the Pfizer-BioNTech (BNT162b2) and Moderna (mRNA1273) COVID-19 vaccines provide similar protection against mortality, sometimes with a Moderna advantage due to slower waning. However, most comparisons do not address selection effects for those who are vaccinated and with which vaccine. We report evidence on large selection effects, and use a novel method to control for these effects. Instead of directly studying COVID-19 mortality, we study the COVID-19 excess mortality percentage (CEMP), defined as the COVID-19 deaths divided by non-COVID-19 natural deaths for the same population, converted to a percentage. The CEMP measure uses non-COVID-19 natural deaths to proxy for population health and control for selection effects. We report the relative mortality risk (RMR) for each vaccine relative to the unvaccinated population and to the other vaccine, using linked mortality and vaccination records for all adults in Milwaukee County, Wisconsin, from 1 April 2021 through 30 June 2022. For two-dose vaccinees aged 60+, RMRs for Pfizer vaccinees were consistently over twice those for Moderna, and averaged 248% of Moderna (95% CI = 175%,353%). In the Omicron period, Pfizer RMR was 57% versus 23% for Moderna. Both vaccines demonstrated waning of two-dose effectiveness over time, especially for ages 60+. For booster recipients, the Pfizer-Moderna gap is much smaller and statistically insignificant. A possible explanation for the Moderna advantage for older persons is the higher Moderna dose of 100 µg, versus 30 µg for Pfizer. Younger persons (aged 18-59) were well-protected against death by two doses of either vaccine, and highly protected by three doses (no deaths among over 100,000 vaccinees). These results support the importance of a booster dose for ages 60+, especially for Pfizer recipients. They suggest, but do not prove, that a larger vaccine dose may be appropriate for older persons than for younger persons.

The role of digital transformation in the socio-economic recovery post COVID-19

Several measures have been taken to reduce the impact of COVID-19 pandemic. One of these measures is the broad digital transformation that has rapidly and unexpectedly forced the deployment of digital technologies into corporations' business models and organizational structures. This digital transformation has affected all the socio-economic aspects. In response to the COVID-19 global pandemic, this paper explores the impact of the implementation of digital transformation on the socio-economic recovery by employing cross-sectional regression analysis on 99 countries in year 2020. The paper analyzes the impact of digital transformation on each of economic growth, health care, and income inequality. The results reveal that the digital transformation has a positive and significant impact on the GDP per capita in which a 1% increase in digital transformation results in 1.52% increase in GDP per capita, a positive and significant impact on income equality in which a 1% increase in digital transformation leads to 0.05% increase in income equality, and a negative and significant impact on infant mortality rate, in which a 1% increase in digital transformation results in 0.85% decrease in infant mortality rate which reflects its positive impact on the health care. Hence, the digital transformation has a positive and significant effects on different socio-economic aspects.

Critical appraisal of the Coronavirus preparedness among countries using the global health security index

Introduction: This critical study was aimed to investigate the utility of the Global Health Security Index in predicting the current COVID-19 responses. Material and Methods: Number of infected patients, deaths, incidence and the death rate per 100,000 populations related to 55 countries per week for 26 weeks were extracted. The relationship of GHSI scores and country preparedness for the pandemic was compared. Results: According to the GHSI, the incidence rate in most prepared countries was higher than the incidence rate in the more prepared countries, and which was higher than the incidence rate in the least prepared countries. However, Prevention, Detection and reporting, Rapid response, Health system, compliance with international norms and Risk environment, as well as Overall, the incidence and death rate per 100,000 people have not been like this. Conclusion: Due to mismatch between the GHSI score and fact about COVID-19 incidence, it seems necessary to investigate the factors involved in this discrepancy. © 2022, Published by Frontiers in Health Informatics.

Assessing the Impact of COVID-19 on Indigenous Peoples in Latin America: Towards Effective Post-Pandemic Policies

[...]a broad and inclusive approach to post-pandemic policy-making—one that considers Indigenous forms of knowledge whilst fostering appreciation for their cultures and lives—is needed to adequately assist Indigenous peoples in repairing the harm they have suffered as a result of COVID-19.3 COVID-19 and its deadly impact on Indigenous communities There are no less than eight hundred distinct Indigenous communities across Latin America, each with its own unique identity, culture, and [End Page 169] history. In Bolivia, for example, where Indigenous groups comprise a significant portion of the electorate (between 41 and 62 percent of the population), Latin America's first Indigenous political executive was elected in 2006.4 In most instances, however, Indigenous peoples make up only a small proportion of Latin American country populations (generally ranging from 0.5–15 percent), one factor ensuring limited political influence and the widespread marginalization of their interests.5 As a consequence, Indigenous peoples across the region entered the pandemic whilst already suffering from a range of serious economic and socio-cultural inequalities.6 Inadequate access to medical care, chronic poverty and economic marginalization, racism and prejudice, and inadequate access to education are common issues that exacerbated the impact of the pandemic.7 The World Health Organization confirmed the arrival of the pandemic in the region on February 26, 2020. [...]Indigenous mortality rates were 4.03 percent in Brazil and 19.9 percent in Mexico—significantly higher than 2.2 percent and 5.7 percent overall mortality rates in each country respectively.9 Unfortunately, the lack of regional data on, and deliberate under-reporting of, Indigenous mortality rates across much of Latin America has problematized many of the available datasets.10 In Brazil, for example, organizations such as The Articulation of Indigenous Peoples (APIB), have shown that the total number of recognized Indigenous deaths (902 persons as of April 7, 2022), undercounts the actual figure by at least 31 percent.11 Other sources, such as the Special Secretariat for Indigenous Health (SESAI), which is responsible for Indigenous medical care, also provides incomplete data on Brazilian Indigenous mortality by failing to count Indigenous urban dwellers or those who live outside of recognized government-controlled territories in their data sets.12 Such groups are among some of the most vulnerable Indigenous communities in the country, receiving little, if any, support from government agencies charged with supporting Indigenous communities.13 As a result, the scale and scope of COVID-19's impact on Indigenous Brazilians is, and for the foreseeable future will likely remain, unknowable.14 Despite a lack of adequate data across much of Latin America, a growing body of evidence indicates that Indigenous peoples were particularly vulnerable to COVID-19, and that they likely died or suffered long-term health issues in disproportionate numbers.15 In a study of Indigenous peoples in Chile, for instance, regions with larger Indigenous populations recorded a noticeable increase in overall mortality.16 Where direct data do not exist, emerging studies suggest that the medical impact of COVID-19 was likely compounded by a range of structural inequalities and environmental factors.17 Many Indigenous peoples lack access to adequate medical care. [...]disproportionate exposure to pesticides—used extensively in agricultural industries in which many Indigenous people find employment, as well as exposure to smoke inhalation—caused by out-of-control forest fires across Latin America—likely exacerbated the repertory symptoms caused by COVID-19.18 As a consequence, Indigenous peoples had to face COVID-19 not only with fewer resources, but with greater exposure to the types of pre-existing conditions known to aggravate the impact of the disease.19 Particularly high mortality rates among Indigenous elders, who act as stores of traditional knowledge, affected cultural continuity and community cohesion.20 To better understand this we spoke with a representative of the Indigenous Kaingang people, Duko Vãgfy, who explained that "[t]he worst losses [we suffered] were the elders, because they held so much knowledge about [our] people.

Fiscal Space Policies for Sustainable Development and Debt Relief: Empirical Analysis in West African Countries

The uncertainty that the COVID-19 pandemic has brought demonstrates that income redistribution and traditional debt relief mechanisms are insufficient to meet public spending needs, mitigate external debt, and comply with the UN's Sustainable Development Goals (SDGs), which aim to reduce multilateral debt to sustainable levels. Also, West African countries have focused their attention on the long-term fight against poverty and inequality and strengthening their social programs, especially in primary health care and macroeconomic stability. However, for more than a decade, the developing and least developed countries of West Africa have faced rapidly weakening macroeconomic conditions, combining several interrelated crises such as the sharp decline in oil prices, volatile financial markets and tourism disruptions, a global recession, the crisis of climate change, and shortages of food and energy, along with the economic contraction of COVID-19. Data from these countries show that health spending increases economic growth, minimizes infant mortality rates, and reduces debt. Furthermore, increasing government spending efficiency reduces the total debt and improves the health sector, in particular.

HIV-related mortality in the United States during the COVID-19 pandemic: A population-based study.

BACKGROUND: US progress toward ending the HIV epidemic was disrupted during the COVID-19 pandemic. OBJECTIVES: To determine the impact of the pandemic on HIV-related mortality and potential disparities. METHODS: Using data from the Centers for Disease Control and Prevention and the United States (US) Census Bureau, HIV-related mortality data of decedents aged ≥25 years between 2012 and 2021 were analyzed. Excess HIV-related mortality rates were estimated by determining the difference between observed and projected mortality rates during the pandemic. The trends of mortality were quantified with joinpoint regression analysis. RESULTS: Of the 79,725 deaths documented in adults aged 25 years and older between 2012 and 2021, a significant downward trend was noted in HIV-related mortality rates before the pandemic, followed by a surge during the pandemic. The observed mortality rates were 18.8% (95% confidence interval [CI]: 13.1%-25.5%) and 25.4% (95%CI: 19.9%-30.4%) higher than the projected values in 2020 and 2021, respectively. Both of these percentages were higher than that in the general population in 2020 (16.4%, 95%CI: 14.9%-17.9%) and 2021 (19.8%, 95%CI: 18.0%-21.6%), respectively. Increased HIV-related mortality was observed across all age subgroups, but those aged 25-44 years demonstrated the greatest relative increase and the lowest COVID-19-related deaths when compared to middle- and old-aged decedents. Disparities were observed across racial/ethnic subgroups and geographic regions. CONCLUSIONS: The pandemic led to a reversal in the attainments made to reduce the prevalence of HIV. Individuals living with HIV were disproportionately affected during the pandemic. Thoughtful policies are needed to address the disparity in excess HIV-related mortality.

COVID-19, mobility, leisure, and travel around the world

The paper uses daily data from Google to analyze the impact of the COVID-19 pandemic on people's mobility around the world regarding three types of leisure and travel activity: retail shopping and recreation;participation in open spaces, such as parks, beaches, gardens, and marinas;and food and medicine. These types of activity reflect important leisure and travel choices of people under conditions of epidemiological risk. We use the daily mortality rate as a key predictor. The results show that higher rates of mortality are associated with a lower mobility in shopping and recreation activities, higher mobility in open space activities, and rather insignificant changes in mobility regarding necessities. The effect depends on the stringency of the lockdown policies. The results remain robust after applying endogeneity analysis and country-level controls.

A Dynamic Interaction Semiparametric Function-on-Scalar Model

Motivated by recent work studying massive functional data, such as the COVID-19 data, we propose a new dynamic interaction semiparametric function-on-scalar (DISeF) model. The proposed model is useful to explore the dynamic interaction among a set of covariates and their effects on the functional response. The proposed model includes many important models investigated recently as special cases. By tensor product B-spline approximating the unknown bivariate coefficient functions, a three-step efficient estimation procedure is developed to iteratively estimate bivariate varying-coefficient functions, the vector of index parameters, and the covariance functions of random effects. We also establish the asymptotic properties of the estimators including the convergence rate and their asymptotic distributions. In addition, we develop a test statistic to check whether the dynamic interaction varies with time/spatial locations, and we prove the asymptotic normality of the test statistic. The finite sample performance of our proposed method and of the test statistic are investigated with several simulation studies. Our proposed DISeF model is also used to analyze the COVID-19 data and the ADNI data. In both applications, hypothesis testing shows that the bivariate varying-coefficient functions significantly vary with the index and the time/spatial locations. For instance, we find that the interaction effect of the population aging and the socio-economic covariates, such as the number of hospital beds, physicians, nurses per 1000 people and GDP per capita, on the COVID-19 mortality rate varies in different periods of the COVID-19 pandemic. The healthcare infrastructure index related to the COVID-19 mortality rate is also obtained for 141 countries estimated based on the proposed DISeF model.

Policy measures, information technology, and people's collective behavior in Taiwan's COVID-19 response

COVID-19 has rampaged globally with devastating consequences on human lives and livelihoods. Taiwan, a democratic island-country with 23.5 million population, was predicted to have the second highest risk of imported cases at the outset and instead registered among the lowest COVID-19 prevalence and mortality rates during year one. This chapter describes Taiwan's emergency response policies, including the Communicable Disease Control Act (CDCA), pandemic measures in different segments of the population, the role of national health insurance and accessible healthcare, innovative integrations of information technology, and amendments to laws and regulations adapted to the evolving situation. Taiwan's CDCA was introduced in 1944. In addition to posting travel advisories, the Taiwan Centers for Disease Control (CDC) enhanced border control, as required by the CDCA. Taiwan CDC officers stationed at airports implemented health screening of passengers and provided healthcare advice. © 2023 John Wiley & Sons, Inc.

COVID-19 and BAME Group in the United Kingdom

COVID-19 is known to disproportionately affect ethnic minorities in number of settings. This phenomenon has also been reported in the UK where the black, Asian and minority ethnic (BAME) group has adverse health outcomes in terms of number of both cases and mortality rates when compared to the white local population. This trend is also observed among the BAME staff working in the National Health Service. Number of plausible explanations and the importance of various approaches including social-determinants approach is pointed out. This pandemic has re-ignited the debate on social inequalities, issues around social deprivation and health inequalities within the UK. This article concludes with some policy recommendations.

Public Health Measures Enacted by the Norwegian Political Leadership to Protect the Elderly in Response to the SARS-CoV-2 Pandemic Crisis

The SARS-CoV-2 pandemic crisis is ongoing, and the elderly are still affected by the virus, sometimes with fatal consequences. The political leaders are, inter alia, focussed on protecting citizens, including this vulnerable group. This article aims to describe the response of the Norwegian political leadership, with a focus on the public health measures enacted to protect the elderly during the SARS-CoV-2 pandemic crisis in the years 2020 and 2021. This study has a descriptive qualitative research design using thematic-content analysis as a methodology to evaluate data collected from official documents, national statistics and public health documents from Norway. Statistics show that the elderly mortality rate per 100,000 person-weeks during the first wave of the SARS-CoV-2 pandemic was 2.69 in Norway;during the second wave of the pandemic, it was 1.43. The public health measures the Norwegian political leadership instigated were more effective in containing the crisis when compared to other European countries, and this paper investigates the reasons. The results of our study provide public health policy decision-makers with insights into analytical material showing the usefulness of different measures enacted by the Norwegian government. The Norwegian government's responses to the crisis, such as the public health measures, restrictions, social consequences for vulnerable groups such as the elderly, as well as cross-government and cross-community cooperation, will need further in-depth analysis. © 2023 Miroslava Tokovska et al., published by Sciendo 2023.

Exploratory Analysis of Twitter Data to Support Decision-Making in Law Enforcement: An Analytical Study of COVID-19 Using the NodeXL Tool

The COVID-19 epidemic constituted a crisis for health facilities in 2020. This was due to less medical staff available, degrading employment conditions, and higher death rates. These conditions led to tweets (messages posted on Twitter) launching hashtags titled #ln_solidarity_with_the_Egyptian_doctors (#Solidarity_with_doctors_Egypt) to urge medical staff in Egypt to strike for better working conditions. This resulted in less medical care being provided and threats to public security. This study addresses the exploratory analysis of "Twitter Platform" data during the COVID-19 pandemic in Egypt in April 2020 to test documented mechanisms to process mass data and identify accounts that lead the public opinion-gathering processes on Twitter. It analyzes the hierarchical structure and their ideological belonging. The study uses the URL Decoder/Encoder tool to transfer Arabic hashtags into codec symbols. The study deduced that dialogue clusters on Twitter formed Community Cluster Networks in the study sample. Findings proved significant in determining the accounts leading the public opinion-gathering process. They were recognized through the coordination and arrangement function, as well as the hierarchical structure of the group and their intellectual and ideological tendencies. Finally, the study confirmed the increase of decision makers' opportunities in gathering accurate information and producing high-quality inferences when using multiple open-source analytical tools, especially information exploratory analysis tools.

Impact of COVID-19 on Spanish mortality rates in 2020 by age and sex.

BACKGROUND: Previous studies have used different biometric indicators to measure the effect of Covid-19 on population mortality such as the number of deaths or the decrease of life expectancy showing a dependence of mortality on age and sex. According to them, the impact of the pandemic was greater on women than in men and that the older the population, the greater the number of deaths caused by Covid-19. METHODS: We apply graduation techniques and non-parametric methods to estimate mortality rates allowing us to obtain an age-by-age picture of changes in mortality rates from 2018-2019 to 2020. RESULTS: Graduation techniques have detected a significant U-shaped reduction in infant mortality rates although with an anomalous peak in girls aged 10-12. Likewise, we have observed a notable increase in mortality rates of the female population between 28 and 40 years of age. The increase of mortality rates after the age of 70 years was similar for both men and women with a slight decline after the age of 80. CONCLUSIONS: The use of graduation techniques and the focus on age-by-age changes in mortality rates showed a complex behaviour in some tranches of the mortality curve that might otherwise have gone unnoticed.

European cancer mortality predictions for the year 2023 with focus on lung cancer.

BACKGROUND: We predicted cancer mortality figures for 2023 for the European Union (EU-27), its five most populous countries, and the UK. We also focused on mortality from lung cancer. MATERIALS AND METHODS: Using cancer death certification and population data from the World Health Organization and Eurostat databases for 1970-2018, we predicted numbers of deaths and age-standardized rates (ASRs) for 2023 for all cancers combined and the 10 most common cancer sites. We investigated the changes in trends over the observed period. The number of avoided deaths over the period 1989-2023 were estimated for all cancers as well as lung cancer. RESULTS: We predicted 1 261 990 cancer deaths for 2023 in the EU-27, corresponding to ASRs of 123.8/100 000 men (-6.5% versus 2018) and 79.3 for women (-3.7%). Over 1989-2023, ∼5 862 600 cancer deaths were avoided in the EU-27 compared with peak rates in 1988. Most cancers displayed favorable predicted rates, with the exceptions of pancreatic cancer, which was stable in EU men (8.2/100 000) and rose by 3.4% in EU women (5.9/100 000), and female lung cancer, which, however, tends to level off (13.6/100 000). Steady declines are predicted for colorectal, breast, prostate, leukemia, stomach in both sexes, and male bladder cancers. The focus on lung cancer showed falls in mortality for all age groups in men. Female lung cancer mortality declined in the young (-35.8%, ASR: 0.8/100 000) and middle-aged (-7%, ASR: 31.2/100 000) but still increased by 10% in the elderly (age 65+ years). CONCLUSIONS: The advancements in tobacco control are reflected in favorable lung cancer trends, and should be pushed further. Greater efforts on the control of overweight and obesity, alcohol consumption, infection and related neoplasms, together with improvements in screening, early diagnosis, and treatments may achieve a further 35% reduction in cancer mortality in the EU by 2035.

Evidences of Citizens' Engagement from COVID-19 Pandemic in Italy. Health Care System' Facebook Communication

The study aims at demonstrating how social communication has changed in terms of flows and content during the COVID-19 pandemic to get to the fact that health system organizations have embarked on a path of rapprochement with the citizen that starts from the methods of communication and interaction. This article presents an exploratory and multidisciplinary study conducted through the analysis of the Facebook page of the Italian Local Health Units (LHUs) site in the areas with the highest cumulative COVID-19-induced mortality rate. The study affirms that they are in an early stage of the process both for the acquisition of skills for social communication and for the definition of a communication strategy.

Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States.

BACKGROUND: The pandemic has resulted in an increase of deaths not directly related to COVID-19 infection. We aimed to use a national death dataset to determine the impact of the pandemic on people with liver disease in the U.S, focusing on alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). METHODS: Using data from the National Vital Statistic System from the CDC WONDER platform and ICD-10 codes, we identified deaths associated with liver disease. We evaluated observed versus predicted mortality for 2020-2021 based on trends from 2010-2019 with joinpoint and prediction modeling analysis. RESULTS: Among 626,090 chronic liver disease-related deaths between 2010 and 2021, Age-standardized mortality rates (ASMR) for ALD dramatically increased between 2010-2019 and 2020-2021 (annual percentage change [APC] 3.5% to 17.6%, P<0.01), leading to a higher observed ASMR (per 100,000 persons) than predicted for 2020 (15.67 vs.13.04) and 2021 (17.42 vs.13.41). ASMR for NAFLD also increased during the pandemic (APC:14.5%), while the rates for hepatitis B and C decreased. Notably, the ASMR rise for ALD was most pronounced in non-Hispanic Whites, Blacks, and Alaska Indians/Native Americans (APC: 11.7%, 10.8%, 18.0%, all P<0.05), with similar but less critical findings for NAFLD while rates were steady for non-Hispanic Asians throughout 2010-2021 (APC: 4.9%). The ASMR rise for ALD was particularly severe for the 25-44 age group (APC: 34.6%, versus 13.7% and 12.6% for 45-64 and ≥65, all P<0.01), which were also all higher than pre-COVID-19 rates (all P<0.01). CONCLUSIONS: ASMR for ALD and NAFLD increased at an alarming rate during the COVID-19 pandemic with the largest disparities among the young, non-Hispanic White, and Alaska Indian/Native American populations. LAY SUMMARY: The impact of the pandemic on people with liver disease in the U.S remains unclear. This study indicated that age-standardized mortality rates for alcohol associated liver disease and non-alcohol fatty liver disease greatly accelerated during the COVID-19 pandemic with the largest disparities among the young, non-Hispanic White, and Alaska Indian/Native American populations. Increasing awareness about the care importance of chronic liver disease in specific populations must be prioritized.