ABSTRACT
Background: The focus on treatment of COVID-19 patients during the Sars-CoV-2 outbreak, lockdown measures and individuals' anxiety regarding potential infection when seeing a healthcare provider have likely implications on the extent of diagnosis and quality of treatment of non-COVID-19 patients. This hypothesis has been evaluated exemplarily for the early detection, diagnosis and treatment of colorectal cancer in Saxony within the framework of the CancerCOVID project. Method(s): The situation during 2020 was compared with the situation before the Sars-CoV-2 pandemic (i.e., 2019). The evaluation is based on pseudonymised routine statutory health insurance data for Saxony including more than 50% of the population. Result(s): A main finding was the drop in the number of diagnosis of new colorectal cancer cases between 2019 and 2020 (i.e., 1797 versus 1352). Furthermore, the per-patient rate of surgeries for incident colorectal cancer cases increased slightly (2.4 to 2.5), as did the rate of intravenous (IV) cytostatics administration (2.2 to 2.4) and radiation therapy (1.1 to 1.4). The per-patient rate of surgeries for prevalent colorectal cancer patients remained constant (0.3), as did the rate of radiation therapy (0.2). However, the per-patient rate of IV cytostatics for prevalent colorectal cancer patients decreased from 1.7 to 1.4. The results of analyses pertaining to cancer screenings and mortality are available as well. Discussion(s): It is likely that reduced screenings and fewer contacts with healthcare providers due to the pandemic led to the drop in new diagnosis. The reasons for the small numeric increases in the rates of procedures per incident patient versus the largely flat trajectory in the rate of health care services for prevalent cases require further exploration. Conclusion(s): COVID-19 was associated with changes in the provision of health care especially for cancer patients, which should be taken into consideration in the resource planning when preparing for another pandemic or public health emergency.
ABSTRACT
Background. COVID-19 presents a serious health risk to pregnant people and pregnancy outcomes. However, pregnant people were not included in pivotal phase III COVID-19 vaccine efficacy trials. Methods. We used Cox regression models in a cohort study to determine hazard ratios (HR) of a PCR positive test ("infection") comparing vaccinated with unvaccinated pregnant persons in Kaiser Permanente Northern California. HRs were adjusted for age, race/ethnicity, type of insurance coverage, geographical area, BMI, preexisting diabetes, hypertension, parity, time since pregnancy onset and smoking status. Vaccine effectiveness (VE), calculated as 1 minus adjusted HR, was estimated for fully vaccinated < 150 and >= 150 days prior to infection. VE was estimated for before and during Delta, and Omicron. We also calculated incidence rates of COVID-pneumonia associated hospitalization by vaccination status. Results. Among 68836 pregnancies between 12/15/2020 and 3/31/2022, 21834 (31.7%) were fully vaccinated and 5980 (8.7%) were boosted by the end of pregnancy. Compared with unvaccinated persons, the HRs of infection for fully vaccinated < 150 days prior were 0.13 (95% CI: 0.07 - 0.23;VE=87% [77% - 93%]) before Delta;0.25 (CI: 0.20 - 0.30;VE=75% [70% - 80%]) during Delta and 0.76 (CI: 0.61 - 0.94;VE= 24% [16% - 39%]) during Omicron. The HRs for >= 150 days prior were 0.38 (CI: 0.31 - 0.46;VE=62 % [54% - 69%]) during Delta and 1.04 (CI: 0.89 - 1.22;VE= -0.04% [-0.22% - 0.11%]) during Omicron. The HRs for boosted persons were 0.10 (CI: 0.04 - 0.25;VE= 90% [75% - 96%]) during Delta and 0.42 (CI: 0.34 - 0.52;VE=58% [48% - 66%]) during Omicron periods. Incidence rates (IR) per 1000 person-years for hospitalization before delta were 0.75 among unvaccinated and zero among vaccinated. During Delta, the IR was 6.64 for unvaccinated and zero for fully vaccinated and boosted. During Omicron, the IR was 10.27 for unvaccinated, zero for fully vaccinated < 150 days prior, 2.48 for fully vaccinated >= 150 days prior and zero for those boosted. Conclusion. COVID-19 vaccines protect against infection and hospitalization among pregnant people. However, vaccine effectiveness against infection wanes over time and was lower during Omicron. Booster doses are necessary for continuous protection.
ABSTRACT
Purpose: Adolescent and young adult (AYA) health care access for preventive services allows for screening and treatment of common adolescent comorbidities. AYA living in areas of poverty experience transportation access barriers and health disparities for these common comorbidities. The objective of this study is to explore the relationship between neighborhood poverty and preventive service needs among adolescents who utilized an institutionally sponsored commercial ride sharing service (ISCRSS) before and during the COVID-19 pandemic. Methods: An ISCRSS using Lyft was launched in an urban academic adolescent clinic as a quality improvement project for 21 months, 10/1/19 – 6/30/21. Collected rider data included demographics, insurance, visit types, visit diagnoses, and pick-up/drop-off locations. 1024 rides were categorized into 6 visit types. We analyzed annual well and acute care visits exclusively (n=537) given the practice philosophy to deliver as many services as possible based on need during visits, particularly during the COVID-19 pandemic. The mean neighborhood poverty rate for pick-up/drop-off locations of 23.7% (S.D. 8.63, median=25.4%) was greater than the 2019 10.5% federal poverty rate. Neighborhoods above the federal poverty rate were subsequently subdivided into low and high poverty categories using the median split. Preventive services received were obtained via secondary chart review and included screening and treatment for STIs, mental health, substance use, obesity, hypertension, family planning, immunizations and female reproductive health. Bivariate analyses assessed patient characteristics, neighborhood poverty level, visit types, and preventive services received for each visit. Linear regression was used to evaluate the number of preventive services received by gender and visit type. Results: Of the 537 clinical visits, 81.4% were acute care. There was a significant difference between number of preventive services received by visit type with an average of 2.9 (SD 1.3) preventive services per visit for annual visits and 1.5 (SD 1) for acute visits, (p<0.001). Mean age of AYA receiving annual well visits was 18.7 years (SD 2.7) and 20.0 years (SD 2.8) for acute visits, (p<0.001). For both visit types, most AYA were female (78%) and had public insurance (88%). Number of preventive services received also differed by insurance, 78% of publicly insured vs 65% of privately insured received 1-2 preventive services per visit (p=0.031). Of the preventive services offered, obesity (92.45%, p<0.001), mental health (80.32%, p=0.024), and immunizations (81.24%, p=0.001) were greater in acute visits compared to annual well visits. Linear regression models indicated female patients received 0.640 more services [B=0.640, SEB=0.111, p<0.001] than males and acute visits received 1.44 fewer services [B= -1.442, SEB= 0.12, p <0.001] than annual well visits. There was no significant effect for neighborhood poverty level on the type of visit nor the mean number of preventive services received. Conclusions: This study demonstrates that AYA using an ISCRSS for transportation support to clinical care are leveraging well and acute care visits to obtain preventive services. As the pandemic continues carefully thinking through ways to optimize preventive services while you can, may be critical for youth residing in impoverished communities with low transportation access. Sources of Support: Johns Hopkins Children’s Center Innovation Grant, NICHD T32HD052459.