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1.
Public Health ; 213: 5-11, 2022 Oct 25.
Article in English | MEDLINE | ID: covidwho-2083185

ABSTRACT

OBJECTIVES: The COVID-19 pandemic highlighted the importance of routine syndromic surveillance of respiratory infections, specifically new cases of severe acute respiratory infection (SARI). This surveillance often relies on questionnaires carried out by research nurses or transcriptions of doctor's notes, but existing, routinely collected electronic healthcare data sets are increasingly being used for such surveillance. We investigated how patient diagnosis codes, recorded within such data sets, could be used to capture SARI trends in Scotland. STUDY DESIGN: We conducted a retrospective observational study using electronic healthcare data sets between 2017 and 2022. METHODS: Sensitive, specific and timely case definition (CDs) based on patient diagnosis codes contained within national registers in Scotland were proposed to identify SARI cases. Representativeness and sensitivity analyses were performed to assess how well SARI cases captured by each definition matched trends in historic influenza and SARS-CoV-2 data. RESULTS: All CDs accurately captured the peaks seen in laboratory-confirmed positive influenza and SARS-CoV-2 data, although the completeness of patient diagnosis records was discovered to vary widely. The timely CD provided the earliest detection of changes in SARI activity, whilst the sensitive CD provided insight into the burden and severity of SARI infections. CONCLUSIONS: A universal SARI surveillance system has been developed and demonstrated to accurately capture seasonal SARI trends. It can be used as an indicator of emerging secondary care burden of emerging SARI outbreaks. The system further strengthens Scotland's existing strategies for respiratory surveillance, and the methods described here can be applied within any country with suitable electronic patient records.

2.
Int J Environ Res Public Health ; 19(20)2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2071452

ABSTRACT

To date, there is a lack of comprehensive understanding regarding the effect of coronavirus disease 2019 (COVID-19) on the healthcare-seeking behavior and utilization of health services in rural areas where healthcare resources are scarce. We aimed to quantify the long-term impact of COVID-19 on hospital visits of rural residents in China. We collected data on the hospitalization of all residents covered by national health insurance schemes in a county in southern China from April 2017 to March 2021. We analyzed changes in residents' hospitalization visits in different areas, i.e., within-county, out-of-county but within-city, and out-of-city, via a controlled interrupted time series approach. Subgroup analyses based on gender, age, hospital levels, and ICD-10 classifications for hospital visits were examined. After experiencing a significant decline in hospitalization cases after the COVID-19 outbreak in early 2020, the pattern of rural residents' hospitalization utilization differed markedly by disease classification. Notably, we found that the overall demand for hospitalization utilization of mental and neurological illness among rural residents in China has been suppressed during the pandemic, while the utilization of inpatient services for other common chronic diseases was redistributed across regions. Our findings suggest that in resource-poor areas, focused strategies are urgently needed to ensure that people have access to adequate healthcare services, particularly mental and neurological healthcare, during the COVID-19 pandemic.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Interrupted Time Series Analysis , Pandemics , Rural Population , China/epidemiology , Hospitals
3.
American Journal of Transplantation ; 22(Supplement 3):874-875, 2022.
Article in English | EMBASE | ID: covidwho-2063454

ABSTRACT

Purpose: To characterize demographics, treatment patterns, and outcomes among 3,998 transplant patients hospitalized for COVID-19 over 16 months of the pandemic (May '20-Aug '21). Method(s): Adult patients in a transplant cohort (TC) and non-transplant cohort (NTC) hospitalized with COVID-19 (ICD-10: U07.1) were compared in the Premier Healthcare Database from May '20-Aug '21. Baseline measures in first two days, demographics, comorbidity, COVID-19 treatments and immunosuppressants were analyzed. Outcomes included mortality (discharge status expired or hospice) and hospital and ICU LOS. Result(s): 3,998 TC patients were hospitalized for COVID-19 in 587 US hospitals. Compared to NTC, TC were younger (61 vs 64 yrs;p<.0001), less likely to be white (59% vs 67%;p<.0001), obese (24% vs 33%;p<.0001) or have COPD (17% vs 24%;p<.0001). TC had higher rates hypertension (84% vs 69%;p<.0001), renal disease (80% vs 22%, p<.0001), diabetes (48% vs 29%;p<.0001) and chronic heart failure (23% vs 18%;p<.0001). During hospitalization, a lower proportion of TC needed any oxygen therapy compared to NTC (p<.05). Compared to NTC, fewer TC received remdesivir (RDV) (44% vs 48%;p<.0001), but more received corticosteroids (87% vs 78%;p<.0001), anticoagulants (44% vs 29%;p<.0001) and convalescent plasma (18% vs 16%;p=0.007). In TC, 44% received MMF, 73% calcineurin inhibitors and 5% mTOR. Use of MMF did not change over time (43% May-Jul 2020;43% Aug- Dec 2020;45% 2021). TC had higher ICU admission rates (31% vs 28%;p.001), but similar hospital LOS and ICU LOS compared to NTC. All-cause mortality in NTC (15% overall;16% May-Jul 2020;16% Aug-Dec 2020;14% 2021) was not significantly different than TC over time (16% overall;13% May-Jul 2020;16% Aug-Dec 2020;16% 2021). Conclusion(s): Very few large studies have assessed COVID-19 management in transplant patients over time. All-cause mortality was comparable in both cohorts despite TC immunosuppression. RDV use was lower in TC. Uncertainty around MMF use in COVID-19 patients did not impact reported use of MMF. Further analyses are needed to evaluate confounding factors (medication sequence, time since transplant, disease severity) and impact of external factors such as earlier testing and treatment for COVID-19, vaccination, and new variants. (Table Presented).

4.
American Journal of Transplantation ; 22(Supplement 3):918-919, 2022.
Article in English | EMBASE | ID: covidwho-2063442

ABSTRACT

Purpose: CMS introduced new performance metrics for Organ Procurement Organizations (OPO). CDC death records define donation eligible deaths, the denominator of the donation and transplant rate metrics. The COVID-19 pandemic has had an unprecedented and geographically varied impact on United States death statistics. Thus, we examined the potential impact of COVID-19 on the calculation of the OPO performance metrics. Method(s): Eligible deaths include hospitalized decedents with "donation appropriate" diagnoses. We extracted death certificate data from the CDC WONDER system for baseline years (2015-2019) and the CDC COVID Data Tracker (after 2019). CDC aggregates data by state and broad disease groups including Circulatory Death (CD), death from Cerebrovascular Disease ICD-10 i60-i69 and Ischemic Heart Disease ICD-10 i20-i25. Deaths related to COVID (ICD-10 U07.1) were separately grouped. The proportion of CD during the pandemic was compared to baseline and correlated with COVID. Result(s): At baseline, CD accounted for 66.2% of OPO eligible deaths, increasing markedly in 2020 and 2021. (Figure A) The week of April 11, 2020, the national proportion of CD peaked at +23.8% over baseline, paralleling the dramatic increase in the proportion of deaths due to COVID (20%). Early in the pandemic, the proportion of CD and COVID deaths were strongly correlated (2020 r=.44). This attenuated over time (2021: r=.25). The CD and COVID death association evolved as the pandemic spread geographically. (Figure B) In 2020, the change in proportion of CD varied from New York (+20.6%) to Massachusetts (-6.5%). The COVID - CD correlation was highest in the Northeast and Florida, (New Jersey [.78], New York [.75] and Florida [.75]). By 2021, the change in proportion of CD was highest in Mississippi (+14.5%) and lowest in West Virginia (-28.6%), while the COVID - CD correlation diminished and spread west (Florida [.65], Tennessee [.54] and California [.53]. Conclusion(s): Accurate eligible death assessment has been difficult, leading to a shift in calculations based on ICD-10 coded death certificates instead of OPO reported deaths. CD constitutes 2/3 of recorded donation eligible deaths historically, which has been substantially, but variably, impacted by the COVID-19 pandemic. Thus, these metrics based on CDC data may be sensitive to unanticipated and uneven shocks such as disease outbreaks, leading to inaccurate estimates of donor potential. CMS metrics should be refined to better account for external shocks such as the COVID-19 pandemic. (Figure Presented).

5.
Cardiology in the Young ; 32(Supplement 2):S55, 2022.
Article in English | EMBASE | ID: covidwho-2062118

ABSTRACT

Background and Aim: World-wide, Kawasaki disease (KD) is known to affect predominantly children under the age of 5, mostly boys. An increasing incidence has been reported from select countries, as well as seasonal differences, although with great variation among reports. Sweden has unique population-based health registers which can be linked to population registers via a personal number. In this study we therefore utilized population-based data over a period of more than 30 years to investigate demographics and epi-demiology of Kawasaki disease in a Scandinavian country. Method(s): Individuals receiving a diagnosis of Kawasaki disease in Sweden from 1987-2018 (before the occurrence of MIS-C) were identified by ICD9 and ICD10 discharge diagnoses in the Patient register at the National Board of Health and Welfare, and basic demographic information obtained by cross-linking with popula-tion registers at Statistics Sweden. Age-stratified population statis-tics were also retrieved during the corresponding time-period. Result(s): A total of 1,785 individuals with a KD diagnosis during the study period were identified, confirming a relatively low incidence in the Scandinavian population. Less than 5% of the cases were born in another country. The majority of cases (78%) occurred before 5 years of age, and there was a male dominance (61%). Sweden has a temperate climate of the northern hemisphere, and analysis of case distribution over the yearly cycle revealed peak incidence during the winter months. Notably, the incidence rose from around 6/100,000 lt;5-year-olds to 15/100,000 lt;5-year-olds during the 30-year study period. Two years with prominently higher incidence than prior and following years were observed. A large part of the rise in incidence seems to be associated with immigration and occurred before the occurrence of Multisystem Inflammatory Syndrome in Children related to SARS-CoV-2. Conclusion(s): Demographic parameters for Kawasaki disease in Sweden regarding age and sex distribution are similar to previous reports from other countries. Our data from a 30-year study period of population-based observations confirm peak incidence during the cold period, and a rising incidence during recent years, even before the occurrence of MIS-C. Our data also indicate outbursts during two years and immigration-associated patterns in rise in incidence.

6.
Chest ; 162(4):A2407, 2022.
Article in English | EMBASE | ID: covidwho-2060943

ABSTRACT

SESSION TITLE: Racial Disparities in Pulmonary Embolism Risk Factors and Mortality in the SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 1:30 pm - 2:30 pm PURPOSE: Racial disparities in pulmonary embolism (PE) related mortality rates have been reported for decades in the United States (US). The risk factors contributing to the observed disparity remain unclear. Our objective is to examine recent PE-related mortality trends and PE risk factors by race. We hypothesize racial disparity gap in PE-related mortality and risk factors has persisted and might have widened with the COVID 19 pandemic. METHODS: The Centers for Disease Control and Prevention (CDC) wide-ranging online data for epidemiologic research for both underlying cause of death (UCOD) and multiple causes of death (MCOD) in the US between the years 1999-2020 was used for this study. Non-Hispanic black (NHB) and non-Hispanic white (NHW) decedents aged 25 years and older with an ICD-10 code for PE (I26) were included. Age-adjusted mortality rates (AAMR) with 95% Confidence Intervals (CIs) were computed by race for age groups, year, Health & Human Services (HHS) regions, and urbanization and PE risk factors. Risk factors examined were trauma, cancer, cardiovascular diseases, obesity, sepsis, chronic lower respiratory diseases, and COVD-19 among PE decedents. RESULTS: Between the years 1999-2020, PE was the UCOD in 168,540 decedents, with 137,128 (81.4%) NHWs and 31,412 (18.6%) NHBs. The overall age-adjusted mortality rate (AAMR) decreased from 1999(5.3;95% CI, 5.2 - 5.4) to 2009(3.6;95% CI, 3.5 - 3.7), and then increased from 2010(3.8;95% (3.7 - 3.8) to 2020(4.2;95% CI, 4.1 - 4.3).There was a steep rise in the overall AAMR for 2020 (4.2;95% CI, 4.1 - 4.3) compared to the year prior 2019 (3.9;95% CI, 3.8 - 4.0) with highest annual % change among NHBs when compared to NHWs (NHB men (13%), NHB women (15%), NHW men (8.3%), NHW women (6%).) NHB men (AAMR 7.2;95% CI, 7.1-7.4) and NHB women (AAMR 6.6;95% CI, 6.5-6.7) had 2-fold higher AAMR compared to NHW men (AAMR 3.8;95% CI, 3.8-3-9) and NHW women (AAMR 3.7;95% CI, 3.7-3.7). Similar trends were also noted in geographical regions. The highest AAMRs were in HHS regions 3, 4, 5,6, 7, and 8. Within these HHS regions, NHBs and NHWs who resided in small metro and non-metropolitan areas had the highest AAMRs. However, NHB-NHW disparity in AAMR was seen in all 10 HHS regions and Urbanization. When risk factors such as trauma, cancer, obesity, cardiovascular diseases, sepsis, and chronic lower respiratory diseases were each mentioned as MCOD with PE decedents, rates varied by risk factor but NHBs had consistently higher AAMR than NHWs. CONCLUSIONS: We showed that PE-related mortality has increased over the past decade and racial disparities persisted and varied by gender, region, urbanization, and risk factors. The decades-long disparity observed in PE-related mortality may be narrowed by allocating resources to the management of common comorbidities. CLINICAL IMPLICATIONS: Racial disparity in PE-related mortality is related to comorbidities listed in MCOD data. DISCLOSURES: No relevant relationships by Isaac Ikwu No relevant relationships by Alem Mehari No relevant relationships by Lamiaa Rougui

7.
Chest ; 162(4):A1878, 2022.
Article in English | EMBASE | ID: covidwho-2060879

ABSTRACT

SESSION TITLE: COPD Medications and Treatment Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Conclusive data on whether inhaled corticosteroids (ICS) have a protective effect on COVID-19 hospitalization rates or outcomes are lacking. The main objective of our study was to assess the impact of pre-hospitalization ICS use on the clinical course of hospitalized COVID-19 patients with underlying obstructive lung diseases - asthma and chronic obstructive pulmonary disease (COPD). METHODS: We conducted a retrospective chart review study of all COVID-19 patients hospitalized at our institution between March 1st - June 3th, 2020. Diagnosis of asthma and COPD was determined using ICD-10 codes. Demographics, information about pre-hospitalization ICS use and clinical data were recorded through chart review. Outcomes of interest were all-cause 28-day mortality and need for intubation. Chi-square or Fischer’s exact test was used to assess univariate associations. Linear and logistic regression models were constructed to adjust for potential confounders. RESULTS: Data was analyzed from 356 hospitalized COVID-19 patients with prior diagnosis of obstructive lung disease;219/356 (62%) had asthma, 137/356 (38%) had COPD. Hospitalized COVID-19 patients with asthma were younger (mean age 61 [range: 51-71] vs 74 [range:67-81] years, p<0.01), more likely to be female (69% vs 48%, p<0.01), Hispanic (43% vs 25%, p<0.01) and never smokers (52% vs 20%, p<0.01) compared to those with COPD. There was no difference in the use of pre-hospitalization ICS between the two groups (35.2% in Asthma vs 38% in COPD, p=0.59). Overall, COVID-19 patients with COPD were more likely to die compared to those with asthma (47% vs 25%, p<0.01). Pre-hospitalization ICS use was not significantly associated with all-cause 28-day mortality (asthma: OR 0.9 [95%CI 0.4-2.0], p=0.85;COPD: OR 0.7 [95%CI 0.3-1.5], p=0.3) or need for intubation (asthma: OR 1.0 [95%CI 0.5-2.0], p=0.94;COPD: OR 0.7 [95%CI 0.3-1.7],p=041) after adjusting for potential confounders. CONCLUSIONS: Mortality among hospitalized COVID-19 patients with COPD was higher compared to those with asthma. While the pre-hospitalization use of ICS was similar between the two groups, it did not protect hospitalized COVID-19 patients in either group from intubation or mortality. High mortality rates among COVID-19 patients with COPD is likely due to concomitant risk factors such as older age, and comorbidities such as diabetes and chronic kidney disease. Being a retrospective study, the quality of our data was limited and dependent on documentation accuracy. CLINICAL IMPLICATIONS: Pre-hospitalization ICS use did not improve outcomes in hospitalized COVID-19 patients with asthma or COPD. Further studies are required to investigate the role of ICS in preventing COVID-19 related hospitalizations, morbidity and mortality in randomized control settings. DISCLOSURES: No relevant relationships by Hammad Aleem No relevant relationships by Denisa Ferastraoaru No relevant relationships by Manuel Hache Marliere No relevant relationships by Gabriel Hernández Romero No relevant relationships by Christa McPhee No relevant relationships by Francine Palmares No relevant relationships by Divya Reddy No relevant relationships by Felix Reyes No relevant relationships by Deborah Schwartz

8.
Chest ; 162(4):A1172, 2022.
Article in English | EMBASE | ID: covidwho-2060787

ABSTRACT

SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Ethnic and racial disparities have been found to be influential drivers for poor outcomes in COVID-19 patients. Hispanic ethnic group has been recognized to have disproportionately higher COVID-19 infections and associated hospitalizations and deaths, which have been attributed to differences in socioeconomic and health factors, including high burden of comorbidities. However, studies specifically addressing the risk of death related to ethnicity alone are lacking. Therefore, we evaluated the association between Hispanic ethnicity and 30-day mortality in patients without comorbidities hospitalized with a COVID-19 diagnosis. METHODS: We included hospitalized patients with a COVID-19 diagnosis (based on the ICD-10 code U07.1) in an observational cohort study at the South Texas Veterans Health Care System (STVHCS) from April 1st, 2020 until December 31st, 2021. Additionally, we selected patients with no comorbidity burden based on a Charlson Comorbidity Index (excluding age) equal to zero. The index date was considered at the first documentation of COVID-19 diagnosis. We compared two independent groups: Hispanic vs. non-Hispanics. Our outcome of interest was 30-day all-cause mortality. Continuous variables were expressed as medians with interquartile ranges (IQR) and categorical variables were reported as absolute frequencies and percentages. A priori multivariable analysis was set to adjust for age, gender, and the probability of death at 30-days according to the validated Veterans Health Administration COVID-19 Index (VACO score). RESULTS: We identified 219 hospitalized COVID-19 patients with no comorbidities, stratified into Hispanics (n=87 [39.7%]) and non-Hispanics (n=132 [60.3%]). Demographic characteristics for Hispanics and non-Hispanics were comparable for median (IQR) age (48 [39-58] years vs. 51 [40-61] years), while there was a greater proportion of male gender in the Hispanic group (n=80 [92.0%] vs. n=110 [83.3%]). Hispanics had a lower probability of death according to the VACO score compared to non-Hispanics (0.22% [0.22%-2.95%] vs. 1.97% (0.22%-4.96%). Both groups had similar 30-day all-cause mortality, n=4 (4.6%) for Hispanics and n=4 (3.0%) for non-Hispanics with p-value=0.72. Due to the low number of deaths between the two groups, we were unable to perform a multivariate analysis. CONCLUSIONS: In this cohort of hospitalized COVID-19 patients without comorbidities, Hispanic ethnicity was not associated with an increased 30-day all-cause mortality. CLINICAL IMPLICATIONS: Our study demonstrates Hispanic ethnicity alone does not account for differences in outcomes of COVID-19 patients. Other factors, such as social determinants of health and comorbidity burden, have been shown to play significant roles and should be the focus of efforts to mitigate morbidity and mortality in COVID-19. DISCLOSURES: No relevant relationships by Liwayway Andrade No relevant relationships by Nicholas Hodgeman No relevant relationships by Michael Mader No relevant relationships by Marcos Restrepo No relevant relationships by Sandra Sanchez-Reilly

9.
Chest ; 162(4):A1169, 2022.
Article in English | EMBASE | ID: covidwho-2060785

ABSTRACT

SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: The COVID-19 pandemic resulted in an unexpected increase in mortality primarily among patients with preexisting comorbidities. San Antonio Texas and the surrounding areas are home to a proportionally larger Hispanic population relative to the remainder of the state and country. It has been well documented that patients with pre-existing comorbidities have increased mortality when admitted for COVID-19, but limited data are available regarding the Hispanic minority ethnic group. We determined whether Hispanic ethnicity contributed to 30-day mortality when compared to non-Hispanics among hospitalized COVID-19 patients with similar comorbidity burden. METHODS: We performed an observational cohort study among hospitalized patients that were enrolled at the South Texas Veterans Health Care System (STVHCS) from April 1, 2020 until December 31, 2021 and diagnosed with COVID-19 disease. The index data was defined as the day of COVID-19 diagnosis according to the ICD-10 code U07.1. Our independent variable was stratified according to the Hispanic ethnic group. We included COVID-19 patients with similar comorbidity burden, defined by a Charlson Comorbidity Index (CCI) of greater than or equal to 1. A priori adjustment was performed for variables that influence clinical outcome such as age, gender, and CCI, respectively. The primary outcome was 30-day all-cause mortality. Descriptive and multivariate analysis were performed using the IBM SPSS statistics software. RESULTS: Of the 1257 hospitalized patients during the study period, 1038 met inclusion criteria. There were 372 (35.8%) Hispanics and 666 (64.2%) non-Hispanics. Hispanic patients had similar demographic characteristics to non-Hispanic patients, regarding median age in years (68 [56-73] vs. 68 [58-74], male gender (n=354 [95.2%] vs. n=610 [91.6%]) and median CCI (4.0 [2.0-6.8] vs. 4.0 [2.0-7.0]), respectively. The 30-day all-cause mortality was 13.8% (n=50) in the Hispanic group compared to 14.0% (n=93) in the non-Hispanic group (p=0.81). After adjusting for age, gender and CCI, Hispanics had a similar 30-day all-cause mortality to the non-Hispanic group of COVID-19 hospitalized (AOR 0.98, 95% CI 0.66-1.43, p=0.97). CONCLUSIONS: Hispanic ethnicity was not associated with an increased 30-day all-cause mortality in a population of hospitalized COVID-19 patients with similar comorbidity burden. CLINICAL IMPLICATIONS: Hispanic ethnicity does not appear to be an independent risk factor for increased mortality related to COVID-19 DISCLOSURES: No relevant relationships by Liwayway Andrade No relevant relationships by Nicholas Hodgeman No relevant relationships by Marcos Restrepo

10.
Investigative Ophthalmology and Visual Science ; 63(7):2230-A0526, 2022.
Article in English | EMBASE | ID: covidwho-2058415

ABSTRACT

Purpose : Patients on systemic immunomodulatory therapy (IMT) for uveitis are at higher risk of infection and infectious complications. While other medical specialties have studied the safety of IMT in non-ocular, autoimmune conditions vis-à-vis coronavirus disease 2019 (COVID-19), little is known about the effects of these drugs in uveitis patients specifically. The objective of this study was to determine if uveitis patients with COVID-19 were at higher risk of hospitalization for this pandemic illness and whether systemic IMT affected this risk. Methods : Retrospective cohort study of uveitis patients in 2020 in the United States. The Symphony health insurance claims dataset was used. Inclusion criteria were an ICD10 code for COVID-19, a code for any form of non-infectious uveitis or scleritis, and age 18 or greater. Drugs studied included methotrexate, mycophenolate, azathioprine, tacrolimus, cyclosporine, adalimumab, infliximab, tocilizumab, rituximab, and JAK, IL-17, and IL-12/23 inhibitors. The main outcome measure was adjusted odds of hospitalization for COVID19. Multivariable logistic regression was used to adjust for major risk factors for severe COVID-19 disease, including age, biological sex, cardiac, pulmonary, hepatic, and renal disease, obesity, organ transplant, stroke, and certain cancers. Results : 3,974,272 patients in the dataset were diagnosed with COVID-19 in 2020. Of these, 6389 (0.16%) had established diagnoses of uveitis or scleritis. Within the uveitis group, mean age was 54 years (SD 16), and 62% were female. 708 (11.1%) of the uveitis patients were hospitalized for COVID-19, significantly greater than the 7.3% rate amongst all adult, COVID-19-positive patients in the dataset (p < 0.001) and the CDC estimate of 7.5% for the US population in 2020 (p < 0.001). No agent showed a statistically significant effect on hospitalization. The higher rate of hospitalization in uveitis patients was partly, though not completely, explained by higher rates in uveitis-associated autoimmune conditions in the dataset as a whole. Conclusions : Uveitis patients have a greater risk of hospitalization for COVID-19 compared with the general population. As a whole, conventional IMT and biologics do not increase the risk of COVID-19 hospitalization amongst uveitis patients infected with the virus.

11.
Investigative Ophthalmology and Visual Science ; 63(7):588-A0153, 2022.
Article in English | EMBASE | ID: covidwho-2058250

ABSTRACT

Purpose : COVID changed follow-up logistics starting 3/2020 in South Texas (STX). The incidence of proliferative retinovascular (RV) events in the emergent setting increased after shut down in STX. We investigate patterns of follow-up behavior in patients with and without proliferative complications of RV diseases. Methods : We used CPT and ICD-10 codes in date range 1/2018 to 4/2021 to include patients diagnosed with diabetic retinopathy (DR) and retinal vein/artery occlusions (RVO/RAO) and analyzed them as two groups: anti-VEGF ± panretinal photocoagulation (PRP) (nonvitrectomy group) vs vitrectomies. We compared before and after COVID-era: appointment intervals and lapses, rate of progression in EDTRS staging for patients with DR. Results : At initial encounter, 2/133/125 patients of 1503 had mild/moderate/severe DR. 40/5 patients had RVO/RAO. There were 429/1074 patients in the vitrectomy/nonvitrectomy group. Vitrectomy group had 123 non-clearing vitreous hemorrhages, 72 tractional retinal detachments, and 189 unclassified proliferative retinovascular complications. Prior to COVID, visit interval was 28.4 ± 43.2 vs 30.8 ± 47.8 days in the vitrectomy vs nonvitrectomy group (p=0.61). After COVID, the interval duration for the vitrectomy group increased to 39.8 ± 76.5 days with no increase in the nonvitrectomy group (p<0.001). Time to diagnosis of EDTRS-staged progression after COVID increased by an average of 21.5 days in the vitrectomy group and by 26.7 days in the nonvitrectomy group. After COVID restrictions, missed appointments in the vitrectomy vs nonvitrectomy group changed from 24.5% to 30.8% vs 28.1% to 33.4%. Across all encounters, the vitrectomy versus nonvitrectomy group had 19.1% vs 21.9% cancellation rate (6.08 vs 5.85 appointments/patient) and 7.81% vs 8.39% no show rate (3.09 vs 2.97 appointments/patient). Overall, patients with DR who experienced EDTRS-staged progression missed 21.2% of appointments (6.8 per patient for those with missed appointments). Conclusions : Patients who required vitrectomy versus those able to be managed in clinic missed appointments in the same proportion and quantity before COVID and increased appointment lapses similarly after COVID restrictions, but interval duration and variability was significantly higher in patients that eventually suffer a complication severe enough to necessitate vitrectomy.

12.
Investigative Ophthalmology and Visual Science ; 63(7):3272-A0324, 2022.
Article in English | EMBASE | ID: covidwho-2057747

ABSTRACT

Purpose : Computer Vision Syndrome (CVS) is a form of asthenopia that manifests with symptoms such as eye pain/discomfort, headache, and blurred vision, among others. Early identification of CVS is especially relevant during the COVID-19 pandemic, which has led to an increase in virtual schooling and digital screen time among children worldwide. This study seeks to evaluate differences in etiologies of eye pain, treatment recommendations, and the relationship between refractive errors and eye pain in the pediatric population before and during the COVID-19 pandemic. Methods : After IRB approval, we retrospectively reviewed the records of patients who visited our tertiary care institution between 2018 and 2021 with a chief complaint of eye pain, determined by the encounter's primary ICD-10 code. Patients who visited before 03/11/2020, when the WHO declared COVID-19 a pandemic, were classified as the pre-pandemic group (PPG), while patients who consulted after this date were classified as the during-pandemic group (DPG). Demographics, symptoms, refractive error, treatment, and schooling method were recorded as covariates and analyzed using a Chi-square and Fisher's exact test. Results : 38 patients were included in the study (21 PPG;17 DPG). The mean age was 10.1 ± 3.2 years, and the majority were African American (44.7%). Virtual school attendance for the PPG and DPG was 4.8% and 58.8%, respectively (P<0.05) (Table 1). There was a higher prevalence of reported blurry vision, headaches, eye redness, eye swelling, and rubbing among DPG patients (Table 1). Counseling on screen time minimization was more likely to be documented in the DPG (Table 2). A greater proportion of patients were prescribed new glasses in the DPG though there was no significant relationship between eye pain and refractive error or anisometropia in either group (P>0.05). Conclusions : The increased prevalence of CVS symptoms in the DPG suggests an association between virtual schooling and CVS in children. There is a role for ophthalmologists to improve rates of counseling for the prevention of eye pain-related symptomatology with digital device usage. Further studies will survey parents to assess their awareness of conservative treatments for eye pain such as artificial tears and decreased screen time.

13.
Investigative Ophthalmology and Visual Science ; 63(7):3560-A0447, 2022.
Article in English | EMBASE | ID: covidwho-2057442

ABSTRACT

Purpose : To determine whether there is an increased risk of herpes zoster ophthalmicus (HZO) following COVID-19 vaccination. Methods : Retrospective observational study utilizing OptumLabs® Data Warehouse, a longitudinal, real-world data asset with de- identified administrative claims and electronic health record data. A cohort study design and a self-controlled design were both utilized to investigate HZO following vaccination, defined by an ICD-10 diagnosis code within 30 days after vaccine administration (or up to the second dose if a second dose was administered), plus a new prescription or dose escalation of antivirals within 5 days of HZO diagnosis. Using a cohort design, COVID-19 vaccinated individuals from 12/11/2020- 6/30/2021 were compared to two influenza-vaccinated cohorts: a pre-pandemic group (1/1/2018-12/13/2019) and an early pandemic group (3/1/2020-11/1/2020). Cox proportional hazard models were used to identify unadjusted and adjusted hazard ratios for HZO. Using a self-controlled design, the incidence rate ratio comparing the risk of HZO in the risk intervals following COVID-19 vaccination to a control interval 60 to 90 days prior to the first dose was estimated using conditional Poisson regression. Results : Among 3,567,715 patients in the COVID-19 vaccinated cohort, there were 60 post-vaccine HZO cases. Patients vaccinated against COVID-19 were not at increased risk of HZO compared to pre-pandemic influenza vaccinated patients (N= 5,101,709;HR= 0.84;95% CI: 0.61-1.16;p= 0.29) and early pandemic influenza vaccinated patients (N= 4,060,412;HR= 0.93;95% CI: 0.64-1.34;p= 0.69) after adjustment for demographics, comorbidities, zoster vaccine, and medication use. Additionally, HZO cases post-COVID-19 vaccination were less likely to be prescribed ophthalmic steroids compared to cases following pre-pandemic and early pandemic influenza vaccination (18.3% vs 29.6% vs 41.4%, respectively). In the self-controlled design, patients were not at increased risk of HZO after COVID-19 vaccination compared to their control interval (IRR= 0.74;95% CI: 0.49-1.12;p= 0.15). Conclusions : There is not an increased risk of HZO following COVID-19 vaccination. These results provide reassurance for the safety of the COVID-19 vaccine from an ophthalmic standpoint.

14.
Investigative Ophthalmology and Visual Science ; 63(7):3148-A0043, 2022.
Article in English | EMBASE | ID: covidwho-2057434

ABSTRACT

Purpose : Despite an increasing incidence of skin cancer over the last decade, studies have reported a decline in the diagnosis and treatment of skin cancer during the COVID19 pandemic. We performed a retrospective cohort study using a large population-based cohort from the Veterans Health Administration (VHA) to determine how the pandemic has affected tumor size and morbidity in veterans with periocular non-melanoma skin cancer. Methods : Electronic health records from all VHA sites were accessed through the VA Informatics and Computing Infrastructure (VINCI). Data were stored in the Observational Medical Outcomes Partnership (OMOP) model and queried via SQL Server. ICD-10 and current procedural terminology codes were used to identify patients who received Mohs surgery for periocular basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) between 08/01/2018 and 09/10/2021. A combination of structured algorithms and manual review were used to extract patient demographics, lesion characteristics, and surgical outcome at three time points, ie. pre-COVID, early, and late COVID. Unpaired t-tests were used to assess statistical significance. Results : Patient characteristics were similar between pre- and post-COVID cohorts in terms of gender, age, race, and tumor type. The average number of Mohs periocular surgeries performed per week were 23.1% (7.31 vs 5.62) and 13.1% (7.49 vs 6.51) lower in the early and later pandemic, respectively, compared to similar pre-COVID timeframes by month (Figure 1). Mean lesion size (maximum diameter) was 1.35 cm larger post-COVID compared to pre-COVID (95% CI 0.19 2.51, P=0.022);however, the defect size remained similar (Figure 2). Stratifying by tumor type, the same trends were noted in BCC, particularly early in the pandemic. However, mean SCC lesion and defect sizes did not vary over time. Conclusions : Periocular Mohs surgery rates declined in the COVID pandemic across VHA. Lesions were larger particularly in the earlier phase of the pandemic for BCC. Future analyses using this cohort will attempt to determine if telehealth and travel time were associated with distinct outcomes.

15.
HemaSphere ; 6:4042-4043, 2022.
Article in English | EMBASE | ID: covidwho-2032160

ABSTRACT

Background: Special epidemiological measures aimed at suppressing SARS-CoV-2 outbreak were introduced in Croatia in March 2020, thus reducing regular work capacity in hematological outpatient and inpatient care. In our hospital, this included relocating the entire Hematology Department to a remote location, reduction of hospital beds in the Hematology Inpatient Unit by approximately 60%, Day Clinic operating at a reduced capacity, and a complete suspension of Hematology Polyclinic during first lockdown. Aims: Herein we report our observation of unusually high incidence of newly diagnosed malignant hematological diseases following first lockdown ease in May/June 2020. Methods: We collected data of patients hospitalized in Hematology Department for 4 periods: May 1 - June 15, 2020 for the test arm, and the same calendar period during previous 3 years (May 1 - June 15 of each of the calendar years 2017, 2018 and 2019), for the control arm. The rationale for such design was that a phenomenon of re-establishing regular work capacity, following temporary restriction, was only observed in the test arm. The study included patients of both sexes older than 18 who were diagnosed with either: Hodgkin lymphoma (C81.0 -C81.9 according to the 10th ICD Revision), different types of non-Hodgkin lymphoma (subsections C82.0 - C83.9 and C85.1-C85), as well as multiple myeloma and malignant plasma cell neoplasms (C90.0 - C90.3). Excluded from our study were diagnoses of T/NK cell lymphoma (C84.0- C84.9;C86.0 - C86.6), malignant immunoproliferative diseases (C88.0 - C88.9), leukemias and other specified malignant neoplasms of lymphatic, hematopoietic and related tissues (C91.0 - C96.9) as well as polycythemia vera and non-malignant hematological diseases (D45 and D50 - D89 in ICD-10). Results: In years 2017-2019, similar numbers of patients were diagnosed with a hematological malignancy in our Department (n=4 for 2017, n=8 for 2018, n=4 for 2019) whereas in 2020, a total of 28 patients were diagnosed during the same calendar period (Hodgkin lymphoma: n=5, NHL n=12, multiple myeloma n=7, CLL/SLL n=4). Statistical analysis revealed a significant increase (p ≤0.05) of newly diagnosed hematological malignancies in May and first half of June 2020, when compared to the same calendar periods during previous three years. Further statistical analysis has not established significant differences in outcome (difference in EFS statistically insignificant, p=0.86), as we had expected in the short follow-up period. (Table Presented) Summary/Conclusion: Facilitating treatment of patients affected by the novel coronavirus represented a welcome change in healthcare system in early 2020, in our country and abroad. At the same time, however, the reduction of tertiary health care capacity aimed at population with hematological diseases presented serious risks for successful diagnosis and treatment outcome, a subject that gained wide attention in literature. It has been reported that, also due to psychological reasons, a fraction of patients delayed seeking medical attention after noticing symptoms. In our study we aimed at analyzing the effects of lockdown ease on the number of newly diagnosed hematological malignancies. We were able to demonstrate the effect of pandemic-related measures on detecting new disease cases. It remains to be clarified if a sudden surge in new diagnoses was due to delayed first physician's appointments/hospitalizations, as is suggested by available literature. The results of our study suggest that longer follow-up period will be required in order to clarify the effects of possible late diagnoses on the treatment outcome.

16.
Journal of Thoracic Oncology ; 17(9):S240, 2022.
Article in English | EMBASE | ID: covidwho-2031516

ABSTRACT

Introduction: New York City was the first place in the US to record a COVID-19 case on March 1, 2020, and soon became the epicenter of the pandemic. Because of the large number of hospitalized patients, Governor Cuomo imposed a halt on all elective care from March 22 to June 8, 2020. Such action resulted in delayed cancer screening rates, care and treatment. However, no study has quantified the effect of the “pause” on cancer stage at diagnosis, one of the best indicators of cancer prognosis. We analyze here data from the Mount Sinai Heath System cancer registry;we chose lung cancer as an example of a condition where early diagnosis can dramatically modify survival. Methods: Lung cancer cases diagnosed between January 1, 2018 and February 28, 2021 (n=1884) at the Mount Sinai Health System were identified from Mount Sinai’s cancer registry, based on ICD-10 codes of C34.x. Only analytic cases (00-22) were included, based on Commission on Cancer guidelines. For multi-tumor or multi-hospital cases, unique patients were identified by selecting the earliest date of diagnosis. The ratio of the number of monthly cases in 2020-2021 over the average number of monthly cases in 2018 and 2019 was calculated. The percent of monthly diagnoses with early (0/I/II), late (III/IV) and unknown stage over the total number of monthly diagnoses was examined and was compared to the average percent in 2018 and 2019 from the same month. Results: The number of diagnoses sharply dropped in March 2020, reaching a minimum in April (78% lower than pre-pandemic averages), and returned to near pre-pandemic levels by July 2020, began to decline again in January and February 2021 (35% lower than pre-pandemic averages) (Figure 1a). Stages 0/I/II dropped to 21.9% of total in May 2020, while stage III/IV hit 75% in April 2020. Early stage diagnoses dropped again to 23.5% of total, while late stages increased to 64.7% of total in February 2021 (Figure 1b). The percent of stage III/IV diagnoses in April of 2020 was 1.79 times greater than the pre-pandemic average, the percent of stage 0/I/II diagnoses was 50% lower. The percent of stage 0/I/II cases increased between August 2020 and January 2021, but in February 2021 it was 50% lower than pre-pandemic levels, and the percent of stage III/IV diagnoses was 1.3 times greater than pre-pandemic levels (Figure 1c). Conclusions: This descriptive analysis suggests an immediate negative impact on lung cancer diagnoses of COVID-19 restrictions, which affected screening, early detection, and drastically reduced any patient’s contact with the health system that would have prompted an early lung cancer diagnosis. The increase in late stage diagnoses during pandemic surges may reflect the fact that only sick patients with symptoms, and acute events that require immediate care were seeking hospital attention. The data suggests that we will likely observe an increase in lung cancer mortality in the next few months and years, as consequence of stage shift at diagnosis associated with the COVID-19 pandemic. Keywords: Lung cancer, Covid-19, Stage shift

17.
Journal of the American Academy of Dermatology ; 87(3):AB184, 2022.
Article in English | EMBASE | ID: covidwho-2031395

ABSTRACT

Objective: We evaluated mortality in patients with pemphigus compared with non-pemphigus individuals matched on age and gender, in the United States (US). Methods: This retrospective cohort study used data from the US Optum Clinformatics claims database between May 1, 2000 and December 31, 2020. Mortality was assessed during a follow-up of up to 4 years after the index date (first pemphigus diagnosis). A sensitivity analysis was conducted (end of study period, March 31, 2020) to exclude the potential impact of COVID-19 on mortality analysis. Multivariable models (comorbidities as adjustment variables) were used to assess hazard ratios (HRs). Propensity score matched (PSM) model was used to minimize comorbidities difference at baseline. Results: Overall, 1391 patients with pemphigus (ICD-9 and ICD-10 codes) were identified (mean [SD] age: 63.7 [17.9] years;females: 57.0%). During follow-up, 227 patients (16.3%) died in the pemphigus cohort, compared with 172 patients (12.4%) in the non-pemphigus cohort. Pemphigus patients had higher death rate than the non-pemphigus cohort (adjusted HR [95% CI]: 1.69 [1.37–2.09];unadjusted HR [95% CI]: 1.33 [1.09–1.63];PSM HR [95% CI]: 1.49 [1.19–1.86];P <.01 for all). Similar results were observed in the sensitivity analysis (adjusted HR [95% CI]: 1.77 [1.41–2.23];P <.01);PSM HR [95% CI]: 1.52 [1.20–1.93];P <.01]). Infections, hypertension, diabetes, hematologic abnormalities, and cardiovascular comorbidities were strongly associated with mortality in pemphigus patients. Conclusions: These results suggest that pemphigus is associated with increased mortality observed over 4 years, highlighting the need for better treatment options for these patients.

18.
Journal of the American Academy of Dermatology ; 87(3):AB83, 2022.
Article in English | EMBASE | ID: covidwho-2031381

ABSTRACT

Objective: We evaluated mortality in patients with pemphigus compared with nonpemphigus individuals matched on age and gender, in the United States (US). Methods: This retrospective cohort study used data from the US Optum Clinformatics claims database between May 1, 2000 and December 31, 2020. Mortality was assessed during a follow-up of up to 4 years after the index date (first pemphigus diagnosis). A sensitivity analysis was conducted (end of study period, March 31, 2020) to exclude the potential impact of COVID-19 on mortality analysis. Multivariable models (comorbidities as adjustment variables) were used to assess hazard ratios (HRs). Propensity score matched (PSM) model was used to minimize comorbidities difference at baseline. Results: Overall, 1391 patients with pemphigus (ICD-9 and ICD-10 codes) were identified (mean [SD] age: 63.7 [17.9] years;females: 57.0%). During follow-up, 227 patients (16.3%) died in the pemphigus cohort, compared with 172 patients (12.4%) in the nonpemphigus cohort. Pemphigus patients had higher death rate than the nonpemphigus cohort (adjusted HR [95% CI]: 1.69 [1.37–2.09];unadjusted HR [95% CI]: 1.33 [1.09–1.63];PSM HR [95% CI]: 1.49 [1.19–1.86];P <.01 for all). Similar results were observed in the sensitivity analysis (adjusted HR [95% CI]: 1.77 [1.41–2.23];P <.01);PSM HR [95% CI]: 1.52 [1.20–1.93];P <.01]). Infections, hypertension, diabetes, hematologic abnormalities, and cardiovascular comorbidities were strongly associated with mortality in pemphigus patients. Conclusions: These results suggest that pemphigus is associated with increased mortality observed over 4 years, highlighting the need for better treatment options for these patients.

19.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009621

ABSTRACT

Background: The COVID-19 pandemic had a profound impact on cancer care delivery throughout the nation. Data regarding the outcomes of patients on cancer therapy who had COVID-19 is lacking. The US Oncology Network had 14 practices participating in the Oncology Care Model (OCM) during performance period 8 (PP8) which enrolled patients from 1/2/2020 to 7/1/2020. OCM enrolls patients with Medicare undergoing treatment for a cancer diagnosis. Utilizing OCM claims files, we evaluated the impact of COVID-19 on outcomes and costs for patients enrolled in the OCM during the first stages of the pandemic. Methods: Utilizing claims and episode data from the OCM, we were able to identify episodes with patients who had a positive COVID-19 diagnosis. Episodes were flagged with COVID-19 based on the ICD-10 code U07.1 on claims files. We were then able to compare the total cost of care (TCOC), inpatient costs and death rate to those patients in the OCM that did not have a COVID-19 ICD-10 claim. Results: 2.5% of patient episodes in PP8 had a positive COVID-19 ICD-10 claim. TCOC per episode increased 36% per patient from $34,340 for those without COVID-19 to $53,605 for those with COVID-19, a difference of $19,265 per patient. Inpatient costs increased from $3,276 for those without COVID-19 to $12,226 for those with a COVID-19 diagnosis. 8.9% of patients without a COVID-19 diagnosis died during the episode vs 20.0% of those with a COVID-19 diagnosis. Other costs including the cost of drugs did not significantly differ between the two groups. Conclusions: A diagnosis of COVID-19 for patients in the OCM receiving cancer treatment during PP8 led to a significant increase in costs, especially the costs of hospitalization. The death rate more than doubled for patients with COVID-19 during an OCM episode. Patients with Medicare and cancer undergoing treatment were at high-risk for complications and death from COVID-19 during OCM performance period 8.

20.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009591

ABSTRACT

Background: In a national survey 40.9% of 4,975 adults reported delaying or avoiding care due to concerns over COVID-19. Avoidance of medical care with lockdown and a decrease in access to services carries the possibility of increased morbidity and mortality from metastatic disease due to delays in diagnosis. We examine the trends in cancer diagnosis in admitted adult patients, comparing the incidences of diagnoses before lockdowns, after lockdowns, and as restrictions were lifted. Increase in diagnoses linked with metastatic disease in the late pandemic compared to early when lockdowns occurred would show delays in care due to decreased access from the pandemic, and likely increase in morbidity and mortality. Methods: Data was retrospectively analyzed patients admitted to HCA hospitals March 2020 to December 2021, separated to three periods: pre (Mar 2019-Feb 2020), early (Mar 2020-November 2020) and late pandemic (Dec 2020-December 2021). 66,022 patients with ICD-10 codes matching malignancies of lung, small intestine, colorectal, pancreas, breast, or cervix were included and patients that additionally had ICD-10 codes for metastatic disease were identified. Patients with unlinked metastatic disease codes were removed. Population demographics including sex, race, ethnicity, insurance were also included. Results: There was a decrease in lung cancer diagnoses in the pre-pandemic period from 6,546 to early at 3,248, and an increase in the late period to 4,763. Diagnoses of metastatic disease with lung cancer decreased from 4,143 in pre-pandemic to 3,357 in late pandemic. Colorectal cancer (CRC) patients without metastatic disease pre-pandemic numbered at 5,836;3,717 early pandemic;and 5,672, late pandemic. Diagnoses with metastatic disease decreased from 2,980 to 2,511 in the late period. Pancreatic cancer diagnoses decreased from 1,623 pre-pandemic to 1,508 late pandemic. Associated metastatic disease decreased from 1,181 pre-pandemic to 1,061 late pandemic. Breast cancer diagnoses decreased from 2,241 pre-pandemic to 1,915 late pandemic, and diagnoses with metastatic disease decreased from 2,334 to 1,711. Cervical cancer diagnoses increased from 385 pre-pandemic to 444 late pandemic and diagnoses with metastatic disease decreased from 252 to 187 in the late pandemic. Conclusions: Delays in access to care due to the pandemic are reflected in decreases of diagnoses seen. There was a decrease in lung, colorectal, pancreatic, breast, and cervical cancer diagnoses in the early pandemic period likely due to lockdown and diversion of medical effort. In the late pandemic period, diagnoses of these cancers rose, reflecting loosened restrictions. Our study is not able to determine the impact of delayed diagnosis, but likely results in increased morbidity and mortality. These effects could be mitigated in the future with uninterrupted access to telehealth and cancer screening.

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