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1.
Przegl Epidemiol ; 76(2): 233-242, 2022.
Article in English | MEDLINE | ID: covidwho-2067622

ABSTRACT

BACKGROUND: The year 2020 in the extent of HCV infection was set for the first milestones on the road to the eradication of HCV infection in 2030. In addition, in 2020 there was a global public health crisis - the COVID-19 pandemic. The aim of this paper was to assess the epidemiological situation of HCV infection based on epidemiological surveillance data in Poland in 2020. MATERIAL AND METHODS: Analysis of: 1) individual data from surveillance in 2020 conducted by EpiBaza system; 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2014-2020; and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of Statistics Poland. RESULTS: In 2020, there was a significant decrease in the number of reported cases and thus in the diagnosis rate of HCV infection in Poland - 955 HCV infections were reported (2.49/100,000 - in comparison with 2019, 3.5 times less). The decrease occurred in all voivodeships (ranging from 0.50 to 6.37/100,000), we observe more districts in which HCV infections were not detected (in 2020 - 35.3%; in 2019 - 16.8%). The diagnosis rate of HCV infection in women and men was at a similar level. However, large disproportions are visible if age groups are considered in addition to gender. For years, we have observed a variation of the diagnosis rate of HCV infection depending on the environment of residence - also in 2020, higher values were reported overall in residents of urban than in rural areas (2.90 vs. 1.88/100,000). In 2.9% of newly diagnosed HCV infections, at the same time cirrhosis was already present, 0.4% had liver failure, and 0.1% had hepatocellular carcinoma. Among exposures of HCV infection, those related to nosocomial transmission still dominate (59%), also in acute hepatitis C (60%). One-third of reported infections were diagnosed in primary health care, and one in four were diagnosed during hospitalization. CONCLUSIONS: The data presented in this paper show that the COVID-19 pandemic deepened the inequalities observed for years in HCV areas. Establishing a diverse system of testing and linking to care in Poland, reaching those in the greatest risk of ongoing transmission of HCV infection, and providing methodologically correct studies to assess progress in the eradication of HCV infection is becoming increasingly urgent to achieve the planned 2030 WHO targets.


Subject(s)
COVID-19 , Hepatitis C , Age Distribution , COVID-19/epidemiology , Disease Outbreaks , Female , Hepacivirus , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Humans , Incidence , Infant , Male , Pandemics , Poland/epidemiology , Registries , Rural Population , Sex Distribution , Urban Population
2.
Arch Iran Med ; 25(4): 201-208, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1904197

ABSTRACT

BACKGROUND: Mental disorders are the most common health problems that affect different population groups. According to the national survey in 2015 based on General Health Questionnaire-28 (GHQ-28), 23.44% of Iranians older than 15 years were suspected of having a mental disorder. The study aimed to determine the mental health status of the population over 15 years of age in the Islamic Republic of Iran, one year after the outbreak of COVID-19 in 2020. METHODS: The population-based study was performed on 24584 individuals over 15 years of age in Iran between December and February, 2020. The GHQ-28 was completed through telephone interviews. Data were analyzed using descriptive statistics, chi-square test, independent t-test, and multiple logistic regression at 95% confidence level. RESULTS: The results showed that the mean age of participants was 44.18±16.47 years. The prevalence of mental disorders was 29.7%. Mental disorder was associated with female gender (OR=1.195, 95% CI 1.10-1.29), 25-44 years (OR=1.206, 95% CI 1.06-1.36), urban life (OR=1.116, 95% CI 1.04-1.19), illiteracy (OR=1.286, 95% CI 1.11-1.48), being divorced (OR=1.924, 95% CI 1.50- 2.45), and unemployment (OR=1.657, 95% CI 1.40-1.94). Among the participants and their families, 14.7% and 32.3% were infected with the disease, respectively. The COVID-19 mortality rate in their families was 13.2%. The prevalence of mental disorders in infected people (40% vs. 27.3%) and bereaved families (39.6% vs. 35.3%) was more than the non-infected groups. CONCLUSION: Our results showed that in Iran, the mental health of the general population had a rising trend compared to 2015, especially in people infected with COVID-19 and bereaved families. The observed difference may be due to the prevalence of the COVID-19 epidemic and rapid demographic, social, and economic changes in Iran. Planning to improve mental health in the mentioned population should be considered for the post COVID-19 era.


Subject(s)
COVID-19 , Mental Disorders , Adolescent , Adult , Age Distribution , COVID-19/epidemiology , Cross-Sectional Studies , Disease Outbreaks , Female , Forecasting , Health Status , Health Surveys , Humans , Iran/epidemiology , Mental Disorders/epidemiology , Middle Aged , Rural Population , Sampling Studies , Sex Distribution , Surveys and Questionnaires , Urban Population
6.
Child Abuse Negl ; 127: 105573, 2022 05.
Article in English | MEDLINE | ID: covidwho-1719456

ABSTRACT

India has the highest number of suicides in the world. Indian men account for a quarter of global suicides, while Indian women account for 36% of all global suicides in the 15-39 age group. One suicide every 25 min. These are not isolated incidents. Mental health experts say that one of the main reasons for this situation is rampant domestic violence. India's official data are hugely underestimated and do not convey the true scale of the problem. Women from this country are responsible for 36% of global female suicide deaths. In a country like India, with its wide sociocultural variations, there can be multiple risk factors: hanging, pesticide consumption, drug overdose, and self-immolation. Access to these "lethal" resources is an important factor.


Subject(s)
Domestic Violence , Suicide , Female , Humans , India/epidemiology , Male , Sex Distribution
7.
Ann Surg ; 275(3): 435-437, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1707712

ABSTRACT

Sex inequity in academic achievement was well documented before the COVID-19 pandemic, and evolving data suggest that women in academic surgery are disproportionately disadvantaged by the pandemic. This perspective piece reviews currently accepted solutions to the sex achievement gap, with their associated shortcomings. We also propose innovative strategies to overcoming barriers to sex equity in academic medicine that broadly fall into three categories: strategies to mitigate inequitable caregiving responsibilities, strategies to reduce cognitive load, and strategies to value uncompensated, impactful work. These approaches address inequities at the system-level, as opposed to the individual-level, lifting the burden of changing the system from women.


Subject(s)
COVID-19 , Faculty, Medical , Physicians, Women , Specialties, Surgical , Female , Humans , Sex Distribution
8.
MMWR Morb Mortal Wkly Rep ; 71(8): 306-312, 2022 Feb 25.
Article in English | MEDLINE | ID: covidwho-1707039

ABSTRACT

Suicide was among the 10 leading causes of death in the United States in 2020 among persons aged 10-64 years, and the second leading cause of death among children and adolescents aged 10-14 and adults aged 25-34 years (1). During 1999-2020, nearly 840,000 lives were lost to suicide in the United States. During that period, the overall suicide rate peaked in 2018 and declined in 2019 and 2020 (1). Despite the recent decline in the suicide rate, factors such as social isolation, economic decline, family stressors, new or worsening mental health symptoms, and disruptions to work and school associated with the COVID-19 pandemic have raised concerns about suicide risk in the United States. During 2020, a total of 12.2 million U.S. adults reported serious thoughts of suicide and 1.2 million attempted suicide (2). To understand how changes in suicide death rates might have varied among subpopulations, CDC analyzed counts and age-adjusted suicide rates during 2019 and 2020 by demographic characteristics, mechanism of injury, county urbanization level, and state. From 2019 to 2020, the suicide rate declined by 3% overall, including 8% among females and 2% among males. Significant declines occurred in seven states but remained stable in the other states and the District of Columbia. Despite two consecutive years of declines, the overall suicide rate remains 30% higher compared with that in 2000 (1). A comprehensive approach to suicide prevention that uses data driven decision-making and implements prevention strategies with the best available evidence, especially among disproportionately affected populations (3), is critical to realizing further declines in suicide and reaching the national goal of reducing the suicide rate by 20% by 2025 (4).


Subject(s)
Suicide/statistics & numerical data , Suicide/trends , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Population Surveillance , Sex Distribution , United States/epidemiology , Urbanization , Young Adult
9.
MMWR Morb Mortal Wkly Rep ; 71(8): 319-324, 2022 Feb 25.
Article in English | MEDLINE | ID: covidwho-1702097

ABSTRACT

In 2021, a national emergency* for children's mental health was declared by several pediatric health organizations, and the U.S. Surgeon General released an advisory† on mental health among youths. These actions resulted from ongoing concerns about children's mental health in the United States, which was exacerbated by the COVID-19 pandemic (1,2). During March-October 2020, among all emergency department (ED) visits, the proportion of mental health-related visits increased by 24% among U.S. children aged 5-11 years and 31% among adolescents aged 12-17 years, compared with 2019 (2). CDC examined changes in U.S. pediatric ED visits for overall mental health conditions (MHCs) and ED visits associated with specific MHCs (depression; anxiety; disruptive behavioral and impulse-control disorders; attention-deficit/hyperactivity disorder; trauma and stressor-related disorders; bipolar disorders; eating disorders; tic disorders; and obsessive-compulsive disorders [OCD]) during 2019 through January 2022 among children and adolescents aged 0-17 years, overall and by sex and age. After declines in weekly visits associated with MHCs among those aged 0-17 years during 2020, weekly numbers of ED visits for MHCs overall and for specific MHCs varied by age and sex during 2021 and January 2022, when compared with corresponding weeks in 2019. Among adolescent females aged 12-17 years, weekly visits increased for two of nine MHCs during 2020 (eating disorders and tic disorders), for four of nine MHCs during 2021 (depression, eating disorders, tic disorders, and OCD), and for five of nine MHCs during January 2022 (anxiety, trauma and stressor-related disorders, eating disorders, tic disorders, and OCD), and overall MHC visits during January 2022, compared with 2019. Early identification and expanded evidence-based prevention and intervention strategies are critical to improving children's and adolescents' mental health (1-3), especially among adolescent females, who might have increased need.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Emergency Treatment/trends , Facilities and Services Utilization/trends , Mental Disorders/psychology , Mental Health , Adolescent , Age Distribution , COVID-19/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Mental Disorders/classification , SARS-CoV-2 , Sentinel Surveillance , Sex Distribution , United States/epidemiology
10.
Mayo Clin Proc ; 97(3): 454-464, 2022 03.
Article in English | MEDLINE | ID: covidwho-1665266

ABSTRACT

OBJECTIVE: To describe the clinical data from the first 108 patients seen in the Mayo Clinic post-COVID-19 care clinic (PCOCC). METHODS: After Institutional Review Board approval, we reviewed the charts of the first 108 patients seen between January 19, 2021, and April 29, 2021, in the PCOCC and abstracted from the electronic medical record into a standardized database to facilitate analysis. Patients were grouped into phenotypes by expert review. RESULTS: Most of the patients seen in our clinic were female (75%; 81/108), and the median age at presentation was 46 years (interquartile range, 37 to 55 years). All had post-acute sequelae of SARS-CoV-2 infection, with 6 clinical phenotypes being identified: fatigue predominant (n=69), dyspnea predominant (n=23), myalgia predominant (n=6), orthostasis predominant (n=6), chest pain predominant (n=3), and headache predominant (n=1). The fatigue-predominant phenotype was more common in women, and the dyspnea-predominant phenotype was more common in men. Interleukin 6 (IL-6) was elevated in 61% of patients (69% of women; P=.0046), which was more common than elevation in C-reactive protein and erythrocyte sedimentation rate, identified in 17% and 20% of cases, respectively. CONCLUSION: In our PCOCC, we observed several distinct clinical phenotypes. Fatigue predominance was the most common presentation and was associated with elevated IL-6 levels and female sex. Dyspnea predominance was more common in men and was not associated with elevated IL-6 levels. IL-6 levels were more likely than erythrocyte sedimentation rate and C-reactive protein to be elevated in patients with post-acute sequelae of SARS-CoV-2 infection.


Subject(s)
COVID-19/complications , Adult , COVID-19/immunology , Female , Humans , Male , Middle Aged , Prospective Studies , Sex Distribution
12.
Nature ; 603(7902): 587-598, 2022 03.
Article in English | MEDLINE | ID: covidwho-1655590

ABSTRACT

SARS-CoV-2 infection is benign in most individuals but, in around 10% of cases, it triggers hypoxaemic COVID-19 pneumonia, which leads to critical illness in around 3% of cases. The ensuing risk of death (approximately 1% across age and gender) doubles every five years from childhood onwards and is around 1.5 times greater in men than in women. Here we review the molecular and cellular determinants of critical COVID-19 pneumonia. Inborn errors of type I interferons (IFNs), including autosomal TLR3 and X-chromosome-linked TLR7 deficiencies, are found in around 1-5% of patients with critical pneumonia under 60 years old, and a lower proportion in older patients. Pre-existing auto-antibodies neutralizing IFNα, IFNß and/or IFNω, which are more common in men than in women, are found in approximately 15-20% of patients with critical pneumonia over 70 years old, and a lower proportion in younger patients. Thus, at least 15% of cases of critical COVID-19 pneumonia can be explained. The TLR3- and TLR7-dependent production of type I IFNs by respiratory epithelial cells and plasmacytoid dendritic cells, respectively, is essential for host defence against SARS-CoV-2. In ways that can depend on age and sex, insufficient type I IFN immunity in the respiratory tract during the first few days of infection may account for the spread of the virus, leading to pulmonary and systemic inflammation.


Subject(s)
COVID-19/genetics , COVID-19/immunology , Interferon Type I/immunology , Age Distribution , Autoantibodies/immunology , COVID-19/mortality , COVID-19/pathology , Critical Illness , Dendritic Cells/immunology , Genome-Wide Association Study , Humans , Interferon Type I/genetics , Sex Distribution , Toll-Like Receptor 3/deficiency , Toll-Like Receptor 7/deficiency , Toll-Like Receptor 7/genetics
13.
JAMA ; 327(4): 331-340, 2022 01 25.
Article in English | MEDLINE | ID: covidwho-1649976

ABSTRACT

Importance: Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. The risks and outcomes of myocarditis after COVID-19 vaccination are unclear. Objective: To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US. Design, Setting, and Participants: Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021. Exposures: Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna). Main Outcomes and Measures: Reports of myocarditis to VAERS were adjudicated and summarized for all age groups. Crude reporting rates were calculated across age and sex strata. Expected rates of myocarditis by age and sex were calculated using 2017-2019 claims data. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test results, treatment, and early outcomes. Results: Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males comprised 82% of the myocarditis cases for whom sex was reported. The crude reporting rates for cases of myocarditis within 7 days after COVID-19 vaccination exceeded the expected rates of myocarditis across multiple age and sex strata. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). There were 826 cases of myocarditis among those younger than 30 years of age who had detailed clinical information available; of these cases, 792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic resonance imaging results. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%). Conclusions and Relevance: Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.


Subject(s)
2019-nCoV Vaccine mRNA-1273/adverse effects , BNT162 Vaccine/adverse effects , Myocarditis/etiology , Adolescent , Adult , Age Distribution , COVID-19 Vaccines/adverse effects , Female , Humans , Immunization, Secondary/adverse effects , Male , Myocarditis/epidemiology , Risk Factors , Sex Distribution , United States/epidemiology , Young Adult
15.
Dermatol Online J ; 27(10)2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1643785

ABSTRACT

Teledermatology has been widely adopted during the COVID-19 pandemic as virtual patient care promotes social distancing and decreases viral exposure risk. As teledermatology has become more prominent during this period, it is essential to assess whether virtual visits allow for adequate patient care. To assess perceptions of advantages and disadvantages of teledermatology, a survey was sent to academic dermatologists through the Association of Professors of Dermatology (APD) listserv. Of the physicians surveyed, 94% reported their departments had implemented teledermatology during the COVID-19 pandemic. The majority (64%) described teledermatology as an effective tool for patient care because of improved access to care, decreased risk of COVID-19 exposure, and convenience. Frequently cited limitations of teledermatology were image quality, technical difficulties, and inability to perform a comprehensive skin examination. Thirty-seven percent of respondents reported teledermatology as a contributor to their professional burnout. Although teledermatology has become more prevalent as a result of the pandemic, its role moving forward is uncertain given its limitations.


Subject(s)
COVID-19/epidemiology , Dermatologists , Dermatology/methods , Pandemics , Telemedicine , Adult , Age Distribution , Aged , Burnout, Professional/etiology , COVID-19/prevention & control , Computer Terminals/standards , Dermatologists/psychology , Dermatologists/statistics & numerical data , Dermatology/trends , Female , Health Care Surveys , Health Services Accessibility , Humans , Male , Middle Aged , Physical Examination , Sex Distribution , Telemedicine/trends , Uncertainty
16.
Ann Intern Med ; 174(12): 1700-1709, 2021 12.
Article in English | MEDLINE | ID: covidwho-1614239

ABSTRACT

BACKGROUND: Fully assessing the mortality burden of the COVID-19 pandemic requires measuring years of life lost (YLLs) and accounting for quality-of-life differences. OBJECTIVE: To measure YLLs and quality-adjusted life-years (QALYs) lost from the COVID-19 pandemic, by age, sex, race/ethnicity, and comorbidity. DESIGN: State-transition microsimulation model. DATA SOURCES: Health and Retirement Study, Panel Study of Income Dynamics, data on excess deaths from the Centers for Disease Control and Prevention, and nursing home death counts from the Centers for Medicare & Medicaid Services. TARGET POPULATION: U.S. population aged 25 years and older. TIME HORIZON: Lifetime. PERSPECTIVE: Individual. INTERVENTION: COVID-19 pandemic through 13 March 2021. OUTCOME MEASURES: YLLs and QALYs lost per 10 000 persons in the population. The estimates account for the age, sex, and race/ethnicity of decedents, along with obesity, smoking behavior, lung disease, heart disease, diabetes, cancer, stroke, hypertension, dementia, and nursing home residence. RESULTS OF BASE-CASE ANALYSIS: The COVID-19 pandemic resulted in 6.62 million QALYs lost (9.08 million YLLs) through 13 March 2021, with 3.6 million (54%) lost by those aged 25 to 64 years. The greatest toll was on Black and Hispanic communities, especially among men aged 65 years or older, who lost 1138 and 1371 QALYs, respectively, per 10 000 persons. Absent the pandemic, 38% of decedents would have had average or above-average life expectancies for their subgroup defined by age, sex, and race/ethnicity. RESULTS OF SENSITIVITY ANALYSIS: Accounting for uncertainty in risk factors for death from COVID-19 yielded similar results. LIMITATION: Estimates may vary depending on assumptions about mortality and quality-of-life projections. CONCLUSION: Beyond excess deaths alone, the COVID-19 pandemic imposed a greater life expectancy burden on persons aged 25 to 64 years, including those with average or above-average life expectancies, and a disproportionate burden on Black and Hispanic communities. PRIMARY FUNDING SOURCE: National Institute on Aging.


Subject(s)
COVID-19/mortality , Pandemics , Adult , Age Distribution , Aged , COVID-19/ethnology , COVID-19/prevention & control , COVID-19 Vaccines , Comorbidity , Cost of Illness , Health Status Disparities , Humans , Life Expectancy , Middle Aged , Quality-Adjusted Life Years , Risk Factors , SARS-CoV-2 , Sex Distribution , United States/epidemiology
17.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 65(1): 11-17, 2022 Jan.
Article in German | MEDLINE | ID: covidwho-1603181

ABSTRACT

BACKGROUND AND OBJECTIVE: Although suicide is not a criminal offence and the person who commits suicide is neither a victim nor a perpetrator in the classic police sense, suicides are the subject of police investigations and sometimes even recorded in the police crime statistics. In the state of Bavaria, available data go back to 1986. The present analysis provides information about the development of suicides registered by the police, the social characteristics of the individuals who commit suicide, and the methods and circumstances for suicide. In particular, the extent to which the first few months of the COVID-19 pandemic had an impact on suicide risk is examined. METHODS: Descriptive statistical analysis of completed and attempted suicides based on the Bavarian police crime statistics from 1986-2020. RESULTS: The number of suicide deaths has continuously declined over the decades. This positive trend is also visible in the reporting year 2020, which is profoundly influenced by the COVID-19 pandemic. Most of the persons who commit suicide are male and older than the age of 60. Hanging is the most commonly used method to commit suicide and the circumstances for doing so are often a mental or physical illness. DISCUSSION: Prevention of danger is an important duty of police. Data generated by the police, experience-based knowledge, and police intervention and influence can help prevent suicides. The statistical recording of suicides in the police crime statistics is a valuable addition to the causes of death statistics and provides a basis for optimizing prevention and emergency care.


Subject(s)
COVID-19 , Police , Age Distribution , Cause of Death , Germany/epidemiology , Homicide , Humans , Male , Pandemics , SARS-CoV-2 , Sex Distribution
18.
Medicine (Baltimore) ; 100(43): e27634, 2021 Oct 29.
Article in English | MEDLINE | ID: covidwho-1597449

ABSTRACT

ABSTRACT: Acute sstroke is the most common time-dependent disease attended in the emergency medical service (EMS) of Madrid (SUMMA 112). Community of Madrid has been one of the most affected regions in Spain by the coronavirus disease 2019 (COVID-19) pandemic. A significant reduction in acute sstroke hospital admissions has been reported during the COVID-19 pandemic compared to the same period 1 year before. As international clinical practice guidelines support those patients with suspected acute stroke should be accessed via EMS, it is important to know whether the pandemic has jeopardized urgent pre-hospital stroke care, the first medical contact for most patients. We aimed to examine the impact of the COVID-19 in stroke codes (SC) in our EMS among 3 periods of time: the COVID-19 period, the same period the year before, and the 2019-2020 seasonal influenza period.We compared the SC frequency among the periods with high cumulative infection rate (above the median of the series) of the first wave of COVID-19, seasonal influenza, and also with the same period of the year before.One thousand one hundred thirty SC were attended during the 3 periods. No significant reduction in SC was found during the COVID-19 pandemic. The reduction of hospital admissions might be attributable to patients attending the hospital by their means. The maximum SC workload seen during seasonal influenza has not been reached during the pandemic. We detected a nonsignificant deviation from the SC protocol, with a slight increase in hospitals' transfers to hospitals without stroke units.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Stroke/epidemiology , Age Distribution , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sex Distribution , Spain/epidemiology
19.
Lancet ; 398(10311): 1593-1618, 2021 10 30.
Article in English | MEDLINE | ID: covidwho-1590726

ABSTRACT

BACKGROUND: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS: We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). FINDINGS: In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39-1·59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1-4 years (2·4%), and around a third less than in females aged 1-4 years (2·5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. INTERPRETATION: Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
Cause of Death/trends , Global Burden of Disease , Mortality/trends , Adolescent , Age Distribution , Child , Female , Humans , Male , Sex Distribution , Socioeconomic Factors , Young Adult
20.
JAMA Intern Med ; 182(2): 153-162, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1598451

ABSTRACT

Importance: Persons with immune dysfunction have a higher risk for severe COVID-19 outcomes. However, these patients were largely excluded from SARS-CoV-2 vaccine clinical trials, creating a large evidence gap. Objective: To identify the incidence rate and incidence rate ratio (IRR) for COVID-19 breakthrough infection after SARS-CoV-2 vaccination among persons with or without immune dysfunction. Design, Setting, and Participants: This retrospective cohort study analyzed data from the National COVID Cohort Collaborative (N3C), a partnership that developed a secure, centralized electronic medical record-based repository of COVID-19 clinical data from academic medical centers across the US. Persons who received at least 1 dose of a SARS-CoV-2 vaccine between December 10, 2020, and September 16, 2021, were included in the sample. Main Outcomes and Measures: Vaccination, COVID-19 diagnosis, immune dysfunction diagnoses (ie, HIV infection, multiple sclerosis, rheumatoid arthritis, solid organ transplant, and bone marrow transplantation), other comorbid conditions, and demographic data were accessed through the N3C Data Enclave. Breakthrough infection was defined as a COVID-19 infection that was contracted on or after the 14th day of vaccination, and the risk after full or partial vaccination was assessed for patients with or without immune dysfunction using Poisson regression with robust SEs. Poisson regression models were controlled for a study period (before or after [pre- or post-Delta variant] June 20, 2021), full vaccination status, COVID-19 infection before vaccination, demographic characteristics, geographic location, and comorbidity burden. Results: A total of 664 722 patients in the N3C sample were included. These patients had a median (IQR) age of 51 (34-66) years and were predominantly women (n = 378 307 [56.9%]). Overall, the incidence rate for COVID-19 breakthrough infection was 5.0 per 1000 person-months among fully vaccinated persons but was higher after the Delta variant became the dominant SARS-CoV-2 strain (incidence rate before vs after June 20, 2021, 2.2 [95% CI, 2.2-2.2] vs 7.3 [95% CI, 7.3-7.4] per 1000 person-months). Compared with partial vaccination, full vaccination was associated with a 28% reduced risk for breakthrough infection (adjusted IRR [AIRR], 0.72; 95% CI, 0.68-0.76). People with a breakthrough infection after full vaccination were more likely to be older and women. People with HIV infection (AIRR, 1.33; 95% CI, 1.18-1.49), rheumatoid arthritis (AIRR, 1.20; 95% CI, 1.09-1.32), and solid organ transplant (AIRR, 2.16; 95% CI, 1.96-2.38) had a higher rate of breakthrough infection. Conclusions and Relevance: This cohort study found that full vaccination was associated with reduced risk of COVID-19 breakthrough infection, regardless of the immune status of patients. Despite full vaccination, persons with immune dysfunction had substantially higher risk for COVID-19 breakthrough infection than those without such a condition. For persons with immune dysfunction, continued use of nonpharmaceutical interventions (eg, mask wearing) and alternative vaccine strategies (eg, additional doses or immunogenicity testing) are recommended even after full vaccination.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , Health Status , Vaccination/statistics & numerical data , Adult , Aged , COVID-19 Vaccines , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Sex Distribution
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