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1.
Front Public Health ; 10: 996311, 2022.
Article in English | MEDLINE | ID: covidwho-2109882

ABSTRACT

With over 500 million confirmed cases and 6.2 million deaths worldwide, the novel coronavirus has highlighted the underlying disparities in healthcare, unpreparedness to deal with a new disease and the need for monitoring and surveillance for a post-infectious syndrome as well as complicated diseases. Initially, children were thought to be spared but reports of a new phenomenon manifesting as Kawasaki-like disease, toxic shock syndrome, and multi-system inflammatory syndrome, which developed after a few weeks of severe COVID-19 infection, emerged in the pediatric population. As the pandemic progressed, increased prevalence of multi-system inflammatory syndrome in children (MIS-C) related to COVID-19 was seen in non-Hispanic blacks, Asians, and Latinos as compared to the white population drawing attention to a possible role of ethnicity and socio-economic disparities. The CDC currently reports that 31% of MIS-C cases were seen in Black Non-Hispanics and 26% in Latinos, who were historically more affected in previous pandemics. Furthermore, MIS-C cases in developing countries showed higher mortality as compared to high-income countries, which points toward the role of social determinants of health and limitations in a low-resource set up in increasing the disease burden of MIS-C, which should be treated as a public health emergency. Our review highlights the role of ethnicity, socio-economic factors, comorbidities, and differences in populations affected by MIS-C in high-income vs. low- and middle-income countries.


Subject(s)
COVID-19 , Child , Humans , COVID-19/epidemiology , Ethnicity , Pandemics , Socioeconomic Factors
2.
J Health Care Poor Underserved ; 33(4): 1736-1746, 2022.
Article in English | MEDLINE | ID: covidwho-2109262

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected certain high-risk populations, including those with underlying chronic illnesses and those who are socioeconomically disadvantaged. METHODS: Our study evaluated county-level rates of fully vaccinated populations after classifying counties based on rates of non-communicable diseases (NCDs) and socioeconomic inequities below the 25th percentile of overall distribution of counties for each measure as low, counties above the 75th percentile as high, and all other counties as medium. RESULTS: Counties with higher rates of non-communicable diseases and socioeconomic disparities had lower COVID-19 vaccination coverage than did counties with lower rates of non-communicable diseases and socioeconomic disparities. Co-occurrence of high NCD and high socioeconomic vulnerability among counties in the lower half of vaccination coverage was also found for some counties. CONCLUSION: These findings demonstrate the co-occurrence of low rates of vaccine coverage, high rates of NCDs, and high rates of socioeconomic disparities as a syndemic.


Subject(s)
COVID-19 , Noncommunicable Diseases , Vaccines , Humans , United States , Noncommunicable Diseases/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Syndemic , COVID-19 Vaccines , Vaccination , Socioeconomic Factors
3.
Lancet Respir Med ; 10(11): 1009, 2022 11.
Article in English | MEDLINE | ID: covidwho-2106216
5.
Int J Environ Res Public Health ; 19(21)2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2099519

ABSTRACT

The coronavirus disease 2019 (COVID-19) has had a rapid and sustained negative impact on sleep and mental health in the United States with disproportionate morbidity and mortality among socioeconomically deprived populations. We used multivariable and logistic regression to evaluate the associations among sleep duration, mental health, and socioeconomic deprivation (social deprivation index) in 14,676 Ohio residents from 1101 zip code tabulation areas from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey. Higher socioeconomic deprivation was associated with shorter sleep and poorer mental health after adjusting for covariates (age, sex, race, education, income, and body mass index) in the multivariable linear regression models. Those in the highest socioeconomically deprived areas had 1.6 and 1.5 times higher odds of short sleep (duration < 6 h) and poor mental health (>14 poor mental health days), respectively, in the logistic regression models. Previous researchers have focused on limited socio-environmental factors such as crowding and income. We examined the role of a composite area based measure of socioeconomic deprivation in sleep duration and mental health during the first year of COVID-19. Our results suggest the need for a broader framework to understand the associations among socioeconomic deprivation, sleep duration, and mental health during a catastrophic event.


Subject(s)
COVID-19 , United States/epidemiology , Humans , COVID-19/epidemiology , Pandemics , Mental Health , Income , Sleep , Socioeconomic Factors
6.
Int J Environ Res Public Health ; 19(21)2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2099507

ABSTRACT

The COVID-19 pandemic posed challenges to governments in terms of contact tracing. Like many other countries, Germany introduced a mobile-phone-based digital contact tracing solution ("Corona Warn App"; CWA) in June 2020. At the time of its release, however, it was hard to assess how effective such a solution would be, and a political and societal debate arose regarding its efficiency, also in light of its high costs. This study aimed to analyze the effectiveness of the CWA, considering prevented infections, hospitalizations, intensive care treatments, and deaths. In addition, its efficiency was to be assessed from a monetary point of view, and factors with a significant influence on the effectiveness and efficiency of the CWA were to be determined. Mathematical and statistical modeling was used to calculate infection cases prevented by the CWA, along with the numbers of prevented complications (hospitalizations, intensive care treatments, deaths) using publicly available CWA download numbers and incidences over time. The monetized benefits of these prevented cases were quantified and offset against the costs incurred. Sensitivity analysis was used to identify factors critically influencing these parameters. Between June 2020 and April 2022, the CWA prevented 1.41 million infections, 17,200 hospitalizations, 4600 intensive care treatments, and 7200 deaths. After offsetting costs and benefits, the CWA had a net present value of EUR 765 m in April 2022. Both the effectiveness and efficiency of the CWA are decisively and disproportionately positively influenced by the highest possible adoption rate among the population and a high rate of positive infection test results shared via the CWA.


Subject(s)
COVID-19 , Mobile Applications , Humans , Contact Tracing/methods , COVID-19/epidemiology , COVID-19/prevention & control , Pandemics/prevention & control , Socioeconomic Factors
7.
Int J Environ Res Public Health ; 19(21)2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2099495

ABSTRACT

The present study aims to analyze the prevalence of depressive symptoms and its sociodemographic-associated factors in Peruvian adults. Data was extracted from a nation-wide representative survey in which depression symptoms were measured with the PHQ-9 and sociodemographic information was extracted from household data. Depression severity rates were estimated for each symptom, and responses were modeled through the Rating Scale Model to obtain a depression measure used as dependent variable on a Generalized Mixed Linear Model. The most frequent depression symptoms were emotional, such as discouragement, sad mood, hopelessness, and lack of pleasure when doing activities. Our model showed that, after controlling the effects of all the variables considered, the most relevant predictors were gender, education level, physiographic region, age, marital status, and number of coresidents. Higher depression levels were found in women, people who did not complete higher education, participants living in the Highlands, older adults, single participants, and people living alone. Thus, interventions to promote or prevent depression severity during similar situations as the pandemic should focus on specific sociodemographic groups and their particular needs.


Subject(s)
COVID-19 , Female , Humans , Aged , COVID-19/epidemiology , Pandemics , Cross-Sectional Studies , Prevalence , Depression/epidemiology , Depression/psychology , Peru/epidemiology , Sociodemographic Factors , Socioeconomic Factors , Anxiety/epidemiology
9.
Med Trop Sante Int ; 2(3)2022 09 30.
Article in French | MEDLINE | ID: covidwho-2091753

ABSTRACT

The COVID-19 pandemic has led to a rediscovery of the concept of "One Health" and the idea that animals, humans and the environment are intimately linked. This is not a new concept, but it is still labile, contributing to inevitable confusion. There is still a lack of action on the ground, and "One Health" fails to integrate all three dimensions. This editorial aims to share six challenges for implementing the "One Health" approach in order to avoid the pitfalls of other global health initiatives. One Health programmes cannot be relevant and sustainable without the active involvement of communities. This deployment implies the necessary decolonisation of health, i.e. a rethinking of how programmes are governed, financed, formulated, implemented and evaluated, with and for the citizens and countries concerned. It cannot be done without addressing social inequalities in health and power issues. This approach leads to questioning the exploitation models of both agricultural and natural resources. Thinking about "One Health" implies thinking about issues and interventions from an intersectoral, inclusive and participatory perspective, from an interdisciplinary, if not transdisciplinary perspective, and understanding the resulting complexity. Finally, research findings should be taken into account to build public actions. Considering these different challenges and adopting a systemic and interdisciplinary perspective anchored in local contexts according to a participatory and inclusive approach thus seems essential to us to respond in an appropriate, relevant and sustainable manner to the issues associated with "One Health".


Subject(s)
COVID-19 , One Health , Humans , Global Health , Pandemics/prevention & control , COVID-19/epidemiology , Socioeconomic Factors
10.
Int J Environ Res Public Health ; 19(21)2022 Oct 29.
Article in English | MEDLINE | ID: covidwho-2090178

ABSTRACT

The pandemic outbreak has dramatically changed every sector and walk of life. Specifically, the developing countries with scarce resources are facing unprecedented crises that further jeopardize efforts to achieve sustainable life. Considering the case of a developing country, Pakistan, this study empirically identifies the most important strategies to reduce the socio-economic and health challenges during COVID-19. Initially, the study identified 14 key strategies from the prior literature. Later, these strategies were determined with the help of the interpretive structural modeling (ISM) approach through expert suggestions. The ISM model represents seven levels of pandemic containment strategies based on their significance level. The strategies existing at the top level of ISM model are the least important, while the strategies at the bottom of hierarchy levels are highly significant. Therefore, the study results demonstrated that "strong leadership and control" and "awareness on social media" play significant roles in reducing pandemic challenges, while "promoting online purchase behavior" and "online education" are the least important strategies in tackling pandemic crisis. This study will benefit government authorities and policymakers, enabling them to focus more on significant measures in battling this ongoing crisis.


Subject(s)
COVID-19 , Social Media , Humans , COVID-19/epidemiology , Pandemics/prevention & control , SARS-CoV-2 , Socioeconomic Factors
11.
Front Public Health ; 10: 978991, 2022.
Article in English | MEDLINE | ID: covidwho-2089938

ABSTRACT

From 2019 to 2020, the Mexican economy declined for two consecutive years, especially in the last one when it was hit by a decline of 8.4% before the COVID-19 pandemic impacts which was not only one of the worst in the OECD club, but also the deepest economic recession since 1932 in the national history. At the same time, both the number of people in poverty and poverty rate in 2020 have increased compared with those registered in 2018. Through the analysis, we can find that the current Mexican government has increased the intensity and scope of the implementation of social relief policies adhered to the principal of "for the good of all, first the poor (Por el bien de todos, Primero los pobres)." However, in the context of recession caused by the COVID-19, neither the general decrease in residents' income could be avoided, nor the number of people in poverty has been reduced. Besides, in accordance with the benefits obtained by the distinct household deciles based on the income and expenditure survey published by INEGI, it showed that the implementation of government relief measures has relatively reduced the support for the low-income people and further aggravated the deterioration of poverty due to its indifferent application with respect to high-income households and the low-income ones. Therefore, the deficiencies in the response implemented in the face of the epidemic, especially poverty alleviation actions and social relief policies, have further enhanced the poverty problem at least partially. In this sense, recover and improve the economic growth rate as soon as possible will not enough to reduce the poverty, and it should be accompanied by the necessary adjustments in the poverty alleviation measures and social relief policies, especially with a focalized approach inclined to the low-income segments of the population.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Socioeconomic Factors , Pandemics/prevention & control , Poverty , Public Policy
12.
Cad Saude Publica ; 38(9): e00272921, 2022.
Article in Portuguese | MEDLINE | ID: covidwho-2089512

ABSTRACT

This study aimed to verify the temporal trend and inequalities in self-reported cervical cancer screening in Brazilian capitals from 2011 to 2020. This is a trend study with Risk and Protective Factors Surveillance System for Chronic Non-Communicable Diseases Through Telephone Interview (Vigitel) data from 2011 to 2020. The outcome was the prevalence of cytopathological examination in the last three years. Slope index of inequality (SII) and concentration index (CIX) were used to estimate inequalities. An increasing trend in the outcome was observed in Brazil in the period surveyed, as well as a decrease in most regions, capitals, and in all groups according to education. There was a decrease in coverage in most regions of Brazil. We highlight that SII presented its worst results in 2011 and 2012, reaching 15.8p.p. (95%CI: 14.1; 17.6) and 15.0p.p. (95%CI: 13.1; 16.9), respectively, among women with 12 years or more of education. There was a decrease in coverage of cervical cancer screening in most Brazilian regions and capitals from 2011 to 2020. In the period before and during the pandemic, a reduction in the outcome was observed in the South and Southeast regions, suggesting that the COVID-19 pandemic caused geographical inequalities in the coverage for this exam in Brazil.


Este estudo teve como objetivo verificar a tendência temporal e desigualdades no rastreamento autorrelatado do câncer de colo de útero nas capitais brasileiras entre os anos de 2011 e 2020. Estudo de tendência com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) de 2011 a 2020. O desfecho foi a prevalência de realização de exame citopatológico nos últimos três anos. Para estimar as desigualdades, foram utilizados os índices de desigualdade de inclinação (slope index of inequality - SII) e de concentração (concentration index - CIX). Observou-se tendência crescente do desfecho no país no período pesquisado e queda na maioria das regiões, capitais e em todos os grupos de acordo com escolaridade. Houve uma queda da cobertura na maioria das regiões do Brasil. Destaca-se que o SII apresentou seus piores resultados em 2011 e 2012, alcançando 15,8p.p. (IC95%: 14,1; 17,6) e 15,0p.p. (IC95%: 13,1; 16,9), respectivamente, entre as mulheres com 12 anos ou mais de estudo. Houve queda na cobertura da realização do exame preventivo de câncer de colo de útero na maioria das regiões e capitais brasileiras entre os anos de 2011 e 2020. No período antes e durante a pandemia, houve redução do desfecho no país, nas regiões Sul e Sudeste, sugerindo que a pandemia de COVID-19 acarretou desigualdades geográficas na cobertura desse exame no país.


Este estudio tuvo como objetivo verificar la tendencia temporal y las desigualdades en el seguimiento autoinformado de cáncer de cuello uterino en las capitales brasileñas entre 2011 y 2020. Estudio de tendencias con datos de Vigilancia de Factores de Riesgo y Protección de Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en el período de 2011 a 2020. El desenlace fue la prevalencia del examen citopatológico en los últimos tres años. Para estimar las desigualdades se utilizaron los índices de inequidad absoluto (slope index of inequality - SII) y de concentración (concentration index - CIX). Hubo tendencia a un aumento del desenlace en el período en estudio y un descenso en la mayoría de las regiones, capitales y en todos los grupos según el nivel educativo. Se observó un descenso en la cobertura en la mayoría de las regiones de Brasil. Se destaca que el SII presentó un peor resultado en 2011 y 2012, alcanzando 15,8p.p. (IC95%: 14,1; 17,6) y 15,0p.p. (IC95%: 13,1; 16,9), respectivamente, entre mujeres con 12 años o más de escolaridad. Hubo un descenso en la cobertura de la detección de cáncer de cuello uterino en la mayoría de las regiones y capitales brasileñas entre 2011 y 2020. En el período anterior y durante la pandemia, hubo una reducción en el desenlace para el país, en las regiones Sur y Sudeste, lo que apunta que la pandemia del COVID-19 provocó desigualdades geográficas en la cobertura de este examen a nivel nacional.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , Humans , Female , Brazil/epidemiology , Self Report , Early Detection of Cancer , Uterine Cervical Neoplasms/diagnosis , Pandemics , COVID-19/diagnosis , COVID-19/epidemiology , Socioeconomic Factors
13.
JAMA Netw Open ; 5(10): e2238670, 2022 Oct 03.
Article in English | MEDLINE | ID: covidwho-2084340

ABSTRACT

Importance: There have been no published randomized clinical trials with a primary outcome of socioeconomic inclusion for young people who have experienced homelessness. Objective: To explore whether young people exiting homelessness who received rent subsidies and adult mentorship experienced more socioeconomic inclusion relative to young people who received only rent subsidies. Design, Setting, and Participants: This was a convergent mixed-methods, unblinded, 2-group, parallel randomized clinical trial with 1:1 allocation embedded within a community-based framework in 3 cities in Ontario, Canada. Participants were enrolled between March 1 and September 30, 2019, and were followed up through March 31, 2022. Interventions: Participants (n = 24) were randomly assigned adult mentors (n = 13) who had been recruited and screened by community partner agencies. All participants received portable rent subsidies (subsidy not tied to a specific location) for 2 years. Main Outcomes and Measures: Primary quantitative outcomes were self-reported measures of community integration (psychological and physical) and self-esteem-proxy indicators of socioeconomic inclusion. Community integration was measured with the Community Integration Scale, with a score range of 1 to 7 for the physical component and 4 to 20 for the psychological component; higher scores indicate higher integration. Self-esteem was measured with the Rosenberg Self-Esteem Scale, with a score range of 0 to 30; higher scores indicate greater self-esteem. Secondary quantitative outcomes included social connectedness, hopelessness, and academic and vocational participation. All analyses followed the intention-to-treat principle. Results: A total of 24 youths (12 women [50.0%]; mean [SD] age, 21.8 [2.2] years [range, 18-26 years]; race and ethnicity: 10 White [41.7%], 8 Black [33.3%], 2 Asian [8.3%], 2 Indigenous [8.3%], and 2 different choice [8.3%]) transitioned out of homelessness and into market-rent housing. All youths in the group that received mentorship and in the group that did not receive mentorship had stable or nonsignificant improvements in all study outcomes at the primary end point of 18 months compared with baseline (mean [SD] Community Integration Scale psychological score: mentorship group, 11.3 [2.6] at baseline and 11.2 [3.9] at 18 months; no-mentorship group, 10.8 [4.1] at baseline and 13.2 [2.9] at 18 months; mean [SD] Rosenberg Self-Esteem Scale score: mentorship group, 16.0 [4.6] at baseline and 18.1 [5.2] at 18 months; no-mentorship group, 16.3 [6.1] at baseline and 19.6 [5.7] at 18 months). However, there were no significant differences between the 2 groups in the Community Integration Scale psychological score (adjusted mean difference, -2.0; 95% CI, -5.0 to 1.0; P = .18) and Rosenberg Self-Esteem Scale score (adjusted mean difference, -1.4; 95% CI, -5.0 to 2.3; P = .44) 18 months after randomization. Ancillary analysis suggested that youths with informal mentors (mentors outside the study) at baseline felt more psychologically integrated at 18 months relative to those with no informal mentors at baseline (adjusted mean difference, 3.6; 95% CI, 0.4-6.8; P = .03). Conclusions and Relevance: In this randomized clinical trial, COVID-19 pandemic-related restrictions made it challenging for mentors and mentees to connect, which may have affected the findings. Steady socioeconomic outcomes-potentially attributable to portable rent subsidies-are noteworthy, given the socioeconomic inequities this population has faced during the COVID-19 pandemic. The possible benefit of informal mentorship warrants further investigation. This small pilot study was designed with the intention of generating data and hypotheses for a full-scale study; findings should be interpreted with caution. Trial Registration: ClinicalTrials.gov Identifier: NCT03779204.


Subject(s)
COVID-19 , Homeless Persons , Adult , Adolescent , Female , Humans , Young Adult , Pilot Projects , Pandemics , Homeless Persons/psychology , Socioeconomic Factors , Ontario
14.
Front Public Health ; 10: 970092, 2022.
Article in English | MEDLINE | ID: covidwho-2080291

ABSTRACT

Socio-economic conditions and social attitudes are known to represent epidemiological determinants. Credible knowledge on socio-economic driving factors of the COVID-19 epidemic is still incomplete. Based on linear random effects regression, an ecological model is derived to estimate COVID-19 incidence in German rural/urban districts from local socio-economic factors and popularity of political parties in terms of their share of vote. Thereby, records provided by Germany's public health institute (Robert Koch Institute) of weekly notified 7-day incidences per 100,000 inhabitants per district from the outset of the epidemic in 2020 up to December 1, 2021, are used to construct the dependent variable. Local socio-economic conditions including share of votes, retrieved from the Federal Statistical Office of Germany, have been used as potential risk factors. Socio-economic parameters like per capita income, proportions of protection seekers and social benefit claimants, and educational level have negligible impact on incidence. To the contrary, incidence significantly increases with population density and we observe a strong association with vote shares. Popularity of the right-wing party Alternative for Germany (AfD) bears a considerable risk of increasing COVID-19 incidence both in terms of predicting the maximum incidences during three epidemic periods (alternatively, cumulative incidences over the periods are used to quantify the dependent variable) and in a time-continuous sense. Thus, districts with high AfD popularity rank on top in the time-average regarding COVID-19 incidence. The impact of the popularity of the Free Democrats (FDP) is markedly intermittent in the course of time showing two pronounced peaks in incidence but also occasional drops. A moderate risk emanates from popularities of the Green Party (GRÜNE) and the Christian Democratic Union (CDU/CSU) compared to the other parties with lowest risk level. In order to effectively combat the COVID-19 epidemic, public health policymakers are well-advised to account for social attitudes and behavioral patterns reflected in local popularities of political parties, which are conceived as proper surrogates for these attitudes. Whilst causal relations between social attitudes and the presence of parties remain obscure, the political landscape in terms of share of votes constitutes at least viable predictive "markers" relevant for public health policy making.


Subject(s)
COVID-19 , COVID-19/epidemiology , Germany/epidemiology , Humans , Incidence , Risk Factors , Socioeconomic Factors
15.
PLoS One ; 17(10): e0276507, 2022.
Article in English | MEDLINE | ID: covidwho-2079771

ABSTRACT

OBJECTIVES: We aimed to estimate associations between COVID-19 incidence and mortality with neighbourhood-level immigration, race, housing, and socio-economic characteristics. METHODS: We conducted a population-based study of 28,808 COVID-19 cases in the provincial reportable infectious disease surveillance systems (Public Health Case and Contact Management System) which includes all known COVID-19 infections and deaths from Ontario, Canada reported between January 23, 2020 and July 28, 2020. Residents of congregate settings, Indigenous communities living on reserves or small neighbourhoods with populations <1,000 were excluded. Comparing neighbourhoods in the 90th to the 10th percentiles of socio-demographic characteristics, we estimated the associations between 18 neighbourhood-level measures of immigration, race, housing and socio-economic characteristics and COVID-19 incidence and mortality using Poisson generalized linear mixed models. RESULTS: Neighbourhoods with the highest proportion of immigrants (relative risk (RR): 4.0, 95%CI:3.5-4.5) and visible minority residents (RR: 3.3, 95%CI:2.9-3.7) showed the strongest association with COVID-19 incidence in adjusted models. Among individual race groups, COVID-19 incidence was highest among neighbourhoods with the high proportions of Black (RR: 2.4, 95%CI:2.2-2.6), South Asian (RR: 1.9, 95%CI:1.8-2.1), Latin American (RR: 1.8, 95%CI:1.6-2.0) and Middle Eastern (RR: 1.2, 95%CI:1.1-1.3) residents. Neighbourhoods with the highest average household size (RR: 1.9, 95%CI:1.7-2.1), proportion of multigenerational families (RR: 1.8, 95%CI:1.7-2.0) and unsuitably crowded housing (RR: 2.1, 95%CI:2.0-2.3) were associated with COVID-19 incidence. Neighbourhoods with the highest proportion of residents with less than high school education (RR: 1.6, 95%CI:1.4-1.8), low income (RR: 1.4, 95%CI:1.2-1.5) and unaffordable housing (RR: 1.6, 95%CI:1.4-1.8) were associated with COVID-19 incidence. Similar inequities were observed across neighbourhood-level sociodemographic characteristics and COVID-19 mortality. CONCLUSIONS: Neighbourhood-level inequities in COVID-19 incidence and mortality were observed in Ontario, with excess burden experienced in neighbourhoods with a higher proportion of immigrants, racialized populations, large households and low socio-economic status.


Subject(s)
COVID-19 , Humans , Incidence , Ontario/epidemiology , COVID-19/epidemiology , Residence Characteristics , Family Characteristics , Socioeconomic Factors
16.
BMJ Open ; 12(10): e064118, 2022 10 17.
Article in English | MEDLINE | ID: covidwho-2078990

ABSTRACT

OBJECTIVE: To assess the impact of COVID-19 on pregnancy-related healthcare utilisation and differences across social groups. DESIGN: Nationwide longitudinal prospective registry-based study. SETTING: Norway. PARTICIPANTS: Female residents aged 15-50 years (n=1 244 560). MAIN OUTCOME MEASURES: Pregnancy-related inpatient, outpatient and primary care healthcare utilisation before the COVID-19 pandemic (prepandemic: 1 January to 11 March 2020), during the initial lockdown (first wave: 12 March to 3 April 2020), during the summer months of low restrictions (summer period: 4 April to 31 August 2020) and during the second wave to the end of the year (second wave: 1 September to 31 December 2020). Rates were compared with the same time periods in 2019. RESULTS: There were 130 924 inpatient specialist care admissions, 266 015 outpatient specialist care consultations and 2 309 047 primary care consultations with pregnancy-related diagnostic codes during 2019 and 2020. After adjusting for time trends and cofactors, inpatient admissions were reduced by 9% (adjusted incidence rate ratio (aIRR)=0.91, 95% CI 0.87 to 0.95), outpatient consultations by 17% (aIRR=0.83, 95% CI 0.71 to 0.86) and primary care consultations by 10% (aIRR=0.90, 95% CI 0.89 to 0.91) during the first wave. Inpatient care remained 3%-4% below prepandemic levels throughout 2020. Reductions according to education, income and immigrant background were also observed. Notably, women born in Asia, Africa or Latin America had a greater reduction in inpatient (aIRR=0.87, 95% CI 0.77 to 0.97) and outpatient (aIRR 0.90, 95% CI 0.86 to 0.95) care during the first wave, compared with Norwegian-born women. We also observed that women with low education had a greater reduction in inpatient care during summer period (aIRR=0.88, 95% CI 0.83 to 0.92), compared with women with high educational attainment. CONCLUSION: Following the introduction of COVID-19 mitigation measures in Norway in March 2020, there were substantial reductions in pregnancy-related healthcare utilisation, especially during the initial lockdown and among women with an immigrant background.


Subject(s)
COVID-19 , Patient Acceptance of Health Care , Prenatal Care , Female , Humans , Pregnancy , Communicable Disease Control , COVID-19/epidemiology , COVID-19/prevention & control , Pandemics/prevention & control , Patient Acceptance of Health Care/statistics & numerical data , Registries , Adolescent , Young Adult , Adult , Middle Aged , Norway/epidemiology , Socioeconomic Factors , Longitudinal Studies , Prospective Studies
17.
Soc Sci Med ; 314: 115447, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2069699

ABSTRACT

Loneliness among older adults is a public health problem that has received particular attention since the emergence of the COVID-19 pandemic. Studies to date have however found a rather modest psychosocial impact of the pandemic on older adults, and scarce research has analyzed this impact using a comprehensive equity lens. The present study used an intersectional approach to examine social inequalities in loneliness before and during the early phase of the pandemic among older adults receiving eldercare in Sweden. The study population (analytical N = 205,529) came from two waves (2019 and 2020) of a total population survey to all older adult (>65 years of age) home care recipients and nursing home residents in Sweden. Loneliness was self-reported by a single-item measure, and survey data were linked to population register data on age, gender, residential setting, income, and country of birth. Additive binomial regression models were used to estimate prevalence differences and discriminatory accuracy according to an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach. Results showed inequalities in loneliness arising particularly in the intersection of country of birth, income, and residential setting. The inequalities widened slightly but ubiquitously following the emergence of the pandemic in 2020, with particularly nursing home residents emerging as a risk group. The discriminatory accuracy of inequalities was consistently low to moderate throughout the analyses but increased marginally during the pandemic in 2020. The study illustrates how social inequalities engenders heterogeneity in the psychosocial risk of older adults before and during the pandemic. These findings should stimulate more nuanced and equity-oriented depictions, research and policies about loneliness among older adults in the peri-pandemic era.


Subject(s)
COVID-19 , Loneliness , Humans , Aged , Loneliness/psychology , Pandemics , COVID-19/epidemiology , Sweden/epidemiology , Socioeconomic Factors
20.
Int J Environ Res Public Health ; 19(19)2022 Sep 29.
Article in English | MEDLINE | ID: covidwho-2065962

ABSTRACT

This study aimed to identify changes in the prevalence of childhood (children under five years of age) overweight and obesity in Peru as a whole and at the departmental level, before and during the coronavirus disease (COVID-19) pandemic. We performed a secondary data analysis of two Demographic and Family Health Surveys (2019 and 2021) in Peru. The outcome was childhood overweight and obesity, defined as a weight-for-height score greater than 2 standard deviations. Poisson log generalized linear regression models adjusted for sex and/or age in months of the child were fitted to obtain the prevalence ratios of the changes in childhood overweight and obesity from 2019 to 2021. The analysis included 41,533 (2019: 20,414; 2021: 21,119) participants. The prevalence of childhood overweight and obesity was 6.4% in 2019 and 7.8% in 2021. Female children, aged 2, 3 and 4 years, and mothers who self-identified as non-native, had secondary and higher education, belonged to the middle and richer wealth quintile and resided in an urban area, in a village, in a small city and in the coastal region showed the largest increases in the prevalence of childhood overweight and obesity in 2021 compared to 2019. The departments of Pasco, Apurímac, Junín, Cusco, Lambayeque and La Libertad presented the largest increases in the prevalence of these nutritional disorders. During the pandemic, an increase in the prevalence of childhood overweight and obesity was observed, with demographic and socioeconomic factors accounting for the largest increases in the prevalence rates. A restructuring of overweight and obesity control strategies is required to curb this steady increase.


Subject(s)
COVID-19 , Pediatric Obesity , Body Mass Index , COVID-19/epidemiology , Child , Child, Preschool , Female , Humans , Overweight/epidemiology , Pandemics , Pediatric Obesity/epidemiology , Peru/epidemiology , Prevalence , Socioeconomic Factors
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