Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 293
Filter
1.
BMJ Open ; 12(4): e055791, 2022 Apr 07.
Article in English | MEDLINE | ID: covidwho-1784818

ABSTRACT

OBJECTIVE: We examined the association between stay-at-home order implementation and the incidence of COVID-19 infections and deaths in rural versus urban counties of the United States. DESIGN: We used an interrupted time-series analysis using a mixed effects zero-inflated Poisson model with random intercept by county and standardised by population to examine the associations between stay-at-home orders and county-level counts of daily new COVID-19 cases and deaths in rural versus urban counties between 22 January 2020 and 10 June 2020. We secondarily examined the association between stay-at-home orders and mobility in rural versus urban counties using Google Community Mobility Reports. INTERVENTIONS: Issuance of stay-at-home orders. PRIMARY AND SECONDARY OUTCOME MEASURES: Co-primary outcomes were COVID-19 daily incidence of cases (14-day lagged) and mortality (26-day lagged). Secondary outcome was mobility. RESULTS: Stay-at-home orders were implemented later (median 30 March 2020 vs 28 March 2020) and were shorter in duration (median 35 vs 54 days) in rural compared with urban counties. Indoor mobility was, on average, 2.6%-6.9% higher in rural than urban counties both during and after stay-at-home orders. Compared with the baseline (pre-stay-at-home) period, the number of new COVID-19 cases increased under stay-at-home by incidence risk ratio (IRR) 1.60 (95% CI, 1.57 to 1.64) in rural and 1.36 (95% CI, 1.30 to 1.42) in urban counties, while the number of new COVID-19 deaths increased by IRR 14.21 (95% CI, 11.02 to 18.34) in rural and IRR 2.93 in urban counties (95% CI, 1.82 to 4.73). For each day under stay-at-home orders, the number of new cases changed by a factor of 0.982 (95% CI, 0.981 to 0.982) in rural and 0.952 (95% CI, 0.951 to 0.953) in urban counties compared with prior to stay-at-home, while number of new deaths changed by a factor of 0.977 (95% CI, 0.976 to 0.977) in rural counties and 0.935 (95% CI, 0.933 to 0.936) in urban counties. Each day after stay-at-home orders expired, the number of new cases changed by a factor of 0.995 (95% CI, 0.994 to 0.995) in rural and 0.997 (95% CI, 0.995 to 0.999) in urban counties compared with prior to stay-at-home, while number of new deaths changed by a factor of 0.969 (95% CI, 0.968 to 0.970) in rural counties and 0.928 (95% CI, 0.926 to 0.929) in urban counties. CONCLUSION: Stay-at-home orders decreased mobility, slowed the spread of COVID-19 and mitigated COVID-19 mortality, but did so less effectively in rural than in urban counties. This necessitates a critical re-evaluation of how stay-at-home orders are designed, communicated and implemented in rural areas.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Incidence , Interrupted Time Series Analysis , Rural Population , United States/epidemiology , Urban Population
2.
Front Public Health ; 9: 742355, 2021.
Article in English | MEDLINE | ID: covidwho-1775899

ABSTRACT

Objective: Health disparities related to basic medical insurance in China have not been sufficiently examined, particularly among patients with hepatocellular carcinoma (HCC). This study aims to investigate the disparities in HCC survival by insurance status in Tianjin, China. Methods: This retrospective analysis used data from the Tianjin Basic Medical Insurance claims database, which consists of enrollees covered by Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Resident Basic Medical Insurance (URRBMI). Adult patients newly diagnosed with HCC between 2011 and 2016 were identified and followed until death from any cause, withdrawal from UEBMI or URRBMI, or the latest data in the dataset (censoring as of December 31st 2017), whichever occurred first. Patients' overall survival during the follow-up was assessed using Kaplan-Meier and extrapolated by six parametric models. The hazard ratio (HR) and 95% confidence intervals (CI) were calculated with the adjusted Cox proportional hazards model including age at diagnosis, sex, baseline comorbidities and complications, baseline healthcare resources utilization and medical costs, tumor metastasis at diagnosis, the initial treatment after diagnosis and antiviral therapy during the follow-up. Results: Two thousand sixty eight patients covered by UEBMI (N = 1,468) and URRBMI (N = 570) were included (mean age: 60.6 vs. 60.9, p = 0.667; female: 31.8 vs. 27.7%, p = 0.074). The median survival time for patients within the UEBMI and URRBMI were 37.8 and 12.2 months, and the 1-, 3-, 5-, 10-year overall survival rates were 63.8, 50.2, 51.0, 33.4, and 44.4, 22.8, 31.5, 13.1%, respectively. Compared with UEBMI, patients covered by URRBMI had 72% (HR: 1.72; 95% CI: 1.47-2.00) higher risk of death after adjustments for measured confounders above. The survival difference was still statistically significant (HR: 1.49; 95% CI: 1.21-1.83) in sensitivity analysis based on propensity score matching. Conclusions: This study reveals that HCC patients covered by URRBMI may have worse survival than patients covered by UEBMI. Further efforts are warranted to understand healthcare disparities for patients covered by different basic medical insurance in China.


Subject(s)
Carcinoma, Hepatocellular , Health Status Disparities , Liver Neoplasms , Adult , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/therapy , China/epidemiology , Female , Humans , Insurance Coverage , Insurance, Health , Liver Neoplasms/mortality , Liver Neoplasms/therapy , Middle Aged , Retrospective Studies , Urban Population
3.
Front Public Health ; 9: 707907, 2021.
Article in English | MEDLINE | ID: covidwho-1775824

ABSTRACT

Objectives: To investigate the association of state-level Medicaid expansion and non-elderly mortality rates from 1999 to 2018 in Northeastern urban settings. Methods: This quasi-experimental study utilized a synthetic control method to assess the association of Medicaid expansion on non-elderly urban mortality rates [1999-2018]. Counties encompassing the largest cities in the Northeastern Megalopolis (Washington D.C., Baltimore, Philadelphia, New York City, and Boston) were selected as treatment units (n = 5 cities, 3,543,302 individuals in 2018). Cities in states without Medicaid expansion were utilized as control units (n = 17 cities, 12,713,768 individuals in 2018). Results: Across all cities, there was a significant reduction in the neoplasm (Population-Adjusted Average Treatment Effect = -1.37 [95% CI -2.73, -0.42]) and all-cause (Population-Adjusted Average Treatment Effect = -2.57 [95%CI -8.46, -0.58]) mortality rate. Washington D.C. encountered the largest reductions in mortality (Average Treatment Effect on All-Cause Medical Mortality = -5.40 monthly deaths per 100,000 individuals [95% CI -12.50, -3.34], -18.84% [95% CI -43.64%, -11.67%] reduction, p = < 0.001; Average Treatment Effect on Neoplasm Mortality = -1.95 monthly deaths per 100,000 individuals [95% CI -3.04, -0.98], -21.88% [95% CI -34.10%, -10.99%] reduction, p = 0.002). Reductions in all-cause medical mortality and neoplasm mortality rates were similarly observed in other cities. Conclusion: Significant reductions in urban mortality rates were associated with Medicaid expansion. Our study suggests that Medicaid expansion saved lives in the observed urban settings.


Subject(s)
Medicaid , Mortality , Urban Population , Humans , Middle Aged , Neoplasms , Patient Protection and Affordable Care Act , United States/epidemiology , Washington
4.
Front Public Health ; 10: 824587, 2022.
Article in English | MEDLINE | ID: covidwho-1776022

ABSTRACT

This study aimed to compare and analyse the differences in smoking prevalence, and knowledge, attitudes, and factors associated with smoking between the rural and urban elderly population in China. In total, 6,966 participants aged 60 and above were included in this study, which assessed their smoking-related knowledge, attitudes, and perceptions toward tobacco control. The Chi-square test and logistic regression model were used for statistical analysis, and the Fairlie model was used for decomposition analysis. The overall prevalence of smoking was 25.6%; the rate was much higher in men than in women (overall: OR = 26.234; urban: OR = 31.260; rural: OR = 23.889). The rate of correct responses to all questions on smoking problems was significantly higher among the urban elderly than the rural elderly. Further, 64.18% of the participants supported printing photos of the health hazards of smoking on the cover of cigarette packs, and the rural elderly were more supportive of this. Moreover, only 36.52% of the participants supported increasing taxation and retail price of cigarettes; the urban elderly showed more support for this. Rules about smoking at home also played an important role, especially for families where smoking was not allowed at home, but with exceptions to the rule; however, this factor was only meaningful in urban families (urban: OR = 0.117). Through the Fairlie decomposition analysis, gender (-1.62%), age (-2.03%), region (13.68%), knowing about e-cigarettes (5.17%), rules about smoking at home (3.95%), and smoking-related knowledge scores (42.85%) were found to be associated with rural-urban disparities. This study focused on the differences in smoking between urban and rural areas in China. Smoking among the urban elderly was significantly less prevalent compared with the rural population. Factors including education, region, and smoking-related knowledge need to be addressed to reduce the gap between urban and rural health hazards in China.


Subject(s)
Health Knowledge, Attitudes, Practice , Smoking Prevention , Smoking , Aged , China/epidemiology , Cross-Sectional Studies , Electronic Nicotine Delivery Systems , Female , Humans , Male , Middle Aged , Prevalence , Rural Population , Smoking/epidemiology , Urban Population
5.
Front Public Health ; 10: 808988, 2022.
Article in English | MEDLINE | ID: covidwho-1776006

ABSTRACT

Objective: This study aimed to assess the knowledge, attitude, and practice (KAP) of diabetic subjects with diabetic retinopathy (DR) and those without DR (NDR) in an urban community in Northeast China, as well as their risk factors in subjects with DR and NDR. Methods: A community-based survey involving 1,662 subjects was conducted in Fushun, China, between July 2012 and May 2013. The subjects included diabetics with DR (n = 783) and those NDR (n = 879), and questionnaires were completed to collect information about their sociodemographic and healthcare characteristics. A Chi-square test and multiple logistic analyses were performed to analyze the data. Results: Among the DR group, 21.88% had a good knowledge of DR, 94.15% had a positive attitude, and 68.07% followed good practice, whereas 20.98% of the NDR group had a good knowledge of DR, 94.18% had a positive attitude, and 66.92% followed good practice. There was no significant difference in the KAP of the two groups of subjects. In the NDR group, a good level of knowledge was associated with a high-level of education (OR = 0.1, 0.2; p < 0.05), a good attitude was associated with retirement (OR = 0.2; p < 0.05), and good practice was associated with being female, having a high-level of education, and the type of treatment (OR = 0.5, 0.4, 2.3, 3.1; p < 0.05). In the DR group, good practice was associated with older age and retirement (OR = 0.6, 0.4; p < 0.05). Conclusions: There was no significant difference between the DR and NDR subjects in the overall levels of KAP, but both groups showed a poor level of knowledge. Age, gender, education, occupation, and type of treatment were the main factors associated with the KAP scores, more risk factors in the NDR group than in the DR group. There is an urgent need for coordinated educational campaigns with a prioritized focus on the northeast region of China, especially NDR group.


Subject(s)
Diabetes Mellitus , Diabetic Retinopathy , Health Knowledge, Attitudes, Practice , China , Cross-Sectional Studies , Female , Humans , Urban Population
6.
Front Public Health ; 10: 731326, 2022.
Article in English | MEDLINE | ID: covidwho-1775965

ABSTRACT

Background: Studies indicate that children and adolescent populations in most countries show a low level of physical activity (PA) and an increasing prevalence of obesity. Addressing gender disparity in PA is the main element of public health programs. There is currently a paucity of studies, particularly, in developing countries that investigate gender differences and correlates of PA among children and adolescents. Objective: The study is aimed to assess the gender difference and correlates of PA among children and adolescents in Ethiopia. Methods: An observational population-based cross-sectional study was conducted in representative samples of children and adolescents in the capital city of Ethiopia, Addis Ababa. Multivariable logistic regression models with robust estimation of SEs were fitted to predict the odds ratios (ORs) and 95% CIs. Results: A total of 632 children and adolescents-parent dyads were included in the study. More boys than girls (17.0 and 11.7%) were engaged in moderate intensity PA 3 days a week or more (p = 0.057). Age, mothers working in a private business, attending public schools, longer sleep duration, and being taught the benefits of PA were positively associated with meeting moderate-to-vigorous PA (MVPA) in both sexes combined and in a sub-sample of boys. Furthermore, an inverse association was found between overweight/obesity and MVPA in the overall children and girls as well. For moderate PA (MPA); the age of the children, maternal education and occupation, school type, overweight/obesity, and sleep duration on school nights were significant correlates among the studied children. Conclusions: The present study provided evidence of several correlates identified associated with meeting MVPA and MPA in both sexes combined. Girls are less likely than boys to engage in PA. Therefore, there is a need to take into perspectives the provision of a comprehensive multifaceted health behavior modification and interventions, such as focused and regular physical education in schools.


Subject(s)
Exercise , Sex Factors , Adolescent , Child , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Humans , Male , Urban Population
7.
Front Public Health ; 9: 749330, 2021.
Article in English | MEDLINE | ID: covidwho-1775928

ABSTRACT

Objectives: Large-scale rural-to-urban migration of China has provoked heated discussion about the health of migrants and whether they have equal access to the health resources. This article aimed to compare the public and commercial medical insurance enrollment rates between temporary, permanent migrants and urban natives. Methods: Average marginal effects (AME) of the weighted logistic regression models using 2017 China General Social Survey from 2,068 urban natives, 1,285 temporary migrants, and 1,295 permanent migrants. Results: After controlling for the demographic and socio-economic characteristics, our results show that while the temporary and permanent migrants have a similar public insurance enrollment rate compared with the urban natives, both temporary and permanent migrants have significantly lower commercial insurance enrollment rates (7.5 and 5.3%, respectively) compared with the urban natives. Conclusions: The results highlight significant institutional barriers preventing the temporary migrants from gaining access to public medical insurance and the adverse impact of disadvantaged socio-economic backgrounds on the access of temporary migrants to both public and commercial insurance.


Subject(s)
Insurance , Transients and Migrants , China , Humans , Urban Population
8.
PLoS One ; 17(3): e0261056, 2022.
Article in English | MEDLINE | ID: covidwho-1770728

ABSTRACT

The relationship between nature contact and mental well-being has received increasing attention in recent years. While a body of evidence has accumulated demonstrating a positive relationship between time in nature and mental well-being, there have been few studies comparing this relationship in different locations over long periods of time. In this study, we analyze over 1.5 million tweets to estimate a happiness benefit, the difference in expressed happiness between in- and out-of-park tweets, for the 25 largest cities in the US by population. People write happier words during park visits when compared with non-park user tweets collected around the same time. While the words people write are happier in parks on average and in most cities, we find considerable variation across cities. Tweets are happier in parks at all times of the day, week, and year, not just during the weekend or summer vacation. Across all cities, we find that the happiness benefit is highest in parks larger than 100 acres. Overall, our study suggests the happiness benefit associated with park visitation is on par with US holidays such as Thanksgiving and New Year's Day.


Subject(s)
Parks, Recreational , Social Media , Cities , Happiness , Humans , Recreation , Urban Population
9.
Sci Rep ; 11(1): 22120, 2021 11 11.
Article in English | MEDLINE | ID: covidwho-1758321

ABSTRACT

The outbreak of the Coronavirus disease 2019 (COVID-19), and the drastic measures taken to mitigate its spread through imposed social distancing, have brought forward the need to better understand the underlying factors controlling spatial distribution of human activities promoting disease transmission. Focusing on results from 17,250 epidemiological investigations performed during early stages of the pandemic outbreak in Israel, we show that the distribution of carriers of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes COVID-19, is spatially correlated with two satellite-derived surface metrics: night light intensity and landscape patchiness, the latter being a measure to the urban landscape's scale-dependent spatial heterogeneity. We find that exposure to SARS-CoV-2 carriers was significantly more likely to occur in "patchy" parts of the city, where the urban landscape is characterized by high levels of spatial heterogeneity at relatively small, tens of meters scales. We suggest that this spatial association reflects a scale-dependent constraint imposed by the city's morphology on the cumulative behavior of the people inhabiting it. The presented results shed light on the complex interrelationships between humans and the urban landscape in which they live and interact, and open new avenues for implementation of multi-satellite data in large scale modeling of phenomena centered in urban environments.


Subject(s)
COVID-19/epidemiology , Cities/epidemiology , Human Activities , Humans , Israel/epidemiology , SARS-CoV-2/isolation & purification , Satellite Imagery , Urban Population
10.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(6): 741-747, 2021 Dec 25.
Article in English | MEDLINE | ID: covidwho-1753706

ABSTRACT

: To explore the association between napping status and depressive symptoms in urban residents during the coronavirus disease 2019 (COVID-19) epidemic. : The survey was embedded in the Wellness Living Laboratory-China (WELL China) cohort study. Health and lifestyle information during the COVID-19 epidemic were obtained via the telephone interview from April 8, 2020 to May 29, 2020. A total of 3075 residents aged 18 to from Gongshu district of Hangzhou city with complete data were included in the analyses. The World Health Organization-Five Well-being Index (WHO-5) was used to measure depressive symptoms. Multiple logistic regression model was used to assess the association between napping status and depressive symptoms in the participants. : The prevalence of depressive symptoms was 20.6% in the participants during the epidemic. Daytime napping behavior, especially napping time ≤30 min, was associated with a lower risk of prevalent depressive symptoms (=0.61, 95%: 0.47-0.79, <0.01) and incident depressive symptoms in the population (=0.66, 95%: 0.50-0.88, <0.01). Among those with depressive symptoms at baseline, napping time ≤ was beneficial for the outcome of depressive symptoms (=0.42, 95%: 0.21-0.82, <0.05). : One in five urban residents have depressive symptoms during the COVID-19 epidemic, and a short nap during the day may be a protective factor against depressive symptoms.


Subject(s)
COVID-19 , Adolescent , COVID-19/epidemiology , Cohort Studies , Depression/diagnosis , Depression/epidemiology , Humans , Risk Factors , Urban Population
11.
Int J Environ Res Public Health ; 19(6)2022 03 17.
Article in English | MEDLINE | ID: covidwho-1753486

ABSTRACT

BACKGROUND: Digital transformation has become a key intervention strategy for the global response to the COVID-19 epidemic, and digital technology is helping cities recover from the COVID-19 epidemic. However, the effects of urban digital transformation on the recovery from the COVID-19 epidemic still lack mechanism analyses and empirical testing. This study aimed to explain the theoretical mechanism of urban digital transformation on the recovery from the COVID-19 epidemic and to test its effectiveness using an empirical analysis. METHODS: This study, using a theoretical and literature-based analysis, summarizes the impact mechanisms of urban digital transformation on the recovery of cities from the COVID-19 epidemic. A total of 83 large- and medium-sized cities from China are included in the empirical research sample, covering most major cities in China. The ordinary least squares (OLS) method is adopted to estimate the effect of China's urban digitalization level on population attraction in the second quarter of 2020. RESULTS: The theoretical analysis found that urban digital transformation improves the ability of cities to recover from the COVID-19 epidemic by promoting social communication, collaborative governance, and resilience. The main findings of the empirical analysis show that the digital level of a city has a significant positive effect on urban population attraction (p < 0.001). CONCLUSIONS: A positive relationship was found between urban digital transformation and the rapid recovery of cities from the COVID-19 epidemic. Digital inventions for social communication, collaborative governance, and urban resilience are an effective way of fighting the COVID-19 emergency.


Subject(s)
COVID-19 , Epidemics , COVID-19/epidemiology , China/epidemiology , Cities/epidemiology , Humans , Urban Population
12.
BMC Public Health ; 22(1): 522, 2022 03 17.
Article in English | MEDLINE | ID: covidwho-1745466

ABSTRACT

BACKGROUND: Malawi is at the brink of experiencing food insecurity amidst the COVID-19 pandemic as the vast majority of its population lives in extreme poverty. While measures are being implemented to avert the spread of COVID-19, little is known about how COVID-19 policy measures have impacted food insecurity in urban Malawi. This study addresses this gap by exploring the implications of COVID-19 policy measures on food insecurity in low-income areas of Blantyre in Malawi. METHODS: We used Bronfenbrenner's ecological theory to explore the implications of COVID-19 policy measures on peoples' access to food. In-depth interviews were conducted with fifteen participants comprising of private school teachers, street vendors, sex workers, and minibus drivers. Data were analyzed using thematic analysis in which emerging patterns and themes from the transcripts were identified. RESULTS: The COVID-19 lockdown measures undermined participants' ability to maintain livelihoods. These measures have increased the vulnerability of the residents to food insecurity, forcing them to face severe challenges to accessing adequate food to support their families as a result of low incomes, job loss, and business disruptions. CONCLUSION: Our study underscores the need for the Malawi government to seriously consider the provision of basic necessities such as food to the urban poor. We also suggest that the Malawi government should continue and expand the social cash transfer or relief funding packages by targeting the most vulnerable groups in the city. There is also a need for the government to engage all stakeholders and work collaboratively with people at local level in policymaking decisions in times of crisis.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Food Insecurity , Food Supply , Humans , Malawi/epidemiology , Pandemics/prevention & control , Policy , Urban Population
13.
PLoS One ; 17(3): e0264820, 2022.
Article in English | MEDLINE | ID: covidwho-1745316

ABSTRACT

The purpose of this cross-sectional study is to examine disparities in hand washing and social distancing among 2,509 adults from the United States, Italy, Spain, the Kingdom of Saudi Arabia, and India. Respondents were recruited via Qualtrics' participant pool and completed an online survey in the most common language spoken in each country. In hierarchical linear regression models, living in a rural area (ß = -0.08, p = .001), older age (ß = 0.07, p < .001), identifying as a woman (ß = 0.07, p = .001), and greater educational attainment (ß = 0.07, p = .017) were significantly associated with hand washing. Similar results were found regarding social distancing, in which living in a rural area (ß = -0.10, p < .001), country of residence (ß = 0.11, p < .001), older age (ß = 0.17, p < .001), identifying as a woman (ß = 0.11, p < .001), and greater educational attainment (ß = 0.06, p = .019) were significant predictors. Results from the multivariable linear regression models demonstrate more nuanced findings with distinct and significant disparities across the five countries found with respect to hand washing and social distancing. Taken together, the results suggest multiple influencing factors that contribute to existing disparities regarding social distancing and hand washing among adults internationally. As such, more tailored public interventions are needed to promote preventive measures to mitigate existing COVID-related disparities.


Subject(s)
COVID-19/prevention & control , Hand Disinfection , Physical Distancing , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Educational Status , Female , Health Behavior , Humans , India/epidemiology , Italy/epidemiology , Linear Models , Male , Rural Population/statistics & numerical data , Saudi Arabia/epidemiology , Sex Factors , Spain/epidemiology , United States/epidemiology , Urban Population/statistics & numerical data
14.
MMWR Morb Mortal Wkly Rep ; 71(9): 335-340, 2022 Mar 04.
Article in English | MEDLINE | ID: covidwho-1727014

ABSTRACT

Higher COVID-19 incidence and mortality rates in rural than in urban areas are well documented (1). These disparities persisted during the B.1.617.2 (Delta) and B.1.1.529 (Omicron) variant surges during late 2021 and early 2022 (1,2). Rural populations tend to be older (aged ≥65 years) and uninsured and are more likely to have underlying medical conditions and live farther from facilities that provide tertiary medical care, placing them at higher risk for adverse COVID-19 outcomes (2). To better understand COVID-19 vaccination disparities between urban and rural populations, CDC analyzed county-level vaccine administration data among persons aged ≥5 years who received their first dose of either the BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) COVID-19 vaccine or a single dose of the Ad.26.COV2.S (Janssen [Johnson & Johnson]) COVID-19 vaccine during December 14, 2020-January 31, 2022, in 50 states and the District of Columbia (DC). COVID-19 vaccination coverage with ≥1 doses in rural areas (58.5%) was lower than that in urban counties (75.4%) overall, with similar patterns across age groups and sex. Coverage with ≥1 doses varied among states: 46 states had higher coverage in urban than in rural counties, one had higher coverage in rural than in urban counties. Three states and DC had no rural counties; thus, urban-rural differences could not be assessed. COVID-19 vaccine primary series completion was higher in urban than in rural counties. However, receipt of booster or additional doses among primary series recipients was similarly low between urban and rural counties. Compared with estimates from a previous study of vaccine coverage among adults aged ≥18 years during December 14, 2020-April 10, 2021, these urban-rural disparities among those now eligible for vaccination (aged ≥5 years) have increased more than twofold through January 2022, despite increased availability and access to COVID-19 vaccines. Addressing barriers to vaccination in rural areas is critical to achieving vaccine equity, reducing disparities, and decreasing COVID-19-related illness and death in the United States (2).


Subject(s)
COVID-19 Vaccines/administration & dosage , Healthcare Disparities , Vaccination Coverage , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Rural Population , United States/epidemiology , Urban Population
15.
Nutrients ; 12(6)2020 Jun 06.
Article in English | MEDLINE | ID: covidwho-1725883

ABSTRACT

COVID-19, a Public Health Emergency of International Concern, has imposed enormous challenges on the health system, economy, and food supply and has substantially modified people's lifestyles. This study aimed to (1) explore the dietary diversity during the lockdown time in China and (2) examine factors associated with dietary diversity including socio-economic characteristics, sources for food and food purchases, and specific dietary behaviors responding to COVID-19 and isolation. A cross-sectional questionnaire-based survey was conducted online in March 2020. Multi-stage sampling was used to recruit participants living in Hubei Province and other parts of China. Dietary diversity was assessed using the Household Dietary Diversity Score (HDDS) and clustering analysis was used to categorize people with different propensities of methods for purchasing or obtaining foods. Logistic regression was used to model the associations among HDDS, participants' characteristics, approaches to purchase or obtain food, and behaviors adopted to cope with COVID-19. Results: A total of 1938 participants were included in the analysis. The overall mean HDDS was 9.7 ± 2.1, and the median (25th, 75th) was 10 (8, 12). There were relatively low consumptions of fish, legumes, and miscellaneous foods (e.g., processed food like snacks and beverages). After adjusting for age, family income, and geographic regions, people living in places where laboratory confirmed COVID-19 cases were above 500 (ORadjusted = 0.79, 95%CI 0.65, 0.96), or living in Hubei Province (ORadjusted = 0.60, 95%CI 0.39, 0.93) had a lower HDDS. During isolation time, the most common sources for food and food purchases were in-house storage and in person grocery shopping. More than half of the participants (55.9%) purchased food at least once via online ordering and delivery services. There was no significant difference in HDDS among people with distinct dependences on different ways to obtain or purchase food (i.e., dependence on in-person grocery shopping, dependence on both in-house storage and in-person grocery shopping, or dependence on online food purchasing). We also identified a total of 37.7% participants who consumed certain foods or nutritional supplements to cope with COVID-19, which included vitamin C, probiotics, other dietary supplements, alcohol, and vinegar. People who reported these specific dietary behaviors had a significantly higher HDDS (ORadjusted = 1.23, 95%CI 1.02, 1.45) than those who did not do so. This study revealed an overall good dietary diversity among the studied Chinese residents during the COVID-19 pandemic. However, we observed a lower dietary diversity among people living in areas with a high number of confirmed COVID-19 cases. Online ordering and delivery services were popular and could serve as a feasible method to obtain and purchase food, contributing to ensure diversified diets during the time of lockdown. Certain dietary behaviors associated with COVID-19 were also identified and had significant impacts on HDDS.


Subject(s)
Coronavirus Infections/epidemiology , Diet/classification , Disease Outbreaks , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Child , Child, Preschool , China/epidemiology , Coronavirus Infections/physiopathology , Cross-Sectional Studies , Diet/standards , Diet/trends , Dietary Supplements/statistics & numerical data , Drugs, Chinese Herbal/administration & dosage , Female , Food Supply/methods , Food Supply/statistics & numerical data , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , Rural Population , Surveys and Questionnaires , Urban Population , Young Adult
16.
Int J Environ Res Public Health ; 17(12)2020 06 20.
Article in English | MEDLINE | ID: covidwho-1725656

ABSTRACT

Purpose: The purpose of this study is to examine the differences in preventive behaviors of COVID-19 between urban and rural residents, as well as identify the factors that might contribute to such differences. Methods: Our online survey included 1591 participants from 31 provinces of China with 87% urban and 13% rural residents. We performed multiple linear regressions and path analysis to examine the relationship between rural status and behavioral intention, attitude, subjective norms, information appraisal, knowledge, variety of information source use, and preventive behaviors against COVID-19. Findings: Compared with urban residents, rural residents were less likely to perform preventive behaviors, more likely to hold a negative attitude toward the effectiveness of performing preventive behaviors, and more likely to have lower levels of information appraisal skills. We identified information appraisal as a significant factor that might contribute to the rural/urban differences in preventive behaviors against COVID-19 through attitude, subjective norms, and intention. We found no rural/urban differences in behavioral intention, subjective norms, knowledge about preventive behaviors, or the variety of interpersonal/media source use. Conclusions: As the first wave of the pandemic inundated urban areas, the current media coverage about COVID-19 prevention may not fully satisfy the specific needs of rural populations. Thus, rural residents were less likely to engage in a thoughtful process of information appraisal and adopt the appropriate preventive measures. Tailoring health messages to meet rural populations' unique needs can be an effective strategy to promote preventive health behaviors against COVID-19.


Subject(s)
Coronavirus Infections/prevention & control , Health Behavior , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Adolescent , Adult , Aged , Attitude , Betacoronavirus , COVID-19 , China , Cross-Sectional Studies , Female , Humans , Intention , Linear Models , Male , Middle Aged , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
17.
JAMA Netw Open ; 5(3): e220773, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1718200

ABSTRACT

Importance: Women with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. Objective: To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. Design, Setting, and Participants: This randomized, participant-unblinded controlled trial investigated a 12-month lifestyle intervention vs usual care at 19 urban hospitals in India, Sri Lanka, and Bangladesh. Participants included women with recent diagnosis of GDM who did not have type 2 diabetes at an oral glucose tolerance test (OGTT) 3 to 18 months postpartum. They were enrolled from November 2017 to January 2020, and follow-up ended in January 2021. Data were analyzed from April to July 2021. Interventions: A 12-month lifestyle intervention focused on diet and physical activity involving group and individual sessions, as well as remote engagement, adapted to local context and resources. This was compared with usual care. Main Outcomes and Measures: The primary outcome was worsening category of glycemia based on OGTT using American Diabetes Association criteria: (1) normal glucose tolerance to prediabetes (ie, impaired fasting glucose or impaired glucose tolerance) or type 2 diabetes or (2) prediabetes to type 2 diabetes. The primary analysis consisted of a survival analysis of time to change in glycemic status at or prior to the final patient visit, which occurred at varying times after 12 months for each patient. Secondary outcomes included new-onset type 2 diabetes and change in body weight. Results: A total of 1823 women (baseline mean [SD] age, 30.9 [4.9] years and mean [SD] body mass index, 26.6 [4.6]) underwent OGTT at a median (IQR) 6.5 (4.8-8.2) months postpartum. After excluding 160 women (8.8%) with type 2 diabetes, 2 women (0.1%) who met other exclusion criteria, and 49 women (2.7%) who did not consent or were uncontactable, 1612 women were randomized. Subsequently, 11 randomized participants were identified as ineligible and excluded from the primary analysis, leaving 1601 women randomized (800 women randomized to the intervention group and 801 women randomized to usual care). These included 600 women (37.5%) with prediabetes and 1001 women (62.5%) with normoglycemia. Among participants randomized to the intervention, 644 women (80.5%) received all program content, although COVID-19 lockdowns impacted the delivery model (ie, among 644 participants who engaged in all group sessions, 476 women [73.9%] received some or all content through individual engagement, and 315 women [48.9%] received some or all content remotely). After a median (IQR) 14.1 (11.4-20.1) months of follow-up, 1308 participants (81.2%) had primary outcome data. The intervention, compared with usual care, did not reduce worsening glycemic status (204 women [25.5%] vs 217 women [27.1%]; hazard ratio, 0.92; [95% CI, 0.76-1.12]; P = .42) or improve any secondary outcome. Conclusions and Relevance: This study found that a large proportion of women in South Asian urban settings developed dysglycemia soon after a GDM-affected pregnancy and that a lifestyle intervention, modified owing to the COVID-19 pandemic, did not prevent subsequent glycemic deterioration. These findings suggest that alternate or additional approaches are needed, especially among high-risk individuals. Trial Registration: Clinical Trials Registry of India Identifier: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry Identifier: SLCTR/2017/001; and ClinicalTrials.gov Identifier: NCT03305939.


Subject(s)
Diabetes Mellitus, Type 2/prevention & control , Diabetes, Gestational/prevention & control , Diet , Exercise , Glycemic Control/methods , Life Style , Postpartum Period , Adult , Bangladesh , Blood Glucose , Diabetes Mellitus, Type 2/ethnology , Diabetes, Gestational/ethnology , Female , Glucose Tolerance Test , Humans , India , Pregnancy , Sri Lanka , Survival Analysis , Treatment Outcome , Urban Population
18.
PLoS One ; 16(11): e0259139, 2021.
Article in English | MEDLINE | ID: covidwho-1702775

ABSTRACT

An understanding of the types of shocks that disrupt and negatively impact urban household food security is of critical importance to develop relevant and targeted food security emergency preparedness policies and responses, a fact magnified by the current COVID-19 pandemic. This gap is addressed by the current study which draws from the Hungry Cities Partnership (HCP) city-wide household food insecurity survey of Nairobi city in Kenya. It uses both descriptive statistics and multilevel modelling using General Linear Mixed Models (GLMM) to examine the relationship between household food security and 16 different shocks experienced in the six months prior to the administration of the survey. The findings showed that only 29% of surveyed households were completely food secure. Of those experiencing some level of food insecurity, more experienced economic (55%) than sociopolitical (16%) and biophysical (10%) shocks. Economic shocks such as food price increases, loss of employment, and reduced income were all associated with increased food insecurity. Coupled with the lack of functioning social safety nets in Nairobi, households experiencing shocks and emergencies experience serious food insecurity and related health effects. In this context, the COVID-19 pandemic is likely to have a major negative economic impact on many vulnerable urban households. As such, there is need for new policies on urban food emergencies with a clear emergency preparedness plan for responding to major economic and other shocks that target the most vulnerable.


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2/pathogenicity , Adult , Aged , COVID-19/prevention & control , COVID-19/virology , Female , Food Insecurity , Food Supply/standards , Humans , Hunger , Income , Kenya/epidemiology , Male , Middle Aged , SARS-CoV-2/genetics , Socioeconomic Factors , Urban Population , Young Adult
19.
BMJ Open ; 12(2): e057402, 2022 02 23.
Article in English | MEDLINE | ID: covidwho-1703968

ABSTRACT

OBJECTIVE: We aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Bangladesh. DESIGN: Setting and participantsA cross-sectional survey among 476 households was conducted during October-December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted. OUTCOME MEASURES: Percentage of people suffering from general illness, percentage of people suffering from chronic illness, percentage of people seeking healthcare, percentage of people seeking maternal care, health system challenges resulting from COVID-19. RESULTS: About 12% of members suffered from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers. 39% of the recently delivered women sought healthcare in 3 months preceding the survey. An overall reduction in healthcare use was reported during the lockdown period compared with prepandemic time. Mismanagement and inefficient use of resources were reported as challenges of health financing during the pandemic. Health information sharing was inadequate at the urban slums, resulting from the lack of community and stakeholder engagement (51% received COVID-19-related information, 49% of respondents knew about the national hotline number for COVID-19 treatment). Shortage of human resources for health was reported to be acute during the pandemic, resulting from the shortage of specialist doctors and uneven distribution of health workforce. COVID-19 test was inadequate due to the lack of adequate test facilities and stigma associated with COVID-19. Lack of strong leadership and stakeholder engagement was seen as the barriers to effective pandemic management. CONCLUSION: The findings of the current study are expected to support the government in tailoring interventions and allocating resources more efficiently and timely during a pandemic.


Subject(s)
COVID-19 , Poverty Areas , Bangladesh/epidemiology , COVID-19/drug therapy , Communicable Disease Control , Cross-Sectional Studies , Female , Humans , SARS-CoV-2 , Urban Population
20.
Epidemiol Infect ; 149: e247, 2021 10 20.
Article in English | MEDLINE | ID: covidwho-1692716

ABSTRACT

In a Nicaraguan population-based cohort, SARS-CoV-2 seroprevalence reached 28% in the first 6 months of the country's epidemic and reached 35% 6 months later. Immune waning was uncommon. Individuals with a seropositive household member were over three times as likely to be seropositive themselves, suggesting the importance of household transmission.


Subject(s)
COVID-19/epidemiology , SARS-CoV-2/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cohort Studies , Female , Humans , Male , Middle Aged , Nicaragua/epidemiology , Prevalence , Seroepidemiologic Studies , Urban Population/statistics & numerical data , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL