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1.
PLoS One ; 16(7): e0246217, 2021.
Article in English | MEDLINE | ID: covidwho-1331980

ABSTRACT

OBJECTIVE: We explored longitudinal trends in sociodemographic characteristics, reported symptoms, laboratory findings, pharmacological and non-pharmacological treatment, comorbidities, and 30-day in-hospital mortality among hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: This retrospective cohort study included patients diagnosed with COVID-19 in the United States Veterans Health Administration between 03/01/20 and 08/31/20 and followed until 09/30/20. We focused our analysis on patients that were subsequently hospitalized, and categorized them into groups based on the month of hospitalization. We summarized our findings through descriptive statistics. We used Cuzick's Trend Test to examine any differences in the distribution of our study variables across the six months. RESULTS: During our study period, we identified 43,267 patients with COVID-19. A total of 8,240 patients were hospitalized, and 13.1% (N = 1,081) died within 30 days of admission. Hospitalizations increased over time, but the proportion of patients that died consistently declined from 24.8% (N = 221/890) in March to 8.0% (N = 111/1,396) in August. Patients hospitalized in March compared to August were younger on average, mostly black, urban-dwelling, febrile and dyspneic. They also had a higher frequency of baseline comorbidities, including hypertension and diabetes, and were more likely to present with abnormal laboratory findings including low lymphocyte counts and elevated creatinine. Lastly, there was a decline from March to August in receipt of mechanical ventilation (31.4% to 13.1%) and hydroxychloroquine (55.3% to <1.0%), while treatment with dexamethasone (3.7% to 52.4%) and remdesivir (1.1% to 38.9%) increased. CONCLUSION: Among hospitalized patients with COVID-19, we observed a trend towards decreased disease severity and mortality over time.


Subject(s)
COVID-19/mortality , Veterans Health/statistics & numerical data , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Aged , Aged, 80 and over , Alanine/analogs & derivatives , Alanine/therapeutic use , COVID-19/drug therapy , Comorbidity , Dexamethasone/therapeutic use , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Longitudinal Studies , Lymphocyte Count , Lymphocytes/immunology , Male , Middle Aged , Respiration, Artificial/methods , Retrospective Studies , United States
2.
Am Heart J ; 237: 1-4, 2021 07.
Article in English | MEDLINE | ID: covidwho-1141561

ABSTRACT

Patients with coronavirus disease 2019 (COVID-19) are at heightened risk of venous thromboembolic events (VTE), though there is no data examining when these events occur following a COVID-19 diagnosis. We therefore sought to characterize the incidence, timecourse of events, and outcomes of VTE during the COVID-19 pandemic in a national healthcare system using data from Veterans Affairs Administration.


Subject(s)
Anticoagulants/administration & dosage , COVID-19 , Venous Thromboembolism , Veterans Health/statistics & numerical data , Aged , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Nucleic Acid Testing , Chemoprevention/methods , Chemoprevention/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Male , Outcome Assessment, Health Care , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , United States/epidemiology , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Venous Thromboembolism/therapy
3.
Diagn Microbiol Infect Dis ; 100(1): 115312, 2021 May.
Article in English | MEDLINE | ID: covidwho-1039330

ABSTRACT

Reporting of Coronavirus disease 2019 (COVID-19) co-infections with other respiratory pathogens has varied. We evaluated 825,280 molecular and/or viral culture respiratory assays within the Veterans Health Administration from September 29, 2019 to May 31, 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in 10,222 of 174,746 (5.8%) individuals. 30,063 (17.2%) of 174,746 individuals tested for SARS-CoV-2 had additional respiratory pathogen testing; co-infection was identified in 56 of 3757 (1.5%) individuals positive for SARS-CoV-2. Among those negative for SARS-CoV-2, 1022 of 26,306 (3.9%) were positive for at least 1 respiratory pathogen. Compared to COVID-19 mono-infection, individuals with COVID-19 co-infection had lower odds of being female. Compared to non-COVID-19 respiratory pathogen infection, individuals with COVID-19 co-infection had lower odds of being female, were hospitalized more frequently, had higher odds of death, and were younger at death. Our findings suggest COVID-19 co-infections were rare; however, not all COVID-19 patients were concurrently tested for other respiratory pathogens and seasonal decreases in other respiratory pathogens were occurring as COVID-19 emerged.


Subject(s)
COVID-19/epidemiology , Respiratory Tract Infections/epidemiology , Veterans Health/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Coinfection/epidemiology , Female , Humans , Influenza, Human/epidemiology , Male , Middle Aged , Prevalence , Respiratory Tract Infections/microbiology , Respiratory Tract Infections/virology , United States/epidemiology , United States Department of Veterans Affairs , Veterans Health Services , Young Adult
4.
PLoS Med ; 18(1): e1003490, 2021 01.
Article in English | MEDLINE | ID: covidwho-1021593

ABSTRACT

BACKGROUND: The COVID-19 epidemic in the United States is widespread, with more than 200,000 deaths reported as of September 23, 2020. While ecological studies show higher burdens of COVID-19 mortality in areas with higher rates of poverty, little is known about social determinants of COVID-19 mortality at the individual level. METHODS AND FINDINGS: We estimated the proportions of COVID-19 deaths by age, sex, race/ethnicity, and comorbid conditions using their reported univariate proportions among COVID-19 deaths and correlations among these variables in the general population from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). We used these proportions to randomly sample individuals from NHANES. We analyzed the distributions of COVID-19 deaths by race/ethnicity, income, education level, and veteran status. We analyzed the association of these characteristics with mortality by logistic regression. Summary demographics of deaths include mean age 71.6 years, 45.9% female, and 45.1% non-Hispanic white. We found that disproportionate deaths occurred among individuals with nonwhite race/ethnicity (54.8% of deaths, 95% CI 49.0%-59.6%, p < 0.001), individuals with income below the median (67.5%, 95% CI 63.4%-71.5%, p < 0.001), individuals with less than a high school level of education (25.6%, 95% CI 23.4% -27.9%, p < 0.001), and veterans (19.5%, 95% CI 15.8%-23.4%, p < 0.001). Except for veteran status, these characteristics are significantly associated with COVID-19 mortality in multiple logistic regression. Limitations include the lack of institutionalized people in the sample (e.g., nursing home residents and incarcerated persons), the need to use comorbidity data collected from outside the US, and the assumption of the same correlations among variables for the noninstitutionalized population and COVID-19 decedents. CONCLUSIONS: Substantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19.


Subject(s)
COVID-19/mortality , Healthcare Disparities/standards , Public Health , Social Determinants of Health/statistics & numerical data , Socioeconomic Factors , Aged , Comorbidity , Female , Health Services Needs and Demand , Humans , Male , Mortality , Public Health/methods , Public Health/standards , Quality Improvement/organization & administration , SARS-CoV-2/isolation & purification , United States , Veterans Health/statistics & numerical data
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