ABSTRACT
BACKGROUND: As COVID-19 continues to affect millions of people around the world, it has become vital to understand how comorbidities such as diabetes affect the health outcomes of these patients. While earlier studies have focused on major metropolitan areas, rural settings have been comparatively understudied. The goal of this study is to understand the effect on mortality that these two diseases have in the inpatient setting of a rural population. METHODS: The electronic medical records of all adult patients admitted to Freeman Health System, Joplin, Missouri, United States, between April 1, 2020, and December 31, 2021, were reviewed for the presence of COVID-19 infection and/or diabetes (type I and type II). Freeman Health is a major health system headquartered in Southwest Missouri. Diagnoses were obtained through the use of standard International Classification of Disease, 10th edition (ICD-10) codes. The initial data set consisted of 19,323 admissions. After excluding duplicate admissions and those who had already been infected with COVID-19, 1,729 patients with COVID-19, 172 patients with type I diabetes, and 3,992 patients with type II diabetes were included in the analysis of inpatient all-cause mortality. We hypothesized that patients with type I and type II diabetes would both show an increased risk of all-cause mortality. Mortality in the context of our study results refers to all-cause mortality. RESULTS: The all-cause mortality rate was 19.94% (137/687, with a 95% confidence interval (CI) of 16.95%-22.93%) in patients admitted with both diabetes (the combined type I and type II subsets) and COVID-19 (P1). The mortality rate was 16.03% (167/1042, with 95% CI of 13.80%-18.25%) in patients admitted with COVID-19 who did not have diabetes (P2). Patients admitted with a comorbid diagnosis of diabetes but without COVID-19 (P5) had a much lower mortality rate of 5.98% (249/4164, with a 95% CI of 5.26%-6.70%). The combination of both COVID-19 and diabetes together was associated with a higher mortality rate than either of the two separately. The mortality rate was additionally elevated in patients with both type II diabetes and COVID-19 (P4) (134/663, mortality rate of 20.21% with 95% CI of 17.15%-23.27%) versus those with COVID-19 without diabetes (P2) (167/1042, 16.03% with 95% CI of 13.80%-18.25%), an overall difference of 4.18% (95% CI of 0.40%-7.94%). The subset of patients with type I diabetes with COVID-19 (P3) and type I diabetes without COVID-19 (P6) were too small to accurately power individual analysis. The subset of patients with diabetes (type I and type II) and without COVID-19 (P5) had the lowest mortality rate of any subset adequately powered for analysis at 5.98% (249/41464, CI of 5.26%-6.70%). Conclusions: The results of this study show that type II diabetes is a significant risk factor for mortality in admitted COVID-19 patients. P4 had the highest overall mortality of any subset studied. The study was underpowered to show if type I diabetes patients, with and without COVID-19, had an increased mortality when analyzed separately. COVID-19 significantly increased mortality in all subsets adequately powered for full analysis.
ABSTRACT
Background COVID-19 is a respiratory disease caused by SARS-CoV-2, a coronavirus discovered in 2019. Its impact on the world continues to be studied due to the significant death toll of the disease. As the COVID-19 pandemic remains ongoing, examining the association of COVID-19 with comorbidities and resulting mortality is necessary. This study focuses on population health outcomes with COVID-19 infection and hyperlipidemia (total cholesterol greater than or equal to 200 mg/dL) as a comorbidity, including potential associations with age and sex. Methods As a retrospective analytical study, patients were divided into three populations based on COVID-19 and/or hyperlipidemia based on the International Classification of Diseases, Tenth Edition (ICD-10) codes reported in the electronic medical record system at Freeman Health System (FHS) in Southwest Missouri from April 1, 2020, to December 31, 2021. Wald's methods and two sample proportion summary hypotheses with confidence intervals (CIs) were used for comparison. The populations were subdivided and analyzed for age and sex differences. Results Patients with both COVID-19 and hyperlipidemia had a higher mortality rate than patients with COVID-19 and without hyperlipidemia and patients with hyperlipidemia and without COVID-19; patients with COVID-19 and without hyperlipidemia had a higher mortality rate than patients with hyperlipidemia and without COVID-19. All comparisons across these populations were statistically significant (p-value < 0.05). While increased age was associated with increased mortality in all groups, sex was not predictive in this regard. Conclusion Our study provides insights into variables affecting COVID-19 outcomes in a rural Midwestern population by showing how the comorbidity hyperlipidemia contributes to increased mortality.
ABSTRACT
Background Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produces the coronavirus disease of 2019 (COVID-19), primarily presenting with respiratory symptoms, including cough, shortness of breath, etc. Respiratory failure can present similarly to a COVID-19 infection, and COVID-19 infection can cause respiratory failure. Thus, it is important to study respiratory failure, COVID-19, and the interaction between the two in hopes of improving patient outcomes. In this study, we compared mortality rates in patients admitted with COVID-19, respiratory failure, or both. Mortality rates in our study populations were further scrutinized based on patient age. Materials and methods Respiratory failure and COVID-19 data were collected via the electronic medical records system at Freeman Health System, a 410-bed, rural hospital, in Neosho and Joplin, Missouri, from April 2020 through December 2021. The patient population included all patients admitted to the hospital with a diagnosis of COVID-19 or respiratory failure, as defined by the International Classification of Disease, Tenth Revision (ICD-10). Patients with or without COVID-19, with or without respiratory failure, and patients with respiratory failure with COVID-19 were included. Results There was a significant increase in mortality (17.28%) in patients with COVID-19 and respiratory failure (P1) compared to patients with COVID-19 who did not have respiratory failure (P2). No significance was found when comparing patients with COVID-19 and respiratory failure (P1) and patients with respiratory failure without COVID-19 (P3) (p value=0.4921). In contrast, when divided based on age, we found a significant increase in mortality in patients 65 and older with COVID-19 and respiratory failure compared to patients 65 and older with respiratory failure who did not have COVID-19 (P5). There were no significant mortality increases in other comparisons. Conclusion When comparing patient populations within the Freeman Health System, patients with COVID-19 and respiratory failure had similar mortality rates as those with respiratory failure without COVID-19, while patients with only COVID-19 had a markedly reduced mortality rate, relatively. The higher mortality rates in patients with only respiratory failure when compared to patients with both respiratory failure and COVID-19 indicate that the presence of respiratory failure likely plays a bigger role in the inflammatory response that reduces one's chance of survival in this setting. Furthermore, age was shown to be a significant risk factor as patients aged 65 and older showed a greater mortality rate when patients had both COVID-19 and respiratory failure compared to patients with both conditions below the age of 65. The decrease in immune response that results in older patients is likely the largest contributing factor along with the increased likelihood of patients in this population also having more comorbidities, further decreasing the chance of survival. Future studies can investigate alternate treatment plans for patients aged 65 and older who are at higher risk of mortality with COVID-19 and respiratory failure.
ABSTRACT
Background and objective Urology residency match occurs through the American Urological Association (AUA), and hence information about the success of applicants in finding a match is not readily available. The average number of publications a successful urology applicant has when applying for residency is unknown. In light of this, we conducted this study to examine the number of PubMed-indexed research projects involving US senior medical students who successfully matched into the top 50 urology residency programs in the 2021, 2022, and 2023 match cycles. We also assessed these applicants based on their medical schools and gender. Methods Doximity Residency Navigator was used to generate the top 50 residency programs as sorted by reputation. Newly matched residents were found using program Twitter accounts and residency program websites. PubMed was queried for peer-reviewed publications of incoming interns. Results The average number of publications across all incoming interns in the three years was 3.65. The average number of urology-specific publications was 1.86 and that of first-author urology publications was 1.11. The median number of total publications for matched applicants was 2, and applicants with a total of five publications were in the 75th percentile for research productivity. Conclusion A successful applicant had two PubMed-indexed urology papers on average and also had a urology-specific first-author paper in the cycles we surveyed. There has been an increase in publications per applicant when comparing the results to previous application cycles, which can be attributed to post-pandemic changes.
