Delay-adjusted age- and sex-specific case fatality rates for COVID-19 in South Korea: Evolution in the estimated risk of mortality throughout the epidemic.

OBJECTIVES: The aim of this study was to estimate delay-adjusted case fatality rates (CFRs) for COVID-19 in South Korea, and evaluate how these estimates have evolved over time throughout the epidemic. METHODS: Public data from the Korea Centers for Disease Control and Prevention (KCDC) were used to estimate age- and sex-specific CFRs for COVID-19 in South Korea up to June 12, 2020. We applied statistical methods previously developed to adjust for the delay between diagnosis and death, and presented both delay-adjusted and crude (unadjusted) CFRs throughout the epidemic. RESULTS: The overall estimated delay-adjusted CFR was 2.39% (3.05% for males and 1.92% for females). Within each age strata where deaths were reported, males were found to have significantly higher CFRs than females. The estimated CFRs increased substantially from age 60 years in males and from 70 years in females. Both the delay-adjusted and crude CFRs were found to have evolved substantially, particularly early in the epidemic, converging only from mid-April 2020. CONCLUSIONS: The CFRs for South Korea provide an estimate of mortality risk in a setting where case ascertainment is likely to be more complete. The evolution in CFRs throughout the epidemic highlights the need for caution when interpreting CFRs calculated at a given time point.

Parental international migration is not associated with improved health care seeking for common childhood illnesses and nutritional status of young children left-behind in Nepal.

OBJECTIVE: To examine the impact of parental international migration on health care seeking for common childhood illnesses (diarrhoea, fever, and acute respiratory infections) and nutritional status (stunting, underweight and wasting) in young children in Nepal using the most recent nationally representative Multiple Indicator Cluster Survey. STUDY DESIGN: Nationally representative cross-sectional survey. METHODS: We used multiple logistic regression models to examine the association between parental international migration and the study outcomes adjusting for a range of potential confounders. RESULTS: Of 5310 children, 23.5% had at least one parent living abroad. Health care for common childhood illnesses was sought for 52.1% (95% confidence interval [CI]: 45.0%-59.2%) and 47.0% (95% CI: 42.7%-51.1%) of children from migrant and non-migrant families, respectively. The prevalence of stunting, underweight and wasting among left-behind children were 35.3% (95% CI: 31.5%-39.1%), 28.3% (95% CI: 24.2%-32.2%) and 11.8% (95% CI: 8.8%-14.7%), respectively. In adjusted analyses, there were no statistically significant differences in health care seeking or nutritional status by parent's migration status. CONCLUSIONS: Despite large economic benefits to Nepal due to international labour migration, we did not observe any apparent differences in young left-behind children in terms of seeking health care for common childhood illnesses or prevalence of under-nutrition. Longitudinal studies are needed to accurately measure whether migration has any substantial temporal effect on the nutritional status of young children or seeking for health care.

Association between body mass index and laboratory-confirmed influenza in middle aged and older adults: a prospective cohort study.

BACKGROUND: Studies conducted during the 2009 influenza A (H1N1) pandemic found that obesity increases the risk of severe influenza including hospitalization and death. In this study, we examined the relationship of BMI with having laboratory-confirmed seasonal influenza and influenza-related respiratory hospitalization. METHODS: We linked a cohort of 246,494 adults aged ≥45 years with data on BMI to subsequent laboratory-confirmed influenza notifications and cause-specific hospitalizations from 2006 to 2015. Cox-proportional hazard models were used to estimate the risk of incident laboratory-confirmed influenza and influenza-related respiratory hospitalizations according to BMI, adjusting for age, sex and other covariates. RESULTS: After 1,840,408 person-years of follow-up, 1891 participants had laboratory-confirmed influenza notifications (crude rate 10.3/10,000 person-years) of whom 623 were hospitalized for a respiratory illness. Compared to those with healthy BMI (22.5 to <25.0 kg/m2), influenza incidence was respectively 27% (adjusted HR [aHR]: 1.27, 95% CI: 1.10-1.46) and 69% (aHR: 1.69, 1.24-2.29) greater among obese (BMI: 30 to <40 kg/m2) and very obese adults (40 to <50 kg/m2). The equivalent aHRs for hospitalization were 1.57 (95% CI: 1.22-2.01) and 4.81 (95% CI: 3.23-7.17). For every 5-unit BMI increase above 22.5 kg/m2, there was a 15% (aHR: 1.15, 95% CI: 1.09-1.22) increase in risk of having a diagnosis of influenza and 42% increase in hospitalization (aHR: 1.42, 95% CI: 1.30-1.60). These trends did not differ between the pandemic year (2009) and other years. CONCLUSIONS: Our results suggest that obese adults have a similar risk of hospitalization for seasonal influenza as adults with cardiovascular disease and diabetes, and should therefore  be equally prioritized for funded interventions such as targeted immunization programs.

Urinary symptoms and incontinence in an urban community: prevalence and associated factors in older men and women.

BACKGROUND: There is increasing recognition of the importance of a wide range of urinary symptoms in both men and women and that these symptoms are undertreated. AIMS: To determine the prevalence of and factors associated with urinary symptoms, including nocturia, urgency, urge and stress incontinence and, in men, urinary stream difficulties; and the prevalence of being bothered by the symptoms and ever seeking treatment for them. METHOD: Household survey by computer-assisted telephone interviews of people aged 41 years and over and living in inner metropolitan Sydney. RESULTS: Fifty-three per cent (95% confidence interval (CI) 46-60) of men and 61% (95% CI 55-67) of women reported one or more symptoms in the previous month. In men, the most frequently reported symptoms were urgency (30%, 95% CI 24-36) and nocturia (25%, 95% CI 19-31). In women, stress incontinence (35%, 95% CI 29-41) and urgency (33%, 95% CI 27-39) were the most common symptoms reported. In men, the significant factors associated with reporting one or more symptoms, after adjustment for other variables, were age 60 years or more, no private medical insurance, obesity and fair or poor self-rated health. For women, the significant associations were age 50-59 years, age 70 years or more, no private health insurance, high psychological distress and fair or poor self-rated health. CONCLUSIONS: Urinary symptoms are experienced by more than half of men and women aged over 40 in the central Sydney community, but many do not seek treatment. Such symptoms should be considered more broadly than the traditional focus on male 'prostatism' and female incontinence.

Acute poststreptococcal glomerulonephritis: public health implications of recent clusters in New South Wales and epidemiology of hospital admissions.

Acute poststreptococcal glomerulonephritis (APSGN) is an inflammatory kidney condition that can complicate Group A streptococcal infections. Two clusters of APSGN occurred recently in New South Wales (NSW), Australia; one in a rural town in December 1999 and the other in a Sydney suburb in January 2000. We interviewed carers of the affected children but found no common exposures except three of the Sydney cases were cousins in frequent contact. To assess the probability of these clusters occurring, we analysed hospital admissions for acute glomerulonephritis, as a proxy for APSGN in younger patients. The incidence of acute glomerulonephritis in NSW during 1989/90-1997/8 in residents aged under 20 years was 2.2/100000/year (95% CI 2.0-2.5). Incidence was highest in children aged 5-9 years, boys and Aboriginal children. We found no evidence for other clusters during that period. The recent clusters highlight the continued potential for unexpected future outbreaks of APSGN.