Age-adjusted associations between comorbidity and outcomes of COVID-19: a review of the evidence

ABSTRACT Background Current evidence suggests that older people and people with underlying comorbidities are at increased risk of severe disease and death following hospitalisation with COVID-19. As comorbidity increases with age, it is necessary to understand the age-adjusted relationship between comorbidity and COVID-19 outcomes, in order to enhance planning capabilities and our understanding of COVID-19. Methods We conducted a rapid, comprehensive review of the literature up to 10 April 2020, to assess the international empirical evidence on the association between comorbidities and severe or critical care outcomes of COVID-19, after accounting for age, among hospitalised patients with COVID-19. Results After screening 579 studies, we identified seven studies eligible for inclusion and these were synthesised narratively. All were from China. The emerging evidence base mostly indicates that after adjustment for age (and in some cases other potential confounders), obesity, hypertension, diabetes mellitus, chronic obstructive airways disease (COPD), and cancer are all associated with worse outcomes. The largest study, using a large nationwide sample of COVID-19 patients in China, found that those with multiple comorbidities had more than twice the risk of a severe outcome or death compared with patients with no comorbidities, after adjusting for age and smoking (HR=2.59, 95% CI 1.61, 4.17). Conclusions This review summarises for clinicians, policymakers, and academics the most robust evidence to date on this topic, to inform the management of patients and control measures for tackling the pandemic. Given the intersection of comorbidity with ethnicity and social disadvantage, these findings also have important implications for health inequalities. As the pandemic develops, further research should confirm these trends in other settings outside China and explore mechanisms by which various underlying health conditions increase risk of severe COVID-19

The chasm in percutaneous coronary intervention and in-hospital mortality rates among acute myocardial infarction patients in rural and urban hospitals in China: A mediation analysis

Objectives: To determine to what extent the inequality in the ability to provide percutaneous coronary intervention (PCI) translates into outcomes for AMI patients in China. Methods: We identified 82,677 patients who had primary diagnoses of AMI and were hospitalized in Shanxi Province, China, between 2013 and 2017. We applied logistic regressions with inverse probability weighting based on propensity scores and mediation analyses to examine the association of hospital rurality with in-hospital mortality and the potential mediating effects of PCI. Results: In multivariate models where PCI was not adjusted for, rural hospitals were associated with a significantly higher risk of in-hospital mortality (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.03–1.37). However, this association was nullified (OR: 0.94, 95% CI: 0.81–1.08) when PCI was included as a covariate. Mediation analyses revealed that PCI significantly mediated 132.3% (95% CI: 104.1–256.6%) of the effect of hospital rurality on in-hospital mortality. The direct effect of hospital rurality on in-hospital mortality was insignificant. Conclusion: The results highlight the need to improve rural hospitals’ infrastructure and address the inequalities of treatments and outcomes in rural and urban hospitals

Effect of Poverty Level on the Relationship Between Hyperlipidemia and Cardiorenal Syndrome

Purpose. Elevated cholesterol is known to be associated with chronic kidney disease (CKD) and cardiovascular disease (CVD) independently. Cardiorenal syndrome (CRS), a recently defined syndrome, is characterized by renal failure that is closely interrelated to cardiac dysfunction. The effect of socioeconomic status on cardiorenal syndrome has not been explored in a multi-ethnic population. In this retrospective secondary analysis, the hypothesis was tested if socioeconomic status modifies the effect of hyperlipidemia on CRS. Methods. The National Health and Nutrition Examination Survey (NHANES) is a cross sectional survey done on the non-institutionalized population of the United States. All patients from the NHANES study, 20 years and older between the years 1999-2010 were included in the analysis. CRS was determined using a standard GFR equation and history of CVD. Analysis was performed using complex samples logistic regression to determine the relationship of hyperlipidemia on CRS. Results. Data on CRS status was available for 24,625 individuals (48.9% males & 51.1% females) and was representative of 173,805,863 individuals. The overall unadjusted odds ratio of CRS for hyperlipidemia to no hyperlipidemia was 3.01 (95% confidence interval [CI], 2.62-3.47, p \u3c 0.001). The adjusted OR was elevated, 2.20 (CI 1.20-4.05, p \u3c 0.01), among individuals living below poverty threshold but close to 1.0 (1.63 CI 1.31-2.03, p \u3c 0.001) among patients above poverty threshold, after the results were controlled for medical risk factors and demographic risk factors. Conclusions. Hyperlipidemia is strongly associated with CRS in a nationally representative multi-ethnic population and must be taken into special consideration when treating underprivileged patients. Longitudinal studies should further examine this association and demonstrate how socioeconomic status plays a role

Socio-Spatial Disparities in Dementia Mortality in the United States

Mainly due to the expansion of the geriatric population, the number of deaths attributable to dementia in the United States is likely to increase rapidly in the coming decades. In the hope of offering some valuable insights into discovering disease risk factors linked to geography, advocating place-based prevention and intervention strategies and supporting equitable access to end-of-life care, this study examines three aspects of socio-spatial disparities in dementia mortality in the U.S.: (i) small area spatial and temporal variations in dementia mortality risk; (ii) “place effects” on the differentials in individual dementia mortality risk; and (iii) disparities in place of death of decedents from dementia across populations and places. Results from the study indicate that, first, there are substantial spatial and temporal variations in dementia mortality risk in the U.S. Specifically, regions including Pacific Northwest, Ohio River Valley and the Carolinas were found to be the most likely high-risk clusters; while counties in the Northeast and Florida were the most likely low-risk clusters. Temporal information of clusters suggested a reduction in the relative risk of Alzheimer’s disease and all-cause dementia mortality in most of the highly likely clusters. The results may provide etiologic clues linked to geography and time and propel public health agencies to evaluate the capacity of local health and social care to meet dementia patients’ needs before death, especially in those high-risk cluster areas. Second, differences in individual dementia mortality risk were in part due to the “place effects.” Among the three environmental variables examined, area socioeconomic deprivation and PM2.5 concentration were significantly associated with dementia mortality risk; area social integration did not have a significant relationship in models adjusted for individual-level factors. Although the relationship between area socioeconomic deprivation was nonlinear, the association between PM2.5 concentration and individual dementia mortality risk revealed a dose-response relationship. The relationship between the three environmental factors and dementia mortality risk also differed by age group. The results suggested that environmental interventions, especially improving local air quality, might be an effective measure to reduce dementia mortality risk. Third, results showed a persistent shift from deaths at institutional settings (hospitals and nursing home/long-term care facilities) to deaths at home and other places among decedents from dementia during 2000 and 2014. There were wide interstate variations in place of death of decedents from dementia. In addition to socio-demographic characteristics of the decedents, state-level factors including access to care facility resources and Medicare and Medicaid expenditure on long-term care might have contributed to the changing landscape. Although biomedical approaches still dominate in our efforts to understand the diseases, this dissertation research examined the effects of factors “outside the body” on socio-spatial disparities in dementia mortality. The findings provide new insights to inform future epidemiological and health services research related to dementia

Prediction Models for COVID-19 Integrating Age Groups, Gender, and Underlying Conditions

The COVID-19 pandemic has caused hundreds of thousands of deaths, millions of infections worldwide, and the loss of trillions of dollars for many large economies. It poses a grave threat to the human population with an excessive number of patients constituting an unprecedented challenge with which health systems have to cope. Researchers from many domains have devised diverse approaches for the timely diagnosis of COVID-19 to facilitate medical responses. In the same vein, a wide variety of research studies have investigated underlying medical conditions for indicators suggesting the severity and mortality of, and role of age groups and gender on, the probability of COVID-19 infection. This study aimed to review, analyze, and critically appraise published works that report on various factors to explain their relationship with COVID-19. Such studies span a wide range, including descriptive analyses, ratio analyses, cohort, prospective and retrospective studies. Various studies that describe indicators to determine the probability of infection among the general population, as well as the risk factors associated with severe illness and mortality, are critically analyzed and these findings are discussed in detail. A comprehensive analysis was conducted on research studies that investigated the perceived differences in vulnerability of different age groups and genders to severe outcomes of COVID-19. Studies incorporating important demographic, health, and socioeconomic characteristics are highlighted to emphasize their importance. Predominantly, the lack of an appropriated dataset that contains demographic, personal health, and socioeconomic information implicates the efficacy and efficiency of the discussed methods. Results are overstated on the part of both exclusion of quarantined and patients with mild symptoms and inclusion of the data from hospitals where the majority of the cases are potentially ill

International trends in the rate of logistic mortality increase

Meeting Theme: Are sex differences in health expectancy a social issue?BACKGROUND: Thatcher et al. (2010) used the simple logistic model with two parameters, which is known to fit data on old-age mortality well (Thatcher 1999), to investigate the old-age mortality compression and estimated the rate of logistic mortality increase, denoted by b, for ages 70-90. They concluded that if logit m(x) tends to fall faster at younger ages, then the slope b of the logit line will become steeper and mortality compression will occur. In this paper, we aim to estimate the rate of logistic mortality increase, denoted by b, for ages 70-90 in 23 countries with good and acceptable quality of data from Human Mortality Database and examine whether there is a universal trend in b. METHODS: We adopt a special case of the logistic model of mortality, which has only two parameters as does the Lexis model, and it is usually written in the form of model (1) μ(x) = a ebx / (1 + a ebx) (1) RESULTS: Our results show that the rate of logistic increase has steadily risen for females and males from about 0.10 in the 1950s to about 0.13 in recent years for most established market-economy countries in Europe as shown in group A (19 European countries). Among males, the value of parameter b is about 0.02 smaller than that for females and the rate of logistic mortality increase always lags behind females about 20 years. However, for Japanese females, although the increase was similar to the common pattern from 0.10 in 1947 to 0.13 in 1984, then the value of parameter b reached the highest 0.14 and became levelling off in the decade 1984-1995. Afterwards, it reverted to the level of 1984. In Canada, b increased at a relatively slower pace from 0.10 in 1950 to 0.12 in 2006 among females, whereas in the US the value of b tended to stay at 0.10-0.11 throughout the whole period 1921-2006. In Australia, b for females fluctuated around 0.10-0.11 before 1980, then a noticeable increase was observed from 0.12 in 1980 to 0.14 in 2007. CONCLUSIONS: The results show that the rate of logistic increase has steadily risen for females and males from about 0.10 in the 1950s to about 0.13 in recent years for most established market-economy countries. Deviant patterns such as slow increase, plateau and decrease are observed for some periods in Australia, Canada, Denmark, Japan and the USA. Possible reasons for those dominant and deviant trends are discussed.postprin

The burden of cancer and its distribution and consequences for australia: evidence from health economic evaluation and advanced statistical modelling

Cancer is expected to rank as the most significant global public health problem and a leading cause of death and illness in the world in the 21st century. The burden of cancer is rapidly increasing globally, including Australia. The responses to this growing burden of cancer have been limited owing to a poor understanding of the long-term burden of cancer and its consequences. The overarching aim of this thesis is to investigate the burden of cancer on patients, households, as well as on society over time. This thesis also aims to generate evidence for health policymakers, who make nationwide cancer control and management decisions on cancer prevention (e.g., cancer vaccination) and cancer treatment programs. This thesis has examined the burden of cancer using a geographical lens, including regional, rural, and remote areas in Australia. To accomplish this aim, five empirical studies for assessing the impact of the cancer burden in terms of longterm cancer outcomes (an incidence-based approach); health status burden, chronic comorbid conditions, productivity-related work disability (mixedlongitudinal approach); and the economics of cancer vaccination (economic evaluation) have been conducted. This thesis is constructed using three main themes of study including ‘understanding the challenges of cancer outcomes’, ‘the long-term cancer burden (i.e., health status burden, chronic comorbid conditions, productivity-related work disability, and its consequences)’, and ‘evaluation of cancer vaccination’ in the context of Australia. These inter-related studies result in a thesis by publication. These studies are constructed based on a quantitative approach, using health economic evaluation and advanced statistical modelling. The thesis is based on six articles, national health data sets are utilised for the first article, three of them (Articles 2 to 4) being mixed-longitudinal nature survey-data driven from the Household Income and Labour Dynamics in Australia survey, and two of them (Articles 5 and 6) based on national and international contexts and published data sources related to cancer and health economics modelling. The findings of this thesis have been theorised inductively, which means the analytical exploration has been data-grounded, rather than theory-dictated. In this thesis, every finding is underpinned by a suitable theoretical framework. Three inductively generated theories are adopted: social conflict theory, stress-coping theory, and portfolio theory perspectives. The thesis revealed that all of these factors (e.g., cancer incidence, hospitalisation, cancer-related mortality, and burden of cancer) increased significantly over the period. Furthermore, survival inequality was most pronounced for cervix, prostate, melanoma, Non-Hodgkin Lymphoma, and breast cancers. Additionally, socioeconomically disadvantaged people were more likely to bear an increasing cancer burden in terms of incidence, mortality, and death. The findings of the thesis showed that approximately 36% of cancer patients had an initial high health status burden in 2013, which had declined significantly to 21% by 2017. Adequate levels of sleep, physical activity, social support, and higher economic status were significantly associated with improving health status. This thesis revealed that 61% of cancer patients experienced at least one chronic condition over the period, and 21% of patients experienced three or more chronic conditions. An inadequate level of physical activity, patients who suffered from extreme health burden or moderate health burden, and patients living in the poorest households were significantly associated with a higher risk of chronic comorbid conditions. This research also found that approximately 50% of cancer patients had experienced with long-term productivity-related work disability, 18% of patients had experienced extreme work disability, which was more pronounced with the magnitude of their health status burden. Finally, cancer prevention program (cancer vaccination) demonstrated ‘good value for money’, if the adopted vaccination strategies could accomplish a high vaccination coverage and provide protection. With a continued assessment of the potential vaccine properties as well as vaccine delivery and scale-up strategies, the two-dose 9vHPV vaccine would provide significant health and economic benefits for preadolescents and society. This thesis provides a better understanding of the challenges of cancer outcomes and long-term consequences on health status burden, chronic comorbid conditions, and productivity-related work disability, and has provided an evaluation of cancer vaccination for preventing cancer-related infections, along with contributing to the ongoing debate of cancer research. The findings are also significant for health care providers, including physical therapists and oncologists, who must manage the unique problems that challenge this population and who should advocate for prevention and evidence-based interventions that incorporate comprehensive social supports. The findings of this thesis will contribute to the decision-making process regarding the prevention of cancer illness, better outline the management of a sequelae course of treatment for cancer survivors, both of which aim to reduce the long-term burden in Australia

Socioeconomic inequalities in the prevalence and management of hypertension: analyses of the Chilean National Health Surveys 2003, 2010 and 2017

Background: Up-to-date information on hypertension prevalence and management indicators (awareness, treatment, control); measures of its socioeconomic inequalities; and their impacts are required in Chile. This PhD aims to quantify the prevalence of these indicators, the magnitude of their socioeconomic inequalities, and their association with mortality risk among adults in Chile 2003, 2010, and 2017. Methods: First, using 2003, 2010, and 2017 Chilean national health surveys (ENS) I analysed secular changes in levels of hypertension outcomes by demographic variables. Secondly, I analysed socioeconomic position (SEP) inequalities in hypertension outcomes using individual-level measures (educational level, income, and health insurance). Thirdly, using a multilevel approach, I evaluated the association between individual educational level and hypertension prevalence, before and after adjustment for socioeconomic environment measures (county-level income inequality, poverty, and unemployment). Finally, I analysed all-cause and cardiovascular mortality rates by educational level and hypertension status using ENS data linked with mortality registries. Results: Between 2003 and 2017, hypertension prevalence decreased (34%-31%), awareness increased slightly (58%-66%), whereas treatment (38%-65%) and control (13%-34%) levels increased substantially. Hypertension management levels were lower among males than females. Secondly, hypertension prevalence was higher among adults with lower levels of education. Inequalities by education in hypertension prevalence, untreated, and uncontrolled hypertension were more pronounced among females. Thirdly, multilevel analyses showed that the magnitude of inequalities by education level were minimally affected by socioeconomic environment measures. Finally, I found a higher risk of all-cause and cardiovascular mortality in participants with hypertension and at the lowest educational level. Conclusions: Despite favourable changes in hypertension outcomes over time, Chile currently needs innovative and collaborative strategies to improve hypertension management (especially among males), and simultaneously decrease SEP inequalities in hypertension outcomes (mainly among females). Interventions decreasing hypertension prevalence, improving hypertension management, and increasing educational levels could help to decrease the burden of premature mortality

A Scoping Review Exploration of the Intended and Unintended Consequences of eHealth on Older People:A Health Equity Impact Assessment

eHealth is one perceived mechanism to extend the range and reach of limited health-care resources for older adults. A decade-scoping review (2007–2017) was conducted to systematically search and synthesize evidence to understand the intended and unintended consequences of eHealth initiatives, informed by a health equity impact assessment framework. Scoping review sources included international academic and grey literature on eHealth initiatives (e.g., eHealth records, telemedicine/telecare, and mobile eHealth application) focused on the varying needs of older adults (aged 60+), particularly individuals experiencing sociocultural and economic difficulties. Findings suggest that eHealth has several potential benefits for older adults, but also the possibility of further excluding already marginalized groups, thereby exacerbating existing health disparities. Ongoing evaluation of eHealth initiatives for older adults is necessary and requires attention to unique individual-level, socioeconomic, and cultural characteristics to heighten benefits and better capture both the intended and unintended outcomes of advanced eHealth systems.peerReviewe

Age, Race/Hispanic Origin, and COVID-19 Mortality Among Sickle Cell Disease Patients in the United States

The COVID-19 pandemic remains a global health challenge, with 6.7 million deaths worldwide as of January 2023. It has illuminated the health iniquities in underserved communities and populations like those with sickle cell disease (SCD). Researchers have associated the COVID-19 outcome among SCD patients in other regions of the globe. The purpose of this retrospective cross-sectional observational study was to investigate the relationship between age, race/Hispanic origin, and COVID-19 mortality among persons with SCD in the United States from January 2020 to March 2021. The Krieger ecosocial theory of disease distribution framed the study. Data were drawn from an existing Centers for Disease Control and Prevention provisional SCD death data set (N = 140). The binary logistic regression analysis result showed a statistically significant relationship between age and race/Hispanic origin and COVID-19 mortality. The variability between ages was 42.9%; race/Hispanic origin was 29.9%; and age and race/Hispanic origin were the highest, with 62.4% dying from COVID-19. Non-Hispanic Black patients were 9.6 times more likely to die overall but those aged 60+ were 17.5 times more likely to die from COVID-19 than the reference groups (0–19-year-old and other race). This study can benefit the research community, public health workers, medical professionals, and policymakers to understand better and influence policy on developing and prioritizing age- and race-tailored preventive protocols and medical care. They may minimize pain and suffering while mitigating mortality from COVID-19 and other unforeseen future pandemics within the SCD community at home and abroad and positively effect social chang