Geographic factors associated with poorer outcomes in patients diagnosed with covid-19 in primary health care

Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidi-ties, and geographic variables. Methods: A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results: The multivariate Cox model showed that women had a better prognosis in any type of analysed prog-nosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions: Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols

¿Es posible una mejor identificación de la enfermedad celiaca en sujetos mexicanos por medio de HLA-DQ8 que de HLA-DQ2?

Resumen: Introducción y objetivos: Existe una fuerte asociación entre la enfermedad celiaca (EC) y el antígeno leucocitario humano (HLA). En Europa predomina el alelo HLA-DQ2; sin embargo, estudios en América Latina indican que el HLA-DQ8 podría ser más frecuente. En México no se ha reportado la frecuencia de estos alelos en sujetos con EC. Por lo tanto, el objetivo de nuestro estudio fue determinar la distribución de HLA-DQ2 y HLA-DQ8 en sujetos mexicanos con EC. Material y métodos: Se llevó a cabo un estudio exploratorio con una cohorte de 49 individuos, en quienes se buscó la presencia de marcadores serológicos, histológicos y genéticos de la EC. Resultados: Treinta sujetos (23 mujeres) con una edad promedio de 54.2 ± 15.5 años presentaron EC; 24 (80%) de ellos expresaron HLA-DQ8 y 15 (50%) HLA-DQ2; 11 (37%) presentaron ambos alelos; sin embargo, en 5 (10%) individuos no se encontró HLA-DQ2 ni HLA-DQ8. Entre los sujetos con diarrea crónica que no tuvieron EC, 12 (63%) presentaron HLA-DQ2 y 7 (37%) HLA-DQ8. Los sujetos con EC expresaron más frecuentemente la combinación de HLA-DQ8/DQ2 (37% vs. 5%) y los alelos HLA-DR4/DQ8 (60% vs. 26%). Conclusiones: En sujetos mexicanos con EC la expresión de HLA-DQ8 fue más frecuente que la de HLA-DQ2, lo cual indica que la distribución de HLA podría ser similar a las descritas en otros países de América Latina. Sin embargo, la naturaleza y el tamaño de la muestra de este estudio no permiten hacer más conclusiones. Abstract: Introduction and aims: A strong genetic association between celiac disease (CD) and the human leukocyte antigen (HLA) has been widely demonstrated. In Europe, the HLA-DQ2 allele is predominant. However, studies in Latin America indicate that HLA-DQ8 could be more frequent. In Mexico, the frequency of those alleles has not been reported in subjects with CD. Therefore, the aim of the present study was to evaluate the distribution of HLA-DQ2 and HLA-DQ8 in Mexican individuals with CD. Material and methods: An exploratory study was conducted on a cohort of 49 subjects with chronic diarrhea. Autoantibodies for CD, duodenal atrophy, and HLA haplotypes were determined. Results: Thirty individuals had CD (23 women, mean age 54.2 ± 15.5 years), 24 (80%) of whom expressed HLA-DQ8, 15 (50%) expressed HLA-DQ2, and 11 (37%) presented with both alleles. However, neither the HLA-DQ2 nor the HLA-DQ8 allele was found in 5 (10%) individuals. In subjects with chronic diarrhea that did not have CD, 12 (63%) presented with HLA-DQ2, and 7 (37%) with HLA-DQ8. Individuals with CD expressed the combinations of the HLA-DQ8/DQ2 alleles (37 vs. 5%) and the HLA-DR4/DQ8 alleles (60 vs. 26%) more frequently than the subjects without CD. Conclusions: In Mexican subjects with CD, HLA-DQ8 distribution was more frequent than that of HLA-DQ2, indicating a possible similarity to the frequency reported in other Latin American countries. However, given the nature of the present study and its sample size, further conclusions could not be reached. Palabras clave: Enfermedad celiaca, HLA-DQ2, HLA-DQ8, Keywords: Celiac disease, HLA-DQ2, HLA-DQ

Is celiac disease better identified through HLA-DQ8 than through HLA-DQ2 in Mexican subjects?

Introduction and aims: A strong genetic association between celiac disease (CD) and the human leukocyte antigen (HLA) has been widely demonstrated. In Europe, the HLA-DQ2 allele is predominant. However, studies in Latin America indicate that HLA-DQ8 could be more frequent. In Mexico, the frequency of those alleles has not been reported in subjects with CD. Therefore, the aim of the present study was to evaluate the distribution of HLA-DQ2 and HLA-DQ8 in Mexican individuals with CD. Material and methods: An exploratory study was conducted on a cohort of 49 subjects with chronic diarrhea. Autoantibodies for CD, duodenal atrophy, and HLA haplotypes were determined. Results: Thirty individuals had CD (23 women, mean age 54.2 ± 15.5 years), 24 (80%) of whom expressed HLA-DQ8, 15 (50%) expressed HLA-DQ2, and 11 (37%) presented with both alleles. However, neither the HLA-DQ2 nor the HLA-DQ8 allele was found in 5 (10%) individuals. In subjects with chronic diarrhea that did not have CD, 12 (63%) presented with HLA-DQ2, and 7 (37%) with HLA-DQ8. Individuals with CD expressed the combinations of the HLA-DQ8/DQ2 alleles (37 vs. 5%) and the HLA-DR4/DQ8 alleles (60 vs. 26%) more frequently than the subjects without CD. Conclusions: In Mexican subjects with CD, HLA-DQ8 distribution was more frequent than that of HLA-DQ2, indicating a possible similarity to the frequency reported in other Latin American countries. However, given the nature of the present study and its sample size, further conclusions could not be reached. Resumen: Introducción y objetivos: Existe una fuerte asociación entre la enfermedad celiaca (EC) y el antígeno leucocitario humano (HLA). En Europa predomina el alelo HLA-DQ2; sin embargo, estudios en América Latina indican que el HLA-DQ8 podría ser más frecuente. En México no se ha reportado la frecuencia de estos alelos en sujetos con EC. Por lo tanto, el objetivo de nuestro estudio fue determinar la distribución de HLA-DQ2 y HLA-DQ8 en sujetos mexicanos con EC. Material y métodos: Se llevó a cabo un estudio exploratorio con una cohorte de 49 individuos, en quienes se buscó la presencia de marcadores serológicos, histológicos y genéticos de la EC. Resultados: Treinta sujetos (23 mujeres) con una edad promedio de 54.2 ± 15.5 años presentaron EC; 24 (80%) de ellos expresaron HLA-DQ8 y 15 (50%) HLA-DQ2; 11 (37%) presentaron ambos alelos; sin embargo, en 5 (10%) individuos no se encontró HLA-DQ2 ni HLA-DQ8. Entre los sujetos con diarrea crónica que no tuvieron EC, 12 (63%) presentaron HLA-DQ2 y 7 (37%) HLA-DQ8. Los sujetos con EC expresaron más frecuentemente la combinación de HLA-DQ8/DQ2 (37% vs. 5%) y los alelos HLA-DR4/DQ8 (60% vs. 26%). Conclusiones: En sujetos mexicanos con EC la expresión de HLA-DQ8 fue más frecuente que la de HLA-DQ2, lo cual indica que la distribución de HLA podría ser similar a las descritas en otros países de América Latina. Sin embargo, la naturaleza y el tamaño de la muestra de este estudio no permiten hacer más conclusiones. Keywords: Celiac disease, HLA-DQ2, HLA-DQ8, Palabras clave: Enfermedad celiaca, HLA-DQ2, HLA-DQ

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers. © 2020 Elsevier Lt

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline