More Kindergarteners are Exempted from Required School Vaccinations than in the Past

The percentage of kindergarteners being granted exemption from vaccination is growing across the U.S. as parents increasingly request exemptions for philosophical reasons. During the 2017-18 school year, 2.2% of kindergartners were exempted from vaccination. This is up from 1.6% during the 2011-12 school year

Unhealthier States have Lower COVID-19 Testing Rates

This data slice dissects the various rates of state testing for COVID-19 across the country, and explains implications of the low test rates in the unhealthier states

Geographic Disparities in COVID-19 Testing: An Urgent Call to Action

This research brief shows that testing rates are lower in states with the unhealthiest populations and worst health care access. Disparities in testing rates are troubling because delays in testing increase the risk of a surge in silent spread and severe COVID-19 cases in these states

COVID-19 Testing Rates are Lower in States with More Black and Poor Residents

This data slice shows that testing rates to date have been lower in states with higher percent black populations and higher poverty rates. Without proper testing and physical distancing protocols, these states risk a surge in severe COVID-19 cases, overwhelming their already resource strapped healthcare systems

Rural-Urban and Within-Rural Differences in COVID-19 Mortality Rates

Since late-2020, COVID-19 mortality rates have been higher in rural than in urban America, but there has also been substantial within-rural heterogeneity. Using CDC data, we compare COVID-19 mortality rates across the rural-urban continuum as well as within rural counties across different types of labor markets and by metropolitan adjacency. As of October 1, 2021, the cumulative COVID-19 mortality rate was 247.0 per 100,000 population in rural counties compared to 200.7 in urban counties. Higher COVID-19 mortality rates in rural counties are explained by lower average educational attainment and lower median household income. Within rural counties, mortality rates have been highest in farming-dependent counties and lowest in recreation-dependent counties. Those differences are similarly explained by differences in educational attainment and median household income. Our findings have implications for ongoing COVID-19 prevention and vaccination efforts as well as for informing preparation efforts for future infectious disease outbreaks

Rural COVID-19 Mortality Rates are Highest in Counties with the Largest Percentages of Blacks and Hispanics

COVID-19 mortality risk is not distributed equally across the U.S. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest percentages of Black and Hispanic residents

Democratic Erosion Predicts Rising Deaths from Drug Poisoning and Infectious Disease

Strong democratic functioning is good for population health. However, democratic functioning eroded in many U.S. states in recent decades. The erosion was especially pronounced for one aspect of democratic functioning—electoral democracy, which refers to free and fair elections. This brief summarizes findings from a study examining how changes in electoral democracy in the 50 states predicted changes in the risk of death among adults ages 25-64 during 2000-2019. Findings demonstrate that democratic erosion strongly predicts rising deaths from drug poisoning, infectious disease, suicide, and homicide

CD8+ T cells specific for an immunodominant SARS-CoV-2 nucleocapsid epitope display high naive precursor frequency and TCR promiscuity

To better understand primary and recall T cell responses during coronavirus disease 2019 (COVID-19), it is important to examine unmanipulated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific T cells. By using peptide-human leukocyte antigen (HLA) tetramers for direct ex vivo analysis, we characterized CD8+ T cells specific for SARS-CoV-2 epitopes in COVID-19 patients and unexposed individuals. Unlike CD8+ T cells directed toward subdominant epitopes (B7/N257, A2/S269, and A24/S1,208) CD8+ T cells specific for the immunodominant B7/N105 epitope were detected at high frequencies in pre-pandemic samples and at increased frequencies during acute COVID-19 and convalescence. SARS-CoV-2-specific CD8+ T cells in pre-pandemic samples from children, adults, and elderly individuals predominantly displayed a naive phenotype, indicating a lack of previous cross-reactive exposures. T cell receptor (TCR) analyses revealed diverse TCRαβ repertoires and promiscuous αβ-TCR pairing within B7/N105+CD8+ T cells. Our study demonstrates high naive precursor frequency and TCRαβ diversity within immunodominant B7/N105-specific CD8+ T cells and provides insight into SARS-CoV-2-specific T cell origins and subsequent responses

Genetic diversity fuels gene discovery for tobacco and alcohol use

Tobacco and alcohol use are heritable behaviours associated with 15% and 5.3% of worldwide deaths, respectively, due largely to broad increased risk for disease and injury(1-4). These substances are used across the globe, yet genome-wide association studies have focused largely on individuals of European ancestries(5). Here we leveraged global genetic diversity across 3.4 million individuals from four major clines of global ancestry (approximately 21% non-European) to power the discovery and fine-mapping of genomic loci associated with tobacco and alcohol use, to inform function of these loci via ancestry-aware transcriptome-wide association studies, and to evaluate the genetic architecture and predictive power of polygenic risk within and across populations. We found that increases in sample size and genetic diversity improved locus identification and fine-mapping resolution, and that a large majority of the 3,823 associated variants (from 2,143 loci) showed consistent effect sizes across ancestry dimensions. However, polygenic risk scores developed in one ancestry performed poorly in others, highlighting the continued need to increase sample sizes of diverse ancestries to realize any potential benefit of polygenic prediction.Peer reviewe

Causal effect of plasminogen activator inhibitor type 1 on coronary heart disease

Background--Plasminogen activator inhibitor type 1 (PAI-1) plays an essential role in the fibrinolysis system and thrombosis. Population studies have reported that blood PAI-1 levels are associated with increased risk of coronary heart disease (CHD). However, it is unclear whether the association reflects a causal influence of PAI-1 on CHD risk. Methods and Results--To evaluate the association between PAI-1 and CHD, we applied a 3-step strategy. First, we investigated the observational association between PAI-1 and CHD incidence using a systematic review based on a literature search for PAI-1 and CHD studies. Second, we explored the causal association between PAI-1 and CHD using a Mendelian randomization approach using summary statistics from large genome-wide association studies. Finally, we explored the causal effect of PAI-1 on cardiovascular risk factors including metabolic and subclinical atherosclerosis measures. In the systematic meta-analysis, the highest quantile of blood PAI-1 level was associated with higher CHD risk comparing with the lowest quantile (odds ratio=2.17; 95% CI: 1.53, 3.07) in an age- and sex-adjusted model. The effect size was reduced in studies using a multivariable-adjusted model (odds ratio=1.46; 95% CI: 1.13, 1.88). The Mendelian randomization analyses suggested a causal effect of increased PAI-1 level on CHD risk (odds ratio=1.22 per unit increase of log-transformed PAI-1; 95% CI: 1.01, 1.47). In addition, we also detected a causal effect of PAI-1 on elevating blood glucose and high-density lipoprotein cholesterol. Conclusions--Our study indicates a causal effect of elevated PAI-1 level on CHD risk, which may be mediated by glucose dysfunction