scholarly journals 669. Changing Epidemiology of Murine Typhus in Texas

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S242-S242 ◽  
Author(s):  
Jennifer Shuford ◽  
Patrick Hunt ◽  
Bonny Mayes
Keyword(s):  
Hot Spot ◽  
Severe Disease ◽  
Public Health Education ◽  
The United States ◽  
Spatial Cluster ◽  
Clinical Findings ◽  
South Texas ◽  
Murine Typhus ◽  
Increased Risk ◽  
Central Texas

Abstract Background Murine (also known as flea-borne) typhus is uncommon in the United States, but it is considered endemic in certain parts of Texas, especially the southernmost region. It is caused by Rickettsia typhi, which is transmitted to humans by rat and cat fleas. Murine typhus is often a mild illness with nonspecific clinical findings, though delayed treatment may result in severe disease and increased risk of complications. Diagnostic tests have low sensitivity in early disease. Therefore, correctly diagnosing patients with murine typhus is challenging unless clinical suspicion is high. In endemic regions, physicians are aware of the disease and diagnose it readily. However, in areas that have not historically been affected, physicians may be less familiar with the presentation of this rickettsial infection, impacting their ability to diagnose and treat it effectively. Methods Probable and confirmed murine typhus cases reported in Texas were collected for 1944–2017. Cases were mapped by county for each of the last 5 years. Cases reported over the last 5 years were also geocoded by residence for spatial cluster analysis by year. Results There has been an overall rise in the number of murine typhus cases reported per year over the last 13 years (Figure 1). The distribution of reported cases throughout Texas has changed over the last 5 years. There continues to be a high number of reported cases in South Texas and Central Texas, while reported cases are increasing in the Harris County/Houston area, Tarrant County/Ft. Worth area, and Dallas County/Dallas area. Spatial cluster (hot spot) analysis of typhus cases in Texas over the last 5 years shows areas of increased risk of murine typhus in South Texas that have persisted over time, while other areas of increased risk have appeared more recently in North Texas and Central Texas (Figures 2 and 3). Conclusion Murine typhus can be a difficult diagnosis to make based on clinical presentation, and physician awareness of its epidemiology is important. The gradual increase in case counts and the changing distribution of cases within Texas may put patients at risk of missed diagnoses. Recognizing the changing epidemiology of typhus in Texas may help inform public health education and control efforts. Disclosures All authors: No reported disclosures.

scholarly journals Cannabis Use and the Onset of Cigarette and E-cigarette Use: A Prospective, Longitudinal Study Among Youth in the United States

2020 ◽  
Author(s):  
Andrea H Weinberger ◽  
Jiaqi Zhu ◽  
Joun Lee ◽  
Shu Xu ◽  
Renee D Goodwin
Keyword(s):  
United States ◽  
Public Health Education ◽  
The United States ◽  
Unintended Consequences ◽  
Cannabis Use ◽  
Cigarette Use ◽  
Prospective Longitudinal Study ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Prospective Longitudinal

Abstract Introduction Cigarette use is declining among youth in the United States, whereas cannabis use and e-cigarette use are increasing. Cannabis use has been linked with increased uptake and persistence of cigarette smoking among adults. The goal of this study was to examine whether cannabis use is associated with the prevalence and incidence of cigarette, e-cigarette, and dual product use among U.S. youth. Methods Data included U.S. youth ages 12–17 from two waves of the Population Assessment of Tobacco and Health (PATH) Study (Wave 1 youth, n = 13 651; Wave 1 tobacco-naive youth, n = 10 081). Weighted logistic regression models were used to examine the association between Wave 1 cannabis use and (1) Wave 1 prevalence of cigarette/e-cigarette use among Wave 1 youth and (2) Wave 2 incidence of cigarette/e-cigarette use among Wave 1 tobacco-naive youth. Analyses were run unadjusted and adjusted for demographics and internalizing/externalizing problem symptoms. Results Wave 1 cigarette and e-cigarette use were significantly more common among youth who used versus did not use cannabis. Among Wave 1 tobacco-naive youth, Wave 1 cannabis use was associated with significantly increased incidence of cigarette and e-cigarette use by Wave 2. Conclusions Youth who use cannabis are more likely to report cigarette and e-cigarette use, and cannabis use is associated with increased risk of initiation of cigarette and e-cigarette use over 1 year. Continued success in tobacco control—specifically toward reducing smoking among adolescents—may require focusing on cannabis, e-cigarette, and cigarette use in public health education, outreach, and intervention efforts. Implications These data extend our knowledge of cigarette and e-cigarette use among youth by showing that cannabis use is associated with increased prevalence and incidence of cigarette and e-cigarette use among youth, relative to youth who do not use cannabis. The increasing popularity of cannabis use among youth and diminished perceptions of risk, coupled with the strong link between cannabis use and tobacco use, may have unintended consequences for cigarette control efforts among youth.

scholarly journals COVID-19 Severity among Women of Reproductive Age with Symptomatic Laboratory-Confirmed SARS-CoV-2 by Pregnancy Status – United States, Jan 1, 2020 – Sep 30, 2021

2021 ◽  
Author(s):  
Penelope Strid ◽  
Lauren B. Zapata ◽  
Van T. Tong ◽  
Laura D. Zambrano ◽  
Kate R. Woodworth ◽  
...  
Keyword(s):  
United States ◽  
Severe Disease ◽  
The United States ◽  
Reproductive Age ◽  
Invasive Ventilation ◽  
Women Of Reproductive Age ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Pregnancy Status ◽  
Risk Ratios

Abstract Importance: Pregnant people are at increased risk for severe COVID-19 compared with nonpregnant people. Limited information is available on the severity of COVID-19 attributable to the Delta variant, the predominant variant in the United States as of late June 2021, among pregnant persons.Objective: To assess risk for severe COVID-19 by pregnancy status and time period relative to Delta variant predominance. Design: Using a cross-sectional design, we describe characteristics of symptomatic women of reproductive age (WRA) with COVID-19 and calculate adjusted risk ratios for severe disease comparing pregnant with nonpregnant WRA during the pre-Delta period (January 1, 2020 – June 26, 2021) and the Delta period (June 27, 2021 – September 30, 2021). Additionally, we calculate adjusted risk ratios for severe disease comparing the Delta period with the pre-Delta period for pregnant and nonpregnant WRA.Setting: Reports of COVID-19 in the United States occurring from January 1, 2020 ─ September 30, 2021, submitted to the CDC.Participants: Pregnant and nonpregnant women aged 15-44 years.Exposure(s): Laboratory-confirmed, symptomatic SARS-CoV-2 infection.Main Outcome(s): Severe disease: (intensive care unit [ICU] admission, receipt of invasive ventilation or extracorporeal membrane oxygenation [ECMO], and death).Results: Among 1,856,428 cases of symptomatic COVID-19 in WRA, the risk for severe disease was increased among pregnant compared with nonpregnant WRA during the pre-Delta and Delta periods. Compared with the pre-Delta period, the risk of ICU admission during the Delta period was 66% higher (adjusted risk ratio [aRR] 1.66, 95% CI: 1.34-2.06) for pregnant WRA and 23% higher (aRR 1.23, 95% CI: 1.12-1.35) for nonpregnant WRA. The risk of invasive ventilation or ECMO was higher for pregnant and nonpregnant WRA in the Delta period. During the Delta period, the risk of death was 3.40 (95% CI: 2.36-4.91) times the risk in the pre-Delta period among pregnant WRA and 1.96 (95% CI: 1.75-2.18) among nonpregnant WRA. Conclusions and Relevance: The overall risk for severe COVID-19 among WRA remains low; however, symptomatic pregnant WRA remain at increased risk for severe outcomes compared with symptomatic nonpregnant WRA during Delta variant predominance. Compared with the pre-Delta period, pregnant and nonpregnant WRA are at increased risk for severe COVID-19 in the Delta period.

scholarly journals Epidemiology and Clinical Features of Cryptosporidium Infection in Immunocompromised Patients

2002 ◽  
Vol 15 (1) ◽  
pp. 145-154 ◽  
Author(s):  
Paul R. Hunter ◽  
Gordon Nichols
Keyword(s):  
T Cell ◽  
Cell Response ◽  
Diarrheal Disease ◽  
Gastrointestinal Disease ◽  
Severe Disease ◽  
Severe Combined Immunodeficiency ◽  
The United States ◽  
T Cell Response ◽  
Increased Risk ◽  
Immunodeficiency Syndrome

SUMMARY Cryptosporidium spp. are a major cause of diarrheal disease in both immunocompetent and immunodeficient individuals. They also cause waterborne disease in both the United States and United Kingdom. Studies on the mechanisms of immunity to cryptosporidiosis indicate the importance of the T-cell response. The spectrum and severity of disease in immunocompromised individuals with cryptosporidiosis reflect this importance since the most severe disease is seen in individuals with defects in the T-cell response. The most commonly studied group is that of patients with AIDS. These patients suffer from more severe and prolonged gastrointestinal disease that can be fatal; in addition, body systems other than the gastrointestinal tract may be affected. The widespread use of antiretroviral therapy does appear to be having a beneficial effect on recovery from cryptosporidiosis and on the frequency of infection in human immunodeficiency virus-positive patients. Other diseases that are associated with increased risk of severe cryptosporidiosis, such as primary immunodeficiencies, most notably severe combined immunodeficiency syndrome, are also predominantly associated with T-cell defects. Of the remaining groups, children with acute leukemia seem to be most at risk from cryptosporidiosis. There is less evidence of severe complications in patients with other malignant diseases or in those receiving immunosuppressive chemotherapy.

scholarly journals Systemic Inflammatory Mediators Are Effective Biomarkers for Predicting Adverse Outcomes in Clostridioides difficile Infection

mBio ◽  
2020 ◽  
Vol 11 (3) ◽  
Author(s):  
Michael G. Dieterle ◽  
Rosemary Putler ◽  
D. Alexander Perry ◽  
Anitha Menon ◽  
Lisa Abernathy-Close ◽  
...  
Keyword(s):  
Severe Disease ◽  
The United States ◽  
Human Infection ◽  
Serum Biomarkers ◽  
Adverse Outcomes ◽  
Gastrointestinal Infections ◽  
Content Type ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Patients At Risk

ABSTRACT Clostridioides difficile infection (CDI) can result in severe disease and death, with no accurate models that allow for early prediction of adverse outcomes. To address this need, we sought to develop serum-based biomarker models to predict CDI outcomes. We prospectively collected sera ≤48 h after diagnosis of CDI in two cohorts. Biomarkers were measured with a custom multiplex bead array assay. Patients were classified using IDSA severity criteria and the development of disease-related complications (DRCs), which were defined as ICU admission, colectomy, and/or death attributed to CDI. Unadjusted and adjusted models were built using logistic and elastic net modeling. The best model for severity included procalcitonin (PCT) and hepatocyte growth factor (HGF) with an area (AUC) under the receiver operating characteristic (ROC) curve of 0.74 (95% confidence interval, 0.67 to 0.81). The best model for 30-day mortality included interleukin-8 (IL-8), PCT, CXCL-5, IP-10, and IL-2Rα with an AUC of 0.89 (0.84 to 0.95). The best model for DRCs included IL-8, procalcitonin, HGF, and IL-2Rα with an AUC of 0.84 (0.73 to 0.94). To validate our models, we employed experimental infection of mice with C. difficile. Antibiotic-treated mice were challenged with C. difficile and a similar panel of serum biomarkers was measured. Applying each model to the mouse cohort of severe and nonsevere CDI revealed AUCs of 0.59 (0.44 to 0.74), 0.96 (0.90 to 1.0), and 0.89 (0.81 to 0.97). In both human and murine CDI, models based on serum biomarkers predicted adverse CDI outcomes. Our results support the use of serum-based biomarker panels to inform Clostridioides difficile infection treatment. IMPORTANCE Each year in the United States, Clostridioides difficile causes nearly 500,000 gastrointestinal infections that range from mild diarrhea to severe colitis and death. The ability to identify patients at increased risk for severe disease or mortality at the time of diagnosis of C. difficile infection (CDI) would allow clinicians to effectively allocate disease modifying therapies. In this study, we developed models consisting of only a small number of serum biomarkers that are capable of predicting both 30-day all-cause mortality and adverse outcomes of patients at time of CDI diagnosis. We were able to validate these models through experimental mouse infection. This provides evidence that the biomarkers reflect the underlying pathophysiology and that our mouse model of CDI reflects the pathogenesis of human infection. Predictive models can not only assist clinicians in identifying patients at risk for severe CDI but also be utilized for targeted enrollment in clinical trials aimed at reduction of adverse outcomes from severe CDI.

Comprehensive Testing Highlights Racial, Ethnic, and Age Disparities in the COVID-19 Outbreak: Epidemiological and Clinical Characteristic of Cases in Utah

2020 ◽  
Author(s):  
Sharia M Ahmed ◽  
Rashmee U. Shah ◽  
Margaret Bale ◽  
Jordan B. Peacock ◽  
Ben Berger ◽  
...  
Keyword(s):  
Salt Lake ◽  
Severe Disease ◽  
Vital Signs ◽  
Ethnic Disparities ◽  
Population Level ◽  
The United States ◽  
Duration Of Symptoms ◽  
University Of Utah ◽  
Increased Risk ◽  
Exposure Risks

AbstractThe United States (US), which is currently the epicenter for the COVID-19 pandemic, is a country whose demographic composition differs from that of other highly-impacted countries. US-based descriptions of SARS-CoV-2 infections have, for the most part, focused on patient populations with severe disease, captured in areas with limited testing capacity. The objective of this study is to compare characteristics of positive and negative SARS-CoV-2 patients, in a population primarily comprised of mild and moderate infections, identified from comprehensive population-level testing. Here, we extracted demographics, comorbidities, and vital signs from 20,088 patients who were tested for SARS-CoV-2 at University of Utah Health clinics, in Salt Lake County, Utah; and for a subset of tested patients, we performed manual chart review to examine symptoms and exposure risks. To determine risk factors for testing positive, we used logistic regression to calculate the odds of testing positive, adjusting for symptoms and prior exposure. Of the 20,088 individuals, 1,229 (6.1%) tested positive for SARS-CoV-2. We found that Non-White persons were more likely to test positive compared to non-Hispanic Whites (adjOR=1.1, 95% CI: 0.8, 1.6), and that this increased risk is more pronounced among Hispanic or Latino persons (adjOR=2.0, 95%CI: 1.3, 3.1). However, we did not find differences in the duration of symptoms nor type of symptom presentation between non-Hispanic White and non-White individuals. We found that risk of hospitalization increases with age (adjOR=6.9 95% CI: 2.1, 22.5 for age 60+ compared to 0-19), and additionally show that younger individuals (aged 019), were underrepresented both in overall rates of testing as well as rates of testing positive. We did not find major race/ethnic differences in hospitalization rates. In this analysis of predominantly non-hospitalized individuals tested for SARS-CoV-2, enabled by expansive testing capacity, we found disparities in both testing and SARS-CoV-2 infection status by race/ethnicity and by age. Further work on addressing racial and ethnic disparities, particularly among Hispanic/Latino communities (where SARS-CoV-2 may be spreading more rapidly due to increased exposure and comparatively reduced testing), will be needed to effectively combat COVID-19 in the US.

scholarly journals 331. Hospitalized COVID-19 infections in Infants < 1 Year of Age

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S271-S272
Author(s):  
Christina Gagliardo ◽  
Eberechi I Nwaobasi-Iwuh ◽  
Niva Shah ◽  
Aparna Prasad ◽  
Neeraja Kairam ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Preventive Measures ◽  
Severe Disease ◽  
Pediatric Intensive Care ◽  
The United States ◽  
Severe Illness ◽  
Hospital System ◽  
Presenting Symptoms ◽  
Young Infants ◽  
Increased Risk

Abstract Background Nearly 4 million children have tested positive for coronavirus disease 2019 (COVID-19) in the United States. Some studies suggest infants might be at increased risk for severe illness and hospitalization from COVID-19. Our objective was to describe the clinical and laboratory features of young infants admitted to a hospital system with COVID-19. Methods An observational retrospective study was performed in infants ≤1 year of age admitted with COVID-19 from March 1, 2020 to May 30, 2021. Data was extracted into a REDCap database and analyzed using descriptive statistics. Results Sixteen infants &lt; 1 year were hospitalized with COVID-19. Fever, poor feeding, and respiratory symptoms were the most common presenting symptoms (Table 1). Two required pediatric intensive care unit (ICU) care, three required oxygen support, and one was intubated. There were no deaths. Five infants with echocardiograms performed showed normal findings. Four infants received Remdesivir without side effects. Conclusion Infants with COVID-19 can present with severe disease requiring ICU care and oxygen support. In our experience, a large proportion of infants developed hematologic abnormalities, but none had cardiac involvement. Preventive measures including vaccination will become critical to decrease transmission and severe disease in this young patient population. Disclosures All Authors: No reported disclosures

scholarly journals Predictors of Biologic Use and Satisfaction Among Patients With Psoriasis: An Analysis and Geographic Visualization of the 2016 and 2017 National Psoriasis Foundation Annual Surveys

2020 ◽  
Vol 5 (3) ◽  
pp. 100-108
Author(s):  
Clinton W. Enos ◽  
Hadiza Galadima ◽  
Arjun D. Saini ◽  
Stacie Bell ◽  
Michael Siegel ◽  
...  
Keyword(s):  
United States ◽  
Biologic Therapy ◽  
Residual Disease ◽  
Hot Spot ◽  
Severe Disease ◽  
Southeastern United States ◽  
The United States ◽  
Annual Survey ◽  
National Psoriasis Foundation ◽  
Survey Responses

Background: There are an increasing number of biologic therapies approved for the treatment of psoriasis. Previous reports have identified undertreatment as a concern in the United States. Undertreatment has been associated with decreased patient satisfaction and increased morbidity. Objectives: Assess biologic use and satisfaction among respondents to the 2016 and 2017 National Psoriasis Foundation (NPF) Annual Surveys. Methods: Retrospective data analysis of the 2016 and 2017 NPF Annual Survey responses from individuals with psoriasis. ArcGIS Pro software was utilized to generate maps and perform an optimized hot spot analysis of moderate-to-severe psoriasis and biologic use. Results: There were 427 patients with psoriasis involving the skin alone. Biologics were used in <23% of respondents, while nearly 69% reported body surface area (BSA) >3%. Respondents with BSA <3% and 3% to 4% were less likely to be on biologic therapy (odds ratio [OR]: 0.29, 0.11-0.78 and OR: 0.22, 0.09-0.56, respectively). Nonbiologic users were more likely to be very unsatisfied with their treatment compared to those receiving biologic therapy (OR: 5.23, 2.80-9.75). With geographic information systems (GIS), counties with increased moderate-to-severe disease were identified in the southeastern United States. Conclusion: Despite the increasing number of Food and Drug Administration–approved biologic medications, the proportion of respondents on biologic therapy remained small. Treatment with biologics correlated with less residual disease and increased satisfaction. Geographic variation in state legislation as well as state and federal health insurance did not impact biologic use. However, using GIS, we identify a greater burden of moderate-to-severe disease among respondents in the Southeastern United States and a lack of commensurate use of biologics in those areas.

scholarly journals Factors Associated With Potentially Inappropriate Phosphodiesterase-5 Inhibitor Use for Pulmonary Hypertension in the United States, 2006 to 2015

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Kari R. Gillmeyer ◽  
Seppo T. Rinne ◽  
Mark E. Glickman ◽  
Kyung Min Lee ◽  
Qing Shao ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Severe Disease ◽  
The United States ◽  
Heart Catheterization ◽  
Health Administration ◽  
Right Heart ◽  
Factors Associated ◽  
Increased Risk ◽  
Group 2 ◽  
Phosphodiesterase 5

Background: Use of phosphodiesterase-5 inhibitors (PDE5i) for groups 2 and 3 pulmonary hypertension (PH) is rising nationally, despite guidelines recommending against this low-value practice. Although receiving care across healthcare systems is encouraged to increase veterans’ access to specialists critical for PH management, receiving care in 2 systems may increase risk of guideline-discordant prescribing. We sought to identify factors associated with prescribing of PDE5i for group 2/3 PH, particularly, to test the hypothesis that veterans prescribed PDE5i for PH in the community (through Medicare) will have increased risk of subsequently receiving potentially inappropriate treatment in Veterans Health Administration (VA). Methods and Results: We constructed a retrospective cohort of 34 775 Medicare-eligible veterans with group 2/3 PH by linking national patient-level data from VA and Medicare from 2006 to 2015. We calculated adjusted odds ratios (ORs) of receiving daily PDE5i treatment for PH in VA using multivariable models with facility-specific random effects. In this cohort, 1556 veterans received VA prescriptions for PDE5i treatment for group 2/3 PH. Supporting our primary hypothesis, the variable most strongly associated with PDE5i treatment in VA for group 2/3 PH was prior treatment through Medicare (OR, 6.5 [95% CI, 4.9–8.7]). Other variables strongly associated with increased likelihood of VA treatment included more severe disease as indicated by recent right heart failure (OR, 3.3 [95% CI, 2.8–3.9]) or respiratory failure (OR, 3.7 [95% CI, 3.1–4.4]) and prior right heart catheterization (OR, 3.8 [95% CI, 3.4–4.3]). Conclusions: Our data suggest a missed opportunity to reassess treatment appropriateness when pulmonary hypertension patients seek prescriptions from VA—a relevant finding given policies promoting shared care across VA and community settings. Interventions are needed to reinforce awareness that pulmonary vasodilators are unlikely to benefit group 2/3 pulmonary hypertension patients and may cause harm.

Abstract 14693: Rheumatic Heart Disease and Deprivation in the United States: A Retrospective Review

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sarah R De Loizaga ◽  
Lindsay Arthur ◽  
Bhawna Arya ◽  
Andrew F Beck ◽  
Brian Beckman ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Cardiovascular Health ◽  
Pacific Islands ◽  
Severe Disease ◽  
The United States ◽  
Standard Deviation Increase ◽  
Increased Risk ◽  
The Us ◽  
Rheumatic Heart

Introduction: Rheumatic heart disease (RHD) tracks with other cardiovascular health inequities in the US; however, RHD mortality captures a fraction of those affected and lags behind diagnosis by decades. There is little contemporary data on children living with acute rheumatic fever (ARF) and RHD within the US. This study describes recent pediatric ARF/RHD in the US and examines the association with community deprivation. Methods: Sixty US institutions were invited to participate in a 10-year review (2008-2018). Geocoding was used to determine a census tract-based socioeconomic deprivation index (DI) ranging from 0-1 (1 being most deprived). Independent sample t-test was used to compare DI means. Odds ratios (OR) with 95% confidence intervals were obtained from multivariable logistic regression. The DI was scaled to provide ORs for a one standard deviation increase. Results: Data for 947 cases from 22 institutions showed median age at diagnosis of 9 years, with half identifying as male (51%) and non-white (52%), and three-quarters (74%) identifying as non-Hispanic. Most identified English as their primary language, had health insurance, and were first diagnosed in the US (84%, 89%, and 82%, respectively). Of the 157 (17%) with travel exposure, Pacific Islands (38%) and Africa (21%) were most commonly identified. Nearly three-quarters (73%) were diagnosed with ARF and most (98%) had an echocardiogram at diagnosis. While 96% of patients were prescribed secondary prophylaxis, only half (58%) were prescribed intramuscular Benzathine penicillin (BPG), the gold standard. The mean DI was 0.39±0.15. Higher deprivation was associated with RHD as opposed to ARF at diagnosis (DI 0.42 vs. 0.38, p<0.001). Additionally, higher deprivation was associated with increased risk of severe RHD (OR 1.34; 95% CI 1.11-1.62) and increased use of BPG vs enteral penicillin for secondary prevention (OR 0.67; 95% CI 0.56-0.8). Conclusions: Recent pediatric cases of ARF and RHD in the US are endemic, rather than from foreign exposure and children who live in more deprived communities are at risk for more severe disease. Additional research is needed into why intramuscular penicillin, which has superior efficacy compared to oral penicillin, is prescribed in only half of cases.

scholarly journals Risk factors for severe outcomes of COVID-19: a rapid review

2020 ◽  
Author(s):  
Aireen Wingert ◽  
Jennifer Pillay ◽  
Michelle Gates ◽  
Samantha Guitard ◽  
Sholeh Rahman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Low Income ◽  
Severe Disease ◽  
The United States ◽  
Male Gender ◽  
Rapid Review ◽  
Class Iii ◽  
Refugee Status ◽  
Increased Risk

Background: Identification of high-risk groups is needed to inform COVID-19 vaccine prioritization strategies in Canada. A rapid review was conducted to determine the magnitude of association between potential risk factors and risk of severe outcomes of COVID-19. Methods: Methods, inclusion criteria, and outcomes were prespecified in a protocol that is publicly available. Ovid MEDLINE(R) ALL, Epistemonikos COVID-19 in LOVE Platform, and McMaster COVID-19 Evidence Alerts, and select websites were searched to 15 June 2020. Studies needed to be conducted in Organisation for Economic Co-operation and Development countries and have used multivariate analyses to adjust for potential confounders. After piloting, screening, data extraction, and quality appraisal were all performed by a single reviewer. Authors collaborated to synthesize the findings narratively and appraise the certainty of the evidence for each risk factor-outcome association. Results: Of 3,740 unique records identified, 34 were included in the review. The studies included median 596 (range 44 to 418,794) participants with a mean age between 42 and 84 years. Half of the studies (17/34) were conducted in the United States and 19/34 (56%) were rated as good quality. There was low or moderate certainty evidence for a large (≥2-fold) association with increased risk of hospitalization in people having confirmed COVID-19, for the following risk factors: obesity class III, heart failure, diabetes, chronic kidney disease, dementia, age over 45 years (vs. younger), male gender, Black race/ethnicity (vs. non-Hispanic white), homelessness, and low income (vs. above average). Age over 60 and 70 years may be associated with large increases in the rate of mechanical ventilation and severe disease, respectively. For mortality, a large association with increased risk may exist for liver disease, Bangladeshi ethnicity (vs. British white), age over 45 years (vs. <45 years), age over 80 years (vs. 65-69 years), and male gender in those 20-64 years (but not older). Associations with hospitalization and mortality may be very large (≥5-fold increased risk) for those aged over 60 years. Conclusion: Among other factors, increasing age (especially >60 years) appears to be the most important risk factor for severe outcomes among those with COVID-19. There is a need for high quality primary research (accounting for multiple confounders) to better understand the level of risk that might be associated with immigration or refugee status, religion or belief system, social capital, substance use disorders, pregnancy, Indigenous identity, living with a disability, and differing levels of risk among children. PROSPERO registration: CRD42020198001

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