scholarly journals Risk of adverse outcomes with COVID-19 in the Republic of Ireland

2020 ◽  
Author(s):  
M Roe ◽  
P Wall ◽  
P Mallon ◽  
M Horgan
Keyword(s):  
Intensive Care ◽  
Hospital Admission ◽  
Population Based ◽  
Adverse Outcomes ◽  
Noncommunicable Diseases ◽  
Republic Of Ireland ◽  
Increased Risk ◽  
The Republic ◽  
High Level ◽  
Clinical Conditions

AbstractAimsTo compare the risk of adverse outcomes (i.e. hospital/intensive care admission, death) in population sub-groups during two periods of the COVID-19 pandemic in the Republic of Ireland.MethodsWe analysed routinely-collected, publicly-available data on 67,900 people with laboratory confirmed COVID-19 infection between 29th Feb to 14th Nov 2020. This period encompassed two waves of infection and two corresponding national lockdowns. For two observational periods covering each wave (W1, W2), each ending 17-19 days before implementation of high-level national restrictions, we segmented the population based on age and underlying clinical conditions.ResultsThe prevalence of laboratory confirmed COVID-19 was 1.4%. The risk of admission to hospital, admission to intensive care, and death was 7.2%, 0.9%, and 2.5%, respectively. Compared to younger confirmed cases, those aged ≥65 y had increased risk of hospital admission (RR 5.61), ICU admission (RR 3.56), and death (RR 60.8). W2 was associated with more cases and fewer adverse events than W1. The risk of all adverse outcomes was reduced in W2 than in W1.ConclusionsOngoing responses should consider the variation in risk of adverse outcomes between specific sub-groups. These findings indicate the need to sustain the prevention, identification and management of noncommunicable diseases to reduce the burden of COVID-19.

Lower perception of pharmacological treatment increases risk of non-adherence to medication

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
CB Graversen ◽  
JB Valentin ◽  
ML Larsen ◽  
S Riahi ◽  
T Holmberg ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Poisson Regression ◽  
Drug Class ◽  
Angiotensin Receptor Blockers ◽  
Adverse Outcomes ◽  
Adherence To Medication ◽  
Increased Risk ◽  
Patient Reported ◽  
High Level

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data. Purpose To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD. Methods This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega. Results Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67). Conclusion Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class. Abstract Figure. Figre: Multiple adjusted analyses

scholarly journals Correlates of Adverse Outcomes in Abdominally Obese Individuals: Findings from the Five-Year Followup of the Population-Based Study of Health in Pomerania

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Nele Friedrich ◽  
Harald J. Schneider ◽  
Ulrich John ◽  
Marcus Dörr ◽  
Sebastian E. Baumeister ◽  
...  
Keyword(s):  
Abdominal Obesity ◽  
Regression Models ◽  
Kidney Diseases ◽  
Premature Death ◽  
Population Based ◽  
Serum Glucose ◽  
Adverse Outcomes ◽  
Population Based Study ◽  
Logistic Regression Models ◽  
Increased Risk

Background. Abdominal obesity is a major risk factor of cardiovascular disease (CVD), type 2 diabetes (T2DM), and premature death. However, it has not been resolved which factors predispose for the development of these adverse obesity-related outcomes in otherwise healthy individuals with abdominal obesity.Methods. We studied 1,506 abdominal obese individuals (waist-to-height ratio (WHtR) ≥ 0.5) free of CVD or T2DM from the population-based Study of Health in Pomerania and assessed the incidence of CVD or T2DM after a five-year followup. Logistic regression models were adjusted for major cardiovascular risk factors and liver, kidney diseases, and sociodemographic status.Results. During follow-up time, we observed 114 and 136 new T2DM and CVD cases, respectively. Regression models identified age, waist circumference, serum glucose, and liver disease as predictors of T2DM. Regarding CVD, only age, unemployment, and a divorced or widowed marital status were significantly associated with incident CVD. In this subgroup of obese individuals blood pressure, serum glucose, or lipids did not influence incidence of T2DM or CVD.Conclusion. We identified various factors associated with an increased risk of incident T2DM and CVD among abdominally obese individuals. These findings may improve the detection of high-risk individuals and help to advance prevention strategies in abdominal obesity.

scholarly journals Effects of Metformin on Clinical outcomes in Patients with Type 2 Diabetes and Covid-19

2021 ◽  
Vol 5 (3) ◽  
pp. 01-04
Author(s):  
Nasser Mikhail
Keyword(s):  
Type 2 Diabetes ◽  
Lactic Acidosis ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Retrospective Studies ◽  
English Literature ◽  
Population Based ◽  
Increased Risk ◽  
Pubmed Search

Background: The effects of metformin therapy on the prognosis of patients with coronavirus disease 2019 (COVID-19) are unclear. Objective: To review effects of metformin on clinical outcomes, particularly mortality, in patients with type 2 diabetes and COVID-19. Methods: Review of English literature by PUBMED search until April 20, 2021. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, and consensus guidelines are reviewed. Results: All available studies in this area are retrospective. Two population-based studies did not find significant association between metformin use and susceptibility to COVID-19. Most, but not all studies, suggest that metformin use prior to hospital admission might be associated with significant decrease in mortality in patients with type 2 diabetes and COVID-19. Continuing metformin use after hospital admission did not have significant impact on COVID-19 related death but may decrease risk of acute respiratory distress syndrome (ARDS). Meanwhile, in-hospital metformin administration may be associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking ≥2 gm/d of metformin, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m2. Conclusions: Although most retrospective studies suggest that metformin administration may be associated with decreased risk of COVID-19 mortality, these data should be confirmed by randomized trials. In patients with type 2 diabetes and COVID-19 admitted to the hospital, metformin use should be avoided in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR < 60 ml/min/1.73m2), and in daily doses of ≥ 2 gm due to increased risk of lactic acidosis.

scholarly journals Insulin Treatment May Increase Adverse Outcomes in Patients With COVID-19 and Diabetes: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yan Yang ◽  
Zixin Cai ◽  
Jingjing Zhang
Keyword(s):  
Hospital Admission ◽  
Insulin Therapy ◽  
Large Scale ◽  
Insulin Treatment ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Hospitalization Time ◽  
Increased Risk ◽  
Significant Difference

Background and ObjectiveRecently, insulin treatment has been found to be associated with increased mortality and other adverse outcomes in patients with coronavirus disease 2019 (COVID-19) and diabetes, but the results remain unclear and controversial, therefore, we conducted this meta-analysis.MethodsFour databases, namely, PubMed, Web of Science, EMBASE and the Cochrane Library, were used to identify all studies concerning insulin treatment and the adverse effects of COVID-19, including mortality, incidence of severe/critical complications, in-hospital admission and hospitalization time. To assess publication bias, funnel plots, Begg’s tests and Egger’s tests were used. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to access the effect of insulin therapy on mortality, severe/critical complications and in-hospital admission. The association between insulin treatment and hospitalization time was calculated by the standardized mean difference (SMD) with 95% CIs.ResultsEighteen articles, involving a total of 12277 patients with COVID-19 and diabetes were included. Insulin treatment was significantly associated with an increased risk of mortality (OR=2.10; 95% CI, 1.51-2.93) and incidence of severe/critical COVID-19 complications (OR=2.56; 95% CI, 1.18-5.55). Moreover, insulin therapy may increase in-hospital admission in patients with COVID-19 and diabetes (OR=1.31; 95% CI, 1.06-1.61). However, there was no significant difference in the hospitalization time according to insulin treatment (SMD=0.21 95% CI, -0.02-0.45).ConclusionsInsulin treatment may increase mortality and severe/critical complications in patients with COVID-19 and diabetes, but more large-scale studies are needed to confirm and explore the exact mechanism.

scholarly journals COVID-19 in Cancer Patients, Risk Factors for Disease and Adverse Outcome, a Population-Based Study From Norway

2021 ◽  
Vol 11 ◽  
Author(s):  
Tom Børge Johannesen ◽  
Sigbjørn Smeland ◽  
Stein Aaserud ◽  
Eirik Alnes Buanes ◽  
Anna Skog ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cancer Patients ◽  
Adverse Outcome ◽  
Population Based ◽  
Treatment Modalities ◽  
Major Surgery ◽  
Prescription Database ◽  
Population Based Study ◽  
The Past ◽  
Increased Risk

BackgroundCancer has been suggested as a risk factor for severe outcome of SARS-CoV-2 infection. In this population-based study we aimed to identify factors associated with higher risk of COVID-19 and adverse outcome.MethodsData on all confirmed SARS-CoV-2 positive patients in the period January 1 to May 31, 2020 were extracted from the Norwegian Surveillance System for Communicable Diseases. Data on cancer and treatment was available from the Cancer Registry of Norway, the Norwegian Patient Registry and the Norwegian Prescription Database. Deaths due to COVID-19 were extracted from the Cause of Death Registry. From the Norwegian Intensive Care and Pandemic Registry we retrieved data on admittance to hospital and intensive care. We determined rates of COVID-19 disease in cancer patients and the rest of the population. We also ran multivariate analyses adjusting for age and gender.ResultsA total of 8 410 patients were diagnosed with SARS-CoV-2 infection in Norway during the study period, of which 547 (6.5%) were cancer patients. Overall, we found similar age adjusted rates of COVID-19 in the population with cancer as in the population without cancer. Unadjusted analysis showed that patients having undergone major surgery within the past 3 months had an increased risk of COVID-19 while we did not find increased Odds Ratio (OR) related to other oncological treatment modalities. No patients treated with stem cell or bone marrow transplant were diagnosed with COVID-19. The fatality rate of COVID-19 among cancer patients was 0.10. This was similar to non-cancer patients, when adjusting for age and sex with OR (95% CI) for death= 0.99 (0.68–1.42). Patients with distant metastases had significantly increased OR of death due to COVID-19 disease of 9.31 (95% CI 2.60–33.34). For the combined outcome death and/or admittance to hospital due to COVID-19, we found significant two-fold increased risk estimates for patients diagnosed with cancer less than one 1 year ago (OR 2.08, 95% CI 1.14–3.80), for those treated with anti-cancer drugs during the past 3 months (OR 1.80, 95% CI 1.07–3.01) and for patients undergoing major surgery during the past 3 months (OR 2.19, 95% CI 1.40–3.44).

scholarly journals The Safety of Delayed Versus Immediate Antibiotic Prescribing for Upper Respiratory Tract Infections

2020 ◽  
Author(s):  
Tjeerd Pieter van Staa ◽  
Victoria Palin ◽  
Benjamin Brown ◽  
William Welfare ◽  
Yan Li ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Hospital Admission ◽  
Respiratory Tract Infections ◽  
Population Based ◽  
Upper Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Increased Risk ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background This study aimed to evaluate the clinical safety of delayed antibiotic prescribing for upper respiratory tract infections (URTIs), which is recommended in treatment guidelines for less severe cases. Methods Two population-based cohort studies used the English Clinical Practice Research Databank and Welsh Secure Anonymized Information Linkage, containing electronic health records from primary care linked to hospital admission records. Patients with URTI and prescriptions of amoxicillin, clarithromycin, doxycycline, erythromycin, or phenoxymethylpenicillin were identified. Patients were stratified according to delayed and immediate prescribing relative to URTI diagnosis. Outcome of interest was infection-related hospital admission after 30 days. Results The population included 1.82 million patients with an URTI and antibiotic prescription; 91.7% had an antibiotic at URTI diagnosis date (immediate) and 8.3% had URTI diagnosis in 1–30 days before (delayed). Delayed antibiotic prescribing was associated with a 52% increased risk of infection-related hospital admissions (adjusted hazard ratio, 1.52; 95% confidence interval, 1.43–1.62). The probability of delayed antibiotic prescribing was unrelated to predicted risks of hospital admission. Analyses of the number needed to harm showed considerable variability across different patient groups (median with delayed antibiotic prescribing, 1357; 2.5% percentile, 295; 97.5% percentile, 3366). Conclusions This is the first large population-based study examining the safety of delayed antibiotic prescribing. Waiting to treat URTI was associated with increased risk of hospital admission, although delayed antibiotic prescribing was used similarly between high- and low-risk patients. There is a need to better target delayed antibiotic prescribing to URTI patients with lower risks of complications.

scholarly journals P102 Outcomes of coronavirus disease 2019 among patients with inflammatory bowel diseases and the influence of IBD-related medications– A Danish prospective population-based cohort study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S197-S197
Author(s):  
M Attauabi ◽  
A Poulsen ◽  
M Kajbæk Verner-Andersen ◽  
M Rosager Hansen ◽  
N Pedersen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Admission ◽  
Population Based ◽  
Intensive Care Treatment ◽  
Disease Course ◽  
Danish Population ◽  
Population Based Study ◽  
Systemic Steroids ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Abstract Background Population-based data regarding outcomes of coronavirus disease 2019 (COVID-19) among patients with ulcerative colitis (UC) and Crohn’s disease (CD) are limited. Studies on the association of COVID-19 outcomes and immunomodulating therapies, are scarce. Therefore, we aimed to conduct a population-based study investigating the outcomes of COVID-19 among patients with UC and CD in Denmark. Methods The Danish COVID-19 IBD Database is an extensive population-based database that prospectively monitors the disease course of laboratory-confirmed COVID-19 among patients with UC and CD in Denmark. Severe COVID-19 was defined as COVID-19 necessitating intensive care unit admission, ventilator use, or death. Regression analysis was adjusted for age, sex, disease type, disease activity, cardiovascular disease, and corticosteroids. Results The study recruited 363 patients (UC: 223; CD: 140) from January 28th, 2020, to February 7th, 2021. A total of 36 (16.1%) and 18 (12.9%) patients with UC and CD, respectively, required a COVID-19 related hospitalization, while eight (3.6%) and three (2.1%) patients required intensive care treatment. Death due to COVID-19 was observed among eight (3.6%) and two (1.4%) patients, respectively. The association between these outcomes and IBD-related treatment is presented in Table 1. As shown, none of the IBD-related medications were associated with severe COVID-19 in univariate and adjusted analysis. However, systemic steroids were found to be associated with the risk of COVID-19 related hospital admission among patients with UC (adjusted odds ratio (aOR)=6.54 (95% CI 1.09-36.39)) and CD (aOR=5.45 (95% CI 2.07-12.24)). Conclusion This ongoing Danish population-based study on COVID-19 outcomes among patients with UC and CD demonstrated severe COVID-19 among only a minority of patients, which was not associated with IBD-related medications. However, use of systemic steroids were associated with COVID-19 necessitating hospital admission among patients with UC and CD.

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