The Missing Science: Epidemiological data gaps for COVID-19 policy in the United States

AbstractWe report on a scoping study of COVID-19 epidemiological data available for COVID-19 policy and management decisions for U.S. settings. We synthesize current US Centers for Disease and Control and Prevention (CDC) estimates for parameter of infectious transmission, infection severity, and disease burden, and summarize epidemiologic contributions to these parameters published by CDC-affiliated investigators through Oct 30, 2020. Authoritative estimates of most infectious transmission and infection severity parameters exist but rely primarily on data from studies conducted in non-U.S. populations. Estimates of secondary infection risks for household, workplace, school, or other community settings are lacking and estimates of the clinical fraction remain uncertain. The CDC reports multiple disease incidence and prevalence measures at national and state geographies, including some measures disaggregated by age group, race/ethnicity and sex; however, nationally uniform disease burden measures are not available at the sub-state level or for sub-populations defined by exposure setting, limiting opportunities for targeted interventions. CDC-affiliated investigators authored 133 quantitative studies on COVID-19 through Oct 30, 2020; however only 34 employed analytic methods. The remainder were descriptive. Of the 34 analytic studies, eleven reported on risk factors for infection, seven reported on risk factors for severe disease, three on symptomatic infections, three reported secondary infection risks, and four reported on indirect pandemic effects. Gaps remain in the epidemiological data required for an efficient and equitable public health policy response to COVID-19. The existence of these gaps one year after the onset of the COVID-19 pandemic underscores the need for standardizing data collection and research priorities and protocols in the context of a rapidly emerging infectious disease epidemics.

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Abstract 78: Factors Associated with Thrombotic Events During Pregnancy in the United States: NIS 2000-2010

Stroke ◽

10.1161/str.46.suppl_1.78 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Ali Razmara ◽

Steven Cen ◽

Diana L Jin ◽

Nerses Sanossian ◽

Amytis Towfighi

Keyword(s):

Risk Factors ◽

The United States ◽

The South ◽

Targeted Interventions ◽

Factors Associated ◽

Thrombosis Risk ◽

Significant Difference ◽

Acute Mi ◽

Hospital Factors ◽

Peripartum Period

Intro: Thrombosis risk is increased during pregnancy and puerperium. There are no recent data on nationwide trends in thrombotic events during the delivery period. Objective: To determine risk factors for thrombotic events in women hospitalized for deliveries. Methods: Data from the Nationwide Inpatient Sample (2000-2010) were used to identify deliveries. Weighted proportion of pregnancy hospitalizations with comorbid thrombotic events, including TIA, ischemic stroke, hemorrhagic stroke, acute MI, and venous thromboembolism, was determined. Poisson regression was used to identify risk factors for thrombotic events. The first multivariable model adjusted for sociodemographic and hospital factors. The second model in addition adjusted for comorbid conditions. Results: There were 4,305,561 women hospitalized for delivery (21.5 million US deliveries), of which 7,242 (0.17%) had thrombotic events in the peripartum period. From 2000-2010, there was an increase in deliveries with associated thrombotic events observed from 7.46/10K to 34.8/10K. Compared to 2000, deliveries with thromboses was 8-fold more likely in 2010 (RR 7.94, 95% CI 1.98-31.93). There was no significant difference in rates from 2000 to 2010 after adjustment for sociodemographic and hospital factors. From 2000-2010, pregnant women with thrombotic events were older, more likely to be White, to smoke, to lack insurance, to be admitted to rural hospitals, and to be admitted in the South or Midwest. After multivariable adjustment for sociodemographics, hospital factors, and comorbidities, admissions in the South (RR 1.26, 95% CI 1.02-1.55) or Midwest (1.33, 95% CI 1.05-1.68), atrial fibrillation (1.28, 95% CI 1.01-1.62), pre-/eclampsia (5.78, 95% CI 4.37-7.66), dyslipidemia (1.72, 95% CI 1.42-2.09), atrial septal defect (14.38, 95% CI 6.76-30.58), and valvular heart disease (1.67, 95% CI 1.25-2.24) were independently associated with higher risk of thrombotic events. Conclusions: From 2000-2010, there was a sizeable increase in deliveries with associated thrombosis. Identification of factors associated with thrombotic events for women hospitalized for normal pregnancies will aid in targeted interventions to screen for, prevent and treat thrombosis related to pregnancy.

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Incidence and Severity of Cavity Spot of Carrot as Affected by Pigmentation, Temperature, and Rainfall

Plant Disease ◽

10.1094/pdis-10-13-1021-re ◽

2014 ◽

Vol 98 (7) ◽

pp. 929-936 ◽

Cited By ~ 4

Author(s):

C. Saude ◽

P. W. Simon ◽

M. R. McDonald

Keyword(s):

Agricultural Research ◽

Disease Incidence ◽

Secondary Infection ◽

Organic Soil ◽

The United States ◽

Field Trials ◽

United States Department ◽

Breeding Line ◽

Total Rainfall ◽

Cavity Spot

Field trials to determine the effect of carrot pigmentation and weather parameters on cavity spot (CS) of carrot were conducted in the Holland/ Bradford Marsh region of Ontario between 2002 and 2009. In all, 23 colored carrot cultivars from the United States Department of Agriculture (USDA) Agricultural Research Service breeding program at the University of Wisconsin (n = 5) and commercial seed companies (n = 18) were seeded in organic soil (pH 6 to 7, 45 to 75% organic matter) in late May to early June and harvested in late October or early November. Carrot roots were assessed for CS severity midseason and postharvest. Evaluations postharvest indicated that the purple pigmented carrot from breeding line ‘USDA 106-3’ and cultivars ‘Purple Rain’ and ‘Purple Haze’ consistently had low CS severity. The orange-pigmented ‘USDA 101-23’, ‘Cellobunch’, ‘YaYa’, and ‘Envy’ had moderate CS; and the red-pigmented carrot breeding line ‘USDA 104-3’ and cultivars ‘Atomic Red’, ‘Proline Red’, ‘Dragon’, and an unnamed line from India had high CS. Differences in CS severity in carrot cultivars between evaluations at midseason and postharvest suggest that some carrot cultivars are more susceptible to Pythium spp. inoculum in soil (alloinfection) and others to secondary infection (autoinfection) that can be attributed to the Pythium sp. involved in CS. CS severity was positively correlated with total rainfall 2 and 3 months after seeding, and was negatively correlated with number of days with air temperature ≥30°C 3 and 4 months after seeding. Soil temperature and total rainfall were the best predictors of CS incidence and severity. These results could allow a forecast of disease incidence and severity at harvest.

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464. Structural Vulnerability among Patients with HIV and SARS-CoV-2 Coinfection: Descriptive Case Series from the U.S. Midwest

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.663 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S334-S335

Author(s):

Natasha E Hongsermeier-Graves ◽

Rohan Khazanchi ◽

Nada Fadul

Keyword(s):

Risk Factors ◽

Disease Progression ◽

Legal Status ◽

Medical Center ◽

Disease Incidence ◽

Demographic Data ◽

Case Series ◽

Retrospective Chart Review ◽

The United States ◽

Hiv Disease

Abstract Background It is well known that the HIV epidemic and COVID-19 pandemic have both disproportionately harmed marginalized minority and immigrant communities in the United States. The risk factors associated with disease incidence and outcomes reaffirm that structural vulnerabilities—sociopolitically imposed risk factors like discrimination, legal status, poverty, and beyond which impact a patient’s opportunity to achieve optimal health—play a key role in facilitating the inequitable harms of COVID-19 and HIV alike. This study explores the role of structural forces in increasing the risk of SARS-CoV-2 coinfection among people with HIV (PWH). Methods We performed a retrospective chart review of PWH receiving care at the University of Nebraska Medical Center HIV clinic in Omaha, Nebraska, to collect patient demographics, comorbidities, HIV outcomes, and COVID-19 outcomes for 37 patients with HIV and SARS-CoV-2 coinfection as of August 27, 2020. As a comparison group, we obtained demographic data from a registry of all patients seen at the HIV clinic. We used R Statistical Software to perform descriptive statistical analysis. Results Relative to our overall HIV clinic population, over twice as many Hispanic patients (35.1% vs. 16.0%), three times as many undocumented patients (13.5% vs. 4.2%), and four times as many refugee patients (16.2% vs. 4.0%) had COVID-19. The majority (67.6%) of coinfected patients reported working in “essential” jobs during the pandemic. Thirty-four of the 37 people with HIV and COVID-19 (PWHC) had at least one comorbidity, including increased BMI (83.7%), hypertension (64.9%), or hyperlipidemia (48.6%). All 37 PWHC remained alive as of October 4, 2020. Demographics and HIV Disease Progression of People with HIV and SARS-CoV-2 Coinfection vs. Overall HIV Clinic Registry Demographics and HIV Disease Progression of People with HIV and SARS-CoV-2 Coinfection vs. Overall HIV Clinic Registry (continued) Conclusion The disproportionate burden of SARS-CoV-2 coinfection on Hispanic, undocumented, and refugee PWH may be a product of structural vulnerabilities contributing to greater risk of exposure. Although all 37 PWHC had well-controlled HIV and relatively mild COVID-19 courses, the broader theme of disproportionate COVID-19 incidence among vulnerable sub-populations of people with HIV reaffirms the importance of structural interventions to mitigate current and downstream harms. Disclosures All Authors: No reported disclosures

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MON-LB003 Risk Factors For 30-day Readmission After Diabetic Ketoacidosis Using Nationwide Readmissions Database

Journal of the Endocrine Society ◽

10.1210/js.2019-mon-lb003 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Ron Varghese ◽

Diana Jacob ◽

Roy Kamoga ◽

Khaled Khasawneh ◽

Neal Mehta

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Multivariate Analysis ◽

Diabetic Ketoacidosis ◽

The United States ◽

Index Admission ◽

Multivariate Logistic Regression Model ◽

Endocrine Society ◽

Specific Patient ◽

Targeted Interventions

Abstract Introduction: Nearly 1 in 10 individuals in the United States have Diabetes Mellitus [1]. One potential preventable complication is Diabetic Ketoacidosis (DKA). Better understanding of the risk factors for readmissions of DKA will allow the development and implementation of specific patient-centered interventions to decrease future readmissions. We sought out to determine the 30-day all-cause readmission rate for adults (age > 18) admitted with DKA and the associated predictors of readmissions. Methods: We utilized Agency of Healthcare Research and Quality’s (AHRQ) Health Care Utilization Project’s (HCUP) 2014 Nationwide Readmission Database which includes 14.9 Million discharges across 22 states accounting for 51.2% of the total U.S. population and 49.3% of all U.S. hospitalizations to identify admissions with a DKA related ICD-9 diagnosis (250.10, 250.11, 250.12, and 250.13) associated with both Type 1 and Type 2 Diabetes Mellitus. Applicable admissions were all adults (age > 18)with an index hospitalization between January 1 and November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. All-cause readmission including DKA within 30-days of DKA were analyzed. Statistical analysis was completed with Stata 15 (StataCorp, College Station, TX) with p-values < 0.05 considered statistically significant. A univariate and multivariate analysis of data collected was completed using both odds ratio and chi square test for significance. Predictors for readmission were determined using a multivariate logistic regression model following sequential step-wise elimination of covariates including demographics, comorbidities, hospital characteristics, length of stay (LOS) for index admission, and the modified Elixhauser Comorbidity Index. Results: A total of 66,896 patients met criteria for DKA related index admission. Of which, there was 12,954 (19.36%) all-cause readmissions within 30-days including 7,167 were again for DKA accounting for 55.32% of all readmissions. Multivariate analysis showed that the predictors of 30-day readmission were younger age, (with adults age <35 the highest risk), female, disposition at discharge to short term hospital or home health or against medical advice), from a zip code with the lowest income quartile, Medicare as payer, lengthier LOS, presence of comorbidities, absence of obesity, and presence of renal failure. Conclusion: Almost 1 in 5 (19.36%) patients discharged after a DKA admission were readmitted within 30 days. Physician awareness and development of targeted interventions for individuals with risk factors and high-risk for readmissions may help decrease future morbidity and mortality. References: [1] CDC: National Diabetes Statistics Report (2017). https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

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Mapping the Trends in Esophageal Cancer Disease Burden in the United States: Results from the Global Burden of Disease Study 2017

10.21203/rs.2.21803/v1 ◽

2020 ◽

Author(s):

Di Lu ◽

Jintao Zhan ◽

Xiguang Liu ◽

Xiaoying Dong ◽

Siyang Feng ◽

...

Keyword(s):

United States ◽

Esophageal Cancer ◽

Burden Of Disease ◽

Disease Burden ◽

Disease Incidence ◽

The United States ◽

Global Burden Of Disease ◽

Global Burden ◽

Cancer Disease ◽

Life Years

Abstract Background: Esophageal cancer is the 7th leading cancer globally and the 10th leading cancer in the United States. However, it is has received limited attention over more common malignancies. Only a few studies have comprehensively assessed disease burden from esophageal cancer in the United States (US). Methods: Using states-categorized data on incidence, mortality, and Disability-adjusted Life Years (DALYs), this study analyzed the current trends in esophageal cancer disease burden. Data and risk factor indicators were obtained from Global Burden of Disease (GBD) online resource and used to determine annual relative change. Results: We report here that between 1990 and 2017, the number of esophageal cancer new cases, deaths and DALYs in the US increased significantly, while the Age-standardized Rate (ASR) of disease incidence remained constant. During the same time, disease burden from esophageal cancer in males was higher than that in females. Economically stronger states trend to had lesser disease burden from esophageal cancer. Smoking and alcohol use contributed most of the burden while influence of high body-mass index and diet low in fruits grew largely. Conclusions: This study provided an analysis of esophageal cancer disease burden in the United States that will inform the design of targeted strategies for disease prevention tailored to different states.

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Predictors of Premature Discontinuation of Opioid Use Disorder Treatment in the United States

10.1101/2021.07.26.21261080 ◽

2021 ◽

Author(s):

Celia Stafford ◽

Wesley Marrero ◽

Rebecca B. Naumann ◽

Kristen Hassmiller Lich ◽

Sarah Wakeman ◽

...

Keyword(s):

Risk Factors ◽

Substance Use ◽

The United States ◽

Opioid Use Disorder ◽

Geographic Region ◽

Influential Factors ◽

Opioid Use ◽

Living Situation ◽

Data Set ◽

Targeted Interventions

Over the last few decades, opioid use disorder (OUD) and overdose have dramatically increased. Evidence shows that treatment for OUD, particularly medication for OUD, is highly effective; however, despite decreases in barriers to treatment, retention in OUD treatment remains a challenge. Therefore, understanding key risk factors for OUD treatment discontinuation remains a critical priority. We built a machine learning model using the Treatment Episode Data Set-Discharge (TEDS-D). Included were 2,446,710 treatment episodes for individuals in the U.S. discharged between January 1, 2015 and December 31, 2018 (the most recent available data). Exposures contain 32 potential risk factors, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. Our findings show that the most influential risk factors include characteristics of treatment service setting, geographic region, primary source of payment, referral source, and health insurance status. Importantly, several factors previously reported as influential predictors, such as age, living situation, age of first substance use, race and ethnicity, and sex had far weaker predictive impacts. The influential factors identified in this study should be more closely explored to inform targeted interventions and improve future models of care.

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Rotavirus disease burden pre-vaccine introduction in young children in Rural Southern Mozambique, an area of high HIV prevalence

PLoS ONE ◽

10.1371/journal.pone.0249714 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249714

Author(s):

Sozinho Acácio ◽

Tacilta Nhampossa ◽

Llorenç Quintò ◽

Delfino Vubil ◽

Marcelino Garrine ◽

...

Keyword(s):

Risk Factors ◽

Disease Burden ◽

Conditional Logistic Regression ◽

Epidemiological Data ◽

Daily Basis ◽

African Countries ◽

Severe Diarrhea ◽

Vaccine Introduction ◽

Rotavirus Vaccines ◽

The Impact

Background Rotavirus vaccines have been adopted in African countries since 2009, including Mozambique (2015). Disease burden data are needed to evaluate the impact of rotavirus vaccine. We report the burden of rotavirus-associated diarrhea in Mozambique from the Global Enteric Multicenter Study (GEMS) before vaccine introduction. Methods A case-control study (GEMS), was conducted in Manhiça district, recruiting children aged 0–59 months with moderate-to-severe diarrhea (MSD) and less-severe-diarrhea (LSD) between December 2007 and November 2012; including 1–3 matched (age, sex and neighborhood) healthy community controls. Clinical and epidemiological data and stool samples (for laboratory investigation) were collected. Association of rotavirus with MSD or LSD was determined by conditional logistic regression and adjusted attributable fractions (AF) calculated, and risk factors for rotavirus diarrhea assessed. Results Overall 915 cases and 1,977 controls for MSD, and 431 cases and 430 controls for LSD were enrolled. Rotavirus positivity was 44% (217/495) for cases and 15% (160/1046) of controls, with AF = 34.9% (95% CI: 32.85–37.06) and adjusted Odds Ratio (aOR) of 6.4 p< 0.0001 in infants with MSD compared to 30% (46/155) in cases and 14% (22/154) in controls yielding AF = 18.7%, (95% CI: 12.02–25.39) and aOR = 2.8, p = 0.0011 in infants with LSD. The proportion of children with rotavirus was 32% (21/66) among HIV-positive children and 23% (128/566) among HIV-negative ones for MSD. Presence of animals in the compound (OR = 1.9; p = 0.0151) and giving stored water to the child (OR = 2.0, p = 0.0483) were risk factors for MSD; while animals in the compound (OR = 2.37, p = 0.007); not having routine access to water on a daily basis (OR = 1.53, p = 0.015) and washing hands before cooking (OR = 1.76, p = 0.0197) were risk factors for LSD. Conclusion The implementation of vaccination against rotavirus may likely result in a significant reduction of rotavirus-associated diarrhea, suggesting the need for monitoring of vaccine impact.

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Mutation Landscape of SARS COV2 in Africa

10.1101/2020.12.20.423630 ◽

2020 ◽

Author(s):

Angus A. Nassir ◽

Clarisse Musanabaganwa ◽

Ivan Mwikarago

Keyword(s):

Disease Burden ◽

Severe Disease ◽

Experimental Studies ◽

Low Frequency ◽

The United States ◽

Sub Saharan Africa ◽

Single Nucleotide ◽

Low Frequencies ◽

Sub Saharan

ABSTRACTCOVID-19 disease has had a relatively less severe impact in Africa. To understand the role of SARS CoV2 mutations on COVID-19 disease in Africa, we analysed 282 complete nucleotide sequences from African isolates deposited in the NCBI Virus Database. Sequences were aligned against the prototype Wuhan sequence (GenBank accession: NC_045512.2) in BWA v. 0.7.17. SAM and BAM files were created, sorted and indexed in SAMtools v. 1.10 and marked for duplicates using Picard v. 2.23.4. Variants were called with mpileup in BCFtools v. 1.11. Phylograms were created using Mr. Bayes v 3.2.6. A total of 2,349 single nucleotide polymorphism (SNP) profiles across 294 sites were identified. Clades associated with severe disease in the United States, France, Italy, and Brazil had low frequencies in Africa (L84S=2.5%, L3606F=1.4%, L3606F/V378I/=0.35, G251V=2%). Sub Saharan Africa (SSA) accounted for only 3% of P323L and 4% of Q57H mutations in Africa. Comparatively low infections in SSA were attributed to the low frequency of the D614G clade in earlier samples (25% vs 67% global). Higher disease burden occurred in countries with higher D614G frequencies (Egypt=98%, Morocco=90%, Tunisia=52%, South Africa) with D614G as the first confirmed case. V367F, D364Y, V483A and G476S mutations associated with efficient ACE2 receptor binding and severe disease were not observed in Africa. 95% of all RdRp mutations were deaminations leading to CpG depletion and possible attenuation of virulence. More genomic and experimental studies are needed to increase our understanding of the temporal evolution of the virus in Africa, clarify our findings, and reveal hot spots that may undermine successful therapeutic and vaccine interventions.

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Role of high-dose exposure in transmission hot zones as a driver of SARS-CoV2 dynamics

10.1101/2020.10.07.20208231 ◽

2020 ◽

Author(s):

Dominik Wodarz ◽

Natalia L. Komarova ◽

Luis M. Schang

Keyword(s):

Severe Disease ◽

Epidemiological Data ◽

High Dose ◽

Infection Prevalence ◽

Targeted Interventions ◽

Mild Disease ◽

Successful Infection ◽

Hot Zone ◽

Infection Spread

AbstractEpidemiological data on the spread of SARS-CoV-2 in the absence and presence of various non-pharmaceutical interventions indicate that the virus is not transmitted uniformly in the population. Transmission tends to be more effective in select settings that involve exposure to relatively high viral dose, such as in crowded indoor settings, assisted living facilities, prisons, or food processing plants. To explore the effect on infection dynamics, we describe a new mathematical model where transmission can occur (i) in the community at large, characterized by low dose exposure and mostly mild disease, and (ii) in so called transmission hot zones, characterized by high dose exposure that can be associated with more severe disease. Interestingly, we find that successful infection spread can hinge upon high-dose hot zone transmission, yet the majority of infections are predicted to occur in the community at large with mild disease. This gives rise to the prediction that targeted interventions that specifically reduce virus transmission in the hot zones (but not in the community at large) have the potential to suppress overall infection spread, including in the community at large. The model can further reconcile seemingly contradicting epidemiological observations. While in some locations like California, strict stay-home orders failed to significantly reduce infection prevalence, in other locations, such as New York and several European countries, stay-home orders lead to a pronounced fall in infection levels, which remained suppressed for some months after re-opening of society. Differences in hot zone transmission levels during and after social distancing interventions can account for these diverging infection patterns. These modeling results warrant further epidemiological investigations into the role of high dose hot zone transmission for the maintenance of SARS-CoV-2 spread.

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Epidemiology of mucopolysaccharidoses (MPS) in United States: challenges and opportunities

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01880-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yana Puckett ◽

Alejandra Mallorga-Hernández ◽

Adriana M. Montaño

Keyword(s):

United States ◽

Disease Incidence ◽

State Level ◽

The United States ◽

Incidence Rates ◽

Mandated Reporting ◽

Prevalence Rates ◽

Lysosomal Storage ◽

Live Births ◽

The Us

Abstract Background Mucopolysaccharidoses (MPS) are rare, inherited lysosomal storage disorders characterized by progressive multiorgan involvement. Previous studies on incidence and prevalence of MPS mainly focused on countries other than the United States (US), showing considerable variation by country. This study aimed to identify MPS incidence and prevalence in the US at a national and state level to guide clinicians and policy makers. Methods This retrospective study examined all diagnosed cases of MPS from 1995 to 2015 in the US using the National MPS Society database records. Data included year of birth, patient geographic location, and MPS variant type. US population information was obtained from the National Center for Health Statistics. The incidence and prevalence rates were calculated for each disease. Incidence rates were calculated for each state. Results We obtained information from 789 MPS patients during a 20-year period. Incidence of MPS in the US was found to be 0.98 per 100,000 live births. Prevalence was found to be 2.67 per 1 million. MPS I, II, and III had the highest incidence rate at birth (0.26/100,000) and prevalence rates of 0.70–0.71 per million. Birth incidences of MPS IV, VI, and VII were 0.14, 0.04 and 0.027 per 100,000 live births. Conclusions This is the most comprehensive review of MPS incidence and prevalence rates in the US. Due to the large US population and state fragmentation, US incidence and prevalence were found to be lower than other countries. Nonetheless, state-level studies in the US supported these figures. Efforts should be focused in the establishment of a national rare disease registry with mandated reporting from every state as well as newborn screening of MPS.

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