scholarly journals The Relationship Between Age, Gender, Race, Diabetes and Obesity on Clinical Outcomes in a Large Cohort of Patients Hospitalized for Covid-19 in Metropolitan Detroit

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A351-A351
Author(s):  
Jaspreet Hehar ◽  
Erika Todter ◽  
Sharon Wu Lahiri
Keyword(s):  
African American ◽  
African Americans ◽  
Inflammatory Markers ◽  
Severe Disease ◽  
Significant Proportion ◽  
Male Gender ◽  
Icu Admission ◽  
Henry Ford ◽  
Poor Outcomes ◽  
American Ethnicity

Abstract The Severe Acute Respiratory Syndrome Coronavirus-2 infection has resulted in a global pandemic with survival statistics 95–99%, however severe disease has been described. This is a retrospective cohort study of patients > age 18 admitted to Henry Ford Health System in Detroit from March 1 - June 1, 2020 for COVID-19 infection with aims to: 1. Determine the incidence of poor outcomes (mechanical ventilation (MV), ICU admission, death, and venous thromboembolism (VTE)), 2. Describe the clinical characteristics of this group, and 3. Evaluate relationships between demographics, diabetes mellitus (DM), obesity, and inflammatory markers on outcomes. We hypothesized that older age, male gender, African American ethnicity, DM, obesity, and elevated inflammatory markers would predict poor outcomes. 8751 inpatients were included, of whom 682 (7.79%) required MV, 867 (9.91%) were admitted to the ICU, 753 (8.6%) died, and 430 (4.91%) had VTE. 4447 (50.8%) were African American, 4951 (56.6%) female, 5152 (58.9%) > age 50, and 2068 (23.6%) had DM. Of those who had BMI and A1c recorded, 2556 (50.2%) had BMI >30 kg/m2 and 1138 (74.3%) had A1c >5.7%. Analyses controlling for demographics and comorbidities found that age and male gender were significant predictors of MV (OR = 1.031; CI= 1.025–1.037; P < 0.0001, OR =2.023; CI= 1.700–2.407; P<0.0001), ICU admission (OR 1.024; CI= 1.018–1.029; P<0.0001, OR 1.824; CI= 1.561–2.130; P<0.001), death (OR 1.077; CI= 1.069–1.085; P<0.0001, OR 1.823; CI= 1.521–2.185; P<0.0001), and VTE (OR 1.021; CI= 1.014–1.028; P<0.001, OR 1.293; CI= 1.043–1.603; P=0.0193). African American, compared to Caucasian ethnicity, was significantly associated with MV (OR 1.437; CI= 1.131–1.825; P=0.0009) and ICU admission (OR 1.428; CI= 1.150–1.773; P=0.0002), but not VTE. African Americans had significantly lower odds of death relative to Caucasians (OR 0.765; CI=0.604–0.969; P=0.0200). DM predicted MV (OR 1.999; CI= 1.677–2.383; P<0.0001), ICU admission (OR 2.014; CI= 1.717–2.364; P<0.0001), death (OR 1.501; CI= 1.250–1.803; P<0.0001), and VTE (OR 1.468; CI= 1.171–1.840; P=0.0009). Obesity predicted MV (OR 1.540; CI= 1.284–1.847; P<0.0001) and ICU admission (OR 1.395; CI= 1.186–1.642; P<0.0001) but not death or VTE. All inflammatory markers (D-dimer, ferritin, CRP, IL-6 and procalcitonin) were significantly correlated with MV and death. 3 of the 5 markers were also predictive of both ICU admission and VTE. This large retrospective study of a diverse population with a significant proportion of African Americans highlights the importance of taking age, male gender, African American ethnicity, presence of DM and obesity into account when determining risk of poor outcomes. These results contribute to the growing data on disparities in health care which have become more evident during this pandemic and the need to address this when designing public policy.

scholarly journals Lack of Association Between 25-Hydroxyvitamin D Level and Outcomes in Hospitalized Indian Patients With COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A277-A278
Author(s):  
Ganesh Jevalikar ◽  
Rutuja Sharma ◽  
Khalid J Farooqui ◽  
Anshu Singh ◽  
Sandeep Budhiraja ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Inflammatory Markers ◽  
Severe Disease ◽  
Laboratory Data ◽  
Ordinal Scale ◽  
Nasopharyngeal Swab ◽  
Icu Admission ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D ◽  
D Dimer

Abstract Vitamin D deficiency (VDD) is thought to play a role in determining the outcomes of COVID-19. India has a high prevalence of VDD. We hypothesized that VDD as measured by serum 25-hydroxyvitamin D (25OHD) <20 ng/mL is associated with severe COVID-19 infection. Outcomes were assessed by the WHO ordinal scale for clinical improvement (OSCI)1, the need for oxygen therapy, admission to an intensive care unit (ICU), and inflammatory markers. The diagnosis of COVID-19 was proven by RT-PCR on the nasopharyngeal swab for SARS-CoV2. Serum 25OHD and PTH were measured in addition to the standard protocol for COVID-19. Clinical and laboratory data were extracted from electronic medical records and analyzed using SPSS v22.0. Patients with OSCI score < 5 were classified as mild and ≥5 as severe disease. The study was approved by the Institutional Ethics Committee. A total of 410 patients (127 females, 9 pediatric, 17 asymptomatic) were included with a median age of 54 years (6–92 years) with 272(66.3%) having at least one co-morbid condition, including diabetes (190, 46.3%) and hypertension (164,40%). Patients with VDD (197,48%) were significantly younger (46.7±17.1 vs. 57.8±14.7 years) and had lesser prevalence of diabetes and hypertension (39.1% vs 52.4%, 29.4% vs 49.5%). Proportion of severe cases (26,13.2% vs. 31,14.6%), mortality (4, 2% vs. 11, 5.2%), oxygen requirement (68,34.5% vs.92,43.4), ICU admission (29, 14.7% vs. 42, 19.8%), need for inotropes (7,3.6% vs.12,5.7%) was not significantly different between patients with VDD and those with normal 25OHD level. The proportion of severe cases was similar across all 25OHD categories. There was no significant correlation between 25OHD levels and outcome OSCI, inflammatory markers (CRP, IL-6, D-dimer, ferritin, LDH). PTH levels positively correlated with D-dimer (r 0.117, p- 0.019), ferritin (r 0.132, p-0.010) and LDH (r0.124, p-0.018). Amongst VDD patients, 128(64.9%) were treated with cholecalciferol with a median dose of 60000 IU. The proportion of severe cases, oxygen, or ICU admission was not significantly different in the treated vs. untreated group. In conclusion, baseline levels of 25OHD did not determine the severe clinical outcomes of COVID-19 or levels of inflammatory markers. Treatment with cholecalciferol did not make any difference to the clinical outcomes of those with VDD. Reference:1WHO R&D Blueprint, novel Coronavirus. Retrieved from: https://www.who.int/blueprint/priority-diseases/key-action/COVID-19_Treatment_Trial_Design_Master_Protocol_synopsis_Final_18022020.pdf

scholarly journals Undiagnosed Kidney Injury in Uninsured and Underinsured Diabetic African American Men and Putative Role of Meprin Metalloproteases in Diabetic Nephropathy

2018 ◽  
Vol 2018 ◽  
pp. 1-16 ◽  
Author(s):  
Lei Cao ◽  
Rashin Sedighi ◽  
Ava Boston ◽  
Lakmini Premadasa ◽  
Jamilla Pinder ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Kidney Disease ◽  
African American Men ◽  
Significant Proportion ◽  
Kidney Injury ◽  
Diabetic Patients ◽  
Targeted Interventions ◽  
Meprin Metalloproteases ◽  
Kidney Injury Molecule 1

Diabetes is the leading cause of chronic kidney disease. African Americans are disproportionately burdened by diabetic kidney disease (DKD) and end stage renal disease (ESRD). Disparities in DKD have genetic and socioeconomic components, yet its prevalence in African Americans is not adequately studied. The current study used multiple biomarkers of DKD to evaluate undiagnosed DKD in uninsured and underinsured African American men in Greensboro, North Carolina. Participants consisted of three groups: nondiabetic controls, diabetic patients without known kidney disease, and diabetic patients with diagnosed DKD. Our data reveal undiagnosed kidney injury in a significant proportion of the diabetic patients, based on levels of both plasma and urinary biomarkers of kidney injury, namely, urinary albumin to creatinine ratio, kidney injury molecule-1, cystatin C, and neutrophil gelatinase-associated lipocalin. We also found that the urinary levels of meprin A, meprin B, and two kidney meprin targets (nidogen-1 and monocytes chemoattractant protein-1) increased with severity of kidney injury, suggesting a potential role for meprin metalloproteases in the pathophysiology of DKD in this subpopulation. The study also demonstrates a need for more aggressive tests to assess kidney injury in uninsured diabetic patients to facilitate early diagnosis and targeted interventions that could slow progression to ESRD.

scholarly journals Characteristics and Outcomes of Latinx Patients With COVID-19 in Comparison With Other Ethnic and Racial Groups

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Saef Izzy ◽  
Zabreen Tahir ◽  
David J Cote ◽  
Ali Al Jarrah ◽  
Matthew Blake Roberts ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Asian American ◽  
Age Groups ◽  
Racial Groups ◽  
Icu Admission ◽  
Younger Age ◽  
Multivariable Regression ◽  
The Impact ◽  
White Patients

Abstract Background There is a limited understanding of the impact of coronavirus disease 2019 (COVID-19) on the Latinx population. We hypothesized that Latinx patients would be more likely to be hospitalized and admitted to the intensive care unit (ICU) than White patients. Methods We analyzed all patients with COVID-19 in 12 Massachusetts hospitals between February 1 and April 14, 2020. We examined the association between race, ethnicity, age, reported comorbidities, and hospitalization and ICU admission using multivariable regression. Results Of 5190 COVID-19 patients, 29% were hospitalized; 33% required the ICU, and 4.3% died. Forty-six percent of patients were White, 25% Latinx, 14% African American, and 3% Asian American. Ethnicity and race were significantly associated with hospitalization. More Latinx and African American patients in the younger age groups were hospitalized than whites. Latinxs and African Americans disproportionally required the ICU, with 39% of hospitalized Latinx patients requiring the ICU compared with 33% of African Americans, 24% of Asian Americans, and 30% of Whites (P < .007). Within each ethnic and racial group, age and male gender were independently predictive of hospitalization. Previously reported preexisting comorbidities contributed to the need for hospitalization in all racial and ethnic groups (P < .05). However, the observed disparities were less likely related to reported comorbidities, with Latinx and African American patients being admitted at twice the rate of Whites, regardless of such comorbidities. Conclusions Latinx and African American patients with COVID-19 have higher rates of hospitalization and ICU admission than White patients. The etiologies of such disparities are likely multifactorial and cannot be explained only by reported comorbidities.

scholarly journals COVID-19 Pandemic Highlights Health Disparities in Latinos in San Diego

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-30
Author(s):  
Elisa Quiroz ◽  
David J Hermel ◽  
Samantha R Bagsic ◽  
Carrie L. Costantini ◽  
Anuj Mahindra ◽  
...  
Keyword(s):  
Latin American ◽  
San Diego ◽  
Myelogenous Leukemia ◽  
Blood Type ◽  
High Rate ◽  
San Diego County ◽  
P Value ◽  
Icu Admission ◽  
Poor Outcomes ◽  
American Ethnicity

Introduction: Minority healthcare disparities are well known in many areas of medicine. Higher mortality has been reported in minorities with different cancer types despite adjusting for income or education. In hematological malignancies the trend persists. Despite favorable prognostic factors upon diagnosis of acute myelogenous leukemia, the mortality risk for Latinos and African Americans is higher by 12% and 7%, respectively. Both incidence and mortality in acute lymphoblastic leukemia are highest in Latinos. In Hodgkin's Lymphoma, Latino and African American adolescents and young adults have a higher risk of death at 35% and 62%, respectively. The COVID-19 pandemic has drawn attention to the immense disparities in healthcare outcomes in minority communities. Disproportionate rates of hospitalization and death related to COVID-19 have been reported across the nation, highlighting the stark consequences of historic racial and economic injustices. With these findings comes a call to action and an urgency to create systemic change to promote health equity. Methods: Patients hospitalized at any Scripps Health hospital in San Diego County from March 1, 2020 to July 30, 2020 with a PCR confirmed diagnosis of COVID-19 and blood type were included in the analysis (n = 316). Demographic, laboratory and clinical data were extracted from the electronic medical record and included age, ethnicity, BMI, sex, medications, co-morbidities, blood type, white blood cell count, lymphocyte count, hemoglobin, platelets, ESR, CRP and D-dimer. Outcomes of interest included length of say (LOS), intensive care unit (ICU) admission, intubation and mortality. Analysis was performed with an a priori predictor of Latin American ethnicity. Linear regression analysis of LOS, logistic regression of other variables and age-adjusted regression was done. Demographic characteristics that were predictive in univariate analysis with p< 0.1 were included in a multiple regression model for each outcome with Latin American ethnicity as a predictor. If the potentially predictive demographic characteristic maintained trends toward significance (p<0.1), the predictor was retained in the model to produce the final regression results for each outcome. Results: Hospitalized COVID patients were predominantly male, obese (BMI 30.6) and average age was 63 years. 69.3% of patients were Hispanic. 65.51% of patients were diabetic, 26.27% had chronic kidney disease and 23.10% had congestive heart failure. Additional patient characteristics are included in Table 1. Median length of hospital stay was 16.5 days, 59% were admitted to the ICU, 37% were intubated, and 27% died. Blood type was not found to be a predictor of outcomes. The odds ratio (OR) of age adjusted LOS for Latinos was 1.01 days (p-value 0.60), 1.06 for ICU admission (p-value 0.80) and 0.82 for death (p-value 0.50). After adjusting for age and other potentially predictive characteristics, Hispanic ethnicity was not predictive of poor outcomes. Conclusion: In this retrospective analysis of patients hospitalized for COVID-19 in San Diego County, there was a strikingly high rate of hospitalizations in Latino patients. While the 2019 United States Census estimates the Latino population in San Diego to be 34.1%, Latinos comprised nearly 70% of patients hospitalized with COVID-19 in the Scripps Health system. Despite the high rate of admissions in Latino patients, Latin American ethnicity was not a predictor of poor outcomes as previously reported in other populations. The underlying etiology of the high rates of COVID-19 hospital admission in Latinos is likely multifactorial due to overcrowding, lack of access to healthcare and higher prevalence of chronic illness as demonstrated by our cohort's increased incidence of co-morbid conditions. Disclosures No relevant conflicts of interest to declare.

scholarly journals Lack of association of baseline 25-hydroxyvitamin D levels with disease severity and mortality in Indian patients hospitalized for COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ganesh Jevalikar ◽  
Ambrish Mithal ◽  
Anshu Singh ◽  
Rutuja Sharma ◽  
Khalid J. Farooqui ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Prospective Observational Study ◽  
Severe Disease ◽  
Ordinal Scale ◽  
Oxygen Requirement ◽  
Immunomodulatory Effects ◽  
Median Dose ◽  
Icu Admission ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

AbstractVitamin D deficiency (VDD) owing to its immunomodulatory effects is believed to influence outcomes in COVID-19. We conducted a prospective, observational study of patients, hospitalized with COVID-19. Serum 25-OHD level < 20 ng/mL was considered VDD. Patients were classified as having mild and severe disease on basis of the WHO ordinal scale for clinical improvement (OSCI). Of the 410 patients recruited, patients with VDD (197,48.2%) were significantly younger and had lesser comorbidities. The levels of PTH were significantly higher in the VDD group (63.5 ± 54.4 vs. 47.5 ± 42.9 pg/mL). The proportion of severe cases (13.2% vs.14.6%), mortality (2% vs. 5.2%), oxygen requirement (34.5% vs.43.4%), ICU admission (14.7% vs.19.8%) was not significantly different between patients with or without VDD. There was no significant correlation between serum 25-OHD levels and inflammatory markers studied. Serum parathormone levels correlated with D-dimer (r 0.117, p- 0.019), ferritin (r 0.132, p-0.010), and LDH (r 0.124, p-0.018). Amongst VDD patients, 128(64.9%) were treated with oral cholecalciferol (median dose of 60,000 IU). The proportion of severe cases, oxygen, or ICU admission was not significantly different in the treated vs. untreated group. In conclusion, serum 25-OHD levels at admission did not correlate with inflammatory markers, clinical outcomes, or mortality in hospitalized COVID-19 patients. Treatment of VDD with cholecalciferol did not make any difference to the outcomes.

scholarly journals Lack of Association of Baseline 25-Hydroxyvitamin D Levels and Cholecalciferol Treatment With Disease Severity and Mortality in Indian Patients Hospitalized for Covid-19

2020 ◽  
Author(s):  
Ganesh Jevalikar ◽  
Ambrish Mithal ◽  
Anshu Singh ◽  
Rutuja Sharma ◽  
Khalid Farooqui ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Prospective Observational Study ◽  
Severe Disease ◽  
Ordinal Scale ◽  
Oxygen Requirement ◽  
Immunomodulatory Effects ◽  
Median Dose ◽  
Icu Admission ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

Abstract Vitamin D deficiency (VDD) owing to its immunomodulatory effects is believed to influence outcomes in COVID-19. We conducted a prospective, observational study of patients, hospitalized with COVID-19. Serum 25-OHD level < 20 ng/mL was considered VDD. Patients were classified as having mild and severe disease on basis of the WHO ordinal scale for clinical improvement (OSCI). Of the 410 patients recruited, patients with VDD (197,48∙2%) were significantly younger and had lesser comorbidities. The proportion of severe cases (13∙2% vs.14∙6%), mortality (2% vs. 5∙2%), oxygen requirement (34∙5% vs.43∙4%), ICU admission (14∙7% vs.19∙8%) was not significantly different between patients with or without VDD. There was no significant correlation between serum 25-OHD levels and inflammatory markers studied. Serum parathormone levels correlated with D-dimer (r 0∙117, p- 0∙019), ferritin (r 0∙132, p-0∙010), and LDH (r 0∙124, p-0∙018). Amongst VDD patients, 128(64.9%) were treated with oral cholecalciferol (median dose of 60000 IU). The proportion of severe cases, oxygen, or ICU admission was not significantly different in the treated vs. untreated group. In conclusion, serum 25-OHD levels at admission did not correlate with inflammatory markers, clinical outcomes, or mortality in hospitalized COVID-19 patients. Treatment of VDD with cholecalciferol did not make any difference to the outcomes.

Survival trends of patients with metastatic pancreatic cancer: A Surveillance Epidemiology and End Results registry trend analysis from 1988 to 2008.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14544-e14544
Author(s):  
Mathias Worni ◽  
Ulrich Guller ◽  
Rebekah Ruth White ◽  
Ricardo Pietrobon ◽  
Thomas Cerny ◽  
...  
Keyword(s):  
Overall Survival ◽  
African American ◽  
Pancreatic Head ◽  
Palliative Radiotherapy ◽  
Tumor Location ◽  
Male Gender ◽  
The Body ◽  
Dismal Prognosis ◽  
Civil Status ◽  
American Ethnicity

e14544 Background: Pancreatic adenocarcinoma (PAC) is a disease with dismal prognosis. Only a minority of patients with PAC presents with a resectable tumor and can potentially be cured. Therapeutic options for non-resectable, metastatic tumors are limited and chemotherapy with or without radiation is purely palliative. The aim of the present study was twofold: first, to evaluate predictors of overall survival (OS), and second, to assess trends in OS and in the use of palliative radiotherapy among patients with metastatic PAC. Methods: Patients with metastatic PAC were extracted from the SEER cancer registry from 1988 to 2008. While SEER does contain information regarding radiotherapy and surgery, data on chemotherapy cannot be ascertained. Predictors and trends of OS were assessed using univariate and multivariable Cox proportional hazard models. The trend in use of radiotherapy was analyzed using univariate and multivariable logistic regression models. Results: Overall, 23,387 patients were included (mean age: 68.0±11.8 years); 47.0% of patients were female, tumor location was in the pancreatic head in 57.7% of all patients. Median OS was 3 months. In risk-adjusted analyses, tumor location in the pancreatic body/tail was associated with worse overall survival compared to tumors of the pancreatic head (HR: 1.10, CI: 1.07-1.13, p<0.001). Increasing age, African-American ethnicity, male gender, and non-married civil status were associated with significantly worse OS. From 1988 to 2008, OS increased from a median survival of 2 (95% CI: 2-2) to 3 months (CI: 3-4) months (HR per year: 0.978, CI: 0.976-0.981, p<0.001). From 1988 to 2008, radiotherapy use decreased from 13.2% to 5.8% (adj. OR per year: 0.95, CI: 0.93-0.96, p<0.001). Conclusions: Metastatic PAC remains a disease with poor prognosis with only minimal improvement in OS over a 20-year time-period. The use of palliative radiotherapy has decreased. Tumor location in the body/tail of the pancreas, increasing age, African-American ethnicity, male gender, and non-married civil status were associated with worse OS. Future research is needed to improve OS of metastatic PAC on a population-based level.

scholarly journals Profiles of Reading Motivation among African American and Caucasian Students

2009 ◽  
Vol 41 (3) ◽  
pp. 317-353 ◽  
Author(s):  
John T. Guthrie ◽  
Cassandra S. Coddington ◽  
Allan Wigfield
Keyword(s):  
African American ◽  
Reading Comprehension ◽  
African Americans ◽  
Intrinsic Motivation ◽  
Significant Proportion ◽  
The Other ◽  
Grade 5 ◽  
Perceived Difficulty ◽  
American Students ◽  
Caucasian Students

Previous research has investigated motivations for reading by examining positive or affirming motivations, including intrinsic motivation and self-efficacy. Related to them, we examined two negative, or undermining, motivations consisting of avoidance and perceived difficulty. We proposed that the motivations of intrinsic motivation and avoidance are relatively independent and thus can be combined to form meaningful profiles consisting of avid, ambivalent, apathetic, and averse readers. With Grade 5 students we found that these motivations were relatively independent for both Caucasian and African American students. The two motivations uniquely explained a significant proportion of variance in reading comprehension and other cognitive reading variables. Although intrinsic motivation correlated higher with achievement than avoidance for Caucasians, avoidance correlated higher with achievement than intrinsic motivation for African Americans. For both groups, the profile of avid readers showed higher reading achievement than the other profiles.

More Shadow than Substance

2017 ◽  
Author(s):  
Leah Wright Rigueur
Keyword(s):  
African American ◽  
African Americans ◽  
Substance P ◽  
National Committee ◽  
Party Leaders ◽  
Political Ideas ◽  
Black Republicans ◽  
State And Local ◽  
American Party ◽  
Local Party

This chapter studies how, as the 1970s progressed, black Republicans were able to claim clear victories in their march toward equality: the expansion of the National Black Republican Council (NBRC); the incorporation of African Americans into the Republican National Committee (RNC) hierarchy; scores of black Republicans integrating state and local party hierarchies; and individual examples of black Republican success. African American party leaders could even point to their ability to forge a consensus voice among the disparate political ideas of black Republicans. Despite their ideological differences, they collectively rejected white hierarchies of power, demanding change for blacks both within the Grand Old Party (GOP) and throughout the country. Nevertheless, black Republicans quickly realized that their strategy did not reform the party institution.

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