Retrospective analysis of demographic factors in COVID-19 patients entering the Mount Sinai Health System

With the continued rise of the global incidence of COVID-19 infection and emergent second wave, the need to understand characteristics that impact susceptibility to infection, clinical severity, and outcomes remains vital. The objective of this study was to assess modifying effects of demographic factors on COVID-19 testing status and outcomes in a large, diverse single health system cohort. The Mount Sinai Health System de-identified COVID-19 database contained records of 39,539 patients entering the health system from 02/28/2020 to 06/08/2020 with 7,032 laboratory-confirmed cases. The prevalence of qRT-PCR nasopharyngeal swabs (χ2 = 665.7, p<0.0001) and case rates (χ2 = 445.3, p<0.0001) are highest in Hispanics and Black or African Americans. The likelihood of admission and/or presentation to an intensive care unit (ICU) versus non-ICU inpatient unit, emergency department, and outpatient services, which reflects the severity of the clinical course, was also modified by race and ethnicity. Females were less likely to be tested [Relative Risk(RR) = 1.121, p<0.0001], and males had a higher case prevalence (RR = 1.224, p<0.001). Compared to other major ethnic groups, Whites experienced a higher prevalence of mortality (p<0.05). Males experienced a higher risk of mortality (RR = 1.180, p = 0.0012) at relatively younger ages (70.58±11.75) compared to females (73.02±11.46) (p = 0.0004). There was an increased severity of disease in older patient populations of both sexes. Although Hispanic and Black or African American race was associated with higher testing prevalence and positive testing rates, the only disparity with respect to mortality was a higher prevalence in Whites.

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Comorbidities, sequelae, blood biomarkers and their associated clinical outcomes in the Mount Sinai Health System COVID-19 patients

PLoS ONE ◽

10.1371/journal.pone.0253660 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0253660

Author(s):

Agnieszka Brojakowska ◽

Abrisham Eskandari ◽

Malik Bisserier ◽

Jeffrey Bander ◽

Venkata Naga Srikanth Garikipati ◽

...

Keyword(s):

Health System ◽

Mortality Risk ◽

Kidney Injury ◽

Study Data ◽

Clinical Severity ◽

Blood Biomarkers ◽

Risk Of Mortality ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Mount Sinai

With the continuing rise of SARS-CoV2 infection globally and the emergence of various waves in different countries, understanding characteristics of susceptibility to infection, clinical severity, and outcomes remain vital. In this retrospective study, data was extracted for 39,539 patients from the de-identified Mount Sinai Health System COVID-19 database. We assessed the risk of mortality based on the presence of comorbidities and organ-specific sequelae in 7,032 CoV2 positive (+) patients. Prevalence of cardiovascular and metabolic comorbidities was high among SARS-CoV2+ individuals. Diabetes, obesity, coronary artery disease, hypertension, atrial fibrillation, and heart failure all increased overall mortality risk, while asthma did not. Ethnicity modified the risk of mortality associated with these comorbidities. With regards to secondary complications in the setting of infection, individuals with acute kidney injury and acute myocardial injury showed an increase in mortality risk. Cerebral infarcts and acute venous thromboembolic events were not associated with increased risk of mortality. Biomarkers for cardiovascular injury, coagulation, and inflammation were compared between deceased and survived individuals. We found that cardiac and coagulation biomarkers were elevated and fell beyond normal range more often in deceased patients. Several, but not all, inflammatory markers evaluated were increased in deceased patients. In summary, we identified comorbidities and sequelae along with peripheral blood biomarkers that were associated with elevated clinical severity and poor outcomes in COVID-19 patients. Overall, these findings detail the granularity of previously reported factors which may impact susceptibility, clinical severity, and mortality during the course of COVID-19 disease.

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Effects and utility of an online forward triage tool during the SARS-CoV-2 pandemic: patient perspectives (Preprint)

10.2196/preprints.26553 ◽

2020 ◽

Author(s):

Janet Michel

Keyword(s):

Decision Making ◽

Health System ◽

Information Source ◽

Patient Perspectives ◽

User Friendliness ◽

Fear And Anxiety ◽

Mail Address ◽

Second Wave ◽

E Mail

BACKGROUND Background: Online forward triage tools (OFTT) or symptom checkers are being widely used during this COVID-19 pandemic. The effects and utility of such tools however, have not been widely assessed. OBJECTIVE Objective: To assess the effects (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, exploring patient perspectives as well as eliciting recommendations for tool improvement. METHODS Methods: We employed a mixed-method sequential explanatory study design. Quantitative data of all users of the OFTT between March 2nd, 2020 and May 12th, 2020 were collected. A follow-up survey of people who consented to participation was conducted. Secondly, qualitative data was collected through key informant interviews (n=19) to explain the quantitative findings, as well as explore tool utility, user experience and elicit recommendations. RESULTS Results: An estimate of the effects, (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, and recommendations for tool improvement. In the study period, 6,272 users consulted our OFTT; 560 participants consented to a follow-up survey and provided a valid e-mail address. 176 (31.4%) participants returned a complete follow-up questionnaire. 85.2% followed the recommendations given. 41.5% reported that their fear was allayed after using tool and 41.1% would have contacted the GP or visited a hospital had the tool not existed. Qualitatively, seven overarching themes emerged namely i) accessibility of tool, ii) user-friendliness of tool, iii) utility of tool as an information source, iv) utility of tool in allaying fear and anxiety, v) utility of tool in decision making (test or not to test), vi) utility of tool in reducing the potential for onward transmissions (preventing cross infection) and vii) utility of tool in reducing health system burden. CONCLUSIONS Conclusion: Our findings demonstrated that a COVID-19 OFTT does not only reduce the health system burden, but can also serve as an information source, reduce anxiety and fear, reduce cross infections and facilitate decision making (to test or not to test). Further studies are needed to assess the transferability of these COVID-19 OFTT findings to other contexts as the second wave sweeps across Europe.

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Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-10477-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sajad Vahedi ◽

Amin Torabipour ◽

Amirhossein Takian ◽

Saeed Mohammadpur ◽

Alireza Olyaeemanesh ◽

...

Keyword(s):

Health System ◽

Age Groups ◽

Unmet Need ◽

Healthcare Services ◽

Cross Sectional Study ◽

Outpatient Services ◽

Self Medication ◽

Cross Sectional ◽

Organizational Policies ◽

Utilization Of Healthcare

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

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Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns

BMJ Open ◽

10.1136/bmjopen-2019-029340 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029340 ◽

Cited By ~ 3

Author(s):

Usnish B Majumdar ◽

Christophe Hunt ◽

Patrick Doupe ◽

Aaron J Baum ◽

David J Heller ◽

...

Keyword(s):

New York ◽

Health System ◽

Urban Health ◽

Low Income ◽

Chronic Conditions ◽

Cross Sectional Study ◽

Multiple Chronic Conditions ◽

Cross Sectional ◽

Study Population ◽

Mount Sinai

ObjectiveTo (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs.DesignRetrospective cross-sectional study.SettingMount Sinai Health System, set in all five boroughs of New York City, USA.Participants192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014.MethodsWe classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected.Results61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%.ConclusionsIn this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.

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Methods for assessing the need for health financing: international experience (analytical review)

Health Care of the Russian Federation ◽

10.47470/0044-197x-2021-65-3-261-268 ◽

2021 ◽

Vol 65 (3) ◽

pp. 261-268

Author(s):

Elena G. Potapchik

Keyword(s):

Health System ◽

Health Spending ◽

Demographic Factors ◽

Health Financing ◽

Developed Countries ◽

International Experience ◽

World Health ◽

Free Text ◽

Spending Growth ◽

The Government

There has been an active discussion on estimating the need for public funding of the domestic health system. An analysis of international experience can be helpful to determine methodological approaches to estimate the market for government spending on the Russian health system. Aim. To systemize and summarize approaches and methods used in international practice to estimate the need for health financing; to highlight the most important factors dictating the need for additional funding. Material and methods. A systematic search with the developed protocol for publications, a comprehensive analysis and systematization of the obtained information. The protocol included databases of peer-reviewed publications, search terms, and search restrictions. The search for publications was carried out in the databases of Embase, Pubmed, Medline, Global Health, etc., on the websites of international organizations (World Health Organization (WHO), Organization for Economic Cooperation and Development (OECD), etc.). The search strategy included a combination of the terms “free text” and “Medical subject heading”, which refer to the definition of the need for health financing. The main limitations of the search were the language of publications (English and Russian) and the date of publication (not earlier than 2000). Results. Of the two used in international practice approaches to estimate the need for health financing, a system based on the use of the current level of funding and its forecasting under several factors is used in developed countries. Forecasting health expenditures is one of the most effective tools to identify critical factors affecting needs for sector financing. Despite the variety of indicators and methods used, most studies agree that non-demographic factors, such as GDP growth and technology development, influence health spending growth to the greatest extent. Demographic factors per se, including population ageing, affect health spending growth to a lesser extent. Conclusion. Conducting scenario forecasts contributes to a better understanding of what can happen in the future if the government does not act. This also contributes to a more clear determining of the main spheres for government interventions in the health sector.

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Effectiveness of vaccination in preventing severe SARS CoV-2 infection in South India-a hospital-based cross-sectional study

10.1101/2021.09.17.21263670 ◽

2021 ◽

Author(s):

A Charles Pon Ruban ◽

Aazmi M ◽

Shantaraman K.

Keyword(s):

Tertiary Care ◽

Severity Of Illness ◽

Cross Sectional Study ◽

Demographic Variables ◽

Clinical Severity ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Icu Admission ◽

Second Wave

AbstractBackground & objectivesEstablishing concrete evidence on effect of vaccination on severity of SARS CoV-2 infections in real world situations is the need of the hour. The aim of this study is to estimate the effectiveness Covid 19 vaccines in preventing the new and severe SARS CoV-2 infections.MethodsWe did this retrospective cross-sectional study among the 4765 patients consecutive adult inpatients admitted in the Covid 19 wards of a tertiary care hospital from May 1,2021 to July 7, 2021 during the second wave of Covid 19 pandemic. Information on basic demographic variables, RT PCR status, vaccination status, outcome and clinical severity of illness were obtained from the electronic hospital patient records.Results, and Interpretation & conclusionsType of vaccine and number of doses of vaccines didn’t have any protective effect against new SARS CoV-2 infection. Covid 19 patients vaccinated with at least one dose had 75 % less risk of requiring oxygen (OR 0.25 CI: 0.15 to 0.44) and 60 % less risk of ICU admission (OR 0.4 CI: 0.2 to 0.6) and it was statistically significant. Only 31 % of fully vaccinated Covid 19 positive patients had oxygen requirement (90% less risk) and 15% of the fully vaccinated patients had needed ICU admission (90% less risk).ConclusionVaccination didn’t protect against SARS Cov-2 infection however significant protection was documented against severe SARS Cov-2 infection. Vaccination coverage should be increased urgently in order to halt the impending wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

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COVID-19 Hospitalization is More Frequent and Severe in Down Syndrome and Affects Patients a Decade Younger.

10.1101/2020.05.26.20112748 ◽

2020 ◽

Cited By ~ 4

Author(s):

Louise Malle ◽

Cynthia Gao ◽

Nicole Bouvier ◽

Bethany Percha ◽

Dusan Bogunovic

Keyword(s):

Down Syndrome ◽

Health System ◽

Severe Disease ◽

Healthcare Facility ◽

Added Value ◽

High Risk Population ◽

Risk Population ◽

Hospitalization Rates ◽

Prevention And Treatment ◽

Mount Sinai

AbstractBackgroundIndividuals with rare disorders, like Down syndrome (DS) are historically understudied. Currently, it is not known how COVID-19 pandemic affects individuals with DS. Herein, we report an analysis of individuals with DS who were hospitalized with COVID-19 in the Mount Sinai Health System in New York City, USA.MethodsIn this retrospective, single-center study of 4,615 patients hospitalized with COVID-19, we analyzed all patients with DS admitted in the Mount Sinai Health System. Hospitalization rates, clinical and outcomes were assessed.FindingsContrary to an expected number of one, we identified six patients with DS. We found that patients with DS are at an 8.9-fold higher risk of hospitalization with COVID-19 when compared to non-DS patients. Hospitalized DS individuals are on average 10 years younger than non-DS patients with COVID-19. Moreover, type 2 diabetes mellitus appears to be an important driver of this susceptibility to COVID-19. Finally, patients with DS have more severe outcomes than controls, and are more likely to progress to sepsis in particular.InterpretationWe demonstrate that individuals with DS represent a higher risk population for COVID-19 compared to the general population and conclude that particular care should be taken for both the prevention and treatment of COVID-19 in these patients.FundingNational Institute of Allergy and Infectious Diseases.Research in contextEvidence before this studyWe searched PubMed and Google Scholar on May 26, 2020, for articles describing the features of patients in Down syndrome infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), using the search terms “SARS-CoV-2” or “COVID-19” and “Down syndrome” or “Trisomy 21.” We found only one case report describing a cluster of 4 cases of COVID-19 in a healthcare facility for patients with mental retardation.Added value of this studyWe compared the hospitalization rates of DS patients to over 4,500 individuals without DS, and we assessed comorbidities and outcomes of individuals with DS compared to age, race, and sex-matched controls hospitalized with COVID-19. To the best of our knowledge, we provide the first evidence that patients with DS with are at higher risk of hospitalization with COVID-19 and more severe disease progression than non-DS patients.Implications of all the available evidenceWe demonstrate that individuals with DS are a high-risk population for COVID-19 and suggest appropriate measures should be taken for both the prevention and treatment of COVID-19 in these patients.

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Improving Patient Race and Ethnicity Data Capture to Address Health Disparities: A Case Study From a Large Urban Health System

Cureus ◽

10.7759/cureus.20973 ◽

2022 ◽

Author(s):

Ruben D Vega Perez ◽

Lyndia Hayden ◽

Jefri Mesa ◽

Nina Bickell ◽

Pamela Abner ◽

...

Keyword(s):

Health Disparities ◽

Health System ◽

Urban Health ◽

Race And Ethnicity ◽

Data Capture ◽

Patient Race ◽

Ethnicity Data

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Predictors of young people’s use of sexual and reproductive health services in Nigeria: a mixed-method approach

10.21203/rs.3.rs-30823/v6 ◽

2020 ◽

Author(s):

Amelia Ngozi Odo ◽

Justina Ifeoma OFUEBE ◽

Anthony Ifeanyi ANIKE ◽

Efiong S Samuel

Keyword(s):

Young People ◽

Reproductive Health ◽

Health Services ◽

Health System ◽

Mixed Method ◽

Sexual And Reproductive Health ◽

Demographic Factors ◽

Reproductive Health Services ◽

System Factors ◽

Socio Demographic Factors

Abstract Background Sexual and Reproductive health Services (SRHS) are essential for the prevention and control of SRH problems among young people and the achievement of sustainable development goal 3. These services may be available but certain factors interfere with their access and utilization by the young people. This study sought to determine factors that predict the utilization of SRHS among young people in Enugu State, Nigeria. Methods The study adopted mixed-method research employing a cross-sectional research design. The population of the study comprised young people between the ages of 12 and 22 years. A multi-stage sampling procedure was used to select 1,447 young people used for the study. A questionnaire, in-depth interview, and focus group discussion were used for data collection. Percentages, Chi-square, and logistic regression were used to analyse quantitative data, while qualitative data were thematically analysed using NVivo software.ResultsSocio-demographic factors of gender, age, education, income, and living status (p = < .05) were significant predictors of utilization of SRHS. Psycho-cultural and health system factors (p = < .05) were also significant predictors of utilization of SRHS.Conclusion The study concluded that some socio-demographic factors (of gender, age, level of education, income, and living status), psycho-cultural, and health system factors can be used to predict young people’s utilization of SRHS. These predictors could be addressed through home sex education, regular training of health care providers on youth-friendly services delivery, and policy reforms.

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Updated North Cyprus response status for COVID-19 in comparison with similar country sizes. Highlights on the importance of population per square meter

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2020.699 ◽

2020 ◽

Vol 15 ◽

Author(s):

Nedime Serakinci ◽

Ahmet Savasan ◽

Finn Rasmussen

Keyword(s):

Health System ◽

Local Level ◽

Economic Consequences ◽

European Countries ◽

World Health ◽

Small Communities ◽

North Cyprus ◽

Response Status ◽

Health Organization ◽

Second Wave

The COVID-19 pandemic is straining health systems worldwide. The World Health Organization has provided guidelines on a set of targeted and immediate actions that countries can use on a national, regional, and local level. Recommendations go from public hand hygiene stations, making face masks use obligatory, testing, and index finding which together with national closure of borders have been used to limit the disease so the countries' health care system can cope with the challenges. This is especially important as there seems to be an increased mortality rate even in countries normally regarded as well-functioning and having strong health system. In more susceptible countries this maybe even more important. The effect of these measures should be easier seen in small communities or countries. Societies have acted differently on when to apply the lockdown but most European countries have initiated lockdown after the first SARS-CoV-2 was diagnosed in their countries. With the COVID-19 pandemic and its economic consequences, it became especially important to re-evaluate the effect of response in light of a possible second wave. Yet, little is known about the effect of lockdown with respect to disease development and its handling. Hereby, we compare responses from relatively small 17 European countries including islands in three groups based on their population and report the response from North Cyprus in comparison to other small European countries. Our results indicate the importance of population per meter square, degree of isolation from others as well as social distancing, hygiene rules, timing of lockdowns in response to COVID-19 pandemic in small countries/ societies that are more susceptible for overwhelming their health system.

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