scholarly journals Spatiotemporal Pattern of COVID-19–Related Mortality during the First Year of the Pandemic in Brazil: A Population-based Study in a Region of High Social Vulnerability

2021 ◽  
Author(s):  
Lucas Almeida Andrade ◽  
Wandklebson Silva da Paz ◽  
Alanna G. C. Fontes Lima ◽  
Damião da Conceição Araújo ◽  
Andrezza M. Duque ◽  
...  
Keyword(s):  
High Risk ◽  
Social Vulnerability ◽  
Temporal Trends ◽  
Case Fatality ◽  
Vulnerability Index ◽  
Bayesian Estimator ◽  
Spatiotemporal Pattern ◽  
First Year ◽  
Social Vulnerability Index ◽  
Risk Of Death

Currently, the world is facing a severe pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although the WHO has recommended preventive measures to limit its spread, Brazil has neglected most of these recommendations, and consequently, our country has the second largest number of deaths from COVID-19 worldwide. In addition, recent studies have shown the relationship between socioeconomic inequalities and the risk of severe COVID-19 infection. Herein, we aimed to assess the spatiotemporal distribution of mortality and lethality rates of COVID-19 in a region of high social vulnerability in Brazil (Northeast region) during the first year of the pandemic. A segmented log-linear regression model was applied to assess temporal trends of mortality and case fatality rate (CFR) and according to the social vulnerability index (SVI). The Local Empirical Bayesian Estimator and Global Moran Index were used for spatial analysis. We conducted a retrospective space–time scan to map clusters at high risk of death from COVID-19. A total of 66,358 COVID-19–related deaths were reported during this period. The mortality rate was 116.2/100,000 inhabitants, and the CFR was 2.3%. Nevertheless, CFR was > 7.5% in 27 municipalities (1.5%). We observed an increasing trend of deaths in this region (AMCP = 18.2; P = 0.001). Also, increasing trends were observed in municipalities with high (N = 859) and very high SVI (N = 587). We identified two significant spatiotemporal clusters of deaths by COVID-19 in this Brazilian region (P = 0.001), and most high-risk municipalities were on the coastal strip of the region. Taken together, our analyses demonstrate that the pandemic has been responsible for several deaths in Northeast Brazil, with clusters at high risk of mortality mainly in municipalities on the coastline and those with high SVI.

scholarly journals Time Trend, Social Vulnerability, and Identification of Risk Areas for Tuberculosis in Brazil: an Ecological Study

2021 ◽  
Author(s):  
João Paulo Silva de Paiva ◽  
Mônica Avelar Figueiredo Mafra Magalhães ◽  
Thiago Cavalcanti Leal ◽  
Leonardo Feitosa da Silva ◽  
Lucas Gomes da Silva ◽  
...  
Keyword(s):  
High Risk ◽  
Incidence Rate ◽  
Social Vulnerability ◽  
Time Trend ◽  
Ecological Study ◽  
Vulnerability Index ◽  
Scan Statistics ◽  
Spatial Clusters ◽  
Social Vulnerability Index ◽  
Risk Areas

ABSTRACTINTRODUCTIONTuberculosis is one of the ten leading causes of death and the leading infectious cause worldwide. The disease represents a challenge to health systems around the world. In 2018, it is estimated that 10 million people were affected by tuberculosis, and approximately 1.5 million people died due to the disease worldwide, including 251,000 patients coinfected with HIV. In Brazil, the disease caused 4,490 deaths, with rate of 2.2 deaths per 100,000 inhabitants. The objective of this study was to analyze the time behavior, spatial distribution, and the effects of social vulnerability on the incidence of TB in Brazil during the period from 2001 to 2017.METHODSA spatial-temporal ecological study was conducted, including all new cases of tuberculosis registered in Brazil during the period from 2001 to 2017. The following variables were analyzed: incidence rate of tuberculosis, the Social Vulnerability Index, its subindices, its 16 indicators, and an additional 14 variables available on the Atlas of Social Vulnerability. The statistical treatment of the data consisted of the following three stages: a) time trend analysis with a joinpoint regression model; b) spatial analysis and identification of risk areas based on smoothing of the incidence rate by local empirical Bayesian model, application of global and local Moran statistics, and, finally, spatial-temporal scan statistics; and c) analysis of association between the incidence rate and the indicators of social vulnerability.RESULTSBrazil reduced the incidence of tuberculosis from 42.8 per 100,000 to 35.2 per 100,000 between 2001 and 2017. Only the state of Minas Gerais showed an increasing trend, whereas nine other states showed a stationary trend. A total of 326 Brazilian municipalities were classified as high priority, and 22 high-risk spatial clusters were identified. The overall Social Vulnerability Index and the subindices of Human Capital and Income and Work were associated with the incidence of tuberculosis. It was also observed that the incidence rates were greater in municipalities with greater social vulnerability.CONCLUSIONSThis study identified spatial clusters with high risk of TB in Brazil. A significant association was observed between the incidence rate of TB and the indices of social vulnerability.

scholarly journals Impact of Social Vulnerability on COVID-19 Incidence and Outcomes in the United States

2020 ◽  
Author(s):  
Aditi Nayak ◽  
Shabatun J. Islam ◽  
Anurag Mehta ◽  
Yi-An Ko ◽  
Shivani A. Patel ◽  
...  
Keyword(s):  
Social Vulnerability ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Vulnerability Index ◽  
County Level ◽  
Fatality Rate ◽  
Minority Status ◽  
Social Vulnerability Index ◽  
Unit Increase ◽  
The U.S

ABSTRACTImportancePrior pandemics have disparately affected socially vulnerable communities. Whether regional variations in social vulnerability to disasters influence COVID-19 outcomes and incidence in the U.S. is unknown.ObjectiveTo examine the association of Social Vulnerability Index (SVI), a percentile-based measure of county-level social vulnerability to disasters, and its sub-components (socioeconomic status, household composition, minority status, and housing type/transportation accessibility) with the case fatality rate (CFR) and incidence of COVID-19.DesignEcological study of counties with at least 50 confirmed COVID-19 cases as of April 4th, 2020. Generalized linear mixed-effects models with state-level clustering were applied to estimate county-level associations of overall SVI and its sub-component scores with COVID-19 CFR (deaths/100 cases) and incidence (cases/1000 population), adjusting for population percentage aged ≥65 years, and for comorbidities using the average Hierarchical Condition Category (HCC) score. Counties with high SVI (≥median) and high CFR (≥median) were identified.SettingPopulation-based study of U.S. county-level data.ParticipantsU.S. counties with at least 50 confirmed COVID-19 cases.Main outcomes and measuresCOVID-19 CFR and incidence.ResultsData from 433 counties including 283,256 cases and 6,644 deaths were analyzed. Median SVI was 0.46 [Range: 0.01-1.00], and median CFR and incidence were 1.9% [Range: 0-13.3] and 1.2 per 1000 people [Range: 0.6-38.8], respectively. Higher SVI, indicative of greater social vulnerability, was associated with higher CFR (RR: 1.19 [1.05, 1.34], p=0.005, per-1 unit increase), an association that strengthened after adjustment for age≥65 years and comorbidities (RR: 1.63 [1.38, 1.91], p<0.001), and was further confirmed in a sensitivity analysis limited to six states with the highest testing levels. Although the association between overall SVI and COVID-19 incidence was not significant, the SVI sub-components of socioeconomic status and minority status were both predictors of higher incidence and CFR. A combination of high SVI (≥0.46) and high adjusted CFR (≥2.3%) was observed in 28.9% of counties.Conclusions and RelevanceSocial vulnerability is associated with higher COVID-19 case fatality. High social vulnerability and CFR coexist in more than 1 in 4 U.S. counties. These counties should be targeted by public policy interventions to help alleviate the pandemic burden on the most vulnerable population.KEY POINTSQuestionIs county-level social vulnerability to disasters associated with the case fatality rate (CFR) and incidence of SARS-CoV-2 infection during the COVID-19 pandemic in the U.S.?FindingsEach unit increase in county-level social vulnerability, measured using the Social Vulnerability Index (SVI), was associated with a 63% higher CFR after adjusting for age and comorbidities. Both CFR and incidence of COVID-19 were significantly higher in counties with lower socio-economic status and higher proportion of minority populations.MeaningU.S. counties with higher social vulnerability are experiencing greater mortality rates during the COVID-19 pandemic.

scholarly journals 514. Anti-SARS-CoV-2 Monoclonal Antibodies for Early COVID-19: A Real World Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S358-S359
Author(s):  
Katherine Belden ◽  
Bryan Hess ◽  
Caroline Brugger ◽  
Rachel Carr ◽  
Todd Braun ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
High Risk ◽  
Real World ◽  
Social Vulnerability ◽  
Vulnerability Index ◽  
Primary Study ◽  
Drug Preparation ◽  
Social Vulnerability Index ◽  
High Resource ◽  
Positive Direct

Abstract Background Anti-SARS-CoV-2 monoclonal antibodies afford prompt immunity, have demonstrated reduction in severe COVID-19 in high risk ambulatory patients, and are available through Emergency Use Authorization. Challenges exist, however, to widespread utilization. Methods This operations study 11/23/20-4/30/21 identified patients meeting monoclonal AB EUA criteria by test results or referral. Outreach to harder-hit neighborhoods included connecting with primary care teams and testing sites. Infusion centers with staff trained in infection control, rapid response and drug preparation were utilized. The primary study outcome was treatment of qualifying patients. Secondary outcomes included infusion complications, hospitalization/death, and symptom resolution. Investigational review board approval was obtained. Results 367 patients were treated: mean age of 63, 201(55%) male, 276(75%) white, 54(15%) black. All patients had a first positive direct SARS-CoV-2 test within 10 days, 232(63%) had &gt; 1 high-risk qualification, 32(9%) were vaccinated for SARS-CoV-2. Of patients with available zipcodes, 135(38%) had a Community Need Index &gt;3.5 and 157(45%) a Social Vulnerability Index &gt;0.5. 190(52%) received bamlanivimab, 93(25%) casirivimab/imdevimab, 84(23%) bamlanivimab/etesevimab. Four patients experienced infusion reaction, 1 with anaphylaxis. 172(73%) of 236 patients were symptom free at day 5. 20 patients (5%) were hospitalized for COVID-19 within 30 days with a median time from symptom onset to infusion of 7 days, 11(55%) were admitted within 24 hours, 1 died. Patient Characteristics COVID-19 course Community Need Index and Social Vulnerability Index by Zipcode Conclusion Our study demonstrates that treatment with anti-SARS-CoV-2 monoclonal antibodies is feasible in a high resource setting. There were no related SARS-CoV-2 exposures and therapy was well tolerated. Trials of anti-SARS-CoV-2 monoclonal antibodies have reported lower rates of hospitalizations in treated patients than we found. This may reflect the expanded time frame for EUA therapy as compared to clinical trials, differences in real world patients or viral variants. Given potential benefit in unvaccinated patients or those at risk for poor vaccine response, the equitable utilization of anti-SARS-CoV-2 monoclonal antibody therapy in early COVID-19 should remain a focus for researchers and clinicians. Disclosures All Authors: No reported disclosures

scholarly journals Social Vulnerability across the Great Lakes Basin: A County-Level Comparative and Spatial Analysis

2021 ◽  
Vol 13 (13) ◽  
pp. 7274
Author(s):  
Joshua T. Fergen ◽  
Ryan D. Bergstrom
Keyword(s):  
Great Lakes ◽  
Spatial Patterns ◽  
Social Vulnerability ◽  
Vulnerability Index ◽  
Social Vulnerability Index ◽  
Great Lakes Basin ◽  
Empirical Examination ◽  
Regional Patterns ◽  
Urban Rural ◽  
Social Vulnerabilities

Social vulnerability refers to how social positions affect the ability to access resources during a disaster or disturbance, but there is limited empirical examination of its spatial patterns in the Great Lakes Basin (GLB) region of North America. In this study, we map four themes of social vulnerability for the GLB by using the Center for Disease Control’s Social Vulnerability Index (CDC SVI) for every county in the basin and compare mean scores for each sub-basin to assess inter-basin differences. Additionally, we map LISA results to identify clusters of high and low social vulnerability along with the outliers across the region. Results show the spatial patterns depend on the social vulnerability theme selected, with some overlapping clusters of high vulnerability existing in Northern and Central Michigan, and clusters of low vulnerability in Eastern Wisconsin along with outliers across the basins. Differences in these patterns also indicate the existence of an urban–rural dimension to the variance in social vulnerabilities measured in this study. Understanding regional patterns of social vulnerability help identify the most vulnerable people, and this paper presents a framework for policymakers and researchers to address the unique social vulnerabilities across heterogeneous regions.

scholarly journals Applying the Social Vulnerability Index as a Leading Indicator to Protect Fire-Based Emergency Medical Service Responders’ Health

2021 ◽  
Vol 18 (15) ◽  
pp. 8049
Author(s):  
Emily J. Haas ◽  
Alexa Furek ◽  
Megan Casey ◽  
Katherine N. Yoon ◽  
Susan M. Moore
Keyword(s):  
Emergency Response ◽  
Social Vulnerability ◽  
Vulnerability Index ◽  
Fire Service ◽  
Household Composition ◽  
Fire Departments ◽  
Social Vulnerability Index ◽  
Response Planning ◽  
Leading Indicator ◽  
Increased Risk

During emergencies, areas with higher social vulnerability experience an increased risk for negative health outcomes. However, research has not extrapolated this concept to understand how the workers who respond to these areas may be affected. Researchers from the National Institute for Occupational Safety and Health (NIOSH) merged approximately 160,000 emergency response calls received from three fire departments during the COVID-19 pandemic with the CDC’s publicly available Social Vulnerability Index (SVI) to examine the utility of SVI as a leading indicator of occupational health and safety risks. Multiple regressions, binomial logit models, and relative weights analyses were used to answer the research questions. Researchers found that higher social vulnerability on household composition, minority/language, and housing/transportation increase the risk of first responders’ exposure to SARS-CoV-2. Higher socioeconomic, household, and minority vulnerability were significantly associated with response calls that required emergency treatment and transport in comparison to fire-related or other calls that are also managed by fire departments. These results have implications for more strategic emergency response planning during the COVID-19 pandemic, as well as improving Total Worker Health® and future of work initiatives at the worker and workplace levels within the fire service industry.

scholarly journals Effectiveness of mass treatment of Schistosoma mansoni infection in socially vulnerable areas of a state in northeastern Brazil, 2011–2014

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Flávia Silvestre Outtes Wanderley ◽  
Ulisses Montarroyos ◽  
Cristine Bonfim ◽  
Carolina Cunha-Correia
Keyword(s):  
Schistosoma Mansoni ◽  
Correspondence Analysis ◽  
Social Vulnerability ◽  
Multiple Correspondence Analysis ◽  
Vulnerability Index ◽  
Two Dimensions ◽  
Northeastern Brazil ◽  
Mass Treatment ◽  
Social Vulnerability Index ◽  
Treatment Information

Abstract Background To assess the effectiveness of mass treatment of Schistosoma mansoni infection in socially vulnerable endemic areas in northeastern Brazil. Method An ecological study was conducted, in which 118 localities in 30 municipalities in the state of Pernambuco were screened before 2011 and in 2014 (after mass treatment). Information on the endemic baseline index, mass treatment coverage, socio-environmental conditions and social vulnerability index were used in the multiple correspondence analysis. One hundred fourteen thousand nine hundred eighty-seven people in 118 locations were examined. Results The first two dimensions of the multiple correspondence analysis represented 55.3% of the variability between locations. The human capital component of the social vulnerability index showed an association with the baseline endemicity index. There was a significant reduction in positivity for schistosomes. For two rounds, for every extra 1% of initial endemicity index, the fixed effect of 13.62% increased by 0.0003%, achieving at most 15.94%. Conclusions The mass treatment intervention helped to reduce transmission of schistosomiasis in areas of high endemicity. Thus, it can be recommended that application of mass treatment should be accompanied by other control actions, such as basic sanitation, monitoring of intermediate vectors and case surveillance.

Impact of Social Vulnerability on Access to Educational Programming Designed to Enhance Living Donation

2021 ◽  
pp. 152692482110460
Author(s):  
Alexis J. Carter ◽  
Rhiannon D. Reed ◽  
A. Cozette Kale ◽  
Haiyan Qu ◽  
Vineeta Kumar ◽  
...  
Keyword(s):  
Health Care ◽  
Social Vulnerability ◽  
Living Donor ◽  
Research Question ◽  
College Education ◽  
Vulnerability Index ◽  
Social Vulnerability Index ◽  
Chi Square ◽  
Control And Prevention ◽  
Transplant Candidate

Introduction Transplant candidate participation in the Living Donor Navigator Program is associated with an increased likelihood of achieving living donor kidney transplantation; yet not every transplant candidate participates in navigator programming. Research Question We sought to assess interest and ability to participate in the Living Donor Navigator Program by the degree of social vulnerability. Design Eighty-two adult kidney-only candidates initiating evaluation at our center provided Likert-scaled responses to survey questions on interest and ability to participate in the Living Donor Navigator Program. Surveys were linked at the participant-level to the Centers for Disease Control and Prevention Social Vulnerability Index and county health rankings and overall social vulnerability and subthemes, individual barriers, telehealth capabilities/ knowledge, interest, and ability to participate were assessed utilizing nonparametric Wilcoxon ranks sums tests, chi-square, and Fisher's exact tests. Results Participants indicating distance as a barrier to participation in navigator programming lived approximately 82 miles farther from our center. Disinterested participants lived in areas with the highest social vulnerability, higher physical inactivity rates, lower college education rates, and higher uninsurance (lack of insurance) and unemployment rates. Similarly, participants without a computer, who never heard of telehealth, and who were not encouraged to participate in telehealth resided in areas of highest social vulnerability. Conclusion These data suggest geography combined with being from under-resourced areas with high social vulnerability was negatively associated with health care engagement. Geography and poverty may be surrogates for lower health literacy and fewer health care interactions.

Creation of a social vulnerability index for justice in health planning

1988 ◽  
Vol 10 (4) ◽  
pp. 23-32 ◽  
Author(s):  
G E Alan Dever ◽  
Mark Sciegaj ◽  
Thomas E. Wade ◽  
Teresa C. Lofton
Keyword(s):  
Social Vulnerability ◽  
Health Planning ◽  
Vulnerability Index ◽  
Social Vulnerability Index
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