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1.
PLoS One ; 16(11): e0251683, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34731175

RESUMO

Previous research has shown that the COVID-19 outbreak, social distancing, and lockdown can affect people's psychological well-being. The aims of this study were (1) to estimate the extent to which perceptions and expectations regarding the social, economic, and domestic effects of the COVID-19 outbreak are associated with psychological distress and (2) to identify some demographic, psychosocial, and economic factors associated with increased vulnerability to psychological distress during the COVID-19 outbreak in Chile. 1078 people participated in a telephone survey between May 30 and June 10, 2020. The sample is representative of the Chilean adult population. Psychological distress was assessed through a questionnaire of anxious and depressive symptoms (Patient Health Questionnaire-4). We analyzed the data set using ordinary least-squares regression models, first estimating models for the entire sample, and then stratifying the sample into different groups to explore differences by gender and age. 19.2% of participants displayed significant psychological distress (PHQ-4 ≥ 6), with moderate to severe anxiety-depression symptoms being more prevalent in women than in men (23.9% vs 14.1%, χ2 16.78, p<0.001). The results of this study suggest that being a woman, feeling lonely and isolated, living in the areas hit hardest by the pandemic and lockdown, expecting a lack of income due to having to stop working as a consequence of the pandemic, and having a history of diagnosed mental disorders are significantly associated with psychological distress (p<0.05). The results of this study highlight the need to implement psychosocial programs to guard people's psychological well-being and social policies to address economic uncertainty during the current COVID-19 outbreak in Chile.


Assuntos
COVID-19/psicologia , Efeitos Psicossociais da Doença , Angústia Psicológica , Adolescente , Adulto , COVID-19/economia , Chile , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Pandemias , Adulto Jovem
2.
PLoS One ; 16(11): e0259282, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34731181

RESUMO

Infectious diseases and widespread outbreaks influence different sectors of the economy, including the stock market. In this article, we investigate the effect of EBOV and COVID-19 outbreaks on stock market indices. We employ time-varying and constant bivariate copula methods to measure the dependence structure between the infectious disease equity market volatility index (IEMV) and the stock market indices of several sectors. The results show that the financial and communication services sectors have the highest and the lowest negative dependency on IEMV during the Ebola virus (EBOV) pandemic, respectively. However, the health care and energy sectors have the highest and lowest negative dependency on IEMV during the COVID-19 outbreak, respectively. Therefore, the results confirm the heterogeneous time-varying dependency between infectious diseases and the stock market indices. The finding of our study contributes to the ongoing literature on the impact of disease outbreaks, especially the novel coronavirus outbreak on global large-cap companies in the stock market.


Assuntos
COVID-19/economia , Efeitos Psicossociais da Doença , Surtos de Doenças/economia , Doença pelo Vírus Ebola/economia , Comércio , Ebolavirus , Humanos , Tempo
3.
BMC Pregnancy Childbirth ; 21(1): 755, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749686

RESUMO

BACKGROUND: The COVID-19 pandemic has exacerbated the financial insecurity of women and their families globally. Some studies have explored the impact of financial strain among pregnant women, in particular, during the pandemic. However, less is known about the factors associated with pregnant women's experiences of material hardship. METHODS: This cross-sectional study used a non-probability sample to examine the factors associated with pregnant women's experiences of material hardship during the COVID-19 pandemic. In January 2021, 183 pregnant women living in the United States participated in an online Qualtrics panel survey. In addition to socio-demographic characteristics, individuals were asked about their finances and predictors of financial well-being, mental health symptoms, and intimate partner violence (IPV) experiences. Chi-square analysis and one-way ANOVA were used to examine whether women's experiences with material hardship and associated factors differed by income level (i.e., less than $20,000; $20,000 to $60,000; more than $60,000). Ordinary least squares regression was used to calculate unadjusted and adjusted estimates. RESULTS: Study findings showed that the majority of women in the sample experienced at least one form of material hardship in the past year. Individuals with an annual household income less than $20,000 reported the highest average number of material hardships experienced (M = 3.7, SD = 2.8). Compared to women with household incomes less than $20,000, women with incomes of more than $60,000 reported significantly fewer material hardships, less financial strain, and higher levels of financial support, economic self-efficacy, and economic-self-sufficiency. Women with incomes of $60,000 or more also reported significantly lower levels of psychological abuse, and a smaller percentage met the cut-off for anxiety. Economic self-sufficiency, financial strain, posttraumatic stress disorder, and economic abuse were all significantly associated with material hardship. CONCLUSIONS: A contribution of this study is that it highlights the significant, positive association between economic abuse, a unique form of IPV, and material hardship among pregnant women during the pandemic. These findings suggest the need for policy and practice interventions that help to ameliorate the financial insecurity experienced by some pregnant women, as well as respond to associated bidirectional vulnerabilities (e.g., mental health symptoms, experiences of IPV).


Assuntos
COVID-19/economia , Status Econômico , Renda/classificação , Gestantes/psicologia , Adulto , Ansiedade/epidemiologia , COVID-19/epidemiologia , COVID-19/psicologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Renda/estatística & dados numéricos , Violência por Parceiro Íntimo/psicologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Pandemias , Gravidez , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos , Inquéritos e Questionários , Estados Unidos/epidemiologia
6.
Proc Natl Acad Sci U S A ; 118(46)2021 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-34750264

RESUMO

COVID-19 has had worse health, education, and labor market effects on groups with low socioeconomic status (SES) than on those with high SES. Little is known, however, about whether COVID-19 has also had differential effects on noncognitive skills that are important for life outcomes. Using panel data from before and during the pandemic, we show that COVID-19 affects one key noncognitive skill, that is, prosociality. While prosociality is already lower for low-SES students prior to the pandemic, we show that COVID-19 infections within families amplify the prosociality gap between French high school students of high and low SES by almost tripling its size in comparison to pre-COVID-19 levels.


Assuntos
COVID-19/economia , COVID-19/transmissão , Família , SARS-CoV-2 , Comportamento Social , Classe Social , Adolescente , Humanos
7.
South Med J ; 114(10): 649-656, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34599344

RESUMO

OBJECTIVES: Although disparities in coronavirus disease 2019 (COVID-19) prevalence are known, knowledge of the recent surge of COVID-19 in Texas and factors affecting fatality rates is limited. Understanding the health disparities associated with COVID-19 can help healthcare professionals determine the populations that are most in need of COVID-19 preventive care and treatment. The aim of this study was to assess COVID-19-related case and mortality rates. METHODS: Our cross-sectional analysis used Texas Department of State Health Services COVID-19 case surveillance counts. Case, hospitalization, and mortality counts were obtained from March to July 2020. RESULTS: From March to July 2020, there were 420,397 COVID-19-related cases and 6954 deaths in Texas. There were 3277 new cases and 104 deaths in March, and 261,876 new cases and 3660 deaths in July. The number of new COVID-19 cases was the highest from March to April (relative risk 1.77, 95% confidence interval [CI] 1.76-1.78). Although the death rate in June was a 30% increase over the rate in May, death rates nearly tripled by the end of July, for a total of 3660 deaths. Of the 3958 deaths, demographic data were available for 753 deaths. Of these, 440 were male, 16 Asian, 95 Black, 221 Hispanic, 325 White, and 96 were "Other" or "Unknown." Males were associated with a slightly higher chance of acquiring COVID-19 than females (odds ratio [OR] 1.11, 95% CI 1.09-1.14) and nearly a 29% higher chance of dying of COVID-19 compared with females (OR 1.29, 95% CI 1.11-1.49). Bivariate analysis revealed that the probability of acquiring COVID-19 was 12% higher in older adults compared with individuals younger than 65 years old (OR 1.12, 95% CI 1.08-1.16), and older adults had an 18.8 times higher risk of death when compared with the rate of younger individuals (OR 18.79, 95% CI 15.93-22.15). Hispanics and Blacks were 70% and 48%, respectively, more likely to contract COVID-19 than Whites. All races had lower significant chance of death when compared with Whites. At the end of July, there was a total of 430,485 Texas COVID-19 cases and 6387 fatalities (8.8% of all cases and 4% of all deaths in the United States.). Case fatality ratios were the highest in older adults. As we continued to observe data, in contrast to previous study time points, we found that Asians and Hispanics had no significant difference in COVID mortality rates and were comparable in terms of mortality odds and death case ratios when compared with Whites. CONCLUSIONS: This time period represents the highest COVID-19 surge time in Texas. Although our data consist of a short time period of population-level data in an ongoing pandemic and are limited by information reported to the Texas Department of State Health Services, older age, male sex, Hispanics, and Blacks are currently associated with higher infection rates, whereas older age, male sex, and Whites are associated with higher mortality rates. Clinicians and decision makers should be aware of the COVID-19 health disparities and risk factors for mortality to better promote targeted interventions and allocate resources accordingly.


Assuntos
COVID-19/economia , Grupos de Populações Continentais/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/etnologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Governo Estadual , Texas/epidemiologia
8.
J Orthop Surg Res ; 16(1): 601, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654447

RESUMO

BACKGROUND: The COVID-19 pandemic represents one of the most massive health emergencies in the last century and has caused millions of deaths worldwide and a massive economic and social burden. The aim of this study was to evaluate how the COVID-19 pandemic-during the Italian lockdown period between 8 March and 4 May 2020-influenced orthopaedic access for traumatic events to the Emergency Department (ER). METHODS: A retrospective review of the admission to the emergency room and the discharge of the trauma patients' records was performed during the period between 8 March and 4 May 2020 (block in Italy), compared to the same period of the previous year (2019). Patients accesses, admissions, days of hospitalisation, frequency, fracture site, number and type of surgery, the time between admission and surgery, days of hospitalisation, and treatment cost according to the diagnosis-related group were collected. Chi-Square and ANOVA test were used to compare the groups. RESULTS: No significant statistical difference was found for the number of emergency room visits and orthopaedic hospitalisations (p < 0.53) between the year 2019 (9.5%) and 2020 (10.81%). The total number of surgeries in 2019 was 119, while in 2020, this was just 48 (p < 0.48). A significant decrease in the mean cost of orthopaedic hospitalisations was detected in 2020 compared (261.431 euros, equal to - 52.07%) relative to the same period in 2019 (p = 0.005). Although all the surgical performances have suffered a major decline, the most frequent surgery in 2020 was intramedullary femoral nailing. CONCLUSION: We detected a decrease in traumatic occasions during the lockdown period, with a decrease in fractures in each district and a consequent decrease in the diagnosis-related group (DRG).


Assuntos
COVID-19/economia , COVID-19/epidemiologia , Procedimentos Ortopédicos/economia , Admissão do Paciente/economia , Centros de Atenção Terciária/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , Criança , Pré-Escolar , Custos e Análise de Custo/tendências , Feminino , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/tendências , Pandemias/economia , Admissão do Paciente/tendências , Estudos Retrospectivos , Centros de Atenção Terciária/tendências , Adulto Jovem
9.
Sci Rep ; 11(1): 20451, 2021 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-34650141

RESUMO

This research measures the epidemiological and economic impact of COVID-19 spread in the US under different mitigation scenarios, comprising of non-pharmaceutical interventions. A detailed disease model of COVID-19 is combined with a model of the US economy to estimate the direct impact of labor supply shock to each sector arising from morbidity, mortality, and lockdown, as well as the indirect impact caused by the interdependencies between sectors. During a lockdown, estimates of jobs that are workable from home in each sector are used to modify the shock to labor supply. Results show trade-offs between economic losses, and lives saved and infections averted are non-linear in compliance to social distancing and the duration of the lockdown. Sectors that are worst hit are not the labor-intensive sectors such as the Agriculture sector and the Construction sector, but the ones with high valued jobs such as the Professional Services, even after the teleworkability of jobs is accounted for. Additionally, the findings show that a low compliance to interventions can be overcome by a longer shutdown period and vice versa to arrive at similar epidemiological impact but their net effect on economic loss depends on the interplay between the marginal gains from averting infections and deaths, versus the marginal loss from having healthy workers stay at home during the shutdown.


Assuntos
COVID-19/epidemiologia , Agricultura/economia , COVID-19/economia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Indústria da Construção/economia , Emprego , Humanos , Indústrias/economia , Modelos Econômicos , SARS-CoV-2/isolamento & purificação , Teletrabalho , Estados Unidos/epidemiologia
10.
Kidney Blood Press Res ; 46(5): 639-646, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34662882

RESUMO

BACKGROUND: It is just over a century since the 1918 flu pandemic, sometimes referred to as the "mother" of pandemics. This brief retrospective of the 1918 pandemic is taken from the viewpoint of the current SARS-CoV-2/COVID-19 pandemic and is based on a short lecture given during the 2021 Virtual Congress of the ERA-EDTA. SUMMARY: This review summarizes and highlights some of the earlier pandemic's salient features, some parallels with today, and some potential learnings, bearing in mind that the flu pandemic occurred over 100 years ago at a time of major turmoil during the climax to WWl, and with limited medical expertise and knowledge, research facilities, or well-structured and resourced healthcare services. While there is little or no information on renal complications at the time, or an effective treatment, some observations in relation to COVID-19 and vaccination are included. Key Messages: Lessons are difficult to draw from 1918 other than the importance and value of non-pharmaceutical measures to limit viral transmission. While the economic impact of the 1918 pandemic was significant, as it is now with COVID-19, subsequent economic analysis has shown that protecting public health and preserving economic activity are not mutually exclusive. Both H1N1 and SARS-CoV-2 viruses are neurotropic and may cause chronically debilitating neurological diseases, including conditions such as encephalitis lethargica (still debated) and myalgic encephalomyelitis (chronic fatigue syndrome), respectively. Although coronavirus and influenza viral infections have some similarities, they are certainly not the same, as we are realising, and future infectious pandemics may still surprise us, but being "forewarned is forearmed."


Assuntos
COVID-19 , Influenza Pandêmica, 1918-1919/história , Influenza Humana/transmissão , Pandemias , COVID-19/complicações , COVID-19/economia , História do Século XX , História do Século XXI , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Pandêmica, 1918-1919/economia
11.
J Infect Dev Ctries ; 15(9): 1244-1251, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34669591

RESUMO

INTRODUCTION: Coronavirus is a new pandemic disease that has emerged in Wuhan, China, and then spreads around the world. The cases number of the COVID-19, which have been daily reported in Iraq, has risen slowly. However, no confirmed study has been undertaken to evaluate the situation of the COVID-19 in concerning the confirmed cases, death cases, and recovered. METHODOLOGY: The current study is undertaken to describe and assess the COVID-19 of the present situation in Iraq out of the range of the confirmed, deaths and recovered cases from the date 21 February to 30 April 2020 in Iraq. RESULTS: The study findings have revealed that there is a gradual increase of COVID-19 cases onwards until the top peak in 7th Apr. in which the cases reach 684, then decrease regularly. The total infected people of the study scope is 2085 persons according to the Ministry of Health in Iraq, while the World Health Organization (WHO) states 2003 person. The spatial distribution quantile map showed the hot spots in the province of Babylon, Maysan, and Diyala. However, less was found in three provinces (Nineveh, Salahaddin, and Al Anbar). The result shows that 39% recovered and 3% death cases out of total infected people. CONCLUSIONS: COVID-19 in Iraq comes to be limited via the procedures of Iraqi government. However, the infected people will be increased gradually and many international reports that predict the end of this pandemic in the world will be doubtful as there are many vaccines developed and under development which led to reduce to effect of this pandemic.


Assuntos
COVID-19/epidemiologia , COVID-19/economia , Humanos , Iraque/epidemiologia , Pandemias
12.
J Infect Dev Ctries ; 15(9): 1281-1285, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34669597

RESUMO

INTRODUCTION: The COVID-19 pandemic influences the spirituality and mental health of individuals. It also has caused a global economic recession. COVID-19 is easily transmitted and causes death. Consequently, severe prevention and control measures of COVID 19 are required in this situation. This study aims to analyze the relationship between anxiety, stigma, religiosity, economic conditions, and the prevention of COVID-19. METHODOLOGY: A cross-sectional study was designed. The data collection was taken through online surveys. The population in this study is ninety-two lecturers from the College of Health Sciences and the State Islamic Institute who were chosen using a non-probability snowball sampling technique. Data analysis used logistic regression analysis. RESULTS: The results showed that there was a relationship between anxiety (p = 0.001), stigma (p = 0.008), religiosity (p = 0.005) and the efforts to prevent COVID-19, while economic conditions (p = 0.882) were not related to the preventive efforts. The results of multivariate analysis indicated that the most influential variable affecting COVID-19 preventions was the level of anxiety, with an Odds Ratio of 4.9. CONCLUSIONS: There was a relationship between anxiety, stigma, religiosity, and COVID-19 preventions, while there was no relationship between economic conditions and COVID-19 preventions. The most influencing variable was anxiety. Respondents must be able to manage anxiety levels related to COVID-19 with good coping strategies.


Assuntos
Ansiedade/epidemiologia , COVID-19/psicologia , Docentes , Estigma Social , Espiritualidade , Adulto , COVID-19/economia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Estudos Transversais , Feminino , Humanos , Indonésia , Islamismo , Masculino , Saúde Mental , Inquéritos e Questionários
13.
PLoS One ; 16(10): e0258309, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34669711

RESUMO

Examining the spread of macroeconomic phenomena between countries has become increasingly popular after the 2008 economic crisis, but the recent COVID-19 pandemic rendered this issue much more relevant as it shed more light on the risks arising from strongly interconnected economies. This paper intends to extend previous studies in this line by examining the relationship between trade openness and business cycle synchronization. It extends the scope of previous analyses in three areas. First, we use a Granger-causality approach to identify synchronization. Second, trade is broken down to the sector level and third, we distinguish between upstream and downstream connections. These developments allow for a directed approach in the analysis. We use conditional logit regressions to estimate the effect of trade openness on the probability of shock-transmission. The results presented in this study contribute to the literature in two ways. First, in addition to revealing a positive effect of aggregate two-way trade on shock-contagion, it also points out that this overall effect hides diverse behavior in specific trading sectors as well as upstream and downstream channels. Second, while some sectors are not significant channels of shock-transmission in either directions, upstream channels seem to be important in agriculture while downstream channels dominate machinery and other manufactures. Also, there are sectors (chemicals and related products) trade in which affects shock-transmission negatively.


Assuntos
COVID-19/economia , COVID-19/epidemiologia , Desenvolvimento Econômico , Modelos Econômicos , Pandemias/economia , SARS-CoV-2 , Humanos
16.
Br J Surg ; 108(10): 1162-1180, 2021 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-34624081

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. METHODS: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. RESULTS: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. CONCLUSION: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.


Assuntos
COVID-19/prevenção & controle , Assistência Perioperatória/tendências , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Operatórios/tendências , Adulto , Pesquisa Biomédica/organização & administração , COVID-19/diagnóstico , COVID-19/economia , COVID-19/epidemiologia , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/tendências , Feminino , Saúde Global , Recursos em Saúde/provisão & distribuição , Acesso aos Serviços de Saúde/tendências , Humanos , Controle de Infecções/economia , Controle de Infecções/métodos , Controle de Infecções/normas , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Pandemias , Assistência Perioperatória/educação , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Padrões de Prática Médica/normas , Cirurgiões/educação , Cirurgiões/psicologia , Cirurgiões/tendências , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas
17.
JAMA Netw Open ; 4(10): e2129894, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34661662

RESUMO

Importance: Many insurers waived cost sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care. Assessment of out-of-pocket spending for COVID-19 hospitalizations in 2020 may show the financial burden that patients may experience if insurers allow waivers to expire, as many chose to do during 2021. Objective: To estimate out-of-pocket spending for COVID-19 hospitalizations in the US in 2020. Design, Setting, and Participants: This cross-sectional study used data from the IQVIA PharMetrics Plus for Academics Database, a national claims database representing 7.7 million privately insured patients and 1.0 million Medicare Advantage patients, regarding COVID-19 hospitalizations for privately insured and Medicare Advantage patients from March to September 2020. Main Outcomes and Measures: Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (eg, accommodation charges) and professional and ancillary services billed by clinicians and ancillary providers (eg, clinician inpatient evaluation and management, ambulance transport). Results: Analyses included 4075 hospitalizations; 2091 (51.3%) were for male patients, and the mean (SD) age of patients was 66.8 (14.8) years. Of these hospitalizations, 1377 (33.8%) were for privately insured patients. Out-of-pocket spending for facility services, professional and ancillary services, or both was reported for 981 of 1377 hospitalizations for privately insured patients (71.2%) and 1324 of 2968 hospitalizations for Medicare Advantage patients (49.1%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 ($1411) for privately insured patients and $277 ($363) for Medicare Advantage patients. In contrast, out-of-pocket spending for facility services was reported for 63 hospitalizations for privately insured patients (4.6%) and 36 hospitalizations for Medicare Advantage patients (1.3%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $3840 ($3186) for privately insured patients and $1536 ($1402) for Medicare Advantage patients. Total out-of-pocket spending exceeded $4000 for 2.5% of privately insured hospitalizations compared with 0.2% of Medicare Advantage hospitalizations. Conclusions and Relevance: In this cross-sectional study, few patients hospitalized for COVID-19 in 2020 were billed for facility services provided by hospitals, suggesting that most were covered by insurers with cost-sharing waivers. However, many patients were billed for professional and ancillary services, suggesting that insurer cost-sharing waivers may not have covered all hospitalization-related care. High cost sharing for patients who were billed by facility services suggests that out-of-pocket spending may be substantial for patients whose insurers have allowed waivers to expire.


Assuntos
COVID-19/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Idoso , Idoso de 80 Anos ou mais , COVID-19/economia , Custo Compartilhado de Seguro/estatística & dados numéricos , Estudos Transversais , Bases de Dados Factuais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2
19.
PLoS Med ; 18(10): e1003807, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34673772

RESUMO

BACKGROUND: We examined whether key sociodemographic and clinical risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and mortality changed over time in a population-based cohort study. METHODS AND FINDINGS: In a cohort of 9,127,673 persons enrolled in the United States Veterans Affairs (VA) healthcare system, we evaluated the independent associations of sociodemographic and clinical characteristics with SARS-CoV-2 infection (n = 216,046), SARS-CoV-2-related mortality (n = 10,230), and case fatality at monthly intervals between February 1, 2020 and March 31, 2021. VA enrollees had a mean age of 61 years (SD 17.7) and were predominantly male (90.9%) and White (64.5%), with 14.6% of Black race and 6.3% of Hispanic ethnicity. Black (versus White) race was strongly associated with SARS-CoV-2 infection (adjusted odds ratio [AOR] 5.10, [95% CI 4.65 to 5.59], p-value <0.001), mortality (AOR 3.85 [95% CI 3.30 to 4.50], p-value < 0.001), and case fatality (AOR 2.56, 95% CI 2.23 to 2.93, p-value < 0.001) in February to March 2020, but these associations were attenuated and not statistically significant by November 2020 for infection (AOR 1.03 [95% CI 1.00 to 1.07] p-value = 0.05) and mortality (AOR 1.08 [95% CI 0.96 to 1.20], p-value = 0.21) and were reversed for case fatality (AOR 0.86, 95% CI 0.78 to 0.95, p-value = 0.005). American Indian/Alaska Native (AI/AN versus White) race was associated with higher risk of SARS-CoV-2 infection in April and May 2020; this association declined over time and reversed by March 2021 (AOR 0.66 [95% CI 0.51 to 0.85] p-value = 0.004). Hispanic (versus non-Hispanic) ethnicity was associated with higher risk of SARS-CoV-2 infection and mortality during almost every time period, with no evidence of attenuation over time. Urban (versus rural) residence was associated with higher risk of infection (AOR 2.02, [95% CI 1.83 to 2.22], p-value < 0.001), mortality (AOR 2.48 [95% CI 2.08 to 2.96], p-value < 0.001), and case fatality (AOR 2.24, 95% CI 1.93 to 2.60, p-value < 0.001) in February to April 2020, but these associations attenuated over time and reversed by September 2020 (AOR 0.85, 95% CI 0.81 to 0.89, p-value < 0.001 for infection, AOR 0.72, 95% CI 0.62 to 0.83, p-value < 0.001 for mortality and AOR 0.81, 95% CI 0.71 to 0.93, p-value = 0.006 for case fatality). Throughout the observation period, high comorbidity burden, younger age, and obesity were consistently associated with infection, while high comorbidity burden, older age, and male sex were consistently associated with mortality. Limitations of the study include that changes over time in the associations of some risk factors may be affected by changes in the likelihood of testing for SARS-CoV-2 according to those risk factors; also, study results apply directly to VA enrollees who are predominantly male and have comprehensive healthcare and need to be confirmed in other populations. CONCLUSIONS: In this study, we found that strongly positive associations of Black and AI/AN (versus White) race and urban (versus rural) residence with SARS-CoV-2 infection, mortality, and case fatality observed early in the pandemic were ameliorated or reversed by March 2021.


Assuntos
COVID-19/mortalidade , Grupos de Populações Continentais , Vigilância da População , População Rural/tendências , United States Department of Veterans Affairs/tendências , População Urbana/tendências , Idoso , COVID-19/diagnóstico , COVID-19/economia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Vigilância da População/métodos , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia
20.
Sci Rep ; 11(1): 21174, 2021 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-34707187

RESUMO

Lockdowns implemented to address the COVID-19 pandemic have disrupted human mobility flows around the globe to an unprecedented extent and with economic consequences which are unevenly distributed across territories, firms and individuals. Here we study socioeconomic determinants of mobility disruption during both the lockdown and the recovery phases in Italy. For this purpose, we analyze a massive data set on Italian mobility from February to October 2020 and we combine it with detailed data on pre-existing local socioeconomic features of Italian administrative units. Using a set of unsupervised and supervised learning techniques, we reliably show that the least and the most affected areas persistently belong to two different clusters. Notably, the former cluster features significantly higher income per capita and lower income inequality than the latter. This distinction persists once the lockdown is lifted. The least affected areas display a swift (V-shaped) recovery in mobility patterns, while poorer, most affected areas experience a much slower (U-shaped) recovery: as of October 2020, their mobility was still significantly lower than pre-lockdown levels. These results are then detailed and confirmed with a quantile regression analysis. Our findings show that economic segregation has, thus, strengthened during the pandemic.


Assuntos
COVID-19/epidemiologia , Pandemias , SARS-CoV-2 , COVID-19/economia , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Humanos , Renda , Itália/epidemiologia , Aprendizado de Máquina , Pandemias/economia , Pobreza , Quarentena/economia , Análise de Regressão , Fatores Socioeconômicos , Viagem
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