The Epidemiology of COVID-19 by Race/Ethnicity in Oklahoma City-County, Oklahoma (12 March 2020-31 May 2021).

We aimed to better understand the racially-/ethnically-specific COVID-19-related outcomes, with respect to time, to respond more effectively to emerging variants. Surveillance data from Oklahoma City-County (12 March 2020-31 May 2021) were used to summarize COVID-19 cases, hospitalizations, deaths, and COVID-19 vaccination status by racial/ethnic group and ZIP code. We estimated racially-/ethnically-specific daily hospitalization rates, the proportion of cases hospitalized, and disease odds ratios (OR) adjusting for sex, age, and the presence of at least one comorbidity. Hot spot analysis was performed using normalized values of cases, hospitalizations, and deaths generated from incidence rates per 100,000 population. During the study period, there were 103,030 confirmed cases, 3457 COVID-19-related hospitalizations, and 1500 COVID-19-related deaths. The daily 7-day average hospitalization rate for Hispanics peaked earlier than other groups and reached a maximum (3.0/100,000) in July 2020. The proportion of cases hospitalized by race/ethnicity was 6.09% among non-Hispanic Blacks, 5.48% among non-Hispanic Whites, 3.66% among Hispanics, 3.43% among American Indians, and 2.87% among Asian/Pacific Islanders. COVID-19 hot spots were identified in ZIP codes with minority communities. The Hispanic population experienced the first surge in COVID-19 cases and hospitalizations, while non-Hispanic Blacks ultimately bore the highest burden of COVID-19-related hospitalizations and deaths.

Cost-Benefit Analysis of Allowing Additional Time in Cleaning Hospital Contact Precautions Rooms.

Increasing cleaning time may reduce hospital-acquired transmission of Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococcus (VRE). We constructed a cost-benefit model to estimate the impact of implementing an enhanced cleaning protocol, allowing hospital housekeepers an additional 15 minutes to terminally clean contact precautions rooms. The enhanced cleaning protocol saved the hospital $758 per terminally-cleaned room when accounting for only C. difficile. Scaling up to a hospital with 100 cases of C. difficile/year, and the US annual C. difficile incidence, cost savings were $75,832/year and $169.8 million/year, respectively. These results may inform infection control strategic decision-making and resource allocation.

COVID-19 Mortality Among American Indian and Alaska Native Persons - 14 States, January-June 2020.

American Indian/Alaska Native (AI/AN) persons experienced disproportionate mortality during the 2009 influenza A(H1N1) pandemic (1,2). Concerns of a similar trend during the coronavirus disease 2019 (COVID-19) pandemic led to the formation of a workgroup* to assess the prevalence of COVID-19 deaths in the AI/AN population. As of December 2, 2020, CDC has reported 2,689 COVID-19-associated deaths among non-Hispanic AI/AN persons in the United States.† A recent analysis found that the cumulative incidence of laboratory-confirmed COVID-19 cases among AI/AN persons was 3.5 times that among White persons (3). Among 14 participating states, the age-adjusted AI/AN COVID-19 mortality rate (55.8 deaths per 100,000; 95% confidence interval [CI] = 52.5-59.3) was 1.8 (95% CI = 1.7-2.0) times that among White persons (30.3 deaths per 100,000; 95% CI = 29.9-30.7). Although COVID-19 mortality rates increased with age among both AI/AN and White persons, the disparity was largest among those aged 20-49 years. Among persons aged 20-29 years, 30-39 years, and 40-49 years, the COVID-19 mortality rates among AI/AN were 10.5, 11.6, and 8.2 times, respectively, those among White persons. Evidence that AI/AN communities might be at increased risk for COVID-19 illness and death demonstrates the importance of documenting and understanding the reasons for these disparities while developing collaborative approaches with federal, state, municipal, and tribal agencies to minimize the impact of COVID-19 on AI/AN communities. Together, public health partners can plan for medical countermeasures and prevention activities for AI/AN communities.

Epidemiology and burden of influenza in the U.S. Department of Veterans Affairs.

We describe influenza activity in the US Veterans Affairs (VA) population for the 2010-2011 through 2015-2016 seasons and compare with national CDC FluView data. VA confirmed influenza cases ranged from 1005 to 11 506 per season; triage calls from 6090 to 10 346; outpatient visits from 3849 to 13 406; antiviral prescriptions from 3650 to 32 826; hospitalizations from 546 to 4673; and deaths in hospitalized patients from 17 to 139. Peak activity was generally the same as observed nationally by the CDC. For the seasons analyzed, correlation between VA and CDC %ILI visits (r = .863), influenza hospitalizations (r = .953), positive tests (r = .948), and percent of tests positive (r = .938) was strong. Understanding influenza burden is important for evaluating prevention priorities and resource allocation within VA.

Impact of a National Cancer Prevention and Treatment Program on the Prevalence of Late-Stage Breast Cancer Diagnoses in Oklahoma.

In 2000, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) to provide coverage through Medicaid to women who screened positive for breast and cervical cancer. We aimed to determine if late-stage breast cancer prevalence decreased among Oklahoma women after passage of BCCPTA. Data were obtained from the Oklahoma Central Cancer Registry during 2000-2011. We estimated prevalence proportion ratios (PPR) using modified Poisson regression between the proportion of women with late-stage breast cancer and timing of diagnosis related to BCCPTA. Among uninsured women, the probability of being diagnosed with late-stage cancer after enactment of the BCCPTA was 0.80 (95% CI: 0.67, 0.96) times the probability before enactment. This was significant among uninsured women living in metro counties (PPR: 0.74, 95% CI: 0.61, 0.90) but not in non-metro counties (PPR: 1.05, 95% CI: 0.71, 1.56). These findings may be similar to other rural states with large uninsured populations.

Global Burden of Thrombosis: Epidemiologic Aspects.

Thromboembolic conditions were estimated to account for 1 in 4 deaths worldwide in 2010 and are the leading cause of mortality. Thromboembolic conditions are divided into arterial and venous thrombotic conditions. Ischemic heart disease and ischemic stroke comprise the major arterial thromboses and deep-vein thrombosis and pulmonary embolism comprise venous thromboembolism. Atrial fibrillation is a major risk factor for stroke and systemic arterial thromboembolism. Estimates of the global burden of disease were obtained from Global Burden of Disease Project reports, recent systematic reviews, and searching the published literature for recent studies reporting measures of incidence, burden, and disability-adjusted life-years. Estimates per 100 000 of the global incidence rate (IR) for each condition are ischemic heart disease, IR=1518.7; myocardial infarction, IR=139.3; ischemic stroke, IR=114.3; atrial fibrillation, IR=77.5 in males and 59.5 in females; and venous thromboembolism, IR=115 to 269. Mortality rates (MRs) for each condition are ischemic heart disease, MR=105.5; ischemic stroke, MR=42.3; atrial fibrillation, MR=1.7; and venous thromboembolism, MR=9.4 to 32.3. Global public awareness is substantially lower for pulmonary embolism (54%) and deep-vein thrombosis (44%) than heart attack (88%) and stroke (85%). Over time, the incidence and MRs of these conditions have improved in developed countries, but are increasing in developing countries. Public health efforts to measure disease burden and increase awareness of symptoms and risk factors need to improve, particularly in low- and middle-income regions to address this leading cause of morbidity and mortality.