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1.
MMWR Morb Mortal Wkly Rep ; 70(14): 514-518, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33830985

RESUMEN

COVID-19 has disproportionately affected persons who identify as non-Hispanic American Indian or Alaska Native (AI/AN) (1). The Blackfeet Tribal Reservation, the northern Montana home of the sovereign Blackfeet Nation, with an estimated population of 10,629 (2), detected the first COVID-19 case in the community on June 16, 2020. Following CDC guidance,* and with free testing widely available, the Indian Health Service and Blackfeet Tribal Health Department began investigating all confirmed cases and their contacts on June 25. The relationship between three community mitigation resolutions passed and enforced by the Blackfeet Tribal Business Council and changes in the daily COVID-19 incidence and in the distributions of new cases was assessed. After the September 28 issuance of a strictly enforced stay-at-home order and adoption of a mask use resolution, COVID-19 incidence in the Blackfeet Tribal Reservation decreased by a factor of 33 from its peak of 6.40 cases per 1,000 residents per day on October 5 to 0.19 on November 7. Other mitigation measures the Blackfeet Tribal Reservation used included closing the east gate of Glacier National Park for the summer tourism season, instituting remote learning for public school students throughout the fall semester, and providing a Thanksgiving meal to every household to reduce trips to grocery stores. CDC has recommended use of routine public health interventions for infectious diseases, including case investigation with prompt isolation, contact tracing, and immediate quarantine after exposure to prevent and control transmission of SARS-CoV-2, the virus that causes COVID-19 (3). Stay-at-home orders, physical distancing, and mask wearing indoors, outdoors when physical distancing is not possible, or when in close contact with infected or exposed persons are also recommended as nonpharmaceutical community mitigation measures (3,4). Implementation and strict enforcement of stay-at-home orders and a mask use mandate likely helped reduce the spread of COVID-19 in the Blackfeet Tribal Reservation.


Asunto(s)
/etnología , Indios Norteamericanos/estadística & datos numéricos , Máscaras , Salud Pública/legislación & jurisprudencia , Cuarentena/legislación & jurisprudencia , Características de la Residencia/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Trazado de Contacto , Femenino , Disparidades en el Estado de Salud , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Montana/epidemiología , Adulto Joven
2.
BMJ Glob Health ; 6(4)2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33926892

RESUMEN

INTRODUCTION: Little evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities. METHODS: We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de São Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities. RESULTS: Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45). CONCLUSIONS: Low-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.


Asunto(s)
/etnología , Grupos Étnicos/estadística & datos numéricos , Mortalidad Hospitalaria/etnología , Neumonía Viral , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Estudios Seroepidemiológicos , Factores Socioeconómicos
3.
MMWR Morb Mortal Wkly Rep ; 70(12): 431-436, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33764963

RESUMEN

The U.S. COVID-19 vaccination program began in December 2020, and ensuring equitable COVID-19 vaccine access remains a national priority.* COVID-19 has disproportionately affected racial/ethnic minority groups and those who are economically and socially disadvantaged (1,2). Thus, achieving not just vaccine equality (i.e., similar allocation of vaccine supply proportional to its population across jurisdictions) but equity (i.e., preferential access and administra-tion to those who have been most affected by COVID-19 disease) is an important goal. The CDC social vulnerability index (SVI) uses 15 indicators grouped into four themes that comprise an overall SVI measure, resulting in 20 metrics, each of which has national and state-specific county rankings. The 20 metric-specific rankings were each divided into lowest to highest tertiles to categorize counties as low, moderate, or high social vulnerability counties. These tertiles were combined with vaccine administration data for 49,264,338 U.S. residents in 49 states and the District of Columbia (DC) who received at least one COVID-19 vaccine dose during December 14, 2020-March 1, 2021. Nationally, for the overall SVI measure, vaccination coverage was higher (15.8%) in low social vulnerability counties than in high social vulnerability counties (13.9%), with the largest coverage disparity in the socioeconomic status theme (2.5 percentage points higher coverage in low than in high vulnerability counties). Wide state variations in equity across SVI metrics were found. Whereas in the majority of states, vaccination coverage was higher in low vulnerability counties, some states had equitable coverage at the county level. CDC, state, and local jurisdictions should continue to monitor vaccination coverage by SVI metrics to focus public health interventions to achieve equitable coverage with COVID-19 vaccine.


Asunto(s)
/administración & dosificación , Disparidades en Atención de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Cobertura de Vacunación/estadística & datos numéricos , Poblaciones Vulnerables , /epidemiología , Humanos , Programas de Inmunización , Evaluación de Programas y Proyectos de Salud , Factores Socioeconómicos , Estados Unidos/epidemiología
4.
Ann Afr Med ; 20(1): 9-13, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33727505

RESUMEN

Background: The prevalence of obesity has risen to over 650 million adults in 2016, and accounts for 41 million deaths globally. It is a major contributor to the burden of noncommunicable diseases. We determined the prevalence and associated factors of obesity to inform policy decisions toward developing robust prevention and management strategies. Materials and Methods: We conducted a population-based cross-sectional study in July 2017 among 1265 adults in urban and rural communities in Benue State. We used multistage sampling technique in selecting the participants. The WHO standardized and validated tool were used to collect information on sociodemographic and anthropometric measurements. We calculated age standardized prevalence of obesity and determined factors associated with obesity using logistic regression at 5% level of significance. Results: The age standardized prevalence of obesity was 11.1% (rural 4.2%, urban 14.3%). The odds for obesity was higher among females (adjusted odds ratio [aOR]: 3.4; 95% confidence interval [CI]: 2.27-4.99), those with tertiary education (aOR: 3.3; 95% CI: 1.61-6.95), married (aOR: 2.1; 95% CI: 1.37-3.36), and those residing in urban areas (aOR: 3.0; 95% CI: 1.73-5.05) compared to rural dwellers. Conclusions: The prevalence of obesity was high among adults in Benue State. It is more prevalent among females, married, educated, and urban dwellers. Interventions targeted at healthy lifestyle choices should be directed at these populations for effective control.


Asunto(s)
Obesidad/epidemiología , Vigilancia de la Población/métodos , Características de la Residencia/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Población Rural , Distribución por Sexo , Factores Socioeconómicos , Población Urbana , Adulto Joven
5.
Proc Natl Acad Sci U S A ; 118(13)2021 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-33727410

RESUMEN

Although there is increasing awareness of disparities in COVID-19 infection risk among vulnerable communities, the effect of behavioral interventions at the scale of individual neighborhoods has not been fully studied. We develop a method to quantify neighborhood activity behaviors at high spatial and temporal resolutions and test whether, and to what extent, behavioral responses to social-distancing policies vary with socioeconomic and demographic characteristics. We define exposure density ([Formula: see text]) as a measure of both the localized volume of activity in a defined area and the proportion of activity occurring in distinct land-use types. Using detailed neighborhood data for New York City, we quantify neighborhood exposure density using anonymized smartphone geolocation data over a 3-mo period covering more than 12 million unique devices and rasterize granular land-use information to contextualize observed activity. Next, we analyze disparities in community social distancing by estimating variations in neighborhood activity by land-use type before and after a mandated stay-at-home order. Finally, we evaluate the effects of localized demographic, socioeconomic, and built-environment density characteristics on infection rates and deaths in order to identify disparities in health outcomes related to exposure risk. Our findings demonstrate distinct behavioral patterns across neighborhoods after the stay-at-home order and that these variations in exposure density had a direct and measurable impact on the risk of infection. Notably, we find that an additional 10% reduction in exposure density city-wide could have saved between 1,849 and 4,068 lives during the study period, predominantly in lower-income and minority communities.


Asunto(s)
/transmisión , Disparidades en el Estado de Salud , Características de la Residencia/estadística & datos numéricos , Entorno Construido , /prevención & control , Sistemas de Información Geográfica , Humanos , Ciudad de Nueva York/epidemiología , Factores de Riesgo , Factores Socioeconómicos , Análisis Espacio-Temporal
6.
Cochrane Database Syst Rev ; 3: CD009231, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33721912

RESUMEN

BACKGROUND: The policy several countries is to provide people with a terminal illness the choice of dying at home; this is supported by surveys that indicate that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fifth update of the original review. OBJECTIVES: To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and caregivers compared with inpatient hospital or hospice care. SEARCH METHODS: We searched CENTRAL, Ovid MEDLINE(R), Embase, CINAHL, and clinical trials registries to 18 March 2020. We checked the reference lists of systematic reviews. For included studies, we checked the reference lists and performed a forward search using ISI Web of Science. We handsearched palliative care journals indexed by ISI Web of Science for online first references. SELECTION CRITERIA: Randomised controlled trials evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed study quality. When appropriate, we combined published data for dichotomous outcomes using a fixed-effect Mantel-Haenszel meta-analysis to calculate risk ratios (RR) with 95% confidence intervals (CI). When combining outcome data was not possible, we reported the results from individual studies. MAIN RESULTS: We included four randomised trials and found no new studies from the search in March 2020. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (RR 1.31, 95% CI 1.12 to 1.52; 2 trials, 539 participants; I2 = 25%; high-certainty evidence). Admission to hospital varied among the trials (range of RR 0.62, 95% CI 0.48 to 0.79, to RR 2.61, 95% CI 1.50 to 4.55). The effect on patient outcomes and control of symptoms was uncertain. Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up, with little or no difference at six-month follow-up (2 trials; low-certainty evidence). The effect on caregivers (2 trials; very low-certainty evidence), staff (1 trial; very low-certainty evidence) and health service costs was uncertain (2 trials, very low-certainty evidence). AUTHORS' CONCLUSIONS: The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home. Research that assesses the impact of home-based end-of-life care on caregivers and admissions to hospital would be a useful addition to the evidence base, and might inform the delivery of these services.


Asunto(s)
Actitud Frente a la Muerte , Servicios de Atención de Salud a Domicilio , Cuidados Paliativos al Final de la Vida/psicología , Prioridad del Paciente/psicología , Anciano , Actitud del Personal de Salud , Sesgo , Cuidadores/psicología , Femenino , Accesibilidad a los Servicios de Salud , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Características de la Residencia/estadística & datos numéricos , Factores de Tiempo
7.
J R Soc Med ; 114(4): 182-211, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33759630

RESUMEN

OBJECTIVE: To estimate the proportion of ethnic inequalities explained by living in a multi-generational household. DESIGN: Causal mediation analysis. SETTING: Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020). PARTICIPANTS: Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568). MAIN OUTCOME MEASURES: Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health. RESULTS: Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06-1.30) and 1.21 (95% CI 1.06-1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01-1.13) for elderly men and 1.17 (95% CI 1.07-1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups. CONCLUSION: Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.


Asunto(s)
Composición Familiar/etnología , Vivienda , Mortalidad/etnología , Características de la Residencia/estadística & datos numéricos , Factores de Edad , Anciano , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , /prevención & control , Niño , Inglaterra/epidemiología , Familia , Femenino , Disparidades en el Estado de Salud , Vivienda/normas , Vivienda/estadística & datos numéricos , Humanos , Masculino , Medición de Riesgo , Factores Sexuales , Factores Socioeconómicos
8.
Int J Qual Health Care ; 33(1)2021 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-33644795

RESUMEN

OBJECTIVE: To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital. DESIGN: A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. And a multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata. SETTING: Hospital Ratings are measured by Hospital Compare using the HCAHPS survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for hospitals in the United States. Participants: 2,816 Medicare-certified acute care hospitals across all US states.


Asunto(s)
/epidemiología , Centers for Medicare and Medicaid Services, U.S./normas , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Factores de Edad , Femenino , Humanos , Modelos Lineales , Masculino , Satisfacción del Paciente/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Sexuales , Estados Unidos/epidemiología
9.
Health Place ; 68: 102540, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33647635

RESUMEN

Epidemiological studies have highlighted the disparate impact of coronavirus disease 2019 (COVID-19) on racial and ethnic minority and socioeconomically disadvantaged populations, but data at the neighborhood-level is sparse. The objective of this study was to investigate the disparate impact of COVID-19 on disadvantaged neighborhoods and racial/ethnic minorities in Chicago, Illinois. Using data from the Cook County Medical Examiner, we conducted a neighborhood-level analysis of COVID-19 decedents in Chicago and quantified age-standardized years of potential life lost (YPLL) due to COVID-19 among demographic subgroups and neighborhoods with geospatial clustering of high and low rates of COVID-19 mortality. We show that age-standardized YPLL was markedly higher among the non-Hispanic (NH) Black (559 years per 100,000 population) and the Hispanic (811) compared with NH white decedents (312). We demonstrate that geomapping using residential address data at the individual-level identifies hot-spots of COVID-19 mortality in neighborhoods on the Northeast, West, and South areas of Chicago that reflect a legacy of residential segregation and persistence of inequality in education, income, and access to healthcare. Our results may contribute to ongoing public health and community-engaged efforts to prevent the spread of infection and mitigate the disproportionate loss of life among these communities due to COVID-19 as well as highlight the urgent need to broadly target neighborhood disadvantage as a cause of pervasive racial inequalities in life and health.


Asunto(s)
Grupos de Población Continentales , Grupos Étnicos/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Años de Vida Ajustados por Calidad de Vida , Características de la Residencia/estadística & datos numéricos , Anciano , /mortalidad , Chicago/epidemiología , Femenino , Humanos , Masculino
10.
Natl Vital Stat Rep ; 69(13): 1-83, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33541516

RESUMEN

Objectives-This report presents final 2018 data on U.S. deaths, death rates, life expectancy, infant and maternal mortality, and trends by selected characteristics such as age, sex, Hispanic origin and race, state of residence, and cause of death. The race categories are consistent with 1997 Office of Management and Budget (OMB) standards, which are different from previous reports (1977 OMB standards). Methods-Information reported on death certificates is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the National Center for Health Statistics. Causes of death are processed according to the International Classification of Diseases, 10th Revision. As of 2018, all states and the District of Columbia were using the 2003 revised certificate of death, which includes the 1997 OMB revised standards for race. The 2018 data based on the revised standards are not completely comparable to previous years. Selected estimates are presented in this report for both the revised and previous race standards to provide some reference for interpretation of trends. Results-In 2018, a total of 2,839,205 deaths were reported in the United States. The age-adjusted death rate was 723.6 deaths per 100,000 U.S. standard population, a decrease of 1.1% from the 2017 rate. Life expectancy at birth was 78.7 years, an increase of 0.1 year from 2017. Age-specific death rates decreased in 2018 from 2017 for age groups 15-24, 25-34, 45-54, 65-74, 75-84, and 85 and over. The 15 leading causes of death in 2018 remained the same as in 2017. The infant mortality rate decreased 2.2% to a historically low figure of 5.66 infant deaths per 1,000 live births in 2018. Conclusions-The age-adjusted death rate for the total, male, and female populations decreased from 2017 to 2018, and life expectancy at birth increased in 2018 for the total, male, and female populations.


Asunto(s)
Mortalidad/tendencias , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Niño , Preescolar , Grupos Étnicos/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Esperanza de Vida/tendencias , Masculino , Persona de Mediana Edad , Características de la Residencia/estadística & datos numéricos , Distribución por Sexo , Estados Unidos/epidemiología , Estadísticas Vitales , Adulto Joven
11.
Nursing (Säo Paulo) ; 24(273): 5219-5228, fev.2021.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1148484

RESUMEN

Objetivos: identificar os significados acerca da Estratégia Saúde da Família para uma comunidade. Método: estudo qualitativo, exploratório, descritivo e transversal, amostragem não probabilística e intencional, realizado com 20 participantes, com a utilização de dois instrumentos. Os dados das entrevistas foram avaliados considerando a abordagem do Discurso do Sujeito Coletivo pautados na Teoria das Representações Sociais. Quanto aos dados do questionário foram tratados de forma percentual. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: 75% eram do gênero feminino, faixa etária de 61 a 70 anos, 30% possuem ensino médio completo e 6 meses a 10 anos em que residem próximo a ESF. Emergiram duas ideias centrais "muito bom" e "nenhum". Conclusão: a maioria dos entrevistados atribuiu significados positivos diante da inserção da unidade em sua área de moradia. Porém, apesar da facilidade de acesso, ressaltam a necessidade de melhorias nos serviços.(AU)


Objectives: to identify the meanings about the Family Health Strategy for a community. Method: the study is a qualitative, exploratory, cross-sectional, non probabilistic and intentional sampling, composed with 20 participants using two instruments. The data from the interviews were evaluated considering the collective subject discourse approach based on the Theory of Social Representations. Regarding the data from the questionnaire, they were treated in a percentage way. The study was approved by the Research Ethics Committee. Results: 75% were female, aged 61 to 70 years, 30% had completed high school and 6 months to 10 years in which they live near the ESF. Two central ideas emerged "very good" and "none". Conclusion: the most of the interviewees attributed positive meanings to the insertion of the unit in their housing area. However, despite the ease of access, they still emphasize the need for improvements in services.(AU)


Objetivos: Identificar los significados sobre la Estrategia de Salud Familiar para una comunidad. Método: Estudio de enfoque cualitativo, exploratorio, descriptivo y transversal, muestreo no probabilístico e intencional, con un total de 20 participantes, con el uso de dos instrumentos. Los datos de las entrevistas fueron evaluados considerando el enfoque del discurso de sujeto colectivo basado en la Teoría de las Representaciones Sociales. En cuanto a los datos del cuestionario, fueron tratados de manera porcentual. El estudio fue aprobado por el Comité de ética de la investigación. Resultados: el 75% eran mujeres, de 61 a 70 años, el 30% habían completado la escuela secundaria y 6 meses a 10 años en los que viven cerca del FSE. Dos ideas centrales surgieron "muy buenas" y "ninguna". Conclusión: La mayoría de los entrevistados atribuyeron significados positivos a la inserción de la unidad en su área de vivienda. Sin embargo, a pesar de la facilidad de acceso, siguen insistiendo en la necesidad de mejorar los servicios.(AU)


Asunto(s)
Humanos , Salud de la Familia , Estrategia de Salud Familiar , Enfermería de Atención Primaria , Factores Socioeconómicos , Características de la Residencia/estadística & datos numéricos , Investigación Cualitativa
12.
Isr J Health Policy Res ; 10(1): 17, 2021 02 26.
Artículo en Inglés | MEDLINE | ID: mdl-33637126

RESUMEN

BACKGROUND: Excess all-cause mortality has been used in many countries as an estimate of mortality effects from COVID-19. What was the excess mortality in Israel in 2020 and when, where and for whom was this excess? METHODS: Mortality rates between March to November 2020 for various demographic groups, cities, month and week were compared with the average rate during 2017-2019 for the same groups or periods. RESULTS: Total mortality rates for March-November were significantly higher by 6% in 2020, than the average of 2017-2019, 14% higher among the Arab population and 5% among Jews and Others. Significantly higher monthly mortality rates were found in August, September and October by 11%, 13% and 19%, respectively, among Jews and Others, and by 19%, 64% and 40% in the Arab population. Excess mortality was significant only at older ages, 7% higher rates at ages 65-74 and 75-84 and 8% at ages 85 and above, and greater for males than females in all ages and population groups. Interestingly, mortality rates decreased significantly among the younger population aged under 25. The cities with most significant excess mortality were Ramla (25% higher), Bene Beraq (24%), Bat Yam (15%) and Jerusalem (8%). CONCLUSION: Israel has seen significant excess mortality in August-October 2020, particularly in the Arab sector. The excess mortality in March-November was statistically significant only at older ages, over 65. It is very important to protect this susceptible population from exposure and prioritize them for inoculations. Lockdowns were successful in lowering the excess mortality. The excess mortality is similar to official data on COVID-19 deaths.


Asunto(s)
/mortalidad , Mortalidad/tendencias , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Árabes/estadística & datos numéricos , Niño , Preescolar , Ciudades/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Israel/epidemiología , Judíos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Características de la Residencia/estadística & datos numéricos , Distribución por Sexo , Factores de Tiempo , Adulto Joven
13.
J Rehabil Med ; 53(3): jrm00166, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33624830

RESUMEN

OBJECTIVE: Describing rehabilitation services in a standardized way is a challenge. The International Classification of Service Organizations in Rehabil-itation (ICSO-R) 2.0 was published for this purpose. The ICSO-R was criticized for being tested mainly in high-income countries, and because the testing in lower-income countries did not include community-based rehabilitation services. Therefore, this study was performed to describe community-based rehabilitation services by using ICSO-R 2.0. METHODS: The ICSO-R 2.0 was used to describe 8 community-based rehabilitation services located in 3 cities in 3 different provinces in Indonesia: 6 community-based rehabilitation services in Bandung, West Java; 1 in Tanah Datar, West Sumatra; and 1 in Gowa, South Sulawesi. RESULTS: All the community-based rehabilitation services were owned by the government, as a public body, and in the context of the community. The 6 community-based rehabilitation services in Bandung, West Java, are under the government city of Bandung, while the other 2, from Tanah Datar and Gowa, are integrated within primary healthcare centres. Social welfare supports all 6 community-based rehabilitation services in Bandung. The other 2 community-based rehabilitation services are supported by their respective primary healthcare centres. CONCLUSION: The ICSO-R 2.0 is a feasible tool to describe rehabilitation services, including community-based rehabilitation.


Asunto(s)
Medicina Física y Rehabilitación/clasificación , Características de la Residencia/estadística & datos numéricos , Humanos , Indonesia
14.
JAMA Netw Open ; 4(2): e2036809, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33544146

RESUMEN

Importance: Studying long-term changes in neighborhood socioeconomic status (SES) may help to better understand the associations between neighborhood exposure and weight outcomes and provide evidence supporting neighborhood interventions. Little previous research has been done to examine associations between neighborhood SES and weight loss, a risk factor associated with poor health outcomes in the older population. Objective: To determine whether improvements in neighborhood SES are associated with reduced likelihoods of excessive weight gain and excessive weight loss and whether declines are associated with increased likelihoods of these weight outcomes. Design, Study, and Participants: This cohort study was conducted using data from the National Institutes of Health-AARP (formerly known as the American Association of Retired Persons) Diet and Health study (1995-2006). The analysis included a cohort of 126 179 adults (aged 50-71 years) whose neighborhoods at baseline (1995-1996) were the same as at follow-up (2004-2006). All analyses were performed from December 2018 through December 2020. Exposures: Living in a neighborhood that experienced 1 of 8 neighborhood SES trajectories defined based on a national neighborhood SES index created using data from the US Census and American Community Survey. The 8 trajectory groups, in which high, or H, indicated rankings at or above the sample median of a specific year and low, or L, indicated rankings below the median, were HHH (ie, high in 1990 to high in 2000 to high in 2010), or stable high; HLL, or early decline; HHL, or late decline; HLH, or transient decline; LLL, or stable low; LHH, or early improvement; LLH, or late improvement; and LHL, or transient improvement. Main Outcomes and Measures: Excessive weight gain and loss were defined as gaining or losing 10% or more of baseline weight. Results: Among 126 179 adults, 76 225 (60.4%) were men and the mean (SD) age was 62.1 (5.3) years. Improvements in neighborhood SES were associated with lower likelihoods of excessive weight gain and weight loss over follow-up, while declines in neighborhood SES were associated with higher likelihoods of excessive weight gain and weight loss. Compared with the stable low group, the risk was significantly reduced for excessive weight gain in the early improvement group (odds ratio [OR], 0.87; 95% CI, 0.79-0.95) and for excessive weight loss in the late improvement group (OR, 0.89; 95% CI, 0.80-1.00). Compared with the stable high group, the risk of excessive weight gain was significantly increased for the early decline group (OR, 1.19; 95% CI, 1.08-1.31) and late decline group (OR, 1.13; 95% CI, 1.04-1.24) and for excessive weight loss in the early decline group (OR, 1.15; 95% CI, 1.02-1.28). The increases in likelihood were greater when the improvement or decline in neighborhood SES occurred early in the study period (ie, 1990-2000) and was substantiated throughout the follow-up (ie, the early decline and early improvement groups). Overall, we found a linear association between changes in neighborhood SES and weight outcomes, in which every 5 percentile decline in neighborhood SES was associated with a 1.2% to 2.4% increase in the risk of excessive weight gain or loss (excessive weight gain: OR, 1.01; 95% CI, 1.00-1.02 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; excessive weight loss: OR, 1.02; 95% CI, 1.01-1.03 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; P for- trend < .0001). Conclusions and Relevance: These findings suggest that changing neighborhood environment was associated with changes in weight status in older adults.


Asunto(s)
Trayectoria del Peso Corporal , Características de la Residencia/estadística & datos numéricos , Clase Social , Anciano , Escolaridad , Grupos Étnicos , Femenino , Vivienda/tendencias , Humanos , Renta/tendencias , Masculino , Persona de Mediana Edad , Asistencia Pública/tendencias , Familia de Padres Solteros , Factores Socioeconómicos , Desempleo/tendencias , Estados Unidos , Aumento de Peso , Pérdida de Peso
15.
Public Health ; 192: 15-20, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33607516

RESUMEN

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has highlighted inequalities in access to healthcare systems, increasing racial disparities and worsening health outcomes in these populations. This study analysed the association between sociodemographic characteristics and COVID-19 in-hospital mortality in Brazil. STUDY DESIGN: A retrospective analysis was conducted on quantitative reverse transcription polymerase chain reaction-confirmed hospitalised adult patients with COVID-19 with a defined outcome (i.e. hospital discharge or death) in Brazil. Data were retrieved from the national surveillance system database (SIVEP-Gripe) between February 16 and August 8, 2020. METHODS: Clinical characteristics, sociodemographic variables, use of hospital resources and outcomes of hospitalised adult patients with COVID-19, stratified by self-reported race, were investigated. The primary outcome was in-hospital mortality. The association between self-reported race and in-hospital mortality, after adjusting for clinical characteristics and comorbidities, was evaluated using a logistic regression model. RESULTS: During the study period, Brazil had 3,018,397 confirmed COVID-19 cases and 100,648 deaths. The study population included 228,196 COVID-19-positive adult in-hospital patients with a defined outcome; the median age was 61 years, 57% were men, 35% (79,914) self-reported as Black/Brown and 35.4% (80,853) self-reported as White. The total in-hospital mortality was 37% (85,171/228,196). Black/Brown patients showed higher in-hospital mortality than White patients (42% vs 37%, respectively), were admitted less frequently to the intensive care unit (ICU) (32% vs 36%, respectively) and used more invasive mechanical ventilation (21% vs 19%, respectively), especially outside the ICU (17% vs 11%, respectively). Black/Brown race was independently associated with high in-hospital mortality after adjusting for sex, age, level of education, region of residence and comorbidities (odds ratio = 1.15; 95% confidence interval = 1.09-1.22). CONCLUSIONS: Among hospitalised Brazilian adults with COVID-19, Black/Brown patients showed higher in-hospital mortality, less frequently used hospital resources and had potentially more severe conditions than White patients. Racial disparities in health outcomes and access to health care highlight the need to actively implement strategies to reduce inequities caused by the wider health determinants, ultimately leading to a sustainable change in the health system.


Asunto(s)
Afroamericanos/estadística & datos numéricos , /mortalidad , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Mortalidad Hospitalaria/etnología , Mortalidad Hospitalaria/tendencias , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Brasil/epidemiología , Comorbilidad , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Respiración Artificial , Estudios Retrospectivos , Factores Socioeconómicos , Adulto Joven
17.
Am J Epidemiol ; 190(2): 295-304, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33524122

RESUMEN

Socioeconomic status has been associated with cardiovascular disease risk factors. However, few studies have examined this relationship among populations in the US Gulf Coast region. We assessed neighborhood deprivation in relation to obesity and diabetes in 9,626 residents participating in the Gulf Long-Term Follow-Up Study (2011-present) who completed a home visit (2011-2013) with height, weight, waist, and hip measurements. Obesity was categorized as body mass index of at least 30, and diabetes was defined by doctor's diagnosis or prescription medication. Participant home addresses were linked to an established Area Deprivation Index and categorized into 4 levels (1 = least deprived). In adjusted, modified Poisson regression models, participants with greatest deprivation were more likely to have obesity compared with those with least deprivation (adjusted prevalence ratio (aPR) = 1.21, 95% confidence interval (CI): 1.08, 1.35), central obesity (aPR = 1.11, 95% CI: 1.04, 1.19), and diabetes (aPR = 1.49, 95% CI: 1.03, 2.14). Repeated analyses among a subgroup of participants (n = 3,016) whose hemoglobin A1C values were measured 3 years later indicated the association with diabetes (defined as diagnosis, medications, or hemoglobin A1C ≥ 6.5) was similar (aPR = 1.46, 95% CI: 1.14, 1.86). Results suggest neighborhood deprivation is associated with obesity and diabetes in a US region with high baseline prevalence.


Asunto(s)
Diabetes Mellitus/epidemiología , Obesidad/epidemiología , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Índice de Masa Corporal , Fumar Cigarrillos/epidemiología , Femenino , Hemoglobina A Glucada , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Clase Social , Factores Socioeconómicos , Sudeste de Estados Unidos/epidemiología , Texas/epidemiología
18.
BMJ Open ; 11(1): e042464, 2021 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-33509849

RESUMEN

OBJECTIVE: To characterise the self-isolating household units (bubbles) during the COVID-19 Alert Level 4 lockdown in New Zealand. DESIGN, SETTING AND PARTICIPANTS: In this cross-sectional study, an online survey was distributed to a convenience sample via Facebook advertising and the Medical Research Institute of New Zealand's social media platforms and mailing list. Respondents were able to share a link to the survey via their own social media platforms and by email. Results were collected over 6 days during Alert Level 4 from respondents living in New Zealand, aged 16 years and over. MAIN OUTCOMES MEASURES: The primary outcome was the mean size of a self-isolating household unit or bubble. Secondary outcomes included the mean number of households in each bubble, the proportion of bubbles containing essential workers and/or vulnerable people, and the mean number of times the home was left each week. RESULTS: 14 876 surveys were included in the analysis. The mean (SD) bubble size was 3.58 (4.63) people, with mean (SD) number of households 1.26 (0.77). The proportion of bubbles containing one or more essential workers, or one or more vulnerable persons was 45.3% and 42.1%, respectively. The mean number of times individual bubble members left their home in the previous week was 12.9 (12.4). Bubbles that contained at least one vulnerable individual had fewer outings over the previous week compared with bubbles that did not contain a vulnerable person. The bubble sizes were similar by respondent ethnicity. CONCLUSION: In this New Zealand convenience sample, bubble sizes were small, mostly limited to one household, and a high proportion contained essential workers and/or vulnerable people. Understanding these characteristics from a country which achieved a low COVID-19 infection rate may help inform public health interventions during this and future pandemics.


Asunto(s)
/epidemiología , Composición Familiar , Características de la Residencia/estadística & datos numéricos , Adulto , Estudios Transversales , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Composición Familiar/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Encuestas y Cuestionarios , Poblaciones Vulnerables/estadística & datos numéricos
19.
Am J Public Health ; 111(3): 494-497, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33476228

RESUMEN

Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods.Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitudinal cohort (n = 605) previously followed from 2011 to 2018. We examined longitudinal trends in food insecurity from 2011 to 2020 and compared them with national trends. We also assessed use of food assistance in our sample in 2018 versus 2020.Results. From 2018 to 2020, food insecurity increased from 20.7% to 36.9% (t = 7.63; P < .001) after steady declines since 2011. As a result of COVID-19, the United States has experienced a 60% increase in food insecurity, whereas this sample showed a nearly 80% increase, widening a preexisting disparity. Participation in the Supplemental Nutrition Assistance Program (52.2%) and food bank use (35.9%) did not change significantly during the early weeks of the pandemic.Conclusions. Longitudinal data highlight profound inequities that have been exacerbated by COVID-19. Existing policies appear inadequate to address the widening gap.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Humanos , Estudios Longitudinales , Pandemias , Pennsylvania/epidemiología , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Estados Unidos/epidemiología
20.
BMC Public Health ; 21(1): 176, 2021 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478445

RESUMEN

The response to the coronavirus outbreak and how the disease and its societal consequences pose risks to already vulnerable groups such those who are socioeconomically disadvantaged and ethnic minority groups. Researchers and community groups analysed how the COVID-19 crisis has exacerbated persisting vulnerabilities, socio-economic and structural disadvantage and discrimination faced by many communities of social disadvantage and ethnic diversity, and discussed future strategies on how best to engage and involve local groups in research to improve outcomes for childbearing women experiencing mental illness and those living in areas of social disadvantage and ethnic diversity. Discussions centred around: access, engagement and quality of care; racism, discrimination and trust; the need for engagement with community stakeholders; and the impact of wider social and economic inequalities. Addressing biomedical factors alone is not sufficient, and integrative and holistic long-term public health strategies that address societal and structural racism and overall disadvantage in society are urgently needed to improve health disparities and can only be implemented in partnership with local communities.


Asunto(s)
Disparidades en el Estado de Salud , Salud Materna , Características de la Residencia/estadística & datos numéricos , /epidemiología , Diversidad Cultural , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Salud Materna/etnología , Áreas de Pobreza , Embarazo , Reino Unido/epidemiología
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