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1.
MMWR Morb Mortal Wkly Rep ; 69(41): 1485-1491, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33056951

RESUMEN

Frequent hand hygiene, including handwashing with soap and water or using a hand sanitizer containing ≥60% alcohol when soap and water are not readily available, is one of several critical prevention measures recommended to reduce the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19).* Previous studies identified demographic factors associated with handwashing among U.S. adults during the COVID-19 pandemic (1,2); however, demographic factors associated with hand sanitizing and experiences and beliefs associated with hand hygiene have not been well characterized. To evaluate these factors, an Internet-based survey was conducted among U.S. adults aged ≥18 years during June 24-30, 2020. Overall, 85.2% of respondents reported always or often engaging in hand hygiene following contact with high-touch public surfaces such as shopping carts, gas pumps, and automatic teller machines (ATMs).† Respondents who were male (versus female) and of younger age reported lower handwashing and hand sanitizing rates, as did respondents who reported lower concern about their own infection with SARS-CoV-2§ and respondents without personal experience with COVID-19. Focused health promotion efforts to increase hand hygiene adherence should include increasing visibility and accessibility of handwashing and hand sanitizing materials in public settings, along with targeted communication to males and younger adults with focused messages that address COVID-19 risk perception.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Higiene de las Manos/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Adolescente , Adulto , Factores de Edad , Anciano , Grupos de Población Continentales/psicología , Grupos de Población Continentales/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/etnología , Grupos Étnicos/psicología , Grupos Étnicos/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/etnología , Factores Sexuales , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
2.
MMWR Morb Mortal Wkly Rep ; 69(41): 1481-1484, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33056954

RESUMEN

Breast cancer among males in the United States is rare; approximately 2,300 new cases and 500 associated deaths were reported in 2017, accounting for approximately 1% of all breast cancers.* Risk for male breast cancer increases with increasing age (1), and compared with women, men receive diagnoses later in life and often at a later stage of disease (1). Gradual improvement in breast cancer survival from 1976-1985 to 1996-2005 has been more evident for women than for men (1). Studies examining survival differences among female breast cancer patients observed that non-Hispanic White (White) females had a higher survival than non-Hispanic Black (Black) females (2), but because of the rarity of breast cancer among males, few studies have examined survival differences by race or other factors such as age, stage, and geographic region. CDC's National Program of Cancer Registries (NPCR)† data were used to examine relative survival of males with breast cancer diagnosed during 2007-2016 by race/ethnicity, age group, stage at diagnosis, and U.S. Census region. Among males who received a diagnosis of breast cancer during 2007-2016, 1-year relative survival was 96.1%, and 5-year relative survival was 84.7%. Among characteristics examined, relative survival varied most by stage at diagnosis: the 5-year relative survival for males was higher for cancers diagnosed at localized stage (98.7%) than for those diagnosed at distant stage (25.9%). Evaluation of 1-year and 5-year relative survival among males with breast cancer might help guide health care decisions regarding early detection of male breast cancer and establishing programs to support men at high risk for breast cancer and male breast cancer survivors.


Asunto(s)
Neoplasias de la Mama Masculina/mortalidad , Distribución por Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama Masculina/etnología , Neoplasias de la Mama Masculina/patología , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Geografía , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/estadística & datos numéricos , Análisis de Supervivencia , Estados Unidos/epidemiología
3.
MMWR Morb Mortal Wkly Rep ; 69(41): 1473-1480, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33056955

RESUMEN

Among U.S. men, prostate cancer is the second leading cause of cancer-related death (1). Past studies documented decreasing incidence of prostate cancer overall since 2000 but increasing incidence of distant stage prostate cancer (i.e., signifying spread to parts of the body remote from the primary tumor) starting in 2010 (2,3). Past studies described disparities in prostate cancer survival by stage, age, and race/ethnicity using data covering ≤80% of the U.S. population (4,5). To provide recent data on incidence and survival of prostate cancer in the United States, CDC analyzed data from population-based cancer registries that contribute to U.S. Cancer Statistics (USCS).* Among 3.1 million new cases of prostate cancer recorded during 2003-2017, localized, regional, distant, and unknown stage prostate cancer accounted for 77%, 11%, 5%, and 7% of cases, respectively, but the incidence of distant stage prostate cancer significantly increased during 2010-2017. During 2001-2016, 10-year relative survival for localized stage prostate cancer was 100%. Overall, 5-year survival for distant stage prostate cancer improved from 28.7% during 2001-2005 to 32.3% during 2011-2016; for the period 2001-2016, 5-year survival was highest among Asian/Pacific Islanders (API) (42.0%), followed by Hispanics (37.2%), American Indian/Alaska Natives (AI/AN) (32.2%), Black men (31.6%), and White men (29.1%). Understanding incidence and survival differences by stage, race/ethnicity, and age can guide public health planning related to screening, treatment, and survivor care. Future research into differences by stage, race/ethnicity, and age could inform interventions aimed at improving disparities in outcomes.


Asunto(s)
Neoplasias de la Próstata/epidemiología , Anciano , Anciano de 80 o más Años , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/estadística & datos numéricos , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Análisis de Supervivencia , Estados Unidos/epidemiología
6.
MMWR Morb Mortal Wkly Rep ; 69(39): 1391-1397, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33001873

RESUMEN

Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy (1). ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27-36 (2,3). Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal with racial/ethnic disparities persisting (4-6). To assess influenza and Tdap vaccination coverage among women pregnant during the 2019-20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018-19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018-19 season (4). Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%). Compared with the 2018-19 season, increases in influenza vaccination coverage were observed during the 2019-20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018-19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019-20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Disparidades en Atención de Salud/etnología , Vacunas contra la Influenza/administración & dosificación , Mujeres Embarazadas/etnología , Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Adulto , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Estados Unidos , Adulto Joven
7.
MMWR Morb Mortal Wkly Rep ; 69(38): 1337-1342, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32970045

RESUMEN

During 2018, gay, bisexual, and other men who have sex with men (MSM) accounted for 69.4% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Moreover, in all 42 jurisdictions with complete laboratory reporting of CD4 and viral load results,* percentages of MSM linked to care within 1 month (80.8%) and virally suppressed (viral load <200 copies of HIV RNA/mL or interpreted as undetected) within 6 months (68.3%) of diagnosis were below target during 2018 (2). African American/Black (Black), Hispanic/Latino (Hispanic), and younger MSM disproportionately experience HIV diagnosis, not being linked to care, and not being virally suppressed. To characterize trends in these outcomes, CDC analyzed National HIV Surveillance System† data from 2014 to 2018. The number of diagnoses of HIV infection among all MSM decreased 2.3% per year (95% confidence interval [CI] = 1.9-2.8). However, diagnoses did not significantly change among either Hispanic MSM or any MSM aged 13-19 years; increased 2.2% (95% CI = 1.0-3.4) and 2.0% (95% CI = 0.6-3.3) per year among Black and Hispanic MSM aged 25-34 years, respectively; and were highest in absolute count among Black MSM. Annual percentages of linkage to care within 1 month and viral suppression within 6 months of diagnosis among all MSM increased (2.9% [95% CI = 2.4-3.5] and 6.8% [95% CI = 6.2-7.4] per year, respectively). These findings, albeit promising, warrant intensified prevention efforts for Black, Hispanic, and younger MSM.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Infecciones por VIH/etnología , Homosexualidad Masculina/etnología , Homosexualidad Masculina/estadística & datos numéricos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Distribución por Edad , Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Carga Viral/estadística & datos numéricos , Adulto Joven
8.
PLoS Med ; 17(9): e1003379, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32960880

RESUMEN

BACKGROUND: There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). We investigated racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent mortality in the largest integrated healthcare system in the United States. METHODS AND FINDINGS: This retrospective cohort study included 5,834,543 individuals receiving care in the US Department of Veterans Affairs; most (91%) were men, 74% were non-Hispanic White (White), 19% were non-Hispanic Black (Black), and 7% were Hispanic. We evaluated associations between race/ethnicity and receipt of COVID-19 testing, a positive test result, and 30-day mortality, with multivariable adjustment for a wide range of demographic and clinical characteristics including comorbid conditions, health behaviors, medication history, site of care, and urban versus rural residence. Between February 8 and July 22, 2020, 254,595 individuals were tested for COVID-19, of whom 16,317 tested positive and 1,057 died. Black individuals were more likely to be tested (rate per 1,000 individuals: 60.0, 95% CI 59.6-60.5) than Hispanic (52.7, 95% CI 52.1-53.4) and White individuals (38.6, 95% CI 38.4-38.7). While individuals from minority backgrounds were more likely to test positive (Black versus White: odds ratio [OR] 1.93, 95% CI 1.85-2.01, p < 0.001; Hispanic versus White: OR 1.84, 95% CI 1.74-1.94, p < 0.001), 30-day mortality did not differ by race/ethnicity (Black versus White: OR 0.97, 95% CI 0.80-1.17, p = 0.74; Hispanic versus White: OR 0.99, 95% CI 0.73-1.34, p = 0.94). The disparity between Black and White individuals in testing positive for COVID-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41-2.95, p < 0.001) than the West (OR 1.24, 95% CI 1.11-1.39, p < 0.001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Study limitations include underrepresentation of women and a lack of detailed information on social determinants of health. CONCLUSIONS: In this nationwide study, we found that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. There is an urgent need to proactively tailor strategies to contain and prevent further outbreaks in racial and ethnic minority communities.


Asunto(s)
Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Grupos Étnicos/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Veteranos/estadística & datos numéricos , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Betacoronavirus , Estudios de Cohortes , Infecciones por Coronavirus/etnología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/etnología , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto Joven
10.
BMJ Open ; 10(9): e039886, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-32873684

RESUMEN

OBJECTIVES: To illustrate the intersections of, and intercounty variation in, individual, household and community factors that influence the impact of COVID-19 on US counties and their ability to respond. DESIGN: We identified key individual, household and community characteristics influencing COVID-19 risks of infection and survival, guided by international experiences and consideration of epidemiological parameters of importance. Using publicly available data, we developed an open-access online tool that allows county-specific querying and mapping of risk factors. As an illustrative example, we assess the pairwise intersections of age (individual level), poverty (household level) and prevalence of group homes (community-level) in US counties. We also examine how these factors intersect with the proportion of the population that is people of colour (ie, not non-Hispanic white), a metric that reflects histories of US race relations. We defined 'high' risk counties as those above the 75th percentile. This threshold can be changed using the online tool. SETTING: US counties. PARTICIPANTS: Analyses are based on publicly available county-level data from the Area Health Resources Files, American Community Survey, Centers for Disease Control and Prevention Atlas file, National Center for Health Statistic and RWJF Community Health Rankings. RESULTS: Our findings demonstrate significant intercounty variation in the distribution of individual, household and community characteristics that affect risks of infection, severe disease or mortality from COVID-19. About 9% of counties, affecting 10 million residents, are in higher risk categories for both age and group quarters. About 14% of counties, affecting 31 million residents, have both high levels of poverty and a high proportion of people of colour. CONCLUSION: Federal and state governments will benefit from recognising high intrastate, intercounty variation in population risks and response capacity. Equitable responses to the pandemic require strategies to protect those in counties at highest risk of adverse COVID-19 outcomes and their social and economic impacts.


Asunto(s)
Factores de Edad , Infecciones por Coronavirus , Grupos Étnicos/estadística & datos numéricos , Composición Familiar , Pandemias , Neumonía Viral , Pobreza/estadística & datos numéricos , Salud Pública , Análisis de Supervivencia , Adulto , Anciano , Betacoronavirus , Análisis por Conglomerados , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Prevalencia , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos
11.
N Z Med J ; 133(1520): 99-103, 2020 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-32994598

RESUMEN

In this viewpoint we briefly review the evidence for smoke-free car legislation. We find that this legislation has been consistently associated with reduced secondhand exposure in cars with children/youth in all nine jurisdictions studied. Despite this, there are various aspects of this intervention that warrant further study-especially determining its impact on reducing tobacco-related ethnic inequalities. So we argue that the New Zealand Ministry of Health should invest in a thorough evaluation of this important upcoming public health intervention. This could both help the country in further refining the design of the law (if necessary) and would also be a valuable contribution to advancing the knowledge base for international tobacco control.


Asunto(s)
Automóviles/legislación & jurisprudencia , Exposición a Riesgos Ambientales/prevención & control , Política para Fumadores/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Adolescente , Automóviles/normas , Niño , Exposición a Riesgos Ambientales/efectos adversos , Grupos Étnicos/estadística & datos numéricos , Humanos , Nueva Zelanda/epidemiología , Salud Pública/economía , Salud Pública/legislación & jurisprudencia , Factores Socioeconómicos , Tabaco/efectos adversos , Contaminación por Humo de Tabaco/efectos adversos , Contaminación por Humo de Tabaco/prevención & control
13.
Medicine (Baltimore) ; 99(38): e21884, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32957309

RESUMEN

The Dulong nationality is one of the 5 smallest ethnic minorities in China. The suicide rate among people of the Dulong nationality is very serious. To address this issue, we conducted cross-sectional epidemiological studies on the prevalence of mental disorders in ethnic groups. Studying the unique situation of ethnic minorities can help us better understand their mental state and improve their quality of life.We conducted a cross-sectional epidemiological survey on a minority group in Southwest China. We used the cluster sampling method, and 2129 people were included in the study.The highest 1-month disorder prevalence was for alcohol dependence/abuse (4.16%), and the prevalence of lifelong mood disorders was 9.82%. The results of multivariate analysis showed that women faced a higher risk of mood disorders and anxiety disorders.This epidemiological survey of the prevalence of mental disorders in ethnic minorities in Southwest China provides a significant reference for mental health interventions for other ethnic minorities around the world.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Trastornos Mentales/etnología , Adolescente , Adulto , Anciano , Alcoholismo/etnología , China/epidemiología , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Factores Sexuales , Factores Socioeconómicos , Adulto Joven
14.
Medicine (Baltimore) ; 99(38): e22037, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32957322

RESUMEN

To investigate the relationship between serum lipoprotein (a) (LP(a)) levels and breast cancer as well as the clinicopathologic characteristics of breast cancer in a Han Chinese population.This study included 314 breast cancer patients, 51 patients with benign breast tumors, and 185 healthy control subjects. All study subjects were Han Chinese with similar socio-economic backgrounds, who were local residents of Zhoushan, Zhejiang, China or who had lived in Zhoushan for a long period of time. Serum concentrations of LP(a) were determined using a latex-enhanced immunoturbidimetric assay. Clinicopathological characteristics of patients were retrieved from medical records, which included the histopathological type, grade, stage, and molecular subtype of the disease, the expression of estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki67, and the level of reproductive hormones. Correlations between 2 groups were evaluated using the Spearman correlation analysis. Associations among ≥3 groups were interpreted using the Kruskal-Wallis H test or the logistic regression test.Elevated serum LP(a) levels were detected in breast cancer patients compared with healthy control subjects, but no significant differences in LP(a) were detected between breast cancer and benign tumor or between benign tumor and healthy control. In breast cancer patients, serum LP(a) levels were inversely associated with HER2 expression, but they were not significantly correlated with any other clinicopathologic characteristics of breast cancer evaluated in this study.Elevated serum LP(a) levels were associated with breast cancer in a Han Chinese population.


Asunto(s)
Neoplasias de la Mama/etnología , Grupos Étnicos/estadística & datos numéricos , Hiperlipoproteinemias/etnología , Lipoproteína(a)/sangre , China/epidemiología , Femenino , Humanos , Receptor ErbB-2/metabolismo , Receptores Estrogénicos/metabolismo , Receptores de Progesterona/metabolismo , Índice de Severidad de la Enfermedad
15.
N Z Med J ; 133(1521): 28-39, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32994635

RESUMEN

AIMS: There is limited evidence as to how clinical outcomes of COVID-19 including fatality rates may vary by ethnicity. We aim to estimate inequities in infection fatality rates (IFR) in New Zealand by ethnicity. METHODS: We combine existing demographic and health data for ethnic groups in New Zealand with international data on COVID-19 IFR for different age groups. We adjust age-specific IFRs for differences in unmet healthcare need, and comorbidities by ethnicity. We also adjust for life expectancy reflecting evidence that COVID-19 amplifies the existing mortality risk of different groups. RESULTS: The IFR for Maori is estimated to be 50% higher than that of non-Maori, and could be even higher depending on the relative contributions of age and underlying health conditions to mortality risk. CONCLUSIONS: There are likely to be significant inequities in the health burden from COVID-19 in New Zealand by ethnicity. These will be exacerbated by racism within the healthcare system and other inequities not reflected in official data. Highest risk communities include those with elderly populations, and Maori and Pacific communities. These factors should be included in future disease incidence and impact modelling.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/etnología , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Esperanza de Vida/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Neumonía Viral/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Zelanda , Pandemias , Neumonía Viral/mortalidad , Tasa de Supervivencia , Adulto Joven
16.
N Z Med J ; 133(1522): 84-95, 2020 09 25.
Artículo en Inglés | MEDLINE | ID: mdl-32994619

RESUMEN

AIMS: Global trends show an increase in medication dispensing for attention-deficit/hyperactivity disorder (ADHD) in young people over time. The current study aimed to examine whether similar trends were observed in New Zealand youth over the period of 2007/08 to 2016/17. METHODS: We estimated the prevalence in ADHD medication dispensing using national pharmaceutical data for each fiscal year from 2007/08 to 2016/17 in approximately 2.4 million New Zealand youth aged 1-24 years. We also examined whether trends varied by sociodemographic factors. RESULTS: The total dispensing prevalence almost doubled from 516 per 100,000 to 996 per 100,000 over the study period. Males had a consistently higher dispensing prevalence relative to females. Young people aged 7-17 years had the highest dispensing prevalence. The most deprived quintile had a slightly lower dispensing prevalence relative to other quintiles. Ethnic differences in dispensing prevalence were apparent, with deprivation differences also existing within most ethnic groups. CONCLUSIONS: Overall, our study showed an increase in ADHD medication use by young people in New Zealand, similar to international findings. Further research is needed into why disparities in dispensing prevalence occur across ethnic and socioeconomic groups.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Prescripciones de Medicamentos/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Estudios Transversales , Grupos Étnicos/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Lactante , Masculino , Nueva Zelanda/epidemiología , Prevalencia , Adulto Joven
17.
PLoS Med ; 17(9): e1003321, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32911500

RESUMEN

BACKGROUND: At the beginning of June 2020, there were nearly 7 million reported cases of coronavirus disease 2019 (COVID-19) worldwide and over 400,000 deaths in people with COVID-19. The objective of this study was to determine associations between comorbidities listed in the Charlson comorbidity index and mortality among patients in the United States with COVID-19. METHODS AND FINDINGS: A retrospective cohort study of adults with COVID-19 from 24 healthcare organizations in the US was conducted. The study included adults aged 18-90 years with COVID-19 coded in their electronic medical records between January 20, 2020, and May 26, 2020. Results were also stratified by age groups (<50 years, 50-69 years, or 70-90 years). A total of 31,461 patients were included. Median age was 50 years (interquartile range [IQR], 35-63) and 54.5% (n = 17,155) were female. The most common comorbidities listed in the Charlson comorbidity index were chronic pulmonary disease (17.5%, n = 5,513) and diabetes mellitus (15.0%, n = 4,710). Multivariate logistic regression analyses showed older age (odds ratio [OR] per year 1.06; 95% confidence interval [CI] 1.06-1.07; p < 0.001), male sex (OR 1.75; 95% CI 1.55-1.98; p < 0.001), being black or African American compared to white (OR 1.50; 95% CI 1.31-1.71; p < 0.001), myocardial infarction (OR 1.97; 95% CI 1.64-2.35; p < 0.001), congestive heart failure (OR 1.42; 95% CI 1.21-1.67; p < 0.001), dementia (OR 1.29; 95% CI 1.07-1.56; p = 0.008), chronic pulmonary disease (OR 1.24; 95% CI 1.08-1.43; p = 0.003), mild liver disease (OR 1.26; 95% CI 1.00-1.59; p = 0.046), moderate/severe liver disease (OR 2.62; 95% CI 1.53-4.47; p < 0.001), renal disease (OR 2.13; 95% CI 1.84-2.46; p < 0.001), and metastatic solid tumor (OR 1.70; 95% CI 1.19-2.43; p = 0.004) were associated with higher odds of mortality with COVID-19. Older age, male sex, and being black or African American (compared to being white) remained significantly associated with higher odds of death in age-stratified analyses. There were differences in which comorbidities were significantly associated with mortality between age groups. Limitations include that the data were collected from the healthcare organization electronic medical record databases and some comorbidities may be underreported and ethnicity was unknown for 24% of participants. Deaths during an inpatient or outpatient visit at the participating healthcare organizations were recorded; however, deaths occurring outside of the hospital setting are not well captured. CONCLUSIONS: Identifying patient characteristics and conditions associated with mortality with COVID-19 is important for hypothesis generating for clinical trials and to develop targeted intervention strategies.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Diabetes Mellitus/epidemiología , Pandemias , Neumonía Viral , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Factores de Edad , Enfermedad Crónica/clasificación , Enfermedad Crónica/epidemiología , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Registros Electrónicos de Salud/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Factores Sexuales , Estados Unidos/epidemiología
18.
BMC Public Health ; 20(1): 1384, 2020 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-32912230

RESUMEN

BACKGROUND: In light of the COVID-19 pandemic, many have flagged racial and ethnic differences in health outcomes in western countries as an urgent global public health priority. Kuwait has a unique demographic profile with two-thirds of the population consisting of non-nationals, most of which are migrant workers. We aimed to explore whether there is a significant difference in health outcomes between non-Kuwaiti and Kuwaiti patients diagnosed with COVID-19. METHODS: We used a prospective COVID-19 registry of all patients (symptomatic and asymptomatic) in Kuwait who tested positive from February 24th to April 20th, 2020, collected from Jaber Al-Ahmad Al-Sabah Hospital, the officially-designated COVID-19 healthcare facility in the country. We ran separate logistic regression models comparing non-Kuwaitis to Kuwaitis for death, intensive care unit (ICU) admission, acute respiratory distress syndrome (ARDS) and pneumonia. RESULTS: The first 1123 COVID-19 positive patients in Kuwait were all recruited in the study. About 26% were Kuwaitis and 73% were non-Kuwaiti. With adjustments made to age, gender, smoking and selected co-morbidities, non-Kuwaitis had two-fold increase in the odds of death or being admitted to the intensive care unit compared to Kuwaitis (OR: 2.14, 95% CI 1.12-4.32). Non-Kuwaitis had also higher odds of ARDS (OR:2.44, 95% CI 1.23-5.09) and pneumonia (OR: 2.24, 95% CI 1.27-4.12). CONCLUSION: This is the first study to report on COVID-19 outcomes between Kuwaiti and non-Kuwaiti patients. The current pandemic may have amplified the differences of health outcomes among marginalized subpopulations. A number of socioeconomic and environmental factors could explain this health disparity. More research is needed to advance the understanding of policymakers in Kuwait in order to make urgent public health interventions.


Asunto(s)
Infecciones por Coronavirus/etnología , Infecciones por Coronavirus/terapia , Grupos Étnicos/estadística & datos numéricos , Disparidades en el Estado de Salud , Neumonía Viral/etnología , Neumonía Viral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Kuwait/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , Sistema de Registros , Resultado del Tratamiento , Adulto Joven
19.
MMWR Morb Mortal Wkly Rep ; 69(37): 1277-1282, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32941410

RESUMEN

The spontaneous death or loss of a fetus during pregnancy is termed a fetal death. In the United States, national data on fetal deaths are available for losses at ≥20 weeks' gestation.* Deaths occurring during this period of pregnancy are commonly known as stillbirths. In 2017, approximately 23,000 fetal deaths were reported in the United States (1). Racial/ethnic disparities exist in the fetal mortality rate; however, much of the known disparity in fetal deaths is unexplained (2). CDC analyzed 2015-2017 U.S. fetal death report data and found that non-Hispanic Black (Black) women had more than twice the fetal mortality rate compared with non-Hispanic White (White) women and Hispanic women. Fetal mortality rates also varied by maternal state of residence. Cause of death analyses were conducted for jurisdictions where >50% of reports had a cause of death specified. Still, even in these jurisdictions, approximately 31% of fetal deaths had no cause of death reported on a fetal death report. There were differences by race and Hispanic origin in causes of death, with Black women having three times the rate of fetal deaths because of maternal complications compared with White women. The disparities suggest opportunities for prevention to reduce the U.S. fetal mortality rate. Improved documentation of cause of death on fetal death reports might help identify preventable causes and guide prevention efforts.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Mortalidad Fetal/etnología , Disparidades en el Estado de Salud , Adulto , Femenino , Humanos , Embarazo , Estados Unidos/epidemiología , Estadísticas Vitales , Adulto Joven
20.
Am J Mens Health ; 14(5): 1557988320957545, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32938298

RESUMEN

While there is evidence of variations in the risk perceptions of COVID-19 and that they are linked to both engagement in health-protective behaviors and poor mental health outcomes, there has been a lack of attention to how individuals perceive the risk of COVID-19 relative to other infectious diseases. This paper examines the relative perceptions of the severity of COVID-19 and HIV among a sample of U.S. gay, bisexual, and other men who have sex with men (GBMSMs). The "Love and Sex in the Time of COVID-19" survey was conducted online from April 2020 to May 2020. GBMSMs were recruited through paid banner advertisements featured on social networking platforms, resulting in a sample size of 696. The analysis considers differences in responses to two scales: the Perceived Severity of HIV Infection and the Perceived Severity of COVID-19 Infection. Participants perceived greater seriousness for HIV infection (mean 46.67, range 17-65) than for COVID-19 infection (mean 38.81, range 13-62). Some items reflecting more proximal impacts of infection (anxiety, loss of sleep, and impact on employment) were similar for HIV and COVID-19. Those aged over 25 and those who perceived higher prevalence of COVID-19 in the United States or their state were more likely to report COVID-19 as more severe than HIV. There is a need to develop nuanced public health messages for GBMSMs that convey the ongoing simultaneous health threats of both HIV and COVID-19.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Grupos Étnicos/estadística & datos numéricos , Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Neumonía Viral/epidemiología , Asunción de Riesgos , Adolescente , Adulto , Anciano , Bisexualidad/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Incidencia , Internet , Masculino , Persona de Mediana Edad , Pandemias , Medición de Riesgo , Índice de Severidad de la Enfermedad , Conducta Sexual , Análisis de Supervivencia , Estados Unidos/epidemiología , Adulto Joven
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