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1.
BMC Infect Dis ; 21(1): 686, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271870

RESUMO

BACKGROUND: Associations between community-level risk factors and COVID-19 incidence have been used to identify vulnerable subpopulations and target interventions, but the variability of these associations over time remains largely unknown. We evaluated variability in the associations between community-level predictors and COVID-19 case incidence in 351 cities and towns in Massachusetts from March to October 2020. METHODS: Using publicly available sociodemographic, occupational, environmental, and mobility datasets, we developed mixed-effect, adjusted Poisson regression models to depict associations between these variables and town-level COVID-19 case incidence data across five distinct time periods from March to October 2020. We examined town-level demographic variables, including population proportions by race, ethnicity, and age, as well as factors related to occupation, housing density, economic vulnerability, air pollution (PM2.5), and institutional facilities. We calculated incidence rate ratios (IRR) associated with these predictors and compared these values across the multiple time periods to assess variability in the observed associations over time. RESULTS: Associations between key predictor variables and town-level incidence varied across the five time periods. We observed reductions over time in the association with percentage of Black residents (IRR = 1.12 [95%CI: 1.12-1.13]) in early spring, IRR = 1.01 [95%CI: 1.00-1.01] in early fall) and COVID-19 incidence. The association with number of long-term care facility beds per capita also decreased over time (IRR = 1.28 [95%CI: 1.26-1.31] in spring, IRR = 1.07 [95%CI: 1.05-1.09] in fall). Controlling for other factors, towns with higher percentages of essential workers experienced elevated incidences of COVID-19 throughout the pandemic (e.g., IRR = 1.30 [95%CI: 1.27-1.33] in spring, IRR = 1.20 [95%CI: 1.17-1.22] in fall). Towns with higher proportions of Latinx residents also had sustained elevated incidence over time (IRR = 1.19 [95%CI: 1.18-1.21] in spring, IRR = 1.14 [95%CI: 1.13-1.15] in fall). CONCLUSIONS: Town-level COVID-19 risk factors varied with time in this study. In Massachusetts, racial (but not ethnic) disparities in COVID-19 incidence may have decreased across the first 8 months of the pandemic, perhaps indicating greater success in risk mitigation in selected communities. Our approach can be used to evaluate effectiveness of public health interventions and target specific mitigation efforts on the community level.


Assuntos
COVID-19/epidemiologia , Ocupações/estatística & dados numéricos , Meio Social , Transportes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/etnologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Humanos , Incidência , Renda/estatística & dados numéricos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Movimento/fisiologia , Pandemias , Características de Residência/estatística & dados numéricos , Fatores de Risco , SARS-CoV-2/fisiologia , Fatores Socioeconômicos , Fatores de Tempo , Populações Vulneráveis/etnologia , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
2.
Nutrients ; 13(7)2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34209665

RESUMO

(1) Background: The present study aimed to investigate the association between home-related factors, community environmental factors, and sugar-sweetened beverages (SSBs) intake among Northeastern Chinese children. (2) Methods: Cross-sectional. Children with complete data were included in the analysis (n = 901). A questionnaire modified according to BEVQ-15 measured the intake of SSBs. Logistic regression was applied to determine the factors associated with the consumption of SSBs. IBM SPSS Statistics 23.0 was applied to perform all statistical analyses. (3) Results: The mean total amount of SSBs consumed on a weekly basis was 2214.04 ± 2188.62 mL. Children's weekly pocket money, frequency of SSBs purchase, SSBs availability at home, the number of accessible supermarkets, and frequency of weekly visits to convenience stores were all found to be associated with a high intake of SSBs among all children. Among children of normal weight, the findings indicated that weekly pocket money, SSBs availability at home, and number of accessible supermarkets were associated with a high SSBs intake. At the same time, frequency of SSBs purchase, mother's SSBs intake, and frequency of weekly visits to convenience stores were associated with a high SSBs intake among children with obesity. (4) Conclusions: Given the potential negative health effects of high SSBs intake, it is crucial to pay attention to home-related factors and community environment.


Assuntos
Comportamento de Ingestão de Líquido , Abastecimento de Alimentos/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Bebidas Adoçadas com Açúcar/estatística & dados numéricos , Adolescente , Criança , China/epidemiologia , Comportamento do Consumidor , Estudos Transversais , Inquéritos sobre Dietas , Feminino , Humanos , Modelos Logísticos , Masculino , Obesidade Pediátrica/epidemiologia , Características de Residência/estatística & dados numéricos , Bebidas Adoçadas com Açúcar/efeitos adversos , Bebidas Adoçadas com Açúcar/provisão & distribuição , Inquéritos e Questionários
3.
Lancet Public Health ; 6(7): e462-e471, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34175000

RESUMO

BACKGROUND: Early childhood overweight and obesity increased substantially in high-income countries throughout the 1980s and 1990s. The flattening or reversal of this trend since the early 2000s might conceal widening inequalities. This study aimed to identify trends in body-mass index Z score (BMIz) among children aged 1-3·5 years in Victoria (Australia), by socioeconomic status and geographical location. METHODS: This repeated, cross-sectional study used deidentified records of height, weight, and demographic information from electronic databases in the Victorian Maternal and Child Health system. Data from the consultations for children aged 1, 2, and 3·5 years were included in this analysis. We removed duplicate records; records with missing data for sex, age, weight, height, or postcode; and records with postcodes that were outside of Victoria. The coprimary outcomes were trends in mean BMIz (continuous linear models) and prevalence of high BMIz (>+1; generalised linear models), estimated for six independent age-sex groups. Secondary analysis was done for the prevalence of BMIz greater than 2. Effect modification by socioeconomic status and remoteness was evaluated. FINDINGS: Electronic data were available for 48 local government areas collected between Jan 1, 2003, and Dec 31, 2017, representing approximately 63% of the Victorian population. Overall, 1 329 520 measurements from 675 991 children were included in the analysis. There were small, significantly decreasing trends in mean BMIz across all six age-sex groups, overall and in major cities. Similar patterns were observed for some subgroups in prevalence of high BMIz. These decreasing trends appear to be partly explained by migration. Conversely, in regional areas the trends in BMIz were consistently increasing in all age-sex groups and across socioeconomic strata, although not all groups were statistically significant. Inequalities in BMIz according to socioeconomic status persisted throughout the study period, such that the children from more advantaged areas had lower mean BMIz. INTERPRETATION: This study showed that at a state level, mean BMIz and prevalence of high BMIz decreased in children aged 1, 2, and 3·5 years in Victoria between 2003 and 2017. We found metropolitan-regional differences to be key source of inequality in early childhood BMIz trends, alongside area-level socioeconomic status. These findings highlight the risk that analysis of overall trends in childhood BMIz might obscure important inequalities according to, for example, remoteness, socioeconomic status, and ethnicity. Future research requires monitoring data with large population samples to adequately examine differences in prevalence and trends between population subgroups. FUNDING: None.


Assuntos
Índice de Massa Corporal , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Obesidade Pediátrica/epidemiologia , Características de Residência/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Classe Social , Fatores Socioeconômicos , Vitória
4.
JAMA Netw Open ; 4(6): e2113818, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34143191

RESUMO

Importance: Limited information on the transmission and dynamics of SARS-CoV-2 at the city scale is available. Objective: To describe the local spread of SARS-CoV-2 in Valencia, Spain. Design, Setting, and Participants: This single-center epidemiological cohort study of patients with SARS-CoV-2 was performed at University General Hospital in Valencia (population in the hospital catchment area, 364 000), a tertiary hospital. The study included all consecutive patients with COVID-19 isolated at home from the start of the COVID-19 pandemic on February 19 until August 31, 2020. Exposures: Cases of SARS-CoV-2 infection confirmed by the presence of IgM antibodies or a positive polymerase chain reaction test result on a nasopharyngeal swab were included. Cases in which patients with negative laboratory results met diagnostic and clinical criteria were also included. Main Outcomes and Measures: The primary outcome was the characterization of dissemination patterns and connections among the 20 neighborhoods of Valencia during the outbreak. To recreate the transmission network, the inbound and outbound connections were studied for each region, and the relative risk of infection was estimated. Results: In total, 2646 patients were included in the analysis. The mean (SD) age was 45.3 (22.5) years; 1203 (46%) were male and 1442 (54%) were female (data were missing for 1); and the overall mortality was 3.7%. The incidence of SARS-CoV-2 cases was higher in neighborhoods with higher household income (ß2 [for mean income per household] = 0.197; 95% CI, 0.057-0.351) and greater population density (ß1 [inhabitants per km2] = 0.228; 95% CI, 0.085-0.387). Correlations with meteorological variables were not statistically significant. Neighborhood 3, where the hospital and testing facility were located, had the most outbound connections (14). A large residential complex close to the city (neighborhood 20) had the fewest connections (0 outbound and 2 inbound). Five geographically unconnected neighborhoods were of strategic importance in disrupting the transmission network. Conclusions and Relevance: This study of local dissemination of SARS-COV-2 revealed nonevident transmission patterns between geographically unconnected areas. The results suggest that tailor-made containment measures could reduce transmission and that hospitals, including testing facilities, play a crucial role in disease transmission. Consequently, the local dynamics of SARS-CoV-2 spread might inform the strategic lockdown of specific neighborhoods to stop the contagion and avoid a citywide lockdown.


Assuntos
COVID-19/epidemiologia , Área Programática de Saúde/estatística & dados numéricos , Surtos de Doenças/estatística & dados numéricos , Transmissão de Doença Infecciosa/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/transmissão , Estudos de Coortes , Feminino , Geografia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , SARS-CoV-2 , Espanha/epidemiologia
5.
J Environ Public Health ; 2021: 3234083, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122561

RESUMO

Introduction: Physical inactivity is a global concern, especially among adolescent men. Little research has been done on the association between parental factors and young adults' physical activity in the context of residential environment. We aimed to reveal what parental factors are associated with physical activity among adolescent men living in built and natural environments. Methods: A population-based sample of 1,904 men (mean age = 17.9, SD = 0.7 years) completed a questionnaire regarding physical activity, parental factors, and lifestyle in Northern Finland in 2012 and 2013. Geographical information system methods and dominant land-use type were used to define the residential environment in a 1-kilometer radius buffer zone surrounding each participant's home address. If the residential area included more artificial surfaces, it was defined as a built environment, and areas including more nature were defined as natural environments. Results: According to multivariable analyses, a mother's physical activity (OR = 1.9; 95% CI: 1.3-2.8) was positively associated with the physical activity of adolescent men living in built environments, and the father's physical activity was positively associated with the physical activity of adolescent men living in natural environments (2.8; 1.7-4.8). Self-rated health (built 5.9 [4.0-8.7]; natural 5.2 [3.0-9.0]) was positively associated with physical activity level. Those with symptoms of depression were more likely to be physically inactive (built 0.5 [0.3-0.8]; natural 0.3 [0.1-0.6]). Adolescent men were equally physically active regardless of the living environment. Conclusions: The level of physical activity of parents, self-rated health, and depressive symptoms should be considered when designing physical activity promotions for adolescent men according to their residential environments.


Assuntos
Ambiente Construído/estatística & dados numéricos , Exercício Físico , Pais , Características de Residência/estatística & dados numéricos , Adolescente , Sistemas de Informação Geográfica , Humanos , Masculino , Comportamento Sedentário , Meio Social , Inquéritos e Questionários , Adulto Jovem
6.
Reprod Health ; 18(Suppl 1): 120, 2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34134720

RESUMO

BACKGROUND: In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission of HIV. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban-rural disparities. METHODS: HIV prevalence data at ages 15-19 years were obtained for 31 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Country medians and average annual rates of changes were used to summarize the trends for two subregions in sub-Saharan Africa, Eastern and Southern Africa and West and Central Africa, which largely correspond with higher and lower HIV prevalence countries. Data on HIV incidence at ages 15-24 and prevalence at 5-9 and 10-14 years were reviewed from 11 recent national surveys. Trends in urban-rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15-24 years, using the same surveys. RESULTS: HIV prevalence among girls 15-19 years declined in eastern and Southern Africa from 5.7 to 2.6% during 2005-2015 (country median), corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1 to 1.2%. Changes were also observed in West and Central Africa where median HIV prevalence among girls decreased from 0.7 to 0.4% (average annual rate of reduction 5.9%), but not for boys (0.3%). Girl-boy differences at 10-14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15-24 had at least 1.5 times higher HIV prevalence than their rural counterparts in both subregions, and since the urban-rural declines were similar, the gaps persisted during 2005-2015. CONCLUSIONS: HIV prevalence among adolescents declined in almost all countries during the last decade, in both urban and rural settings. The urban-rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in Eastern and Southern African countries.


Assuntos
Infecções por HIV/epidemiologia , Características de Residência/estatística & dados numéricos , População Rural , População Urbana , Adolescente , África ao Sul do Saara/epidemiologia , África Austral , Feminino , Humanos , Incidência , Masculino , Vigilância da População/métodos , Prevalência , Distribuição por Sexo , Adulto Jovem
7.
Econ Hum Biol ; 42: 101018, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34098432

RESUMO

The first wave of Covid-19 pandemic had a geographically heterogeneous impact even within the most severely hit regions. Exploiting a triple-differences methodology, we find that in Italy Covid-19 hit relatively harder in peripheral areas: the excess mortality in peripheral areas was almost double that of central ones in March 2020 (1.2 additional deaths every 1000 inhabitants). We leverage a rich dataset on Italian municipalities to explore mechanisms behind this gradient. We first show that socio-demographic and economic features at municipal level are highly collinear, making it hard to identify single-variable causal relationships. Using Principal Components Analysis we model excess mortality and show that areas with higher excess mortality have lower income, lower education, larger households, lower trade and higher industrial employments, and older population. Our findings highlight a strong centre-periphery gradient in the harshness of Covid-19, which we believe is also highly relevant from a policy-making standpoint.


Assuntos
COVID-19/epidemiologia , Características de Residência/estatística & dados numéricos , COVID-19/mortalidade , Cidades , Humanos , Itália/epidemiologia , Masculino , Pandemias , SARS-CoV-2 , Fatores Socioeconômicos
8.
Health Secur ; 19(S1): S27-S33, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33956531

RESUMO

More than a century of research has shown that sociodemographic conditions affect infectious disease transmission. In the late spring and early summer of 2020, reports of the effects of sociodemographic variables on the spread of COVID-19 were used in the media with minimal scientific proof attached. With new cases of COVID-19 surging in the United States at that time, it became essential to better understand how the spread of COVID-19 was varying across all segments of the population. We used hierarchical exponential growth curve modeling techniques to examine whether community socioeconomic characteristics uniquely influence the incidence of reported COVID-19 cases in the urban built environment. We show that as of July 19, 2020, confirmed coronavirus infections in New York City and surrounding areas-one of the early epicenters of the COVID-19 pandemic in the United States-were concentrated along demographic and socioeconomic lines. Furthermore, our data provides evidence that after the onset of the pandemic, timely enactment of physical distancing measures such as school closures was essential to limiting the extent of the coronavirus spread in the population. We conclude that in a pandemic, public health authorities must impose physical distancing measures early on as well as consider community-level factors that associate with a greater risk of viral transmission.


Assuntos
COVID-19/epidemiologia , Características de Residência/estatística & dados numéricos , População Urbana/estatística & dados numéricos , COVID-19/diagnóstico , Estudos Transversais , Humanos , Incidência , Cidade de Nova Iorque/epidemiologia , Saúde Pública , Fatores de Risco , Fatores Socioeconômicos , Análise Espacial
10.
Public Health ; 194: 167-169, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33945930

RESUMO

OBJECTIVES: To consider death doulas in relation to compassionate communities, role delineation and regulation, and end-of-life care delivery. STUDY DESIGN: A narrative describing the emerging role of death doula in the increasingly complex end-of-life space. METHODS: A discussion of death doula in end-of-life care. RESULTS: Compassionate communities calls for the mobilisation of informal care around the dying and their families. Formal health services as well, including palliative care, are already providing care as are death doulas. The death doula role is not yet fully articulated and has layers of complexity associated with a lack of formalised training and no registration. CONCLUSIONS: There is much to consider in the informal caregiving space at the end of life. Conversations are required for coherent, coordinated care delivery in what has become a complex arena. There are those who are in paid positions, volunteers, those who are negotiating fees, as well as role overlap and role blurring.


Assuntos
Doulas , Empatia , Papel Profissional , Características de Residência/estatística & dados numéricos , Assistência Terminal/organização & administração , Humanos
11.
BMJ Glob Health ; 6(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33926892

RESUMO

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.


Assuntos
COVID-19/etnologia , COVID-19/mortalidade , Grupos Étnicos/estatística & dados numéricos , Mortalidade Hospitalar/etnologia , Pneumonia Viral , Áreas de Pobreza , Características de Residência/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Estudos Soroepidemiológicos , Fatores Socioeconômicos
12.
Health Place ; 69: 102574, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33895489

RESUMO

We aim to understand the spatial inequality in Coronavirus disease 2019 (COVID-19) positivity rates across New York City (NYC) ZIP codes. Applying Bayesian spatial negative binomial models to a ZIP-code level dataset (N = 177) as of May 31st, 2020, we find that (1) the racial/ethnic minority groups are associated with COVID-19 positivity rates; (2) the percentages of remote workers are negatively associated with positivity rates, whereas older population and household size show a positive association; and (3) while ZIP codes in the Bronx and Queens have higher COVID-19 positivity rates, the strongest spatial effects are clustered in Brooklyn and Manhattan.


Assuntos
COVID-19/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Características de Residência/estatística & dados numéricos , Teorema de Bayes , Geografia , Humanos , Cidade de Nova Iorque/epidemiologia , Fatores Socioeconômicos , Análise Espacial , Teletrabalho/estatística & dados numéricos
13.
MMWR Morb Mortal Wkly Rep ; 70(14): 514-518, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33830985

RESUMO

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.


Assuntos
COVID-19/etnologia , COVID-19/prevenção & controle , Índios Norte-Americanos/estatística & dados numéricos , Máscaras , Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/transmissão , Criança , Pré-Escolar , Busca de Comunicante , Feminino , Disparidades nos Níveis de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Montana/epidemiologia , Adulto Jovem
14.
Neurology ; 96(20): e2500-e2512, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-33853894

RESUMO

OBJECTIVE: To test the hypothesis that neighborhood-level disadvantage is associated with longitudinal measures of neurodegeneration and cognitive decline in an unimpaired cohort. METHODS: Longitudinal MRI and cognitive testing data were collected from 601 cognitively unimpaired participants in the Wisconsin Registry for Alzheimer's Prevention Study and the Wisconsin Alzheimer's Disease Research Center clinical cohort. Area Deprivation Index was geospatially determined based on participant residence geocode and ranked relative to state of residence. Linear regression models were fitted to test associations between neighborhood-level disadvantage and longitudinal change in cortical thickness and cognitive test performance. Mediation tests were used to assess whether neurodegeneration and cognitive decline were associated with neighborhood-level disadvantage along the same theoretical causal path. RESULTS: In our middle- to older-aged study population (mean baseline age 59 years), living in the 20% most disadvantaged neighborhoods (n = 19) relative to state of residence was associated with cortical thinning in Alzheimer signature regions (p = 0.002) and decline in the Preclinical Alzheimer's Disease Cognitive Composite (p = 0.04), particularly the Trail-Making Test, part B (p < 0.001), but not Rey Auditory Verbal Learning Test (p = 0.77) or Story Memory Delayed Recall (p = 0.49) subtests. Associations were attenuated but remained significant after controlling for racial and demographic differences between neighborhood-level disadvantage groups. Cortical thinning partially mediated the association between neighborhood-level disadvantage and cognitive decline. CONCLUSIONS: In this longitudinal study of cognitively unimpaired adults, living in the most highly disadvantaged neighborhoods was associated with accelerated degeneration in Alzheimer signature regions and cognitive decline. This study provides further evidence for neighborhood-level disadvantage as a risk factor for preclinical neurodegeneration and cognitive decline in certain populations. Limitations of the present study, including a small number of participants from highly disadvantaged neighborhoods and a circumscribed geographic setting, should be explored in larger and more diverse study cohorts.


Assuntos
Afinamento Cortical Cerebral/epidemiologia , Disfunção Cognitiva/epidemiologia , Características de Residência/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Espessura Cortical do Cérebro , Afinamento Cortical Cerebral/diagnóstico por imagem , Cognição , Disfunção Cognitiva/diagnóstico , Escolaridade , Emprego/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Pobreza/estatística & dados numéricos
15.
Health Place ; 68: 102540, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33647635

RESUMO

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.


Assuntos
COVID-19 , Grupos de Populações Continentais , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Características de Residência/estatística & dados numéricos , Idoso , COVID-19/epidemiologia , COVID-19/mortalidade , Chicago/epidemiologia , Feminino , Humanos , Masculino
16.
PLoS Negl Trop Dis ; 15(3): e0009154, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33657101

RESUMO

Domestic rats are the principal reservoir for urban leptospirosis. However, few studies have identified infestation markers in slums and evaluated their predictivity for leptospirosis risk. We compared households with leptospirosis cases in Salvador, Brazil between 2007 and 2009 and their neighbors using a case control design, surveying for rodent infestation signs and environmental characteristics. With the 2007-2008 data, a conditional logistic regression modeling identified the peridomiciliar presence of rodent burrows (OR, 3.30; 95% CI, 1.50-7.26), rat feces (2.86; 1.24-6.59), runs (2.57; 1.06-6.22), households bordering abandoned houses (2.48; 1.04-6.02), and unplastered walls (2.22; 1.02-6.02) as risk factors and developed a predictive score for leptospirosis. With an independent data set from 2009, a receiver operating characteristic (ROC) curve analysis evaluated the prediction score performance, with the area under the curve being 0.70 (95% CI, 0.64-0.76) for score development and 0.71 (0.65-0.79) for validation. Results indicate that high proportions of urban slum households are infested with R. norvegicus. The score performed well when identifying high-risk households within slums. These findings need confirmation in other urban centers, but suggest that community-based screening for rodent infestation can allow to target rodent and environmental control measures in populations at highest risk for leptospirosis.


Assuntos
Leptospirose/epidemiologia , Ratos , Características de Residência/estatística & dados numéricos , Animais , Brasil/epidemiologia , Estudos de Casos e Controles , Reservatórios de Doenças , Humanos , Modelos Logísticos , Áreas de Pobreza , Fatores de Risco
17.
Int J Health Serv ; 51(3): 311-324, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33650453

RESUMO

Social inequalities in health are known to be influenced by the socioeconomic status of the territory in which people live. In the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic, this study is aimed at assessing the role of 5 area-level indicators in shaping the risk of contagion in the provinces of Milan and Lodi (Lombardy, Italy), namely: educational disadvantage, unemployment, housing crowding, mobility, and population density. The study area includes the municipalities at the origin of the first Italian epidemic outbreak. Data on COVID-19 patients from the Integrated Datawarehouse for COVID Analysis in Milan were used and matched with aggregate-level data from the National Institute of Statistics Italy (Istat). Multilevel logistic regression models were used to estimate the association between the census block-level predictors and COVID-19 infection, independently of age, sex, country of birth, and preexisting health conditions. All the variables were significantly associated with the outcome, with different effects before and after the lockdown and according to the province of residence. This suggests a pattern of socioeconomic inequalities in the outbreak, which should be taken into account in the eventuality of future epidemics to contain their spread and its related disparities.


Assuntos
COVID-19/epidemiologia , Disparidades nos Níveis de Saúde , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Distribuição por Idade , Idoso , Comorbidade , Feminino , Habitação/estatística & dados numéricos , Humanos , Itália/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Densidade Demográfica , SARS-CoV-2 , Distribuição por Sexo , Classe Social
18.
J R Soc Med ; 114(4): 182-211, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33759630

RESUMO

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.


Assuntos
COVID-19 , Características da Família/etnologia , Habitação , Mortalidade/etnologia , Características de Residência/estatística & dados numéricos , Fatores Etários , Idoso , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , COVID-19/mortalidade , COVID-19/prevenção & controle , Criança , Inglaterra/epidemiologia , Família , Feminino , Disparidades nos Níveis de Saúde , Habitação/normas , Habitação/estatística & dados numéricos , Humanos , Masculino , Medição de Risco , SARS-CoV-2 , Fatores Sexuais , Fatores Socioeconômicos
19.
MMWR Morb Mortal Wkly Rep ; 70(12): 431-436, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33764963

RESUMO

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.


Assuntos
Vacinas contra COVID-19/administração & dosagem , Disparidades em Assistência à Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Populações Vulneráveis , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Programas de Imunização , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos , Estados Unidos/epidemiologia
20.
Int J Qual Health Care ; 33(1)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33644795

RESUMO

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.


Assuntos
COVID-19/epidemiologia , Centers for Medicare and Medicaid Services, U.S./normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Fatores Etários , Feminino , Humanos , Modelos Lineares , Masculino , Satisfação do Paciente/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , SARS-CoV-2 , Fatores Sexuais , Estados Unidos/epidemiologia
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