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1.
Artigo em Inglês | MEDLINE | ID: mdl-33810055

RESUMO

Extant research is growing in its ability to explain sex differences in novel coronavirus 2019 (COVID-19) diagnosis and mortality. Moving beyond comparisons based on biological sex is now warranted to capture a more nuanced picture of disparities in COVID-19 diagnosis and mortality specifically among men who are more likely to die of the illness. The objective of this study was to investigate racial disparities in COVID-19-related psychosocial, behavior and health variables among men. The present study utilizes a sample of 824 men who participated in a free health event held in a Midwestern state. Chi-square analysis showed that African American men were more likely to report an adverse impact of COVID-19 based on several factors including experiencing more COVID-19-related medical issues (χ2 = 4.60 p = 0.03); higher COVID-19 diagnosis (χ2 = 4.60 p = 0.02); trouble paying for food (χ2 = 8.47, p = 0.00), rent (χ2 = 12.26, p = 0.00), medication (χ2 = 7.10 p = 0.01) and utility bills (χ2 = 19.68, p = 0.00); higher fear of contracting COVID-19 (χ2 = 31.19, p = 0.00); and higher rates of death of close friends and family due to COVID (χ2 = 48.85, p = 0.00). Non-Hispanic white men reported more increased stress levels due to COVID-19 compared to African American men (χ2 = 10.21, p = 0.01). Regression analysis showed that race was a significant predictor of self-reported COVID-19 diagnosis (OR = 2.56, p < 0.05) after controlling for demographic characteristics. The results showed that compared to non-Hispanic White men, African American men were more likely to report an adverse impact of COVID-19 based on several factors including experiencing more COVID-19-related medical issues; higher COVID-19 diagnosis; trouble paying for food, rent, medication and utility bills; higher fear of contracting COVID-19; and higher rates of death of close friends and family due to COVID. Interestingly, non-Hispanic white men reported more increased stress levels due to COVID-19 compared to African American men.


Assuntos
Coronavirus , Feminino , Humanos , Masculino , Saúde do Homem , Michigan/epidemiologia , Fatores Raciais
2.
BMJ Open ; 11(4): e042042, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827831

RESUMO

OBJECTIVE: To report the clinical characteristics of patients hospitalised with COVID-19 in Southeast Michigan. DESIGN: Retrospective cohort study. SETTING: Eight hospitals in Southeast Michigan. PARTICIPANTS: 3219 hospitalised patients with a positive SARS-CoV-2 infection by nasopharyngeal PCR test from 13 March 2020 until 29 April 2020. MAIN OUTCOMES MEASURES: Outcomes were discharge from the hospital or in-hospital death. Examined predictors included patient demographics, chronic diseases, home medications, mechanical ventilation, in-hospital medications and timeframe of hospital admission. Multivariable logistic regression was conducted to identify risk factors for in-hospital mortality. RESULTS: During the study period, 3219 (90.4%) patients were discharged or died in the hospital. The median age was 65.2 (IQR 52.6-77.2) years, the median length of stay in the hospital was 6.0 (IQR 3.2-10.1) days, and 51% were female. Hypertension was the most common chronic disease, occurring in 2386 (74.1%) patients. Overall mortality rate was 16.0%. Blacks represented 52.3% of patients and had a mortality rate of 13.5%. Mortality was highest at 18.5% in the prepeak hospital COVID-19 volume, decreasing to 15.3% during the peak period and to 10.8% in the postpeak period. Multivariable regression showed increasing odds of in-hospital death associated with older age (OR 1.04, 95% CI 1.03 to 1.05, p<0.001) for every increase in 1 year of age and being male (OR 1.47, 95% CI 1.21 to 1.81, p<0.001). Certain chronic diseases increased the odds of in-hospital mortality, especially chronic kidney disease. Administration of vitamin C, corticosteroids and therapeutic heparin in the hospital was associated with higher odds of death. CONCLUSION: In-hospital mortality was highest in early admissions and improved as our experience in treating patients with COVID-19 increased. Blacks were more likely to get admitted to the hospital and to receive mechanical ventilation, but less likely to die in the hospital than whites.


Assuntos
/epidemiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Idoso , Comorbidade , Feminino , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Respiração Artificial , Estudos Retrospectivos
3.
JAMA Netw Open ; 4(3): e212816, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33688968

RESUMO

Importance: Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in the United States are still emerging. Objective: To elucidate SARS-CoV-2 seroprevalence and symptom onset in a culturally linked community across 5 states in the United States. Design, Setting, and Participants: This cross-sectional study included adults (aged ≥18 years) recruited from the orthodox Jewish community across 5 states (California, Connecticut, Michigan, New Jersey, and New York) in 3 geographically distinct areas of the United States between May 13 and July 6, 2020. Participants completed an online survey and underwent SARS-CoV-2 antibody testing. Main Outcomes and Measures: Seroprevalence and date of symptom onset of SARS-CoV-2. Results: Overall, 9507 adults (mean [SD] age, 39.6 [15.0] years; 3777 [39.7%] women) completed the SARS-CoV-2 survey, of whom 6665 (70.1%) had immunoglobin G anti-SARS-CoV-2 antibody levels assessed. A high seroprevalence of SARS-CoV-2 antibodies was observed across all communities, with the highest proportion of positive testing observed in New Jersey (1080 of 3323 [32.5%]) and New York (671 of 2196 [30.6%]). Most individuals with a positive SARS-CoV-2 immunoglobin G antibody test reported a date of symptom-onset between March 9 and March 31, 2020 (California: 135 of 154 [87.7%]; Connecticut: 32 of 34 [94.1%]; Michigan: 44 of 50 [88.0%]; New Jersey: 964 of 1168 [82.5%]; New York: 571 of 677 [84.3%]). This start date was coincident with the Jewish festival of Purim, celebrated March 9 to 10, 2020, with extensive intracommunity spread in the weeks following (mean and mode of peak symptom onset, March 20, 2020), occurring in the absence of strong general and culture-specific public health directives. Conclusions and Relevance: This cross-sectional study of orthodox Jewish adults across the US found that socioculturally bound communities experienced early parallel outbreaks in discrete locations, notably prior to substantive medical and governmental directives. Further research should clarify optimal national, local, community-based, and government policies to prevent outbreaks in social and cultural communities that traditionally gather for holidays, assemblies, and festivals.


Assuntos
/epidemiologia , Assistência à Saúde Culturalmente Competente , Transmissão de Doença Infecciosa , Férias e Feriados , Judeus/estatística & dados numéricos , Grupos Minoritários , Saúde Pública , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Connecticut/epidemiologia , Estudos Transversais , Surtos de Doenças , Feminino , Humanos , Judaísmo , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , New Jersey/epidemiologia , New York/epidemiologia , Características de Residência , Estudos Soroepidemiológicos , Estados Unidos/epidemiologia , Adulto Jovem
4.
Am J Public Health ; 111(3): 430-437, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33566641

RESUMO

The global influenza pandemic that emerged in 1918 has become the event of reference for a broad spectrum of policymakers seeking to learn from the past. This article sheds light on multiple waves of excess mortality that occurred in the US state of Michigan at the time with insights into how epidemics might evolve and propagate across space and time. We analyzed original monthly data on all-cause deaths by county for the 83 counties of Michigan and interpreted the results in the context of what is known about the pandemic. Counties in Michigan experienced up to four waves of excess mortality over a span of two years, including a severe one in early 1920. Some counties experienced two waves in late 1918 while others had only one. The 1920 wave propagated across the state in a different manner than the fall and winter 1918 waves. The twin waves in late 1918 were likely related to the timing of the statewide imposition of a three-week social distancing order. Michigan's experience holds sobering lessons for those who wish to understand how immunologically naïve populations encounter novel viral pathogens.


Assuntos
/epidemiologia , Influenza Pandêmica, 1918-1919/história , Influenza Pandêmica, 1918-1919/mortalidade , Causas de Morte , História do Século XX , História do Século XXI , Humanos , Michigan/epidemiologia , Pandemias
5.
PLoS One ; 16(2): e0246447, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33556117

RESUMO

COVID-19 has had a substantial impact on clinical care and lifestyles globally. The State of Michigan reports over 80,000 positive COVID-19 tests between March 1, 2020 and July 29, 2020. We surveyed 8,041 Michigan Medicine biorepository participants in late June 2020. We found that 55% of COVID-19 cases reported no known exposure to family members or to someone outside the house diagnosed with COVID-19. A significantly higher rate of COVID-19 cases were employed as essential workers (45% vs 19%, p = 9x10-12). COVID-19 cases reporting a fever were more likely to require hospitalization (categorized as severe; OR = 4.4 [95% CI: 1.6-12.5, p = 0.005]) whereas respondents reporting rhinorrhea was less likely to require hospitalization (categorized as mild-to-moderate; OR = 0.16 [95% CI: 0.04-0.73, p = 0.018]). African-Americans reported higher rates of being diagnosed with COVID-19 (OR = 4.0 [95% CI: 2.2-7.2, p = 5x10-6]), as well as higher rates of exposure to family or someone outside the household diagnosed with COVID-19, an annual household income < $40,000, living in rental housing, and chronic diseases. During the Executive Order in Michigan, African Americans, women, and the lowest income group reported worsening health behaviors and higher overall concern for the potential detrimental effects of the pandemic. The higher risk of contracting COVID-19 observed among African Americans may be due to the increased rates of working as essential employees, lower socioeconomic status, and exposure to known positive cases. Continued efforts should focus on COVID-19 prevention and mitigation strategies, as well as address the inequality gaps that result in higher risks for both short-term and long-term health outcomes.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis , Adulto , Afro-Americanos , Idoso , Comorbidade , Feminino , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Viagem/legislação & jurisprudência
6.
BMJ Open ; 11(2): e043024, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33550257

RESUMO

OBJECTIVE: To assess the trends in visits, overall and by age, to urban and non-urban emergency departments (EDs), and visits resulting in admission to hospital before and during the COVID-19 pandemic using a large regional database. SETTING: A large regional database of 28 EDs during the COVID-19 pandemic in Michigan, with an index case of 11 March 2020 and peak in the first week of April. PARTICIPANTS: ED visits during the first 5 months of the calendar year were included and compared with the previous year. Facilities where these participants were seen were classified as urban or non-urban, with comparisons of total visits, COVID-like cases, paediatric and trauma. OUTCOME MEASURES: Daily visits to EDs of patients presenting with COVID-like symptoms, trauma, age patterns and total cases, and stratified between urban and non-urban settings. RESULTS: There were 1 732 852 visits across the 2 years, 953 407 between study and comparison periods, and 457 130 visits defined as COVID-like (median age 44 years). Total ED visits decreased to 48% of the previous year, showing a delayed-inverse relationship with COVID-19. Trauma cases dropped but returned to the pre-COVID-19 rate by the end of May in Urban centres. Paediatric cases decreased to 20% of the previous year by the end of April. The oldest age groups showed the least change in ED visits in response to the pandemic. CONCLUSIONS: This large US Midwestern state study describes a dramatic decrease in ED visits after the onset of the COVID-19 pandemic in Michigan, including stratification by varying ages and trauma, demonstrating the tangible impact of the COVID-19 pandemic on urban and non-urban EDs.


Assuntos
Serviço Hospitalar de Emergência/tendências , Pandemias , Adulto , Criança , Hospitais , Humanos , Michigan/epidemiologia
7.
BMC Public Health ; 21(1): 245, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514350

RESUMO

BACKGROUND: Public Health policies related to social distancing efforts during the COVID-19 pandemic helped slow the infection rate. However, individual-level factors associated with social distancing are largely unknown. We sought to examine social distancing during the COVID-19 pandemic in Michigan, an infection "hotspot" state in the United States early in the pandemic. METHODS: Two surveys were distributed to Michigan residents via email lists and social media following COVID-19 related state mandates in March; 45,691 adults responded to the first survey and 8512 to the second. Staying home ≥ 3 out of 5 previous days defined having more social distancing. Logistic regression models were used to examine potential factors associated with more social distancing. RESULTS: Most respondents were women (86% in Survey 1, 87% in Survey 2). In Survey 1, 63% reported more social distancing, increasing to 78% in Survey 2. Female sex and having someone (or self) sick in the home were consistently associated with higher social distancing, while increasing age was positively associated in Survey 1 but negatively associated in Survey 2. Most respondents felt social distancing policies were important (88% in Survey 1; 91% in Survey 2). CONCLUSIONS: Michiganders responding to the surveys were both practicing and supportive of social distancing. State-level executive orders positively impacted behaviors early in the COVID-19 pandemic in Michigan. Additional supports are needed to help vulnerable populations practice social distancing, including older individuals.


Assuntos
/prevenção & controle , Pandemias , Adulto , Feminino , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Política Pública , Inquéritos e Questionários
8.
Public Health ; 190: 93-98, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33385640

RESUMO

OBJECTIVES: The objective of the study is the identification of racial differences in characteristics and comorbidities in patients hospitalized for COVID-19 and the impact on outcomes. STUDY DESIGN: The study design is a retrospective observational study. METHODS: Data for all patients admitted to seven community hospitals in Michigan, United States, with polymerase chain reaction confirmed diagnosis of COVID-19 from March 10 to April 15, 2020 were analyzed. The primary outcomes of racial disparity in inpatient mortality and intubation were analyzed using descriptive statistics and multivariate regression models. RESULTS: The study included 336 Black and 408 White patients. Black patients were younger (62.9 ± 15.0 years vs 71.8 ± 16.4, P < .001), had a higher mean body mass index (32.4 ± 8.6 kg/m2 vs 28.8 ± 7.5, P < .001), had higher prevalence of diabetes (136/336 vs 130/408, P = .02), and presented later (6.6 ± 5.3 days after symptom onset vs. 5.4 ± 5.4, P = .006) compared with White patients. Younger Black patients had a higher prevalence of obesity (age <65 years, 69.9%) than older Black patients (age >65 years, 39.2%) and younger White patients (age < 65, 55.1%). Intubation did not reach statistical significance for racial difference (Black patients 61/335 vs. 54/406, P = .08). Mortality was not higher in Black patients (65/335 vs. 142/406 in White patients, odds ratio 0.61, 95% confidence interval: 0.37 to 0.99, 2-sided P = .05) in multivariate analysis, accounting for other risk factors associated with mortality. CONCLUSIONS: Higher prevalence of obesity and diabetes in young Black populations may be the critical factor driving disproportionate COVID-19 hospitalizations in Black populations. Hospitalized Black patients do not have worse outcomes compared with White patients.


Assuntos
/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Obesidade/epidemiologia , Afro-Americanos/estatística & dados numéricos , Idoso , Índice de Massa Corporal , /virologia , Comorbidade , Grupos de Populações Continentais/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitais Comunitários , Humanos , Unidades de Terapia Intensiva , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Pandemias , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
10.
J Surg Res ; 261: 39-42, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33412507

RESUMO

The Center for Basic and Translational Science was formed to address the unique challenges faced by surgeon-scientists. Shortly after its inception, COVID-19 upended research workflows at our institution. We discuss how the collaborative Center for Basic and Translational Science framework was adapted to support laboratories during the pandemic by assisting with ramp-down, promoting mentorship and community building, and maintaining research productivity.


Assuntos
/prevenção & controle , Colaboração Intersetorial , Pesquisadores/organização & administração , Cirurgiões/organização & administração , Pesquisa Médica Translacional/organização & administração , /epidemiologia , Eficiência , Humanos , Mentores , Michigan/epidemiologia , Pandemias
11.
JAMA Otolaryngol Head Neck Surg ; 147(3): 287-295, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443539

RESUMO

Importance: The coronavirus disease 2019 (COVID-19) pandemic required the rapid transition to telehealth with the aim of providing patients with medical access and supporting clinicians while abiding by the stay-at-home orders. Objective: To assess demographic and socioeconomic factors associated with patient participation in telehealth during the COVID-19 pandemic. Design, Setting, and Participants: This cohort study included all pediatric and adult patient encounters at the Department of Otolaryngology-Head & Neck Surgery in a tertiary care, academic, multisubspecialty, multisite practice located in an early hot spot for the COVID-19 pandemic from March 17 to May 1, 2020. Encounters included completed synchronous virtual, telephone, and in-person visits as well as visit no-shows. Main Outcomes and Measures: Patient demographic characteristics, insurance status, and 2010 Census block level data as a proxy for socioeconomic status were extracted. Univariate and multivariate logistic regression models were created for patient-level comparisons. Results: Of the 1162 patients (604 females [52.0%]; median age, 55 [range, 0-97] years) included, 990 completed visits; of these, 437 (44.1%) completed a virtual visit. After multivariate adjustment, females (odds ratio [OR], 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.70; 95% CI, 1.40-5.20) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, 0.98; 95% CI, 0.98-0.99) and being in the lowest median household income quartile (OR, 0.60; 95% CI, 0.42-0.86) were associated with lower odds of completing a virtual visit overall. Those patients within the second (OR, 0.53; 95% CI, 0.28-0.99) and lowest (OR, 0.33; 95% CI, 0.17-0.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, 0.47; 95% CI, 0.23-0.94) were more likely to complete a telephone visit. Finally, being within the lower 2 quartiles of proportion being married (OR for third quartile, 0.49 [95% CI, 0.29-0.86]; OR for lowest quartile, 0.39 [95% CI, 0.23-0.67]) was associated with higher likelihood of a no-show visit. Conclusions and Relevance: These findings suggest that age, sex, median household income, insurance status, and marital status are associated with patient participation in telehealth. These findings identify vulnerable patient populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape.


Assuntos
/epidemiologia , Disparidades em Assistência à Saúde , Otolaringologia , Participação do Paciente/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Demografia , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Pandemias , Fatores Socioeconômicos , Estados Unidos
12.
Public Health Rep ; 136(1): 27-31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33059533

RESUMO

An increased use of disinfectants during the coronavirus disease 2019 (COVID-19) pandemic may increase the number of adverse health effects among people who apply them or among those who are in the area being disinfected. For the 3-month period from January 1 to March 30, 2020, the number of calls about exposure to cleaners and disinfectants made to US poison centers in all states increased 20.4%, and the number of calls about exposure to disinfectants increased 16.4%. We examined calls about cleaners and disinfectants to the Michigan Poison Center (MiPC) since the onset of the COVID-19 pandemic. We compared all calls related to exposure to cleaners or disinfectants, calls with symptoms, and calls in which a health care provider was seen during the first quarters of 2019 and 2020 and in relationship to key COVID-19 dates. From 2019 to 2020, the number of all disinfectant calls increased by 42.8%, the number of calls with symptoms increased by 57.3%, the average number of calls per day doubled after the first Michigan COVID-19 case, from 4.8 to 9.0, and the proportion of calls about disinfectants among all exposure calls to the MiPC increased from 3.5% to 5.0% (P < .001). Calls for exposure to cleaners did not increase significantly. Exposure occurred at home for 94.8%97.1% of calls, and ingestion was the exposure route for 59.7% of calls. Information about the adverse health effects of disinfectants and ways to minimize exposure should be included in COVID-19 pandemic educational materials.


Assuntos
/epidemiologia , Desinfetantes/toxicidade , Centros de Controle de Intoxicações/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Michigan/epidemiologia , Pandemias
13.
Crit Care Med ; 49(3): 482-489, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33372746

RESUMO

OBJECTIVES: To investigate the potential influence of racial differences in outcomes of patients infected by coronavirus disease 2019-positive patients who require intensive care in an urban hospital. DESIGN: Retrospective cohort study. SETTING: Henry Ford Health System Multidisciplinary ICU, a total of 156 beds spread throughout the hospital in Detroit, MI. PATIENTS: We obtained data from the electronic medical record of all adult severe acute respiratory syndrome coronavirus-2-positive patients managed in the ICU of Henry Ford Hospital in Detroit, MI, between March 13, 2020, and July 31, 2020. Included patients were divided into two groups: people of color (including Black, Asian, Hispanic/Latino, and Arab) and White. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 365 patients were evaluated: 219 were Black (60.0%), 129 were White (35.3%), two were Asian (0.6%), eight were Hispanic/Latino (2.2%), and seven were Arab (1.9%). People of color were younger (62.8 vs 67.1; p = 0.007), with equal distribution of sex. People of color had less coronary artery disease (34 [14.4%] vs 35 [27.1%]; p =0.003) and less self-reported use of regular alcohol consumption (50 [21.2%] vs 12 [9.3%]; p = 0.004) than Whites, with no differences in diabetes (125 [53.0%] vs 66 [51.2%]; p = 0.742), hypertension (188 [79.7%] vs 99 [76.8%]; p = 0.516), congestive heart failure (41 [17.4%] vs 32 [24.8%]; p = 0.090), or chronic kidney disease (123 [54.1%] vs 55 [42.6%]; p = 0.083).There was no difference in ICU length of stay between people of color (18 d [CI, 7-47 d]) and Whites (18 d [CI, 6-48 d]; p = 0. 0.979). Neither frequency (72.5% vs 71.3%; p = ns) nor median time to mechanical ventilation between people of color (9 d [CI, 6-15 d]) and Whites (10 d [CI, 5-16 d]; p = 0.733) was different. Overall, 188 patients (51.5 %) died in the hospital. The 28-day mortality was lower in people of color (107/236; 45.3%) versus Whites (73/129; 56.6%) (adjusted odds ratio 0.60; p = 0.034), and there was an increased median survival time in people of color (20 d) versus Whites (13.5 d; hazard ratio 0.62; p = 0.002). The inhospital mortality was lower in people of color versus White, but the difference was not statistically significant (113 [47.9%] vs 75 [58.1%], respectively; p = 0.061). Finally, there was no significant difference in days of symptoms prior to admission, frequency of presenting symptoms, or frequency or severity of acute respiratory distress syndrome between the two groups. CONCLUSIONS: In critically ill patients infected with coronavirus disease 2019, people of color had a lower 28-day mortality than Whites with no difference in hospital mortality, ICU length of stay, or rates of intubation. These findings are contrary to previously held beliefs surrounding the pandemic.


Assuntos
/etnologia , Resultados de Cuidados Críticos , Cuidados Críticos , Grupos Étnicos , Hospitalização , Fatores Raciais , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Tempo para o Tratamento
14.
J Perinat Med ; 48(9): 883-891, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33151180

RESUMO

The outbreak of the SARS-CoV-2 elicited a surge in publications. Obstetric reports were with few exceptions characterized by small sample sizes with potentially limited generalizability. In this review, evidence suggests increased susceptibility to COVID-19 in pregnancy; common pregnancy comorbidities may help explain worse outcomes. While the risk of death is low, pregnancy may be associated with increased need for ventilation. Prematurity rates seem to be increased but may be accounted for in part by higher cesarean rates, to a large degree accounted for by elective decision to shorten the course of the labor. Though fetal/neonatal complication rates may be higher in the presence of COVID-19 infection, survival rates seem unaffected and vertical transmission is rare. As the outbreak continues in the USA with resurgence in many other western countries that achieved initial success in suppressing the virus, much remains to be learned. For example, the question related to the degree to pregnancy modifying symptomatology remains open. Currently, routine polymerase chain reaction testing remains limited by supply shortages possibly delaying diagnosis until later in the course of the disorder and thus altering the symptom complex at presentation. To add to the knowledge base, we initiated a regional COVID-19 in pregnancy collaborative observational study with a coordinating center, standardized data collection and a shared database. This was facilitated by a longstanding tradition of collaboration among regional obstetric services. Over an anticipated two-year study duration, we expect to study 400 documented and suspected COVID-19 pregnancies with time and site of services controls for cohort effect and high power to detect several adverse maternal/infant outcomes. We include a complete listing of variables in our database, which, along with our experience in setting up our regional collaborative, we hope and believe will be of use in other settings.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Colaboração Intersetorial , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Suscetibilidade a Doenças , Feminino , Humanos , Metanálise como Assunto , Michigan/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Sistema de Registros , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , Revisões Sistemáticas como Assunto , Resultado do Tratamento
15.
JAMA Netw Open ; 3(10): e2025197, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33084902

RESUMO

Importance: Black patients are overrepresented in the number of COVID-19 infections, hospitalizations, and deaths in the US. Reasons for this disparity may be due to underlying comorbidities or sociodemographic factors that require further exploration. Objective: To systematically determine patient characteristics associated with racial/ethnic disparities in COVID-19 outcomes. Design, Setting, and Participants: This retrospective cohort study used comparative groups of patients tested or treated for COVID-19 at the University of Michigan from March 10, 2020, to April 22, 2020, with an outcome update through July 28, 2020. A group of randomly selected untested individuals were included for comparison. Examined factors included race/ethnicity, age, smoking, alcohol consumption, comorbidities, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and residential-level socioeconomic characteristics. Exposure: In-house polymerase chain reaction (PCR) tests, commercial antibody tests, nasopharynx or oropharynx PCR deployed by the Michigan Department of Health and Human Services and reverse transcription-PCR tests performed in external labs. Main Outcomes and Measures: The main outcomes were being tested for COVID-19, having test results positive for COVID-19 or being diagnosed with COVID-19, being hospitalized for COVID-19, requiring intensive care unit (ICU) admission for COVID-19, and COVID-19-related mortality (including inpatient and outpatient). Medical comorbidities were defined from the International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, codes and were aggregated into a comorbidity score. Associations with COVID-19 outcomes were examined using odds ratios (ORs). Results: Of 5698 patients tested for COVID-19 (mean [SD] age, 47.4 [20.9] years; 2167 [38.0%] men; mean [SD] BMI, 30.0 [8.0]), most were non-Hispanic White (3740 patients [65.6%]) or non-Hispanic Black (1058 patients [18.6%]). The comparison group included 7168 individuals who were not tested (mean [SD] age, 43.1 [24.1] years; 3257 [45.4%] men; mean [SD] BMI, 28.5 [7.1]). Among 1139 patients diagnosed with COVID-19, 492 (43.2%) were White and 442 (38.8%) were Black; 523 (45.9%) were hospitalized, 283 (24.7%) were admitted to the ICU, and 88 (7.7%) died. Adjusting for age, sex, socioeconomic status, and comorbidity score, Black patients were more likely to be hospitalized compared with White patients (OR, 1.72 [95% CI, 1.15-2.58]; P = .009). In addition to older age, male sex, and obesity, living in densely populated areas was associated with increased risk of hospitalization (OR, 1.10 [95% CI, 1.01-1.19]; P = .02). In the overall population, higher risk of hospitalization was also observed in patients with preexisting type 2 diabetes (OR, 1.82 [95% CI, 1.25-2.64]; P = .02) and kidney disease (OR, 2.87 [95% CI, 1.87-4.42]; P < .001). Compared with White patients, obesity was associated with higher risk of having test results positive for COVID-19 among Black patients (White: OR, 1.37 [95% CI, 1.01-1.84]; P = .04. Black: OR, 3.11 [95% CI, 1.64-5.90]; P < .001; P for interaction = .02). Having any cancer was associated with higher risk of positive COVID-19 test results for Black patients (OR, 1.82 [95% CI, 1.19-2.78]; P = .005) but not White patients (OR, 1.08 [95% CI, 0.84-1.40]; P = .53; P for interaction = .04). Overall comorbidity burden was associated with higher risk of hospitalization in White patients (OR, 1.30 [95% CI, 1.11-1.53]; P = .001) but not in Black patients (OR, 0.99 [95% CI, 0.83-1.17]; P = .88; P for interaction = .02), as was type 2 diabetes (White: OR, 2.59 [95% CI, 1.49-4.48]; P < .001; Black: OR, 1.17 [95% CI, 0.66-2.06]; P = .59; P for interaction = .046). No statistically significant racial differences were found in ICU admission and mortality based on adjusted analysis. Conclusions and Relevance: These findings suggest that preexisting type 2 diabetes or kidney diseases and living in high-population density areas were associated with higher risk for COVID-19 hospitalization. Associations of risk factors with COVID-19 outcomes differed by race.


Assuntos
Afro-Americanos , Infecções por Coronavirus/etnologia , Grupo com Ancestrais do Continente Europeu , Disparidades nos Níveis de Saúde , Hospitalização , Pneumonia Viral/etnologia , Adulto , Idoso , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Nefropatias/epidemiologia , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Obesidade/epidemiologia , Razão de Chances , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Densidade Demográfica , Estudos Retrospectivos , Fatores de Risco
16.
Intern Emerg Med ; 15(8): 1485-1499, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32970246

RESUMO

Coronavirus disease (COVID-19) has aggressively spread across the United States with numerous fatalities. Risk factors for mortality are poorly described. This was a multicentered cohort study identifying patient characteristics and diagnostic markers present on initial evaluation associated with mortality in hospitalized COVID-19 patients. Epidemiological, demographic, clinical, and laboratory characteristics of survivors and non-survivors were obtained from electronic medical records and a multivariable survival regression analysis was conducted to identify risk factors of in-hospital death. Of 1629 consecutive hospitalized adult patients with confirmed COVID-19 from March 1st thru March 31, 2020, 1461 patients were included in final analysis. 327 patients died during hospitalization and 1134 survived to discharge. Median age was 62 years (IQR 50.0, 74.0) with 56% of hospitalized patients under the age of 65. 47% were female and 63% identified as African American. Most patients (55%) had either no or one comorbidity. In multivariable analysis, older age, admission respiratory status including elevated respiratory rate and oxygen saturation ≤ 88%, and initial laboratory derangements of creatinine > 1.33 mg/dL, alanine aminotransferase > 40 U/L, procalcitonin > 0.5 ng/mL, and lactic acid ≥ 2 mmol/L increased risk of in-hospital death. This study is one of the largest analyses in an epicenter for the COVID-19 pandemic. Older age, low oxygen saturation and elevated respiratory rate on admission, and initial lab derangements including renal and hepatic dysfunction and elevated procalcitonin and lactic acid are risk factors for in-hospital death. These factors can help clinicians prognosticate and should be considered in management strategies.


Assuntos
Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar/tendências , Pneumonia Viral/mortalidade , Adulto , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Infecções por Coronavirus/complicações , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
17.
Obstet Gynecol ; 136(4): 657-662, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925626

RESUMO

The maternal mortality ratio in the United States is increasing; understanding the significance of this change and developing effective responses requires a granular analysis of the contributing factors that a well-informed maternal mortality review committee can provide. Data collection and analysis, clinical factors, preventability, social determinants of health, and racial inequities combine to affect this outcome, and each factor must be considered individually and in combination to recommend a robust response. Obstetrician-gynecologists formed the State of Michigan's Maternal Mortality Review Committee (the Committee) in 1950 to identify gaps in care that needed to be systematically addressed at the time. In the early years, the Committee witnessed a reduction in the number of maternal deaths; over time, prioritization of maternal mortality decreased, yet the Committee witnessed changing patterns of death, varied data collection and evaluation processes, delayed reviews, and unimplemented recommendations. The calculation of the maternal mortality ratio was not informed by the outcomes of Committee reviews. Today, the Committee, with increased support from the Michigan Department of Health & Human Services, can clearly identify and report preventable pregnancy-related mortality along with its causes and is close to achieving a near real-time surveillance system that allows the development of timely clinical and policy recommendations and interventions. The Committee's adaptations in response to the rise in maternal mortality have resulted in several lessons learned that may be helpful for currently operating committees and in the formation of new ones.


Assuntos
Uso Indevido de Medicamentos , Mortalidade Materna/tendências , Complicações na Gravidez , Serviços Preventivos de Saúde , Melhoria de Qualidade , Suicídio , Adulto , Comitês Consultivos/normas , Comitês Consultivos/estatística & dados numéricos , Uso Indevido de Medicamentos/mortalidade , Uso Indevido de Medicamentos/prevenção & controle , Falha da Terapia de Resgate/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/normas , Humanos , Michigan/epidemiologia , Mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/prevenção & controle , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/tendências , Determinantes Sociais da Saúde/etnologia , Suicídio/prevenção & controle , Suicídio/estatística & dados numéricos
18.
Artigo em Inglês | MEDLINE | ID: mdl-32784593

RESUMO

The objective of the study was to investigate, using academic-community epidemiologic co-analysis, the odds of reported heat-related illness for people with (1) central air conditioning (AC) or window unit AC versus no AC, and (2) fair/poor vs. good/excellent reported health. From 2016 to 2017, 101 Detroit residents were surveyed once regarding extreme heat, housing and neighborhood features, and heat-related illness in the prior 5 years. Academic partners selected initial confounders and, after instruction on directed acyclic graphs, community partners proposed alternate directed acyclic graphs with additional confounders. Heat-related illness was regressed on AC type or health and co-selected confounders. The study found that heat-related illness was associated with no-AC (n = 96, odds ratio (OR) = 4.66, 95% confidence interval (CI) = 1.22, 17.72); living ≤5 years in present home (n = 57, OR = 10.39, 95% CI = 1.13, 95.88); and fair/poor vs. good/excellent health (n = 97, OR = 3.15, 95% CI = 1.33, 7.48). Co-analysis suggested multiple built-environment confounders. We conclude that Detroit residents with poorer health and no AC are at greater risk during extreme heat. Academic-community co-analysis using directed acyclic graphs enhances research on community-specific social and health vulnerabilities by identifying key confounders and future research directions for rigorous and impactful research.


Assuntos
Ar Condicionado/estatística & dados numéricos , Calor Extremo/efeitos adversos , Transtornos de Estresse por Calor/epidemiologia , Adolescente , Adulto , Idoso , Pesquisa Participativa Baseada na Comunidade , Feminino , Nível de Saúde , Temperatura Alta , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários
19.
Am J Cardiol ; 133: 154-161, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32829913

RESUMO

Although certain risk factors have been associated with increased morbidity and mortality in patients admitted with Coronavirus Disease 2019 (COVID-19), the impact of cardiac injury and high-sensitivity troponin-I (hs-cTnI) concentrations are not well described. In this large retrospective longitudinal cohort study, we analyzed the cases of 1,044 consecutively admitted patients with COVID-19 from March 9 until April 15. Cardiac injury was defined by hs-cTnI concentration >99th percentile. Patient characteristics, laboratory data, and outcomes were described in patients with cardiac injury and different hs-cTnI cut-offs. The primary outcome was mortality, and the secondary outcomes were length of stay, need for intensive care unit care or mechanical ventilation, and their different composites. The final analyzed cohort included 1,020 patients. The median age was 63 years, 511 (50% patients were female, and 403 (40% were white. 390 (38%) patients had cardiac injury on presentation. These patients were older (median age 70 years), had a higher cardiovascular disease burden, in addition to higher serum concentrations of inflammatory markers. They also exhibited an increased risk for our primary and secondary outcomes, with the risk increasing with higher hs-cTnI concentrations. Peak hs-cTnI concentrations continued to be significantly associated with mortality after a multivariate regression controlling for comorbid conditions, inflammatory markers, acute kidney injury, and acute respiratory distress syndrome. Within the same multivariate regression model, presenting hs-cTnI concentrations were not significantly associated with outcomes, and undetectable hs-cTnI concentrations on presentation did not completely rule out the risk for mechanical ventilation or death. In conclusion, cardiac injury was common in patients admitted with COVID-19. The extent of cardiac injury and peak hs-cTnI concentrations were associated with worse outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Cardiopatias/etiologia , Pacientes Internados , Pneumonia Viral/complicações , Troponina I/sangue , Adulto , Idoso , Biomarcadores/sangue , Infecções por Coronavirus/epidemiologia , Feminino , Seguimentos , Cardiopatias/sangue , Cardiopatias/epidemiologia , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
20.
Hemoglobin ; 44(4): 284-289, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32722950

RESUMO

The city of Detroit has a large population of individuals with sickle cell disease, and hospitals in Detroit have seen some of the highest numbers of cases of coronavirus disease-19 (COVID-19) in 2020. The purpose of this study was to examine the pathophysiological characteristics of COVID-19 in patients with sickle cell disease or trait to determine whether these patients have unique manifestations that might require special consideration. This retrospective analysis included 24 patients with confirmed COVID-19 and sickle cell disease or trait who were seen at the Henry Ford Hospital, Detroit, MI, USA, between March 1 and April 15 2020. Of the 24 patients, 18 (75.0%) had heterozygous sickle cell trait, one (4.0%) was a double heterozygote for Hb S (HBB: c.20A>T)/ß+-thalassemia (ß+-thal), four had sickle cell anemia (ßS/ßS) and one (4.0%) had Hb S/Hb C (HBB: c.19G>A) disease. A total of 13 (54.0%) patients required hospitalization. All four patients with sickle cell anemia, developed acute pain crisis. We observed one patient who developed acute pulmonary embolism and no patients developed other sickle cell associated complications. Additionally, three (13.0%) patients required packed red blood cell transfusion without the need of exchange transfusion, and one patient required admission to the intensive care unit (ICU), mechanical ventilation and subsequently died. Patients with sickle cell disease or trait and laboratory-confirmed COVID-19 had a generally mild, or unremarkable, course of disease, with lower chances of intubation, ICU admission and death, but with a slightly longer hospitalization.


Assuntos
Anemia Falciforme/complicações , Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Falciforme/terapia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Transfusão de Eritrócitos , Feminino , Humanos , Hipertensão/complicações , Tempo de Internação , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Obesidade/complicações , Dor/etiologia , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Embolia Pulmonar/etiologia , Estudos Retrospectivos , Traço Falciforme/complicações , Avaliação de Sintomas , População Urbana , Adulto Jovem
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