COVID-19 Mortality Risk Research Articles

COVID-19 mortality across occupations and secondary risks for elderly individuals in the household: A population register-based study.

ObjectivesThis is the first population-level study to examine inequalities in COVID-19 mortality according to working-age individuals’ occupations and the indirect occupational effects on COVID-19 mortality of older individuals who live with them.MethodsWe used early-release data for the entire population of Sweden of all recorded COVID-19 deaths from 12 March 2020 to 23 February 2021, which we linked to administrative registers and occupational measures. Cox proportional hazard models assessed relative risks of COVID-19 mortality for the working-aged population registered in an occupation in December 2018 and the older population who lived with them.ResultsAmong working aged-adults, taxi/bus drivers had the highest relative risk of COVID-19 mortality: over four times that of skilled workers in IT, economics, or administration when adjusted only for basic demographic characteristics. After adjusting for socioeconomic factors (education, income and country of birth), there are no occupational groups with clearly elevated (statistically significant) COVID-19 mortality. Neither a measure of exposure within occupations nor the share that generally can work from home were related to working-aged adults’ risk of COVID-19 mortality. Instead of occupational factors, traditional socioeconomic risk factors best explained variation in COVID-19 mortality. Elderly individuals, however, faced higher COVID-19 mortality risk both when living with a delivery or postal worker or worker(s) in occupations that generally work from home less, even when their socioeconomic factors are taken into account.ConclusionsInequalities in COVID-19 mortality of working-aged adults were mostly based on traditional risk factors and not on occupational divisions or characteristics in Sweden. However, older individuals living with those who likely cannot work from home or work in delivery or postal services were a vulnerable group.

COVID-19 Mortality Risk Correlates Inversely with Vitamin D3 Status, and a Mortality Rate Close to Zero Could Theoretically Be Achieved at 50 ng/mL 25(OH)D3: Results of a Systematic Review and Meta-Analysis.

Background: Much research shows that blood calcidiol (25(OH)D3) levels correlate strongly with SARS-CoV-2 infection severity. There is open discussion regarding whether low D3 is caused by the infection or if deficiency negatively affects immune defense. The aim of this study was to collect further evidence on this topic. Methods: Systematic literature search was performed to identify retrospective cohort as well as clinical studies on COVID-19 mortality rates versus D3 blood levels. Mortality rates from clinical studies were corrected for age, sex, and diabetes. Data were analyzed using correlation and linear regression. Results: One population study and seven clinical studies were identified, which reported D3 blood levels preinfection or on the day of hospital admission. The two independent datasets showed a negative Pearson correlation of D3 levels and mortality risk (r(17) = −0.4154, p = 0.0770/r(13) = −0.4886, p = 0.0646). For the combined data, median (IQR) D3 levels were 23.2 ng/mL (17.4–26.8), and a significant Pearson correlation was observed (r(32) = −0.3989, p = 0.0194). Regression suggested a theoretical point of zero mortality at approximately 50 ng/mL D3. Conclusions: The datasets provide strong evidence that low D3 is a predictor rather than just a side effect of the infection. Despite ongoing vaccinations, we recommend raising serum 25(OH)D levels to above 50 ng/mL to prevent or mitigate new outbreaks due to escape mutations or decreasing antibody activity.

More evidence for worse COVID-19 outcomes in people with HIV

More evidence for worse COVID-19 outcomes in people with HIV

Moderate to severe Vitamin D deficiency increases the risk for COVID-19 mortality in patients treated in a respiratory intensive care unit

Moderate to severe Vitamin D deficiency increases the risk for COVID-19 mortality in patients treated in a respiratory intensive care unit

Meta-Analysis of COVID-19 treatments on patients with a previous diagnosis of cardiovascular disease

BackgroundThe COVID-19 pandemic has spread globally, infecting and killing millions. Those subjects with cardiovascular disease (CVD) are at higher risk of severe COVID-19 morbidity and mortality following SARS-CoV-2 infection.PurposeTo investigate the response to different treatments against COVID-19 in patients with a pre-existing CVD.MethodsWe conducted a systematic review and meta-analysis following Cochrane, PRISMA and MOOSE guidelines (PROSPERO ref:CRD42020183057). Eligible articles reported in-hospital mortality rate in COVID-19 patients with CVD after testing specific treatments. Statistical concordance was performed by Cohen's kappa coefficient. The primary outcome was in-hospital mortality rate, secondary outcome was the length of hospital stay (LOS). The analysis utilised a random-effects model. Categorical variables were expressed as risk ratio (RR) and continuous variable with weighted mean difference (WMD) and standard deviation with 95% confidence interval (CI). I2 and Chi-tests were used to assess studies' heterogeneity. Publication bias was visualised by L'Abbe' plot and funnel plot with Egger's test. Subgroup analysis (pooling analysis) was also performed to compare the three groups' mortality differences: 'CVD treated' vs.'CVD untreated' vs.'no-CVD (treated and untreated)'. Meta-regression models were used to determine the effects of specific treatments and risk factors on the primary outcomes. R-studio used for analysis.ResultsOf 1,673 articles retrieved, 46 studies included CVD patients from which 11 included control group, finally five were comparative studies and were included in the quantitative analysis. From those studies, the sample size was 130 (mean age 63.9±2.7 years; 55.3% male). There was 100% concordance between reviewers equating to a Cohen's kappa coefficient of κ=1. The most frequent CV risk factor (CVRF) was hypertension (60%) followed by diabetes (28.5%). The most frequent CVD seen in patients was coronary artery disease at 9.09% and peripheral arterial disease at 5.4%. Mortality rate was significant higher in the CVD treated group (RR:1.52; 95% CI [1.05,2.21], CVD treated vs overall population p=0.03). Meta-regression showed that no treatment was significant associated to mortality and systemic hypertension, but an independent risk factor for mortality. Pooled single analysis showed no difference between treated vs untreated CVD patients. There was certain degree of heterogeneity (I2 50%) across the studies. L'Abbe and funnel plot visualized not significant dispersion (Egger test, p=0.71). There was no difference in terms of LOS [0,79, 95% CI (−0.48, 2,05); p-value 0.22].ConclusionsThis quantitative analysis showed that CVD patients despite specific treatments were exposed to significant higher mortality when compared to the overall population. These results remark the clinical relevance to reduce CVD risk factors and ameliorate specific COVID-19 treatments to lower the risk of mortality in this groupFunding AcknowledgementType of funding sources: None.

Deaths involving COVID-19 by self-reported disability status during the first two waves of the COVID-19 pandemic in England: a retrospective, population-based cohort study

BackgroundPeople with learning disabilities are at substantially increased risk of COVID-19 mortality, but evidence on risks of COVID-19 mortality for disabled people more generally is limited. We aimed to use population-level data to estimate the association between self-reported disability and death involving COVID-19 during the first two waves of the COVID-19 pandemic in England.MethodsWe conducted a retrospective, population-based cohort study of adults aged 30–100 years living in private households or communal establishments in England, using data from the Office for National Statistics Public Health Data Asset. Participants were present at the 2011 Census and alive on Jan 24, 2020. Participants reported being limited a lot in their daily activities, limited a little, or not limited at all, in response to a question from the 2011 Census. The outcome was death involving COVID-19, occurring between Jan 24, 2020, and Feb 28, 2021. We used Cox proportional hazards regression to calculate hazard ratios (HRs) for the association between disability and death involving COVID-19, sequentially adjusting for age, residence type (private household, care home, or other communal establishment), geographical characteristics (local authority district and population density), sociodemographic characteristics (ethnicity, highest qualification, Index of Multiple Deprivation decile, household characteristics [National Statistics Socio-economic Classification of the household reference person, tenure of household, household size, family status, household composition, and key worker in household], key worker type, individual and household exposure to disease, and individual and household proximity to others), and health status (pre-existing health conditions, body-mass index, and number of admissions to hospital and days spent in hospital over the previous 3 years).Findings29 293 845 adults were included in the study (13 806 623 [47%] men, 15 487 222 [53%] women), of whom 3 038 772 (10%) reported being limited a little and 2 011 576 (7%) reported being limited a lot. During follow-up, 105 213 people died from causes involving COVID-19 in England, 61 416 (58%) of whom were disabled. Age-adjusted analyses showed higher mortality involving COVID-19 among disabled people who were limited a lot (HR 3·05 [95% CI 2·98–3·11] for men; 3·48 [3·41–3·56] for women) and disabled people who were limited a little (HR 1·88 [1·84–1·92] for men; 2·03 [1·98–2·08] for women) than among non-disabled people. Adjustment for residence type, geography, sociodemographics, and health conditions reduced but did not eliminate the associations between disability and death involving COVID-19 (HR 1·35 [1·32–1·38] for men who were limited a lot; 1·21 [1·18–1·23] for men who were limited a little; 1·55 [1·51–1·59] for women who were limited a lot; and 1·28 [1·25–1·31] for women who were limited a little).InterpretationGiven the association between disability and mortality involving COVID-19, verification of these findings and consideration of recommendations for protective measures are now required.FundingNone.

Examining the elevated risk of COVID-19 in transgender communities with an intersectional lens.

COVID-19 has presented unique and unprecedented struggles for all people, yet they tend to be magnified among marginalized communities. Indeed, in the United States, transgender (trans) people experience oppression in many facets of their lives, which places them at an increased risk for both COVID-19 exposure and complications. This oppression can be broadly categorized into two distinct, yet interrelated categories: health disparities (e.g., decreased immune health) and structural barriers (e.g., employment discrimination, policing). Recent scholarship has examined trans people’s risk for COVID-19 exposure and mortality, however few articles examine intersectional identities, and, to our knowledge, none have interrogated oppressive power structures (e.g., the prison industrial complex). We aim to fill these critical gaps and argue that it is imperative for cisgender people to partner with trans communities to dismantle these harmful systems, positively impacting the lives of trans individuals during the pandemic and beyond. We make several key recommendations for researchers, policymakers, healthcare workers, and allies to do so.

Hesitancy and malignancy: Vaccine hesitancy among individuals with cancer.

148 Background: The World Health Organization cited vaccine hesitancy as one of 2019’s top ten threats to global health, a threat that has been further exacerbated by COVID-19 pandemic. Existing COVID-19 vaccine hesitancy research focuses on the general population, but less is known about the specific concerns of medically vulnerable populations, including individuals with cancer. Methods: This cross-sectional analysis used data that assessed likelihood of COVID-19 vaccination (likely vs unlikely/unsure) among past or current patients with cancer from a nationwide survey administered in December 2020 by the Patient Advocate Foundation (PAF), a non-profit organization that provides case management and financial aid to patients diagnosed with a chronic illness. Inclusion criteria included previous or current cancer treatment, aged ≥ 19, and a valid e-mail address. Age, sex, race/ethnicity, and urban/rural residence were abstracted from the PAF database. Respondents self-reported education level, employment status, trust in media regarding COVID-19 pandemic, and media viewership on COVID-19 vaccine development. The Group-Based Medical Mistrust Scale assessed respondents’ level of mistrust in medical providers based on ethnicity. Likelihood of COVID-19 vaccine acceptance was evaluated using risk ratios (RR) and 95% confidence intervals (CI) from modified Poisson regression models with robust error variance. All variables were included in our model. Results: Of 429 respondents, 48% were unlikely/unsure about accepting the COVID-19 vaccine, primarily due to concerns about vaccine safety (32%) and worry about health conditions (12%). When compared to those likely to accept COVID-19 vaccine, respondents who were unlikely/unsure were more often Black, Indigenous, or People of Color (40% vs. 23%), aged 36-55 (40% vs. 29%), and female (80% vs. 65%). In adjusted analysis, Black respondents were 55% less likely to accept a COVID-19 vaccine, when compared to White respondents (RR 0.55; 95% CI 0.4-0.8). When compared to those who did not follow the media regarding COVID-19 vaccine development, those who followed the media very closely were 4.5 times more likely to accept a COVID-19 vaccine (RR 4.5; 95% CI 1.6-13.2). Respondents who reported below average trust in the media were 60% less likely to accept a COVID-19 vaccine (RR 0.6; 95% CI 0.5-0.8), compared to those who reported above average trust in the media. Conclusions: Despite being at high risk of COVID-19 morbidity and mortality, a substantial proportion of under-resourced individuals with cancer were unlikely/unsure about vaccination, exposing a significant disconnect between risk of severe disease and vaccine acceptance. Our analysis also reveals a need to assess for and debunk misinformation to increase vaccine enthusiasm among medically vulnerable populations.

Fear of COVID-19: Effects on mental health in under-resourced patients with cancer.

152 Background: Given the high risk of COVID-19 mortality, patients with cancer are not only vulnerable to physical consequences of COVID-19 infection, but also to adverse psychological outcomes, including fear of COVID-19. Without intervention, psychological distress in patients with cancer can lead to worsening symptoms, poor quality of life, and lower survival. We sought to evaluate the association between fear of COVID-19 and psychological distress for under-resourced patients with cancer during the pandemic. Methods: This observational, longitudinal survey study, fielded during early (May 20- July 11, 2020) and later pandemic (December 2-December 23, 2020), evaluated the pandemic’s impact on patients with cancer receiving Patient Advocate Foundation (PAF) services from July 2019 – April 2020. Questions focused on individual experiences with COVID-19 and psychological, emotional, physical, and material effects from the pandemic. The validated Fear of COVID-19 Scale was used to determine fear of COVID-19. Psychological distress was determined using a four-item questionnaire by Holingue et al. (score range 4 – 16). Means and 95% confidence intervals (CI) were estimated using generalized estimating equation modeling with repeated measures to assess the effect of fear of COVID-19 on psychological distress early and later in the pandemic. Models adjusted for age, sex, race/ethnicity, region, annual household income, household size, marital status, employment status, Area Deprivation Index category, Rural-Urban Commuting Code category, cases per 100,000 in county of residence, cancer type, and number of comorbidities. Results: Amongst 1199 survey respondents, 94% considered themselves high risk for COVID-19. 448 respondents completed both the first and second survey. The majority of respondents were female (72%) and age 56-75 (55%); 40% were Black, Indigenous, or Persons of Color. In adjusted models of respondents who completed the early pandemic survey, respondents with more fear of COVID-19 had a higher mean psychological distress score (10.21; 95% CI 9.38-11.03) compared to respondents with less fear (7.55; 95% CI 6.75-8.36). Among those who completed the later pandemic survey, median fear of COVID-19 decreased (20 vs 19)median distress scores remained the same (8); respondents with more fear of COVID-19 had a higher mean psychological distress score (9.98; 95%CI 9.04-10.92) compared to respondents with less fear (7.87; 95%CI 6.98-8.76). Conclusions: Fear of COVID-19 was linked to psychological distress and persisted throughout the pandemic among under-resourced patients with cancer. Timely psychosocial support is critical to meet increased care needs experienced by patients with cancer during the COVID-19 pandemic. Given these results, fear of COVID-19 could be considered as a trigger to integrate psychological interventions in patients with cancer to treat psychological distress.

COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study

SummaryBackgroundThe UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020–21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We aimed to estimate the frequency of COVID-19 hospitalisation or death in people who received at least one vaccine dose and characterise these individuals.MethodsWe conducted a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) national surveillance platform, which contained linked vaccination, primary care, RT-PCR testing, hospitalisation, and mortality records for 5·4 million people (around 99% of the population) in Scotland. Individuals were followed up from receiving their first dose of the BNT162b2 (Pfizer–BioNTech) or ChAdOx1 nCoV-19 (Oxford–AstraZeneca) COVID-19 vaccines until admission to hospital for COVID-19, death, or the end of the study period on April 18, 2021. We used a time-dependent Poisson regression model to estimate rate ratios (RRs) for demographic and clinical factors associated with COVID-19 hospitalisation or death 14 days or more after the first vaccine dose, stratified by vaccine type.FindingsBetween Dec 8, 2020, and April 18, 2021, 2 572 008 individuals received their first dose of vaccine—841 090 (32·7%) received BNT162b2 and 1 730 918 (67·3%) received ChAdOx1. 1196 (<0·1%) individuals were admitted to hospital or died due to COVID-19 illness (883 hospitalised, of whom 228 died, and 313 who died due to COVID-19 without hospitalisation) 14 days or more after their first vaccine dose. These severe COVID-19 outcomes were associated with older age (≥80 years vs 18–64 years adjusted RR 4·75, 95% CI 3·85–5·87), comorbidities (five or more risk groups vs less than five risk groups 4·24, 3·34–5·39), hospitalisation in the previous 4 weeks (3·00, 2·47–3·65), high-risk occupations (ten or more previous COVID-19 tests vs less than ten previous COVID-19 tests 2·14, 1·62–2·81), care home residence (1·63, 1·32–2·02), socioeconomic deprivation (most deprived quintile vs least deprived quintile 1·57, 1·30–1·90), being male (1·27, 1·13–1·43), and being an ex-smoker (ex-smoker vs non-smoker 1·18, 1·01–1·38). A history of COVID-19 before vaccination was protective (0·40, 0·29–0·54).InterpretationCOVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation.FundingUK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Scottish Government, and Health Data Research UK.

An international comparison of age and sex dependency of COVID-19 deaths in 2020: a descriptive analysis

The number of reported coronavirus disease (COVID-19) deaths per 100,000 persons observed so far in 2020 is described in 15 European countries and the USA as dependent on age groups and sex. It is compared with the corresponding historic all-cause mortality per year depending on age and sex observed in these countries. Some common features exist although substantial differences in age and sex dependency of COVID-19 mortality were noted between countries. An exponential increase with age is a good model to describe and analyze both COVID-19 and all-cause mortality above 40 years old, where almost all COVID-19 deaths occur. Moreover, age dependency is stronger for COVID-19 mortality than for all-cause mortality, and males have an excess risk compared with women, which is less pronounced in the higher age groups. Additionally, concerning calendar time, differences in the age and sex dependency between countries were noted with the common tendency that male excess risk for COVID-19 mortality was smaller in the second half of the year.

Comparing mortality from covid-19 to mortality due to overdose: A micromort analysis

ObjectiveTo compare the mortality risk due to covid-19 with death due to overdose in British Columbia, Canada. The opioid epidemic was declared a public health emergency in 2016. MethodsMortality risk was calculated in micromorts with covid-19 data for January–October 2020, derived from the BC center for Disease Control, and illicit drug toxicity deaths for January 2010–September 2020, derived from the BC Coroners Service. Age-stratified covid-19 incidence and deaths per 100,000 population and age-stratified illicit drug toxicity death rates per 100,000 population were calculated. A micromort is a unit of risk equivalent to a one-in-a-million chance of death. ResultsDuring the covid-19 pandemic, illicit drug toxicity deaths reached 1.0 micromorts per day, representing an increase of 0.5 micromorts per day relative to 2019 rates. In comparison, covid-19 mortality risk was 0.05 micromorts per day among individuals from the general population living in British Columbia and 21.1 micromorts per day among those infected with covid-19. Covid-related mortality risk was significantly lower among individuals aged <60 years, relative to older adults, whereas drug toxicity-related mortality was highest for individuals aged 30–59 years. ConclusionsThe mortality associated with covid-19 is apparent and distributed unevenly across subpopulations. The mortality due to overdose has increased during covid-19 and exceeds mortality due to covid-19. Our results instantiate the triple threat caused by covid-19 (i.e., public health crisis, economic crisis and mental health crisis) and quantitatively highlight the externality of increased mortality due to deaths of despair in response to public health efforts to reduce covid-related mortality.

English

BACKGROUND The corona virus disease-19 (Covid-19) pandemic has put human civilization into a huge challenge, especially in the field of medicine in the management of patients with co-morbidities. Health authorities across the world depend greatly on reliable data to make major decisions and this is especially true during this global pandemic. The present review was conducted to estimate the challenges in the management of Covid-19 patients with metabolic syndrome with special emphasis on gender and age. Patients having pre-existing health conditions e.g., heart disease, diabetes are at higher risk of morbidity and mortality due to COVID-19. According to the WHO newsletter, COVID-19 has tragically claimed more than 1.5 million lives. The burden of obesity across the world has nearly tripled since 1975. In 2016, 1.9 billion adults, were overweight; 650 million were obese; 13 % of the world's adult population (11 % of males and 15 % of females) were obese in 2016. Obesity has been observed to be a high-risk factor for COVID-19 severity. Severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) targets the angiotensinconverting enzyme 2 (ACE2) for cell entry and ACE2 is highly expressed in adipose tissue. This suggests an important role for the tissue in determining COVID-19 disease severity in obese individuals.1-2 There has been an increase in death from diabetes by 70 % globally between 2000 and 2019, and an 80 % rise in deaths among males has been observed. Metabolic syndrome comprises three or more of the following factors: increased waist circumference; hypertriglyceridemia; elevated blood pressure; reduced high-density lipoprotein cholesterol; hyperglycemia.1-2 Visceral fat is known to produce higher concentrations of proinflammatory cytokines. These are then released in the bloodstream. Release of proinflammatory markers in blood stream may cause auto-amplifying cytokine production (“cytokine storms”) and low-grade inflammation. Cytokine storm and low-grade inflammation can contribute to worsening of COVID-19 patients with obesity. Components of metabolic syndrome such as hypertension, type 2 diabetes mellitus (T2DM), and obesity are highly prevalent among the general population and have been observed to significantly increase the risk of hospitalization and mortality in COVID-19 patients.1-2 KEYWORDS Covid-19 Pandemic, Metabolic syndrome, Aging, Gender

COVID-19 Infections and Mortality in Florida Counties: Roles of Race, Ethnicity, Segregation, and 2020 Election Results.

PurposeThis study investigates the association of racial and ethnic composition, segregation, and 2020 presidential election voting results with COVID-19 infections and deaths in Florida counties.MethodsFlorida county COVID-19 infection and death counts reported through March 2021 were supplemented with socioeconomic characteristics and 2020 presidential results to form the dataset employed in this ecological study. Poisson regression analysis measured the association of infection and mortality rates with county demographic and economic characteristics, then assessed the moderating role of county political preferences.ResultsCounties with higher proportions of Black residents experience disproportionately higher COVID-19 infection and mortality rates. Disparities are further inflated in counties with larger Republican vote shares. That voting effect extends to Hispanic population proportions and segregation, both of which are associated with higher COVID-19 infection and mortality rates in more Republican-leaning counties.ConclusionsCommunities challenged by pre-existing health disparities, segregation, and economic hardship before the pandemic bear disproportionate risk of COVID-19 infection and mortality. Factors associated with voter preference for the 2020 Republican presidential candidate compound those problems, worsening consequences for all county residents, suggesting deeper structural health challenges.

High Prevalence of Pre-Existing Liver Abnormalities Identified Via Autopsies in COVID-19: Identification of a New Silent Risk Factor?

A high prevalence of hepatic pathology (in 17 of 19 cases) was reported in post-mortem (PM) examinations of COVID-19 patients, undertaken between March 2020 and February 2021 by a single autopsy pathologist in two English Coronial jurisdictions. The patients in our cohort demonstrated high levels of recognised COVID-19 risk factors, including hypertension (8/16, 50%), type 2 diabetes mellitus (8/16, 50%) and evidence of arteriopathy 6/16 (38%). Hepatic abnormalities included steatosis (12/19; 63%), moderate to severe venous congestion (5/19; 26%) and cirrhosis (4/19; 21%). A subsequent literature review indicated a significantly increased prevalence of steatosis (49%), venous congestion (34%) and cirrhosis (9.3%) in COVID-19 PM cases, compared with a pre-pandemic PM cohort (33%, 16%, and 2.6%, respectively), likely reflecting an increased mortality risk in SARS-CoV-2 infection for patients with pre-existing liver disease. To corroborate this observation, we retrospectively analysed the admission liver function test (LFT) results of 276 consecutive, anonymised COVID-19 hospital patients in our centre, for whom outcome data were available. Of these patients, 236 (85.5%) had significantly reduced albumin levels at the time of admission to hospital, which was likely indicative of pre-existing chronic liver or renal disease. There was a strong correlation between patient outcome (length of hospital admission or death) and abnormal albumin at the time of hospital admission (p = 0.000012). We discuss potential mechanisms by which our observations of hepatic dysfunction are linked to a risk of COVID-19 mortality, speculating on the importance of recently identified anti-interferon antibodies.

Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study

ObjectivesTo derive and validate risk prediction algorithms to estimate the risk of covid-19 related mortality and hospital admission in UK adults after one or two doses of covid-19 vaccination.DesignProspective, population...

Current state of the obesity research: genetic aspects, the role of microbiome, and susceptibility to COVID-19

Obesity affects over 700 million people worldwide and its prevalence keeps growing steadily. The problem is particularly relevant due to the increased risk of COVID-19 complications and mortality in obese patients. Obesity prevalence increase is often associated with the influence of environmental and behavioural factors, leading to stigmatization of people with obesity due to beliefs that their problems are caused by poor lifestyle choices. However, hereditary predisposition to obesity has been established, likely polygenic in nature. Morbid obesity can result from rare mutations having a significant effect on energy metabolism and fat deposition, but the majority of patients does not present with monogenic forms. Microbiome low diversity significantly correlates with metabolic disorders (inflammation, insulin resistance), and the success of weight loss (bariatric) surgery. However, data on the long-term consequences of bariatric surgery and changes in the microbiome composition and genetic diversity before and after surgery are currently lacking. In this review, we summarize the results of studies of the genetic characteristics of obesity patients, molecular mechanisms of obesity, contributing to the unfavourable course of coronavirus infection, and the evolution of their microbiome during bariatric surgery, elucidating the mechanisms of disease development and creating opportunities to identify potential new treatment targets and design effective personalized approaches for the diagnosis, management, and prevention of obesity.

The willingness of UK adults with intellectual disabilities to take COVID-19 vaccines.

BackgroundGiven the much greater COVID‐19 mortality risk experienced by people with intellectual disabilities (ID), understanding the willingness of people with ID to take a COVID‐19 vaccine is a major public health issue.MethodIn December 2020 to February 2021, across the United Kingdom, 621 adults with ID were interviewed remotely and 348 family carers or support workers of adults with ID with greater needs completed an online survey, including a question on willingness to take a COVID‐19 vaccine if offered.ResultsEighty‐seven per cent of interviewees with ID were willing to take a COVID‐19 vaccine, with willingness associated with white ethnicity, having already had a flu vaccine, gaining information about COVID‐19 from television but not from social media, and knowing COVID‐19 social restrictions rules. A percentage of 81.7% of surveyed carers of adults with ID with greater needs reported that the person would be willing to take a COVID‐19 vaccine, with willingness associated with white ethnicity, having a health condition of concern in the context of COVID‐19, having had a flu vaccine, being close to someone who had died due to COVID‐19, and having shielded at some point during the pandemic.ConclusionsReported willingness to take the COVID‐19 vaccine is high among adults with ID in the United Kingdom, with factors associated with willingness having clear implications for public health policy and practice.

COVID-19 mortality among people with diagnosed HIV compared to those without during the first wave of the COVID-19 pandemic in England.

ObjectivesWe describe COVID‐19 mortality among people with and without HIV during the first wave of the pandemic in England.MethodsNational surveillance data on adults (aged ≥ 15 years) with diagnosed HIV resident in England were linked to national COVID‐19 mortality surveillance data (2 March 2020–16 June 2020); HIV clinicians verified linked cases and provided information on the circumstances of death. We present COVID‐19 mortality rates by HIV status, using negative binomial regression to assess the association between HIV and mortality, adjusting for gender, age and ethnicity.ResultsOverall, 99 people with HIV, including 61 of black ethnicity, died of/with COVID‐19 (107/100 000) compared with 49 483 people without HIV (109/100 000). Compared to people without HIV, higher COVID‐19 mortality rates were observed in people with HIV of black (188 vs. 122/100 000) and Asian (131 vs. 77.0/100 000) ethnicity, and in both younger (15–59 years: 58.3 vs. 10.2/100 000) and older (≥ 60 years: 434 vs. 355/100 000) people. After adjustment for demographic factors, people with HIV had a higher COVID‐19 mortality risk than those without (2.18; 95% CI: 1.76–2.70). Most people with HIV who died of/with COVID‐19 had suppressed HIV viraemia (91%) and at least one comorbidity reported to be associated with poor COVID‐19 outcomes (87%).ConclusionsIn the first wave of the pandemic in England, COVID‐19 mortality among people with HIV was low, but was higher than in those without HIV, after controlling for demographic factors. This supports the strategy of prioritizing COVID‐19 vaccination for people with HIV and strongly encouraging its uptake, especially in those of black and Asian ethnicity.

The impact of comorbid allergic airway disease on the severity and mortality of COVID-19: a systematic review and meta-analysis.

PurposeTo analyze the impact of AAD on the severity and mortality of COVID-19 patients and compare clinical outcomes between patients with and without AAD.MethodsIn the systematic review and meta-analysis, we searched PubMed, Embase, Web of Science for studies reporting allergic rhinitis, asthma prevalence in COVID-19 patients and compared clinical outcomes, and excluded duplicate publications, reviews, comments, single or few cases reports (< 100 cases). We determined the pooled effect estimates using random effect model.ResultsThirty-four studies (345,091) were finally included for the meta-analysis. On the basis of 32 studies (337,821) involving with the severity of COVID-19, we did not find significant association between AAD and the severity of COVID-19 (p = 0.35, OR 1.10, 95% CI 0.90–1.35). Subgroup analysis indicated there was no the variability in the prevalence of AAD among COVID-19 patients in different study designs, disease categories, countries, the definition of severity, and population size of AAD. Based on 21 studies (306,331) involving with the mortality of COVID-19, AAD was significantly associated with the decreased mortality of COVID-19 (p < 0.05, OR 0.83, 95% CI 0.70–0.99). The subgroup analysis showed AAD was not associated with the mortality of COVID-19 in different countries or regions. Based on the population size of AAD, we found AAD within 100 cases was not associated with the mortality of COVID-19 (p = 0.63, OR 1.15, 95% CI 0.65–2.03). Moreover, study design was possible heterogeneity source as the heterogeneity I2 was reduced to 0 in prospective studies.ConclusionThe preexisting AAD was not inclined to deteriorate the course of COVID-19. The prevalence of AAD was not associated with the severity of COVD-19 patients and inclined to be significantly associated with the decreased mortality risk of COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-021-07072-1.