COVID-19 Pandemic Research Articles

ABSTRACT Nipah virus (NiV) outbreak was declared in Kozhikode district, Kerala state, India, on 12 September 2023. The local, state, and national authorities worked in an integrated way to tackle and control the outbreak. Indian Council of Medical Research (ICMR) deployed a team from the ICMR-National Institute of Virology (NIV), Pune, India, along with an indigenously developed and validated Mobile BSL-3 (MBSL-3) laboratory for providing onsite NiV diagnosis. The Kozhikode district of Kerala state was the epicenter of three NiV outbreaks on May 2018, August 2021, and most recently in September 2023. The Ernakulam district of Kerala also reported a NiV outbreak in June 2019. In the 2023 outbreak, six confirmed NiV cases were detected, with two deaths. During previous outbreaks in 2019 and 2021, the team from ICMR-NIV, Pune, had successfully established a field laboratory utilizing the BSL-2 facility for NiV onsite diagnosis. BSL-3 personnel protective equipment and standard operative procedures were used to handle clinical specimens. Post COVID-19 pandemic, under the pioneering initiative of the Government of India, ICMR, and Klenzaids Contamination Control Pvt. Ltd, Mumbai developed a rapidly deployable, pragmatic, access control, and containment laboratory on bus chassis. The MBSL-3 laboratory was utilized for the NiV onsite diagnosis for early containment of outbreaks, reducing the turnaround time for diagnosis to just 4 hrs. The MBSL-3 laboratory plays a significant role in NiV outbreak response and could be utilized in the future also reaching the remotest areas of the country.

Background: The influence of COVID-19 for out-of-hospital cardiac arrest (OHCA) who received extracorporeal pulmonary resuscitation (ECPR) was not fully elucidated. We examined whether there were differences in frequency and outcomes for OHCA patients who received ECPR during COVID-19 pandemic. Methods: Using the JAAM-OHCA registry, which is a nationwide registry, we evaluated the OHCA patients who received ECPR from 2019-2022. Since the first state of emergency was declared in April, 2020, we compared outcomes for OHCA patient before COVID-19 pandemic (from January 1, 2019 to March 31, 2020), and those during COVID-19 pandemic (from April 1, 2020 to December 31, 2022). We performed logistic regression analysis adjusted age, sex, witnessed cardiac arrest (CA), bystander cardiopulmonary resuscitation, initial/on hospital arrival shockable rhythm, and time from call to extracorporeal membrane oxygenation initiation and interrupted time series analysis (ITSA). Primary outcome was the proportion of 30-day neurological favorable outcome defined as Cerebral Performance Category scores of 1-2 between two groups. Results: After excluding patients, 1,903 ECPR cases (681 in pre-pandemic group and 1,222 in pandemic group) were included in the study period. ECPR frequency was decreased during pandemic (4.4% [681/15,344], 45.4 cases per month in pre-pandemic group, and 3.8% [1,222/32,020], 37.1 cases per month in pandemic group, OR 0.86 95%CI 0.78–0.94,p<0.01). Multivariable logistic regression analysis revealed COVID-19 pandemic was not associated with 30-day favorable neurological outcome (12.5% [85/681] in pre-pandemic group and 12.6% [154/1,221] in pandemic group, OR 0.92, 95%CI 0.67–1.30, p=0.64). ITSA revealed the frequency of ECPR decreased significantly (-17.2 per month, 95%CI -26.0–-8.5, p<0.01), while the proportion of 30-day neurological favorable outcomes did not differ (RR 1.16, 95%CI 0.70–1.96, p=0.56) during pandemic period. Conclusions: Although the frequency of ECPR for OHCA patients decreased, prognosis including favorable neurological outcomes did not differ during COVID-19 pandemic.

Background: The COVID-19 pandemic has significantly impacted healthcare systems and patient behaviors, potentially affecting cardiovascular disease prevalence and outcomes. This study aims to analyze trends in acute myocardial infarction (AMI)-related hospitalizations and in-hospital mortality by age and sex in California from 2016 to 2022, with a particular focus on the pandemic years 2020-2022. Methods: This retrospective analysis utilized patient discharge data from California from 2016-2022. Nearly 25 million inpatient events were screened for primary ICD-10-CM diagnosis codes I21. Age-and-sex-standardized hospitalization rates (ASHR) and in-hospital mortality rates (IMR) per 100,000 population were calculated for ages 20 and over. The effects of pre- and post-COVID-19 periods on AMI Hospitalization and In-hospital Mortality events were evaluated using multivariate logistic regression (MLR), adjusting for age, gender, race/ethnicity, geographic region, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR). Results: The study identified 776,609 AMI-related hospitalizations and 81,210 in-hospital deaths (10.46%). ASHR increased from 288.9 in 2016 to 365.9 in 2022, with a significant acceleration during the pandemic period (2020-2022) compared to the pre-pandemic period (2016-2019). Young adults (20-44 years) exhibited an alarming increase in AMI prevalence during the pandemic years. For males, rates rose from 39.4 to 70.2 per 100,000, and for females from 17.7 to 35.2 per 100,000. IMR increased from 29.0 in 2016 to 36.9 in 2022, with a marked acceleration during the pandemic years. Mortality rates increased significantly for both males, from 31.31 to 41.52, and for females, from 26.84 to 32.65. MLR showed that the post-COVID period had significantly higher rates of hospitalizations and in-hospital deaths compared to the pre-COVID period. Hospitalizations increased by 31% (AOR=1.31; 95% CI=1.30-1.31; p<0.001) and deaths increased by 22.6% (AOR=1.23; 95% CI=1.21-1.25; p<0.001). Conclusion: AMI-related hospitalizations and in-hospital mortality rates significantly increased in California from 2016 to 2022, with the steepest rises observed during the COVID-19 pandemic years. Young adults, particularly males, experienced a disproportionate surge in AMI prevalence. These findings suggest a substantial impact of the COVID-19 pandemic on cardiovascular health and underscore the need for targeted prevention and equitable care strategies.

Background: The COVID-19 pandemic disrupted healthcare systems and significantly impacted individuals with chronic conditions. Research Question: What was the impact of the pandemic on diabetes mellitus (DM) as a contributing condition on cardiovascular disease (CVD) mortality trends and place of death? Methods: Using the CDC WONDER database (2018–2023), we identified deaths due to CVD (ICD-10 codes: I00–I99) in individuals with DM (ICD-10 codes: E10-E14) in the United States. The study was divided into pre-COVID (2018-2019), during COVID (2020-2021), and post-COVID (2022-2023) periods. Age-adjusted mortality rates (AAMRs) per 100,000 population were stratified by age, sex, race/ethnicity, and regions. Places of death were classified as inpatient, outpatient/ER, home, hospice, or nursing home/long-term care. Results: There were a total of 617,414 deaths due to CVD in patients with DM and the AAMR increased from 22.18 per 100,000 pre-COVID to 26.24 during COVID and remained high at 25.84 post-COVID. AAMR increased across all age groups during the pandemic, with the most increase among adults aged 25-44 (+29.8%), followed by 45-64 (+20.8%) and ≥65 (+17.3%) which decreased by 4.68%, 4.02% and 0.73% post-COVID respectively (Table 1). Home deaths increased considerably from 40.6% (69,344 of 170,777) pre-COVID to 46.2% (94,512 of 204,566) during COVID-19, with a slight decline to 45.1% (94,020 of 208,388) post-COVID. In contrast, deaths in nursing homes (−2.67%), outpatient/ER settings (−1.07%), and inpatient (−1.68%) declined during COVID. Regionally, the South had greatest increase in AAMR (+21.3%) which increased to (+23.2%) post-COVID, followed by the West (+16.2% to +13.3%), Midwest (+16.6% to 12.6%), and Northeast (+15.8% to +9.4). Males and females had a comparable mortality increase during the pandemic (+18% and 17.9%) while non-Hispanic individuals had a higher increase in AAMR (+17.1%) as compared to Hispanics (+10.6%). Among races, Black individuals had the highest AAMR increase (+23.6%), followed by Asian (+21%), White (+17%), and American Indian or Alaska Native (+6.2%). Conclusion: The COVID-19 pandemic was associated with considerable rise in CVD mortality in patients with DM, especially younger adults. This trend continued post-COVID and a considerable and lasting shift in place of death toward home settings was observed. These disparities underscore systemic gaps in prevention and chronic disease management that were magnified during the pandemic.

Introduction: Transcatheter percutaneous aortic valve replacement (TAVR) was FDA-approved as an alternative to surgical aortic valve replacement (SAVR) in high (2012), intermediate (2016) and low-risk (2019) pts with aortic stenosis (AS). We assessed the impact of TAVR on SAVR in a marjority-minority population in Hawaii. Methods: We used data from The Queen’s Medical Center STS/ACC TVT and STS Adult Cardiac Surgery registries to identify all pts who underwent TAVR or isolated SAVR from 2012-23. We compared demographics, comorbidities, pre-op risk of mortality (ROM) score, procedural data and in-hospital outcomes. We used SPSS for descriptive analyses and parametric and non-parametric tests as appropriate. Results: From 2012-23, 1,732 pts had aortic valve replacement (AVR): 489 (28.2%) isolated SAVR and 1,243 (71.8%) TAVR. Whites, Asians, and Native Hawaiians underwent 38.1%, 47.6%, and 11.3% of procedures respectively. Total volume decreased during COVID-19 pandemic (2020-2023), with TAVR also negatively impacted in 2018-19 by changes in staffing. From 2012-23, each additional year was associated with a 21.0% increase in the odds of receiving TAVR vs. SAVR (OR 1.2, p < 0.001) - a corresponding 17.4% annual decrease in the odds of undergoing SAVR. The odds of receiving TAVR were 2.3 times higher during 2020-23 than before (p < 0.001). SAVR ROM significantly decreased with time (r = -0.170, p< 0.001). SAVR pts were younger (64.3 ± 12.5 vs. 79.1 ± 9.8 yrs, p < .001) with lower ROM (2.2 ± 3.2 vs 5.4 ± 4.2, p < .001) and more urgent procedures (14.7% vs 3.6%, p < 0.001). Conversely, TAVR pts were more often women (39.3% vs 28.8%, p < .001), with more diabetes (40.4% vs 31.3%, p < 0.001), prior MI (19.2% vs 9.4%, p < 0.001), and Medicaid/Medicare (84.8% vs 57.3%, p < 0.001). In-hospital mortality was significantly lower in TAVR vs SAVR (1.6% vs 3.3%, p = 0.02). Overall, the total number of AVRs increased 30.9% between 2013-14 (116.5 procedures/yr) and 2022-23 (152.5 procedures/yr). Among pts <65y, TAVR increased from 2013-14 to 2022-23 (9.1% vs. 42.6%) and SAVR decreased (90.9% vs.57.4%). Conclusion: With expanding indications for TAVR to include low-risk pts, annual TAVR volume has started to rebound following the COVID-19 pandemic. Despite fewer SAVRs, the annual number of all AVRs has substantially increased over the past decade, suggesting that TAVR has expanded access to AVRs to a broader range of pts.

Background: Granulomatosis with polyangiitis (GPA) is a rare ANCA-associated vasculitis characterized by necrotizing granulomatous inflammation and small- to medium-vessel vasculitis. The COVID-19 pandemic has raised interest in its potential to trigger autoimmune diseases like GPA. This retrospective study investigates changes in GPA frequency, clinical features, and serological patterns before and after the COVID-19 pandemic. Methods: This retrospective study analyzed 72 patients with granulomatosis with polyangiitis (GPA) at one of the most referral hospitals (2016–2024), divided into pre-COVID (n = 27) and post-COVID (n = 45). Demographic, clinical, radiological, and laboratory data were collected. Pre and post-COVID groups were compared using t-tests and chi-square tests. Firth’s logistic regression identified predictors of post-COVID GPA, adjusting for age, sex, ANCA subtype, and clinical features. Results: A total of 72 patients with granulomatosis with polyangiitis (GPA) were analyzed, including 27 diagnosed pre-COVID-19 and 45 post-COVID-19. The post-COVID-19 cohort was significantly younger (mean age 37.75 ± 10.38 vs. 50.66 ± 12.76 years, P < 0.001) and showed increased prevalence of pulmonary ground-glass opacities (64.4% vs. 25.9%, P = 0.003), cutaneous manifestations (75.6% vs. 25.9%, P = 0.004), and ophthalmic involvement (44.4% vs. 11.1%, P = 0.007). Firth’s logistic regression identified younger age (OR = 0.89, 95% CI: 0.82–0.97, P = 0.008), male sex (OR = 1.94, 95% CI: 1.02–3.99, P = 0.044), pulmonary ground-glass opacities (OR = 5.71, 95% CI: 1.84–18.27, P = 0.002), and ophthalmic complications (OR = 3.27, 95% CI: 1.02–10.48, P = 0.047) as predictors of post-COVID-19 GPA. No association was found between COVID-19 vaccination and GPA onset or relapse (P = 0.429). Conclusion: This study reveals a higher frequency of granulomatosis with polyangiitis (GPA) and a younger age at onset post-COVID-19. Predictors of post-COVID-19 GPA included younger age, male sex, and pulmonary involvement. SARS-CoV-2 may trigger autoimmune activation, but no link with vaccination was found. GPA clinical features remained consistent, warranting ongoing monitoring and research into COVID-19’s autoimmune effects.

Background: The COVID-19 pandemic disrupted health care systems and emergency care access across the United States. Research Question: What was the impact of COVID-19 on mortality of patients with IHD and their places of death? Methods: We used the CDC WONDER database to identify deaths due to IHD (ICD-10 codes I20-I25) from 2018-2023. The study was divided into pre-COVID (2018–2019), during COVID (2020–2021), and post-COVID (2022–2023) periods. Deaths were categorized by place of death: inpatient, outpatient or ER, decedent’s home, hospice facility, and nursing home/long term care. Adjusted mortality rates (AAMRs) per 100,000 population were stratified by age, sex, race, ethnicity and region. Results: Overall, 2,205,804 individuals died due to IHD and the AAMR increased from 89.4 per 100,000 pre-COVID to 92.2 during COVID, before declining to 84.9 in the post-COVID era. AAMR for individuals having concomitant IHD and Covid-19 decreased by 52.5% from 10.76 during the pandemic to 5.11 after the pandemic. (Table 1) Place of death analysis revealed substantial shift toward home deaths during the pandemic which increased from 38.7% (264,005 of 682,196) to 44.9% (318,249 of 708,342) during COVID, remaining elevated post-COVID (44.7%). Inpatient deaths fell from 23.6% to 21.8% during COVID and Deaths in outpatient/ER (14.0% to 13%), nursing homes (19.5% to 16.7%), and hospice (4.0% to 3.6%) also declined. (Table 2) Young adults aged 25-44 had the largest AAMR rise during COVID (+12.5%), with smaller increases in those aged 45-64 (+6.9%) and ≥65 (+2.1%). Geographically, AAMR increased the highest in the South and West (+4.5%) with greatest post-COVID declines in the Northeast (-11.7%). Hispanic individuals saw a 6.8% increase in AAMR during COVID and a 13.4% decline after. Increases in AAMR during COVID were highest among Black (+6.9%), Asian (+6.6%), and Pacific Islander (+6.4%) individuals, while White individuals had a smaller rise (+2.7%). Conclusion: COVID-19 pandemic was associated with a temporary rise in IHD mortality and a substantial shift in place of death toward home, which continued post-COVID. Although overall IHD mortality declined post-pandemic, this recovery was uneven across age, race, and region. This highlights persistent disparities and long-term changes in healthcare utilization and end-of-life care patterns following the pandemic and underscore the urgent need for targeted interventions to improve healthcare access.

Background: Acute myocardial infarction (AMI) represents a significant component of cardiovascular disease (CVD) mortality among the young and middle-aged populations of the United States (US). Research Question: To analyze the long-term trends and the impact of the COVID-19 pandemic on AMI-related mortality among the young and middle-aged populations of the US. Methods: Data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database were used to analyze death certificates from 1999 to 2023 for AMI-related deaths among the young and middle-aged population (aged 25-64) of the US. Age-adjusted mortality rates (AAMRs) per 100,000 people and associated annual percent changes (APCs) and average APC (AAPCs) were analyzed using Joinpoint regression analysis. Mortality trends were stratified by sex, race/ethnicity, and census region. Results: From 1999 to 2023, there were 970,454 AMI-related deaths among U.S. adults aged 25-64 years. The annual number of AMI-related deaths decreased from 44,040 in 1999 to 31,522 in 2023. The overall AAMR per 100,000 decreased from 31.02 deaths (95% CI, 30.73 to 31.31) in 1999 to 15.29 (95% CI, 15.11 to 15.46) in 2023 (AAPC -2.92%, 95% CI -3.22 to -2.75). The AAMR per 100,000 declined at a faster rate from 31.02 in 1999 to 19.57 in 2010 (1999-2010, APC -4.26), followed by a slower rate from 19.57 in 2010 to 16.67 in 2019 (2010-2019, APC -1.41), The declining trend was disrupted by a transient increase during the COVID-19 pandemic, with a peak AAMR of 19.73 (95% CI, 19.53 to 19.93) in 2021 (2019-2021, APC 8.52). The declining trend resumed from 2021 to 2023, with AAMR decreasing to the lowest levels of 15.29 in 2023 (2021-2023, APC -12.58). Heterogeneity across demographic and regional groups has narrowed during these 25 years. However, they are still prevalent, with men ( figure 1 ), non-Hispanic (NH) Black or African American, NH American Indian or Alaska Native ( figure 2 ), and the residents of the Southern United States ( figure 3 ) having higher mortality rates. Conclusion: Over the past 25 years, AMI-related mortality has declined in the young and middle-aged population of the US, although rates spiked during the COVID-19 pandemic before resuming their decline in 2022. While disparities among demographic and regional groups have narrowed, they still exist, necessitating comprehensive efforts to improve cardiovascular health outcomes.

Background: Essential hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality. The COVID-19 pandemic introduced major disruptions in chronic disease care, but its impact on hypertension-specific mortality at the population level remains underexplored. Methods: We used the CDC WONDER Multiple Cause of Death database to extract mortality data for essential hypertension (ICD-10 I10) from 2016–2023. We compared pre-COVID (2016–2019) and post-COVID (2020–2023) periods. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated using bridged-race census estimates and stratified by sex, race/ethnicity, age group, state, urbanization, year, and place of death. Results: There were 89,835 deaths pre-COVID and 107,425 deaths post-COVID, with the national AAMR increasing from 5.61 to 6.44 per 100,000. Increases were observed across all demographics: male AAMR rose from 5.74 to 6.76 and female from 5.34 to 5.97. Black individuals had the highest AAMR in both periods (9.20 to 10.66), while White individuals had the lowest (5.24 to 6.03). Adults ≥65 accounted for the majority of deaths; among them, the 65–74 group rose from 13.1 to 16.2 and the 75–84 group from 32.7 to 36.4. Geographically, Mississippi and West Virginia had the highest AAMRs in both eras, while Colorado and Utah consistently had the lowest. Urban-rural differences persisted, with Non-Core areas experiencing the highest AAMR post-COVID (6.16 to 6.95). Notably, the proportion of deaths occurring at home increased from 37.3% to 43.4%, while inpatient deaths remained stable around 16%, indicating a shift toward out-of-hospital deaths. Conclusion: Essential hypertension mortality increased following the COVID-19 pandemic, with widening disparities by sex and race and a marked shift toward out-of-hospital deaths. These findings highlight the urgent need to strengthen outpatient hypertension management and community health strategies, especially in vulnerable populations.

The effects of pandemic-related restrictions on people in prisons who tend to have multiple complex health needs are not well understood. We aimed to measure changes in adjudications and self-harm among people in prisons before and during the pandemic. We examined effects of time and demographic characteristics on odds and counts of adjudications and self-harm over a three-year period, starting one year before the COVID-19 pandemic, in 861 individuals from 21 Offender Personality Disorder Pathway prison sites. The odds of adjudicating were lower in people of older age (odds ratio 0.98 (95% CI: 0.96-0.99)), and during COVID-19 year one (odds ratio 0.37 (95% CI: 0.23-0.60)) and year two (odds ratio 0.40 (95% CI: 0.25-0.65)) compared to pre-COVID-19. Being of White ethnicity was associated with increased odds (odds ratio 4.42 (95% CI: 2.06-9.47)) and being older was associated with reduced odds (odds ratio 0.97 (95% CI: 0.95-0.99)) of self-harm. The odds of self-harm were significantly reduced during COVID-19 year two (odds ratio 0.45 (95% CI: 0.26-0.78)), but not during COVID-19 year one (odds ratio 0.68 (95% CI: 0.40-1.14)), compared with the 12 months before COVID-19. Although adjudications and self-harm were generally lower during the pandemic, younger people showed increased odds of adjudications and self-harm compared with older people, while White people showed increased odds of self-harm compared with people of the global majority. Our findings highlight the importance of considering potential health inequities and environmental effects of lockdowns for people in prisons.

Introduction: Public satisfaction with General Practice (GP) services has reached an all-time low, amid increasing demand for appointments and strain on resources. In response, the UK government launched the “Delivery Plan for Recovering Access to Primary Care,” which includes a commitment to modernise primary care and improve patient access through digital innovation. A key component of this transformation is the implementation of Total Patient Triage (TPT), a model that assesses all patient contacts to determine the most appropriate clinical pathway. Widely adopted during the COVID-19 pandemic, TPT facilitates remote consultations, reduces reliance on traditional telephone booking systems, and aims to optimise time for both patients and clinicians. Aim: This project aimed to evaluate whether training using simulation could enhance NHS staff understanding of the TPT model and foster collaborative working across all roles in General Practice. Methods: A tabletop simulation was developed using a bespoke “triage card” system. Fourty anonymised, real-life patient queries were printed on cards resembling a deck of playing cards. Each query was paired with a range of potential triage outcomes, such as referral to a GP, pharmacist, nurse, or digital response options like questionnaires. Participants were asked to decide on the appropriate clinician, mode of consultation (face-to-face or remote), and urgency (same day, two weeks, or routine). Additionally, a set of “CHANCE” cards, inspired by the Monopoly game, introduced unexpected scenarios (e.g., medical emergencies) to encourage discussion around managing unpredictable events and their ripple effects on workload. The simulation was conducted across five GP practices in Surrey during protected learning time (PLT), involving both clinical and administrative staff. The session was also delivered to GP trainees at the Royal Surrey County Hospital. Results: Participants completed an anonymous online feedback form, capturing their roles, prior interest in TPT, and session evaluation using a Likert scale. All respondents (100%) indicated they would recommend the session to colleagues. Feedback highlighted increased awareness of TPT and emphasised the value of multidisciplinary collaboration in improving patient flow and care prioritisation (Table 1). Discussion: The training simulation proved effective in promoting understanding of the TPT model and enhancing team-based decision-making. Bringing together diverse roles in a shared learning environment helped reinforce the collective responsibility and adaptability needed to manage modern primary care demands Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

SUMMARYDrug-resistant tuberculosis (DR-TB) causes substantial morbidity and mortality and has hindered progress toward TB elimination. This slowed progress toward the WHO End TB Strategy's targets was exacerbated by lower TB detection during the COVID-19 pandemic. To inform research and development priorities, we conducted a narrative review of global DR-TB epidemiology and strategies for DR-TB prevention, diagnostics, and treatment. Gaps remain in DR-TB diagnosis, TB drug susceptibility testing (DST), and treatment. The review also shows that DR-TB causes significant post-disease disability, particularly chronic lung disease, impacting quality of life. Newer oral regimens for multidrug-resistant TB are shorter and more effective than traditional regimens. New antibiotics under development may help overcome remaining safety and tolerability issues, while novel advanced therapeutics and precision medicine offer hope to those failing treatment. Emerging diagnostics include rapid DST for second-line drugs, but a paradigm shift is needed to ensure novel DSTs become available as new drugs are introduced. Person-centered research is urgently needed to accelerate the response to DR-TB amidst the global threat of antimicrobial resistance, yet global investment in TB prevention and care currently falls short of need. A holistic approach to interventions to improve DR-TB prevention and care is needed, encompassing all health system components and their interactions, including a One Health approach and consideration of the wider determinants of health.

Background: Hypertension (HTN) is a key modifiable risk factor for cardiovascular morbidity and mortality. Though often linked to older adults, HTN-related deaths are rising among younger individuals. Healthcare disruptions from COVID-19 likely impacted medication adherence and chronic disease management, potentially worsening hypertension outcomes. This study evaluates HTN-related mortality in U.S. adults aged 15–44 before, during, and after the pandemic. Methods: Mortality data were extracted from the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to assess age-adjusted mortality rates (AAMR) per 100,000 population for HTN-related deaths in the US from 2018-2023. AAMRs were standardized to the 2000 US standard population. Trends were examined across three periods: pre-pandemic (2018–2019), peak pandemic (2020–2021), and post-pandemic (2022–2023), stratified by sex and race. Absolute mean differences (AMD) with 95% confidence intervals (CI) were calculated, and an independent z-test was used to determine statistical significance (p<0.05). Results: Between 2018 and 2023, 83,329 HTN-related deaths occurred. AAMR rose significantly from 9.27 in the pre-pandemic to 13.15 during the peak-pandemic (AMD: 3.88; 95% CI, 3.69 to 4.07; p<0.001), followed by a decline to 12.08 post-pandemic (AMD: -1.07; 95% CI, -1.27 to -0.87; p<0.001). Males experienced a greater increase than females during the peak-pandemic (AMD: 5.13 vs. 2.49; both p<0.001), compared to the pre-pandemic. Post-pandemic, females had a significant decline (AMD: -0.64, p<0.001), whereas males’ decline was not significant (AMD: -0.24, p=0.15). All racial groups reported an increase in AAMR during the pandemic, with the highest in NH Native Hawaiians (AMD: 15.57; p<0.001) and NH American Indians (AMD: 10.34; p<0.001), compared to the pre-pandemic period. During the post-pandemic period, most racial groups showed a decline, notably NH Blacks (AMD: -3.41; p<0.001). However, AAMR continued to rise non-significantly in NH Native Hawaiians (AMD: 1.11; p=0.76) and NH multiracial individuals (AMD: 0.24; p=0.52), but these effects were not significant. Conclusion: HTN-related mortality among younger adults increased significantly during the COVID-19 pandemic, especially in males and specific racial minorities. Despite declines post-pandemic, rates remain above pre-pandemic levels, underscoring the need for targeted preventive interventions to reduce cardiovascular risk.

Introduction: Thyroid disorders are strongly associated with cardiovascular diseases (CVD) due to the wide ranging effects of thyroid hormones on the cardiovascular system. A significant number of annual deaths are attributed to the co-occurrence of these conditions. However, the extent of mortality and varying trends remain understudied. Research Question: The study aims to explore the trends and disparities in thyroid and CVD related mortality between 1999 and 2023 among U.S adults aged ≥35 years. Methods: This is a retrospective analysis of the mortality data of U.S adults aged ≥35 years from 1999 to 2023, taken from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, using ICD-10 codes for CVD and thyroid disease. Age-associated mortality rates (AAMRs) per 100,000 population were calculated and annual percentage changes (APCs) were analyzed via joinpoint regression. Outcomes were stratified by year, sex, race, region and type of thyroid disorder. Results: From 1999 to 2023, a total of 512,402 thyroid-CVD-related deaths were recorded in U.S adults ≥35 years. The overall AAMR showed a slight variation from 10.9 in 1999 to 11.2 in 2018 (APC: -0.3; 95% CI: -0.5 to -0.08), followed by a significant increase to 14.9 in 2021 (APC:12.5; 95% CI: 4.8 to 20.7) and a drop to 13.6 in 2023 (APC: -5.5; 95% CI: -11.3 to 0.69). Most of the CVD related mortalities were linked to hypothyroidism (AAMR hypothyroidism: 10.4, hyperthyroidism: 0.73, other thyroid disorders: 0.40). Women showed a consistently higher AAMR than men from 1999 (women:13.1, men:6.9) to 2023 (women:16.4, men:9.8). Regional disparities were evident (AAMR Midwest: 12.5, West: 11.9, South: 10.9, Northeast: 10.8). Nonmetropolitan counties had a higher AAMR (12.4) than metropolitan counties (9.6). Non-Hispanic (NH) White population had the highest AAMR (12.2) followed by NH American Indians (11.8), NH Black (8.5), Hispanic/Latino (8.2) and NH Asians/Pacific Islanders (5.24). Conclusion: Thyroid-CVD-related mortality among U.S adults aged ≥35 years has shown a notable rise after 2018, coinciding with the COVID19 pandemic. Most of the deaths are linked to hypothyroidism with the highest mortality burden among women, White population and ones living in Midwest and non metropolitan regions. These results warrant further research to address the variations and create targeted public health strategies for better outcomes.

Background: The COVID-19 pandemic disrupted healthcare access and delivery for vulnerable populations, including individuals with cancer. Research Question: What is the impact of the COVID-19 pandemic on cardiovascular mortality and the shifts in place of death in patients with cancer? Methodology: We used CDC WONDER data (2018–2023) to identify cancer patients with mortality due to CVD. The study period was categorized into pre-COVID (2018–2019), during COVID (2020–2021), and post-COVID (2022–2023). We extracted age-adjusted mortality rates (AAMRs) per 100,000 population, stratified by age, sex, race, ethnicity, and Census region. Deaths were categorized by location: inpatient, outpatient/emergency department, home, hospice, and nursing home/long-term care. Results: Among 183,256 deaths, the AAMR for CVD among individuals with cancer increased from 6.81 per 100,000 in the pre-COVID period to 7.48 during COVID, and remained elevated to 7.75 post-COVID. (Table 1) Home deaths increased from 35.2% (18,569 of 52,754) pre-COVID to 41.8% (24,484 of 58,556) during COVID, then to 39.7% post-COVID. In contrast, deaths in inpatient hospitals (-2.2%), outpatient/ER settings (-0.4%), and nursing homes (-3.4%) declined during the pandemic; however, hospice deaths remained relatively stable. (Table 2) Age-stratified data showed that AAMR in ≥65 adults, increased by 9.9% during the pandemic (47.56 to 52.26) and by 14.0% post-COVID (54.24). Males consistently had higher mortality than females, with AAMRs increasing by 12.9% and 14.9% respectively. AAMR increased in non-Hispanic individuals by (+14.6%) vs (+13.2%) in Hispanic. Asian individuals had the highest increase in AAMR +22.1% during COVID followed by multiple-race (+16.8%), White (+13.9%) and Black individuals (+12.75) In contrast AIAN individuals dropped to -5.2% post-COVID after an initial increase of +13.9%. By region, AAMR in South increased to +13.6% during the pandemic which further increased to +22% post-COVID, followed by the Midwest (+6.60 to +11.1%), West (+9.9% to +10.9%), and Northeast (+6.93 to +6.8%). Conclusion: Cardiovascular mortality among cancer patients rose during and after the pandemic, with disproportionate increases across demographic and regional groups. A sustained rise in home deaths suggests lasting changes in end-of-life care. These patterns underscore the need for strengthened chronic disease management and support systems for vulnerable populations during public health emergencies.

Background: Obesity has been considered a major threat to cardiovascular diseases, particularly premature cardiac arrest among adults. As obesity continues to rise in the United States (US), there is growing concern about its impact on cardiac mortality. This study aims to assess mortality trends associated with premature cardiac arrest in obese patients in the United States (US) and to identify the affected population. Methods: Data for this study were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, which offers detailed information on causes of mortality across the United States. Mortality data related to premature cardiac arrest in individuals with obesity were analyzed. Age-adjusted mortality rates (AAMRs) were estimated, and mortality trends were analyzed using JoinPoint regression to determine the annual percent change (APC). Results: From 1999 to 2023, a total of 127,874 deaths were linked to premature cardiac arrest with obesity as a contributing factor. The AAMRs increased from 11.3 in 1999 to 32.6 in 2023, showing a 2.9-fold increase in mortality. A pronounced rise was observed during the COVID-19 pandemic, with the AAMR reaching 50 and an APC of 14.9. Males experienced higher mortality rates compared to females (38.6 vs 26.9 in 2023). Among racial and ethnic groups, Hispanic or Latino individuals had the highest average AAMR, followed by non-Hispanic (NH) Black or African American individuals, NH White individuals, and lastly NH other populations. Geographically, the West among census regions had the highest AAMR and rural areas had higher mortality rates than urban areas. Conclusion: This study shows a concerning rise in obesity-associated premature cardiac arrest mortality in the United States from 1999 to 2023, with a 2.9-fold increase in age-adjusted mortality rates. Demographic and geographic disparities were seen, with men, Hispanic and non-Hispanic Black populations, and individuals in rural and western regions facing comparatively higher mortality rates. These findings emphasize the need for public health measures and preventive care.

Background: Despite advances in hyperlipidemia therapies, ideal screening and control of lipids remains a challenge. This study aims to evaluate mortality trends associated with ischemic heart disease in hyperlipidemic patients in the United States and to identify the affected population. Methods: Data for this study were taken from the CDC WONDER database, which provides comprehensive data on the leading causes of mortality across the United States. Mortality data related to ischemic heart disease in individuals with hyperlipidemia were analyzed. Age-adjusted mortality rates (AAMRs) were measured, and mortality trends were analyzed using JoinPoint regression to determine the annual percent change (APC). Results: From 1999 to 2023, a total of 778,109 deaths were associated with ischemic heart disease, with hyperlipidemia as a contributing factor. The AAMRs increased from 6.21 in 1999 to 19.97 in 2023, showing a 3.2-fold increase in mortality. A pronounced rise was observed during the COVID-19 pandemic, with the AAMR reaching 20.82 and an APC of 12.2%(95%CI:9.82 to 13.84). Males showed higher mortality rates compared to females (28.15 vs. 13.52 in 2023) with highest APC 12.66%(95%CI:10.51 to 14.45) in males from 2018-2021 .Among racial and ethnic groups, Non-Hispanic (NH) White individuals showed the highest AAMR of 21.99 and highest APC of 12.40%(95%CI:10.31 to 14.10),followed by NH American Indian or Alaska Native individuals, NH African American individuals, Hispanic individuals, and lastly NH Asian or Pacific Islander individuals. Geographically, the Midwest among census regions had the highest AAMR 21.61, and rural areas had higher mortality rates compared to urban areas with highest AAMR of 24.08 and APC of 14.30%(95%CI:10.01 to 17.13). Conclusion: This study reveals an alarming 3.2-fold increase in hyperlipidemia-related ischemic heart disease mortality in the United States from 1999 to 2023. Significant disparities were observed. These findings highlight the urgent need to address clinical inertia in treating hyperlipidemia.

Background: Patients presenting to the emergency department (ED) with chest pain but no myocardial infarction are frequently admitted for monitoring or testing, though the value of these admissions has been questioned. During the COVID-19 pandemic, hospital crowding altered admission practices leading to more of these patients being discharged from the ED. Nonetheless, the impact on patients’ outcomes remains unclear. Hypothesis: Increased ED discharges of chest pain patients during COVID did not lead to worse outcomes. Methods: We used OneFlorida+ dataset, which contains data on over 19 million patients from Florida, Georgia and Alabama, to identify patients with chest pain without myocardial infarction who presented to the ED between Jan 1, 2019 and until Dec 31, 2022 and compared the outcomes of patients admitted or observed vs discharged. We evaluated the impact of the COVID-19 pandemic (2020–2022) on management patterns and outcomes, compared to the pre-COVID period in 2019. The primary outcome was a composite of 30-day death or myocardial infarction. Results: A total of 82,717 patients met our inclusion criteria. The average age of patients was 46.3 years and 56.7% were women. The admission/ observation rate was significantly lower during the COVID era (9.3% vs 18.4%, OR: 0.46; 95% CI: 0.44 – 0.47). Using univariate analysis, the outcome of death or myocardial infarction at 30-days did not increase during COVID (0.7% pre-COVID vs 0.6% during COVID) and death at 30-days was the same in both periods (0.1%). Among discharged patients, the outcome of death or myocardial at 30-days was unchanged between pre-COVID vs COVID era (0.3%). On multivariate analysis including interaction based on pre-COVID vs during COVID, the significant reduction in admissions during COVID did not have significant impact on our primary outcome (-0.08% predicted risk pre COVID vs 0.04% predicted risk during COVID). On Interrupted time series analysis, The onset of COVID was not associated with an immediate change in the primary outcome (estimate= 0.00; p = 0.82), and the rate primary outcome in the post-COVID period remained unchanged (estimate= 0.00; p = 0.40). Conclusion: Patients presenting to the ED with chest pain but without myocardial infarction have a very low rate of adverse events. The reduction in admissions during the COVID era was not associated with worse outcomes, highlighting a significant opportunity to safely increase discharge rates.

Purpose In this research, we present the results of a systematic literature review (SLR) on workplace well-being in relation to performance, whether individual or organizational. Design/methodology/approach To achieve our research objective, we followed a rigorous bibliometric approach using several scientific databases. A total of 250 articles were identified for the period from 2000 to 2024, but only 67 were deemed to meet our inclusion criteria. For data processing, we used: Nvivo, VOSviewer and Excel. Findings This SLR confirms a significant correlation between well-being and performance across all contexts. Furthermore, interest in the topic has increased since the COVID-19 pandemic. The conceptual dimensions of WB and performance have not yet reached a consensus among researchers, which opens a perspective for identifying a universal model of these concepts. From a practical standpoint, we demonstrated that workplace well-being promotes both individual and organizational performance. We also identified several human resource (HR)-related actions that can simultaneously enhance well-being and performance. Research limitations/implications This study has three limitations. First, our research strategy was constrained by the inclusion and exclusion criteria we selected. Second, this review is narrative, and no meta-analysis was conducted. Third, SLR doesn’t eliminate the limitations inherent in individual studies. We will further elaborate on these limitations in the conclusion section. Practical implications From a practical standpoint, we demonstrated that workplace well-being promotes both individual and organizational performance. We also identified several HR-related actions that can simultaneously enhance well-being and performance. Originality/value This paper brought together various aspects of well-being at work and performance and presented various findings from previous studies on the link between them. As a result, we sought to highlight the various variables and factors that could affect well-being and its relationship with performance.

Background: After decades of progress, cardiovascular (CV) mortality among younger US adults is rising, but little is known about how these patterns vary by income. Objective: To evaluate trends in cardiovascular mortality among working-age US adults by county-level income from 1999-2023. Methods: We used American Community Survey data to assign US counties to quintiles by median household income (Q1: lowest; Q5: highest). Age-adjusted CV mortality rates (AAMRs) per 100,000 population in each quintile were obtained from CDC WONDER for adults age 25-64 using ICD codes I.00-99 as the primary cause of death. Annual percent changes (APCs) were determined for 1999-2009 and 2009-2019 using inverse variance-weighted log-linear regression models. Differential trends were assessed using interaction terms with Q1 and Q5 as reference groups. Given the short time period around the COVID-19 pandemic, absolute changes in AAMRs between 2019 and 2023 were calculated and compared using two-sample z-tests. Results: From 1999-2023, cardiovascular mortality rates were consistently higher in lower-income counties ( Figure ). Between 1999-2009, CV mortality declined in all quintiles, but higher-income counties experienced a greater decline than lower-income counties (Q5 APC -2.8% [-2.9, -2.7] vs. Q1 APC -1.3% ([-1.5,-1.2]; p <0.0001). From 2009-2019, trends reversed and mortality increased for those in the lower income counties (Q1 APC +0.8% [0.5-1.1]; Q2 APC +0.9% [0.7-1.1];), whereas mortality continued to decline in the highest income counties (Q5: APC -0.5% [-0.7, -0.3]). From 2019-2023, CV mortality increased across all income quintiles, but increases were greatest in the lowest-income county (ΔAAMR +9.5 [6.0-13.0]) compared to all other income groups ( p <0.05) (Table) . Conclusions: From 1999-2023, income-based disparities in cardiovascular (CV) mortality widened substantially among working-age U.S. adults. Although CV mortality declined across all income quintiles between 1999 and 2009, gains were more pronounced in higher-income counties. This progress stalled and reversed in 2009, with mortality rates rising among adults in the lowest-income counties while continuing to improve in the highest-income counties. From 2019 to 2023, CV mortality increased across all income groups, but the steepest rises occurred in the lowest-income quintiles. These findings highlight the urgent need to address rising CV mortality that is disproportionately impacting low-income, working-age adults.