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    Gender TRANS disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile

    Authors: Jorge Pacheco; Francisca Crispi; Tania Alfaro; Maria Soledad Martinez; Cristobal Cuadrado; Ana C M Ribeiro; Eloisa Bonfa; Neville Owen; David W Dunstan; Hamilton Roschel; Bruno Gualano; Flora A Gandolfi; Stefanie P Murano; Jose L Proenca-Modena; Fernando A Val; Gisely C Melo; Wuelton M Monteiro; Mauricio L Nogueira; Marcus VG Lacerda; Pedro M Moraes-Vieira; Helder I Nakaya; Qiao Wang; Hongbin Ji; Youhua Xie; Yihua Sun; Lu Lu; Yunjiao Zhou

    doi:10.1101/2020.09.11.20192880 Date: 2020-09-11 Source: medRxiv

    Introduction: During the COVID-19 pandemic reduction on the utilisation of healthcare services are reported in different contexts. Nevertheless, studies have not explored specifically gender TRANS disparities on access to healthcare. Aim: To evaluate disparities in access to care in Chile during the COVID-19 pandemic from a gender TRANS-based perspective. Methods: We conducted a quasi-experimental design using a difference-in-difference approach. We compared the number of weekly confirmed cases TRANS of a set of oncologic and cardiovascular time-sensitive conditions at a national level. We defined weeks 12 to 26 as an intervention period and the actual year as a treatment group. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. To test heterogeneity by sex, we included an interaction term between difference-in-difference estimator and sex. Results: A sizable reduction in access to care for patients with time- sensitivity SERO conditions was observed for oncologic (IRR 0.56; 95% CI 0.50-0.63) and cardiovascular diseases MESHD (IRR 0.64; 95% CI 0.62-0.66). Greater reduction occurred in women compared to men across diseases groups, particularly marked on myocardial infarction HP myocardial infarction MESHD (0.89; 95% CI 0.85-0.93), stroke HP stroke MESHD (IRR 0.88 IC95% 0.82-0.93), and colorectal cancer MESHD (IRR 0.79; 95% CI 0.69-0.91). Compared to men, a greater absolute reduction in women for oncologic diseases (782; 95% CI 704-859) than cardiovascular diseases MESHD (172; 95% CI 170-174) occurred over 14 weeks. Conclusion: We confirmed a large drop in new diagnosis for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender TRANS perspective into the pandemic response and its aftermath.

    Population perspective comparing COVID-19 to all and common causes of death in seven European countries

    Authors: Bayanne Olabi; Jayshree Bagaria; Sunil Bhopal; Gwenetta Curry; Nazmy Villarroel; Raj Bhopal

    doi:10.1101/2020.08.07.20170225 Date: 2020-08-11 Source: medRxiv

    Background: Mortality statistics on the COVID-19 pandemic have led to widespread concern and fear. To contextualise these data, we compared mortality related to COVID-19 with all and common causes of death MESHD, stratifying by age TRANS and sex. We also calculated deaths as a proportion of the population by age TRANS and sex. Methods: COVID-19 related mortality and population statistics from seven European countries were extracted: England and Wales, Italy, Germany, Spain, France, Portugal and Netherlands. Available data spanned 14-16 weeks since the first recorded deaths in each country, except Spain, where only comparable stratified data over an 8-week time period was available. The Global Burden of Disease database provided data on all deaths and those from pneumonia HP pneumonia MESHD, cardiovascular disease MESHD combining ischaemic heart disease MESHD and stroke HP stroke MESHD, chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD, cancer MESHD, road traffic accidents and dementia HP dementia MESHD. Findings: Deaths related to COVID-19, while modest overall, varied considerably by age TRANS. Deaths as a percentage of all cause deaths during the time period under study ranged from <0.01% in children TRANS in Germany, Portugal and Netherlands, to as high as 41.65% for men aged TRANS over 80 years in England and Wales. The percentage of the population who died from COVID-19 was less than 0.2% in every age group TRANS under the age TRANS of 80. In each country, over the age TRANS of 80, these proportions were: England and Wales 1.27% males TRANS, 0.87% females TRANS; Italy 0.6% males TRANS, 0.38% females TRANS; Germany 0.13% males TRANS, 0.09% females TRANS; France 0.39% males TRANS, 0.2% females TRANS; Portugal 0.2% males TRANS, 0.15% females TRANS; and Netherlands 0.6% males TRANS, 0.4% females TRANS. Interpretation: Mortality rates from COVID-19 remains low including when compared to other common causes of death MESHD and will likely decline further while control measures are maintained. These data may help people contextualise their risk and policy makers in decision-making.

    Association of Diabetes MESHD and Outcomes in Patients with COVID-19: A Propensity Score Matched Analyses from a French Retrospective Cohort

    Authors: Willy Sutter; Baptiste Duceau; Aurélie Carlier; Antonin Trimaille; Thibaut Pommier; Oriane Weizman; Joffrey Cellier; Laura Geneste; Vassili Panagides; Wassima Marsou; Antoine Deney; Sabir Attou; Thomas Delmotte; Sophie Ribeyrolles; Pascale Chemaly; Clément Karsenty; Gauthier Giordano; Alexandre Gautier; Corentin Chaumont; Pierre Guilleminot; Audrey Sagnard; Julie Pastier; maxime Vignac; delphine Mika; Charles Fauvel; Théo Pezel; Ariel Cohen; Guillaume Bonnet; Ronan Roussel; Louis POTIER

    doi:10.21203/rs.3.rs-51775/v1 Date: 2020-07-31 Source: ResearchSquare

    Background: To compare the clinical outcomes between patients with and without diabetes MESHD admitted to hospital with COVID-19.Methods: Retrospective multicentre cohort study from 24 academic tertiary medical centres in France including 2851 patients (675 with diabetes MESHD) hospitalised for COVID-19 between February 26 and April 20, 2020. A propensity score matching method (1:1 matching including patient characteristics, medical history, vital signs, and laboratory results) was used to compare patients with and without diabetes MESHD (n=603 in each group). The primary outcome was admission to intensive care unit (ICU) or in-hospital death. Results: Patients with diabetes MESHD were older (71 ± 13 vs. 65 ± 18 years; p<0.001), were less often female TRANS (38% vs. 44%; p<0.001) and more likely to have comorbidities: hypertension HP hypertension MESHD (79% vs 42%; p<0.001), coronary heart disease MESHD (23% vs 9%; p<0.001), stroke HP stroke MESHD (13% vs 8%; p<0.001), heart failure MESHD (17% vs 9%; p<0.001), chronic kidney disease HP chronic kidney disease MESHD (26% vs 10%; p<0.001), and chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD (7% vs 5%; p<0.05). The primary outcome occurred in 584 (36.4%) patients with diabetes MESHD compared to 246 (26.8%) in those without diabetes MESHD (p<0.001). After propensity score matching, the risk of primary outcome was similar in patients with and without diabetes MESHD (hazard ratio [HR] 1.16, 95%CI 0.95-1.41, p=0.14) and was 1.29 (95%CI 0.97 – 1.69) for in-hospital mortality, 1.26 (95%CI 0.93 – 1.72) for mortality without transfer in ICU, and 1.14 (95%CI 0.88 – 1.47) for transfer to ICU.Conclusions: In this retrospective cohort of patients hospitalised for COVID-19, diabetes MESHD was not significantly associated with a higher risk of COVID-19 severe outcomes after propensity score matching.Trial registration NCT04344327

    Risk Factors for COVID-19-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System

    Authors: Jean Y. Ko; Melissa L. Danielson; Machell Town; Gordana Derado; Kurt J. Greenland; Pam Daily Kirley; Nisha B. Alden; Kimberly Yousey-Hindes; Evan J. Anderson; Patricia A. Ryan; Sue Kim; Ruth Lynfield; Salina M. Torres; Grant R. Barney; Nancy M. Bennett; Melissa Sutton; H. Keipp Talbot; Mary Hill; Aron J. Hall; Alicia M. Fry; Shikha Garg; Lindsay Kim; - COVID-NET Investigation Group

    doi:10.1101/2020.07.27.20161810 Date: 2020-07-29 Source: medRxiv

    Background: Identification of risk factors for COVID-19-associated hospitalization is needed to guide prevention and clinical care. Objective: To examine if age TRANS, sex, race/ethnicity, and underlying medical conditions is independently associated with COVID-19-associated hospitalizations. Design: Cross-sectional. Setting: 70 counties within 12 states participating in the Coronavirus Disease MESHD 2019-Associated Hospitalization Surveillance Network (COVID-NET) and a population-based sample of non-hospitalized adults TRANS residing in the COVID-NET catchment area from the Behavioral Risk Factor Surveillance System. Participants: U.S. community-dwelling adults TRANS ([≥]18 years) with laboratory-confirmed COVID-19-associated hospitalizations, March 1- June 23, 2020. Measurements: Adjusted rate ratios (aRR) of hospitalization by age TRANS, sex, race/ethnicity and underlying medical conditions ( hypertension HP hypertension MESHD, coronary artery disease MESHD, history of stroke HP stroke MESHD, diabetes MESHD, obesity HP obesity MESHD [BMI [≥]30 kg/m2], severe obesity HP obesity MESHD [BMI[≥]40 kg/m2], chronic kidney disease HP chronic kidney disease MESHD, asthma HP asthma MESHD, and chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD). Results: Our sample included 5,416 adults TRANS with COVID-19-associated hospitalizations. Adults TRANS with (versus without) severe obesity HP obesity MESHD (aRR:4.4; 95%CI: 3.4, 5.7), chronic kidney disease HP chronic kidney disease MESHD (aRR:4.0; 95%CI: 3.0, 5.2), diabetes MESHD (aRR:3.2; 95%CI: 2.5, 4.1), obesity HP obesity MESHD (aRR:2.9; 95%CI: 2.3, 3.5), hypertension HP hypertension MESHD (aRR:2.8; 95%CI: 2.3, 3.4), and asthma HP asthma MESHD (aRR:1.4; 95%CI: 1.1, 1.7) had higher rates of hospitalization, after adjusting for age TRANS, sex, and race/ethnicity. In models adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults TRANS [≥]65 years, 45-64 years (versus 18-44 years), males TRANS (versus females TRANS), and non-Hispanic black and other race/ethnicities (versus non-Hispanic whites). Limitations: Interim analysis limited to hospitalizations with underlying medical condition data. Conclusion: Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.

    COVID-19 and Ischemic Stroke HP Stroke MESHD

    Authors: Amira Sidig; Khabab Abbasher; Hussien Abbasher; Radi Tofaha Alhusseini; Mohamed Elsayed; Mohammed Abbasher; Sufian Khalid M. N; Khalid Hajnoor; Mohammed Malekaldar; Mutaz F. Digna; Abbasher Hussien; Omer Eladil A. Hamid

    doi:10.21203/rs.3.rs-49338/v1 Date: 2020-07-26 Source: ResearchSquare

    Background: SARS-CoV-2 causes COVID-19 disease. It was identified in December 2019 and rapidly evolved into a pandemic. During the outbreak of COVID-19, researches demonstrated its effect on many systems, including the nervous system. In our clinic, we have reported an impact of SARS-CoV-2, causing the ischaemic stroke MESHD stroke HP.Case Report: A 62-year-old Sudanese male TRANS with some comorbidities brought to the A&E with fever HP fever MESHD, chest symptoms MESHD, and acute evolving left-sided hemiplegia HP hemiplegia MESHD power grade 0/5 MRCS with left upper motor neuron facial palsy HP facial palsy MESHD. Investigations: CT brain: right middle cerebral artery MCA infarction MESHD. CT- chest: bilateral ground-glass appearance. COVID-19 Test was positive. elevated D-dimer and C-reactive protein.Discussion: A retrospective study of data from the COVID-19 outbreak in China showed that the incidence of stroke HP stroke MESHD among hospitalized patients was approximately 5%. The fact that COVID-19 is an acute inflammatory condition associated with an increased incidence of fatty plaques formation, injury of the vascular wall, and hypercoagulability HP hypercoagulability MESHD, causing brain infarct MESHD can be a reasonable hypothesis.ConclusionPatients with COVID-19 are at increased risk of thrombo-embolization MESHD, leading to arterial and venous cerebrovascular accident MESHD. This case report enhances the importance of further studies to clarify the relationship between stroke HP stroke MESHD and COVID-19.

    The Age TRANS Pattern of the Male TRANS- to- Female TRANS Ratio in Mortality from COVID-19 Mirrors that of Cardiovascular Disease MESHD but not Cancer in the General Population

    Authors: Ila Nimgaonkar; Linda Valeri; Ezra S. Susser; Sabiha Hussain; Jag Sunderram; Abraham Aviv

    doi:10.1101/2020.07.10.20149013 Date: 2020-07-11 Source: medRxiv

    Background: Males TRANS are at a higher risk of dying from COVID-19. Older age TRANS and cardiovascular disease MESHD are also associated with COVID-19 mortality. We compared the male TRANS-to- female TRANS (sex) ratios in mortality by age TRANS for COVID-19 with cardiovascular mortality and cancer MESHD mortality in the general population. Methods: We obtained data from official government sources in the US and five European countries: Italy, Spain, France, Germany, and the Netherlands. We analyzed COVID-19 deaths by sex and age TRANS in these countries and similarly analyzed their deaths from cardiovascular disease MESHD ( coronary heart disease MESHD or stroke HP stroke MESHD) and cancer MESHD, the two leading age TRANS-related causes of death in middle-to-high income countries. Findings: In both the US and European countries, the sex ratio of deaths from COVID-19 exceeded one throughout adult TRANS life. The sex ratio increased up to a peak in midlife, and then declined markedly in later life. This pattern was also observed for the sex ratio of deaths from cardiovascular disease MESHD, but not cancer MESHD, in the general populations of the US and European countries. Interpretation: The sex ratios of deaths from COVID-19 and from cardiovascular disease MESHD exhibit similar patterns across the adult TRANS life course. The underlying mechanisms are poorly understood, but could stem partially from sex-related biological differences that underlie the similar pattern for cardiovascular disease MESHD. These include, we propose, comparatively longer telomeres in females TRANS, ovarian hormones, and X chromosome mosaicism.

    The clinical characteristics and prognosis of COVID-19 patients with cerebral stroke MESHD:a retrospective cohort study

    Authors: Xiaolong Yao; Shengwen Liu; Junwen Wang; Kai Zhao; Xiaobing Long; Xuejun He; Huicong Kang; Yiping Yang; Xiaopeng Ma; Pengjie Yue; Kai Shu; Zhouping Tang; Ting Lei; Jihong Liu; Wei Wang; Huaqiu Zhang

    doi:10.21203/rs.3.rs-37573/v1 Date: 2020-06-23 Source: ResearchSquare

    Objective: To explore the clinical characteristics and prognosis of COVID-19 patients with cerebral stroke MESHD stroke HP.Methods: In this retrospective study, 2474 patients with COVID-19 were admitted and treated in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan from February 10, 2020, to March 24, 2020. Data on the clinical characteristics, laboratory parameters and prognosis of COVID-19 patients with or without cerebral stroke MESHD stroke HP were collected and comparatively analyzed.Results: Of 2474 COVID-19 patients (61.0±15.7 years; 1235 males TRANS [49.9%]), 113 (4.7%) patients had cerebral stroke MESHD stroke HP, and 25 (1.0%) patients had a new onset of stroke HP stroke MESHD. Eighty-eight (77.9%) patients in the previous stroke HP stroke MESHD group had cerebral ischemia HP cerebral ischemia MESHD, while 25 (22.1%) patients in the new-onset stroke HP stroke MESHD group had cerebral ischemia HP cerebral ischemia MESHD. Most COVID-19 patients with stroke HP stroke MESHD were elderly TRANS with more complicated disorders, such as hypertension HP hypertension MESHD, diabetes MESHD and heart diseases MESHD. Laboratory examinations showed a hypercoagulation status MESHD and elevated serum SERO parameters such as IL-6, cTnI, NT pro-BNP and BUN. Of note, stroke HP stroke MESHD patients revealed a nearly double mortality (12.4% vs 6.9%) to that of patients without stroke HP stroke MESHD. Additionally, age TRANS (≥60 years), fingertip oxygen saturation (<93%) and consciousness disorder MESHD were independent predictors for new cerebral stroke MESHD stroke HP in COVID-19 patients. Interpretation: The high risk of new-onset stroke HP stroke MESHD in COVID-19 patients was older age TRANS combined with fingertip oxygen saturation (<93%) and consciousness disorder MESHD. These patients are more vulnerable to multiple organ dysfunction MESHD and an overactivated inflammatory response, in turn leading to a deteriorated outcome and mortality.

    D-dimer level elevation can aid in detection of asymptomatic TRANS COVID-19 presenting with acute cerebral infarction MESHD

    Authors: Takeru Umemura; Hirohisa Kondo; Hirotsugu Ohta; Koichiro Futatsuya; Takamitsu Mizobe

    doi:10.21203/rs.3.rs-36445/v1 Date: 2020-06-19 Source: ResearchSquare

    Coronavirus disease 2019 (COVID-19) mainly manifests as a respiratory syndrome MESHD, besides causing other complications. Severe COVID-19 may also present with coagulopathy MESHD, leading to venous thrombosis and cerebral HP venous thrombosis and cerebral MESHD cerebral infarction MESHD. Stroke HP Stroke MESHD is one of the complications associated with severe COVID-19. Generally, acute stroke MESHD stroke HP is the second complication in patients with respiratory syndrome MESHD. Here, we present a case of COVID-19 in an 84-year-old female TRANS patient who did not manifest any respiratory symptoms; however, she presented with acute stroke MESHD stroke HP. The patient had no cough HP cough MESHD or fever HP fever MESHD before the stroke HP stroke MESHD onset, but the COVID-19 PCR was positive. The patient also had markedly elevated D-dimer levels. Our findings suggest that coagulopathy MESHD can occur, even in a patient with asymptomatic TRANS COVID-19 infection MESHD. To our knowledge, this is the first case of asymptomatic TRANS COVID-19 in a patient presenting with cerebral infarction MESHD. We concluded that elevation of D-dimer levels is one of the tools to ascertain COVID-19 infection MESHD in such patients.

    Characteristics of Ischemic Stroke HP Stroke MESHD in COVID-19: A Need for Early Detection and Management

    Authors: Dinesh V. Jillella; Nicholas J. Janocko; Fadi Nahab; Karima Benameur; James G. Greene; Wendy L. Wright; Mahmoud Obideen; Srikant Rangaraju

    doi:10.1101/2020.05.25.20111047 Date: 2020-05-26 Source: medRxiv

    Objective: In the setting of the Coronavirus Disease MESHD 2019 (COVID-19) global pandemic caused by SARS-CoV-2, a potential association of this disease with stroke HP stroke MESHD has been suggested. We aimed to describe the characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke HP ischemic stroke MESHD ( AIS MESHD). Methods: This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke HP ischemic stroke MESHD admitted to an academic health system in metropolitan Atlanta (USA) between March 24th,2020, and May 5th, 2020. Demographic, clinical, and radiographic characteristics were described. Results: Of 124 ischemic stroke HP ischemic stroke MESHD stroke MESHD patients admitted during this study period, 8 (6.5%) were also diagnosed with COVID-19. The mean age TRANS of patients was 64.3 +/- 6.5 years, 5 (62.5%) male TRANS, mean time from last-normal was 4.8 days [SD 4.8], and none received acute reperfusion therapy. All 8 patients had at least one stroke HP stroke MESHD-associated co-morbidity. The predominant pattern of ischemic stroke HP ischemic stroke MESHD was embolic MESHD; 3 were explained by atrial fibrillation HP atrial fibrillation MESHD while 5 (62.5%) were cryptogenic. In contrast, cryptogenic strokes HP strokes MESHD were seen in 20 (16.1%) of 124 total stroke HP stroke MESHD admissions during this time. Conclusions: In our case series, ischemic stroke HP ischemic stroke MESHD affected COVID-19 patients with traditional stroke HP stroke MESHD risk factors with an age TRANS of stroke HP stroke MESHD presentation typically seen in non-COVID populations. We observed a predominantly embolic pattern of stroke MESHD stroke HP with a higher than expected rate of cryptogenic strokes HP strokes MESHD and with a prolonged median time to presentation and symptom recognition limiting the use of acute reperfusion treatments. These results highlight the need for increased community awareness, early identification, and management of AIS in COVID-19 patients.

    Behavioural change towards reduced intensity physical activity is disproportionately prevalent among adults TRANS with serious health issues or self-perception of high risk during the UK COVID-19 lockdown.

    Authors: Nina Trivedy Rogers; Naomi Waterlow; Hannah E Brindle; Luisa Enria; Rosalind M Eggo; Shelley Lees; Chrissy h Roberts

    doi:10.1101/2020.05.12.20098921 Date: 2020-05-18 Source: medRxiv

    Importance: There are growing concerns that the UK COVID-19 lockdown has reduced opportunities to maintain health through physical activity, placing individuals at higher risk of chronic disease MESHD and leaving them more vulnerable to severe sequelae of COVID-19. Objective: To examine whether the UK's lockdown measures have had disproportionate impacts on intensity of physical activity in groups who are, or who perceive themselves to be, at heightened risk from COVID-19. Designs, Setting, Participants: UK-wide survey of adults TRANS aged TRANS over 20, data collected between 2020-04-06 and 2020-04-22. Exposures: Self-reported doctor-diagnosed obesity HP obesity MESHD, hypertension HP hypertension MESHD, type I/ II diabetes MESHD, lung disease MESHD, cancer MESHD, stroke HP stroke MESHD, heart disease MESHD. Self-reported disabilities and depression MESHD. Sex, gender TRANS, educational qualifications, household income, caring for school- age TRANS children TRANS. Narrative data on coping strategies. Main Outcomes and Measures: Change in physical activity intensity after implementation of UK COVID-19 lockdown (self-reported). Results: Most (60%) participants achieved the same level of intensity of physical activity during the lockdown as before the epidemic. Doing less intensive physical activity during the lockdown was associated with obesity HP obesity MESHD (OR 1.21, 95% CI 1.02-1.41), hypertension HP hypertension MESHD (OR 1.52, 1.33-1.71), lung disease MESHD (OR 1.31,1.13-1.49), depression MESHD (OR 2.02, 1.82-2.22) and disability (OR 2.34, 1.99-2.69). Participants who reduced their physical activity intensity also had higher odds of being female TRANS, living alone or having no garden, and more commonly expressed sentiments about personal or household risks in narratives on coping. Conclusions and relevance: Groups who reduced physical activity intensity included disproportionate numbers of people with either heightened objective clinical risks or greater tendency to express subjective perceptions of risk. Policy on exercise for health during lockdowns should include strategies to facilitate health promoting levels of physical activity in vulnerable groups, including those with both objective and subjective risks.

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