News Scan for Aug 24, 2022

News brief

Life expectancy fell amid COVID, especially for Hispanic and Black males

In 2020, amid the COVID-19 pandemic, life expectancy in the United States fell by 4.5 and 3.6 years for Hispanic and Black males, respectively, while declining 1.5 years for their White counterparts, finds a study published yesterday in PNAS.

University of Oxford researchers studied national data to identify trends in lifespan inequality, average years of life lost, and the role of causes of death and age in racial life-expectancy disparities from 2010 to 2020.

While declines in life expectancy were observed around the world in 2020, the United States saw bigger drops than many other high-income countries—particularly among racial minority populations, the authors noted. Among all Americans, life expectancy fell by 1.7 years for females and 2.1 years for males, mostly owing to COVID-19 deaths.

The pandemic nearly eliminated the Hispanic life-expectancy advantage over the White population seen from 2010 to 2019 while dramatically deepening the already large divide between Black and White life expectancy.

Average years of life lost rose substantially for all groups but Hispanic males were hardest hit (4.1 years, 25% due to COVID-19), followed by Black males (3.5 years, 10% attributed to COVID-19).

Lifespan inequality, or variation in length of life, rose slightly for Hispanic and White populations but fell for Black people, which the researchers said reflected the younger age pattern of COVID-19 deaths in Hispanic people.

The decreases in life expectancy for Hispanic Americans were mostly driven by COVID-19 deaths, but cardiovascular diseases and "deaths of despair" were the most common contributors in their Black peers.

The reasons behind the life-expectancy disparities could include social inequality, crowded housing, low access to preventive information, and the disproportionate number of racial minorities who had to continue working outside the home in jobs that put them at higher risk for infection.

"Future work should continue to examine the direct impact of COVID-19 but also the impact of pandemic social and economic disruptions on racial/ethnic differences in health," the authors concluded.
Aug 23 PNAS study


Age, co-morbidities linked to COVID-19 mortality regardless of variant type

A new study in BMC Infectious Diseases shows that increased age and multiple co-morbidities were the most strongly linked to COVOD-19 mortality, regardless of which variant caused infection.

The study included 9,528 COVID-positive hospitalized East Coast US patients, of whom 7,112 (75%) were hospitalized during the pre-Delta period (March 2020–June 2021), 860 (9%) during the Delta period (July–November 2021), and 1,556 (16%) during the Omicron period (December 2021–February 2022).

According to the authors, the COVID-positive inpatients were the oldest during the Omicron period and had the highest comorbidity rates, "Despite this, COVID disease severity as measured by the oxygen saturation at time of admission and the presence of COVID pneumonia was the lowest during the Omicron period," they noted.

This is likely associated with a high proportion of vaccinated patients (61%) during the Omicron surge, they said.

Hospital stays were longest during the Delta phase (mean of 9.7 days), compared with the pre-Delta phase (9.2), and Omicron phase (7.1). The rate of intensive care unit use decreased from 29%, to 21%, to 15% in each phase, respectively, and the rate of mechanical ventilation use changed from 12%, to 13%, to 8%, respectively.

Inpatient mortality was highest during the pre-Delta phase (11.1%), and not significantly different in the Delta and Omicron phases (9.4% and 7.8%). Outcomes for those over 75 years were worse during all variants.

"These results suggest that adverse inpatient outcomes from COVID-19 are primarily carried by elderly people with a high number of comorbid medical conditions even in the era of vaccination and antiviral regimens," the authors concluded.
Aug 22 BMC Infect Dis


Global survey highlights factors in non-prescription antibiotic dispensing

A global survey of pharmacists found that, despite good knowledge about antibiotics and antimicrobial resistance (AMR), nearly two-thirds had dispensed antibiotics without a prescription at least once, and those who did were much likely to come from lower-income countries, researchers reported today in JAC-Antimicrobial Resistance.

The survey, disseminated by the Commonwealth Pharmacists' Association during the World Health Organization's World Antibiotic Awareness Week, asked respondents about antibiotic supply practices, knowledge, and beliefs about AMR. A total of 546 pharmacists from 59 countries responded, with Africa (41%), Asia (26%) and Oceania (22%) most represented. Forty-four percent were from low-income countries, and most practiced in nations with antibiotic prescribing regulations (94%), and had 10 or more years of experience (51%).

Participants reported supplying a mean of 46 antibiotic prescriptions per week (standard deviation, 81), of which 73% ± 35% were given in response to a prescription. Overall, 227 respondents (60.2%) dispensed antibiotics at least once without a prescription. Respondents scored well in the knowledge section of the survey, with mean knowledge scores of 9.6 ± 1.3 (out of 12), and held positive beliefs about the importance of addressing AMR, with a mean score of 3.5 ± 0.6 (out of 5).

Further analysis found that the better knowledge that respondents had about antibiotics, the fewer misperceptions they had relating to AMR. Also, having more positive beliefs about addressing AMR was associated with lower odds of supplying antibiotics without a prescription (adjusted odds ratio [aOR], 0.91; 95% confidence interval [CI], 0.86 to 0.95). But the odds of supplying antibiotics without a prescription were 7.4 times higher among respondents from lower-income countries (aOR, 7.4; 95% CI, 4.16 to 13.24), and the respondents from lower-income countries had lower scores for beliefs about AMR compared with respondents from higher-income countries.

"This finding has important implications when considering the development of global health policies relating to AMR as this could have implications for public access to necessary antimicrobials even though stricter regulation could reduce unnecessary antimicrobial use," the study authors wrote. "AMS [antimicrobial stewardship] initiatives should consider a pharmacist's individual beliefs about AMR but also the country context in which pharmacists practise."
Aug 24 JAC-Antimicrob Resist study

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