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Can pre-existing medical conditions explain occupational differences in COVID-19 disease severity? An analysis of 3.17 million people insured in Germany
OBJECTIVE: Occupational differences in COVID-19 are well documented, but the empirical evidence on potential reasons for these differences remains limited. Possible reasons include pre-existing health conditions. This study investigated occupational differences in COVID-19 disease severity and whether they can be attributed to pre-existing health conditions. METHODS: Our study used German health insurance data covering 3.17 million insured individuals (age 18–67 years), with details on COVID-19-related hospitalization and mortality in 2020 and 2021, information on occupation (regrouped into four classifications) and pre-existing health conditions (divided into seven disease groups). In addition to descriptive statistics, we estimated multivariable Cox regression models with varying sets of adjustments. RESULTS: We found clear occupational differences in COVID-19 hospitalization and mortality, with the highest risks for the production sector (especially manufacturing), commercial services (especially cleaning) and for low-skilled occupations. These findings persisted after adjusting for age, sex, and region, and also after mutual adjustment for other occupational classifications. We also found some evidence that the association between occupation and disease severity was partly explained by pre-existing conditions, especially in the case of low skill levels. CONCLUSIONS: Our findings provide support for occupational differences in COVID-19, where the occupational classifications under study were independently related to risk differences (eg, skill-level and job sector). Furthermore, we provide empirical evidence that differences by occupational skill levels are partly due to pre-existing conditions. This finding suggests that occupational inequalities in health increased during the pandemic, with those with poorer health who worked in disadvantaged occupations also being more likely to experience severe COVID-19 outcomes.
Journal Article
Extreme intelligence : development, predicaments, implications
\"In this ambitious and highly original book, Sonja Falck explores the idea that a firm correlation has been demonstrated between higher intelligence and various successful life outcomes and achievements, alongside the contradictory documentation of extremely high intelligence being associated with various poor outcomes. Drawing on the author's own research interviews with the highly gifted, the book argues that understanding the dynamics of how extreme intelligence is cultivated, or hampered, interpersonally can facilitate better outcomes. It will be essential reading for anyone supporting or working with the highly gifted, as well as those researching the field of intelligence\"-- Provided by publisher.
Book
Psychotic experiences and general medical conditions: a cross-national analysis based on 28 002 respondents from 16 countries in the WHO World Mental Health Surveys
Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.
In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.
After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1-1.5] to 1.9 (95% CI 1.4-2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2-1.9) to 1.7 (95% CI 1.2-2.4).
PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.
Journal Article
Substance Use and Associated Health Conditions throughout the Lifespan
A life stage perspective is necessary for development of age-appropriate strategies to address substance use disorders (SUDs) and related health conditions in order to produce better overall health and well-being. The current review evaluated the literature across three major life stages: adolescence, adulthood, and older adulthood.
Findings: 1) Substance use is often initiated in adolescence, but it is during adulthood that prevalence rates for SUDs peak; and while substance involvement is less common among older adults, the risk for health complications associated with use increases. 2) Alcohol, tobacco, marijuana, and, increasingly, prescription medications, are the most commonly misused substances across age groups; however, the use pattern of these and other drugs and the salient impact vary depending on life stage. 3) In terms of health outcomes, all ages are at risk for overdose, accidental injury, and attempted suicide. Adolescents are more likely to be in vehicular accidents while older adults are at greater risk for damaging falls. Adulthood has the highest rates of associated medical conditions (e.g., cancer, sexually transmitted disease, heart disease) and mental health conditions (e.g., bipolar disorder, anxiety disorders, antisocial personality disorder).
Conclusion: Prolonged heavy use of drugs and/or alcohol results in an array of serious health conditions. Addressing SUDs from a life stage perspective with assessment and treatment approaches incorporating co-occurring disorders are necessary to successfully impact overall health.
Journal Article
Resting Heart Rate and Associations With Clinical Measures From the Project Baseline Health Study: Observational Study
Though widely used, resting heart rate (RHR), as measured by a wearable device, has not been previously evaluated in a large cohort against a variety of important baseline characteristics.
This study aimed to assess the validity of the RHR measured by a wearable device compared against the gold standard of ECG (electrocardiography), and assess the relationships between device-measured RHR and a broad range of clinical characteristics.
The Project Baseline Health Study (PHBS) captured detailed demographic, occupational, social, lifestyle, and clinical data to generate a deeply phenotyped cohort. We selected an analysis cohort within it, which included participants who had RHR determined by both ECG and the Verily Study Watch (VSW). We examined the correlation between these simultaneous RHR measures and assessed the relationship between VSW RHR and a range of baseline characteristics, including demographic, clinical, laboratory, and functional assessments.
From the overall PBHS cohort (N=2502), 875 (35%) participants entered the analysis cohort (mean age 50.9, SD 16.5 years; n=519, 59% female and n=356, 41% male). The mean and SD of VSW RHR was 66.6 (SD 11.2) beats per minute (bpm) for female participants and 64.4 (SD 12.3) bpm for male participants. There was excellent reliability between the two measures of RHR (ECG and VSW) with an intraclass correlation coefficient of 0.946. On univariate analyses, female and male participants had similar baseline characteristics that trended with higher VSW RHR: lack of health care insurance (both P<.05), higher BMI (both P<.001), higher C-reactive protein (both P<.001), presence of type 2 diabetes mellitus (both P<.001) and higher World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score (both P<.001) were associated with higher RHR. On regression analyses, within each domain of baseline characteristics (demographics and socioeconomic status, medical conditions, vitals, physical function, laboratory assessments, and patient-reported outcomes), different characteristics were associated with VSW RHR in female and male participants.
RHR determined by the VSW had an excellent correlation with that determined by ECG. Participants with higher VSW RHR had similar trends in socioeconomic status, medical conditions, vitals, laboratory assessments, physical function, and patient-reported outcomes irrespective of sex. However, within each domain of baseline characteristics, different characteristics were most associated with VSW RHR in female and male participants.
ClinicalTrials.gov NCT03154346; https://clinicaltrials.gov/study/NCT03154346.
Journal Article
The medical metropolis : health care and economic transformation in Pittsburgh and Houston
\"This book traces how health care helped to build the postindustrial city into the \"medical metropolis,\" a city where health care plays a dominant role in its economy and identity\"-- Provided by publisher.
Book
Associations between Social Adversities and Chronic Medical Conditions in a Statewide Sample of Individuals in Treatment for Mental Illnesses
Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.g., gender, age, smoking status, alcohol use), the presence of one or more adversities was associated with the presence of at least one medical condition (prevalence ratio (PR) = 1.21) or two or more medical conditions (PR = 1.46), and two or more adversities was associated with at least one medical condition (PR = 1.25) or two or more medical conditions (PR = 1.52) (all significant at p < .0001). Greater attention to primary, secondary, and tertiary prevention of chronic medical conditions is needed in mental health treatment settings, especially among those experiencing social adversities.
Journal Article