Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Sustainable Development Goals

Utility Analysis and the Consumption Function: An Interpretation of Cross-Section Data

https://researchportal.port.ac.uk/portal/files/20192880/STOTEN_D_20_04893R2_COVID_19_accepted_article.pdf

COVID-19: A promising cure for the global panic.

This chapter discusses different aspects of cancer. Many of the attitudes toward cancer today are similar to the popular prejudices that were held about infections before the germ theory was worked out and before the causes of different infections were understood. One of the popular misconceptions about cancer is that it is a single disease. In fact, cancer is a group of many different disorders affecting the different parts of the body, and cancer of one part is quite different from cancer of another part. It is a common belief that cancer is always incurable, but in truth, 70%–90% of patients can be completely cured of certain types of cancers. It is also believed that cancer can be transmitted by coming in contact with a cancer patient and that it is caused by dirty living, by knocks or blows, or by tinned foods. Doctors have recognized that lung cancer is associated with cigarette smoking even though they have not completely worked out the combination of chemicals that causes this effect.

What is Cancer

With the ongoing demographic and epidemiological transition, cancer is emerging as a major public health concern in India. This paper uses nationally representative household survey to examine the overall prevalence and economic burden of cancer in India. The age-standardized prevalence of cancer is estimated to be 97 per 100,000 persons with greater prevalence in urban areas. The evidence suggests that cancer prevalence is highest among the elderly and also among females in the reproductive age groups. Cancer displays a significant socioeconomic gradient even after adjusting for age-sex specifics and clustering in a multilevel regression framework. We find that out of pocket expenditure on cancer treatment is among the highest for any ailment. The average out of pocket spending on inpatient care in private facilities is about three-times that of public facilities. Furthermore, treatment for about 40 percent of cancer hospitalization cases is financed mainly through borrowings, sale of assets and contributions from friends and relatives. Also, over 60 percent of the households who seek care from the private sector incur out of pocket expenditure in excess of 20 percent of their annual per capita household expenditure. Given the catastrophic implications, this study calls for a disease-based approach towards financing such high-cost ailment. It is suggested that universal cancer care insurance should be envisaged and combined with existing accident and life insurance policies for the poorer sections in India. In concluding, we call for policies to improve cancer survivorship through effective prevention and early detection. In particular, greater public health investments in infrastructure, human resources and quality of care deserve priority attention.

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Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014.

Out-of-pocket (OOP) health care payments financed through borrowings or sale of household assets are referred to as distressed health care financing. This article expands this concept (to include contributions from friends or relatives) and examines the incidence and correlates of distressed health care financing in India. The analysis finds a decisive influence of distressed financing in India as over 60 and 40% of hospitalization cases from rural and urban areas, respectively, report use of such coping strategies. Altogether, sources such as borrowings, sale of household assets and contributions from friends and relatives account for 58 and 42% share in total OOP payments for inpatient care in rural and urban India, respectively. Further, the results show significant socioeconomic gradient in the distribution of distressed financing with huge disadvantages for marginalized sections, particularly females, elderly and backward social groups. Multivariate logistic regression informs that households are at an elevated risk of indebtedness while seeking treatment for non-communicable diseases, particularly cancer. Evidence based on intersectional framework reveals that, despite similar socioeconomic background, males are more likely to use borrowings for health care financing than females. In conclusion, the need for social protection policies and improved health care coverage is emphasized to curtail the incidence of distressed health care financing in India.

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Distressed financing of household out-of-pocket health care payments in India: incidence and correlates.

AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy represents the alternative systems of medicine recognized by the Government of India. Understanding the patterns of utilization of AYUSH care has been important for various reasons including an increased focus on its mainstreaming and integration with biomedicine-based health care system. Based on a nationally representative health survey 2014, we present an analysis to understand utilization of AYUSH care across socioeconomic and demographic groups in India. Overall, 6.9% of all patients seeking outpatient care in the reference period of last two weeks have used AYUSH services without any significant differentials across rural and urban India. Importantly, public health facilities play a key role in provisioning of AYUSH care in rural areas with higher utilization in Chhattisgarh, Kerala and West Bengal. Use of AYUSH among middle-income households is lower when compared with poorer and richer households. We also find that low-income households display a greater tendency for AYUSH self-medication. AYUSH care utilization is higher among patients with chronic diseases and also for treating skin-related and musculo-skeletal ailments. Although the overall share of AYUSH prescription drugs in total medical expenditure is only about 6% but the average expenditure for drugs on AYUSH and allopathy did not differ hugely. The discussion compares our estimates and findings with other studies and also highlights major policy issues around mainstreaming of AYUSH care.

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Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

Most interventions to foster child growth and development in India focus on improving food quality and quantity. We aimed to assess the pattern in food consumption and dietary diversity by socioeconomic status (SES) among Indian children. The most recent nationally representative, cross-sectional data from the National Family Health Survey (NFHS-4, 2015–16) was used for analysis of 73,852–74,038 children aged 6–23 months. Consumption of 21 food items, seven food groups, and adequately diversified dietary intake (ADDI) was collected through mother’s 24-h dietary recall. Logistic regression models were conducted to assess the association between household wealth and maternal education with food consumption and ADDI, after controlling for covariates. Overall, the mean dietary diversity score was low (2.26; 95% CI:2.24–2.27) and the prevalence of ADDI was only 23%. Both household wealth and maternal education were significantly associated with ADDI (OR:1.28; 95% CI:1.18–1.38 and OR:1.75; 95% CI:1.63–1.90, respectively), but the SES gradient was not particularly strong. Furthermore, the associations between SES and consumption of individual food items and food groups were not consistent. Maternal education was more strongly associated with consumption of essential food items and all food groups, but household wealth was found to have significant influence on intake of dairy group only. Interventions designed to improve food consumption and diversified dietary intake among Indian children need to be universal in their targeting given the overall high prevalence of inadequate dietary diversity and the relatively small differentials by SES.

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Socio-economic patterning of food consumption and dietary diversity among Indian children: evidence from NFHS-4.

Background: Early reports on coronavirus disease 2019 (COVID-19) case fatalities in India suggests that males are at a greater disadvantage than females, but it is unclear whether males experience a higher risk of mortality throughout the age-spectrum or there are sexdifferentials in survival risk. We adopt a gender lens and present a disaggregated view of agesex specific COVID-19 infection and mortality risk in India. Methods: We use crowdsourced data (https://www.covid19india.org/) to provide preliminary estimates for age-sex specific COVID-19 case fatality rate (CFR) for India. We analyse the burden of the cases and deaths for age-sex categories. CFR is estimated as the ratio of confirmed deaths in total confirmed cases. We report binomial confidence interval for the CFR estimates. Also, an adjusted-CFR is developed to capture the potential mortality among the currently active infections. Results: As of May 20, 2020, males share a higher burden (66%) of COVID-19 infections than females (34%) but the infection is more or less evenly distributed in under-five as well as elderly age groups. The CFR among males and females is 2.9% and 3.3%, respectively. The age-specific COVID-19 CFR assumes ‘Nike-swoosh’ pattern with elevated risks among the elderly. The World Health Organization world standard population structure standardized CFR for India is 3.34%. The adjusted-CFR is estimated to be 4.8%. Conclusion: Early evidence indicates that males have higher overall burden, but females have a higher relative-risk of COVID-19 mortality in India. Elderly males and females both display high mortality risk and require special care when infected. Greater focus on data collection and sharing of age-sex specific COVID-19 cases and mortality data is necessary to develop robust estimates of COVID-19 case fatality to support policy decisions.

https://e-jghs.org/pdf/10.35500/jghs.2020.2.e17

William Joe

Papers

Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014.

Distressed financing of household out-of-pocket health care payments in India: incidence and correlates.

Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

Socio-economic patterning of food consumption and dietary diversity among Indian children: evidence from NFHS-4.

Equal risk, unequal burden? Gender differentials in COVID-19 mortality in India