https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/ underlyingconditions.html † CDC defines post-COVID-19 conditions as new, returning, or ongoing health problems occurring ≥4 weeks after being infected with SARS-CoV-2. https:// www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html

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Background Poor access to food among low income adults has been recognized as a risk factor for CKD, but there is no data on the impact of food insecurity on progression to ESRD. We hypothesized that food insecurity would be independently associated with risk of ESRD among persons with and without CKD. Study Design Longitudinal cohort study Setting & Participants 2,320 adults (≥20 years) with CKD and 10,448 adults with ‘No-CKD’ enrolled in NHANES III (1988–1994) with household income ≤400% of the federal poverty level linked to Medicare ESRD Registry for a median follow-up period of 12 years. Predictor Food insecurity, defined as an affirmative response to the food insecurity screening question. Outcome Development of treated ESRD. Measurements Demographics, income, diabetes, hypertension, eGFR, and albuminuria. DAL was estimated from the 24-hr dietary recall. We used a Fine-Gray competing risk model to estimate the relative hazard [RH] for ESRD associated with food insecurity after adjusting for covariates. Results 4.5% adults with CKD were food insecure. Food insecure individuals were more likely to be younger, have diabetes (29.9%) and hypertension (73.9%), or have albuminuria (90.4%) as compared to their counterparts (V p<0.05). Median DAL in the food secure vs. food insecure group was 51.2 mEq/day vs 55.6 mEq/day, respectively (p=0.05). Food insecure adults were more likely to develop ESRD (RH [95% CI]: 1.38 [1.08–3.10]) compared to food secure adults after adjustment for demographics, income, diabetes, hypertension, eGFR and albuminuria. In the No-CKD group, 5.7% were food insecure. Here, we did not find a significant association between food insecurity and ESRD (0.77 [0.40–1.49]). Limitations use of a single 24-hr diet recall, lack of laboratory follow-up data, and measure of changes in food insecurity over time; follow-up of the cohort ended 10 years ago. Conclusion Among individuals with CKD, food insecurity was independently associated with a higher likelihood of developing ESRD. Innovative approaches to address food insecurity should be tested for their impact on CKD outcomes.

Background Late sequelae of COVID-19 have been reported; however, few studies have investigated the time-course or incidence of late new COVID-19-related health conditions (post-COVID conditions) after COVID-19 diagnosis. Studies distinguishing post-COVID conditions from late conditions caused by other etiologies are lacking. Using data from a large administrative all-payer database, we assessed the type, association, and timing of post-COVID conditions following COVID-19 diagnosis. Methods Using the Premier Healthcare Database Special COVID-19 Release (PHD-SR) (release date, October 20, 2020) data, during March–June 2020, 27,589 inpatients and 46,857 outpatients diagnosed with COVID-19 (case-patients) were 1:1 matched with patients without COVID-19 through the 4-month follow-up period (control-patients) by using propensity score matching. In this matched-cohort study, adjusted odds ratios were calculated to assess for late conditions that were more common in case-patients compared with control-patients. Incidence proportion was calculated for conditions that were more common in case-patients than control-patients during 31–120 days following a COVID-19 encounter. Results During 31–120 days after an initial COVID-19 inpatient hospitalization, 7.0% of adults experienced at least one of five post-COVID conditions. Among adult outpatients with COVID-19, 7.7% experienced at least one of ten post-COVID conditions. During 31–60 days after an initial outpatient encounter, adults with COVID-19 were 2.8 times as likely to experience acute pulmonary embolism as outpatient control-patients and were also more likely to experience a range of conditions affecting multiple body systems (e.g. nonspecific chest pain, fatigue, headache, and respiratory, nervous, circulatory, and gastrointestinal system symptoms) than outpatient control-patients. Children with COVID-19 were not more likely to experience late conditions than children without COVID-19. Conclusions These findings add to the evidence of late health conditions possibly related to COVID-19 in adults following COVID-19 diagnosis and can inform health care practice and resource planning for follow-up COVID-19 care.

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