Higher COVID-19 mortality in low-income communities in the City of Cape Town – a descriptive ecological study

Hussey, Hannah; Zinyakatira, Nesbert; Morden, Erna; Ismail, Muzzammil; Paleker, Masudah; Bam, Jamy-Lee; London, Leslie; Boulle, Andrew; Davies, Mary‐Ann

doi:10.12688/gatesopenres.13288.1

Cited by 20 publications

(15 citation statements)

References 18 publications

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“…Importantly, among those aged ≥40 years, mortality was associated with recent first HIV evidence, which, in this age group, could indicate delayed HIV diagnosis or start of ART, and thus suggests delayed HIV care access. The wave pattern observed in our study population (a relatively large first wave) mirrored that in the lower socio-economic status subdistricts in the WC [19,20], consistent with the burden of HIV in South Africa being disproportionately higher among the poor.…”

Section: Discussionsupporting

confidence: 79%

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

Kassanjee

Davies

Ngwenya

et al. 2022

Preprint

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Introduction: While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty about the role of HIV disease severity on COVID-19 outcomes, especially in lower income settings. We studied the association between mortality and characteristics of HIV severity and management, and vaccination, among adult PWH. Methods: We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with CD4 cell count, viral load, evidence of ART, time since first HIV evidence, and vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results: Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17 831 first diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load (among those with ART evidence), and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis, chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions: Mortality was strongly associated with suboptimal HIV control, and prevalence of these risk factors increased in later COVID-19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimised.

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Section: Discussionsupporting

confidence: 79%

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

Kassanjee

Davies

Ngwenya

et al. 2022

Preprint

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“…Only one study from the WHO Africa region was found. This South African study by Hussey and colleagues 124 identified a socioeconomic gradient in COVID-19 mortality at the subdistrict level in Cape Town up to Feb 24, 2021.…”

Section: Covid-19 Mortality and Deprivationmentioning

confidence: 99%

COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities

McGowan¹,

Bambra²

2022

The Lancet Public Health

156

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“…These waves have resulted in high seroprevalence of ~70% from prior infection, especially in poorer communities where social distancing is challenging [ 11 , 12 ]. Whilst such high seroprevalence came at the cost of exceptionally high mortality during the first wave of COVID‐19, these areas were relatively protected from both infections and severe disease in subsequent waves [ 13 ]. For example, in the large urban township of Khayelitsha, the poorest subdistrict in Cape Town, anti‐nucleocapsid antibody seroprevalence resulting from prior infection was 45% by the end of wave one [ 11 ], increasing to >70% by the end of wave three (Nei‐Yuan Hsiao, personal communication).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of laboratory‐confirmed SARS‐CoV‐2 infection in the Omicron‐driven fourth wave compared with previous waves in the Western Cape Province, South Africa

Davies

Kassanjee

Rosseau

et al. 2022

Tropical Med Int Health

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113

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OBJECTIVES The objective was to compare COVID‐19 outcomes in the Omicron‐driven fourth wave with prior waves in the Western Cape, assess the contribution of undiagnosed prior infection to differences in outcomes in a context of high seroprevalence due to prior infection and determine whether protection against severe disease conferred by prior infection and/or vaccination was maintained. METHODS In this cohort study, we included public sector patients aged ≥20 years with a laboratory‐confirmed COVID‐19 diagnosis between 14 November and 11 December 2021 (wave four) and equivalent prior wave periods. We compared the risk between waves of the following outcomes using Cox regression: death, severe hospitalisation or death and any hospitalisation or death (all ≤14 days after diagnosis) adjusted for age, sex, comorbidities, geography, vaccination and prior infection. RESULTS We included 5144 patients from wave four and 11,609 from prior waves. The risk of all outcomes was lower in wave four compared to the Delta‐driven wave three (adjusted hazard ratio (aHR) [95% confidence interval (CI)] for death 0.27 [0.19; 0.38]. Risk reduction was lower when adjusting for vaccination and prior diagnosed infection (aHR: 0.41, 95% CI: 0.29; 0.59) and reduced further when accounting for unascertained prior infections (aHR: 0.72). Vaccine protection was maintained in wave four (aHR for outcome of death: 0.24; 95% CI: 0.10; 0.58). CONCLUSIONS In the Omicron‐driven wave, severe COVID‐19 outcomes were reduced mostly due to protection conferred by prior infection and/or vaccination, but intrinsically reduced virulence may account for a modest reduction in risk of severe hospitalisation or death compared to the Delta‐driven wave.

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Higher COVID-19 mortality in low-income communities in the City of Cape Town – a descriptive ecological study

Cited by 20 publications

References 18 publications

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities

Outcomes of laboratory‐confirmed SARS‐CoV‐2 infection in the Omicron‐driven fourth wave compared with previous waves in the Western Cape Province, South Africa

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