Decline in and recovery of fertility rates after COVID-19-related state of emergency in Japan

Introduction
The COVID-19 pandemic led to a decline in fertility rates worldwide. Although many regions have experienced a temporary drop in fertility rates with the spread of the infection, subsequent recovery has varied across countries. This study aimed to evaluate the impact of COVID-19 infection rates and regional sociodemographic factors on the recovery of fertility rates in Japan following the state of emergency.

Methods
This study examined prefectural fertility data from before the COVID-19 pandemic to forecast fertility rates up to 2022 using a seasonal autoregressive integrated moving average model. A regression analysis was conducted on fertility rates during the first state of emergency and the subsequent recovery rate with respect to the number of new COVID-19 cases and sociodemographic factors specific to each prefecture.

Results
During the first state of emergency, the monthly fertility rate decreased by an average of –13.8% (SD: 6.26, min: –28.78, max: 0.15) compared with the previous year. Over the following 22 months, the average fertility recovery rate was +2.31% (SD: 3.57; min: –8.55, max: 19.54). Multivariate analysis of the impact of the pandemic on fertility changes during the first emergency indicated a negative correlation between new COVID-19 cases per capita and the proportion of nuclear households. No significant correlation was found between fertility recovery rate and new COVID-19 cases or emergency duration. When classifying fertility rate fluctuation patterns before and after the emergency into four clusters, variations were noted in the proportion of the elderly population, marriage divorce rate and the number of internet searches related to pregnancy intentions across the clusters.

Conclusions
No association was found between pregnancy intentions related to the spread of infection, such as the number of new cases and the fertility recovery rate following the first state of emergency. Differences in the patterns of decline and recovery during the pandemic were observed based on population composition and internet searches for infection and pregnancy across different prefectures.

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Ottobre 2024

Uncovering Pediatric Long COVID

The COVID-19 pandemic has had devastating consequences globally, and the immediate and short-term consequences of SARS-CoV-2 infection have been well described. Although most individuals recover, many endure longer-lasting effects, referred to as long COVID, post-COVID condition, or postacute sequelae of SARS-CoV-2 (PASC). PASC is composed of a heterogeneous collection of symptoms and conditions that can affect virtually any organ system, with common manifestations including fatigue, cough, malaise, and pain. Those at increased risk for long COVID include females, those hospitalized due to acute COVID-19, and individuals with underlying comorbidities. Several hypotheses have been proposed to explain the underlying pathophysiology, which is likely multifactorial, including immune dysregulation, autoimmunity and immune printing, microvascular clotting with endothelial dysfunction, and impaired neurological signaling.

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Ottobre 2024

Association of early statin initiation during COVID-19 admission with inpatient mortality at an academic health system in Illinois, March 2020 to September 2022: a target trial emulation using observational data

Objective
We assessed the association of early statin initiation with inpatient mortality among hospitalised COVID-19 patients.

Design, setting and participants
This observational study emulated a hypothetical target trial using electronic health records data from Northwestern Medicine Health System, Illinois, 2020–2022. We included patients who were ≥40 years, admitted ≥48 hours for COVID-19 from March 2020 to August 2022 and had no evidence of statin use before admission.

Interventions
Individuals who initiated any statins within 48 hours of admission were compared with individuals who did not initiate statins during this period.

Primary outcome measures
Inpatient mortality at hospital days 7, 14, 21 and 28 were determined using hospital records. Risk differences between exposure groups were calculated using augmented inverse propensity weighting (AIPW) with SuperLearner.

Results
A total of 8893 individuals (24.5% early statin initiators) were included. Early initiators tended to be older, male and have higher comorbidity burdens. Unadjusted day 28 mortality was higher in early initiators (6.0% vs 3.6%). Adjusted analysis showed slightly higher inpatient mortality risk at days 7 (RD: 0.5%, 95% CI: 0.2 to 0.8) and 21 (RD: 0.6%, 95% CI: 0.04 to 1.1), but not days 14 (RD: 0.4%, 95% CI: –0.03 to 0.9) and 28 (RD: 0.4%, 95% CI: –0.2 to 1.1). Sensitivity analyses using alternative modelling approaches showed no difference between groups.

Conclusions
Early statin initiation was not associated with lower mortality contrasting with findings of previous observational studies. Trial emulation helped in identifying and addressing sources of bias incompletely addressed by previous work. Statin use may be indicated for other conditions but not COVID-19.

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Ottobre 2024