Understanding the Impact of COVID-19 on Roma Vulnerable Communities in Western Romania: Insights and Predictive Factors from a Retrospective Study.

Autor: Capraru ID; Department of Epidemiology, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania., Marian C; Department of Biochemistry and Pharmacology, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania.; Center for Complex Networks Science, 'Victor Babes' University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania., Vulcanescu DD; Department of Microbiology, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania.; Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania., Tanasescu S; Department of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania., Dragomir TL; Medical Semiology II Discipline, Internal Medicine Department, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania., Marti TD; Department of Medicine, 'Vasile Goldis' University of Medicine and Pharmacy, 310414 Arad, Romania.; Department of Microbiology, Emergency County Hospital, 310037 Arad, Romania., Boru C; Department of Medicine, 'Vasile Goldis' University of Medicine and Pharmacy, 310414 Arad, Romania., Avram CR; Department of Residential Training and Post-University Courses, 'Vasile Goldis' Western University, 310414 Arad, Romania., Susan M; Centre for Preventive Medicine, Department of Internal Medicine, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania., Vlad CS; Discipline of Pharmacology, Department of Pharmacology and Biochemistry, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Jazyk: angličtina
Zdroj: Viruses [Viruses] 2024 Mar 12; Vol. 16 (3). Date of Electronic Publication: 2024 Mar 12.
DOI: 10.3390/v16030435
Abstrakt: Background: The COVID-19 pandemic disproportionately affected vulnerable populations like Roma patients in Western Romania due to marginalization and limited healthcare access.
Methods: A retrospective study analyzed COVID-19 cases between March 2020 and August 2022 using data from the Directorate of Public Health in Timis county. Demographic, epidemiological, clinical, and laboratory data were assessed, along with risk factors and biomarkers for ICU admission and mortality prediction. The following biomarkers were assessed: C-reactive protein (CRP), ferritin (FER), IL-6, D-dimers, lactate dehydrogenase (LDH), high density lipoprotein cholesterol (HDL), and 25-OH vitamin D (25-OHD).
Results: In comparison with the general population (GP), Roma patients were more overweight ( p = 0.0292), came from rural areas ( p = 0.0001), could not recall transmission source ( p = 0.0215), were admitted to the intensive care unit (ICU, p = 0.0399) more frequently, had worse symptomatology ( p = 0.0490), showed more elevated levels of CRP ( p = 0.0245) and IL-6 ( p < 0.0001) and lower levels of HDL ( p = 0.0008) and 25-OHD ( p = 0.0299). A stronger, significant correlation was observed between CRP and severity (rho = 0.791 vs. 0.433 in GP), and an inverse stronger significant one was observed between HDL and severity (rho = -0.850 vs. -0.734 in GP) in the Roma patients. The male sex continues to be an important risk factor for ICU admission (OR = 2.379) and death (OR = 1.975), while heavy smoking was more important in relation to ICU admission (OR = 1.768). Although the Roma ethnicity was 1.454 times more at risk of ICU admission than the GP, this did not prove statistically significant ( p = 0.0751). CRP was the most important predictive factor in regards to admission to the ICU for both Roma (OR = 1.381) and the GP (OR = 1.110) and in regards to death (OR = 1.154 for Roma, OR = 1.104 for GP). A protective effect of normal values of HDL and 25-OHD was observed in the GP for both ICU admission (OR = 0.947, 0.853, respectively) and death (OR = 0.920, 0.921, respectively), while for the Roma group, normal 25-OHD values were only considered protective in regards to death (OR = 0.703). Cutoff values for ICU admission were 28.98 mg/L for Roma and 29.03 mg/L for GP patients, with high specificity for both groups (over 95).
Conclusions: Higher rates of ICU admissions, severe symptomatology, and distinct laboratory biomarker profiles among Roma patients emphasize the critical importance of personalized care strategies and targeted interventions to mitigate the disproportionate burden of COVID-19 on vulnerable communities. CRP values at admission have had a clear impact as a risk assessment biomarker for Roma patients, while the significance of IL-6, HDL, and 25-OHD should also not be overlooked in these patients.
Databáze: MEDLINE
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